The Compensation and Pension medical exam system has always had a delay. This year, between some structural changes and the coronavirus pandemic, backlog has tripled.
Before the pandemic hit, the VA was well into the process of contracting C&P examinations to non-VA doctors. 60% of examinations were by contractors, rising to nearly 100%. During the pandemic, even that stopped.
In April 2020, the VA cancelled all C&P examinations in all parts of the country. Later that year, the VA allowed these exams to resume on a limited basis. During a recent hearing before the House Committee on Veterans’ Affairs Subcommittee on Disability Assistance and Memorial Affairs, lawmakers were concerned that the VA did not have an effective plan to reduce the backlog and that it had not heeded some General Accounting Office suggestions for improving the process. VA Secretary Denis McDonough has promised to do better in these areas.
Basic Medical Evidence in Disability Claims
A C&P exam is not about getting treatment. It’s about evidence.
Physical, mental, or other disability is not just a medical issue. The D-word has implications for everything from vocation to law. However, medical evidence in a disability claim is usually the most important proof a VA disability lawyer presents. In a C&P examination, a VA doctor (or contractor) examines the claimant and identifies physical, emotional, and other limitations. A Claims Examiner then translates these findings to a certain disability rating.
Two things can go wrong for victims at this point. First, the Claims Examiner almost always takes the C&P doctor’s word for what the appropriate rating is. The C&P doctor might not be experienced with the type of disability the Veteran has. That is especially true if the C&P doctor is an independent contractor. The VA has very little control over what doctor is assigned to what cases. Additionally, the Claims Examiner could apply the incorrect disability rating. Some C&P doctors are not specific in their reports. If there is any doubt, Claims Examiners usually err on the side of a lower rating. This is legally incorrect— if the expert’s report is too vague, VA is supposed to request more information. But this requirement is not always obeyed.
Either breakdown could be grounds for an appeal. An inadequate C&P examination usually requires additional evidence, as outlined below. Incorrect disability ratings are usually legal questions. So, the appeals process might be quicker in these situations.
To challenge the conclusions in a C&P report, attorneys usually order Independent Medical Evaluations. IMEs come from private physicians who do not answer to VA. Furthermore, attorneys usually seek out specialists. A doctor who focuses on brain injuries will not evaluate a veteran suffering from back problems. Most IME physicians charge nothing upfront for these examinations. They defer billing until the case is resolved.
Sometimes, the additional evidence does not need to be from experts. Buddy statements and lay testimony are often effective. These witnesses testify about the effects of the injury. This testimony often affects the disability rating. This is especially true in brain injury cases, where the buddy statement may show an outside perspective on symptoms or behavior changes that the veteran themself might not have noticed.
Buddy statements also sometimes establish a service-related connection. Perhaps a service buddy saw an accident which is not in the Veteran’s service record, or maybe a buddy can give before-and-after testimony (e.g. “Before Jim went on patrol he could walk fine. When he came back he was limping.”). These statements usually can’t talk about what the right diagnosis is—that takes an expert—but anyone can say what symptoms they’ve seen and how bad they were at what times.
Connect With Diligent Attorneys
Compelling medical evidence is usually the lynchpin of a successful disability claim. For a free consultation with an experienced Veterans disability lawyer, contact the Cameron Firm, P.C. at 800-861-7262 or fill out the contact box to your right. We are here to represent Veterans nationwide.
This article is for educational and marketing purposes only. It does not create an attorney-client relationship.