I’ve been conducting VA Compensation and Pension (C&P) disability examinations for several years now, and if one thing is painfully clear, it is that there is a unique set of challenges faced by our aging veteran population – a group which accounts for a profound number of disability cases.
In fact, as of July 2023, nearly half of all veterans in the United States are over 65, and it’s a growing demographic.
Since veterans entering older age account for so much of the disability system, I think it’s worth addressing the challenges that are unique to these veterans as they attend C&P exams.
Some familiar examples may include:
- The confusion that arises from having multiple major medical problems
- The functional limitations that can get in the way during an assessment
- Failing to grasp the importance of risk factors that could prevent you from being successful
Follow along for my best tips and tricks that’ll help boost your chances of success during C&P exams.
Key Takeaways
- When you have multiple illnesses, anticipate that it can be hard to isolate one disability’s unique impact on your functional capacity, and prepare accordingly: compile a list of your medical issues and get an expert opinion.
- Make sure age-related functional limitations don’t get in the way your assessment: bring a knowledgeable family member, ensure the use of assistive aids, and prepare in advance.
- Develop an understanding of risk factors, how advanced age may be seen as causing your disability, and how to combat that idea: show how few risk factors you have aside from age, seek expert opinions, and gather supporting research.
Sifting through the Contribution of Multiple Illnesses
If you’ve submitted a claim for disability, one of my main tasks as an examiner is to assess the impact of that claimed disability on your functional capacity.
The reason for that is so that the VA can make a judgment call on the severity of your disability in order to appropriately assign a percentage rating of disability.
The trouble with that is, as veterans enter older age, they rarely have just one major medical problem (what we call “comorbidities”).
Rather, there’s usually a few issues that could be contributing to your functional decline.
One common example is for heart conditions.
If you have something like ischemic heart disease or have had heart surgery, it’s likely that the condition affects your general level of cardiovascular capacity.
Because of that, we ask questions that will help us understand your limitations, like whether you can climb a flight or two of stairs, mow the lawn, walk a few blocks, etc.
That said, while your heart condition may be affecting your ability to do those things, so could other conditions you may also have, like COPD, asthma, low back pain, knee issues, excess weight, or a number of other problems.
As an examiner, we use heart-related diagnostics to help us understand how much those limitations have to do with cardiac issues, but, truth be told, the available diagnostics often paint an incomplete picture.
So what do you do about this? In this example, you might consider talking to your cardiologist and asking them to offer an expert opinion on how much of your functional limitation is due to your claimed condition.
This isn’t helpful just for heart conditions – an approach like this could also be used for any disability.
As an examiner, it’s also helpful for me to see a bulleted list of all your major medical problems to help me provide context to my findings.
Of course, this information is typically available within your C-File (the medical and military records the VA gives us to be able to complete the exam), but often, the information there may be out of date, so having it handy for your examiner can be really helpful.
The Potential for Functional Limitations Affecting Your Exam
While we’re on the subject of functional limitations, let’s discuss how they might actually get in the way of being properly assessed during a C&P exam.
Consider how the following age-related changes can cause issues:
- Cognitive impairment: even an early or mild case of dementia or Alzheimer’s can affect your ability to answer questions, recall events, or follow instructions during an exam.
- Hearing impairment: not being able to hear your examiner’s questions will have obvious impacts on your ability to communicate your disability to them.
- Vision loss: if you have any paperwork with you, you might have trouble reading through it and finding what you need during the exam.
- Decreased stamina/fatigue: something that’s not mentioned frequently is how long C&P disability exams can take – if you’ve submitted several individual claims, the VA is likely to have blocked off close to a 2 hour appointment for your exam.
Many older adults suffer from some of these problems! It is not uncommon, and there are many ways to address it successfully.
Some ways may include:
- Bring a knowledgeable family member or caregiver to the exam. This piece of advice alone will likely help you overcome almost all of the above issues as your loved one can fill in the gap of information you may miss.
- Make sure you’re using any necessary aids, like hearing aids or glasses.
- If you have cognitive impairments or trouble remembering details, prepare in advance by reviewing the details of your case and any key points you want to be sure to remember.
- If you feel an exam will be longer than you can handle, request that the VA split up the exam into several, smaller appointments. This way, you can stay alert and focused throughout your entire assessment.
The Effects of Advancing Age
The question that examiners like myself get asked is, “Is it at least as likely as not that military service caused x disability?”
In order to understand how we go about answering this question, I have to talk about risk factors.
Without going into too much detail, what I’m curious about as an examiner is whether you have other risk factors besides military service for developing a condition.
For most chronic illnesses, advancing age is a substantial risk factor in and of itself.
You’re more at risk for diabetes, heart disease, hypertension, dementia, etc., just by aging.
The reasons for this depend on the illness, but it can throw a wrench in the gears when you submit a claim asserting that a disability has been caused by military service.
The best thing you can do is show how few risk factors you have for developing a condition aside from advanced age.
This can demonstrate that you are otherwise generally in a low-risk population for developing the condition, but that the risks posed by serving in the military have made you high-risk.
There’s other things you can do, too.
Have your doctor offer an expert opinion if they agree with your conclusion.
Find research that shows that an aging veteran population is more at risk for developing the disability than a comparable aging civilian population. Hearing loss is actually a great example of this because of the noise exposure veterans face.
Advocacy for Aging Veterans
If all this sounds overwhelming to you, it can be!
One of our jobs at Hill and Ponton is advocating for veterans who are facing the challenges associated with aging.
It helps to have someone in your corner who can find detailed evidence like I’ve mentioned above, provide legal support, represent you, and help you navigate the complexities of the VA disability system.
In conclusion, while aging veterans face unique challenges in the C&P examination process, there are things you can do to plan for success.
Understand your comorbidities and how they uniquely affect to your functional capacity, make preparations for functional limitations that could interfere with your exam, grasp the importance of risk factors, and seek the help of a disability lawyer – all of this can improve your chances of receiving the benefits you deserve.
Read More Content from VA Medical Examiner Nathan Costiuc, MSN, APRN, FNP-BC
