How the TDIU C&P Exam Can Help or Hurt Your VA Claim

A Compensation & Pension (C&P) exam is a medical examination that is often requested by the U.S. Department of Veterans Affairs (VA) to gather information and evidence about conditions a veteran is wanting benefits for.

These exams are a critical (and often frustrating) part of a VA disability claim, helping determine both service connection and severity of the condition, which directly impacts the disability rating and benefits that are awarded.

The Purpose of C&P Exams for TDIU Claims

Total Disability based on Individual Unemployability (TDIU) allows veterans who do not meet the 100% disability rating to be compensated at that rate if they are unable to secure gainful employment due to their service-connected disabilities.

C&P exams for TDIU will primarily focus on how a veteran’s service-connected conditions interfere with their ability to work, rather than just assessing the severity itself.

Veterans may wonder what to do and say at TDIU C&P exams. This is an understandable concern, and there usually are some differences from a typical C&P exam for VA disability benefits.

Examiners at TDIU C&P exams will often use Disability Benefits Questionnaires (DBQs) to help streamline the process and allow veterans to provide detailed information about their symptoms.

The biggest focus in a TDIU exam, and what a veteran should prepare to be asked about in depth, is anything surrounding their employability.

Veterans will be able to talk a lot about quality of life and concerns as they relate to jobs they’ve had and their future employment, in order for the medical examiner to learn if TDIU is a viable option for benefits.

Who Conducts TDIU medical exams for VA benefits?

VA-approved medical professionals conduct compensation and pension (C&P) examinations. The type of specialist usually depends on the nature of the disability.

For example, for mental health conditions, a C&P may be conducted by a VA or VA-contracted psychologist, but a physical condition may be conducted by a VA or VA-contracted physician.

These examiners review the veteran’s entire claims file, which includes medical records, service records and all previously submitted evidence and documentation.

Your examiner is important in ensuring you have fair and accurate records for your claim. If you feel they are not qualified to evaluate your condition or that your C&P examiner did not ask you enough relevant questions about your condition as it relates to your employment, you should contact the VA. 

Do I Need to Have Another C&P Exam for TDIU?

While the VA often requires a Compensation & Pension exam to assess the extent of a veteran’s service-connected disabilities and how they impact their ability to secure and maintain substantially gainful employment, it is not always a mandatory step in the process.

When a C&P Exam is Needed

• Initial TDIU Claim: For initial TDIU claims, a C&P exam is usually required. This exam helps the VA determine if the veteran’s disabilities are severe enough to warrant TDIU.
• Insufficient Evidence: If the evidence submitted with the TDIU claim (such as medical records, employment history and statements) is not sufficient to make a determination, the VA will schedule a C&P exam to gather additional information.
• Conflicting Information: If there is conflicting information in the veteran’s file, a C&P exam may be necessary to clarify the veteran’s condition and its impact on employability.

When a C&P Exam May Not Be Needed

• Ample Supporting Evidence: If the veteran has submitted comprehensive and sufficient evidence with their TDIU claim, including such items as detailed medical records that detail the severity of their service-connected disabilities and the impact on their employment, VA may decide a C&P exam is unnecessary.
• Recent Exams: If the veteran has undergone a C&P exam or another relevant medical evaluation recently and there have been no significant changes in their condition, the VA might use the existing records to come to a decision.
• Obvious unemployability: In cases where unemployability is obvious based on the veteran’s disabilities and employment history (e.g., a veteran with a 100% schedular rating for a single disability), the VA might not require an additional C&P exam.

C&P Exam Missed!

What can you do if your TDIU was denied because you were late, or missed the C&P exam entirely?

Missing a scheduled C&P exam can significantly impact your TDIU claim, potentially leading to a denial because of the lack of necessary medical evidence. However, missing this exam doesn’t mean your claim is over. Here’s some steps you can take:

• Contact the VA Immediately and Reschedule: If you missed the exam, contact the VA as soon as possible. Explain the reason for missing the appointment and request to reschedule. The VA understands that emergencies and unavoidable circumstances can occur, so providing a valid reason and being prompt about it, may allow them to give you another opportunity.
• Provide Evidence of Your Absence: If your absence was due to a medical emergency, personal crisis or any other significant reason, provide documentation to support your explanation. This can include medical records, police reports or other documents.
• Submit a Statement in Support of Claim (VA Form 21-4138): Filing a VA Form 21-4138 allows you to submit a personal statement explaining why you might have missed your C&P exam. Be honest and thorough in your explanation, emphasizing any factors that were beyond your control. 
• Appeal the Decision: If your TDIU claim gets denied because you missed the C&P exam, you have the right to appeal. The appeal process involves submitting a Notice of Disagreement (NOD) and requesting a review of your case. During the appeal, you can explain why you missed the exam and provide any supporting evidence.

Missing a C&P exam can be a setback for your TDIU claim, but it’s not the end of the road! After taking these steps, stay proactive and follow up with the VA to prevent further complications. You are your own best advocate when filing your claim. 

The C&P Exam Hurt My TDIU Claim, What Do I Do?

If your TDIU claim was denied due to a poor C&P exam or because you missed your exam, it’s important to take action. 

At Hill & Ponton, our experienced VA disability benefits attorneys can help you navigate the appeals process and fight for the benefits you deserve. Contact us today for a free case evaluation and let us assist you in securing the compensation you’re entitled to.

Content Reviewed by

Attorney Matthew Hill

Attorney Matthew Hill, licensed in Florida and Washington D.C., a dedicated advocate for disabled veterans with over two decades of experience, reviewed the information in this post.