What is a VA PTSD C&P Exam?

Once a veteran files a VA claim for PTSD, the United States Department of Veterans Affairs will make the veteran undergo a Compensation and Pension Examination (C&P exam)  VA will verify the diagnosis for posttraumatic stress disorder even if the veteran already has a diagnosis of PTSD from a qualified medical professional.  This is part of the qualification process for VA benefits.

The C&P exam also determines if the PTSD is related to service and assesses the severity of the condition. Veterans generally need to go attend a C&P exam even if a treating VA doctor has diagnosed the veteran with PTSD.

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What is the Purpose of a VA C&P exam for Posttraumatic Stress Disorder?

A C&P exam is a way to prove that you have a disability. If you have been getting mental health treatment at a VA medical facility, the doctor who does the C&P exam will not be your regular doctor.

If a veteran has been seeing a VA doctor for many years and that doctor diagnoses the veteran with PTSD after military trauma exposure, the Department of Veterans Affairs may still require the veteran to attend a C&P Exam with a different doctor to have their mental health evaluated according to the rating criteria. exam. The new doctor may not agree with the diagnosis from the first doctor.

How do C&P examiners approach the PTSD C&P exam?

Most C&P examiners do not have the time, patience, or resources to review every veteran’s case. They usually just look at if the veteran has a physical injury or not. They don’t have time to figure out how the veteran feels or what their symptoms are.

It is important that veterans be honest with the C&P examiner. VA will usually give more weight to the diagnosis from the C&P examiner than the doctor who is treating you. If the C&P examiner does not think you meet the diagnostic criteria for PTSD, VA will deny your case.

Sometimes the C&P examiner diagnoses a veteran with a different psychiatric disorder. In this case, VA will deny the PTSD case. The C&P examiner’s opinion is what VA usually considers as the most persuasive.

How will VA diagnose me if I have more than one psychiatric condition?

People with psychiatric disorders can sometimes have problems telling them apart. This is because many disorders share symptoms. For example, a veteran with PTSD might also have symptoms of anxiety and depression. Sometimes a veteran who is being treated for PTSD by the VA might not be diagnosed with PTSD by a C&P examiner.

The examiner may say the veteran has an anxiety disorder. However, mental disorders are evaluated under the same VA disability rating formula, 38 CFR 4.130 on va.gov. This means that in some ways, the actual diagnosis doesn’t matter as much as what VA assigns for a rating.

However, many veterans who suffer from PTSD want the VA to recognize that they have PTSD. They want the VA to see that their mental health condition is specific to PTSD, not generalized anxiety or another similar disorder. To learn more about PTSD and depression, click here.

What tests does VA use to determine whether I have PTSD?

The VA uses the criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) to evaluate whether there is a valid diagnosis of PTSD. The PTSD diagnosis must satisfy all of the DSM-5 criteria to validly diagnose PTSD. If the veteran’s PTSD does not meet the diagnosis, the VA will deny the claim.

It is important for veterans to document all their PTSD symptoms. They need to be open and honest with their providers so that VA can have a true understanding of how PTSD has impacted their life.

What do I do at a VA Compensation and Pension exam for PTSD?

It is always a good idea for the veteran to take a witness to the examination. This person can be a spouse, adult child, family member, or close friend. A witness is important for a couple of reasons. First, it is easy for a veteran to not fully understand how PTSD affects him. 

The witness will be able to discuss how the veteran interacts with others, which is a crucial part of PTSD. Second, veterans tend to forget important details about the exam. Third, this person can help the veteran deal with the stress veterans experience during VA’s C&P exams.

If possible, the veteran should take the witness into the examination room with them. Unfortunately, the examiner frequently denies this request. Even if the witness cannot go with the veteran, it is important the veteran proceed with the exam. Failure to cooperate with a C&P examination can result in denial of the claim.

Why you should write down your symptoms before the C&P exam

Veterans don’t need to bring their complete medical records or itemized medical histories to the VA facility, but they should bring a written PTSD checklist of symptoms, even embarrassing symptoms, to refresh their memory. Remember, this exam is the chance to show how Post-Traumatic Stress Disorder affects your life day-to-day.

Details that a veteran might think are not important could be the key to their claim. The examiner needs to know all the details of the veteran’s situation in order to make a decision about their claim. If the veteran’s treating mental health professional (Psychiatry, Psychologist, trauma therapist) has provided a favorable opinion in the matter, the veteran should bring that medical evidence too. This may help!

What symptoms of PTSD should I bring up at my C&P exam?

Nightmares are of the most intense symptoms of PTSD. However, as awful as nightmares can be, they only fall under the 30 percent rating symptom cluster in the VA’s rating formula. Therefore, it is important to consider other symptoms like anger and difficulty dealing with authority which may open the door to eligibility for an increased rating for PTSD.

These symptoms, even if they aren’t as frequent or intense, show the true measure of the severity of the disability. Loved ones, especially those acting as caregivers,  usually are better at observing these, so written statements from those individuals may be helpful as well.

VA PTSD Disability Benefits Questionnaire DBQ

Recently, the VA has insisted that C&P examiners use Disability Benefits Questionnaires (DBQs). The VA created DBQs to streamline the VA claims process intended to ensure that the record is complete to decide a VA disability claim. According to the VA, there are more than 70 DBQs, covering the majority of disabilities, including PTSD.

When the exam is over, the veteran should ask for the examiner’s business card and contact information. After the exam, the veteran will want to order a copy of the exam report. The veteran should check that the person doing the examination was the one who wrote the final report.

What do I do at a VA PTSD Increase Rating C&P exam?

Once VA admits that your PTSD is service-connected then the focus turns to the correct rating. VA ratings vary drastically from 0% to 100%. Frequently, PTSD can tear the veteran’s relationships—with all people in their lives—apart. This can lead to occupational and social impairment that prevents them from being unable to work.

It can also lead the veteran to be socially isolated. As important as it is to prove service connection, it is more important to make sure VA raters get the rating right. Click here for more on PTSD ratings. When a veteran seeks a PTSD rating increase, the VA will send her to another C&P exam.

This exam will include additional psychological testing. Too frequently, VA finds the veteran is malingering, instead of finding evidence for a rating increase. Malingering is not a mental illness. The DSM-V defines it as “the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs.” According to the American Psychological Association Law Society, experts disagree as to whether veterans overreport PTSD because of malingering.

What tests do VA PTSD C&P examiners use?

There are a few different tests that a VA doctor may use to attempt to uncover malingering. One of these tests is the M-FAST (Miller-Forensic Assessment of Symptoms). The developers of this test looked to provide clinicians with a reliable screening tool for malingered mental illness. The test consists of a 25 item screening interview over seven scales, or categories.

The categories are: reported vs. observed symptoms, extreme symptomatology, rare combinations, unusual hallucinations, unusual symptom course, negative image, and suggestibility. A score higher than 6 indicates possible malingering. The M-FAST can be used alone, but it is also meant to be used as part of a larger assessment. If a veteran scores high on the M-FAST, additional tests may be done like the MMPI-2 (Minnesota Multiphasic Personality Inventory-2).

The MMPI-2 comes with its own set of issues. It is a long, involved personality and psychopathy test. It has two sections devoted specifically to PTSD to detect malingering. As discussed in the VA’s Best Practice Manual for PTSD Compensation and Pension Examinations, the MMPI-2 consists of “validity scales.” When a person is exaggerating his symptoms these scales are elevated. 

There is also a revised version of the test, the MMPI-2RF, which doesn’t include PTSD specific sections. Many clinicians are concerned that this shorter test has not been proven effective. They are further concerned that VA may use it anyway to save money and time. Other tests used to detect malingering are the Personality Assessment Inventory (PAI) and the Trauma Symptom Inventory (TSI).

Do VA Examiners Always do Multiple Psy Tests?

VA examiners do not always administer multiple tests to determine if a veteran is malingering. If a veteran scores M-FAST score of 6 or higher, the VA doctor may report the veteran is possibly malingering. Because that one word is now a part of the veteran’s claims file, the PTSD claim will be even more difficult to win. The veteran will likely need an independent medical opinion that refutes the allegation of malingering.

The Army recognized this back in 2012. It issued policy guidance on the assessment and treatment of PTSD. The memo stressed that “the diagnosis of malingering should not be made unless there is substantial and definitive evidence from collateral or objective sources that there are false or grossly exaggerated symptoms that are consciously produced for external incentives.”

The memo noted that there is “considerable evidence” that malingering is rare among veterans and that malingering is unlikely to be a factor in the vast majority of disability determinations. Even the VA concedes that Vietnam veterans may have elevated scores on tests due to their chronic post-traumatic difficulties.

In fact, no test for malingering exists which can reliably tell which symptoms are being exaggerated. Tests like the M-FAST, MMPI-2, PAI, and TSI are the best available. That said, the tests’ findings can easily result in labeling veterans with genuine PTSD as malingers.

Does being labeled a malingerer hurt my PTSD case?

Unfortunately, bias against the “malingering veteran” still exists among VA examiners. This bias can hurt those whose PTSD has legitimately gotten worse. Therefore, it is just as important to use the tips in this section during any subsequent PTSD exams. You must be prepared to submit evidence that your PTSD has gotten worse to back up the increased rating claim.

NOTE: In the early 2000s, the VA published a Best Practice Manual for PTSD Compensation and Pension Examinations. This manual gives very technical, detailed instructions for clinicians administering C&P exams for PTSD, including the tests used for malingering, such as the MMPI-2. It is unclear how much weight VA C&P examiners give this manual since it has not been updated in over 10 years.

Be that as it may, VA has not officially repealed it. Also note that because the manual pre-dates the publication of the DSM-V, its analysis revolves around the diagnostic criteria of the DSM-IV, including the Global Assessment of Functioning (GAF Psychology) scale.

Tips for What To Do After PTSD C&P Exam?

After a C&P examination, the veteran and any witnesses should write down their thoughts about the examination asap. Issues for a witness to write down include:

• how long the exam was
• whether the examiner would let you come back and give your testimony
• any changes in the veteran’s mood before and after the exam, and
• any other observations about the facility.

Issues for the veteran to write down include whether:

•  exam was thorough
• did the veteran get to express all of his thoughts about the disabilities being evaluated
• the examiner seemed to be listening and writing down the veteran’s responses,
• whether the examiner expressed a negative opinion to the veteran about the strength of his or her claim.

The more specific the veteran and the witnesses are regarding any deficiencies with the C&P exams the better. Should the veterans’ disability claim be denied, the veteran can show the inadequacies of the exam. 

The veteran or his representative may choose to send in a response to the VA challenging the C&P results. The challenge may demand VA to order a new exam with a different examiner. Alternately, the challenge could request that the VA get the examiner to clarify his opinion.

How To Contest a Bad C&P Exam Results

• sufficiently describe the symptomatology
• identify and adequately describe the stressor
• acknowledge and reconcile prior reports that demonstrate a diagnosis of PTSD and
• show why these reports are not probative. 

Continue to Part Four to learn how PTSD is rated by the VA.

If you are experiencing PTSD following active duty military service and are seeking veterans benefits, contact the team at Hill & Ponton. Our team of attorneys has chosen to focus in veterans’ disability and social security law, helping former service members obtain fair disability compensation. Click here to obtain a free case evaluation.