When veterans apply for disability compensation through the U.S. Department of Veterans Affairs (VA), the VA claim exam—formally called a Compensation and Pension (C&P) exam—often becomes the most influential step in determining whether a condition is service-connected and how severe it is.
The evaluation helps shape the disability rating and, ultimately, the benefits a veteran may receive.
VA Claim Exam Guide
| Key Fact | Detail |
|---|---|
| Purpose | Determines service connection and severity of disability |
| Required? | Not always; VA may use existing medical records |
| Conducted By | VA clinicians or VA-contracted examiners |
| Typical Duration | 15–60 minutes depending on conditions |
| Outcome | Contributes to disability rating and claim decision |
Understanding the VA Claim Exam
A VA claim exam is a medical or psychological evaluation used to determine the legitimacy and severity of a veteran’s disability claim. While it may resemble a standard clinical appointment, the VA emphasizes that the exam is not a treatment visit. Instead, it is an evidence-gathering action meant to supplement or clarify the information already in a veteran’s file.
According to VA policy documents, examiners review service treatment records, prior medical evaluations, and statements submitted by veterans or witnesses. They then produce a report used by VA rating specialists. These specialists, not the examiner, decide the veteran’s disability rating.
Why the VA Claim Exam Matters
A Key Determinant in Disability Ratings
Experts from the RAND Corporation note that the VA claim exam is “often the most critical single document in a disability rating decision,” particularly when medical evidence is incomplete or conflicting. This is because the exam provides the VA with standardized data using Disability Benefits Questionnaires (DBQs), ensuring consistency across conditions ranging from musculoskeletal injuries to PTSD.
A former senior VA claims adjudicator said in an interview published by Military Times:
“If the C&P exam paints an incomplete picture, the claim can suffer. If the exam is thorough and accurate, it can make the process far smoother for the veteran.”
How Veterans Are Notified About an Exam
The VA or one of several contracted vendors (including QTC, LHI/OptumServe, or VES) contacts the veteran by mail, email, or phone. Exams are usually scheduled within 50 miles of the veteran’s residence, though rural veterans may face longer travel times.
If the proposed appointment conflicts with work, caregiving responsibilities, or medical issues, veterans may reschedule. VA guidance advises contacting the exam provider at least 48 hours in advance.
Failure to attend without “good cause” can delay the claim or result in a decision made without key evidence.
What Happens During the Examination
Interview and Clinical Review
The examiner will ask questions such as:
- How long you’ve had the condition
- How frequently symptoms occur
- How your daily activities are affected
- How often you have “bad days”
Mental health exams often include discussion of trauma exposure, mood, sleep, cognition, and social functioning.
Physical Examination
Depending on the condition, the clinician may check:
- Joint mobility
- Respiratory or cardiovascular function
- Neurological responses
- Scarring or skin conditions
The VA stresses that the exam should align with clinical standards and the specific DBQ for the claimed disability.
What the Exam Does Not Do
The VA emphasizes that:
- Examiners do not provide treatment
- They cannot diagnose new conditions unrelated to the claim
- They cannot inform you of your disability rating
- They do not determine whether a condition is service-connected
Their sole responsibility is to produce accurate documentation.
Expert Commentary on Exam Quality
Oversight reports by the Government Accountability Office (GAO) have documented variability in exam quality, especially when conducted by contractors. GAO identified problems including inconsistent exam documentation and insufficient mental-health evaluation procedures.
However, recent reforms have attempted to standardize training and increase examiner oversight. A 2023 GAO report found “modest improvement in exam accuracy” but noted that mental-health evaluations remained “an area requiring continued attention.”
After the Exam: What Veterans Should Expect
Examiner Report Submission
After the appointment, the examiner submits a report to VA claims processors. Veterans do not receive the results directly but may request a copy through VA’s records request process.
How the VA Uses the Exam
The VA combines:
- The exam report
- Service treatment records
- Military personnel files
- Private and VA medical records
- Lay statements
A rating specialist then determines whether the condition is service-connected and, if so, assigns a percentage rating based on the VA Schedule for Rating Disabilities (VASRD).
Claim Decision Timeline
The VA reports that the typical processing time for disability claims is around 90 days, though cases involving multiple conditions, secondary conditions, or mental-health claims may take longer.
Historical and Policy Context
Why C&P Exams Became Central
The modern VA disability system emerged after World War II, with standardized exams implemented as a way to handle millions of returning service members. As disability claims increased during the Iraq and Afghanistan conflicts, the number and complexity of exams grew dramatically.
Impact of the PACT Act
The Honoring our Promise to Address Comprehensive Toxics (PACT) Act expanded presumptive conditions linked to burn pits and toxic exposures. Even though presumptive illnesses require no independent proof of service connection, VA claim exams are still needed to assess severity.
Challenges Veterans Commonly Face
1. Long Travel Times
Rural veterans often travel more than 100 miles for an exam, despite VA guidelines recommending closer locations.
2. Insufficient Time with Examiners
Some veterans report exams as brief as 10 minutes. Advocacy groups argue that short visits can lead to incomplete evaluations.
3. Contractor Oversight Issues
Investigations by the VA Office of Inspector General (OIG) have found instances where contractor clinicians failed to follow required procedures.
4. Poor Communication
Some veterans say they were unaware they had exams scheduled due to outdated contact information or unclear communication from vendors.
Veteran Experiences and Perspectives
Veterans’ reactions vary widely. Some describe exams as straightforward and professional, while others report feeling rushed or misunderstood.
An Iraq War veteran quoted in a federal oversight hearing stated:
“It felt like the examiner didn’t understand my PTSD. He asked the questions, but the interview lasted maybe fifteen minutes.”
In contrast, another veteran from the Vietnam era said:
“The exam was thorough. The doctor took the time to ask detailed questions and review my medical history.”
Oversight, Reforms, and Accountability
Congress and veteran-service organizations (VSOs) regularly push for improvements to the exam system. Recent reforms include:
- Mandatory examiner training
- Quality audits
- New mental-health protocols
- Expanded telehealth options
- Simplified exam rescheduling
Veterans’ advocates continue urging more consistent standards and greater transparency.
Related Links
Retirees Get New Deadline: Government Sets Late-November Date to Check Updated COLA Notices
New Push for Higher COLA: Lawmakers Introduce $200 Monthly Boost After $56 Increase Criticized
Tips to Prepare for a VA Claim Exam
- Review your claim before the appointment
- Bring a list of symptoms and how they affect daily life
- Be honest and specific—avoid minimizing or exaggerating
- Describe your worst days, not just your best days
- If uncomfortable, request a gender-specific provider
- Immediately report any exam issues to the VA
What Happens If You Miss the Exam
Missing the exam without “good cause” can lead to:
- Delayed decisions
- Reduced ratings
- Claim denial
Good cause may include hospitalization, natural disasters, or family emergencies.
The VA continues refining its disability evaluation system amid rising claim counts and increasing scrutiny. More changes are expected as Congress evaluates oversight gaps and veterans’ groups lobby for enhanced transparency. For now, understanding the VA claim exam process remains essential for any veteran pursuing disability benefits.
