Yes! You heard me right. It is possible to receive a rating decision from the VA without being scheduled a C&P exam. Continue reading to learn more.
What is a C&P exam?
This exam is set up by the VA to obtain medical information and/or examination for rating percentage purposes. It is scheduled when a rater does not have all pertinent information needed to decide your claim. Historically everyone was sent for a C&P exam no matter what information you uploaded for your case file. There is new regulation/guidance that allows for the rater to decide your claim from the information you provide to them.
When did this happen?
The most recent guidance was published July 1, 2022 in the M21-1.
What is the M21-1?
The M21-1 is the Adjudication Procedures Manual and M21-5 is the Appeals and Reviews Manual. They are general guidelines designed to provide explanation of the title 38 of the United States Code (U.S.C.) and title 38 of the Code of Federal Regulations (CFR) governing service-connection.
What does the M21-1 say about skipping the C&P exam?
Here is the section and title for your reference:
V.ii.1.A.3.k. Statements From Physicians as Acceptable Evidence for Rating Purposes Without Further Examination
A statement from any medical provider can be accepted for rating purposes without further examination if it
is otherwise sufficient for rating purposes, and
includes sufficient objective medical documentation that is generally accepted by medical authorities.
What does this mean for my claim? What should I do to give myself the best chance of bypassing the C&P exam?
It means that a lot claims can qualify for this by using the information you submit to the VA. You will need to ensure that you have sufficient objective medical evidence. This includes treatment notes with a formal diagnosis, lab tests (if applicable), imaging studies (if applicable), procedures (if applicable). Most connections are secondary to another service-connected condition and the connection specifics or rationale are NOT commonly found in treatment records.
This is where a nexus letter can be helpful. Unless your condition is commonly found to be caused by your service connected condition, you will likely need a nexus letter to make this connection if you have hopes to bypass the C&P exam. Your treating doctor may be willing to do this or you can purchase one through an expert company like MRPY Professional Services. If your doctor is willing to write a nexus letter ensure they are familiar with how to do this. My last post discussed this situation.
We also have a product to bridge the gap and help your doctor write a solid and compelling nexus letter if they support your connection. It is called NexusPrep™ and it is composed of two parts. The first is instruction to your doctor to ensure the formatting and technical phrases are included on your document. The second part is the medical based evidence for your selected connection.
Submitting a private DBQ from your doctor or us can be helpful as well. A DBQ contains information specific about the rating percentages and can contain valuable rating information not found in your treatment records to determine where your condition severity is on the 38cfr rating code.
A nexus letter or private DBQ is not required for consideration of service connection, but it can be greatly helpful. It can allow for you to bypass the C&P exam if you meet the criteria above and provide a positive medical opinion for your claim. If you only have a negative medical opinion then the rater will most likely side with that negative opinion as the deciding factor and deny your claim.
Don't leave your VA disability claims to chance or to an examiner who does not believe in the connection you are claiming. Reach out to talk to one of our expert assistants now for FREE and see if one of our services can benefit your situation.