VETERANS VOICE: How VA rates disabilities
When a veteran files a claim for service-connected disabilities or requests increases in already rated disabilities, the VA regional office will in most cases request Compensation and Pension examinations (C&Ps).
It is important to remember these exams are not intended to provide medical treatment and are normally not diagnostic in nature. A C&P exam is ordered to verify your claimed condition, while the results of the exam will determine the percentage of disability awarded if service-connection granted.
Many veterans get C&P exams mixed up with their routine VA medical care and sometimes complain that the C&P examiner didn't do any tests or wouldn't discuss medical concerns. That's because the C&P examiner is not a medical provider. He or she is given an order by the VA regional office to perform a standard exam for the specific claimed condition in order to rate it. They are not allowed to discuss other health concerns or questions, because that's the role of the veteran's private or VA primary care physician or specialist.
For example, some of the most common types of disability claims are for joint conditions, such as degenerative disc disease or osteoarthritis. These conditions are rated on how the disability affects one's ability to fully use the specific joint, which means they are rated on pain on motion and/or range of motion. To get a higher rating, the joint must have a more severe limitation in range of motion or, for the knee, limitation in flexion or extension, or, lateral instability or subluxation (kneecap condition).
Clients often believe that if X-rays or MRIs show a "worsening" of degeneration that they deserve a higher rating, which is not true. Again, an increase in a rating for a joint is not based on a worsening of a radiology image, but on a worsening of range of motion.
Mental health conditions such as PTSD are rated based on psychological global assessment testing and severity of symptoms such as depression, anxiety, panic attacks, etc. and how the disability affects a veteran's ability to maintain effective work and social relationships.
Other conditions are rated based on specific medical evidence or test results. For example, if a veteran wants to claim erectile dysfunction as a new disability related to an existing service-connected disability, a C&P exam is not going to be able to provide that evidence. A veteran's medical records showing the condition was diagnosed, treated and linked to a service-connected condition should be provided with the claim. The same applies for a variety of conditions such as heart disease or diabetes, which are rated based on specific diagnostic test results.
There are also VA Disability Benefit Questionnaires a veteran's private doctor can complete to include with a claim, found at: http://www.benefits.va.gov/compensation/dbq_ListByDBQFormName.asp. If they are completed accurately with supporting medical evidence, a rating and decision can be made without VA ordering a C&P exam.
A VA decision letter will always explain why a certain claimed disability was denied or why a certain percentage was awarded or what needs to be in evidence to warrant a higher rating. Rating criteria can also be found in the Code of Federal Regulations (CFR) 38.
There are myriad factors involved in the claims processes depending on the specific disability, so it's best to consult a knowledgeable veterans service officer who can explain rating criteria and advise you on how to gather evidence and file a well-grounded claim.
Sandy Britt is an Air Force veteran and a Montgomery County veterans service officer. If you have a topic you'd like covered in a future column, email sjbritt@mcgtn.net. Questions about specific claims can be addressed only by calling the MCVSO at 931-553-5173 for an office appointment with a service officer.