Tips to help out with C&P Exams from a Veteran Service Representative

First and foremost, it would always behoove you to write out support of claim statements for each and every contention that you are filing a claim. Make sure to bring a copy of this with you to your exam. It would be highly intelligent to have any paperwork that would be critical for your examiner to have pertaining to your claim on hand with you when at your exam. Case in point, when I went for my sleep apnea exam, my examiner stated that they couldn’t find the sleep study. I knew that it was in VBMS (the system that stores all documents and the system that VSRs and RVSRs aka raters use to process claims) as the VA not only sent me out for the sleep study to a third party, but I also submitted the results as part of my evidence that I was building and submitting for my sleep apnea claim. However, there was no issue because I simply handed her a copy of my sleep study because I had it on hand. I literally had a thumb drive with all x rays, MRI images, radiology reports, C File, buddy statements, support of claims etc, and paper copies of any relevant information that could potentially be asked for.
For hearing loss and tinnitus exams, know what can and won’t give your statement more probative value. Yes, your MOS/Rate will be taken into account. So will combat. If you can prove via DD 214 i.e. Combat Action Bage, Combat Infantry Badge, Combat Medic Badge, Purple Heart……….you get the idea, they are awards that can concede combat exposure. This gives more probative value to any of your statements made concerning hearing loss. However, keep in mind, with regards to hearing loss, they primarily look at audiograms………….entrance and exit audiograms, and any audiograms that you provide up to 12 months after service……….much beyond that, one can’t likely connect that to service. If one shoots guns recreationally, rides a motorcycle to work, uses power tools regularly etc, this also throws other factors into the equation that could affect hearing loss.
For tinnitus…………if you are claiming tinnitus, I honestly don’t know why one would show up to the exam and say that their ears aren’t ringing, but it happens all of the time. Another common phenomenon is that people didn’t complain about it in service or go to get treated for it (there is no treatment really for it other than trying lipoflavinoids or newer hearing aids that can block it out via white noise.) However, there is one little-known thing about tinnitus……it is essentially the only illness that a Veteran can actually diagnose themselves.
Here is the most important manual reference for tinnitus claims………….it clearly says that you do not need a diagnosis of tinnitus in service so long as you provide a competent lay statement indicating that you had it while in service AND you get it diagnosed later on (hint hint……..get an exam done privately.)
III.iv.4.D.3.b. Requesting Medical Opinions for Tinnitus
A medical opinion is not required to establish direct SC for claimed tinnitus if
STRs document the original complaints and/or diagnosis of tinnitus
there is current medical evidence of a diagnosis of tinnitus or the Veteran competently and credibly reports current tinnitus, and
the Veteran claims continuity of tinnitus since service or there are records or other competent and credible evidence of continuity of tinnitus diagnosis or symptomatology.
Exception: An opinion may be necessary in the fact pattern above if evidence suggests a superseding post-service cause of current tinnitus.
A tinnitus examination may also be necessary if the STRs do not document tinnitus but
there is evidence establishing noise exposure or another in-service event, injury, or disease (for example ear infections, use of ototoxic medication, head injury, barotrauma, or other tympanic trauma) that is medically accepted as a potential cause of tinnitus, and
there is a competent diagnosis or competent report of current tinnitus.
Notes:
Under Jandreau v. Nicholson, 492 F.3d. 1372 (Fed. Cir. 2007), a layperson may provide a competent diagnosis of a condition when a layperson is competent to identify a medical condition. Tinnitus is a medical condition that a layperson is competent to identify in himself/herself because the condition is defined by what the person experiences or perceives – namely subjective perception of sounds in his/her own ear(s) or head. Therefore, a layperson may establish the diagnosis of tinnitus at any point in time from service to present. However, consider credibility and weight of the evidence in deciding whether to accept lay testimony as proving tinnitus in service or presently.
The Hearing Loss and Tinnitus Disability Benefits Questionnaire tinnitus-only examination includes a number of options for examiner opinions on etiology. The examination may be conducted by an audiologist or non-audiologist clinician.
Only ask the audiologist to offer an opinion about the association to hearing loss if hearing loss is concurrently claimed or already SC.
Know the Disability Ratings before you go into the exam. You will want to check out this website: https://www.law.cornell.edu/cfr/text/38/part-4/subpart-B 38 CFR Subpart B
For instance, if you have any issues with bones/joints etc, you will want to check out this: https://www.law.cornell.edu/cfr/text/38/4.71 and https://www.law.cornell.edu/cfr/text/38/4.71a
Know the politics………………
There are some good posts on here about PTSD exams, and I agree with most of what has been said. I must add on to some of it, and some of it is very very crucial. We are Veterans…..that is why we are here. Generally speaking, most of us are going to be politically conservative. Guess what, most psychiatrists and psychologists do not tend to be. Statistically speaking, of all of the MDs (yes, a psychiatrist is an MD), psychiatrists are the most politically liberal (left) of all MD fields whereas surgeons are the polar opposite. Guess what might not be a good idea to do in exams? You guessed it………bring up politics. In fact, I would suggest that going in there acting like a hard ass would not bode well for you. If you walk in there wearing a MAGA hat, you might want to consider writing up your appeal later that evening. If it is a female examiner (and you’re a male), I would suggest not grimacing at them during your mental health/PTSD exam.
I would suggest not trying to play the examiners; sure, you can roll the dice and try some of the advice about talking about wanting to kill people all of the time and acting super hypervigilant in the room and making sure to sit where you can clearly monitor all exits etc, but I suspect that most of these examiners see 5-8 people a day and have become very astute on picking up on the bull shit artists and won’t think twice about drawing a line through your name rather than under it. I would suggest being truthful…….that doesn’t mean that you can’t elaborate on your worst experiences pertaining to the questions that are asked, but I wouldn’t recommend lying or exaggerating. I certainly wouldn’t recommend lying about anything pertaining to your military record either, as while the examiner might be none the wiser, the raters reviewing it are more likely than not Veterans are thoroughly adept at combing through military records i.e. don’t tell the examiner that you were an Army Ranger when you were a chaplain assistant.