VA C&P Exam Guide
A plain-English overview of what a Compensation & Pension exam is, how to prepare honestly, and what to expect — for educational purposes only.
Educational information only. This guide describes how the C&P process generally works. It is not coaching on what to say or how to answer questions. Always answer the examiner honestly and accurately. Veterans and their accredited representatives are bound by VA standards of conduct.
What a C&P exam is
A Compensation & Pension (C&P) exam is a medical examination ordered by the VA to evaluate a claimed condition for service connection or rating purposes. It is performed either by a VA medical center clinician or a contracted vendor (VES, QTC, LHI/Optum Serve).
The examiner reviews your claims file, takes a history, performs the appropriate physical or psychological evaluation, and completes a Disability Benefits Questionnaire (DBQ) for the claimed condition. The DBQ becomes the central piece of medical evidence the rater uses to apply 38 CFR Part 4 rating criteria.
What an ACE exam is
ACE stands for Acceptable Clinical Evidence. It is a VA review process in which a clinician completes the Disability Benefits Questionnaire (DBQ) using the existing medical record — without requiring the veteran to attend an in-person exam.
An ACE review is generally considered when the existing medical evidence (VA treatment notes, private records, prior DBQs, imaging) is sufficient to address the rating criteria for the claimed condition. The clinician may also conduct a telephone interview to clarify the history.
ACE is most commonly used for stable, well-documented conditions such as tinnitus, scars, prior surgical residuals, and certain rating-increase reviews. Conditions that depend on a current physical examination (range of motion, current cardiac function, mental status exam) often still require an in-person C&P.
An ACE-completed DBQ carries the same evidentiary weight as an in-person C&P. If the existing record is incomplete or inconsistent, the reviewing clinician may decline ACE and request a full exam.
Key points
- • ACE = file/records review, optionally with a phone interview.
- • No in-person visit required when records are adequate.
- • Same evidentiary weight as a traditional C&P exam.
- • Veterans may submit additional records before or during the review to ensure the file is complete.
General preparation
- • Review your prior C&P reports and rating decisions so you know what's already documented.
- • Bring a printed list of all current medications, dosages, and prescribers.
- • Bring relevant private treatment records the examiner may not already have.
- • Plan to describe your symptoms accurately — including how often flare-ups occur — since rating criteria measure overall functional impairment.
- • Arrive early. Failure to appear is one of the most common reasons for unnecessary denials.
Worried your upcoming C&P exam won't go well?
A VA-Accredited Claims Agent can review your records before the exam and tell you, in plain English, what the rating criteria actually require. Free, no obligation.
What to gather, by condition type
These are general categories of evidence relevant to each type of claim. They are not scripts or recommended answers.
Mental health (PTSD, depression, anxiety)
- • Treatment history and current providers, medications, and dosages
- • Documentation of symptom frequency, triggers, and functional impact at work, in relationships, and in daily routines
- • Records of hospitalizations, therapy notes, or crisis-line contacts if applicable
- • Lay statements from family, friends, or coworkers describing day-to-day impact
Musculoskeletal (back, knees, shoulders, joints)
- • Pain location, frequency, and what activities trigger flare-ups
- • Range-of-motion limitations and use of assistive devices (braces, canes)
- • Imaging reports (MRI, X-ray, CT) and any orthopedic or PT notes
- • How the condition affects standing, walking, lifting, sleep, and work
Sleep apnea
- • Sleep study (polysomnography or home sleep test) showing diagnosis
- • CPAP/BiPAP prescription and current compliance data if available
- • Documentation of daytime fatigue, hypersomnolence, or impact on work
- • Notes on related conditions (PTSD, weight, GERD) when relevant to a secondary claim
Tinnitus and hearing loss
- • Audiogram results, ideally both pre- and post-service if available
- • Documentation of in-service noise exposure (MOS, hazardous duty, citations)
- • Description of how tinnitus or hearing loss affects daily life and work
Migraines and headaches
- • A headache log showing frequency, duration, and severity over several months
- • Documentation of prostrating attacks (when symptoms force you to stop activity and lie down)
- • Treatment records, prescribed abortive or preventive medications
- • Statements describing missed work or canceled activities
Cardiovascular and respiratory
- • Most recent METs testing, echocardiogram, or pulmonary function test (PFT) results
- • Cardiology or pulmonology notes
- • Medication list and any hospitalizations
- • Description of exertional limits in daily life
After the exam
1. Request a copy of the exam report through VA.gov or your accredited representative.
2. Compare the findings against the relevant 38 CFR Part 4 rating criteria for the condition.
3. If the report contains factual errors or omissions, document them in writing.
4. If the exam was inadequate (for example, required testing was not performed, or aggravation was not addressed), the rating decision can be challenged through Higher-Level Review, a Supplemental Claim, or a Board appeal.
5. An Independent Medical Opinion (IMO) from a qualified private clinician can address nexus or rating questions a C&P examiner did not adequately answer.
Common misunderstandings
Need help reviewing a C&P exam report?
A VA-accredited claims agent can review the report against the rating criteria and identify whether a challenge is warranted.