My C&P Exam Went Badly — What Now?

Step 1 — Get the actual exam report

Your impression of how the exam went and what the examiner wrote often differ. Pull the DBQ and any narrative addendum through the 'Files' tab on VA.gov (after the claim is open), through VA Form 20-10206 (FOIA/Privacy Act request), or through your accredited representative's access to the eFolder. Read every checked box and the examiner's free-text comments against the rating criteria for your condition (find them in /diagnostic-codes or 38 CFR Part 4).

Common surprises: the examiner checked symptoms supporting a higher rating than you received; the decision summary contradicts the DBQ; or the examiner addressed only one of several conditions you claimed.

Step 2 — Identify what's wrong

• Examiner factual error — recorded a symptom incorrectly, missed a range-of-motion measurement, or noted the wrong duration of an event.
• Failure to follow regulatory requirements — did not address DeLuca factors on a musculoskeletal exam (pain, weakness, flare-ups), did not consider lay statements, used a GAF score post-2014, or did not review the claims file when required.
• Medical error — applied the wrong diagnostic criteria, ignored a specialist's prior diagnosis, or attributed symptoms to the wrong cause.
• Inadequate examination — exam was too brief, did not include required testing (PFTs, imaging, audio test, etc.), or examiner outside the appropriate specialty.
• Examiner bias or unprofessional conduct — relevant for a complaint but rarely the most efficient ground for appeal; use the substantive errors above.

Step 3 — Pick the right lane

The decision-review lane you pick depends on what you have:

Higher-Level Review (HLR) — Use when the existing record contains a clear error of fact or law and you do not have new evidence. A senior reviewer re-examines the same record. HLR is fastest (averages 4-5 months) but does not allow new evidence. You may request an informal conference to point out specific errors.

Supplemental Claim (SC) — Use when you have new and relevant evidence — most commonly an Independent Medical Opinion (IMO) that addresses the C&P examiner's reasoning, or new medical records showing worsened severity. VA must order another exam if the new evidence raises a reasonable possibility of substantiating the claim.

Board appeal (NOD to BVA) — Use when HLR has been tried and failed, or when the case has complex legal issues better suited to a Veterans Law Judge. Three dockets: Direct Review (no new evidence, fastest), Evidence (90 days to submit new evidence), and Hearing (BVA hearing with a judge — adds the most time but allows live testimony).

Step 4 — Build the IMO if going Supplemental

An IMO should specifically address the C&P examiner's reasoning, not just provide a general opinion. The clinician should: (1) note they reviewed the C&P exam report, (2) identify any factual or medical errors, (3) provide a competing opinion using the 'at least as likely as not' standard, and (4) explain the medical rationale with citations to literature where applicable.

Caluza v. Brown (CAVC 1995) and Nieves-Rodriguez v. Peake (CAVC 2008) require VA to weigh both opinions and explain why one is given more weight than the other. An IMO that directly engages the C&P examiner's reasoning is far more effective than one that ignores it.

Step 5 — Request a new exam if appropriate

On HLR, if the senior reviewer agrees the prior exam was inadequate, they can request a new one (a 'duty-to-assist error' return). On Supplemental, the new evidence often triggers a new C&P automatically. On Board appeal, the Veterans Law Judge can remand for a new exam.

When VA orders a new exam, prepare for it: review the rating criteria, list current symptoms with frequency and severity, note any flare-ups with specific examples, and bring an updated medication list. If transportation is an issue, request the exam at a closer facility or by telehealth where appropriate.

What not to do

• Do not file a new claim for the same condition right after a denial — that resets the effective date and is the wrong procedural vehicle. Use HLR or Supplemental instead.
• Do not argue with the examiner during the exam. Answer questions directly and factually. Any disagreement is documented after the exam in writing.
• Do not exaggerate symptoms. C&P examiners are trained to identify inconsistency, and exaggeration can poison your credibility on the entire claim.
• Do not skip the exam without a documented reason. Failure to attend without good cause can result in denial under 38 CFR §3.655.
• Do not assume the rating decision summary is accurate — read the underlying DBQ.

Frequently Asked Questions