Was Your C&P Exam Adequate for Rating Purposes?

What 'adequate' means

An examination is adequate when it is based on consideration of the claimant's prior medical history and describes the disability in sufficient detail that the Board's evaluation is a fully informed one. A medical opinion is adequate when the examiner explains the reasoning connecting the evidence to the conclusion — a conclusion with no supporting analysis carries no weight, regardless of the examiner's credentials.

Certain rating criteria carry their own measurement requirements. Musculoskeletal examinations must address painful motion and functional loss under 38 CFR §§ 4.40, 4.45, and 4.59, and the Court in Correia v. McDonald, 28 Vet. App. 158 (2016) addressed testing in active and passive motion and in weight-bearing and non-weight-bearing where applicable. Where the criteria call for a specific measurement and the report does not contain it, the gap is visible on the face of the report.

Getting and reading the report

Exam reports are part of the claims file. They can be requested through a records request or obtained by a representative with access to the file. Comparing the report against the diagnostic code VA applied is the core exercise: does the report contain each finding the criteria for the next higher evaluation require, and does it address flare-ups and functional loss where the criteria contemplate them?

• Does the report reference the service treatment records and prior treatment history, or only the day's interview?
• Where an opinion was requested, is there a stated rationale, or a conclusion alone?
• Does the report use the phrase 'less likely than not' without explaining why?
• Are the required measurements present for the diagnostic code applied?
• For mental health, are the symptoms described in terms the criteria in 38 CFR § 4.130 use?

How the issue is raised after a decision

If the argument is that the examination in the file was inadequate and VA should have obtained a better one, that is a duty-to-assist argument on the existing record — the posture that Higher-Level Review is built for (38 CFR § 3.2601). If a private medical opinion has since been obtained that addresses what the VA examination did not, that is new and relevant evidence for a Supplemental Claim under 38 CFR § 3.2501.

Common misunderstandings

• ×Judging the exam by how short or unfriendly the appointment was rather than by what the written report contains.
• ×Assuming a negative opinion is final; adequacy turns on the reasoning, and an unexplained opinion is entitled to no weight.
• ×Missing the exam entirely — failure to report can result in the claim being decided on the evidence of record or denied under 38 CFR § 3.655.

Frequently Asked Questions

References & sources

1. Barr v. Nicholson, 21 Vet. App. 303 (2007) — U.S. Court of Appeals for Veterans Claims
2. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) — U.S. Court of Appeals for Veterans Claims
3. 38 CFR § 4.59 — Painful motion — eCFR