Categories

Subscribe!

qtq80-10vUJ4

RI Veterans: Did you know? 24 March 22 – John A. Cianci

by John A Cianci, Department Veterans Service Officer, Italian American War Veterans (ITAM)

Understanding VA Compensation & Pension (C&P) Exams

Let’s start off with a question from one of our readers. 

I received a call from a company called VES claiming they were contracted with the VA to do a medical exam, however, before they could provide additional information, I had to give them my date-of-birth. Is this a scam? Bob A , Foster RI

AnswerFirst, VES (Veterans Evaluation Services) is one of the private contractors contracted with the VA to conduct in-person disability compensation and pension (C & P) medical exams.

For my own personal communication with VA private contractors who contact me by phone, I do not disclose any personal information until I verify the caller is not a scam. 

How do I do this since the caller will not disclose any information why the VA has contracted with them, without me giving the caller my date of birth?

1.    I ask the caller (contractor like VES) to send me an email with the required information to call the contractor back.

2.    After receiving the email, I verify via website or calling the VA to ensure the contractor is legit. 

3.    After verification, I seek information from the contractor exactly what the VA has contracted for review. More than likely, the contractor will provide you this information via phone call. 

Based on your question, it appears you have filed a claim for a disability or requested the VA to increase your current service-connected disability.

The VA claim system is a three-step process:

1.    Veteran and/or his representative files the claim with the VA.

2.    VA receives the claim and will schedule an exam called a C & P to verify the veteran has a medical diagnosis. 

3.    After the exam, the VA will adjudicate to determine if the medical diagnosis is service connected; in layman terms, how is the veteran’s service is connected to the medical diagnosis.

VETTIP – Example. A Veteran has hearing issues and on and off ringing in the ears 30 years after getting discharged from the U.S. Army. Veterans can recall after exposure to loud noises during training exercises, the veteran had one or two incidents after the sound he had limited or no hearing for a few minutes. Moreover, a day or two later he still had a headache. Over the 30 years after getting off after duty, he has ringing in his left ear and over time his hearing has worsened. The VSO assisting him recommends the veteran can fill out the VA Form 21-4138, also known as the Statement in Support of Claim. This is a multi-purpose form that has been used by the VA for many years, on which veterans are able to write any information that they would like the VA to know how the veteran is connecting hearing loss and ringing in the ears to his service. Consensus among VSO’s the Italian American War Veterans of UD networks with – all recommend the veteran submit the VA 21-4138 with claim and have at the exam to give a copy to the examiner. This ensures no confusion on what the examiner documents in the conversation with the veteran during the exam. 

After you file the claim, the VA will, more often than not, schedule the veteran for a disability compensation and pension medical exam, called C & P. 

Bob: more information on the VA C & P exam covered in this week’s article.

Understanding Compensation & Pension (C&P) Exams

The C&P Exam (short for “Compensation and Pension”) is an exam performed by a VA salaried or contracted physician to document the current severity of a condition that is being considered for service-connected disability.

The C&P Exam is the second step of the VA disability process and is scheduled after the veteran submits the required documentation to the VA for the claim. 

TheVA, more than likely, will request a contact examination in support of a Veteran’s claim, if needed. 

According to the VA website, after a claim is received by the VA, the VA orders an exam. 

The vendor will contact the Veteran by telephone, registered mail, or email to schedule an appointment within three business days of acknowledging the request from VA. If the vendor is unable to reach the Veteran by telephone, they will schedule the examination and mail a notification to the Veteran with the appointment details.

Vendors will provide confirmation of all scheduled examinations by letter at least five business days prior to the appointment – or less if verbal confirmation of attendance to the appointment is received. Vendors will also follow up with the Veteran by telephone prior to a scheduled appointment.

Veterans have the opportunity to contact the contract vendor identified in their appointment letter directly to request their appointments be rescheduled. If Veterans have questions concerning their examination, or if they need to cancel or reschedule their appointment, they should contact the contract vendor that scheduled their appointment directly.

VETTIP – All communications with contractors or vendors contracted by the VA should be documented by the veteran. As the VSO for the Italian American War Veterans, I recommend you document by sending yourself an email summarizing the communication with the vendor. 

In some cases, more than one C&P Exam will be required. The first exam is usually conducted by a general physician. In most cases, this will be the only exam needed.

If, however, the veteran has a vision, hearing, dental, or psychiatric condition, then a specialist will have to do the evaluation for that condition—an optometrist for an eye condition, an audiologist for hearing, etc. The VA is required by law to have specialists conduct the exam for any of these conditions. Each of these additional exams is also referred to as a “C&P Exam.”

In the C&P Exam report, the physician should establish the diagnosis of the condition, note the exact nature of the condition, and record all necessary measurements/test results needed to rate the condition.    

Do I need to attend the C & P Exam?

You need to attend scheduled Compensation & Pension (C&P) Exams, even if the VA initiated to review your current existing service-disconnected disability. 

If you do not attend the exam, the VA could consider your claim abandoned and close out the claim, which, more than likely, the VA will deny the claim.

What if I did not file a claim and the C & P is for current service-connected disability?

First, understand the rules of when the VA can review existing VA service-connected claims:

1.    Possible fraud involved in awarding of the claim.

2.    VA Disability 5-Year Rule. The VA disability rating 5-year rule states that the Department of Veterans Affairs (VA) cannot reduce a veteran’s disability rating if it has been in place for five years or more unless the condition shows sustained improvement over time.  In this situation, the veteran’s rating is considered a stabilized rating.

Can VA Reduce a Rating After 5 Years? After five years, a disability rating can only be reduced if VA obtains medical evidence indicating the veteran’s condition is substantially improving over time on a sustained basis.  Essentially, VA must provide an explanation for why it is reasonably certain that the veteran’s condition will continue to show sustained improvement. If a rating is considered stabilized, two things must be evidence before VA can propose a reduction:

VA must show that the improvement is not just temporary through a C& P re-examination and medical records; and VA must provide evidence that the veteran’s claims file demonstrates sustained improvement.

3.    VA’s Disability 10-Year Rule. According to the VA disability 10-year rule, while VA can reduce a veteran’s rating after 10 years—provided substantial medical evidence suggests steady improvement over time—it can only fully terminate benefits if there is evidence of fraud.

4.    VA’s Disability 20-Year Rule: Continuous Ratings. Service-connected conditions rated at or above a certain disability rating for 20 years or more are considered continuous. According to the VA 20-year rule, VA cannot reduce a continuous rating below its original disability rating unless the rating was based on fraud. For example, say a veteran was initially rated a 50 percent for a service-connected disability and over 20 years it fluctuates between 50 and 70 percent disabling. After the 20-year mark, VA must continue to rate the veteran’s condition at least 50 percent for the remainder of their life.

VETTIP – Veterans who are over the age of 55 are often protected from VA rating re-evaluations. in many situations. This is a case-by-case determination, and if the veteran is over 55, the veteran should contact the VA and request information why he is being re-evaluated. Again, detail and document. 

There is a chance you could lose your VA benefits if you don’t attend your C&P exam. You should make every possible effort to complete a scheduled exam. If you are unable to attend your C&P exam, you must inform the U.S. Department of Veterans Affairs (VA) as soon as possible. You can do this by calling 1-800-827-1000.

If you refuse to attend a scheduled C&P exam the VBA can say you have abandoned your claim.

There are some things a Veteran can do to prevent unneeded exams that not only waste money but also put their benefits at risk, oftentimes erroneously.

1.   If you get a notice of a review C&P exam being scheduled, ask your representative if they can find out why the C&P review is required. If you have representation through a VSO, claims agent or VA attorney, they will be able to contact the VA and determine why the C&P is being ordered and, if necessary, gather evidence you may need to ensure that their rating is not reduced (unless it is truly warranted).

2    Make sure treatment is consistent for the level of severity of the service-connected condition. For example, if you have a 70% rating for a mental health condition and are not seeing anyone for medication management or therapy, the VA is going to question if you are really disabled at that high of level. You can reduce the likelihood of this by attending treatment, even if you don’t participate, and having it noted in the records why you are refusing treatment and making sure your symptoms are being recorded on a regular basis.

3.  Provide the VA with private treatment records when necessary. If you are seeing a private provider, the VA is not automatically going to request those records unless it is through the VA Community Care. You can request those private provider records be shared with the VA, so the VA has a complete understanding of your condition and is less likely to request an unnecessary C&P exam. This can be done through your online VA access using https://www.myhealth.va.gov/mhv…/electronic-record-sharing

4.  Ensure the VA has records of any emergency issues that arise related to your service-connected conditions. For example, if you are on vacation or out of the area and present at an emergency room, make sure to ask the VA to obtain those records for your file so they are aware of the condition and have complete records.

The veterans should work with the VA as much as possible to ensure that your records contain the information needed to continue to support your rating level is the best way for a Veteran to reduce their chance of having a review C&P called as well as having their benefits reduced without warrant. This saves thousands of dollars per Veteran and helps Veterans retain their benefits at their current levels rather than risking reductions and having to fight to have their benefits reinstated. And… the more money saved; the more Veterans can be served.

VETTIP – If the VA contacted  you to reevaluate your existing service-connected disability, I recommend you review and understand the decision which awarded you the service connected disability. 

Tips preparing for the C & P exam:

C&P Exams

  1. In a C&P (Compensation and Pension) exam be careful in volunteering too much information and answer questions that are asked and try not to be too verbose.
  2. Focus on your worst day, not the day of the exam.
  3. If you are asked…”How are you today?”, if you answer ‘Fine’, then the examiner may write in the exam that the Veteran said he was fine.
  4. Don’t be nervous, be honest.
  5. If you are emotional, then be emotional.
  6. This is an exam, not a test.
  7. You will not get treatment from this exam as that is your primary care physician’s job.
  8. I assume you have had continuous care or treatment since you got out showing your condition in medical notes.
  9. A C&P examiner may not be a doctor, and this is normal.
  10. If you experience pain, always give a quantitative response. It is difficult to gauge a scrunched up facial expression or even a grunt. For example…”I feel pain at an 8 out of 10, 10 being the worst”. This gives the examiner a real number to assess your pain level. Do not let the examiner exceed a comfortable ROM (Range of Motion) without some indication that you are in pain.
  11. Review the DBQ (Disability Benefits Questionnaire) for the conditions you have filed for so you will have an idea what they will need to do during the exam. All DBQs are online and printable.
  12. Getting a DBQ done by your own doctors will help because your doctors know you better than a 15-minute exam. Any MD, DO, APRN or PA can do medical DBQs and nexus letters. Any psychiatrist or psychologist can do initial mental health DBQs and nexus letters. In addition, a psych APRN or LCSW can review or increase DBQs.
  13. If this is an initial claim, nexus statements can help, especially if the conditions are not in your military medical records or you are filing for secondary conditions and also presumptive conditions.
  14. Take notes with you, if you like, and you can also take notes for later.
  15. Do not expect any evidence you have such as a personal statement, spouse, family, friend and coworker statements, DBQs, nexus letters, buddy letters or any medical records to be delivered to the VBA (Veterans Benefits Administration). These need to be submitted with your claim.
  16. If you want someone in the exam with you, ask the examiner. This must come from the Veteran, and it is the examiner’s option, not yours.

The exam is complete – now what?

The results of the exam are not the only evidence the RVSR (VA Rater) uses. That, plus it is not the C&P examiner who decides your claims. It is the RVSR. Even then, once a RVSR and their team decide your claim it still must be approved through the ‘chain of command’. 

The veteran is entitled to a copy of the exam; however, the examiner cannot provide the results to the veteran.

To obtain a copy of the exam and all the notes, you contact the Department of Veterans Affairs, Veteran Benefit Administration (VBA) since the results of the exam will not be in the veteran’s VA medical file. Yes, more than likely, the exam will not be in your VA medical files, and you must obtain a copy from the VBA processing your claim. For example, if your home of record is a zip code in Rhode Island, you could obtain a copy of the exam a few different ways:

1.    Go to Providence Medical Center on Chalkstone Ave, basement, and ask for the office where you can obtain a copy of a recent exam performed outside the VA.

2.    Or you can write, 

       Department of Veterans Affairs/VBA, 830 Chalkstone Ave, Providence RI 02908

In the content of the letter, detail exactly what you are requesting. For example, I am seeking a copy of an exam I had on March 1, 2022, at Dr. Michael’s office.

VETTIP – You are not seeking a copy of your VA medical records, just a recent exam. 

After obtaining the exam review and if the paperwork reflects communication, you had that day with the examiner and accurately affects communication you had with the examiner, great.

What if I don’t agree with the C & P?

If you don’t agree with the examiner’s notes, the veteran should prepare another VA 21-4138 detailing what he or she disagrees with. Remember, you, in most cases, don’t have the medical background to challenge a medical opinion, however, if the examiner writes information, you do not agree with, you can challenge it.

For example, assisting a veteran understanding the C & P, the examiner noted the veteran only reports 1-2 headaches a month. This note was inaccurate, as the veteran reported 1-2 headaches a week. 

You can challenge the credentials of the C&P examiner if the decision comes down against you. Ask for the doc’s CV (Curriculum Vitae – a brief account of a person’s education, qualifications, and previous experience). 

You must fight his or her credentials on the initial appeals (any of the three lanes and including an appeal to the Board) or you waive the argument. You have a limited amount of time to do this (one year).

In short, a VA’s examiner (contract or VA employee) is PRESUMED to be competent, and your provider may or may not be depending on the RVSR determining your claim. 

In conclusion, a lot of must know information on the VA C & P exam which should assist a veteran who has filed a claim for an illness he or she is seeking to link to their service. Linking the illness will ensure the veteran obtains a lifetime of benefits of medical treatment and possibly even a lifetime of financial compensation. 

Now you know more about step 2 of the VA Claim Process.

_____

RESOURCES

AARP offers a free career center for veterans, http://campaigns-aarp-org-stage.targetclose.com/veteran-job-center . The center offers a free course, Veterans Career Advantage,  job search tool for companies seeking veteran employees, link to access what a good resume looks like, and other tips for veterans seeking employment. 

EVENTS

March 24, 2022, 1:00-5pm, Rhode Island Veterans Home, Bristol, RI, women veterans and active-duty women are invited to the annual tea event which also will recognize Women’s Military History.

All Military Active-Duty Women and Women Veterans are invited to the RI Veterans Home to honor and celebrate the annual tea. All services, all eras, all wars, please come and enjoy coffee, tea and refreshments. Recognize Women’s History Month by telling your stories or listen to stories of Women who served in the Military, Women who served their country in many ways

and legacy of achievements.

___

DISCOUNTS

Restaurants

Applebee’s – Military Discount … With more than 2,000 locations, Applebee’s is a family grill restaurant. Applebee’s gives 10% off for active duty and veteran. Last verified 07/31/2028

Denny’s – Hartford Ave, Johnston offers 10% discount for veterans and active duty . Denny’s is a table service diner-style restaurant chain.  Last verified 07/31/2028 (PS I had breakfast there on Saturday).

Outback Steakhouse – 10% Discount to active and veterans. Last verified 07/28/2021

99 Restaurant & Pub – The 99 Restaurant & Pub offers a 10% military discount to members of Veterans Advantage. Available at select locations only. Bring valid military ID

Retailers

Advance Auto Parts – 10% for Active Duty, Veterans, and families. Last verified 07/28/2021

AT&T Wireless Discount
Active Duty, Reserves, National Guard, Spouses and Veterans get 25% off on mobile phone services. Just present identification or proof veteran status to any AT&T store

Bass Pro Shops –  Offers a 5% discount to active-duty military, reservists, and National Guard. Sign up and verify your status online or bring your military ID when you shop at your nearest Bass Pro store (source).

BJs Wholesale – Reduced membership fee. BJ’s offers all military personnel over 25% off their Membership. Last verified 07/28/2021

Lowes – Enroll in the Lowe’s Military Discount Program to activate your 10% discount

“Our way of saying Thank You” to our active duty, retired and military veterans and their spouses with a 10% discount on eligible items.

Verification of your military status is fast and easy through our partner, ID.me.

ID.me is our trusted technology partner in helping to keep your personal information safe.

GameStop – is offering a 10% in-store military discount on all pre-owned products, collectibles, and select new products. Available to current and former military members who bring any valid proof of service or when they verify through ID.me

Home Depot – Offers a 10% off military discount on regularly priced merchandise for in-store purchases for active duty, retired military, and reservists at participating locations. Customers are required to show a valid government-issued military ID card to redeem this offer.

Kohls – 15% discount offers for active military, veterans, retirees, and their immediate family members a 15% discount on purchases made on Mondays, in store only. In order to receive the military discount, eligible customers must present proper identification along with any tender type.

Jiffy Lube – HONORING VETERANS ALL DAY EVERY DAY!

We didn’t want to wait for Veteran’s Day to express our appreciation and gratitude for your service. That’s why every Team Car Care owned and operated Jiffy Lube® service center is offering our BEST discount of 15% OFF as a “Thank You” to the men and women of our Armed Forces for their service to our country. *Disclaimer*- I.D. required. No coupon is required. Excludes batteries and brakes, alignment, and diagnostic services. Available only at select locations listed below:

Tioque Ave, Coventry RI

Bald Hill Road, Warwick RI

Park Ave, Cranston RI

Michaels – offers a 15% off military discount on the entire in-store purchase including sale items for active duty, retired military, guard, reservists, veterans, and family members. How to get –

1.    Create an Account. Log in or create a Michaels Rewards account.

2.    Get Verified. Provide your military information to get verified instantly.

3.    Go Shopping! To use your discount online and in store, just sign into your account or provide your Michaels Rewards phone number at checkout.

O’Reilly Auto Parts – 10% discount on in store items for Active Duty, Veterans and families. Last verified 3/4/21.

T-Mobile
T-Mobile offers up to half off military discount wireless plans. Save $25 per line on up to four lines with the Magenta Military signature plan, and $35 per line on up to four lines with the premium plan, Magenta Plus Military. The military programs are available to active-duty military, veterans, retirees, and reservists.

Verizon Fios
Veterans, active-duty military, retirees, and reservists can receive a discount on either new or existing Verizon Fios services (Internet, TV, Landline). Offer includes $10 off Fios Triple Play, $5 off Fios Double Play, or $5 off standalone internet.

Verizon Wireless
Active-Duty military and all Federal Government employees can get 15% discount on monthly plans $35 and above and 25% off accessories.

Xfinity Residential
If you are currently serving in the military or you are a veteran Xfinity offers a $100 Visa® Prepaid card and $25 Xfinity Coupon that can be used toward your next Xfinity On Demand rental or purchase or as a credit toward your bill.

_____

If you are a retailer and or a veteran aware of a business not listed above, please forward , itamri4vets@gmail.com:  the business’s name , location, and military and veteran discount offered.

_____

If you have an event, meeting, other pertinent veteran information, or email questions or help needed, contact the Italian American War Veteran Service Officer, John A Cianci, itamri4vets@gmail.com, ITAM Office 1-(401)677-9VET(9838)

_____

To read all columns in this series go to: https://rinewstoday.com/john-a-cianci/

John A. Cianci is a Veteran Service Officer. Retired, U.S. Army MSgt., Persian Gulf War and Iraq War combat theater.

Cianci, a combat disabled Veteran, served in Desert Shield/Storm and Operation Iraqi Freedom. His awards include Bronze Star, Combat Action Badge, Good Conduct, and others.

Cianci belongs to numerous veterans organizations – Italian American War Veterans, American Legion, Veterans of Foreign War, United Veterans Council of Rhode Island, and many more organizations. He is an active volunteer assisting veterans to navigate federal and state benefits they have earned. He is Department of Rhode Island Department Commander Italian American War Veterans and Veteran Service Officer.

He is a graduate of Roger Williams University (BS Finance), UCONN business school* (Entrepreneur Bootcamp For Veterans), Solar Energy International Residential, Commercial and Battery Based Photovoltaic Systems certificate programs, numerous certificates from the Department of Defense renewable energy programs, including graduate of the Solar Ready Vets Program.