Qualifications of Doctors Performing C&P and CE Exams.
By Douglas I. Friedman of Friedman Law Firm, P.C.
Thursday, October 8, 2020
The VA may send you for a Compensation and Pension Exam, (C&P) or SSA may send you to a Consultative Examination (CE). The VA and Social Security Administration rely on these exams in deciding your case. What do you need to know before you go?
Who is performing the exam?
The examiner's qualifications are important and can make a big difference in the result. And, those qualifications may vary more than you think!
You might be used to getting treated by a specialist who is an expert in your condition. But, when your exam is scheduled, you may not be scheduled to see a specialist. Or, if you have multiple conditions, the VA or SSA might find someone who knows just enough to perform a basic exam in all areas.
We don’t think that the government is intentionally trying to limit the information available from an exam. It’s just a matter of balancing availability of an examiner with the need to get you examined as quickly as possible, and hopefully during just one visit. Because of this, often you will be seen by an internist or nurse practitioner. These exams can be excellent -- --; internists and nurse practitioners are qualified in their professions. But, they presumably do not have the expertise of a specialist (in the case of an internist) or a physician (in the case of a nurse practitioner).
What if the examiner doesn't do a good, thorough exam?
In these situations, if you get a “bad” exam, we encourage clients to seek an explanatory opinion from their own treating doctor. On VA cases, if the evidence is equal on both sides -- for denial and for a grant --; the law is that the VA should grant service-connection. For Social Security cases, your treating doctor is presumed to know about your condition than someone who only sees you once.
In VA cases, we often ask your doctor to complete the same form that is completed by the VA examiner. These forms are called Disability Benefit Questionnaires. There are different DBQs for different medical conditions. The VA used to encourage veterans to submit DBQs, but no longer does so. But, the forms are available on the internet, and veterans still ask their treating physicians to complete them. Some treating physicians will do so, and some will not. But it can’t hurt to ask.
On the Social Security side, we have various different forms that we ask the doctors to fill out, based upon what medical conditions you have. These forms are not going to line up exactly with what the Social Security examiner filled out, but they will cover much of the same information.
How does the decision-maker view these exams?
I remember a sign that I saw hanging above the desks of VA employees who decided whether to grant or deny claims. It said: "Grant if you can; Deny if you must; and Always give the veteran the benefit of the doubt.” The “benefit of the doubt” comes in when the evidence is equal -- what the law calls being in “equipoise.” While the SSA does not give as much "benefit of the doubt" as the VA, every positive bit of information your doctor provides can help tilt the scales in your favor.
So, if you have a negative exam it is usually good to consider whether a positive opinion may be available from your treating physician or even an expert witness. Hopefully the positive opinion will balance out the negative one. Sometimes, if the positive opinion is given by a more qualified source, it may even outweigh the negative opinion.
In conclusion, the quality of the exam is often crucial to a successful claim. Getting a favorable second opinion may be what just what the doctor calls for.
For questions or to obtain additional information, call us at 205-879-3033 or email LifeHealth@FriedmanFirmPC.com
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What to know about Disability Exams (a.k.a. Compensation and Pension or Consultative Exams)