How to Ace Your C&P Exam for Anxiety and Depression (The Insider’s Guide)

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In this Insider’s Guide, Air Force veteran Brian Reese will explain how to ace your C&P exam for Anxiety and Depression.

It’s normal to feel scared and uncomfortable about discussing your mental health struggles during a C&P exam, especially with a healthcare provider you’ve never met and don’t trust.

However, knowing what to expect and how to prepare can make a huge difference.

Familiarizing yourself with the process and the types of questions you might get asked during a C&P exam for mental health can help put your mind at ease (you’re still going to be nervous on exam day).

Remember, it’s crucial to be completely honest and vulnerable.

Talk about how you feel on your very worst days, and don’t hold back!

Summary of Key Points

• Types of Exams: There are three main types of VA exams for anxiety and depression: initial exams for new claims, increase exams if you already have a rating but are pursuing a higher rating, and secondary exams for mental health conditions linked to other service-connected issues.

• Exam Purpose: A C&P exam for anxiety and depression evaluates three areas: (#1) confirming a DSM-5 diagnosis of a mental health condition, (#2) determining the “nexus” for service connection, and (#3) assessing the severity of symptoms and impact of your mental health condition(s) on your occupational and social functioning.

• VA Ratings for Mental Health: The VA assigns disability ratings for anxiety and depression based on symptom severity and impact on your work, life, and social functioning with ratings ranging from 0% to 100% with breaks at 10%, 30%, 50%, and 70%. The most common VA rating for anxiety and depression is 70%.

• Preparation Tips: Prepare by understanding the exam process, being honest about your symptoms, documenting their impact, gathering relevant medical records, and reviewing the Disability Benefits Questionnaire (DBQ) for Mental Disorders.

3 Types of C&P Exams for Anxiety and Depression

There are three different types of Anxiety and Depression C&P exams:

#1. Anxiety and Depression Initial Exam

If you’re filing a new claim for anxiety and depression, you’ll undergo an initial VA exam for mental health.

Initial exams are typically longer than review exams and require additional development.

#2. Anxiety and Depression Increase Exam

If you already have a VA rating for anxiety and depression and are seeking an increase, you’ll have an increase exam.

This type of exam is for veterans who are already service-connected for anxiety and depression and are looking to increase their rating or review their initial rating within the first 5 years.

The primary focus of an increase exam for mental health is to determine if your symptoms have worsened since your previous exam and last rating.

#3. Anxiety and Depression Secondary Exam

An anxiety and depression secondary exam are similar to an initial mental health exam except that the C&P examiner will give their medical opinion for secondary service connection.

For example, if you file a VA claim for anxiety and depression secondary to tinnitus, you’ll get a mental health exam plus a request for a secondary medical opinion.

The Purpose of a VA Depression and Anxiety Examination

A C&P exam for depression and anxiety is designed to evaluate three main areas:

• (#1) Determine if you have a mental health diagnosis that conforms to DSM-5 standards.

• (#2) The examiner will provide their medical opinion on whether your anxiety and depression were caused or made worse by your active duty military service or another service-connected condition.

• (#3) Assess the severity of your mental health symptoms in terms of frequency, severity, and duration, and their negative impact on your occupational and social impairment.

What to Expect During a C&P Exam for Anxiety and Depression

Here are six things you can expect during a VA C&P exam for anxiety and depression:

Review of Medical History

The C&P examiner will begin by reviewing your medical records, including any previous diagnoses, treatments, or evaluations related to your anxiety or depression. The examiner has access to the medical records and documents you submitted to the VA.

Discussion of Symptoms

The examiner will ask you about your symptoms of anxiety and depression, including when you first noticed them, how often you experience them, and their severity.

• Anxiety often manifests as excessive worry, restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances. Veterans with anxiety might also experience panic attacks, characterized by intense fear, palpitations, sweating, shaking, shortness of breath, or a feeling of impending doom. They may engage in avoidance behaviors and suffer from physical symptoms such as nausea, headaches, or dizziness.

• Depression typically includes persistent sadness, loss of interest in activities once enjoyed, significant weight changes, sleep disturbances, fatigue, and feelings of worthlessness or guilt. Veterans with depression may also have difficulty concentrating, experience psychomotor agitation or retardation, and have recurrent thoughts of death or suicide. Physical aches and pains, such as unexplained back pain or headaches, are also common in depression.

Impact on Daily Life

You’ll be asked about how your anxiety and depression affect your daily activities, such as sleeping, working, socializing, and overall quality of life. Be honest and provide specific examples of how your conditions interfere with your ability to function normally.

Mental Health Evaluation

The examiner will conduct a mental health evaluation, which includes asking about your military service, any traumatic experiences, and the progression of your symptoms. They may also assess your coping mechanisms and any treatments you’ve received.

Psychological Testing

You may undergo standardized psychological tests to assess the severity of your anxiety and depression symptoms. These tests help the examiner understand your condition objectively and can include questions about your mental state and emotional well-being.

Completion of the Disability Benefits Questionnaire (DBQ) for Mental Health Conditions

The examiner will document their findings on the VA DBQ for Mental Disorders (Other Than PTSD and Eating Disorders), which is then submitted to the VA rater for further processing. The VA rater will use the examiner’s report to approve, deny, or defer your VA claim based on the documented results. The outcomes of your exam as recorded on the DBQ largely determine your final VA rating for anxiety and depression.

List of Common Anxiety and Depression C&P Exam Questions

During a C&P exam for depression and anxiety, the examiner will likely ask a range of questions to assess your mental health condition based on the Disability Benefits Questionnaire (DBQ) criteria.

Here are some of the key questions you can expect on exam day:

SECTION I: DIAGNOSIS

Medical Diagnosis

• Have you been diagnosed with a mental disorder that conforms to DSM-5 criteria?
• If yes, what is the date of diagnosis? Please provide the ICD code if known.

SECTION II: HISTORY

Relevant Social/Marital/Family History

• Can you describe your family and social relationships before, during, and after your military service?

Relevant Occupational and Educational History

• What was your occupation and highest level of education before, during, and after your military service?

Relevant Mental Health History

• Have you previously been treated for mental health issues? What medications have been prescribed, if any?

Relevant Legal and Behavioral History

• Have you had any legal issues or notable changes in behavior before, during, or after your military service?

Relevant Substance Abuse History

• Have you had any history of substance abuse? If so, please specify substances used and the period of use.

SECTION III: MENTAL HEALTH SYMPTOMS

Check All Symptoms That Apply

• Do you experience frequent or persistent depressed mood?
• Do you experience anxiety? How often?
• Do you have panic attacks? If yes, how often do they occur?
• Are you experiencing any chronic sleep impairments?
• Do you suffer from memory loss? Please specify if it’s mild or severe.
• Do you have difficulty establishing and maintaining personal relationships?
• Are you having difficulty adapting to stressful circumstances?
• Do you experience suicidal thoughts?
• Do you engage in any obsessional rituals that interfere with routine activities?

SECTION IV: BEHAVIORAL OBSERVATIONS

Behavioral Observations

• How do you appear today? (Note observations of the veteran’s demeanor, appearance, and cooperativeness).

SECTION V: OTHER SYMPTOMS

Other Symptoms

• Are there any other symptoms you experience that have not been listed above? If yes, please describe.

SECTION VI: COMPETENCY

Financial Competency

• Are you capable of managing your financial affairs? If not, please explain.

REMARKS

Additional Remarks

• Are there any other comments or observations you would like to add about your condition?

How Occupational and Social Impairment Can Lead to Your Anxiety and Depression VA Rating

During a C&P exam for anxiety and depression, the level of occupational and social impairment is a crucial factor.

Note: The examiner is required to document your symptoms of anxiety and depression and then determine how those symptoms negatively affect your occupational and social functioning.

Here are the categories of impairment, ordered from no rating to 100%:

No Mental Disorder Diagnosis (no rating)

• Meaning: The veteran has no diagnosed mental health condition.
• Implication for VA Rating: No rating is assigned as there is no mental health diagnosis impacting occupational or social functioning.

A Mental Condition Has Been Formally Diagnosed, but Symptoms Are Not Severe Enough to Interfere with Occupational and Social Functioning or to Require Continuous Medication (0% VA Rating)

• Meaning: The veteran has a diagnosed mental condition, but the symptoms do not significantly impact their ability to work or socialize and do not require ongoing medication.
• Example: The veteran might experience occasional anxiety or sadness, which they can manage without significant interference in daily life.
• Implication for VA Rating: This corresponds to a 0% disability rating, indicating recognition of a condition that does not warrant compensation.

Occupational and Social Impairment Due to Mild or Transient Symptoms (10% VA Rating)

• Meaning: The veteran’s symptoms are mild or transient, affecting work efficiency and the ability to perform occupational tasks only during periods of significant stress. Symptoms are generally controlled by medication.
• Example: The veteran performs adequately at work and socially most of the time but may have difficulties during stressful periods.
• Implication for VA Rating: This corresponds to a 10% disability rating.

Occupational and Social Impairment with Occasional Decrease in Work Efficiency and Intermittent Periods of Inability to Perform Occupational Tasks (30% VA Rating)

• Meaning: The veteran generally functions satisfactorily, but experiences occasional decreases in work efficiency and intermittent periods where they are unable to perform occupational tasks, typically triggered by episodes of increased anxiety or depression.
• Example: The veteran may handle routine tasks well but struggles during episodes of increased anxiety or depression.
• Implication for VA Rating: This level of impairment corresponds to a 30% disability rating.

Occupational and Social Impairment with Reduced Reliability and Productivity (50% VA Rating)

• Meaning: The veteran experiences frequent symptoms that notably reduce reliability and productivity in work and social situations.
• Example: The veteran may have frequent episodes of panic, persistent feelings of hopelessness, or concentration difficulties that interfere with work and social interactions.
• Implication for VA Rating: This corresponds to a 50% disability rating.

Occupational and Social Impairment with Deficiencies in Most Areas (70% VA Rating, Most Common VA Rating for Mental Health)

• Meaning: The veteran has significant impairments in several major areas such as work, school, family relations, judgment, thinking, or mood.
• Example: The veteran may struggle with maintaining employment, have severe relationship issues, poor judgment, and frequent severe mood swings.
• Implication for VA Rating: This level of impairment typically corresponds to a 70% disability rating.

Total Occupational and Social Impairment (100% VA Rating)

• Meaning: The veteran is completely unable to function in a work or social environment due to their symptoms of anxiety and depression.
• Example: The veteran cannot maintain employment, lacks social relationships, and requires significant assistance with daily living activities.
• Implication for VA Rating: This level typically corresponds to a 100% disability rating, indicating the most severe level of impairment.

The 31 Mental Health Symptoms from the Mental Health DBQ with Examples

Here’s a list of the 31 mental health symptoms from the DBQ for Mental Disorders along with the definition of each symptom and an example:

Depressed Mood:

• Meaning: Persistent feelings of sadness, emptiness, or hopelessness.
• Example: Feeling sad and hopeless most days, struggling to find joy in activities that were once enjoyable.

Anxiety:

• Meaning: Excessive worry, nervousness, or fear that is difficult to control.
• Example: Constantly feeling on edge, worrying excessively about everyday tasks or future events.

Suspiciousness:

• Meaning: Distrust of others and belief that people are out to harm you.
• Example: Believing that neighbors are spying on you without any concrete evidence.

Panic Attacks (weekly or less often):

• Meaning: Sudden episodes of intense fear or discomfort that occur occasionally.
• Example: Experiencing a sudden heart-pounding episode of intense fear while shopping, occurring once or twice a month.

Panic Attacks (more than once a week):

• Meaning: Frequent sudden episodes of intense fear or discomfort.
• Example: Having severe panic attacks multiple times a week, leading to avoidance of crowded places.

Near-continuous Panic or Depression:

• Meaning: Constant feelings of panic or depression that severely impact daily functioning.
• Example: Feeling a constant state of panic or depression that makes it impossible to work or socialize effectively.

Chronic Sleep Impairment:

• Meaning: Ongoing difficulty falling or staying asleep or having restless sleep.
• Example: Waking up frequently throughout the night and feeling exhausted during the day due to persistent nightmares.

Mild Memory Loss:

• Meaning: Occasional forgetfulness, such as forgetting names, directions, or recent events.
• Example: Frequently forgetting where you put your keys or what you planned to do after entering a room.

Impairment of Short- and Long-Term Memory:

• Meaning: Difficulty retaining new information and remembering important tasks.
• Example: Forgetting important appointments or failing to recall significant events from the past few months.

Memory Loss for Names of Close Relatives, Own Occupation, or Own Name:

• Meaning: Severe memory loss affecting recognition of close family members, one’s job, or even one’s own name.
• Example: Struggling to remember the names of your children or forgetting what you do for a living.

Flattened Affect:

• Meaning: Lack of emotional expression and response.
• Example: Speaking in a monotone voice and showing little to no facial expressions during conversations.

Circumstantial, Circumlocutory, or Stereotyped Speech:

• Meaning: Indirect, roundabout, or repetitive speech patterns.
• Example: Taking a long time to get to the point of a story because of unnecessary details or repeated phrases.

Speech Intermittently Illogical, Obscure, or Irrelevant:

• Meaning: Inconsistent speech that is difficult to follow or understand.
• Example: Responding to a question with unrelated information or statements that don’t make sense.

Difficulty in Understanding Complex Commands:

• Meaning: Trouble comprehending and following intricate instructions.
• Example: Struggling to follow multi-step instructions at work, needing tasks to be broken down into simpler steps.

Impaired Judgment:

• Meaning: Poor decision-making abilities.
• Example: Making impulsive decisions without considering the consequences, such as spending money recklessly.

Impaired Abstract Thinking:

• Meaning: Difficulty in thinking about concepts and ideas that are not concrete.
• Example: Struggling to understand idioms or metaphors, taking them literally instead.

Gross Impairment in Thought Processes or Communication:

• Meaning: Severe disruption in the ability to think clearly and communicate effectively.
• Example: Having disorganized thoughts that make it hard to hold a coherent conversation.

Disturbances of Motivation and Mood:

• Meaning: Lack of drive or significant changes in mood and emotional state.
• Example: Feeling unmotivated to get out of bed or complete daily tasks, experiencing sudden mood swings.

Difficulty in Establishing and Maintaining Effective Work and Social Relationships:

• Meaning: Struggles with forming and keeping productive professional and personal relationships.
• Example: Frequently clashing with colleagues or avoiding social gatherings due to discomfort.

Difficulty Adapting to Stressful Circumstances:

• Meaning: Challenges in coping with stress, especially in work or similar settings.
• Example: Feeling overwhelmed and shutting down when faced with tight deadlines or high-pressure situations.

Inability to Establish and Maintain Effective Relationships:

• Meaning: Complete inability to form and sustain healthy relationships.
• Example: Isolating oneself and having no close friends or supportive relationships.

Suicidal Ideation:

• Meaning: Thoughts of taking one’s own life.
• Example: Frequently thinking about suicide or having a detailed plan to end one’s life.

Obsessional Rituals Which Interfere with Routine Activities:

• Meaning: Compulsive behaviors that disrupt daily life.
• Example: Repeatedly checking if the door is locked for an hour before being able to leave the house.

Impaired Impulse Control:

• Meaning: Unprovoked irritability and anger leading to violent outbursts.
• Example: Getting into physical altercations over minor disagreements.

Spatial Disorientation:

• Meaning: Confusion about location or surroundings.
• Example: Getting lost in a familiar neighborhood or being unable to navigate one’s own home.

Persistent Delusions or Hallucinations:

• Meaning: Continuous false beliefs or perceptions without external stimuli.
• Example: Believing you are being followed when no one is there, or hearing voices that no one else hears.

Grossly Inappropriate Behavior:

• Meaning: Actions that are socially unacceptable or out of context.
• Example: Laughing uncontrollably at a funeral or making inappropriate comments in serious situations.

Persistent Danger of Hurting Self or Others:

• Meaning: Constant risk of causing harm to oneself or others.
• Example: Frequently engaging in self-harm or expressing a desire to harm others.

Neglect of Personal Appearance and Hygiene:

• Meaning: Lack of self-care and personal cleanliness.
• Example: Not bathing for weeks, wearing dirty clothes, and appearing disheveled.

Intermittent Inability to Perform Activities of Daily Living:

• Meaning: Occasional inability to manage basic self-care tasks.
• Example: Some days being unable to cook, clean, or dress oneself.

Disorientation to Time or Place:

• Meaning: Confusion about the current time or location.
• Example: Not knowing what day it is or where you are after waking up.

How to Prepare for Your VA Anxiety and Depression C&P Exam

Preparing for your VA C&P exam for anxiety and depression is crucial to ensure you effectively communicate the severity of your symptoms and their impact on your daily life.

Here are some tips to help you get ready for your exam:

Gather Records and Documents

Collect all relevant medical records, including diagnoses, treatment history, therapy notes, and any correspondence related to your anxiety and depression. These documents provide essential evidence to support your claim. Review them in detail and bring hard copies with you to the exam for reference.

Create a Symptom Diary

Keep a detailed log of your symptoms, noting their frequency, severity, and duration. Document any factors that exacerbate or alleviate your symptoms, such as stressors or coping mechanisms. This diary will help you articulate the impact of your anxiety and depression on your daily life during the exam.

List Functional Impacts

Make a list of specific ways your anxiety and depression affect your ability to perform daily tasks and activities. This may include difficulties with concentration, sleep disturbances, or challenges in social or work environments. Providing concrete examples of how your conditions negatively impact your daily functioning will strengthen your case during the exam.

Review the DBQ for Anxiety and Depression

It’s a good idea to review the Disability Benefits Questionnaire (DBQ) for anxiety and depression (other mental health conditions).

Be prepared to describe the onset and progression of your symptoms over time, as well as any treatments you have pursued and their effectiveness.

Additionally, be ready to discuss how your mental health issues impact your work, life, and social functioning.

Bring a Support Person

Consider bringing a trusted friend, family member, or advocate to the exam.

They can provide additional insights into how anxiety and depression affect you and offer emotional support.

Their perspective can be valuable in illustrating the impact of your condition.

Note: This is not required.

Be Honest and Detailed

When discussing your symptoms and their impact, be honest and detailed.

Don’t downplay your experiences.

Explain your worst days and how anxiety and depression affect you at their most severe.

This honesty is crucial for an accurate assessment of your condition.

VA Mental Health C&P Exam Checklists

It’s very common to receive various mental health checklists at your exam, including the PHQ-9 and the GAD-7, among others.

Here are the most common mental health checklists so you know what to expect on exam day.

Patient Health Questionnaire-9 (PHQ-9)

This checklist is a widely used tool for screening and diagnosing depression.

It consists of 9-10 questions that assess the frequency of symptoms experienced over the past two weeks. Here are the questions.

These questions are scored on a scale from 0 to 3, with 0 representing “Not at all” and 3 representing “Nearly every day”.

The total score can then be used to categorize the severity of depression symptoms.

1. Over the last 2 weeks, how often have you been bothered by little interest or pleasure in doing things?
2. Over the last 2 weeks, how often have you been bothered by feeling down, depressed, or hopeless?
3. Over the last 2 weeks, how often have you been bothered by trouble falling or staying asleep, or sleeping too much?
4. Over the last 2 weeks, how often have you been bothered by feeling tired or having little energy?
5. Over the last 2 weeks, how often have you been bothered by poor appetite or overeating?
6. Over the last 2 weeks, how often have you been bothered by feeling bad about yourself – or that you are a failure or have let yourself or your family down?
7. Over the last 2 weeks, how often have you been bothered by trouble concentrating on things, such as reading the newspaper or watching television?
8. Over the last 2 weeks, how often have you been bothered by moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual?
9. Over the last 2 weeks, how often have you been bothered by thoughts that you would be better off dead or of hurting yourself in some way?
10. If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?

Generalized Anxiety Disorder-7 (GAD-7)

The Generalized Anxiety Disorder 7-item scale (GAD-7) is a self-reported 7-question checklist used to assess the severity of generalized anxiety disorder.

These questions are scored on a scale from 0 to 3, with 0 representing “Not at all” and 3 representing “Nearly every day”.

1. Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious, or on edge?
2. Over the last 2 weeks, how often have you been bothered by not being able to stop or control worrying?
3. Over the last 2 weeks, how often have you been bothered by worrying too much about different things?
4. Over the last 2 weeks, how often have you been bothered by having trouble relaxing?
5. Over the last 2 weeks, how often have you been bothered by being so restless that it’s hard to sit still?
6. Over the last 2 weeks, how often have you been bothered by becoming easily annoyed or irritable?
7. Over the last 2 weeks, how often have you been bothered by feeling afraid as if something awful might happen?

List of VA Mental Health Exam Checklists

VA C&P examiners often use structured interviews, rating scales, and assessment tools to aid in the diagnostic process.

Here are some commonly used checklists and assessment tools aligned with the DSM-5 criteria for diagnosing mental health conditions:

• Mini International Neuropsychiatric Interview (MINI): A brief structured diagnostic interview used to assess major psychiatric disorders, including mood disorders, anxiety disorders, psychotic disorders, and substance use disorders.

• Structured Clinical Interview for DSM Disorders (SCID): A comprehensive diagnostic interview designed to assess major psychiatric disorders according to DSM criteria. It includes modules for mood disorders, psychotic disorders, substance use disorders, and other conditions.

• Hamilton Rating Scale for Depression (HAM-D): A standardized questionnaire used to assess the severity of depressive symptoms in individuals diagnosed with major depressive disorder.

• Patient Health Questionnaire-9 (PHQ-9): A self-reported questionnaire used to assess depressive symptoms based on DSM-5 criteria.

• Generalized Anxiety Disorder-7 (GAD-7): A self-reported questionnaire used to assess the severity of generalized anxiety disorder symptoms based on DSM-5 criteria.

• PTSD Checklist for DSM-5 (PCL-5): This is only if you’ve filed a claim for PTSD. A self-report measure used to assess symptoms of post-traumatic stress disorder (PTSD) according to DSM-5 criteria.

DBQ for Anxiety and Depression [Download]

The C&P examiner will complete the electronic version of the Mental Disorders DBQ at the conclusion of your exam.

We’ve made a copy available for download below:

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