C&P Exam for Bipolar Disorder: What to Expect and How to Prepare!

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Today, VA disability expert Brian Reese will explain everything you need to know to crush your C&P exam for bipolar disorder.

It’s completely normal to be 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 big difference.

Understanding 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).

Let’s begin!

Summary of Key Points

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

• Exam Purpose: A C&P exam for bipolar evaluates three main 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 Bipolar: The VA assigns disability ratings for bipolar disorder 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 bipolar 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.

Types of C&P Exams for Bipolar

There are three main types of bipolar C&P exams:

#1. Bipolar Initial Exam

If you’re filing a new claim for bipolar disorder, you’ll undergo an initial VA exam for mental health.

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

#2. Bipolar Increase Exam

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

This type of exam is for veterans who are already service-connected for bipolar 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. Bipolar Secondary Exam

A bipolar 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.

Bipolar is typically a primary condition for direct service connection; however, it is still possible to get it service connected secondary to another condition.

The Purpose of a VA Bipolar Examination

A C&P exam for bipolar is designed to evaluate three main areas:

• (#1) Determine if you have a mental health diagnosis of bipolar type I, II, or cyclothymia that conforms to DSM-5 standards.

• (#2) The examiner will provide their medical opinion on whether your bipolar was 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 Bipolar

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

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 bipolar, including when you first noticed them, how often you experience them, and their severity.

• Bipolar I Disorder: Veterans with Bipolar I experience severe mood episodes, ranging from manic episodes with excessive energy, restlessness, and impulsive behavior to depressive episodes marked by persistent sadness, loss of interest in activities, and feelings of worthlessness or guilt. These extreme highs and lows can significantly disrupt daily life and functioning.

• Bipolar II Disorder: This type involves milder episodes of hypomania, characterized by increased energy and activity levels without the severe impairment seen in full mania, alternating with periods of severe depression. Veterans may feel euphoric or irritable during hypomanic episodes and suffer from intense sadness, fatigue, and suicidal thoughts during depressive episodes.

• Cyclothymic Disorder: Veterans with Cyclothymic Disorder experience chronic mood instability, with frequent mood swings between hypomania and mild depression over at least two years. These mood changes are less severe than those in Bipolar I and II but can still impact their daily lives and relationships.

• Other Types: This category includes bipolar and related disorders caused by substances like drugs or alcohol or medical conditions such as traumatic brain injuries or stroke. Veterans may face mood disturbances directly related to these external factors, complicating the diagnosis and treatment of bipolar disorder.

Impact on Daily Life

You’ll be asked about how your bipolar affects 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 bipolar 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 Bipolar Disorders

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 bipolar.

List of Common Bipolar Disorder C&P Exam Questions

During a C&P exam for bipolar, 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:

Questions a Veteran Can Expect at a C&P Exam for Bipolar Disorder

Diagnosis and Symptoms:

• Have you been diagnosed with a bipolar disorder? If so, what is/are the diagnoses?
• Can you describe the symptoms you experience related to bipolar disorder?
• How often do you experience manic or depressive episodes?
• How severe are your mental health symptoms during these episodes?

Symptom Differentiation:

• Do you have more than one mental health diagnosis? If yes, can you distinguish the symptoms attributable to each diagnosis?
• Do you have a diagnosed traumatic brain injury (TBI)? If so, can you differentiate symptoms attributable to TBI from those of bipolar disorder?

Occupational and Social Impairment:

• How do your mental health symptoms affect your ability to work and perform daily tasks?
• Do your symptoms impact your social relationships or family life?
• Can you describe any specific challenges you face at work, school, or in social settings due to your symptoms?

History:

• What is your relevant social, marital, and family history before, during, and after your military service?
• Can you describe your occupational and educational history, including any difficulties you’ve faced?
• What is your mental health history, including prescribed medications and any family history of mental health issues?
• Have you had any legal or behavioral issues related to your mental health condition?
• What is your substance abuse history, if any, before, during, and after military service?
• Have you ever been hospitalized for a manic or depressive episode related to bipolar?

Symptoms Checklist:

• Do you experience symptoms such as depressed mood, anxiety, or panic attacks? How frequently?
• Have you had issues with sleep, memory, or concentration?
• Do you engage in obsessive rituals, experience hallucinations, or have suicidal thoughts?
• Do you have difficulty managing stress, maintaining relationships, or controlling impulses?

Behavioral Observations:

• The examiner will observe your behavior, mood, and overall demeanor during the exam.

Other Symptoms:

• Are there any other symptoms related to your mental health that we haven’t discussed?

Competency:

• Are you capable of managing your financial affairs independently?

Remarks and Additional Information:

• Is there anything else you believe is important for us to know about your condition?
• Are there any test results or additional remarks you’d like to share?

How Occupational and Social Impairment Can Lead to Your Bipolar VA Rating

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

Note: The examiner is required to document your mental health symptoms 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 mood disorder episodes caused by bipolar.
• Example: The veteran may handle routine tasks well but struggles during episodes mania 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 bipolar.
• 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 Bipolar C&P Exam

Preparing for your VA C&P exam bipolar 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 bipolar disorder. 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 bipolar on your daily life during the exam.

List Functional Impacts

Make a list of specific ways your bipolar affects 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 Bipolar Disorder

It’s a good idea to review the Disability Benefits Questionnaire (DBQ) for Bipolar (other mental disorders).

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 bipolar negatively affects you and those around you.

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 bipolar impacts you when it’s 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 Mood Disorder Questionnaire (MDQ), PHQ-9, and GAD-7, among others.

Mood Disorder Questionnaire (MDQ)

Instructions: Answer “yes” or “no” to each question. This questionnaire should be used as a starting point. It is not a substitute for a full medical evaluation. Bipolar disorder is a complex illness, and an accurate, thorough diagnosis can only be made through a personal evaluation by your doctor.

1. Has there ever been a period of time when you were not your usual self and:

• …you felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble?
• …you were so irritable that you shouted at people or started fights or arguments?
• …you felt much more self-confident than usual?
• …you got much less sleep than usual and found you didn’t really miss it?
• …you were much more talkative or spoke faster than usual?
• …thoughts raced through your head or you couldn’t slow your mind down?
• …you were so easily distracted by things around you that you had trouble concentrating or staying on track?
• …you had much more energy than usual?
• …you were much more active or did many more things than usual?
• …you were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night?
• …you were much more interested in sex than usual?
• …you did things that were unusual for you or that other people might have thought were excessive, foolish, or risky?
• …spending money got you or your family in trouble?

2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time? Please check 1 response only.

3. How much of a problem did any of these cause you — like being able to work; having family, money, or legal troubles; getting into arguments or fights? Please check 1 response only.

• No problem
• Minor problem
• Moderate problem
• Serious problem

4. Have any of your blood relatives (i.e., children, siblings, parents, grandparents, aunts, uncles) had manic-depressive illness or bipolar disorder?

5. Has a health professional ever told you that you have manic-depressive illness or bipolar disorder?

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.

• Mood Disorder Questionnaire (MDQ): Used as a screening tool designed to help identify symptoms of bipolar disorder by asking about periods of elevated mood, behavior changes, and family history of the condition.

• 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 Bipolar Disorder [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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