How to Successfully Navigate a C&P Exam for Hypertension

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After you’ve filed a VA claim for hypertension, you’ll likely get scheduled for a Compensation and Pension (C&P) exam from a private third-party contractor.

The purpose of a C&P exam for hypertension (also known as High Blood Pressure) is for the examiner to accomplish three things:

• Determine if the veteran has hypertension, and if so, is it diagnosed.

• Give their medical opinion for service connection depending on the type of claim you filed (new claim, increase claim, secondary claim, aggravation claim, or presumptive claim).

• Evaluate the veteran’s severity of symptoms in terms of frequency (how often), severity (how bad), and duration (how long) and any negative impacts to their work, life, and social functioning.

Pro Tip: The VA rates hypertension from 10% to 60% with breaks at 20% and 40%. A 60% rating is given if the diastolic pressure measures 130 or higher, while a 40% rating is warranted for diastolic pressure ranging from 120 to 129. For diastolic pressure of 110 to 119, or systolic pressure of 200 or higher, a 20% rating is assigned, and a 10% rating is given for diastolic pressure of 100 to 109, or systolic pressure of 160 to 199.

What to Expect During a C&P Exam for Hypertension

C&P exams are conducted in one of four ways: In-person, video teleconference, phone call, or through a records-only review (known as an ACE exam).

For hypertension claims, you can expect a face-to-face examination with a healthcare professional who will review your medical records and ask important questions.

An in-person exam for hypertension is preferred because the C&P examiner is required to take multiple blood pressure readings with a sphygmomanometer, also known as a blood pressure monitor.

Here’s six things you can expect at your hypertension C&P exam:

• Review of Medical Records: The examiner will review your medical records, including any documentation related to your diagnosis of hypertension, treatments received, and any related medical conditions or complications.

• Interview and Questions: You will be asked detailed questions about your medical history, including when you were diagnosed with hypertension, any symptoms you experience (such as headaches, dizziness, or chest pain), and any treatments or medications you are currently taking.

• Physical Examination: The examiner will conduct a physical examination, which will include measuring your blood pressure using a blood pressure cuff. They may also assess other vital signs, such as heart rate, and listen to your heart and lungs for any abnormalities. For VA rating purposes, “hypertension” is a condition where the diastolic blood pressure consistently measures 90mm or higher, while isolated systolic hypertension indicates that the systolic blood pressure consistently measures 160mm or higher with a diastolic blood pressure below 90mm. To establish the initial diagnosis, blood pressure readings must be confirmed through measurements taken on two or more occasions, each on at least three different days. These readings can be obtained from existing medical records or through scheduled visits specifically for blood pressure measurement. The C&P examiner will likely take your blood pressure multiple times at the exam.

• Functional Impairment: The examiner will inquire about how hypertension affects your daily life and functional abilities. They may ask about any limitations you experience in performing activities of daily living, work-related tasks, or recreational activities due to your hypertension.

• Discussion of Lifestyle Factors: The examiner may ask about your lifestyle habits, such as diet, exercise, smoking, and alcohol consumption, as these factors can influence blood pressure levels and overall cardiovascular health.

• Assessment of Complications: If you have any complications or comorbidities related to hypertension, such as heart disease, kidney disease, or vision problems, the examiner will discuss these and may perform additional evaluations as needed.

• Documentation of Findings: The examiner will document their findings from the exam, including blood pressure readings, physical exam findings, and any functional limitations or complications related to hypertension.

• Completion of the VA Disability Benefits Questionnaire (DBQ) for Hypertension The C&P examiner will document their findings on the Hypertension DBQ, which is then submitted to the VA Rater for further processing. Eventually, the VA Rater will either approve, deny, or defer your claim.

Potential Causes or Aggravating Factors of Hypertension in Veterans

There are numerous potential causes or aggravating factors for hypertension in veterans.

Here’s a list of some of the factors:

• Stressful Environments: Veterans may have been exposed to high-stress situations during their service, such as combat deployments, which can lead to chronic stress and elevated blood pressure levels.

• Exposure to Noise and Vibrations: Military personnel may have been exposed to loud noises and vibrations from heavy machinery, vehicles, or weapons, which can contribute to hypertension development.

• Exposure to Chemicals and Toxins: Veterans may have been exposed to various chemicals, pollutants, or toxins during deployment or while working with hazardous materials, which can affect blood pressure regulation and cardiovascular health. Hypertension was added to the presumptive list when the PACT Act was signed into law. Thus, hypertension can be a presumptive disability for service connection.

• Unhealthy Lifestyle Habits: Some veterans may adopt unhealthy lifestyle habits during or after their military service, such as poor diet, lack of exercise, tobacco use, or excessive alcohol consumption, all of which are risk factors for hypertension.

• Physical Demands of Service: The physical demands of military service, including rigorous training, carrying heavy equipment, or prolonged standing, may contribute to hypertension development or exacerbate existing symptoms.

• Sleep Disorders: Conditions such as sleep apnea, which are prevalent among veterans, can contribute to hypertension by disrupting normal sleep patterns and causing intermittent drops in blood oxygen levels.

• Post-Traumatic Stress Disorder (PTSD): Veterans with service connected PTSD may be at an increased risk of hypertension due to the physiological effects of chronic stress and anxiety on blood pressure regulation.

• Traumatic Brain Injury (TBI): TBI, which is common among veterans, can disrupt autonomic nervous system function and increase the risk of hypertension.

• Genetic Predisposition: Some veterans may have a genetic predisposition to hypertension, which, when combined with environmental factors and lifestyle habits, can increase their risk of developing the condition.

What Questions Will I Be Asked During a C&P Exam for High Blood Pressure?

Here’s a list of questions you can expect during a high blood pressure C&P exam:

#1. Does the veteran have a diagnosis of Hypertension or Isolated Systolic Hypertension based on the following criteria?

• For VA rating purposes, the term “hypertension” or High Blood Pressure, means that the diastolic blood pressure is predominantly 90mm or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm.

• The initial diagnosis of hypertension or isolated systolic hypertension must be confirmed by readings taken 2 or more times on at least 3 different days. Blood pressure results may be obtained from existing medical records or through scheduled visits for blood pressure measurements.

• Also, complete any appropriate questionnaires for hypertension-related complications, if any, such as Kidney, if renal insufficiency is attributable to hypertension.

• If the veteran does have a diagnosis of High Blood Pressure indicate the type, ICD Code, and date of diagnosis.

#2. Describe the history, including onset and course, of the veteran’s High Blood Pressure (Hypertension) condition?

Give a brief summary.

#3. Does the veteran’s treatment plan include taking continuous medication for Hypertension or Isolated Systolic Hypertension?

If yes, list the medications.

#4. Was the veteran’s initial diagnosis of Hypertension or Isolated Systolic Hypertension confirmed by blood pressure readings taken 2 or more times on at least 3 different days?

If yes, provide the blood pressure readings used to establish initial diagnosis.

#5. Does the veteran have a history of a diastolic blood pressure elevation of predominantly 100 or more?

If yes, describe the frequency and severity of diastolic blood pressure elevation.

#6. What are the current dates of this evaluation and corresponding blood pressure readings?

The veteran should be seated comfortably with back and feet supported. There is no need to take lying or standing blood pressures. There is no specified time interval between readings, and they may be completed sequentially.

#7. Does the veteran have any other pertinent physical findings, complications, conditions, signs, or severity of ymptoms related to the conditions listed in the diagnosis section?

If yes, describe.

#8. Does the veteran’s Hypertension or Isolated Systolic Hypertension impact his/her ability to work?

If yes, describe the impact of the veteran’s hypertension or isolated systolic hypertension, providing one or more examples.

#9. What is the likely cause or origin of the veteran’s hypertension?

Please explain.

#10. In your medical opinion, is it at least as likely as not that the veteran’s hypertension is due to military service?

Explain your rationale.

#11. For secondary service connection, is the veteran’s hypertension proximately due to or aggravated by another condition?

Explain your rationale.

#12. For presumptive service connection, did the veteran serve in a qualifying location during a qualifying period?

Please explain.

#13. Is there anything else you’d like to add?

Please explain.

How to Prepare for Your Hypertension C&P Exam

Here are some tips to help you prepare for your C&P exam for high blood pressure:

• Gather Records and Documents: Collect all relevant medical records, including diagnosis reports, treatment history, and any correspondence related to your hypertension. This documentation will provide essential evidence to support your claim during the examination. Review the documents thoroughly and consider bringing hard copies with you to the C&P exam for reference.

• Maintain a Blood Pressure Log: Keep a detailed log of your blood pressure readings, noting the date, time, and readings taken. There are free apps available to help you to do this. Document any factors that may influence your blood pressure, such as stress levels, physical activity, diet, and medication adherence. This log will help you and the examiner understand the patterns and fluctuations in your blood pressure over time. If you aren’t able to maintain a log, at least be familiar with your current and past blood pressure readings and where to find the information in your medical records.

• Note Functional Impacts: Make a list of specific ways in which hypertension affects your daily life and activities. This may include symptoms like headaches, dizziness, fatigue, difficulty concentrating, or limitations in physical activity. Providing concrete examples of how hypertension negatively impacts your daily functioning will help the examiner assess the severity of your condition.

• Familiarize Yourself with the DBQ for Hypertension: Take the time to review the VA DBQ for hypertension before your exam. Be prepared to discuss the onset and progression of your symptoms, any treatments you have tried, and their effectiveness. Additionally, familiarize yourself with the criteria used to assess the severity of hypertension and the associated disability ratings.

DBQ for Hypertension [Download]

The Hypertension DBQ will be completed electronically by the C&P examiner at your exam.

We’ve made a copy available for review and download below:

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