Did the VA Deny Your Claim Even Though You Had a FAVORABLE C&P Exam? Top 5 Reasons Why!

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Having your VA claim denied after a favorable C&P exam can be extremely frustrating and confusing.

Despite the positive findings noted at your C&P exam, why did the VA still deny your claim?

While the results of your VA C&P exam play a crucial role in determining whether your claim gets approved or denied, it’s not the only factor the VA Rater considers when making a rating decision.

Here are the top 5 reasons your VA claim may have been denied despite a favorable C&P exam, along with detailed explanations and examples for each one.

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Summary of Key Points

• VA Claim Denial Despite Favorable C&P Exams: A favorable C&P exam does not guarantee claim approval, as the VA Rater evaluates all evidence in your file. Discrepancies, such as lack of a diagnosis, conflicting medical evidence, or incomplete medical opinions for service connection, can lead to denials even when the C&P findings support your claim.

• Top Reasons for VA Claim Denials: Claims may be denied for reasons like inconsistent medical evidence, lack of a clear nexus between the condition and military service, contradictory opinions from multiple C&P exams, failure to address key evidence, or administrative errors (e.g., missed exams). For instance, an examiner may fail to link PTSD to a verified stressor or overlook a documented in-service injury, resulting in denial.

• Action Steps to Take If the VA Denied Your Claim: After a denial, veterans should carefully review the VA rating decision letter to understand the rationale behind the decision and the evidence reviewed. This document is critical for identifying gaps or errors in the claim. Based on the denial reasons, veterans can choose to file a Higher-Level Review (HLR) to challenge errors or a Supplemental Claim to submit new and relevant evidence.

• Appealing Denied VA Claims: To successfully appeal a denial, veterans should ensure they submit comprehensive and consistent medical evidence, including a current diagnosis, nexus opinion, and proof of the condition’s impact on daily life. Filing an appeal online and actively tracking the claim status can streamline the process. Veterans are encouraged to stay in-the-fight, as the VA claim process is not over until they quit!

#1. Inconsistent Medical Evidence

Even with a favorable C&P exam, discrepancies between your C&P exam results and other medical records can lead to denial.

The VA evaluates all evidence in your file, and if your medical history contains conflicting information, it may weaken your case.

Example: You claim chronic knee pain as service-connected. While the C&P examiner notes limited range of motion and a positive medical opinion for service connection, earlier medical records from a civilian provider indicate the injury was likely due to a post-service sports accident. The VA Rater may assign higher probative value to the earlier civilian records, resulting in a claim denial.

#2. Lack of a Clear “Nexus” for Service Connection

A favorable C&P exam must explicitly establish a “nexus” (or link) between your condition and your military service on an “at least as likely as not” basis (50/50).

If the C&P examiner’s report doesn’t definitively connect your condition to your service, the VA may deny your claim due to insufficient evidence of service connection.

This can also happen if the C&P examiner notes that a medical opinion can’t be affirmatively established without resorting to mere speculation.

Example: During your C&P exam for migraines, the examiner documents the severity and frequency of your headaches but fails to explicitly state that the condition is “at least as likely as not” (50/50) caused or aggravated by your military service. Without that clear nexus statement, the VA may conclude there isn’t enough positive evidence to grant service connection.

#3. Contradictory Medical Opinions

The VA Rater may order a second C&P exam and request a new medical opinion, especially if they perceive gaps, uncertainties, or lack of specificity in the first C&P exam.

If the second C&P examiner disputes the findings of your first C&P examiner, the VA Rater might give more weight to the opposing medical opinion if it’s more credible and detailed.

This can also happen if the VA Rater assigns more weight to a negative medical opinion at your C&P exam versus a positive independent medical opinion (IMO) from a private healthcare provider.

Example: You file a claim for PTSD due to a traumatic in-service event on a Navy ship. At your first C&P exam, the examiner diagnoses PTSD, explains some symptoms, but fails to adequately explain their medical opinion related to the in-service stressor event in the DBQ report. So, the VA orders a second C&P exam for PTSD to clarify whether you meet the criteria for PTSD, get a new medical opinion, and document your severity of symptoms on the DBQ for PTSD Initial. The second C&P examiner concludes that there is no evidence of a traumatic stressor event and that your symptoms are more consistent with generalized anxiety disorder unrelated to your military service. The VA Rater denies your claim, favoring the second examiner’s opinion because it includes detailed evidence-based rationale explaining how your mental health condition is “less likely than not related” to your military service.

#4. Failure to Address Key Evidence

If the C&P examiner overlooks critical evidence in your medical records, the VA Rater may consider the examination inadequate for rating purposes.

This can result in a denial because the examiner didn’t evaluate your full medical history or missed specific events or documentation supporting your claim.

Example: You submit a claim for a back injury linked to a documented in-service fall. The C&P examiner notes your current back pain but doesn’t reference the fall or the in-service medical records in their medical opinion for service connection. You did not submit lay evidence or buddy statements to help document the in-service back injury. Because of the failure to address key evidence, the VA Rater may deny the claim, citing a lack of proof connecting the condition to service.

#5. Administrative Errors or Missing Examinations

If you missed a scheduled C&P exam or the VA couldn’t retrieve all necessary evidence, your claim could be denied.

While a favorable C&P exam helps your case, any administrative errors or skipped steps in the process can hurt your chances for an approval.

Example: You attend a favorable C&P exam for tinnitus, but the VA later requests an additional exam to clarify the severity of your symptoms. If you miss this follow-up exam without rescheduling, the VA may deny your claim for insufficient evidence, even though your initial exam was favorable.

Action Steps to Take After a VA Claim Denial

Step #1: Review Your VA Rating Decision Letter

The first step after a denial or underrating is to review your VA rating decision letter in detail.

Pay particular attention to the reasons for decision and evidence reviewed sections.

A VA rating decision letter is a document prepared by the VA Rater that formally explains the VA’s rationale for approving, denying, or deferring your VA disability claim.

Your VA disability rating decision letter includes the VA’s final rating decision and analysis as well as WHY and HOW the VA Rater and C&P examiner arrived at their opinions and conclusions for your VA claim.

In our opinion, it’s the #1 most important document you’ll ever receive from the VA!

Step #2: Decide Your Best Option to Appeal

The second step is to decide your best course of action to appeal the denied or underrated disability claim.

If you had all the right medical evidence, but still got denied due to an error or you want a second opinion, you should file a VA Higher-Level Review (HLR).

If you didn’t have all the right medical evidence, and want to add new and relevant evidence not previously considered, you should file a Supplemental Claim.

If your Higher-Level Review (HLR), Supplemental Claim, and HLR of your Supplemental Claim are denied, you should consider a records-only Board Appeal.

Step #3: Review Your Submitted Medical Evidence

The third step before filing an appeal on your denied VA claim, is to review the medical evidence you submitted with your original claim.

Match what you submitted with the evidence reviewed in your VA rating decision letter – make sure it’s accurate and consistent.

This is also a good time to ensure you provided the VA with a current diagnosis in a medical record, a nexus for service connection, and evidence of your severity of symptoms and negative impacts to your work, life, and social functioning.

If anything important was missing from your original claim, file a Supplemental Claim with the new and relevant evidence not previously considered.

Step #4: File Your VA Claim Appeal Online

The final step to challenge a denied or underrated VA claim decision is to file your VA Higher Level Review (HLR) or Supplemental Claim online.

Friendly reminder that you can’t submit new and relevant evidence with a Higher-Level Review (HLR), but you can with a Supplemental Claim.

After claim submission, be proactive, patient, and don’t ever give up.

The VA claim process never ends unless you quit!

There’s always another option if you’re willing to fight back.

Conclusion & Wrap-Up

Navigating the VA disability claims process can be scary, frustrating, and daunting, especially when your claim is denied despite a favorable C&P exam.

But remember this: a VA claim denial is not the end of the road.

It’s an opportunity to regroup, strengthen your evidence, and fight for the benefits you’ve earned.

By understanding the common reasons for denials and taking proactive steps—such as reviewing your VA decision letter, ensuring your medical evidence is complete, and pursuing the right appeal option—you can turn a setback into VA claim victory.

Stay persistent, get educated, and advocate for yourself every step of the way.

The VA disability benefits system is complex, but with the right knowledge and determination, you can successfully navigate the process and secure the VA rating and compensation you deserve.

Never forget: YOU SERVED. YOU DESERVE.

Now go get what’s rightfully yours!

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