No C&P Exam for PTSD: Should I Be Worried?

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After you’ve filed a VA claim for PTSD, you’re likely going to get scheduled for a VA C&P exam for PTSD.

However, sometimes the VA doesn’t schedule you for a mental health exam; this is referred to as “no C&P exam for PTSD.”

If you’re in this situation, you’re understandably scared and worried that your PTSD claim will get denied.

But that’s not necessarily the case.

Let’s explore some of the reasons why the VA didn’t schedule you for a PTSD C&P exam.

Summary of Key Points

• VA Standard for Scheduling a PTSD C&P Exam: The VA schedules a PTSD C&P exam if there is credible evidence of the stressor, current PTSD symptoms, and if existing medical records are inadequate for rating purposes.

• Reasons for No C&P Exam: Administrative errors, insufficient evidence, or incomplete applications can result in no C&P exam being scheduled. Errors include misfiled documents, incorrect contact information, or a claim already adjudicated.

• Medical Evidence Factors: No current PTSD diagnosis, lack of service connection evidence, adequate existing records, or conflicting medical evidence can also prevent the scheduling of a C&P exam.

• Claimant-Related Issues: Missed appointments, failure to respond to VA requests, withdrawn claims, miscommunication, and incorrect or incomplete forms can lead to the VA not scheduling a C&P exam.

VA Standard for Scheduling a C&P Exam for PTSD

According to M21-1, Part VIII, Subpart iv, Chapter 1, Section C – Examinations for Posttraumatic Stress Disorder (PTSD) Claims, VA claims adjudicators should schedule a veteran for a PTSD C&P exam if:

• (#1) There is credible supporting evidence that the claimed stressor occurred, and

• (#2) Evidence (to include lay statements) indicates the veteran currently suffers from symptoms consistent with a diagnosis of PTSD, and

• (#3) Medical evidence adequate for rating purposes is not already of record.

Important: 

• Do not request an examination until development for credible supporting evidence of the claimed stressor is complete as outlined in either M21-1, Part VIII, Subpart iv, 1.A.3 and 4 or M21-1, Part VIII, Subpart iv, 1.B.

• Forward the claims folder to the examining facility and request its review as part of the examination process any time the issue is service-connection for PTSD.

• In PTSD claims alleging personal trauma based on military sexual trauma (MST), a VA examination should be scheduled, and a medical opinion requested when there is either evidence of the claimed stressor or a “marker” found in the records.

Sources: 

• VA’s duty to assist with providing a medical examination or opinion, see M21-1, Part IV, Subpart i, 1.A

• The evidentiary standards for finding an examination or opinion necessary, see M21-1, Part IV, Subpart i, 1.B

• Requesting VA examinations, see M21-1, Part IV, Subpart i, 2, and

• VA’s duty to assist with obtaining records, see M21-1, Part III, Subpart i, 2.C.

Why Didn’t I Get a C&P Exam for PTSD?

There are three categories of possible reasons why you didn’t get scheduled for a C&P exam for PTSD including (#1) Administrative and Procedural Reasons, (#2) Medical Evidence Reasons, and (#3) Claimant Specific Reasons.

Category 1: Administrative and Procedural Reasons

Incomplete Application:

The initial claim application might be missing critical information or documentation, such as a detailed description of the stressor event, a formal diagnosis of PTSD, or relevant medical records. The VA requires comprehensive and complete information to process a claim efficiently. Without all necessary information, the VA might determine that a C&P exam is not warranted until the missing details are provided.

Insufficient Evidence:

The evidence provided might not be enough to justify scheduling a C&P exam. This could include a lack of medical records, absence of a PTSD diagnosis, or insufficient details linking the PTSD to military service. The VA relies on substantial initial evidence to proceed with scheduling a C&P exam. Without it, they might decide that an exam is unnecessary.

Administrative Errors:

Internal processing errors or miscommunication within the VA system can result in a C&P exam not being scheduled. This could involve data entry mistakes, miscommunication between departments, or errors in processing your claim. These errors can delay or prevent the scheduling of necessary exams, potentially impacting the outcome of your claim.

VA Claim Already Adjudicated:

The claim might have been processed and decided without the need for an exam if the VA found the existing evidence sufficient to make a determination. If a decision has already been made based on the available evidence, a C&P exam might not be necessary.

Misfiled or Lost Documentation:

Important documents related to your claim might have been misfiled or lost during the process, leading to delays or omissions in scheduling an exam. Missing documents can hinder the VA’s ability to fully assess your claim, possibly resulting in the absence of a C&P exam.

Incorrect Contact Information:

If the VA has outdated or incorrect contact details for you, they might not be able to inform you about scheduled exams or request additional information. This can lead to missed appointments or lack of communication about necessary steps in the claims process.

Oversight:

Simple human error where your case was overlooked or improperly prioritized within the VA system. This can cause delays in scheduling exams or processing your claim. If you think the VA made a mistake, call 1-800-827-1000 and speak to a VA representative about getting you scheduled for a C&P exam.

Category 2: Medical Evidence Reasons

No Current Diagnosis:

Lack of a current, formal diagnosis of PTSD from a qualified healthcare provider can prevent the VA from scheduling a C&P exam. Without a diagnosis, the VA might determine there is no basis for further examination.

Lack of Service Connection Evidence:

Insufficient evidence linking the PTSD to your military service can lead to the VA not scheduling an exam. This includes lack of documentation of in-service stressors or lack of a “Nexus.” Service connection is crucial for a claim, and without this evidence, the VA might decide an exam is unnecessary.

Adequate Medical Records:

Existing medical records might provide enough information for the VA to make a decision without requiring a C&P exam. If the VA feels they have sufficient information to make a determination, they might not schedule an exam.

Conflicting Medical Evidence:

Conflicting evidence in your medical records might lead the VA to delay scheduling an exam until the discrepancies are resolved. This can complicate the claims process and potentially delay a decision.

Non-Service-Connected Diagnosis:

If the PTSD is determined to be related to non-service-connected events, the VA might not schedule an exam. The VA focuses on service-connected disabilities, so non-service-related issues might not warrant a C&P exam.

Treatment Not Documented:

Lack of documentation showing ongoing treatment for PTSD can impact the scheduling of an exam. Continuous treatment records help establish the severity and ongoing nature of the condition, which are critical for the VA’s assessment. This is called continuity of symptomatology.

Pre-Existing Condition:

If the PTSD is determined to be a pre-existing condition not aggravated by service, the VA might not schedule an exam. Pre-existing conditions must show aggravation due to service for a successful claim.

Category 3: Claimant Specific Reasons

Missed Appointments:

If you missed previous scheduled exams without proper notice, the VA might proceed with your claim without rescheduling. Missed appointments can significantly delay or negatively impact your claim.

Failure to Respond:

Not responding to VA requests for additional information or evidence can lead to delays or the VA proceeding without a C&P exam. Timely responses are crucial to keep the claims process moving forward.

Withdrawn Claim:

If you or your representative withdrew the claim, the VA would not schedule a C&P exam. Withdrawal halts the claims process entirely, eliminating the need for further action by the VA.

Miscommunication:

Misunderstanding or lack of communication about the need for an exam can result in the VA not scheduling one. Clear and continuous communication with the VA is essential for the smooth processing of your claim.

Incorrect or Incomplete Forms:

Submission of incorrect or incomplete forms during the claim process can lead to delays or the VA deciding not to schedule an exam. Accurate and complete forms ensure that the VA has all the information needed to process your claim efficiently.

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