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VA Rating Assistant

DC 6351 · 38 CFR 4.88b

HIV-Related Illness C&P Exam Prep

To document the current severity of your HIV-related illness, including immune function markers (CD4/T4 cell counts), presence of AIDS-defining opportunistic infections or neoplasms, constitutional symptoms, secondary organ system involvement, and the impact of your condition and its treatment on daily functioning and employment.

Format:
Interview + Physical
Typical duration:
30-60 minutes
DBQ form:
HIV_Related_Illnesses (HIV_Related_Illnesses)
Examiner:
Infectious Disease Specialist or Internal Medicine

What the examiner evaluates

  • Current CD4/T4 cell lymphocyte count and nadir (lowest recorded) count
  • Presence and history of AIDS-defining opportunistic infections (e.g., PCP, CMV retinitis, MAC, toxoplasmosis, cryptococcosis)
  • Presence of AIDS-defining neoplasms (e.g., Kaposi's sarcoma, lymphoma, invasive cervical cancer)
  • Constitutional symptoms: fever, weight loss, fatigue, malaise, night sweats, diarrhea
  • Whether constitutional symptoms are recurrent or refractory
  • Pathological or progressive weight loss and baseline versus current weight
  • HIV-related wasting syndrome
  • HIV-related encephalopathy and neurological manifestations
  • Secondary organ system involvement (musculoskeletal, cardiovascular, respiratory, dermatological, neurological, gastrointestinal, genitourinary, endocrine, ophthalmological, hematological, reproductive, dental/oral, mental/psychological)
  • Current antiretroviral and other medications and their side effects or complications
  • Evidence of depression or memory loss with employment limitations
  • Overall debility and functional impairment
  • HIV RNA viral load and treatment response
  • History of HIV diagnosis onset, course, and any related secondary diagnoses

The examination may be conducted in-person or via telehealth. If conducted via telehealth, the examiner must note how the exam was conducted. You have the right to request that the exam be recorded in most states. Bring a trusted support person or advocate if possible - they may provide corroborating lay evidence. Privacy protections around HIV status are particularly important; confirm the setting is confidential.

Measurements and tests

CD4/T4 Cell Lymphocyte Count

What it measures: The number of CD4+ T-helper cells per cubic millimeter of blood, reflecting immune system strength. This is the primary laboratory marker driving VA rating decisions under DC 6351.

What to expect: The examiner will review your most recent CD4 count from lab records. They will also document your lowest (nadir) CD4 count if available. Bring copies of all recent and historical CD4 lab results.

Critical thresholds

  • CD4 count between 200 and 500 cells/mm- Supports a 30% rating when accompanied by symptomatic HIV-related constitutional symptoms (intermittent diarrhea, fatigue, fever, night sweats)
  • CD4 count less than 200 cells/mm- Supports a 60% or higher rating; CD4 <200 meets the immunological definition of AIDS and triggers higher rating tiers
  • CD4 count greater than 500 cells/mm- with use of approved medications Supports a 10% rating when on antiretroviral therapy with no significant constitutional symptoms
  • AIDS with secondary diseases afflicting multiple body systems or with debility and progressive weight loss Supports a 100% rating - the most severe tier under DC 6351

Tips

  • Bring copies of ALL CD4 lab results - not just the most recent one. The nadir (lowest ever) count is critically important.
  • If your CD4 count fluctuates, bring results showing the range over the past 12-24 months.
  • Ask your treating infectious disease physician for a printout of your complete lab history including CD4 counts, viral load, and any opportunistic infection records.
  • The examiner documents both current AND nadir CD4 count - ensure your nadir is accurately captured even if it was years ago.
  • Viral load (HIV RNA) is not a direct rating factor but documents disease activity and treatment response; bring those records too.

Pain considerations: Not applicable for this laboratory measurement; however, note any side effects from medications (such as lipodystrophy, peripheral neuropathy, or gastrointestinal distress from antiretroviral therapy) that affect your quality of life.

Weight Documentation

What it measures: Baseline weight versus current weight to document pathological or progressive weight loss attributable to HIV-related illness or wasting syndrome.

What to expect: The examiner will record your baseline (pre-illness or highest stable) weight and compare it to your current weight. HIV wasting syndrome is defined as involuntary weight loss of more than 10% of baseline body weight.

Critical thresholds

  • Involuntary weight loss >10% of baseline body weight Consistent with HIV wasting syndrome - a CDC AIDS-defining condition that can support 60-100% ratings depending on associated symptoms
  • Progressive weight loss combined with refractory constitutional symptoms and diarrhea Supports 60% rating tier (refractory constitutional symptoms, diarrhea, and pathological weight loss with CD4 <200)

Tips

  • Be prepared to state your pre-HIV or highest stable weight, when that weight was recorded, and your current weight.
  • If you have had significant weight loss, document whether it was involuntary (not due to intentional dieting).
  • Bring records from your treating provider showing weight measurements over time.
  • Note any periods of weight stabilization versus ongoing decline.

Pain considerations: Describe any nausea, vomiting, difficulty swallowing, mouth sores (oral candidiasis), or gastrointestinal symptoms that have contributed to your inability to maintain weight.

Rating criteria by percentage

10%

Asymptomatic HIV infection. Use of approved medications required. No significant constitutional symptoms present. CD4/T4 count may be normal or above 500. Condition is controlled with antiretroviral therapy.

Key symptoms

  • Asymptomatic or minimal symptoms
  • Possible mild lymphadenopathy
  • Controlled with antiretroviral medication
  • CD4 count typically above 500 or at normal range
  • No opportunistic infections
  • No evidence of depression or memory loss affecting employment
  • No pathological weight loss

From 38 CFR: Under 38 CFR 4.88b, DC 6351: Asymptomatic HIV-positive status, with or without lymphadenopathy, or decreased T-cell count, requiring use of approved medications.

30%

Symptomatic development of HIV-related constitutional symptoms (e.g., intermittent diarrhea, night sweats, fever, fatigue, malaise) with CD4/T4 count between 200 and 500 cells/mm-.

Key symptoms

  • Intermittent diarrhea attributable to HIV
  • Night sweats (recurrent)
  • Low-grade fever (recurrent)
  • Fatigue and malaise
  • CD4 count between 200-500 cells/mm-
  • Weight loss (not yet meeting pathological threshold)
  • Symptoms manageable but affecting daily activities

From 38 CFR: Under 38 CFR 4.88b, DC 6351: Symptomatic development of HIV-related constitutional symptoms with CD4/T4 count between 200 and 500. Constitutional symptoms include intermittent diarrhea, fatigue, fever, and night sweats.

60%

Refractory constitutional symptoms (diarrhea and pathological weight loss) with CD4/T4 count less than 200 cells/mm-. OR Development of AIDS-related opportunistic infection or neoplasm. OR Evidence of depression or memory loss with employment limitations.

Key symptoms

  • CD4 count less than 200 cells/mm-
  • Refractory (not responding to treatment) diarrhea attributable to HIV
  • Pathological weight loss (involuntary, >10% baseline)
  • HIV wasting syndrome
  • Development of AIDS-defining opportunistic infection (first episode)
  • AIDS-defining neoplasm (e.g., Kaposi's sarcoma, lymphoma)
  • Depression with employment limitations
  • Memory loss with employment limitations
  • Recurrent constitutional symptoms despite treatment

From 38 CFR: Under 38 CFR 4.88b, DC 6351: Refractory constitutional symptoms, diarrhea, and pathological weight loss, OR development of AIDS-related opportunistic infection or neoplasm, OR evidence of depression or memory loss with employment limitations. CD4 <200.

100%

AIDS with recurrent opportunistic infections OR secondary diseases affecting multiple body systems OR HIV-related illness with debility and progressive weight loss requiring continuous treatment. Essentially total disability.

Key symptoms

  • AIDS with recurrent opportunistic infections (multiple episodes)
  • AIDS-defining secondary diseases afflicting multiple body systems simultaneously
  • Debility and progressive weight loss requiring continuous treatment
  • HIV-related encephalopathy
  • Progressive multifocal leukoencephalopathy
  • Toxoplasmosis of the brain
  • CMV retinitis causing vision loss
  • Recurrent bacterial pneumonia
  • Recurrent Salmonella septicemia
  • Multiple AIDS-defining conditions co-occurring
  • Inability to sustain gainful employment due to illness severity
  • Continuous hospitalization or treatment required

From 38 CFR: Under 38 CFR 4.88b, DC 6351: AIDS with recurrent opportunistic infections or secondary diseases affecting multiple body systems; HIV-related illness with debility and progressive weight loss requiring continuous treatment.

Describing your symptoms accurately

Constitutional Symptoms (Fatigue, Fever, Night Sweats, Malaise)

How to describe it: Accurately describe the frequency (daily, several times per week), duration (how many hours per episode), and severity (mild/moderate/severe) of each symptom. Clarify whether symptoms are recurrent (come and go) or refractory (persistent despite treatment). Explain how these symptoms interfere with your daily activities, work, and social functioning.

Example: On my worst days, I wake up completely soaked from night sweats two to three times per night, which disrupts my sleep so severely that I cannot function the next day. I have a low-grade fever of around 99-100-F that comes and goes for several days at a time, leaving me too weak to leave the house. The fatigue is not ordinary tiredness - it is a bone-deep exhaustion that forces me to lie down even after minimal activity like showering.

Examiner listens for: Whether symptoms are recurrent versus refractory, frequency and duration of episodes, whether symptoms respond to treatment or are treatment-resistant, quantifiable impact on activities of daily living and employment.

Avoid: Saying 'I get tired sometimes' or 'I have occasional night sweats' without context. These minimize severity. Instead, specify frequency, duration, and functional impact accurately.

Diarrhea Attributable to HIV

How to describe it: Describe the frequency of episodes per day or week, consistency, presence of blood or mucus, associated cramping or urgency, whether it is intermittent or persistent, and whether it responds to treatment. Explain how diarrhea restricts your activities (e.g., cannot travel, must remain near a restroom, disrupts sleep, causes dehydration or weight loss).

Example: On my worst days, I have six to eight loose bowel movements per day beginning in the early morning. I cannot be more than a few minutes from a restroom, which means I cannot attend appointments, go to work, or participate in social activities. Despite medications prescribed by my doctor, the diarrhea continues and has caused me to lose significant weight because I cannot absorb nutrients properly.

Examiner listens for: Whether diarrhea is attributable to HIV infection versus other causes, whether it is intermittent (30% tier) or refractory/unresponsive to treatment (60% tier), and whether it is accompanied by pathological weight loss.

Avoid: Minimizing by saying 'I have some stomach issues' - instead describe episodes in concrete terms with frequency, duration, functional limitations, and treatment response (or lack thereof).

Weight Loss

How to describe it: Provide your baseline (pre-illness) weight, your current weight, the time period over which the loss occurred, and whether the loss was involuntary. Explain contributing factors (inability to eat due to nausea, oral candidiasis, malabsorption from diarrhea). Distinguish between stabilized weight loss and ongoing progressive weight loss.

Example: Before my HIV-related illness progressed, I weighed 185 pounds. I now weigh 158 pounds - a loss of 27 pounds I did not choose to lose. My weight continues to decline because I experience nausea and mouth sores that make eating painful, and because the chronic diarrhea prevents me from absorbing what I do eat. My doctors have documented this as pathological weight loss.

Examiner listens for: Whether weight loss is involuntary and attributable to HIV, the percentage of baseline body weight lost, whether the loss is progressive (ongoing) or pathological, and whether it meets wasting syndrome criteria (>10% of baseline body weight with chronic diarrhea, weakness, or fever).

Avoid: Failing to state your baseline weight and letting the examiner only record your current weight without context. Always give both numbers and the timeframe.

Opportunistic Infections and AIDS-Defining Conditions

How to describe it: For each opportunistic infection or AIDS-defining illness you have experienced, state the specific diagnosis, the date of first occurrence, dates of any recurrences, the treatment required, hospitalization history, and residual effects. Clarify whether infections are recurring or whether you have had multiple distinct AIDS-defining conditions.

Example: I was diagnosed with Pneumocystis jirovecii pneumonia (PCP) in [year], which required hospitalization for two weeks. I subsequently developed oral and esophageal candidiasis, which recurs every few months and prevents me from eating solid foods for days at a time. These infections occurring together, combined with my CD4 count of 85, represent AIDS with multiple secondary diseases affecting my respiratory and digestive systems.

Examiner listens for: Specific diagnosis names, whether infections are AIDS-defining per CDC criteria, whether they are recurrent (multiple episodes) versus isolated, which body systems are affected, and whether multiple systems are simultaneously involved.

Avoid: Referring to past infections vaguely as 'I've had some infections.' Name each condition specifically with dates and treatment required. Recurrence is a key rating factor.

Neurological and Cognitive Symptoms (HIV Encephalopathy, Memory Loss)

How to describe it: Describe specific cognitive difficulties: memory problems (short-term, long-term, working memory), difficulty concentrating, word-finding problems, slowed processing speed. Describe any motor symptoms: gait problems, coordination issues, tremors. Explain how these symptoms affect your ability to work, manage finances, follow instructions, or maintain relationships.

Example: On my worst days, I cannot remember conversations I had just a few hours earlier, and I lose track of what I was doing in the middle of tasks. I have had to stop driving because I become confused. My employer eventually let me go because I could not reliably follow multi-step instructions or remember deadlines. My doctors have noted HIV-associated neurocognitive disorder in my records.

Examiner listens for: Whether cognitive and memory symptoms are attributable to HIV (encephalopathy, HAND), whether they result in employment limitations, functional severity (mild vs. moderate vs. severe), and whether formal neuropsychological testing has been done.

Avoid: Saying 'I'm a little forgetful' - describe specific, concrete examples of memory failures and their real-world consequences, especially any employment or financial impacts.

Medication Side Effects and Treatment Burden

How to describe it: List all current HIV medications (antiretrovirals and others). Describe each significant side effect you experience: nausea, vomiting, diarrhea, peripheral neuropathy, lipodystrophy, fatigue, liver effects, kidney effects, cardiovascular effects, bone density loss, sleep disruption. Describe how these side effects affect your daily functioning.

Example: My antiretroviral regimen causes persistent nausea that is worst in the morning, and I sometimes vomit before I can take my medications. The peripheral neuropathy in my feet - a side effect of past antiretroviral therapy - causes burning pain that makes it difficult to stand or walk for extended periods, limiting my ability to work on my feet.

Examiner listens for: Whether medication side effects are clinically significant and attributable to HIV treatment, whether they independently limit functioning, and whether they compound the disability already caused by the HIV infection itself.

Avoid: Failing to mention medication side effects at all, or saying 'I tolerate my meds okay' without distinguishing between tolerability and the absence of side effects that affect your quality of life.

Depression and Mental Health Impact

How to describe it: Describe symptoms of depression: persistent low mood, loss of interest in activities, sleep disturbance, appetite changes, hopelessness, concentration problems, energy loss, thoughts of self-harm. Describe how depression affects your ability to work, maintain relationships, and care for yourself. If you have had mental health treatment, describe the treatment and its effectiveness.

Example: On my worst days, I cannot get out of bed because of profound hopelessness. I have withdrawn from friends and family and stopped doing activities I used to enjoy. My depression is directly linked to managing a chronic illness - the stigma, the fear of disclosure, the physical limitations. I have missed work and eventually lost my job in part because of the depression related to my HIV diagnosis and its progression.

Examiner listens for: Whether depression is service-connected or secondary to the service-connected HIV condition, whether it results in employment limitations (a specific rating factor under DC 6351), severity of depressive symptoms, and whether treatment has been pursued.

Avoid: Failing to connect your mental health symptoms to your HIV illness. The DBQ specifically asks about depression with employment limitations - make sure this connection is clearly communicated.

Common mistakes to avoid

Reporting only your most recent (and possibly improved) CD4 count without mentioning your nadir

Why: Your nadir (lowest) CD4 count documents the historical severity of immune suppression. If your CD4 was 85 at nadir but is now 450 on treatment, the nadir documents that you reached AIDS-level immune deficiency, which supports higher historical ratings and may affect current rating depending on residual conditions.

Do this instead: Bring a complete lab history showing all CD4 counts over time. Explicitly tell the examiner your lowest CD4 count and when it occurred. The DBQ has a specific field for nadir CD4 count.

Impact: 60-100%

Failing to name specific opportunistic infections with dates and recurrence history

Why: The difference between a 60% and 100% rating often hinges on whether opportunistic infections are isolated versus recurrent, and whether multiple body systems are affected. Vague descriptions prevent the examiner from accurately checking the correct DBQ boxes.

Do this instead: Prepare a written timeline of every opportunistic infection diagnosis, the date, treatment, hospitalization, and any recurrence. Use the exact medical names (e.g., 'Pneumocystis jirovecii pneumonia' not 'lung infection').

Impact: 60-100%

Describing symptoms as 'not that bad' or 'manageable' to avoid appearing to complain

Why: The VA rates based on your actual functional impairment. Underreporting symptoms that genuinely limit your functioning results in a rating that does not reflect your true disability level. This is not about exaggerating - it is about accurately communicating the full picture.

Do this instead: Describe your worst days honestly, including how symptoms affect work, self-care, sleep, relationships, and activities. Use concrete examples ('I missed 12 days of work last year due to illness') rather than vague reassurances.

Impact: All levels

Not mentioning medication side effects or treatment complications

Why: Antiretroviral therapy can cause significant side effects (peripheral neuropathy, lipodystrophy, GI distress, metabolic effects) that independently impair functioning. These are specifically evaluated on the DBQ and can support secondary conditions or contribute to the overall picture of disability.

Do this instead: Bring a complete medication list and be prepared to describe side effects for each medication. List complications from past medications even if you have switched regimens.

Impact: 30-100%

Failing to connect depression or cognitive symptoms to HIV

Why: HIV-related encephalopathy, HIV-associated neurocognitive disorder, and depression secondary to HIV illness are specifically listed rating factors under DC 6351 (depression/memory loss with employment limitations). If you do not connect these to HIV, the examiner may not document them as HIV-related.

Do this instead: Explicitly state that your depression, anxiety, or cognitive difficulties developed in the context of your HIV diagnosis and progression. Describe specific employment consequences. Ask your mental health provider to document the connection in your records.

Impact: 60%

Arriving without supporting medical records

Why: The examiner relies heavily on documented medical history. Without records, your account of past infections, CD4 counts, hospitalizations, and treatment cannot be corroborated, which may result in an incomplete or inaccurate DBQ.

Do this instead: Bring organized copies of: CD4/T4 lab results (all available), viral load results, infectious disease clinic notes, hospitalization records for any opportunistic infections, a current medication list, and any specialist notes (neurology, ophthalmology, etc.) for HIV-related secondary conditions.

Impact: All levels

Not disclosing diarrhea or bowel symptoms due to embarrassment

Why: Diarrhea attributable to HIV is an explicit rating criterion that distinguishes the 30% tier (intermittent) from the 60% tier (refractory). Failure to report it may result in a lower rating than you deserve.

Do this instead: Report all gastrointestinal symptoms accurately, including frequency, consistency, urgency, and functional impact. The examiner is a medical professional - this information is medically relevant and protected.

Impact: 30-60%

Prep checklist

  • critical

    Gather complete CD4/T4 and viral load lab history

    Contact your infectious disease clinic or VA primary care team and request a printout of all CD4 counts and viral load measurements since diagnosis. Organize chronologically. Identify your nadir (lowest) CD4 count and the date it occurred. This is the single most important document for this exam.

    before exam

  • critical

    Compile a complete list of all opportunistic infections and AIDS-defining conditions

    Create a written timeline listing every opportunistic infection or AIDS-defining diagnosis with: (1) exact medical name, (2) date of first diagnosis, (3) treatment received, (4) hospitalization required (dates/duration), (5) any recurrence dates. Use the CDC AIDS-defining conditions list as a reference to ensure none are omitted.

    before exam

  • critical

    Document your weight history

    Record your pre-illness or highest stable body weight (with approximate date), current weight, and any significant weight loss milestones. Gather medical records showing documented weight measurements over time. Calculate the total percentage of body weight lost if applicable.

    before exam

  • critical

    Prepare a complete current medication list with side effects

    List every medication you take (antiretrovirals, prophylactic antibiotics, supplements) with dosage and frequency. For each medication, note significant side effects you personally experience. Include past medications that caused complications even if discontinued.

    before exam

  • critical

    Gather records from all treating specialists

    Collect notes from infectious disease, neurology (if applicable for encephalopathy/neuropathy), ophthalmology (if applicable for CMV retinitis or other eye conditions), psychiatry/psychology (if applicable for depression/cognitive symptoms), gastroenterology, and any other specialists treating HIV-related conditions.

    before exam

  • recommended

    Write a personal symptom statement describing worst-day functioning

    Before the exam, write out in your own words how HIV affects you on your worst days. Include: constitutional symptoms (frequency, duration, severity), diarrhea (frequency, impact on activities), fatigue (how it limits daily function), cognitive symptoms, mental health symptoms, and employment impact. Bring this written statement to refer to during the exam.

    before exam

  • recommended

    Identify and document employment impact

    Document any work limitations, missed days, job losses, reduced hours, or inability to work due to HIV-related illness or treatment side effects. Gather employer letters, performance records, or written statements if available. Depression and memory loss with employment limitations are specific rating criteria.

    before exam

  • critical

    Request service treatment records and any in-service HIV documentation

    If you were diagnosed with HIV during military service, gather all relevant service treatment records. If HIV was diagnosed post-service, gather documentation of the service-connection nexus. Review your claims file (C-File) to ensure your prior ratings and medical history are accurately represented.

    before exam

  • recommended

    Consider bringing a buddy statement or lay evidence

    Ask a family member, caregiver, or close friend to write a statement (VA Form 21-4142 lay statement) describing how your HIV-related illness affects your daily functioning. Third-party observations can be powerful corroborating evidence.

    before exam

  • critical

    Arrive in your typical symptomatic state - do not overexert or prepare differently than usual

    Do not alter your normal routine to appear healthier or sicker than you are. The examiner should see you as you typically are. If you are having a particularly bad day, that is valid - do not push through symptoms to appear functional.

    day of

  • critical

    Bring all organized medical documentation

    Bring your CD4 lab history, opportunistic infection timeline, medication list, specialist notes, weight history, and your written symptom statement. Organize in a folder with tabs for easy reference during the exam.

    day of

  • recommended

    Know your right to record the examination

    In most states, you have the right to record your C&P examination. Inform the examiner at the start that you intend to record, or ask if recording is permitted. A recording provides an accurate record if the DBQ does not reflect what was discussed.

    day of

  • optional

    Bring a support person or VSO representative if possible

    A Veterans Service Organization (VSO) representative, trusted friend, or family member may accompany you. They can take notes, help you remember key points, and provide corroborating observations to the examiner.

    day of

  • critical

    Report symptoms based on your worst days, not your best or average days

    Per M21-1 guidance, the rating should capture the full range of your disability. When asked about symptoms, describe how they are on your worst days as well as your typical days. State explicitly: 'On my worst days, [specific symptom description].'

    during exam

  • critical

    Use specific, concrete language - avoid minimizing terms

    Replace vague language with specific descriptions. Instead of 'I'm tired,' say 'I experience debilitating fatigue that forces me to rest for 3-4 hours in the afternoon and prevents me from working a full day.' Quantify whenever possible: frequency, duration, intensity, and functional impact.

    during exam

  • critical

    Explicitly confirm whether symptoms are recurrent or refractory

    The rating criteria distinguish between recurrent (30%) and refractory (60%) constitutional symptoms. Tell the examiner specifically whether your symptoms respond to treatment (recurrent) or persist despite treatment (refractory). This distinction directly affects your rating tier.

    during exam

  • critical

    Mention all body systems affected by HIV or HIV treatment

    The DBQ includes checkboxes for every body system. Proactively mention all HIV-related conditions affecting each system: skin (Kaposi's, molluscum, seborrheic dermatitis), eyes (CMV retinitis), nervous system (neuropathy, encephalopathy), lungs (PCP history, recurrent pneumonia), mental health (depression, anxiety, cognitive changes), etc.

    during exam

  • recommended

    Describe employment and functional limitations explicitly

    If your HIV-related illness has caused employment limitations - including job loss, reduced hours, inability to maintain employment, or difficulty performing job duties - state this clearly. Depression and memory loss with employment limitations are specific 60% rating criteria.

    during exam

  • recommended

    Take notes immediately after the exam

    Immediately after the exam, write down everything you remember: what questions were asked, what you answered, what physical findings were noted, and any statements the examiner made. This is critical if you need to appeal based on an inaccurate DBQ.

    after exam

  • recommended

    Request a copy of the completed DBQ

    You are entitled to a copy of the completed DBQ. Request it through your VSO, ebenefits, or VA.gov. Review it carefully to ensure it accurately reflects what you reported and what was examined. If there are inaccuracies, document them for a potential appeal.

    after exam

  • recommended

    Follow up with your treating physician if the DBQ is inaccurate

    If the C&P DBQ does not accurately capture your symptoms or medical history, ask your treating infectious disease physician to write an independent medical opinion or a nexus letter that accurately documents your condition. A private DBQ from your treating provider can be submitted as supplemental evidence.

    after exam

  • critical

    Review your rating decision carefully when received

    When your rating decision arrives, review which criteria were applied, what evidence was considered, and which DBQ fields drove the rating. If the rating does not reflect your actual disability level, consult with a VSO or accredited claims agent about filing a Higher-Level Review or supplemental claim with new evidence.

    after exam

Your rights during a C&P exam

  • You have the right to a thorough and accurate C&P examination. The examiner must review your claims file and all submitted medical records before completing the DBQ.
  • You have the right to request that your C&P examination be recorded in most states. Inform the examiner at the start of the exam that you intend to record, or ask about the facility's recording policy.
  • You have the right to bring a support person (family member, caregiver, or VSO representative) to your C&P examination.
  • You have the right to submit your own independent medical evidence, including a private DBQ completed by your treating physician, as supplemental evidence for your claim.
  • You have the right to review the completed DBQ. Request a copy through your VSO, VA.gov, or ebenefits portal after the exam.
  • You have the right to dispute an inadequate or inaccurate C&P examination. If the examiner did not review your records, did not conduct a thorough exam, or the DBQ does not accurately reflect your reported symptoms, you can request a new exam or submit a Higher-Level Review.
  • Your HIV status is protected health information. The VA has specific confidentiality protections for HIV-related records under 38 U.S.C. - 7332. You have the right to inquire how your information will be protected and who will have access to it.
  • You have the right to a nexus opinion. If service connection has not yet been established, you have the right to submit a medical nexus opinion linking your HIV diagnosis to your military service.
  • You have the right to benefits back to your effective date. Ensure your original claim date is preserved, as ratings are typically paid retroactively to the date of the claim, not the date of the rating decision.
  • You have the right to a free VSO representative. Veterans Service Organizations such as the DAV, VFW, American Legion, and others provide free claims assistance. You are not required to navigate this process alone.
  • You have the right to submit buddy statements (VA Form 21-10210 or lay statements) from people who can describe how your HIV-related illness affects your daily life and functioning.
  • If your condition worsens after a rating decision, you have the right to file for an increased rating. The VA may also schedule future exams to reassess your condition - you have the right to these continued evaluations.

Related conditions

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.