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VA Rating Assistant

DC 6310 · 38 CFR 4.88b

Late Symptomatic Syphilis C&P Exam Prep

To evaluate the current severity, activity status, and functional impact of late symptomatic syphilis (DC 6310) for VA disability rating purposes. The examiner will assess residual neurological, cardiovascular, musculoskeletal, and other systemic complications of late-stage syphilis, determine whether the condition is active or inactive, and document how symptoms affect daily functioning and work capacity.

Format:
Interview + Physical
Typical duration:
30-45 minutes
DBQ form:
Infectious_Diseases_Other_than_HIV_Related_Illness_Chronic_Fatigue_Syndrome_and_Tuberculosis (Infectious_Diseases_Other_than_HIV_Related_Illness_Chronic_Fatigue_Syndrome_and_Tuberculosis)
Examiner:
Infectious Disease Specialist or Internal Medicine

What the examiner evaluates

  • Presence and severity of neurosyphilis manifestations including tabes dorsalis, general paresis, meningitis, and cranial nerve involvement
  • Cardiovascular syphilis findings including aortitis, aortic aneurysm, and aortic valve insufficiency
  • Gummatous lesions affecting skin, bone, liver, or other organs
  • Current serologic status including RPR/VDRL and FTA-ABS or TPPA titers
  • CSF examination results if neurosyphilis is suspected or confirmed
  • Treatment history including penicillin or alternative antibiotic courses and response to treatment
  • Active versus inactive disease status and date condition became inactive if applicable
  • Functional limitations caused by neurological deficits, pain, weakness, or incoordination
  • Impact on activities of daily living, employment, and quality of life
  • Presence of any residual disabilities attributable to syphilitic tissue damage
  • History of hospitalizations, specialist evaluations, and ongoing follow-up care
  • Secondary conditions caused by or related to late syphilis infection

The exam will be conducted in person at a VA medical facility or contract examination site. You may be examined by a physician, nurse practitioner, or physician assistant with infectious disease or internal medicine expertise. Bring all relevant medical records, lab results, imaging studies, and a written symptom summary. If your exam is scheduled as a telehealth visit, confirm in advance whether a physical examination can still be performed, as certain neurological and cardiovascular findings require in-person assessment. You have the right to request that the exam be recorded in most states.

Measurements and tests

Serologic Testing - RPR/VDRL and Treponemal Tests

What it measures: Non-treponemal tests (RPR, VDRL) reflect disease activity and treatment response; treponemal tests (FTA-ABS, TPPA) confirm prior infection and typically remain reactive for life.

What to expect: The examiner will review your most recent RPR or VDRL titer results, FTA-ABS or TPPA results, and any trend data showing titer changes over time. Blood may be drawn at the examination or the examiner may rely on existing results in your medical record.

Critical thresholds

  • RPR reactive with any titer Supports active or recently treated syphilis; combined with symptoms, can support higher rating
  • RPR non-reactive with reactive FTA-ABS Consistent with adequately treated or late latent syphilis; residual disability still ratable
  • Four-fold or greater titer increase Suggests reinfection or treatment failure; supports active disease designation
  • CSF-VDRL reactive Confirms neurosyphilis; significant for rating neurological residuals under appropriate diagnostic codes

Tips

  • Bring copies of all serologic test results from the past 3-5 years showing titer trends
  • If you have had multiple courses of treatment, document dates, antibiotics used, and response
  • If CSF analysis was ever performed, bring the full laboratory report
  • Note any instances where your provider expressed concern about treatment failure or reinfection

Pain considerations: Serologic testing itself is not painful beyond a blood draw. However, if lumbar puncture for CSF analysis is discussed, you may accurately describe prior procedural experiences and any headache or back pain that followed previous spinal taps.

Neurological Examination

What it measures: Presence and severity of neurological deficits from neurosyphilis including tabes dorsalis (posterior column degeneration), general paresis, Argyll Robertson pupils, cranial nerve palsies, ataxia, sensory loss, and reflex abnormalities.

What to expect: The examiner will test deep tendon reflexes, proprioception and vibration sense, gait and coordination, pupillary reactions, cranial nerve function, cognitive status, muscle strength, and sensory perception. You may be asked to walk, stand with eyes closed (Romberg test), and perform finger-to-nose coordination tasks.

Critical thresholds

  • Absent deep tendon reflexes with positive Romberg Classic tabes dorsalis finding; supports significant neurological rating
  • Argyll Robertson pupils (accommodating but not reacting to light) Pathognomonic for neurosyphilis; supports active or residual neurosyphilis designation
  • Cognitive deficits on mental status testing May support general paresis diagnosis; rated separately under mental disorders criteria
  • Cranial nerve palsy Rated under appropriate cranial nerve diagnostic codes as residual disability

Tips

  • Report ALL neurological symptoms accurately including balance problems, falls, shooting or lightning pains, numbness, tingling, weakness, visual changes, hearing loss, difficulty speaking, and memory or personality changes
  • Describe your worst symptom days, not just your best days
  • If you use a cane, walker, or other assistive device due to balance or gait problems, bring it to the exam
  • Report any history of falls or near-falls related to ataxia or sensory loss

Pain considerations: Tabes dorsalis characteristically causes sudden, severe lancinating or lightning pains in the extremities and trunk. When describing these, communicate the frequency, intensity on a 0-10 scale, duration of each episode, and how they interrupt sleep, work, and daily activities. Do not minimize these pain episodes as they are clinically significant for rating purposes.

Cardiovascular Examination

What it measures: Presence and severity of cardiovascular syphilis including syphilitic aortitis, aortic aneurysm, coronary ostial stenosis, and aortic valve insufficiency.

What to expect: The examiner will auscultate heart sounds for aortic regurgitation murmur, assess blood pressure in both arms, review chest X-ray and echocardiogram findings, and evaluate for symptoms of heart failure or angina. Imaging studies such as CT aortography may be referenced.

Critical thresholds

  • Aortic regurgitation present on examination or echocardiogram Supports cardiovascular syphilis diagnosis; severity rated under cardiac diagnostic codes
  • Ascending aortic aneurysm on imaging Major finding for cardiovascular syphilis; rated based on size and functional impact
  • Coronary ostial stenosis with exertional angina Supports higher rating for cardiovascular limitation

Tips

  • Bring all cardiology records, echocardiogram reports, and any CT or MRI aortic imaging
  • Report any chest pain, shortness of breath on exertion, palpitations, or dizziness accurately
  • If you have exercise limitations due to cardiovascular symptoms, describe specific activities you can no longer do and why
  • Document any cardiac medications prescribed for syphilis-related cardiac complications

Pain considerations: Chest pain from syphilitic coronary ostial stenosis should be described in full detail including character, radiation, precipitating and relieving factors, and frequency. Do not dismiss chest discomfort as minor if it limits your activities.

Rating criteria by percentage

100%

Active late syphilis with significant systemic involvement. This may include active neurosyphilis with ongoing neurological progression, active cardiovascular syphilis with hemodynamically significant aortic disease, or active gummatous disease with substantial organ involvement. Rating at this level reflects the severity of the underlying active infectious process and its systemic consequences.

Key symptoms

  • Active serologic evidence of infection with symptoms of late-stage disease
  • Progressive neurological deficits attributable to ongoing neurosyphilis
  • Hemodynamically significant aortic regurgitation or aortic aneurysm
  • Active gummatous lesions causing significant organ dysfunction
  • Evidence of treatment failure or reinfection with persistent systemic symptoms
  • Hospitalization or intensive outpatient management for syphilitic complications
  • Inability to maintain substantial gainful employment due to syphilitic residuals

From 38 CFR: Under 38 CFR 4.88b DC 6310, late symptomatic syphilis is rated based on the predominant disabling manifestation. When multiple body systems are affected, residuals may be rated separately under the most analogous diagnostic codes for the affected system (neurological, cardiovascular, dermatological). A 100% rating reflects total disability from active late syphilitic disease.

60%

Moderately severe late symptomatic syphilis with significant but not totally disabling systemic manifestations. Persistent neurological residuals causing functional limitations, cardiovascular involvement with moderate functional impairment, or gummatous disease affecting one or more organ systems with moderate disability.

Key symptoms

  • Established neurosyphilis with stable but significant neurological deficits
  • Tabes dorsalis with gait disturbance, sensory loss, or recurrent lightning pains
  • Aortic regurgitation with moderate exertional limitation
  • Residual cranial nerve deficits affecting vision, hearing, or facial function
  • Cognitive impairment from prior general paresis affecting work capacity
  • Recurrent symptoms requiring ongoing specialist management

From 38 CFR: Residual disabilities from late syphilis such as tabes dorsalis or syphilitic aortitis that cause moderate limitations in occupational and social functioning without constituting complete disability. The examiner should document specific functional deficits and their impact on daily activities.

30%

Mild to moderate residual disability from late symptomatic syphilis following treatment. Serologic evidence of prior infection with persistent but mild neurological or systemic residuals. Condition may be designated inactive but with documented residual deficits affecting function.

Key symptoms

  • Mild sensory deficits or diminished reflexes as residuals of tabes dorsalis
  • Minimal aortic regurgitation without significant exertional limitation
  • Mild gait instability not requiring assistive devices
  • Occasional lightning pains controlled with medication
  • Stable serologic titers after treatment completion
  • Mild fatigue or reduced endurance attributable to prior syphilitic organ involvement

From 38 CFR: Inactive late syphilis with documented residual signs or symptoms that affect physical or occupational functioning. The condition is no longer actively progressing but has left permanent deficits ratable under DC 6310 or analogous codes.

10%

Minimal residual disability from late symptomatic syphilis. Condition is inactive following treatment with only minor or subclinical residuals. Serologic evidence of prior infection with reactive treponemal tests but non-reactive or minimally reactive non-treponemal tests. No significant functional impairment.

Key symptoms

  • Non-reactive RPR with reactive FTA-ABS or TPPA confirming prior infection
  • Minimal or subclinical neurological findings on examination
  • No functional limitation from syphilitic residuals in daily activities
  • Stable condition not requiring active treatment
  • Incidentally noted serologic reactivity without symptomatic disease

From 38 CFR: Adequately treated late syphilis with minimal or no residual symptomatology. The condition is documented as inactive but the veteran retains a ratable disability based on the history of late symptomatic disease and any objective residual findings.

Describing your symptoms accurately

Neurological Pain - Lightning or Lancinating Pains

How to describe it: Describe the sudden, shooting, electric shock-like pains characteristic of tabes dorsalis. Specify which body parts are affected (legs, trunk, arms), how long each episode lasts (seconds to minutes), how many episodes occur per day or week, what triggers or worsens them (movement, cold, touch), what partially relieves them, and how they interrupt sleep, work, and daily activities.

Example: On my worst days, I have 15 or more sudden stabbing pains shooting from my hips down through my legs. Each one feels like an electric shock and lasts 10 to 30 seconds. These wake me from sleep at least 3 times a night and make it impossible to walk more than half a block without stopping. I cannot stand at a counter to cook or stand in line because the unpredictable nature of the pain makes me fear falling. On these days I take my prescribed pain medication, which reduces the frequency but leaves me drowsy and unable to concentrate.

Examiner listens for: Frequency and severity of episodic pain consistent with posterior column disease; functional limitation during and between pain episodes; medication use and side effects; impact on sleep, ambulation, and occupational activity; unpredictability of pain onset

Avoid: Do not say 'I just have some leg pain sometimes' or 'I manage it okay.' Tabes dorsalis pain is characteristically severe and episodic. Failing to describe the frequency, intensity, and functional disruption caused by lightning pains may result in the examiner documenting mild or insignificant pain.

Gait and Balance Disturbance

How to describe it: Describe your walking stability, history of falls, use of assistive devices, and specific activities you can no longer perform safely. Explain how your gait has changed over time and what compensatory strategies you use. Note whether balance is worse in the dark or with eyes closed, which is characteristic of posterior column disease.

Example: On my worst days I cannot walk through my house at night without holding onto walls because I cannot feel the floor under my feet. I have fallen three times in the past year, twice going down stairs. I now use a cane whenever I leave the house. I cannot walk on uneven ground without someone supporting me. I have given up hiking, yard work, and using a ladder. Even on better days I shuffle when I walk and my family has commented that I look drunk even when I am sober.

Examiner listens for: Objective gait abnormality on examination; positive Romberg sign; history of falls with dates and circumstances; use of assistive devices; specific functional limitations in work and daily life; worsening in low light or with eyes closed

Avoid: Do not minimize falls by saying they were accidental or due to unrelated causes if your balance problem contributed. Do not fail to mention nighttime worsening or light-dependent gait problems, as these are diagnostically significant and functionally important.

Cardiovascular Symptoms

How to describe it: Describe any chest pain, shortness of breath, palpitations, or dizziness with specific attention to what activities trigger symptoms, how far you can walk or climb stairs before stopping, and how your exercise capacity has changed since diagnosis.

Example: On my worst days I become short of breath climbing one flight of stairs and have to rest at the top. I have chest pressure that radiates to my left arm when I walk more than two blocks on flat ground. I have stopped mowing my lawn, carrying groceries, and participating in activities with my grandchildren because of fear of chest pain and breathlessness. My cardiologist has restricted me from heavy lifting or vigorous exercise.

Examiner listens for: Exertional chest pain or dyspnea consistent with cardiovascular syphilis; exercise tolerance quantified in blocks, stairs, or MET equivalents; cardiologist-imposed activity restrictions; medication burden for cardiac management; objective findings on auscultation or imaging review

Avoid: Do not say you are fine with activity if you have modified your life to avoid triggering symptoms. Describe what you used to be able to do versus what you can do now.

Cognitive and Psychiatric Symptoms

How to describe it: If you have experienced memory loss, personality changes, difficulty with concentration, or mood disturbances related to neurosyphilis or general paresis, describe these with specific examples. Explain how these symptoms have affected your ability to manage finances, maintain relationships, hold employment, or perform complex tasks.

Example: On my worst days I cannot remember conversations I had earlier the same day. I have gotten lost driving in my own neighborhood twice. I make mistakes at work that I never would have made before and my supervisor has expressed concern. My spouse reports that my personality has changed and that I am more irritable and impulsive than I was before my illness. I am no longer able to manage our household finances without help.

Examiner listens for: Cognitive deficits on mental status examination consistent with general paresis; neuropsychological testing results; impact on instrumental activities of daily living; employment consequences; psychiatric symptoms including depression, anxiety, or psychosis secondary to neurosyphilis

Avoid: Do not minimize cognitive changes as normal aging or stress. General paresis and other forms of neurosyphilis can cause measurable cognitive decline that is separately ratable under mental disorders criteria.

Systemic Fatigue and Reduced Endurance

How to describe it: Describe fatigue that is disproportionate to activity level, including how it differs from normal tiredness, how it affects your ability to work full days or complete household tasks, and whether it has changed over time since your syphilis diagnosis and treatment.

Example: On my worst days I am exhausted after showering and getting dressed. By noon I need to rest even if I have not done anything physically demanding. I cannot work a full eight-hour day. I have used up all of my sick leave and my employer has placed me on a performance improvement plan because of absences and reduced productivity. Even on better days I can only work about four to five hours before fatigue forces me to stop.

Examiner listens for: Fatigue severity and its proportionality to activity; impact on work attendance and productivity; relationship to syphilitic organ damage or treatment side effects; whether fatigue is a primary symptom or secondary to specific organ system involvement

Avoid: Do not say you are just tired without quantifying how fatigue limits your function. Connect fatigue specifically to your syphilis diagnosis and its effects on your body systems.

Common mistakes to avoid

Reporting only current average symptoms rather than worst-day severity

Why: VA rating is based on the full picture of disability including worst-day functioning. M21-1 guidance specifically directs examiners to consider the worst typical presentation of a condition. Reporting only your best or average days systematically underrepresents your disability.

Do this instead: Before the exam, write down your worst days from the past 12 months. Bring specific examples with dates if possible. When asked how you are doing, lead with your worst experiences rather than your average or best days.

Impact: All rating levels - can affect rating by one or two full steps

Failing to connect neurological symptoms specifically to syphilis

Why: The examiner must document which symptoms are attributable to late syphilis versus other conditions. If you do not explicitly link your gait problems, sensory loss, or cognitive changes to your syphilis diagnosis, the examiner may attribute these to unrelated causes or fail to document the connection.

Do this instead: Use language such as 'My neurologist told me my balance problems are from the nerve damage caused by syphilis' or 'These symptoms began after my syphilis diagnosis and have been attributed to neurosyphilis in my medical records.' Bring records explicitly connecting your symptoms to syphilitic pathology.

Impact: Can determine whether a condition is rated at all versus not recognized

Downplaying serologic reactivity by saying you were treated and cured

Why: While treatment may render syphilis inactive, late symptomatic syphilis can leave permanent residual disabilities. Treponemal tests remain reactive for life. Saying you were cured may cause the examiner to document inactive disease without residual disability, eliminating your claim.

Do this instead: Accurately state that you completed treatment and that the disease may be inactive or controlled, but emphasize the permanent damage and residual symptoms that treatment did not reverse. Use language such as 'I was treated but I still have permanent nerve damage that my doctor says will not improve.'

Impact: Can result in 0% or non-compensable rating when a compensable rating is warranted

Not mentioning the full range of affected body systems

Why: Late syphilis can affect multiple organ systems simultaneously. If you only mention one set of symptoms (e.g., neurological) and fail to mention cardiovascular or dermatological manifestations, those systems will not be evaluated and separate ratings may not be assigned.

Do this instead: Prepare a complete symptom inventory covering neurological, cardiovascular, musculoskeletal, dermatological, and psychiatric symptoms before the exam. Present all symptoms to the examiner even if they seem minor or unrelated to your primary complaint.

Impact: Can result in missed secondary ratings worth 10-60% each

Failing to bring serologic test results and specialist records

Why: The examiner must document the diagnostic basis for the syphilis diagnosis. If your records are not available at the exam, the examiner may note that the diagnosis cannot be confirmed, which can delay or deny your claim.

Do this instead: Request copies of all RPR, VDRL, FTA-ABS, TPPA, and CSF laboratory results from your treating providers. Bring neurology, cardiology, and infectious disease clinic notes. Organize these chronologically in a binder you bring to the exam.

Impact: Can affect claim decision at all rating levels

Minimizing functional impact on employment and daily activities

Why: The functional impact section of the DBQ (field 164) directly influences the rating decision. Examiners who document minimal functional impact may support lower ratings even when objective findings are significant.

Do this instead: Before the exam, list every activity you can no longer do or can only do with difficulty due to your condition: driving, cooking, cleaning, climbing stairs, walking distances, concentrating at work, managing finances, maintaining relationships. Bring this list and refer to it when asked about functional impact.

Impact: Most impactful at the 30-60% boundary

Prep checklist

  • critical

    Gather all serologic test results showing RPR/VDRL titer trend over time

    Collect RPR and VDRL titer results from the earliest positive test through the most recent. Include FTA-ABS or TPPA confirmatory results. Organize chronologically. These are essential for establishing diagnosis and disease activity status on the DBQ.

    before exam

  • critical

    Obtain all specialist records related to syphilitic complications

    Request records from infectious disease, neurology, cardiology, ophthalmology, and any other specialists who have treated conditions related to your syphilis. Ensure neurosyphilis evaluations, CSF results if applicable, echocardiograms, and aortic imaging reports are included.

    before exam

  • critical

    Write a detailed symptom narrative covering all affected body systems

    Create a written summary describing every symptom attributable to your late syphilis, organized by body system. Include onset dates, progression, severity on worst days, and specific functional limitations for each symptom. Bring this to the exam and refer to it to ensure completeness.

    before exam

  • critical

    Document your treatment history including all antibiotic courses

    List dates, antibiotics used (typically benzathine penicillin G), doses, number of doses, and your provider's assessment of treatment response. Note any treatment failures, retreatments, or changes in serologic titers following treatment.

    before exam

  • critical

    Prepare a functional impact statement describing limitations in work and daily life

    Write specific examples of tasks you can no longer perform or can only perform with difficulty: walking distances, climbing stairs, driving, cooking, working full days, concentrating, managing finances, participating in family activities. Quantify limitations (e.g., can only walk 1 block before stopping) wherever possible.

    before exam

  • recommended

    List all current medications with dosages and what each treats

    Include antibiotics, pain medications for lightning pains, cardiac medications, neurological medications, and any supplements. Note side effects that themselves cause functional limitation such as drowsiness, dizziness, or cognitive fog from medications.

    before exam

  • recommended

    Review your worst-day experiences from the past 12 months

    Think back to your most symptomatic days over the past year. Write down specific dates if possible, what happened, how long it lasted, and how it affected your ability to function. These real-world examples are powerful evidence of true disability severity.

    before exam

  • recommended

    Check your state's law regarding recording of C&P examinations

    Most states permit veterans to audio or video record their C&P examination. Confirm your state's current law, and if recording is permitted, bring a device and notify the examiner at the start of the exam that you will be recording. This protects you if the exam report is inaccurate.

    before exam

  • optional

    Identify and bring a buddy statement from a family member or caregiver if available

    A written statement from a spouse, family member, or caregiver describing how your late syphilis symptoms affect you daily can corroborate your own account. Describe changes in your behavior, mobility, cognitive function, and ability to perform household tasks as observed by someone who knows you well.

    before exam

  • critical

    Arrive in your typical symptomatic condition - do not mask symptoms

    Do not take extra pain medication, push through fatigue to appear energetic, or otherwise present yourself better than your typical functional state. The examiner should see you as you normally are. If you are having a bad symptom day, that is the most accurate representation of your disability.

    day of

  • critical

    Bring all medical records, lab results, and your written symptom narrative

    Organize documents in a binder or folder: serologic results first, then specialist records chronologically, then your symptom narrative and functional impact statement. Offer these to the examiner at the start of the exam and ask that they be reviewed and referenced in the DBQ.

    day of

  • recommended

    Bring any assistive devices you use such as a cane, walker, or hearing aids

    If you use any assistive devices because of your syphilis-related disabilities, bring and use them at the examination. This documents their necessity. Do not leave your cane in the car to appear more capable than you are on a typical day.

    day of

  • optional

    If you have a support person, confirm whether they may accompany you

    Contact the examination facility in advance to confirm their policy on support persons in the exam room. A support person can help you remember to report all symptoms and can note any discrepancies between what you said and what is later reflected in the exam report.

    day of

  • critical

    Report ALL symptoms - do not assume the examiner will find them

    The DBQ requires the examiner to document what you report and what they find. Do not wait to be asked about specific symptoms. If the examiner does not ask about a particular body system, volunteer that information. Say: 'I also want to make sure you know about my balance problems and lightning pains in my legs.'

    during exam

  • critical

    Describe symptoms in terms of worst days, not best or average days

    When asked how severe your symptoms are, lead with your worst experiences. Use language such as 'On my worst days, which happen about twice a week, I cannot walk without my cane and I have shooting pains every 15 minutes.' This accurately represents the full range of your disability.

    during exam

  • critical

    Explicitly connect all symptoms to your syphilis diagnosis

    For every symptom you report, state that you believe it is caused by or related to your late syphilis. Do not assume the examiner will make this connection independently. Say: 'My neurologist has told me that my balance problems and sensory loss are permanent damage from neurosyphilis.'

    during exam

  • critical

    Do not minimize symptoms when asked direct questions about severity

    When asked 'How are you doing?' or 'How is your pain today?' resist the social impulse to say 'fine' or 'okay.' Instead say: 'Today is a moderate day for me. I have had much worse days. Let me tell you about what my worst days are like.'

    during exam

  • recommended

    Ask the examiner to note any symptoms or limitations you feel were not fully addressed

    At the end of the exam, ask: 'Is there anything I mentioned that you were not able to include in your evaluation today?' and 'Were you able to document all of the functional limitations I described?' This creates an opportunity to address gaps before the report is finalized.

    during exam

  • critical

    Write down everything that happened during the exam while your memory is fresh

    Immediately after the exam, write a detailed account of what questions were asked, what you reported, what physical tests were performed, and anything that seemed incomplete or inaccurate. This record is essential if you need to request a new exam or submit a rebuttal to the exam report.

    after exam

  • critical

    Request a copy of the completed DBQ report

    You are entitled to a copy of your C&P examination report. Request it through your VA MyHealtheVet portal, your regional office, or through a FOIA request if necessary. Review it carefully for accuracy and completeness. If it omits significant symptoms you reported or contains factual errors, you can submit a written rebuttal.

    after exam

  • recommended

    If the exam report is inaccurate or inadequate, take action promptly

    If the DBQ report omits symptoms you reported, mischaracterizes your condition, or appears to be based on a cursory examination, you may: file a statement in support of claim correcting inaccuracies, request a new examination citing inadequacy of the prior exam, or obtain an independent medical opinion (nexus letter) from a private provider.

    after exam

Your rights during a C&P exam

  • You have the right to a thorough and contemporaneous examination. The examiner must conduct a physical examination when clinically indicated and cannot rate your condition based solely on a records review if your symptoms require direct assessment.
  • You have the right to review and receive a copy of your C&P examination report. Request it through MyHealtheVet or your regional office after the exam is completed.
  • You have the right to request a new examination if you believe the first examination was inadequate, incomplete, or based on inaccurate information. Submit a written request to your regional office explaining the specific inadequacies.
  • In most states, you have the right to record your C&P examination. Confirm your state's law before the exam and bring a recording device if permitted. Notify the examiner that you will be recording at the start of the session.
  • You have the right to submit additional evidence including private medical opinions (nexus letters), buddy statements, and supplemental medical records to support your claim at any time before a final rating decision.
  • You have the right to be accompanied by a representative, accredited claims agent, or Veterans Service Organization (VSO) representative throughout the claims process, including assistance with preparing for and responding to C&P examinations.
  • You have the right to a rating based on your entire clinical picture including your worst-day functioning, not just a single snapshot on the day of the exam. M21-1 guidance directs raters to consider the full range of disability severity.
  • You have the right to separate ratings for each distinct disability caused by late syphilis. Neurological, cardiovascular, dermatological, and psychiatric residuals of late syphilis may each be rated separately under the most appropriate diagnostic code rather than combined under a single rating.
  • You have the right to obtain and submit an independent medical examination (IME) or private nexus opinion if you believe the VA examiner's conclusions are incorrect or inadequately supported. Private medical opinions are entitled to full consideration in the rating decision.
  • You have the right to appeal any rating decision through the Supplemental Claim, Higher-Level Review, or Board of Veterans' Appeals lanes under the Appeals Modernization Act (AMA).

Related conditions

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This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.

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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.