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VA Rating Assistant

DC 5201 · 38 CFR 4.71a

Shoulder and Arm C&P Exam Prep

To document the current severity of your shoulder and arm condition under 38 CFR 4.71a DC 5201 (limitation of arm motion), including active and passive range of motion, functional loss, DeLuca factors, and any related diagnoses such as rotator cuff tear, impingement, bursitis, or instability.

Format:
Interview + Physical
Typical duration:
30-45 minutes
DBQ form:
Shoulder_and_or_Arm (Shoulder_and_or_Arm)
Examiner:
Physician or Physician Assistant

What the examiner evaluates

  • Active range of motion (flexion, abduction, internal rotation, external rotation) for both right and left shoulder
  • Passive range of motion and whether it differs from active ROM
  • Pain on motion - where it begins in the arc and where it ends the arc (end-point pain)
  • Functional loss due to pain, fatigue, weakness, or incoordination after repetitive use
  • Flare-up history: frequency, severity, duration, and precipitating factors
  • Diagnoses present (rotator cuff tear, impingement, bursitis, tendinitis, labral tear, instability, arthritis, etc.)
  • Surgical history including arthroscopic procedures and joint replacement
  • Assistive devices (sling, brace)
  • Dominant hand determination
  • Functional impact on daily and occupational activities
  • Special orthopedic tests: Hawkins impingement, Empty Can (supraspinatus), External Rotation Strength (infraspinatus), Lift-Off (subscapularis), Crank/Apprehension/Relocation (instability)
  • Muscle atrophy, swelling, deformity, crepitus, and instability findings
  • Radiologic and diagnostic test results (X-ray, MRI, EMG)

Examination is typically conducted in person. The examiner will observe your gait and posture upon entry, conduct an interview about your history and symptoms, then perform a physical examination. In some cases the exam may be conducted via telehealth; you may request in-person examination. You have the right to record the exam in most states - bring a recording device and politely notify the examiner at the start.

Measurements and tests

Shoulder Flexion (Active & Passive)

What it measures: Forward elevation of the arm from anatomical position (0-) toward overhead (180- normal). DC 5201 rating thresholds are 90- (shoulder level), 45- (midway), and 25- (near side).

What to expect: The examiner will ask you to raise your arm forward as far as possible. They will use a goniometer. They will then passively raise your arm to compare. Expect to report exactly where pain begins in the arc.

Critical thresholds

  • -25- flexion 40% dominant / 30% non-dominant
  • -45- flexion 30% dominant / 20% non-dominant
  • -90- flexion 20% both arms

Tips

  • Move at your actual comfortable maximum - do not push through severe pain to demonstrate higher ROM.
  • Clearly tell the examiner at what degree your pain begins, not just where your arm stops.
  • If ROM is worse after repetitive movement or during a flare-up, describe that reduced level accurately.
  • If you cannot perform the movement due to pain rather than mechanical restriction, say so explicitly.

Pain considerations: Per DeLuca v. Brown, pain on motion is a functional loss factor. State if pain begins early in the arc (e.g., 'pain starts at about 30- and becomes severe by 60-). The examiner should document pain throughout the arc, not just at end-range.

Shoulder Abduction (Active & Passive)

What it measures: Lateral elevation of the arm away from the body (0-180- normal). DC 5201 uses the same thresholds as flexion: 25-, 45-, 90-.

What to expect: You will be asked to raise your arm out to the side. The examiner measures with a goniometer. The painful arc (typically 60-120- in impingement) should be communicated clearly.

Critical thresholds

  • -25- abduction 40% dominant / 30% non-dominant
  • -45- abduction 30% dominant / 20% non-dominant
  • -90- abduction 20% both arms

Tips

  • Abduction and flexion are evaluated together under DC 5201 - the more limited of the two drives the rating.
  • Describe the painful arc - e.g., 'it's most painful between 60 and 100 degrees then eases slightly overhead.'
  • Report if overhead activity (e.g., reaching a shelf, putting on a shirt) reproduces pain.

Pain considerations: A painful arc limited to 60-120- is classic for impingement and should be reported in full, even if the arm can technically be raised higher. Functional loss from pain within the arc counts under 38 CFR 4.40 and 4.45.

Internal Rotation (Active & Passive)

What it measures: Rotation of the humerus inward (normal: approximately 70-90-). Typically assessed by how far the thumb can reach up the back.

What to expect: You may be asked to reach behind your back as high as possible (Apley's scratch test). The examiner records degrees or vertebral level reached.

Critical thresholds

  • Significantly limited internal rotation Can support higher rating under DC 5201 combined limitation analysis; also relevant under DC 5200 (ankylosis) if severe

Tips

  • Describe difficulty with activities requiring internal rotation: fastening a bra strap, tucking in a shirt, reaching into a back pocket.
  • Note if this motion is painfully limited rather than mechanically blocked.

Pain considerations: Pain with internal rotation is a hallmark of impingement, frozen shoulder, and rotator cuff pathology. Report if this motion is the most provocative movement in your daily life.

External Rotation (Active & Passive)

What it measures: Rotation of the humerus outward (normal: approximately 60-90-). Also tested via infraspinatus strength test.

What to expect: The examiner will test external rotation in neutral and/or at 90- abduction. The infraspinatus strength test evaluates rotator cuff integrity.

Critical thresholds

  • Weakness or limited external rotation Indicates rotator cuff (infraspinatus/teres minor) pathology; documents functional loss beyond pure ROM

Tips

  • Weakness in external rotation against resistance is an important DeLuca factor - report this clearly.
  • Describe activities affected: throwing, reaching across the body, combing hair.

Pain considerations: External rotation weakness after repetitive use (e.g., after 10 repetitions) is a key DeLuca finding. Tell the examiner if the motion becomes significantly more painful or weak with repeated use.

Hawkins Impingement Test

What it measures: Detects subacromial impingement by compressing the supraspinatus tendon under the acromion.

What to expect: The examiner will flex your arm to 90-, bend your elbow to 90-, and forcibly internally rotate. A positive test reproduces pain in the anterior/lateral shoulder.

Critical thresholds

  • Positive test Supports diagnosis of impingement syndrome (DC 5201 basis); documented in DBQ field

Tips

  • Tell the examiner 'yes' if this maneuver reproduces your typical shoulder pain.
  • Note if the pain quality matches your everyday pain - 'that's exactly where it hurts.'

Pain considerations: A positive Hawkins test is objective evidence of impingement. It supports the examiner documenting pain on motion and functional loss.

Empty Can Test (Supraspinatus Strength)

What it measures: Assesses the integrity and strength of the supraspinatus rotator cuff muscle.

What to expect: You will hold your arm out at 90- abduction in the scapular plane with thumb pointing down, and resist downward pressure applied by the examiner. Pain or weakness is noted.

Critical thresholds

  • Weakness or pain with resistance Documents rotator cuff pathology; supports DeLuca weakness factor; relevant to DC 5201 rating

Tips

  • Do not 'fake' weakness, but do not compensate or cheat the movement - let the examiner see your true strength level.
  • If the muscle fatigues rapidly, mention that endurance is more limited than initial strength.

Pain considerations: Pain during this test documents pain on use, which per 38 CFR 4.40 is a functional loss factor. Report concurrent pain clearly.

Lift-Off Test (Subscapularis Strength)

What it measures: Tests the strength of the subscapularis muscle (internal rotator).

What to expect: You will place the dorsum of your hand on your lower back and lift it away from the back against resistance.

Critical thresholds

  • Weakness or inability to perform Documents subscapularis tear or weakness; supports DeLuca factors

Tips

  • Describe if this motion causes pain or if you cannot perform it at all.
  • Functional correlates: pushing open a heavy door, lifting from behind, reaching backward.

Pain considerations: Inability to perform this test due to pain rather than mechanical failure is itself a documented functional loss.

Crank / Apprehension / Relocation Test

What it measures: Assesses glenohumeral joint instability and labral pathology (e.g., SLAP tear, recurrent dislocation).

What to expect: The examiner will abduct and externally rotate your arm, applying anterior pressure to the humeral head. A positive apprehension test means you feel like the shoulder will dislocate. Relocation test is positive if symptoms are relieved by posterior pressure.

Critical thresholds

  • Positive apprehension Supports diagnosis of glenohumeral instability (DC 5201 basis); also relevant under dislocation DBQ fields

Tips

  • If you have a history of dislocations, describe frequency, mechanism, and how many times it has occurred.
  • Describe if you voluntarily avoid certain positions (e.g., sleeping position, overhead reaching) due to instability fear.

Pain considerations: Guarding of movement due to instability fear is a DeLuca incoordination/functional loss factor.

Rating criteria by percentage

40%

Dominant arm: flexion and/or abduction limited to 25- from side. This means the arm can barely move away from the body - the most severely restricted level under DC 5201.

Key symptoms

  • Arm essentially fixed at side with only minimal movement possible
  • Severe pain even with minimal motion
  • Inability to perform nearly all overhead or lateral arm tasks
  • Profound weakness or muscle atrophy
  • Severe functional loss documented on worst days / flare-ups

From 38 CFR: 38 CFR 4.71a DC 5201: 'Flexion and/or abduction limited to 25- from side' - rated 40% for dominant arm, 30% for non-dominant arm.

30%

Dominant arm: flexion and/or abduction midway between side and shoulder level (limited to 45-). Non-dominant arm: limited to 25- from side. The arm can be raised to approximately waist height only.

Key symptoms

  • Cannot raise arm to shoulder level
  • Significant pain arc beginning below shoulder level
  • Difficulty with tasks at waist level and below
  • Marked weakness with overhead or lateral movements
  • Functional loss with repetitive use (DeLuca fatigue/weakness)

From 38 CFR: 38 CFR 4.71a DC 5201: 'Midway between side and shoulder level (flexion and/or abduction limited to 45-)' - rated 30% dominant, 20% non-dominant.

20%

Flexion and/or abduction limited to 90- (shoulder level) for either arm. The arm can be raised to shoulder height but not above.

Key symptoms

  • Pain becomes limiting at or before shoulder level
  • Cannot raise arm above shoulder for overhead work
  • Difficulty with tasks above head: reaching shelves, washing hair, lifting
  • Moderate pain on use with some functional restriction
  • May have painful arc or impingement signs

From 38 CFR: 38 CFR 4.71a DC 5201: 'At shoulder level (flexion and/or abduction limited to 90-)' - rated 20% for both dominant and non-dominant arms.

0%

ROM exceeds 90- in both flexion and abduction, or the condition is present but does not meet any compensable threshold under DC 5201. However, if arthritis is confirmed by x-ray (DC 5003), a separate 10% rating may still apply.

Key symptoms

  • ROM above 90- but with reported pain on motion
  • Subjective complaints without objective motion restriction
  • Functional loss not well documented

From 38 CFR: If ROM is above 90-, DC 5201 alone does not yield a compensable rating. Consider analogous codes, DC 5003 (degenerative arthritis with x-ray evidence), or DeLuca factors to support functional loss documentation.

Describing your symptoms accurately

Pain - Location and Character

How to describe it: Describe pain by location (anterior, lateral, posterior shoulder; top of shoulder at AC joint; radiating down arm), character (sharp, aching, burning, stabbing), and circumstances (at rest, with movement, after use, at night). Give a 0-10 severity rating for average day AND worst day.

Example: On my worst days, I wake up at night unable to sleep on my right side because the pain is 8/10. When I try to reach for something above my head, I get a sharp stabbing pain at about 70 degrees that stops me from going further. After doing any repetitive arm activity like vacuuming for 5 minutes, the pain increases to 9/10 and I have to stop and rest for an hour.

Examiner listens for: Specific anatomical location, night pain (sign of severity), pain that begins within the ROM arc (not just end-range), post-activity pain increase, pain at rest, radiation pattern.

Avoid: Saying 'it's just a little sore' or 'I manage it OK' when in fact it limits your daily activity. Describe your worst day, not your best day.

DeLuca Factor - Fatigue and Lack of Endurance

How to describe it: Describe how quickly the shoulder fatigues with use. Specify what activity causes it and how much time you need to rest. Connect fatigue to specific tasks.

Example: After raising my arm to put dishes away for just 2 minutes, the muscle gets extremely fatigued and I have to stop. It takes about 30-45 minutes before I can use it again at any level. During a flare-up, even holding a telephone to my ear for 5 minutes causes significant fatigue.

Examiner listens for: Decline in ROM or strength with repetitive use, specific time or repetition thresholds, rest requirements, impact on employment and daily tasks. The examiner should note functional loss from fatigability under 38 CFR 4.40.

Avoid: Failing to mention that the shoulder works 'okay at first' but degrades quickly. Initial ROM may appear adequate but functional loss occurs with repetitive use - this is a critical DeLuca factor the examiner must document.

DeLuca Factor - Weakness

How to describe it: Describe specific loss of strength. Quantify if possible: 'I can only lift 5 pounds overhead before it gives out.' Connect weakness to specific work or daily tasks.

Example: I dropped a gallon of milk last week because my right shoulder gave out. I cannot lift more than a few pounds above waist level. My grip is okay but once I involve my shoulder, I lose strength immediately. I can't do my old job as a warehouse worker because I can't lift even 10 pounds overhead.

Examiner listens for: Specific weight or activity thresholds, give-way weakness, drop events, job-related limitations, weakness that worsens with repeated use.

Avoid: Saying 'I'm just not as strong as I used to be' without specifics. Give the examiner concrete examples and numbers.

DeLuca Factor - Flare-Ups

How to describe it: Describe flare-ups: how often they occur (weekly, monthly), what triggers them (weather, activity, sleep position), how severe they get (pain scale), how long they last, and what treatment you use during flare-ups.

Example: I have severe flare-ups about twice a month, typically triggered by any overhead activity or cold weather. During a flare-up, my ROM drops dramatically - I can barely lift my arm to chest height. The pain is 9-10 out of 10. The flare-up lasts 3-5 days and I have to rest in bed and use a heating pad and stronger pain medication.

Examiner listens for: Frequency, duration, trigger factors, impact on ROM and function during flare-up, treatment used, occupational/functional consequences. DBQ field _276 requires the examiner to document your description of flare-ups.

Avoid: Not mentioning flare-ups at all because the day of the exam happens to be a good day. Always describe your worst-day and flare-up status explicitly.

DeLuca Factor - Incoordination

How to describe it: Describe any loss of coordination, guarding of movement, or inability to perform precise movements with the affected arm. Include avoidance behaviors.

Example: I constantly guard my right arm - I automatically brace it against my side when walking because sudden movement causes intense pain. I can't throw a ball, swing a hammer, or reach behind me without sharp pain and a feeling that the shoulder might give out or dislocate. I use my left hand for most tasks now even though I'm right-handed.

Examiner listens for: Guarding posture, avoidance of certain movements, compensatory use of the other arm, instability-related incoordination.

Avoid: Performing the exam without mentioning habitual guarding. Describe your typical behavior - not how you perform in the exam room.

Functional Impact on Occupation and Daily Life

How to describe it: Connect your shoulder symptoms to specific job duties and ADLs. Be concrete and specific about what you cannot do or can only do with difficulty or pain.

Example: I had to change positions at work because I can no longer work on an assembly line requiring repeated overhead arm use. At home, I cannot wash my own hair without pain, put on a shirt over my head without assistance, carry groceries, or sleep through the night. I have had to hire someone to help with home maintenance tasks I used to do myself.

Examiner listens for: Specific occupation-related limitations, ADL limitations, sleep disturbance, need for assistive devices, changes in employment or duties. DBQ field _870 asks the examiner to document functional impact.

Avoid: Underreporting occupational impact or saying 'I get by.' The examiner is specifically required to document how the condition affects your ability to work and perform ADLs.

Common mistakes to avoid

Performing your best ROM during the exam rather than your typical or worst-day ROM

Why: Adrenaline, the clinical setting, or a temporarily good day may allow you to push further than usual, resulting in a recorded ROM that is higher than your functional reality.

Do this instead: Move to your actual comfortable limit. If you feel pain beginning at 60- but can push to 90- with severe pain, stop at 60- and tell the examiner that 60- is where pain becomes limiting. Describe your average and worst-day ROM explicitly.

Impact: Could be the difference between 20% and 30% or 40%

Failing to report flare-ups because the exam day is a 'good day'

Why: C&P exams are a snapshot, but ratings are based on the average disability level, including worst days. Examiners are required to consider flare-up descriptions under M21-1 and DeLuca.

Do this instead: Explicitly tell the examiner: 'Today is actually a better day than usual. During my typical bad days or flare-ups, my ROM is approximately X degrees and my pain is X/10.' The DBQ has a specific field for flare-up descriptions.

Impact: Can affect any rating level - critical for 30% and 40% thresholds

Not reporting DeLuca factors (fatigue, weakness, incoordination, pain on repetitive use)

Why: The examiner may only document initial ROM and miss the additional functional loss that occurs with repeated use. Under 38 CFR 4.40 and 4.45, functional loss from these factors is separately ratable.

Do this instead: After the examiner measures your initial ROM, state: 'I should mention that after repetitive use, my ROM decreases significantly - after 5 repetitions my arm can only reach X degrees.' Describe weakness and fatigue with specific examples.

Impact: Can provide basis for increased rating when initial ROM alone is at a lower threshold

Omitting night pain and sleep disturbance

Why: Night pain is a significant indicator of severity in shoulder conditions and influences how the examiner characterizes the disability. It is often overlooked.

Do this instead: Specifically describe if you wake at night due to shoulder pain, cannot sleep on the affected side, and how many nights per week this occurs.

Impact: Supports higher rating and functional impact documentation

Failing to specify which arm is dominant

Why: Under DC 5201, the dominant arm receives a higher rating (e.g., 40% vs 30% for the same level of limitation at 25-). If dominance is not confirmed, it may default incorrectly.

Do this instead: Clearly state your dominant hand at the start of the exam. The DBQ field RG_Dominant_Hand_RG captures this - ensure the examiner records it.

Impact: 10% difference at every threshold level

Not describing the full impact of instability episodes (dislocation/subluxation)

Why: Glenohumeral instability, recurrent dislocations, and apprehension may be ratable under additional DCs beyond 5201 (e.g., glenohumeral dislocation) but will only be documented if fully described.

Do this instead: Describe each dislocation or subluxation episode: date, mechanism, frequency, treatment required, and residual fear of movement. Mention guarding and avoidance behaviors.

Impact: May support additional separate rating under instability/dislocation codes

Understating the effect on occupational functioning

Why: Functional impact on employment is a required DBQ field and influences how the examiner characterizes the overall disability level. Underreporting may lead to an inadequate nexus opinion.

Do this instead: Explicitly connect shoulder limitations to your job duties - past and present. If you changed jobs, were reassigned, or lost income due to shoulder limitations, state this clearly.

Impact: Affects the functional impact narrative that supports all rating levels

Prep checklist

  • critical

    Gather all medical records and imaging related to your shoulder

    Collect X-ray and MRI reports, operative reports (arthroscopy, rotator cuff repair, joint replacement), physical therapy records, and all private and VA treatment notes for the shoulder. Bring copies or confirm they are in your claims file (eFolder).

    before exam

  • critical

    Write a personal statement documenting your symptoms on a typical day and your worst day

    Include: pain location and score (0-10) on average and worst days; exact ROM limitations you experience; flare-up frequency, triggers, duration, and severity; specific activities you can no longer perform; occupational impact; and DeLuca factors (fatigue, weakness, incoordination). Bring this to the exam.

    before exam

  • critical

    Review the DC 5201 rating thresholds so you understand what movements matter most

    The key thresholds are flexion/abduction limited to 90-, 45-, or 25-. Know approximately what each degree level looks like (90- = shoulder level; 45- = midway between side and shoulder; 25- = barely off the side). This helps you accurately communicate your real limits.

    before exam

  • critical

    Note your dominant hand clearly in your records and be prepared to state it

    Dominant arm limitation receives higher ratings under DC 5201. If your dominant arm is affected, confirm this is documented in your claims file and state it at the start of your exam.

    before exam

  • recommended

    List all medications and treatments used for shoulder pain

    Include prescription NSAIDs, opioids, muscle relaxants, corticosteroid injections (frequency and dates), physical therapy, and any assistive devices (sling, brace). This demonstrates the severity requiring ongoing treatment.

    before exam

  • recommended

    Identify any buddy statements, lay statements, or occupational records

    Statements from co-workers, supervisors, family members, or friends who have observed your shoulder limitations add lay evidence of functional loss. Submit these via VA Form 21-10210 before the exam date.

    before exam

  • optional

    Research your recording rights in your state

    Many states and VA exam locations allow veterans to record C&P exams. Check your state's recording consent laws and confirm VA policy. Bring a recording device and notify the examiner politely at the start if you intend to record.

    before exam

  • critical

    Do not take extra pain medication before the exam to 'push through' it

    Taking extra pain medication before the exam may artificially suppress your symptoms and allow you to demonstrate a higher ROM than is typical. Maintain your usual medication regimen so the exam reflects your actual functional status.

    day of

  • recommended

    Dress appropriately for a shoulder exam

    Wear a sleeveless shirt, tank top, or a shirt that is easy to remove. The examiner needs clear access to both shoulders for ROM testing and physical examination including palpation and special tests.

    day of

  • critical

    Bring your written symptom statement and medication list

    If the examiner does not ask about flare-ups, fatigue, or functional impact, politely provide your written statement and request it be reviewed and incorporated into the DBQ.

    day of

  • recommended

    Arrive early and observe your own symptoms

    Note how your shoulder feels getting dressed, driving to the appointment, and sitting in the waiting room. These real-world observations can be shared with the examiner as examples of day-to-day functional status.

    day of

  • critical

    Explicitly state your worst-day and flare-up ROM if today is a better day

    If the exam day is a relatively good day, proactively say: 'I want to note that today is better than usual. On bad days or during flare-ups, I can only raise my arm to approximately X degrees and my pain is X/10.' This must be documented by the examiner.

    during exam

  • critical

    Report pain throughout the ROM arc - not just at end range

    Tell the examiner exactly where in the arc your pain begins and how it changes. Example: 'Pain starts at about 40- and becomes severe by 70-. I could technically force it to 90- but only with 8/10 pain that I would not do in real life.' This documents painful arc and functional loss under 38 CFR 4.45.

    during exam

  • critical

    Demonstrate and describe all DeLuca factors after initial ROM testing

    After the examiner measures ROM, state: 'I should also mention that with repetitive use, my ROM decreases significantly. After 5 or so repetitions, my arm can only reach [reduced degrees] and the pain increases to [score].' Also describe fatigue onset time, weakness with resistance, and incoordination or guarding behaviors.

    during exam

  • critical

    Tell the examiner how the condition affects your occupation and daily activities

    Even if not directly asked, provide specific examples: 'I had to stop working as a [job] because I cannot perform [specific task].' Or: 'I cannot put on a shirt, wash my hair, or carry groceries without significant pain.' The examiner is required to document functional impact in the DBQ.

    during exam

  • recommended

    Confirm the examiner is documenting your dominant hand

    You may politely ask: 'Can you confirm you are recording which arm is my dominant arm?' A 10% rating difference exists between dominant and non-dominant arms at every threshold.

    during exam

  • recommended

    Ask the examiner to note if repetitive use testing was or was not performed

    If the examiner does not perform repetitive use testing (3 repetitions of ROM), note this. Per DeLuca requirements and M21-1, functional loss from repetitive use should be documented. You may state: 'My symptoms are significantly worse with repetitive motion - should that be documented?'

    during exam

  • critical

    Document everything you remember immediately after leaving

    Write down what questions were asked, what tests were performed, what you said, and what the examiner appeared to document. Note if any DeLuca factors or flare-up descriptions were omitted. Keep this for potential future appeals.

    after exam

  • critical

    Request a copy of the completed DBQ once it is filed

    You can request your C&P exam report through your VA eFolder (via VA.gov or VSO). Review it for accuracy - particularly ROM measurements, dominant hand notation, DeLuca factors, and functional impact documentation.

    after exam

  • recommended

    If the DBQ is inaccurate or incomplete, request a supplemental claim or CUE

    If DeLuca factors are missing, ROM measurements are inaccurate, dominant hand is wrong, or flare-up descriptions are absent, work with a VSO or accredited claims agent to submit a supplemental claim with a private nexus/DBQ opinion or file a Notice of Disagreement if a rating decision has been issued.

    after exam

Your rights during a C&P exam

  • You have the right to have a VSO (Veterans Service Organization) representative or accredited claims agent present during the exam in most circumstances.
  • You have the right to record the C&P examination in many states; check your state's recording consent law and notify the examiner at the start of the exam.
  • You have the right to request an in-person examination rather than a telehealth exam if you believe your condition cannot be adequately evaluated remotely.
  • You have the right to receive a copy of the completed DBQ examination report through your VA eFolder via VA.gov.
  • You have the right to request a new C&P examination if the original DBQ is inadequate - for example, if DeLuca factors were not addressed, ROM was not measured, or flare-up descriptions were omitted.
  • You have the right to submit a private medical opinion (nexus letter or private DBQ) as evidence to supplement or rebut the VA C&P examiner's findings.
  • You have the right to file a Notice of Disagreement (NOD) or Supplemental Claim if you disagree with the rating decision, including if the examiner failed to follow proper protocols.
  • Under M21-1 and 38 CFR 4.40, functional loss due to pain, fatigue, weakness, or incoordination must be considered separately from ROM measurements - you have the right to have these factors documented.
  • Under the benefit-of-the-doubt standard (38 CFR 3.102), when there is approximate balance of positive and negative evidence, the benefit of the doubt shall be given to the veteran.
  • You have the right to present lay evidence (personal statements, buddy statements) regarding the nature, onset, and severity of your symptoms, which the examiner and adjudicator must consider.

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.