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VA Rating Assistant

DC 5120 · 38 CFR 4.71a

Upper Extremity Loss of Use (Complete Arm Function Loss) C&P Exam Prep

To evaluate the nature, level, and functional impact of upper extremity amputation or complete loss of use under DC 5120, including stump condition, prosthetic use, and whether the limb/residual limb meets criteria for loss of use equivalent to amputation at the shoulder.

Format:
Interview + Physical
Typical duration:
30-60 minutes
DBQ form:
amputations (amputations)
Examiner:
Orthopedic Surgeon, Physiatrist, or Prosthetist

What the examiner evaluates

  • Level and date of amputation or surgical procedure
  • Whether loss of use is equivalent to amputation at the shoulder disarticulation level
  • Stump condition including length, skin integrity, neuromas, and bony prominences
  • Prosthesis use: type, frequency, tolerance, and functional benefit
  • Whether amputation is improvable by prosthesis
  • Residual limb complications such as phantom pain, stump pain, skin breakdown, or infection
  • Presence of forequarter amputation, shoulder disarticulation, or above/below deltoid insertion amputation
  • Pronator teres insertion level for forearm amputations
  • Functional impact on activities of daily living, occupational performance, and self-care
  • Use of assistive devices including prostheses, braces, canes, crutches, wheelchairs, or walkers
  • Dominant vs. non-dominant limb status
  • Presence of concurrent conditions affecting the contralateral limb or overall function
  • Neurological complications including phantom limb sensation or residual nerve pain

Exam will involve direct physical inspection of the residual limb or affected extremity, review of amputation records and surgical reports, prosthetic fitting and use assessment, and functional performance evaluation. Bring your prosthetic device(s) to the exam if you use one. The examiner will document exact amputation level relative to anatomical landmarks (deltoid insertion, pronator teres insertion, metacarpophalangeal joints). Be prepared to demonstrate functional limitations both with and without the prosthesis.

Measurements and tests

Residual Limb Length Measurement

What it measures: The length of the residual stump from the most proximal bony landmark to the distal end, which directly determines the applicable diagnostic code and rating level under 38 CFR 4.71a.

What to expect: The examiner will use a tape measure to document stump length in centimeters from anatomical reference points such as the acromion, deltoid insertion, or lateral epicondyle. The relationship to the deltoid insertion (above vs. below) is critical for upper arm amputations, and the pronator teres insertion is critical for forearm amputations.

Critical thresholds

  • Forequarter amputation (complete removal of scapula and clavicle) DC 5110 - 80% for dominant arm, 70% for non-dominant arm; qualifies for SMC(a)
  • Shoulder disarticulation (complete removal of humerus) DC 5110 - 80% dominant, 70% non-dominant; qualifies for SMC(a)
  • Amputation above deltoid insertion DC 5110 - 80% dominant, 70% non-dominant
  • Amputation below deltoid insertion DC 5120 - 60% dominant, 50% non-dominant
  • Amputation above pronator teres insertion (forearm) DC 5120 - 60% dominant, 50% non-dominant
  • Amputation below pronator teres insertion (forearm) DC 5152 - 50% dominant, 40% non-dominant
  • Loss of use equivalent to amputation at shoulder (non-amputation) DC 5120 - rated as amputation at shoulder level; qualifies for SMC(a)

Tips

  • Know your exact amputation level before the exam by reviewing your surgical operative reports.
  • Understand that the deltoid insertion is approximately at the midpoint of the humerus - amputation above vs. below this landmark changes the rating.
  • If you have a functional limb but complete loss of use, the examiner must document why prosthesis cannot improve function, which affects whether SMC(a) applies.
  • Bring any prior measurements documented in VA treatment records to ensure consistency.

Pain considerations: Report any stump pain, phantom limb pain, or pain with prosthetic use that limits wear time or function. Pain that prevents consistent prosthetic use is a critical rating factor.

Stump Condition Assessment

What it measures: The physical condition of the residual limb including skin integrity, bony prominences, neuromas, scarring, contractures, and suitability for prosthetic fitting.

What to expect: The examiner will visually inspect and palpate the stump, noting skin health, presence of neuromas, bony spurs, adherent scars, ulcerations, infections, or edema. The shape and soft tissue coverage will be assessed for prosthetic compatibility.

Critical thresholds

  • Defective stump not improvable by prosthesis Rated at next higher amputation level; may qualify for SMC at higher level
  • Stump permitting prosthetic use with functional benefit Rated at actual anatomical amputation level
  • Stump with painful neuromas or skin breakdown preventing prosthetic wear May support defective stump rating and entitlement to higher evaluation

Tips

  • Report all stump complications honestly and specifically: neuroma location, frequency of skin breakdown, infection history.
  • Note how long per day you can tolerate wearing the prosthesis - less than 4 hours suggests significant stump pathology.
  • If your stump has changed since your last exam (worsened scarring, new neuroma, increased pain), describe these changes explicitly.
  • Bring documentation of any stump revisions, wound care visits, or dermatology consultations.

Pain considerations: Phantom limb pain and stump end pain are distinct - describe both separately. Rate them on a 0-10 scale on your worst days and explain how they interfere with prosthetic use and daily activities.

Prosthetic Functional Assessment

What it measures: Whether and to what extent a prosthetic device restores arm function, including type of prosthesis (body-powered, myoelectric, passive), hours of daily use, activities enabled vs. still limited, and whether function is truly 'improved' by the prosthesis.

What to expect: The examiner will ask about your prosthesis type, how long you have used it, how many hours per day you wear it, what you can and cannot do with it, and whether it causes pain or skin problems. You may be asked to demonstrate donning/doffing and functional grip or reach tasks.

Critical thresholds

  • Amputation not improvable by prosthesis (natural elbow joint not preserved or stump too short) Rated as loss of use at shoulder level - maximum rating under DC 5120
  • Amputation improvable by prosthesis but prosthesis not currently used Rated at anatomical level; document medical reasons for non-use if applicable
  • Prosthesis used but with significant functional limitations Functional impact documented in DBQ supports higher combined or secondary ratings

Tips

  • Be specific about what your prosthesis cannot do: overhead reaching, fine motor tasks, bilateral activities, carrying heavy objects.
  • If you choose not to wear your prosthesis, explain the medical reason (skin breakdown, pain, sweating, ill fit) rather than simply preference.
  • A myoelectric prosthesis that works inconsistently due to signal loss or discomfort is still a limitation worth documenting.
  • Ask your prosthetist to write a letter documenting fit issues, functional limitations, and hours of comfortable use before the exam.

Pain considerations: Document pain caused by prosthetic socket pressure, harness chafing, or residual limb heat and swelling during use. Describe how pain limits the number of hours you can wear the prosthesis on your worst days.

Functional Reach and Grip Assessment

What it measures: The residual functional capacity of the affected extremity or the compensatory function developed in the intact limb, used to document overall occupational and daily living impact.

What to expect: The examiner may observe or ask about your ability to perform overhead reach, forward reach, grip strength, pinch, and bimanual tasks. For loss-of-use claims on an intact but non-functional limb, the examiner must document that the limb is no more useful than if it were amputated at the shoulder.

Critical thresholds

  • Limb cannot be used for any gainful purpose (loss of use, non-amputation) Rated as amputation at shoulder level under DC 5120
  • Partial functional loss May be rated under separate DCs for weakness, limitation of motion, or paralysis rather than 5120

Tips

  • For loss-of-use claims on an intact limb, document that you cannot perform any meaningful task with that limb without assistance.
  • Describe specific activities you cannot perform: buttoning clothing, typing, lifting a glass, turning a doorknob.
  • Describe compensatory strategies you use (relying entirely on the opposite arm) as evidence of the affected arm's uselessness.
  • Pain, weakness, incoordination, and fatigue that collectively render the limb non-functional should all be described - these are DeLuca factors.

Pain considerations: For intact but non-functional limbs, report pain on a 0-10 scale at rest and with attempted use. Note how quickly the limb becomes painful or fatigued with any attempted activity, even on your best days.

Rating criteria by percentage

80%

Forequarter amputation (complete removal of arm, scapula, and clavicle) - dominant arm. Also applies to shoulder disarticulation involving complete removal of the humerus, dominant arm. Qualifies the veteran for Special Monthly Compensation (SMC) at the 'a' level for loss of use of a creative organ substitute.

Key symptoms

  • Complete absence of the entire upper extremity including shoulder girdle
  • No residual limb below the glenohumeral or acromioclavicular joint
  • Total loss of all arm function with no prosthetic improvement possible
  • Significant phantom pain or referred neuropathic pain in absent limb
  • Complete dependence on contralateral arm for all bilateral activities
  • Psychological and functional impact of total limb loss

From 38 CFR: 38 CFR 4.71a DC 5110: Amputation at shoulder level or above, or with so little remaining that a prosthesis of any kind cannot be used. Dominant arm rated 80%.

70%

Forequarter amputation or shoulder disarticulation - non-dominant arm. Complete removal of the non-dominant arm at or above the shoulder joint. Qualifies for SMC(a).

Key symptoms

  • Complete absence of non-dominant upper extremity at or above shoulder level
  • No usable residual limb for prosthetic fitting
  • Total dependence on dominant arm for all activities
  • Phantom limb pain or stump neuropathy
  • Loss of bilateral hand function affecting all complex tasks

From 38 CFR: 38 CFR 4.71a DC 5110: Non-dominant arm, forequarter or shoulder disarticulation level. Rated 70%.

60%

Amputation of the upper arm (humerus) below the shoulder disarticulation but above the deltoid insertion, dominant arm. Also covers amputation above the pronator teres insertion in the forearm, dominant arm. Includes loss of use of a hand or arm equivalent to this level under DC 5120.

Key symptoms

  • Residual limb present but above the deltoid insertion level
  • Loss of all elbow function below the amputation site
  • Stump may permit limited prosthetic fitting but function remains severely limited
  • Phantom limb pain, stump end pain, or neuroma pain
  • Inability to perform overhead activities, heavy lifting, or fine motor tasks
  • Prosthesis not improvable due to stump level or condition (for DC 5120 loss of use)

From 38 CFR: 38 CFR 4.71a DC 5120: Amputation at elbow or above, or with so little remaining that a prosthesis cannot be used - dominant arm 60%. DC 5120 also captures loss of use where the limb cannot be used as effectively as a prosthesis would allow.

50%

Amputation above deltoid insertion or above pronator teres insertion - non-dominant arm. Also covers loss of use of the non-dominant arm at this level under DC 5120.

Key symptoms

  • Loss of non-dominant upper extremity at or above the defined anatomical landmarks
  • Stump condition permitting or not permitting prosthetic use
  • Functional loss preventing use of the non-dominant limb for any assistive role
  • Pain, weakness, or neuropathy limiting prosthetic tolerance

From 38 CFR: 38 CFR 4.71a DC 5120: Non-dominant arm amputation above deltoid or pronator teres insertion - rated 50%.

Describing your symptoms accurately

Phantom Limb Pain and Sensation

How to describe it: Describe phantom pain as distinct from stump pain. Specify: location within the absent limb (e.g., 'feels like burning in my missing hand'), intensity on a 0-10 scale, frequency (constant vs. episodic), duration of episodes, and any triggers. Note whether it disrupts sleep, concentration, or the ability to wear a prosthesis.

Example: On my worst days, the phantom pain in my absent forearm feels like a 9 out of 10 burning and crushing sensation that lasts 4-6 hours. It wakes me from sleep at least three nights per week and prevents me from wearing my prosthesis because any socket contact intensifies the sensation.

Examiner listens for: Documentation of neurological-type pain that is distinct from mechanical stump pain; evidence that phantom pain is chronic, severe, and functionally limiting; impact on prosthetic use and sleep.

Avoid: Do not simply say 'I have some phantom pain sometimes.' Quantify frequency, intensity, duration, and functional impact. Do not conflate phantom sensation (non-painful awareness of absent limb) with phantom pain - they are rated differently.

Stump Pain and Skin Complications

How to describe it: Describe stump end pain, neuroma pain (sharp, electric, point-specific), skin breakdown, ulceration, infection history, sweating under the socket, and bony prominence pain. Specify how many hours per day you can tolerate the prosthetic socket before pain forces removal.

Example: On my worst days, the neuroma at the end of my stump causes sharp electric shocks radiating up my arm with any pressure, limiting prosthesis wear to less than 2 hours. I develop a skin ulcer at the distal end approximately once per month requiring wound care and 5-7 days of prosthesis discontinuation.

Examiner listens for: Objective stump pathology that limits prosthetic use; history of stump revisions or wound care; evidence that the stump is 'defective' under VA rating criteria; pain severity that supports a higher rating level.

Avoid: Do not say 'the skin gets a little irritated.' Document specific locations, frequency of breakdown, treatment required, and how it affects prosthetic use. Skin problems that limit prosthesis to under 4 hours daily are material to the rating.

Functional Limitations in Activities of Daily Living

How to describe it: Describe every task you cannot perform or can only perform with great difficulty due to the limb loss. Categorize by self-care (bathing, dressing, grooming), home management (cooking, cleaning, opening containers), occupational tasks, and recreational activities. Describe bilateral tasks you cannot perform without adaptive equipment or assistance.

Example: I cannot button my shirt, tie my shoes, open a jar, cut food, carry a bag on that side, shake hands, type with two hands, or hold my child with both arms. On bad days when phantom pain is severe, I cannot concentrate well enough to perform even simple computer tasks. I require adaptive equipment for dressing and rely on my spouse to help with meal preparation daily.

Examiner listens for: Specific, concrete functional limitations that demonstrate the arm is not usable for any meaningful purpose; evidence of dependence on the contralateral limb or caregiver assistance; impact on employment and quality of life.

Avoid: Avoid vague statements like 'I can't do much with it.' Provide a specific list of activities impaired. Do not minimize difficulties by saying 'I manage' - describe the effort, pain, or time required even when you do manage.

Prosthetic Use Limitations and Challenges

How to describe it: Describe prosthesis type (body-powered hook, myoelectric hand, passive cosmetic), hours of comfortable daily wear, situations requiring removal, mechanical failures, tasks the prosthesis cannot replicate, and how long it took to learn to use it. Note if you were prescribed a prosthesis but cannot use it due to stump condition.

Example: I use a myoelectric prosthesis but can only wear it 3-4 hours on a good day and less than 1 hour on bad days due to socket pressure pain and heat buildup. The prosthesis cannot perform fine pinch, overhead tasks, or rapid grip changes. In wet conditions, rain or sweat causes signal failures. I cannot sleep in it and must remove it for all personal hygiene tasks.

Examiner listens for: Evidence that the prosthesis does not fully restore arm function; medical reasons for limited prosthetic use; whether the stump condition prevents prosthetic use altogether, supporting a 'not improvable by prosthesis' finding.

Avoid: Do not imply your prosthesis works well if it does not. Do not omit limitations because you feel you 'should' be able to use it better. The examiner needs an honest, complete picture of actual prosthetic function, not idealized performance.

Pain with Attempted Use - DeLuca Factors

How to describe it: For veterans with loss of use of an intact (non-amputated) limb, describe all six DeLuca factors: (1) pain at rest and with movement, (2) fatigue after attempted use, (3) weakness throughout range of motion, (4) incoordination or loss of fine motor control, (5) flare-up frequency and duration, and (6) loss of function after repetitive use.

Example: When I attempt to use my arm, within 30 seconds of effort I develop severe pain rated 8/10, the arm trembles and loses coordination, and I experience complete weakness within 2 minutes. On flare-up days, which occur 3-4 times per week, I cannot raise the arm above waist level at all. After any attempted repetitive use, function deteriorates for 24-48 hours.

Examiner listens for: Objective and subjective evidence that the limb cannot be used for any useful purpose; consistency between reported limitations and observed behavior during the exam; evidence that function is equivalent to absence of the limb.

Avoid: Do not perform tasks during the exam that contradict your reported limitations. If the examiner asks you to do something painful, say so immediately and rate the pain. Do not push through pain silently - the examiner needs to observe your true functional limit.

Common mistakes to avoid

Wearing the prosthesis to the exam and demonstrating smooth functional use

Why: If you wear your prosthesis comfortably for the entire exam duration, the examiner may note that the prosthesis improves function, potentially reducing the rating or defeating a loss-of-use claim.

Do this instead: Wear the prosthesis only as long as comfortable. If it causes pain or skin irritation during the exam, remove it and explain why. Demonstrate your actual functional tolerance, not your best-day performance. Bring the prosthesis to show the examiner but accurately represent daily use limitations.

Impact: 60%-80%

Failing to specify dominant vs. non-dominant arm status

Why: Under DC 5120, the dominant arm is rated 10 percentage points higher than the non-dominant arm at most levels. If you do not clarify dominance, the examiner may default to a lower rating.

Do this instead: Explicitly state which arm is your dominant arm at the start of the exam. If the amputated arm was your dominant arm, emphasize the occupational and daily living impact of losing your dominant extremity.

Impact: 50%-80%

Not reporting phantom limb pain or minimizing its severity

Why: Phantom pain is a legitimate, rateable complication of amputation that affects prosthetic use and quality of life. Underreporting it may prevent documentation of a defective stump or secondary psychiatric/pain condition.

Do this instead: Prepare a written log of phantom pain episodes before the exam, noting frequency, intensity (0-10), duration, triggers, and impact on sleep and prosthetic use. Present this to the examiner.

Impact: All levels; also affects SMC eligibility

Not bringing all prosthetic devices to the exam

Why: If you have multiple prostheses (e.g., a work hook and a cosmetic hand) and only bring one, the examiner cannot assess the full scope of your prosthetic needs and limitations.

Do this instead: Bring every prosthetic device prescribed to you, including any that no longer fit, are uncomfortable, or are rarely used. Show the examiner why certain devices are not practical for daily use.

Impact: All levels

Describing only current average symptoms rather than worst-day symptoms

Why: VA rating is based on the full range of the condition's impact, including worst-day function. The M21-1 guidance and DeLuca factors require the examiner to consider the highest level of impairment, not just average presentation.

Do this instead: Explicitly tell the examiner: 'On my worst days, which occur [frequency], I experience [specific symptoms at maximum severity].' Contrast this with average and best days to provide a complete picture.

Impact: All levels

Omitting secondary conditions related to the amputation

Why: Upper extremity amputation often causes secondary conditions including overuse injuries to the contralateral arm, cervical spine strain, depression, PTSD, and sleep disorders, all of which may be separately ratable or support a higher combined rating.

Do this instead: Report all conditions that developed or worsened after the amputation. Describe how the loss of one arm has placed excessive strain on the opposite shoulder, neck, or back. Mention any mental health impacts and ensure these are separately claimed.

Impact: Overall combined rating and SMC eligibility

Not requesting a copy of the completed DBQ before leaving the exam

Why: Errors in DBQ documentation - wrong amputation level, incorrect dominance notation, failure to check key boxes - can significantly reduce the rating. You have the right to review the completed form.

Do this instead: Ask the examiner or scheduling coordinator how to obtain a copy of the completed DBQ. Review it promptly through your VA MyHealtheVet records and file a supplemental claim or request a new exam if errors are found.

Impact: All levels

Prep checklist

  • critical

    Obtain and review all surgical operative reports documenting amputation level

    Request records through VA MyHealtheVet or your private surgeon. Confirm the exact anatomical level documented (forequarter, shoulder disarticulation, above/below deltoid insertion, above/below pronator teres insertion). This is the single most important document for determining your rating level under DC 5120.

    before exam

  • critical

    Write a detailed symptom statement covering all DeLuca factors and worst-day experiences

    Create a 1-2 page written statement covering: phantom limb pain (frequency, intensity, duration), stump condition (skin, neuromas, pain), prosthetic use hours per day, specific daily activities impaired, dominant arm status, and secondary conditions. Bring copies to hand to the examiner.

    before exam

  • critical

    Contact your prosthetist for a functional assessment letter

    Ask your prosthetist to document: prosthesis type and date of fitting, hours of comfortable daily wear, documented stump complications, activities that cannot be performed with the prosthesis, and any recommendation for prosthetic changes. This third-party functional evidence is highly persuasive.

    before exam

  • recommended

    Compile all prosthetic prescription and fitting records

    Gather records for all prostheses ever prescribed, including dates, types, fit issues, and reasons for discontinuation if applicable. If you were prescribed a prosthesis that you cannot use due to stump problems, this evidence supports a 'not improvable by prosthesis' finding.

    before exam

  • critical

    Document dominant hand status clearly in written materials

    State clearly in your symptom statement which arm is dominant. If the amputated arm was dominant, describe specifically how losing your dominant arm has affected every aspect of daily function, work, and hobbies.

    before exam

  • recommended

    Review 38 CFR 4.71a rating criteria for DC 5120 and related codes

    Understand the difference between DC 5110 (shoulder disarticulation), DC 5120 (elbow level and above, or loss of use), and DC 5152 (below pronator teres). Knowing which level applies to you helps you confirm the examiner is using the correct anatomical landmarks.

    before exam

  • recommended

    Identify and document all secondary conditions caused by the amputation

    List all conditions that developed after your amputation: contralateral shoulder overuse (rotator cuff tears, tendinitis), cervical spine issues, depression, anxiety, PTSD, sleep apnea, and chronic pain syndromes. These should be separately claimed as secondary conditions.

    before exam

  • recommended

    Check your state's laws on recording C&P examinations

    Most states permit single-party consent audio recording. Verify your state's rules and bring a small recording device or use your phone. Inform the examiner that you are recording. A recording can be invaluable if you need to contest an inadequate exam.

    before exam

  • critical

    Bring all prosthetic devices to the examination

    Bring every prosthesis you own, including those that do not fit well or cause pain. If possible, also bring any adaptive equipment you use (one-handed can openers, dressing aids, hook attachments). This demonstrates the full scope of your adaptive needs.

    day of

  • recommended

    Dress to facilitate easy examination of your residual limb

    Wear clothing that allows quick and complete exposure of the residual limb and shoulder region. Avoid compression garments that take a long time to remove. Wear your prosthetic liner or suspension system as you normally would.

    day of

  • critical

    Do not take extra pain medication to 'get through' the exam

    Take only your normal prescribed medications. Do not take additional pain medication to suppress symptoms for the exam. The examiner must see your typical functional level, not an artificially suppressed pain state.

    day of

  • critical

    Arrive early and bring your written symptom statement

    Arrive 15 minutes early. Hand your written symptom statement directly to the examiner at the start of the appointment and ask them to include it in the exam file. This ensures your worst-day symptoms are documented even if the examiner's questions are brief.

    day of

  • critical

    Verbally report pain immediately when it occurs during physical examination

    If the examiner touches your stump, asks you to move a residual limb segment, or manipulates your prosthesis during the exam and you experience pain, say so immediately with a numeric rating. Do not remain silent.

    during exam

  • critical

    Confirm and correct the examiner's documentation of amputation level

    At the conclusion of the exam, ask the examiner to confirm which amputation level they are documenting (above deltoid, below deltoid, forequarter, etc.). If they state an incorrect level, respectfully correct them and reference your surgical records.

    during exam

  • critical

    Explicitly describe your worst-day function, not your best

    If the examiner asks how you are doing or what you can do, begin with: 'On my worst days, which happen approximately [X] times per week...' Then describe maximum limitations before describing average function.

    during exam

  • critical

    Describe all six DeLuca factors if you have a non-amputated limb with loss of use

    For loss-of-use claims, proactively describe: pain at rest, pain with use, fatigue after repetitive use, weakness throughout range of motion, incoordination, and flare-up frequency and severity. Do not wait for the examiner to ask about each factor.

    during exam

  • recommended

    Request the examiner document functional impact on occupational activities

    Ask the examiner to document in the DBQ remarks section how the condition affects your ability to work, particularly if you perform manual labor or any job requiring bilateral hand use. This supports potential TDIU claims.

    during exam

  • critical

    Request a copy of the completed DBQ through VA MyHealtheVet

    Access your completed DBQ through VA MyHealtheVet Blue Button records or VBMS if you have VSO access, typically within 2-4 weeks after the exam. Review every checkbox and narrative for accuracy, especially amputation level, dominance, and functional impact descriptions.

    after exam

  • critical

    File a supplemental claim or inadequate exam request if DBQ contains errors

    If the examiner incorrectly documented the amputation level, noted incorrect dominance, failed to address all required elements, or did not review submitted records, contact your VSO or accredited claims agent immediately. You have the right to request a new adequate examination.

    after exam

  • recommended

    Verify that any secondary conditions are included in your active claims

    After the exam, review your claims file to ensure secondary conditions (contralateral overuse, depression, chronic pain) are active. If they were not examined, file new claims with supporting buddy statements and medical nexus letters.

    after exam

Your rights during a C&P exam

  • You have the right to a thorough, in-person examination by a qualified examiner (Orthopedic Surgeon, Physiatrist, or Prosthetist) with specific expertise relevant to upper extremity amputation and loss of use.
  • You have the right to request an audio or video recording of the C&P examination in most U.S. states under single-party consent laws. Verify your state's specific law before the exam.
  • You have the right to submit a written symptom statement, lay evidence, buddy statements, and supporting medical records before or during the examination, and all evidence must be considered by the examiner.
  • You have the right to have a VSO representative, accredited claims agent, or attorney present during the examination if you request it in advance.
  • You have the right to receive a copy of the completed DBQ through VA MyHealtheVet, VBMS, or a formal records request under the Privacy Act.
  • You have the right to challenge an inadequate examination by requesting a new examination through a Notice of Disagreement, Supplemental Claim, or Board Appeal if the examiner failed to address required DBQ elements, used incorrect anatomical landmarks, or did not review all submitted evidence.
  • You have the right to a Favorable Finding Letter documenting any facts confirmed during the exam that support your claim, under the VA's duty to assist.
  • You have the right to know the name and credentials of your examiner, and to request a qualified substitute if the assigned examiner lacks appropriate expertise in upper extremity amputation evaluation.
  • You have the right to be evaluated based on your worst-day symptoms, not your best-day performance, as required by M21-1 adjudication guidance and DeLuca v. Brown case precedent.
  • You have the right to have all secondary conditions and complications of your service-connected upper extremity loss evaluated concurrently, including phantom pain, psychiatric conditions, and contralateral overuse injuries.
  • You have the right to Special Monthly Compensation (SMC) evaluation if your amputation level or loss of use qualifies under 38 U.S.C. 1114(k) for loss of use of a creative organ or SMC(l) for loss of use of both extremities, and the examiner is required to document findings relevant to SMC eligibility.
  • You have the right to an Independent Medical Opinion (IMO) or nexus letter from a private physician, which carries equal evidentiary weight to the C&P examination under 38 CFR 3.303.

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.