Why does the VA want me to attend another C&P Exam?

“Why does the VA want me to attend another C&P exam?”

I hear this question a lot from veterans that I’ve assisted in getting VA Disability Compensation (VADC). 

We filed a veteran’s claim for mesothelioma or lung cancer, they attended a Compensation & Pension (C&P) Exam, their claim was approved, and they have been drawing VADC at 100% for some time now. Then, out of the blue, the veteran is contacted by one of the medical agencies contracted by the VA to perform C&P exams, and told they need to come in for another medical examination.

So why does the VA do this?

The answer is in the VA Ratings Guidelines for pleural mesothelioma, peritoneal mesothelioma and lung cancer along with something the VA calls “residuals.”  

 

Ratings Guidelines and Residuals

The rating guidelines for each disease say essentially the same thing – award a 100% disability rating when the veteran has active malignancy, with a caveat that reads as follows:

“Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. If there has been no local recurrence or metastasis, rate on residuals.”

In other words, if you have gone more than six months since receiving any treatment for your cancer, and you currently have no signs of cancer (based on your most recent CT scan), the VA isn’t going to continue to pay you at the 100% rate. Instead, they are going to determine your new rating based on residuals.  

Residuals are any lingering disabilities you have either from the cancer itself or from the treatment of it. For instance, if you have had part of a lung removed, then your decreased lung capacity as a result of surgery is also service-connected.  Therefore, your new rating will be, at least in part, based on your lost lung capacity.

Now, if you have mesothelioma, I know what you’re thinking: “But my doctor tells me my mesothelioma is not curable, so how can the VA reduce my rating, even if I have no signs of current malignancy? I’m told it’s only a matter of time before it comes back.”

Yes, it is true mesothelioma is generally considered a terminal illness, but not always.  There are many people who have beaten their mesothelioma and lived more than five years without a recurrence. But none of this – whether your mesothelioma returns or not – matters to the VA.  

All the VA cares about is whether you are still battling cancer or not. If you still have detectable malignancy, then you will continue to receive a 100% rating. If you no longer have any signs of cancer, and your doctor is monitoring you for a recurrence with regularly scheduled CT scans, and it has been more than six months since you have received any treatment, then the VA is going to rate you going forward based on your residuals.  

Of course, if they reduce your rating and then you have a recurrence of your cancer, you can request an increase in your rating, submit your most recent CT scan showing the cancer has returned, and the VA will restore your 100% rating and begin paying once again at the 100% rate.  

 

Another Example of VA Asking for a Second C&P Exam

One other, less-common situation is when the VA asks for a second C&P exam before ever making an initial decision on the claim based on the first C&P Exam.  

I actually had this happen recently where the VA scheduled a second C&P exam for a veteran with pleural mesothelioma about seven months after his original C&P exam. The veteran called me rather flustered asking me why the VA would do this.

I told him the only reasonable reason the VA would do this is because it’s taken them so long to make a decision on your claim. They have allowed more than six months to pass since they received the last C&P doctor’s report. Therefore, it is possible (albeit unlikely) that he was now more than six months since he had any treatment and could therefore possibly be in remission. This means the VA would only pay him the 100% disability rate up until the six month point since his last treatment and then rate him based on residuals.  

So I told him to just go to the second C&P exam and bring some recent medical records showing he still has mesothelioma and is being treated for it. The VA took about a month to approve his claim and award him a 100% rating.

If you have any questions about C&P exams or need advice regarding your VA claim, feel free to reach out to me anytime. I can be reached by phone at 844-838-6376 or by email at cjewett@mesotheliomaguide.com.