Q: "If I submit a private DBQ, will the VA call me in for a C&P exam?"
- Deborah Miller
- Apr 10
- 5 min read
Written by: Deborah Miller, PhD, HSPP - Owner and lead psychologist at Veteran Disability Services (vetnexusletter.com)
Submitting a Disability Benefits Questionnaire (DBQ) completed by a private healthcare provider can strengthen your VA disability claim by offering detailed medical evidence. However, the VA may still require you to attend a Compensation & Pension (C&P) exam if they determine that additional information is necessary to make a decision on your claim.
The VA is obligated to consider all evidence, including private DBQs, when evaluating your claim. They cannot dismiss a privately completed DBQ without a justifiable and documented reason. If the VA finds the private DBQ insufficient for rating purposes, they may request a C&P exam to gather the needed information.
This is where the gray area comes into play - what factors cause the VA to deem a private DBQ "insufficient" for rating purposes? The VA is not necessarily required to explain why they have deemed a DBQ insufficient, but here are some factors that might trigger a follow-up C&P exam:
1. Incompleteness or Errors
Missing or unclear sections.
Inconsistent or contradictory medical information.
Failure to include necessary diagnostic testing or exam findings.
2. Lack of Specificity
DBQ doesn't address specific rating criteria outlined in 38 CFR Part 4.
Vague symptom descriptions without clear clinical connections to the claimed condition.
3. Insufficient Detail or Rationale
Minimal narrative or rationale provided by the physician.
No clear explanation linking symptoms to the claimed disability.
4. Provider Credibility or Qualifications
The healthcare provider lacks relevant expertise or proper credentials.
Provider is unfamiliar with VA guidelines or regulations.
5. Conflicting Medical Evidence
Discrepancies between the private DBQ and other medical records or statements in your file.
Significant differences between the DBQ findings and previously documented VA exams.
6. Timing and Currency
The DBQ is outdated or doesn't reflect current medical status.
Submitted DBQ lacks recent medical evidence or testing results required for accurate assessment.
7. Suspicion of Bias
DBQs prepared by organizations frequently associated with exaggerated claims or previously questioned by the VA.
Patterns suggesting the DBQ was influenced by coaching or guided responses.
To combat these issues with private DBQs and nexus letters, you can do the following:
Make sure you are providing your examiner with all the relevant information. If you tell your private examiner that you are severely depressed because of your chronic pain, but your medical records indicate that you always tell your physician you are doing great and are very happy, then the VA might consider that contradictory evidence and call you in for an examination.
Get your symptoms documented in your medical records. If you are the type of person who always checks the "no" box on the screening for depression at the doctor's office - now is the time to change that. Do not lie about your symptoms, but don't hide them either.
Make sure the person completing your DBQ has the qualifications required by the VA to provide a diagnosis for your condition and complete the DBQ. For mental health exams, the VA requires that the DBQ is completed by a psychiatrist or psychologist, or a clinician working "under close supervision" of one of these.
Ensure that the person completing your DBQ has knowledge and training in the VA disability process and how to complete DBQs according to VA standards. The DBQ seems like a simple form, however, there are certain details that providers can overlook that may trigger a C&P exam.
If you are hiring an independent examiner, ensure that they run a reputable business and that they do not provide unethical services to their clients. All reputable clinicians should state clearly that they do not promise a positive outcome for your examination. Findings should be reported objectively and be based on evidence from the examination, your personal statements, lay statements, medical records, service treatment records, etc.
If your current examination provides very different results compared to previous C&P exams, the examiner should provide a plausible explanation as to why that is. An example I see often is that veterans are not used to talking about their mental health symptoms, so they have no record of mental health issues in their medical records. They apply for a mental health condition because their service-connected chronic pain is ruining their life. They get to their C&P exam and the examiner is rushing them through, taking only 15-20 minutes, and important questions are not asked during the exam. The veteran's claim gets denied because the examiner stated there was no mental health diagnosis based on the (inadequate) C&P exam. Then the veteran seeks help from a private psychologist who provides a thorough diagnostic exam, uncovering the true nature of the mental health disorder once the veteran is given time and feels comfortable sharing. In this case, the veteran should write a personal statement regarding the problems they have faced with talking about their mental health issues in the past (stigma, embarrassment, not wanting to appear weak, military culture, etc.) and also the issues with the C&P examination. The provider preparing the DBQ and accompanying nexus letter should directly address the discrepancies between the C&P exam and the private exam in their letter, to provide the VA with a reasonable explanation of the discrepancies and decrease the need for an additional C&P exam.
Finally:
If you get called in for a C&P exam, it's not the end of the world. Your private DBQ examiner could have done everything right, and the VA may still call you in. Despite how discouraging this may feel, remain level-headed and attend the C&P exam. Make sure to provide them all the information you provided your private examiner. Ask them directly if they read the private exam and nexus letter, and where they feel the detail is lacking so that you can address those concerns during the C&P exam. Read through your DBQ/nexus letter prior to the C&P exam and make sure to share your symptoms clearly with the C&P examiner, even if they don't directly ask you a question about your symptom.
Some companies will tell you to decline to attend the C&P exam. I personally have seen this work - and also fail - for my clients. I have had clients attend a C&P examination that provided a negative opinion about their claim, but the VA used my documents instead of their own examiner's documents because mine were higher quality. I've had clients get approved without a C&P examination, even in cases where they should have been called in for a C&P exam (for instance, for combat-related PTSD cases). The VA is unpredictable and run by humans - and humans are notorious for making errors, especially when they are poorly trained and underpaid. While I can't recommend any particular decision to make when you're called in for a C&P exam, since I'm not a lawyer or VSO, I would highly recommend thinking carefully about your decision to attend or not attend a C&P examination, as declining a C&P exam is a very easy way for the VA to reject your claim without having to give any other reason.
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