What Happens During the VA Mental Health C&P Exam? (A Veteran's Guide)

Written by: Deborah Miller, PhD, HSPP - Owner and Lead Psychologist at vetnexusletter.com

If you’ve filed a VA disability claim for PTSD, depression, anxiety, or another mental health condition, you’ll likely be scheduled for a Compensation & Pension (C&P) exam. For many veterans, this appointment can feel confusing or even intimidating. What should you expect? How can you prepare? And what role does this exam play in your claim?

As a psychologist who has conducted hundreds of C&P exams on a contract basis with the VA, and who has consulted with hundreds of veterans for independent mental health exams to support their VA claims, I have a thorough understanding of what SHOULD happen in a C&P exam - and what could go wrong.

Understanding the C&P Exam Process

- The C&P exam is not a typical medical appointment. It’s an evaluation to help the VA determine if your mental health condition is service-connected and how it affects your daily life.

- The examiner (often a VA psychologist or psychiatrist, or someone contracted by the VA) will review your records, ask about your symptoms, and may use standardized questionnaires.

- You’ll be asked about your military history, any traumatic events (stressors), and how your symptoms impact work, relationships, and daily functioning.

- The examiner is not there to provide treatment or make recommendations for care. Their job is to gather information for the VA’s decision-making process.

What the Examiner Looks For

- Consistency between your reported symptoms and your medical records.

- Evidence that your condition began or worsened during (or because of) your military service.

- The severity and frequency of your symptoms, and how they affect your ability to function.

Deficiencies in the C&P Process

While the C&P process is meant to favor the veteran, as the VA states that the disability process is not meant to be contentious or weighted against the veteran, the unfortunate truth is that some C&P examiners don't do a great job.

Independent investigations and Congressional oversight have revealed significant deficiencies in VA C&P examinations conducted by third-party contractors. A 2021 letter from Senator Elizabeth Warren to the VA raised concerns about the quality and oversight of contracted C&P exams, noting that veterans were frequently subjected to rushed, inconsistent, or inaccurate evaluations. The Government Accountability Office (GAO) has also criticized the VA’s oversight, highlighting that some contractors failed to ensure that examiners were properly trained or that exams adhered to VA standards. These issues have led to erroneous disability determinations and unnecessary appeals, undermining veterans’ access to timely and accurate benefits decisions (GAO, 2018; Warren, 2021).

Personally, in my time as a VA contractor, I noted these same issues. Contractors are paid poorly for their time, creating a temptation to rush through an exam as quickly as possible to fit more exams into the day. In working with veterans who are trying to get appropriate documentation for their mental health symptoms, I often hear - "My C&P exam was only 15 minutes. They barely asked any questions and just made me feel like I had to make sure to tell them every detail off the top of my head. I had no idea what they needed to hear from me - I had never had a mental health exam so I wasn't sure what to say."

An appropriate, ethical diagnostic evaluation will usually take 45-90 minutes, depending on the complexity of the case and how talkative the veteran is. The examiner should be asking probing questions to get to the heart of the veteran's issues - not forcing the veterans to rely on their own guesses of what information the examiner might need.

If you've had a deficient C&P examination, here are the steps you should follow.

How a Psychologist Can Help

- If you feel your C&P exam didn’t capture the full picture, or if the VA examiner’s opinion was unfavorable, a private psychologist can provide an independent evaluation. A private psychologist who is trained in diagnostic evaluation and is familiar with VA disability claims will be likely to take ample time for your exam and ask you detailed questions to gather the information required by the VA to support your claim.

- A detailed nexus letter or DBQ (Disability Benefits Questionnaire) from a qualified psychologist can clarify your diagnosis, the impact of your symptoms on your daily life, and how your symptoms are connected to your time in service.

- Independent medical opinions can be especially helpful if your claim was denied or if you need to appeal.

Take the Next Step

If you need an independent mental health evaluation and/or nexus letter to support your VA claim, we’re here to help. Contact Dr. Miller by filling out this form.