VA Exams
In the first part we discussed the claim process and various VA letters that a claimant is likely to receive during the claim process. We now focus exclusively on VA exams. It’s a crucial element of the claims process, and often the most stress-inducing and frustrating part. A successful exam weighs greatly in the overall success of a claim, so its important that the Veteran is ready for these examinations!
3 Things to Keep in Mind for a Successful Exam
1. All exams start with a blank page: All exams start with a blank exam report. How much the examiner is able to fill in on that paper is up to you! Be honest, candid, and forthcoming about your symptoms. Communicate with the examiner during the examination, especially during range of motion testing for musculoskeletal conditions. Be exceedingly honest about the impact of symptoms on your daily life, work, or well-being. If symptoms ebb and flow, as is common in any condition, discuss what a bad day looks like and how often those occur. Do not assume any knowledge on the part of the examiner – they may or may not have read your file prior to the medical appointment. While the report may be blank at the beginning of the examination; you can help the results be more than a series of check boxes by communicating effectively during the exam.
2. Know what the exam is for. Apart from actually showing up at the exam, knowing what issues the exam will be focused on is incredibly important. When you submit a claim, you can reasonably assume that an examination will be ordered. What you claim (and even how you claim it) will have a direct bearing on the specific questions that VA asks its examiners to answer. If you don’t know what the exam is for – you won’t know how best to discuss your symptoms. The contractor should tell you what the purpose of the exam is, but if they do not, contact your accredited representative. Read more here for a few examples of how knowing what the exam is for can help produce successful exam results:
3. Bring some notes: There are generally two purposes in any VA examination (1) Record the history of the condition (this also helps to establish the “nexus” requirement for service connection claims), and (2) Document the current severity of a condition. The current severity of the condition is what VA will use to rate the claim using the VA’s rating schedule. The schedule contains criteria and symptoms necessary to award a rating at each interval. During an exam, its easy to be nervous and overcome with the questions being asked. To help ensure that you’re able to convey your symptoms accurately, take some notes prior to your appointment and bring those notes in with you. Explain to the examiner that you wrote down some notes about your condition so you wouldn’t forget, but don’t try to give your notes to the examiner (the examiner cannot accept them). But do use them to answer questions about the frequency and severity of your condition. [READ MORE HERE ON HOW TO PREPARE NOTES FOR AN EXAM]
So to prepare for an exam, what do you write in your notes? Think of it like a daily journal –
1. A scale of 1-10 – how bad is your pain/symptom today?
2. Did you take medication? And if so when?
3. Did the medication drop your pain on the pain scale?
4. Did you use other methods to alleviate the symptom? For example, with musculoskeletal conditions – did you use a hot/cold compress? Topical ointment? Rest?
5. How long did the symptom last?
6. Where the symptoms triggered by anything specific?
7. Did it prevent you from engaging in activities (including sleep)? If so, what?
8. Was there an increase in the symptom due to a flare up? If so, was there a particular trigger to the flare up?
Try to record at least a week of symptoms, but more if you can manage. Again, you can be reasonably assured that VA is going to schedule an examination, so you can start your log as soon as you submit your claim to have the most data available by the time of the appointment.
For example, migraines are rated based on the frequency of migraines, as well as the severity and duration of the migraine attack, including whether migraines resulted in “completely prostrating” symptoms. Completely prostrating means a migraine headache that results in incapacity; thus, you might be asked whether you stay in bed during a migraine, or stay in a dark and quiet room until the symptoms alleviate. In other words, the examiner is trying to determine whether there is an inability to complete any other tasks during a migraine. Here is the full schedule for migraine headaches:
Keep a headache log that includes the following details
1. Date of the headache
2. Record specific details about your headache: Generally, there’s 3 areas you want to capture: Severity or intensity of the headache (scale of 1-10) at onset (and any worsening); location (e.g., front, back, side(s) of head); and duration of the headache.
3. Did you take medication? Did it reduce the intensity of the migraine?
4. Did you experience any other symptoms? (nausea, vomiting, sensitivity to light, sound, etc);
5. What did you do during the migraine? (did you have to lie down? dark room? Cold/hot compresses, etc.)
6. Triggers: Sometimes its helpful to identify certain triggers to migraine attacks, especially in a claim for service connection. For example, if you experience a migraine headache closely after a panic attack, sudden increase in anxiety, or a sudden worsening of tinnitus, or a bout of vertigo, those might all be relevant to record if the issue concerns service connection for migraine headaches.
PS: You don’t have to do this the “old fashion” way with a pen and paper. There are many apps that can help to record symptoms that are just waiting you to fill in the blanks. But it does help your representative and the physician if you are able to export the data from the app periodically.
What about a mental health conditions? These conditions can be a little more difficult to log because sometimes we’re not aware of exactly how our symptoms are impacting us, or we’ve lived with a symptom for so long that its become too normal to take note of.
Here are some tips for keeping a journal of mental health symptoms:
1. Establish a Format: Create a consistent format for recording your mental health symptoms. Include sections for the date, time, mood, triggers, and any specific symptoms you want to track (e.g., anxiety levels, sleep patterns, energy levels).
2. Record Regularly: Make it a habit to record your mental health observations regularly. This could be daily, weekly, or as often as you feel necessary.
3. Document Mood and Emotions: Note your overall mood and emotions. Use a scale or descriptive words to capture the intensity of your feelings.
4. Identify Triggers: Record any events, situations, or factors that may have triggered a change in your mental health. This could include stressors, relationship issues, work-related issues, or significant life events.
5. Track Sleep Patterns: Include information about your sleep patterns, such as the duration, quality, and any disturbances.
6. Track Energy Levels: Keep track of your energy levels throughout the day. Note if you experience periods of fatigue, lethargy, or hyperactivity. Changes in energy levels can be linked to mood fluctuations.
7. Document Other Specific Symptoms: Record any other specific mental health symptoms, such as anxiety, panic attacks, depression, irritability, or changes in appetite.
4. Show up: Unfortunately, VA can (and often does) deny claims for missed VA examinations. Exams are quite often a necessary part of the claims process. If you cannot make an examination, first, try to reschedule the examination with the provider that contacted your originally (this is usually one of VA’s contractors such as Optum Serve). If the contractor will not reschedule the examination, contact your accredited representative for the appropriate next steps.
5. Don’t be a litigator: This one can be tough – especially if you’ve been through the exam process and had a negative experience more than once. It’s natural to become defensive during the exam and want to plead your case. After all, who knows more about your case than you! But it is recommended to resist that temptation. Try to be as cooperative and forthcoming during the examination as you can. If you feel the examiner did not take proper consideration of your statements during the examination, try not to argue with the examiner, instead, talk to your accredited representative after the examination.
We hope these tips are helpful to use in preparing for your next exam. However, keep in mind that all information contained on this blog is for informational purposes only and is not intended as legal advice for your specific circumstances. If you need assistance with your specific claim, please reach out to us!