Compensation and Pension Exam

May 27, 2024 – A compensation and pension exam for PTSD and other mental disorders is a forensic1 psychological evaluation in which a psychologist ascertains if a veteran suffers from one or more mental disorders, and if so, determines if a nexus (connection) exists between the veteran's military service and the mental disorder(s), or between a service-connected condition and a mental disorder.2

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VA C&P Exam vs. Independent Psychological Examination

A psychologist's (or other health professional's) role determines the nature of the exam.

VA medical examiners perform VA compensation and pension exams.

Non-VA experts conduct independent medical examinations (IME) and independent psychological examinations (IPE). (Note: The VA uses the term fee-based medical examiner.)3


VA Compensation and Pension Exam

United States veterans can receive disability compensation and other benefits if they suffer from PTSD and other mental disorders that were incurred in, or aggravated by, their military service.4

When a veteran files a disability claim for PTSD or other mental disorders, the Department of Veterans Affairs (VA) almost always requires a compensation and pension examination (C&P exam).

The VA sends veterans primarily to contracted examiners—healthcare professionals in the private sector who receive referrals from one of four MDE companies who have contracts with VA to perform this service. (MDE stands for Medical Disability Examination.)

About 90% of C&P exams are conducted by contracted examiners. The remaining 10% receive their exam from VA medical center staff. 

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Unique Meaning of "VA Medical Examiner"

Who or what is a "VA medical examiner"? One might understandably assume that the term means physicians employed by the Department of Veterans Affairs who conduct C&P exams. But that is not what it means. 

First, VA refers to all of its examiners as "medical" examiners. Physicians, physician associates, nurse practitioners, psychologists, and audiologists are all medical examiners according VA.

Second, according to the Department of Veterans Affairs, a VA medical examiner is:

  • a VA employee; or

  • an independent contractor who conducts exams on behalf of the Veterans Health Administration (VHA); or

  • a health professional in the private sector who performs C&P exams as an independent contractor on behalf of a third-party medical disability examination (MDE) company.

MDE companies contract with VA to develop a network of qualified examiners and manage almost all aspects of the compensation and exam process.

The Veterans Benefits Administration (VBA) oversees MDE company performance and sets policy for compensation and pension exams, sometimes in consultation with VHA.

Private practice clinicians working on behalf of MDE companies conduct the vast majority of  C&P exams. 

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Independent Psychological Examination (IPE)

If you are a veterans law attorney or VA-accredited claims agent seeking an IPE for a veteran you represent, schedule a consultation call with me (Dr. Worthen) to ascertain if my services might prove beneficial (15 minutes, no charge), or contact Dr. Worthen via email.

I conduct IPEs directly for veterans, but only in select cases – learn more on the Nexus Letters for VA Claims page.

An independent psychological examination (IPE) is essentially a compensation and pension exam performed by a non-VA psychologist. (Psychiatrists use the term independent medical examination since they are physicians.)

When writing a C&P exam report, the psychologist places more emphasis on reviewing, analyzing, and rebutting erroneous VA medical examiner opinions. But otherwise the examination procedures (assessment methods) and reporting format are the same or very similar to a C&P exam. 

Psychologists in the private sector are independent if they are not VA medical examiners.

Thus, an independent examiner ...

  • is not a VA employee;

  • does not conduct C&P exams for VHA as an independent contractor; and 

  • does not evaluate veterans on behalf of an MDE company.

Private sector psychologists who conduct independent psychological examinations (IPE) ...

  • do not have a boss telling them how to conduct a compensation and pension exam;

  • do not have to worry that VHA will stop hiring them to conduct C&P exams because they don't conduct exams in manner dictated by VHA administrators;

  • are not influenced by an MDE company's billing, coding, and reimbursement policies;

  • do not feel constrained by low fees (contract examiners) or time pressure (VA staff).

The big difference between a VA exam and an IPE is the independent examiner's freedom to conduct a comprehensive exam without interference from VA or an MDE company.

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Value of an Independent Psychological Examination

If the Veterans Benefits Administration (VBA) denies a veteran's initial claim for disability benefits, the veteran can request a "decision review"—commonly referred to as appealing a decision. (There are additional avenues for appeal.)

In most instances, an independent compensation and pension exam conducted by an expert  psychologist will bolster a veteran's chances to win their claim during the decision review process.

Since non-VA psychologists who conduct an IPE receive payment commensurate with their expertise, they have the time and resources needed to conduct an evidence-based, reliable and valid psychological evaluation. You get what you pay for.

Adjudicators—decision review officers and veterans law judges—appreciate thorough, scientifically-sound psychological evaluations that include well-articulated medical opinions and a cogent rationale for the opinion.

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Mark D Worthen PsyD provides consultation to veterans law attorneys and VA-accredited claims agents. Schedule a free consultation via Zoom or phone, or contact Dr. Worthen via email. 

I also conduct IPEs directly for veterans, but only in select cases – learn more on the Nexus Letters for VA Claims page.

Footnotes

  1. Forensic, Oxғᴏʀᴅ Eɴɢʟɪsʜ Dɪᴄᴛɪᴏɴᴀʀʏ, 3rd ed. (rev. July, 2023) ("2.b. spec. Designating branches of forensic medicine, the natural and physical sciences, and other fields of study that provide evidence in legal proceedings and the investigation of crime. Also: designating experts or specialists in such fields"), see also Stressor Determinations for Posttraumatic Stress Disorder, 75 Fed. Reg. 39843, 39848 (July 12, 2010) ("a C&P examination is forensic evidence for purposes of determining whether a veteran is entitled to disability compensation for PTSD and, if so, how much").

  2. 38 C.F.R. § 3.310.

  3. Vᴇᴛᴇʀᴀɴs Bᴇɴᴇғɪᴛs Aᴅᴍɪɴ., Dᴇᴘ'ᴛ Vᴇᴛᴇʀᴀɴs Aғғᴀɪʀs, M21-1 Aᴅᴊᴜᴅɪᴄᴀᴛɪᴏɴ Pʀᴏᴄᴇᴅᴜʀᴇs Mᴀɴᴜᴀʟ, Accepting a Fee-Based Examiner’s Report, pt. IV, subpt. i, ch. 3, sec. A, topic 1, block q (rev. Feb. 7, 2024), https://perma.cc/Z3DB-A5TY.

  4. 38 C.F.R. § 3.303.

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