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C&P Exam Prep: Autoimmune Diseases (Lupus / Rheumatoid Arthritis / Gout)
DBQ Overview
Interview + Physical- Form Name
- Systemic_Lupus_Erythematosus_and_Other_Autoimmune_Diseases
- Form Code
- Systemic_Lupus_Erythematosus_and_Other_Autoimmune_Diseases
- Page Count
- 9
- Examiner Type
- Rheumatologist or Physician
- Estimated Duration
- 30-45 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the nature, severity, and functional impact of your autoimmune disease (such as SLE, RA, or gout) for VA disability rating purposes under DC 6350 and related codes. The examiner will assess which organ systems are affected, the frequency and severity of flares, laboratory findings, current medications, and how the condition impacts your daily life and ability to work.
What the examiner evaluates:
- Confirmed diagnosis of autoimmune condition with date of onset
- Current symptoms and affected organ systems (skin, joints, kidneys, heart, lungs, blood, nervous system)
- Frequency and severity of flares or exacerbations
- Cutaneous manifestations (malar rash, discoid lesions, photosensitivity, alopecia, oral ulcers)
- Musculoskeletal involvement (joint swelling, stiffness, range of motion, deformities)
- Renal involvement (proteinuria, hematuria, glomerulonephritis, elevated creatinine, reduced eGFR)
- Cardiac involvement (pericardial effusion, myocarditis, valvular disease, Libman-Sacks endocarditis)
- Pulmonary involvement (pleuritis, pulmonary hypertension, shrinking lung syndrome)
- Hematologic abnormalities (anemia, leukopenia, thrombocytopenia)
- Neurological involvement (headaches, cognitive dysfunction, seizures, neuropathy)
- Vascular complications (arterial or venous thrombosis, antiphospholipid syndrome)
- Laboratory results (ANA, anti-dsDNA, anti-Smith, anti-Ro, complement levels, CBC, urinalysis, CRP, ESR, BUN, creatinine)
- Current medications and their classes (oral corticosteroids, immunosuppressives, topical steroids, biologics)
- Functional impact on work, ADLs, and social functioning
- Hospitalizations, ER visits, or incapacitating episodes
Exam may be conducted in person at a VA facility or contract examination center, or via telehealth. If conducted via telehealth, the examiner must note how the examination was conducted. Bring all medications in original bottles. Bring a list of recent lab results if possible. You have the right to request recording of the exam in most states - notify the examiner at the start.
Typical duration: 30-45 minutes
Antinuclear Antibody (ANA) Titer
Presence and level of autoantibodies that attack the body's own cells; a key diagnostic marker for SLE and other autoimmune diseases
What to expect:
Blood draw; results expressed as a titer (e.g., 1:160, 1:320). Higher titers are more significant. The examiner will ask about your most recent result and whether it was positive.
Key thresholds:
- Positive at any titer — Supports autoimmune diagnosis; contributes to meeting diagnostic criteria for SLE under SLICC or ACR criteria
- High titer (-1:320) — Stronger support for active systemic disease; may correlate with higher severity rating
Tips:
- Know your most recent ANA titer result and date
- Bring lab printouts if available
- If your ANA fluctuates, mention both the highest recorded value and the most recent value
- Note whether your rheumatologist ordered follow-up tests such as anti-dsDNA or anti-Smith antibodies
Pain considerations: N/A - blood test only, but mention if blood draws are difficult due to fragile veins from long-term IV medications
Anti-dsDNA and Anti-Smith Antibodies
Highly specific antibodies for SLE; anti-dsDNA also correlates with disease activity and lupus nephritis
What to expect:
Blood test results reviewed by examiner. The DBQ specifically asks about these antibodies. Elevated anti-dsDNA often correlates with renal flares.
Key thresholds:
- Positive anti-dsDNA — Strongly supports SLE diagnosis; elevated levels may indicate active nephritis and higher severity
- Positive anti-Smith — Highly specific for SLE; supports diagnosis even with low anti-dsDNA
Tips:
- Know whether your rheumatologist has ever tested for these and the results
- If positive, note the date and the clinical context (during a flare vs. remission)
- Mention if your doctor monitors these levels to track disease activity
Pain considerations: N/A - blood test; however, mention systemic symptoms (fatigue, joint pain) that coincided with elevated antibody levels
Urinalysis and Renal Function Panel (BUN, Creatinine, eGFR, Protein)
Kidney function and signs of lupus nephritis; proteinuria and hematuria indicate renal involvement which significantly impacts rating
What to expect:
The examiner will review your most recent urinalysis results and kidney function labs. They will specifically look for protein in urine (proteinuria), blood in urine (hematuria), and urinary casts (hyaline, granular). Reduced eGFR indicates chronic kidney disease.
Key thresholds:
- Proteinuria (>500mg/day) — Indicates lupus nephritis; can support higher disability ratings and may trigger separate kidney rating
- Elevated creatinine / reduced eGFR (<60) — Indicates moderate-to-severe kidney impairment; significantly elevates overall rating
- Hematuria or urinary casts — Supports active glomerulonephritis; contributes to renal manifestation documentation
Tips:
- Bring your most recent urinalysis and metabolic panel results
- Mention if your nephrologist or rheumatologist monitors your kidneys regularly
- Note any episodes of swelling (edema) in your legs or around your eyes, which can indicate kidney problems
- Report any foamy urine, which is a sign of protein loss
Pain considerations: Kidney involvement does not typically cause pain until advanced stages; describe any flank pain, swelling, or fatigue associated with kidney flares
Complete Blood Count (CBC) - Hemoglobin, Hematocrit, WBC, RBC, Platelet Count
Hematologic manifestations of autoimmune disease including anemia of chronic disease, autoimmune hemolytic anemia, leukopenia/lymphopenia, and immune thrombocytopenia
What to expect:
Examiner reviews your most recent CBC. The DBQ specifically asks about hemoglobin, hematocrit, RBC, WBC (with differential), and platelet counts. Low values in any category can indicate active autoimmune disease.
Key thresholds:
- WBC <4,000 / lymphocytes <1,500 cells/-L — Meets SLE diagnostic criterion for leukopenia/lymphopenia; documents hematologic manifestation
- Hemoglobin <10 g/dL — Indicates significant anemia; contributes to fatigue symptoms and functional impairment documentation
- Platelets <100,000/-L (thrombocytopenia) — Meets SLE diagnostic criterion; may indicate life-threatening autoimmune thrombocytopenia
Tips:
- Bring your most recent CBC results
- Mention if you have ever been hospitalized for low blood counts
- Note any symptoms of anemia: extreme fatigue, shortness of breath, pallor, dizziness
- Note any bleeding episodes related to low platelets (bruising, nosebleeds, prolonged bleeding)
Pain considerations: Anemia causes profound fatigue and weakness that mimics musculoskeletal pain - describe how your energy level on bad days prevents you from basic activities
Inflammatory Markers (ESR, CRP, Complement C3/C4)
Disease activity and systemic inflammation; low complement levels (C3/C4) are a hallmark of active SLE; elevated ESR and CRP indicate inflammation
What to expect:
Examiner reviews these blood test results. Low complement levels during flares are particularly significant for SLE. Elevated ESR and CRP support active inflammatory disease.
Key thresholds:
- Low C3 or C4 complement — Classic finding in active SLE; supports diagnosis and disease activity documentation
- Significantly elevated ESR (>50mm/hr) or CRP — Supports active inflammation; correlates with clinical flares and functional impairment
Tips:
- Know your complement levels if SLE is your diagnosis
- Mention whether these levels fluctuate with your symptoms
- If your doctor uses these values to adjust your medications, mention that as evidence of active disease management
Pain considerations: High inflammatory markers correlate with joint pain, fatigue, and systemic symptoms - describe how you feel when these are elevated versus when in remission
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 100% | Acute or active flares of systemic lupus erythematosus with severe constitutional symptoms and/or requiring immunosuppressive therapy, OR with widespread activity involving major organs (kidneys, heart, lungs, CNS). Evaluate as totally disabling when the condition causes prostrating attacks or requires continuous immunosuppressive or corticosteroid therapy causing serious side effects. |
CFR: Under DC 6350, total disability is warranted when SLE requires continuous systemic immunosuppressive or corticosteroid therapy with severe constitutional symptoms or multi-organ involvement. Per 38 CFR 4.88b, evaluate based on the degree of activity of the disease and the need for continuous treatment. |
| 60% | Systemic lupus with exacerbations two or more times per year or with acute symptoms of such severity to require prolonged treatment with immunosuppressive or corticosteroid drugs, with retarding of normal healing processes. Evaluate at 60% when there is documented multi-system involvement that does not continuously require hospitalization but substantially limits functioning. |
CFR: Under DC 6350, 60% applies when exacerbations occur at least twice yearly with need for immunosuppressive or prolonged corticosteroid therapy. The examiner should note the frequency, duration, and treatment required for each flare documented in medical records. |
| 40% | Systemic lupus with exacerbations once or twice per year or symptoms controllable by continuous drug therapy, with minor residuals between attacks. The condition is active enough to require ongoing medical management but does not cause continuous debilitating symptoms. |
CFR: DC 6350 at 40% reflects SLE that is somewhat controlled but still requires active medication management. The key is documenting that the condition is not in sustained full remission and requires ongoing treatment with residual functional impact between exacerbations. |
| 10% | Systemic lupus in remission or with minimal symptoms, maintained on minimal medications. Condition is documented and confirmed but currently inactive or only mildly symptomatic. Residual functional limitation is minimal. |
CFR: Under DC 6350, a 10% rating reflects confirmed SLE that is currently in remission but still requires ongoing monitoring and medication. The diagnosis must be confirmed and the condition service-connected; however, current activity is minimal. |
100% Acute or active flares of systemic lupus erythematosus with ...
Acute or active flares of systemic lupus erythematosus with severe constitutional symptoms and/or requiring immunosuppressive therapy, OR with widespread activity involving major organs (kidneys, heart, lungs, CNS). Evaluate as totally disabling when the condition causes prostrating attacks or requires continuous immunosuppressive or corticosteroid therapy causing serious side effects.
Key Symptoms
- Frequent, severe, or prostrating flares (multiple per year requiring hospitalization or ER visits)
- Active lupus nephritis with significant proteinuria or renal insufficiency
- Active CNS lupus (seizures, psychosis, cognitive dysfunction)
- Severe anemia, thrombocytopenia, or leukopenia requiring treatment
- Pulmonary hypertension or recurrent pleuritis
- Cardiac involvement (myocarditis, pericarditis, Libman-Sacks endocarditis)
- Requirement for long-term high-dose oral corticosteroids or multiple immunosuppressives
- Inability to perform any substantial gainful activity
CFR: Under DC 6350, total disability is warranted when SLE requires continuous systemic immunosuppressive or corticosteroid therapy with severe constitutional symptoms or multi-organ involvement. Per 38 CFR 4.88b, evaluate based on the degree of activity of the disease and the need for continuous treatment.
60% Systemic lupus with exacerbations two or more times per year ...
Systemic lupus with exacerbations two or more times per year or with acute symptoms of such severity to require prolonged treatment with immunosuppressive or corticosteroid drugs, with retarding of normal healing processes. Evaluate at 60% when there is documented multi-system involvement that does not continuously require hospitalization but substantially limits functioning.
Key Symptoms
- Two or more acute exacerbations per year requiring immunosuppressive or corticosteroid therapy
- Persistent proteinuria or hematuria indicating ongoing renal involvement
- Recurrent pleurisy or pericarditis
- Significant joint involvement affecting multiple joints with inflammation
- Pronounced fatigue preventing sustained work activity
- Moderate anemia or thrombocytopenia
- Skin manifestations requiring topical or systemic treatment
- Periodic hospitalizations for disease management
CFR: Under DC 6350, 60% applies when exacerbations occur at least twice yearly with need for immunosuppressive or prolonged corticosteroid therapy. The examiner should note the frequency, duration, and treatment required for each flare documented in medical records.
40% Systemic lupus with exacerbations once or twice per year or ...
Systemic lupus with exacerbations once or twice per year or symptoms controllable by continuous drug therapy, with minor residuals between attacks. The condition is active enough to require ongoing medical management but does not cause continuous debilitating symptoms.
Key Symptoms
- One to two flares per year requiring treatment adjustment
- Controlled with maintenance-level immunosuppressive medications (e.g., hydroxychloroquine, low-dose prednisone)
- Intermittent joint pain and stiffness
- Mild skin manifestations (photosensitivity, occasional rash)
- Fatigue that limits but does not preclude work activity
- Mild laboratory abnormalities during flares (positive ANA, mildly elevated anti-dsDNA)
- Minor residual symptoms between attacks
CFR: DC 6350 at 40% reflects SLE that is somewhat controlled but still requires active medication management. The key is documenting that the condition is not in sustained full remission and requires ongoing treatment with residual functional impact between exacerbations.
10% Systemic lupus in remission or with minimal symptoms, mainta ...
Systemic lupus in remission or with minimal symptoms, maintained on minimal medications. Condition is documented and confirmed but currently inactive or only mildly symptomatic. Residual functional limitation is minimal.
Key Symptoms
- Disease in sustained remission with rare or no flares
- Maintenance medication only (e.g., hydroxychloroquine alone)
- Minimal or no organ involvement
- Occasional mild symptoms (fatigue, mild joint stiffness)
- Normal or near-normal laboratory values
- Minimal functional limitation
CFR: Under DC 6350, a 10% rating reflects confirmed SLE that is currently in remission but still requires ongoing monitoring and medication. The diagnosis must be confirmed and the condition service-connected; however, current activity is minimal.
How to Describe Your Symptoms
Fatigue and Constitutional Symptoms
How to describe:
Describe your fatigue in concrete, functional terms. Specify how many hours per day you can be active, whether you require rest periods, how many days per week you are significantly impaired by fatigue, and what activities you cannot complete due to exhaustion. Distinguish lupus fatigue from normal tiredness - it is often sudden, overwhelming, and unrelated to exertion.
Worst-day example:
“On my worst days, I wake up already exhausted and cannot get out of bed for more than 1-2 hours at a time. I cannot shower, cook a meal, or drive without needing to lie down afterward. This happens 2-3 times per week and is completely unpredictable - I cannot plan activities or reliably show up for work because I never know when a bad day will strike.”
What the examiner listens for:
Frequency of debilitating fatigue days, whether fatigue correlates with disease flares or is constant, impact on ability to sustain employment, whether fatigue is related to anemia or active inflammation, and any functional aids or accommodations used.
Understatements to avoid:
Saying 'I get tired sometimes' - instead specify frequency, severity, and functional impact. Do not minimize your fatigue by comparing yourself to others or saying you 'manage' without explaining what that management costs you.
Joint Pain and Musculoskeletal Involvement
How to describe:
Identify each affected joint by name and location. Describe pain on a 0-10 scale during average days and worst days. Describe morning stiffness duration (in minutes or hours), whether joints are visibly swollen or warm, and how joint pain limits your ability to grip, walk, climb stairs, or perform fine motor tasks. Include DeLuca factors: pain at rest, with motion, with repetitive use, and during/after activity.
Worst-day example:
“During a flare, both my hands, wrists, and knees are swollen and hot. My fingers are so stiff in the morning that I cannot make a fist for the first two hours. The pain is 8/10 and I cannot open jars, button shirts, or type at a keyboard. Walking more than 50 feet causes sharp knee pain and I need to hold railings on stairs. After even 15 minutes of light activity my joints ache for the rest of the day.”
What the examiner listens for:
Specific joints affected, presence of synovitis (warmth, swelling, tenderness), duration of morning stiffness, functional limitations tied to specific joints, whether joint damage is documented on imaging (erosions, narrowing), and whether joint involvement is inflammatory versus mechanical.
Understatements to avoid:
Saying 'my joints hurt' without specifying which joints, severity, or functional impact. Avoid minimizing by saying 'I push through it' without explaining what that push costs you functionally.
Skin Manifestations
How to describe:
Describe all skin manifestations you have experienced - malar (butterfly) rash, discoid lesions, photosensitivity, oral ulcers, hair loss (alopecia), or rashes on other body areas. Specify location, frequency, duration, whether lesions scar, and any treatment required (topical steroids, antimalarials). Note whether sun exposure triggers or worsens symptoms.
Worst-day example:
“During flares, the butterfly rash across my face is bright red and painful, lasting 1-2 weeks. I have ongoing hair loss that has caused visible bald patches on my scalp from scarring. I cannot be in sunlight for more than 10-15 minutes without triggering a full-body flare including rash, joint pain, and extreme fatigue. I have painful mouth sores that make eating difficult during flares.”
What the examiner listens for:
Specific type of cutaneous involvement (discoid vs. malar vs. subacute), whether scarring or permanent alopecia has occurred, percentage of body surface area affected, whether photosensitivity causes systemic triggers, and current skin-directed treatments.
Understatements to avoid:
Not mentioning oral ulcers or mild hair loss because they seem minor - these are diagnostic criteria for SLE and should be reported. Do not describe rashes as only cosmetic when they cause pain, interfere with daily activities, or are associated with systemic flares.
Renal (Kidney) Involvement
How to describe:
Report any history of protein in your urine (foamy urine is a sign), blood in your urine, swelling in your legs or around your eyes (edema), or high blood pressure related to kidney disease. Mention if you have been diagnosed with lupus nephritis and the class. Report any changes in your kidney function tests (creatinine, eGFR) over time.
Worst-day example:
“During my lupus nephritis flare, my legs swelled so severely I could not wear shoes. I had foamy urine and my blood pressure spiked to 165/100 requiring emergency treatment. My creatinine rose to 2.1 and my rheumatologist placed me on IV cyclophosphamide therapy for 6 months. My eGFR dropped to 45 and has never fully recovered, now stable at 58.”
What the examiner listens for:
History of biopsy-confirmed lupus nephritis, current proteinuria levels, BUN/creatinine trends, eGFR trajectory, hypertension secondary to renal involvement, whether dialysis has ever been required, and current nephrology follow-up.
Understatements to avoid:
Failing to mention past episodes of kidney involvement because they are 'under control now' - the history of nephritis is critical for rating. Report all abnormal urinalysis results and any prior nephrology referrals.
Cardiac and Pulmonary Manifestations
How to describe:
Describe any history of chest pain related to lupus (pleuritis or pericarditis), shortness of breath, diagnosed pulmonary hypertension, or cardiac conditions documented by your cardiologist or rheumatologist. Note any echocardiogram findings, elevated pulmonary artery pressures, or diagnoses of Libman-Sacks endocarditis or myocarditis.
Worst-day example:
“I have had three episodes of lupus pleuritis in the past two years, each lasting 2-3 weeks with sharp stabbing chest pain that worsened with breathing. During my last episode I was hospitalized for 4 days. My pulmonary function tests show reduced lung volumes consistent with shrinking lung syndrome. I am now on supplemental oxygen for exertion.”
What the examiner listens for:
Documented pericarditis or pleuritis episodes (frequency and treatment required), echocardiogram findings, pulmonary artery pressure measurements, any valvular abnormalities, and whether cardiac or pulmonary complications have required hospitalization.
Understatements to avoid:
Minimizing chest pain episodes as 'just inflammation' - pleuritis and pericarditis are serious manifestations that significantly impact rating. Do not omit cardiac findings from echocardiograms even if your cardiologist said they were 'not severe enough to treat yet.'
Neurological and Psychiatric Manifestations
How to describe:
Report any neurological symptoms including headaches (frequency and severity), cognitive difficulties (brain fog, memory problems, difficulty concentrating), seizures, peripheral neuropathy (numbness, tingling), or mood symptoms directly related to your autoimmune disease or its treatments (especially corticosteroids). Distinguish between disease-caused and medication-caused neuropsychiatric symptoms.
Worst-day example:
“I experience severe cognitive fog during flares that makes it impossible to follow conversations, remember appointments, or perform my job tasks. I have had two seizures attributed to CNS lupus. I have ongoing headaches 4-5 days per week at 6/10 intensity. My hands and feet have constant tingling from peripheral neuropathy. During high-dose prednisone treatment I experienced severe mood swings and insomnia that required psychiatric intervention.”
What the examiner listens for:
Any history of CNS lupus manifestations (documented by neurology), seizure history, cognitive testing results, neuropathy documented by nerve conduction studies, and steroid-induced psychiatric effects with documentation.
Understatements to avoid:
Dismissing brain fog as 'just stress' - cognitive dysfunction is a recognized manifestation of SLE and should be clearly linked to disease activity. Do not omit seizure history even if seizures are now controlled.
Flare Frequency and Severity
How to describe:
Provide a precise accounting of your flares over the past 12 months and the past few years. For each flare, describe: what triggered it, how long it lasted, what symptoms were present, what treatment was required (dose adjustments, ER visits, hospitalizations), and how long recovery took. Distinguish between minor flares managed at home and major flares requiring medical intervention.
Worst-day example:
“In the past year I have had four major flares. The worst lasted six weeks and required a prednisone burst from my maintenance dose of 5mg to 60mg daily, plus a Medrol dose pack. I went to the ER twice and missed 18 days of work. Even between flares I have daily symptoms - fatigue, joint stiffness, and headaches - so I am never fully well.”
What the examiner listens for:
Number of flares per year, treatment required for each flare, whether flares are predictable or unpredictable, recovery time between flares, whether the veteran maintains employment during flares, and whether between-flare symptoms are truly mild or just more tolerable versions of the same symptoms.
Understatements to avoid:
Saying you have had 'maybe two or three flares' without specifying what a flare looks like for you. The examiner needs details about each flare to properly document frequency and severity for the rating decision. Report your worst flares, not your average ones.
Medication Side Effects and Treatment Burden
How to describe:
Describe all current medications and their side effects that affect your functioning. Corticosteroids cause weight gain, mood changes, bone loss, increased infection risk, elevated blood glucose, and cataracts. Immunosuppressives cause fatigue, infection susceptibility, and require regular monitoring bloodwork. Biologics require infusions or injections that affect your schedule. This treatment burden is relevant to your overall disability picture.
Worst-day example:
“Long-term prednisone use has given me significant weight gain, avascular necrosis of my left hip, steroid-induced diabetes, and osteoporosis with two compression fractures. I take methotrexate weekly which causes severe nausea for 24-48 hours after each dose. I have monthly lab draws and quarterly rheumatology visits just to manage my medications. The treatment itself is disabling.”
What the examiner listens for:
Duration of corticosteroid use (particularly long-term use), documented side effects such as avascular necrosis, diabetes, osteoporosis, cataracts, or adrenal suppression, frequency of monitoring requirements, and whether medication side effects independently limit functioning.
Understatements to avoid:
Not mentioning medication side effects because they are 'just side effects' - secondary conditions caused by required treatments for a service-connected autoimmune disease may be separately ratable or may contribute to the overall disability picture.
Common Mistakes to Avoid
Reporting only current symptoms without describing worst-day or flare symptoms
Autoimmune diseases are episodic by nature. If you happen to be in partial remission on exam day, the examiner may underrate your condition if you only describe your current state rather than your full range of symptoms including flares.
Instead: Explicitly state: 'Today I am having a relatively good day, but during my typical flares, which occur [frequency], I experience [specific symptoms at worst severity].' Reference your medical records that document flare episodes.
Impact: Could prevent 60-100% rating by underrepresenting flare frequency and severity
Failing to bring or reference recent laboratory results
The DBQ has extensive sections for laboratory values (ANA, anti-dsDNA, CBC, urinalysis, complement levels, CRP, ESR, renal function). If the examiner does not have access to these results, critical documentation of organ involvement may be missing from the DBQ.
Instead: Bring printed copies of your most recent lab results covering at least the past 12 months. Organize them by test type. Bring results from flare periods as well as stable periods to show variability.
Impact: May result in failure to document organ involvement, reducing rating from 40-100% to 10-40%
Not mentioning all affected organ systems
SLE is a multi-system disease and the rating under DC 6350 accounts for multi-organ involvement. Veterans often focus only on their most prominent symptoms (joint pain, fatigue) and fail to mention renal, cardiac, pulmonary, neurological, or hematologic involvement.
Instead: Go through each body system before the exam and prepare to report any history of involvement: kidneys, heart, lungs, blood, skin, nervous system, and joints. Even past involvement that is currently controlled should be reported.
Impact: Missing organ system documentation can reduce rating from 60-100% to 40% or lower
Downplaying medication side effects and treatment burden
Long-term use of corticosteroids and immunosuppressives causes significant comorbidities (steroid-induced diabetes, avascular necrosis, osteoporosis, opportunistic infections) that independently impact functioning and may be separately ratable.
Instead: List all medications, their doses, how long you have been taking them, and all documented side effects. Mention any secondary conditions your doctors have attributed to your medications.
Impact: Missing secondary conditions may prevent additional ratings that increase overall combined disability percentage
Not quantifying the functional impact on work and daily activities
The DBQ specifically asks about the impact of the autoimmune disease on occupational and daily functioning. Vague statements like 'it affects my life' do not give the examiner concrete information to document.
Instead: Prepare specific examples: 'I have missed X days of work in the past year due to flares. I cannot lift more than 10 pounds due to joint involvement. I require X hours of rest per day. I cannot stand for more than 20 minutes without joint pain.'
Impact: Insufficient functional documentation can prevent 60-100% rating regardless of laboratory findings
Confusing the DBQ requirements for SLE with those for rheumatoid arthritis
While both use the same DBQ form, SLE (DC 6350) is rated differently from RA (DC 5002). SLE rating emphasizes systemic organ involvement and flare frequency, while RA rating emphasizes joint involvement and functional limitation. Veterans with both conditions should ensure the examiner addresses both diagnostic codes appropriately.
Instead: If you have both SLE and RA, ask the examiner to document both diagnoses. For RA, ensure the examiner notes specific joint involvement, morning stiffness duration, synovitis findings, and functional limitations per DeLuca factors.
Impact: Failure to properly distinguish conditions can result in incorrect diagnostic code assignment and an inaccurate rating
Not mentioning antiphospholipid syndrome or thrombotic events
Antiphospholipid syndrome (APS) with arterial or venous thrombosis is a serious SLE manifestation specifically listed on the DBQ. Recurrent thrombosis has major functional implications and may support a higher rating or secondary service connection for related conditions.
Instead: Report any history of blood clots (DVT, PE, stroke, TIA), positive antiphospholipid antibodies, or anticoagulation therapy. Bring documentation from your hematologist or vascular specialist if applicable.
Impact: Missing thrombotic history can result in underrating systemic disease severity at the 40-60% level
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to request a copy of the completed DBQ/C&P examination report through a VA records request; review it for accuracy after your rating decision.
- You have the right to record your C&P examination in most states - check your state's recording consent laws and notify the examiner at the start of the exam.
- You have the right to submit additional medical evidence (private physician's IMO/IME, buddy statements, medical records) to supplement or rebut the C&P examiner's findings before a rating decision is issued.
- You have the right to request a new C&P examination if the original was inadequate - factors supporting inadequacy include an exam under 10 minutes, failure to review records, failure to address all claimed symptoms, or a DBQ that is internally inconsistent with the medical evidence.
- You have the right to bring a support person (family member, VSO representative, or advocate) to your C&P exam for emotional support, though they typically cannot speak on your behalf during the examination.
- You have the right to a Compensation and Pension exam that addresses all claimed conditions and all manifestations of those conditions - the examiner must document all symptoms you report, not only those they personally observe.
- Under the benefit of the doubt standard (38 CFR 3.102), when there is an approximate balance of positive and negative evidence, the VA must resolve the question in your favor - you do not need to prove your case beyond a doubt.
- You have the right to appeal a rating decision you believe is inaccurate through a Supplemental Claim (new and relevant evidence), Higher Level Review (by a senior rater), or Board of Veterans' Appeals hearing.
- You have the right to request a Total Disability Rating based on Individual Unemployability (TDIU) if your autoimmune condition - alone or in combination with other service-connected conditions - prevents you from maintaining substantially gainful employment, even if your combined rating is below 100%.
- You have the right to have all secondary conditions caused by your service-connected autoimmune disease or its required treatments evaluated for separate service connection - including steroid-induced diabetes, avascular necrosis, osteoporosis, cataracts, and cardiovascular conditions.
Related Conditions
- Rheumatoid Arthritis Multi joint inflammatory arthritis rated under DC 5002; may be ratable separately from SLE if diagnosed as a distinct condition; RA and SLE can be co diagnosed but cannot be double counted for the same manifestations
- Lupus Nephritis / Chronic Kidney Disease Renal involvement is a major manifestation of SLE; lupus nephritis can be separately rated under DC 7531 (nephritis) when it causes significant renal impairment; document separately if your rheumatologist and nephrologist both follow you
- Antiphospholipid Syndrome Occurs in approximately 30 40% of SLE patients; associated with arterial and venous thrombosis, recurrent pregnancy loss, and thrombocytopenia; may support higher rating or secondary service connection for DVT, PE, or stroke
- Sj-gren's Syndrome Autoimmune condition that frequently overlaps with SLE; characterized by dry eyes and dry mouth; can be evaluated under the same DBQ and may be separately ratable as a secondary condition
- Steroid-Induced Diabetes Mellitus Long term corticosteroid use for autoimmune disease commonly causes steroid induced diabetes; secondary service connection available if steroid use is required for a service connected autoimmune condition; rated under DC 7913
- Avascular Necrosis (Osteonecrosis) A known complication of long term corticosteroid therapy used to treat autoimmune conditions; secondary service connection available; most commonly affects the femoral head (hip); rated based on joint functional limitation
- Osteoporosis with Compression Fractures Long term corticosteroid use causes bone density loss leading to osteoporosis and vertebral compression fractures; secondary service connection available; rated based on resulting functional limitations
- Pulmonary Hypertension Can occur as a direct manifestation of SLE or scleroderma; rated separately under DC 6817 when present; requires right heart catheterization for definitive diagnosis; significantly impacts rating at higher disability levels
- Fibromyalgia Frequently co occurs with SLE and RA; characterized by widespread musculoskeletal pain, fatigue, and cognitive dysfunction; rated under DC 5025; symptoms can overlap with autoimmune disease symptoms but represent a distinct diagnosis
- Peripheral Neuropathy Neurological manifestation of autoimmune disease or a side effect of immunosuppressive medications (especially methotrexate); secondary service connection available; rated based on motor and sensory deficits under the neurological diagnostic codes
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.