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C&P Exam Prep: Hand and Finger
DBQ Overview
Interview + Physical- Form Name
- Hand_and_Finger
- Form Code
- Hand_and_Finger
- Page Count
- 17
- Examiner Type
- Physician or Physician Assistant
- 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 hand and finger conditions for VA disability rating purposes under 38 CFR 4.71a. The examiner will record range of motion (ROM), joint deformities, ankylosis, grip strength, and functional limitations for each affected digit and joint on the affected hand(s).
What the examiner evaluates:
- Active and passive range of motion for each affected finger joint (MCP, PIP, DIP) and thumb (CMC, MCP, IP)
- Presence and degree of ankylosis (favorable vs. unfavorable position) at each joint
- Deformities including swan neck, boutonniere, mallet finger, Dupuytren's contracture, and gamekeeper's thumb
- Joint instability, angulation, and rotation
- Grip strength and hand function measurements (cm)
- DeLuca factors: pain on motion, fatigability, weakness, and incoordination during repetitive use
- Flare-up frequency, severity, and functional loss during exacerbations
- Assistive devices used (brace, splint, adaptive equipment)
- Muscle atrophy (circumference measurements of affected vs. normal side)
- Dominant hand determination
- Diagnosis type: arthritis (degenerative, post-traumatic, rheumatoid, other), tendinopathy, tenosynovitis, trigger finger, instability, prosthetic replacement, or other
- Imaging findings (x-ray, MRI) supporting the diagnosis
- Whether the condition affects the dominant or non-dominant hand
Exam is typically conducted in-person. You have the right to request the exam be recorded in most states. Wear clothing that allows easy access to both hands and wrists. Do not take pain medications that would artificially improve your ROM performance before the exam - accurately represent your typical level of function.
Typical duration: 30-45 minutes
Finger MCP Joint Flexion/Extension (Active)
Active range of motion at the metacarpophalangeal joint for each finger. Normal flexion is approximately 90 degrees; normal extension is 0 degrees (neutral).
What to expect:
The examiner will ask you to bend and straighten each finger individually. A goniometer may be used to measure the exact degrees of motion at MCP joints. This is repeated for index, long, ring, and little fingers bilaterally.
Key thresholds:
- Flexion limited to 90 degrees or less — Reduced ROM is documented; combined with other limitations may affect overall rating
- Ankylosis in favorable position (slight flexion) — Favorable ankylosis ratings range from 10-50% depending on number of digits
- Ankylosis in unfavorable position (excessive flexion, extension, or non-functional position) — Unfavorable ankylosis ratings range from 20-60% depending on digits involved
Tips:
- Move only as far as you actually can - do not push through pain to demonstrate maximum effort
- Mention pain at each point where motion causes discomfort
- Perform the motion at your typical painful level, not at your absolute maximum
- If your ROM worsens after repetitive use, tell the examiner before testing begins
Pain considerations: Under DeLuca v. Brown, if pain causes you to stop motion before full range, that pain-limited ROM is your rating-relevant measurement. Clearly state 'that is where the pain stops me' when applicable.
Finger PIP Joint Flexion/Extension (Active and Passive)
Range of motion at the proximal interphalangeal joint. Normal flexion is approximately 100 degrees; normal extension is 0 degrees.
What to expect:
The examiner will measure both active (you move the joint) and passive (examiner moves the joint) ROM. Passive ROM is compared to active ROM - if passive is greater than active, it may indicate pain-limited active motion. Per Correia requirements, both active and passive ROM must be documented.
Key thresholds:
- Flexion limited to less than 100 degrees — Documents limitation; combined with other findings affects overall functional rating
- Extension deficit (inability to fully straighten PIP) — Extension lag is separately documented and contributes to functional loss rating
- Ankylosis at PIP joint — Position of ankylosis (favorable vs. unfavorable) determines rating level under DC 5216-5221
Tips:
- Ensure the examiner tests BOTH active and passive ROM per Correia v. McDonald requirements
- If passive ROM is significantly better than your active ROM, this suggests pain is limiting your active motion - communicate this clearly
- Report any locking, catching, or triggering sensations during PIP movement
- Describe whether stiffness is worse in the morning, after rest, or after prolonged use
Pain considerations: Pain during passive motion testing is also relevant - if even the examiner's passive movement of your finger causes pain, state this clearly, as it documents the severity of joint involvement.
Thumb CMC and IP Joint Motion
Motion at the carpometacarpal (CMC), metacarpophalangeal (MCP), and interphalangeal (IP) joints of the thumb. Thumb opposition and grip are also assessed.
What to expect:
Examiner will assess thumb abduction, opposition, flexion, and extension at each joint. Thumb function is critical for overall hand function and is weighted more heavily in ratings (DC 5151-5155).
Key thresholds:
- Loss of thumb opposition — Severe functional limitation; may warrant higher rating or separate evaluation
- Ankylosis of thumb CMC in favorable position — 20% for dominant/major, 20% for minor hand
- Ankylosis of thumb in unfavorable position — 40% for major hand, 30% for minor hand depending on joint
Tips:
- Demonstrate your ability (or inability) to touch your thumb to each fingertip
- Show difficulty with pinch grip tasks (picking up small objects, buttoning clothing)
- Report if the CMC joint causes pain with any resisted pinch or grasp activity
- Inform examiner if you have previously had a splint or brace for the thumb
Pain considerations: Basilar thumb arthritis (CMC joint) causes pain with nearly every pinch and grasp activity. Be specific: 'I cannot twist a jar lid, button a shirt, or turn a key without significant pain radiating from the base of my thumb.'
Hand Grip Strength
Overall grip force in kilograms or pounds, measured by dynamometer when available. Circumference measurements may also be taken to document muscle atrophy.
What to expect:
You may be asked to squeeze a dynamometer with each hand for comparison. The examiner will also visually inspect and may measure the circumference of the affected hand/wrist compared to the unaffected side to document atrophy.
Key thresholds:
- Significant reduction in grip strength vs. contralateral hand — Documents functional weakness; supports DeLuca factors of weakness and fatigability
- Measurable muscle atrophy (circumference difference) — Objective evidence of disuse atrophy; directly supports higher functional impairment rating
Tips:
- Grip with your typical level of effort - do not maximize effort through pain
- If grip weakens with repeated squeezing, demonstrate this and report it
- Mention specific tasks you can no longer perform: opening jars, holding tools, carrying bags
- Report if grip strength is reduced in the morning vs. later in the day, or vice versa
Pain considerations: Grip strength tests are objective but can underestimate disability if you hold back due to pain. Tell the examiner: 'I am stopping here because further squeezing causes significant pain, not because I have reached my maximum strength.'
Repetitive Use Testing (DeLuca Factors)
Whether ROM, strength, or function decreases after repetitive use of the hand and fingers - as required by DeLuca v. Brown and M21-1 guidance.
What to expect:
The examiner should assess whether your condition worsens with repeated motion over time. This may involve performing movements multiple times to observe degradation, or may be based on your reported history. The examiner must document whether functional ability is limited due to pain, weakness, fatigability, or incoordination during repetitive use.
Key thresholds:
- ROM decreases after repetitive motion — Additional functional loss documented; rater must account for worst-case ROM
- Pain increases with repeated use (fatigability) — Supports higher rating under DeLuca; functional loss during repetitive use is compensable
Tips:
- Before the exam, tell the examiner: 'My condition is significantly worse after use or later in the day'
- Describe specific work or daily activities that cause increased pain or weakness
- If the examiner does not ask about repetitive use effects, proactively raise the topic
- Bring a written statement describing how your hand function degrades throughout a typical workday
Pain considerations: Per M21-1 guidance, the examiner must address functional loss during flare-ups OR with repeated use. If your hand becomes nearly non-functional after prolonged use, this is rating-critical information. Describe your worst-performing scenario, not your best.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 60% | Unfavorable ankylosis of four digits including the thumb and any three fingers of one hand (major/dominant hand). This is among the highest ratings for finger conditions short of amputation. |
CFR: DC 5217: Unfavorable ankylosis of four digits - Thumb and any three fingers: 60% (major), 50% (minor). Index, long, ring, and little fingers: 50% (major), 40% (minor). Note: Also consider whether evaluation as amputation is warranted. |
| 50% | Favorable ankylosis of five digits of one hand, OR unfavorable ankylosis of four digits (index, long, ring, and little fingers) of the major hand, OR unfavorable ankylosis of thumb and three fingers of the minor hand. |
CFR: DC 5220: Favorable ankylosis of five digits: 50% (major), 40% (minor). DC 5221: Favorable ankylosis of four digits (thumb + three fingers): 50% (major), 40% (minor). DC 5217: Unfavorable ankylosis of four digits (index/long/ring/little): 50% (major), 40% (minor). |
| 40% | Favorable ankylosis of four digits (index, long, ring, and little fingers) of the major hand, OR favorable ankylosis of five digits of the minor hand, OR unfavorable ankylosis of four digits of the minor hand (thumb + three fingers). |
CFR: DC 5221: Favorable ankylosis - index, long, ring, and little fingers: 40% (major), 30% (minor). DC 5220: Favorable ankylosis of five digits: 40% (minor). DC 5217: Unfavorable ankylosis (thumb + three fingers): 40% (minor). |
| 20% | Limited range of motion of multiple finger joints, pain on use, weakness, and reduced function without complete ankylosis. Limitation of motion of individual fingers or limited grip strength due to arthritis, tendinopathy, or injury. |
CFR: Limitation of motion of individual digits rated under applicable DCs (5151-5156 for individual finger joints). Degenerative arthritis under DC 5003 rated at 20% if X-ray evidence present with at least 2 joints involved OR painful motion. |
| 10% | Mild limitation of motion with pain on use, or X-ray evidence of arthritis without significant functional limitation. Condition is present and service-connected but with minimal documented functional impact. |
CFR: DC 5003 (degenerative arthritis): 10% when X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups with occasional incapacitating exacerbations. Also rated 10% for painful motion per 38 CFR 4.59. |
60% Unfavorable ankylosis of four digits including the thumb and ...
Unfavorable ankylosis of four digits including the thumb and any three fingers of one hand (major/dominant hand). This is among the highest ratings for finger conditions short of amputation.
Key Symptoms
- Complete loss of motion (ankylosis) in four digits including thumb
- Joints fused in non-functional position (excessive flexion, extension, or deviation)
- Unable to perform any grip, pinch, or opposition function
- Severe functional loss of dominant hand
CFR: DC 5217: Unfavorable ankylosis of four digits - Thumb and any three fingers: 60% (major), 50% (minor). Index, long, ring, and little fingers: 50% (major), 40% (minor). Note: Also consider whether evaluation as amputation is warranted.
50% Favorable ankylosis of five digits of one hand, OR unfavorab ...
Favorable ankylosis of five digits of one hand, OR unfavorable ankylosis of four digits (index, long, ring, and little fingers) of the major hand, OR unfavorable ankylosis of thumb and three fingers of the minor hand.
Key Symptoms
- Ankylosis of four or five digits
- Multiple joints fused - some in functional positions
- Severely limited hand function; unable to perform fine motor tasks
- May retain limited gross grasp depending on position of fusion
CFR: DC 5220: Favorable ankylosis of five digits: 50% (major), 40% (minor). DC 5221: Favorable ankylosis of four digits (thumb + three fingers): 50% (major), 40% (minor). DC 5217: Unfavorable ankylosis of four digits (index/long/ring/little): 50% (major), 40% (minor).
40% Favorable ankylosis of four digits (index, long, ring, and l ...
Favorable ankylosis of four digits (index, long, ring, and little fingers) of the major hand, OR favorable ankylosis of five digits of the minor hand, OR unfavorable ankylosis of four digits of the minor hand (thumb + three fingers).
Key Symptoms
- Multiple digit ankylosis in functional (favorable) positions
- Able to perform some gross grasp but fine motor severely limited
- Unable to perform precision tasks, keyboard work, or tool use
- Significant occupational functional impairment
CFR: DC 5221: Favorable ankylosis - index, long, ring, and little fingers: 40% (major), 30% (minor). DC 5220: Favorable ankylosis of five digits: 40% (minor). DC 5217: Unfavorable ankylosis (thumb + three fingers): 40% (minor).
20% Limited range of motion of multiple finger joints, pain on u ...
Limited range of motion of multiple finger joints, pain on use, weakness, and reduced function without complete ankylosis. Limitation of motion of individual fingers or limited grip strength due to arthritis, tendinopathy, or injury.
Key Symptoms
- Painful limited ROM in one or more finger joints
- Reduced grip strength
- Pain with repetitive grasping or pinching
- Morning stiffness lasting more than 30 minutes
- Functional limitations with work and daily tasks
CFR: Limitation of motion of individual digits rated under applicable DCs (5151-5156 for individual finger joints). Degenerative arthritis under DC 5003 rated at 20% if X-ray evidence present with at least 2 joints involved OR painful motion.
10% Mild limitation of motion with pain on use, or X-ray evidenc ...
Mild limitation of motion with pain on use, or X-ray evidence of arthritis without significant functional limitation. Condition is present and service-connected but with minimal documented functional impact.
Key Symptoms
- Mild pain on use of affected finger(s)
- Slight reduction in ROM not reaching threshold for higher rating
- X-ray evidence of degenerative changes
- Minimal functional limitation in typical daily activities
CFR: DC 5003 (degenerative arthritis): 10% when X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups with occasional incapacitating exacerbations. Also rated 10% for painful motion per 38 CFR 4.59.
How to Describe Your Symptoms
Pain - Location, Character, and Triggers
How to describe:
Describe pain by joint location (e.g., 'base of my left thumb CMC joint'), character (sharp, aching, burning, throbbing), triggers (gripping, pinching, typing, cold weather), and duration. Use a 0-10 scale when asked.
Worst-day example:
“On my worst days, the pain at the base of my thumb and along my index finger PIP joint is a 9 out of 10. I cannot hold a coffee mug without dropping it, I cannot turn a doorknob, and any gripping motion sends a sharp stabbing pain up my hand into my wrist. The pain lasts for hours after even brief activity.”
What the examiner listens for:
Examiner notes whether pain is present at rest vs. with motion, whether it limits active ROM, whether it is consistent with the diagnosed condition, and whether it causes functional loss per DeLuca factors.
Understatements to avoid:
Do not say 'it's not too bad' or 'I manage okay' - if you manage by avoiding activities, that avoidance IS the functional loss. Say instead: 'I have stopped doing those activities because the pain is too severe.'
Flare-Ups - Frequency, Duration, and Functional Impact
How to describe:
Describe how often flare-ups occur (e.g., 2-3 times per week, after any significant hand use), how long they last (hours to days), what triggers them, and what you cannot do during a flare-up.
Worst-day example:
“During a flare-up, which happens about three times a week, my fingers swell visibly and I cannot close my hand into a fist at all. I cannot perform any tasks requiring grip - I cannot cook, dress myself fully, write, or use my phone normally. Flare-ups last 1-3 days and I often need to use my other hand for everything.”
What the examiner listens for:
The examiner must document flare-up description per DBQ field 270. This information is critical for ratings under DeLuca and M21-1 because the rater must account for functional loss during the worst periods of the condition, not just the day of the exam.
Understatements to avoid:
Do not let the examiner skip the flare-up question. If they do not ask, proactively say: 'I also want to describe how my condition is during flare-ups, which are significantly worse than today.'
Weakness and Fatigability
How to describe:
Describe specific strength deficits (inability to open jars, carry items, use tools) and how your hand fatigues with use. Distinguish between constant weakness and weakness that worsens with activity.
Worst-day example:
“My grip strength is so reduced I cannot open a sealed water bottle without using a tool. After typing for 10 minutes my hand feels completely exhausted and I must rest for 30 minutes. By mid-afternoon, I have almost no useful grip strength remaining in my dominant hand.”
What the examiner listens for:
DBQ fields for weakness (1820, 1868, 1880, 1929, 1973) and fatigability (1819, 1867, 1879, 1928, 1972) are specifically documented. The examiner should note whether weakness is present on initial exam, after repetitive testing, or is constant.
Understatements to avoid:
Do not only report your strength at the beginning of the exam. If you can grip normally for the first squeeze but lose strength after 5 repetitions, demonstrate this and say: 'My strength decreases significantly with repeated use.'
Incoordination and Fine Motor Loss
How to describe:
Describe inability to perform precision tasks: buttoning shirts, picking up coins, writing, using a keyboard, threading a needle, manipulating small objects. These demonstrate incoordination and fine motor loss directly relevant to DBQ.
Worst-day example:
“I can no longer button my own shirt - my fingers do not cooperate and the pain when trying is unbearable. I drop small objects constantly. I cannot use a pen for more than 2-3 minutes before my fingers cramp and the writing becomes illegible. I have had to switch to voice-to-text for all written communication.”
What the examiner listens for:
DBQ fields for incoordination (1822, 1870, 1882, 1931, 1975, 2019) specifically address this DeLuca factor. The examiner should note these observations and their impact on occupational and daily functioning.
Understatements to avoid:
Do not focus only on gross motor tasks like lifting. Finger conditions primarily affect fine motor precision - ensure you describe all precision tasks you have lost: writing, typing, sewing, playing instruments, using phones, manipulating fasteners.
Functional Impact on Work and Daily Life
How to describe:
Describe your job duties that are affected, any accommodations your employer has made, tasks you have stopped doing at home, and how the condition affects your independence (dressing, grooming, cooking, driving).
Worst-day example:
“I was a carpenter before my condition worsened. I can no longer swing a hammer, use power tools, or grip lumber. I had to leave my trade entirely. At home, my spouse now opens all containers, cuts my food, and helps me with buttons and zippers. I cannot hold my grandchildren safely because I fear dropping them.”
What the examiner listens for:
DBQ Section 8 (functioning) and the functional impact narrative fields (1293, 2083, 2070) capture this. The examiner uses this to support nexus between clinical findings and real-world disability.
Understatements to avoid:
Veterans frequently underreport domestic and personal care limitations out of pride. Remember: your rating affects your benefits for life. Accurately report every activity that has been affected, including personal hygiene, meal preparation, and caregiving tasks.
Common Mistakes to Avoid
Performing maximum ROM during the exam because 'it does not hurt today as much as usual'
C&P exams are snapshots, but ratings must reflect the condition as it typically presents, including bad days. If you demonstrate better motion than is typical, your rating reflects that best-case performance.
Instead: Before beginning ROM testing, tell the examiner: 'I want you to know that today is a better day than average. On typical days my motion is [describe]. On my worst days I cannot [describe].' Move only to your typical painful limit.
Impact: Can drop rating by one or two full levels if worst-day function is not documented
Failing to mention all affected digits and both hands if applicable
The DBQ has separate sections for each digit on each hand. If you only report the most painful finger, the other affected digits will not be evaluated, and you may receive a lower combined rating.
Instead: Before the exam, make a list of every affected finger and joint on both hands. Bring this list and refer to it during the exam to ensure complete coverage of all affected areas.
Impact: Missing digits can result in loss of 10-30% per unclaimed affected finger
Not disclosing the dominant hand
Under 38 CFR 4.68 and hand disability codes, the major (dominant) hand typically receives a higher rating than the minor hand for the same level of impairment. Failing to clearly identify your dominant hand may result in the minor-hand rating being applied.
Instead: At the start of the exam, clearly state your dominant hand. If you have adapted to use the other hand due to injury to your dominant hand, specify both which hand is naturally dominant AND the functional impact on your dominant hand.
Impact: 5-20% difference between major and minor hand ratings at each level
Not reporting that flare-ups are significantly worse than the exam day presentation
The C&P examiner can only rate what they observe and what is documented. If your flare-ups involve complete loss of hand function but the exam occurs during a moderate symptom period, your rating will be based on the exam finding unless flare-up information is explicitly provided.
Instead: Proactively describe your flare-ups in detail. Use the phrase: 'This is not representative of my worst days - during flare-ups I experience [specific limitations].' Ensure the examiner documents this in the flare-up narrative field.
Impact: Critical - can mean the difference between a 10% and 40-50% rating
Failing to connect hand condition to occupational and daily functional limitations
VA raters use functional impact narratives to assign ratings at the appropriate level. Clinical ROM numbers alone may appear borderline between rating levels; functional impact testimony pushes the rating to the correct higher level.
Instead: Prepare a written list of at least 10 specific daily and work activities you can no longer perform or that cause significant pain. Present this list if the examiner does not ask, and ensure it is documented in the exam record.
Impact: Can be determinative at any rating level boundary
Accepting the examiner's conclusion that passive ROM equals active ROM without clarification
Per Correia v. McDonald, both active and passive ROM must be measured. If the examiner marks 'passive same as active' without actually testing passive motion, this shortcut can undercount your functional limitation. Pain-limited active ROM may be less than passive ROM, which is important documentation.
Instead: If the examiner only tests active ROM and marks the checkbox without passive testing, politely ask: 'Are you also going to test passive range of motion separately?' Your passive ROM documentation is legally required.
Impact: Affects all rating levels - required by case law
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 a thorough and accurate C&P examination that fully addresses all claimed conditions, including all affected digits on both hands.
- You have the right to have both active AND passive range of motion measured separately per Correia v. McDonald, 28 Vet.App. 158 (2016).
- You have the right to have DeLuca factors (pain, weakness, fatigability, incoordination during repetitive use and flare-ups) documented per DeLuca v. Brown, 8 Vet.App. 202 (1995).
- You have the right to request a new C&P examination if the original exam is inadequate, incomplete, or inaccurate (38 CFR 3.159(c)(4)).
- You have the right to submit additional evidence (buddy statements, personal statements, private medical opinions) before a rating decision is issued.
- You have the right to record your C&P examination in most U.S. states. Check your state's recording consent laws before the exam.
- You have the right to be examined by a qualified examiner. If you believe the examiner lacked appropriate credentials or the exam was conducted improperly, you may raise this concern with your VSO.
- You have the right to review your C&P examination report before your rating decision is finalized and to submit evidence addressing any inaccuracies.
- You have the right to appeal a rating decision you believe is incorrect, including requesting a Higher-Level Review, Supplemental Claim, or Board of Veterans' Appeals hearing.
- You have the right to have your dominant (major) hand considered separately from your non-dominant (minor) hand, as ratings differ between the two under applicable diagnostic codes.
- Under 38 CFR 4.59 (painful motion), you are entitled to the minimum compensable rating for any joint where motion is demonstrated to be painful, even if ROM is otherwise within normal limits.
- You have the right to be believed - the benefit of the doubt standard (38 CFR 3.102) requires that when the evidence is approximately balanced, the decision must be made in your favor.
Related Conditions
- Wrist Conditions (Musculoskeletal) The wrist is the proximal joint to the hand. Wrist conditions (DC 5214 5215) frequently co occur with finger conditions. Separately ratable if distinct functional limitations exist.
- Carpal Tunnel Syndrome Median nerve compression at the wrist causes hand pain, weakness, and numbness affecting fingers. Often co occurs with hand arthritis or tendinopathy. Rated separately under peripheral nerve codes.
- Peripheral Neuropathy (Upper Extremity) Nerve damage affecting the hand and fingers can cause pain, weakness, and sensory loss. Rated separately from musculoskeletal conditions if attributable to a separate disease process.
- Rheumatoid Arthritis (Multi-Joint) RA frequently affects finger and hand joints. May be rated under DC 5002 (multi joint) if multiple joint groups are involved, which may yield a higher rating than individual finger codes.
- Post-Traumatic Arthritis (Hand) Arthritis developing after hand injury or fracture. Rated under DC 5010 (traumatic arthritis) or the applicable limitation of motion code, whichever is higher. Requires X ray evidence.
- Tendinitis / Tenosynovitis (Hand) Inflammation of tendons or tendon sheaths in the hand. Can be rated separately or as part of the overall hand condition depending on whether it produces distinct and non overlapping functional loss.
- Dupuytren's Contracture Fibrotic thickening of the palmar fascia causing permanent flexion contracture of fingers. Rated under applicable ankylosis or limitation of motion codes. Specifically addressed in the Hand and Finger DBQ.
- Trigger Finger (Stenosing Tenosynovitis) Locking or catching of a finger during flexion due to tendon sheath narrowing. Specifically listed in the Hand and Finger DBQ and may affect ROM and functional use ratings.
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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.