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C&P Exam Prep: Large Intestine Resection
DBQ Overview
Interview + Physical- Form Name
- intestines
- Form Code
- intestines
- Page Count
- 11
- Examiner Type
- Gastroenterologist or Physician
- Estimated Duration
- 20-30 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the current severity of your large intestine resection and any resulting complications, including stoma status, bowel function, nutritional status, and impact on daily functioning, so that VA can assign an accurate disability rating under DC 7329.
What the examiner evaluates:
- Extent of large intestine removed (partial vs. total colectomy)
- Presence and type of stoma (permanent colostomy or ileostomy)
- Whether reanastomosis was performed and outcomes thereof
- High-output syndrome and episodes of dehydration requiring IV hydration
- Frequency and character of bowel movements and diarrhea
- Loss of ileocecal valve
- Nutritional status including need for TPN or tube feeding
- BMI and weight loss / wasting
- Peritoneal adhesions and complications
- Presence of fistulous disease
- Systemic manifestations such as anemia, weakness, fatigue
- Current medications and dietary management requirements
- Hospitalizations and emergency treatments in the past 12 months
- Impact on ability to work and activities of daily living
Exam may be conducted in person or via telehealth. If telehealth, the examiner must document how the examination was conducted. Bring all surgical records, operative reports, pathology reports, and recent lab work if available. Arrive having tracked your bowel movement frequency, stoma output, and any recent hospitalizations.
Typical duration: 20-30 minutes
BMI Calculation
Body Mass Index, used to assess nutritional status and undernutrition severity
What to expect:
The examiner will record your current height and weight and calculate your BMI. This directly affects rating thresholds.
Key thresholds:
- BMI < 16 — Supports highest nutritional deficiency rating level
- BMI 16-18 inclusive — Supports significant nutritional deficiency rating level
- BMI > 18 — Less likely to support nutritional deficiency-based rating elevation
Tips:
- Weigh yourself consistently (same time of day, before eating) in the weeks prior to accurately report your weight trend
- Report any unintentional weight loss since surgery or in the past 6-12 months
- Note if your weight fluctuates due to dehydration episodes
Pain considerations: N/A - weight-bearing not applicable for this measurement
Complete Blood Count (CBC)
Hemoglobin, hematocrit, white blood cell count, and platelets - used to identify anemia, infection/inflammation, and systemic complications
What to expect:
Blood draw may be ordered or prior lab results reviewed. The examiner will document hemoglobin, hematocrit, WBC, and platelet values.
Key thresholds:
- Low hemoglobin / hematocrit — Supports anemia related to malabsorption; may elevate rating
- Elevated WBC — Supports leukocytosis / systemic infection finding
Tips:
- Bring copies of any recent bloodwork from your treating physician
- Note if you have been diagnosed with iron-deficiency or B12-deficiency anemia since the resection
- Inform the examiner of any IV iron infusions or B12 injections you receive
Pain considerations: N/A
Stoma Output Assessment
Volume and frequency of ostomy output, used to evaluate high-output syndrome
What to expect:
The examiner will ask about daily stoma output volume, consistency, and any need for pad changes or pouching system upgrades.
Key thresholds:
- High-output syndrome (generally >1500 mL/day ostomy output) — Critical for 100% rating when combined with total colectomy and 2+ dehydration episodes requiring IV hydration
- Daily discharge requiring pad changes — Supports higher rating within colostomy/ileostomy categories
Tips:
- Keep a log of daily ostomy output volume for at least 2 weeks before the exam
- Document how often you change your pouch or appliance daily
- Note any episodes of leakage, skin breakdown (peristomal dermatitis), or need for emergency pouch changes
Pain considerations: N/A
Dehydration Episode Tracking
Number of episodes in the past 12 months requiring intravenous hydration for dehydration
What to expect:
The examiner will ask specifically how many times you required IV fluids for dehydration at an emergency department, urgent care, or hospital in the past year.
Key thresholds:
- More than 2 episodes requiring IV hydration in past 12 months — Required criterion for 100% rating under DC 7329 when combined with total colectomy, ileostomy, and high-output syndrome
Tips:
- Gather all ER records, hospital discharge summaries, and treatment notes documenting IV hydration visits
- Count visits accurately - do not undercount or overcount
- Note dates, locations, and duration of each hospitalization or ER visit
Pain considerations: N/A
Bowel Movement Frequency Log
Number and character of bowel movements per day, used for rating diarrhea severity and post-reanastomosis outcomes
What to expect:
Examiner will ask about daily bowel movement frequency, urgency, consistency, presence of blood or mucus, and ability to control defecation.
Key thresholds:
- More than 3 episodes of diarrhea per day — Required for 20% rating under partial colectomy with reanastomosis and loss of ileocecal valve
- 4 or more episodes of diarrhea per day — Supports higher rating consideration and functional impact documentation
Tips:
- Keep a bowel diary for at least 2 weeks before the exam recording number, time, urgency, and consistency of each movement
- Document your worst days, not just average days
- Note any episodes of fecal incontinence or explosive/unpredictable bowel movements
Pain considerations: Note if bowel movements are associated with pain, cramping, or significant urgency that limits your ability to leave home or work
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 100% | Total colectomy with formation of ileostomy, high-output syndrome, AND more than two episodes of dehydration requiring intravenous hydration in the past 12 months. All three elements must be present. |
CFR: Total colectomy with formation of ileostomy, high-output syndrome, and more than two episodes of dehydration requiring intravenous hydration in the past 12 months. |
| 60% | Total colectomy with or without permanent colostomy or ileostomy, without high-output syndrome. |
CFR: Total colectomy with or without permanent colostomy or ileostomy without high-output syndrome. |
| 40% | Partial colectomy with permanent colostomy or ileostomy, without high-output syndrome. |
CFR: Partial colectomy with permanent colostomy or ileostomy without high-output syndrome. |
| 20% | Partial colectomy with reanastomosis (reconnection of intestinal tube) with loss of ileocecal valve AND recurrent episodes of diarrhea more than 3 times per day. |
CFR: Partial colectomy with reanastomosis (reconnection of the intestinal tube) with loss of ileocecal valve and recurrent episodes of diarrhea more than 3 times per day. |
| 10% | Partial colectomy with reanastomosis (reconnection of the intestinal tube) without the additional findings required for a higher rating. |
CFR: Partial colectomy with reanastomosis (reconnection of the intestinal tube). |
100% Total colectomy with formation of ileostomy, high-output syn ...
Total colectomy with formation of ileostomy, high-output syndrome, AND more than two episodes of dehydration requiring intravenous hydration in the past 12 months. All three elements must be present.
Key Symptoms
- Total colectomy with ileostomy
- High-output syndrome (excessive stoma output causing fluid and electrolyte imbalance)
- More than 2 separate episodes of dehydration requiring IV hydration in the past 12 months
- Significant nutritional compromise
- Weight loss and wasting
- Weakness and fatigue
- Potential requirement for TPN
CFR: Total colectomy with formation of ileostomy, high-output syndrome, and more than two episodes of dehydration requiring intravenous hydration in the past 12 months.
60% Total colectomy with or without permanent colostomy or ileos ...
Total colectomy with or without permanent colostomy or ileostomy, without high-output syndrome.
Key Symptoms
- Total colectomy confirmed by surgical records
- Permanent colostomy or ileostomy present OR reanastomosis performed
- No high-output syndrome OR high-output syndrome controlled
- Altered bowel function
- Dietary modifications required
- Possible nutritional supplementation required
- Ongoing fatigue and weakness
CFR: Total colectomy with or without permanent colostomy or ileostomy without high-output syndrome.
40% Partial colectomy with permanent colostomy or ileostomy, wit ...
Partial colectomy with permanent colostomy or ileostomy, without high-output syndrome.
Key Symptoms
- Partial colectomy (not total removal)
- Permanent colostomy or ileostomy present
- No high-output syndrome
- Ongoing stoma management needs
- Dietary restrictions
- Possible skin complications around stoma
- Activity limitations due to stoma
CFR: Partial colectomy with permanent colostomy or ileostomy without high-output syndrome.
20% Partial colectomy with reanastomosis (reconnection of intest ...
Partial colectomy with reanastomosis (reconnection of intestinal tube) with loss of ileocecal valve AND recurrent episodes of diarrhea more than 3 times per day.
Key Symptoms
- Partial colectomy with surgical reconnection of bowel
- Loss of ileocecal valve documented
- Recurrent diarrhea more than 3 times per day
- Urgency and unpredictability of bowel movements
- Possible nutritional deficiencies (B12, fat-soluble vitamins, bile salt malabsorption)
- Abdominal cramping and pain
- Explosive or watery bowel movements
CFR: Partial colectomy with reanastomosis (reconnection of the intestinal tube) with loss of ileocecal valve and recurrent episodes of diarrhea more than 3 times per day.
10% Partial colectomy with reanastomosis (reconnection of the in ...
Partial colectomy with reanastomosis (reconnection of the intestinal tube) without the additional findings required for a higher rating.
Key Symptoms
- Partial colectomy with bowel reconnection
- Ileocecal valve preserved OR diarrhea not exceeding 3 times per day
- Mild to moderate bowel irregularity
- Dietary modifications may be needed
- Some change in stool frequency or form
- Possible mild abdominal discomfort or bloating
CFR: Partial colectomy with reanastomosis (reconnection of the intestinal tube).
How to Describe Your Symptoms
Bowel Movement Frequency and Urgency
How to describe:
Describe the exact number of bowel movements or stoma evacuations per day on both average and worst days. Specify whether movements are watery, loose, or formed, and whether you have urgency, accidents, or explosive movements that are difficult to predict or control. Quantify how this limits you - e.g., 'I cannot leave home for more than 90 minutes without risking an accident' or 'I have to plan all outings around bathroom access.'
Worst-day example:
“On my worst days, I have 6-8 watery bowel movements before noon, with no warning. I have had multiple accidents in public. I cannot travel, attend appointments, or work a full shift because I cannot be more than 30 feet from a bathroom at all times. The urgency wakes me from sleep 2-3 times per night.”
What the examiner listens for:
Specific frequency counts, urgency severity, nocturnal awakening for bowel movements, fecal incontinence episodes, and functional limitations caused by unpredictability.
Understatements to avoid:
Do not say 'I go to the bathroom a lot' - give numbers. Do not minimize accidents or urgency to avoid embarrassment. Do not report only your best days.
Stoma Management and Complications
How to describe:
For veterans with a colostomy or ileostomy, describe daily stoma care burden, approximate output volume, frequency of pouch changes, and any complications such as skin breakdown, peristomal hernia, prolapse, retraction, leakage, or odor. Describe how the stoma affects your ability to work, exercise, be intimate, travel, and participate in social activities.
Worst-day example:
“My stoma output can exceed 2 liters per day during flares. I change my pouch 4-5 times daily and still have leakage. The skin around my stoma is constantly raw and painful, requiring prescription barrier cream. I cannot wear certain clothing, cannot swim, cannot travel by air, and I have had to leave work early multiple times due to pouch failures.”
What the examiner listens for:
Output volume estimates, pouch change frequency, skin complications, parastomal hernia, need for specialist ostomy nursing, and psychosocial impact of permanent stoma.
Understatements to avoid:
Do not say 'I manage okay' without describing the daily time burden and complications. Do not omit skin breakdown or peristomal hernia. Do not understate the psychological impact.
Dehydration and Electrolyte Imbalances
How to describe:
Describe every episode in the past 12 months when you required IV fluids at an ER, urgent care, or hospital for dehydration. Provide dates, locations, duration of treatment, and symptoms that prompted each visit (e.g., dizziness, confusion, muscle cramps, inability to keep fluids down). Also describe ongoing daily symptoms of chronic dehydration such as constant thirst, dark urine, muscle cramps, and fatigue.
Worst-day example:
“I have been to the emergency room four times in the past year for IV fluids. Each time I was dizzy, unable to stand, had severe muscle cramping, and my sodium and potassium were critically low. Between visits, I am chronically dehydrated - I drink over 3 liters of oral rehydration solution daily and still feel parched and fatigued.”
What the examiner listens for:
Exact count of IV hydration episodes in past 12 months, specific electrolyte abnormalities documented, whether hospitalizations were required, and whether oral rehydration is sufficient between episodes.
Understatements to avoid:
Do not combine multiple-day hospital stays as 'one episode' if each was a separate admission. Do not omit urgent care IV hydration visits. Do not forget to mention chronic ongoing dehydration symptoms between acute episodes.
Nutritional Deficiencies and Weight Loss
How to describe:
Describe any documented nutritional deficiencies (iron, B12, vitamin D, calcium, fat-soluble vitamins), current BMI and weight relative to your pre-surgery weight, any need for prescribed dietary supplementation, enteral tube feeding, or total parenteral nutrition (TPN). Describe weakness, fatigue, hair loss, bone pain, or other symptoms attributable to malnutrition.
Worst-day example:
“I have lost 45 pounds since my surgery and my BMI is now 16.8. I require B12 injections monthly, iron infusions every 3 months, and prescription high-calorie oral supplements daily. On bad days, I am too weak to climb a flight of stairs. My doctor has discussed starting TPN if my weight continues to decline.”
What the examiner listens for:
Documented BMI, specific deficiencies confirmed by lab work, prescribed supplementation regimen, weight loss trajectory, and functional weakness attributed to malnutrition.
Understatements to avoid:
Do not say 'I take vitamins' without distinguishing between over-the-counter supplements and physician-prescribed supplementation for documented deficiencies. Do not omit weight loss amounts.
Abdominal Pain and Peritoneal Adhesions
How to describe:
Describe the location, character (cramping, sharp, constant, intermittent), severity (0-10 scale), and duration of abdominal pain. If you have peritoneal adhesions, describe episodes of partial obstruction, nausea, vomiting, and emergency visits. Note what activities worsen pain (eating, physical activity, stress) and what provides relief. Describe how pain limits your ability to eat normal meals, work, or perform daily activities.
Worst-day example:
“On my worst days, I have constant 8/10 cramping abdominal pain that begins within 30 minutes of eating anything. I have had three ER visits for suspected bowel obstruction from adhesions in the past 18 months. The pain prevents me from eating normal meals - I eat 5-6 very small portions daily to try to avoid triggering pain, but I still lose weight.”
What the examiner listens for:
Pain frequency (intermittent vs. constant), relationship to eating, evidence of partial or complete obstruction from adhesions, and functional limitation on eating and activity.
Understatements to avoid:
Do not say 'some discomfort' when you mean significant pain. Do not omit ER visits for obstruction. Report pain on your worst days, not only when currently comfortable.
Fatigue, Weakness, and Functional Impairment
How to describe:
Describe how fatigue and weakness from your large intestine resection affect your ability to perform work, household chores, recreational activities, and self-care. Quantify - e.g., 'I can only stand for 20 minutes before needing to rest' or 'I sleep 10-12 hours per night and still wake exhausted.' Connect fatigue to specific causes: anemia, malnutrition, dehydration, disrupted sleep from nocturnal bowel movements.
Worst-day example:
“My fatigue is debilitating on my worst days. I wake 3-4 times per night for bowel movements and am exhausted all day. I cannot work more than 4 hours before needing to lie down. I can no longer do yard work, exercise, or play with my grandchildren. My spouse handles most household tasks because I do not have the energy.”
What the examiner listens for:
Connection between GI symptoms and fatigue (anemia, malnutrition, sleep disruption), specific functional limitations, and impact on work capacity and activities of daily living.
Understatements to avoid:
Do not say 'I'm a little tired' - describe the severity and daily impact. Do not omit the nocturnal disruption from bowel movements.
Common Mistakes to Avoid
Reporting only average symptom days instead of worst days
VA ratings are based on the full picture of disability, including your worst days. Reporting only 'typical' days can result in a rating that does not reflect your actual worst-case function.
Instead: Describe both your average day and your worst day explicitly. Say: 'On an average day I have 5 bowel movements, but on my worst days I have 10-12 and cannot leave my home.'
Impact: All levels - particularly the 20% vs. 40%+ distinction based on diarrhea frequency
Failing to document the exact number of IV hydration episodes in the past 12 months
More than 2 IV hydration episodes is a specific threshold criterion for the 100% rating. Without documented proof and accurate reporting, you may not receive the highest rating even if you qualify.
Instead: Gather all ER records, admission records, and clinic notes documenting IV fluid administration. Present the exact count and dates to the examiner.
Impact: 100%
Not clearly distinguishing between partial and total colectomy
The entire rating structure under DC 7329 depends on whether your resection was partial or total. If the examiner does not clearly document total vs. partial, you may be rated at a lower tier.
Instead: Bring your operative report and any pathology reports confirming the extent of resection. Tell the examiner explicitly: 'I had a total colectomy' or 'I had a partial colectomy removing X portion of my colon.'
Impact: 60% vs. 40% and 100% vs. 60%
Omitting the loss of ileocecal valve when it was removed
Loss of the ileocecal valve is a specific criterion that differentiates the 20% rating from the 10% rating in partial colectomy with reanastomosis cases.
Instead: Review your operative report to confirm whether the ileocecal valve was preserved or removed. Inform the examiner specifically about valve loss and its consequences (increased diarrhea, B12 malabsorption, bile salt issues).
Impact: 10% vs. 20%
Downplaying stoma complications or daily management burden
The functional burden of stoma care - including skin breakdown, leakage, output volume, and social/occupational impact - directly informs the overall severity determination and functional impact sections of the DBQ.
Instead: Describe all peristomal skin problems, frequency and reasons for appliance changes, and every way the stoma limits your daily life, employment, and social activities.
Impact: 40% and 60%
Failing to mention peritoneal adhesions as a separate complicating condition
Peritoneal adhesions (DC 7301) can be rated separately or contribute to the overall picture of disability. If not mentioned, the examiner may not check the relevant DBQ fields or recommend a separate evaluation.
Instead: Report any episodes of partial bowel obstruction, bowel obstruction pain, or hospitalizations attributable to adhesions. Ask your VSO or attorney about filing a separate claim for peritoneal adhesions if appropriate.
Impact: All levels - may support a separate compensable rating
Not bringing supporting records to the exam
The examiner has a short window to document your condition. Without surgical records, lab results, or hospitalization documentation, findings may be based solely on your verbal report, which is more susceptible to challenge.
Instead: Bring operative reports, discharge summaries, recent labs (CBC, metabolic panel, vitamin levels), ostomy nursing notes, gastroenterology clinic notes, and any ER visit records.
Impact: All levels
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 have the exam conducted in person. If a telehealth exam is proposed and you prefer an in-person exam, you may request one.
- You have the right to request that your C&P exam be recorded (audio or video) in most states. Check your state's consent laws. Recording creates a verbatim record of what was said and protects against inaccurate documentation.
- You have the right to submit a written statement before the exam describing your symptoms, functional limitations, and daily life impact. This becomes part of your claims file and the examiner should review it.
- You have the right to review the completed DBQ examination report and to notify your VSO, accredited claims agent, or attorney if it contains inaccuracies or omissions.
- You have the right to request a new or supplemental examination if the original examination is inadequate, based on an inaccurate history, or does not address all relevant rating criteria under DC 7329.
- You have the right to submit a private medical nexus opinion or independent medical examination (IME) to supplement or rebut the VA examiner's findings.
- You have the right to representation by a Veterans Service Organization (VSO), accredited claims agent, or attorney at no charge for claims representation at the regional office level.
- You have the right to the benefit of the doubt under 38 U.S.C. - 5107(b) - when there is an approximate balance of positive and negative evidence regarding any issue material to the determination, VA must resolve the matter in the veteran's favor.
- You have the right to file a Higher-Level Review or Board appeal if you disagree with the rating assigned following this examination.
- Under the PACT Act, if your large intestine resection is connected to toxic exposure (e.g., Agent Orange, burn pits, radiation), you have additional rights to presumptive service connection. Ensure your examiner is aware of any relevant toxic exposure history.
Related Conditions
- Peritoneal Adhesions Common complication after large intestine resection surgery. Adhesions can cause partial or complete bowel obstruction, chronic abdominal pain, and may be separately ratable under DC 7301. Often develops post operatively and can worsen over time.
- Irritable Bowel Syndrome (IBS) May develop after large intestine resection as a post surgical functional bowel disorder. DC 7319 may apply as an alternative or additional rating basis. Under DC 7327, IBS and large intestine resection are evaluated under whichever DC results in a higher rating.
- Short Bowel Syndrome Can result from extensive resection of both large and small intestine. Characterized by malabsorption, high output diarrhea, and dependence on TPN or enteral nutrition. May require rating under DC 7329 or combined evaluation with small intestine resection (DC 7328).
- Small Intestine Resection When both small and large intestine are resected, VA evaluates each under its respective diagnostic code (DC 7328 and DC 7329) and assigns the most favorable combined evaluation. Veterans should ensure both are claimed if applicable.
- Malabsorption Syndrome Frequently develops after large intestine resection, particularly with loss of ileocecal valve or extensive resection. Characterized by nutritional deficiencies, chronic diarrhea, weight loss, and weakness. DBQ fields for malabsorption syndrome overlap significantly with DC 7329 evaluation.
- Anemia (Iron Deficiency / B12 Deficiency) Secondary condition commonly resulting from large intestine resection due to blood loss, reduced absorption of iron and B12, and chronic inflammation. May be separately ratable or contribute to the overall disability picture documented in the GI Intestines DBQ.
- Crohn's Disease Crohn's disease is a common underlying cause of large intestine resection. If the veteran's resection resulted from Crohn's, both the Crohn's disease and the resection sequelae should be evaluated. The examiner will assess whether to rate under DC 7326 (Crohn's) or DC 7329 (resection), or both as appropriate.
- Ulcerative Colitis Ulcerative colitis is a frequent cause of total colectomy. If the resection resulted from ulcerative colitis, both conditions should be claimed. Total colectomy may resolve the colitis but leaves permanent anatomical and functional changes rated under DC 7329.
- Colorectal Cancer (Malignant Neoplasm) Large intestine resection performed for colorectal cancer is rated at 100% during active treatment under 38 CFR 4.115a. After treatment completion, residuals (including resection status) are rated under DC 7329. Veterans should ensure continuity of rating from active cancer to post treatment residuals.
- Diverticular Disease / Diverticulitis Diverticulitis with perforation is a common cause of emergency large intestine resection. If the resection resulted from service connected or service caused diverticulitis, both the underlying diverticular disease and the resection should be evaluated and claimed.
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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.