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C&P Exam Prep: Lung Cancer (Malignant Respiratory Neoplasm)
DBQ Overview
Interview + Physical- Form Name
- Respiratory_Conditions_Other_than_Tuberculosis_and_Sleep_Apnea
- Form Code
- Respiratory_Conditions_Other_than_Tuberculosis_and_Sleep_Apnea
- Page Count
- 11
- Examiner Type
- Pulmonologist or Physician
- Estimated Duration
- 20-45 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the current status, treatment history, residuals, and functional impact of a malignant respiratory neoplasm (lung cancer) for VA disability rating purposes under DC 6819. Active malignancy is rated 100%; after treatment ends, a mandatory re-examination at six months post-treatment determines the ongoing rating based on residuals.
What the examiner evaluates:
- Confirmation and documentation of the lung cancer diagnosis, ICD code, date of diagnosis, and whether primary or metastatic
- Current treatment status: surgery, radiation therapy, antineoplastic chemotherapy, immunotherapy, or other therapeutic procedures
- Date of treatment completion or anticipated completion date
- Presence of local recurrence or distant metastasis
- Pulmonary function testing results (FVC, FEV1, FEV1/FVC ratio, DLCO) with pre- and post-bronchodilator values
- Systemic symptoms: weight loss, anorexia, hemoptysis, night sweats, fever, fatigue
- Physical examination findings: scattered rales, limitation of diaphragm excursion, pain or discomfort on exertion, cor pulmonale, right ventricular hypertrophy, pulmonary hypertension
- Imaging results: chest X-ray, CT scan, MRI, PET scan with dates and findings
- Biopsy and bronchoscopy results
- Tumor characteristics: location, size measurements (length x width in cm), primary vs. secondary/metastatic designation
- Residual conditions following treatment completion
- Any complications such as pleural effusion, pneumothorax, respiratory failure, cardiopulmonary complications
- Need for supplemental outpatient oxygen therapy
- Episodes of acute respiratory failure
- Functional impact on occupational and daily activities
- Whether condition is in active treatment, remission, or resolved
Exam may be conducted in person or via telehealth. Bring all oncology records, imaging reports, pathology/biopsy reports, operative reports, and treatment summaries. If post-treatment, bring documentation of treatment completion dates. The examiner will review your claims file (C-file) and may order or review pulmonary function tests. Confirm ahead of time whether PFTs will be performed at the exam or if prior results will be used.
Typical duration: 20-45 minutes
Spirometry - FVC (Forced Vital Capacity)
The total amount of air you can forcefully exhale after a full breath; reflects restrictive or obstructive lung disease patterns and is used to rate respiratory disability after cancer treatment ends.
What to expect:
You will be asked to breathe in as deeply as possible, then exhale as hard and fast as you can into a mouthpiece connected to a spirometer. The test is repeated at least three times. Post-bronchodilator testing may follow.
Key thresholds:
- FVC > 80% predicted — No pulmonary impairment - would support lower residuals rating (0-10%) if cancer resolved
- FVC 65-80% predicted — Mild restriction - supports 30% residuals rating
- FVC 50-64% predicted — Moderate restriction - supports 60% residuals rating
- FVC < 50% predicted — Severe restriction - supports 100% residuals rating
Tips:
- Perform your best effort on every attempt - hold nothing back, as submaximal effort produces lower numbers that underrepresent your true impairment
- Do not use short-acting bronchodilators (albuterol) within 4 hours of the test unless medically necessary
- Bring any prior PFT results from your oncologist or pulmonologist so the examiner can compare trends
- Report any chest pain, shortness of breath, or dizziness during the test immediately to the technician
Pain considerations: If you experience chest pain, chest wall discomfort, or post-surgical pain that limits your ability to take a full breath or exhale forcefully, tell the technician before and during testing. Surgical resection (lobectomy, pneumonectomy) significantly reduces lung volume and will affect results.
Spirometry - FEV1 (Forced Expiratory Volume in 1 Second)
The volume of air exhaled in the first second of a forced breath; the primary metric used to rate COPD and obstructive patterns that may coexist with or result from lung cancer or its treatment.
What to expect:
Measured simultaneously with FVC during spirometry. The ratio of FEV1/FVC helps distinguish obstructive vs. restrictive patterns. Both pre- and post-bronchodilator values are typically recorded.
Key thresholds:
- FEV1 > 80% predicted — No significant obstruction - supports lower residuals rating
- FEV1 71-80% predicted — Mild obstruction - supports 30% rating on obstructive pattern
- FEV1 56-70% predicted — Moderate obstruction - supports 60% rating
- FEV1 40-55% predicted — Moderately severe - supports 60% rating
- FEV1 < 40% predicted — Severe obstruction - supports 100% rating on residuals
Tips:
- Report any wheezing, bronchospasm, or difficulty breathing after inhalation of bronchodilator
- If you use daily inhalers (bronchodilators or corticosteroids), list all of them to the examiner - these are captured on the DBQ
- If post-pneumonectomy, FEV1 will be markedly reduced and should be compared against post-surgical predicted values
Pain considerations: Post-thoracotomy or post-VATS pain can cause splinting (guarding the chest wall), which artificially reduces FEV1 and FVC. Inform the examiner if pain is limiting your respiratory effort.
DLCO (Diffusing Capacity of the Lungs for Carbon Monoxide)
How effectively oxygen crosses from the air sacs into the bloodstream; reduced in conditions that damage alveolar tissue, including post-radiation fibrosis, surgical resection, or chemotherapy-induced lung damage.
What to expect:
You inhale a small amount of carbon monoxide mixed with other gases, hold your breath for about 10 seconds, then exhale. The difference in gas concentration measures gas transfer efficiency. Usually done after spirometry.
Key thresholds:
- DLCO > 70% predicted — Normal to mildly reduced - less supportive of higher residuals ratings
- DLCO 56-70% predicted — Moderate reduction - relevant to 60% residuals consideration
- DLCO < 40% predicted — Severely reduced - supports 100% residuals rating
Tips:
- Do not smoke for at least 24 hours before the test
- Do not exercise heavily before the test
- Inform the technician of any recent blood transfusion or hemoglobin changes, which affect results
Pain considerations: If radiation pneumonitis or post-radiation fibrosis is present, DLCO is often more impaired than FEV1 or FVC alone. Be sure to mention any history of radiation therapy to the chest and any onset of new shortness of breath after radiation.
Exercise Capacity / Oxygen Saturation Testing
Functional exercise tolerance and oxygen saturation during exertion; used to document desaturation, dyspnea on exertion, and the need for supplemental oxygen therapy.
What to expect:
May involve a six-minute walk test or pulse oximetry at rest and with exertion. If you require home oxygen therapy, this will be documented separately on the DBQ.
Key thresholds:
- SpO2 < 88% on exertion — Supports need for supplemental oxygen, relevant to 100% rating
- MET level < 5 — Significantly reduced exercise capacity supporting higher disability rating
Tips:
- If you currently use home oxygen, bring the prescription and equipment specifications
- Accurately report at what activity level (e.g., walking 50 feet, climbing one flight of stairs) you become short of breath
- Do not downplay exertional limitations - report your typical worst-day functional capacity
Pain considerations: Chest wall pain, pleuritic pain, or post-surgical pain that limits exertion should be explicitly reported to the examiner and linked to your lung cancer diagnosis or its treatment.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 100% | Active malignant respiratory neoplasm (lung cancer) under DC 6819. A rating of 100% is assigned for any active malignant neoplasm of the respiratory system. This rating continues beyond the cessation of surgical treatment, radiation therapy, antineoplastic chemotherapy, or other therapeutic procedures. Six months after treatment discontinuance, a mandatory VA examination is required to determine the appropriate ongoing rating based on residuals. Any rating change based on that or subsequent examinations is subject to 38 CFR 3.105(e) (rating reduction protections). |
CFR: 38 CFR 4.97, DC 6819: 'Neoplasms, malignant, any specified part of respiratory system exclusive of skin growths - 100. Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination.' |
| 100% | Post-treatment residuals - severe pulmonary impairment. After the mandatory six-month post-treatment examination, if residuals are severe (FVC or FEV1 less than 50% predicted, or DLCO less than 40% predicted, or requirement for continuous oxygen, or documented cor pulmonale or pulmonary hypertension), a 100% rating on residuals may continue. Rating is determined by the degree of functional impairment remaining after active cancer treatment ends. |
CFR: After six months post-treatment, the rating is determined by the degree of residual impairment. Severe pulmonary function test results, continued oxygen dependency, or cancer recurrence would maintain or restore the 100% rating. |
| 60% | Post-treatment residuals - moderate to moderately severe pulmonary impairment. Applies after the mandatory six-month post-treatment examination when residuals show FVC or FEV1 between 50-70% predicted, or FEV1/FVC ratio reduced with significant functional limitation. Rated analogously under DC 6600 (COPD) or DC 6844 (interstitial lung disease) depending on the pattern of residual impairment. |
CFR: Rated analogously after cancer treatment ends; moderate restriction (FVC 50-64%) or moderate obstruction (FEV1 56-70%) with significant daily functional limitation supports a 60% rating on residuals. |
| 30% | Post-treatment residuals - mild pulmonary impairment. Applies after the mandatory six-month post-treatment examination when residuals are mild; FVC 65-80% predicted or FEV1 71-80% predicted with intermittent symptoms managed with occasional bronchodilators or other medications. |
CFR: Mild pulmonary function impairment post-treatment supports a 30% rating on residuals under an analogous respiratory diagnostic code (e.g., DC 6600 or DC 6844). |
| 10% | Post-treatment residuals - minimal pulmonary impairment or asymptomatic with normal pulmonary function tests. Applies after the mandatory six-month post-treatment examination when the veteran has minimal or no measurable residual pulmonary function impairment but may have mild persistent symptoms. |
CFR: Minimal residuals after cancer treatment with essentially normal or near-normal pulmonary function would support a 10% rating on residuals under an analogous code. |
100% Active malignant respiratory neoplasm (lung cancer) under DC ...
Active malignant respiratory neoplasm (lung cancer) under DC 6819. A rating of 100% is assigned for any active malignant neoplasm of the respiratory system. This rating continues beyond the cessation of surgical treatment, radiation therapy, antineoplastic chemotherapy, or other therapeutic procedures. Six months after treatment discontinuance, a mandatory VA examination is required to determine the appropriate ongoing rating based on residuals. Any rating change based on that or subsequent examinations is subject to 38 CFR 3.105(e) (rating reduction protections).
Key Symptoms
- Active cancer diagnosis - primary or metastatic malignancy confirmed by pathology/biopsy
- Currently undergoing or recently completed surgery, chemotherapy, radiation, immunotherapy, or targeted therapy
- Local recurrence or distant metastasis present
- Hemoptysis (frank or massive)
- Significant weight loss with documented baseline and current weight
- Anorexia
- Fever and night sweats
- Progressive pulmonary disease
- Respiratory failure requiring hospitalization
- Cor pulmonale or right ventricular hypertrophy
- Pulmonary hypertension documented by echocardiogram or cardiac catheterization
- Requirement for outpatient oxygen therapy
CFR: 38 CFR 4.97, DC 6819: 'Neoplasms, malignant, any specified part of respiratory system exclusive of skin growths - 100. Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination.'
100% Post-treatment residuals - severe pulmonary impairment. Afte ...
Post-treatment residuals - severe pulmonary impairment. After the mandatory six-month post-treatment examination, if residuals are severe (FVC or FEV1 less than 50% predicted, or DLCO less than 40% predicted, or requirement for continuous oxygen, or documented cor pulmonale or pulmonary hypertension), a 100% rating on residuals may continue. Rating is determined by the degree of functional impairment remaining after active cancer treatment ends.
Key Symptoms
- FVC < 50% predicted on post-bronchodilator testing
- FEV1 < 40% predicted on post-bronchodilator testing
- DLCO severely reduced (< 40% predicted)
- Requirement for continuous home oxygen therapy
- Cor pulmonale or right heart failure
- Post-pneumonectomy with severe restrictive pattern
- Recurrence or metastasis identified at six-month mandatory exam
- Severe dyspnea limiting activities of daily living to bed or chair rest
CFR: After six months post-treatment, the rating is determined by the degree of residual impairment. Severe pulmonary function test results, continued oxygen dependency, or cancer recurrence would maintain or restore the 100% rating.
60% Post-treatment residuals - moderate to moderately severe pul ...
Post-treatment residuals - moderate to moderately severe pulmonary impairment. Applies after the mandatory six-month post-treatment examination when residuals show FVC or FEV1 between 50-70% predicted, or FEV1/FVC ratio reduced with significant functional limitation. Rated analogously under DC 6600 (COPD) or DC 6844 (interstitial lung disease) depending on the pattern of residual impairment.
Key Symptoms
- FEV1 40-70% predicted after treatment
- FVC 50-69% predicted
- Dyspnea with moderate exertion (walking on level ground, minimal activity)
- Productive cough - daily or near-constant
- Purulent sputum at times
- Scattered rales on auscultation
- Some limitation of diaphragmatic excursion
- Requirement for inhalational bronchodilator therapy
- Post-radiation fibrosis with reduced DLCO
CFR: Rated analogously after cancer treatment ends; moderate restriction (FVC 50-64%) or moderate obstruction (FEV1 56-70%) with significant daily functional limitation supports a 60% rating on residuals.
30% Post-treatment residuals - mild pulmonary impairment. Applie ...
Post-treatment residuals - mild pulmonary impairment. Applies after the mandatory six-month post-treatment examination when residuals are mild; FVC 65-80% predicted or FEV1 71-80% predicted with intermittent symptoms managed with occasional bronchodilators or other medications.
Key Symptoms
- FEV1 71-80% predicted
- FVC 65-80% predicted
- Dyspnea on more than ordinary exertion
- Intermittent productive cough
- Occasional use of inhalational bronchodilators
- Mild limitation of activities
- No acute respiratory failure episodes
CFR: Mild pulmonary function impairment post-treatment supports a 30% rating on residuals under an analogous respiratory diagnostic code (e.g., DC 6600 or DC 6844).
10% Post-treatment residuals - minimal pulmonary impairment or a ...
Post-treatment residuals - minimal pulmonary impairment or asymptomatic with normal pulmonary function tests. Applies after the mandatory six-month post-treatment examination when the veteran has minimal or no measurable residual pulmonary function impairment but may have mild persistent symptoms.
Key Symptoms
- FVC and FEV1 both > 80% predicted
- Essentially normal spirometry post-treatment
- Occasional mild dyspnea
- Minimal productive cough
- No requirement for bronchodilators or oxygen
CFR: Minimal residuals after cancer treatment with essentially normal or near-normal pulmonary function would support a 10% rating on residuals under an analogous code.
How to Describe Your Symptoms
Dyspnea (Shortness of Breath)
How to describe:
Describe exactly what activity triggers your shortness of breath and how it limits you. Use specific distances, stair counts, or time durations. Distinguish between rest, mild exertion (dressing, walking to the bathroom), moderate exertion (walking one block, climbing one flight), and strenuous activity. Report your worst-day experience, not your best day.
Worst-day example:
“On my worst days, I become severely short of breath after walking fewer than 50 feet on level ground. I have to stop and rest before continuing. I cannot climb a single flight of stairs without stopping halfway due to air hunger. I need to use my rescue inhaler before any physical activity and still feel winded afterward.”
What the examiner listens for:
Specific activity thresholds, frequency of occurrence, whether dyspnea is progressive (worsening over time), whether it limits work activities, and whether supplemental oxygen is needed.
Understatements to avoid:
Do not say 'I get a little winded sometimes.' Instead say: 'I am short of breath with minimal exertion, including activities like getting dressed or walking from my bedroom to the kitchen, and this occurs every day.'
Hemoptysis (Coughing Up Blood)
How to describe:
Report whether you cough up blood-tinged sputum occasionally, have frank hemoptysis (bright red blood), or have experienced massive hemoptysis. Note frequency, volume, and any associated emergency care. The DBQ distinguishes between blood-tinged sputum, occasional hemoptysis, frank hemoptysis, and massive hemoptysis - make sure the examiner documents the accurate category.
Worst-day example:
“On my worst episodes, I cough up bright red blood approximately two to three times per week. The amount varies from streaks in my sputum to occasionally coughing up a full tablespoon of blood. I had one episode severe enough that I went to the emergency room.”
What the examiner listens for:
Frequency, volume, acuity (blood-tinged vs. frank vs. massive), need for emergency or hospital care, and relationship to cancer or its treatment.
Understatements to avoid:
Do not minimize hemoptysis by saying 'just a little blood.' If you have experienced frank hemoptysis, say so clearly and describe how often it occurs.
Constitutional Symptoms (Weight Loss, Anorexia, Fatigue, Night Sweats, Fever)
How to describe:
For weight loss, provide a specific baseline weight before your diagnosis or the onset of symptoms, your current weight, and the time period over which the loss occurred. For fatigue, describe how it limits your ability to work, perform household tasks, or engage in recreational activities. For night sweats, report frequency and severity (e.g., needing to change clothes or bedding).
Worst-day example:
“I have lost 28 pounds over the past eight months, going from 195 lbs to 167 lbs without intentionally dieting. My appetite is poor most days - I can only eat small amounts before feeling full or nauseated. My fatigue is so severe that I spend most of my day resting and cannot complete basic household tasks without needing to lie down afterward. I experience night sweats at least four nights per week that soak through my clothing.”
What the examiner listens for:
Quantified weight loss with documented baseline, the temporal relationship of weight loss to cancer diagnosis and treatment, severity and frequency of fatigue, and whether these symptoms are treatment-related (e.g., chemotherapy side effects) vs. cancer-related.
Understatements to avoid:
Do not say 'I've lost some weight.' Provide exact numbers. Do not underreport fatigue by only mentioning it in passing - describe its impact on your ability to perform daily activities, work, and social functioning.
Cough (Productive and Non-Productive)
How to describe:
Distinguish between a dry cough and a productive cough with sputum. If productive, describe the color (clear, yellow, green, blood-tinged), consistency, and approximate volume. Report frequency: intermittent, daily, or near-constant. Note whether it wakes you from sleep, affects your ability to speak or eat, or has required antibiotic treatment.
Worst-day example:
“I have a persistent productive cough every day. On bad days, I cough almost continuously throughout the day, producing yellowish-green sputum in significant amounts. The cough wakes me up at night at least three to four times per week. I have required antibiotic treatment twice in the last year for infections related to this cough.”
What the examiner listens for:
Frequency (intermittent vs. daily vs. near-constant), character (productive vs. dry), sputum characteristics, whether antibiotics are required, and whether the cough causes secondary complications like rib pain, vomiting, or sleep disruption.
Understatements to avoid:
Do not say 'I just have a little cough.' Specify how often you cough, what comes up, and how it affects your daily life and sleep.
Chest Pain and Functional Limitations
How to describe:
Describe any chest pain, chest wall discomfort, or pleuritic pain. Note whether it is at rest or with exertion, its location, severity on a 1-10 scale, and what makes it better or worse. Also describe the overall functional impact of your condition on your ability to work, perform ADLs (activities of daily living), drive, exercise, and maintain social relationships.
Worst-day example:
“On my worst days, I have a constant dull aching pain in my left chest wall where I had surgery, rated 6 out of 10, that worsens to 9 out of 10 with any deep breathing or physical exertion. This pain, combined with my shortness of breath, prevents me from working, lifting anything heavier than a gallon of milk, walking more than a short distance, or participating in activities I previously enjoyed.”
What the examiner listens for:
Specific pain descriptors, relationship to exertion and respiration, impact on occupational and social functioning, and whether the pain is related to surgical resection, tumor invasion, or post-radiation changes.
Understatements to avoid:
Do not say 'I'm managing.' Report the true impact on your daily function. The examiner is required to document the functional impact of your condition on your occupation and daily activities.
Treatment Side Effects and Complications
How to describe:
Accurately report all side effects from chemotherapy, radiation, surgery, or immunotherapy that continue to affect you. This includes peripheral neuropathy, radiation pneumonitis, post-radiation fibrosis, post-surgical complications, immunotherapy-related lung inflammation, and any hospitalizations resulting from treatment complications.
Worst-day example:
“Since completing chemotherapy, I experience persistent nausea, profound fatigue, and decreased exercise tolerance that has not returned to pre-treatment levels. My radiation treatments caused radiation pneumonitis that was treated with steroids and has left me with reduced lung capacity. I was hospitalized once during treatment for a respiratory complication requiring oxygen therapy.”
What the examiner listens for:
Specific treatment-related complications, whether they are resolved or ongoing, hospitalization dates and reasons, whether they have resulted in permanent residual conditions, and the cumulative functional impact of the cancer and its treatment.
Understatements to avoid:
Do not omit hospitalizations or ER visits related to your cancer or its treatment. These are directly relevant to the DBQ and support documentation of disease severity.
Common Mistakes to Avoid
Not bringing complete oncology treatment records to the exam
The DBQ requires specific dates of diagnosis, surgery, chemotherapy start/completion, radiation therapy, and immunotherapy. Without these records, the examiner may document incomplete information, which can lead to an inaccurate rating.
Instead: Bring a complete packet including: pathology/biopsy reports, surgical operative reports, chemotherapy treatment summaries with start and end dates, radiation therapy records, most recent oncology visit notes, and all imaging reports (CT, PET scan, MRI, chest X-ray).
Impact: 100% active / post-treatment mandatory re-exam
Not understanding the six-month post-treatment mandatory re-examination rule
Many veterans do not realize that their 100% rating continues for six months after treatment ends, after which VA must schedule a mandatory exam to rate the condition based on residuals. Missing this exam or failing to prepare for it can result in an uninformed rating reduction.
Instead: Know the exact date your last treatment ended. Six months later, expect a mandatory VA exam. Prepare a complete residuals summary showing PFT results, ongoing symptoms, functional limitations, and any new complications. If cancer has recurred or metastasized, document that clearly to maintain the 100% rating.
Impact: 100% post-treatment transition
Failing to accurately report the full extent of weight loss
Weight loss is a specific rated symptom on the DBQ and reflects cancer severity and systemic impact. Vague reporting ('I've lost some weight') does not give the examiner what is needed to check the weight loss checkbox and document the baseline vs. current weight fields on the DBQ.
Instead: Know your pre-diagnosis or pre-treatment weight (baseline) and your current weight. Bring documentation from medical records if possible. State the exact numbers: 'I weighed 185 lbs before my diagnosis and currently weigh 157 lbs, a loss of 28 lbs over the past ten months.'
Impact: 100% active / residuals rating
Downplaying or minimizing symptoms because 'the cancer is in remission'
Even if cancer is currently in remission, residual effects of the disease and its treatment (surgical resection, radiation fibrosis, chemotherapy-induced lung damage) are ratable and important. Veterans sometimes feel their symptoms 'don't count' after remission, leading to under-documentation.
Instead: Report all ongoing symptoms accurately, including those caused by treatment. Residual pulmonary function impairment, persistent fatigue, post-surgical pain, and reduced exercise capacity are all legitimate and ratable. Describe your symptoms as they actually are on your worst days.
Impact: Post-treatment residuals rating (30-100%)
Not disclosing hospitalizations or ER visits related to cancer or treatment
The DBQ specifically asks about episodes of acute respiratory failure, hospitalizations, and complications resulting in hospitalization. Omitting these underrepresents the severity of your condition and may result in a lower rating.
Instead: List all hospitalizations and ER visits related to your lung cancer or its treatment, including dates and reasons. Bring discharge summaries if available. Report any episodes of respiratory failure, oxygen dependence, or ICU admission.
Impact: 100% active / residuals rating
Failing to mention the need for supplemental oxygen or breathing medications
The DBQ has a specific field for outpatient oxygen therapy requirement and for inhalational bronchodilator and corticosteroid use. These are significant markers of severity. Veterans who use oxygen at home or take daily pulmonary medications sometimes forget to mention them.
Instead: Bring a complete list of all medications, including inhalers, oral steroids, oral bronchodilators, and oxygen prescriptions with liter-flow rates. Tell the examiner if you use oxygen at rest, with exertion, or only at night.
Impact: 100% active and residuals rating
Not reporting how lung cancer and treatment have impacted your ability to work
The DBQ has a specific section on functional impact, and the examiner is required to document how the condition affects occupational and daily activities. Failure to address this leaves a gap that raters may use to assign a lower rating.
Instead: Prepare a clear, specific statement about how your condition has affected your ability to work, including any job loss, reduced hours, inability to perform physical tasks, cognitive effects from chemotherapy ('chemo brain'), or inability to tolerate occupational environments with dust, fumes, or physical demands.
Impact: All rating levels and TDIU consideration
Assuming the examiner will automatically connect all related conditions to the lung cancer
Secondary conditions such as pulmonary hypertension, cor pulmonale, COPD, restrictive lung disease, or pleural disease caused by or resulting from lung cancer or its treatment must be explicitly mentioned. The examiner rates what is documented.
Instead: Tell the examiner about every respiratory condition that has developed or worsened since your lung cancer diagnosis or treatment. Ask the examiner to document secondary conditions and their relationship to your primary lung cancer claim.
Impact: Residuals rating and secondary condition claims
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 record your C&P examination in most states - check your state's consent laws and notify the examiner at the start of the appointment.
- You have the right to receive a copy of the completed Disability Benefits Questionnaire (DBQ) after the exam by requesting it from VA.
- You have the right to request a new or additional C&P examination if the original exam was inadequate, incomplete, or based on inaccurate information.
- You have the right to submit buddy statements (VA Form 21-4142 or 21-10210) from family members, caregivers, or fellow veterans who can attest to your symptoms and functional limitations.
- You have the right to submit a private medical opinion from your own treating physician or a qualified medical expert to support or rebut the VA examiner's findings.
- You have the right to a mandatory re-examination six months after treatment cessation under DC 6819 - VA is required to conduct this exam before reducing or discontinuing your 100% rating.
- Under 38 CFR 3.105(e), VA must provide you advance written notice before reducing a disability rating that has been in effect for five or more years, and you have the right to submit evidence and request a hearing before any reduction takes effect.
- Under the PACT Act (August 10, 2022), veterans with respiratory cancers linked to toxic exposures including burn pits, Agent Orange, radiation, or occupational military exposures may be entitled to presumptive service connection without needing to prove a specific nexus.
- You have the right to free representation from an accredited Veterans Service Organization (VSO), accredited claims agent, or VA-accredited attorney throughout the claims process.
- You have the right to appeal any rating decision through the Supplemental Claim lane, the Higher-Level Review lane, or the Board of Veterans' Appeals, and you have one year from the date of the rating decision to select an appeal option.
- You have the right to request your complete claims file (C-file) from VA to review all evidence of record before and after your examination.
- If your lung cancer results in an inability to maintain substantially gainful employment, you have the right to file for Total Disability Individual Unemployability (TDIU) under 38 CFR 4.16.
Related Conditions
- COPD (Chronic Obstructive Pulmonary Disease) May co exist with lung cancer (both associated with smoking and toxic exposures) or may develop as a residual of lung cancer treatment, including post radiation airway inflammation or surgical resection reducing lung volume. Also a PACT Act presumptive condition.
- Pulmonary Fibrosis / Interstitial Lung Disease Post radiation fibrosis is a common residual of thoracic radiation therapy used to treat lung cancer. Chemotherapy agents (bleomycin, cyclophosphamide) can also cause pulmonary fibrosis. This condition is separately ratable as a secondary condition caused by lung cancer treatment.
- Pulmonary Hypertension Can develop as a secondary condition to lung cancer related hypoxia, pulmonary thromboembolism (common in cancer patients), or post treatment lung damage. Documented on the DBQ under cardiac complications and separately ratable.
- Cor Pulmonale (Right Heart Failure) A serious complication of severe pulmonary disease including post lung cancer residuals. Specifically identified on the DBQ and indicative of end stage pulmonary impairment supporting the highest disability ratings.
- Peripheral Neuropathy Common secondary condition caused by platinum based chemotherapy agents (cisplatin, carboplatin) used in lung cancer treatment. Ratable as a secondary condition under neurological diagnostic codes.
- Restrictive Lung Disease (Post-Surgical) Following lobectomy or pneumonectomy for lung cancer, significant restrictive ventilatory impairment is expected. Post treatment residuals are rated analogously under appropriate respiratory diagnostic codes based on PFT results.
- Pleuritis / Pleural Disease Pleural effusions and pleuritic disease frequently occur with lung cancer (malignant pleural effusion) or as a result of thoracic surgery or radiation. Listed as a PACT Act presumptive condition and also ratable as a secondary condition.
- Depression and Anxiety (Cancer-Related) Mental health conditions including major depressive disorder and generalized anxiety disorder frequently develop secondary to a lung cancer diagnosis and its treatment. These are separately ratable as secondary mental health conditions under 38 CFR 4.130.
- Chronic Bronchitis May co exist with lung cancer due to shared risk factors (tobacco smoke, toxic inhalation exposures). Also listed as a PACT Act presumptive condition. Documented on the same Respiratory Conditions DBQ.
- Constrictive / Obliterative Bronchiolitis Can develop after lung transplant or bone marrow transplant for lung cancer treatment, or as a result of certain toxic inhalation exposures associated with military service. PACT Act presumptive condition.
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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.