These guides are AI-generated educational summaries — not legal or medical advice.
C&P Exam Prep: Spina Bifida
DBQ Overview
Interview + Physical- Form Name
- Spina_Bifida
- Form Code
- Spina_Bifida
- Page Count
- 5
- Examiner Type
- Neurologist or Physician
- Estimated Duration
- 30-45 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To evaluate the current level of disability resulting from spina bifida under 38 CFR 3.814, and to assign a disability level (I, II, or III) based on neurological impairment across three categories: extremity function/mobility, urinary/bowel continence, and cognitive/intellectual function. The exam also captures any secondary disabilities resulting from spina bifida or its treatment procedures.
What the examiner evaluates:
- Type and form of spina bifida (spina bifida occulta, meningocele, or myelomeningocele)
- Primary means of mobility in the community (walking without braces, braces/crutches, wheelchair)
- Sensory and motor function of upper extremities (ability to grasp pen, feed self, perform self-care)
- Cognitive and intellectual function (IQ level if testing available)
- Urinary continence status (continent, managed with medication, or unable to remain dry for 3 hours three or more times per week despite treatment)
- Bowel continence status (continent, managed, fecal leakage frequency, need for manual evacuation, colostomy use)
- History and onset of spina bifida diagnosis and course of disability
- Surgical procedures performed related to spina bifida and their outcomes
- Secondary or associated disabilities resulting from spina bifida or its treatment (e.g., hydrocephalus, tethered cord, Chiari malformation, renal failure, seizures, blindness)
- Functional impact on activities of daily living
- Diagnostic test results (imaging, urodynamics, IQ testing, nerve conduction studies)
This exam is conducted in person with a neurologist or physician. VA may also accept statements from private physicians or reports from government or private institutions in lieu of a full VA examination under M21-1 VIII.i.3.C.10.a. Spina bifida occulta alone does not qualify for monetary allowance under 38 CFR 3.814 and completion of the full DBQ may not be required if that is the only diagnosis. Note that MRI is specifically NOT to be requested for this exam type per M21-1 guidance.
Typical duration: 30-45 minutes
Mobility Assessment
The veteran's primary means of locomotion in the community, which directly determines the mobility component of the disability level rating.
What to expect:
The examiner will ask how you primarily get around outside your home - whether you walk independently without braces or support, walk with braces or crutches, or use a wheelchair as your primary means. They may observe your gait or transfer ability if you are present in person.
Key thresholds:
- Walks without braces or external support — Supports Level I (lowest payment tier) for the mobility category
- Walks with braces, crutches, or other external support as primary means — Supports Level II for the mobility category
- Uses wheelchair as primary means of mobility in the community — Supports Level III for the mobility category - highest tier
Tips:
- Be specific about what you use most of the time outside the home, not just what you are capable of on your best day
- If you use a wheelchair for community mobility but can take a few steps indoors, clarify that the wheelchair is your primary means for going outside
- Bring any prescriptions or medical orders for your mobility devices to the exam
- If your mobility has recently declined, describe both current status and the trajectory of change
Pain considerations: If pain, fatigue, or weakness affects how far you can walk before needing assistive devices or a wheelchair, describe those limits clearly and quantify distance (e.g., 'I can take about 20 steps before falling without my braces').
Upper Extremity Sensory and Motor Function Assessment
The degree of sensory or motor impairment in the arms and hands, specifically whether impairment prevents grasping a pen, feeding oneself, or performing self-care tasks.
What to expect:
The examiner may ask about your ability to hold a pen, use utensils, button clothing, or perform personal hygiene tasks. Physical testing of grip strength, fine motor coordination, and sensation in the hands may be performed.
Key thresholds:
- No upper extremity sensory or motor impairment — Supports Level I for the upper extremity category
- Some upper extremity impairment but able to grasp pen, feed self, and perform self-care — Supports Level II for the upper extremity category
- Impairment severe enough to prevent grasping a pen, feeding self, AND performing self-care — Supports Level III for the upper extremity category - highest tier
Tips:
- Describe difficulty with specific tasks, not just general weakness - for example, 'I cannot hold a standard pen without dropping it' or 'I need adaptive utensils to eat'
- Report all three functions separately: pen grasping, feeding yourself, and self-care (bathing, dressing, hygiene)
- If you use adaptive tools, state what adaptations you require and why
- Describe your worst-day function, not your best-day capability
Pain considerations: Note any pain, numbness, or tingling in the hands or arms that interferes with fine motor tasks, including how long you can sustain gripping before losing control.
Intellectual and Cognitive Function Assessment (IQ Evaluation)
The veteran's level of intellectual and cognitive functioning, typically determined by formal IQ testing results if available in the record.
What to expect:
The examiner will review any prior IQ testing results in your medical record. If no formal testing exists, they may note the absence. They may ask about educational history, special education placement, memory difficulties, and ability to manage daily tasks independently.
Key thresholds:
- IQ of 90 or higher — Supports Level I for the intellectual category
- IQ of 70 to 89 — Supports Level II for the intellectual category
- IQ of 69 or less — Supports Level III for the intellectual category - highest tier
Tips:
- If you have had formal neuropsychological or IQ testing, bring copies of the results or ensure they are in your VA record
- Mention any history of special education, learning disabilities, or academic accommodations
- Describe any memory problems, difficulty learning new tasks, or need for supervision in daily activities
- Request formal IQ testing if it has never been done and you believe cognitive impairment may affect your rating level
Pain considerations: Cognitive fatigue (difficulty concentrating after brief mental effort) should be described alongside formal IQ concerns, as it affects daily functional capacity.
Urinary Continence Assessment
The degree of urinary incontinence and the effectiveness of any treatment or management methods in controlling bladder function.
What to expect:
The examiner will ask detailed questions about your bladder management routine, frequency of incontinence episodes, whether you are on medication or use catheterization, and how many times per week you are unable to remain dry for at least three hours during waking hours despite treatment.
Key thresholds:
- Continent without medication or other means — Supports Level I for the urinary continence category
- Continent only with use of medication or management techniques — Supports Level II for the urinary continence category
- Despite medication or management, unable to remain dry for 3 hours at least 3 times per week during waking hours — Supports Level III for the urinary continence category - highest tier
Tips:
- Keep a bladder diary for the two weeks before your exam documenting wet episodes, time between episodes, and any management methods used
- Clearly state what management techniques you currently use (e.g., intermittent catheterization, medications, pads)
- Report how often treatment FAILS - not just that you are on treatment
- Note the number of days per week and times per day that leakage occurs despite your management regimen
- Mention any urinary tract infections, hospitalizations, or specialist care related to bladder dysfunction
Pain considerations: Describe any pain, burning, or discomfort associated with bladder management procedures, and how bladder dysfunction limits your ability to participate in activities outside the home.
Bowel Continence Assessment
The severity of bowel impairment, frequency of fecal leakage, necessity of manual evacuation or digital stimulation, or presence of a colostomy.
What to expect:
The examiner will ask about your bowel management routine, frequency of accidents, whether you wear absorbent materials, and whether you require manual evacuation or digital stimulation. They will also ask about any surgical interventions such as colostomy.
Key thresholds:
- Continent of feces without medication or other means — Supports Level I for the bowel category
- Continent only with use of bowel management techniques or medication — Supports Level II for the bowel category
- Fecal leakage requiring absorbent materials at least 4 days/week despite treatment; OR regularly requires manual evacuation or digital stimulation; OR has a colostomy requiring a bag — Supports Level III for the bowel category - highest tier
Tips:
- Keep a bowel diary for two weeks before the exam tracking accidents, absorbent material use, and management attempts
- Be specific about how many days per week you have fecal leakage requiring protective pads or garments
- If you perform manual evacuation or digital stimulation, state how regularly (e.g., daily, multiple times per week)
- If you have a colostomy, specify whether a bag is required and how it affects your daily life
- Do not minimize the frequency or severity of bowel accidents - report accurately based on your typical and worst weeks
Pain considerations: Describe any pain or discomfort related to bowel management procedures, skin breakdown from leakage, and how bowel dysfunction limits social activities, work, or travel.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 3% | Level III - Maximum payment level. Assigned when the individual uses a wheelchair as primary means of community mobility; OR has sensory or motor impairment of the upper extremities severe enough to prevent grasping a pen, feeding self, AND performing self-care; OR has an IQ of 69 or less; OR despite treatment, is unable to remain dry for 3 hours at least 3 times per week during waking hours; OR has fecal leakage severe enough to require absorbent materials at least 4 days per week despite treatment; OR regularly requires manual evacuation or digital stimulation; OR has a colostomy requiring a bag. Additionally, the Director of Compensation Service may increase to Level III equivalent in exceptional cases where secondary disabilities such as blindness, uncontrolled seizures, or renal failure result from spina bifida or its treatment. |
CFR: Level III criteria are specified at 38 CFR 3.814(d)(1)(iii). The Director of Compensation Service may increase payment in exceptional cases where secondary disabilities resulting from spina bifida or its treatment severely limit the individual's ability to engage in ordinary day-to-day activities, including activities outside the home. |
| 2% | Level II - Intermediate payment level. Assigned when the individual uses braces, crutches, or other external support as the primary means of community mobility; OR has some sensory or motor impairment of the upper extremities that does not rise to the level of preventing grasping a pen, feeding self, or performing self-care; OR has an IQ of 70 to 89; OR is continent of urine only with the use of medication or other management techniques; OR achieves bowel continence only through management techniques or medication. |
CFR: A Level II or Level III payment will be awarded depending on whether the effects of a disability are of equivalent severity to the effects specified under Level II or Level III per 38 CFR 3.814(d)(1). |
| 1% | Level I - Minimum payment level. Assigned when the individual walks without braces or other external support as the primary means of community mobility, has no sensory or motor impairment of the upper extremities, has an IQ of 90 or higher, and is continent of urine and feces without medication or other management means. Also assigned as the default minimum level when medical evidence is insufficient to support a higher level. |
CFR: VA will pay at Level I unless or until it receives medical evidence supporting a higher payment. When evidence is insufficient, Level I (minimum) is the default assignment per 38 CFR 3.814(d)(4). |
| 0% | Spina Bifida Occulta Only - Not eligible for monetary allowance under 38 CFR 3.814. A diagnosis of spina bifida occulta as the only form of spina bifida does not qualify for benefits under this program. No disability level is assigned. |
CFR: Completion of the full DBQ is not required when spina bifida occulta is the only type present. Benefits are denied with code 02 (Diagnosis of spina bifida occulta) on the codesheet. |
3% Level III - Maximum payment level. Assigned when the individ ...
Level III - Maximum payment level. Assigned when the individual uses a wheelchair as primary means of community mobility; OR has sensory or motor impairment of the upper extremities severe enough to prevent grasping a pen, feeding self, AND performing self-care; OR has an IQ of 69 or less; OR despite treatment, is unable to remain dry for 3 hours at least 3 times per week during waking hours; OR has fecal leakage severe enough to require absorbent materials at least 4 days per week despite treatment; OR regularly requires manual evacuation or digital stimulation; OR has a colostomy requiring a bag. Additionally, the Director of Compensation Service may increase to Level III equivalent in exceptional cases where secondary disabilities such as blindness, uncontrolled seizures, or renal failure result from spina bifida or its treatment.
Key Symptoms
- Wheelchair as primary means of community mobility
- Upper extremity impairment preventing grasping pen, self-feeding, AND self-care
- IQ of 69 or less
- Unable to remain dry for 3 hours at least 3 times per week despite treatment
- Fecal leakage requiring absorbent materials at least 4 days per week despite treatment
- Regularly requires manual evacuation or digital stimulation for bowel emptying
- Colostomy requiring a bag
- Secondary disabilities such as blindness, uncontrolled seizures, or renal failure resulting from spina bifida or its treatment
CFR: Level III criteria are specified at 38 CFR 3.814(d)(1)(iii). The Director of Compensation Service may increase payment in exceptional cases where secondary disabilities resulting from spina bifida or its treatment severely limit the individual's ability to engage in ordinary day-to-day activities, including activities outside the home.
2% Level II - Intermediate payment level. Assigned when the ind ...
Level II - Intermediate payment level. Assigned when the individual uses braces, crutches, or other external support as the primary means of community mobility; OR has some sensory or motor impairment of the upper extremities that does not rise to the level of preventing grasping a pen, feeding self, or performing self-care; OR has an IQ of 70 to 89; OR is continent of urine only with the use of medication or other management techniques; OR achieves bowel continence only through management techniques or medication.
Key Symptoms
- Uses braces, crutches, or external support as primary community mobility method
- Upper extremity impairment present but not preventing basic self-care tasks
- IQ in the range of 70 to 89
- Requires medication or management to maintain urinary continence
- Requires medication or management to maintain bowel continence
CFR: A Level II or Level III payment will be awarded depending on whether the effects of a disability are of equivalent severity to the effects specified under Level II or Level III per 38 CFR 3.814(d)(1).
1% Level I - Minimum payment level. Assigned when the individua ...
Level I - Minimum payment level. Assigned when the individual walks without braces or other external support as the primary means of community mobility, has no sensory or motor impairment of the upper extremities, has an IQ of 90 or higher, and is continent of urine and feces without medication or other management means. Also assigned as the default minimum level when medical evidence is insufficient to support a higher level.
Key Symptoms
- Ambulatory without assistive devices for community mobility
- Full upper extremity function - can grasp pen, feed self, and perform self-care
- IQ of 90 or higher
- Continent of urine and feces without any management intervention
CFR: VA will pay at Level I unless or until it receives medical evidence supporting a higher payment. When evidence is insufficient, Level I (minimum) is the default assignment per 38 CFR 3.814(d)(4).
0% Spina Bifida Occulta Only - Not eligible for monetary allowa ...
Spina Bifida Occulta Only - Not eligible for monetary allowance under 38 CFR 3.814. A diagnosis of spina bifida occulta as the only form of spina bifida does not qualify for benefits under this program. No disability level is assigned.
Key Symptoms
- Spina bifida occulta as the sole diagnosis
- No open spinal defect
- No neurological impairment attributable to open spina bifida
CFR: Completion of the full DBQ is not required when spina bifida occulta is the only type present. Benefits are denied with code 02 (Diagnosis of spina bifida occulta) on the codesheet.
How to Describe Your Symptoms
Mobility and Ambulation
How to describe:
Describe your typical and worst-day ability to move around in the community - outside your home. State exactly what you use most of the time: no support, braces/crutches, or wheelchair. Be specific about distances, surfaces, and what causes you to need more support. Use concrete language: 'I use a power wheelchair for all trips outside my home because I cannot safely walk more than 10 feet without falling even with braces.'
Worst-day example:
“On my worst days, I cannot stand long enough to transfer safely without assistance. My legs give out without warning after a few steps even inside the house, and I have not attempted to walk in the community without my wheelchair for over two years.”
What the examiner listens for:
Whether wheelchair use is primary and consistent for community mobility versus occasional or indoor use only. The examiner needs to document what the veteran actually does in the real world, not what they theoretically could do.
Understatements to avoid:
Do not say 'I can get around okay' if you rely on braces or a wheelchair outside. Do not describe your indoor walking ability as your community mobility method. Do not omit that you stopped trying to walk in the community because of falls or fatigue.
Upper Extremity Function
How to describe:
Address each of the three specific functions separately: (1) Can you grip a standard pen and write? (2) Can you feed yourself with standard utensils without adaptive equipment? (3) Can you perform self-care tasks such as bathing, dressing, and personal hygiene independently? Use precise language about what you cannot do versus what requires adaptation or assistance.
Worst-day example:
“On my worst days, my hands are so weak and numb that I drop my fork before I finish a meal. I cannot button my shirt or use a standard pen - I require a thick-grip adaptive pen and even then my writing is illegible after a few words. My caregiver assists me with showering on most days because I cannot safely grip the grab bars.”
What the examiner listens for:
The critical threshold is whether impairment prevents ALL THREE functions - grasping a pen, feeding self, AND performing self-care. The examiner listens for whether this is a consistent pattern versus occasional difficulty. They document what you need help with, what adaptive tools you require, and whether you can perform these tasks independently.
Understatements to avoid:
Do not say 'I manage' if you require adaptive equipment or caregiver assistance. Do not describe only one impaired function - describe all three specifically. Do not omit weakness, numbness, or incoordination that affects hand function even if you have adapted around it.
Cognitive and Intellectual Function
How to describe:
Describe any difficulties with learning, memory, processing speed, or independent decision-making. Reference any formal IQ testing, special education history, or documented cognitive evaluations. Describe how cognitive difficulties affect your daily independence, employment, and ability to manage personal affairs.
Worst-day example:
“On my worst days, I cannot follow multi-step instructions without writing them down and reviewing them multiple times. I was in special education throughout school and was formally evaluated with an IQ of 74. I require reminders and assistance managing my medications, appointments, and finances.”
What the examiner listens for:
The specific IQ score if formal testing has been done, and whether cognitive impairment affects daily functional independence. The examiner also listens for consistency between self-reported difficulties and any documented history of cognitive evaluation.
Understatements to avoid:
Do not dismiss cognitive difficulties as 'just being slow' - describe specific functional impacts. Do not forget to mention special education, disability accommodations in school or work, or any prior formal psychological testing. Do not conflate cognitive fatigue with baseline intellectual function - report both.
Urinary Continence
How to describe:
Be precise about your management regimen and how often it fails. State the specific number of days per week and times per day that you are unable to remain dry for at least three hours despite your treatment. Use a diary if possible. Describe what 'unable to remain dry' means practically - leaking through clothing, needing to change pads, wetting yourself in public.
Worst-day example:
“On my worst days, even with scheduled intermittent catheterization every three hours and my bladder medication, I have leakage accidents four to five times in a single day. This happens at least three or four days every week. I wear pads at all times outside the home and have had to leave social events early because of accidents.”
What the examiner listens for:
The frequency of failed continence despite active treatment - specifically whether it meets the three-times-per-week threshold of being unable to remain dry for three hours. The examiner documents what management is in place and how consistently it fails.
Understatements to avoid:
Do not say 'I'm on treatment so it's controlled' if you still have regular accidents. Do not omit the frequency and severity of accidents. Do not forget to mention all management techniques you use (catheterization, medications, pads, dietary restrictions) so the examiner understands the full picture.
Bowel Continence
How to describe:
Describe your bowel management routine in detail and how often you have accidents, leakage, or require manual assistance to empty your bowel. State the number of days per week you require absorbent materials due to fecal leakage despite your regimen. If you require manual evacuation or digital stimulation, state how regularly. If you have a colostomy, describe your bag use.
Worst-day example:
“On my worst days, I have fecal leakage despite performing my bowel program that morning. I wear protective undergarments every single day because I cannot predict when I will have an accident. I require manual evacuation at least every other day, and I have had leakage severe enough to require full clothing changes in public at least five days this past week.”
What the examiner listens for:
Frequency of fecal leakage requiring absorbent material use (the threshold is four or more days per week), regularity of manual evacuation or digital stimulation, and whether a colostomy bag is in use. The examiner documents what management is in place and whether it achieves continence.
Understatements to avoid:
Do not minimize by saying 'I just wear pads as a precaution' if you have regular leakage. Do not omit the need for manual evacuation out of embarrassment - this is a critical rating threshold. Do not underreport the number of days per week you have accidents or require protective garments.
Secondary and Associated Disabilities
How to describe:
Identify all conditions that have resulted from spina bifida itself or from treatment procedures for spina bifida. Common secondary conditions include hydrocephalus with shunt, tethered cord syndrome, Chiari malformation, neurogenic bladder, kidney disease or renal failure, seizure disorder, vision problems or blindness, skin breakdown/pressure sores, chronic pain, and orthopedic complications. Describe how each affects your daily functioning.
Worst-day example:
“My shunt for hydrocephalus malfunctioned last year requiring emergency surgery. I now have chronic headaches daily, have had two seizure episodes in the past six months that are not yet fully controlled, and my nephrologist recently told me I have early chronic kidney disease from recurrent urinary tract infections. Each of these conditions limits my ability to leave home independently.”
What the examiner listens for:
Whether any secondary disabilities such as blindness, uncontrolled seizures, or renal failure result from spina bifida or its treatment, as these may warrant an exceptional-case increase to Level III payment even if standard Level III criteria are not otherwise met. The examiner documents all identified secondary conditions and their functional impact.
Understatements to avoid:
Do not fail to connect secondary conditions to spina bifida or its treatment. Do not omit surgeries, hospitalizations, or specialist care related to spina bifida complications. Do not assume that only the spinal defect itself matters - all downstream conditions are relevant and potentially rating-determinative.
Common Mistakes to Avoid
Describing best-day or average-day function instead of worst-day or typical-bad-day function
VA rating is based on the full picture of disability, and M21-1 guidance supports documenting the worst-day functional status. Describing only good days results in a rating that doesn't capture the actual burden of the condition.
Instead: When asked about your abilities, describe your worst-day function and also characterize how often those worst days occur. For example: 'At my worst, which happens three or four days a week, I cannot...'
Impact: Can prevent Level II or Level III assignment
Describing indoor or home mobility instead of community mobility
The VA rating criteria specifically ask about the primary means of mobility in the community (outside the home). Veterans who use a wheelchair outside but take a few steps at home may incorrectly describe themselves as ambulatory.
Instead: Be explicit: 'My wheelchair is how I get around everywhere outside my home - grocery stores, medical appointments, anywhere in the community. I may shuffle a few steps indoors but that is not how I function in the community.'
Impact: Can prevent Level III assignment for mobility
Stating that continence is 'managed' or 'controlled' without specifying failure rate
The rating threshold for Level III urinary continence is not whether you are on treatment - it is whether treatment FAILS to keep you dry for three hours at least three times per week. Similarly for bowel, it is whether leakage still occurs despite management.
Instead: Explicitly state: 'Despite using intermittent catheterization and my bladder medication, I am unable to stay dry for three hours at least four times per week.' Keep a diary to support accurate reporting.
Impact: Can prevent Level III assignment for continence
Not mentioning secondary conditions such as seizures, renal failure, or blindness
Under 38 CFR 3.814(d)(2), secondary disabilities resulting from spina bifida or its treatment can trigger an exceptional-case increase to Level III even if standard Level III criteria are not met. Failing to report these conditions means the Director of Compensation Service cannot make that determination.
Instead: Compile a complete list of all conditions caused by or treated as part of spina bifida. Bring relevant medical records documenting each condition and its connection to spina bifida or its treatments.
Impact: Can prevent exceptional-case Level III assignment
Omitting the need for manual evacuation or digital stimulation for bowel management
The need for regular manual evacuation or digital stimulation is an independent Level III bowel criterion. Many veterans perform this as a routine matter and forget to mention it, or feel embarrassed to disclose it.
Instead: Proactively tell the examiner: 'I require manual evacuation / digital stimulation to empty my bowel. I do this [daily / several times per week / every other day].' This is a critical rating threshold.
Impact: Can prevent Level III assignment for bowel continence
Failing to bring documentation of IQ testing or prior neuropsychological evaluations
The IQ threshold for Level III is 69 or below, and Level II is 70-89. Without documentation, the examiner may not be able to support a higher intellectual impairment level, defaulting the rating to Level I for the cognitive category.
Instead: Obtain and bring copies of any IQ testing, neuropsychological evaluations, special education records, or disability accommodation documentation. Request testing if none has been performed and you believe cognitive impairment is present.
Impact: Can prevent Level II or Level III assignment for intellectual function
Not describing the functional impact of each symptom on daily life and community participation
The DBQ specifically asks the examiner to describe the impact of conditions on the veteran's ability to engage in ordinary day-to-day activities. Without this narrative, the examiner may only document clinical findings without capturing how those findings limit real-world function.
Instead: For every symptom you describe, add a functional consequence: 'Because of this, I cannot... / I need help with... / I have stopped doing...' Be specific and concrete about impacts on work, social activities, self-care, and community participation.
Impact: Can affect all rating levels, particularly exceptional-case determinations
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 an accurate and thorough examination - the examiner must document the history, findings, and all relevant functional limitations in sufficient detail to support a rating decision under 38 CFR 3.814.
- In most states, you have the right to audio or video record your C&P examination. Verify your state's recording laws and the specific VA facility's policy in advance of the exam.
- You have the right to submit private physician statements or reports from government or private institutions in lieu of, or in addition to, a VA examination, per M21-1 VIII.i.3.C.10.a. VA must consider these records.
- You have the right to review and obtain a copy of your completed DBQ examination report. Request this through your VA claims file after the exam.
- If you believe the examination report contains errors or does not accurately reflect your functional status, you have the right to submit a written statement correcting the record before the rating decision is issued.
- You have the right to request a new or supplemental examination if the original exam was inadequate for rating purposes under M21-1 adjudication standards.
- You have the right to periodic reassessment of your disability level if your condition worsens over time, and to submit new medical evidence supporting a higher level of disability under 38 CFR 3.814(d)(5) and (d)(6).
- In exceptional cases, you have the right to request that the Director of Compensation Service consider an upward adjustment to your disability level when secondary disabilities resulting from spina bifida or its treatment (such as uncontrolled seizures, blindness, or renal failure) severely limit your ability to engage in ordinary day-to-day activities, per 38 CFR 3.814(d)(2).
- You have the right to bring a support person or caregiver to your examination. Check with the examining facility in advance about their policy on support persons in the exam room.
- You have the right to a rating decision that is based on the highest disability level supported by the evidence - VA must assign the highest level for which medical evidence qualifies you under 38 CFR 3.814.
- You have the right to appeal any rating decision you disagree with through the Supplemental Claim, Higher-Level Review, or Board of Veterans' Appeals lanes under the Appeals Modernization Act.
Related Conditions
- Hydrocephalus Commonly associated with myelomeningocele; shunt placement and revisions are frequently required and may themselves cause secondary disabilities affecting the rating
- Neurogenic Bladder A direct consequence of spinal cord involvement in spina bifida; drives the urinary continence rating criteria and may be separately rated under 38 CFR 4.115b
- Neurogenic Bowel A direct consequence of spinal cord involvement in spina bifida; drives the bowel continence rating criteria and may be separately rated
- Tethered Spinal Cord Syndrome Frequently occurs in individuals with spina bifida and may cause progressive neurological deterioration affecting mobility, bladder, bowel, and upper extremity function
- Chiari Malformation Type II Strongly associated with myelomeningocele; can cause brainstem dysfunction, respiratory problems, and upper extremity weakness that affects rating criteria
- Chronic Kidney Disease / Renal Failure May result from recurrent urinary tract infections and neurogenic bladder dysfunction secondary to spina bifida or its treatment; qualifies as an exceptional case secondary disability under 38 CFR 3.814(d)(2)
- Seizure Disorder May result from hydrocephalus or shunt complications secondary to spina bifida or its treatment; uncontrolled seizures qualify as an exceptional case secondary disability under 38 CFR 3.814(d)(2)
- Pressure Ulcers / Decubitus Ulcers Occur due to sensory loss and wheelchair use secondary to spina bifida; may be separately ratable and affect overall functional capacity
- Scoliosis Frequently occurs in spina bifida due to vertebral and muscular abnormalities; may contribute to mobility impairment and respiratory complications
- Syringomyelia Can occur in association with Chiari malformation and spina bifida; rated under Diagnostic Code 8024 with a minimum 30% rating under 38 CFR 4.124a
Get Personalized C&P Exam Preparation
Upload your medical records for AI-powered prep that maps YOUR symptoms to the exact DBQ fields your examiner will evaluate.
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.