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C&P Exam Prep: Thyroid and Parathyroid Conditions

DC 7900 endocrine 38 CFR 4.119

DBQ Overview

Interview + Physical
Form Name
Thyroid_and_Parathyroid
Form Code
Thyroid_and_Parathyroid
Page Count
10
Examiner Type
Endocrinologist or Physician
Estimated Duration
15-30 minutes
Exam Format
Interview + Physical

What to Expect During Your Exam

Exam Overview

To evaluate the current severity, functional impact, and symptom burden of thyroid and/or parathyroid conditions for disability rating purposes under 38 CFR 4.119. The examiner will assess your diagnosis type, current thyroid/parathyroid function, treatment history, physical findings, lab results, associated systemic complications, and how your condition affects daily life and occupational functioning.

What the examiner evaluates:

  • Specific diagnosis type: hyperthyroidism (including Graves' disease), hypothyroidism, thyroiditis, thyroid enlargement (toxic or non-toxic), benign or malignant neoplasm of thyroid or parathyroid, hyperparathyroidism, hypoparathyroidism, C-cell hyperplasia, or other thyroid/parathyroid dysfunction
  • History of radioactive iodine treatment, surgical intervention, antineoplastic chemotherapy, radiation therapy, or other therapeutic procedures
  • Current thyroid function status: whether thyroid function is normal, hypothyroid, or hyperthyroid
  • Presence and severity of hypothyroid symptoms and whether myxedema is present and stabilized
  • Presence and severity of hyperthyroid symptoms including heart rate, pulse character, and cardiovascular findings
  • Parathyroid status: hyperparathyroidism or hypoparathyroidism, presence of hypercalcemia and whether treatment is required
  • Neck/thyroid physical examination findings including enlargement, nodules, disfigurement, and scar characteristics
  • Systemic manifestations referred to appropriate DBQs: respiratory/ENT, cardiovascular, gastrointestinal, genitourinary, reproductive, skin, eyes, neurological, musculoskeletal, mental/psychological, dental/oral
  • Relevant laboratory results: TSH, Free T4, Free T3, thyroid antibodies, PTH, calcium, ionized calcium, and other diagnostic tests
  • Imaging studies: MRI, CT, thyroid scan, thyroid ultrasound
  • Biopsy results if applicable
  • Fatigue, anorexia, nausea, constipation as constitutional symptoms
  • Functional impact on occupational and daily activities
  • Neoplasm status: benign vs. malignant, primary vs. secondary, active vs. in remission
  • Residual conditions and complications from treatment or disease progression
  • Eye involvement such as exophthalmos requiring separate evaluation under DC 6090 or 6061-6066

Exam will include a clinical interview covering your medical history and current symptoms, a physical examination of the neck and thyroid gland, vital sign documentation (heart rate, blood pressure, pulse character), and review of available laboratory and imaging records. The examiner will determine whether additional DBQs are needed for systemic complications. Bring all recent lab results, thyroid function tests, imaging reports, and a list of current medications. If you have had thyroid surgery, bring operative reports and discharge summaries.

Typical duration: 15-30 minutes

Thyroid Function Panel (TSH, Free T4, Free T3)

TSH measures pituitary signal to the thyroid; elevated TSH indicates hypothyroidism, suppressed TSH indicates hyperthyroidism. Free T4 and Free T3 measure active thyroid hormones circulating in the blood.

What to expect:

The examiner will review existing lab values from your records. Bring the most recent and any historical results showing fluctuations. The examiner may order new labs if recent values are unavailable. Normal TSH is approximately 0.4-4.0 mIU/L; ranges vary by lab.

Key thresholds:

  • TSH consistently suppressed with elevated Free T4/T3 — Supports active hyperthyroidism rating; severity of symptoms drives percentage under DC 7900
  • TSH elevated with low Free T4 — Supports hypothyroidism diagnosis under DC 7903; symptom burden and presence of myxedema drive rating percentage
  • Normal TSH with ongoing symptoms despite treatment — May still support a compensable rating if symptoms persist and functional impairment is documented

Tips:

  • Bring lab results from the past 12-24 months to show the course of your condition, not just the most recent stable value
  • If your TSH fluctuates, bring multiple lab printouts demonstrating instability
  • Note whether your labs were drawn at the same time of day and under similar conditions, as TSH varies diurnally
  • If you have been recently treated with radioactive iodine or surgery, labs immediately post-treatment may not reflect your chronic state

Pain considerations: Thyroid dysfunction itself does not cause pain measured by TSH, but symptoms like muscle aches, joint pain, and fatigue should be separately articulated to the examiner.

Thyroid Antibodies (TPO Antibodies, TRAb, Thyroglobulin Antibodies)

Detects autoimmune thyroid disease such as Hashimoto's thyroiditis or Graves' disease. Elevated antibodies confirm an autoimmune etiology and may support a service connection nexus argument.

What to expect:

The examiner will review antibody results from your records. These are particularly important if your condition is Graves' disease (DC 7900) or autoimmune thyroiditis (DC 7906).

Key thresholds:

  • Elevated TSH receptor antibodies (TRAb) — Confirms Graves' disease; supports hyperthyroidism rating and potential for ongoing active disease
  • Elevated TPO antibodies — Confirms Hashimoto's; may support hypothyroid rating and evidence of ongoing autoimmune activity even when TSH is normal

Tips:

  • Bring all antibody testing results, including historical values
  • If antibodies remain elevated despite treatment, this documents ongoing autoimmune disease activity

Pain considerations: Elevated antibodies may correlate with inflammatory symptoms including neck tenderness in thyroiditis; describe any neck discomfort or tenderness to the examiner.

Serum Calcium and Ionized Calcium / PTH Level

Evaluates parathyroid function. Elevated calcium (hypercalcemia) and elevated PTH indicate hyperparathyroidism. Low PTH with low calcium indicates hypoparathyroidism. Critical for rating under DC 7904 (hyperparathyroidism) and DC 7905 (hypoparathyroidism).

What to expect:

If you have a parathyroid condition, the examiner will review PTH and calcium lab results. The DBQ specifically asks about hypercalcemia indicated by: bone mineral density T-score less than or equal to -2.5, total calcium greater than 12 mg/dL (3.0 mmol/L), ionized calcium greater than 5.6 mg/dL (1.4 mmol/L), or creatinine clearance less than 60 mL/min.

Key thresholds:

  • Total calcium > 12 mg/dL (3.0 mmol/L) — Meets threshold for hypercalcemia under DC 7904; may support higher rating if treatment required
  • Ionized calcium > 5.6 mg/dL (1.4 mmol/L) — Alternative threshold for hypercalcemia documentation
  • Bone mineral density T-score - -2.5 — Osteoporosis from hypercalcemia; supports hypercalcemia-related rating criteria
  • Creatinine clearance < 60 mL/min due to hypercalcemia — Renal impairment from hypercalcemia; may support additional ratings under genitourinary system

Tips:

  • Bring 24-hour urine calcium test results if available
  • Bring bone density (DEXA scan) results if ordered by your doctor
  • Document any kidney stones, as nephrolithiasis is a complication of hyperparathyroidism that supports the severity of your condition

Pain considerations: Bone pain and joint aches from hypercalcemia should be described as a separate symptom category; describe location, frequency, and intensity.

Heart Rate and Pulse Character

Elevated resting heart rate (tachycardia) and irregular pulse are hallmark findings of hyperthyroidism and Graves' disease. The DBQ specifically documents heart rate and blood pressure. Hyperthyroid heart disease is separately rated under DC 7008.

What to expect:

The examiner will take your vital signs during the exam. Be aware that anxiety about the exam itself may temporarily elevate your heart rate. Bring documentation of heart rate measurements from your primary care or endocrinology visits to establish a pattern.

Key thresholds:

  • Resting heart rate > 100 bpm (tachycardia) — Supports active hyperthyroidism; may trigger separate cardiovascular DBQ referral for DC 7008 evaluation
  • Irregular pulse / atrial fibrillation — Supports hyperthyroid heart disease; may warrant separate cardiovascular evaluation

Tips:

  • Track and document your resting heart rate at home daily for 2 weeks before the exam using a pulse oximeter or smartwatch
  • Bring records of any Holter monitor studies, EKGs, or cardiology consultations
  • If your heart rate is controlled by medications (beta-blockers), inform the examiner and note what your rate is when unmedicated or when medications are adjusted

Pain considerations: Palpitations, chest pounding, and shortness of breath related to elevated heart rate should be described in detail, including frequency and impact on physical activity.

Thyroid Imaging (Ultrasound, Thyroid Scan, CT, MRI)

Thyroid ultrasound assesses size, nodules, and structural abnormalities. Thyroid scan (radioiodine uptake) evaluates functional activity. CT/MRI may assess compressive effects on trachea/esophagus. The DBQ documents findings from each imaging modality.

What to expect:

The examiner will review existing imaging reports. A new exam-day ultrasound is not typically performed. Bring all imaging reports with dates and findings.

Key thresholds:

  • Enlarged thyroid with tracheal compression documented on imaging — Supports respiratory/ENT symptoms referral and may support disfigurement finding
  • Malignant nodule confirmed on biopsy — Triggers malignant neoplasm rating at 100% during active treatment; post-treatment residuals rated separately

Tips:

  • Bring imaging reports, not just the disc; written reports are what the examiner needs for the DBQ
  • If nodules were biopsied, bring pathology reports
  • Note the date of each imaging study so the examiner can document the most recent results

Pain considerations: If an enlarged thyroid causes neck pressure, difficulty swallowing, or voice changes, describe these symptoms specifically and in detail.

Estimate

Rating Criteria Breakdown

100% DC 7900 Hyperthyroidism (Graves' disease): Warm, moist skin; ...

DC 7900 Hyperthyroidism (Graves' disease): Warm, moist skin; tachycardia greater than 100 beats per minute; eye involvement (exophthalmos); muscular weakness (tremors); weight loss greater than 15 percent; emotional instability; heat intolerance. DC 7903 Hypothyroidism: Hypothyroidism with cold intolerance, muscular weakness, cardiovascular involvement, or mental symptoms. DC 7907/7908 Malignant neoplasm of thyroid or parathyroid: Active malignancy or during period of treatment (rated 100% until treatment completion, then residuals evaluated). DC 7904 Hyperparathyroidism: Hypercalcemia requiring treatment AND with bone mineral density T-score - -2.5, total calcium > 12 mg/dL, ionized calcium > 5.6 mg/dL, OR creatinine clearance < 60 mL/min. NOTE: Also evaluate myxedema (severe hypothyroidism with characteristic physical findings) at 100% under DC 7903.

Key Symptoms

  • Warm, moist skin with visible sweating
  • Resting heart rate consistently greater than 100 bpm
  • Exophthalmos or other significant eye involvement
  • Significant unintentional weight loss greater than 15 percent of body weight
  • Severe muscular weakness or tremors
  • Marked emotional instability, anxiety, or irritability
  • Heat intolerance significantly impairing daily activities
  • Cold intolerance with cardiovascular or mental involvement (hypothyroid)
  • Active malignancy of thyroid or parathyroid
  • Hypercalcemia with bone loss, renal impairment, or high calcium requiring treatment
  • Myxedema with characteristic features

CFR: Graves' disease with exophthalmos, tachycardia, weight loss >15%, and muscular weakness. Hypothyroidism with myxedema, cardiovascular involvement, and mental symptoms. Active thyroid or parathyroid malignancy during treatment period.

60% DC 7900 Hyperthyroidism: Warm, moist skin; tachycardia great ...

DC 7900 Hyperthyroidism: Warm, moist skin; tachycardia greater than 100 beats per minute; muscular weakness (no tremors); some weight loss; emotional instability; heat intolerance - without the full constellation of 100% criteria. DC 7903 Hypothyroidism: Persistent symptoms despite treatment including fatigue, cold intolerance, constipation, weight gain, cognitive slowing, and mild cardiovascular manifestations. DC 7904 Hyperparathyroidism: Hypercalcemia present but not yet meeting all 100% criteria thresholds; symptomatic with fatigue, bone pain, nausea.

Key Symptoms

  • Tachycardia over 100 bpm with moist skin but no exophthalmos
  • Muscular weakness without tremors
  • Some unintentional weight loss (less than 15%)
  • Moderate emotional instability or irritability
  • Moderate heat intolerance
  • Persistent fatigue despite thyroid hormone replacement
  • Cold intolerance affecting daily activities
  • Mild cardiovascular findings (hypertension, mild arrhythmia)
  • Cognitive slowing or memory difficulty
  • Symptomatic hypercalcemia with nausea, constipation, bone pain

CFR: Hyperthyroidism with tachycardia and muscular weakness but without full Graves' eye disease or severe weight loss. Hypothyroidism with persistent fatigue and cold intolerance despite levothyroxine therapy.

30% DC 7900 Hyperthyroidism: Moist skin, slight tremor, tachycar ...

DC 7900 Hyperthyroidism: Moist skin, slight tremor, tachycardia 80-100 bpm, some heat intolerance, and emotional instability - mild manifestations. DC 7903 Hypothyroidism: Mild symptoms with some fatigue, mild cold intolerance, skin changes, or hair loss, with thyroid function maintained near normal on replacement therapy. Symptoms present but not severely disabling.

Key Symptoms

  • Mild tremor
  • Heart rate 80-100 bpm at rest
  • Mild heat intolerance
  • Mild emotional instability
  • Moist skin without overt diaphoresis
  • Mild fatigue
  • Mild cold intolerance
  • Dry skin or hair loss (hypothyroid skin changes)
  • Mild constipation
  • Mild weight changes

CFR: Mild hyperthyroidism with slight tremor, moist skin, heart rate in the 80-100 bpm range, and some heat intolerance. Mild hypothyroidism with fatigue and cold intolerance managed on levothyroxine but with residual symptoms.

10% Hypothyroidism or hyperthyroidism currently controlled by tr ...

Hypothyroidism or hyperthyroidism currently controlled by treatment with minimal or no persistent symptoms. Thyroiditis with normal thyroid function (euthyroid) is rated 0% under DC 7906 but may be upgraded if manifesting as hypo- or hyperthyroidism. Non-toxic thyroid enlargement without dysfunction or significant symptoms. Residual scarring or mild surgical changes without functional impairment.

Key Symptoms

  • Thyroid condition requiring ongoing medication management
  • Minimal residual symptoms that do not substantially impair function
  • Surgical scar without disfigurement
  • Occasional mild fatigue controllable with medication adjustment
  • Thyroid enlargement without compression or dysfunction

CFR: Hypothyroidism well-controlled on levothyroxine with occasional mild fatigue but no cardiovascular, neurological, or musculoskeletal involvement. Post-thyroidectomy scar without functional limitation.

0% Thyroiditis with normal thyroid function (euthyroid) per DC ...

Thyroiditis with normal thyroid function (euthyroid) per DC 7906. No current symptoms, no functional impairment, no ongoing treatment required, and all labs within normal limits. Condition resolved without residual disability. NOTE: A 0% rating still establishes service connection, which is important for potential future increases and eligibility for related secondary conditions.

Key Symptoms

  • No current symptoms
  • Normal TSH, Free T4, Free T3
  • No medication required
  • No functional limitations
  • Euthyroid thyroiditis

CFR: Thyroiditis (DC 7906) with normal thyroid function currently. Resolved benign thyroid nodule with no remaining dysfunction.

How to Describe Your Symptoms

Fatigue and Energy

How to describe:

Describe fatigue in concrete, functional terms: how many hours per day you can be active before needing to rest, whether you need to nap during the day, how fatigue affects your ability to work, perform household tasks, or participate in social activities. Note whether fatigue is present even after adequate sleep.

Worst-day example:

“On my worst days, I wake up already exhausted even after 9 hours of sleep. By noon I cannot stay awake and must lie down for 1-2 hours. I cannot complete basic household tasks like grocery shopping or cooking without stopping to rest multiple times. I have called out sick from work on average twice per month due to fatigue alone.”

What the examiner listens for:

The examiner is looking for whether fatigue is a persistent, disabling symptom separate from normal tiredness. They want to hear specific examples that demonstrate functional impairment for the DBQ field on functional impact.

Understatements to avoid:

Saying 'I'm a little tired sometimes' when you mean 'I am unable to work a full shift or complete daily activities without significant rest periods.' Do not minimize fatigue as something you simply push through - describe its real impact.

Cardiovascular Symptoms (Palpitations, Tachycardia, Heat Intolerance)

How to describe:

Describe frequency of palpitations (how many times per week, duration of each episode), resting heart rate at home, and impact on physical exertion. For heat intolerance, describe specific situations where heat causes distress and how you adapt your life to avoid heat exposure.

Worst-day example:

“On my worst days, my heart is racing at rest - I have documented home readings of 110-120 beats per minute. I feel my heart pounding when lying still in bed. I cannot tolerate temperatures above 75 degrees and have had to leave work environments due to heat. I use air conditioning year-round even in winter to stay comfortable.”

What the examiner listens for:

Consistent resting tachycardia above 100 bpm, documented palpitation episodes, heat sensitivity that limits work or activity, and whether these symptoms occur despite medication. The examiner will document your heart rate and blood pressure at exam.

Understatements to avoid:

Do not say 'my heart races sometimes when I exercise' if you have resting tachycardia. Do not wait until asked - proactively describe palpitations and heat intolerance. Do not attribute these symptoms to anxiety without clarifying they are thyroid-related.

Cold Intolerance and Temperature Sensitivity (Hypothyroid)

How to describe:

Describe specific scenarios: what temperature triggers symptoms, how many layers of clothing you need, whether you use a space heater when others are comfortable, and how cold intolerance limits your ability to work outdoors or in air-conditioned environments.

Worst-day example:

“I wear a winter coat inside air-conditioned buildings year-round. When exposed to temperatures below 68 degrees I experience uncontrollable shivering, profound fatigue, and difficulty thinking clearly. I have had to decline work assignments requiring outdoor activity during fall and winter months.”

What the examiner listens for:

Cold intolerance that is disproportionate to environmental conditions, concrete adaptive behaviors (extra layers, space heaters), and functional limitations in work or daily life due to temperature sensitivity.

Understatements to avoid:

Avoid simply saying 'I get cold easily.' Describe the severity and functional impact. Do not omit winter months or season-specific problems.

Weight Changes

How to describe:

Provide specific weight data: your pre-illness weight, current weight, highest or lowest weight since diagnosis, and the timeframe of change. For hyperthyroidism, describe unintentional weight loss despite normal or increased appetite. For hypothyroidism, describe weight gain despite dietary restriction.

Worst-day example:

“At my worst I lost 22 pounds in 3 months without trying to lose weight - I was eating more than usual but couldn't maintain my weight. My clothes no longer fit and I had visible muscle wasting in my arms and legs. I have documentation from my primary care physician showing the weight loss.”

What the examiner listens for:

Weight loss greater than 15 percent of body weight is a specific rating criterion for 100% under DC 7900. The examiner will want documented weights from medical records, not just your estimate.

Understatements to avoid:

Do not guess your weight loss - bring medical records showing serial weights. Do not minimize weight loss by saying 'I lost a little weight.'

Cognitive and Psychological Symptoms

How to describe:

Describe memory problems, difficulty concentrating, brain fog, emotional lability, anxiety, or depression in specific, functional terms. Note how these affect work performance, relationships, and daily decision-making. Distinguish thyroid-related cognitive symptoms from any separately diagnosed psychiatric conditions.

Worst-day example:

“On my worst days I cannot remember whether I have taken my medication, lose track of conversations mid-sentence, and cannot complete simple paperwork without rereading the same line multiple times. I have made errors at work that I attribute to cognitive dysfunction and received a written warning.”

What the examiner listens for:

Cognitive symptoms that map to thyroid dysfunction (hypothyroid slowing or hyperthyroid anxiety/emotional instability), functional impact on employment or ADLs, and whether symptoms persist despite treatment.

Understatements to avoid:

Do not say 'I'm just a little forgetful' when you experience significant cognitive dysfunction. Do not omit psychological symptoms from thyroid conditions out of embarrassment - they are legitimate, documentable rating factors.

Eye Involvement (Graves' Ophthalmopathy, Exophthalmos)

How to describe:

Describe eye bulging (proptosis), double vision (diplopia), eye pain, tearing, light sensitivity, and any changes in vision. Note whether eye symptoms have required separate treatment including eye drops, steroids, orbital decompression, or radiation. Eye conditions due to thyroid disease are separately rated under DC 6090 (diplopia) or DC 6061-6066 (visual acuity impairment).

Worst-day example:

“My eyes protrude visibly - multiple people have commented on the change in my appearance. I have constant eye pressure, my vision doubles when looking to the right, and I cannot drive at night due to light sensitivity. My ophthalmologist has recommended orbital decompression surgery.”

What the examiner listens for:

Documented exophthalmos, diplopia, corneal involvement, or visual acuity changes. The examiner will note eye involvement on the DBQ and refer for a separate ophthalmology DBQ. Make sure to clearly request evaluation for a separate eye rating.

Understatements to avoid:

Do not omit eye symptoms even if you think they are minor. Even mild proptosis or intermittent double vision may qualify for a separate compensable rating under the eye schedule.

Musculoskeletal Symptoms (Weakness, Tremor, Muscle/Joint Pain)

How to describe:

Describe muscle weakness in functional terms: difficulty climbing stairs, rising from a chair, carrying groceries, or lifting. For tremors, describe which body parts are affected, frequency, and whether tremors interfere with writing, eating, or fine motor tasks. For bone or joint pain from parathyroid conditions, describe location, severity on a 0-10 scale, frequency, and what makes it worse.

Worst-day example:

“My hand tremor is so severe on bad days that I cannot hold a cup of coffee without spilling it. I have dropped items at work due to hand weakness. My thigh muscles are so weak I need to use handrails and cannot rise from a low chair without pushing off with my arms.”

What the examiner listens for:

Objective tremor on exam, proximal muscle weakness (difficulty rising from chair, climbing stairs), and documentation of how musculoskeletal symptoms impair occupational and daily functioning. The examiner may refer for a separate musculoskeletal DBQ.

Understatements to avoid:

Do not say 'I'm a bit shaky' when you have a disabling tremor. Do not minimize muscle weakness as 'I just need to exercise more.' Describe the true functional impact.

Gastrointestinal Symptoms (Nausea, Constipation, Anorexia)

How to describe:

Describe frequency of nausea (how many days per week), whether it leads to vomiting, whether it affects your ability to eat regular meals, and how constipation affects your daily routine. Note whether these symptoms are present despite treatment and whether they require separate management.

Worst-day example:

“I experience nausea 4-5 days per week that prevents me from eating breakfast. My constipation requires daily laxative use and I have had to miss work due to abdominal cramping. I have lost interest in food and frequently skip meals due to nausea.”

What the examiner listens for:

GI symptoms (nausea, constipation, anorexia) that are consistent with either hypothyroidism or hypercalcemia, their frequency and functional impact, and whether they require treatment. The examiner may refer for a separate GI DBQ.

Understatements to avoid:

Do not dismiss GI symptoms as separate from your thyroid condition. They are documented DBQ fields and contribute to the overall disability picture.

Skin and Hair Changes

How to describe:

Describe skin texture changes (dry, rough, myxedematous thickening for hypothyroid; warm, moist, sweaty for hyperthyroid), hair loss patterns (diffuse thinning, eyebrow loss for hypothyroid), nail changes, and any scar characteristics from thyroid surgery. For surgical scars, describe location, length, width, whether raised or depressed, and any restricted movement.

Worst-day example:

“My skin is so dry and thickened it cracks and bleeds in winter despite daily moisturizer. I have lost the outer third of both eyebrows and my hair has thinned by approximately 50 percent requiring me to change my hairstyle to cover it. My surgical scar is raised, 8 cm long, and uncomfortable when wearing collared shirts.”

What the examiner listens for:

Objective skin findings on exam including texture, pigmentation changes, hair and nail changes, and surgical scar characteristics. Scar findings feed into the disfigurement and scar evaluation sections of the DBQ.

Understatements to avoid:

Do not fail to mention hair loss or skin changes because you think they are cosmetic. They are legitimate symptoms of thyroid dysfunction and are evaluated on the DBQ.

Functional Impact on Work and Daily Activities

How to describe:

Describe specific work tasks you cannot perform, number of sick days taken, any job accommodations made, and whether you have had to reduce work hours or change jobs due to your thyroid condition. Describe impacts on household tasks, childcare, social activities, and self-care.

Worst-day example:

“I was forced to reduce from full-time to part-time work due to fatigue and cognitive symptoms. I cannot stand for more than 30 minutes at a time, cannot work in environments above 72 degrees, and have had to hire assistance for yard work and grocery shopping. My spouse has taken over meal preparation because I lack the energy to cook.”

What the examiner listens for:

The DBQ has a dedicated functional impact section. The examiner needs specific examples of how the condition limits occupational and daily functioning - this directly feeds the disability narrative and can support extraschedular consideration.

Understatements to avoid:

Do not say 'it affects my life a little.' Be specific, concrete, and comprehensive. The functional impact section of the DBQ is a critical rating factor.

Common Mistakes to Avoid

Prep Checklist

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Before Your Exam

Day Of

During the Exam

After the Exam

Your Rights During a C&P Exam

  • You have the right to have a representative (VSO, attorney, claims agent, or family member) accompany you to your C&P examination.
  • You have the right to request a copy of the completed DBQ and all examination findings after the exam is conducted.
  • In most states, you have the right to audio or video record your C&P examination after providing advance notice to the examiner and/or facility - check your state's recording consent laws and notify the facility in writing before the exam.
  • You have the right to an adequate examination - one in which the examiner reviews all available evidence, physically examines you when relevant, and addresses all claimed conditions. If the exam is inadequate, you can request a new one.
  • You have the right to submit a written statement (VA Form 21-4138) correcting or supplementing the exam record at any time before a final rating decision.
  • You have the right to submit private medical opinions and independent medical examinations (IMEs) as evidence to counter or supplement the C&P examiner's findings.
  • You have the right to be rated under the most favorable diagnostic code when multiple codes apply to your condition, per M21-1 adjudication guidance.
  • You have the right to request that your thyroid-related eye conditions (exophthalmos, diplopia, visual impairment) be separately evaluated under 38 CFR 4.79 in addition to your primary thyroid rating.
  • You have the right to request that all systemic manifestations of your thyroid or parathyroid condition be separately evaluated under appropriate diagnostic codes, including cardiovascular (DC 7008), neurological, musculoskeletal, and other body systems.
  • You have the right to a contemporaneous rating decision explanation - the VA must explain why a particular rating level was assigned and what evidence was considered.
  • If you disagree with the C&P examiner's conclusions or the resulting rating decision, you have the right to file a supplemental claim with new evidence, request a higher-level review, or appeal to the Board of Veterans' Appeals.
  • You cannot be penalized for asserting your rights or for providing thorough, detailed descriptions of your symptoms - providing complete and accurate information is your right and responsibility.

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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.