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C&P Exam Prep: Vertebral Fracture or Dislocation (Cervical)

DC 5235 musculoskeletal 38 CFR 4.71a

DBQ Overview

Interview + Physical
Form Name
Neck_Conditions_Cervical_Spine
Form Code
Neck_Conditions_Cervical_Spine
Page Count
14
Examiner Type
Physician or Physician Assistant
Estimated Duration
30-45 minutes
Exam Format
Interview + Physical

What to Expect During Your Exam

Exam Overview

To document the current severity of your cervical vertebral fracture or dislocation, including range of motion, neurological findings, functional impairment, and any secondary conditions such as radiculopathy or myelopathy, so that VA raters can assign an accurate disability percentage under DC 5235 and the General Rating Formula for Diseases and Injuries of the Spine.

What the examiner evaluates:

  • Confirmed diagnosis of vertebral fracture or dislocation with date of diagnosis and ICD code
  • Active and passive cervical range of motion in all six planes (forward flexion, extension, right/left lateral flexion, right/left lateral rotation)
  • Whether range of motion is limited by pain, spasm, or guarding
  • Pain on motion, including the specific degree at which pain begins
  • Functional loss due to pain, fatigue, weakness, incoordination, or lack of endurance
  • Additional loss of motion after repetitive use (DeLuca factors)
  • Presence and severity of muscle spasm, guarding, or tenderness on palpation
  • Crepitus on range-of-motion testing
  • Segmental instability or abnormal spinal contour/gait
  • Neurological examination: reflexes (biceps, triceps, brachioradialis), sensation (upper and lower extremities), muscle strength
  • Evidence of radiculopathy: nerve root involvement at C5-C6 (upper), C7 (middle), or C8-T1 (lower)
  • Evidence of spinal cord involvement or myelopathy
  • Intervertebral disc syndrome incapacitating episodes if applicable
  • Assistive devices used (brace, cane, walker, crutches, wheelchair)
  • Functional impact on activities of daily living, occupational functioning, and mobility
  • Any comorbid cervical conditions (spinal stenosis, spinal fusion, degenerative disc disease, spondylolisthesis)
  • Muscle atrophy measurements (bilateral arm circumference in centimeters)
  • History of treatment and current treatment regimen

The exam will take place in a VA or contract clinic. You will be asked to perform neck movements in a standing or seated position. A physical neurological exam of your upper and lower extremities will follow. Bring all assistive devices you use for your neck condition. The examiner may observe your gait and posture throughout the visit, not just during formal testing.

Typical duration: 30-45 minutes

Cervical Forward Flexion (Active)

How far forward you can bring your chin toward your chest. Normal is 0-45 degrees.

What to expect:

You will be asked to slowly tuck your chin as far down as you can. The examiner will use a goniometer or inclinometer to record the degree of motion achieved. They will also note the degree at which pain begins, even if you can move beyond that point.

Key thresholds:

  • 15 degrees or less — Meets 30% criteria under General Rating Formula (forward flexion 15 degrees or less)
  • 16-30 degrees — Meets 20% criteria under General Rating Formula (forward flexion greater than 15 degrees but not greater than 30 degrees)
  • 31-40 degrees — Meets 10% criteria under General Rating Formula (forward flexion greater than 30 degrees but not greater than 40 degrees)
  • Greater than 40 degrees — May still support rating if combined range of motion is 170 degrees or less, or if other qualifying criteria such as muscle spasm, guarding, or pain on motion are present

Tips:

  • Move only as far as you actually can without significantly increasing your pain - do not push through severe pain to appear more capable.
  • If pain begins at a lower degree than your end range of motion, tell the examiner: 'Pain begins at approximately X degrees.'
  • If you notice your range is better on the day of the exam than on a typical bad day, proactively tell the examiner about your average and worst-day function.
  • Do not hold your breath or tense up - natural movement provides the most accurate measurement.
  • If your condition has fluctuating symptoms, describe that variability out loud during testing.

Pain considerations: The examiner must document the degree at which pain begins, not just the maximum range. If you experience pain onset at 10 degrees even though you can flex to 25 degrees, state clearly: 'I feel sharp/aching pain in my neck starting at about 10 degrees of flexion.' Under DeLuca v. Brown, pain that limits function must be documented even if it does not restrict end-range motion.

Cervical Extension (Active)

How far back you can tilt your head. Normal is 0-45 degrees.

What to expect:

You will be asked to slowly tilt your head backward as far as you can. The examiner records the degree achieved. Pain onset degree should also be reported.

Key thresholds:

  • Combined ROM 170 degrees or less — Supports 10% or higher rating when combined cervical ROM falls at or below this threshold

Tips:

  • Extension often aggravates cervical fracture/dislocation residuals - report any radiating pain, dizziness, or numbness that occurs during extension.
  • If extension causes radicular symptoms such as shooting arm pain, stop and tell the examiner immediately.
  • Describe any position that reliably worsens your symptoms during the exam.

Pain considerations: Extension may provoke foraminal compression symptoms in veterans with vertebral fracture residuals. Report any arm tingling, shooting pain, or weakness that occurs during extension testing.

Right and Left Lateral Flexion (Active)

How far you can tilt your ear toward each shoulder. Normal is 0-45 degrees each side.

What to expect:

You will be asked to tilt your head to the right and left without rotating or shrugging your shoulders. The examiner measures each side separately.

Key thresholds:

  • Asymmetrical motion between sides — Asymmetry may indicate structural abnormality or residual dislocation deformity - documents severity and aids in nexus narrative

Tips:

  • Keep your shoulders level and do not compensate by raising a shoulder.
  • Note if one side is significantly more restricted than the other and explain why to the examiner.
  • Lateral flexion can aggravate brachial plexus irritation - report any electric shock sensations or arm heaviness.

Pain considerations: If lateral flexion toward the injured side is markedly more restricted or painful than the uninjured side, this asymmetry is clinically significant and supports documentation of structural residuals of the fracture or dislocation.

Right and Left Lateral Rotation (Active)

How far you can turn your head side to side. Normal is 0-80 degrees each side.

What to expect:

You will be asked to turn your head as far right and as far left as possible. The examiner records degrees for each direction.

Key thresholds:

  • Combined cervical ROM 170 degrees or less — Combined ROM at or below this level supports 10% under the General Rating Formula

Tips:

  • Rotation restrictions commonly reflect residuals of cervical fracture/dislocation at specific levels - be precise about where in the range your pain begins.
  • If you drive or work and limited rotation affects your ability to check blind spots or perform job duties, describe this functional limitation.
  • Report if rotation causes or worsens headaches, as this may support additional neurological documentation.

Pain considerations: Rotation that produces audible crepitus or a grinding sensation should be mentioned aloud during testing so the examiner can document it in the crepitus field of the DBQ.

Passive Range of Motion Testing (Correia Requirements)

Range of motion when the examiner moves your neck rather than you moving it yourself. Differences between active and passive ROM are clinically significant.

What to expect:

The examiner will gently move your neck through the same planes tested during active ROM while you relax. You should not assist or resist the motion. Any difference between active and passive ranges must be documented.

Key thresholds:

  • Passive ROM greater than active ROM — Suggests pain or spasm is limiting active movement beyond mechanical restriction - this supports a higher functional limitation finding

Tips:

  • Relax your neck muscles completely during passive testing - do not assist the examiner's movements.
  • If passive motion is also limited and painful, say so: 'Even when you move it, I feel pain at that point.'
  • Passive ROM equal to or greater than active ROM is expected; significant discrepancy in either direction should be verbally noted.

Pain considerations: If passive ROM provokes the same pain as active ROM, this suggests true structural restriction rather than voluntary guarding and should be communicated to the examiner.

Repetitive Use Testing (DeLuca Factors)

Whether your range of motion or pain worsens after performing neck movements three consecutive times, simulating the effect of sustained or repetitive use.

What to expect:

After initial ROM testing, the examiner may ask you to repeat the movements. Note any increase in pain, fatigue, or reduced range compared to your first attempt.

Key thresholds:

  • Measurable decrease in ROM or increase in pain after repetition — Under DeLuca v. Brown, this additional functional loss must be considered in the rating - it can push a 10% to a 20% or higher

Tips:

  • If you feel more pain, stiffness, or fatigue after the second or third repetition, say it out loud: 'My range decreases and pain increases with repeated movement.'
  • Describe how your neck feels after a full day of activity versus first thing in the morning.
  • If the examiner does not perform repetitive testing, you may politely note: 'I typically experience increased limitation after sustained use or by end of day.'
  • Document in your personal statement how your neck function changes throughout the day.

Pain considerations: DeLuca factors are legally required to be considered. If the examiner skips repetitive-use assessment, this is a potential basis for a later inadequate examination argument. Proactively describe end-of-day or post-activity worsening.

Neurological Examination - Deep Tendon Reflexes

Reflex integrity of cervical nerve roots: biceps (C5-C6), brachioradialis (C6), triceps (C7). Absent or decreased reflexes indicate nerve root pathology.

What to expect:

The examiner will tap your tendons at the elbow and forearm with a reflex hammer and compare left to right. Results are recorded as normal, decreased, or absent.

Key thresholds:

  • Decreased or absent reflex on one or both sides — Supports radiculopathy diagnosis; cervical radiculopathy is separately ratable and can add 20% (mild), 40% (moderate), or 60% (severe) on top of the spine rating

Tips:

  • Do not voluntarily contract your muscles during reflex testing - let your arm hang relaxed.
  • If you have noted reflex changes at prior medical appointments, mention this history.
  • Asymmetry between left and right reflexes is significant - the examiner must document both sides.

Pain considerations: Reflex testing is objective and does not depend on your report of pain, but be sure to mention any associated symptoms such as weakness or numbness that accompany the reflex abnormality.

Neurological Examination - Sensation

Sensory function in the upper and lower extremities, testing for dermatomal patterns consistent with specific cervical nerve root levels.

What to expect:

The examiner will use a pin or cotton to test light touch and pin-prick sensation across your arms, hands, and potentially your legs. Decreased or absent sensation in specific dermatomal patterns is documented.

Key thresholds:

  • Decreased sensation in a dermatomal distribution — Confirms nerve root involvement; supports separate radiculopathy rating. Lower extremity sensory loss may indicate myelopathy warranting separate spinal cord evaluation.

Tips:

  • Close your eyes during sensory testing and respond honestly about what you feel.
  • Tell the examiner about any ongoing numbness, tingling, or burning in your arms or hands that is present even at rest.
  • Note if sensation changes with neck position - this is diagnostically important.
  • If you have sensory symptoms in your legs or bladder/bowel changes, report these as they may indicate cord involvement.

Pain considerations: Sensory changes often accompany the pain associated with cervical fracture/dislocation residuals. Paresthesias (pins and needles) and dysesthesias (burning) in a dermatomal pattern should be described to the examiner in detail, including frequency, distribution, and any triggers.

Muscle Strength Testing

Motor strength in upper extremity muscle groups innervated by cervical nerve roots: deltoid/biceps (C5-C6), wrist extensors (C6-C7), triceps/wrist flexors (C7), and intrinsic hand muscles (C8-T1). Graded 0-5/5.

What to expect:

The examiner will ask you to push or pull against resistance in specific directions. Each muscle group is graded. Any weakness compared to the opposite side or below normal (5/5) is significant.

Key thresholds:

  • 3/5 or less (movement against gravity only, no resistance) — Severe radiculopathy finding; supports higher radiculopathy evaluation (60%) or separate neurological rating
  • 4/5 (movement against moderate resistance only) — Moderate weakness; supports moderate radiculopathy rating (40%)

Tips:

  • Give your maximum honest effort during strength testing - do not underperform or exaggerate.
  • If certain activities such as gripping, lifting, or overhead reaching are limited by your cervical condition, describe this to the examiner.
  • Note if weakness is worse on one side or after sustained use.
  • If you dropped objects, had trouble opening jars, or experienced arm giving-way episodes, mention these as functional manifestations of weakness.

Pain considerations: Weakness due to pain inhibition (pain preventing you from generating full force) is distinct from true neurological weakness. Tell the examiner which type you are experiencing: 'My strength is reduced because the movement causes pain' versus 'My arm feels genuinely weak even without pain.'

Muscle Atrophy Measurement

Bilateral arm circumference in centimeters to document muscle wasting from disuse or denervation secondary to the cervical condition.

What to expect:

The examiner may measure both arms with a tape measure at a standardized location. A difference greater than 1-2 cm between sides is clinically significant.

Key thresholds:

  • Greater than 1 cm asymmetry between arms — Objective evidence of muscle atrophy supports neurological damage and can influence overall disability evaluation

Tips:

  • If you have noticed one arm appearing thinner or weaker than the other, report this proactively.
  • Atrophy from disuse due to pain is also ratable - mention if you avoid using one arm due to your cervical condition.

Pain considerations: Disuse atrophy due to chronic pain avoidance patterns is a legitimate form of functional impairment under 38 CFR 4.40 and should be communicated to the examiner.

Estimate

Rating Criteria Breakdown

100% Unfavorable ankylosis of the entire spine. Under the General ...

Unfavorable ankylosis of the entire spine. Under the General Rating Formula, this represents complete loss of spinal motion with ankylosis in an unfavorable position.

Key Symptoms

  • Complete ankylosis of the cervical spine in a non-neutral or unfavorable position
  • Unable to perform any neck movement
  • Significant gait disturbance due to spinal contour abnormality
  • Severe neurological deficits consistent with myelopathy or complete radiculopathy

CFR: 38 CFR 4.71a General Rating Formula for Diseases and Injuries of the Spine: 100% - Unfavorable ankylosis of the entire spine.

50% Unfavorable ankylosis of the cervical spine. The cervical sp ...

Unfavorable ankylosis of the cervical spine. The cervical spine is fused or effectively immobile in a non-neutral or functionally compromised position.

Key Symptoms

  • Near-complete loss of cervical motion
  • Ankylosis in an unfavorable (non-neutral) position
  • Significant pain with any attempted movement
  • Marked functional limitation of daily and occupational activities
  • Chronic muscle spasm with observable guarding
  • Abnormal spinal contour

CFR: 38 CFR 4.71a General Rating Formula: 50% - Unfavorable ankylosis of the cervical spine.

30% Forward flexion of the cervical spine 15 degrees or less; OR ...

Forward flexion of the cervical spine 15 degrees or less; OR favorable ankylosis of the cervical spine.

Key Symptoms

  • Forward flexion limited to 15 degrees or less
  • Ankylosis of the cervical spine in a neutral (favorable) position
  • Severe pain on motion throughout the range
  • Inability to perform overhead activities or look down at work surface
  • Muscle spasm documented on examination
  • Frequent or constant pain requiring regular medication management

CFR: 38 CFR 4.71a General Rating Formula: 30% - Forward flexion of the cervical spine 15 degrees or less; or favorable ankylosis of the cervical spine.

20% Forward flexion of the cervical spine greater than 15 degree ...

Forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; OR the combined range of motion of the cervical spine not greater than 170 degrees; OR muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.

Key Symptoms

  • Forward flexion between 16-30 degrees
  • Combined cervical ROM at or below 170 degrees
  • Muscle spasm causing abnormal gait or spinal contour
  • Measurable reduction in ROM after repetitive use
  • Daily functional limitation affecting work and activities of daily living
  • Recurring flare-ups lasting days at a time

CFR: 38 CFR 4.71a General Rating Formula: 20% - Forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or the combined range of motion of the cervical spine not greater than 170 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.

10% Forward flexion of the cervical spine greater than 30 degree ...

Forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; OR the combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; OR muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; OR vertebral body fracture with loss of 50% or more of the height.

Key Symptoms

  • Forward flexion between 31-40 degrees
  • Combined ROM between 171-335 degrees
  • Localized tenderness or muscle spasm without abnormal gait
  • Vertebral body fracture with documented loss of 50% or more of vertebral height on imaging
  • Pain on motion without significant end-range restriction
  • Intermittent symptoms that are manageable but chronic

CFR: 38 CFR 4.71a General Rating Formula: 10% - Forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or the combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height.

How to Describe Your Symptoms

Pain - Location, Character, and Frequency

How to describe:

Be specific about where your pain is located (base of skull, mid-cervical, lower cervical), what it feels like (sharp, stabbing, aching, burning, throbbing), what makes it better or worse, and how often you experience it. Distinguish between pain at rest, pain with motion, and pain that radiates.

Worst-day example:

“On my worst days, I wake up with a 7-8 out of 10 pain at the base of my skull and mid-neck that radiates down my right arm to my elbow. I cannot turn my head to the right without a sharp stabbing pain, and I have to turn my entire body to look sideways. The pain is constant and is only partially relieved by my medication.”

What the examiner listens for:

The examiner is filling in DBQ fields for pain on motion, pain at rest, pain on weight-bearing, frequency of pain, and severity. They need to document whether pain is mild, moderate, or severe and whether it causes functional loss. They are also populating the DeLuca fields for functional loss beyond the measured ROM.

Understatements to avoid:

Do not say 'it's not that bad' or 'I manage okay' if your pain significantly limits your daily function. Do not describe only your best days. The examiner is required to rate your typical and worst-day presentation.

Range of Motion and Stiffness

How to describe:

Describe the degree to which your neck movement is limited in each direction and how this affects specific tasks. Mention morning stiffness duration, end-of-day worsening, and specific activities you can no longer perform or must modify.

Worst-day example:

“On bad days, I can barely tuck my chin to my chest - maybe 10-15 degrees before severe pain stops me. I cannot look over my shoulder while driving. I sleep with a cervical pillow and still wake up stiff for 1-2 hours. By midafternoon, after sitting at a desk, I am almost unable to move my neck at all.”

What the examiner listens for:

The examiner is documenting active ROM in all planes with degree measurements, pain onset degrees, and whether passive ROM exceeds active ROM. They are also noting whether ROM decreases after repetitive use - this is a DeLuca requirement that directly affects your rating.

Understatements to avoid:

Do not perform your maximum range of motion on the exam day if that maximum is not representative of your average or worst-day function. If the examiner asks 'can you move your neck?' do not demonstrate only what is comfortable - demonstrate your true daily limitation and verbally describe your range on bad days.

Radiculopathy - Arm Pain, Numbness, and Weakness

How to describe:

Describe any symptoms that travel from your neck into your shoulders, arms, or hands. Include which arm(s) are affected, what the sensation feels like (electric shock, burning, numbness, tingling, heaviness), which fingers are affected, and whether it is constant or intermittent.

Worst-day example:

“Several times a week, I get a shooting electric pain from the base of my neck down my right arm into my index finger and thumb. My right hand goes numb when I hold the phone or drive for more than 10 minutes. I have dropped objects and cannot open jars with my right hand. The pain is a 6 out of 10 and wakes me from sleep.”

What the examiner listens for:

The examiner is determining whether a radiculopathy diagnosis is warranted. They need dermatomal distribution of symptoms (C5-C6 - thumb/index finger; C7 - middle finger; C8-T1 - ring/little finger), correlation with reflex and strength findings, and the severity level (mild, moderate, severe) for separate rating under 38 CFR 4.71a. A separately rated radiculopathy can add 20-60% on top of the cervical spine rating.

Understatements to avoid:

Do not dismiss arm symptoms as 'just occasional tingling.' Radiculopathy is separately ratable and can substantially increase your overall rating. If you have any radiating pain, numbness, or weakness in your arms or hands, describe it in detail even if the examiner does not specifically ask.

Flare-Ups - Frequency, Duration, and Triggers

How to describe:

Describe episodes where your cervical symptoms significantly worsen beyond your baseline. Include how often flare-ups occur, how long they last, what triggers them (activity, weather, stress, sleep position), and what you are unable to do during a flare-up.

Worst-day example:

“I have flare-ups about twice a month that last 3-5 days. During these episodes I cannot drive, work at my computer, or sleep through the night. I have had to call in sick to work multiple times and have spent entire days in bed with ice packs on my neck. The flare-ups are triggered by prolonged sitting, cold weather, or any sudden head movement.”

What the examiner listens for:

The examiner must document your description of flare-ups in the DBQ flare-up narrative field. Flare-up frequency and duration directly affect the intervertebral disc syndrome incapacitating episode rating and the overall functional loss assessment. Under M21-1, your description of flare-ups, even if not occurring during the exam, must be recorded.

Understatements to avoid:

Do not assume your flare-ups are too minor to mention because you are not currently in one during the exam. The VA rating system is designed to capture your worst-case function, not your best day. Flare-ups that temporarily increase your limitation to a higher rating level must be communicated and documented.

Fatigue, Weakness, and Lack of Endurance (DeLuca Factors)

How to describe:

Explain how your cervical condition causes fatigue of the neck and upper extremities with sustained activity, and how your functional capacity deteriorates over the course of a day or with repeated movements.

Worst-day example:

“By midday, holding my head upright is exhausting. My neck muscles fatigue after 30-45 minutes of computer work. I have to lie down for 30 minutes to relieve the fatigue and pain before I can resume activity. By evening, I have almost no ability to turn my head and my arms feel heavy and weak.”

What the examiner listens for:

The DBQ has specific checkboxes for fatigability, weakness, lack of endurance, and incoordination as sources of functional loss. These are the DeLuca factors. The examiner must document each of these if present. These factors can support a higher rating even when the observed ROM measurement does not cross a threshold.

Understatements to avoid:

Do not focus only on pain while neglecting to mention fatigue and endurance limitations. Many veterans receive lower ratings because they only describe pain on motion but fail to articulate the fatigue and weakness that develop with sustained activity or by end of day.

Functional Impact on Daily Life and Work

How to describe:

Describe the specific ways your cervical condition affects your ability to perform work tasks, household activities, personal care, driving, exercise, and social activities. Use concrete examples with time limits and frequency.

Worst-day example:

“I can no longer work at my previous job as a construction supervisor because I cannot look up to supervise overhead work or turn my head quickly to monitor equipment. I can only sit at a computer for 20 minutes before pain forces me to stop. I cannot wash dishes without neck pain. I cannot exercise. My wife assists me with tasks that require looking upward. I wake up 3-4 times per night from neck pain.”

What the examiner listens for:

The examiner must document functional impact in the DBQ functional loss section. This includes interference with sitting, standing, locomotion disturbance, deformity, swelling, and other functional manifestations. The nexus between your cervical condition and occupational/daily living impairment is critical to the rating.

Understatements to avoid:

Do not give vague answers like 'it limits me somewhat.' Give specific activities, time limits, and the consequences of exceeding those limits. Specific examples are far more valuable to a rater than general statements.

Segmental Instability and Structural Findings

How to describe:

If you have been told you have instability, abnormal motion, or structural deformity at your fracture site, describe any symptoms of instability such as a sensation of the neck giving way, clicking or grinding sounds, or the need to support your head with your hands.

Worst-day example:

“I can feel my neck shift or give way when I turn too quickly. I hear and feel a grinding/clicking in my neck with most movements. I have to use a cervical collar during flare-ups to stabilize my neck. My chiropractor and spine surgeon have told me my fracture site shows chronic instability on imaging.”

What the examiner listens for:

The examiner has a specific DBQ checkbox for segmental instability (field 39). This finding may independently support a higher rating level or support a favorable ankylosis finding. Structural instability is directly relevant to DC 5235 and should be communicated with supporting imaging history.

Understatements to avoid:

Do not assume the examiner has reviewed your imaging reports. Reference specific MRI, CT, or x-ray findings from your treatment records that document fracture residuals, subluxation, or instability. Say: 'My MRI from [date] at [facility] showed [finding] at [level].'

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 be treated respectfully and professionally during your C&P examination.
  • You have the right to have your description of flare-ups, worst-day function, and daily limitations documented in the DBQ even when those symptoms are not directly observable during the exam.
  • You have the right to review your completed DBQ - request a copy through VA.gov, your VSO, or a records request.
  • In most states, you have the right to audio-record your C&P examination. Check your specific state law regarding one-party versus two-party consent. Announce the recording at the start of the exam.
  • You have the right to bring a support person (caregiver, spouse, or advocate) to the exam for moral support, though they typically should not answer questions on your behalf.
  • You have the right to provide a written personal statement of your symptoms, functional limitations, and flare-up history, and to request that it be incorporated into the examination record.
  • You have the right to bring supporting evidence to the exam, including imaging reports, private physician letters, buddy statements, and employment records documenting functional impact.
  • You have the right to request a new or supplemental C&P examination if the original examination was inadequate, failed to address all relevant factors, or contained a clearly unsupported medical opinion. Consult your VSO or accredited attorney to initiate this process.
  • You have the right to an examination that complies with DeLuca v. Brown requirements - the examiner must consider pain, fatigue, weakness, incoordination, lack of endurance, and functional loss from repetitive use, not merely end-range measurements.
  • You have the right to have each separately ratable condition (such as radiculopathy secondary to your cervical fracture) evaluated individually for its own disability rating.
  • You have the right to be examined by a qualified healthcare provider (Physician or Physician Assistant) with sufficient knowledge to evaluate musculoskeletal and neurological conditions.
  • You have the right to file a Notice of Disagreement (NOD) if you disagree with the rating decision that results from this examination. You have one year from the date of the rating decision to appeal.

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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.