Guide
Nexus letter or C&P exam: how they differ
What each document is for, and what to do when a C&P examiner's opinion goes against you.
Veterans often assume that having had a compensation and pension examination means the medical question is settled. It frequently is not, and understanding why is worth a few minutes.
What a C&P examination is
A C&P exam is arranged by the VA, conducted by a VA clinician or a contracted examiner, and exists to answer questions the VA has posed. It typically serves two purposes: establishing the current severity of a condition for rating purposes, and, where the VA asks for it, giving a medical opinion on service connection.
The examiner is not your provider and is not acting on your behalf. They are answering the VA's questions, often under significant time pressure and sometimes without the complete file in front of them.
How an independent opinion differs
- It is obtained by you, not the VA, and you choose whether to submit it.
- The physician reviews the records you provide, with time to read them properly.
- It focuses on the nexus question specifically, rather than also covering severity.
- It can respond directly to a prior negative opinion, which a C&P examiner has no reason to do.
When the C&P opinion goes against you
This is the situation where an independent opinion does the most work. A negative C&P opinion is evidence, but it is not the end of the matter. It can be rebutted, and the way to rebut it is with a better-reasoned opinion that engages with its specific shortcomings.
Get a copy of the examination report first. You are entitled to it, and you cannot rebut reasoning you have not read. Common weaknesses worth looking for: an examiner who states they reviewed the claims file but whose reasoning shows they missed a key document; an opinion resting on a factual premise that is simply wrong; a conclusion with no rationale; or reasoning that contradicts established medicine.
You can have both
Submitting an independent opinion does not replace or invalidate your C&P examination, and it does not require you to have had one. Where the C&P opinion was favourable, an independent opinion may be unnecessary. Where it was unfavourable, or where the VA never asked for a nexus opinion at all, it may be the evidence that decides your claim.