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VA Rating Assistant

DC 8017 · 38 CFR 4.124a

Amyotrophic Lateral Sclerosis (ALS) C&P Exam Prep

To document the full extent of your ALS diagnosis and all associated complications for VA rating purposes. Under 38 CFR 4.124a DC 8017, a confirmed diagnosis of ALS is itself sufficient to warrant a 100% rating. The exam also documents every complication-such as limb paralysis, bulbar dysfunction, respiratory failure, dysphagia, bowel/bladder involvement, and speech impairment-so the VA can correctly assign Special Monthly Compensation (SMC) and ancillary benefits including Specially Adapted Housing (SAH), automobile allowance, and Dependents' Educational Assistance (DEA).

Format:
Interview + Physical
Typical duration:
60-90 minutes
DBQ form:
Central_Nervous_System_and_Neuromuscular_Diseases (Central_Nervous_System_and_Neuromuscular_Diseases)
Examiner:
Physician or Psychologist

What the examiner evaluates

  • Confirmed ALS diagnosis and date of onset
  • Upper motor neuron signs: spasticity, hyperreflexia, pathological reflexes (Babinski), pseudobulbar affect
  • Lower motor neuron signs: progressive muscle weakness, fasciculations, muscle atrophy with circumferential measurements
  • Bulbar involvement: dysarthria, dysphagia, aspiration risk, soft palate paralysis
  • Respiratory compromise: FVC%, FEV1, need for BiPAP/CPAP/ventilator support
  • Limb function: grip strength, pinch strength, elbow/wrist/knee/ankle ROM and muscle strength testing in all extremities
  • Gait and mobility: ambulatory status, need for cane, crutches, walker, wheelchair, or braces
  • Assistive devices currently in use and frequency of use
  • Bladder dysfunction: retention, incontinence, catheterization needs, UTI history
  • Bowel dysfunction: incontinence, constipation, need for bowel program or medications
  • Speech: intelligibility, aphonia, need for augmentative/alternative communication
  • Nutrition: weight loss, need for PEG tube or enteral feeding
  • Sleep disturbances: insomnia, hypersomnia, sleep apnea requiring CPAP/BiPAP/tracheostomy
  • Cognitive and emotional status: pseudobulbar affect, dementia (ALS-FTD spectrum)
  • Environmental/toxic exposure history: herbicide/Agent Orange exposure, heavy metals, solvents, pesticides, nerve agents
  • All current medications for ALS symptom management
  • Impact of condition on occupational and daily functioning

The exam will include both a structured clinical interview and a full neurological physical examination. If you require a wheelchair, transport assistance, or augmentative communication device, notify the scheduling office in advance. You have the right to have a caregiver or support person present. In most states, you have the right to record the examination with a handheld device-notify the examiner at the start of the appointment.

Measurements and tests

Forced Vital Capacity (FVC%) and FEV1

What it measures: Respiratory muscle strength and lung capacity, which decline progressively in ALS due to diaphragm and intercostal muscle weakness

What to expect: You will breathe into a spirometer. The examiner will record your FVC percentage of predicted normal, FEV1, and FEV1/FVC ratio. Results directly inform the need for respiratory assistance devices and SMC levels.

Critical thresholds

  • FVC < 50% predicted Strong indicator for BiPAP initiation; supports SMC aid-and-attendance level needs
  • FVC < 30% predicted Severe respiratory failure; may support SMC housebound or higher-level SMC
  • Requires mechanical ventilation or tracheostomy Supports SMC at the highest levels under 38 CFR 3.350

Tips

  • Bring copies of your most recent pulmonology or neurology spirometry results to the exam
  • Inform the examiner if you already use BiPAP, CPAP, or a ventilator at night or continuously
  • Accurately report if your breathing is worse when lying flat (orthopnea), during exertion, or at night
  • Do not try to perform better than your actual capacity-accurate results are essential for SMC determination

Pain considerations: Respiratory effort during spirometry may cause fatigue or dyspnea. Inform the examiner if the testing worsens your symptoms.

Manual Muscle Testing (MMT) - Upper and Lower Extremities

What it measures: Motor strength in individual muscle groups bilaterally (biceps, triceps, brachioradialis, wrist flexors/extensors, grip, pinch, knee extensors, ankle dorsiflexors/plantarflexors) using the Medical Research Council (MRC) 0-5 scale

What to expect: The examiner will ask you to push, pull, and resist force with each arm and leg. Results are graded 0 (no contraction) through 5 (normal strength). Asymmetric weakness is highly characteristic of ALS and will be carefully documented.

Critical thresholds

  • MRC Grade 0-1 in any extremity Complete or near-complete paralysis; supports SMC loss-of-use determination for that extremity
  • MRC Grade 2-3 in both lower extremities Significant functional loss; supports SMC aid-and-attendance and wheelchair dependency
  • Loss of use of both feet or both hands Qualifies for SMC under 38 CFR 3.350(a) and Specially Adapted Housing under 38 CFR 3.809

Tips

  • Do not brace, compensate, or use your stronger side to assist during testing of the weaker side
  • Tell the examiner which side is dominant (right/left/ambidextrous) as this affects SMC calculations
  • Report any fasciculations (muscle twitching) you experience at rest or with exertion
  • Describe your weakest functional state, not your best performance on a good day-this is your 'worst day' representation

Pain considerations: Muscle fatigue following MMT is common in ALS. Inform the examiner if testing causes disproportionate exhaustion, cramping, or increased weakness afterward.

Grip Strength and Pinch Strength Testing

What it measures: Fine motor and gross hand strength bilaterally; critical for determining loss of use of hands for VA SMC purposes

What to expect: You will squeeze a dynamometer or resist the examiner's grip pressure. Pinch testing assesses lateral and tip pinch. Results are compared bilaterally and against normal values.

Critical thresholds

  • Minimal to no functional grip (unable to perform activities of daily living independently) Supports loss-of-use-of-hand SMC determination under 38 CFR 3.350
  • Inability to hold utensils, writing instruments, or perform hygiene tasks Functional loss documented for SMC purposes

Tips

  • Bring any adaptive equipment you use (button hooks, utensil grips, stylus) to demonstrate your level of impairment
  • Report if you drop objects, cannot open containers, or require assistance with dressing, hygiene, or eating
  • Describe difficulty with fine motor tasks such as typing, buttoning, or writing

Pain considerations: Cramping during grip testing is a recognized ALS symptom. Report it to the examiner immediately.

Range of Motion (ROM) Testing - All Major Joints

What it measures: Active and passive ROM in elbows (flexion/extension), wrists (flexion/extension), knees (extension), and ankles (dorsiflexion/plantarflexion) bilaterally; spasticity-related ROM restrictions are common in ALS

What to expect: The examiner will move your joints both actively (you move them) and passively (examiner moves them). In ALS, spasticity from upper motor neuron involvement often limits passive ROM, while lower motor neuron loss limits active ROM.

Critical thresholds

  • Active ROM severely limited due to weakness/spasticity Supports functional loss and SMC determinations
  • Contractures present Documented muscle atrophy with contractures supports higher SMC levels

Tips

  • Inform the examiner if you experience spasticity, stiffness, or painful muscle spasms during ROM testing
  • Do not force movement beyond your comfortable limit-accurate passive ROM is more important than demonstrating maximum effort
  • Describe how spasticity or weakness affects your ability to walk, climb stairs, dress, or transfer from bed to chair

Pain considerations: Pain during ROM testing should be reported immediately. Spasticity in ALS can cause significant discomfort during passive stretching.

Muscle Atrophy Assessment

What it measures: Circumferential limb measurements at standardized anatomical points to quantify muscle wasting bilaterally; a hallmark finding in ALS lower motor neuron degeneration

What to expect: The examiner will measure the circumference of your arms and legs using a tape measure, comparing dominant versus non-dominant limbs and recording the difference in centimeters.

Critical thresholds

  • Measurable asymmetric atrophy (>2 cm circumference difference) Objective evidence of lower motor neuron loss; documented in DBQ field for atrophy with specific measurements
  • Diffuse bilateral atrophy Supports advanced ALS staging and high SMC need

Tips

  • Do not wear bulky clothing or compression garments that may obscure atrophy
  • Point out areas where you have noticed visible muscle wasting, such as the thenar eminence, forearms, or calves
  • Bring photos if you have documented visible atrophy over time, as progression is meaningful

Pain considerations: Atrophy measurement is non-painful but the examiner should be informed of fasciculations (visible or felt twitching) in the muscles being examined.

Gait and Mobility Assessment

What it measures: Ambulatory ability, need for assistive devices, fall risk, and degree of lower extremity functional loss

What to expect: You will be observed walking, if able. The examiner will document whether you use a cane, walker, crutches, wheelchair, or braces, and how frequently. The DBQ specifically asks whether these are your normal mode of locomotion.

Critical thresholds

  • Requires wheelchair as normal mode of locomotion Meets 38 CFR 3.808/3.809 criteria for automobile allowance, adaptive equipment, and SAH
  • Requires braces/AFOs as normal mode of locomotion Supports SMC determinations and assistive device documentation

Tips

  • Use your actual assistive device during the examination-do not attempt to walk without it to appear more capable
  • State clearly and honestly how often you use each device and whether you could safely ambulate without it
  • If you have fallen due to ALS-related weakness, report the number of falls and circumstances

Pain considerations: Foot drop, spasticity, and leg weakness can cause pain and trip hazards during gait testing. Inform the examiner of any discomfort.

Speech and Bulbar Function Assessment

What it measures: Dysarthria severity, aphonia, palatal function, swallowing ability (dysphagia), and aspiration risk

What to expect: The examiner will listen to your speech quality, ask you to perform palatal movements, assess your swallowing history, and document any nasal regurgitation or choking episodes.

Critical thresholds

  • Speech not intelligible or individual is aphonic Directly rated in DBQ and supports maximum SMC level; constant inability to communicate by speech is a separately ratable complication
  • Dysphagia requiring daily medication, PEG tube, or esophageal stent Separately rated ALS complication supporting higher SMC and ancillary benefits
  • Aspiration events documented Supports respiratory complications and aspiration pneumonia risk

Tips

  • Bring your augmentative/alternative communication (AAC) device if you use one, and demonstrate its use
  • Report the progression of your speech impairment-when it started, how quickly it has worsened
  • Describe specific functional losses: cannot make phone calls, family cannot understand you, require text-to-speech software
  • Report all episodes of choking, aspiration, or pneumonia related to swallowing difficulties

Pain considerations: Fatigue during speech testing is expected in ALS with bulbar involvement. Inform the examiner if speaking during the exam causes significant exhaustion.

Rating criteria by percentage

100%

ALS is rated at 100% under 38 CFR 4.124a, DC 8017 for all service-connected cases. A confirmed diagnosis of ALS alone is sufficient to support a 100% evaluation effective January 19, 2012. No functional threshold must be met beyond the diagnosis itself. The examiner must document all compensable complications-including limb paralysis, bulbar dysfunction, respiratory failure, dysphagia, bowel/bladder impairment, and speech loss-because these complications drive Special Monthly Compensation (SMC) levels above 100%, not the basic percentage rating. VA must also consider entitlement to DEA, automobile allowance and adaptive equipment, and Specially Adapted Housing (SAH) for all ALS veterans.

Key symptoms

  • Progressive upper and lower motor neuron degeneration
  • Muscle weakness and atrophy in limbs, trunk, and bulbar musculature
  • Fasciculations at rest
  • Spasticity and hyperreflexia (UMN signs)
  • Dysarthria progressing to aphonia
  • Dysphagia with aspiration risk
  • Respiratory muscle weakness with declining FVC
  • Bowel and bladder dysfunction
  • Loss of use of one or more extremities
  • Wheelchair or assistive device dependence
  • Weight loss and malnutrition
  • Sleep-disordered breathing requiring CPAP/BiPAP/ventilator
  • Pseudobulbar affect
  • Cognitive changes (ALS-FTD spectrum)

From 38 CFR: 8017 Amyotrophic lateral sclerosis - 100 percent. Note: Consider the need for special monthly compensation. Per M21-1, Part V, Subpart iii, 12.C.2.c, a diagnosis of ALS alone is sufficient to support an evaluation of 100 percent. Per M21-1, Part V, Subpart iii, 12.C.2.d, if a complication of ALS independently warrants 100%, assign that as the primary DC using a hyphenated code (e.g., 8017-5110), and separately evaluate additional complications. All ALS awards must be assigned at least a 100% evaluation. SMC and ancillary benefits (SAH, automobile allowance, DEA) must be evaluated in every ALS case.

Describing your symptoms accurately

Limb Weakness and Muscle Atrophy

How to describe it: Describe specific functional losses in concrete, daily-life terms. State which limb was affected first and how the weakness has progressed. Quantify your limitations: how many steps you can walk before needing to rest, whether you can lift objects, whether you drop things, and whether you can transfer independently.

Example: On my worst days, I cannot lift my right arm above shoulder height, I drop objects without warning, and I cannot take more than 10 steps without using my walker. My left hand cramps painfully when I try to grip anything, and I can no longer button my shirt or hold a fork independently.

Examiner listens for: Specific muscle groups affected, bilateral versus unilateral involvement, rate of progression, functional tasks that are impaired (grooming, dressing, eating, writing), and whether weakness is worse with fatigue or repetitive activity.

Avoid: Do not say 'I manage okay' or 'I get by.' Do not demonstrate your best performance during testing. Do not minimize weakness because you have adapted with assistive devices-describe what you cannot do without those devices.

Respiratory Symptoms

How to describe it: Describe shortness of breath at rest and with exertion, orthopnea (worsening when lying flat), morning headaches from CO2 retention, and disrupted sleep due to respiratory insufficiency. State whether you currently use BiPAP, CPAP, or supplemental oxygen, and how many hours per day.

Example: I cannot lie flat without my BiPAP-without it I wake up gasping. I have significant shortness of breath walking from my bedroom to the kitchen. I wake up with headaches most mornings, and my spouse says I stop breathing during sleep. I am fatigued constantly from poor sleep quality.

Examiner listens for: FVC trend over time, current respiratory support requirements, orthopnea severity, frequency of respiratory infections, and any hospitalizations for respiratory failure.

Avoid: Do not minimize breathing difficulties as just 'being out of shape.' If you use BiPAP only at night, still report it clearly. Report every respiratory hospitalization and every ER visit for breathing.

Bulbar Symptoms - Speech and Swallowing

How to describe it: Describe when your speech first changed, how quickly it has progressed, and the practical impact: people cannot understand you on the phone, in noisy environments, or after short conversations. For swallowing, describe specific foods you have had to eliminate, coughing or choking episodes, and any weight loss attributable to eating difficulty.

Example: On my worst days, my speech is completely unintelligible to strangers and even family members misunderstand me after a few minutes of conversation. I have stopped eating solid foods because I choked three times in the past month. I have lost 18 pounds in the past six months because eating takes so long and is exhausting.

Examiner listens for: Rate of progression of dysarthria, whether aphonia has occurred, use of AAC devices, documented aspiration events, pneumonia episodes from aspiration, weight loss trajectory, and whether PEG tube placement has been discussed or performed.

Avoid: Do not speak in your clearest, most effortful voice during the exam while downplaying how you typically sound when fatigued. Report aspiration events even if they did not require hospitalization.

Bladder and Bowel Dysfunction

How to describe it: Describe the specific type of dysfunction: urinary urgency, incontinence episodes per day, need for catheterization, recurrent UTIs, bowel incontinence, constipation requiring a bowel program, and use of absorbent materials. Quantify how many times per day/night these symptoms interfere with function.

Example: I have urinary urgency that gives me less than a minute of warning, and I have urinary incontinence episodes at least twice daily. I use absorbent pads that I change more than four times per day. I have had three UTIs in the past year requiring antibiotics. For bowel function, I require daily medications and a prescribed bowel program to prevent impaction.

Examiner listens for: Frequency and severity of incontinence, catheter use, UTI frequency, bowel program requirements, need for absorbent materials and how frequently they are changed, and any hospitalizations for these complications.

Avoid: Do not omit bladder or bowel symptoms out of embarrassment-these are rated complications that affect SMC. Do not understate the frequency of incontinence episodes.

Fatigue and Functional Capacity

How to describe it: In ALS, fatigue is both primary (neurological) and secondary (from respiratory insufficiency, malnutrition, poor sleep). Describe how quickly you fatigue, how long recovery takes, and how fatigue limits your ability to complete activities of daily living independently.

Example: After showering and dressing-with assistance-I am exhausted and need to rest for 30 to 45 minutes before I can do anything else. Any physical activity, including a short conversation, significantly worsens my fatigue. By mid-afternoon I have no functional reserve and require full assistance for all remaining daily activities.

Examiner listens for: Time to fatigue onset, recovery time required, impact on ADLs, need for caregiver assistance, and whether fatigue has led to loss of employment or community participation.

Avoid: Do not describe your energy level on a good day or after rest. Report your functional capacity at its worst, which is your typical baseline per M21-1 'worst day' guidance.

Mobility and Assistive Device Use

How to describe it: Clearly state which devices you use, how often, and whether they are your normal mode of locomotion. The VA specifically needs to know if a wheelchair, walker, cane, or braces are required for your typical daily ambulation-not just occasional use.

Example: I use my power wheelchair as my primary means of getting around. I cannot safely walk more than a few feet even with my walker because of foot drop and leg weakness, and I have fallen three times in the past two months. Without the wheelchair I would be confined to bed or a chair.

Examiner listens for: Whether the device is required for routine daily locomotion versus occasional use, fall history, distance limitations, and whether ambulation without the device is unsafe.

Avoid: Do not leave your wheelchair or walker in the car to appear more independent. The VA rates you on your actual functional needs, and using your device is not a sign of weakness-it is medical evidence.

Environmental and Toxic Exposure History

How to describe it: ALS is presumptively service-connected under 38 CFR 3.318 for veterans who served 90 or more days. The examiner will document exposure history including herbicide/Agent Orange, heavy metals, solvents, pesticides, insecticides, and nerve gas agents. Provide complete and accurate deployment and occupational history.

Example: N/A - this is a factual history section, not a symptom description. Provide dates, locations, and nature of exposures as accurately as possible.

Examiner listens for: Service dates (must be 90+ days to qualify for presumptive), deployment locations with known herbicide exposure (Vietnam, certain bases), MOS involving chemical exposure, and any documented exposure incidents.

Avoid: Do not omit deployments or duty stations. Even if you were not in a combat role, the examiner needs your full service history. If you are unsure about specific chemical exposures, say so rather than guessing.

Common mistakes to avoid

Performing at your best during the examination instead of accurately representing your typical function

Why: Veterans often feel compelled to demonstrate capability or toughness. For ALS, where the rating is already 100%, the exam's primary purpose is to document complications for SMC-understating disability means lower SMC and fewer ancillary benefits.

Do this instead: Represent your typical day and your worst day accurately. Use assistive devices you normally use. If you are fatigued by the time the physical exam portion begins, say so. Report your function after a day of activities, not after a full night of rest.

Impact: SMC determination and ancillary benefits (SAH, automobile allowance, DEA, Aid and Attendance)

Failing to report all ALS complications because they seem unrelated or embarrassing

Why: Each complication-bladder dysfunction, bowel incontinence, speech loss, respiratory failure, dysphagia-is separately evaluated for SMC purposes. Omitting any complication leaves SMC benefits on the table.

Do this instead: Before the exam, write a complete list of every symptom and functional loss you experience. Bring this list and share it with the examiner. Include bladder/bowel, speech, swallowing, breathing, and all limbs.

Impact: SMC levels S through O under 38 CFR 3.350; SAH; Aid and Attendance

Not bringing current pulmonary function test results or other recent diagnostic data

Why: The DBQ specifically asks for FVC%, FEV1, and FEV1/FVC ratio. If you do not provide current values, the examiner may not have adequate documentation to support respiratory-based SMC.

Do this instead: Bring copies of your most recent spirometry, EMG/nerve conduction studies, and any neurological evaluations. Contact your neurologist before the exam to obtain updated pulmonary function testing.

Impact: Respiratory complication rating and SMC determination

Not disclosing all assistive devices or leaving them at home to appear more independent

Why: The examiner must document whether a wheelchair, walker, braces, or cane constitute your normal mode of locomotion. This is a legal threshold for SAH, automobile allowance, and high-level SMC.

Do this instead: Arrive at the exam using every device you normally use. Bring your wheelchair even if you can walk short distances. The examiner needs to see and document your actual assistive device use.

Impact: SAH eligibility under 38 CFR 3.809; automobile allowance; SMC under 38 CFR 3.350

Failing to document the need for caregiver assistance or Aid and Attendance

Why: Aid and Attendance SMC requires documentation that you need regular assistance with daily activities. If caregiving needs are not described during the exam, the examiner cannot document them.

Do this instead: Describe every activity for which you require assistance: bathing, dressing, eating, toileting, transfers, medication management. State how many hours per day a caregiver assists you and whether you can be safely left alone.

Impact: SMC Aid and Attendance under 38 CFR 3.350(b)

Describing only current symptoms without conveying rate of progression

Why: ALS is a progressive disease. The examiner and rater need to understand the trajectory to appropriately document permanence and total disability. Progression also affects SMC review timelines.

Do this instead: Describe when each symptom began, how quickly it has worsened, and what abilities you have lost over the past 6 and 12 months. Bring a symptom timeline if you have kept one.

Impact: Permanence designation; Total Disability Individual Unemployability (TDIU) if applicable prior to 100% rating; SMC review scheduling

Not mentioning cognitive or behavioral changes (ALS-FTD spectrum)

Why: Some ALS patients develop frontotemporal dementia symptoms including personality change, disinhibition, or executive dysfunction. These may be separately ratable and affect SMC.

Do this instead: If you or family members have noticed personality changes, memory issues, behavioral changes, or difficulty with planning and decision-making, report these to the examiner. Bring a family member or caregiver who can corroborate.

Impact: Separately ratable cognitive complication; potential SMC for mental health sequelae

Prep checklist

  • critical

    Gather all ALS medical records and specialist notes

    Collect neurologist notes, EMG/nerve conduction study results, pulmonary function tests (FVC%, FEV1), MRI/imaging reports, and any multidisciplinary ALS clinic visit summaries. Organize chronologically to show disease progression.

    before exam

  • critical

    Obtain current spirometry results (FVC% and FEV1)

    Contact your pulmonologist or neurologist to obtain spirometry within the last 3 months if possible. The DBQ has specific fields for FVC, FEV1, and FEV1/FVC ratio that directly impact respiratory complication documentation and SMC.

    before exam

  • critical

    Write a comprehensive symptom and functional loss inventory

    Document every symptom across all body systems: limb weakness by specific muscle groups, speech changes with dates of onset, swallowing difficulties, respiratory symptoms, bladder/bowel symptoms, weight loss, fatigue, assistive devices in use, caregiver hours required per day, and falls in the past year. Use the 'worst day' framework per M21-1 guidance.

    before exam

  • critical

    Document all assistive devices with dates of acquisition

    List every device: wheelchair (manual or power), walker, cane(s), crutches, AFOs/braces, BiPAP/CPAP, ventilator, PEG tube, AAC device, hospital bed, Hoyer lift. Note when you began using each and how many hours per day you use it. This directly affects SMC and ancillary benefit eligibility.

    before exam

  • critical

    Verify your military service records confirm 90+ days of active duty

    ALS is presumptively service-connected under 38 CFR 3.318 for veterans with 90 or more days of active duty. Ensure your DD-214 is in your claims file showing qualifying service dates.

    before exam

  • critical

    Consult a VSO or accredited VA claims agent before the exam

    A Veterans Service Organization representative can review your claims file, ensure all evidence is submitted, and advise on SMC levels you may qualify for. Contact your nearest VSO (DAV, VFW, American Legion, etc.) or accredited claims agent at least two weeks before the exam.

    before exam

  • recommended

    Research SMC eligibility based on your specific ALS complications

    Review 38 CFR 3.350 SMC levels with your VSO. Loss of use of limbs, Aid and Attendance needs, housebound status, and respiratory dependence each correspond to specific SMC levels. Understanding what VA must evaluate helps ensure the examiner documents all relevant findings.

    before exam

  • recommended

    Prepare a written caregiver statement

    Have your primary caregiver (spouse, family member, or professional caregiver) write a detailed statement describing: hours of assistance provided daily, what tasks they perform (bathing, dressing, feeding, transfers, medication management, toileting), and whether you can be safely left alone. Submit this as a lay evidence statement (VA Form 21-10210 or 21-4142).

    before exam

  • recommended

    Check your state's laws regarding exam recording

    Most states permit you to record your C&P examination with a handheld device without the examiner's consent, but some require two-party consent. Verify your state's law in advance. Recording provides a verbatim record if errors appear in the examiner's report.

    before exam

  • recommended

    Confirm accommodation needs with the scheduling office

    Notify the VA or contract exam provider of any accommodations needed: wheelchair-accessible facility, transportation assistance, need for a longer appointment due to fatigue, requirement for a caregiver to be present, or AAC device use during the interview.

    before exam

  • critical

    Arrive using all assistive devices you normally use

    Do not leave your wheelchair, walker, or other devices in the car. Arrive in your actual functional state. If you use BiPAP at night and are fatigued in the morning, that fatigue is clinically relevant-do not schedule the exam for your peak energy time if it is not representative of your typical state.

    day of

  • critical

    Bring all documentation packets

    Bring printed copies of: recent medical records, spirometry results, list of all current medications (name, dose, indication), list of all assistive devices, written symptom inventory, caregiver statement, and any photographs documenting muscle atrophy or functional decline if available.

    day of

  • recommended

    Bring your AAC device and any other adaptive equipment

    Bring your augmentative communication device, adaptive eating utensils, or any other equipment that documents your level of functional need. Ask to demonstrate its use for the examiner.

    day of

  • recommended

    Bring a trusted caregiver or family member as a witness

    A caregiver who assists you daily can corroborate your functional status, provide a second perspective on your worst days, and serve as a witness to the examination. They should not answer questions for you but can provide clarifying information when asked.

    day of

  • optional

    Notify the examiner if you wish to record the exam

    At the start of the exam, state clearly: 'I would like to inform you that I am recording this examination.' Place your recording device visibly. This is your right in most states.

    day of

  • critical

    Accurately describe your worst-day functional status

    Per M21-1 guidance, you should communicate your condition at its worst. When asked how far you can walk, describe your worst day-not your best. When asked about speech, describe end-of-day fatigue-related speech, not your morning clarity. Use specific examples and numbers.

    during exam

  • critical

    Report every complication across all organ systems

    Go through your symptom inventory systematically. If the examiner does not ask about bladder function, speech, nutrition, sleep, or cognition-raise these topics yourself. Say: 'I also wanted to make sure you document my [symptom].'

    during exam

  • critical

    Do not perform better than your actual capacity during physical testing

    During muscle strength, grip, ROM, or gait testing, do not exert maximum effort if that is not representative of your daily functional level. If you are fatigued mid-exam, say so. State: 'This is more effort than I can typically sustain-I am already fatiguing significantly.'

    during exam

  • recommended

    Provide a clear progression timeline for each symptom

    For each symptom, state when it started, how quickly it has progressed, and what you can no longer do now that you could do 6 or 12 months ago. Progression documents the rapidly advancing nature of ALS for permanence and SMC review purposes.

    during exam

  • recommended

    Correct any inaccurate statements during the examination

    If the examiner misquotes you or you realize you understated a symptom, correct it immediately. Say: 'I want to clarify my earlier answer-I actually [corrected statement].' You may also submit a written statement after the exam if you realize errors were made.

    during exam

  • critical

    Request a copy of the completed DBQ

    You have the right to request a copy of the C&P examination report (DBQ) after it is completed. File a request through your VA MyHealtheVet account, your VSO, or a written FOIA request. Review it carefully for errors, omissions, or inadequate rationale.

    after exam

  • critical

    Review the DBQ for errors and submit a rebuttal if necessary

    If the DBQ contains factual errors, omits documented symptoms, or fails to reflect the severity of your condition, submit a written rebuttal or a supplemental statement immediately. Contact your VSO for assistance. You may also request an Inadequate Examination finding if the DBQ is clearly deficient.

    after exam

  • critical

    Follow up on SMC and ancillary benefit determinations

    Ensure VA has adjudicated your SMC eligibility (38 CFR 3.350), SAH (38 CFR 3.809), automobile allowance and adaptive equipment (38 CFR 3.808), and DEA eligibility. If the rating decision does not address these, contact your VSO immediately and file for any missing benefits.

    after exam

  • recommended

    Submit updated medical evidence if your condition has progressed since the exam

    ALS progresses rapidly. If significant decline occurs between the exam and the rating decision, submit updated medical records, a new caregiver statement, or a supplemental claim with current evidence.

    after exam

Your rights during a C&P exam

  • You have the right to a thorough and accurate C&P examination. If the examination is inadequate-meaning the examiner did not test the relevant functions, did not review your records, or the report contains clear errors-you have the right to request a new examination.
  • You have the right to have a caregiver, family member, or support person present during your C&P examination. They may observe but should not answer questions on your behalf unless invited to do so by the examiner.
  • In most states, you have the right to record your C&P examination using a personal recording device. Verify your state's recording consent laws before your appointment.
  • You have the right to request a copy of the completed DBQ/C&P examination report. Submit your request through MyHealtheVet, your VSO, or a written FOIA request after the exam is finalized.
  • ALS is presumptively service-connected under 38 CFR 3.318 for veterans who served 90 or more days on active duty. You do not need to prove the disease was caused by military service-qualifying service alone establishes the presumption.
  • A diagnosis of ALS is sufficient to support a 100% disability rating under 38 CFR 4.124a DC 8017. You do not need to meet any symptom threshold beyond the confirmed diagnosis.
  • You are entitled to Special Monthly Compensation (SMC) above the 100% rating if ALS complications result in loss of use of limbs, need for Aid and Attendance, housebound status, or other qualifying disabilities. VA must evaluate SMC in every ALS case.
  • You are entitled to Specially Adapted Housing (SAH) under 38 CFR 3.809 based solely on a service-connected ALS diagnosis rated 100% disabling-without meeting the typical locomotion-preclusion threshold.
  • You are entitled to an automobile allowance and adaptive equipment under 38 CFR 3.808 if ALS has caused loss of use of one or both feet, one or both hands, or permanent impairment of vision.
  • You may be entitled to Dependents' Educational Assistance (DEA) under Chapter 35 based on a permanent and total disability rating. VA must evaluate DEA eligibility in every ALS case.
  • You have the right to submit a written statement (VA Form 21-10210) correcting or supplementing information from your C&P examination if the report contains errors or omissions.
  • You have the right to appeal any unfavorable rating decision through the Supplemental Claim, Board of Veterans' Appeals Direct Review, or Higher-Level Review lanes under the Appeals Modernization Act (AMA).
  • If you are terminally ill, you have the right to expedited processing of your claim. Notify the VA that your claim involves a terminal diagnosis-ALS qualifies-and request Priority Processing.
  • VA must provide benefits at the highest level supported by the evidence. VA cannot assign a rating below 100% for a confirmed service-connected ALS diagnosis. If the rating decision assigns anything less than 100%, it is legally erroneous and must be appealed immediately.

Related conditions

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This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.

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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.