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VA Rating Assistant

DC 7627 · 38 CFR 4.116

Breast Cancer (Malignant Neoplasm) C&P Exam Prep

To document the current status of your breast cancer diagnosis including whether it is active or in remission, what treatments have been performed or are ongoing, the surgical history and extent of any procedures, presence of metastases, and all residual conditions resulting from the cancer or its treatment. This exam establishes the foundation for both the 100% rating during active treatment/within six months of treatment completion, and for any residual ratings thereafter.

Format:
Interview + Physical
Typical duration:
30-45 minutes
DBQ form:
Breast_Conditions (Breast_Conditions)
Examiner:
Oncologist, Breast Surgeon, or appropriate clinician

What the examiner evaluates

  • Whether a malignant neoplasm of the breast is currently present and whether it is active
  • Which breast(s) are affected (left, right, or bilateral)
  • Whether metastases are present and to which body systems
  • Current treatment status: active treatment, watchful waiting, or treatment completed
  • All surgical procedures performed: biopsy, wide local excision (lumpectomy), simple/total mastectomy, modified radical mastectomy, radical mastectomy, axillary or sentinel lymph node excision
  • Whether surgery resulted in significant alteration of size or form of the breast
  • Whether radiation therapy was received and to which side
  • Whether antineoplastic chemotherapy was received
  • Whether other therapeutic procedures were performed (e.g., hormonal therapy, targeted therapy, immunotherapy)
  • Dates of diagnosis, most recent treatment, and completion or anticipated completion of treatment
  • Presence of scars, disfigurement, or skin changes
  • Presence of lymphedema and its severity
  • Functional impairment including limitation of arm, shoulder, and wrist motion
  • Loss of grip strength due to cancer treatment or surgical residuals
  • Loss of sensation in the affected arm or chest wall
  • Residuals from muscle harvesting for reconstructive purposes
  • Impact on occupational functioning and daily activities
  • Whether veteran is regularly seen at a clinic for this condition
  • Any associated or secondary conditions related to breast cancer or treatment

The exam will involve a review of your medical records, a structured interview about your cancer history and current symptoms, and a physical examination. Bring all relevant medical records including oncology notes, surgical reports, pathology reports, and current treatment records. The examiner will complete the Gynecological Conditions and Disorders DBQ, which covers both the active malignancy and any chronic residuals. If your cancer is active or you are within six months of completing treatment, the primary focus will be documenting treatment status for the mandatory 100% rating. If you are more than six months post-treatment, the focus shifts to documenting residual impairments for appropriate residual ratings.

Measurements and tests

Arm and Shoulder Range of Motion (ROM)

What it measures: Functional limitation of the arm and shoulder on the affected side, which can result from mastectomy, axillary lymph node dissection, radiation fibrosis, or chest wall muscle harvesting for reconstruction. Rated under musculoskeletal diagnostic codes as a residual condition.

What to expect: Goniometric measurement of shoulder flexion, abduction, internal rotation, and external rotation. May also include elbow and wrist motion. The examiner should test both active and passive ROM. If pain limits motion before the anatomical end range, that painful arc must be documented.

Critical thresholds

  • Shoulder flexion limited to 90 degrees Corresponds to 40% rating for shoulder (DC 5201) if on major extremity, 30% if minor
  • Shoulder flexion limited to 45 degrees or less Corresponds to higher ratings (60%+) under shoulder diagnostic codes for major extremity
  • Any painful motion Under DeLuca factors, ROM limited by pain is rated at the point where pain begins, not the anatomical endpoint

Tips

  • Perform your ROM test as you would on your worst day - do not push through pain to demonstrate maximum mobility
  • Inform the examiner immediately if any movement causes pain and at exactly which degree the pain begins
  • If fatigue or repetitive use makes the limitation worse, say so clearly and ask that it be documented
  • If you have had axillary lymph node dissection, you may have ongoing shoulder restriction - describe this fully
  • Ask the examiner to test both active ROM (you move the arm) and passive ROM (examiner moves the arm)

Pain considerations: Under DeLuca v. Brown, pain that limits motion is ratable at the point where pain begins. If your shoulder hurts at 60 degrees of flexion but you can force it to 90 degrees, the functional ROM should be recorded as 60 degrees. Always report exactly where pain begins during movement.

Grip Strength Assessment

What it measures: Hand and forearm grip strength on the affected side, which can be diminished by nerve damage from axillary dissection, lymphedema, or radiation-induced neuropathy.

What to expect: The examiner may use a dynamometer or manual grip testing to compare strength between your affected and unaffected hands. Numbness, tingling, or weakness in the hand or fingers should be reported.

Critical thresholds

  • Measurable grip strength loss compared to contralateral side Supports residual rating under peripheral nerve or musculoskeletal diagnostic codes
  • Complete or near-complete loss of grip strength May support higher residual ratings and functional impairment documentation

Tips

  • Test on your worst day - do not over-perform to appear more capable than you are day-to-day
  • Report any numbness, tingling, burning, or shooting pain in the hand or fingers from the affected side
  • If lymphedema affects your hand or forearm, describe how it limits your ability to grasp, hold, or manipulate objects

Pain considerations: If gripping causes pain, report this clearly. Pain with use is a DeLuca factor that affects functional rating even if raw grip strength appears preserved.

Lymphedema Assessment

What it measures: Presence, severity, and functional impact of lymphedema in the arm, hand, or chest wall on the side of axillary lymph node dissection or radiation. Lymphedema is a recognized chronic residual of breast cancer treatment.

What to expect: The examiner will observe and palpate the affected arm for swelling, pitting, skin changes, and compare limb circumference to the contralateral side. They will ask about frequency of swelling, use of compression garments, and impact on daily activities.

Critical thresholds

  • Mild lymphedema (minimal swelling, responds to elevation) Residual rating under soft tissue diagnostic codes; supports functional limitation documentation
  • Moderate to severe lymphedema (persistent, requiring compression garments, limiting arm use) Supports higher residual ratings and significant functional impairment documentation
  • Lymphedema with recurrent infections (cellulitis) May support additional secondary condition ratings

Tips

  • Do not elevate or compress the arm for several days before the exam - attend with your typical baseline presentation
  • Bring or wear your compression garment to show the examiner you require it
  • Document how many days per week you experience significant swelling and what activities worsen it
  • Describe how lymphedema affects your ability to work, lift, carry, and perform household tasks

Pain considerations: Lymphedema is often painful or associated with heaviness, tightness, and aching. Describe these sensations specifically - 'my arm feels tight and heavy by midday and I cannot lift more than a light grocery bag' is more useful than 'my arm swells sometimes.'

Scar and Disfigurement Evaluation

What it measures: Presence, location, size, and characteristics of surgical scars from mastectomy, lumpectomy, reconstruction, biopsy, or lymph node dissection. Also documents any disfigurement from radiation skin changes or surgical alteration of breast size or form.

What to expect: Physical inspection of the chest, breast area, axilla, and any reconstruction sites. The examiner will note scar characteristics (adherent, non-adherent, tender, painful, keloid, hypertrophic) and document whether there is significant alteration of breast size or form.

Critical thresholds

  • Scar that is painful or unstable Supports rating under DC 7804 (painful scar) at 10% per location
  • Scar that is adherent, not pliable, or limits underlying tissue movement Supports higher scar ratings under DC 7805 or 7802
  • Significant alteration of breast size or form following mastectomy or wide local excision Directly affects DBQ fields for rating category under DC 7627/7630

Tips

  • Point out every scar including biopsy sites, port placement scars, and donor sites if muscle was harvested for reconstruction
  • Tell the examiner if any scar is painful to touch, itches, restricts movement, or becomes inflamed
  • If your scar is adherent to underlying tissue or limits your ability to raise your arm or turn, demonstrate and describe this
  • If you have had reconstruction, describe whether the form of the breast was significantly altered compared to the pre-surgical baseline

Pain considerations: Scar tenderness and pain with pressure or movement are separate ratable conditions. Do not minimize scar pain - if touching or stretching the scar causes pain, say so explicitly.

Rating criteria by percentage

100%

Active malignant neoplasm of the breast, OR currently undergoing surgical, radiation, antineoplastic chemotherapy, or other therapeutic procedure for breast cancer. The 100% rating continues beyond cessation of treatment. A mandatory VA examination is required six months after discontinuance of all treatment to determine the appropriate residual disability rating.

Key symptoms

  • Active cancer diagnosis confirmed by pathology or imaging
  • Currently receiving chemotherapy (antineoplastic agents)
  • Currently receiving radiation therapy
  • Currently recovering from breast cancer surgery
  • Currently receiving hormonal therapy, targeted therapy, or immunotherapy as cancer treatment
  • Presence of metastatic disease to any body system
  • Active cancer under watchful waiting surveillance
  • Within six months of completing all cancer treatment

From 38 CFR: Under 38 CFR 4.116, DC 7627 and DC 7630: A rating of 100 percent shall continue beyond the cessation of any surgical, radiation, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Separate 100% evaluations are assigned for both active gynecological cancer and active breast cancer per M21-1. Metastasis to a different body system is also evaluated separately.

0%

Post-treatment residual rating: After the mandatory six-month post-treatment examination, the 100% rating is discontinued and replaced by ratings based on chronic residuals. Residuals are rated under the appropriate diagnostic codes within the relevant body system. Common residual ratings include: mastectomy or lumpectomy effects on breast size/form, lymphedema, shoulder/arm ROM limitation, peripheral neuropathy, scar ratings, and lymph node excision sequelae. Each residual is rated separately and combined under 38 CFR 4.25.

Key symptoms

  • Lymphedema of the arm requiring compression garments
  • Limited shoulder or arm range of motion from surgery or radiation
  • Neuropathy or loss of sensation in the arm, hand, or chest wall
  • Loss of grip strength from nerve or muscle damage
  • Painful or disfiguring surgical scars
  • Significant alteration of breast size or form from mastectomy or lumpectomy
  • Chronic pain at surgical sites or chest wall
  • Fatigue from ongoing hormonal therapy or radiation sequelae
  • Restricted arm motion from radiation fibrosis
  • Secondary psychiatric conditions including depression or anxiety related to cancer diagnosis and treatment

From 38 CFR: Per 38 CFR 4.116 Notes under DC 7627 and DC 7630: Rate chronic residuals to include scars, lymphedema, disfigurement, and/or other impairment of function under the appropriate diagnostic code(s) within the appropriate body system. Examples include limitation of arm, shoulder, and wrist motion; loss of grip strength; loss of sensation; and residuals from harvesting of muscles for reconstructive purposes. Also evaluate under DC 7626 for scars.

Describing your symptoms accurately

Active Cancer Status and Treatment

How to describe it: Be precise about every treatment you are receiving or have received. Name the specific chemotherapy agents if possible, the dates and frequency of radiation sessions, and all surgical procedures. Clearly state whether you are still in active treatment, on maintenance therapy, or whether treatment has been completed and when.

Example: I completed my last chemotherapy infusion on [date]. I am currently taking Tamoxifen daily as maintenance hormonal therapy. On my worst days during chemotherapy I was unable to get out of bed, had severe nausea for 3 days after each infusion, lost 15 pounds, and could not work for 8 months. I had radiation to my left breast - 28 sessions completed on [date] - and still have radiation dermatitis and fibrosis in the chest wall.

Examiner listens for: Specific treatment modalities, dates of initiation and completion, side effects that persist after treatment ends, current medications related to cancer management, and any anticipated future procedures or surveillance schedules.

Avoid: Do not say 'I finished chemo and I'm doing okay now.' This fails to document ongoing maintenance therapy, residual side effects, or the psychological burden of living in remission. Be thorough and specific about every symptom that persists.

Lymphedema Symptoms

How to describe it: Describe the swelling in terms of frequency, severity, what triggers it, what relieves it, and how it limits your function. Use objective measures where possible (e.g., 'my left arm is consistently 3 cm larger in circumference than my right') and describe the daily management burden.

Example: On my worst days my left arm swells from the hand to the elbow by early afternoon. It feels tight, heavy, and painful - like a blood pressure cuff that won't release. I cannot close my hand fully around objects. I wear a compression sleeve every day and I have to elevate my arm for at least 30 minutes in the evening. I cannot carry groceries, swing a bag, or use a keyboard for more than 20 minutes without the swelling worsening. I have had two episodes of cellulitis requiring antibiotics in the past year.

Examiner listens for: Bilateral comparison of arm circumference, frequency and severity of swelling episodes, use of compression garments, history of infections, impact on grip and fine motor function, and limitation on occupational and daily activities.

Avoid: Do not say 'I have a little swelling sometimes.' Lymphedema is a serious chronic condition. Describe it at its worst and describe what you have to do every day to manage it. If you have stopped certain activities because of lymphedema, list those activities explicitly.

Shoulder and Arm Functional Limitation

How to describe it: Connect your shoulder restriction directly to your cancer treatment - whether from axillary lymph node dissection, radiation fibrosis, mastectomy scar adhesions, or muscle harvest for reconstruction. Describe what activities you cannot do and at what point during movement pain or restriction occurs.

Example: Since my axillary lymph node dissection I cannot raise my left arm above shoulder height. On my worst days I cannot reach overhead to put dishes in a cabinet, wash or style my hair, or put on a shirt without significant pain starting at about 70 degrees of elevation. I had physical therapy for 6 months but my range never fully recovered. The restriction is worse in the morning and after any activity that involves using my arm.

Examiner listens for: Specific degree of restriction, whether limitation is due to pain, structural restriction, or both, which activities of daily living are affected, whether the condition fluctuates (DeLuca flare-ups), and whether prior physical therapy has been completed with incomplete recovery.

Avoid: Do not demonstrate your best possible ROM. If reaching overhead causes pain, say 'it hurts here' when pain begins - do not silently push through the pain to reach maximum range. The functional ROM is where pain begins, not the maximum anatomical endpoint.

Surgical Scars and Disfigurement

How to describe it: Identify every scar by location, describe its characteristics (raised, adherent, tender, itching, discolored), and explain how each scar affects your daily life or limits function. If the appearance of scars causes psychological distress or has affected your personal relationships, describe this as well.

Example: I have a 22-centimeter mastectomy scar across my left chest that is adherent and pulls when I raise my arm. It is painful to touch and aches in cold weather. I also have a 4-centimeter scar in my axilla from lymph node dissection that limits shoulder rotation. The mastectomy scar has significantly changed the appearance of my chest and I have avoided situations involving physical intimacy because of how I feel about the disfigurement.

Examiner listens for: Number, location, and dimensions of scars; whether they are painful, tender to palpation, or unstable; whether they are adherent to underlying tissue; whether they limit the motion of surrounding structures; and any psychological impact from disfigurement.

Avoid: Do not say 'I have a scar but it doesn't really bother me' if it causes any pain, restriction, or psychological distress. Each scar that is painful at rest or with movement is separately ratable. Do not minimize the functional and psychological impact of disfigurement following mastectomy.

Fatigue, Neuropathy, and Treatment Side Effects

How to describe it: Describe cancer-related fatigue, chemotherapy-induced peripheral neuropathy, cognitive effects (chemo brain), and hormonal therapy side effects with specific examples of how they limit your daily function, work capacity, and quality of life.

Example: I have numbness and tingling in both hands and feet from chemotherapy-induced neuropathy that never fully resolved. On my worst days I drop objects, have difficulty with buttons and fine motor tasks, and cannot feel the floor under my feet when walking. I also have severe fatigue - not like being tired, but a bone-deep exhaustion where I need 2-hour rest periods during the day just to function. My cognitive function has been affected - I forget appointments, lose words mid-sentence, and can no longer perform complex tasks at work that were routine before treatment.

Examiner listens for: Specific neurological symptoms with distribution, severity of fatigue rated on a functional scale, cognitive impairment with concrete examples, and the degree to which these residuals prevent gainful employment or normal daily activities.

Avoid: Do not assume these symptoms are outside the scope of the breast cancer exam. Chemotherapy-induced neuropathy, fatigue, and cognitive changes are compensable residuals. Describe them in detail and ask that they be documented even if the examiner does not specifically ask.

Impact on Occupational and Daily Functioning

How to describe it: The DBQ specifically asks about the impact of your breast condition on occupational functioning and daily activities. Prepare concrete examples of job tasks you can no longer perform, hours of work you have missed, and daily activities that are now limited or impossible.

Example: Before my diagnosis I worked full-time as a [job title] and regularly lifted 20 pounds, used a keyboard for 8 hours a day, and traveled for work. Since treatment I have been on medical leave for 14 months. I cannot lift more than 5 pounds with my left arm due to lymphedema risk, I cannot type for more than 20 minutes due to hand numbness and pain, and I cannot stand for more than 30 minutes due to fatigue and neuropathy in my feet. I rely on my spouse to carry laundry, do grocery shopping, and help me dress on my worst days.

Examiner listens for: Specific occupational limitations, total work time lost, accommodations required, whether the veteran has been able to return to their prior occupation, and the degree of assistance required with activities of daily living.

Avoid: Do not say 'I'm managing' or 'I'm doing better' in a way that minimizes your ongoing limitations. Describe your current functional capacity accurately and completely. The examiner must document impact on occupation and daily life - give them the full picture.

Common mistakes to avoid

Attending the exam without a complete list of all treatments and dates

Why: The DBQ has specific fields for dates of most recent treatment, completion of treatment, dates of surgery, and dates of radiation. If the examiner cannot document these accurately, the rating decision may be based on incomplete information, potentially triggering an incorrect determination of whether the 100% active-treatment rating still applies.

Do this instead: Before the exam, create a written timeline of every treatment: diagnosis date, all surgery dates and types, chemotherapy start and end dates, radiation start and end dates, and any ongoing therapies. Bring this document to the exam and provide it to the examiner.

Impact: 100% active malignancy rating

Failing to report all residual symptoms after treatment completion

Why: After the mandatory six-month post-treatment exam, the 100% rating is discontinued and replaced by residual ratings. Veterans who do not clearly describe all lingering symptoms - lymphedema, neuropathy, shoulder restriction, scar pain - risk being assigned a 0% or very low combined rating for residuals.

Do this instead: Prepare a written list of every symptom that persists after treatment. Include lymphedema, neuropathy, ROM restriction, fatigue, cognitive changes, scar pain, and psychological symptoms. Bring this list to every future C&P exam and ensure each item is documented.

Impact: Post-treatment residual ratings

Demonstrating maximum ROM during the exam rather than functional ROM on a typical or worst day

Why: Veterans sometimes try to appear capable during the exam by pushing through pain to demonstrate full ROM. This results in an artificially high ROM measurement that does not reflect actual daily functional capacity, leading to an underrated shoulder or arm condition.

Do this instead: Stop the movement when pain begins and tell the examiner 'this is where I feel pain.' Under DeLuca v. Brown, the ratable ROM is the point at which pain limits further motion, not the anatomical maximum. Your exam should reflect your worst day, not your best performance.

Impact: Musculoskeletal residual ratings (shoulder, arm)

Not mentioning maintenance or hormonal therapy as ongoing treatment

Why: Many veterans complete chemotherapy and radiation but remain on long-term maintenance therapy such as Tamoxifen, Anastrozole, Herceptin, or other agents. Some fail to mention this, leading the examiner to incorrectly mark treatment as 'completed,' which may prematurely trigger a rating reduction exam.

Do this instead: Clearly state every medication you take for cancer management, including hormonal therapy, targeted therapy, and immunotherapy. These count as ongoing therapeutic treatment. Ask the examiner to document each agent by name and the anticipated duration of treatment.

Impact: 100% active treatment rating

Not requesting that secondary conditions be separately evaluated

Why: Breast cancer and its treatment frequently cause secondary conditions including depression, anxiety, lymphedema, peripheral neuropathy, and endocrine disorders from hormonal therapy. Veterans who do not raise these conditions may lose out on separate ratings for each.

Do this instead: Before the exam, identify all conditions that developed or worsened because of your breast cancer or its treatment. File or note these as secondary-service-connected conditions. At the exam, ask the examiner to document the relationship between these conditions and your primary breast cancer diagnosis.

Impact: Secondary condition ratings (psychiatric, neurological, lymphatic)

Describing symptoms only on a good day or using minimizing language

Why: Per M21-1 guidance, C&P exams are intended to capture the full range of the veteran's disability including the worst manifestations. Using phrases like 'it's not that bad' or 'I'm getting used to it' creates a record that understates the true severity of the condition.

Do this instead: Prepare to describe your worst day in concrete, functional terms. Describe the worst episode of lymphedema you have had, the worst pain you experience from scars, and the worst functional limitation you face. Use specific examples rather than general statements.

Impact: All rating levels

Failing to bring documentation of the specific type of surgery performed

Why: The DBQ has separate rating fields for wide local excision with or without significant alteration of size/form, simple mastectomy, modified radical mastectomy, radical mastectomy, and axillary/sentinel lymph node excision. Each carries different rating implications. If the examiner cannot confirm the specific procedure, the wrong rating category may be applied.

Do this instead: Bring your operative reports and pathology reports to the exam. Know whether your surgery was a lumpectomy (wide local excision), simple mastectomy, modified radical mastectomy, or radical mastectomy, and whether significant alteration of size or form occurred. This directly determines your rating category under DC 7627/7630.

Impact: Surgical residual ratings under DC 7627/7630

Prep checklist

  • critical

    Compile complete cancer treatment timeline

    Create a written chronological list of: initial diagnosis date and biopsy results; all surgery types and dates; chemotherapy agents, start and end dates, and number of cycles; radiation therapy dates, fields treated, and total dose; all current ongoing therapies including hormonal therapy, targeted therapy, or immunotherapy; upcoming scheduled treatments or surveillance procedures.

    before exam

  • critical

    Gather all medical records and operative reports

    Obtain copies of pathology reports confirming diagnosis and staging; operative notes specifying the exact surgical procedures performed and which breast was involved; oncology treatment records; radiation therapy records; most recent surveillance imaging results (mammogram, MRI, PET scan); and records from any reconstructive surgery. These documents support accurate completion of multiple DBQ fields.

    before exam

  • critical

    Document all residual symptoms in writing

    Write down every symptom that persists after treatment: lymphedema (frequency, severity, management); shoulder and arm ROM restriction (which movements, at what degree pain begins, which activities are impossible); scar pain (location, characteristics, functional impact); peripheral neuropathy (distribution, severity, functional limitations); fatigue (daily pattern, impact on work and activities); cognitive changes; depression or anxiety. Bring this list to the exam.

    before exam

  • critical

    Identify and document all secondary conditions

    List all conditions that developed or worsened as a result of breast cancer diagnosis or treatment: depression, anxiety, PTSD related to cancer; chemotherapy-induced peripheral neuropathy; lymphedema; endocrine disorders from hormonal therapy (osteoporosis, joint pain, hot flashes); cardiac issues from certain chemotherapy agents; fatigue syndromes. These may warrant separate VA disability ratings.

    before exam

  • critical

    Prepare functional impact statement

    Write a one-page description of how your breast cancer and its treatment have affected your ability to work, perform daily activities, and maintain personal relationships. Include specific examples: 'I cannot lift my arm above shoulder height to perform my job duties,' 'I missed 14 months of work,' 'I require assistance with dressing and personal care on my worst days.' This directly informs the DBQ functional impact fields.

    before exam

  • recommended

    Verify exam recording rights in your state

    Veterans have the right to record their C&P examination in most states. Contact your VSO or VA regional office before the exam to confirm whether recording is permitted in your state and what notice, if any, must be provided to the examiner. Recording creates a verbatim record of what was said and what was examined.

    before exam

  • recommended

    Review the applicable rating criteria under DC 7627 and DC 7630

    Understand that 100% is mandatory during active treatment and for six months after completion. After that, residuals are rated under musculoskeletal, dermatological, neurological, and lymphatic diagnostic codes. Knowing this helps you ensure the examiner documents every residual condition that could support a combined residual rating.

    before exam

  • recommended

    Contact a VSO or accredited claims agent for pre-exam counseling

    A Veterans Service Organization representative or VA-accredited claims agent can review your file, identify gaps in evidence, and help you prepare specific talking points for the exam. This is especially important for the six-month mandatory post-treatment exam where the transition from 100% to residual ratings occurs.

    before exam

  • critical

    Attend the exam on a representative day - not your best day

    M21-1 guidance supports rating based on the full range of the veteran's disability. Do not schedule strenuous activity or aggressive compression therapy before the exam that would artificially reduce your lymphedema presentation. Wear your typical compression garment if you use one. Do not take extra pain medication that would mask symptoms you would normally report.

    day of

  • critical

    Bring all documentation in organized form

    Bring two organized packets: one for the examiner and one for your own reference. Each should include your treatment timeline, operative reports, pathology report, most recent oncology notes, list of current medications, list of residual symptoms with functional descriptions, and any buddy statements or lay evidence from family members describing your limitations.

    day of

  • recommended

    Dress in clothing that allows easy examination of your chest, surgical sites, and arm

    Wear loose, easy-to-remove clothing that allows the examiner to inspect all surgical scars, the affected breast area, the axilla, and to assess your arm and shoulder ROM without restriction. If you have a port, drain scar, or donor site scar from reconstruction, ensure those are accessible.

    day of

  • optional

    Bring a support person or advocate if permitted

    You may bring a VSO representative, advocate, or trusted support person to the exam. Their presence can help ensure the examiner documents all symptoms, and they can serve as a witness to what was and was not examined. Confirm in advance whether the exam facility permits a support person in the examination room.

    day of

  • critical

    Confirm the examiner reviews your records before the interview

    Ask the examiner what evidence they reviewed before the exam. The DBQ requires documentation of evidence reviewed. If key records - operative reports, pathology, oncology notes - are not mentioned, provide your copies and specifically ask that they be considered and noted in the DBQ.

    during exam

  • critical

    Report pain at the point it begins during ROM testing - do not push through

    When the examiner measures your shoulder, arm, or wrist ROM, stop the movement and say clearly 'this is where I feel pain' at the point pain begins. Do not silently push through pain to reach maximum range. Under DeLuca v. Brown, the ratable endpoint is where pain begins, not the anatomical maximum. This is one of the most impactful things you can do during the exam.

    during exam

  • critical

    Explicitly describe flare-ups and their functional impact

    Tell the examiner how often your symptoms flare, what triggers flare-ups (activity, weather, stress), how severe flare-ups are, and how long they last. Describe what you cannot do during a flare-up. DeLuca factors include flare-ups as a ratable consideration. Say: 'On bad days I cannot use my arm at all and the lymphedema swells to the point where I need emergency compression therapy.'

    during exam

  • critical

    Confirm every surgical procedure is documented

    Before the exam ends, confirm the examiner has documented every surgical procedure you have had: biopsy type and date, lumpectomy vs. mastectomy type, whether significant alteration of size or form occurred, axillary or sentinel lymph node excision, and any reconstructive procedures. These are specific DBQ checkbox fields with direct rating implications.

    during exam

  • critical

    Ask the examiner to document all residual conditions

    Before concluding the exam, review your residual symptom list and ask the examiner to confirm that each item has been documented in the DBQ: lymphedema, scar characteristics, ROM limitations, neuropathy, and functional impairment. If the examiner has not addressed a symptom, raise it directly: 'I also have numbness and tingling in my hand from the axillary dissection - can you document that as well?'

    during exam

  • critical

    Accurately describe the impact on employment and daily activities

    The DBQ specifically asks about impact on occupational functioning and daily activities. When asked, use your prepared functional impact statement. Give specific examples: job tasks you cannot perform, hours missed, activities of daily living you need help with, and social or recreational activities you have stopped. Vague answers like 'it affects my life' provide no useful information for the rater.

    during exam

  • critical

    Request a copy of the completed DBQ

    After the exam, submit a written request to your VA Regional Office for a copy of the completed DBQ under the Privacy Act and Freedom of Information Act. Review it for accuracy and completeness. If information is missing, inaccurate, or contradicts what you reported, you have the right to submit a written statement for the record and request a supplemental exam if the DBQ is inadequate.

    after exam

  • recommended

    Document your own account of the exam immediately afterward

    Within 24 hours of the exam, write down everything that was examined, every question asked and how you answered, what the examiner did and did not test, and the approximate duration of the exam. This contemporaneous account is invaluable if you need to challenge an inadequate exam or file a Board of Veterans Appeals notice of disagreement.

    after exam

  • recommended

    File claims for all secondary conditions if not already claimed

    If secondary conditions were identified during or after the exam - lymphedema, neuropathy, depression, cardiac issues - file separate VA disability claims for each as secondary to your service-connected breast cancer. These are compensable under 38 CFR 3.310 as conditions proximately caused by a service-connected disability.

    after exam

  • critical

    Prepare for the mandatory six-month post-treatment exam

    Under 38 CFR 4.116, a mandatory VA examination must be conducted six months after discontinuance of all treatment. This exam determines your post-treatment residual rating. Begin preparing your comprehensive residual symptom documentation now. Any change in evaluation from this exam is subject to the provisions of 38 CFR 3.105(e), which protects existing evaluations from reduction without proper basis.

    after exam

Your rights during a C&P exam

  • You have the right to receive a thorough, competent, and impartial C&P examination. The examiner must review your claims file and medical records before completing the DBQ.
  • You have the right to record your C&P examination in most states. Confirm your state's specific rules with your VSO or VA Regional Office before the exam date.
  • You have the right to request a copy of the completed DBQ examination report under the Privacy Act and Freedom of Information Act.
  • You have the right to submit a written statement challenging an inadequate, inaccurate, or incomplete C&P examination report. File this statement with your VA Regional Office promptly.
  • You have the right to request a new or supplemental C&P examination if the existing examination is found to be inadequate to rate your condition. Grounds for inadequacy include failure to test ROM, failure to address all claimed conditions, or a conclusory opinion without supporting rationale.
  • Under 38 CFR 3.303 and M21-1, the benefit of the doubt standard applies - when evidence is in approximate balance, it must be resolved in the veteran's favor.
  • Under 38 CFR 4.116, the 100% rating for active malignant neoplasm continues beyond cessation of treatment. The VA must conduct a mandatory exam six months after treatment ends before any rating reduction can occur.
  • Under 38 CFR 3.105(e), an existing disability evaluation cannot be reduced without proper notice, an opportunity to be heard, and a finding that the reduction is supported by the preponderance of medical evidence.
  • You are entitled to separate 100% evaluations for both active gynecological cancer and active breast cancer if both are present, per M21-1, Part V, Subpart iii, Chapter 8. You may also be entitled to Special Monthly Compensation (SMC) for anatomical loss of a creative organ.
  • You have the right to bring a VSO representative, accredited claims agent, or support person to your C&P examination. Confirm the facility's policy in advance.
  • You have the right to submit lay evidence - your own statements and buddy statements from family, friends, and coworkers - describing the functional impact of your condition. Lay evidence is competent evidence under 38 CFR 3.303.
  • Under DeLuca v. Brown, ROM limited by pain must be rated at the point where pain begins. You have the right to have painful ROM accurately documented, not just the maximum achievable ROM.
  • If you are denied or receive a rating you believe is incorrect, you have the right to request a Higher-Level Review, file a Supplemental Claim with new and relevant evidence, or appeal directly to the Board of Veterans Appeals.

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.