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VA Rating Assistant

DC 6319 · 38 CFR 3.317 / 4.88b

Leishmaniasis C&P Exam Prep

To document the diagnosis, current status (active or inactive), residual disabilities, and nexus of leishmaniasis to military service in a Southwest Asia or other qualifying theater of operations, and to assess the impact of the condition and any residuals on the veteran's daily functioning and occupational capability.

Format:
Interview + Physical
Typical duration:
30-45 minutes
DBQ form:
Persian_Gulf_Afghanistan_Infectious_Diseases (Persian_Gulf_Afghanistan_Infectious_Diseases)
Examiner:
Infectious Disease Physician or Internist

What the examiner evaluates

  • Confirmation of diagnosis of leishmaniasis (cutaneous, mucocutaneous, or visceral) and ICD code
  • Whether the disease is currently active or inactive/resolved
  • Date of initial diagnosis and date treatment ceased (if applicable)
  • Laboratory confirmation: culture results, histopathology, serologic testing, or other diagnostic lab testing
  • Presence and severity of any residual disabilities resulting from the infection
  • History of relapse or recurrence of active infection
  • Impact of the condition on occupational and daily activities
  • Whether the condition is related to service in Southwest Asia or other qualifying geographic area under 38 CFR 3.317
  • Whether the veteran has had any additional Persian Gulf and/or Southwest Asia theater exposures
  • Any co-occurring infectious diseases from the same qualifying service

Exam typically conducted in a VA medical center or contract examiner clinic. Bring all private treatment records, lab reports, pathology reports, and any deployment documentation. Veterans in most states have the right to record the examination with prior notice. The examiner will review your service treatment records, VA treatment records, and any submitted evidence before or during the exam. If examined via telehealth or records review rather than in person, this will be documented on the DBQ.

Measurements and tests

Serologic Testing (Anti-Leishmania Antibody)

What it measures: Presence of antibodies indicating past or current Leishmania infection, particularly relevant for visceral leishmaniasis (kala-azar).

What to expect: The examiner will review existing lab results. Blood may be drawn if recent testing is not available. Positive serology supports diagnosis confirmation. For visceral disease, direct agglutination test (DAT) or rK39 strip test results are key.

Critical thresholds

  • Positive serology with consistent clinical presentation Supports active or historical diagnosis; critical for establishing service connection and rating under DC 6301 (visceral) or DC 6319 (cutaneous/mucocutaneous by analogy)
  • Negative serology with documented prior positive May indicate resolved infection; examiner documents date disease became inactive and evaluates residuals separately

Tips

  • Bring all prior lab reports showing positive serologic testing, even if from years ago
  • If serology was done at a military treatment facility during deployment, request those records via STR request before the exam
  • Antibody titers may remain elevated long after treatment; inform the examiner if you have completed treatment
  • Do not assume a past positive result is in your file - confirm it is documented

Pain considerations: Not applicable for serologic testing itself, but systemic symptoms such as fatigue, fever, and weight loss associated with active visceral disease should be communicated clearly during the exam.

Culture / Histopathology

What it measures: Direct identification of Leishmania parasites via tissue biopsy, bone marrow aspirate, or splenic aspirate culture; confirms active infection and is required by the DBQ for diagnosis confirmation and recurrence.

What to expect: The examiner will review pathology reports. Culture or biopsy results are required on the DBQ to confirm initial diagnosis and any relapse. If you had a skin biopsy for cutaneous leishmaniasis or bone marrow biopsy for visceral disease, bring those pathology reports.

Critical thresholds

  • Positive culture or histopathology showing amastigotes Definitive diagnostic confirmation; supports 100% rating during active visceral leishmaniasis under DC 6301
  • Prior positive biopsy with current scarring or mucosal residuals Supports rating of residual disabilities under appropriate body system DCs even if infection is now inactive

Tips

  • Obtain copies of all pathology reports, biopsy results, or bone marrow reports from military or VA treatment
  • If biopsy was performed overseas or at a deployment medical facility, request records through NPRC or military records request
  • Cutaneous leishmaniasis scars are visible and documentable - ensure examiner notes their location, number, and size
  • Mucosal involvement (nose, mouth, throat) should be specifically described and examined

Pain considerations: Biopsy sites or mucosal lesions may cause ongoing discomfort. Describe any pain, tenderness, or functional limitation at biopsy scar sites accurately.

Physical Examination - Visceral Disease Findings

What it measures: Splenomegaly, hepatomegaly, lymphadenopathy, weight loss, pallor, and other systemic signs of active or residual visceral leishmaniasis.

What to expect: The examiner will palpate the abdomen for organ enlargement, assess lymph nodes, evaluate skin color and weight, and review vital signs. Chronic fatigue, recurrent fever patterns, and weight loss will be discussed.

Critical thresholds

  • Active visceral leishmaniasis with splenomegaly, hepatomegaly, and systemic symptoms Rated 100% under DC 6301 while active; requires ongoing treatment documentation
  • Resolved visceral disease with residual organ damage, anemia, or immune compromise Rated under appropriate body system (e.g., hematologic, hepatic) for residual disabilities separately

Tips

  • Report all ongoing symptoms including fatigue, night sweats, recurrent low-grade fevers, unintended weight loss, and abdominal fullness
  • If you have residual anemia, thrombocytopenia, or liver/spleen changes on imaging, bring those lab and imaging reports
  • Do not minimize fatigue - it is a primary and ratable symptom of both active and residual disease
  • Report your worst days, not just how you feel on the day of the exam

Pain considerations: Abdominal discomfort from splenomegaly or hepatomegaly should be described in terms of frequency, severity (0-10 scale), and what activities worsen it. Describe whether pain affects sleep, eating, or physical activity.

Physical Examination - Cutaneous and Mucocutaneous Findings

What it measures: Location, size, number, and characteristics of cutaneous lesions, ulcers, or scars; presence of mucosal involvement in nose, palate, pharynx, or larynx for mucocutaneous disease.

What to expect: The examiner will visually inspect skin lesions or scars and may refer to ENT or dermatology for mucosal evaluation. Document all lesion sites on the body. The examiner records whether disease is active (open lesions) or inactive (scarring).

Critical thresholds

  • Active cutaneous lesions Rated as active disease; evaluated under General Rating Formula by analogy
  • Scarring or disfigurement from healed cutaneous lesions Rated separately under scars DC (7800-7805) based on size, location, and functional impact
  • Mucosal destruction of nose, palate, or throat Rated separately under ear, nose, throat system for functional loss (breathing, swallowing, speech)

Tips

  • Before the exam, photograph all visible scars or lesions and bring printed copies or have them available on your phone
  • Describe any itch, pain, sensitivity, or cosmetic disfigurement associated with cutaneous scars
  • Mucocutaneous disease affecting the nose or throat may cause breathing problems, nosebleeds, or difficulty swallowing - report all of these
  • Report whether scars are on cosmetically sensitive areas (face, neck, hands) as this affects scar ratings

Pain considerations: Scar pain, sensitivity to touch, restricted movement if scars are near joints, and psychological impact of disfiguring scars should all be communicated. These may support secondary claims for scars or mental health conditions.

Rating criteria by percentage

100%

Active visceral leishmaniasis (DC 6301): Rated 100% during the period of active infection. Under the General Rating Formula applied to leishmaniasis (DC 6319 by analogy), a 100% rating applies during the acute or active phase requiring ongoing treatment, with severe systemic symptoms including high fever, significant weight loss, splenomegaly, hepatomegaly, and debilitating fatigue.

Key symptoms

  • Active Leishmania infection confirmed by culture, histopathology, or serology
  • Persistent fever or episodic high fever
  • Significant unintentional weight loss
  • Marked splenomegaly or hepatomegaly
  • Severe debilitating fatigue preventing occupational activities
  • Thrombocytopenia or anemia requiring treatment
  • Currently undergoing active treatment (amphotericin B, miltefosine, antimonials)

From 38 CFR: 38 CFR 4.88b DC 6301 provides a 100% rating for visceral leishmaniasis while active. Under 38 CFR 3.317, undiagnosed or medically unexplained illnesses related to Southwest Asia service may be rated using hyphenated codes under the General Rating Formula. DC 6319 directs evaluation under the General Rating Formula for leishmaniasis not otherwise classified as visceral.

0%

Inactive/resolved leishmaniasis with no ratable residuals: When the infection is confirmed as inactive and treatment has ceased, and there are no residual disabilities that meet minimum rating thresholds under any applicable body system, the condition is rated 0% (noncompensable). A 0% rating still establishes service connection, preserving the veteran's right to future ratings if residuals worsen.

Key symptoms

  • Infection confirmed resolved by laboratory testing or clinical assessment
  • Treatment completed with no ongoing therapy
  • No residual cutaneous scarring meeting scar rating criteria
  • No residual organ damage (hepatic, splenic, hematologic)
  • No functional limitations attributable to past infection

From 38 CFR: Under 38 CFR 4.88b, the General Rating Formula is applied when the condition is inactive. Residuals are rated separately under the appropriate body system. A 0% rating is assigned when the infection is inactive and no residuals are ratable.

-1%

Residual disabilities rated separately under appropriate body system: When leishmaniasis becomes inactive, any persistent residual disabilities are rated under the relevant diagnostic codes. Examples include: scars (DC 7800-7805), anemia (DC 7700-7716), liver disease (DC 7301-7354), mucosal/nasal/pharyngeal residuals (DC 6500-6599), neurological residuals (DC 8000-8999), or psychological residuals (DC 9201-9440). Each residual is rated independently and combined using VA math.

Key symptoms

  • Cutaneous scars - disfiguring, painful, or limiting movement
  • Mucosal destruction - nasal perforation, palate destruction, voice changes
  • Chronic anemia or thrombocytopenia post-treatment
  • Hepatic fibrosis or splenic damage
  • Immune suppression or recurrent secondary infections
  • Chronic fatigue persisting after treatment cessation
  • Anxiety, depression, or PTSD related to disfigurement or chronic illness

From 38 CFR: 38 CFR 4.88b DC 6301 Note and DC 6319 both direct: rate under the appropriate body system any residual disability of infection. Veterans should claim each residual as a separate secondary condition linked to the primary leishmaniasis diagnosis.

Describing your symptoms accurately

Fatigue and Functional Limitation

How to describe it: Describe fatigue in terms of how it limits specific daily activities. Quantify: How many hours per day are you functional? Can you complete an 8-hour workday? Do you need to rest mid-task? Has fatigue forced you to reduce work hours, change jobs, or stop working?

Example: On my worst days, I cannot get out of bed until mid-morning. Even after sleeping 10 hours, I feel exhausted. I have had to cancel work shifts and have missed important family events because I simply cannot physically function. Simple tasks like grocery shopping require a rest period afterward.

Examiner listens for: Frequency and duration of fatigue episodes, impact on employment and activities of daily living, whether fatigue is constant or episodic, any relationship to physical exertion.

Avoid: Saying 'I get tired sometimes' or 'I push through it.' Be specific about how often, how severely, and what you cannot do because of fatigue.

Fever and Constitutional Symptoms

How to describe it: Document the pattern of fevers: How often do they occur? What is the temperature? How long do episodes last? Are they associated with chills, sweating, or rigors? Have you missed work or required medical care during fever episodes?

Example: During active episodes, I run fevers of 102-103-F that last for days at a time. I shake with chills and then drench my sheets with sweats. I cannot eat, can barely drink fluids, and have ended up in the urgent care twice this year alone.

Examiner listens for: Pattern of fever (intermittent, remittent, or continuous), association with other constitutional symptoms, requirement for hospitalization or urgent care visits, impact on ability to work.

Avoid: Do not say fevers have stopped if you are still experiencing them intermittently. Report both current and historical worst episodes.

Cutaneous Scars and Skin Manifestations

How to describe it: Identify every scar by location, size, and character (raised, depressed, painful, discolored, itchy). Note if scars are on the face, hands, or other cosmetically or functionally significant areas. Describe any pain, hypersensitivity, or restriction of movement.

Example: The scar on my forearm is about 3 cm across and slightly raised. It itches constantly and becomes painful when the weather changes. The scar on my face has caused me significant emotional distress - I avoid social situations and have developed anxiety about my appearance since returning from deployment.

Examiner listens for: Number, size, location, and symptomatology of scars; whether scars are cosmetically disfiguring; whether scars are painful or limit movement; psychological impact.

Avoid: Do not fail to mention emotional or psychological effects of disfiguring scars. Do not say 'it's just a scar' - scars are independently ratable and can support secondary mental health claims.

Mucosal and Upper Respiratory Symptoms (Mucocutaneous Disease)

How to describe it: Describe any nasal congestion, nosebleeds, destruction of nasal septum, difficulty swallowing, changes to voice, or oral lesions. Note how often these occur and how they affect eating, speaking, or breathing.

Example: I have chronic nosebleeds that occur several times a week. My nasal passages feel partially blocked all the time. I have difficulty breathing through my nose, especially at night, which disrupts my sleep. My voice has become hoarse and I struggle to project my voice at work, which affects my job performance.

Examiner listens for: Evidence of nasal perforation or mucosal destruction, frequency and severity of nosebleeds, voice changes, dysphagia, impact on sleep and occupational functioning.

Avoid: Do not underreport nosebleeds or voice changes as 'minor.' These are rateable residuals under the ENT body system and should be fully described.

Systemic Organ Impact (Visceral Disease Residuals)

How to describe it: Report any persistent abdominal discomfort, bloating, or early satiety related to spleen or liver involvement. Report ongoing abnormal lab values (anemia, low platelets, elevated liver enzymes). Describe any secondary infections or immune problems since the leishmaniasis diagnosis.

Example: Even though my doctors say the infection is treated, I still have a feeling of fullness and pressure in my left side after eating small amounts. My blood counts have never fully normalized - I still have borderline anemia that makes me short of breath when I climb stairs or exert myself.

Examiner listens for: Persistent abnormal laboratory findings, ongoing organ enlargement on imaging, secondary complications related to immune suppression, functional limitations from hematologic or hepatic residuals.

Avoid: Do not assume that because the infection is 'treated,' there are no ratable residuals. Bring recent lab work and imaging to demonstrate ongoing pathology.

Occupational and Daily Functional Impact

How to describe it: Describe specifically how the condition affects your ability to work, maintain relationships, perform household tasks, and participate in recreational activities. Quantify lost work days, reduced hours, or job changes attributable to the condition.

Example: I have gone from a full-time position to part-time because I cannot reliably complete a full workday. I have missed an average of two days per month over the last year due to fatigue, fevers, or medical appointments. I can no longer coach my child's soccer team because I cannot sustain physical activity for more than 30 minutes without exhaustion.

Examiner listens for: Specific occupational limitations, documented absences or job changes, impact on social and family functioning, ability to sustain activities over time.

Avoid: Do not speak only in general terms. Specific numbers (days missed, hours reduced, activities stopped) are far more useful to the examiner than vague statements like 'it affects my work.'

Common mistakes to avoid

Reporting only how you feel on the day of the exam

Why: C&P examiners are instructed to rate the average severity and worst-day presentation, not a snapshot of a single day. Veterans often feel pressure to appear well or have an unexpectedly good day.

Do this instead: Explicitly tell the examiner: 'Today is not a typical day for me. On my worst days, which occur approximately X times per month, I experience...' Then describe your worst presentation accurately.

Impact: All rating levels - underreporting directly leads to lower ratings

Failing to connect residual symptoms to the leishmaniasis diagnosis

Why: The DBQ and rating system require each residual to be linked back to the primary service-connected condition. If you report fatigue or anemia without connecting it to the leishmaniasis, the examiner may not document it as a residual.

Do this instead: Explicitly state: 'My [fatigue/anemia/scarring/nasal problems] began after my leishmaniasis diagnosis and treatment, and my doctors have confirmed it is related to the infection.' File separate secondary claims for each residual.

Impact: Residual ratings - failure to link residuals means they are not rated

Not bringing laboratory and pathology documentation to the exam

Why: The DBQ requires confirmation of diagnosis by culture, histopathology, or serologic testing. If these records are not in your file and you do not bring them, the examiner may be unable to check those critical confirmation boxes.

Do this instead: Compile all lab reports, biopsy pathology reports, culture results, and serologic testing results. Bring physical copies to the exam and confirm with your VSO that these are in your claims file beforehand.

Impact: Service connection and all rating levels - without diagnostic confirmation, the claim may be denied

Not disclosing the type of leishmaniasis (cutaneous vs. mucocutaneous vs. visceral)

Why: Visceral leishmaniasis (DC 6301) has a specific 100% rating criteria while active. Cutaneous and mucocutaneous forms are rated by analogy under DC 6319 using the General Rating Formula. Failing to distinguish the type may result in incorrect application of rating criteria.

Do this instead: Know your diagnosis type before the exam. Tell the examiner clearly: 'I was diagnosed with [cutaneous / mucocutaneous / visceral] leishmaniasis.' If you had visceral (kala-azar), emphasize systemic symptoms.

Impact: 100% rating for active visceral disease specifically

Saying the condition is 'all better' or 'resolved' without acknowledging residuals

Why: Even after successful treatment, residual disabilities (scarring, anemia, hepatic changes, mucosal destruction, chronic fatigue, immune impairment) remain ratable. Saying you are fully recovered closes the door on residual ratings.

Do this instead: Distinguish between the infection being treated and any ongoing symptoms or functional limitations. Say: 'The active infection was treated, but I continue to experience [specific residuals] that affect my daily life.'

Impact: 0% vs. compensable ratings for residuals

Not reporting psychological impact of chronic illness or disfigurement

Why: Disfiguring cutaneous scars, chronic illness, and the experience of a serious tropical infection can cause anxiety, depression, social isolation, and PTSD. These are separately ratable secondary conditions that veterans frequently fail to report.

Do this instead: Report any changes in mood, sleep, social functioning, or emotional wellbeing since the diagnosis. If you have sought mental health treatment, mention it. Consider filing a secondary claim for a mental health condition.

Impact: Secondary mental health ratings - unreported = unrated

Failing to establish the geographic service nexus for presumptive consideration

Why: Under 38 CFR 3.317, leishmaniasis may be eligible for presumptive service connection for veterans who served in Southwest Asia and qualifying areas. Failing to confirm deployment location and dates weakens the nexus.

Do this instead: Bring deployment orders, DD-214 with theater of service listed, unit records, or any documentation of service in Iraq, Afghanistan, Kuwait, Saudi Arabia, or other qualifying Southwest Asia locations.

Impact: Service connection - without established nexus, the entire claim fails

Prep checklist

  • critical

    Obtain all diagnostic laboratory records

    Collect every culture result, histopathology/biopsy report, serologic testing result (rK39, DAT, ELISA), blood smear, and any other confirmatory lab work. These are required by the DBQ for diagnosis confirmation and are critical to checking the confirmation boxes on the form. Request from military treatment facilities, VA, and any private physicians.

    before exam

  • critical

    Confirm deployment records establishing Southwest Asia service

    Gather DD-214, deployment orders, unit assignment records, or any documentation confirming service in Iraq, Afghanistan, Kuwait, Saudi Arabia, Bahrain, Qatar, UAE, Oman, Yemen, Djibouti, or other qualifying geographic areas under 38 CFR 3.317. This establishes the presumptive service nexus.

    before exam

  • critical

    Identify and document all residual symptoms

    Make a written list of every ongoing symptom attributable to the leishmaniasis, including fatigue, scars (with locations and measurements), mucosal symptoms, abdominal discomfort, anemia, immune problems, mood changes, and sleep disturbances. Bring this list to the exam to ensure nothing is forgotten.

    before exam

  • critical

    Compile recent laboratory results showing ongoing pathology

    Bring recent CBC (complete blood count) showing anemia or thrombocytopenia, liver function tests, imaging studies (ultrasound or CT showing splenomegaly or hepatomegaly), and any other objective evidence of ongoing organ involvement. Date these within the last 12 months if possible.

    before exam

  • recommended

    Photograph cutaneous scars and lesions

    Take clear, dated photographs of all cutaneous scars or active lesions. Include a ruler or common object for scale reference. Print copies to bring to the exam and email to your VSO or attorney for the claims file. Photographs provide objective evidence when lesions are not at their worst on exam day.

    before exam

  • recommended

    Review your complete claims file (C-file)

    Request a copy of your claims file through your VSO or directly from VA before the exam. Confirm that all diagnostic records, service treatment records, and prior medical opinions are present. Identify any gaps and bring physical copies of missing records to the exam.

    before exam

  • recommended

    Prepare a written symptom timeline

    Create a chronological timeline from deployment through present day: when you first noticed symptoms, when you were diagnosed, what treatments you received and when, when treatment ended, and what symptoms persist today. This helps the examiner accurately complete the history section of the DBQ.

    before exam

  • recommended

    Identify all secondary conditions to mention

    List any conditions that developed or worsened after the leishmaniasis diagnosis that may be secondary: anemia, liver disease, splenic conditions, nasal or mucosal damage, skin scarring, anxiety, depression, or other immune-related conditions. Plan to mention each one explicitly during the exam.

    before exam

  • optional

    Verify your right to record the exam in your state

    Research your state's recording consent laws. In most states, veterans have the right to record C&P examinations. Check with your VSO or accredited claims agent. If you plan to record, bring a recording device and notify the examiner at the start of the appointment.

    before exam

  • critical

    Arrive with complete documentation packet

    Bring organized copies of: all lab and pathology reports, deployment records, current medication list, recent medical records, symptom timeline, scar photographs, and your written symptom list. Use a binder or folder with labeled tabs for easy reference during the exam.

    day of

  • critical

    Do not minimize symptoms on a good day

    If you are having a relatively good day, proactively tell the examiner: 'Today is not representative of my typical experience. My worst days involve [specific symptoms].' Describe frequency: how many bad days per week or month. The examiner is required to rate based on the full clinical picture, not a single observation.

    day of

  • critical

    Specify the type of leishmaniasis clearly

    Confirm with the examiner at the start: 'I was diagnosed with [cutaneous/mucocutaneous/visceral] leishmaniasis.' Ensure the correct checkbox on the DBQ is selected. Visceral disease (kala-azar) warrants DC 6301 and 100% while active; other forms use DC 6319 by analogy.

    day of

  • recommended

    Report impact on employment and daily activities with specifics

    Quantify missed work days, reduced hours, job changes, and activities you can no longer perform. Say: 'I miss approximately X days per month' or 'I reduced from full-time to part-time in [year] because of this condition.' Specific numbers matter far more than general statements.

    day of

  • recommended

    Mention all residuals explicitly, even if you think they are minor

    If the examiner does not ask about a specific residual symptom (fatigue, mucosal issues, scar pain, mood changes), proactively bring it up. Say: 'I also wanted to make sure you document that I experience [symptom] as a result of this condition.' Unmentioned symptoms are not documented.

    day of

  • critical

    Ask the examiner to document the nexus to service in Southwest Asia

    If the examiner does not mention the 38 CFR 3.317 presumptive provision, politely note your qualifying Southwest Asia service and ask that the nexus to service be addressed in the DBQ. Say: 'I served in [location] from [dates] - I wanted to make sure that's noted in connection with this diagnosis.'

    during exam

  • recommended

    Request the examiner document all residuals described

    As you describe residual symptoms, ask: 'Are you documenting the [specific symptom] as a residual of the leishmaniasis?' If the examiner indicates a symptom is outside the scope, ask for a referral or note that you will be filing a separate secondary claim.

    during exam

  • recommended

    Confirm the active vs. inactive status determination

    Ask the examiner: 'Based on my symptoms and test results, are you documenting the disease as active or inactive?' Understand the implications: active visceral disease = 100% under DC 6301; inactive = evaluated based on residuals. If you believe it remains active, provide supporting documentation.

    during exam

  • critical

    Request a copy of the completed DBQ

    After the exam, request a copy of the completed DBQ from the examiner or through your MyHealtheVet account. Review it for accuracy. Check that: the correct type of leishmaniasis is documented, active/inactive status is correctly noted, all residuals you described are listed, and laboratory confirmation methods are checked.

    after exam

  • recommended

    File a buddy statement or lay evidence if exam was inadequate

    If the examiner was dismissive, failed to document important symptoms, or the exam seemed rushed, work with your VSO to submit a buddy statement (VA Form 21-10210) from yourself, family members, or coworkers describing the impact of the condition. Request a new examination if the DBQ is clearly inadequate.

    after exam

  • critical

    File secondary claims for all identified residuals

    After the exam, work with your VSO or accredited claims agent to file VA Form 21-526EZ secondary claims for each ratable residual condition linked to the leishmaniasis: scars (DC 7800-7805), anemia (DC 7700-7716), liver conditions, ENT residuals, mental health conditions. Each residual must be claimed separately.

    after exam

Your rights during a C&P exam

  • You have the right to record your C&P examination in most states - check your state's consent laws and notify the examiner at the start if you plan to record.
  • You have the right to request a copy of the completed DBQ after the examination through your MyHealtheVet account or by submitting a records request.
  • You have the right to submit a written statement correcting inaccuracies in the DBQ if you believe it does not accurately reflect what you reported during the exam.
  • You have the right to request a new C&P examination if the original examination was inadequate, if the examiner lacked the appropriate specialty, or if new and relevant evidence has emerged since the original exam.
  • You have the right to bring a VSO representative, accredited claims agent, or accredited attorney to the C&P examination as an observer (they may not speak during the exam, but their presence is permitted).
  • You have the right to have a language interpreter present at your C&P examination at no cost if English is not your primary language.
  • Under the PACT Act and 38 CFR 3.317, veterans who served in Southwest Asia and qualifying geographic areas may be entitled to presumptive service connection for leishmaniasis without proving a specific in-service event, as long as the condition manifested to a compensable degree.
  • You have the right to appeal any rating decision you believe is incorrect through the Supplemental Claim, Higher-Level Review, or Board of Veterans' Appeals pathways under the Appeals Modernization Act (AMA).
  • You have the right to submit buddy statements (VA Form 21-10210) from family members, fellow service members, or coworkers that describe how your condition affects your daily life and functioning - this lay evidence can be critical to your rating.
  • You are not required to prove your condition is at its worst on the day of the exam. You have the right to accurately describe your full range of symptoms, including worst-day presentations and flare-up frequency, as contemplated by M21-1 adjudication guidance.

Related conditions

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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.