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VA Rating Assistant

DC 7347 · 38 CFR 4.114

Pancreatitis C&P Exam Prep

To document the current severity, frequency, and functional impact of chronic pancreatitis for VA disability rating purposes under DC 7347. The examiner must determine how frequently you experience abdominal or mid-back pain episodes, whether hospitalizations have been required, what ongoing medical management is needed, and whether complications such as maldigestion, malabsorption, cysts, pseudocysts, intestinal obstruction, or ascites are present.

Format:
Interview + Physical
Typical duration:
30-45 minutes
DBQ form:
pancreas (pancreas)
Examiner:
Gastroenterologist or Physician

What the examiner evaluates

  • Frequency of abdominal or mid-back pain episodes per year
  • Number of hospitalizations per year required for pain management or complications
  • Whether pain requires ongoing physician management
  • Presence of maldigestion and malabsorption requiring dietary restriction and pancreatic enzyme supplementation
  • Complications including cysts, pseudocysts, intestinal obstruction, and ascites
  • Need for outpatient medical treatment for pain or digestive problems
  • Current medications prescribed for pancreatitis management
  • Results of diagnostic studies confirming abdominal pain results from pancreatitis (per Note 1, 38 CFR 4.114 DC 7347)
  • Presence of endocrine dysfunction or diabetes mellitus due to pancreatic insufficiency (rated separately under DC 7913)
  • Nutritional status, weight changes, and dietary modifications
  • Results of relevant lab work including amylase, lipase, alkaline phosphatase, bilirubin, and WBC
  • Imaging studies such as CT, MRI/MRCP, EUS, ERCP
  • Any surgical history including pancreatectomy or other procedures
  • Functional impact on daily activities and occupational functioning
  • Presence of scars or disfigurement from surgical interventions

Exam may be conducted in person at a VA facility, VA-contracted clinic, or via telehealth. You have the right to request an in-person examination if a telehealth exam is scheduled and you believe your condition requires physical assessment. Bring all relevant medical records, imaging reports, lab results, and a written symptom summary. In most states, you have the right to record the examination with advance notice.

Measurements and tests

Serum Amylase

What it measures: Pancreatic enzyme elevated during acute flares; used to confirm pancreatitis activity

What to expect: Blood draw; results reviewed in context of clinical history. May be normal between flares in chronic pancreatitis.

Critical thresholds

  • Elevated above normal reference range Supports active pancreatitis diagnosis and confirms pain episodes are pancreatic in origin per Note 1 requirement
  • Normal between flares Does not negate diagnosis; chronic pancreatitis can present with normal amylase; emphasize clinical history and prior documented episodes

Tips

  • Bring copies of prior amylase results from hospitalizations or ER visits
  • Note dates when amylase was elevated to correlate with pain episodes
  • Inform the examiner if your amylase tends to normalize quickly after flares

Pain considerations: Acute elevation correlates with active pain episodes; document when levels were drawn relative to pain onset

Serum Lipase

What it measures: More specific pancreatic enzyme than amylase; remains elevated longer during flares

What to expect: Blood draw; often reviewed alongside amylase. More sensitive and specific for pancreatitis.

Critical thresholds

  • Greater than 3x upper limit of normal Strong objective confirmation of acute pancreatitis episode, supporting hospitalization necessity
  • Mildly elevated or borderline May reflect chronic smoldering disease; document alongside symptom history

Tips

  • Ensure prior hospitalization records showing lipase levels are included in your records
  • If lipase was drawn during ER visits, bring those records explicitly
  • Discuss with examiner that lipase elevates earlier and stays elevated longer than amylase

Pain considerations: Lipase elevation directly supports that abdominal pain episodes are pancreatic in origin, satisfying the diagnostic confirmation requirement under Note 1 of DC 7347

CT Scan of Abdomen/Pancreas

What it measures: Structural changes to the pancreas including calcifications, ductal dilation, pseudocysts, and parenchymal atrophy characteristic of chronic pancreatitis

What to expect: Review of prior imaging; examiner will note findings documented in radiology reports

Critical thresholds

  • Calcifications, ductal changes, or pseudocysts present Confirms structural chronic pancreatitis diagnosis; supports higher rating levels
  • Pseudocyst identified Qualifies as complication under the 30% criterion (ongoing outpatient treatment for management of complications including cyst/pseudocyst)

Tips

  • Bring printed radiology reports, not just the CD of images
  • Highlight any reports mentioning pseudocysts, calcifications, ductal dilation, or pancreatic atrophy
  • Note the dates of imaging and correlate with symptom flares

Pain considerations: CT findings provide objective structural evidence confirming that abdominal pain originates from the pancreas, which is required by Note 1 of DC 7347

MRI/MRCP (Magnetic Resonance Cholangiopancreatography)

What it measures: Detailed ductal anatomy, strictures, stones, and parenchymal changes without radiation; highly sensitive for chronic pancreatitis

What to expect: Review of prior imaging reports; examiner may order if not recently completed

Critical thresholds

  • Main pancreatic duct dilation or stricture Objective structural evidence supporting chronic pancreatitis and related complications
  • Intraductal stones or parenchymal fibrosis Supports diagnosis and severity of chronic pancreatitis

Tips

  • If MRCP was performed, bring the full radiology report
  • MRCP is considered the gold standard non-invasive imaging for chronic pancreatitis

Pain considerations: MRCP findings documenting ductal abnormalities strengthen the objective link between pain episodes and pancreatitis

Complete Blood Count (CBC) and Liver Function Tests

What it measures: WBC elevation indicates infection or inflammation; alkaline phosphatase and bilirubin elevations suggest biliary complications from pancreatitis

What to expect: Blood draw; results may already be in VA or private records

Critical thresholds

  • Elevated WBC during pain episodes Supports toxicity/infection component of severe episodes
  • Elevated alkaline phosphatase or bilirubin Indicates biliary obstruction or cholangitis as complication of chronic pancreatitis

Tips

  • Bring all hospitalization labs showing WBC and liver function abnormalities
  • Note if you have had jaundice, dark urine, or light stools indicating biliary involvement

Pain considerations: Elevated inflammatory markers during pain episodes corroborate the severity and frequency descriptions you provide to the examiner

Fecal Elastase or Fecal Fat Studies

What it measures: Exocrine pancreatic insufficiency causing maldigestion and malabsorption; reduced elastase indicates inadequate pancreatic enzyme production

What to expect: Stool sample analysis; examiner reviews prior results if available

Critical thresholds

  • Fecal elastase below 200 mcg/g Confirms exocrine pancreatic insufficiency; supports need for dietary restriction and pancreatic enzyme supplementation relevant to 100% rating criterion
  • Steatorrhea documented Objective evidence of malabsorption supporting dietary restriction and enzyme supplementation requirement

Tips

  • If prescribed pancreatic enzyme replacement therapy (PERT) such as Creon, this is strong evidence of documented malabsorption
  • Bring your current medication list showing enzyme supplements
  • Document any dietary restrictions such as low-fat diet prescribed by your physician

Pain considerations: Exocrine insufficiency with malabsorption directly maps to the 100% rating criterion requiring maldigestion and malabsorption with dietary restriction and enzyme supplementation

Rating criteria by percentage

100%

Daily episodes of abdominal or mid-back pain that require three or more hospitalizations per year; AND pain management by a physician; AND maldigestion and malabsorption requiring dietary restriction and pancreatic enzyme supplementation. All three elements must be present simultaneously.

Key symptoms

  • Daily abdominal or mid-back pain episodes
  • Three or more hospitalizations per year for pain management
  • Active physician management of pain
  • Documented maldigestion and malabsorption
  • Prescribed dietary restriction (e.g., low-fat diet)
  • Pancreatic enzyme supplementation (e.g., Creon, Zenpep)
  • Significant weight loss or nutritional deficiencies
  • Inability to maintain adequate oral intake without modification

From 38 CFR: All three criteria under 38 CFR 4.114 DC 7347 must be met: (1) daily pain episodes with 3+ hospitalizations/year, (2) physician-managed pain, and (3) maldigestion/malabsorption requiring dietary restriction and enzyme supplementation.

60%

Three or more episodes of abdominal or mid-back pain per year AND at least one episode per year requiring hospitalization for management either of complications related to abdominal pain or complications of tube enteral feeding.

Key symptoms

  • Three or more discrete pain episodes per year
  • At least one hospitalization per year
  • Hospitalization for complications of abdominal pain (e.g., pseudocyst, obstruction, ascites)
  • Hospitalization for complications of tube enteral feeding
  • Significant functional limitation during flares
  • Emergency department visits that escalate to admission
  • Pain requiring IV pain management during hospitalizations
  • Inability to eat or tolerate oral intake during flares

From 38 CFR: Under 38 CFR 4.114 DC 7347, three or more pain episodes per year with at least one requiring inpatient hospitalization for complications related to the abdominal pain or tube feeding complications.

30%

At least one episode per year of abdominal or mid-back pain that requires ongoing outpatient medical treatment for pain, digestive problems, or management of related complications including but not limited to cyst, pseudocyst, intestinal obstruction, or ascites. Note 1 requires appropriate diagnostic studies confirming abdominal pain results from pancreatitis.

Key symptoms

  • At least one pain episode per year
  • Ongoing outpatient treatment with a physician for pain or digestive problems
  • Management of complications such as pseudocyst, cyst, intestinal obstruction, or ascites
  • Prescription medications for pancreatitis management
  • Regular gastroenterology or primary care follow-up
  • Dietary modifications to manage symptoms
  • Diagnostic imaging or lab monitoring for complications
  • Functional limitations during pain episodes affecting daily activities

From 38 CFR: Under 38 CFR 4.114 DC 7347, at least one annual pain episode requiring ongoing outpatient management for pain, digestive problems, or complications. Diagnostic confirmation of pancreatic origin is required under Note 1.

Describing your symptoms accurately

Abdominal and Mid-Back Pain Episodes

How to describe it: Describe pain episodes with specific details: onset, location (epigastric radiating to mid-back is classic), intensity on 0-10 scale, duration, and what triggers or worsens episodes (e.g., eating fatty foods, alcohol, stress). State clearly how many distinct episodes you have had in the past 12 months and the past year before that. Distinguish between background daily pain and acute flare episodes.

Example: On my worst days, I wake up with a 9/10 burning and stabbing pain in my upper abdomen that radiates straight through to my mid-back. I cannot eat or drink anything without triggering vomiting. I am unable to get comfortable in any position. The pain is so severe I require IV pain medication in the emergency room. This has happened at least four times this past year, and each time I was admitted for two to five days.

Examiner listens for: The examiner is listening for the number of discrete episodes per year, whether any required hospitalization, the nature and location of pain, whether pain is daily versus episodic, and whether a physician is actively managing the pain. They need this information to check the appropriate rating-level fields on the DBQ.

Avoid: Do not say 'I just have some stomach pain sometimes.' Do not minimize the severity by saying 'it comes and goes.' Be specific about frequency, severity, and the impact on your ability to function, eat, and work.

Hospitalization History

How to describe it: Report each hospitalization in the past 12 months with the approximate date, facility name, length of stay, and reason for admission. If you have been hospitalized more than three times in a year, state this clearly and early in the exam. Distinguish between hospitalizations for acute pain management, IV fluids, pseudocyst drainage, obstruction, or other complications.

Example: In the past year I have been hospitalized three times. The first was in February for five days at [facility] because my pain was uncontrollable and I needed IV morphine and fluids. The second was in June for three days when imaging showed my pseudocyst had enlarged and was causing obstruction. The third was in October for four days when I could not keep food down and my lipase was over 2000.

Examiner listens for: The examiner needs to document number of hospitalizations per year and the reason for each admission. Three or more hospitalizations per year is a threshold criterion for the 100% rating. Any one hospitalization per year is a threshold for the 60% rating.

Avoid: Do not conflate ER visits with hospitalizations but also do not forget to mention ER visits that did not result in admission, as they document the severity and frequency of your pain episodes. Bring discharge summaries and hospitalization records to document each admission accurately.

Maldigestion and Malabsorption

How to describe it: Describe any prescribed dietary restrictions such as a low-fat or low-fiber diet, and all enzyme supplements you take (name, dose, frequency). Describe symptoms of malabsorption including oily or greasy stools (steatorrhea), foul-smelling stools, weight loss, bloating, early satiety, and nutritional deficiencies. State that these were prescribed by your physician as a direct result of your chronic pancreatitis.

Example: I take Creon 36,000 units with every meal and snack as prescribed by my gastroenterologist. Even with the enzymes, I have loose, oily stools several times a day when I eat anything with fat. I have lost 22 pounds over the past 18 months because I cannot absorb nutrients properly. My doctor has restricted me to a strict low-fat diet of under 20 grams of fat per day.

Examiner listens for: The examiner is looking for prescribed dietary restriction and pancreatic enzyme supplementation as objective markers of maldigestion and malabsorption. This combination, together with daily pain and three or more hospitalizations, supports the 100% rating.

Avoid: Do not fail to mention enzyme supplementation by name. Do not describe dietary changes as personal choices rather than physician-prescribed restrictions. Bring prescription bottles and your written dietary prescription if available.

Ongoing Outpatient Medical Management

How to describe it: Describe all outpatient appointments for pancreatitis management including gastroenterology visits, primary care visits for pain management, pain management clinic visits, and any procedures such as ERCP or endoscopic ultrasound. State how frequently you are seen and for what purpose. List all current medications prescribed specifically for pancreatitis.

Example: I see my gastroenterologist every three months for monitoring and management of my chronic pancreatitis. I am on scheduled oral opioids for pain management, Creon for malabsorption, and I had an ERCP in [date] for a bile duct stricture related to my pancreatitis. I also see a pain management specialist monthly who monitors my narcotic pain regimen.

Examiner listens for: Active physician management of pain is required for the 100% rating. Ongoing outpatient treatment is the threshold for the 30% rating. The examiner needs to document the nature, frequency, and provider type for outpatient care.

Avoid: Do not say you 'just take some Tylenol.' List all prescriptions including enzyme supplements, pain medications, proton pump inhibitors, antinausea medications, and any other drugs prescribed for your pancreatitis. Bring your current medication list.

Complications (Pseudocysts, Cysts, Obstruction, Ascites)

How to describe it: If you have been diagnosed with any complication of pancreatitis, describe it clearly including when it was diagnosed, how it was treated, whether it has recurred, and how it affects your daily life. Complications are relevant at both the 30% and 60% rating levels. Be specific about procedures performed to manage complications.

Example: I was diagnosed with a pancreatic pseudocyst in [date] that was found on CT scan. It caused severe abdominal pain, early satiety, and nausea. I was hospitalized for its management and ultimately required endoscopic drainage. It recurred six months later and I was hospitalized again.

Examiner listens for: The examiner will check whether complications including cysts, pseudocysts, intestinal obstruction, or ascites are present and whether they require outpatient or inpatient management. These complications are explicitly named in DC 7347 as relevant to the 30% and 60% criteria.

Avoid: Do not forget to mention complications that have resolved if they required hospitalization. Past hospitalizations for resolved complications still count toward the annual hospitalization tallies.

Functional and Occupational Impact

How to describe it: Describe how pancreatitis affects your ability to work, perform daily activities, eat normally, sleep, and maintain relationships. Be specific about days missed from work, activities you can no longer perform, and how symptoms affect your daily routine. Include fatigue, nausea, and inability to predict or control symptom flares.

Example: During flares I am completely bedridden for days at a time. I have missed over 30 days of work in the past year due to hospitalizations and recovery. I cannot attend social events involving food without fear of triggering a flare. I have to plan every meal carefully, carry my medications with me at all times, and stay near a bathroom. The unpredictability of my symptoms prevents me from maintaining full-time employment.

Examiner listens for: The DBQ includes a functional impact section where the examiner documents how the condition affects daily activities and employment. This information is critical for a complete and accurate rating and may support a Total Disability based on Individual Unemployability (TDIU) claim.

Avoid: Do not describe your best days as typical. Per M21-1 guidance, report how the condition affects you on your worst days and how frequently those worst days occur.

Common mistakes to avoid

Failing to report the exact number of hospitalizations per year

Why: The number of hospitalizations per year is the primary differentiator between the 30%, 60%, and 100% rating levels under DC 7347. Vague answers like 'a few times' or 'several' may result in an inaccurate lower rating.

Do this instead: Before your exam, count and write down every hospitalization in the past 12 months and the 12 months before that, including dates, facilities, and lengths of stay. Bring discharge summaries as supporting documentation.

Impact: 60% and 100%

Not mentioning pancreatic enzyme replacement therapy by name

Why: Prescribed enzyme supplementation (e.g., Creon, Zenpep, Pancreaze) combined with dietary restriction is a specific required criterion for the 100% rating. If you take these medications but fail to mention them, the examiner may not document this critical finding.

Do this instead: Bring your current medication list with drug names, doses, and prescribing physicians. State explicitly that your gastroenterologist prescribed these medications due to documented malabsorption from chronic pancreatitis.

Impact: 100%

Describing dietary changes as personal choices rather than physician-prescribed restrictions

Why: The 100% rating requires maldigestion and malabsorption requiring dietary restriction. If you describe your low-fat diet as something you chose rather than something your doctor prescribed because of documented malabsorption, the examiner may not recognize it as meeting the rating criterion.

Do this instead: State clearly: 'My gastroenterologist prescribed a low-fat diet of under X grams of fat per day because I have documented malabsorption from my chronic pancreatitis.' Bring any written dietary prescriptions or treatment plans that reference dietary restriction.

Impact: 100%

Minimizing pain severity on the day of the exam because you are having a relatively good day

Why: Per M21-1 guidance, ratings are based on the average condition over time, including worst days. If you underreport pain severity because you feel better on exam day, the DBQ will not capture the true burden of your condition.

Do this instead: Describe your symptoms across the full spectrum: your average day, your typical flare day, and your worst day. Explicitly tell the examiner 'Today is a relatively good day for me. On my worst days, which occur approximately X times per month, my symptoms are...'

Impact: 30%, 60%, and 100%

Not mentioning complications such as pseudocysts or ascites

Why: Complications including cysts, pseudocysts, intestinal obstruction, and ascites are explicitly named in DC 7347 as qualifying conditions for ongoing outpatient management at the 30% level and as reasons for hospitalization at the 60% level.

Do this instead: Review your imaging reports and treatment history before the exam. If any complication has been diagnosed, document when it occurred, how it was treated, and whether it required hospitalization. Bring relevant imaging reports.

Impact: 30% and 60%

Failing to address the diagnostic confirmation requirement under Note 1

Why: Note 1 of DC 7347 requires that appropriate diagnostic studies confirm abdominal pain results from pancreatitis. Without objective evidence linking pain to pancreatitis, the rating criteria cannot be applied. If you have not had recent confirmatory testing, the examiner may order it or the claim may be delayed.

Do this instead: Bring copies of all relevant lab results (amylase, lipase) and imaging reports (CT, MRI/MRCP) that confirm your diagnosis and correlate your pain episodes with pancreatic activity. Highlight reports that specifically state 'consistent with chronic pancreatitis.'

Impact: 30%, 60%, and 100%

Forgetting to mention diabetes mellitus resulting from pancreatic insufficiency

Why: Under Note 2 of DC 7347, diabetes mellitus due to pancreatic insufficiency must be separately rated under DC 7913. If you have diabetes caused by your chronic pancreatitis and do not raise this, you may be leaving a separate ratable condition unaddressed.

Do this instead: If you have been diagnosed with diabetes mellitus and your physician has linked it to your chronic pancreatitis (pancreatic exocrine and endocrine insufficiency), inform the examiner and ensure it is documented. File a separate claim for diabetes under DC 7913 if not already claimed.

Impact: Separate DC 7913 claim

Not reporting functional impact on work and daily activities

Why: The DBQ includes a section on functional impact that directly feeds into overall disability determinations including potential TDIU. Veterans who omit functional impact information may receive accurate condition ratings but miss opportunities for unemployability consideration.

Do this instead: Prepare specific examples of how your condition affects work attendance, job performance, daily activities, and social functioning. Include number of workdays missed, activities you have had to stop, and any job accommodations required.

Impact: Overall disability determination and TDIU

Prep checklist

  • critical

    Compile complete hospitalization records for the past two years

    Gather all inpatient discharge summaries, emergency room visit records, and admission notes documenting hospitalizations for pancreatitis-related pain or complications. Note the date, facility, length of stay, and reason for each admission. Count the total number per year to compare against rating criteria thresholds.

    before exam

  • critical

    Compile all relevant imaging reports confirming pancreatitis diagnosis

    Gather radiology reports from CT scans, MRI/MRCP, EUS, or ERCP studies that document structural evidence of chronic pancreatitis including calcifications, ductal dilation, pseudocysts, or parenchymal changes. These satisfy the Note 1 diagnostic confirmation requirement under DC 7347.

    before exam

  • critical

    Print current medication list with all pancreatitis-related prescriptions

    Include pancreatic enzyme replacement therapy (e.g., Creon with dose and frequency), pain medications (scheduled and as-needed), proton pump inhibitors, antinausea medications, and any other drugs prescribed for pancreatitis management. Note prescribing physician name and dates.

    before exam

  • critical

    Obtain documentation of dietary restrictions prescribed by physician

    Request from your gastroenterologist or primary care provider a written record or treatment note documenting any prescribed dietary restrictions (e.g., low-fat diet, small frequent meals, dietary supplementation) as a result of maldigestion and malabsorption from chronic pancreatitis. This is a required element for the 100% rating.

    before exam

  • critical

    Gather recent laboratory results including amylase, lipase, liver function tests, and CBC

    Collect lab results from hospitalizations and outpatient visits showing elevations in amylase, lipase, alkaline phosphatase, bilirubin, or WBC. Correlate lab dates with pain episode dates. Results from within the past 12 months are most relevant.

    before exam

  • critical

    Write a detailed symptom chronology and pain episode log

    Before your exam, write a timeline of all pain episodes in the past 12 months including approximate dates, severity, duration, triggers, and whether each episode resulted in an ER visit, outpatient visit, or hospitalization. This written log helps ensure accurate and complete reporting during the exam.

    before exam

  • recommended

    Review 38 CFR 4.114 DC 7347 rating criteria

    Familiarize yourself with the three rating levels (30%, 60%, 100%) and the specific criteria for each. Know which criteria you meet based on your symptom history so you can communicate your condition accurately and completely during the exam.

    before exam

  • recommended

    Prepare a written functional impact statement

    Write a brief statement describing how chronic pancreatitis affects your ability to work, attend events, eat normally, sleep, and perform daily activities. Include specific examples such as days missed from work, activities you have had to stop, and accommodations you have required.

    before exam

  • recommended

    Check state law regarding exam recording rights

    In most states, you have the right to record your C&P examination with advance notice to the examiner. Check your state's laws and VA policy. If permitted, bring a recording device or use your smartphone. Inform the examiner at the start of the exam.

    before exam

  • recommended

    Determine whether diabetes mellitus from pancreatic insufficiency should be separately claimed

    Under Note 2 of DC 7347, diabetes mellitus due to pancreatic insufficiency is rated separately under DC 7913. If you have diabetes and your physician has linked it to your pancreatitis, consult with a VSO about filing a separate claim if one is not already in progress.

    before exam

  • recommended

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

    Consider consulting with a Veterans Service Organization (VSO), accredited VA claims agent, or VA-accredited attorney to review your evidence before the exam. They can help identify documentation gaps and ensure your claim is as complete as possible.

    before exam

  • critical

    Arrive with all documentation organized and tabbed

    Organize your records into clearly labeled sections: hospitalization records, imaging reports, lab results, medication list, dietary prescription, and functional impact statement. A well-organized binder helps ensure the examiner reviews all evidence and can cite it in the DBQ.

    day of

  • critical

    Do not take extra pain medication before the exam to minimize discomfort

    Attend the exam in your usual medicated state. Taking extra medication to reduce pain for the exam may cause you to appear better than your baseline condition, resulting in an underestimate of your disability. The examiner should see you as you typically are.

    day of

  • optional

    Bring a trusted support person if allowed

    Consider bringing a family member, caregiver, or VSO representative who can help recall specific incidents, dates, and hospitalizations. Inform the examiner of this person's role. Their presence can also serve as a witness to the exam.

    day of

  • optional

    Eat a normal meal before the exam to assess your typical post-meal symptoms

    Eating before the exam allows you to describe post-meal symptoms such as pain, bloating, nausea, or diarrhea from firsthand experience on exam day. If eating typically triggers your symptoms, the examiner may be able to observe clinical signs.

    day of

  • critical

    Describe your worst days, not your best days, when asked about symptoms

    Per M21-1 guidance, disability ratings are based on the average condition including worst-day severity. Explicitly tell the examiner 'Today is a relatively better day. My typical worst day looks like...' and describe your most severe symptom presentations.

    during exam

  • critical

    Report the exact number of hospitalizations in the past 12 months

    State the number clearly and provide dates and facilities. Do not approximate. If the examiner does not ask about hospitalizations, volunteer this information. This is the most important data point for differentiating between the 30%, 60%, and 100% rating levels.

    during exam

  • critical

    Explicitly state whether your pain is managed by a physician

    State the name and specialty of the physician managing your pain, the medications prescribed, and the frequency of visits. Active physician pain management is a required element for the 100% rating. Do not assume the examiner will infer this from your medication list.

    during exam

  • critical

    Mention all complications by name if present

    If you have or have had pseudocysts, pancreatic cysts, intestinal obstruction, or ascites as complications of your pancreatitis, name these specifically. These are explicitly listed in DC 7347 as relevant complications at the 30% and 60% rating levels.

    during exam

  • critical

    Confirm that enzyme replacement therapy and dietary restrictions were physician-prescribed

    State clearly: 'My physician prescribed Creon and a low-fat diet specifically because I have documented malabsorption and maldigestion from my chronic pancreatitis.' Do not leave this for the examiner to infer.

    during exam

  • recommended

    Describe the functional impact on work and daily activities with specific examples

    Provide concrete examples: number of workdays missed, activities you can no longer do, how the unpredictability of flares affects your ability to maintain employment or social commitments. Request that the examiner document functional impact in the DBQ.

    during exam

  • recommended

    Ask the examiner to confirm they have reviewed all submitted evidence

    Politely ask whether the examiner has had the opportunity to review your medical records, hospitalization documents, and imaging reports. If not, offer your organized documentation for review during the exam.

    during exam

  • critical

    Request a copy of the completed DBQ

    You are entitled to receive a copy of the completed DBQ. Request it from the examiner or the VA facility before leaving. Review it for accuracy, particularly the number of hospitalizations documented, symptom severity descriptions, and complication listings.

    after exam

  • recommended

    Document your recollection of the exam in writing immediately after

    As soon as possible after the exam, write down what questions were asked, what you reported, and what the examiner documented or commented on. This contemporaneous record is useful if you need to identify errors or file for a new exam.

    after exam

  • critical

    Review the DBQ for errors and omissions within 30 days

    When you receive the completed DBQ, compare it against your symptom log and documentation. If the examiner under-documented hospitalizations, omitted medications, or failed to address specific symptoms, contact your VSO about submitting a request for a new or corrected examination.

    after exam

  • recommended

    Monitor your VA.gov portal for exam results and rating decision

    Check your VA.gov account regularly for updates on your claim status. Once a rating decision is issued, review it carefully against the DBQ findings and rating criteria. If the decision appears inconsistent with the evidence, discuss appeal options with a VSO.

    after exam

Your rights during a C&P exam

  • You have the right to be examined in person rather than solely through a records review if your condition requires a physical examination. If scheduled for a telehealth or records-only review, you may request an in-person examination.
  • In most states, you have the right to record your C&P examination with advance notice to the examiner. Check your state's laws and VA policy before the exam.
  • You have the right to receive a copy of the completed DBQ form. Request it at the time of the examination.
  • You have the right to submit a buddy statement (VA Form 21-10210) from a family member, caregiver, or fellow veteran attesting to the frequency and severity of your pancreatitis symptoms.
  • You have the right to request a new C&P examination if you believe the original examination was inadequate, the examiner failed to review all evidence, or the DBQ contains significant errors or omissions.
  • You have the right to submit a private medical opinion from your treating gastroenterologist or other physician to supplement or rebut C&P exam findings.
  • You have the right to appeal a rating decision you disagree with through the Supplemental Claim lane, Higher-Level Review lane, or Board of Veterans' Appeals under the AMA appeals process.
  • Under 38 CFR 4.114 Note 2, if you have diabetes mellitus resulting from pancreatic insufficiency, you have the right to have this condition separately rated under DC 7913 in addition to your pancreatitis rating under DC 7347.
  • You have the right to have the benefit of the doubt applied in your favor when there is an approximate balance of positive and negative evidence regarding any issue material to your claim (38 CFR 3.102).
  • You have the right to have your disability rated based on the full range of your symptoms over time, including your worst days, not solely your condition on the day of the examination.

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.