Skip to main content
VA Rating Assistant

DC 7335 · 38 CFR 4.114

Rectum and Anus (Hemorrhoids / Fissures) C&P Exam Prep

To document current diagnosis, severity, and functional impact of anorectal conditions including hemorrhoids, anal fissures, rectal prolapse, fistulas, abscesses, pruritus ani, and related conditions for VA disability rating purposes under 38 CFR 4.114.

Format:
Interview + Physical
Typical duration:
15-30 minutes
DBQ form:
rectum-and-anus (rectum-and-anus)
Examiner:
Gastroenterologist or Physician

What the examiner evaluates

  • Type and location of hemorrhoids (internal, external, or both)
  • Frequency and severity of thrombosis episodes per year
  • Presence and persistence of bleeding and associated anemia (hemoglobin/hematocrit values)
  • Degree and reducibility of prolapse (spontaneous, manual, or irreducible)
  • Presence of anal fissures and associated symptoms
  • Presence of fistulas with drainage characteristics
  • Presence of abscesses
  • Sphincter control and continence
  • Pruritus ani with or without bleeding or excoriation
  • Luminal narrowing or stricture
  • Pain during or after defecation
  • Straining during defecation
  • Current treatments including diet, medication, surgery, and procedures
  • Functional impact on daily activities and occupational functioning
  • Lab values including hemoglobin, hematocrit, and platelet count if anemia is suspected

The exam will include a structured interview about your symptoms and medical history. A physical examination of the anorectal region is likely. The examiner will review your medical records and any supporting documentation you bring. Bring a list of all current medications and any recent lab work related to anemia or GI conditions.

Measurements and tests

Hemoglobin and Hematocrit Assessment

What it measures: Blood levels to determine if persistent bleeding has resulted in anemia, which is a specific rating criterion under DC 7336.

What to expect: The examiner may order or review recent lab work showing hemoglobin and hematocrit values. Normal hemoglobin is approximately 13.5-17.5 g/dL for males and 12.0-15.5 g/dL for females. Values below normal indicate anemia.

Critical thresholds

  • Hemoglobin below normal range with documented persistent hemorrhoidal bleeding Supports 20% rating under DC 7336 for internal or external hemorrhoids with persistent bleeding and anemia
  • Normal hemoglobin despite bleeding episodes May still support 10% or 20% rating based on thrombosis frequency or prolapse criteria independent of anemia

Tips

  • Request copies of any recent CBC (complete blood count) lab results from your VA or private provider and bring them to the exam
  • If you have had iron deficiency anemia attributed to hemorrhoidal bleeding, ensure this is documented in your medical records
  • Ask your treating provider to document explicitly that your anemia is due to hemorrhoidal bleeding in their clinical notes
  • If you take iron supplements due to bleeding-related anemia, bring documentation of this prescription

Pain considerations: Anal pain and discomfort from bleeding episodes can be severe and affect your ability to perform daily activities. Accurately describe the frequency, intensity, and duration of pain associated with each bleeding episode.

Physical Examination of the Anorectal Region

What it measures: Visual and digital assessment to identify external hemorrhoids, fissures, excoriation, prolapse, fistula openings, abscess formation, and sphincter tone.

What to expect: The examiner will likely perform a visual inspection of the perianal region in a lateral decubitus or lithotomy position. A digital rectal exam may be performed to assess sphincter tone, internal hemorrhoids, and rectal prolapse. An anoscope may be used to directly visualize internal hemorrhoids.

Critical thresholds

  • Visible irreducible prolapsed hemorrhoids Supports 20% rating for continuously prolapsed internal hemorrhoids with 3 or more thrombosis episodes per year
  • Spontaneously reducible prolapse with documented thrombosis frequency Supports 10% rating if 2 or fewer thrombosis episodes per year, or 20% if 3 or more episodes per year of thrombosis
  • External hemorrhoids with documented thrombosis frequency 10% rating for 3 or more episodes per year of thrombosis

Tips

  • Report any pain or discomfort during the exam promptly and accurately - do not minimize discomfort
  • If you are having a flare-up at the time of the exam, notify the examiner before the physical examination begins
  • If you are between flare-ups, clearly describe your typical presentation during active episodes
  • Do not use topical anesthetics or suppositories immediately before the exam unless medically necessary, as they may temporarily reduce visible signs

Pain considerations: Physical examination of hemorrhoids can cause significant pain, especially during active thrombosis or flare-up periods. You have the right to describe pain during the exam, and the examiner should document this in the DBQ.

Proctoscopy or Anoscopy

What it measures: Direct visualization of internal hemorrhoids, their grade/severity, and associated mucosal changes.

What to expect: May be performed during the C&P exam or referenced from prior clinical records. The examiner uses a short scope to view the anal canal and lower rectum.

Critical thresholds

  • Grade III-IV internal hemorrhoids with prolapse Directly informs prolapse status and supports higher rating criteria
  • Active bleeding or excoriation noted on scope Supports persistent bleeding criterion for 20% rating

Tips

  • If you have had a recent colonoscopy, sigmoidoscopy, or anoscopy, bring a copy of the procedure report and pathology findings
  • Note the date of your most recent GI procedure on your preparation timeline
  • Ask your gastroenterologist to document hemorrhoid grade in their procedure notes if this has not already been done

Pain considerations: Scope procedures can cause significant discomfort, especially with active hemorrhoidal disease. Report pain accurately and do not feel compelled to minimize it.

Rating criteria by percentage

20%

Internal or external hemorrhoids with persistent bleeding AND anemia; OR continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis.

Key symptoms

  • Persistent rectal bleeding requiring documentation
  • Hemoglobin or hematocrit values below normal range (anemia)
  • Continuous prolapse of internal hemorrhoids that does not spontaneously or manually reduce
  • Three or more documented thrombosis episodes per calendar year
  • Significant pain associated with thrombosis episodes
  • Functional impairment from chronic bleeding or prolapse

From 38 CFR: Per DC 7336: 'Internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis - 20%'

10%

Prolapsed internal hemorrhoids with two or fewer episodes per year of thrombosis; OR external hemorrhoids with three or more episodes per year of thrombosis.

Key symptoms

  • Documented prolapse of internal hemorrhoids that is spontaneously or manually reducible
  • One to two thrombosis episodes per year for internal hemorrhoids
  • Three or more thrombosis episodes per year for external hemorrhoids
  • Rectal pain and discomfort during and after thrombosis episodes
  • Bleeding that does not meet the persistent bleeding plus anemia threshold
  • Disruption of daily activities during thrombotic episodes

From 38 CFR: Per DC 7336: 'Prolapsed internal hemorrhoids with two or less episodes per year of thrombosis; or external hemorrhoids with three or more episodes per year of thrombosis - 10%'

10%

Pruritus ani (anal itching) with bleeding or excoriation, rated separately under DC 7337 if present as an additional diagnosed condition.

Key symptoms

  • Chronic anal itching
  • Visible excoriation or skin breakdown in the perianal area
  • Bleeding associated with scratching or excoriation
  • Secondary skin changes from chronic irritation

From 38 CFR: Per DC 7337: 'Pruritus ani (anal itching): With bleeding or excoriation - 10%; Without bleeding or excoriation - 0%'

0%

Pruritus ani without bleeding or excoriation (DC 7337); or hemorrhoidal condition present but not meeting any higher rating criteria threshold.

Key symptoms

  • Mild anal itching without visible skin breakdown
  • Minor hemorrhoidal symptoms without prolapse, persistent bleeding, anemia, or qualifying thrombosis episodes

From 38 CFR: Per DC 7337: 'Pruritus ani (anal itching): Without bleeding or excoriation - 0%'

Describing your symptoms accurately

Thrombosis Episodes - Frequency and Severity

How to describe it: Count and describe each episode of acute thrombosis during the past 12 months. A thrombosis episode is a distinct event where a blood clot forms in a hemorrhoid, causing sudden severe pain, swelling, and a firm, tender lump. Describe how long each episode lasted, how it was treated, and whether it affected your work, sleep, or daily activities.

Example: During my worst thrombosis episode last March, I could not sit down at all for five days. The pain was a 9 out of 10 and radiated into my lower back and tailbone. I missed three days of work, could not drive, and had to sleep on my side using a pillow to avoid any pressure. My partner had to help me with basic tasks because standing and walking were extremely painful.

Examiner listens for: Specific number of distinct thrombosis episodes in the past 12 months, duration of each episode, severity of pain, functional limitations during episodes, treatments used, and whether episodes required medical attention.

Avoid: Do not say 'I get flare-ups sometimes' without specifying how many distinct episodes you have had and how severe each was. The difference between 2 episodes per year and 3 episodes per year is the difference between a 10% and 20% rating for external hemorrhoids, so precision matters.

Bleeding - Persistence and Severity

How to describe it: Describe exactly how often you bleed, how much blood is present, and whether the bleeding requires medical management. Distinguish between occasional spotting on toilet paper and persistent, heavy bleeding that soaks through clothing or pads, causes fatigue, or has resulted in anemia. Reference any lab work showing low hemoglobin or hematocrit.

Example: On my worst bleeding days, I bleed with every bowel movement and sometimes between movements as well. The blood drips into the toilet bowl and is not just on the toilet paper. This happens approximately four to five days per week during active periods. My last blood test showed a hemoglobin of 10.8 g/dL and my doctor prescribed iron supplements. I feel fatigued and lightheaded during these periods and cannot do physical work.

Examiner listens for: Frequency of bleeding episodes, amount of blood loss, association with anemia confirmed by lab values, whether bleeding is intermittent or persistent, impact on fatigue and daily functioning, and current treatments for bleeding-related anemia.

Avoid: Do not describe persistent bleeding as 'a little blood sometimes.' If you have been told you are anemic or have been prescribed iron supplements due to rectal bleeding, this is a critical fact that must be communicated clearly to the examiner.

Prolapse - Type and Reducibility

How to describe it: Explain whether hemorrhoidal tissue protrudes from the anus and what is required to return it. Spontaneously reducing means the tissue goes back on its own after a bowel movement. Manually reducible means you must physically push it back. Irreducible or continuously prolapsed means the tissue remains outside and cannot be returned.

Example: My internal hemorrhoids prolapse with every bowel movement and sometimes when I am standing for more than 20 minutes or lifting anything heavy. I have to manually push the tissue back in after each bowel movement, which is painful and takes several minutes. During the worst weeks, the tissue will not go back in at all and remains outside, causing constant pressure, leaking mucus, and making it impossible to sit comfortably at work.

Examiner listens for: Whether prolapse is spontaneous, manual, or irreducible, how frequently prolapse occurs, what triggers it, how long it lasts, associated symptoms such as mucus discharge, and impact on ability to work and perform daily activities.

Avoid: Do not simply say 'things come out sometimes.' Use the specific clinical terms: spontaneously reducible, manually reducible, or continuously prolapsed and irreducible. The type of prolapse directly determines your rating level.

Pain - Location, Character, and Functional Impact

How to describe it: Describe pain using specific descriptors: location (anal, perianal, lower rectal), character (sharp, burning, throbbing, pressure), timing (during defecation, after defecation, constant, positional), severity on a 0-10 scale, and how pain affects sitting, standing, walking, working, sleeping, and social activities.

Example: On my worst pain days, I experience a sharp, burning pain rated 8 out of 10 during bowel movements that continues as a deep throbbing ache for one to two hours afterward. I cannot sit on a hard chair for more than 15 minutes. I avoid public restrooms because the pain and bleeding are embarrassing and difficult to manage. I have had to turn down overtime hours at work because prolonged sitting aggravates my condition significantly.

Examiner listens for: Severity and duration of pain, functional limitations caused by pain, impact on occupational performance, relationship between pain and specific activities, and whether pain is adequately controlled with current treatments.

Avoid: Do not minimize pain to appear stoic. The examiner needs an accurate picture of your worst-day functioning, not your best-day functioning or your average controlled day on medication.

Anal Itching and Excoriation (Pruritus Ani)

How to describe it: If applicable, describe the severity and persistence of anal itching, whether scratching has caused skin breakdown, bleeding, or open sores, and how the itching affects sleep, concentration, and daily activities.

Example: The anal itching wakes me up at night two to three times per week. On my worst nights, I scratch until I bleed and the area becomes raw and excoriated. I have visible skin breakdown that my doctor has documented. The itching and soreness affect my ability to sit comfortably during my entire work shift.

Examiner listens for: Whether itching is accompanied by visible excoriation, bleeding from scratching, secondary skin changes, and functional impact on sleep and daily activities. The presence of bleeding or excoriation is the threshold between a 0% and 10% rating under DC 7337.

Avoid: Do not dismiss pruritus ani as insignificant if it occurs with any bleeding or skin breakdown. If your treating provider has noted excoriation or skin changes in clinical notes, ensure these records are available at the exam.

Functional Impact on Daily Life and Work

How to describe it: Describe how your condition affects your ability to perform job duties, particularly those involving prolonged sitting, lifting, physical exertion, and access to bathroom facilities. Include impact on social activities, travel, and relationships.

Example: On my worst days, I cannot perform my job duties as a truck driver because sitting for more than 30 minutes causes severe pain and increases prolapse and bleeding. I have had to call in sick on average two to three times per month during active flare periods. I carry extra clothing to work because of unpredictable bleeding. I avoid social situations involving extended sitting such as movies, long car trips, and dining out.

Examiner listens for: Specific occupational limitations, frequency of missed work or reduced productivity, accommodations made to manage the condition, and overall quality-of-life impact. The examiner must document functional impact for the DBQ to accurately reflect your disability level.

Avoid: Do not focus only on physical symptoms without connecting them to functional consequences. The examiner needs to understand how your condition limits what you can do, not just what symptoms you experience.

Common mistakes to avoid

Failing to count thrombosis episodes precisely

Why: The rating criteria for DC 7336 hinge directly on whether you have had 2 or fewer vs. 3 or more thrombosis episodes per year. Veterans often describe having flare-ups without specifying the exact number of distinct thrombotic events.

Do this instead: Before the exam, review your calendar, medical records, and pharmacy records to count the number of distinct thrombosis episodes in the past 12 months. Write this number down and communicate it clearly to the examiner. A thrombosis episode is a distinct, acute event with a firm painful clot - it is not the same as general soreness or bleeding.

Impact: 10% vs. 20%

Not connecting bleeding to anemia with lab documentation

Why: The 20% rating requires both persistent bleeding AND anemia. Veterans who have had anemia confirmed by lab work but do not bring documentation or do not specifically connect their anemia to hemorrhoidal bleeding may lose this criterion.

Do this instead: Bring recent CBC lab results showing hemoglobin and hematocrit values. Ensure your treating provider has documented in clinical notes that anemia is attributable to hemorrhoidal bleeding. If you take iron supplements for this reason, bring prescription records.

Impact: 10% vs. 20%

Describing prolapse vaguely without specifying reducibility type

Why: The DBQ asks specifically whether prolapse is spontaneously reducible, manually reducible, or persistently irreducible. Vague descriptions like 'things come out' do not allow the examiner to accurately check the correct DBQ field, which directly impacts the rating assigned.

Do this instead: Learn and use the correct clinical terminology: spontaneously reducible (returns on its own), manually reducible (you must push it back), or continuously prolapsed and irreducible (remains outside and cannot be returned). Use these exact terms when describing your prolapse to the examiner.

Impact: 10% vs. 20%

Describing only typical or average symptom days rather than worst-day functioning

Why: Per M21-1 guidance, the VA rates your disability based on its worst presentation, not your best or average days. Veterans who report well-controlled, average-day symptoms may receive lower ratings that do not reflect their actual disability burden during flare periods.

Do this instead: Prepare specific descriptions of your worst-day symptoms including worst pain severity, worst functional limitations, and worst-case bleeding or prolapse episodes. Present both your typical day and your worst day to the examiner so they have the complete picture.

Impact: All rating levels

Failing to mention all associated conditions on the same DBQ

Why: The Rectum and Anus DBQ covers multiple ratable conditions including fistulas, abscesses, stricture, pruritus ani, rectal prolapse, and dyssynergic defecation. Veterans who only discuss their primary hemorrhoid diagnosis may miss additional ratable conditions that could be rated separately or combined.

Do this instead: Review the full list of conditions covered by this DBQ and report all symptoms you experience, including anal itching, sphincter control problems, constipation, fistula drainage, and abscess history. Each separately diagnosed condition may carry its own rating.

Impact: All rating levels

Not reporting the impact of the condition on bowel habits and continence

Why: The DBQ includes fields for sphincter control impairment, inability to open the anus, straining during defecation, and management by dietary intervention. These findings can support additional ratings or nexus to related conditions.

Do this instead: Be thorough in describing any changes to your bowel habits, including frequency of bowel movements, consistency of stool, straining, urgency, incomplete evacuation, and any episodes of fecal incontinence or leakage. Report whether you use fiber supplements, laxatives, or dietary modifications to manage your bowel function.

Impact: All rating levels

Minimizing symptoms due to embarrassment

Why: Anorectal conditions involve sensitive body functions and areas. Veterans sometimes underreport symptoms or minimize their severity due to embarrassment in discussing them with the examiner, resulting in ratings that do not reflect the true impact of the condition.

Do this instead: Remember that the examiner is a medical professional conducting a clinical assessment. Accurate and complete reporting of all symptoms - including bleeding, discharge, prolapse, itching, pain, and fecal soiling - is essential to receive a fair and accurate rating. The C&P exam is not a social conversation; it is a medical evaluation.

Impact: All rating levels

Prep checklist

  • critical

    Gather and organize all relevant medical records

    Collect VA and private medical records documenting diagnosis of hemorrhoids, fissures, fistulas, or other anorectal conditions. Include procedure reports from colonoscopy, sigmoidoscopy, or anoscopy; operative reports from any hemorrhoidectomy or fistulotomy; pathology reports; and clinic notes from your gastroenterologist, colorectal surgeon, or primary care provider.

    before exam

  • critical

    Obtain recent laboratory results showing hemoglobin and hematocrit

    If your hemorrhoids have caused persistent bleeding, obtain a recent complete blood count (CBC) showing hemoglobin, hematocrit, and platelet levels. If you have been diagnosed with iron deficiency anemia attributable to rectal bleeding, ensure this is explicitly documented in a provider's note and bring those records. Normal hemoglobin for males is approximately 13.5-17.5 g/dL and for females approximately 12.0-15.5 g/dL.

    before exam

  • critical

    Document thrombosis episode frequency for the past 12-24 months

    Review your calendar, medical visit records, and pharmacy records to identify and count each distinct acute thrombosis episode. Record the approximate date, duration, severity, treatment used, and functional impact for each episode. Bring this written log to the exam. The threshold between 10% and 20% ratings depends on whether you have had 2 or fewer vs. 3 or more thrombosis episodes per year.

    before exam

  • critical

    Prepare a complete and current medication list

    List all medications used for your anorectal condition including topical treatments (hydrocortisone creams, suppositories, ointments), stool softeners, fiber supplements, laxatives, oral pain medications, and any prescription medications such as nitroglycerin ointment or calcium channel blockers for fissures. Include dosage, frequency, prescribing provider, and date first prescribed. The DBQ asks whether prescribed medications are being used for the condition.

    before exam

  • critical

    Write a structured personal statement describing your worst-day symptoms

    Prepare a written personal statement (buddy statement or lay statement) describing: (1) the number of thrombosis episodes in the past year with dates and severity; (2) the frequency and amount of rectal bleeding; (3) whether you have been told you are anemic due to bleeding; (4) the type and frequency of prolapse; (5) pain severity on worst days and its impact on work and daily life; (6) any anal itching, excoriation, or skin breakdown; (7) functional limitations at work, home, and socially. Submit this statement with your VA file before the exam if possible.

    before exam

  • critical

    Review the rating criteria for DC 7336 and DC 7337

    Understand what the VA evaluates under diagnostic codes 7336 (hemorrhoids) and 7337 (pruritus ani). Know the specific thresholds: 20% requires persistent bleeding plus anemia, or continuously prolapsed hemorrhoids with 3 or more thrombosis episodes per year; 10% requires prolapsed internal hemorrhoids with 2 or fewer thrombosis episodes per year, or external hemorrhoids with 3 or more thrombosis episodes per year. This knowledge helps you communicate the most relevant information to the examiner.

    before exam

  • recommended

    Identify and document all associated anorectal conditions

    The DBQ covers numerous additional conditions including anal fissures, anorectal fistulas, perianal abscesses, rectal prolapse, rectal stricture, pruritus ani, dyssynergic defecation, anismus, rectal neoplasms, and impairment of sphincter control. If you have any of these conditions in addition to hemorrhoids, ensure they are documented in your medical records and plan to report them during the exam.

    before exam

  • recommended

    Prepare for questions about surgical and procedural history

    Compile dates and descriptions of all anorectal procedures including rubber band ligation, sclerotherapy, infrared coagulation, hemorrhoidectomy, sphincterotomy, fistulotomy, abscess drainage, and any other interventions. The DBQ asks about surgery dates, most recent procedure dates, and anticipated completion of treatment. Having this information organized saves time during the exam.

    before exam

  • recommended

    Check your state's rules on recording C&P exams

    Many states permit veterans to record their C&P examination with proper notice. Research your state's recording consent laws. If recording is permitted, inform the examiner at the start of the appointment. Recording creates an accurate record of what was discussed and can be valuable if you need to appeal or request a new exam.

    before exam

  • critical

    Arrive early and request a private consultation space

    Arrive at least 15 minutes early. Anorectal conditions involve sensitive symptoms. You have the right to a private examination space. Request privacy before discussing your symptoms and inform the front desk staff if you have concerns about the examination environment.

    day of

  • critical

    Bring all documentation in a clearly organized folder

    Bring copies of medical records, lab results, medication list, thrombosis episode log, personal statement, and any photographs of external hemorrhoids or perianal excoriation taken by your treating provider. Organize documents by date and category for easy reference during the exam.

    day of

  • recommended

    Do not take prescription pain medications that would mask symptoms before the exam unless medically necessary

    If you are in active pain or having a flare-up on the day of the exam, do not suppress your symptoms with maximum doses of pain medication before the exam if the result would be that you cannot accurately describe or demonstrate your condition. You need to accurately represent your functional status. However, always follow your physician's medical guidance - never stop prescribed medications without consulting your provider.

    day of

  • critical

    Note your symptom status on the day of the exam

    If you are having a typical day, a good day, or a bad day on the date of the exam, tell the examiner. If today is not representative of your worst symptoms, clearly say so and describe what your worst days are like. The examiner should document the full range of your condition, not just your presentation on one day.

    day of

  • critical

    Report all symptoms completely - do not minimize due to embarrassment

    Anorectal symptoms including bleeding, discharge, prolapse, itching, excoriation, fecal soiling, and sphincter control problems must all be reported accurately. The examiner cannot rate what is not documented. Use clinical terms where you know them and describe symptoms plainly where you do not.

    during exam

  • critical

    Clearly state the number of thrombosis episodes in the past 12 months

    When the examiner asks about your condition history, proactively state: 'I have had [specific number] distinct acute thrombosis episodes in the past 12 months, occurring in approximately [months/dates].' Do not leave this to be inferred. The exact number is a binary rating threshold.

    during exam

  • critical

    Describe your worst-day functioning, not just your typical or medicated functioning

    When asked how your condition affects you, describe your worst days: worst pain level, worst bleeding episode, worst functional limitation. Then describe your typical or average day separately. This gives the examiner the complete range of your disability for accurate documentation.

    during exam

  • recommended

    Report pain and discomfort during the physical examination

    If the physical examination causes pain, tell the examiner. Pain during examination should be documented and is relevant to the overall assessment of your disability severity.

    during exam

  • critical

    Correct any inaccuracies in real time

    If the examiner states something that does not accurately reflect your condition - such as understating the frequency of your symptoms or mischaracterizing the type of prolapse - politely but clearly correct the record. For example: 'I want to clarify that my prolapse does not always reduce spontaneously; I often need to manually reduce it.'

    during exam

  • critical

    Request a copy of the completed DBQ

    You have the right to request a copy of the completed DBQ. Review it for accuracy, particularly the fields documenting thrombosis episode frequency, bleeding status, anemia, prolapse type, and functional impact. If you identify errors, you can submit a written request for a new examination or provide additional evidence.

    after exam

  • recommended

    Submit a supplemental personal statement if key symptoms were not addressed

    If the exam was shorter than expected or the examiner did not ask about important symptoms such as thrombosis frequency, anemia, prolapse type, or functional impact, submit a follow-up personal statement to your regional office documenting those facts along with any supporting medical evidence.

    after exam

  • recommended

    Follow up with your treating provider if new documentation is needed

    If the exam reveals gaps in your medical records - such as no documented hemoglobin values, no documented thrombosis episode count, or no explicit diagnosis of anemia related to bleeding - schedule a follow-up with your treating gastroenterologist or primary care provider to obtain that documentation and submit it as additional evidence.

    after exam

Your rights during a C&P exam

  • You have the right to a thorough and contemporaneous examination that accurately reflects the current severity of your condition. An inadequate examination that does not address all relevant rating criteria can be the basis for a request for a new examination.
  • You have the right to request a copy of your completed DBQ and to review it for accuracy before a rating decision is made.
  • You have the right to submit additional evidence, including personal statements, buddy statements, private medical opinions, and additional records, at any time before a final rating decision.
  • You have the right to request a new C&P examination if you believe the original examination was inadequate, relied on an inaccurate medical history, or failed to address key symptoms relevant to the rating criteria.
  • In many states you have the right to record your C&P examination. Research your state's consent laws before your appointment and notify the examiner at the start of the exam if you choose to record.
  • You have the right to bring a representative - such as a VSO (Veterans Service Organization) representative, accredited claims agent, or VA-accredited attorney - to your C&P examination as an observer.
  • You have the right to a private examination environment. You may request that the examination be conducted in a private room and that only necessary medical personnel be present.
  • You are not required to accept a rating decision. If you disagree with the assigned rating, you have the right to file a Notice of Disagreement and choose a review lane under the Appeals Modernization Act, including a direct review, evidence submission, or hearing before a Veterans Law Judge at the Board of Veterans' Appeals.
  • You have the right to receive a written explanation of how your rating was determined, including which evidence was considered and how it was weighed under the applicable diagnostic codes.
  • Under the benefit of the doubt standard (38 CFR 3.102), when there is an approximate balance of positive and negative evidence regarding any issue material to a determination, the benefit of the doubt shall be given to you as the claimant.

Related conditions

Get a personalized prep packet

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.

Get personalized prep

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.