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VA Rating Assistant

DC 6602 · 38 CFR 4.97

Respiratory Conditions (Asthma / COPD / Bronchitis) C&P Exam Prep

To document the current severity of your respiratory condition (asthma, COPD, or chronic bronchitis), establish or confirm its diagnosis, assess pulmonary function test results, and evaluate how your symptoms impact your daily functioning and ability to work.

Format:
Interview + Physical
Typical duration:
20-45 minutes
DBQ form:
Respiratory_Conditions_Other_than_Tuberculosis_and_Sleep_Apnea (Respiratory_Conditions_Other_than_Tuberculosis_and_Sleep_Apnea)
Examiner:
Pulmonologist or Physician

What the examiner evaluates

  • Current diagnosis and ICD code for claimed respiratory condition(s)
  • Pulmonary function test (PFT) results including FEV-1, FVC, FEV-1/FVC ratio, and DLCO
  • Frequency and severity of exacerbations or asthma attacks
  • Current medications including inhalational bronchodilators, anti-inflammatory inhalers, and systemic corticosteroids
  • Requirement for outpatient oxygen therapy
  • Episodes of acute respiratory failure or hospitalization
  • Presence of cor pulmonale, right ventricular hypertrophy, or pulmonary hypertension
  • Symptoms including productive cough, dyspnea, wheezing, hemoptysis, and chest tightness
  • Functional impact on occupational and daily activities
  • History of condition onset, course, and any in-service exposures
  • Nexus between current condition and military service

Pulmonary function tests (spirometry) will likely be performed at the same appointment or as a separate scheduled test. Bring your rescue inhaler and any maintenance inhalers to the exam. Do NOT use your short-acting bronchodilator within 4-6 hours of spirometry unless medically necessary - but always follow your doctor's guidance for safety first. The examiner will review your service treatment records, VA treatment records, and any private medical records submitted. Physical examination will include auscultation of the lungs, assessment of breathing effort, and observation for signs of accessory muscle use or barrel chest.

Measurements and tests

FEV-1 (Forced Expiratory Volume in 1 Second)

What it measures: The amount of air you can forcibly exhale in one second. Expressed as a percentage of your predicted normal value based on age, height, sex, and race. This is the single most important rating metric for asthma and COPD under 38 CFR 4.97.

What to expect: You will be asked to take the deepest breath possible and then blow out as hard and fast as you can into a spirometry device. This will be repeated at least 3 times for reproducibility. Results are reported as both raw liters and percent predicted. Post-bronchodilator testing may also be performed.

Critical thresholds

  • FEV-1 less than 40% predicted Supports 100% rating (DC 6602) or 100% rating (DC 6600)
  • FEV-1 40-55% predicted Supports 60% rating
  • FEV-1 56-70% predicted Supports 30% rating
  • FEV-1 71-80% predicted Supports 10% rating
  • FEV-1 greater than 80% predicted May result in 0% rating without other qualifying criteria

Tips

  • Do not use short-acting bronchodilator (albuterol) 4-6 hours before testing unless medically necessary for safety
  • Avoid caffeine, heavy exercise, and smoking for several hours before the test
  • Give maximum effort on every blow - the test depends entirely on your best effort
  • If you feel the test was not done correctly or you were not allowed to give full effort, politely inform the examiner
  • Request that both pre- and post-bronchodilator results be recorded, as VA rates on the most favorable result
  • If you have a bad respiratory day (infection, high pollen, etc.), inform the examiner - this is your 'worst day' presentation

Pain considerations: If forceful exhalation causes chest pain, chest tightness, coughing spasms, or dizziness, immediately inform the examiner so it is documented in the DBQ.

FEV-1/FVC Ratio (Tiffeneau-Pinelli Index)

What it measures: The ratio of FEV-1 to Forced Vital Capacity (total air exhaled). A low ratio indicates obstructive lung disease. Expressed as a percentage. An independent rating criterion separate from FEV-1 alone.

What to expect: Calculated automatically from the same spirometry maneuver as FEV-1. No additional effort required. Results will show both FVC in liters and FEV-1/FVC ratio as a percentage.

Critical thresholds

  • FEV-1/FVC less than 40% Supports 100% rating (DC 6602 or 6600)
  • FEV-1/FVC 40-55% Supports 60% rating
  • FEV-1/FVC 56-70% Supports 30% rating
  • FEV-1/FVC 71-80% Supports 10% rating

Tips

  • VA must use the most favorable test result among all qualifying criteria at each rating level
  • Even if FEV-1 alone does not qualify for a higher rating, the FEV-1/FVC ratio may independently qualify
  • Ensure the examiner records both metrics in the DBQ - omission of either is an error

Pain considerations: Alert the examiner if the forced exhalation causes bronchospasm or coughing fits that prevent a valid test - this itself is clinically significant and should be noted.

DLCO (SB) - Diffusion Capacity of the Lung for Carbon Monoxide, Single Breath Method

What it measures: How efficiently your lungs transfer gas from inhaled air to the bloodstream. Particularly relevant for COPD (DC 6600) and emphysema. A low DLCO indicates loss of functional lung tissue or surface area.

What to expect: You will inhale a small, safe amount of carbon monoxide gas, hold your breath for about 10 seconds, and then exhale. The test measures how much CO was absorbed. May be conducted separately from spirometry.

Critical thresholds

  • DLCO (SB) less than 40% predicted Supports 100% rating under DC 6600 (Chronic Bronchitis/COPD)
  • DLCO (SB) 40-55% predicted Supports 60% rating under DC 6600
  • DLCO (SB) 56-70% predicted Supports 30% rating under DC 6600

Tips

  • Particularly important for COPD/emphysema claims - ensure this test is ordered and results recorded
  • Do not smoke for at least 24 hours before this test as carboxyhemoglobin interferes with results
  • Report all respiratory symptoms you experience during and after the test

Pain considerations: Inform the examiner if breath-holding causes dizziness, lightheadedness, or significant discomfort - these are clinically relevant findings.

Exercise Capacity Testing (Maximum Oxygen Consumption, VO2 max)

What it measures: Maximum oxygen consumption in ml/kg/min during exertion, with cardiac or respiratory limitation. Used specifically under DC 6600 for COPD/Chronic Bronchitis rating.

What to expect: May involve a treadmill, stationary bicycle, or walking test with simultaneous monitoring of breathing and heart rate. Not always performed - the examiner must document why if not indicated.

Critical thresholds

  • Less than 15 ml/kg/min with cardiorespiratory limitation Supports 100% rating under DC 6600
  • 15-20 ml/kg/min with cardiorespiratory limitation Supports 60% rating under DC 6600

Tips

  • If exercise testing was not performed, ask the examiner to document the clinical reason on the DBQ
  • Describe your real-world exercise intolerance vividly - how many steps before shortness of breath, inability to climb stairs, etc.
  • Functional reports (buddy statements, personal statements) about activity limitation complement this test

Pain considerations: If exertion causes chest pain, severe dyspnea, or you require stopping before completion, ensure this is fully documented as it demonstrates exercise intolerance independent of test thresholds.

Rating criteria by percentage

100%

FEV-1 less than 40% predicted, OR FEV-1/FVC less than 40%, OR more than one asthma attack per week with episodes of respiratory failure, OR requires daily use of systemic (oral or parenteral) high-dose corticosteroids or immunosuppressive medications. For COPD (DC 6600): also DLCO (SB) less than 40% predicted, or maximum exercise capacity less than 15 ml/kg/min, or cor pulmonale, or right ventricular hypertrophy, or pulmonary hypertension (by echo/cath), or episodes of acute respiratory failure, or requires outpatient oxygen therapy.

Key symptoms

  • Near-constant or daily severe dyspnea
  • Multiple asthma attacks per week requiring emergency treatment
  • Episodes of respiratory failure requiring hospitalization
  • Dependence on daily systemic oral/parenteral corticosteroids or immunosuppressants
  • Requirement for home oxygen therapy
  • Cor pulmonale or right heart failure
  • Inability to perform minimal activities without severe breathlessness
  • Right ventricular hypertrophy confirmed by imaging
  • Pulmonary hypertension confirmed by echocardiogram or cardiac catheterization

From 38 CFR: Under DC 6602: Veteran requires daily prednisone or is admitted to the ER more than once a week for respiratory failure. Under DC 6600: Veteran on home oxygen and has documented cor pulmonale by echocardiogram.

60%

FEV-1 of 40-55% predicted, OR FEV-1/FVC of 40-55%, OR at least monthly physician visits for required care of exacerbations (asthma, DC 6602), OR intermittent courses of systemic corticosteroids at least 3 times per year (DC 6602). For COPD (DC 6600): also DLCO (SB) of 40-55% predicted, or maximum oxygen consumption of 15-20 ml/kg/min with cardiorespiratory limitation.

Key symptoms

  • Frequent exacerbations requiring physician visits at least monthly
  • Intermittent systemic steroid bursts (at least 3 per year)
  • Significant exercise intolerance limiting daily activities
  • Persistent shortness of breath with moderate exertion
  • Frequent productive cough with purulent sputum
  • Recurrent respiratory infections requiring antibiotics

From 38 CFR: Under DC 6602: Veteran has required prednisone burst 4 times in the past year and sees their pulmonologist monthly for uncontrolled asthma. Under DC 6600: FEV-1 measures 52% predicted on spirometry.

30%

FEV-1 of 56-70% predicted, OR FEV-1/FVC of 56-70%, OR daily inhalational or oral bronchodilator therapy, OR inhalational anti-inflammatory medication.

Key symptoms

  • Daily use of rescue or maintenance inhaler (albuterol, Symbicort, Advair, Spiriva, etc.)
  • Daily use of inhaled corticosteroids (ICS) such as fluticasone, budesonide
  • Dyspnea with moderate exertion (walking uphill, stairs)
  • Intermittent wheezing episodes
  • Morning chest tightness
  • Exercise-induced bronchospasm

From 38 CFR: Veteran uses albuterol rescue inhaler daily and fluticasone/salmeterol (Advair) twice daily for persistent asthma. FEV-1 measures 63% predicted.

10%

FEV-1 of 71-80% predicted, OR FEV-1/FVC of 71-80%, OR intermittent (not daily) inhalational or oral bronchodilator therapy. NOTE: In the absence of clinical findings at time of examination, a verified history of asthmatic attacks must be of record to receive any rating.

Key symptoms

  • Intermittent shortness of breath with exertion
  • Occasional wheezing episodes
  • As-needed use of rescue inhaler (not daily)
  • Seasonal or trigger-based exacerbations
  • Mild reduction in exercise tolerance

From 38 CFR: Veteran uses albuterol inhaler 2-3 times per week only when symptomatic with exertion or allergen exposure. FEV-1 measures 75% predicted.

Describing your symptoms accurately

Dyspnea (Shortness of Breath)

How to describe it: Be specific about what activities trigger your shortness of breath and how it has changed over time. Use concrete functional benchmarks: 'I can only walk half a block before I need to stop,' or 'I cannot climb one flight of stairs without stopping to catch my breath.' Describe both your average day and your worst days.

Example: On my worst days, I become short of breath just getting up from the couch to walk to the bathroom - approximately 20 feet. I have to stop and lean against the wall to recover. I cannot carry groceries, mow the lawn, or walk my dog. I sometimes wake up at night unable to breathe and have to sit upright for 30 minutes before I can lie back down.

Examiner listens for: Exertional vs. rest dyspnea, nocturnal symptoms, orthopnea (need to sit upright to breathe), activity limitations that map to functional impairment, frequency and duration of episodes.

Avoid: Saying 'I get a little winded sometimes' when you mean you are significantly limited. Describing only your best days. Failing to mention nighttime symptoms or awakenings due to breathing difficulty.

Asthma Attacks / Exacerbations

How to describe it: Document the number of attacks or exacerbations in the past 12 months. Specify whether they required emergency room visits, hospitalizations, oral steroid bursts, or physician office visits. Describe triggers (exercise, cold air, allergens, smoke, occupational exposures). Include any attacks during military service.

Example: In the past year, I had 5 episodes where my rescue inhaler was not enough to control my symptoms. Three of those required me to go to the urgent care clinic for oral steroids and a breathing treatment. One required an ER visit. During each attack, I cannot speak in full sentences, my lips sometimes turn blue, and I feel like I am breathing through a straw.

Examiner listens for: Frequency of attacks (more than one per week supports 100%), whether attacks result in respiratory failure, number of steroid bursts per year (3+ per year supports 60%), whether physician visits are monthly or more frequent.

Avoid: Minimizing the severity of attacks. Forgetting to count urgent care or telehealth visits as physician care. Not mentioning ER visits or hospitalizations.

Medication Requirements

How to describe it: List every inhaler and oral medication you take for your respiratory condition. Be precise: name the drug, dose, frequency, and whether it is daily or as-needed. Distinguish between rescue inhalers (albuterol/SABA), maintenance inhalers (ICS, LABA, LAMA), oral bronchodilators, and oral or injectable corticosteroids (prednisone, methylprednisolone). Bring your actual medication bottles or a medication list.

Example: I take Symbicort 160/4.5 twice every day without fail. I also use my albuterol rescue inhaler at least once daily, and on bad days, 4 or more times. Three times this year my pulmonologist prescribed a 5-day course of prednisone 40mg because my symptoms were out of control. Without all of these medications, I cannot function.

Examiner listens for: Daily vs. intermittent bronchodilator use (daily = 30%), daily inhalational anti-inflammatory medication (30%), systemic corticosteroid bursts (3+ per year = 60%), daily systemic high-dose steroids or immunosuppressants (100%).

Avoid: Saying 'I just use an inhaler' without specifying frequency. Forgetting to mention oral steroid prescriptions received from urgent care or primary care. Failing to list all inhalers including maintenance medications.

Productive Cough and Sputum Production

How to describe it: For chronic bronchitis, describe the frequency, duration, and character of your cough. Note whether sputum is produced, its color (clear, yellow, green = purulent), and whether it is blood-tinged. Describe how long you have had a chronic cough (chronic bronchitis is defined as productive cough for 3+ months in 2+ consecutive years).

Example: I cough productively every morning for at least 30 to 45 minutes before I can clear enough mucus to breathe comfortably. The sputum is usually thick and yellowish-green. On bad days, I cough throughout the day and have sometimes coughed so hard I vomited or noticed streaks of blood in the mucus.

Examiner listens for: Chronic productive cough consistent with chronic bronchitis diagnosis, frequency and character of sputum, presence of hemoptysis, whether cough disrupts sleep or daily activities.

Avoid: Dismissing cough as 'just a cough.' Not mentioning blood-tinged sputum. Failing to describe how long the cough has persisted.

Functional Limitations and Daily Life Impact

How to describe it: Describe specific activities you can no longer do or that are severely limited because of your breathing condition. Include occupational impact (unable to work, had to change jobs, missed work days), social impact (avoiding activities that trigger symptoms), and personal care impact (difficulty showering, dressing, walking around the house).

Example: I had to leave my job as a construction foreman because I could not tolerate dust, fumes, or prolonged physical exertion. I now work a sedentary desk job but still miss approximately 2 days per month due to exacerbations. I cannot play with my grandchildren, walk more than one block, or attend outdoor events in cold weather. I sleep in a recliner because lying flat makes my breathing worse.

Examiner listens for: Specific functional limitations that correlate with pulmonary impairment, occupational impact, social and recreational restrictions, whether the veteran can perform activities of daily living independently.

Avoid: Saying 'I manage okay' when you have significantly modified your life around your breathing limitations. Not describing occupational restrictions or job changes related to the condition.

Wheezing, Chest Tightness, and Other Symptoms

How to describe it: Describe wheezing (audible whistling sound when breathing), chest tightness, chest pain with exertion, and any other symptoms. Note frequency, triggers, and duration. Include any symptoms that occur at rest versus only with exertion.

Example: My chest tightens every morning when I wake up, and I can hear myself wheezing without a stethoscope. During cold weather or when I am around any smoke or strong smells, the wheezing becomes so loud my family can hear it across the room. I experience chest pressure that I would describe as a 7/10 on bad days.

Examiner listens for: Whether wheezing is present at rest or only with exertion, whether it is audible to others, presence of barrel chest or accessory muscle use on physical exam, cyanosis.

Avoid: Not mentioning audible wheezing. Failing to describe chest pain or tightness that accompanies breathing difficulty.

Common mistakes to avoid

Using your rescue inhaler before spirometry testing

Why: Short-acting bronchodilators (albuterol) temporarily open airways and artificially improve FEV-1 results, potentially masking the true severity of obstruction and resulting in a lower rating.

Do this instead: Unless medically unsafe, avoid using short-acting bronchodilators for 4-6 hours before spirometry. Always tell the examiner your last dose time so pre-bronchodilator vs. post-bronchodilator results are properly labeled. Discuss with your regular physician first if withholding is medically risky.

Impact: Can affect the difference between 30%, 60%, and 100% ratings

Reporting only your best or 'average good' days rather than your worst days

Why: VA rating is based on the overall severity of your condition, and M21-1 guidance supports evaluating the condition at its worst typical presentation. Minimizing symptoms leads to an underestimate of true disability.

Do this instead: Before the exam, write down your three worst episodes in the past year in detail. Describe them accurately to the examiner. Bring a symptom diary if you keep one.

Impact: Affects all rating levels, most critically 60% vs. 100%

Forgetting to report all steroid burst prescriptions from urgent care, ER, or primary care

Why: The number of systemic corticosteroid courses per year is a direct rating criterion. Three or more courses per year supports 60%. Daily systemic steroids supports 100%. Prescriptions from non-VA providers or urgent care may not be in the VA record.

Do this instead: Gather pharmacy records showing all prednisone, methylprednisolone, or other systemic steroid prescriptions. Submit them to VA before the exam or bring copies to the appointment.

Impact: Critical for 60% and 100% ratings under DC 6602

Not mentioning hospitalization or ER visits for respiratory failure

Why: Episodes of acute respiratory failure and hospitalizations are independent criteria for 100% rating under DC 6600. These events are often underreported, especially if they occurred at civilian hospitals not captured in VA records.

Do this instead: Compile dates and records of all hospitalizations, ER visits, or urgent care visits for respiratory emergencies. Submit hospital records or bring them to the exam.

Impact: Critical for 100% rating under DC 6600

Saying 'I just use an inhaler sometimes' without specifying daily versus as-needed use

Why: Daily bronchodilator or anti-inflammatory inhaler use is a standalone criterion for 30% rating. Intermittent use supports only 10%. The distinction is critical.

Do this instead: Be explicit: 'I use my albuterol inhaler every day, multiple times a day' or 'I use Advair every morning and every night without exception, as prescribed.' Bring your inhalers to show the examiner.

Impact: Determines difference between 10% and 30% ratings

Not giving maximum effort during spirometry

Why: Spirometry results depend entirely on the patient's maximal effort. Submaximal effort produces falsely low lung function values, but more importantly, submaximal effort may not accurately represent your true condition and can be flagged as inconsistent.

Do this instead: Breathe in as deeply as possible, blast out as hard and fast as you can, and continue exhaling for as long as the technician instructs (usually 6 seconds). The goal is accurate documentation of your actual condition.

Impact: Affects all spirometry-based rating levels

Failing to document the functional impact of the condition on work and daily activities

Why: The DBQ has a specific section for functional impact. An examiner who does not ask about it still must complete it. If functional impact is not captured, the rating decision may be lower than warranted, and it provides weaker evidence for TDIU if applicable.

Do this instead: Proactively describe how the condition affects your ability to work, complete household tasks, participate in social activities, exercise, and care for yourself. Use specific examples and concrete limitations.

Impact: Affects TDIU eligibility and overall combined rating

Not mentioning oxygen therapy requirements

Why: Requirement for outpatient oxygen therapy is a standalone criterion for 100% rating under DC 6600. Veterans sometimes do not report this because it seems routine or they think it is already in the records.

Do this instead: If you use home oxygen or supplemental oxygen during activity, explicitly tell the examiner. Bring your oxygen prescription or equipment documentation if available.

Impact: Critical for 100% rating under DC 6600

Prep checklist

  • critical

    Gather all pulmonary function test (PFT) records from the past 2-3 years

    Collect spirometry results, DLCO tests, and any exercise capacity tests from VA and private providers. PFT results from your regular treating pulmonologist may show worse values than a one-time exam-day test, especially if taken during an exacerbation. Submit these to your VA file before the exam.

    before exam

  • critical

    Compile complete medication list with doses and frequencies

    List every respiratory medication: all inhalers (rescue and maintenance), oral corticosteroids, oral bronchodilators, leukotriene modifiers, biologics (dupilumab, mepolizumab, etc.), and any other prescribed medications. Note how often you actually use each medication versus how often prescribed.

    before exam

  • critical

    Document all hospitalizations and ER visits for respiratory causes

    List dates, facilities, diagnoses, and treatments for all hospital admissions, ER visits, and urgent care visits related to asthma attacks, COPD exacerbations, respiratory failure, or pneumonia. Obtain discharge summaries if possible and submit to VA.

    before exam

  • critical

    Record all systemic steroid prescriptions in the past 12 months

    Gather pharmacy records showing every prescription for prednisone, methylprednisolone, dexamethasone, or other systemic corticosteroids. Count the total number of separate courses. Three or more per year is a direct 60% criterion for asthma (DC 6602).

    before exam

  • critical

    Write a detailed personal statement describing symptoms and functional limitations

    Using VA Form 21-4138 or a signed personal statement, document your worst-day symptoms, activity limitations, occupational impact, frequency of exacerbations, medications, and how the condition has progressed since service. Submit before the exam.

    before exam

  • recommended

    Obtain buddy statements from family members or coworkers who have witnessed symptoms

    Statements from people who have witnessed your attacks, oxygen use, activity limitations, or hospitalizations add lay evidence to your claim. Particularly valuable if they describe symptoms not otherwise documented.

    before exam

  • critical

    Identify and document any in-service exposures that may have caused or worsened your condition

    Document any in-service exposure to burn pits, toxic chemicals, industrial fumes, smoke, asbestos, Agent Orange, sand and dust, or other respiratory hazards. Note locations and dates. This is essential for establishing service connection.

    before exam

  • recommended

    Review the 38 CFR 4.97 rating criteria for your specific condition

    Understand exactly what criteria support each rating level for DC 6602 (Asthma) or DC 6600 (Chronic Bronchitis/COPD). Know which level you believe your condition meets and be prepared to clearly describe the symptoms that support that level.

    before exam

  • optional

    Research your state's laws on recording C&P examinations

    Many states allow recording with one-party consent. If you have the right to record, plan to bring a smartphone or recording device. Inform the examiner at the start of the appointment. Check your state's laws at a legal aid resource before the exam.

    before exam

  • critical

    Avoid using short-acting bronchodilators (albuterol) for 4-6 hours before spirometry if medically safe

    Short-acting bronchodilators temporarily improve FEV-1 and may mask true severity. Consult your treating physician before the exam about whether it is safe to withhold. If you must use your inhaler for safety, tell the examiner the exact time of last use so results are properly labeled as post-bronchodilator.

    day of

  • critical

    Bring all inhalers and respiratory medications to the appointment

    Having the actual medications present helps ensure they are accurately documented on the DBQ. The examiner can verify names, doses, and formulations. This also demonstrates the complexity of your medication regimen.

    day of

  • critical

    Arrive in your typical condition - do not try to appear healthier than you are

    Wear comfortable clothing. Do not push through fatigue or breathlessness to appear functional. If you are having a bad breathing day, that is medically relevant information. Do not time your medications to minimize symptoms at the exam.

    day of

  • recommended

    Bring your written symptom summary and medication list

    Having written notes prevents forgetting important details during the exam when you may be anxious or fatigued. Offer the examiner a copy and ask that it be noted in the record.

    day of

  • recommended

    Avoid heavy exercise, smoking, and caffeine before spirometry

    Heavy exercise within 4 hours can temporarily improve lung function. Smoking irritates airways and alters results. Caffeine has mild bronchodilator properties. Avoid all three on the day of testing for accurate baseline results.

    day of

  • critical

    Give maximum effort during spirometry but report any symptoms it causes

    Blow out as hard, fast, and long as you can. However, if the exertion causes chest pain, bronchospasm, severe coughing, or dizziness, immediately tell the examiner so it is documented. These reactions are clinically significant.

    during exam

  • critical

    Describe your worst-day symptoms, not your average or best days

    When the examiner asks how you are doing, describe your condition as it is on your worst typical days - the days that best represent your disability. Per M21-1 guidance, the rating should reflect the true impact of the condition, including bad days.

    during exam

  • critical

    Report all symptoms comprehensively - do not wait to be asked

    Proactively mention dyspnea, wheezing, productive cough, hemoptysis, chest tightness, nocturnal symptoms, oxygen use, functional limitations, and any complications (cor pulmonale, pulmonary hypertension, etc.). If the examiner does not ask, volunteer the information.

    during exam

  • critical

    Clearly state the functional impact on your work and daily activities

    The DBQ has a section specifically for functional impact. Tell the examiner exactly what activities you can no longer do or that are severely limited: walking distances, climbing stairs, carrying objects, working, exercising, socializing, sleeping flat, etc.

    during exam

  • recommended

    Ask the examiner to confirm they are documenting all reported symptoms

    It is appropriate to politely ask, 'Are you noting that symptom in the report?' or 'Will that be included in the DBQ?' You have the right to ensure your reported symptoms are accurately captured.

    during exam

  • recommended

    Write down everything that was discussed while memory is fresh

    Immediately after the exam, document what questions were asked, what the examiner said, what tests were performed, and whether any of your symptoms appeared to be minimized or omitted. This is important if you need to challenge a negative exam.

    after exam

  • critical

    Request a copy of the completed DBQ through your VSO or myVA access

    Once the C&P exam results are uploaded to your VA file (usually within days to weeks), you can access them through VA.gov or your VSO. Review the DBQ for accuracy. If symptoms you reported are missing or inaccurate, work with your VSO to request a supplemental exam or submit a statement identifying the discrepancy.

    after exam

  • recommended

    Contact your VSO if the exam appeared inadequate

    If the exam was very short (under 10 minutes), the examiner seemed dismissive, failed to perform spirometry, or did not ask about functional impact, your VSO can help you challenge the exam as inadequate and request a new one under M21-1 standards.

    after exam

  • recommended

    Continue documenting symptoms and seek regular treatment

    Regular VA or private medical treatment creates an ongoing paper trail of your condition. Missed appointments can be used against you in a rating decision. Continue attending scheduled appointments and ensuring exacerbations are documented in medical records.

    after exam

Your rights during a C&P exam

  • You have the right to record your C&P examination in most states - verify your state's one-party consent laws before the exam and notify the examiner at the start of the appointment.
  • You have the right to submit your own private medical evidence, including PFT results, physician statements, and nexus letters, which VA must weigh alongside the C&P examiner's opinion.
  • You have the right to request a copy of your completed DBQ through the VA's records request process (VA Form 20-10206) or via VA.gov after it is uploaded to your claim file.
  • You have the right to challenge an inadequate C&P examination. If the examiner failed to perform required tests (such as spirometry), did not address all claimed conditions, or conducted an unreasonably brief exam, you can request a new exam through your VSO.
  • You have the right to bring a VSO representative, accredited claims agent, or attorney to your C&P examination as an observer.
  • You have the right to submit a personal statement (VA Form 21-4138) describing your symptoms, functional limitations, and in-service nexus before and after the examination.
  • You have the right to the benefit of the doubt - under 38 U.S.C. - 5107(b), when there is an approximate balance of positive and negative evidence, VA must resolve the doubt in your favor.
  • You have the right to request that VA obtain an independent medical opinion or order additional testing if you believe the initial examination was insufficient or incorrect.
  • Under the PACT Act, if you have qualifying in-service exposure to burn pits, Agent Orange, or other toxic substances, you may be entitled to presumptive service connection for certain respiratory conditions without proving a direct nexus.
  • You have the right to an effective date back to your original claim date if a grant of service connection is made on appeal, preserving your potential retroactive benefits.
  • You have the right to request a higher-level review or Board of Veterans' Appeals hearing if you disagree with your rating decision, with the opportunity to submit new evidence in the supplemental claim lane.

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.