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VA Rating Assistant

DC 7328 · 38 CFR 4.114

Small Intestine Resection C&P Exam Prep

To accurately document the current severity and functional impact of your small intestine resection for VA disability rating purposes under 38 CFR - 4.114, DC 7328. The examiner will assess your post-surgical status, any ongoing symptoms, nutritional deficiencies, need for supplementation or parenteral nutrition, and how the condition affects your daily life and work capacity.

Format:
Interview + Physical
Typical duration:
20-30 minutes
DBQ form:
intestines (intestines)
Examiner:
Gastroenterologist or Physician

What the examiner evaluates

  • Confirmation of small intestine resection and surgical history including type, extent, and date
  • Whether short bowel syndrome is present and its severity (high vs. without high output syndrome)
  • Current symptoms including diarrhea frequency, abdominal pain, bloating, nausea, and vomiting
  • Nutritional status including BMI, weight loss, anemia, vitamin deficiencies, and hypocalcemia
  • Need for prescribed oral dietary supplementation, enteral tube feeding, or total parenteral nutrition (TPN)
  • Presence of peritoneal adhesions and any complications such as obstruction, abscess, or fistula
  • Whether the condition results in an inability to work
  • Frequency of emergency treatment or hospitalizations for intestinal episodes
  • Presence of an ileostomy or colostomy
  • All current medications used to manage the condition
  • Laboratory results including CBC, hemoglobin, hematocrit, white blood cell count, and platelets
  • Systemic manifestations such as weakness, fatigue, dermatitis, and lymph node enlargement
  • Functional impact on daily activities and occupational capacity

The exam will be conducted by a gastroenterologist or general physician, typically at a VA facility or contract examination site. The examiner will review your medical records, conduct a focused physical examination, and interview you about your current symptoms and functional limitations. Bring all relevant records, medication lists, and surgical documentation. You have the right to request that the exam be recorded in most states.

Measurements and tests

Body Mass Index (BMI)

What it measures: Nutritional status and degree of undernutrition resulting from malabsorption following small intestine resection

What to expect: The examiner will measure or record your current height and weight to calculate BMI. Values below 18 or below 16 are tied directly to specific rating thresholds.

Critical thresholds

  • BMI less than 16 Meets criteria for severe undernutrition at higher rating levels
  • BMI 16 to 18 inclusive Meets criteria for moderate undernutrition relevant to mid-tier ratings
  • BMI above 18 Does not meet BMI-based undernutrition threshold; other symptom criteria still apply

Tips

  • Weigh yourself regularly before the exam and track your lowest consistent weight
  • Report any unintentional weight loss since surgery, even if your current weight has stabilized
  • If you have lost significant weight on your worst days or during flare-ups, communicate this clearly
  • Bring any records of historical weights from treating providers showing a downward trend

Pain considerations: N/A for BMI measurement itself, but abdominal pain and discomfort after eating may directly drive nutritional deficits; be sure to connect these symptoms to your inability to maintain adequate weight.

Complete Blood Count (CBC)

What it measures: Anemia, leukocytosis, and platelet abnormalities related to malabsorption and nutritional deficiencies following small intestine resection

What to expect: The examiner may review prior CBC results from your medical records. Values for hemoglobin, hematocrit, white blood cell count, and platelets will be noted on the DBQ. A new blood draw may or may not occur at the exam.

Critical thresholds

  • Low hemoglobin / low hematocrit Supports anemia related to malabsorption, which is a documented systemic manifestation that can influence severity rating
  • Elevated white blood cell count (leukocytosis) May indicate active inflammation or infection, potentially supporting higher-severity findings

Tips

  • Bring copies of any recent lab results, especially if obtained within the past 12 months
  • Ask your treating gastroenterologist or primary care provider for updated labs prior to the exam if none are recent
  • Note whether your anemia has required treatment such as iron infusions or B12 injections, as this demonstrates severity

Pain considerations: Anemia from malabsorption can cause fatigue, weakness, and reduced ability to perform daily tasks; accurately connect these symptoms to your lab findings when describing functional impact.

Nutritional and Vitamin Level Assessment

What it measures: Presence of nutritional deficiencies, low vitamin levels (e.g., B12, D, A, K), and hypocalcemia resulting from malabsorption

What to expect: The examiner will inquire about and review laboratory evidence of vitamin and mineral deficiencies. This may include B12, folate, fat-soluble vitamins, and calcium levels.

Critical thresholds

  • Documented low vitamin levels (e.g., B12 deficiency) Supports systemic manifestations of malabsorption; contributes to higher severity documentation
  • Hypocalcemia Documents significant malabsorptive consequence; relevant to higher rating levels

Tips

  • Bring records of all vitamin supplement prescriptions, especially if prescribed by a physician rather than self-initiated
  • Distinguish between prescribed oral dietary supplementation and over-the-counter vitamins you take on your own
  • If you require B12 injections due to inability to absorb oral B12, this is a significant finding to communicate

Pain considerations: Nutritional deficiencies can cause neurological symptoms, bone pain, muscle cramps, and fatigue; describe how these affect your ability to function on your worst days.

Stool Output Frequency and Characteristics

What it measures: Severity of diarrhea, short bowel syndrome with high output, and functional bowel disruption

What to expect: The examiner will ask you to describe your bowel movements, including frequency, consistency, urgency, and whether you experience explosive or uncontrollable episodes. This is a clinical history assessment, not a laboratory test.

Critical thresholds

  • 4 or more episodes of diarrhea per day Meets threshold criteria for higher rating levels under post-resection symptoms
  • High output syndrome (short bowel syndrome) Distinguishes more severe short bowel syndrome and supports higher rating levels
  • Watery bowel movements difficult to predict or control Supports functional impairment documentation

Tips

  • Keep a bowel diary for 1-2 weeks before your exam to accurately document frequency on typical and worst days
  • Note whether urgency prevents you from leaving the house, attending work, or sleeping through the night
  • Describe whether explosive bowel movements occur with little or no warning
  • Report any episodes of fecal incontinence accurately and without understatement

Pain considerations: The unpredictability and urgency of diarrhea episodes may cause significant anxiety, social isolation, and work limitations; these functional consequences are relevant to your overall disability picture.

Rating criteria by percentage

100%

Under DC 7328, rated as DC 7329 (large intestine resection) if it produces a higher rating, or as celiac disease under DC 7355 if applicable. At the 100% level under analogous criteria: requiring complete dependence on total parenteral nutrition (TPN), or short bowel syndrome with high output syndrome requiring TPN, or condition resulting in an inability to work with severe malabsorption. Essentially the most severe manifestation with near-total loss of intestinal function.

Key symptoms

  • Complete dependence on total parenteral nutrition (TPN)
  • Short bowel syndrome with high output syndrome
  • Severe undernutrition with BMI less than 16
  • Requiring continuous TPN for extended periods
  • Inability to work due to severity of condition
  • Recurrent emergency treatment for intestinal episodes
  • Permanent ileostomy with complications
  • Severe systemic manifestations including profound anemia, weakness, and fatigue

From 38 CFR: Analogous rating to DC 7329 at 100%: symptom complex so severe as to preclude any employment; complete dependence on artificial nutritional support. Alternatively, rated under DC 7355 for celiac disease at 100% if applicable and produces higher rating.

60%

Severe manifestation with significant nutritional consequences and ongoing functional impairment. Short bowel syndrome without high output syndrome but with significant symptoms; or malabsorption syndrome causing weakness interfering with daily activities; or requiring enteral nutrition (tube feeding); or BMI 16-18 with significant systemic manifestations. Frequent diarrhea requiring dietary management.

Key symptoms

  • Short bowel syndrome without high output syndrome
  • BMI of 16 to 18 inclusive
  • Requiring enteral nutrition or tube feeding
  • Malabsorption syndrome causing weakness that interferes with activities
  • Four or more diarrhea episodes per day
  • Nutritional deficiencies including anemia, low vitamins, hypocalcemia
  • Recurrent dehydration requiring intravenous fluids (more than 2 episodes)
  • Requiring prescribed oral dietary supplementation
  • Episodic abdominal pain and diarrhea due to lactase or pancreatic enzyme deficiency

From 38 CFR: Analogous to DC 7329 at 60%: four or more loose stools daily with systemic manifestations such as weakness, anemia, or vitamin deficiency; or requiring continuous medication. Significant impact on ability to maintain nutrition through normal means.

40%

Moderate manifestation with ongoing symptoms managed through dietary modification and medication. Malabsorption syndrome causing chronic diarrhea managed with dietary changes; recurrent episodes of diarrhea; abdominal pain; requiring continuous medication for management. Functional impact present but condition is manageable on outpatient basis.

Key symptoms

  • Malabsorption syndrome causing chronic diarrhea managed by dietary modifications
  • Recurrent episodes of diarrhea
  • Recurrent abdominal pain
  • Requiring continuous medication
  • Abdominal bloating and distention
  • Nausea managed by medical treatment
  • Change in stool frequency or form
  • Weakness and fatigue without meeting higher threshold criteria
  • Low vitamin levels requiring supplementation

From 38 CFR: Analogous to DC 7329 at 40%: chronic diarrhea requiring dietary restrictions; episodes of abdominal pain and cramping; condition managed on outpatient basis with medications and dietary changes. Moderate impact on daily activities.

20%

Mild manifestation with minimal symptoms, managed by diet and/or medication. Occasional abdominal discomfort, mild dietary restrictions, no significant nutritional deficiencies. Condition is largely controlled but still present.

Key symptoms

  • Mild or occasional abdominal discomfort
  • Managed by diet and medication without ongoing complications
  • Minimal change in stool frequency
  • No significant nutritional deficiencies
  • Condition requires dietary attention but does not significantly limit function

From 38 CFR: Analogous to DC 7329 at 20%: mild symptoms managed by diet and medication; occasional loose stools; no systemic manifestations; condition largely controlled.

10%

Post-resection status with no or minimal current symptoms. Asymptomatic or with only occasional mild symptoms not significantly affecting quality of life. Condition exists as a matter of record but produces minimal functional impairment.

Key symptoms

  • Status post resection, asymptomatic
  • No current nutritional deficiencies
  • No requirement for dietary supplementation or medication for symptoms
  • Postoperative asymptomatic status

From 38 CFR: Analogous to DC 7329 at 10%: postoperative status with no significant symptoms; asymptomatic resection with intact nutritional status.

Describing your symptoms accurately

Diarrhea and Bowel Frequency

How to describe it: Describe diarrhea in terms of specific frequency per day (e.g., '6-8 loose bowel movements daily'), consistency (watery, liquid), presence of urgency, and whether episodes are difficult to predict or control. Distinguish between your average day and your worst days. Mention whether urgency causes accidents or prevents you from leaving the house.

Example: On my worst days, I have 8 to 10 watery bowel movements. I cannot leave the house because I have less than 30 seconds of warning before I need a bathroom. I have had accidents at work and have had to leave social events early. I wake up 2 to 3 times per night with diarrhea, leaving me exhausted.

Examiner listens for: Specific frequency counts, whether episodes are watery or formed, presence of urgency or incontinence, impact on sleep, work, and social activities, and whether symptoms are controlled or uncontrolled with current treatment.

Avoid: Do not say 'I have loose stools sometimes' without quantifying frequency. Do not omit nighttime episodes. Do not say your diarrhea is 'managed' if you still have multiple daily episodes despite treatment.

Abdominal Pain and Cramping

How to describe it: Describe the location, character (cramping, sharp, dull, constant, intermittent), severity on a 0-10 scale, triggering factors (meals, activity), duration of episodes, and how pain limits your ability to eat, work, or perform daily activities. State whether pain is daily or episodic and how long episodes last.

Example: On bad days I have severe cramping that starts within 30 minutes of eating any meal. The pain is an 8 out of 10 and causes me to double over. I cannot eat a normal meal without anticipating pain, so I avoid eating in public or at work. On these days I am unable to stand for prolonged periods or concentrate on tasks.

Examiner listens for: Frequency, severity, relationship to meals, duration, and how pain interferes with eating, working, and activities of daily living. The examiner is noting whether pain is intermittent or constant and whether it drives avoidance behavior.

Avoid: Do not minimize pain by saying 'it's tolerable.' Do not forget to mention that pain leads you to skip meals, which contributes to nutritional deficiencies and weight loss.

Nutritional Deficiencies and Weight Loss

How to describe it: Report your current weight, your pre-illness weight, and any documented weight loss since surgery. Describe any prescribed dietary supplements, vitamin injections, or special formulas. Explain any doctor-prescribed dietary restrictions (e.g., low-fat, low-fiber, lactose-free). Report specific vitamin or mineral deficiencies documented in laboratory tests.

Example: I have lost 35 pounds since my surgery and cannot maintain weight despite eating as much as I can tolerate. My doctor has prescribed high-calorie oral supplements because I cannot absorb enough nutrition from regular food. My B12 level was critically low and I now receive monthly injections. My calcium is chronically low and I take prescription calcium supplements.

Examiner listens for: Whether supplementation is prescribed (versus self-initiated), documented laboratory evidence of deficiencies, degree of weight loss, BMI, and whether the veteran has progressed to requiring tube feeding or TPN.

Avoid: Do not describe prescribed supplements as 'just vitamins I take.' Clarify that they were prescribed by a physician due to documented deficiencies. Do not omit prescription dietary formulas or special medical foods.

Fatigue and Weakness

How to describe it: Describe fatigue in concrete functional terms: how many hours you can stand, walk, or work before becoming exhausted; whether you need to rest during the day; how fatigue affects your ability to maintain employment; and whether weakness affects your physical strength or coordination.

Example: On my worst days I am so fatigued that I cannot work a full day. I have to rest for 1 to 2 hours in the afternoon. I have called in sick to work multiple times per month because of exhaustion combined with uncontrolled diarrhea. I cannot perform physical tasks that require sustained effort because my stamina is severely reduced.

Examiner listens for: Whether fatigue and weakness are documented as systemic manifestations of malabsorption, how they limit occupational and daily functioning, and whether they constitute an inability to work.

Avoid: Do not say 'I get tired.' Quantify: how many hours can you function, how many days per month does fatigue prevent normal activity, and what tasks have you given up because of weakness.

Nausea and Vomiting

How to describe it: State the frequency of nausea (daily, episodic), whether it results in vomiting, whether it is managed with medication, and how it affects your ability to eat adequate nutrition. Distinguish between nausea that is constantly present versus episodes triggered by meals.

Example: I experience nausea every day after eating. About three times per week the nausea leads to vomiting, which means I lose whatever I have just eaten. My doctor has prescribed anti-nausea medication but it only partially controls the symptoms. On my worst days I cannot eat at all due to nausea and vomiting.

Examiner listens for: Whether nausea and vomiting are recurrent, whether they require medical management, and how they contribute to nutritional deficits and weight loss.

Avoid: Do not omit the connection between nausea, vomiting, and your inability to maintain adequate nutrition. Do not fail to mention that your anti-nausea medications were prescribed specifically for this condition.

Functional Impact on Work and Daily Life

How to describe it: Describe specific job tasks you cannot perform, how many days per month you miss work, whether you have lost employment or been unable to maintain employment, and what daily activities (grocery shopping, cooking, socializing, travel) are limited by your condition.

Example: My condition has prevented me from maintaining full-time employment. I cannot work in environments without immediate bathroom access. I have missed more than 10 days of work in the past six months due to diarrhea, pain, and fatigue. I cannot travel by car for more than 20 minutes without planning bathroom access. I no longer attend family gatherings because of unpredictable bowel urgency.

Examiner listens for: Specific functional limitations tied directly to the gastrointestinal condition, occupational impact, and whether the condition results in an inability to work or maintain gainful employment.

Avoid: Do not say 'I manage okay at work' if you have accommodations, have reduced your hours, or have changed jobs because of this condition. Report the accommodations and limitations accurately.

Hospitalization and Emergency Treatment

How to describe it: List all hospitalizations related to your intestinal condition in the past 12 months, including dates, locations, and reasons (dehydration, obstruction, infection). Report any emergency department visits for intestinal episodes. Quantify: how many times, for how long, and for what reason.

Example: In the past year I have been hospitalized twice for severe dehydration requiring intravenous fluids. I have gone to the emergency room three additional times for severe abdominal cramping and uncontrolled diarrhea. Each hospitalization lasted 2 to 3 days.

Examiner listens for: Whether hospitalizations occur at least once per year, whether emergency treatment is recurrent, and whether dehydration requiring IV fluids has occurred more than twice - all of which are documented thresholds on the DBQ.

Avoid: Do not omit emergency department visits that did not result in admission. Do not approximate - bring specific dates and hospital names if possible.

Common mistakes to avoid

Reporting only average symptoms instead of worst-day symptoms

Why: VA rating is based on the full picture of disability, including how the condition affects you at its worst. Reporting only your best or average days leads to an underestimate of severity.

Do this instead: Describe your condition on its worst days clearly and accurately. Per M21-1 guidance, the examiner should document the range of your condition including peak severity. Say: 'On my worst days, which occur approximately [X] times per month, I experience...'

Impact: All levels - particularly the difference between 20% and 60%

Failing to quantify diarrhea frequency with a specific number

Why: The DBQ has specific checkboxes for '4 or more episodes of diarrhea per day' which is a threshold criterion for higher ratings. Vague statements like 'frequent diarrhea' will not trigger these fields.

Do this instead: State a specific number: 'I have 5 to 7 loose bowel movements per day on average, and 8 to 10 on bad days.' Keep a bowel diary before the exam.

Impact: 40% vs. 60% threshold

Not distinguishing between prescribed dietary supplementation and over-the-counter vitamins

Why: The DBQ specifically asks whether the veteran requires 'prescribed oral dietary supplementation.' Self-initiated vitamins do not meet this threshold. Failure to clarify this distinction can result in the examiner not checking the correct field.

Do this instead: Bring your prescription records and clearly state: 'These supplements were prescribed by my doctor because of documented malabsorption and deficiency - they are not over-the-counter vitamins I chose to take on my own.'

Impact: 40% vs. 60%

Minimizing or omitting the need for TPN or enteral tube feeding

Why: Requirement for TPN or tube feeding is associated with the highest rating levels. Veterans who have required TPN even temporarily may not volunteer this information, significantly underrepresenting severity.

Do this instead: Report all periods of TPN or tube feeding, including temporary courses ordered during acute episodes. Bring records with start and end dates.

Impact: 60% vs. 100%

Omitting hospitalizations and emergency visits

Why: The DBQ has specific fields for recurrent emergency treatment and hospitalization at least once per year. These are rating-determinative and will not be captured if you do not report them.

Do this instead: Compile a list of all hospital admissions and ED visits related to your intestinal condition in the past 12 months. Include dates, facilities, and reason for visit.

Impact: 40% vs. 60% and higher

Not mentioning the inability to work or specific occupational limitations

Why: The DBQ has a specific field asking whether the condition results in an inability to work, and requires the examiner to describe how the condition prevents employment. If you do not raise this, the examiner may not address it.

Do this instead: Clearly and specifically describe how your condition limits your ability to maintain employment, including missed workdays, need for bathroom proximity, dietary restrictions at work, and fatigue affecting productivity.

Impact: Higher rating levels and TDIU eligibility

Failing to report post-resection complications such as peritoneal adhesions or fistulous disease

Why: These complications have separate DBQ fields and can support additional ratings or secondary conditions. Veterans may not know to report adhesion-related obstructions as a distinct complication.

Do this instead: Report any history of bowel obstruction, abdominal adhesions, or fistulous tracts that developed after your resection. Bring surgical and imaging records documenting these findings.

Impact: All levels; may support separate ratings

Saying you are 'doing okay' when asked how you are doing at the start of the exam

Why: Social politeness can undermine your claim. An examiner may document this as evidence of minimal symptoms if not corrected.

Do this instead: When greeted with 'how are you?' reply with a brief accurate statement: 'I'm managing today, but my condition significantly affects my daily life and I want to make sure I accurately describe that during the exam.'

Impact: All levels

Prep checklist

  • critical

    Gather all surgical records for your small intestine resection

    Collect operative reports, discharge summaries, and pathology reports from all surgeries related to your small intestine resection. Note the date, type of resection, how much intestine was removed, whether the ileocecal valve was preserved, and any complications during surgery. These directly inform DBQ fields for surgery type, date, and chronic complications.

    before exam

  • critical

    Compile all recent laboratory results

    Obtain the most recent CBC (hemoglobin, hematocrit, WBC, platelets), vitamin B12, folate, vitamin D, fat-soluble vitamins, calcium, and albumin levels. Ideally these should be from the past 6-12 months. If you do not have recent labs, contact your treating provider to order them before your exam.

    before exam

  • critical

    Keep a bowel and symptom diary for 2 weeks before the exam

    Record daily: number of bowel movements, consistency (Bristol stool scale), presence of urgency or accidents, abdominal pain severity (0-10), meals eaten, nausea or vomiting episodes, and fatigue level. This gives you accurate numbers to report rather than estimates.

    before exam

  • critical

    Document all hospitalizations and emergency visits in the past 12 months

    List every hospitalization and ED visit related to your intestinal condition in the past 12 months. Include the facility name, date of admission, date of discharge, and reason for admission (e.g., dehydration, obstruction, infection). The DBQ specifically asks about these events.

    before exam

  • critical

    Compile your complete medication list with prescribing information

    List all medications prescribed for your intestinal condition including antidiarrheal agents, antispasmodics, proton pump inhibitors, anti-nausea medications, prescribed dietary supplements (distinguish from OTC vitamins), and any immunosuppressants. Bring the actual prescription bottles or printout from your pharmacy.

    before exam

  • critical

    Document prescribed dietary supplements and special formulas

    Gather prescription records or physician notes authorizing any prescribed oral dietary supplements, high-calorie formulas, or special medical foods. This distinguishes them from over-the-counter vitamins and meets the DBQ threshold for 'requiring prescribed oral dietary supplementation.'

    before exam

  • critical

    Document any history of TPN or enteral tube feeding

    If you have ever required total parenteral nutrition or enteral tube feeding (even temporarily), gather records documenting start dates, end dates, and reason. This is one of the highest-impact fields on the DBQ and may support ratings of 60% or higher.

    before exam

  • critical

    Record your current weight and review your weight history

    Note your current weight and height for BMI calculation. Gather medical records showing your weight at different time points after surgery to document any progressive weight loss. BMI thresholds of less than 16 and 16-18 are specifically noted on the DBQ and affect rating level.

    before exam

  • recommended

    Prepare a written summary of how your condition affects work and daily activities

    Write a one-page functional impact statement describing: number of workdays missed per month, specific job tasks you cannot perform, accommodations you require (bathroom access, dietary restrictions at work), daily activities you have given up, and social limitations caused by your condition. Practice verbalizing this before the exam.

    before exam

  • recommended

    Review records for peritoneal adhesions, fistulas, or obstruction history

    Gather any imaging reports, surgical notes, or clinical records documenting peritoneal adhesions, intestinal obstruction episodes, or fistulous disease that developed after your resection. These may support additional ratings or document higher severity.

    before exam

  • recommended

    Obtain a buddy statement or lay statement from someone who observes your daily symptoms

    Ask a spouse, family member, roommate, or coworker to write a statement describing what they observe about your condition: bathroom frequency, episodes they have witnessed, how your symptoms affect your work and social functioning. Submit this to VA before or at the time of the exam.

    before exam

  • optional

    Research your right to record the examination in your state

    Veterans have the right to record their C&P examination in most states. Notify the examiner at the beginning of the exam if you intend to record. Check your state's consent laws - most states are one-party consent, meaning you can record without asking permission, but notifying the examiner is professionally recommended.

    before exam

  • critical

    Eat your normal diet before the exam - do not eat restrictively to perform better

    Do not alter your diet the day before or day of the exam to minimize symptoms. The examiner should see your typical presentation. If you normally avoid certain foods to control symptoms, that dietary restriction itself is medically significant and should be reported.

    day of

  • critical

    Bring all documentation in an organized folder

    Bring: surgical records, lab results, medication list, bowel diary, hospitalization records, any imaging reports (CT, MRI, X-ray related to your intestinal condition), and your prepared functional impact statement. Organize in chronological order with a cover page listing the contents.

    day of

  • recommended

    Arrive early and identify bathroom locations

    If you have urgency issues, arrive 15-20 minutes early to locate bathrooms. This reduces anxiety during the exam and ensures you can participate fully without discomfort.

    day of

  • optional

    Bring a support person if allowed

    You are permitted to bring a support person to the exam, though they typically may not speak on your behalf. Having someone present can help you remember to cover all your symptoms and can serve as a witness to what was discussed.

    day of

  • critical

    Report your worst-day symptoms, not your best-day symptoms

    When asked how you are doing, describe your typical and worst-day experience. Use phrases like: 'On a bad day, which happens about [X] times per month, I experience...' and 'Even on a good day, I still have...' The VA rates based on the full picture of your disability.

    during exam

  • critical

    Provide specific numbers for diarrhea frequency

    When the examiner asks about bowel movements, give a specific number: 'I average 5 to 7 loose bowel movements per day. On my worst days I have 8 to 10.' Do not say 'frequent' without a number. The DBQ has a specific threshold of 4 or more per day.

    during exam

  • critical

    Clarify that dietary supplements are physician-prescribed, not self-initiated

    When discussing supplements, clearly state: 'These were prescribed by my doctor because blood tests showed I cannot absorb these nutrients from food. They are not vitamins I chose to take on my own.' This distinction is captured in a specific DBQ field.

    during exam

  • critical

    Connect all symptoms to functional limitations

    For every symptom you report, connect it to a specific functional consequence: 'Because of the unpredictable diarrhea, I cannot work more than 4 hours without guaranteed bathroom access.' 'Because of fatigue, I have had to reduce my work hours.' This helps the examiner document functional impact accurately.

    during exam

  • critical

    Do not minimize or dismiss your symptoms

    Avoid socially polite minimizations such as 'I manage' or 'It could be worse.' If the examiner asks if you have any limitations, do not say 'not really' out of habit. Answer honestly and specifically about what you cannot do or what you struggle to do.

    during exam

  • critical

    Report all hospitalizations, emergency visits, and dehydration episodes

    Proactively mention any hospitalizations or ED visits: 'I have been hospitalized twice in the past year for dehydration from diarrhea and required IV fluids each time.' This addresses the DBQ threshold of more than 2 dehydration episodes requiring IV fluids.

    during exam

  • recommended

    Ask the examiner if they have reviewed your records

    Politely ask at the start: 'Have you had a chance to review my medical records before today?' If not, offer to walk them through your key documents. This ensures the examiner has context for your history.

    during exam

  • critical

    Write down everything you remember from the exam immediately afterward

    As soon as you leave, write down what questions were asked, what you said, whether you felt your symptoms were fully captured, and whether the examiner seemed to review your records. This creates a contemporaneous record if you need to challenge the exam.

    after exam

  • critical

    Request a copy of the DBQ once completed

    You have the right to a copy of your completed DBQ. Submit a FOIA request or ask your VSO to obtain it from your eFolder once it is uploaded. Review it carefully to ensure it accurately reflects what you reported.

    after exam

  • recommended

    If the exam was inadequate, request a new examination or submit a supplemental statement

    If the DBQ does not accurately reflect your symptoms (e.g., your worst-day diarrhea frequency was not recorded, TPN history was omitted, or functional limitations were not captured), you can submit a written statement to VA correcting the record, request a new exam, or appeal the rating decision. A VSO or VA-accredited attorney can assist.

    after exam

  • recommended

    Continue your treating provider relationships and keep records current

    Ensure you have ongoing treatment records from a gastroenterologist or physician documenting your current symptoms, dietary needs, and functional limitations. Continuous treatment records strengthen your claim and any future requests for increased ratings.

    after exam

Your rights during a C&P exam

  • You have the right to request that your C&P examination be recorded in most states. Inform the examiner at the start of the appointment if you intend to record.
  • You have the right to have a representative (VSO, accredited attorney, or claims agent) assist you in preparing for and navigating your C&P examination.
  • You have the right to submit a personal statement, buddy statements, and additional medical evidence at any time before a rating decision is issued.
  • You have the right to a copy of your completed DBQ and all examination reports. These are part of your VA claims file (eFolder) and can be requested via FOIA or through your VSO.
  • You have the right to request a new or additional examination if you believe the original C&P exam was inadequate, did not address all claimed conditions, or did not accurately capture your symptoms.
  • You have the right to challenge a C&P examination that you believe was flawed, cursory, or relied on an inaccurate history. You may submit a buddy statement, personal statement, or a private medical nexus opinion to rebut an unfavorable exam.
  • You have the right to have your condition rated based on your worst-day symptoms and the full range of your disability, not only your presentation on the day of the exam.
  • You have the right to bring a support person with you to the C&P examination, though that person typically may not speak on your behalf during the clinical interview.
  • You have the right to be examined by a qualified examiner with appropriate expertise. If you believe the examiner lacked sufficient knowledge of your condition, you may raise this concern in a statement to VA.
  • You have the right to an Increased Rating or Supplemental Claim if your condition worsens after an initial rating, allowing you to seek a higher disability percentage based on new or increased evidence.

Related conditions

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This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.