Spina Bifida C&P Exam Prep

Mobility Assessment

What it measures: The veteran's primary means of locomotion in the community, which directly determines the mobility component of the disability level rating.

What to expect: The examiner will ask how you primarily get around outside your home - whether you walk independently without braces or support, walk with braces or crutches, or use a wheelchair as your primary means. They may observe your gait or transfer ability if you are present in person.

Pain considerations: If pain, fatigue, or weakness affects how far you can walk before needing assistive devices or a wheelchair, describe those limits clearly and quantify distance (e.g., 'I can take about 20 steps before falling without my braces').

Upper Extremity Sensory and Motor Function Assessment

What it measures: The degree of sensory or motor impairment in the arms and hands, specifically whether impairment prevents grasping a pen, feeding oneself, or performing self-care tasks.

What to expect: The examiner may ask about your ability to hold a pen, use utensils, button clothing, or perform personal hygiene tasks. Physical testing of grip strength, fine motor coordination, and sensation in the hands may be performed.

Pain considerations: Note any pain, numbness, or tingling in the hands or arms that interferes with fine motor tasks, including how long you can sustain gripping before losing control.

Intellectual and Cognitive Function Assessment (IQ Evaluation)

What it measures: The veteran's level of intellectual and cognitive functioning, typically determined by formal IQ testing results if available in the record.

What to expect: The examiner will review any prior IQ testing results in your medical record. If no formal testing exists, they may note the absence. They may ask about educational history, special education placement, memory difficulties, and ability to manage daily tasks independently.

Pain considerations: Cognitive fatigue (difficulty concentrating after brief mental effort) should be described alongside formal IQ concerns, as it affects daily functional capacity.

Urinary Continence Assessment

What it measures: The degree of urinary incontinence and the effectiveness of any treatment or management methods in controlling bladder function.

What to expect: The examiner will ask detailed questions about your bladder management routine, frequency of incontinence episodes, whether you are on medication or use catheterization, and how many times per week you are unable to remain dry for at least three hours during waking hours despite treatment.

Pain considerations: Describe any pain, burning, or discomfort associated with bladder management procedures, and how bladder dysfunction limits your ability to participate in activities outside the home.

Bowel Continence Assessment

What it measures: The severity of bowel impairment, frequency of fecal leakage, necessity of manual evacuation or digital stimulation, or presence of a colostomy.

What to expect: The examiner will ask about your bowel management routine, frequency of accidents, whether you wear absorbent materials, and whether you require manual evacuation or digital stimulation. They will also ask about any surgical interventions such as colostomy.

Pain considerations: Describe any pain or discomfort related to bowel management procedures, skin breakdown from leakage, and how bowel dysfunction limits social activities, work, or travel.

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Spina Bifida Occulta Only - Not eligible for monetary allowance under 38 CFR 3.814. A diagnosis of spina bifida occulta as the only form of spina bifida does not qualify for benefits under this program. No disability level is assigned.

From 38 CFR: Completion of the full DBQ is not required when spina bifida occulta is the only type present. Benefits are denied with code 02 (Diagnosis of spina bifida occulta) on the codesheet.

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Level I - Minimum payment level. Assigned when the individual walks without braces or other external support as the primary means of community mobility, has no sensory or motor impairment of the upper extremities, has an IQ of 90 or higher, and is continent of urine and feces without medication or other management means. Also assigned as the default minimum level when medical evidence is insufficient to support a higher level.

From 38 CFR: VA will pay at Level I unless or until it receives medical evidence supporting a higher payment. When evidence is insufficient, Level I (minimum) is the default assignment per 38 CFR 3.814(d)(4).

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Level II - Intermediate payment level. Assigned when the individual uses braces, crutches, or other external support as the primary means of community mobility; OR has some sensory or motor impairment of the upper extremities that does not rise to the level of preventing grasping a pen, feeding self, or performing self-care; OR has an IQ of 70 to 89; OR is continent of urine only with the use of medication or other management techniques; OR achieves bowel continence only through management techniques or medication.

From 38 CFR: A Level II or Level III payment will be awarded depending on whether the effects of a disability are of equivalent severity to the effects specified under Level II or Level III per 38 CFR 3.814(d)(1).

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Level III - Maximum payment level. Assigned when the individual uses a wheelchair as primary means of community mobility; OR has sensory or motor impairment of the upper extremities severe enough to prevent grasping a pen, feeding self, AND performing self-care; OR has an IQ of 69 or less; OR despite treatment, is unable to remain dry for 3 hours at least 3 times per week during waking hours; OR has fecal leakage severe enough to require absorbent materials at least 4 days per week despite treatment; OR regularly requires manual evacuation or digital stimulation; OR has a colostomy requiring a bag. Additionally, the Director of Compensation Service may increase to Level III equivalent in exceptional cases where secondary disabilities such as blindness, uncontrolled seizures, or renal failure result from spina bifida or its treatment.

From 38 CFR: Level III criteria are specified at 38 CFR 3.814(d)(1)(iii). The Director of Compensation Service may increase payment in exceptional cases where secondary disabilities resulting from spina bifida or its treatment severely limit the individual's ability to engage in ordinary day-to-day activities, including activities outside the home.

Mobility and Ambulation

How to describe it: Describe your typical and worst-day ability to move around in the community - outside your home. State exactly what you use most of the time: no support, braces/crutches, or wheelchair. Be specific about distances, surfaces, and what causes you to need more support. Use concrete language: 'I use a power wheelchair for all trips outside my home because I cannot safely walk more than 10 feet without falling even with braces.'

Example: On my worst days, I cannot stand long enough to transfer safely without assistance. My legs give out without warning after a few steps even inside the house, and I have not attempted to walk in the community without my wheelchair for over two years.

Examiner listens for: Whether wheelchair use is primary and consistent for community mobility versus occasional or indoor use only. The examiner needs to document what the veteran actually does in the real world, not what they theoretically could do.

Avoid: Do not say 'I can get around okay' if you rely on braces or a wheelchair outside. Do not describe your indoor walking ability as your community mobility method. Do not omit that you stopped trying to walk in the community because of falls or fatigue.

Upper Extremity Function

How to describe it: Address each of the three specific functions separately: (1) Can you grip a standard pen and write? (2) Can you feed yourself with standard utensils without adaptive equipment? (3) Can you perform self-care tasks such as bathing, dressing, and personal hygiene independently? Use precise language about what you cannot do versus what requires adaptation or assistance.

Example: On my worst days, my hands are so weak and numb that I drop my fork before I finish a meal. I cannot button my shirt or use a standard pen - I require a thick-grip adaptive pen and even then my writing is illegible after a few words. My caregiver assists me with showering on most days because I cannot safely grip the grab bars.

Examiner listens for: The critical threshold is whether impairment prevents ALL THREE functions - grasping a pen, feeding self, AND performing self-care. The examiner listens for whether this is a consistent pattern versus occasional difficulty. They document what you need help with, what adaptive tools you require, and whether you can perform these tasks independently.

Avoid: Do not say 'I manage' if you require adaptive equipment or caregiver assistance. Do not describe only one impaired function - describe all three specifically. Do not omit weakness, numbness, or incoordination that affects hand function even if you have adapted around it.

Cognitive and Intellectual Function

How to describe it: Describe any difficulties with learning, memory, processing speed, or independent decision-making. Reference any formal IQ testing, special education history, or documented cognitive evaluations. Describe how cognitive difficulties affect your daily independence, employment, and ability to manage personal affairs.

Example: On my worst days, I cannot follow multi-step instructions without writing them down and reviewing them multiple times. I was in special education throughout school and was formally evaluated with an IQ of 74. I require reminders and assistance managing my medications, appointments, and finances.

Examiner listens for: The specific IQ score if formal testing has been done, and whether cognitive impairment affects daily functional independence. The examiner also listens for consistency between self-reported difficulties and any documented history of cognitive evaluation.

Avoid: Do not dismiss cognitive difficulties as 'just being slow' - describe specific functional impacts. Do not forget to mention special education, disability accommodations in school or work, or any prior formal psychological testing. Do not conflate cognitive fatigue with baseline intellectual function - report both.

Urinary Continence

How to describe it: Be precise about your management regimen and how often it fails. State the specific number of days per week and times per day that you are unable to remain dry for at least three hours despite your treatment. Use a diary if possible. Describe what 'unable to remain dry' means practically - leaking through clothing, needing to change pads, wetting yourself in public.

Example: On my worst days, even with scheduled intermittent catheterization every three hours and my bladder medication, I have leakage accidents four to five times in a single day. This happens at least three or four days every week. I wear pads at all times outside the home and have had to leave social events early because of accidents.

Examiner listens for: The frequency of failed continence despite active treatment - specifically whether it meets the three-times-per-week threshold of being unable to remain dry for three hours. The examiner documents what management is in place and how consistently it fails.

Avoid: Do not say 'I'm on treatment so it's controlled' if you still have regular accidents. Do not omit the frequency and severity of accidents. Do not forget to mention all management techniques you use (catheterization, medications, pads, dietary restrictions) so the examiner understands the full picture.

Bowel Continence

How to describe it: Describe your bowel management routine in detail and how often you have accidents, leakage, or require manual assistance to empty your bowel. State the number of days per week you require absorbent materials due to fecal leakage despite your regimen. If you require manual evacuation or digital stimulation, state how regularly. If you have a colostomy, describe your bag use.

Example: On my worst days, I have fecal leakage despite performing my bowel program that morning. I wear protective undergarments every single day because I cannot predict when I will have an accident. I require manual evacuation at least every other day, and I have had leakage severe enough to require full clothing changes in public at least five days this past week.

Examiner listens for: Frequency of fecal leakage requiring absorbent material use (the threshold is four or more days per week), regularity of manual evacuation or digital stimulation, and whether a colostomy bag is in use. The examiner documents what management is in place and whether it achieves continence.

Avoid: Do not minimize by saying 'I just wear pads as a precaution' if you have regular leakage. Do not omit the need for manual evacuation out of embarrassment - this is a critical rating threshold. Do not underreport the number of days per week you have accidents or require protective garments.

Secondary and Associated Disabilities

How to describe it: Identify all conditions that have resulted from spina bifida itself or from treatment procedures for spina bifida. Common secondary conditions include hydrocephalus with shunt, tethered cord syndrome, Chiari malformation, neurogenic bladder, kidney disease or renal failure, seizure disorder, vision problems or blindness, skin breakdown/pressure sores, chronic pain, and orthopedic complications. Describe how each affects your daily functioning.

Example: My shunt for hydrocephalus malfunctioned last year requiring emergency surgery. I now have chronic headaches daily, have had two seizure episodes in the past six months that are not yet fully controlled, and my nephrologist recently told me I have early chronic kidney disease from recurrent urinary tract infections. Each of these conditions limits my ability to leave home independently.

Examiner listens for: Whether any secondary disabilities such as blindness, uncontrolled seizures, or renal failure result from spina bifida or its treatment, as these may warrant an exceptional-case increase to Level III payment even if standard Level III criteria are not otherwise met. The examiner documents all identified secondary conditions and their functional impact.

Avoid: Do not fail to connect secondary conditions to spina bifida or its treatment. Do not omit surgeries, hospitalizations, or specialist care related to spina bifida complications. Do not assume that only the spinal defect itself matters - all downstream conditions are relevant and potentially rating-determinative.