DC 7323 · 38 CFR 4.114
Ulcerative Colitis C&P Exam Prep
To document the current severity of your Ulcerative Colitis under Diagnostic Code 7323, which is rated by analogy to Crohn's Disease (DC 7326). The examiner assesses your symptom burden, treatment requirements, hospitalizations, systemic manifestations, and functional impact to determine an appropriate disability rating.
- Format:
- Interview + Physical
- Typical duration:
- 20-30 minutes
- DBQ form:
- intestines (intestines)
- Examiner:
- Gastroenterologist or Physician
What the examiner evaluates
- Frequency and severity of diarrhea episodes per day
- Presence and frequency of rectal bleeding
- Signs of systemic toxicity: fever, tachycardia, anemia, leukocytosis
- Treatment level: oral/topical agents vs. immunosuppressants/biologics vs. hospitalization
- Surgical history: colectomy, colostomy, ileostomy, resection
- Extraintestinal manifestations: dermatitis, joint involvement, lymph node enlargement, hypocalcemia, low vitamin levels
- Nutritional status: weight loss, BMI, anemia, need for TPN or tube feeding
- Frequency and cause of ER visits or hospitalizations
- Functional and occupational impact
- Medication list and treatment response
The exam is typically conducted in a clinical setting. You may be examined in person or via telehealth. You have the right to request an in-person exam. In most states, you have the right to record the examination - confirm your state's laws before the exam. Bring a written symptom summary and medication list to leave with the examiner.
Measurements and tests
Stool Frequency Count
What it measures: Number of bowel movements per day, including bloody episodes
What to expect: Examiner will ask you to characterize your typical and worst-day stool frequency. This is a primary driver of rating level.
Critical thresholds
- 4+ watery stools/day OR 4+ episodes diarrhea/day Correlates with moderate-to-severe rating criteria under DC 7326
- 6+ episodes/day of rectal bleeding Indicates severe disease activity; supports higher rating level
- Daily diarrhea requiring documentation of frequency DBQ field directly captures this for rating purposes
Tips
- Track your bowel movements daily for at least 2 weeks before the exam using a symptom diary
- Report your WORST days and AVERAGE days separately - do not average them down
- Include nighttime episodes, which significantly impact quality of life
- Note whether urgency causes accidents or prevents leaving home
Pain considerations: Describe associated abdominal pain intensity (0-10 scale), cramping location, duration, and whether it precedes or accompanies bowel urgency. Note if pain disrupts sleep or prevents activities.
Rectal Bleeding Assessment
What it measures: Frequency, volume, and chronicity of hematochezia associated with active UC
What to expect: Examiner will ask about presence, frequency, and quantity of blood in stool. DBQ has a specific field for 6 or more episodes per day of rectal bleeding.
Critical thresholds
- Any rectal bleeding present Indicates active mucosal disease; supports symptomatic rating
- 6 or more bloody episodes per day Directly mapped to severe disease DBQ field; supports highest rating tiers
Tips
- Describe whether bleeding is streaking, mixed with stool, or frank blood
- Note if you have passed blood clots
- Bring documentation of any hospitalizations for GI bleeding
- Report if anemia has been diagnosed or if you have required iron infusions or transfusions
Pain considerations: Not primarily a pain measure, but note associated rectal pain, tenesmus (painful urge to defecate), and anal/rectal discomfort which add to the overall symptom burden.
Complete Blood Count (CBC) / Lab Values
What it measures: Hemoglobin, hematocrit, white blood cell count, platelets - markers of systemic disease activity, anemia, and infection
What to expect: Examiner will review recent lab results. DBQ captures hemoglobin, hematocrit, WBC, and platelets. Bring your most recent labs from your gastroenterologist.
Critical thresholds
- Low hemoglobin/hematocrit (anemia) Indicates systemic toxicity; supports higher severity rating and systemic manifestation checkbox
- Elevated WBC (leukocytosis) Sign of active inflammation or systemic toxicity; directly captured on DBQ
- Elevated platelets (thrombocytosis) Reactive marker of chronic inflammation; supports ongoing disease activity
Tips
- Bring printed copies of your last 12 months of lab results
- Highlight any values outside normal range
- Note if your gastroenterologist has referenced anemia or elevated inflammatory markers in their notes
- Also bring CRP, ESR, fecal calprotectin results if available
Pain considerations: Anemia from chronic GI blood loss often causes significant fatigue and weakness - describe how this functional limitation affects your daily activities and work capacity.
Body Weight / BMI Assessment
What it measures: Nutritional status and weight loss related to malabsorption or active disease
What to expect: Examiner will document current weight and may calculate BMI. DBQ has specific fields for BMI less than 16 and BMI 16-18.
Critical thresholds
- BMI 16-18 Indicates significant undernutrition; captured on DBQ as a severity marker
- BMI less than 16 Severe undernutrition; directly mapped to highest severity DBQ fields
Tips
- Bring documentation of your weight history from your medical records
- Note your pre-illness baseline weight vs. current weight
- Report any prescribed dietary modifications, nutritional supplements, or enteral/parenteral nutrition
- Describe how dietary restrictions limit your daily life and social activities
Pain considerations: Weight loss and malnutrition often cause fatigue, muscle weakness, and reduced stamina - quantify how these symptoms limit physical activity, employment, and self-care.
Endoscopy / Colonoscopy Review
What it measures: Objective evidence of mucosal inflammation, disease extent, and surgical history
What to expect: Examiner will review prior endoscopy reports in your claims file. These establish objective disease severity and extent. DBQ captures endoscopy results directly.
Critical thresholds
- Active inflammation / ulceration noted on scope Confirms ongoing active disease; supports symptomatic rating
- Prior colectomy, ileostomy, or colostomy documented Triggers specific surgical DBQ sections; may support permanent 100% rating
Tips
- Request copies of all colonoscopy and pathology reports before your exam
- Ensure your claims file contains the most recent scope results
- Note the Mayo Score or other disease activity index if your GI doctor uses one
- Bring biopsy results confirming UC diagnosis if available
Pain considerations: Not applicable for direct pain measurement, but document if post-procedure recovery periods were significantly disabling.
Rating criteria by percentage
100%
Pronounced: Six or more stools daily with tenesmus and pain, with hematochezia; requiring hospitalization at least once per year; unresponsive to treatment; OR resulting in colectomy or colostomy
Key symptoms
- 6+ bloody stools per day
- Tenesmus and severe rectal pain
- Unresponsive to immunosuppressants or biologics
- Required hospitalization at least once in the past year
- Colectomy, colostomy, or ileostomy performed
- Signs of systemic toxicity: fever, tachycardia, anemia, leukocytosis
- Inability to maintain employment due to condition
- Severe weight loss or nutritional deficiency requiring TPN or tube feeding
From 38 CFR: Under DC 7326 (used by analogy for 7323): Pronounced IBD with pronounced systemic manifestations; hospitalization required; unresponsive to treatment; or requiring surgical intervention such as colectomy or permanent colostomy.
60%
Severe: Four or more stools daily with blood and mucus; weight loss; anemia; intermittent obstruction; moderate to severe pain; managed with immunosuppressants or biologics on an outpatient basis
Key symptoms
- 4+ daily bloody or mucus-containing stools
- Significant abdominal pain requiring prescription management
- Documented weight loss or anemia
- Management with immunosuppressants (azathioprine, 6-MP) or biologics (infliximab, adalimumab, vedolizumab, ustekinumab)
- Episodic hospitalization or ER visits
- Systemic manifestations present (arthritis, skin lesions, fatigue)
- Recurrent abdominal distension
- Interference with occupational functioning
From 38 CFR: Under DC 7326: Severe IBD with four or more stools daily with blood and mucus, and with one or more of the following: anemia, weight loss, fever, abdominal mass, fistula; managed on outpatient basis with immunosuppressants or biologics.
30%
Moderate: Diarrhea or alternating diarrhea and constipation with more than occasional episodes of abdominal distress; managed with oral or topical agents other than immunosuppressants
Key symptoms
- Frequent loose stools (more than occasional, less than 4/day)
- Recurrent abdominal pain and cramping
- Managed with mesalamine, rectal suppositories, or topical steroids
- Occasional rectal bleeding
- More than occasional abdominal distress
- Symptoms requiring prescription medication but not immunosuppressants
- Some functional limitation but able to maintain employment with accommodations
From 38 CFR: Under DC 7326: Moderate IBD - diarrhea or alternating diarrhea and constipation with more than occasional episodes of abdominal distress managed with oral or topical agents other than immunosuppressants.
10%
Mild: Remission or minimal symptoms; infrequent diarrhea episodes; managed without prescription medication or with minimal intervention; no signs of systemic toxicity
Key symptoms
- Infrequent loose stools
- Minimal abdominal discomfort
- No rectal bleeding currently
- No systemic symptoms
- Manageable with diet modification or OTC agents
- Essentially in remission but with documented history of active UC
- Able to perform all daily activities without restriction
From 38 CFR: Under DC 7326: Mild IBD - infrequent episodes of abdominal distress managed without prescription treatment, or asymptomatic with history confirming diagnosis.
0%
Asymptomatic: Currently in complete remission with no active symptoms, no ongoing prescription treatment, and no functional impairment; diagnosis confirmed but no current disability
Key symptoms
- Complete remission
- No active symptoms
- No prescription medications currently required
- No functional impairment
- Confirmed diagnosis on record
From 38 CFR: Under DC 7326: No current symptoms; diagnosis confirmed but disability not ratable at this time. A noncompensable (0%) evaluation is assigned to preserve the service connection of record.
Describing your symptoms accurately
Diarrhea Frequency and Urgency
How to describe it: State the specific number of bowel movements on your worst days and your average days separately. Include nighttime episodes. Describe urgency - how much warning you have before needing to reach a bathroom. Quantify how many times you have had accidents (fecal incontinence) due to urgency.
Example: On my worst days, I have 8 to 10 bloody bowel movements, including 3 to 4 times overnight. I have less than 60 seconds of warning before I must reach a bathroom. I have had fecal accidents at work and while driving. I cannot leave home on these days without mapping every bathroom on my route.
Examiner listens for: Specific numbers (not vague descriptors like 'a lot'), nighttime frequency, urgency severity, fecal incontinence episodes, impact on ability to leave home, social withdrawal, and occupational attendance.
Avoid: Do not say 'I use the bathroom frequently' or 'I have loose stools sometimes.' These vague statements map to mild criteria. Always provide actual counts and describe the worst-case scenario that occurs regularly.
Rectal Bleeding and Hematochezia
How to describe it: Describe the frequency of bloody stools, the volume of blood (streaks vs. moderate vs. heavy), and whether you have passed clots. Note if bleeding has caused anemia requiring treatment, iron infusions, or blood transfusions.
Example: During flares, I have frank blood in every bowel movement and have passed blood clots. My gastroenterologist has diagnosed me with iron-deficiency anemia from chronic blood loss and I have required two iron infusions in the past year. My hemoglobin dropped to 8.5 g/dL during my most recent hospitalization.
Examiner listens for: Frequency of bloody episodes, severity, resulting anemia, treatment required for anemia, and whether bleeding has required hospitalization or emergency care.
Avoid: Do not minimize bleeding by saying 'just a little blood sometimes.' If you have had anemia from GI blood loss, this is a significant objective finding that directly supports a higher rating.
Abdominal Pain and Cramping
How to describe it: Rate pain on a 0-10 scale. Describe location (diffuse lower abdomen, left-sided, periumbilical), character (cramping, sharp, constant vs. intermittent), duration, what triggers or worsens it, and what relieves it. Note if pain prevents eating, disrupts sleep, or prevents work attendance.
Example: My abdominal pain reaches 8 out of 10 before bowel movements. The cramping is diffuse but worst in my lower left abdomen. It wakes me at night 3 to 4 times per week. On bad days, I cannot eat because eating triggers immediate severe cramping and an urgent need to defecate within 20 minutes.
Examiner listens for: Pain severity and character, relationship to meals, nocturnal symptoms, impact on nutrition and sleep, and whether pain is managed with prescription medication vs. inadequately controlled.
Avoid: Do not say 'I have some stomach pain.' Describe the pattern, intensity, and functional consequences. Tenesmus (painful rectal urgency/spasm) is a specific symptom that should be named and described explicitly.
Systemic Manifestations and Extraintestinal Symptoms
How to describe it: Describe any symptoms beyond the bowel, including joint pain or swelling, skin rashes (pyoderma gangrenosum, erythema nodosum), eye inflammation (uveitis, episcleritis), oral ulcers, liver involvement, fatigue, fever episodes, and lymph node changes. These are tracked in the systemic manifestations section of the DBQ.
Example: I experience severe fatigue that prevents me from working full days during flares. I have had two episodes of fever over 101 degrees in the past six months. My gastroenterologist has noted that I have UC-associated arthropathy affecting both knees. I also have recurring mouth sores during active flares.
Examiner listens for: Systemic toxicity markers (fever, tachycardia, anemia, leukocytosis), extraintestinal manifestations across multiple organ systems, and whether these require separate treatment beyond GI management.
Avoid: Do not focus only on bowel symptoms. Extraintestinal manifestations are explicitly listed on the DBQ and directly support higher rating levels. Many veterans fail to mention fatigue, joint pain, or skin manifestations that are directly connected to their UC.
Treatment History and Response
How to describe it: List all medications by name, dose, and how long you have been taking them. Distinguish between step-up therapy levels: aminosalicylates (mesalamine) - corticosteroids - immunomodulators (azathioprine, 6-MP, methotrexate) - biologics (infliximab, adalimumab, vedolizumab, ustekinumab) - small molecules (tofacitinib, upadacitinib). Note any treatment failures or medication side effects.
Example: I have failed mesalamine and multiple courses of prednisone. I have been on infliximab infusions every 8 weeks for 2 years but have had a secondary loss of response requiring dose escalation. My gastroenterologist is now considering upadacitinib. I also require continuous iron supplementation and have been on prednisone tapers 4 times in the past year.
Examiner listens for: Treatment level (this directly maps to rating criteria - oral/topical vs. immunosuppressants vs. hospitalization), treatment failures, ongoing dependence on advanced therapies, steroid dependence, and unresponsiveness to therapy.
Avoid: Do not just say 'I take medication.' Name each drug. Being on a biologic or immunosuppressant is a specific rating criterion. Emphasize if you are steroid-dependent or if treatments have failed.
Hospitalization and Emergency Care History
How to describe it: List every hospitalization or ER visit related to UC in the past 12 months (and beyond). Include dates, facility, reason for admission, length of stay, and treatments received during hospitalization such as IV steroids, IV fluids for dehydration, blood transfusions, or surgical procedures.
Example: I have been hospitalized twice in the past 12 months for UC flares. The first admission in March lasted 5 days and required IV methylprednisolone and IV hydration for severe dehydration. The second in October was 7 days and required a blood transfusion. I have also visited the ER 3 additional times without resulting in admission.
Examiner listens for: Number of hospitalizations per year (one or more per year is a specific 100% rating criterion), length of stays, treatments required during hospitalization, and whether hospitalizations are recurring and expected to continue.
Avoid: Do not omit ER visits that did not result in admission. Recurrent emergency treatment for intestinal dysfunction is a separate DBQ field. Every hospitalization is critical evidence. Bring discharge summaries to the exam.
Functional and Occupational Impact
How to describe it: Describe specifically how UC prevents or limits work attendance, productivity, social activities, travel, exercise, and sleep. Quantify missed workdays, accommodations required (bathroom access, remote work), and activities you have had to give up entirely.
Example: I missed 47 workdays in the past year due to UC flares. I have had to resign from a supervisory position because I could not guarantee my attendance. I cannot travel more than 15 minutes from home without severe anxiety about bathroom access. I have stopped attending family events and social gatherings due to fear of fecal accidents. I wake at night 3 to 5 times weekly due to UC symptoms.
Examiner listens for: Concrete numbers of missed workdays, whether the condition results in an inability to work (a specific DBQ checkbox), social and recreational limitations, sleep disruption, and whether the veteran has had to change or leave employment due to UC.
Avoid: Do not just say 'it affects my quality of life.' Provide specific, quantifiable examples. The DBQ has a dedicated field for inability to work due to the condition and requires the examiner to discuss how the condition causes that limitation.
Common mistakes to avoid
Reporting only average days instead of worst days
Why: VA adjudicators are instructed under M21-1 to consider the full range of disability including the worst-day severity. If you only describe your average, you may be rated at a lower level than your actual impairment.
Do this instead: Always describe both: 'On an average day I have X symptoms; on my worst days, which occur Y times per month, I have Z symptoms.' Prepare written notes beforehand so you do not underreport under stress.
Impact: Affects distinction between 10-30% and 60-100%
Failing to name the specific treatment class (especially biologics/immunosuppressants)
Why: The rating criteria for UC (by analogy to DC 7326) explicitly distinguish between management with oral/topical agents vs. management with immunosuppressants or biologics. Being on a biologic is a 60% criterion marker - failing to mention it loses this distinction.
Do this instead: Bring a printed medication list with drug names, doses, and start dates. Say explicitly: 'I am currently managed with infliximab infusions, which is a biologic/TNF inhibitor, because mesalamine and steroids were insufficient to control my disease.'
Impact: Difference between 30% and 60%
Not mentioning hospitalizations or minimizing them
Why: Hospitalization at least once per year is a direct 100% rating criterion for severe IBD. Veterans often forget older hospitalizations or view them as 'routine' and fail to report them.
Do this instead: Bring discharge summaries for all UC-related hospitalizations. State the dates, duration, and treatments received. If you have been hospitalized more than once in the past 12 months, state this clearly and prominently.
Impact: Difference between 60% and 100%
Omitting extraintestinal manifestations (joints, skin, eyes, fatigue)
Why: Systemic manifestations are explicitly listed on the IBD DBQ and support higher ratings. Many veterans focus only on bowel symptoms and forget to mention UC-associated arthropathy, skin manifestations, or severe fatigue.
Do this instead: Before the exam, prepare a written list of every symptom - bowel and non-bowel. Review the DBQ systemic manifestations checklist and confirm which apply to you. Mention them proactively during the history portion.
Impact: Affects 60% and 100% rating tiers
Failing to connect inability to work to UC symptoms
Why: The DBQ has a dedicated checkbox for inability to work caused by the condition. Examiners must document this and explain the connection. If you do not raise this, the examiner may not ask.
Do this instead: Proactively tell the examiner: 'My UC has directly caused me to miss [X] workdays in the past year and has required me to [change jobs/resign/request accommodations] because of unpredictable bowel urgency, pain, and fatigue.' If you cannot work, state this clearly.
Impact: Affects 100% rating and potential TDIU eligibility
Not bringing supporting medical records to the exam
Why: The examiner reviews evidence in the claims file, but VA records can be incomplete, delayed, or missing recent office visit notes, lab results, or endoscopy reports. Without this evidence, the examiner can only document what you report verbally.
Do this instead: Bring a physical packet including: most recent gastroenterology notes, colonoscopy/endoscopy reports with pathology, last 12 months of lab work (CBC, CMP, CRP, ESR, fecal calprotectin), hospitalization discharge summaries, and a complete medication list with prescribing provider.
Impact: Affects all rating levels
Describing symptoms in vague terms without specific numbers
Why: The rating criteria are quantitative (4+ stools/day, 6+ episodes/day, 1+ hospitalization/year). Vague descriptions like 'frequent diarrhea' or 'some bleeding' do not map to specific rating criteria.
Do this instead: Keep a 2-week bowel diary before the exam. Count daily bowel movements, bleeding episodes, pain scores, and missed activities. Bring the diary and reference it during the exam: 'In the past 14 days, I averaged 6 bowel movements per day with blood present on 9 of those days.'
Impact: Affects all rating levels
Prep checklist
- critical
Obtain and organize all relevant medical records
Gather gastroenterology office visit notes (past 2 years), colonoscopy/endoscopy reports with pathology results, all laboratory results (CBC, CRP, ESR, fecal calprotectin, albumin, vitamin levels), hospitalization discharge summaries, ER visit records, and radiology reports (CT, MRI of abdomen/pelvis). Organize chronologically and bring 2 copies: one to give to the examiner and one to keep.
before exam
- critical
Prepare a written symptom summary in your own words
Write 1-2 pages describing: (1) typical daily symptoms, (2) worst-day symptoms and how often they occur, (3) symptom history from onset to present, (4) all treatments tried and outcomes, (5) all hospitalizations and ER visits with dates, (6) functional limitations at work, home, and socially, and (7) extraintestinal symptoms. Bring this to the exam and give a copy to the examiner.
before exam
- critical
Keep a 2-week bowel and symptom diary
Each day, record: number of bowel movements, presence/absence of blood, pain score (0-10), fatigue level, any accidents (fecal incontinence), medications taken, and activities limited or missed due to symptoms. Bring this diary to the exam as supporting documentation.
before exam
- critical
Prepare a complete medication list
List every medication you take for UC with drug name, dose, frequency, prescribing provider, and how long you have been taking it. Distinguish which medications are specifically for UC vs. side effect management. Note any medications you have tried and stopped due to inadequate response or side effects.
before exam
- critical
Review the DC 7326 rating criteria
Ulcerative Colitis (DC 7323) is rated by analogy to Crohn's Disease under DC 7326. Familiarize yourself with the 10%, 30%, 60%, and 100% criteria so you can accurately describe your symptoms in terms the examiner will recognize. Focus especially on: stool frequency, treatment level (oral vs. immunosuppressant vs. hospitalization), and hospitalization history.
before exam
- recommended
Research your state's exam recording laws
In most states, veterans have the right to record their C&P examination. Check your state law. If recording is permitted, inform the examiner before the exam begins and use a phone or small audio recorder. This creates a record if you need to challenge an inadequate examination later.
before exam
- recommended
Request a copy of your claims file (C-file)
Submit a FOIA request to VA for your complete claims file before the exam so you know what evidence the examiner will see. Identify any missing medical records and bring copies to the exam. Contact your VSO or accredited VA attorney to assist with this process.
before exam
- recommended
Identify a buddy statement writer
Ask a spouse, family member, caregiver, or coworker to write a buddy statement (VA Form 21-10210) describing what they observe about your UC symptoms - bathroom trips, accidents, missed events, pain episodes, and how the condition affects your relationship and activities. Submit this before the exam if possible.
before exam
- recommended
Consider consulting a VSO or accredited VA claims agent
A Veterans Service Organization (VSO) representative can review your file, identify gaps in evidence, and advise you on how to frame your symptoms for the exam. This is a free service. Contact the DAV, VFW, American Legion, or your state's Department of Veterans Affairs.
before exam
- critical
Arrive early and bring all documents in an organized packet
Arrive 15-20 minutes early. Bring your organized medical records packet, symptom summary, medication list, and bowel diary. Offer the packet to the examiner at the start of the visit. Do not assume the examiner has reviewed your file.
day of
- critical
Do not minimize symptoms on your 'good day'
If your exam falls on a relatively good day, that does not define your disability. Proactively state: 'Today is not a typical bad day for me. My worst days occur [X times per month] and include [specific symptoms]. My average days include [symptoms].' The rating is based on your overall condition, not just the day of the exam.
day of
- critical
Do not take extra medication before the exam that masks symptoms
Take your medications as prescribed but do not take extra doses or additional symptom-control agents specifically to manage the exam day. The examiner should see your condition as it truly is under your current treatment regimen.
day of
- recommended
Dress comfortably and do not understate pain or urgency
If you experience abdominal pain, urgency, or need to use the restroom during the exam, do not suppress or hide this. These real-time observations support your reported symptom severity.
day of
- critical
State both average and worst-day symptom levels proactively
At the start of the history portion, tell the examiner: 'I want to describe both my average days and my worst days, because my condition is variable.' Do not wait to be asked. This framing ensures the examiner documents your full range of impairment.
during exam
- critical
Use specific numbers, not vague descriptors
Say '6 to 8 bowel movements per day on bad days' not 'a lot of diarrhea.' Say 'I missed 40 workdays last year' not 'I miss work sometimes.' Quantify everything you can. Specific numbers map directly to rating criteria.
during exam
- critical
Mention all extraintestinal manifestations
Proactively mention joint pain, skin lesions, eye symptoms, oral ulcers, severe fatigue, fevers, and any other systemic symptoms related to your UC. If the examiner does not ask, volunteer this information: 'In addition to bowel symptoms, I also experience [specific extraintestinal symptoms].'
during exam
- recommended
Confirm the examiner is documenting all reported symptoms
At the end of the exam, ask: 'Were you able to document all of the symptoms and limitations I described today?' If the examiner seems to have skipped any major areas (hospitalizations, inability to work, systemic manifestations), gently raise them before leaving.
during exam
- critical
Describe functional and occupational impact explicitly
Tell the examiner specifically how UC limits your work and daily life. Do not assume the connection is obvious. Say: 'Because of unpredictable bowel urgency and pain, I have had to [specific accommodations/job changes/leave of absence]. My UC directly causes me to [specific functional limitations].'
during exam
- recommended
Do not argue with the examiner or become adversarial
The examiner is not your adversary. Present your information calmly, factually, and thoroughly. If you feel a question is incomplete or a symptom was not addressed, politely raise it. Stay focused on accurate and complete reporting.
during exam
- critical
Write down everything you said and what the examiner documented
Immediately after the exam, write down every question asked, every answer you gave, and any observations about what the examiner seemed to document or skip. Note the examiner's name, specialty, and approximate duration of the exam. This record is critical if you need to challenge the exam later.
after exam
- critical
Request a copy of the completed DBQ
You are entitled to a copy of the completed DBQ. Contact your VA regional office or use eBenefits/VA.gov to obtain the completed examination report once it is available. Review it carefully for accuracy and completeness.
after exam
- recommended
File a CUE or inadequate exam challenge if warranted
If the DBQ omits significant symptoms you reported, fails to address the rating criteria, or contains factual errors, you or your representative can request a supplemental examination or file a notice of disagreement citing an inadequate exam. You must act within your appeal window.
after exam
- recommended
Submit additional buddy statements and private medical opinions if needed
If the exam report does not accurately capture your condition, consider obtaining a private nexus or severity opinion from your treating gastroenterologist or a private IME (Independent Medical Examination) provider. A private medical opinion carries significant weight in appeals.
after exam
Your rights during a C&P exam
- You have the right to an in-person C&P examination. If your exam was conducted via telehealth and you believe an in-person exam is necessary for an accurate assessment of your condition, you may request one through your VA regional office.
- In most U.S. states, you have the right to audio or video record your C&P examination without the examiner's consent. Check your state's recording consent laws before the exam. Recording creates an objective record that can support an inadequate exam challenge.
- You have the right to review the completed DBQ/examination report. Request a copy through VA.gov, eBenefits, or your VSO representative. Review it for completeness and accuracy before a rating decision is issued.
- You have the right to submit a written statement before or after your C&P examination (VA Form 21-4138 or direct submission to your claim). Use this to supplement any symptoms the examiner did not fully document.
- You have the right to request a supplemental examination if the completed DBQ is inadequate, fails to address all rating criteria, contains factual errors, or was conducted by an examiner without appropriate credentials (e.g., non-specialist for a complex GI condition).
- You have the right to bring a VSO representative, accredited claims agent, or accredited attorney to your C&P examination as a support person. Inform the scheduling office in advance.
- You have the right to submit buddy statements (VA Form 21-10210) from family members, caregivers, coworkers, or friends who can corroborate your reported symptoms and functional limitations. These statements are evidence of record.
- You have the right to submit private medical opinions from your treating gastroenterologist or an independent medical examiner to supplement or rebut the VA examiner's findings. Private medical opinions are entitled to full consideration under the benefit-of-the-doubt standard (38 CFR - 3.102).
- Under 38 CFR - 3.102, when there is an approximate balance of positive and negative evidence regarding any issue material to your claim, VA must give the benefit of the doubt to the claimant. You do not need to prove your case beyond a doubt.
- You have the right to appeal any rating decision. The AMA (Appeals Modernization Act) provides three review lanes: Supplemental Claim (new and relevant evidence), Higher-Level Review (de novo review by a senior claims adjudicator), and Board of Veterans' Appeals (with or without a hearing). Each has specific deadlines and you should consult a VSO or accredited representative before choosing a lane.
- If your UC prevents you from maintaining substantially gainful employment, you may be eligible for Total Disability Individual Unemployability (TDIU) under 38 CFR - 4.16, even if your combined or single rating does not reach 100%. This benefit pays at the 100% rate.
Related conditions
- Crohn's Disease UC is rated by analogy to Crohn's Disease under DC 7326. The rating criteria, symptom thresholds, and treatment level distinctions are identical for both conditions under 38 CFR - 4.114.
- Irritable Bowel Syndrome (IBS) IBS is a separate, commonly co-occurring condition that may develop secondary to UC or its treatment. If your GI provider has diagnosed IBS in addition to UC, it may be separately ratable or considered a secondary condition to UC.
- Anemia (Iron Deficiency / Chronic Disease) Chronic GI blood loss from UC commonly causes iron-deficiency anemia. Anemia secondary to UC may be separately rated or may support a higher UC severity rating. Document all anemia diagnoses and treatment history.
- Colorectal Cancer Long-standing UC significantly increases colorectal cancer risk. If colorectal cancer develops, it may be ratable as secondary to UC under 38 CFR - 3.310. Ensure all surveillance colonoscopy records are in your claims file.
- UC-Associated Arthropathy / Peripheral Arthritis Peripheral and axial arthropathy is a well-recognized extraintestinal manifestation of UC. Joint conditions caused by UC may be ratable as secondary conditions under 38 CFR - 3.310 and should be claimed separately if causing additional disability.
- Pyoderma Gangrenosum / Erythema Nodosum These UC-associated skin conditions are extraintestinal manifestations captured on the IBD DBQ. If separately diagnosed and treated, they may be ratable as secondary conditions and should be reported to the examiner during the systemic manifestations assessment.
- Primary Sclerosing Cholangitis (PSC) PSC is a serious liver condition associated with UC in approximately 5% of UC patients. If diagnosed, PSC should be claimed as secondary to UC and rated separately under the appropriate hepatic diagnostic code.
- PTSD / Mental Health (Secondary to Chronic Illness) Chronic, unpredictable, and socially isolating conditions like UC can cause or worsen depression, anxiety, and PTSD. Mental health conditions secondary to the psychological burden of UC disability may be separately ratable. Discuss with your mental health provider and consider filing a secondary claim.
- Osteoporosis / Osteopenia Long-term corticosteroid use for UC and chronic malabsorption cause bone density loss. Osteoporosis secondary to UC or its treatment may be ratable under 38 CFR - 3.310 if it causes additional disability such as fractures or chronic pain.
- Short Bowel Syndrome If UC required surgical resection of the large intestine (colectomy), the resulting short bowel syndrome or resection sequelae are rated under DC 7328 or 7329 and should be separately evaluated and claimed.
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.
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.