What do you do when you need a medical opinion to prove your disability is service-connected, but you don’t have money to hire a doctor on your own, and you don’t have insurance that will cover it. Your only option is a C&P Exam. The good news is, the VA can get you that exam, however, the VA doesn’t have an obligation to get you a medical opinion just because you filed a claim. Remember, it is your job to prove your claim. To get the VA to provide you with a C&P exam, you have to prove four things. These come from a case called McLendon v. Nicholson.
The first thing you have to do is present the VA with competent evidence of a current disability or persistent or recurrent symptoms of a disability. You providing a statement about constantly having migraines at least once a week, that takes you out for a minimum of 4 hours meets this standard. Your disability could just be migraines, it could be TBI, it could be something else. The point is, a statement from you is enough.
The second thing you have to do is prove an in-service event, injury, or disease. To stick with our example, you can get service records or a buddy statement, or your own statement, that shows, you were in a vehicle that was struck by an IED, or during a deployment, you slept right next to a flight line. I’d personally lean towards the service records, including service medical records. It’s harder for the VA to ignore those, but buddy statements should be enough.
The third thing you have to do is provide a plausible chain of events that the in-service event could cause the current symptoms. This is supposed to be a low bar, but don’t assume that. A detailed statement from you that says you never got headaches, but they started days after the IED and you’ve had them ever since should be enough. Don’t give an opinion though. Unless you’re a doctor, don’t try to tell the VA an event caused a disability, just walk through in great detail the symptoms that you observed.
The fourth element is that there is basically no medical opinion already in the file. So if the VA has sent you to get a C&P exam and your C-File already has a medical opinion saying you’re not service-connected, they aren’t going to send you to get another C&P exam. Now if your claim is for TBI and the VA got an opinion from an orthopedic doctor, that’s a different story.
Anyway, that’s a quick overview of what you need to prove to get the VA to send you out for a C&P exam. I hope you found this helpful. If you want me to help you with your disability claim, feel free to reach out to me through my website.