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General C & P For Cancer & Neuropathy



I received notification today that I am scheduled for a "C&P Exam-General" for September 12, 2012. I looked up the name of the person performing the exam and she is listed as a primary care nurse practitioner.

I have a pending claim for multiple myeloma caused by agent orange exposure in Vietnam and severe bilateral neuropathy of the lower extremities secondary to multiple myeloma. In addition to medical test results and other medical evidence I submitted an IMO from my oncologist verifying my multiple myeloma diagnosis and another IMO from my neurologist stating my neuropathy is "more likely than not" secondary to my multiple myeloma. I also provided EMG and Nerve Conduction study test results.

I anticipated a C & P exam from an oncologist for the multiple myeloma claim and a C & P exam from a neurologist for my neuropathy claim.

Question: Is it normal to have a general C & P exam for these type of claims?

Question: Will I receive other C & P exams for these specific conditions?

Question: Will I be examined at anytime by a VA oncologist and VA neurologist?

I do not see how a primary care NP can conduct a competent exam of my two claimed conditions, especially the multiple myeloma which is a rare blood cancer in the bone marrow.

Any input would be appreciated.


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I don't have personal experience with your contentions in regards to a C&P but I can tell you from personal experience that for some reason NP's are being used more and more by VA rather then specialist for C&P's.

This is from a Fast Letter that the VA put out:

Please note that a specialist is only required in limited situations such as dental, vision, hearing, and psychiatric examinations, as indicated by M21-1MR III.iv.3.A.8. For all other types of examinations, a generalist clinician may perform the examination. For example, an office may order a cardiac examination, but it should not generally request that a cardiologist (a specialist) conduct it. See FL 10-32

As Pete992 pointed out in another thread " Get a medical specialist opinion (IMO) prior to filing a claim or at least prior to your C & P exam and get it in your records. DO NOT let the C & P examiner's medical opinion be the only medical opinion in your file. Get treated and get the evidence that you need to win your claim, try to get enough evidence in your file to support your claim that VA has to grant it the first time."

His previous post as well as others can be found on this thread which speaks about FL 10-32:

Kudos to you for having the foresight to submit IMO's from both your oncologist and from your neurologist to the VA. I think many of us here question why a NP are conducting such exams.........

The DBQ's (Disability Benefits Questionairres) are very much like the forms that the C&P examiner fills out - almost identical except that the DBQ's do not have the "more likely, less likely" sentence/phrase in them but a good IMO should have that - as you noted yours do. Not only have I submitted IMO's from specialists, I have also asked them to fill out the DBQ's as well. DBQ's for most contentions may be found here: http://benefits.va.g...isabilityexams/ .

I believe in trying to keep the "benefit of the doubt" rule on my side. More about the benefit of the doubt rule:

VA claimants have the burden to prove their claim to the VA, that is, when a person makes a claim to VA that person has the responsibility to present evidence that will establish entitlement to the benefits that person is seeking. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA will give the “benefit of the doubt” to the claimant.” 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102 (2010); see Gilbert v. Derwinski, 1 Vet. App. 53, 55 (1990) (the benefit of the doubt standard is similar to the sandlot baseball rule that the tie goes to the runner).

For information about M-21-1MR III as I just noted the link in my paragraph is not working......you should be able to copy and paste this: www.benefits.va.gov/warms/docs/admin21/m21.../ch03_seca.doc

Edited by USMC5811 (see edit history)
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Thanks for the info. I was beginning to think I was not going to get any replies. I should have known that a fellow jarhead would take the time to give me some good info.

Semper Fi,


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Your very welcome Georgiapapa....sometimes it just takes a little while - considering how many new posts appear daily for an elder or one of hadit.com more experienced vets (of which, I am not) to help answer a vets question. But from what I've seen - they are very good at ensuring that questions do get answered - just might take a day or two.

Semper Fi! Best wishes that your claim is resolved quickly and accurately.

Edited by USMC5811 (see edit history)
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Well GeorgiaPapa, i assumed you are in ga. Well i recieved a letter to. stating that i have an appointment on sep 13, for a C&P exam at the general medical clinic. I have been waiting on my claim for 2 years. i had asleep apnea C&P done in january of this year.

i went thru my congressman and now i am having a C&P exam on everything. i think because they(va) can't find records and that they said they had them and now they don't and i have sent in all the neccassary information that i need for my claim which should be in my favor. so i will have to wait and see how this goes.

trying to get an eed., where they said if these records are located at a later time the claim would go back to the inital rating.

so i will have to wait and see.


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Reddit & Notorius Kelly,

Thanks for the input.


I am going to the VAMC in Dublin, Ga for my C & P. I also had a problem with the Atlanta VARO not being able to find my complete evidence package mailed to them in 2011 even though I had proof they received the evidence. I finally had to hand deliver another complete package to them on May 1st of this year. On ebenefits they show receiving my evidence on August 13, 2012. Good luck with your C & P.

Notorius Kelly,

Sorry to hear about your disability claim denial with social security. The only positive thing I see with the VA using a NP for my C & P for my cancer and neuropathy claims is my IMOs from my private oncologist and neurologist should carry more weight with the BVA if my claims are denied. I am going to take copies of my IMOs to my C & P and hope that the NP will agree with their conclusions so I don't have to go the BVA route. I hope I have a positive experience with the NP and thanks for your encouragement.


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