VA does not order a compensation and pension (C&P) exam for every claim. There are specific criteria that determine when an exam is necessary. Generally, VA must provide an exam when there is competent evidence of a current disability or persistent symptoms, an indication that the disability may be connected to military service, and insufficient evidence in the file to decide the claim. All three of these elements must be present. The threshold for ordering an exam is relatively low. An indication of a connection to service can be satisfied by your own statements about what happened during service and when your symptoms began. You do not need to have a formal diagnosis or a doctor saying your condition is related to service before VA orders the exam. For claims involving an increase in disability rating, VA should order an exam when the evidence suggests your condition may have worsened since your last evaluation. For secondary service connection claims, an exam is appropriate when there is evidence suggesting a relationship between your claimed condition and an already service-connected disability. If VA denies your claim without providing an exam, and you believe the criteria were met, that can be a strong basis for an appeal. The failure to provide a necessary exam is one of the most common errors identified by the Board of Veterans Appeals.
Note: This article references sections of the VA's M21-1 Adjudication Procedures Manual. The VA periodically reorganizes the M21-1 and section numbers may have changed since this article was written. For the most current section references, visit the VA's public M21-1 Web Automated Reference Material System (WARMS).