Exam-day guide

Universal rules

1. Report your worst real day, not a typical Tuesday. Downplaying from habit, stoicism, or military pride gets marked 'mild' or 'normal'. Answer from flare-up days and worst weeks.
2. Describe flare-ups like a police report. Detail frequency, duration, triggers, severity versus baseline, and what you cannot do; over 65% of exams leave the DBQ flare section blank from vague answers.
3. Use plain, functional language. 'I can't sit with my back to a restaurant door without panicking' beats 'hypervigilance'. Describe your real life in your own words.
4. Upload your records to VA.gov before the exam & write notes beforehand. The examiner does not send records to VA for you. Notes are allowed, demonstrate preparation, and prevent forgetting symptoms under stress.
5. Name what you have surrendered. Concrete lost activities (work, promotions passed, lifting kids, sports or yard work given up, relationship strain) provide objective proof of impairment.

For tinnitus exams

• Prepare a fixed, consistent answer for your onset date, in-service event, and whether the ringing is constant or intermittent.
• A normal audiogram beep test does not disprove tinnitus — tinnitus is evaluated independently under DC 6260 (flat 10% rating for recurrent tinnitus).
• Describe the functional impact on your life: broken sleep, daytime concentration loss, mood effects, and how it impacts quiet environments. Never say "I'm used to it."

For sleep apnea exams

• Sleep apnea (DC 6847) hinges on whether a breathing assistance device (CPAP) is medically required (50% bracket).
• Document daytime hypersomnolence (falling asleep at work, while driving, or during the day).
• Lay statements from a spouse or roommate documenting snoring and stopped breathing are key evidence.

For migraine exams

• Migraines (DC 8100) require tracking prostrating attacks (attacks severe enough to force you to lie down in darkness).
• Maintain a detailed headache log tracking frequency, duration, and whether attacks cause severe economic inadaptability.

For GERD exams

• GERD (DC 7206) is rated on a documented esophageal stricture: trouble swallowing (dysphagia) confirmed by a scope (EGD), barium swallow, or CT, and how often it needs stretching (dilatation). Heartburn alone does not select a row.
• Frequently service-connected secondary to daily NSAID pain medications taken for service-connected joint or back injuries.

For hearing loss exams

• In the booth, press the button every time you think you hear a tone, even if faint. The test measures the quietest threshold you can detect.
• If tinnitus ringing interferes with hearing the test beeps, tell the examiner out loud so it is documented.

For physical range-of-motion exams

• Under 38 CFR § 4.59 (Painful Motion), your legal range of motion ends the moment pain begins, not where you force through pain. Stop immediately when pain begins and clearly say 'that hurts' out loud so the examiner documents the angle.
• Visual eyeball estimates of joint motion fall short of 38 CFR § 4.46, which calls the goniometer indispensable. The examiner must use a physical goniometer tool to measure joint degrees across repetitions. If they do not measure, the exam is incomplete.
• If you took Motrin, say it out loud: the medicine, the dose, and what you still struggle with. Do not play the tough guy. *(Medical safety exception: Never skip life-sustaining medications for heart, blood pressure, or psychiatric needs).*

For mental health exams

• Ratings under 38 CFR § 4.130 are based on occupational and social impairment: work conflicts, absenteeism, social withdrawal, panic attacks, and family friction. Give concrete examples.
• Past ideation without a current plan or intent stays in the interview. A past thought is not a current plan or current intent.
• **DO NOT** do what you were trained for. **DO NOT** sit at attention. **DO NOT** say "doing fine, sir." If you do, the report will read: calm, well-groomed, cheerful.