How to Prepare for a C&P Exam

The baseline requirement for secondary aggravation claims came from 38 C.F.R. § 3.310(b). The Federal Circuit struck down that regulation in Spicer v. McDonough. The statute (38 U.S.C. § 1110) says nothing about baselines. But as of May 2026, VA has not formally rewritten the regulation, and C&P exam templates still ask examiners to address baseline. Here's the key: the exam templates themselves say the aggravation question must be answered "regardless of an established baseline." The baseline is a rating tool, not a gatekeeping tool. When it can't be determined, §§ 3.22 and 4.22 mean no deduction — the veteran gets the full current rating.

A strong secondary nexus letter after Spicer v. McDonough includes seven sections: provider qualifications, records reviewed, veteran-specific timeline, diagnosis, a nexus opinion addressing all three pathways (causation, aggravation, treatment interference), medical rationale with peer-reviewed citations, and proper signature. The five most common reasons nexus letters get denied are: no mechanism explained, template language, ignoring aggravation, wrong probability language, and failing to address the C&P examiner's negative opinion.

The Federal Circuit struck down the old proximate-cause standard. The VA updated its adjudication manual. Here's what changed, what stayed the same, and how your nexus letter needs to adapt — explained by clinicians, not attorneys.