Yes. A nurse practitioner (NP) or physician assistant (PA) can work as a Compensation and Pension (C&P) examiner, performing most general medical and musculoskeletal exams once certified for those exam types. At Rank and Pay, we built the table below from public VA exam forms, federal regulations and VA directives.
A C&P examiner nurse practitioner or PA cannot do initial posttraumatic stress disorder (PTSD) exams, hearing exams, eye exams or an initial traumatic brain injury (TBI) diagnosis. Each of those exams has its own license rule, and the table names the source for every row. For the hiring routes and the four exam contractors, start with our guide to becoming a C&P examiner.
Which C&P Exams Each License Can Perform
Your license decides which C&P exam types you can take on, and four exam groups are reserved for specific licenses. The examiner completes a Disability Benefits Questionnaire (DBQ) on each exam. The public DBQ forms and federal regulations name who may do each exam type.
| License | Exams it can do | Exams it cannot do (or only under close supervision) | Rule source |
|---|---|---|---|
| Physician (doctor of medicine, MD, or doctor of osteopathic medicine, DO) | General medical and musculoskeletal exams once certified by exam type; a TBI exam after the required TBI training when a qualifying specialist has already diagnosed TBI | Initial or review mental disorders and PTSD exams unless a board-certified or board-eligible psychiatrist; hearing exams; eye exams unless an ophthalmologist; an initial TBI diagnosis unless a neurologist, neurosurgeon, physiatrist or psychiatrist | Veterans Health Administration (VHA) Directive 1046(1); 38 Code of Federal Regulations (CFR) 4.85 and 4.75; VA Office of Inspector General (OIG) 2018 TBI report |
| Psychiatrist | Initial and review mental disorders exams, including PTSD, if board-certified or board-eligible; an initial TBI diagnosis | Hearing exams; eye exams | Mental Disorders DBQ; VA OIG 2018 TBI report; 38 CFR 4.85 and 4.75 |
| Psychologist (doctorate) | Initial and review mental disorders exams, including PTSD, if licensed; a non-licensed doctorate-level psychologist working toward licensure can do them under close supervision | Hearing exams; eye exams; an initial TBI diagnosis | Mental Disorders DBQ; Review PTSD DBQ |
| Nurse practitioner | General medical and musculoskeletal exams once certified by exam type; a TBI exam after the required TBI training when a qualifying specialist has already diagnosed TBI | Review PTSD and review mental disorders exams only under close supervision and only if clinically privileged by VHA; no initial mental disorders or PTSD exams, hearing exams, eye exams or initial TBI diagnosis | VHA Directive 1046(1); Review PTSD DBQ; Mental Disorders DBQ |
| Physician assistant | General medical and musculoskeletal exams once certified by exam type; a TBI exam after the required TBI training when a qualifying specialist has already diagnosed TBI | Review PTSD and review mental disorders exams only under close supervision and only if clinically privileged by VHA; no initial mental disorders or PTSD exams, hearing exams, eye exams or initial TBI diagnosis | VHA Directive 1046(1); Review PTSD DBQ; Mental Disorders DBQ |
| Audiologist | Hearing exams, if state-licensed | Initial or review mental disorders and PTSD exams; eye exams; an initial TBI diagnosis | 38 CFR 4.85(a) |
| Optometrist or ophthalmologist | Eye exams, if licensed | Hearing exams; initial or review mental disorders and PTSD exams; an initial TBI diagnosis | 38 CFR 4.75(b) |
| Licensed clinical social worker (LCSW) | Review PTSD and review mental disorders exams under close supervision | Initial mental disorders and PTSD exams; hearing exams; eye exams | Review PTSD DBQ; VHA Directive 1046(1) |
If you are an NP or PA, general medical and musculoskeletal exams are open to you once you pass the required courses for each exam type. Mental health exams are open to you only at the review stage, under close supervision, and only if VHA has clinically privileged you to perform them.
Mental Health and PTSD Exams
Initial mental disorders exams, including PTSD, are limited to psychiatrists, doctorate-level psychologists and closely supervised trainees. The current Mental Disorders DBQ lists five examiner types for the initial exam:
- A board-certified or board-eligible psychiatrist.
- A licensed doctorate-level psychologist.
- A non-licensed doctorate-level psychologist working toward licensure under close supervision.
- A psychiatry resident under close supervision.
- A VHA psychology trainee (intern or resident) under close supervision.
The same DBQ says that if the veteran has a PTSD diagnosis, a VHA staff or contract examiner must complete the Initial PTSD Questionnaire. VA does not post the Initial PTSD DBQ on its public DBQ page.
Review Exams and Close Supervision
Review PTSD and review mental disorders exams open to more licenses, each working under close supervision. The current Review PTSD DBQ adds two groups to the initial-exam list:
- A licensed clinical social worker under close supervision.
- A nurse practitioner, clinical nurse specialist or physician assistant under close supervision who is clinically privileged by VHA to perform C&P mental disorders exams.
The DBQ defines close supervision as three steps, each done by a board-certified or board-eligible psychiatrist or a licensed doctorate-level psychologist:
- The supervisor meets with the veteran.
- The supervisor confers with the supervised clinician.
- The supervisor co-signs the report.
Marriage and family therapists and licensed professional mental health counselors do not appear on either DBQ. For NPs and PAs at a contractor, the public text does not settle whether a contract clinician can meet the "clinically privileged by VHA" wording. Put that question in writing to QTC, VES, Loyal Source and OptumServe before you plan on review mental health work.
Hearing, Eye and TBI Exams
Hearing, eye and initial TBI exams each require a specific license or specialty, set by federal regulation or VA policy. Under 38 CFR 4.85(a), a state-licensed audiologist must conduct the hearing exam. The exam must include a controlled speech discrimination test (the Maryland consonant-nucleus-consonant, or CNC, test) and a puretone audiometry test, both without hearing aids.
Under 38 CFR 4.75(b), a licensed optometrist or a licensed ophthalmologist must conduct the eye exam.
When a veteran has no TBI diagnosis at the time of the claim, VA requires a neurologist, neurosurgeon, physiatrist or psychiatrist to make the diagnosis, according to the 2018 VA OIG report. When one of those four specialists has already diagnosed TBI, any clinician who has completed the required TBI training can do the C&P exam.
If your specialty is not on that list, take only TBI exams where a qualifying specialist has already made the diagnosis.
General Medical Exams a C&P Examiner Nurse Practitioner or PA Can Perform
General medical and musculoskeletal exams have no physician-only rule in VHA Directive 1046(1), so certified NPs and PAs can perform them. The directive, issued in November 2023 and amended in March 2025, lists physicians, dentists, physician assistants, certified nurse practitioners, psychologists, optometrists, social workers and audiologists as VHA examiners.
Certification works by exam type, and the musculoskeletal exam has its own required course.
Contract examiners take more than 11 hours of training before their first exam, with more courses for mental health and musculoskeletal exams, according to Government Accountability Office (GAO) report GAO-24-107730. Contract examiners retrain every 5 years, or after 12 months without conducting an exam, according to VA OIG report 24-00758-138. That report says the VHA directive for staff examiners does not require recertification.
Our C&P certification guide covers the courses in more detail. On every exam, you review records, examine the veteran and complete the DBQ. A VA rater decides the rating, and you do not treat or prescribe during the exam.
On an Acceptable Clinical Evidence (ACE) exam, you complete the DBQ from existing records, sometimes with a telephone interview and no in-person exam. Which DBQs qualify for ACE varies by employer, so ask before you accept the work.
VA and all four contractors named on VA's exam page post NP and PA C&P jobs.
Posting Requirements for PAs, NPs and Physicians
VA's 2026 C&P job postings set separate license and certification requirements for each license.
What a PA Needs to Know
A VA PA practices under an individual scope of practice with a designated collaborating physician, under VHA Directive 1063(2). PA C&P evaluations do not need a physician co-signature unless federal law or VA policy requires one. On review mental health exams, close supervision under the Review PTSD DBQ includes a co-signature by the supervising psychiatrist or psychologist.
The 2026 VA PA C&P posting required graduation from an accredited PA program, passing the Physician Assistant National Certifying Exam (PANCE), and a full, unrestricted state license. That posting preferred two years of primary care experience.
C&P Examiner Nurse Practitioner Requirements
The 2026 VA NP C&P posting required national NP certification in family, adult, adult-gerontology primary care or gerontological practice. It also required a full, unrestricted advanced practice registered nurse (APRN) license. If your certification is in a different population focus, ask the VA hiring office named on the posting whether it qualifies before you apply.
Physicians and Psychiatrists
VA physician C&P postings require one full and unrestricted license from any U.S. state or territory. Psychiatrists who do initial mental disorders exams must be board-certified or board-eligible, per the Mental Disorders DBQ. VA physician postings list DBQ exams and ACE exams among the duties.
Where VA and Contract Jobs Are Posted
VA staff C&P jobs appear on USAJOBS under 2026 titles such as "Nurse Practitioner-Compensation & Pension" and "Physician Assistant-Compensation & Pension." These are Title 38, excepted service positions. On the contract side, Veterans Evaluation Services (VES) describes its network clinicians as independent contractors paid per exam and per DBQ.
Our C&P examiner pay guide covers how pay works on the staff and contract routes.
License Portability for Contract Work
A federal law lets certain contract examiners examine in any state with one license. Under the note to 38 U.S.C. 5101, a physician, PA, NP, audiologist or psychologist qualifies with a current, unrestricted license and no bar in any state. The exams must be performed under a Veterans Benefits Administration (VBA) contract.
For PAs, NPs, audiologists and psychologists, this authority runs to January 5, 2027, after an extension in Public Law 119-37, section 7203. Physicians' portability is permanent. Bills to extend the date or make it permanent were pending but not enacted as of this writing.
Dentists and optometrists are not covered by this law. Contractors set their own license rules by role, and the Leidos QTC Health Services (QTC) provider page asks for a license in the state of practice. VA staff examiners need one full, current, unrestricted license from any U.S. state, territory or D.C.
How to Check Your Eligibility Before You Apply
Four checks show which C&P exams you can take on before you spend time on an application.
- Your license must be full, current and unrestricted. VA staff postings require it, and the portability law requires a current, unrestricted license with no bar in any state.
- List the exam types you want. Match each one (general medical, musculoskeletal, mental health, hearing, eye or TBI) to its row in the table above.
- Ask the employer which DBQs your license and privileges allow. Get the answer in writing, including whether you qualify for review mental health exams and which DBQs the employer runs as ACE exams.
- Check the portability date if you would examine outside your license state. Read the current text of 38 U.S.C. 5101 to see whether the January 5, 2027 date for NPs, PAs, audiologists and psychologists has been extended.
Who This Page Is Not For
Marriage and family therapists and licensed professional mental health counselors will not find a C&P mental health route here, because neither public mental disorders DBQ lists them. Our nexus letter writer jobs guide covers a different clinician job tied to veterans' claims.
Veterans preparing for an exam will not find exam guidance on this page. Our guides to Veterans Evaluation Services and the OptumServe C&P exam are written for veterans.
What Would Change This Answer
- If Congress extends the January 5, 2027 date or makes it permanent, contract NPs, PAs, audiologists and psychologists keep any-state examining. If the date passes with no extension, that authority ends for those four licenses.
- If VA revises the examiner lists on the Mental Disorders DBQ or the Review PTSD DBQ, the mental health rows in the table change.
- If a contractor states that its NPs and PAs meet the "clinically privileged by VHA" wording, contract NPs and PAs there could do review mental health exams under close supervision.
If you are weighing C&P examiner nurse practitioner or PA work, mark the exam types in the table that match your license. Then search USAJOBS for "Compensation & Pension" and send each contractor your list of DBQs with a request to name the ones it will clear you for.
Rank and Pay is not affiliated with VA and has not worked as a C&P examiner. This page offers general information only and is not legal, licensing or career advice. Requirements change, so confirm current rules with VA, each contractor and your licensing board.