Can a VA rater grant service connection even if the C&P exam gives a negative nexus opinion?

Yes. A single negative medical opinion from a C&P examiner is not automatically controlling. Under 38 CFR 3.102, VA must give the veteran the benefit of the doubt when the evidence for and against a claim is in approximate balance, and the rater is required to weigh the examiner's opinion against all other evidence of record, including service treatment records, private treatment records, lay statements, and buddy statements. If the rater finds the examiner's rationale incomplete, inconsistent with the record, or based on an inaccurate factual premise (for example, treating silence in a single post-deployment assessment as dispositive when treatment records from the same deployment show the condition was addressed), the rater can discount that opinion, return it for clarification, or request a new examination rather than rely on it outright.

Continuity of symptomatology under 38 CFR 3.303(b) is most directly available for chronic diseases listed in 38 CFR 3.309(a); psoriasis is not on that list, so the stricter continuity doctrine does not automatically apply, but ordinary direct service connection under 3.303(a) still allows a nexus to be established through a continuous treatment history, lay evidence explaining gaps in records, and medical records showing a consistent diagnosis dating near the in-service onset. A documented reason for a records gap, such as a closed practice with records destroyed per the provider's retention schedule plus corroborating prescription history, is legitimate evidence a rater can and should weigh in the veteran's favor.

A deferral is not a denial. It generally means the rater needs more evidence or development, such as the CAPRI and DPRIS records mentioned, before making a final decision. Once those records are associated with the file, the rater will reweigh everything, and it remains possible for the claim to be granted even though one exam opinion was unfavorable, or for VA to order an addendum opinion if the negative rationale is deemed inadequate.

The concrete next step is to submit a written argument (or ask a VSO or accredited representative to do so) specifically challenging the examiner's rationale as factually inaccurate, citing the in-service treatment record and the civilian continuity evidence, and request that the rater obtain an addendum medical opinion if the current one is found inadequate before any final decision is issued.