High-stakes testing can be a major hurdle for individuals who know the material well, but have trouble understanding the language of the test. Many people have difficulty understanding test questions when the wording of the question is different from the language variation typically used by the test-taker. This research builds on prior research published in 2011 and 2016. The Language Variation Tool (LVT) was created to help determine if problems existed when test questions were reworded in accordance with Southern Caucasian and Southern African American language variations. This tool focused on physical therapy graduate students, and a study published in 2016 demonstrated some predictive value to the LVT with respect to the PT board practice examinations. Students who received a lower overall score on the diagnostic test, also demonstrated lower scores on the practice board examination (Pearson correlation=0.662; p=0.000). This current paper focuses on how the tool was created, and looks at one of many students who have used this tool to help pass the physical therapy board examination. When there is a misunderstanding of the meaning of test questions, there can be increased difficulty passing standardized examinations. This case study supports the utilization of this diagnostic tool to predict success on the high stakes examination, and the power of intervention to overcome the obstacle of successful comprehension. These authors believe that this tool can be created in other languages for other disciplines focusing on various cultural proclivities. Because this is a simple case study, the results may not be generalizable to the population of those taking the physical therapy board examination. As such, it is the opinion of the researchers that simply informing a test-taker of his or her limitations prior to an exam, gives them something to practice and develop prior to retaking the examination with the hope of potentially improving test performance. This contention would require further research.