Overview
In This Section |
This section contains the following topics:
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1. General Information on Examination Requests
Introduction |
This topic contains general information about examination requests, including
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Change Date |
February 19, 2019 |
III.iv.3.A.1.b. Definition: Appropriate Examination Facility |
An appropriate examination facility is a Department of Veterans Affairs (VA) examination facility or contract examination provider that can complete the examination(s) required by the specific claim.
Regional offices (ROs) have the flexibility to request an examination from the VA medical center (VAMC) or designated contract provider closest to where the claimant lives or receives regular medical treatment.
References: For more information on
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III.iv.3.A.1.c. Jurisdiction Over Examination Requests for Foreign Resident Claimants or Beneficiaries |
Use the table below to determine which specific office or center has processing jurisdiction over an examination request involving a claim initiated by a foreign resident claimant or beneficiary.
Note: Once requested, field examinations for foreign resident beneficiaries become the ultimate responsibilities of the Indianapolis and Lincoln Fiduciary Hubs.
References: For more information on the
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III.iv.3.A.1.d. Mandatory Use of the ERRA Tool |
Claims processors must use the ERRA tool when requesting examinations in support of claims for service-connected (SC) compensation. Although the ERRA tool has an option for pension, PMC use of the ERRA tool is optional to determine the closest VAMC to conduct an examination. VA resources will be utilized to the fullest extent possible in performing examinations, but the use of contract/vendor resources is authorized whenever a VA examination facility has reached or exceeded maximum capacity. When queried, the ERRA tool will identify the
Compensation claims processors are required to associate the ERRA tool’s inquiry results with the claims folder. When uploading the results to the Veterans Benefits Management System (VBMS), users should identify the document by entering the following information:
SUBJECT: ERRA Results
CATEGORY – TYPE: Medical Records- VAX & AMIE – Request Worksheets: VA Exam Worksheet
SOURCE: VBMS
ASSOCIATE TO: [End product for which examination is being requested].
Note: Requests for non-Veterans Health Administration (VHA) examinations scheduled through a designated contractor are limited to the geographic area specified by the contractual agreement.
Exceptions:
References: For more information on
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III.iv.3.A.1.e. When an Examination or Opinion Is Necessary |
For more information on when a medical examination or opinion is necessary, see
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III.iv.3.A.1.f. Definition: General Medical Examination |
The main purpose of a general medical examination is to screen all body systems and either
Note: The examiner must fully evaluate any disability that is found or suspected according to the applicable disability benefit questionnaires (DBQs). Opinions addressing etiology and relationship to service are not typically provided by general medical examinations.
References: For more information on
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III.iv.3.A.1.h.Definition: SpecialistExamination |
A specialist examination is any examination that is conducted by a clinician who specializes in a particular field.
Notes:
References: For more information on
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III.iv.3.A.1.i. Veteran’s Legal Rights at an Examination |
A Veteran has no legal right to
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III.iv.3.A.1.j. Contract Examination Exclusions |
Examinations must not be requested from contract examiners under the circumstances specified in the Contract Exam Exclusions List. Use discretion based on RO expertise and consultation with VA Central Office (CO) when determining whether a contract examination is warranted.
Important: Annotate in the Compensation and Pension Record Interchange (CAPRI) REMARKS section when an examination cannot be performed by a contract examiner.
Example of required annotation: Veteran has filed a claim for [excluded condition] – cannot submit to VBA contract exam provider.
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2. Examination Request Tools
Introduction |
This topic contains information about tools used for requesting exams, including
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Change Date |
February 19, 2019
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III.iv.3.A.2.b.ERRA Tool |
Examination facilities designated to conduct exams are found in the ERRA tool.
The ERRA tool’s search results include information about the
Important: This tool is designed as a guide to assist in the routing of C&P examination requests. Its usage in the development of SC compensation claims is mandatory. When routing an examination request, take into account any
Notes:
Important: The ERRA tool’s data are refreshed daily. Therefore, it is imperative to check ZIP codes daily, as the suitability of a claimant’s direction to a VA or contract examination facility may vary in response to demand and facility availability. Routing location and exam type comments may also be subject to daily updates.
References: For more information on the
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III.iv.3.A.2.c. Interpreting the ERRA Tool’s Results |
Use the table below to interpret the ERRA tool’s results and determine the appropriate examination facility to which an examination request should be routed.
Note: If, after reviewing the ERRA tool’s results, the proper VHA routing location is not clear, VA clinics may be contacted to request clarification. Identify points of contact (POCs) by using the C&P Clinic POC List.
Reference: For more information on the ERRA tool’s functionality, see the Disability Examination Program Management page.
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III.iv.3.A.2.d.Index of DBQ/Exams by Disability Tool |
The Index of DBQ/Exams by Disability tool allows users to search by a particular word, phrase, or diagnostic code (DC). Input information in the SEARCH CRITERIA text box, and the tool will generate suggested DBQs, DCs, and relevant legacy examination worksheets.
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III.iv.3.A.2.e. ERB Tool |
The primary purpose of the Exam Request Builder (ERB) tool is to standardize the format for exam requests.
Important:
Note: Report any corrected information needed by e-mail toVAVBAWAS/CO/CAPRI.
Reference: For more information on ERB functionality and training, see the ERB Training Guide.
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III.iv.3.A.2.f.ERB-S Tool |
The Simplified ERB (ERB-S) tool is a streamlined, less functionally comprehensive companion to the traditional ERB tool. Like the latter, it is designed to promote the standardization of the language and formatting used to compose examination requests.
The use of the ERB-S tool in connection with the VBMS examination scheduling requests discussed in M21-1, Part III, Subpart iv, 3.A.10.b, is mandatory.
Reference: For more information on the ERB-S tool, see the ERB Training Guide.
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III.iv.3.A.2.g.Selecting the Appropriate Application for Entering Examination Requests |
Use the table below to determine which application to use in preparing and submitting an examination
References: For more information on
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III.iv.3.A.2.h. MandatoryEntry of Requestor’s Contact Information |
Examination requests submitted through CAPRI must include the primary requestor’s contact information, to include, at a minimum, his/her
Notes:
Reference: For more information on entering contact information in the ERB tool, see the ERB Training Guide.
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3. DBQs
Introduction |
This topic contains information about DBQs, including
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Change Date |
April 24, 2017 |
III.iv.3.A.3.a. Definition: DBQs |
Disability benefit questionnaires (DBQs) are documents used to
DBQs are designed for internal use by both VHA and contract examiners. The majority of DBQs are also approved for public use by private providers.
References: For more information on
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III.iv.3.A.3.b. Use and Acceptance of DBQs for VA Examinations and Opinions |
Use of DBQs to record the results of VA examinations and medical opinions is required.
However, if there is not a DBQ appropriate for a particular type of examination, or examination results or an opinion are submitted in another format, do not return the report as insufficient for rating purposes on that basis alone.
In lieu of a DBQ completed by a VA examiner or contract examiner, decision makers can accept
References: For more information on
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4. ACE Examinations
Introduction |
This topic contains information on ACE examinations, including
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Change Date |
February 19, 2019 |
III.iv.3.A.4.a.Examinations Based on ACE |
In lieu of scheduling an in-person examination, VHA and contract examiners generally (subject to some limitations) have the option to complete a DBQ based on review of existing paper and/or electronic medical evidence. They may also conduct a telephone interview with the claimant. Examinations based upon medical records and history without an in-person clinical examination or testing are known as ACE examinations or the ACE process.
Reference: For more information on categories of examinations where the ACE process is prohibited, see M21-1, Part III, Subpart iv, 3.A.4.b.
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III.iv.3.A.4.b.Categories of Examinations for Which the ACE Process Is Prohibited |
The ACE process is not available in the following categories of examinations:
Example: A claimant who is SC for posttraumatic stress disorder (PTSD) due to military sexual trauma (MST) files a claim for FSAD secondary to PTSD. Both the gynecological DBQ and PTSD medical opinions will require in-person examinations.
VBA may also specifically require an in-person examination, but in the interest of expediting the claims process, RO employees should not routinely exclude the use of the ACE process absent a compelling reason, particularly for
Reference: For more information on the requirement to identify evidence for the examiner’s review, see M21-1, Part III, Subpart iv, 3.A.8.d.
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III.iv.3.A.4.c.Examination Requests and ACE |
When entering an examination request in CAPRI, ensure that the examination request
Notes:
Reference: For more information on requirements of ACE examinations, see M21-1, Part III, Subpart iv, 3.D.2.m.
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5. General Medical Examinations
Introduction |
This topic contains information about general medical examinations, including
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Change Date |
August 4, 2017 |
III.iv.3.A.5.a. When to Request a General Medical Examination |
A general medical examination containing a full report of complaints and functional impairments is the preferred type of examination in cases concerning original compensation claims.
Request a general medical examination if
It may also be appropriate to request a general medical examination to obtain evidence in claims for
Important: When requesting a general medical examination to evaluate an original compensation claim received within one year of discharge, do not specify that the examiner also complete specialty examinations for each claimed disability. However, consider whether specialist examinations are required by virtue of the specific claims. This policy applies to examinations requested from VHA, as well as from private providers under VA contract.
Notes:
References: For more information on
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III.iv.3.A.5.b. When a General Medical Examination Is Not Necessary |
It is not necessary to request a general medical examination if
Exception: In claims for IU, SC under 38 CFR 3.317, or Veterans Pension filed more than one year after service, a general medical examination may be appropriate. General medical DBQs exist for compensation, Veterans Pension, and Gulf War claims.
Reference: For more information on acceptable medical evidence for pension rating purposes, M21-1, Part V, Subpart i, 2.2.f.
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III.iv.3.A.5.c. Conducting a General Medical Examination |
When the medical examiner conducts the examination, he/she should confirm the existence of and evaluate
Note: Opinions addressing etiology and relationship to service are not typically provided by general medical examinations.
Reference: For more information on DBQs used for general medical examinations, see the DBQ Switchboard.
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III.iv.3.A.5.d. Citing Medical Conditions to Be Examined |
The examination request for a general medical examination should clearly cite the conditions or particular diagnoses that require attention.
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6. Specialist Examinations
Introduction |
This topic contains information about specialist examinations, including
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Change Date |
March 12, 2018 |
III.iv.3.A.6.a. Examinations Routinely Performed by Specialists |
Some examinations are routinely performed by specialists. These examinations include
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7. Medical Opinions
Introduction |
This topic contains information about medical opinions, including
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Change Date |
February 19, 2019 |
III.iv.3.A.7.a. Who May Request a Medical Opinion |
Development activity personnel and Military Services Coordinators (MSCs) who have completed training specified by CO are authorized to prepare basic or straightforward medical opinion requests without rating activity review.
The VSCM or PMCM will designate categories of opinions that are sufficiently basic or straightforward for preparation by the development activity. However, medical opinion requests of a complex nature, including the following types, must be prepared by the rating activity:
Exception: M21-1, Part III, Subpart i, 2.D.6.e, authorizes MSCs to independently prepare medical opinion requests regarding in-service aggravation of pre-service disabilities as they pertain to IDES claims. If, however, MSCs recognize the need for other “complex” medical opinion types described above, they must refer them for review in accordance with guidance found in M21-1, Part III, Subpart i, 2.D.6.f.
Notes:
References: For more information on
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III.iv.3.A.7.b. Referring Claims for Complex Medical Opinion Review |
The table below describes the responsibilities of the development and rating activities in ensuring that complex medical opinions are appropriately routed for preparation and entry.
References: For more information on
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III.iv.3.A.7.c. Completing Medical Opinion Requests Using the ERB Tool |
As stated in M21-1, Part III, Subpart iv, 3.A.2.e, use of the ERB tool is mandatory in all CAPRI exam/medical opinion requests for compensation claims.
When requesting a medical opinion using the ERB tool, follow the steps in the table below.
References: For more information on inputting a(n)
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III.iv.3.A.7.d.Procedure for Identifying the Evidence in a Medical Opinion Request in the ERB Tool |
Identify all pertinent evidence for the examiner to review in the ERB tool by completing the TAB screen. For each tabbed item of evidence, populate the following fields:
ERB will generate language in the exam request based on the completion of these fields.
References: For more information on
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III.iv.3.A.7.e.Maintaining Objectivity in Medical Opinion Requests |
When requesting medical opinions, RO employees should identify all relevant evidence for the examiner’s review, both favorable and unfavorable. However, maintain objectivity when preparing medical opinion requests.
References: For more information on
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III.iv.3.A.7.g. Instructions for Providing Medical Opinions – Claims Under 38 U.S.C. 1151 |
When requesting a medical opinion for a claim involving benefits under 38 U.S.C. 1151, use the ERB tool to generate the appropriate language. Ensure the generated request asks the provider only the specific opinion(s) required by the facts of the case.
Medical opinions for conditions claimed under 38 U.S.C. 1151 may be completed at the same facility where the alleged incident happened, as long as there is no conflict of interest.
In general, VHA facilities will determine whether a conflict of interest exists once the request is received from the RO. If applicable, the VHA facility will work with the RO to transfer the medical opinion request to another facility.
Note: The medical opinion for a 38 U.S.C. 1151 claim does not have to be provided by a C&P certified clinician. Any qualified clinician may be designated by the Chief of Staff of the medical facility to render the opinion.
Reference: For more information on disability examinations involving claims under38 U.S.C. 1151, see the C&P Disability Examinations Procedure Guide.
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III.iv.3.A.7.h. Medical Opinions in the Hearing Loss and Tinnitus DBQ |
The DBQ for hearing loss and tinnitus contains specific sections for etiology opinions. However, examiners generally are not expected to provide unsolicited medical opinions, and in some types of hearing loss and tinnitus claims (such as claims for an increased evaluation), an opinion may not be routinely required.
In any case involving SC for hearing loss or tinnitus where an etiology opinion is required, follow the medical opinion procedures outlined in M21-1, Part III, Subpart iv, 3.A.7.d.
Exception: If tinnitus is not claimed, but reported during the course of the exam, examiners will provide this etiology opinion even when not solicited.
Important:
References: For more information on
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III.iv.3.A.7.i. Avoiding Asking for Legal Conclusions in Medical Opinion Requests |
Do not request that a medical authority make conclusions of law, as this is a responsibility inherent to the rating activity. To prevent confusion, avoid using the word “opinion” when asking the examiner a question about any issue that does not require a formal medical opinion.
Examples:
Note: The language generated upon selection of either of the following is legally sufficient to elicit the information necessary to adjudicate the issue of IU:
Reference: For additional information on requesting examinations in IU claims, see M21-1, Part IV, Subpart ii, 2.F.2.d.
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8. Examiner Review of the Claims Folder
Introduction |
This topic contains information about inputting examination requests, including
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Change Date |
February 19, 2019 |
III.iv.3.A.8.a. Importance of Claims Folder Review |
Folder review helps VA ensure that the examiner is given the fullest evidentiary picture possible. The claims folder often contains a history of treatment of the disability at issue. In order to provide an adequate basis for the findings and conclusions of an examination, the examiner needs access to that history.
References: For more information on
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III.iv.3.A.8.b. Examinations Requiring Claims Folder Review |
The examiner must review the claims folder for the following DBQs or claim types:
Note: For pension claims, sending the claims folder for review is not required. However, medical records received with the claim relevant to the issue of whether the claimant is currently permanently and totally disabled due to non-service-connected causes must be uploaded into the eFolder.
References: For more information on
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III.iv.3.A.8.c.Requesting Examiner Review of the Claims Folder |
To ensure VHA examination requests clearly indicate claims folder review is required, use the ERB tool’s
Note: Examination scheduling requests prepared using VBMS examination management functionality will generate the necessary language indicative of the need for folder review without further user intervention.
Important: When requesting a VHA examination for a sensitive-level case, check the SENSITIVE box on the INTRODUCTION screen in the ERB tool.
Reference: For more information on using the ERB tool, see the ERB User Guide.
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III.iv.3.A.8.d. Requirement to Identify Relevant Evidence for the Examiner’s Review |
RO employees must ensure that each piece of relevant evidence in the
Important: All pertinent evidence (to include service treatment records (STRs) when their review is relevant to the underlying request), must be scanned into the eFolder prior to requesting any examination. This includes any case for which a VHA examiner may complete an ACE examination.
Note: Contract examiners do not have access to CAPRI. Any VHA treatment report that needs to be reviewed must be uploaded to the eFolder or, if applicable, printed and filed in the paper claims folder.
References: For more information on
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III.iv.3.A.8.f. Annotating Documents for Examiner Review |
ROs must follow the standardized steps in the table below to annotate documents in the claims folder for the examiner’s review.
Important: There are many available styles of annotations. For the purpose of promoting consistency, use only the Note annotation when tabbing evidence for the examiner’s review.
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9. Inputting Examination Requests in CAPRI
Introduction |
This topic contains information about inputting examination requests, including
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Change Date |
February 19, 2019 |
III.iv.3.A.9.a. Steps to Requesting an Examination in CAPRI |
Follow the steps below when inputting an examination request in CAPRI.
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III.iv.3.A.9.b.Completing a CAPRI Examination Request |
After utilizing the ERB tool to create the exam request, fully complete all fields on the examination request screen in CAPRI, ensuring that those discussed below are appropriately populated.
Important: Entering the ITF date is key to correct examination of claims pending at the time of a rating schedule change. This will alert the examiner as to the need to provide historical DBQ information.
Reference: For more information on completing a CAPRI examination request, see the CAPRI User’s Guide.
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Introduction
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This topic contains information about examination scheduling requests in VBMS, including
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Change Date
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April 1, 2019
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III.iv.3.A.10.a. Entering an Examination Scheduling Request |
As discussed in M21-1, Part III, Subpart iv, 3.A.2.g, and subject to the ERRA tool’s recommendations, requests for contract examinations must be prepared and submitted via VBMS.
Follow the steps outlined in the VMBS User Guide to prepare an examination scheduling request in VBMS.
Important:
Note: VBMS examination scheduling request submission and acceptance will automate the creation of one tracked item for each contention identified in the request. Manual entry of tracked items, as is directed in M21-1, Part III, Subpart iv, 3.A.9.a, for examination requests submitted through CAPRI, is not required for scheduling requests submitted through VBMS. References: For more information on
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III.iv.3.A.10.b. Types of Requests Requiring Supplemental Language from the ERB-S Tool |
Examination scheduling requests involving the components or claim attributes identified in the ERB-S Usage Matrix require supplementation with language generated using the ERB-S tool.
References: For more information on
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III.iv.3.A.10.c. Definition: Request for Clarification |
In the context of VBMS examination management, a request for clarification is a communication from the examining facility, indicating that additional information about an examination request or individual contention is needed. The request generates an Exam Request – Request for Clarification tracked item, which triggers a NWQ event and electronic routing for review and subsequent action by claims processing personnel.
When an examining facility generates a request for clarification, its receipt is reflected by a graphic indicator that appears next to the request in the Exam Scheduling Request Summary table view.
Example:
![]() Reference: For more information on responding to requests for clarification, see
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III.iv.3.A.10.d. Responding to a Request for Clarification |
The response to an examining provider’s request for clarification can be provided with a full edit to the previously-submitted examination scheduling request, or with a claim- or contention-specific narrative response that addresses specific questions posed, depending upon the nature of the information elicited and the processing stage at which the request is received.
Follow the steps in the table below to respond to a request for clarification initiated by an examining facility.
Reference: For more information on requests for clarification, see
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