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M21-1, Part III, Subpart iv, Chapter 3, Section B – Scheduling Examinations

Overview


In This Section

This section contains the following topics:
Topic Topic Name
1
2

1.  General Information on Scheduling Examinations


Introduction

This topic contains general information about scheduling examinations, including

Change Date

October 12, 2016

III.iv.3.B.1.a.  General Information on Scheduling Examinations

“Scheduling examinations” refers to the process by which the Veterans Benefits Administration (VBA) and either a Veterans Health Administration (VHA) examining facility or a contract examiner work together to set up a particular examination.
VBA will request the examination, which may involve notation of information pertinent to the time and place of the examination.  However, the examining facility will actually
  • set up the examination, and
  • advise the claimant of the time and place of the scheduled appointment.
References:  For more information on

III.iv.3.B.1.b.  Examinations for VA-Employee Claimants

In any case where an examination is needed and the claims folder contains VA Form 20-0344, Annual Certification of Veteran Status and Veteran Relatives, or there is a VA Employee flash on the outside of the claims folder, refer to the table below for appropriate action.
If examination by a contract facility is …
Then clearly note on the examination request that the Veteran is an employee, and schedule the examination at the nearest …
available
contract facility that does not employ the Veteran.
not available
Department of Veterans Affairs (VA) facility that does not employ the Veteran.
Important:  Make every attempt to avoid a conflict of interest when scheduling the examinations of VA employees. If the need for an exception arises, follow the guidance in M21-1, Part III, Subpart iv, 3.B.1.c.
Reference:  For more information on handling claims from employees and their relatives, see M21-1, Part III, Subpart ii, 1.C.6.

III.iv.3.B.1.c.  Exceptions for Employees Who Work at an Examining Facility

If an employee works at an examining facility and requires an examination in connection with a pending claim, request the examination from a different facility, as described in M21-1, Part III, Subpart iv, 3.B.1.bunless the Veteran Service Center Manager (VSCM) determines an examination at the employing facility will not affect its integrity.
When a VSCM chooses to allow an examination of an employee at the same facility where he/she works, the VSCM must
  • prepare a signed memorandum explaining the reason(s) for allowing the examination, and
  • file the memorandum in the claims folder.
Important:  An examining facility will reject an examination request if, while processing the request
  • it recognizes the Veteran as an employee of the facility, and
  • there is no indication in the claims folder (if provided) or the request that the VSCM has
    • acknowledged the employee-employer relationship, and
    • approved examination of the employee at the facility.

III.iv.3.B.1.d.  Scheduling Examinations for Conditions Subject to Temporary or Episodic Improvement

Schedule the examination of disabilities subject to temporary or episodic improvement, such as skin conditions and other disabilities listed in 38 CFR 3.344, when the conditions are most likely to show representative or claimed symptoms.
If there is specific competent information that a disability is worse at predictable times, schedule the examination based on that information.
Examples:
  • If a Veteran’s symptoms become worse after work, the examining facility should be asked to examine the Veteran at the end of the day.
  • If a disability is subject to periodic flare-ups, and the record does not contain specific competent information on when a flare-up can be observed, the Veteran can provide the information about the peak periods of the disability and contact the regional office when the condition worsens.  (Note:  If the Veteran received treatment for the worsened condition, he/she should be asked to submit evidence of the treatment.)
Important:  Under the Acceptable Clinical Evidence (ACE) process, VHA examiners may be able to complete a fully adequate Disability Benefits Questionnaire capturing representative or claimed symptoms to include periods of exacerbation and improvement based on review of existing evidence and/or a telephone interview in lieu of an in-person clinical examination or testing.
References:  For more information on

III.iv.3.B.1.e.Scheduling Specialist Examinations

VA medical centers schedule specialist examinations only when requested to do so.
Reference:  For more information on specialist examinations see M21-1, Part III, Subpart iv, 3.A.6.

2.  Determining the Need for Review Examinations


Introduction

This topic contains information about determining the need for review examinations, including


Change Date

December 19, 2017

III.iv.3.B.2.a.  Criteria for Requesting Review Examinations

Request a review examination whenever
  • there is a need to verify either the continued existence or the current severity of a disability
  • it is likely that a disability has improved
  • evidence indicates there has been a material change in a disability
  • the current rating may be incorrect, or
  • it is otherwise required by the regulation or diagnostic code (DC) under which the Veteran is service-connected(SC).
Note:  Do not request a review examination solely to confirm evidence listed in 38 CFR 3.326(b) and (c) that is otherwise adequate for rating.
Reference:  For more information on the criteria for requesting a review examination, see 38 CFR 3.327.

III.iv.3.B.2.b.  Scheduling Future Review Examinations in Compensation Cases

Exercise prudent judgment and refer to 38 CFR 3.327(b) in determining the need for review examination.  It is the policy of VBA to request future examinations only when absolutely necessary, and every effort should be made to limit cases where future examinations are requested.  Consider whether
  • the Veteran’s current condition is an acute exacerbation
  • the Veteran is still recuperating following hospitalization, and/or
  • improvement or recovery can be anticipated.
Important:  Medical evidence from any of the sources listed in 38 CFR 3.326(b) and (c) may satisfy the need for reexamination.
References:  For more information on scheduling review examinations

III.iv.3.B.2.c. Timeframes for Scheduling Review Examinations

Use the table below to determine the interval at which to schedule a future review examination.
If the case necessitates a(n) … Then, at the time of the rating decision’s preparation, schedule the examination to be conducted …
routine future examination to monitor for anticipated improvement in an SC disability
in three years.
reexamination to monitor for evidence ofsustained improvement in a stabilized SC disability that is shown to have improved
in 18, 24, or 30 months, depending upon the facts and implications of the individual case.
examination to facilitate the reevaluation of a prestabilization rating prepared under the authority of 38 CFR 4.28
no earlier than 6 months, nor later than 12 months, following discharge from service.
examination to evaluate an SC mental disorder that was
  • incurred by reason of traumatic stress, and
  • rated in accordance with the provisions of 38 CFR 4.129
within the six-month period following the Veteran’s discharge.
examination to evaluate post-therapeutic residuals of an SC malignancy
six months following cessation of surgical, x-ray, antineoplastic chemotherapy, or other therapeutic procedure.
Exceptions:
  • For SC bone malignancy evaluated under 38 CFR 4.71a, DC 5012, any needed examination must be scheduled one year following cessation of treatment.
  • For SC malignancy of the brain or spinal cord evaluated under38 CFR 4.124a, DCs 8002 or 8021, respectively, any needed examination must be scheduled two years following cessation of treatment.
  • Concede the disability evaluation’s permanence and schedule no future examinations if the considerations discussed in M21-1, Part III, Subpart iv, 5.B.3.a are applicable.
mandatory examination/reexamination in connection with a specific DC
at a time or interval consistent with the applicable regulation’s requirements.
References:  For more information on

III.iv.3.B.2.d.  When Not to Schedule Review Examinations

Do not establish a future examination control in cases when
  • the disability is static, without material improvement over five years
  • the disability is permanent in character and of such nature that there is no likelihood of improvement
  • the Veteran is over 55 years of age (except under unusual circumstances or where required by regulation)
  • the evaluation is the prescribed schedular minimum within its DC
  • the evaluation is 10 percent or less, or
  • the combined evaluation would not change even if the reexamination resulted in a reduced evaluation for one or more disabilities.
Important:
  • When deciding if a disability is static or not, only order a future examination if there is objective evidence stating clearly a disability is likely to improve.
  • The principles expressed in this block apply equally to (1) initial routine future examinations and (2) reexaminations requested in the interest of substantiating sustained improvement.  Therefore, where one or more of the above criteria are applicable, and the evidentiary record includes a single examination report (or alternative form of medical evidence) portraying improvement in a disability that has persisted at its assigned level of evaluation for five years or longer, do not proceed with scheduling an additional reexamination unless doing so is
    • required by regulation, or
    • warranted in light of unusual circumstances, such as in cases of Veterans over age 55.
References:  For more information on

III.iv.3.B.2.e. Considering a Veteran’s Age in Connection With Review Examinations

As is discussed in M21-1, Part III, Subpart iv, 3.B.2.d, and with only a few rare exceptions, Veterans over the age of 55 must not be routinely recalled for reexamination.
In determining whether a Veteran meets the criteria for exemption from reexamination by reason of age, do not limit consideration to his/her age at the time of the rating decision’s preparation.  Instead, consider what age the Veteran will have attained by the time the future review examination is actually conducted.
Use the table below to determine the impact of the Veteran’s age on future reexamination efforts and planning.
If … Then …
the Veteran will have reached or surpassed age 55 by the time the reexamination is conducted
do not schedule the reexamination unless
  • required to do so by specific regulation, or
  • compelled to do so based on unusual circumstances.
  • the expiration of a future examination control (i.e. local diary, 810 series work item, etc.) results in referral to the rating activity, and
  • review of the case indicates that the Veteran is currently age 55 or older
review in connection with an unrelated claim or issue reveals a future examination control for a Veteran who
  • is currently age 55 or older, or
  • will have reached or surpassed age 55 by the time the reexamination is conducted
  • delete or cancel the existing examination control provided it is not
    • required by regulation, or
    • warranted in light of unusual circumstances, and
  • follow guidance as it appears in M21-1, Part III, Subpart iv, 3.B.2.j.
Note:  Whether a case is found to involve the “unusual circumstances” described above and in 38 CFR 3.327(b)(2)(iv) is an individual, fact-specific determination left to the discretion of the rating activity.  If, however, a future review examination is deemed warranted in light of unusual circumstances, the claims processor must identify and document the nature of the unusual facts found in the form of a
  • remark in the SPECIAL NOTATION field on the PROFILE screen in the Veterans Benefits Management System (VBMS) – Rating, or
  • permanent VBMS note, if no rating decision is being simultaneously prepared.

III.iv.3.B.2.f. Example of Considering a Veteran’s Age

Scenario:  A Veteran born on March 7, 1963, claims an increase in his SC posttraumatic stress disorder, currently evaluated as 50-percent disabling.  Medical evidence amassed in connection with the claim supports an increased evaluation of 70 percent, but also indicates that the Veteran recently began attending weekly counseling sessions with a therapist, and that the prognosis for progress is hopeful and the potential for improvement likely.  The claim is forwarded to the rating activity for a decision in February 2017.
Result:  The increased evaluation of 70 percent must be awarded and deemed static, with no future review examination scheduled.
Rationale:  If pursued, a routine future examination would be scheduled for performance in February 2020, three years following the rating decision’s preparation.  The Veteran, though only 54 years old at the time of the claim’s referral to the rating activity, will have surpassed age 55 by the time the examination is conducted.

III.iv.3.B.2.g.  When Review Examination Shows Improvement of a Stabilized Disability

When the results of a review examination show improvement of a stabilized disability, consider the following prior to taking any rating action to reduce the assigned evaluation:

If an additional reexamination is deemed necessary to demonstrate sustained improvement over time and situation, or to resolve any element of doubt concerning the extent of the disability’s improvement, schedule such examination to occur 18, 24, or 30 months from the date of the current rating decision’s preparation, as discussed in M21-1, Part III, Subpart iv, 3.B.2.c.
References:  For more information on

III.iv.3.B.2.h.  Reexaminations in Pension Cases

Do not routinely request reexamination in disability pension cases.
Note:  If a reexamination is scheduled, fully explain the reason for reexamination in the decision narrative.
References:  For more information on

III.iv.3.B.2.i.  Handling Routine Future Examinations Previously Scheduled at Five-Year Intervals

Incidental and unrelated review of a claims folder may reveal that an outstanding routine future examination was previously scheduled for performance five yearsafter the associated rating decision’s preparation.
In such instances,
  • determine whether the routine future examination was actually warranted in the context of M21-1, Part III, Subpart iv, 3.B.2.a and b
  • delete or cancel the existing five-year routine future examination control, and
  • re-establish review examination control, as appropriate,
    • at an interval three years from the date of the previous rating’s preparation, or
    • for immediate performance, if the previous rating decision was prepared more than three years prior to the date of review.
References:  For more information on

III.iv.3.B.2.j.  Documenting the Cancellation of Review Examinations

If a future examination control, such as an 810 series work item, 631A Future Physical Examination diary, or automatically established end product (EP) 310 is canceled, place a note in VBMS as to the reason for cancellation.
References:  For more information on

III.iv.3.B.2.k.  Failure to Report for a Review Examination

For more information on what to do when the claimant fails to report for a review examination, see M21-1, Part III, Subpart iv, 8.E.1.
Important:  According to VAOPGCPREC 4-1991, a Veteran’s refusal to participate in an examination without the presence of an attorney or a recording device will be considered a failure to report for examination under 38 CFR 3.655.

III.iv.3.B.2.l.  Rating Action to Take if a Review Examination Is Canceled

Use the following table to determine the rating action to take if the expiration of a future examination control results in review and the conclusion that the examination is not warranted and should be canceled.
If it is determined that a future examination should be canceled, and the Veteran’s combined evaluation …
Then prepare a rating decision establishing permanence by …
reflects total disability, either by reason of
  • a 100-percent schedular evaluation, or
  • entitlement to individual unemployability
awarding basic eligibility to Dependents’ Educational Assistance (DEA).
References:  For more information on
does not reflect total disability
  • confirming and continuing the existing evaluation of any disability for which review examination was originally scheduled, and
  • identifying the disability(ies) as static, warranting no additional or future examination.
References:  For more information on

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