Overview
In This Section |
This section contains the following topics:
|
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
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.
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.b, unless 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
Important: An examining facility will reject an examination request if, while processing the request
|
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:
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
Change Date |
December 19, 2017
|
III.iv.3.B.2.a. Criteria for Requesting Review Examinations |
Request a review examination whenever
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
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.
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
Important:
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.
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
|
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,
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.
|
5-5-17_Key-Changes_M21-1III_iv_3_SecB.docx | May 15, 2019 | 67 KB |
12-19-17_Key-Changes_M21-1III_iv_3_SecB.docx | May 15, 2019 | 66 KB |
10-12-16_Key-Changes_M21-1III_iv_3_SecB.docx | May 15, 2019 | 57 KB |
3-18-16_Key-Changes_M21-1III_iv_3_SecB.docx | May 15, 2019 | 54 KB |
pt03_sp04_TS_consolidated.doc | May 15, 2019 | 134 KB |
12_29_07.doc | May 15, 2019 | 72 KB |
Change-May-8-2015-Transmittal-Sheet-M21-1MRIII_iv_3_SecB_TS.docx | May 15, 2019 | 42 KB |
Related Articles