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M21-1, Part III, Subpart iv, Chapter 3, Section C – Control of Examinations

Overview


In This Section

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

1.  Control of and Follow-Up on Examination Requests


Introduction

This topic contains information about control of and follow-up on examination requests, including


Change Date

February 20, 2019

III.iv.3.C.1.a.  Determining the Appropriate Suspense Date for Examinations

The initial suspense date of the pending end product (EP) is established automatically based on the suspense reason selected in the Veterans Benefits Management System (VBMS) or Modern Award Processing-Development.
If the examination has not been completed once the suspense date matures,
  • review the status in the
    • Compensation and Pension Record Interchange (CAPRI), or
    • appropriate contract vendor customer service portal, and
  • update the suspense date based on the anticipated completion date of the examination.
Note:  Contract examination scheduling requests prepared in VBMS, once accepted by the scheduling activity, will automatically generate corresponding tracked items that
  • initially reflect 30-day suspense dates, and
  • automatically update based on scheduling, modification, cancellation, and/or completion of individual examination appointment(s).
References:  For information on

III.iv.3.C.1.b.  Checking the Status of Examination Requests Under Special Circumstances

Use the table below to check the status of expedited or overdue examination requests.
If the issue relates to a(n) …
And the examination is pending performance by a …
Then use the information provided in the …
  • expedited follow-up required by special circumstances
  • request for expedited examination, or
  • inquiry on the status of an overdue examination
Veterans Health Administration (VHA) provider
Compensation and Pension (C&P) Clinic Point of Contact (POC) List to reach the examination facility’s designated POC by telephone, instant message, or e-mail, as necessary.
Veterans Benefits Administration contract provider
Contract Examination Inquiry Protocol Job Aid to contact the corresponding contract examination vendor.
Note:  If the rating activity determines that a necessary examination was canceled without avalid reason, it must submit a new examination request to the examining facility and specify why the previous cancellation was inappropriate.

III.iv.3.C.1.c.  Modifying and Canceling VBMS Examination Scheduling Requests

Once an examination scheduling request has been submitted and accepted in the VBMS examination management environment, a modification request may be created to accomplish any of the following:
  • cancellation of the entire scheduling request
  • cancellation of one or more individual contentions
  • change of address
  • modification of appointments, and/or
  • addition of special instructions.
Reference:  For more information on preparing requests for modification to VBMS examination scheduling requests, see the VBMS User Guide.

III.iv.3.C.1.d.  Continued EP Control When Examinations Are Rescheduled

Regional office (RO) personnel must maintain EP control over claims in which the examination facility of jurisdiction reschedules an appointment or directs resubmission of an examination request.
Use the table below to determine what actions to take when examination scheduling issues arise.
If the …
Then …
examination facility reschedules an appointment and extends the pending examination request
  • maintain continued EP control over the claim, and
  • take no rating action to resolve the claim until
    • the requested examination has been conducted, and its results associated with the claims folder, or
    • the examination request has been canceled by reason of the Veteran’s failure to report or RSVP to the examination facility.
examination facility cancels a pending examination request, directing that it be resubmitted for action by another, more appropriate facility
  • resubmit an examination request to the appropriate facility
  • maintain continued EP control over the claim, and
  • take no rating action to resolve the claim until
    • the requested examination has been conducted, and its results associated with the claims folder, or
    • the examination request has been canceled by reason of the Veteran’s failure to report or RSVP to the examination facility.
examination facility cancels a pending examination request based on a Veteran’s election to submit a privately prepared disability benefits questionnaire (DBQ) in lieu of reporting for a clinical appointment
follow guidance as it appears in M21-1, Part III, Subpart iv, 3.C.1.e.
examination request is canceled or contraindicated in light of the Veteran’s return to active duty service
follow guidance as it appears in M21-1, Part IV, Subpart ii, 2.A.4.b and c.
Veteran anticipates his/her own inability to attend an examination appointment and provides the RO with advance notice of his/her unavailability to report prior to the RO requesting an exam
  • notify him/her of the opportunity to submit a privately prepared DBQ in lieu of a Department of Veterans Affairs (VA) examination, allowing 30 days for a response, and
  • take no rating action to resolve the claim until
    • the completed DBQ has been received, or
    • the 30-day evidentiary submission period has elapsed.

Exception:  If the contention(s) at issue is one associated with a DBQ that is approved for internal VA use only, decide the claim based on the evidence of record.

References:  For more information on

III.iv.3.C.1.e. DBQs and Examination Cancellations

Use the table below to handle cases when notified that a scheduled examination(s) has been canceled because the claimant intends on submitting a DBQ completed by his/her primary physician.
Note:  RO personnel must attempt to contact the claimant, via telephone, prior to making a rating decision.
If telephone contact …
Then …
is made
is not made
send the Veteran a follow-up letter explaining that we are giving him/her 30 days to submit the DBQ.  Include the following text in the letter:
[Insert name of examination facility/provider]advised us that they attempted to schedule you for an examination.  However, you informed them that you would be submitting a DBQ from your primary care provider and would not be attending an examination.  Please provide this information within 30 days.  If we do not receive the evidence within 30 days from the date of this letter, we will rate your claim with the evidence we have.  If this is incorrect information, please notify us and we will reschedule your examination.

III.iv.3.C.1.f. Documenting Examination Cancellations and Rejections

VHA examination facilities may communicate cancellation of an examination appointment or rejection of a request by directly e-mailing the claims processor responsible for the request’s submission.  If notice of an examination’s cancellation or rejection is received or discovered in the course of subsequent claims folder review, the claims processor must ensure that the examination’s cancellation/rejection is
  • documented in the claims folder, and
  • reflected in associated tracked items.
Use the table below to determine the actions to take upon receipt of notification or discovery of an examination’s cancellation/rejection.
If an electronic claims folder (eFolder) …
Then …
exists
  • convert any cancellation/rejection notice or notification e-mail to portable document format (PDF)
  • upload the PDF document to the corresponding eFolder
  • close all tracked items associated with the examination request, and
  • resubmit the examination request if necessary and/or appropriate.
does not exist
  • print a copy of any cancellation/rejection notice or notification e-mail
  • file it in the center section of the paper claims folder
  • close all tracked items associated with the examination request, and
  • resubmit the examination request if necessary and/or appropriate.
Exceptions:  The specific actions outlined in the table above are not required if
  • review of the corresponding Veteran’s claims folder and electronic record indicates that the examination’s status has already been appropriately updated via automated or system-generated means, and/or
  • notice of the examination’s cancellation – or the examination scheduling request’s rejection – is being handled using the VBMS examination management system.
References:  For more information on

2.  Control of Future Examinations


Introduction

This topic contains information about controlling future examinations, including


Change Date

April 18, 2019

III.iv.3.C.2.a.  Types of Future Examination Controls

Future examination control may be established through
  • completion of a rating decision
  • establishment of a future, diary EP 310, or
  • use of the DIARY command in Share.

III.iv.3.C.2.b.  Establishing Future Examination Control in a Rating Decision

Use the table below for information on establishing future examination control in a rating decision completed using VBMS – Rating (VBMS-R).
If a future examination …
Then, in the EXAMINATION INFORMATION section of the ISSUE MANAGEMENT tab and SPECIAL ISSUE & EXAMINATION INFORMATION chevron, …
should be scheduled immediately, or during the current month
select AT ONCE.
should be scheduled at a later date
  • select FUTURE DATE, and
  • enter the future examination date in the FUTURE DATE field.
Note:  The earliest date allowed is the first day of the following month. If an earlier examination is required, select AT ONCE.
is not warranted
select STATIC DISABILITY (NO EXAM).
References:  For more information on

III.iv.3.C.2.c.  Establishing Future Examination Control Without a Rating Decision

Use the table below to determine how to establish future examination control when the rating activity determines that a review examination is necessary, but control is not established by a rating decision.
If …
Then establish control by using…
  • there is an active corporate record, and
  • another future examination diary is not currently pending
the DIARY command in Share with reason code 01 – Future Physical Examination.
Note:  A future examination diary cannot be added for a date greater than five years in the future.
  • there is not an active corporate record, and
  • the examination date is neither
    • less than 10 days in the future, nor
    • greater than one year in the future
a future pending issue under EP 310,established in VBMS or Share.
the future examination cannot be controlled by either method described above
a local diary.
Note:  Individual ROs may exercise discretion in the manner in which they control these cases.
Reference:  For more information on establishing future examination control in

III.iv.3.C.2.d.  Action When the Control Period for the Future Examination Matures

Upon maturation of any future review examination control, refer the claims folder for review by
  • the rating activity, or
  • a locally-designated claims processor with expertise in review examination ordering.
Note:  The future review examination control described above may include any of the following:
  • an 810 series work item
    • 631A Future Physical Examination, or
    • 631R Review Need for Reevaluation
  • a locally established diary, or
  • an automatically established EP 310, Routine Future Exam.
Follow the steps in the table below upon review of matured review examination controls.
Step
Action
1
Is it necessary to advance the date of the examination(s) in question?
  • If yes,
    • cancel any pending EP 310 or 810 series work item associated with future examination control
    • establish a new future examination control using Share diary reason 01 – Future Physical Examination
    • add a system note including the
      • reason(s) for postponing, and
      • new future examination date
    • do not prepare or refer for preparation of a rating decision, and
    • disregard the remaining steps in this table.
  • If no, proceed to the next step.
2
  • Establish an EP 310
  • use the date on the 810 series work item, 631A Future Physical Examination, or 631R Review Need for Reevaluation, as the date of claim
  • ensure the SUPPRESS ACKNOWLEDGEMENT LETTER checkbox is selected
  • clear the 810 series work item, if applicable, and
  • proceed to the next step.
Exception:  Do not establish a separate EP 310 if another rating EP is already pending for the specific disability under review, or if review was prompted by the automatic establishment of an EP 310.  Instead, complete all necessary action under the existing EP.
3
Is it necessary to proceed with the examination(s) in question?
  • If yes, request any and all examinations needed.
  • If no, prepare or refer for a rating decision to establish permanency in accordance with procedures outlined in M21-1, Part III, Subpart iv, 3.B.2.l.
References:  For more information on

III.iv.3.C.2.eReviewing EPs 310 for Permanency

An EP 310, Permanent and Total Determination, will generate on a recurring basis when the corporate record of a Veteran who has a combined 100-percent service-connected (SC) evaluation does not reflect either
  • eligibility to Chapter 35 benefits, or
  • a future review examination diary/control.
If an EP 310 is pending for this situation, the claims folder must be reviewed to determine if
  • a review examination is needed, or
  • the specific disability can be identified as permanent and total, and Chapter 35 eligibility addressed in a rating decision.
Use the table below to determine what actions to take in response to EPs 310 generated in these circumstances.
If the absence of Chapter 35 eligibility and/or routine future examination …
Then …
has been resolved by rating action since the time of the EP 310’s generation
  • cancel EP 310, and
  • add a permanent note in VBMS, explaining why no action was necessary.
exists because the 100-percent disability in question has been granted under the provisions of 38 U.S.C. 1151
  • activate the 1151 P&Tcorporate flash to prevent the unnecessary generation of future review tasks, and
  • cancel EP 310.
Reference:  For more information on accessing corporate flashes, see theShare User Guide.
leads to the conclusion, upon review, that additional future examination(s) of one or more SC disabilities is/are required before the case may be rated as to permanency
  • establish future examination control in accordance with procedures discussed in M21-1, Part III, Subpart iv, 3.C.2.c
  • cancel EP 310, and
  • add a permanent note in VBMS to explain the actions taken.
involves none of the variables outlined in rows above
  • order any examinations deemed necessary, and
  • complete a rating decision under EP 310, addressing the targeted disability’s evaluation and/or permanency, as appropriate.
Notes:
  • EPs 310 will continue to be generated for cases that have no existing controls in place and will appear on monthly reports.
  • A rating decision is needed whenever permanency is established, whether the permanency is based on new evidence and/or cancellation of a future examination.
  • Notification to the Veteran should be accomplished whenever Chapter 35 is granted for the first time.
References:  For more information on
  • rating considerations under Chapter 35, see M21-1, Part IX, Subpart ii, 2.1, and
  • former use of EP 684 in connection with permanency reviews, see the attachment, Historical_M21-1III_iv_3_SecC_2-20-19.docx.
Historical_M21-1III_iv_3_SecC_8-15-16.docx May 15, 2019 64 KB
4-24-17_Key-Changes_M21-1III_iv_3_SecC.docx May 15, 2019 66 KB
Historical_M21-1III_iv_3_SecC_4-24-17.docx May 15, 2019 70 KB
2-20-19_Key-Changes_M21-1III_iv_3_SecC.docx May 15, 2019 53 KB
Change-July-15-2015-Transmittal-Sheet-M21-1III_iv_3_SecC_TS.docx May 15, 2019 38 KB
12-19-17_Key-Changes_M21-1III_iv_3_SecC.docx May 15, 2019 63 KB
11-21-16_Key-Changes_M21-1III_iv_3_SecC.docx May 15, 2019 57 KB
8-15-16_Key-Changes_M21-1III_iv_3_SecC.docx May 15, 2019 56 KB
4-25-16_Key-Changes_M21-1III_iv_3_SecC.docx May 15, 2019 63 KB
3-12-18_Key-Changes_M21-1III_iv_3_SecC.docx May 15, 2019 61 KB
4-18-19_Key-Changes_M21-1III_iv_3_SecC.docx May 15, 2019 53 KB
Historical_M21-1MRIII_iv_3_secC_5-1-2015.docx May 15, 2019 48 KB
12_29_07.doc May 15, 2019 72 KB
pt03_sp04_TS_consolidated.doc May 15, 2019 134 KB
Change-May-1-2015-Transmittal-Sheet-M21-1MRIII_iv_3_secC_TS.docx May 15, 2019 40 KB
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