M21-1, Part III, Subpart iv, Chapter 3, Section F – Examinations in Special Situations

In This Section 

Introduction

• purpose of an A&A and housebound examination
• when an A&A and housebound examination may be useful
• requesting an A&A and housebound examination, and
• locally devised checklists.

Change Date

III.iv.3.F.1.a.  Purpose of an A&A and Housebound Examination

• pinpoint findings relevant to A&A determinations under 38 CFR 3.351 and38 CFR 3.352, and
• provide a basis for determining if the housebound benefit may be paid if the need for A&A is not shown.

III.iv.3.F.1.b.  When an A&A and Housebound Examination May Be Useful

III.iv.3.F.1.c.  Requesting an A&A and Housebound Examination

• developing for A&A and housebound status, see M21-1, Part V, Subpart iii, 2.A.3, and
• requesting examinations in
  • general, see M21-1, Part III, Subpart iv, 3.A
  • CAPRI, see the CAPRI User Guide, and
  • VBMS, see the VBMS User Guide.

III.iv.3.F.1.d.  Locally Devised Checklists

Introduction

• examinations of non-Veteran claimants and beneficiaries
• hospital observation
• field examinations
• examinations of incarcerated Veterans
• board examinations
• reexaminations by a different examiner, and
• homeless Veterans examination requests.

Change Date

III.iv.3.F.2.a.  Examinations of Non-Veteran Claimants and Beneficiaries

• only after approval by the Veterans Service Center Manager (VSCM) or Pension Management Center Manager (PMCM), or
• to determine if a
  • claimant is entitled to A&A or housebound benefits
  • Chapter 18 birth defect diagnosis exists
  • claimant was insane at the time he/she caused the death of the Veteran
  • dependent child or child claimant is helpless and/or incompetent, and/or
  • beneficiary is competent to handle his/her funds.

• Chapter 18 birth defects eligibility and development, see M21-1, Part VI, 2.B
• determining when an examination is required to resolve the question of permanent incapacity for self-support, see M21-1, Part III, Subpart iii, 7.2.b, and
• the facts to be considered in a wrongful and intentional death, see M21-1, Part III, Subpart v, 1.F.3.

III.iv.3.F.2.b.  Hospital Observation

III.iv.3.F.2.c.  Field Examinations

• determine the competency of the beneficiary
• assess employment and social adjustment, or
• substantiate items of evidence regarding the existence of disease or injury prior to enlistment.

III.iv.3.F.2.d.  Examinations of Incarcerated Veterans

• Because some State laws restrict the movement of and access to prison inmates, the above options may not be possible.  In such cases, documentation of substantial efforts to schedule and conduct the examination must be added to the claims folder.
• ROs must include the following information, to the extent that it is known, in examination requests for incarcerated Veterans:
  • name of the correctional facility
  • location of the correctional facility
  • circumstances of confinement (e.g. nature/type of conviction, level of institutional security, etc.), and
  • whether the Veteran is considered violent.
• ROs must document all efforts made to schedule an examination, including identifying and requesting the assistance of the appropriate prison officials.
• VHA compensation clinics and VBA contract examination vendors are required to provide documentation that they have
  • made substantial attempts to schedule and conduct the examination, and
  • exhausted all possible avenues for obtaining access to the incarcerated Veteran for the examination.
• If the examination provider has exhausted examination efforts to no avail, treat a Veteran’s inability to attend a necessary examination (claim-relatedor review) by reason of incarceration as the equivalent of a failure to report, and take appropriate action in accordance with M21-1, Part I, 1.C.3.m.

• limitations on payment of compensation for incarcerated Veterans, see
  • M21-1, Part III, Subpart v, 8.A.2.a, and
  • 38 U.S.C. 5313
• effect of incarceration on ratings of IU, see
  • M21-1, Part III, Subpart v, 8.A.2.b, and
  • M21-1, Part IV, Subpart ii, 2.F.4.f
• VA’s duty to examine incarcerated Veterans, see
  • Bolton v. Brown, 8 Vet.App. 185 (1995), and
  • Wood v. Derwinski, 1 Vet.App.190 (1991)
• VHA Medical Examination Coordinators, see C&P Exam Point of Contact List, and
• VHA policy on incarcerated Veteran examinations, see the DMA C&P Disability Examinations Procedure Manual.

III.iv.3.F.2.e.  Board Examinations

• reconcile differing diagnoses, or
• resolve particularly complex issues concerning
  • awards of special monthly compensation, or
  • entitlement to specially adapted housing.

III.iv.3.F.2.f.  Reexaminations by a Different Examiner

• prepare another examination request
• annotate it to show that reexamination is necessary
• identify any specific information needed in the examination report, and
• include the name and the facility of the medical examiner who conducted the prior examination.

Reference:  For more information on preparing examination requests, see M21-1, Part III, Subpart iv, 3.A.

III.iv.3.F.2.g.  Homeless Veteran Examination Requests

Introduction

• reviewing FPOW claims
• considerations when requesting an FPOW protocol examination
• when to order initial FPOW protocol examinations, and
• how to order initial FPOW protocol examinations.

Change Date

III.iv.3.F.3.a.  Reviewing FPOW Claims

• Veteran’s record confirms FPOW status, and
• Veteran was examined under the FPOW protocol.

• FPOW status, see M21-1, Part III, Subpart v, 1.C
• developing claims that are based on FPOW status, see M21-1, Part IV, Subpart ii, 1.G, and
• service records for FPOW claims, see M21-1, Part III, Subpart iii, 2.G.

III.iv.3.F.3.b.  Considerations When Requesting an FPOW Protocol Examination

• would be inadvisable in light of the Veteran’s medical condition, or
• is specifically declined by the Veteran or his/her representative.

III.iv.3.F.3.c.  When to Order Initial FPOW Protocol Examinations

III.iv.3.F.3.d.  How to Order Initial FPOW Protocol Examinations

• utilize the Exam Request Builder (ERB) tool to build the examination request
• select POW in the SPECIAL CONSIDERATION(S) box in CAPRI
• clearly note that an examination under the FPOW protocol is required, and
• request an examination of all claimed and noted disabilities, as well as all other conditions characteristically associated with confinement as an FPOW.

• The examiner is required to review the claims folder for all FPOW examinations.
• The Veteran is required to complete VA Form 10-0048, Former POW Medical History, before the examination.  VHA mails the form to the Veteran with instructions to complete the form and bring the form on the date of examination.
• The forms completed by the Veteran and the completed DBQ will be returned to the requesting RO.

• FPOW examinations, see the
  • Former Prisoner of War (POW) Protocol Disability Benefits Questionnaire, and
  • DMA C&P Disability Examinations Procedure Guide Manual, and
• the ERB tool, see M21-1, Part III, Subpart iv, 3.A.2.e.

Introduction

• who is eligible for pre-discharge examination
• what the Separation Health Assessment (SHA) covers, and
• general medical examinations and the SHA.

Change Date

III.iv.3.F.4.a.  Who Is Eligible for Pre-Discharge Examination

• who may file a pre-discharge claim, see M21-1, Part III, Subpart i, 2.A.1.b, and
• claims that are not processed prior to discharge, see M21-1, Part III, Subpart i, 2.A.1.e.

III.iv.3.F.4.b.  What the SHA Examination Covers

Introduction

• general information on examinations for pregnant claimants
• ancillary conditions of pregnancy
• tests not recommended for pregnant claimants
• how pregnancy affects participation in pre-discharge programs, and
• options for processing claims for pregnant claimants.

Change Date

III.iv.3.F.5.a.  General Information on Examinations for Pregnant Claimants

• directly related to pregnancy, or
• acute and transitory and expected to resolve upon delivery.

Some physical examinations and routine tests required to accurately rate the disabilities identified in claims are complicated and not recommended for or normally performed on pregnant women since they may pose a significant health risk to the woman or baby.

III.iv.3.F.5.b.  Ancillary Conditions of Pregnancy

• anemia
• back pain
• edema in the legs
• gestational diabetes
• hypertension
• shortness of breath, and
• urinary tract infections.

III.iv.3.F.5.c.  Tests Not Recommended for Pregnant Claimants

• x-rays
• pulmonary function tests (PFTs), and
• range of motion examinations.

Note:  When pregnancy is known, include in the examination request a comment indicating that the claimant is pregnant.

III.iv.3.F.5.d.  How Pregnancy Affects Participation in Pre-Discharge Programs

III.iv.3.F.5.e.  Options for Processing Claims for Pregnant Claimants

• defer the entire examination until conclusion of the pregnancy
• rate the entire claim based on existing STRs and evidence of record, or
• rate any claimed conditions that may be awarded based on existing STRs and evidence, and defer consideration of any additional disabilities that may not be examined until conclusion of the pregnancy.

Example:  Service connection for an amputated finger can be awarded based on STRs, but the other claimed issues require specific tests that are prohibited due to pregnancy and must be deferred until the pregnancy concludes and a full examination can be conducted.

Reference:  For more information on partial rating decisions and deferred issues, see M21-1, Part III, Subpart iv, 6.A.

III.iv.3.F.6.a.  Definition:  IMO

• a type of advisory medical opinion that may be obtained from one or more recognized medical experts who are not VA employees, and
• only warranted in connection with
  • claims of significant medical complexity and/or controversy, and/or
  • fulfillment of instructions contained in a remand order from the Board of Veterans Appeals (BVA).

• As discussed in M21-1, Part III, Subpart iv, 3.F.6.d, VA Central Office has the responsibility for deciding
  • if the IMO is warranted, and
  • what medical expert(s) to use.
• Under 38 CFR 3.328, contract examiners who perform examinations during the usual claims process are considered hired in the service of VA, and therefore, are not appropriate medical experts for the purposes of providing an IMO.

III.iv.3.F.6.b.  Who May Initiate a Request for an IMO

• SOJ
• claimant, or
• claimant’s representative.

III.iv.3.F.6.c.  Submitting a Request for an IMO

• in writing
• through the VSCM or PMCM, and
• by stating, in detail,
  • the reasons why the opinion is necessary, and
  • the specific information or opinion required.

III.iv.3.F.6.d.  Processing Requests for an IMO