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M21-1, Part IV, Subpart ii, Chapter 3, Section B – Failure to Report for Review Examination

Overview


1.  General Information on Handling a Veteran’s Failure to Report for a Scheduled Review Examination


Introduction

This topic contains information on handling a Veteran’s failure to report for a scheduled review examination, including

Change Date

September 24, 2018

IV.ii.3.B.1.a.  Required Discontinuation or Reduction of Payments

When a current examination is needed to confirm a Veteran’s continued entitlement to disability benefits, and the Veteran, without good cause, fails to report for the examination, the Department of Veterans Affairs (VA) is required under 38 CFR 3.655 to
  • discontinue payment for the disability(ies) for which the examination was scheduled, or
  • reduce payment for the disability(ies) for which the examination was scheduled to a
    • minimum evaluation established under 38 CFR Part 4, or
    • lower evaluation
      • protected under 38 CFR 3.951(b), or
      • supported by a review of alternative evidence of record, when warranted, without the review examination.
Note:  Reduction or discontinuation of payments under 38 CFR 3.655(c) is notrequired if the evidence of record is sufficient to justify continuation of a current disability evaluation.
References:  For more information on

IV.ii.3.B.1.b.Handling Returned Mail Notifying the Veteran of a Scheduled Examination

If a VA medical facility advises that mail notifying a Veteran of a scheduled VA examination has been returned as undeliverable by the United States Postal Service (USPS), follow the procedures outlined in M21-1, Part I, 1.C.3.o and p.

2.  Protocol for Scheduling Examinations Using VHA RSVP Scheduling Program


Introduction

This topic contains information on VHA’s RSVP program, including

Change Date

February 27, 2017

IV.ii.3.B.2.a.  VHA RSVP Scheduling Program

Based on historical data, when Veterans do not have the opportunity to participate in the scheduling process, they are more likely to fail to report to scheduled examinations.  This results in the non-use of examination appointments that could have been appropriated to other Veterans.
Consequently, the Veterans Health Administration (VHA) established an RSVP program to help ensure Veterans attend their scheduled examinations.  Through this program, VHA attempts to reach Veterans by telephone and via mail in order to schedule examinations.
Important:  VHA examining facilities are not required to participate in the RSVP scheduling program.

IV.ii.3.B.2.b.  VHA RSVP Examination Cancellations

When VHA receives VA Form 21-2507, Request for Physical Examination, from a regional office (RO) that includes the Veteran’s telephone number and address, they will make several attempts to contact the Veteran and schedule the examination.
If a claimant fails to respond to the attempts to schedule the examination in the RSVP program, VHA will cancel the examination request.  The cancellation notification will reflect that the cancellation was due to the claimant’s failure to respond to the RSVP scheduling process.
The documented information indicating the Veteran failed to RSVP to schedule an examination at a mutually convenient time is considered the same as a failure to report for an examination for the purpose of claims processing.
VHA is responsible for ensuring that all procedures and timelines required in the RSVP process were followed.
Reference:  For more information on the VHA RSVP scheduling procedure, see the Office of Disability and Medical Assessment Fact Sheet 15-0033-Revised.

IV.ii.3.B.2.c.  Effect of a Veteran’s Failure to RSVP

When VHA provides notification that the Veteran failed to RSVP, the
RO must

3.  Referrals for and Processing of FTR Rating Decisions


Introduction

This topic contains information on rating action after a Veteran fails to report for a scheduled review examination, including

Change Date

March 20, 2019

IV.ii.3.B.3.a.  Referring Cases to the Rating Activity

Refer any notice that a Veteran failed to report for a scheduled review examination to the rating activity except when a better address is found, as described in M21-1, Part I, 1.C.3.p.
Based on the evidence of record, the rating activity will prepare a failure to report (FTR) rating decision that conforms to the standards discussed in M21-1, Part III, Subpart iv, 8.E.1.

IV.ii.3.B.3.b.  General Action Taken When a Veteran Fails to Report for an Examination

The table below provides an overview of the stages involved in the process of addressing a Veteran’s failure to report for a review examination.
Stage
Who Is Responsible
Description
1
rating activity
Prepares an FTR rating decision in accordance with M21-1, Part III, Subpart iv, 8.E.1.
2
authorization activity
  • Clears end product (EP) 310
  • establishes an EP 600 with a suspense date that is 65 days from the date notice of the proposed reduction is sent to the Veteran
  • sends the Veteran a notice of proposed adverse action under 38 CFR 3.103(b), and
  • continues current payments.

IV.ii.3.B.3.c.  Notification of an FTR Rating Decision

When the rating activity prepares an FTR rating decision, send the Veteran a notice of proposed adverse action that
  • advises that
    • VA must discontinue or reduce, as appropriate, compensation payments because the Veteran did not report for a scheduled examination deemed necessary to determine the current degree of disability severity, and
    • discontinued or reduced payment, if implemented, will be effective as of the later of the
      • first day of the month 60 days after the Veteran is notified of the proposed adverse action, or
      • date of last payment
  • lists the current
    • combined disability evaluation, and
    • monthly rate of compensation payment
  • identifies the
    • individual disability(ies) subject to proposed reduction, as well as its/their current and proposed evaluations
    • proposed combined evaluation, post-reduction, and
    • proposed monthly rate of reduced compensation payment
  • furnishes due process rights, and
  • asks the Veteran to respond if he/she is now ready to report for an examination.
If the Veteran does not respond within 65 days, refer the case for preparation of a final rating decision, as discussed in M21-1, Part IV, Subpart ii, 3.B.4.b.
Important:  As is discussed in M21-1, Part III, Subpart iv, 8.B.1.e, the effective date conventions for reduced or discontinued payment associated with a Veteran’s failure to report for a necessary review examination under 38 CFR 3.655 differsignificantly from those for reduced or discontinued payment associated with a revised rating decision under 38 CFR 3.105.  For this reason, and in the interest of preventing prolonged payment of potentially undue benefits, it is imperative that notices of proposed adverse action based upon a Veteran’s failure to report for examination
  • be judiciously generated using the appropriate letter type in the corresponding claims-processing application, and
  • communicate a proposed effective date outcome consistent with the guidance in this block.
Reference:  For more information on notices of proposed adverse action based on a Veteran’s failure to report for a review examination, see the Veterans Benefits Management System (VBMS) User Guide.

IV.ii.3.B.3.d.  Handling a Veteran’s Willingness to Report for an Examination 

Use the table below to determine how to handle a Veteran’s willingness to report for a VA examination in response to an FTR rating decision.
If the Veteran …
Then …
expresses willingness to report for an examination before the award is reduced or suspended
  • continue the pending EP 600
  • defer adjustment of the award, and
  • refer the case for preparation of a new examination request.
subsequently fails to report for therescheduled examination
  • refer the case to the rating activity for preparation of a final decision, and
  • furnish contemporaneous notice of any and all actions taken.
References:  For more information on

IV.ii.3.B.3.e.  Handling a Veteran’s Request for a Hearing

Upon request, the Veteran is entitled to a hearing to introduce, in person, any available evidence which he/she considers a pertinent argument in connection with the proposed adverse action.
If the Veteran’s request for a hearing is received within 30 days of the date of the notice of proposed adverse action,
  • continue the EP, and
  • do not adjust the Veteran’s award until either
    • the hearing is held, any evidence requested as a result of the hearing is received or deemed unobtainable, and a final rating decision is made, or
    • the Veteran fails to appear for the hearing without good cause.
Reference:  For information on what action to take when a hearing is requested, see M21-1, Part I, 2.C.3.

IV.ii.3.B.3.f. Handling a Veteran’s Failure to Respond to an FTR Rating Decision

Use the table below to determine the action to take if the Veteran fails to respond to notification of an FTR rating decision proposing reduction or termination of compensation payments.
If …
Then …
the Veteran has not responded within 65 days of the date he/she was notified of the proposed adverse action
Reference:  Unless there is justification for resuming benefits, discontinue the award, per M21-1, Part IV, Subpart ii,  3.B.3.d.
the notice of proposed adverse action is returned because
  • the USPS reports the mail cannot be delivered, and
  • a better address cannot be obtained
  • take action as described above, and
  • send the final notice to the last known address.
the notice of proposed adverse action is returned, but the correct address is subsequently identified
  • send another notice of proposed adverse action to the new address
  • continue the pending EP 600, and
  • extend the suspense date by an additional 65 days.
Reference:  For more information on determining where to send the notice of proposed adverse action, see M21-1, Part I, 2.B.3.b.

 

4.  Award Action Taken After a Veteran Fails to Report for a Review Examination


Introduction

This topic contains information on the award action to take after a Veteran fails to report for a review examination, including

Change Date

March 20, 2019

IV.ii.3.B.4.a.  When to Adjust Payments

Do not create an overpayment solely because a Veteran failed to report for a scheduled examination, even under circumstances in which
  • the RO has lost internal control of the underlying proposal, and
  • payments have been unduly continued beyond the normal due process period.
In all such cases, discontinue or reduce compensation payments effective as of the later of the following:
  • the date in the LAST PAID DATE field on the AWARD INFORMATION tab in Share, or
  • the date indicated in the notice of proposed adverse action.

IV.ii.3.B.4.b.  When to Refer the Case to the Rating Activity

If the Veteran does not respond to the notice of proposed adverse action within 65 days, refer the case to the rating activity for preparation of a final rating decision that lists all disabilities with their new or continuing and combined evaluations.
Note:
  • After the final rating decision is complete, refer it to the authorization activity for action.
  • The authorization activity must ensure the corporate record is updated to reflect the new rating information.

IV.ii.3.B.4.c.  Handling Reductions in the Combined Evaluation

Normally, the new combined evaluation is the same as that shown in the initial FTR rating.
However, if the rating activity proposes to reduce the combined evaluation lower than the level originally proposed, send another notice of proposed adverse action before reducing the award based on the new combined evaluation.  In this case,
  • reduce the award as indicated in the original notice of proposed adverse action, and
  • send another notice of proposed adverse action informing the Veteran of the proposed additional reduction.

IV.ii.3.B.4.d.  Handling MRP Cases

If the Veteran receives military retired pay (MRP), action to suspend or discontinue compensation payments generates a notice to the appropriate service department retired pay center.  The service department adjusts the Veteran’s MRP accordingly.
If the Veteran later reports for the examination and compensation payments are resumed or increased, follow the procedures in M21-1, Part III, Subpart v, 5.Bconcerning awards involving MRP.

IV.ii.3.B.4.e. Handling Abandoned Claims

Under 38 CFR 3.158(b), a Veteran who, without adequate reason, fails to report for a scheduled examination within one year of the date he/she was notified of the request gives up the right to benefits based on the claim involved.
Use the table below to determine how to handle different situations involving potentially abandoned claims.
If the Veteran …
Then …
indicated a willingness to report for a rescheduled examination but did notreport
consider the claim abandoned one year from the date of the rescheduled examination.
does not indicate a willingness to report for a rescheduled examination
consider the claim abandoned one year from the date the original examination was to have been conducted.
abandons his/her claim, based on a failure to report for an examination, then subsequently submits another claim and reports for an examination
under 38 CFR 3.158(a), award benefits (if entitlement is found) from the date of receipt of the subsequent claim, if the Veteran reports for the newly scheduled examination within one year of the date of notice to report.

IV.ii.3.B.4.f.  Handling Other Special Situations

For information on handling the failure of a(n)
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