M21-1 Manual  /  Part IV, Subpart i, Chapter 2, Section C

Control of Examinations

M21-1, Part IV, Subpart i, Chapter 2, Section C

Overview

In This Section

This section contains the topic “Control of and Follow-Up on Examination Requests.”


1. Control of and Follow-Up on Examination Requests

Introduction

This topic contains information about control of and follow-up on examination requests, including
  • determining the appropriate suspense date for examinations
  • checking the status of examination requests under special circumstances
  • modifying and canceling examination scheduling requests (ESRs) in the Veterans Benefits Management System (VBMS)
  • continued end product (EP) control when examinations are rescheduled
  • disability benefits questionnaires (DBQs) and examination cancellations
  • documenting examination cancellations and rejections, and
  • obtaining examination reports.

Change Date

January 7, 2025

IV.i.2.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). 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 (ESRs) 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 more information on

IV.i.2.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) providerCompensation 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 (VBA) contract providerContract Exam Inquiry Guidelines to contact the corresponding contract examination vendor.
Note: If the rating activity determines that a necessary examination was canceled without a valid reason, it must submit a new examination request to the examining facility and specify why the previous cancellation was inappropriate.

IV.i.2.C.1.c. Modifying and Canceling ESRs in VBMS

Once an ESR 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 ESR
  • 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 ESRs in VBMS, see the

IV.i.2.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 or contract examination vendor of jurisdiction reschedules an appointment or directs resubmission of an examination request, to include by way of a request for clarification. Note: Contract examination vendors use clarification requests with a variety of narrative reason values to denote examination appointment scheduling irregularities. The only such reason value that may be appropriately considered equivalent to a failure to report for examination, thus warranting application of procedures discussed in M21-1, Part IV, Subpart i, 2.F, is No Show. 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 for examination, or
      • RSVP to the VHA 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 for examination, or
      • RSVP to the VHA 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 appointmentfollow guidance as it appears in M21-1, Part IV, Subpart i, 2.C.1.e.
examination request is canceled or contraindicated in light of the Veteran’s return to active duty servicefollow guidance as it appears in M21-1, Part X, Subpart v, 2.A.1.b and c.
Veteran anticipates an inability to attend an examination and notifies the RO of the unavailability before an examination is requested
  • invite submission of a privately prepared DBQ in lieu of 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 is received, or
    • 30-day evidentiary submission period has elapsed.
Exception: If the contention(s) at issue is one associated with a DBQ approved for internal VA use only, decide the claim based on the evidence of record.
References: For more information on

IV.i.2.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 a private provider. Note: RO personnel must attempt to contact the claimant via telephone prior to making a rating decision.
If telephone contact is ...Then ...
successful
not successfulsend the Veteran a follow-up letter including text to the following effect: [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 disability benefits questionnaire (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.

IV.i.2.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.
Following receipt of notification or discovery of an examination’s cancellation/rejection,
  • convert any cancellation/rejection notice or notification e-mail to portable document format (PDF)
  • upload the PDF file to the corresponding electronic claims folder (eFolder)
  • close all tracked items associated with the examination request, and
  • resubmit the examination request if necessary and/or appropriate.
Exceptions: The specific actions outlined 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 ESR's rejection - is being handled using the VBMS examination management system.
References: For more information on

IV.i.2.C.1.g. Obtaining Examination Reports

Examination reports are automatically uploaded into VBMS, whether completed by VHA examination facilities or VBA contract examiners.If the report from an examination completed by a VHA facility fails to automatically upload into VBMS, claims processors may retrieve the examination report from CAPRI and upload it to the eFolder. Reports that are viewable by VBA personnel in CAPRI are considered finalized. Important:
  • Claims processors must not manually upload reports from the contract examination vendor portals, because these results are not considered finalized.
  • Contract examination reports located in a vendor portal that have not yet been uploaded into VBMS
    • must go through the contract vendor’s quality and review processes before they can be released to the RO, and
    • may still be modified by an examiner and/or the contract vendor.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part IV, Subpart i, Chapter 2, Section C (U.S. government work, reproduced for reference). Browse all sections →