Department of Veterans Affairs M21-1, Part III, Subpart IV



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Department of Veterans Affairs M21-1, Part III, Subpart iv


Veterans Benefits Administration September 24, 2015

Washington, DC 20420

Key Changes



Changes Included in This Revision

The table below describes the changes included in this revision of Veterans Benefits Manual M21-1, Part III, “General Claims Process,” Subpart iv, “General Rating Process.”
Notes:

The term “regional office” (RO) also includes pension management center (PMC), where appropriate.

Unless otherwise noted, the term “claims folder” refers to the official, numbered, Department of Veterans Affairs (VA) repository – whether paper or electronic – for all documentation relating to claims that a Veteran and/or his/her survivors file with VA.

Minor editorial changes have also been made to

update incorrect or obsolete references

update obsolete terminology, where appropriate

reassign alphabetical designations to individual blocks, where necessary, to account for new and/or deleted blocks within a topic

clarify block labels and/or block text, and

bring the document into conformance with M21-1 standards.





Reason(s) for the Change

Citation

  • To add a note that if an examiner states an opinion cannot be rendered and then identifies evidence that would make an opinion possible, then VA has a duty to assist in obtaining the additional evidence.

  • To add a reference to the relevant court case.

M21-1, Part III, Subpart iv, Chapter 3, Section D, Topic 2, Block p (III.iv.3.D.2.p)

  • To add a requirement for medical opinions to provide adequate supporting rationale.

  • To add a reference for weighing evidence.

III.iv.3.D.3.a

  • To add a new Block b providing guidance on the sufficiency of an exam that was erroneously ordered.

  • To add a reference to the relevant court case.

III.iv.3.D.3.b

To clarify the role of Veterans Health Administration (VHA) examiners when a Veterans Benefits Administration (VBA)-contracted exam is insufficient.

III.iv.3.D.3.e



Rescissions

None


Authority

By Direction of the Under Secretary for Benefits


Signature

Thomas J. Murphy, Director



Compensation Service


Distribution

LOCAL REPRODUCTION AUTHORIZED


Section D. Examination Reports

Overview




In This Section

This section contains the following topics:




Topic

Topic Title

1

Locating Examination Reports

2

Examination Report Requirements

3

Handling Examinations Insufficient For Rating Purposes

4

Reviewing Examination Reports for Rating Criteria



1. Locating Examination Reports





Change Date

July 22, 2015




a. Where to Find Examination Reports

Examination reports completed by the Department of Veterans Affairs (VA) examination facilities are located in the Compensation and Pension Record Interchange (CAPRI). These are automatically uploaded into Veterans Business Management System (VBMS). Depending on the template used by the examination provider, a few examination reports still get uploaded into Virtual VA, which is accessible through VBMS.
Examination reports completed by a VA contract examiner are located in either VBMS or Virtual VA. They are also available in the vendor’s web site as follows


  • For Quality, Timeliness, Customer (QTC) service, go to QTC Exam Track.

  • For Veterans Evaluation Services (VES), go to VES Exams.


Important: Access to vendor web sites has to be requested by Regional Office (RO) management. A designated RO contract examination coordinator or liaison may be assigned to monitor contract examinations.
Notes:

  • Examinations contracted by the Veterans Health Administration (VHA) are located in a specific SharePoint site for VHA contracted C&P disability examinations. Due to limited access, each RO has designated individuals with access to the site.

  • Print examination reports on yellow paper when processing claims in the paper environment.



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