## Section A. Examination Requests

#### Overview

+------------+---------------------------------------------------------+
| #          | > This section contains the following topics:           |
| #### In th |                                                         |
| is Section |                                                         |
+------------+---------------------------------------------------------+

  ------------ ---------------------------------------------- ------------
  Topic        Topic Name                                     See Page

  1            General Information on Examination Requests    3-A-2

  2            General Information on Social Surveys          3-A-6

  3            General Medical Examinations                   3-A-8

  4            Benefits Delivery at Discharge (BDD)           3-A-10
               Examinations                                   

  5            BDD Examinations for Pregnant Servicewomen     3-A-11

  6            Prisoner of War (POW) Protocol Examinations    3-A-16

  7            Former POW Social Surveys                      3-A-18

  8            Specialist Examinations                        3-A-20

  9            Medical Opinions                               3-A-22

  10           Aid and Attendance (A&A) and Housebound        3-A-28
               Examinations                                   

  11           Other Types of Examination Requests            3-A-30

  12           Automated Medical Information Exchange         3-A-33
               (AMIE)/Compensation and Pension Record         
               Interchange (CAPRI) or Veterans Examination    
               Request Information System (VERIS) Examination 
               Requests                                       

  13           VA Form 21-2507, Request for Physical          3-A-41
               Examination                                    
  ------------ ---------------------------------------------- ------------

#### 1. General Information on Examination Requests

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains general information on            |
| troduction | > examination requests, including                       |
|            |                                                         |
|            | -   who may request an examination                      |
|            |                                                         |
|            | -   requesting Department of Veterans Affairs (VA)      |
|            |     examinations                                        |
|            |                                                         |
|            | -   when to request an examination                      |
|            |                                                         |
|            | -   description of terms: ***general medical            |
|            |     examination***, ***specialty examination***, and    |
|            |     ***specialist examination***                        |
|            |                                                         |
|            | -   when to send the claims folders with an examination |
|            |     request                                             |
|            |                                                         |
|            | -   a veteran's legal rights                            |
|            |                                                         |
|            | -   jurisdiction for examination requests for foreign   |
|            |     beneficiaries, and                                  |
|            |                                                         |
|            | -   handling field investigations and examination       |
|            |     requests for foreign beneficiaries.                 |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 29, 2007                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > Veterans Service Representatives (VSRs) in the        |
| Who May Re | > Predetermination Team have primary responsibility for |
| quest an E | > requesting the examination of claimants.              |
| xamination | >                                                       |
|            | > A Rating Veterans Service Representative (RVSR) may   |
|            | > provide guidance as necessary. RVSRs also have        |
|            | > authority to request examinations.                    |
|            | >                                                       |
|            | > The Veterans Service Center Manager (VSCM) may        |
|            | > authorize an examination in any case in which he/she  |
|            | > believes it is warranted.                             |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Request Department of Veterans Affairs (VA)           |
| b. Request | > examinations from the                                 |
| ing VA Exa |                                                         |
| minations  | -   VA Medical Center (VAMC) in whose primary service   |
|            |     area the veteran resides                            |
|            |                                                         |
|            | -   VA Medical Center that is able to conduct the type  |
|            |     of examination requested, or                        |
|            |                                                         |
|            | -   designated contracted provider.                     |
|            |                                                         |
|            | > A listing of the counties and zip codes each VAMC     |
|            | > serves *must* be maintained at each regional office   |
|            | > (RO).                                                 |
|            | >                                                       |
|            | > ***Note***: Because not all VA Medical Centers are    |
|            | > able to conduct certain types of specialist           |
|            | > examinations, it may be necessary to schedule the     |
|            | > examination outside the primary service area in which |
|            | > the veteran resides.                                  |
+------------+---------------------------------------------------------+

Continued on next page

1\. General Information on Examination Requests, Continued

+------------+---------------------------------------------------------+
| ##### c.   | > ***Reference***: For more information on when to      |
| When to Re | > request an examination, see [M21-1MR, Part I,         |
| quest an E | > 1.C.7.b](http://10.220.1.4/                           |
| xamination | bl/21/M21-1MR/index.asp?id=pt01_ch01_secC.xml#I.1.C.b). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d.   | > Three terms are commonly used to distinguish basic    |
| Descriptio | > categories of compensation and pension (C&P)          |
| n of Terms | > examinations:                                         |
| : General  |                                                         |
| Medical Ex | -   general medical examination                         |
| amination, |                                                         |
|  Specialty | -   specialty examination, and                          |
|  Examinati |                                                         |
| on, and Sp | -   specialist examination.                             |
| ecialist E |                                                         |
| xamination | > ***General Medical Examination***                     |
|            | >                                                       |
|            | > The main purpose of a general medical examination is  |
|            | > to screen all body systems and either                 |
|            |                                                         |
|            | -   document normal findings, or                        |
|            |                                                         |
|            | -   identify disabilities that are found or suspected.  |
|            |                                                         |
|            | > ***Note***: The examiner must fully evaluate any      |
|            | > disability that is found or suspected according to    |
|            | > the applicable worksheet for each disorder.           |
|            | >                                                       |
|            | > ***References***: For more information on             |
|            |                                                         |
|            | -   general medical examinations, see [M21-1MR, Part    |
|            |     III, Subpart iv,                                    |
|            |     3.A.3](http://10.220.1.4/bl/21/M21-                 |
|            | 1MR/index.asp?id=pt03_sp04_ch03_secA.xml#III.iv.3.A.3), |
|            |     and                                                 |
|            |                                                         |
|            | -   examination worksheets, see "[Index to Disability   |
|            |     Examination                                         |
|            |     Worksheets](http://                                 |
|            | vbaw.vba.va.gov/bl/21/Rating/Medical/exams/index.htm)." |
|            |                                                         |
|            | > ***Specialty Examination***                           |
|            | >                                                       |
|            | > A specialty examination focuses on the disabilities   |
|            | > that are specifically at issue in the veteran's       |
|            | > claim. For example, if a veteran claims that          |
|            | > service-connected arthritis in the left knee and      |
|            | > hypertension have worsened, joint and hypertension    |
|            | > examination worksheets should be requested.           |
|            | >                                                       |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   Specialty examinations generally do not address     |
|            |     disorders that are not at issue in the claim, even  |
|            |     if the disorders are found or suspected during the  |
|            |     examination.                                        |
|            |                                                         |
|            | -   Specialty examinations may be (and usually are)     |
|            |     performed by non-specialist clinicians              |
|            |                                                         |
|            | -   In unusual cases, or as requested by a Board of     |
|            |     Veterans' Appeals (BVA) remand, it may be necessary |
|            |     for the specialty examination to be performed by a  |
|            |     clinician who specializes in the field of study     |
|            |     specific to the worksheet.                          |
+------------+---------------------------------------------------------+

Continued on next page

1\. General Information on Examination Requests, Continued

+------------+---------------------------------------------------------+
| d\.        | > ***Specialist Examination***                          |
| D          | >                                                       |
| escription | > A specialist examination is any examination that is   |
| of Terms:  | > conducted by a clinician who specializes in a         |
| General    | > particular field.                                     |
| Medical    | >                                                       |
| Ex         | > ***Notes***:                                          |
| amination, |                                                         |
| Specialty  | -   All vision, hearing, dental, and psychiatric        |
| Ex         |     examinations *must* be conducted by a specialist.   |
| amination, |     On rare occasions, it may be necessary to request a |
| and        |     specialist examination for other types of           |
| Specialist |     disabilities.                                       |
| E          |                                                         |
| xamination | -   When requesting a mental disorders examination,     |
| (          |     specify that if possible, the veteran's treating    |
| continued) |     mental health professional should not perform the   |
|            |     examination.                                        |
|            |                                                         |
|            | > ***Reference***: For more information on specialist   |
|            | > examinations, see [M21-1MR, Part III, Subpart iv,     |
|            | > 3.A.8](http://10.220.1.4/bl/21/M21-                   |
|            | 1MR/index.asp?id=pt03_sp04_ch03_secA.xml#III.iv.3.A.8). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e    | > Send the claims folders to examining facilities with  |
| . When to  | > the examination requests only in circumstances that   |
| Send the C | > may require claims folder review by the examiner.     |
| laims Fold | >                                                       |
| er With an | > In general, the claims folder should be sent for the  |
|  Examinati | > examiner's review in any case involving a             |
| on Request |                                                         |
|            | -   request for a mental disorders examination          |
|            |                                                         |
|            | -   request for a formal medical opinion, or            |
|            |                                                         |
|            | -   Board of Veterans' Appeals remand.                  |
|            |                                                         |
|            | > ***References***: For more information on             |
|            |                                                         |
|            | -   requests for medical opinions, see [M21-1MR, Part   |
|            |     III, Subpart iv,                                    |
|            |     3.A.9](http://10.220.1.4/bl/21/M21-                 |
|            | 1MR/index.asp?id=pt03_sp04_ch03_secA.xml#III.iv.3.A.9), |
|            |     and                                                 |
|            |                                                         |
|            | -   handling examinations in claims for service         |
|            |     connection for PTSD, see [M21-1MR, Part III,        |
|            |     Subpart iv,                                         |
|            |     4.H.31](http://10.220.1.4/bl/21/M21-1               |
|            | MR/index.asp?id=pt03_sp04_ch04_secH.xml#III.iv.4.D.31). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > A veteran has no legal right to                       |
| #### f. Ve |                                                         |
| teran's Le | -   be accompanied by counsel during an examination, or |
| gal Rights |                                                         |
|            | -   record an examination.                              |
+------------+---------------------------------------------------------+

Continued on next page

1\. General Information on Examination Requests, Continued

+------------+---------------------------------------------------------+
| ##         | > The Pittsburgh Regional Office RO handles requests    |
| ### g. Jur | > for field and medical examinations to be performed by |
| isdiction  | > the Department of State for foreign beneficiaries     |
| for Examin | > except for those handled by the                       |
| ation Requ |                                                         |
| ests for F | -   White River Junction VAM&ROC (Canada), and          |
| oreign Ben |                                                         |
| eficiaries | -   Houston RO (Mexico, Central and South America, and  |
|            |     the Caribbean).                                     |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### h.   | > Use the table below for information on how to handle  |
| Handling F | > field investigations and medical examination requests |
| ield Inves | > for foreign beneficiaries.                            |
| tigations  | >                                                       |
| and Examin | > ***Reference***: For more information on the          |
| ation Requ | > appropriate RO to which requests must be sent, see    |
| ests for F |                                                         |
| oreign Ben | -   [M21-1MR, Part III, Subpart iv,                     |
| eficiaries |     3.A.1.f](../pt03_sp04_ch03_secA#III.iv.3.A.1.f),    |
|            |     and                                                 |
|            |                                                         |
|            | -   [M21-1MR, Part XI,                                  |
|            |     2.B.5](../pt11_ch02_secB.xml#XI.2.B.5).             |
+------------+---------------------------------------------------------+

+----------------------------------+-----------------------------------+
| If requesting a ...              | Then send the request to the ...  |
+----------------------------------+-----------------------------------+
| field investigation              | fiduciary and field examination   |
|                                  | unit of the RO having             |
|                                  | jurisdiction over the area where  |
|                                  | development is required.          |
+----------------------------------+-----------------------------------+
| medical examination on a foreign | the Houston, White River          |
| beneficiary                      | Junction, or Pittsburgh RO by     |
|                                  | submitting the request on *VA     |
|                                  | Form 21-2507*, *Request for       |
|                                  | Physical Examination.*            |
|                                  |                                   |
|                                  | ***Reference***: For more         |
|                                  | information on *VA Form 21-2507*, |
|                                  | see [M21-1MR, Part III, Subpart   |
|                                  | iv,                               |
|                                  | 3.A.13](http://10.220.1.4/        |
|                                  | bl/21/M21-1MR/index.asp?id=pt03_s |
|                                  | p04_ch03_secA.xml#III.iv.3.A.13). |
+----------------------------------+-----------------------------------+

#### 2. General Information on Social Surveys

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about social surveys, |
| troduction | > including                                             |
|            |                                                         |
|            | -   description of a social survey                      |
|            |                                                         |
|            | -   when social surveys can be used to evaluate social  |
|            |     and industrial impairment                           |
|            |                                                         |
|            | -   when social surveys should be used to evaluate      |
|            |     physical or mental disability                       |
|            |                                                         |
|            | -   who conducts a social survey                        |
|            |                                                         |
|            | -   considerations when requesting a social survey, and |
|            |                                                         |
|            | -   returning social surveys for clarification.         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > August 1, 2006                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > A social survey is an interview with the veteran to   |
| Descriptio | > assess the impact of disability on the capacity to    |
| n of a Soc | > interact with others and function in an industrial    |
| ial Survey | > setting.                                              |
|            | >                                                       |
|            | > This type of information may be used in conjunction   |
|            | > with objective clinical findings when, for example,   |
|            | > evaluating psychiatric disabilities, examining former |
|            | > prisoners of war (POW), or considering individual     |
|            | > unemployability (IU).                                 |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > A social survey is an acceptable type of evaluation   |
|  b. When S | > of social or industrial impairment if                 |
| ocial Surv |                                                         |
| eys Can be | -   the rating issue pertains to the evaluation of      |
|  Used to E |     disability, and                                     |
| valuate So |                                                         |
| cial and I | -   a VA examination has established the diagnosis.     |
| ndustrial  |                                                         |
| Impairment | > ***Reference***: For information on social surveys    |
|            | > for former POWs, see [M21-1MR, Part III, Subpart iv,  |
|            | > 3.A.7](http://10.220.1.4/bl/21/M21-                   |
|            | 1MR/index.asp?id=pt03_sp04_ch03_secA.xml#III.iv.3.A.7). |
+------------+---------------------------------------------------------+

Continued on next page

2\. General Information on Social Surveys, Continued

+------------+---------------------------------------------------------+
| #####      | > When a clinical examination alone would not provide   |
|  c. When S | > sufficient information to assess the impact of        |
| ocial Surv | > physical and/or mental disability on the veteran's    |
| eys Should | > capacity to interact with others and function in an   |
|  Be Used t | > industrial setting, request a social survey.          |
| o Evaluate | >                                                       |
|  Physical  | > A social survey may be especially useful in cases     |
| or Mental  | > concerning veterans with                              |
| Disability |                                                         |
|            | -   psychiatric illness                                 |
|            |                                                         |
|            | -   arrested tuberculosis                               |
|            |                                                         |
|            | -   loss of limbs, sight, or hearing                    |
|            |                                                         |
|            | -   physical disfigurement resulting in feelings of     |
|            |     inferiority, or                                     |
|            |                                                         |
|            | -   epilepsy.                                           |
|            |                                                         |
|            | > ***Important***: Do not request a social survey in a  |
|            | > case involving epilepsy without first obtaining the   |
|            | > consent of the claimant.                              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d    | > Social workers are responsible for conducting         |
| . Who Cond | > comprehensive social surveys for medical and rating   |
| ucts a Soc | > purposes.                                             |
| ial Survey |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Include ample information on the Automated Medical    |
|  e. Consid | > Information Exchange (AMIE)/Compensation and Pension  |
| erations W | > Records Interchange (CAPRI) examination request       |
| hen Reques | > worksheet or *VA Form 21-2507* concerning the         |
| ting a Soc |                                                         |
| ial Survey | -   purpose of the examination, and                     |
|            |                                                         |
|            | -   evidence required for rating purposes to assist the |
|            |     social worker conducting the survey.                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > If the rating activity determines that the social     |
| #### f. Re | > survey report is inadequate for rating purposes, it   |
| turning So | > must return the report for clarification.             |
| cial Surve |                                                         |
| ys for Cla |                                                         |
| rification |                                                         |
+------------+---------------------------------------------------------+

#### 3. General Medical Examinations

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on general medical    |
| troduction | > examinations, including                               |
|            |                                                         |
|            | -   when to request a general medical examination       |
|            |                                                         |
|            | -   when a general medical examination is not necessary |
|            |                                                         |
|            | -   conducting a general medical examination, and       |
|            |                                                         |
|            | -   citing medical conditions to be examined.           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > August 1, 2006                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > A general medical examination containing a full       |
| # a. When  | > report of complaints and functional impairments is    |
| to Request | > the preferred type of examination in cases concerning |
|  a General | > original compensation claims (if received within one  |
|  Medical E | > year of discharge).                                   |
| xamination | >                                                       |
|            | > It may also be appropriate to request a general       |
|            | > medical examination to obtain evidence in claims for  |
|            | > individual unemployability or pension.                |
|            | >                                                       |
|            | > ***Important***:                                      |
|            |                                                         |
|            | -   A well-performed general medical examination is     |
|            |     usually of greater value than a number of           |
|            |     specialist examinations that are not correlated.    |
|            |                                                         |
|            | -   When requesting a general medical examination to    |
|            |     evaluate an original compensation claim received    |
|            |     within one year of discharge, do not also generate  |
|            |     specialty examination worksheets for each claimed   |
|            |     disability, except when a specialist examination is |
|            |     required, per [M21-1MR, Part III, Subpart iv,       |
|            |     3.A.8](http://10.220.1.4/bl/21/M21-                 |
|            | 1MR/index.asp?id=pt03_sp04_ch03_secA.xml#III.iv.3.A.8). |
|            |     This policy applies to examinations requested from  |
|            |     the Veterans Health Administration (VHA), as well   |
|            |     as from private providers under VA contract.        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b. W | > It is not necessary to request a general medical      |
| hen a Gene | > examination if an original claim for compensation is  |
| ral Medica | > being rated many years after separation from service. |
| l Examinat |                                                         |
| ion is Not |                                                         |
|  Necessary |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

3\. General Medical Examinations, Continued

+------------+---------------------------------------------------------+
| ##### c.   | > When the medical examiner conducts the examination,   |
| Conducting | > he/she should confirm the existence of and evaluate   |
|  a General |                                                         |
|  Medical E | -   all disabilities listed on the examination request  |
| xamination |     form, and                                           |
|            |                                                         |
|            | -   any other disabilities the veteran identifies       |
|            |     during the examination.                             |
|            |                                                         |
|            | > ***Reference***: To review the contents of the        |
|            | > General Medical Examinations worksheet and all other  |
|            | > examination worksheets, see "[Index to Disability     |
|            | > Examination                                           |
|            | > Worksheets](http://                                   |
|            | vbaw.vba.va.gov/bl/21/Rating/Medical/exams/index.htm)." |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d.   | > The examination request for a general medical         |
| Citing Med | > examination should clearly cite the conditions or     |
| ical Condi | > particular diagnoses that require attention.          |
| tions to B |                                                         |
| e Examined |                                                         |
+------------+---------------------------------------------------------+

#### 4. Benefits Delivery at Discharge (BDD) Examinations

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about Benefits        |
| troduction | > Delivery at Discharge (BDD) examinations, including   |
|            |                                                         |
|            | -   who is eligible for the BDD examination, and        |
|            |                                                         |
|            | -   what the BDD examination covers.                    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > August 1, 2006                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > The Benefits Delivery at Discharge (BDD) examination  |
|  Who Is El | > program is available at specifically designated       |
| igible for | > outprocessing sites to servicemembers with no more    |
|  the BDD E | > than 180 days remaining until discharge.              |
| xamination | >                                                       |
|            | > ***Exception***: The following are currently          |
|            | > precluded from participation in the program:          |
|            |                                                         |
|            | -   those with Gulf War undiagnosed illness or Gulf War |
|            |     environmental hazard issues, or                     |
|            |                                                         |
|            | -   complex rating issues requiring extensive           |
|            |     development.                                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b. W | > At a BDD examination, the claimant is provided a      |
| hat the BD | > general medical examination, any specialty exams      |
| D Examinat | > deemed necessary, and full lab analyses, using VA's   |
| ion Covers | > examination protocols.                                |
+------------+---------------------------------------------------------+

#### 5. BDD Examinations for Pregnant Servicewomen

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about BDD             |
| troduction | > examinations for pregnant servicewomen, including     |
|            |                                                         |
|            | -   general information on BDD examinations for         |
|            |     pregnant servicewomen                               |
|            |                                                         |
|            | -   ancillary conditions of pregnancy                   |
|            |                                                         |
|            | -   tests not recommended for pregnant servicewomen     |
|            |                                                         |
|            | -   how pregnancy affects participation in the BDD      |
|            |     program                                             |
|            |                                                         |
|            | -   options for processing BDD claims for pregnant      |
|            |     servicewomen                                        |
|            |                                                         |
|            | -   assisting and providing information to pregnant     |
|            |     servicewomen                                        |
|            |                                                         |
|            | -   providing information to the claimant, and          |
|            |                                                         |
|            | -   the process when all or part of the case is rated   |
|            |     at discharge.                                       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 29, 2007                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > Many pregnant servicewomen claim conditions that are  |
| # a. Gener | > either                                                |
| al Informa |                                                         |
| tion on BD | -   directly related to pregnancy, or                   |
| D Examinat |                                                         |
| ions for P | -   acute and transitory and expected to resolve upon   |
| regnant Se |     delivery.                                           |
| rvicewomen |                                                         |
|            | > Some physical examinations and routine tests required |
|            | > to accurately rate the disabilities identified in     |
|            | > claims are complicated and not recommended or         |
|            | > normally performed on pregnant women since they may   |
|            | > pose a significant health risk to the woman or baby.  |
|            | >                                                       |
|            | > ***Important***: The information in this topic also   |
|            | > applies to pregnant veterans undergoing examination.  |
+------------+---------------------------------------------------------+

Continued on next page

5\. BDD Examinations for Pregnant Servicewomen, Continued

+------------+---------------------------------------------------------+
| ##         | > Some ancillary conditions common to pregnancy are     |
| ### b. Anc |                                                         |
| illary Con | -   anemia                                              |
| ditions of |                                                         |
|  Pregnancy | -   back pain                                           |
|            |                                                         |
|            | -   edema in the legs                                   |
|            |                                                         |
|            | -   gestational diabetes                                |
|            |                                                         |
|            | -   hypertension                                        |
|            |                                                         |
|            | -   shortness of breath, and                            |
|            |                                                         |
|            | -   urinary tract infections.                           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Tests and procedures that are not recommended for     |
| c. Tests N | > pregnant servicewomen include                         |
| ot Recomme |                                                         |
| nded for P | -   x-rays                                              |
| regnant Se |                                                         |
| rvicewomen | -   pulmonary function tests (PFT), and                 |
|            |                                                         |
|            | -   range of motion examinations.                       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | Pregnant servicewomen are allowed to participate in the |
| ## d. How  | BDD program; however, the claims should not be          |
| Pregnancy  | transferred to the BDD Rating Activity Site. Such cases |
| Affects Pa | will remain at the regional office of jurisdiction.     |
| rticipatio |                                                         |
| n in the B | > Without diagnostic tests and procedures, the examiner |
| DD Program | > may be unable to accurately assess the claimant's     |
|            | > medical condition. This would preclude completion of  |
|            | > the examination of pregnancy-related conditions and   |
|            | > the rating process until after delivery.              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e.   | > There are three options for processing BDD claims for |
|  Options f | > pregnant servicewomen:                                |
| or Process |                                                         |
| ing BDD Cl | -   defer the entire examination until after delivery   |
| aims for P |                                                         |
| regnant Se | -   rate the entire claim based on existing service     |
| rvicewomen |     treatment records (STRs) and evidence, or           |
|            |                                                         |
|            | -   rate any claimed conditions that may be granted     |
|            |     based on existing STRs and evidence. Defer          |
|            |     consideration of any additional disabilities that   |
|            |     may not be examined until after delivery. For       |
|            |     example, a claim for an amputated finger could be   |
|            |     granted but the rest of the claim might be deferred |
|            |     until the pregnancy terminates.                     |
+------------+---------------------------------------------------------+

5\. BDD Examinations for Pregnant Servicewomen, Continued

+------------+---------------------------------------------------------+
| ##### f.   | > The table below describes the process followed by the |
| Assisting  | > Military Services Coordinator (or VSR) at the BDD     |
| and Provid | > Intake Site to assist and provide the necessary       |
| ing Inform | > information to pregnant servicewomen.                 |
| ation to P |                                                         |
| regnant Se |                                                         |
| rvicewomen |                                                         |
+------------+---------------------------------------------------------+

+-------+--------------------------------------------------------------+
| Stage | Description                                                  |
+-------+--------------------------------------------------------------+
| 1     | -   Using the Claim Establishment (CEST) command,            |
|       |     establishes EP 684 to control the claims development     |
|       |     process, and                                             |
|       |                                                              |
|       | -   enters the claim into Modern Award                       |
|       |     Processing-Development (MAP-D) tracking.                 |
+-------+--------------------------------------------------------------+
| 2     | Assists pregnant servicewomen in preparing *VA Form 21-526*, |
|       | *Veteran's Application for Compensation and/or Pension*,     |
|       | documenting all personal and necessary information to        |
|       | facilitate future contacts.                                  |
+-------+--------------------------------------------------------------+
| 3     | > Provides a fact sheet to the pregnant servicewomen         |
|       | > explaining that                                            |
|       |                                                              |
|       | -   the disability examination is deferred because of her    |
|       |     pregnancy                                                |
|       |                                                              |
|       | -   the claim is not adversely affected by the deferral      |
|       |                                                              |
|       | -   she must advise VA of any changes in address or          |
|       |     telephone number                                         |
|       |                                                              |
|       | -   the claim and STRs will be forwarded to the RO of        |
|       |     jurisdiction                                             |
|       |                                                              |
|       | -   the RO of jurisdiction will notify the veteran of the    |
|       |     scheduled Compensation and Pension (C&P) examination     |
|       |     approximately 90 days after the projected delivery date, |
|       |     and                                                      |
|       |                                                              |
|       | -   the claimant should contact VA via the toll free         |
|       |     telephone number if this contact does not happen.        |
+-------+--------------------------------------------------------------+

Continued on next page

5\. BDD Examinations for Pregnant Servicewomen, Continued

  -----------------------------------------------------------------------
  f\. Assisting and Providing Information to Pregnant Servicewomen
  (continued)

  -----------------------------------------------------------------------

+-------+--------------------------------------------------------------+
| Stage | Description                                                  |
+-------+--------------------------------------------------------------+
| 4     | -   Forwards *VA Form 21-526* and STRs to the RO of          |
|       |     jurisdiction after separation, and                       |
|       |                                                              |
|       | -   clears (PCLR) EP 684.                                    |
|       |                                                              |
|       | ***Reference***: For more information on the process         |
|       | followed by the RO of jurisdiction, see [M21-1MR, Part III,  |
|       | Subpart iv, 3.A.5.g](../pt03_sp04_ch03_secA#III.iv.3.A.5.g). |
+-------+--------------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > The table below describes the process followed by the |
| g. Providi | > RO of jurisdiction upon receiving *VA Form 21-526*    |
| ng Informa | > and STRs from the BDD Intake Site.                    |
| tion to th |                                                         |
| e Claimant |                                                         |
+------------+---------------------------------------------------------+

+-------+--------------------------------------------------------------+
| Stage | Description                                                  |
+-------+--------------------------------------------------------------+
| 1     | Using the CEST command, establishes EP 930 with a suspense   |
|       | date of 90 days after the expected delivery date, as         |
|       | reported by the claimant.                                    |
+-------+--------------------------------------------------------------+
| 2     | Schedules the C&P examination when the 90-day suspense       |
|       | period has matured and the claim is located via EP 930.      |
|       |                                                              |
|       | ***Important***: A high degree of coordination is required   |
|       | between the BDD Intake Site coordinator and the RO of        |
|       | jurisdiction to ensure the claim is complete and the EP      |
|       | taken accordingly.                                           |
+-------+--------------------------------------------------------------+
| 3     | Establishes EP 111/011, with a date of claim 90 days after   |
|       | the expected delivery date.                                  |
+-------+--------------------------------------------------------------+

Continued on next page

5\. BDD Examinations for Pregnant Servicewomen, Continued

+------------+---------------------------------------------------------+
| ##### h    | > The table below describes the process when all or     |
| . Process  | > part of the case is rated at discharge.               |
| When All o |                                                         |
| r Part of  |                                                         |
| the Case I |                                                         |
| s Rated at |                                                         |
|  Discharge |                                                         |
+------------+---------------------------------------------------------+

+-------+--------------------------------------------------------------+
| Stage | Description                                                  |
+-------+--------------------------------------------------------------+
| 1     | The BDD Intake Site coordinator or examining physician       |
|       | identifies cases with                                        |
|       |                                                              |
|       | -   significant, non-pregnancy related disability(ies), and  |
|       |                                                              |
|       | -   STRs or medical board records sufficient for rating      |
|       |     purposes.                                                |
+-------+--------------------------------------------------------------+
| 2     | The BDD Intake Site coordinator                              |
|       |                                                              |
|       | -   uses locally established BDD processing procedures, and  |
|       |                                                              |
|       | -   forwards the claim to the RO of jurisdiction.            |
+-------+--------------------------------------------------------------+
| 3     | The RO of jurisdiction                                       |
|       |                                                              |
|       | -   establishes a 111/011 EP with the date of discharge as   |
|       |     the date of claim, and                                   |
|       |                                                              |
|       | -   schedules a future examination to                        |
|       |                                                              |
|       | ```{=html}                                                   |
|       | <!-- -->                                                     |
|       | ```                                                          |
|       | -   validate the rating evaluation, and                      |
|       |                                                              |
|       | -   address any new or deferred issues.                      |
|       |                                                              |
|       | ***Note***: EP 111/011 remains pending if there are any      |
|       | deferred issues.                                             |
+-------+--------------------------------------------------------------+

#### 6. Prisoner of War (POW) Protocol Examinations

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about prisoner of war |
| troduction | > (POW) protocol examinations, including                |
|            |                                                         |
|            | -   reviewing former POW claims                         |
|            |                                                         |
|            | -   considerations when requesting a POW protocol       |
|            |     examination                                         |
|            |                                                         |
|            | -   when to order initial POW protocol examinations     |
|            |                                                         |
|            | -   how to order initial POW protocol examinations, and |
|            |                                                         |
|            | -   when to order reexaminations.                       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > August 1, 2006                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Review all former POW claims, including original      |
| a. Reviewi | > claims, reopened claims, and claims for an increased  |
| ng Former  | > evaluation, to determine if the                       |
| POW Claims |                                                         |
|            | -   record confirms that the veteran was a POW, and     |
|            |                                                         |
|            | -   veteran was examined under the POW protocol,        |
|            |     including a social survey.                          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > If the former POW was not examined under the POW      |
| b. Conside | > protocol, request an examination unless it            |
| rations Wh |                                                         |
| en Request | -   would be inadvisable in light of the veteran's      |
| ing a POW  |     medical condition, or                               |
| Protocol E |                                                         |
| xamination | -   is specifically declined by the veteran or the      |
|            |     veteran's representative.                           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Order initial POW protocol examinations even if       |
| c. When to | > medical evidence to support the claim is not of       |
|  Order Ini | > record but POW status is established.                 |
| tial POW P |                                                         |
| rotocol Ex |                                                         |
| aminations |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

6\. Prisoner of War (POW) Protocol Examinations, Continued

+------------+---------------------------------------------------------+
| #####      | > On the examination request for an initial POW         |
|  d. How to | > protocol examination                                  |
|  Order Ini |                                                         |
| tial POW P | -   clearly note that an examination under the POW      |
| rotocol Ex |     protocol is required, and                           |
| aminations |                                                         |
|            | -   request an examination of all claimed and noted     |
|            |     disabilities, as well as all other conditions       |
|            |     characteristically associated with confinement as a |
|            |     former POW.                                         |
|            |                                                         |
|            | > ***Note***: Provide the claims folder for the         |
|            | > examiner to review on all original claims and as      |
|            | > needed on reopened claims or claims for increased     |
|            | > evaluations.                                          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e    | > If the veteran expresses dissatisfaction with either  |
| . When to  | > the initial examination or the rating decision based  |
| Order Reex | > on the initial examination, order a reexamination.    |
| aminations | >                                                       |
|            | > ***Reference***: For more information on requesting   |
|            | > additional information from the veteran, see          |
|            | > [M21-1MR, Part IV, Subpart ii,                        |
|            | > 1.G.24](http://10.220.1.4/bl/21/M21-                  |
|            | 1MR/index.asp?id=pt04_sp02_ch01_secG.xml#IV.ii.1.G.24). |
+------------+---------------------------------------------------------+

#### 7. Former POW Social Surveys

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about former POW      |
| troduction | > social surveys, including                             |
|            |                                                         |
|            | -   the voluntary nature of social surveys              |
|            |                                                         |
|            | -   refusing social surveys                             |
|            |                                                         |
|            | -   handling examinations that do not include a social  |
|            |     survey                                              |
|            |                                                         |
|            | -   automatic scheduling of former POW social surveys,  |
|            |     and                                                 |
|            |                                                         |
|            | -   specific scheduling of former POW social surveys.   |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > August 1, 2006                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Social surveys are a voluntary examination for former |
| ## a. Volu | > POWs.                                                 |
| ntary Natu |                                                         |
| re of Soci |                                                         |
| al Surveys |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > No claim should be prejudiced by the failure of a     |
| ### b. Ref | > former POW to cooperate in accomplishing the survey.  |
| using Soci |                                                         |
| al Surveys |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > If a social survey was to be conducted for a former   |
| c. Handlin | > POW but was not, then return the examination as       |
| g Examinat | > inadequate for rating purposes *unless* it is         |
| ions That  | > indicated that the former POW declined to participate |
| Do Not Inc | > in the social survey                                  |
| lude a Soc |                                                         |
| ial Survey |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d.   | > VHA automatically schedules a social survey after     |
|  Automatic | > receiving an examination request for a special POW    |
|  Schedulin | > protocol examination.                                 |
| g of Forme |                                                         |
| r POW Soci |                                                         |
| al Surveys |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

7\. Former POW Social Surveys, Continued

+------------+---------------------------------------------------------+
| ##### e    | > In cases where a special POW examination is already   |
| . Specific | > of record and an additional examination for           |
|  Schedulin | > psychiatric disability is necessary, for which a      |
| g of Forme | > social survey is advisable, specifically request a    |
| r POW Soci | > social survey in the Remarks section of the           |
| al Surveys | > examination request.                                  |
|            | >                                                       |
|            | > Use the table below to determine whether to           |
|            | > specifically schedule a former POW social survey in   |
|            | > such cases.                                           |
|            | >                                                       |
|            | > ***Important***: Honor all specific requests for a    |
|            | > social survey from former POWs or their               |
|            | > representatives.                                      |
+------------+---------------------------------------------------------+

+-----------------------------------------+----------------------------+
| If a social survey ...                  | Then ...                   |
+-----------------------------------------+----------------------------+
| was not conducted within the one year   | request a social survey.   |
| period before receipt of the claim      |                            |
+-----------------------------------------+----------------------------+
| was conducted within the one year       | do not request another     |
| period before receipt of the claim      | social survey unless there |
|                                         | is an indication that the  |
|                                         | social/employment          |
|                                         | situation has changed.     |
+-----------------------------------------+----------------------------+
| is needed prior to other appellate      | request a social survey.   |
| procedures in cases where               |                            |
|                                         |                            |
| -   a notice of disagreement (NOD) has  |                            |
|     been filed                          |                            |
|                                         |                            |
| -   the issue on appeal is either       |                            |
|     service connection or evaluation of |                            |
|     a psychiatric disability, and       |                            |
|                                         |                            |
| -   upon review of the claims folder,   |                            |
|     prior to pre-certification of the   |                            |
|     appeal, it is found that a social   |                            |
|     survey was not considered in the    |                            |
|     denial                              |                            |
+-----------------------------------------+----------------------------+

#### 8. Specialist Examinations

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about specialist      |
| troduction | > examinations, including                               |
|            |                                                         |
|            | -   examinations routinely performed by specialists     |
|            |                                                         |
|            | -   who may request other types of specialist           |
|            |     examinations                                        |
|            |                                                         |
|            | -   when to request a specialist examination, and       |
|            |                                                         |
|            | -   who determines the choice of examiner.              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > August 1, 2006                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Some examinations are routinely performed by          |
| a. Examina | > specialists. These examinations include               |
| tions Rout |                                                         |
| inely Perf | -   hearing                                             |
| ormed by S |                                                         |
| pecialists | -   vision                                              |
|            |                                                         |
|            | -   dental, and                                         |
|            |                                                         |
|            | -   psychiatric.                                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > In certain circumstances, specialist examinations for |
| ## b. Who  | > other conditions can be requested by                  |
| May Reques |                                                         |
| t Other Ty | -   the VSR or RVSR                                     |
| pes of Spe |                                                         |
| cialist Ex | -   the medical examiner, or                            |
| aminations |                                                         |
|            | -   the Board of Veteran's Appeals (BVA).               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c.   | > Request a specialist examination only if it is        |
| When to Re | > considered essential for rating purposes.             |
| quest a Sp | >                                                       |
| ecialist E | > ***Example***: A specialist examination may be        |
| xamination | > requested                                             |
|            |                                                         |
|            | -   if an issue is unusually complex                    |
|            |                                                         |
|            | -   if there are conflicting opinions or diagnoses that |
|            |     must be reconciled, or                              |
|            |                                                         |
|            | -   based on a BVA remand.                              |
+------------+---------------------------------------------------------+

Continued on next page

8\. Specialist Examinations, Continued

+------------+---------------------------------------------------------+
| #####      | > The choice of examiners is up to the VA medical       |
| d. Who Det | > facility conducting the examination, unless the BVA   |
| ermines th | > remand specifies that the examination must be         |
| e Choice o | > conducted by a                                        |
| f Examiner |                                                         |
|            | -   "*Board-certified specialist in ...*," or           |
|            |                                                         |
|            | -   "specialist who is Board qualified."                |
|            |                                                         |
|            | > ***Note***: In the absence of a BVA remand, regional  |
|            | > offices (ROs) may not designate qualification         |
|            | > requirements for a specialist examination.            |
+------------+---------------------------------------------------------+

#### 9. Medical Opinions

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about medical         |
| troduction | > opinions, including                                   |
|            |                                                         |
|            | -   who may request a medical opinion                   |
|            |                                                         |
|            | -   general guidelines for requesting a medical opinion |
|            |                                                         |
|            | -   format for medical opinion requests                 |
|            |                                                         |
|            | -   identifying the evidence to be reviewed             |
|            |                                                         |
|            | -   requesting a medical opinion                        |
|            |                                                         |
|            | -   instructions for providing medical opinions for     |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   general claims, and                                 |
|            |                                                         |
|            | -   claims under 38 U.S.C. 1151                         |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   improper medical opinion requests                   |
|            |                                                         |
|            | -   when to obtain an independent medical opinion       |
|            |                                                         |
|            | -   initiating a request for an independent medical     |
|            |     opinion                                             |
|            |                                                         |
|            | -   submitting a request for an independent medical     |
|            |     opinion, and                                        |
|            |                                                         |
|            | -   processing requests for an independent medical      |
|            |     opinion.                                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 29, 2007                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > A VSR assigned to the Predetermination Team may       |
| ### a. Who | > request a basic or straight-forward medical opinion   |
|  May Reque | > if he/she has completed the Advanced Development      |
| st a Medic | > Course. However, an RVSR must review and approve any  |
| al Opinion | > medical opinion request initiated by a VSR.           |
|            | >                                                       |
|            | > RVSRs have the sole authority to initiate complex     |
|            | > medical opinion requests.                             |
|            | >                                                       |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   A Veterans Service Center Manager (VSCM) may        |
|            |     authorize a medical opinion in any case in which    |
|            |     he/she believes it is warranted.                    |
|            |                                                         |
|            | -   A medical opinion request should be signed by the   |
|            |     RVSR (or VSCM) who reviewed and approved it.        |
+------------+---------------------------------------------------------+

Continued on next page

9\. Medical Opinions, Continued

+------------+---------------------------------------------------------+
| #####      | > When requesting a medical opinion                     |
| b. General |                                                         |
|  Guideline | -   specify the                                         |
| s for Medi |                                                         |
| cal Opinio | ```{=html}                                              |
| n Requests | <!-- -->                                                |
|            | ```                                                     |
|            | -   issue(s) under review                               |
|            |                                                         |
|            | -   claimant's contention(s), and                       |
|            |                                                         |
|            | -   opinion requested, and                              |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   provide a summary of evidence available in the      |
|            |     case.                                               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c.   | > Identify the evidence to be reviewed by               |
|  Identifyi |                                                         |
| ng the Evi | -   stating on the medical opinion request form the     |
| dence to b |                                                         |
| e Reviewed | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   source of the evidence (provider or facility)       |
|            |                                                         |
|            | -   subject matter involved, and                        |
|            |                                                         |
|            | -   approximate dates covered by the evidence, and      |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   tabbing the evidence in the claims folder.          |
|            |                                                         |
|            | > ***Note***: Advise the examiner that the review is    |
|            | > not limited to the evidence identified on the request |
|            | > form or tabbed in the claims folder.                  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d.   | > When requesting a medical opinion                     |
|  Requestin |                                                         |
| g a Medica | -   clearly state the nature of the opinion required,   |
| l Opinion  |     and                                                 |
|            |                                                         |
|            | -   explain why the opinion is needed, if this would    |
|            |     clarify the request.                                |
|            |                                                         |
|            | > When requesting an opinion in compliance with BVA     |
|            | > remand instructions, do not simply refer the examiner |
|            | > to the claims folder containing the remand            |
|            | > instructions; however, the instructions may be quoted |
|            | > on the medical opinion request.                       |
+------------+---------------------------------------------------------+

Continued on next page

9\. Medical Opinions, Continued

+------------+---------------------------------------------------------+
| ##### [e.  | > [When requesting a medical opinion, ask the provider  |
|  Instructi | > to]{.mark}                                            |
| ons for Pr | >                                                       |
| oviding Me | > []{.mark}                                             |
| dical Opin |                                                         |
| ions -- Ge | -   [identify the specific evidence reviewed and        |
| neral Clai |     considered in forming the opinion]{.mark}           |
| ms]{.mark} |                                                         |
|            | -   [provide a rationale (explanation/basis) for the    |
|            |     opinion presented, and]{.mark}                      |
|            |                                                         |
|            | -   [state his/her conclusion using one of the          |
|            |     following legally recognized phrases:]{.mark}       |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   [**\[\_\_\_\_\_\]** is caused by or a result of     |
|            |     **\[\_\_\_\_\_\_\]**]{.mark}                        |
|            |                                                         |
|            | -   [**\[\_\_\_\_\_\]** is most likely caused by or a   |
|            |     result of **\[\_\_\_\_\_\_\]**]{.mark}              |
|            |                                                         |
|            | -   [**\[\_\_\_\_\_\]** is as least as likely as not    |
|            |     (50/50 probability) caused by or a result of        |
|            |     **\[\_\_\_\_\_\_\]**]{.mark}                        |
|            |                                                         |
|            | -   [**\[\_\_\_\_\_\]** is less likely as not (less     |
|            |     than 50/50 probability) caused by or a result of    |
|            |     **\[\_\_\_\_\_\_\]**]{.mark}                        |
|            |                                                         |
|            | -   [**\[\_\_\_\_\_\]** is not caused by or a result of |
|            |     **\[\_\_\_\_\_\_\]**, or]{.mark}                    |
|            |                                                         |
|            | -   [**\[\_\_\_\_\_\]** I cannot resolve this issue     |
|            |     without resort to mere speculation.]{.mark}         |
|            |                                                         |
|            | > []{.mark}                                             |
|            | >                                                       |
|            | > [***Note***: The phrase "caused by or a result of"    |
|            | > must be modified for opinion requests based on        |
|            | > aggravation. For more information on what to include  |
|            | > in this type of request, see [M21-1MR, Part IV,       |
|            | > Subpart ii,                                           |
|            | > 2.B.6.c](http://10.220.1.4/bl/21/M21-1MR/index        |
|            | .asp?id=pt04_sp02_ch02_secB.xml#IV.ii.2.B.6.c).]{.mark} |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### [    | > [When requesting a medical opinion for a claim        |
| f. Instruc | > involving benefits under 38 [U.S.C.                   |
| tions for  | > 1151](http://assembler.law.cornell.edu/               |
| Providing  | uscode/html/uscode38/usc_sec_38_00001151----000-.html), |
| Medical Op | > ask the provider to]{.mark}                           |
| inions --  | >                                                       |
| 1151 Claim | > []{.mark}                                             |
| s]{.mark}  |                                                         |
|            | -   [identify the specific evidence reviewed and        |
|            |     considered in forming the opinion]{.mark}           |
|            |                                                         |
|            | -   [provide a rationale (explanation/basis) for the    |
|            |     opinion presented, and]{.mark}                      |
|            |                                                         |
|            | -   [state whether it is as least as likely as not      |
|            |     that]{.mark}                                        |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   [the claimed disability was caused by or became     |
|            |     worse as a result of the VA treatment at            |
|            |     issue]{.mark}                                       |
|            |                                                         |
|            | -   [the additional disability resulted from            |
|            |     carelessness, negligence, lack of skill, or similar |
|            |     incidence of fault on the part of the attending VA  |
|            |     personnel]{.mark}                                   |
|            |                                                         |
|            | -   [the additional disability resulted from an event   |
|            |     that could not have reasonably been foreseen by a   |
|            |     reasonable healthcare provider, and/or]{.mark}      |
|            |                                                         |
|            | -   [failure on the part of VA to timely diagnose       |
|            |     and/or properly treat the claimed disease or        |
|            |     disability allowed the disease or disability to     |
|            |     continue to progress.]{.mark}                       |
|            |                                                         |
|            | > []{.mark}                                             |
|            | >                                                       |
|            | > [***Note***: Do *not* request an examiner under VA's  |
|            | > contract examination program to provide an            |
|            | > examination or medical opinion on a claim involving   |
|            | > benefits under [38 U.S.C.                             |
|            | > 1151](http://assembler.law.cornell.edu/uscode/h       |
|            | tml/uscode38/usc_sec_38_00001151----000-.html).]{.mark} |
+------------+---------------------------------------------------------+

Continued on next page

9\. Medical Opinions, Continued

+------------+---------------------------------------------------------+
| ##         | > Do *not* request a medical authority to assume any    |
| ### g. Imp | > responsibility inherent to the rating activity. To    |
| roper Medi | > prevent confusion, avoid using the word "opinion"     |
| cal Opinio | > when asking the examiner a question about any issue   |
| n Requests | > that does not require a formal medical opinion.       |
|            | >                                                       |
|            | > ***Examples***:                                       |
|            |                                                         |
|            | -   Do *not* request the medical authority to determine |
|            |     if there is loss of use of an extremity; ask for a  |
|            |     description of the remaining function of the        |
|            |     extremity.                                          |
|            |                                                         |
|            | -   Do *not* ask the medical authority to determine if  |
|            |     a particular disability is service-connected (SC).  |
|            |     Instead, identify the in-service injury, event, or  |
|            |     illness, as well as current disability, and ask the |
|            |     examiner to provide an opinion as to whether or not |
|            |     the current disability was caused by or the result  |
|            |     of the identified in-service injury, event, or      |
|            |     illness.                                            |
|            |                                                         |
|            | -   Do *not* ask the medical authority to provide an    |
|            |     opinion as to whether a veteran is unemployable or  |
|            |     entitled to individual unemployability. Instead, in |
|            |     the Remarks section of the examination request, ask |
|            |     the examiner to comment on the veteran's ability to |
|            |     function in an occupational environment and to      |
|            |     describe functional limitations.                    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > If warranted by the medical complexity or the         |
| # h. When  | > controversy of a pending claim, an independent        |
| to Obtain  | > medical opinion under [38 CFR                         |
| an Indepen | > 3.328](http://                                        |
| dent Medic | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_328.DOC) |
| al Opinion | > may be obtained from medical experts who are not VA   |
|            | > employees.                                            |
|            | >                                                       |
|            | > ***Note***: Under VA's contract examination program,  |
|            | > the term "independent medical opinion" refers to an   |
|            | > opinion request requiring a contract examiner to      |
|            | > review medical records contained in a veteran's       |
|            | > claims folder.                                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > A request for an independent medical opinion under    |
| # i. Initi | > [38 CFR                                               |
| ating a Re | > 3.328](http://w                                       |
| quest for  | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_328.DOC), |
| an Indepen | > in conjunction with a pending claim, may be initiated |
| dent Medic | > by the                                                |
| al Opinion |                                                         |
|            | -   RO                                                  |
|            |                                                         |
|            | -   claimant, or                                        |
|            |                                                         |
|            | -   claimant's representative.                          |
+------------+---------------------------------------------------------+

Continued on next page

9\. Medical Opinions, Continued

+------------+---------------------------------------------------------+
| ####       | > Submit a request for an independent medical opinion   |
| # j. Submi | > under [38 CFR                                         |
| tting a Re | > 3.328](http://                                        |
| quest for  | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_328.DOC) |
| an Indepen |                                                         |
| dent Medic | -   in writing                                          |
| al Opinion |                                                         |
|            | -   through the Veterans Service Center Manager (VSCM)  |
|            |                                                         |
|            | -   by stating, in detail,                              |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   the reasons why the opinion is necessary, and       |
|            |                                                         |
|            | -   the specific information or opinion required.       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > The table below describes how to process a request    |
| #### k. Pr | > for an independent medical opinion under [38 CFR      |
| ocessing R | > 3.328](http://                                        |
| equests fo | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_328.DOC) |
| r Independ | > and identifies the responsible parties.               |
| ent Medica |                                                         |
| l Opinions |                                                         |
+------------+---------------------------------------------------------+

+------+--------------------------+-----------------------------------+
| S    | Who is Responsible       | Description                       |
| tage |                          |                                   |
+------+--------------------------+-----------------------------------+
| 1    | -   RVSR                 | Brings the request for an         |
|      |                          | independent medical opinion to    |
|      | -   Decision Review      | the attention of the VSCM.        |
|      |     Officer (DRO), or    |                                   |
|      |                          |                                   |
|      | -   service organization |                                   |
|      |     representative       |                                   |
+------+--------------------------+-----------------------------------+
| 2    | VSCM                     | Decides whether the request has   |
|      |                          | merit                             |
+------+--------------------------+-----------------------------------+
| 3    | VSCM                     | Does the request have merit?      |
|      |                          |                                   |
|      |                          | -   If *yes*, refers the request  |
|      |                          |     to C&P Service (211) for      |
|      |                          |     review.                       |
|      |                          |                                   |
|      |                          | -   If *no*, denies the request   |
|      |                          |     without the need for referral |
|      |                          |     to C&P Service.               |
|      |                          |                                   |
|      |                          | ***Important***: This             |
|      |                          | determination may be contested as |
|      |                          | part of an appeal on the primary  |
|      |                          | issue under consideration.        |
+------+--------------------------+-----------------------------------+
| 4    | Central Office (CO) C&P  | Decides whether the request has   |
|      | Service                  | merit.                            |
+------+--------------------------+-----------------------------------+

Continued on next page

9\. Medical Opinions, Continued

  -----------------------------------------------------------------------
  k\. Processing Requests for Independent Medical Opinions (continued)

  -----------------------------------------------------------------------

+------+--------------------------+-----------------------------------+
| S    | Who is Responsible       | Description                       |
| tage |                          |                                   |
+------+--------------------------+-----------------------------------+
| 5    | CO C&P Service           | Does the request have merit?      |
|      |                          |                                   |
|      |                          | -   If *yes*                      |
|      |                          |                                   |
|      |                          | ```{=html}                        |
|      |                          | <!-- -->                          |
|      |                          | ```                               |
|      |                          | -   notifies the claimant that    |
|      |                          |     the request has been approved |
|      |                          |                                   |
|      |                          | -   obtains the opinion, and      |
|      |                          |                                   |
|      |                          | -   sends a copy of the opinion   |
|      |                          |     when it is available.         |
|      |                          |                                   |
|      |                          | ```{=html}                        |
|      |                          | <!-- -->                          |
|      |                          | ```                               |
|      |                          | -   If *no*, denies the request.  |
|      |                          |                                   |
|      |                          | ***Important***: This             |
|      |                          | determination may be contested as |
|      |                          | part of an appeal on the primary  |
|      |                          | issue under consideration.        |
+------+--------------------------+-----------------------------------+

#### 10. Aid and Attendance (A&A) and Housebound Examinations

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about Aid and         |
| troduction | > Attendance (A&A) and Housebound examinations,         |
|            | > including                                             |
|            |                                                         |
|            | -   purpose of an A&A and Housebound examination        |
|            |                                                         |
|            | -   when to request an A&A and Housebound examination   |
|            |                                                         |
|            | -   requesting an A&A and Housebound examination, and   |
|            |                                                         |
|            | -   prohibition against using locally devised           |
|            |     checklists.                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 29, 2007                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > The Aid and Attendance (A&A) and Housebound           |
| ## a. Purp | > examination is designed to                            |
| ose of an  |                                                         |
| A&A and Ho | -   pinpoint findings relevant to aid and attendance    |
| usebound E |     determinations under [38 CFR                        |
| xamination |     3.351](http://                                      |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_351.DOC) |
|            |     and [38 CFR                                         |
|            |     3.352](http://w                                     |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_352.DOC), |
|            |     and                                                 |
|            |                                                         |
|            | -   provide a basis for determining if the housebound   |
|            |     benefit may be paid if need for A&A is not shown.   |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > Request an A&A and Housebound examination if the      |
|  When to R | > evidence of record demonstrates a reasonable          |
| equest an  | > probability of entitlement to A&A or housebound       |
| A&A and Ho | > benefits but is not sufficient to allow the benefit.  |
| usebound E |                                                         |
| xamination |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

10\. Aid and Attendance (A&A) and Housebound Examinations, Continued

+------------+---------------------------------------------------------+
| ###        | > Use the table below for information on how to request |
| ## c. Requ | > an A&A and Housebound examination.                    |
| esting an  |                                                         |
| A&A and Ho |                                                         |
| usebound E |                                                         |
| xamination |                                                         |
+------------+---------------------------------------------------------+

+----------------------------------+-----------------------------------+
| If using ...                     | Then check the ...                |
+----------------------------------+-----------------------------------+
| the AMIE/CAPRI examination       | A&A and Housebound examination    |
| request worksheet                | field.                            |
+----------------------------------+-----------------------------------+
| *VA Form 21-2507*                | appropriate block in the item     |
|                                  | *require medical examination of*. |
|                                  |                                   |
|                                  | ***Note***: Since the Veterans    |
|                                  | Health Administration (VHA)       |
|                                  | maintains its own stock of forms, |
|                                  | do not attach *VA Form 21-2680*,  |
|                                  | *Examination for Housebound       |
|                                  | Status or Permanent Need for      |
|                                  | Regular Aid and Attendance.*      |
+----------------------------------+-----------------------------------+

+------------+---------------------------------------------------------+
| #          | > Do not use locally devised checklists for completion  |
| #### d. Pr | > by physicians or others.                              |
| ohibition  | >                                                       |
| Against Us | > Since functional impairment is seldom total in        |
| ing Locall | > extent, *Yes* or *No* blocks do not provide           |
| y Devised  | > sufficient descriptive information to assess the      |
| Checklists | > extent of a claimant's incapacitation.                |
+------------+---------------------------------------------------------+

#### 11. Other Types of Examination Requests

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about other types of  |
| troduction | > examination requests, including                       |
|            |                                                         |
|            | -   examinations of non-veteran claimants and           |
|            |     beneficiaries                                       |
|            |                                                         |
|            | -   hospital observation                                |
|            |                                                         |
|            | -   field examinations                                  |
|            |                                                         |
|            | -   examinations of incarcerated veterans               |
|            |                                                         |
|            | -   board examinations, and                             |
|            |                                                         |
|            | -   reexaminations by different examiners.              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| **Change   | > December 29, 2007                                     |
| Date**     |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > Schedule examinations of non-veteran claimants and    |
| # a. Exami | > beneficiaries                                         |
| nations of |                                                         |
|  Non-Veter | -   only after approval by the VSCM, or                 |
| an Claiman |                                                         |
| ts and Ben | -   to determine                                        |
| eficiaries |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   if a claimant is entitled to A&A or Housebound      |
|            |     benefits                                            |
|            |                                                         |
|            | -   if a claimant was insane at the time he/she caused  |
|            |     the death of the veteran                            |
|            |                                                         |
|            | -   if a child claimant is helpless and/or incompetent, |
|            |     and/or                                              |
|            |                                                         |
|            | -   if a beneficiary is competent to handle his/her     |
|            |     funds.                                              |
|            |                                                         |
|            | > ***Reference***: For more information on the facts to |
|            | > be considered in a wrongful and intentional death,    |
|            | > see [M21-1MR, Part III, Subpart v,                    |
|            | > 1.F.23](http://10.220.1.4/bl/21/M21-                  |
|            | 1MR/index.asp?id=pt03_sp05_ch01_secF.xml#III.v.1.F.23). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > To properly visualize and evaluate complex disability |
| Hospital O | > issues the rating activity may request a period of    |
| bservation | > hospitalization for observation and examination.      |
+------------+---------------------------------------------------------+

Continued on next page

11\. Other Types of Examination Requests, Continued

+------------+---------------------------------------------------------+
| ##### c    | > Request a field examination when it is not possible,  |
| . Field Ex | > through the routine examination process, to           |
| aminations |                                                         |
|            | -   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. |
|            |                                                         |
|            | > ***Reference***: For more information on requests for |
|            | > field examinations, see [M21-1MR, Part III, Subpart   |
|            | > vi, 8.8](../pt03_sp06_ch08.xml#III.vi.8.8).           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Because some State laws restrict the movement of and  |
| d. Examina | > access to prison inmates, it may not be possible for  |
| tions of I | > an incarcerated veteran to be examined at a VA        |
| ncarcerate | > medical facility or for Veterans Health               |
| d Veterans | > Administration (VHA) personnel to perform the         |
|            | > examination at the prison.                            |
|            | >                                                       |
|            | > When examination of an incarcerated veteran is        |
|            | > required, the RO and/or the local VHA Medical         |
|            | > Examination Coordinator should confer with prison     |
|            | > authorities to determine whether the veteran should   |
|            | > be                                                    |
|            |                                                         |
|            | -   escorted to a VA medical facility for examination   |
|            |     by VHA personnel, or                                |
|            |                                                         |
|            | -   examined at the prison by                           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   VHA personnel                                       |
|            |                                                         |
|            | -   prison medical providers at VA expense, or          |
|            |                                                         |
|            | -   fee-basis providers contracted by VHA.              |
|            |                                                         |
|            | > ***Note***: If a problem cannot be resolved at the    |
|            | > local level, contact the C&P Service Program Review   |
|            | > Staff (214A) for assistance.                          |
|            | >                                                       |
|            | > ***References***: For more information on             |
|            |                                                         |
|            | -   VA's duty to examine incarcerated veterans, see     |
|            |     [*Bolton v.                                         |
|            |     Brow                                                |
|            | n*](http://vbaw.vba.va.gov/bl/21/Advisory/CAVCDAD.htm), |
|            |     8 Veterans Appeals 185 (1995), and                  |
|            |                                                         |
|            | -   VHA Medical Examination Coordinators, see [M21-1MR, |
|            |     Part III, Subpart iv,                               |
|            |     3.E](http://10.220.1.4/bl/21/M2                     |
|            | 1-1MR/index.asp?id=pt03_sp04_ch03_secE.xml#III.iv.3.E). |
+------------+---------------------------------------------------------+

Continued on next page

11\. Other Types of Examination Requests, Continued

+------------+---------------------------------------------------------+
| ##### e    | > There should be at least two physicians, preferably   |
| . Board Ex | > three, on "board examinations" and at least one,      |
| aminations | > preferably all, should be a recognized specialists in |
|            | > the particular field involved.                        |
|            | >                                                       |
|            | > The rating activity has the authority to request      |
|            | > board examinations to                                 |
|            |                                                         |
|            | -   reconcile differing diagnoses, or                   |
|            |                                                         |
|            | -   resolve particularly complex issues concerning      |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   grants of Special Monthly Compensation (SMC), or    |
|            |                                                         |
|            | -   entitlement to specially adapted housing (SAH).     |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### f    | > The rating activity may request that the claimant be  |
| . Reexamin | > reexamined by another medical examiner if compelling  |
| ations by  | > reasons exist.                                        |
| a Differen | >                                                       |
| t Examiner | > To request a reexamination                            |
|            |                                                         |
|            | -   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 [M21-1MR, Part III, Subpart |
|            | > iv,                                                   |
|            | > 3.A.13](http://10.220.1.4/bl/21/M21-1                 |
|            | MR/index.asp?id=pt03_sp04_ch03_secA.xml#III.iv.3.A.13). |
+------------+---------------------------------------------------------+

#### 12. Automated Medical Information Exchange (AMIE)/ Compensation and Pension Record Interchange (CAPRI) or Veterans Examination Request Information System (VERIS) Examination Requests

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on                    |
| troduction |                                                         |
|            | -   the features of the AMIE/CAPRI or VERIS             |
|            |     Compensation and Pension (C&P) program              |
|            |                                                         |
|            | -   when to complete an AMIE/CAPRI C&P examination      |
|            |     request worksheet                                   |
|            |                                                         |
|            | -   requesting VHA examinations in the geographic       |
|            |     jurisdiction of another RO                          |
|            |                                                         |
|            | -   the responsibilities of ROs in reviewing            |
|            |     examination requests                                |
|            |                                                         |
|            | -   generating worksheets                               |
|            |                                                         |
|            | -   who uses the worksheets                             |
|            |                                                         |
|            | -   the information required to complete an AMIE/CAPRI  |
|            |     C&P examination request worksheet, and              |
|            |                                                         |
|            | -   handling the folder copy.                           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 29, 2007                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

12\. Automated Medical Information Exchange (AMIE)/ Compensation and
Pension Record Interchange (CAPRI) or Veterans Examination Request
Information System (VERIS) Examination Requests, Continued

+------------+---------------------------------------------------------+
| #####      | > The AMIE/CAPRI or VERIS Compensation and Pension      |
| a. Feature | > (C&P) program allows                                  |
| s of the A |                                                         |
| MIE/CAPRI  | -   ROs to electronically transmit examination requests |
| or VERIS C |     to medical centers, examining facilities, and       |
| &P Program |     private examination contractors, as appropriate     |
|            |                                                         |
|            | -   ROs to add, cancel, or modify examination requests  |
|            |     instantly                                           |
|            |                                                         |
|            | -   ROs to use inquiry capabilities for information on  |
|            |     the status of examination requests                  |
|            |                                                         |
|            | -   medical centers and examination contractors to      |
|            |     print                                               |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   examination requests, and                           |
|            |                                                         |
|            | -   standardized worksheets after the specific          |
|            |     examinations have been scheduled, and               |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   medical centers and examination contractors to      |
|            |     electronically transmit transcribed results of      |
|            |     examinations back to the RO for local printing.     |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   The VERIS application is used only at ROs that      |
|            |     participate in the contract examination program.    |
|            |                                                         |
|            | -   Use an AMIE/CAPRI or VERIS C&P examination request  |
|            |     rather than a hardcopy *VA* *Form 21-2507* whenever |
|            |     possible.                                           |
|            |                                                         |
|            | > ***Reference***: For more information on *VA* *Form   |
|            | > 21-2507*, see [M21-1MR, Part III, Subpart iv,         |
|            | > 3.A.13](http://10.220.1.4/bl/21/M21-1                 |
|            | MR/index.asp?id=pt03_sp04_ch03_secA.xml#III.iv.3.A.13). |
+------------+---------------------------------------------------------+

Continued on next page

12\. Automated Medical Information Exchange (AMIE)/ Compensation and
Pension Record Interchange (CAPRI) or Veterans Examination Request
Information System (VERIS) Examination Requests, Continued

+------------+---------------------------------------------------------+
| ##         | > Use AMIE/CAPRI or VERIS to request                    |
| ### b. Whe |                                                         |
| n to Compl | -   examinations                                        |
| ete an AMI |                                                         |
| E/CAPRI or | -   medical opinions                                    |
|  VERIS C&P |                                                         |
|  Examinati | -   social surveys, and                                 |
| on Request |                                                         |
|  Worksheet | -   periods of hospitalization for observation and      |
|            |     examination.                                        |
|            |                                                         |
|            | > ***Exception***: Do *not* make requests for           |
|            | > observation and examination or social surveys in      |
|            | > VERIS, because VA's contract for medical services     |
|            | > does not include these types of examinations.         |
|            | >                                                       |
|            | > ***Reference***: For more information on requesting   |
|            | > examinations or opinions and the duty to assist, see  |
|            | > [M21-1MR, Part I,                                     |
|            | > 1.C.7](http://10.220.1.4/                             |
|            | bl/21/M21-1MR/index.asp?id=pt01_ch01_secC.xml#I.1.C.7). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > Use the table below for requesting VHA examinations   |
| #### c. Re | > that are in the geographic jurisdiction of another    |
| questing V | > RO.                                                   |
| HA Examina | >                                                       |
| tions in t | > ***Note***: Requests for non-VHA examinations         |
| he Geograp | > scheduled through a designated contractor are limited |
| hic Jurisd | > to the geographic area specified by the contractual   |
| iction of  | > agreement.                                            |
| Another RO |                                                         |
+------------+---------------------------------------------------------+

+----------------------------------+-----------------------------------+
| If you want to request the       | Then the person making the        |
| examination of ...               | examination request must ...      |
+----------------------------------+-----------------------------------+
| -   a veteran living within the  | either                            |
|     geographic jurisdiction of   |                                   |
|     another RO, or               | -   complete *VA* *Form 21-2507*, |
|                                  |     or                            |
| -   an employee-veteran who must |                                   |
|     be examined elsewhere        | -   request that an RO linked by  |
|                                  |     AMIE/CAPRI to the examining   |
|                                  |     facility prepare an           |
|                                  |     AMIE/CAPRI examination        |
|                                  |     request.                      |
+----------------------------------+-----------------------------------+
| a veteran residing in a foreign  | complete *VA* *Form 21-2507*.     |
| country other than the           |                                   |
| Philippines                      | ***Reference***: For more         |
|                                  | information on *VA Form 21-2507*, |
|                                  | see [M21-1MR, Part III, Subpart   |
|                                  | iv,                               |
|                                  | 3.A.13](http://10.220.1.4/        |
|                                  | bl/21/M21-1MR/index.asp?id=pt03_s |
|                                  | p04_ch03_secA.xml#III.iv.3.A.13). |
+----------------------------------+-----------------------------------+

Continued on next page

12\. Automated Medical Information Exchange (AMIE)/ Compensation and
Pension Record Interchange (CAPRI) or Veterans Examination Request
Information System (VERIS) Examination Requests, Continued

+------------+---------------------------------------------------------+
| #####      | > ROs must ensure that the types of examinations        |
| d. Respons | > requested are pertinent to the veteran's claim and    |
| ibilities  | > that the request is clear and complete.               |
| of ROs in  |                                                         |
| Reviewing  |                                                         |
| Examinatio |                                                         |
| n Requests |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e. G | > The medical center clerk uses AMIE/CAPRI to generate  |
| enerating  | > standardized worksheets for each type of examination  |
| Worksheets | > requested and scheduled. The private examination      |
|            | > contractor uses VERIS for the same purposes.          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > The examiner uses the AMIE/CAPRI or VERIS             |
| ### f. Who | > standardized worksheets for conducting the            |
|  Uses the  | > examination.                                          |
| Worksheets |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

12\. Automated Medical Information Exchange (AMIE)/ Compensation and
Pension Record Interchange (CAPRI) or Veterans Examination Request
Information System (VERIS) Examination Requests, Continued

+------------+---------------------------------------------------------+
| ##### g.   | > The table below shows the information required to     |
| Informatio | > complete entries on the AMIE/CAPRI C&P examination    |
| n Required | > request worksheet.                                    |
|  to Comple | >                                                       |
| te an AMIE | > ***Important***: Worksheets vary from one RO to       |
| /CAPRI C&P | > another, so instructions for completion may vary.     |
|  Examinati | >                                                       |
| on Request | > ***References***:                                     |
|  Worksheet |                                                         |
|            | -   For more information on completing the entries on   |
|            |     the AMIE/CAPRI C&P examination request worksheet,   |
|            |     see the                                             |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   [AMIE User's                                        |
|            |     Guide]                                              |
|            | (http://vbaw.vba.va.gov/bl/21/systems/docs/amieug.pdf), |
|            |     and                                                 |
|            |                                                         |
|            | -   [CAPRI User's                                       |
|            |     Guide](                                             |
|            | http://vbaw.vba.va.gov/bl/21/systems/docs/capriug.pdf). |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   For information on completing the entries on the    |
|            |     VERIS examination request worksheet, see the [VERIS |
|            |     User's                                              |
|            |     Guide](http                                         |
|            | ://vbaw.vba.va.gov/bl/21/publicat/Users/Index.htm#bmv). |
+------------+---------------------------------------------------------+

+-----+-------------------+-------------------------------------------+
| I   | Entry             | Explanation                               |
| tem |                   |                                           |
+-----+-------------------+-------------------------------------------+
| > 1 | Veteran's         | If the person being examined              |
|     |                   |                                           |
|     | -   First Name    | -   is not a veteran, enter the person's  |
|     |                   |     name followed by their relationship   |
|     | -   Middle        |     to the veteran (for example, enter    |
|     |     Initial, and  |     Tony Smith, child, or Mary Jones,     |
|     |                   |     spouse.).                             |
|     | -   Last Name     |                                           |
|     |                   | -   is not a veteran, in Remarks, enter   |
|     |                   |     the veteran's name and VA claim       |
|     |                   |     number.                               |
|     |                   |                                           |
|     |                   | -   is rated incompetent, indicate this   |
|     |                   |     by adding "*incompetent"* after the   |
|     |                   |     name.                                 |
+-----+-------------------+-------------------------------------------+
| 2   | VAMC Where        | The VAMC selected should be the           |
|     | Examination Is    |                                           |
|     | Requested         | -   closest VAMC to the claimant's        |
|     |                   |     residence unless the VAMC is unable   |
|     |                   |     to conduct that particular exam, or   |
|     |                   |                                           |
|     |                   | -   the closest VAMC able to conduct all  |
|     |                   |     requested examinations.               |
+-----+-------------------+-------------------------------------------+
| 3   | VA Claims File    | Enter the claims folder number.           |
|     | Number            |                                           |
+-----+-------------------+-------------------------------------------+

Continued on next page

12\. Automated Medical Information Exchange (AMIE)/ Compensation and
Pension Record Interchange (CAPRI) or Veterans Examination Request
Information System (VERIS) Examination Requests, Continued

  -----------------------------------------------------------------------
  g\. Information Required to Complete an AMIE/CAPRI C&P Examination
  Request Worksheet (continued)

  -----------------------------------------------------------------------

+-----+-------------------+-------------------------------------------+
| I   | Entry             | Explanation                               |
| tem |                   |                                           |
+-----+-------------------+-------------------------------------------+
| 4   | Social Security   | Enter the SSN if it is different than the |
|     | Number (SSN)      | file number.                              |
|     |                   |                                           |
|     |                   | ***Note***: Enter the SSN of the person   |
|     |                   | being examined if the person is *not* a   |
|     |                   | veteran.                                  |
+-----+-------------------+-------------------------------------------+
| 5   | Telephone Number  | Enter the telephone number of the person  |
|     |                   | being examined.                           |
+-----+-------------------+-------------------------------------------+
| 6   | Power of Attorney | Enter the power of attorney of the person |
|     |                   | being examined.                           |
+-----+-------------------+-------------------------------------------+
| 7   | Date Ordered      | Enter the date on which the examination   |
|     |                   | is requested.                             |
+-----+-------------------+-------------------------------------------+
| 8   | By                | Enter the VSR's/RVSR's name or initials   |
|     |                   | and Correspondence Symbol.                |
+-----+-------------------+-------------------------------------------+
| 9   | Type of           | Be sure to use the designated code to     |
|     | Examination       | indicate the examination type.            |
|     |                   |                                           |
|     |                   | Applicable codes are                      |
|     |                   |                                           |
|     |                   | -   "*E*" for Insufficient **E**xam       |
|     |                   |                                           |
|     |                   | -   "*I*" for Claim **I**ncrease          |
|     |                   |                                           |
|     |                   | -   "*ON*" for **O**riginal               |
|     |                   |     **N**onservice-Connected              |
|     |                   |                                           |
|     |                   | -   "*OS*" for **O**riginal               |
|     |                   |     **S**ervice-Connected                 |
|     |                   |                                           |
|     |                   | -   "*OTH*" for **O**ther                 |
|     |                   |                                           |
|     |                   | -   "*P*" for former **P**OW              |
|     |                   |                                           |
|     |                   | -   "*R*" for **R**eview Examination, and |
|     |                   |                                           |
|     |                   | -   "*T*" for **T**erminal.               |
+-----+-------------------+-------------------------------------------+

Continued on next page

12\. Automated Medical Information Exchange (AMIE)/ Compensation and
Pension Record Interchange (CAPRI) or Veterans Examination Request
Information System (VERIS) Examination Requests, Continued

  -----------------------------------------------------------------------
  g\. Information Required to Complete an AMIE/CAPRI C&P Examination
  Request Worksheet (continued)

  -----------------------------------------------------------------------

+-----+-------------------+-------------------------------------------+
| I   | Entry             | Explanation                               |
| tem |                   |                                           |
+-----+-------------------+-------------------------------------------+
| 10  | Insufficient      | If the request is for additional          |
|     | Examination       | information because a previous            |
|     |                   | examination was inadequate, enter the     |
|     |                   | following in the Remarks section:         |
|     |                   |                                           |
|     |                   | -   the date of the inadequate            |
|     |                   |     examination, and                      |
|     |                   |                                           |
|     |                   | -   a complete explanation of the         |
|     |                   |     necessary corrective action.          |
+-----+-------------------+-------------------------------------------+
| 11  | General Medical   | Indicate any known diagnoses or           |
|     | Examinations      | complaints.                               |
+-----+-------------------+-------------------------------------------+
| 12  | Body System       | Check the specific examination within the |
|     |                   | affected body system to be performed. Do  |
|     |                   | not check if also requesting a general    |
|     |                   | medical examination.                      |
+-----+-------------------+-------------------------------------------+
| 13  | Remarks           | -   If known, provide the diagnosis of    |
|     |                   |     each disability to be examined.       |
|     |                   |                                           |
|     |                   | -   As appropriate, state whether service |
|     |                   |     connection has been established for   |
|     |                   |     the disability or if it is being      |
|     |                   |     sought.                               |
|     |                   |                                           |
|     |                   | -   Restrict other entries to             |
|     |                   |                                           |
|     |                   | ```{=html}                                |
|     |                   | <!-- -->                                  |
|     |                   | ```                                       |
|     |                   | -   any necessary clarifying remarks      |
|     |                   |     regarding the issues to be resolved,  |
|     |                   |     and/or                                |
|     |                   |                                           |
|     |                   | -   the type of examination requested.    |
|     |                   |                                           |
|     |                   | ```{=html}                                |
|     |                   | <!-- -->                                  |
|     |                   | ```                                       |
|     |                   | -   Provide the name and telephone number |
|     |                   |     of the requestor, in the event        |
|     |                   |     clarification is required.            |
|     |                   |                                           |
|     |                   | ***Note***: Do not use manual,            |
|     |                   | regulation, or code citations.            |
+-----+-------------------+-------------------------------------------+
| 14  | Specialist        | Explain the nature of the specialist      |
|     | Examinations      | examination requested and the reason for  |
|     |                   | its request in Remarks.                   |
+-----+-------------------+-------------------------------------------+

Continued on next page

12\. Automated Medical Information Exchange (AMIE)/ Compensation and
Pension Record Interchange (CAPRI) or Veterans Examination Request
Information System (VERIS) Examination Requests, Continued

+------------+---------------------------------------------------------+
| ###        | > Reverse file the claims folder copy of the AMIE/CAPRI |
| ## h. Hand | > examination request worksheet, pending receipt of the |
| ling the F | > completed examination report.                         |
| older Copy |                                                         |
+------------+---------------------------------------------------------+

#### 13. VA Form 21-2507, Request for Physical Examination

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on *VA Form 21-2507,* |
| troduction | > *Request for Physical Examination*, including         |
|            |                                                         |
|            | -   when to use *VA Form 21-2507*                       |
|            |                                                         |
|            | -   entries on *VA Form 21-2507* of special interest    |
|            |                                                         |
|            | -   forwarding examination requests to the appropriate  |
|            |     medical center, and                                 |
|            |                                                         |
|            | -   handling the file copy of the examination request.  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 29, 2007                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > When AMIE/CAPRI cannot be used because the RO is not  |
| a. When to | > linked electronically to the VA medical center,       |
|  Use VA Fo | > complete *VA Form 21-2507*, *Request for Physical     |
| rm 21-2507 | > Examination,* to request                              |
|            |                                                         |
|            | -   examinations                                        |
|            |                                                         |
|            | -   medical opinions                                    |
|            |                                                         |
|            | -   social surveys, and/or                              |
|            |                                                         |
|            | -   periods of hospitalization for observation and      |
|            |     examination.                                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Complete all appropriate entries on *VA Form          |
|  b. Entrie | > 21-2507*.                                             |
| s on VA Fo | >                                                       |
| rm 21-2507 | > The table below describes the entries of special      |
|  of Specia | > interest.                                             |
| l Interest |                                                         |
+------------+---------------------------------------------------------+

+-----------------------+----------------------------------------------+
| Entry                 | Description                                  |
+-----------------------+----------------------------------------------+
| Social Security       | Enter the SSN if it is different than the    |
| Number (SSN)          | claims folder number.                        |
+-----------------------+----------------------------------------------+
| Period of Service     | Enter the                                    |
|                       |                                              |
|                       | -   earliest entitling period of service in  |
|                       |     a pension claim, or                      |
|                       |                                              |
|                       | -   latest period of service in a            |
|                       |     compensation claim.                      |
+-----------------------+----------------------------------------------+

Continued on next page

13\. VA Form 21-2507, Request for Physical Examination, Continued

  -----------------------------------------------------------------------
  b\. Entries on VA Form 21-2507 of Special Interest (continued)

  -----------------------------------------------------------------------

+-----------------------+----------------------------------------------+
| Entry                 | Description                                  |
+-----------------------+----------------------------------------------+
| Veteran's             | If the person being examined is              |
|                       |                                              |
| -   first name        | -   not a veteran                            |
|                       |                                              |
| -   middle name, and  | ```{=html}                                   |
|                       | <!-- -->                                     |
| -   last name.        | ```                                          |
|                       | -   draw a line through the word *veteran*,  |
|                       |     and                                      |
|                       |                                              |
|                       | -   substitute the appropriate designation,  |
|                       |     such as *spouse* for a veteran's widow,  |
|                       |     or                                       |
|                       |                                              |
|                       | ```{=html}                                   |
|                       | <!-- -->                                     |
|                       | ```                                          |
|                       | -   rated incompetent, indicate this by      |
|                       |     adding the word *incompetent* after the  |
|                       |     name.                                    |
+-----------------------+----------------------------------------------+
| Address of Veteran or | Review correspondence from the veteran or    |
| Claimant              | claimant to confirm the current address.     |
|                       | Include the current telephone number.        |
|                       |                                              |
|                       | ***Reference***: For more information on     |
|                       | corresponding with incompetent veterans, see |
|                       | [M21-1MR, Part III, Subpart v,               |
|                       | 9.B                                          |
|                       | .4](../pt03_sp05_ch09_secB.xml#III.v.9.B.4). |
+-----------------------+----------------------------------------------+
| Please Conduct        | Check                                        |
|                       |                                              |
|                       | -   block "A" if a general medical           |
|                       |     examination is requested (see [M21-1MR,  |
|                       |     Part III, Subpart iv,                    |
|                       |     3.A                                      |
|                       | .3](http://10.220.1.4/bl/21/M21-1MR/index.as |
|                       | p?id=pt03_sp04_ch03_secA.xml#III.iv.3.A.3)), |
|                       |     and                                      |
|                       |                                              |
|                       | -   block "B" in all other cases, indicating |
|                       |     the particular disabilities for          |
|                       |     examination.                             |
+-----------------------+----------------------------------------------+
| Service-Connected     | -   List the diagnostic codes for each of    |
| Disabilities          |     the service-connected disabilities shown |
|                       |     on the latest rating decision.           |
|                       |                                              |
|                       | -   Verify the correctness of the SC         |
|                       |     diagnostic code printed on *VA Form      |
|                       |     21-2507a.*                               |
|                       |                                              |
|                       | -   List the descriptive terminology for     |
|                       |     each disability as stated on the latest  |
|                       |     rating decision.                         |
|                       |                                              |
|                       | -   Indicate by check mark those SC          |
|                       |     disabilities to be examined.             |
+-----------------------+----------------------------------------------+

Continued on next page

13\. VA Form 21-2507, Request for Physical Examination, Continued

  -----------------------------------------------------------------------
  b\. Entries on VA Form 21-2507 of Special Interest (continued)

  -----------------------------------------------------------------------

+-----------------------+----------------------------------------------+
| Entry                 | Description                                  |
+-----------------------+----------------------------------------------+
| Other Disabilities    | Provide an adequate description of the       |
|                       | nature of the other disabilities to be       |
|                       | examined.                                    |
+-----------------------+----------------------------------------------+
| Specialist            | -   Check this box to request a specialist   |
| Examinations          |     examination.                             |
|                       |                                              |
|                       | -   Attach a copy of any Board of Veterans'  |
|                       |     Appeals (BVA) remand if the examination  |
|                       |     is required in connection with a remand. |
|                       |                                              |
|                       | ***Note***: Explain the nature of the        |
|                       | examination and the reason for the request   |
|                       | in the Remarks section.                      |
+-----------------------+----------------------------------------------+
| Remarks               | Restrict entries to clarifying remarks       |
|                       | concerning the issue or issues to be         |
|                       | resolved and/or the type of examination      |
|                       | requested.                                   |
|                       |                                              |
|                       | ***Note***: Do not use manual, regulation,   |
|                       | or code citations.                           |
+-----------------------+----------------------------------------------+
| Claimant Represented  | Indicate by an appropriate check or          |
| By                    | annotation, the current accredited service   |
|                       | organization of record.                      |
|                       |                                              |
|                       | ***Note***: If the person being examined is  |
|                       | represented by a person or organization that |
|                       | does *not* have an office located at the RO  |
|                       |                                              |
|                       | -   check the "Other" block in Item 19 ,and  |
|                       |                                              |
|                       | -   enter the complete name and address of   |
|                       |     the person or organization.              |
+-----------------------+----------------------------------------------+
| -   Date              | Enter the                                    |
|                       |                                              |
| -   Signature of      | -   date the form is signed                  |
|     Authorizing       |                                              |
|     Official, and     | -   name of the authorizing official (must   |
|                       |     be legible), and                         |
| -   Correspondence    |                                              |
|     Symbol            | -   correspondence symbol and telephone      |
|                       |     number of the authorizing official.      |
+-----------------------+----------------------------------------------+

Continued on next page

13\. VA Form 21-2507, Request for Physical Examination, Continued

+------------+---------------------------------------------------------+
| ####       | > Forward the examination request to the clinic or      |
| # c. Forwa | > medical center nearest the veteran's residence that   |
| rding Exam | > is able to conduct the type of examination requested. |
| ination Re |                                                         |
| quests to  |                                                         |
| the Approp |                                                         |
| riate Medi |                                                         |
| cal Center |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d.   | > Reverse file a copy of the examination request in the |
|  Handling  | > claims folder pending receipt of the examination      |
| the File C | > report.                                               |
| opy of the |                                                         |
|  Examinati |                                                         |
| on Request |                                                         |
+------------+---------------------------------------------------------+

####