**JUDICIAL REVIEW CONFERENCE CALL INDEX**

July 6, 1995

[Page]{.underline} [Topic]{.underline}

1 Opening Remarks

Code 41 Appeal Study

2 BVA Call-Up of Appellate Cases

3 Retroactive Awards Based on CUE

Chairman\'s Memorandum 01-95-14

Form Letter 25

4 ARMS Search Procedures

Attorney Fee Coordinators

DAD Package

5 [Reiber v. Brown]{.underline}, 93-955

[Villaruz v. Brown]{.underline}, 93-401

[VAOPGCPREC. 11-95]{.underline} (4/7/95)

[VAOPGCPREC. 10-95]{.underline} (3/31/95)

[VAOPGCPREC. 12-95]{.underline} (5/10/95)

6 Questions and Answers between the RO and CO

7 Questions and Answers between the RO and CO (Cont.)

Closing Remarks

8 Addendum I

15 Addendum II

**JUDICIAL REVIEW CONFERENCE CALL**

JULY 6, 1995

**OPENING REMARKS**

Good morning. It seems we just got the transcripts out for the last
conference call and for that I apologize. Assembling all the comments
from the attorney fee coordinators hotline took some extra time. We\'ll
try to get it out more quickly this time. Before we get into COVA
related announcements and the DAD package, we will talk about the
appeals study, BVA call up of cases; and retroactive awards for more
than five years based upon CUE.

**Code 41 Appeal Study**

The C&P Service conducted a study of recently certified code 41 cases
using the claims folders requested from each regional office in All
Station Letter 5-34. The objectives of the study were three-fold:

> 1\. To describe the current level of field compliance with Court
> precedent and procedural guidance;
>
> 2\. To assess the findings described in the first goal and,

3\. If necessary, develop an action plan to determine if there are areas
of disagreement between the C&P Service and the BVA as to developmental
or evidentiary issues.

In conducting the review, we attempted to measure three things:

> \(1\) Compliance with procedures in the initial decision under appeal;
>
> \(2\) Compliance with appeals processing procedures; and
>
> \(3\) Likely BVA action upon receipt of appeal if reviewed today
> without

delays in the appellate process.

Persons conducting the review were members of the C&P Service and two
staff attorneys from the Board of Veterans\' Appeals who worked
independently of our staff so that we could compare findings.

Although the study was not a statistically valid sample, we believe that
it is an accurate reflection of the current state of appeals processing
since many of the findings in our study are similar to findings in other
studies done by the Service, GAO and IG.

The study pointed out a number of strengths in the current process and
other areas that need improvement. Among the significant findings were
the following:

> 1\. It was the opinion of all reviewers (both BVA and C&P) that where

Hearing Officers were involved, all cases were correct when the

Hearing Officer decision was rendered.

> 2\. Some modest improvement in the potential for remand was
> demonstrated.
>
> 3\. The quality of the reasons and bases for the decisions was

significantly improved.

Among weaknesses that continue to be identified are the following:

\(1\) Inadequate Examinations;

\(2\) Inadequate development unrelated to exams;

\(3\) SOC/SSOC issues such as missing regulations, issues not covered
and no SSOC following decision; and,

\(4\) Failure to address issues such as claims not being considered,
medical evidence not considered and inextricably intertwined issues.

Currently we believe we would still have a 40% remand rate on the cases
we reviewed. We do recognize that there would be one more review prior
to shipment to the BVA. However, the Appeals Tracking System indicated
that these cases were ready for BVA review.

There was no significant disagreement between BVA and the C&P Service. A
10 point action plan is being developed. You will be receiving an All
Station Letter shortly which will outline the results of the study and
actions which we will be taking to improve our appeal process.

**BVA Call-Up of Appellate Cases**

The Board of Veterans\' Appeals (BVA) is ready to resume call-up of
appellate cases for review. They will send a letter to each regional
office during the month of July identifying cases to be certified and
transferred to the BVA by mid-September.

The BVA has provided us with a list of the expected appeal cases. You
will receive an All Station Letter shortly which will provide
information about obtaining this list from the VBA bulletin board. These
cases must be reviewed following the procedures cited in M21-1, Part IV,
Chapter 8. In addition, we are requesting an analysis of your findings
to help us assess the overall appeal processing procedures.

Are there any questions?

**Retroactive Awards Based on CUE**

One of the responsibilities of the Advisory Review Staff has been the
processing of requests for retroactive compensation for a period greater
than five years based on clear and unmistakable error. A recent change
to the manual, change 35 (dated May 17, 1995) Part VI, Chapter 9 has
removed the requirement for Central Office approval in these cases. The
authority for these grants has been transferred to the regional offices.
All cases which were in the hands of Central Office staff members have
been returned to the regional office citing this change. We remain
available to offer any assistance in cases requesting an advisory
opinion or other requests for administrative review or supervisory
review. If you have any questions regarding this change, please contact
either the Advisory Review Staff (for questions regarding policy) or the
Rating Procedures Staff (for questions regarding procedures). This
manual change has been distributed to regional offices although not
every office has received sufficient copies for each employee. Please
contact your station Publications Officer or point of contact if you do
not have this change. M21-1, Part VI, paragraph 3.09 which also refers
to retroactive grants was inadvertently left unchanged. This paragraph
is currently being amended to reflect the change stated in item 35.

Are there any questions on this?

**Chairman\'s Memorandum 01-95-14**

We are attaching BVA Chairman\'s Memorandum 01-95-14 for your
information as an addendum to the transcript. This memorandum contains
the procedures BVA will be using to request medical opinions directly
from independent medical experts (IME\'s). The sources they will be
using are the VHA, the Armed Forces Institute of Pathology (AFIP) or
other expert physician opinions, usually obtained through medical
schools. These opinions will be requested directly from the expert
source by the BVA and do not require a remand. If you should receive an
opinion that you suspect should really be directed to the BVA per this
memorandum, contact the medical advisers at the BVA in order to forward
the document to the correct place. \[Please refer to Addendum I\]

**Form Letter 25**

It was recently brought to our attention that the Board of Veterans\'
Appeals revised Form Letter 25 in October 1994. Unfortunately, regional
offices were not notified to rescind all previous editions of that form
letter. Please take immediate action to destroy all previous copies of
Form Letter 25. Effective immediately, Form Letter 25 dated October 1994
is the only approved cover letter for Statements of the Case.

**ARMS Search Procedures**

Offices have had difficulty in searching within the index document found
under the COVA heading. We will put the step by step procedures in an
addendum to this conference call. If anyone needs the information before
the transcript is released, please call the Judicial Review Staff.

**Attorney Fee Coordinators**

A few weeks ago we sent out an all-station request for copies of award
and finance documents in cases where attorneys had been paid fees. Our
request was made because the computer had stopped counting all such
cases. After analysis of the submitted documents, HINES determined that
a change in programming involving special transaction codes processed by
finance had altered our counting program. HINES will take action in the
next four to six weeks to correct the problem. Regional offices had
processed the award actions in accordance with written instructions and
no changes will be required. I want to thank all the Coordinators who
were able to respond to our request for help.

We have developed a distribution list which includes the names of all
regional office coordinators so that future requests for help can be
easily sent. The list consists of the names of the Attorney Fee
Coordinators at each station. Alternates are not included. However, we
did have a request from one station to add the alternate to the
distribution list. If any other station would like the alternates to
receive messages involving fee problems, please add their names to the
national e-mail directory and send their names to the Judicial Review
staff, of course via e-mail. \[After checking on the receipt of the
message we sent, we noted that several coordinators do not seem to check
their mail on a routine basis. Since most employees now have personal
computers rather than WANG, they no longer get a reminder that a message
has been received.\] Please check on your messages on a daily basis.

**DAD PACKAGE**

**[Rollings v. Brown]{.underline}**, No. 93-984 (U.S. Ct. Vet. App. May
26, 1994) - As it has in numerous other decisions, the Court held that
on all material issues of fact and law presented on the record, the VA
must include a written statement of its findings and conclusions, and
the reasons or bases for those findings and conclusions.

**[Reiber v. Brown]{.underline}**, No. 93-955 (U.S. Ct. Vet. App. Apr.
14, 1995) - The veteran, who has service connection for a left ankle
fracture, filed a claim for secondary service connection for a back
disorder because of a fall at work. The Board of Veterans Appeals (BVA)
found the claim not well grounded because there was no competent medical
evidence to make plausible the claim that the back disorder was the
result of the ankle giving out. The Court stated that the appellant had
offered a plausible explanation, along with sufficient evidence, as to
why his back condition should be considered service-connected. The fact
that there might be another plausible explanation does not serve to
negate the well-groundedness of the claim. Finally, the Court noted that
conclusive evidence is not needed for a claim to be well grounded.

**[Villaruz v. Brown]{.underline}**, No. 93-401 (U.S. Ct. Vet. App. May
18, 1995) - In this case the Court found that the BVA had failed to
assess the credibility of evidence and to provide adequate reasons or
bases for rejecting some of the evidence.

**[VAOPGCPREC.11-95]{.underline} (4/7/95)** - The General Counsel held
that the BVA is not required to remand an appealed disability claim
solely because of the passage of time since an otherwise adequate
examination report was prepared.

**[VAOPGCPREC. 10-95]{.underline} (3/31/95)** - In this precedent
opinion, the General Counsel noted that substantive regulations which
have been validly promulgated pursuant to statutory authority have the
force and effect of law and remain in effect even if outdated, until
such time as they are changed. Because 38 C.F.R. § 4.126 requires that
the diagnosis of a mental disorder conform to DSM-III, decisions
concerning service connection and degree of disability must be made in
accordance with the terminology of DSM-III.

**[VAOPGCPREC 12-95]{.underline} (5/10/95)** - This General Counsel
opinion was discussed on last month\'s hotline. The question which led
to General Counsel issuing this opinion dealt with VA hospital medical
records which were not put in a veteran\'s claim folder until after a
decision on a claim was made. This opinion holds that an AOJ\'s failure
to consider medical records which were in VA\'s possession at the time
of a decision which is final on or after July 21, 1992, would be clear
and unmistakable error if the failure affected the outcome of the claim.
Does any one have any questions on the Decision Assessment Package this
month?

Are there any other questions for anybody else who spoke on this
hotline?

Togus RO:

I have a question. It\'s concerning the Index or ARMS search for COVA.
Will this also include a index or a search for the DADs?

C&P Service:

You mean the instructions that we are going to be sending?

Togus RO:

Uh! yes.

C&P Service:

No. There just relating to the index. Apparently there is a problem with
searching on that index. But are you having trouble searching for the
DADs that you need?

Togus RO:

Well, I mean you have all the DADs there but how do we relate or search
for a DAD that we\'ve looked up the COVA decision we know the exact COVA
decision but we don\'t know what DAD to go to?

C&P Service:

Usually the DAD should correspond to the COVA decision, and, it should
have the same name as the name in the COVA decision. I tell you what
though, why don\'t you give me a call after the hotline and I can
explain how it should work although I am not that proficient in ARMS but
I do know what we put in there. All right?

Togus RO;

Okay, thank you.

Minneapolis RO:

I have several cases regarding clear and unmistakable error retroactive
payments. In fact, one of them has potentially a 25 year retroactivity
on a bilateral amputation case. In view of the General Counsel\'s
decision on constructive notice I would be under the assumption that
under the doctrine of estoppel because of current award of an M versus
the subsection N SMC that there would be no bar to granting a 25 year
retroactive on the doctrine of estoppel.

C&P Service:

I know of no restriction that would prevent you from doing that. The
authority is now delegated to the Adjudication Officer or his designee.
If you are recommending a solution with an effective date and a
percentage, you have to deal with your local management now. If you have
a question that pertains to the propriety of it, not to the solution,
than by all means submit it as an advisory opinion but it is not
necessary for you to submit it to us to concur in what you are proposing
only because it is more than 5 years.

Does that answer your question?

Minneapolis RO:

Yes, and the fact that we would still have some availability for
consultation of \...

C&P Service:

Please do not leave this call with the impression that we are cutting
you loose. We are available for whatever assistance we can offer you.
But it is no longer required that you seek our approval in these types
of cases. If you have a specific question that needs to be resolved, by
all means submit it under the procedures for advisory opinions as you
have always done.

Minneapolis RO:

Thank you, very much.

C&P Service:

Any other questions?

Muskogee RO:

This is a question relating to the cases we send to Judicial Review. Are
we to continue faxing the information on the attorney fee coordinator
cases?

C&P Service:

No. I sent a message out to all the fee coordinators about a week ago
and approximately 14 people have not read their mail. But in that
message I thanked everybody and said we had sufficient cases.

Muskogee RO:

Thank you.

C&P Service:

Okay one last chance for questions? If there are none, the next
conference call will be August 3, 1995 at 11:00 EDT. Talk to you then.

Addendum I

Office of the Chairman

Board of Veterans\' Appeals

Washington, D.C. 20420

Date: June 7, 1995

MEMORANDUM

NO. 01-95-14

SUBJ: REVISED PROCEDURES FOR REQUESTING OUTSIDE MEDICAL OPINIONS

1\. REFERENCES

a\. 38 U.S.C. § 7109; 38 C.F.R. §§ 20.901 - 20.903.

b\. Chairman\'s Memorandum No. 01-91-11, \"Delegation of Authority to
Sign Correspondence to Addressees Outside of the Department of Veterans
Affairs.\"

c\. Chairman\'s Memorandum No. 01-93-08, \"Responsibilities of Medical
Advisers and Designation of Chief Medical Adviser.\"

d\. Chairman\'s Memorandum No. 01-94-22, \"Revised Procedures for
Requesting Opinions From Independent Medical Experts.\"

e\. VHA Directive 10-95-040, \"Medical Review Assistance to Board of
Veterans Appeals Cases.\"

2\. BACKGROUND

a\. Under 38 U.S.C. § 7109 and 38 C.F.R. § 20.901, the Board of
Veterans\' Appeals (the Board or BVA) may obtain expert medical opinions
from independent medical experts (IMEs), the Veterans Health
Administration (VHA), or the Armed Forces Institute of Pathology (AFIP)
when, in its own judgment, such expert opinion is warranted by the
medical complexity or controversy involved in an appeal. Under 38 C.F.R.
§ 20.902, the appellant or representative may also request that the
Board obtain such an opinion. The request must be in writing and may be
granted upon a showing of good cause.

b\. Securing medical opinions may be helpful in resolving conflicting
medical evidence and in resolving questions about the credibility of
medical evidence of record. See, e.g., Colvin v. Derwinski, 1 Vet.App.
171, 175 (1991). In light of the Court of Veterans Appeals\' holding in
Austin v. Brown, 6 Vet.App. 547 (1994), Board Members may properly avail
themselves of the statutory and regulatory authority to secure opinions
from medical experts located outside the Board and/or the Department.

3\. PURPOSE OF THIS MEMORANDUM

The purpose of this memorandum is to revise procedures set forth in
Chairman\'s Memorandum No. 01-94-22. It updates instructions on how to
request outside medical opinions from IMEs and it also includes
information regarding obtaining \"medical opinions\" from VHA and/or
AFIP. See paragraph 4 for further information concerning the expansion
of templates on the S-drive for requesting additional \"medical
opinions.\"

4\. INITIAL PREPARATION AND PROCESSING OF THE OPINION REQUESTS BY THE
BOARD SECTION

a\. Initial Procedures. The Board Member to whom the appeal has been
assigned may decide to request an opinion from a medical expert, either
on the Board\'s own motion or at the request of an appellant or
representative. The Board Member will designate a staff counsel to be
responsible for taking the action necessary to initiate the request as
outlined below. Internal procedures within a Board Section, e.g.,
advance consultation between staff counsel and a Board Member before the
drafting of an opinion request, are left to the discretion of the Board
Member.

b\. Initial Procedures in AFIP Opinions. When an opinion from AFIP is
contemplated, before the opinion request is prepared, staff counsel must
coordinate with the Board\'s Medical Adviser who has been designated as
AFIP liaison. After a review of the claims folder, the Medical Adviser
will contact AFIP to see if pertinent pathology materials are located
there under an AFIP accession number. The Medical Adviser will also
contact any other medical facility which may have pertinent pathology
materials. Ordinarily, the Medical Adviser will request a temporary loan
of the materials, thereby avoiding the necessity for a remand. Only
after the Medical Adviser has determined that pathology materials can be
obtained, will the staff counsel go forward with the opinion request.

c\. Utilization of the Templates. After the decision has been made to
request an opinion, the staff counsel responsible for initiating the
request will use either the IME LTR, VHA LTR or AFIP LTR templates to
create a document requesting the medical opinion as illustrated by
Attachments 2, 3 and 4. Staff counsel may also use one of these
templates by dictating the required information and forwarding the audio
cassette to Wilkes-Barre for transcription.

d\. Prepare List of Attachments. At the end of the letters, staff
counsel must identify any attachments to the claims folder that the
medical expert should review, such as X-ray films, tissue slides, etc.
Inasmuch as this list of attachments constitutes the official list of
the records sent to the medical expert and helps assure return of all
the records, it is of the utmost importance that an accurate and
complete listing of attachments be prepared.

e\. VA Form 4287. The staff counsel must also complete VA Form 4287,
\"Outside Medical Opinion Record.\" The information may be typed or
handwritten, as long as the handwriting is legible.

f\. Review by Medical Adviser. In each case, after the staff counsel has
completed the draft letter requesting the opinion, the draft and
associated claims folder(s) must be forwarded for review by one of the
Medical Advisers before review and finalization of the draft letter by
the requesting Board Member. After the staff counsel has completed the
draft letter and other documents, he or she should give these documents
and the claims folder(s) to the Section Program Clerk or Program
Assistant for further processing.

g\. Prepare Routing Slip and Transfer Documents to Medical Advisers.
Upon receipt of the claims folder(s) and related documents from the
staff counsel, the Program Clerk or Program Assistant should make
certain that the opinion request letter has been copied into the
appropriate directory (e.g., ime rqst, vha rqst, afi rqst) on the
S-drive and should include a copy of the document summary sheet inside
the briefface so that the letter can be located. The Program
Clerk/Program Assistant should complete a routing slip (OF 41, \"Routing
and Transmittal Slip,\" or VA Form 3229, \"Routing Slip\") to transfer
these documents and claims folder(s) to \"Medical Adviser.\" The Program
Clerk/Program Assistant should place the draft opinion request letter in
a manila folder; associate the manila folder with the rest of the
appellate record; complete the VACOLS charge to \"75\"; and route the
case to the Medical Adviser (0111A1), Room 647.

5\. REVIEW OF OPINION BY MEDICAL ADVISERS

a\. Maintain Log-In Sheet Showing Receipt and Status of Cases. Upon
receipt of a case, the Secretary to the Senior Deputy Vice Chairman (or
other designated employee) should make entries in the log-in sheet,
showing the veteran\'s name and C-file number, the date that the case is
received, and the name of the requesting Board Member. As each case is
selected by a Medical Adviser, he or she will update the log-in sheet to
reflect the location of the case and the date of selection.

b\. Assignment of Cases. Each Medical Adviser should select cases for
review as his or her workload permits. Collectively, under the
supervision of the Senior Deputy Vice Chairman, the Medical Advisers
will work the cases in the order in which they are entered on the log-in
sheet. Each Medical Adviser should complete the review within three
business days after the date on which the case is logged in. Each
Medical Adviser is personally responsible for making entries on the
log-in sheet to reflect that a case is in his or her possession for
review.

c\. Review for Medical Adequacy. Upon receipt of the claims folder(s)
and related materials, the Medical Adviser responsible for the case
should review the draft letter requesting the opinion. The review should
be limited in scope to questions related to the medical adequacy or
accuracy of the requesting letter, such as: (1) whether the letter
reflects the most appropriate medical specialty, (2) whether opinions
are needed by other specialists, and (3) whether the questions have been
drafted to elicit a meaningful opinion. If the Medical Adviser
determines that the request for an opinion is medically inadequate, he
or she should prepare his or her comments in the space provided in the
briefface for use by Medical Advisers. The comments should identify the
inadequacies or inaccuracies in the opinion request and should contain,
if appropriate, guidance or instructions on how to prepare a more
accurate and effective request. If the Medical Adviser has no comments,
he or she should note in the space provided in the briefface for use by
Medical Advisers that the opinion request has been reviewed, with the
date of review and his or her signature. If the opinion request is
directed to VHA, the Medical Adviser, or his or her designee will review
a list titled \"VHA Medical Specialties\" and annotate in the
\"Opinion\" block, located under the heading \"Attorney Action\" on the
front of the briefface, the three number code corresponding to the
medical specialty involved in the opinion request.

d\. Response by Medical Advisers. Before the end of the third day after
the case has been logged in, the Medical Adviser should annotate the
log-in sheet to reflect that review has been completed and hand-carry
the case to the Office of the Senior Deputy Vice Chairman for VACOLS
charging and forwarding to the requesting Board Member for review.

e\. Status Check by the Secretary to the Senior Deputy Vice Chairman. If
the log does not reflect that the draft opinion request letter and
accompanying documents have been returned by the Medical Adviser on the
third business day after the case was logged in, the Secretary to the
Senior Deputy Vice Chairman should inform the Vice Chairman, who may
confer with the Medical Adviser or Chief Medical Adviser for assignment
or reassignment of the opinion request or referral of the request to the
Board Member without review by the Medical Adviser. The Chief Medical
Adviser or his or her designee should note that direction in the space
reserved in the briefface for use by the Medical Advisers, sign and date
the annotation, and hand-carry the case to the Secretary to the Senior
Deputy Vice Chairman for VACOLS charging and forwarding to the
requesting Board Member for review.

f\. Weekly Status Report. The Secretary to the Senior Deputy Vice
Chairman should forward a copy of the log-in sheet on a weekly basis to
the Vice Chairman. The copy should include those pages reflecting cases
received within the preceding one-week period, as well as pages
containing entries for any cases received prior to that time but
uncompleted.

6\. FINALIZATION BY THE BOARD SECTION OF THE REQUEST FOR MEDICAL
OPINIONS

a\. Board Member Signature. The Board Member will review the medical
opinion request letter and associated materials upon receipt, and may
make, or direct to be made, any revisions to the letter requesting an
opinion that he or she deems necessary, taking into account any Medical
Adviser comments contained in the briefface. When satisfied with the
opinion request, the requesting Board Member must sign the letter
requesting the opinion, as well as VA Form 4287. The IME or VHA letter
will not, at this stage, contain the name of the medical expert to whom
it will be sent. This information will be inserted later. The AFIP
opinion request will always be made by letter memorandum addressed to
the VHA Pathology Service (111F). The requesting Board Member should
associate all related documents with the claims folder(s) and give them
to the Program Clerk/Program Assistant for VACOLS charging and
forwarding to the Administrative Service.

b\. Request for Opinion and Claims Folder(s) Forwarded to the
Administrative Service. Upon receipt of the signed request for a medical
opinion, the Program Clerk/Program Assistant should prepare and attach a
routing slip containing the notation \"IME REQUEST,\" \"VHA REQUEST,\"
or \"AFIP REQUEST,\" and forward the case to the Office of the Director
of Administrative Service (014), Room 343. Uniformity of the notation
will ensure that the case is easily identifiable for special handling.
The Program Clerk or Program Assistant should complete the VACOLS charge
and route the case to the Director\'s Office.

7\. PROCESSING OF IME OPINION REQUESTS BY ADMINISTRATIVE SERVICE

a\. Identification of Medical School. Upon receipt of the signed request
for an IME opinion, with the claims folder, briefface and any
attachments, the designated employee in the Director\'s Office,
Administrative Service, should immediately ensure that he or she can
access the opinion request on the S-drive. The Director, Administrative
Service, or his or her designee should then select a medical school
whose resources are available to the Board which may house the medical
expertise required by the IME opinion request. The participating medical
schools are maintained in a 3\" x 5\" card file in the Director\'s
Office.

b\. Use of Template Creating Letter to the Dean of Medical School. An
employee in the Director\'s Office will use the IME DEAN template to
enter data that creates a letter to the dean of a medical school. The
IME DEAN letter requests that the dean provide the Board with the name
of an individual who has expertise in the relevant medical area. The
Director of Administrative Service will sign this letter on behalf of
the Board. The Director\'s Office employee will also use this template
to create the documents that will accompany the letter to the dean, such
as the letter from the medical school designating the IME and the
notification from the IME that the opinion has been completed.

c\. Package of Documents Mailed to Medical School. The letter to the
dean, accompanied by a self-addressed return envelope, a form for the
school to complete that will supply the requested information, and a
draft copy of the letter specifying the issues that the expert will be
expected to address, will be mailed to the designated medical school.

d\. Identification of the Expert. When the dean responds by providing
the name and address of a physician with expertise in the desired area,
the Director\'s Office employee will complete the draft IME opinion
request letter by typing the name and address of the designated
specialist on the first page of the letter that was signed by the Board
Member. The Director\'s Office employee will date and mail the letter
via overnight delivery (e.g., Federal Express), along with the claims
folder and any attachments, to the specialist for review. The
Director\'s Office employees will initiate follow-up inquiries, as
necessary, to ensure that the case is reviewed and the opinion rendered
promptly.

e\. Notification to the Appellant and Representative. The Director\'s
Office employee will simultaneously inform the appellant and the
appellant\'s representative, if any, by letter that an advisory medical
opinion has been requested at the time the IME opinion request letter
and claims folder are mailed to the specialist for review. 38 C.F.R. §
20.903.

8\. PROCESSING OF VHA AND AFIP OPINION REQUESTS BY ADMINISTRATIVE
SERVICE

a\. Identification of VA Medical Center or AFIP. Upon receipt of the
signed request for a VHA or AFIP opinion, with the claims folder,
briefface and any attachments, an employee in the Director\'s Office
will immediately ensure that he or she can access the opinion request on
the S-drive. The Director, Administrative Service, or his or her
designee, will select one of the participating VA medical centers based
on the areas of expertise listed in the \"VHA Opinion Facilities\"
located in the Director\'s Office. The Director\'s Office employee will
complete the draft VHA opinion request letter by typing the name of the
Chief of Staff and street address of the VA Medical Center on the first
page of the letter that was signed by the Board Member. VHA will provide
the Board with a listing of VA medical centers, Chiefs of Staffs\' names
and the medical centers\' areas of expertise. (See VHA Directive
10-95-040, dated April 17, 1995, Attachment 5) The AFIP opinion request
should already be addressed to the \"VHA Pathology Service (111F), ATTN:
Felicia Nelson, 801 I Street NW, Room 531 TechWorld, Washington, DC
20420\" before transfer to the Director\'s Office. The VHA Pathology
Service coordinates the transfer of AFIP opinion requests.

b\. Package of Documents Mailed to VA Medical Center. The Director\'s
Office employee will date and mail the VHA opinion request letter via
overnight mail (e.g., Federal Express), along with the claims folder and
any attachments, to the medical center for review.

c\. Package of Documents Transferred to AFIP. In AFIP opinion cases, the
memorandum requesting the opinion, accompanied by the claims folder with
the pathology materials securely attached inside, will be transferred
through internal mail to the VHA Pathology Service.

d\. Notification to the Appellant and Representative. The Director\'s
Office employee will simultaneously inform the appellant and the
appellant\'s representative, if any, by letter that an advisory medical
opinion has been requested. 38 C.F.R. § 20.903.

9\. ACTION UPON Return of THE Opinion and VA Records

a\. Approval of Opinion. The completed VA Form 4287, \"Outside Medical
Opinion Record,\" will be associated and remain with the briefface. When
the opinion, claims folder, and attachments are returned to the
Administrative Service, the opinion will be reviewed by the Senior
Deputy Vice Chairman to insure that it adequately responds to the
questions posed. If it does not, the Senior Deputy Vice Chairman will
ask the expert to supplement the opinion to correct the particular
deficiency noted. If the opinion adequately responds to the questions
posed, the Senior Deputy Vice Chairman should indicate his or her
determination to that effect on OF 41, \"Routing and Transmittal Slip,\"
or VA Form 3229, \"Routing Slip.\" In IME cases, the Director,
Administrative Service, will have the bill for the expert\'s services
processed so that payment can be made.

b\. Association of Opinion with the Claims Folder. The Director\'s
Office will insert the original opinion, once it is approved, into the
applicable VA records folder. It will also attach a copy of the opinion
to the briefface.

c\. Opportunity for Comment and/or Submission of Additional Evidence by
the Representative or Appellant. The Director\'s Office will furnish a
copy of the opinion to the representative, or to the appellant if he or
she is unrepresented, using the United States Postal Service. Use of the
United States Postal Service may be waived, in writing, by organizations
co-located with the Board, in which case interoffice mail may be used. A
period of 60 days from the date of mailing of a copy of the opinion will
be allowed for response. The claims folder, briefface, and related
documents will be held in the Director\'s Office for 60 days pending
receipt of the response. When a response has been received, or when the
60-day period has expired without a response, the claims folder,
briefface, and any associated materials will be consolidated and the
case will be forwarded to the requesting Board Member for further
processing of the appeal.

10\. RESCISSIONS

a\. Chairman\'s Memorandum No. 01-92-05 dated February 25, 1992,
entitled \"CMD Opinion Requests,\" is hereby rescinded in its entirety.

b\. Chairman\'s Memorandum No. 01-94-22, dated October 20, 1994,
entitled \"Revised Procedures for Requesting Opinions From Independent
Medical Experts,\" is hereby rescinded in its entirety.

c\. This memorandum is effective until expressly rescinded, modified, or
superseded.

Chairman

Attachments (5)

Distribution: COE (FOR BVA USE ONLY)

Director, Compensation and Pension Service (21)

Director, Records Management Service (045A4)

Wilkes-Barre, PA, 50

**Addendum II**

Steps for searching only within the COVA Index document

1\. Select the Access menu then the Set Domain option.

2\. Click on COVA in the Domain Choices for Level box. COVA should now
be highlighted.

3\. Click on the Next button. This will take you to the second hierarchy
level of the COVA database.

4\. Click on Index in the Domain Choices for Level box. Index should now
be highlighted.

5\. Click on the Select button. Index should be displayed in the Current
Domain box.

6\. Select OK.

These steps will limit searches to only the COVA Index document. To
return the search capability to all documents in the COVA database:

1\. Select the Access menu then the Set Domain option.

2\. Click on the Clear button.

3\. Select OK.