## Section B. Field Examination Requests and Reports 

#### Overview

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

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

  3            Fiduciary Activity Review of Field Examination 2-B-2
               Requests                                       

  4            Field Examination Request and Report Forms     2-B-6

  5            Processing Foreign Field Examination Requests  2-B-11
  ------------ ---------------------------------------------- ------------

#### 3. Fiduciary Activity Review of Field Examination Requests

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information regarding field       |
| troduction | > examination requests. It includes information on      |
|            |                                                         |
|            | -   content requirements for requests                   |
|            |                                                         |
|            | -   conducting a review of requests for adequacy, and   |
|            |                                                         |
|            | -   prioritizing requests.                              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > July 13, 2005                                         |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > The table below contains the content requirements for |
| ### a. Con | > various types of field examination requests.          |
| tent Requi |                                                         |
| rements fo |                                                         |
| r Requests |                                                         |
+------------+---------------------------------------------------------+

+----------------------+-----------------------------------------------+
| Type of Field        | Requirements                                  |
| Examination Request  |                                               |
+----------------------+-----------------------------------------------+
| *All* field          | All requests must include                     |
| examination          |                                               |
| requests, to include | -   a clear statement of the purpose(s) for   |
| requests for         |     the investigation and summary of known    |
| successor            |     facts, if other than an original IA or    |
| appointment          |     scheduled FB, and                         |
|                      |                                               |
|                      | -   complete case identification              |
+----------------------+-----------------------------------------------+

Continued on next page

3\. Fiduciary Activity Review of Field Examination Requests, Continued

  -----------------------------------------------------------------------
  a\. Content Requirements for Requests (continued)

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

+----------------------+-----------------------------------------------+
| Type of Field        | Requirements                                  |
| Examination Request  |                                               |
+----------------------+-----------------------------------------------+
| Original Initial     | In addition to the basic requirements for all |
| Appointment (OIA)    | requests, these requests must also include    |
| requests             | the following attachments:                    |
|                      |                                               |
|                      | -   *VA Form 21-592, Request for Appointment  |
|                      |     of a Fiduciary, Custodian, or Guardian*,  |
|                      |     or                                        |
|                      |                                               |
|                      | ```{=html}                                    |
|                      | <!-- -->                                      |
|                      | ```                                           |
|                      | -   *VA Form 21-3537a, Request for Field      |
|                      |     Examination*, for temporary fiduciaries   |
|                      |                                               |
|                      | ```{=html}                                    |
|                      | <!-- -->                                      |
|                      | ```                                           |
|                      | -   legal documents, if available, and        |
|                      |                                               |
|                      | -   relevant Benefits Delivery Network        |
|                      |     (BDN)/SHARE screens, if available.        |
|                      |                                               |
|                      |     ***Note***: At local option, a copy of    |
|                      |     the final rating decision may be attached |
|                      |     to *VA Form 21-592*. All available leads  |
|                      |     and pertinent information, including      |
|                      |     requests from Legal Instruments Examiners |
|                      |     (LIEs) for specific information, should   |
|                      |     be included in the request or attached to |
|                      |     it.                                       |
+----------------------+-----------------------------------------------+

Continued on next page

3\. Fiduciary Activity Review of Field Examination Requests, Continued

  -----------------------------------------------------------------------
  a\. Content Requirements for Requests (continued)

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

+----------------+-----------------------------------------------------+
| Type of Field  | Requirements                                        |
| Examination    |                                                     |
| Request        |                                                     |
+----------------+-----------------------------------------------------+
| Fiducia        | In addition to the basic requirements for *all*     |
| ry-Beneficiary | requests, these requests must include the           |
| (F-B) requests | following:                                          |
|                |                                                     |
|                | -   a copy of the previous field examination        |
|                |     report, and                                     |
|                |                                                     |
|                | -   relevant BDN/SHARE information.                 |
|                |                                                     |
|                |     ***Notes***:                                    |
|                |                                                     |
|                | -   All available leads and pertinent information,  |
|                |     including requests from LIEs for specific       |
|                |     information should be included in the request   |
|                |     or attached to it.                              |
|                |                                                     |
|                | -   Copies of other file material, including other  |
|                |     field examinations and accountings, should be   |
|                |     attached if such material would be useful in    |
|                |     conducting the current field examination.       |
+----------------+-----------------------------------------------------+
| Misuse         | In addition to the basic requirements for all       |
| Investigation  | requests, these requests must also include the      |
|                | following:                                          |
|                |                                                     |
|                | -   a copy of the complaint document bearing the    |
|                |     identity and contact information for the        |
|                |     complainant, and                                |
|                |                                                     |
|                | -   any other file material, including prior field  |
|                |     examinations and accountings, if such material  |
|                |     would be useful in conducting the misuse        |
|                |     investigation.                                  |
|                |                                                     |
|                | ***Note:*** An anonymous allegation must be         |
|                | documented on *VA Form 119* and include all details |
|                | relating to the alleged misuse.                     |
+----------------+-----------------------------------------------------+
| Onsite Review  | In addition to the basic requirements for all       |
|                | requests, these requests must also include a        |
|                | complete listing of all VA cases managed by the     |
|                | fiduciary.                                          |
+----------------+-----------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Fiduciary program requests must be reviewed by the FE |
|  b. Review | > for adequacy and need. Requests believed to be        |
| ing Fiduci | > inadequate or unnecessary should be brought to the    |
| ary Progra | > attention of the supervisor, who                      |
| m Requests |                                                         |
|            | -   makes a determination regarding adequacy and        |
|            |     necessity, and                                      |
|            |                                                         |
|            | -   takes appropriate action.                           |
+------------+---------------------------------------------------------+

Continued on next page

3\. Fiduciary Activity Review of Field Examination Requests, Continued

+------------+---------------------------------------------------------+
| b\.        | > ***Note***: IA requests are considered inadequate if  |
| Reviewing  | > they contain                                          |
| Fiduciary  |                                                         |
| Program    | -   no evidence of a rating or legal disability or      |
| Requests   |                                                         |
| (          | -   insufficient information to contact the             |
| continued) |     beneficiary.                                        |
|            |                                                         |
|            | > Information may be obtained by telephone or folder    |
|            | > review and returned to the originator, as             |
|            | > appropriate.                                          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c.   | > Non-fiduciary program requests must be reviewed by    |
| Reviewing  | > the fiduciary manager or designee for need and        |
| Non-fiduci | > completeness. Requests containing insufficient        |
| ary Progra | > information, or requests for information that can be  |
| m Requests | > obtained without a field examination, should be       |
|            | > returned to the originator specifically indicating    |
|            | > the reason for return.                                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d. P | > All IA field examinations, misuse investigations, and |
| rioritizin | > non-program requests must be completed on a priority  |
| g Requests | > basis.                                                |
+------------+---------------------------------------------------------+

#### 4. Field Examination Request and Report Forms 

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on the various        |
| troduction | > Department of Veterans Affairs (VA) forms used to     |
|            | > file field examination requests and reports.          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > July 13, 2005                                         |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > The field examination report should be prepared when  |
| # a. When  | > the issue has been resolved or the evidence           |
| to Prepare | > developed, as much as is practical, in the            |
|  the Field | > geographical area serviced by the FE.                 |
|  Examinati |                                                         |
| on Report  | > If the field examination does not permit a final      |
|            | > determination of the issue, the report along with any |
|            | > evidence obtained must                                |
|            |                                                         |
|            | -   show that conclusive evidence is not obtainable in  |
|            |     the area, or at that time, and                      |
|            |                                                         |
|            | -   direct the transfer or reassignment of the request  |
|            |     if the evidence is available elsewhere, or at a     |
|            |     later date.                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Nonfiduciary program field examination requests       |
|  b. Nonfid | > should be made on *VA Form 21-3537a, Field            |
| uciary Pro | > Examination Request*.                                 |
| gram Forms |                                                         |
|            | > Nonfiduciary program field examination reports should |
|            | > be completed on *VA Form 21-3537b, Report of Field    |
|            | > Examination.*                                         |
+------------+---------------------------------------------------------+

Continued on next page

4\. Field Examination Request and Report Forms, Continued

+------------+---------------------------------------------------------+
| ##         | > Several different forms may be used for fiduciary     |
| ### c. Fid | > program requests and reports. These forms are listed  |
| uciary Pro | > in the table below.                                   |
| gram Forms |                                                         |
+------------+---------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Note***: Locally developed formats for field examination         |
| > reports, with the necessary information, may also be used.          |
+-----------------------------------------------------------------------+

+----------------+-----------------+----------------------------------+
| If the field   | Then use ...    | And attach the following to the  |
| examination    |                 | report, as appropriate:          |
| request is for |                 |                                  |
| ...            |                 |                                  |
+----------------+-----------------+----------------------------------+
| an Initial or  | *VA Form        | -   attach either *VA Form       |
| a              | 21-3190, Minor  |     21-555a, Designation of      |
|                | Beneficiary     |     Payee*, or *VA Form 21-555,  |
| F-B            | Field           |     Certificate of Legal         |
| examination    | Examination     |     Capacity to Receive and      |
| for a Minor    | Request and     |     Disburse Benefits*, for IA   |
|                | Report*         |     field examinations involving |
|                |                 |     the appointment of a         |
|                | ***Note***:     |     fiduciary, and               |
|                | This form may   |                                  |
|                | be used for     | -   attach and label any         |
|                | *both* the      |     material obtained in the     |
|                | request and the |     process of appointing or     |
|                | report. Extra   |     supervising a fiduciary,     |
|                | pages should be |     including                    |
|                | attached as     |                                  |
|                | necessary.      | ```{=html}                       |
|                |                 | <!-- -->                         |
|                |                 | ```                              |
|                |                 | -   certified copies of orders   |
|                |                 |     of appointment               |
|                |                 |                                  |
|                |                 | -   certified copy of surety     |
|                |                 |     bond                         |
|                |                 |                                  |
|                |                 | -   inventories of assets (if    |
|                |                 |     required by law)             |
|                |                 |                                  |
|                |                 | -   court pleadings and/or       |
|                |                 |     orders, or                   |
|                |                 |                                  |
|                |                 | -   a completed *VA Form         |
|                |                 |     21-4703, Fiduciary           |
|                |                 |     Agreement*.                  |
+----------------+-----------------+----------------------------------+

Continued on next page

4\. Field Examination Request and Report Forms, Continued

  -----------------------------------------------------------------------
  c\. Fiduciary Program Forms (continued)

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

+----------------+------------------+---------------------------------+
| If the Field   | Then use ...     | And attach the following to the |
| Examination    |                  | report, as appropriate:         |
| Request is for |                  |                                 |
| ...            |                  |                                 |
+----------------+------------------+---------------------------------+
| an Initial or  | *VA Form         | -   attach either *VA Form*     |
| a              | 21-4716a, Adult  |     *21-555a,* or *VA Form*     |
|                | Beneficiary      |     *21-555* for IA field       |
| F-B            | Field            |     examinations involving the  |
| Examination    | Examination      |     appointment of a fiduciary, |
| for an Adult   | Request and      |     and                         |
|                | Report*          |                                 |
|                |                  | -   attach and label any        |
|                | ***Note***: This |     material obtained in the    |
|                | form may be used |     process of appointing or    |
|                | for *both* the   |     supervising a fiduciary,    |
|                | request and the  |     including                   |
|                | report.          |                                 |
|                |                  | ```{=html}                      |
|                |                  | <!-- -->                        |
|                |                  | ```                             |
|                |                  | -   certified copies of orders  |
|                |                  |     of appointment              |
|                |                  |                                 |
|                |                  | -   certified copy of surety    |
|                |                  |     bond                        |
|                |                  |                                 |
|                |                  | -   inventories of assets (if   |
|                |                  |     required by law)            |
|                |                  |                                 |
|                |                  | -   court pleadings and/or      |
|                |                  |     orders, or                  |
|                |                  |                                 |
|                |                  | -   a completed *VA Form        |
|                |                  |     21-4703.*                   |
+----------------+------------------+---------------------------------+

Continued on next page

4\. Field Examination Request and Report Forms, Continued

  -----------------------------------------------------------------------
  c\. Fiduciary Program Forms (continued)

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

+----------------+------------------+---------------------------------+
| If the Field   | Then use ...     | And attach the following to the |
| Examination    |                  | report, as appropriate:         |
| Request is for |                  |                                 |
| ...            |                  |                                 |
+----------------+------------------+---------------------------------+
| a special      | -   *VA Form     | -   attach and label any        |
| problem case   |     21-3537a*    |     material to be submitted    |
| in which *VA   |     for the      |     with *VA Form 21-3537b*,    |
| Form 21-3190*  |     request, and |     including                   |
| or *VA Form    |                  |                                 |
| 21-4716a* is   | -   if the       | ```{=html}                      |
| not            |     report is    | <!-- -->                        |
| appropriate    |     solely for   | ```                             |
| (or adequate)  |     the use of   | -   sworn statements            |
| for making the |     the office   |                                 |
| request        |     where the    | -   physical evidence           |
|                |     Field        |                                 |
|                |     Examiner     | -   *VA Form 119, Report of     |
|                |     works, use   |     Contact*, or                |
|                |     *VA Form     |                                 |
|                |     21-3537a*    | -   other memorandums of        |
|                |     for the      |     interview, and              |
|                |     report as    |                                 |
|                |     well.        | ```{=html}                      |
|                |                  | <!-- -->                        |
|                |                  | ```                             |
|                |    > ***Note***: | -   attach VA Form 21-3190 or   |
|                |     > The report |     VA Form 21-4716a, as        |
|                |     > is         |     appropriate, to VA Form     |
|                |     > normally   |     21-3537a only if            |
|                |     > submitted  |                                 |
|                |     > on *VA     | ```{=html}                      |
|                |     > Form*      | <!-- -->                        |
|                |                  | ```                             |
|                |                  | -   the request is made on *VA  |
|                |    > *21-3537b.* |     Form 21-3537a*, and         |
|                |                  |                                 |
|                |                  | -   an IA or F-B exam is needed |
|                |                  |     in addition to the          |
|                |                  |     information requested.      |
+----------------+------------------+---------------------------------+
| a misuse       | -   VA Form      | -   attach and label any        |
| investigation, |     21-3537a for |     material to be submitted    |
| or an onsite   |     the request, |     with *VA Form 21-3537b*,    |
| review         |     and          |     including                   |
|                |                  |                                 |
|                | -   VA Form      | ```{=html}                      |
|                |     *21-3537b*   | <!-- -->                        |
|                |     for the      | ```                             |
|                |     report.      | -   sworn statements            |
|                |                  |                                 |
|                |                  | -   physical evidence           |
|                |                  |                                 |
|                |                  | -   *VA Form 119, Report of     |
|                |                  |     Contact*, or                |
|                |                  |                                 |
|                |                  | ```{=html}                      |
|                |                  | <!-- -->                        |
|                |                  | ```                             |
|                |                  | -   other memorandums of        |
|                |                  |     interview.                  |
+----------------+------------------+---------------------------------+

Continued on next page

4\. Field Examination Request and Report Forms, Continued

+------------+---------------------------------------------------------+
| #####      | > All field examination reports should be prepared as   |
| d. Prepari | > quickly as possible, using one of the methods listed  |
| ng Reports | > below.                                                |
|            |                                                         |
|            | -   Reports may be typed on a typewriter, personal      |
|            |     computer, or other word processor and submitted in  |
|            |     hardcopy on a computer diskette or transmitted      |
|            |     electronically.                                     |
|            |                                                         |
|            | -   Reports may be typed directly into the regional     |
|            |     office (RO) data system via a personal computer     |
|            |     terminal.                                           |
|            |                                                         |
|            | -   Reports may be dictated.                            |
|            |                                                         |
|            | -   A brief report for the exclusive use of the         |
|            |     Veterans Service Center (VSC) may be prepared in    |
|            |     longhand, provided the report is legible and in     |
|            |     ink. Under unusual circumstances, when all other    |
|            |     means are unavailable or impractical, longer        |
|            |     reports for the exclusive use of VSC personnel may  |
|            |     be handwritten if they are legible.                 |
+------------+---------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Note:*** Field examination reports may be subject to third party |
| > review. They must be professionally written and must not contain    |
| > derogatory statements reflecting the Field Examiner's personal      |
| > opinions and/or biases.                                             |
+-----------------------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e    | > Reports should be submitted as quickly as possible.   |
| . Submitti | > Reports may be                                        |
| ng Reports |                                                         |
|            | -   transmitted to the RO                               |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   electronically via modem or direct line, or         |
|            |                                                         |
|            | -   by fax                                              |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   sent by mail, or                                    |
|            |                                                         |
|            | -   delivered in person.                                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Each FE working on a case should have the field       |
| f. Copies  | > examination report prepared in original and one copy. |
| of Reports |                                                         |
|            | > Additional copies of the report and attachments       |
|            | > should be prepared when necessary.                    |
+------------+---------------------------------------------------------+

#### 5. Processing Foreign Field Examination Requests

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on processing foreign |
| troduction | > field examination requests.                           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > February 2, 2005                                      |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a. F | > Requests for field examinations for beneficiaries in  |
| orwarding  | > foreign countries are transmitted by the fiduciary    |
| Requests T | > activity to the appropriate foreign service post      |
| hrough ROs | > through one of the following regional offices (ROs):  |
|            |                                                         |
|            | -   Houston                                             |
|            |                                                         |
|            | -   White River Junction, or                            |
|            |                                                         |
|            | -   Pittsburgh                                          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > A written request, in duplicate, stating the exact    |
| ## b. Rout | > nature of the examination and outlining the           |
| ing Field  | > information to be obtained by post personnel should   |
| Examinatio | > be forwarded to the appropriate office as outlined in |
| n Requests | > the table below.                                      |
+------------+---------------------------------------------------------+

+--------------------------------+-------------------------------------+
| Requests concerning            | Are forwarded through ...           |
| beneficiaries residing in ...  |                                     |
+--------------------------------+-------------------------------------+
| -   Mexico                     | Department of Veterans Affairs (VA) |
|                                | Regional Office                     |
| -   South and Central America, |                                     |
|     and                        | (362/21F)                           |
|                                |                                     |
| -   the Caribbean              | 6900 Almeda Road                    |
|                                |                                     |
|                                | Houston, TX 77030-4200              |
+--------------------------------+-------------------------------------+
| Canada                         | VA Regional Office                  |
|                                |                                     |
|                                | (405/21)                            |
|                                |                                     |
|                                | 215 North Main Street               |
|                                |                                     |
|                                | White River Junction, VT 5009-0001  |
+--------------------------------+-------------------------------------+
| all other foreign countries    | VA Regional Office                  |
|                                |                                     |
|                                | 1000 Liberty Ave.                   |
|                                |                                     |
|                                | Pittsburgh, PA 15222                |
+--------------------------------+-------------------------------------+

Continued on next page

5\. Processing Foreign Field Examination Requests, Continued

+------------+---------------------------------------------------------+
| ###        | The table below describes the process for transmitting  |
| ## c. Tran | foreign field examination requests.                     |
| smittal In |                                                         |
| structions |                                                         |
+------------+---------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Note***: This process applies to the Houston, White River        |
| > Junction, and Pittsburgh ROs.                                       |
+-----------------------------------------------------------------------+

+-------+--------------------------------------------------------------+
| Stage | Description                                                  |
+-------+--------------------------------------------------------------+
| 1     | A cover letter authorizing reimbursement is enclosed with    |
|       | all requests for field examinations and forwarded to foreign |
|       | service posts for action. The authorization letter should    |
|       | include the following statement:                             |
|       |                                                              |
|       | *"Actual and necessary expenses incurred in connection with  |
|       | this field examination may be paid at the post. Vouchers     |
|       | prepared by the Department should reference appropriation    |
|       | (applicable appropriation symbol), as chargeable."*          |
|       |                                                              |
|       | For information purposes, a copy of the transmittal letter   |
|       | should be forwarded to the originating RO.                   |
+-------+--------------------------------------------------------------+
| 2     | The Houston and Pittsburgh ROs forward field examination     |
|       | requests to the appropriate foreign service post.            |
|       |                                                              |
|       | The White River Junction RO forwards field examination       |
|       | requests to Veterans Affairs Canada at the following         |
|       | address:                                                     |
|       |                                                              |
|       | Foreign Countries Operations                                 |
|       |                                                              |
|       | Department of Veterans Affairs                               |
|       |                                                              |
|       | 66 Slater Street                                             |
|       |                                                              |
|       | Ottawa, Ontario                                              |
|       |                                                              |
|       | CANADA K1A OP4                                               |
+-------+--------------------------------------------------------------+
| 3     | Controls are established to ensure timely completion of the  |
|       | examinations. A 90-to-120-day diary is suggested, and        |
|       | follow-up requests are initiated, as appropriate.            |
+-------+--------------------------------------------------------------+

Continued on next page

5\. Processing Foreign Field Examination Requests, Continued

+------------+---------------------------------------------------------+
| ##### d.   | > In certain instances, RO employees may conduct field  |
|  Examinati | > examinations for beneficiaries residing in Mexico or  |
| ons Conduc | > Canada. These instances are infrequent and should be  |
| ted by VA  | > limited to those cases where it is clearly            |
| Employees  | > demonstrated that completion by the local office      |
| in Canada  | > would be the most efficient approach.                 |
| and Mexico |                                                         |
+------------+---------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Note***: All VA employees traveling to Canada or Mexico on       |
| > official business must obtain an official passport.                 |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***References***: For more information on                           |
|                                                                       |
| -   obtaining a passport, see MP-1, Part II, 2.5, and                 |
|                                                                       |
| -   foreign travel, see VBA Circular 20-01-3.                         |
+-----------------------------------------------------------------------+