g. Definition: 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 (SC) hypertension has worsened, an examination using the hypertension DBQ 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, but 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 specialist. h. Definition: Specialist Examination A specialist examination is any examination that is conducted by a clinician who specializes in a particular field. Notes: All vision, hearing, dental, and psychiatric examinations must be conducted by a specialist. In unusual cases, or as requested by a BVA remand, it may be necessary to request a specialist examination for other types of disabilities. Reference: For more information on specialist examinations, see M21-1, Part III, Subpart iv, 3.A.6. i. Veteran’s Legal Rights at an Examination A Veteran has no legal right to be accompanied by counsel during an examination, or record an examination. j. Contract Examination Exclusions Examinations must not be requested from contract examiners under certain circumstances. Use discretion based on RO expertise and consultation with VHA and/or contract exam providers when determining whether a contract examination is warranted. Circumstances under which contract examinations must not be requested include, but are not limited to, the following: Former Prisoner of War (FPOW) Protocol Exam is required claim for disability based on exposure to environmental hazards such as Gulf War exposure, Camp Lejeune water contamination, and chemical and biological warfare agents (includes new claims, review exams, and claims for increase in disability) claim for undiagnosed illness Veteran requires overnight stay, (for example, a sleep study)
ERB will generate language in the exam request based on the completion of these fields. References: For more information on ERB fields, see the requirement to identify relevant evidence for an examiner’s review, see Part III, Subpart iv, 3.A.15.d, and annotating or bookmarking evidence in the electronic claims folder (eFolder), see M21-1, Part III, Subpart iv, 3.A.15.e and f. e. Maintaining Objectivity in Medical Opinion Requests When requesting medical opinions, RO employees should identify all relevant evidence for the examiner’s review, both favorable and unfavorable. However, maintain objectivity when preparing medical opinion requests. Use a neutral and unbiased tone. Do not slant the facts. Do not communicate that VA prefers one answer or outcome over another. Reference: For more information on requesting a medical opinion in an impartial manner, see , 23 Vet.App. 19, 24, 25-26 (2009). f. Medical Opinions Required For Remands When requesting an opinion in compliance with BVA remand instructions explain specifically what is needed. Quoting the instructions from BVA on the medical opinion request may be helpful, but try to avoid legal jargon. Important: Do not simply refer the examiner to the claims folder containing the remand instructions. g. Instructions for Providing Medical Opinions – Claims Under 38 U.S.C. 1151 When requesting a medical opinion for a claim involving benefits under , use the to generate the appropriate language. Ensure the generated request asks the provider only the specific opinion(s) required by the facts of the case. Medical opinions for conditions claimed under may be completed at the same facility where the alleged incident happened, as long as there is no conflict of interest. In general, the VHA facility will determine whether a conflict of interest exists once the request is received from the RO. If applicable, the VHA facility will work with the RO to transfer the medical opinion request to another facility. Notes: