Claims Corner: the importance of VA exams

Your claim could depend on your scheduled medical exam!


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Remember when you were in the military and your commanding officer or staff NCO threatened to “write you up” because you failed to get your vaccination or resolve another medical issue near deployment time? Back then, you didn’t have to be as proactive with your medical appointments because safety nets were in place (thanks to your gunny/first sergeant/senior master sergeant/chief petty officer!) to make sure you made it to sick call.

The transition from military to civilian life can make remembering to attend your scheduled medical appointments a little tricky – especially if you’re in the middle of a job search or attending college for the first time. However, it’s important you know that making your scheduled VA exams is essential to accurately processing your claim. VA assesses your exam results when determining service connection for your claimed medical condition. These medical examinations are scheduled by VA and are performed by either a VA physician or contracted physician. It’s important to note these exams aren’t always required to evaluate your medical conditions; however, in instances when they are needed, it’s important that you make every effort to show up!

VA medical examination

VA assesses your exam results when determining service connection for your claimed medical condition.

During my time as a Veterans Service Representative, I would periodically see cases where a Veteran failed to report to his or her medical appointment. While we certainly understand that life can get in the way, missing an exam can have huge ramifications to your benefits to include:

  1. Denial of your original or reopened claim, or claim for increase. When you fail to report for an exam, your claim will be rated based on the evidence available in your record. This could be detrimental to your original claim because the exam results could provide the necessary evidence needed to satisfy service connection. In reopened claims, the exam results may provide the new and material evidence needed to overturn a prior VA decision or, in the case of a claim for increase, show that your condition has worsened.
  2. Reduction or termination of your current benefits. When you fail to report for a reexamination of a running entitlement, VA, under law, is required to issue you a notice that proposes to either reduce or terminate your monthly benefit if an examination is needed to maintain a current rating.
  3. Delay in the decision of your pending claim. Examination requests are in high demand. Rescheduling can delay the processing of your claim and a final decision from VA.

In order to avoid these potential pitfalls, follow these simple tips:

  1. Keep your scheduled exam whenever possible.
  2. Can’t make it? Tell VA immediately by phone, online, or in person. We may be able to reschedule your exam date.
  3. Make sure your address and phone number is up-to-date in eBenefits. VA will attempt to notify you of an exam by letter and telephone. I’ve personally seen countless amounts of returned mail because applicants moved without notifying VA. The easiest and quickest way to update your address and telephone number is through eBenefits.

More information on this topic can be found in 38 Code of Federal Regulation 3.655.

As always, if you still have questions, a VA representative or a Veterans Service Organization may be able to help.

Have a question about VA exams? Leave a comment below!

Author

Mark Ledesma

– Mark P. Ledesma is a public affairs specialist with the Veterans Benefits Administration after having served six years as a senior Veterans Service Representative at the San Diego VA Regional Office. Mark is also a Veteran of the United States Marine Corps.

Comments

  1. Margareth    

    I am a veteran was in the military 1974-1978 I was given a `10 % disability when I was discharged from the service. I left the army and went to college., where I joined R,O,T.C I graduated from college in 1982 and joined the reserve where I was in the active reserve for 14 years , I left the reserve in 1996 . While in the reserve I was told I could not be payed twice by the government I was told I had to give up my disability and I did. after my discharge from the reserve no mention of my disability was made . Las year in 2014 I found out I could get my disability back I applied thru the VA office in Miami at the VA center . I requested an interview with a physicians and I never got an appointment last august I got a letter from the VA
    denying my claim I have made several call to the person who helped me filled my claim and have not been able to contact her I called the VA regional center I got th run around I filled to two notice of disagreement and never received an answer I have called .I am now filing another notice of disagreement and since I started the process I have had several falls and I am under medical treatment for painful and swelling to my R ankle which has severely affected my ability to work can you help me

  2. Daniel G. Klem    

    Please tell me why the VA at Jerry Pettis Loma Linda, San Bernardino county has taken almost a month to put my name on the Choice programs list for knee surgery. My pre-op was June 18th and the scheduler in the Orthopedic department sent my name along with several others on June 21st. to be forwarded and downloaded to the Choice program. I have called the department that does this at Loma Linda voice mail full never answers the phone and as per the scheduler in the Ortho dept. she has sent several messages. This schedulers name is Yen and she has been trying to the Ortho patients waiting for surgery approved so the Choice program can make appointments and get on with their surgeries. My wait time to have a knee replacement at the Loma Linda facility is May of 2016. Please help because the department that handles this at Jerry Pettis Loma Linda has a lot of people waiting and if they are anything like me they are in pain.

    Please help,
    Daniel G. Klem

  3. Steve Rodriguezsalazar    

    June 26th 2015, VA sends me a letter to confirm exam appointment at the DC VA Hospital before July 4th (JULY 6th obviously a holiday weekend). The 10 day window might seem appropriate, but when it falls on a weekend, specially a holiday weekend, it needs to be extended. I got the letter Monday July 5th.

    July 6th – (one day before the deadline to confirm my appointment)- Voicemail from case manager stating that my appointment will be cancelled if I don-t call her)

    July 6th- I called the case manager but there was not response so left a VM.

    July 7th- Spoke to case manager and she states that my July 10th VA exam has been cancelled and marked a no show. NO show? it’s not for another 3 days!!!! and that I would JUST need to call the VA regional office to request them to re request the exam.

    July 17th- Just 10 days after the case manager cancelled my appointment with out giving me a change to confirm the date I get a letter stating that my benefits are getting reduced because my condition got better??????? WHAT?? How is this legal? There needs to be a better way to get these exams scheduled other than by snail mail, and a small window ( not to mention you count weekends and holidays as actual days that count against you). How about you try contacting us BEFORE sending the scheduled date of the exam to confirm if it will be convenient. People have kids, jobs, and responsibilities. Perhaps send us at least 3 dates that we can choose from,and give us a chance to respond? And if on the 3rd attempt to contact us send us a letter to let us know you’ve been trying to contact me?

    I really dont want to give up hope that Vets that earned these benefits will get them, but the way the system is stacked with the odds against the veteran to be able to confirm these exams in a small windows of opportunity such as this, is quite disappointing.

    I have since restarted the long dark journey of what will be a long drawn out process to try and get my exam scheduled again. In the mean time Im supposed to take the reduced benefit because my condition simply “healed itself”, because you failed to contact me in time to give me an exam.

    Come on Mr. Robert A. McDonald we can do better than this.

    Respectfully submitted.

    Steve Rodriguez, USN Vet.

  4. Steve Rodriguezsalazar    

    June 26th 2015, VA sends me a letter to confirm exam appointment at the DC VA Hospital before July 4th (JULY 6th obviously a holiday weekend). The 10 day window might seem appropriate, but when it falls on a weekend, specially a holiday weekend, it needs to be extended. I got the letter Monday July 5th.

    July 6th – (one day before the deadline to confirm my appointment)- Voicemail from case manager stating that my appointment will be cancelled if I don-t call her)

    July 6th- I called the case manager but there was not response so left a VM.

    July 7th- Spoke to case manager and she states that my July 10th VA exam has been cancelled and marked a no show. That I would JUST need to call the VA regional office to request them to re request the exam.

    July 17th- Just 10 days after the case manager cancelled my appointment with out giving me a change to confirm the date I get a letter stating that my benefits are getting reduced because my condition got better??????? WHAT?? How is this legal? There needs to be a better way to get these exams scheduled other than by snail mail, and a small window ( not to mention you count weekends and holidays as actual days that count against you). How about you try contacting us BEFORE sending the scheduled date of the exam to confirm if it will be convenient. People have kids, jobs, and responsibilities. Perhaps send us at least 3 dates that we can choose from,and give us a chance to respond? And if on the 3rd attempt to contact us send us a letter to let us know you’ve been trying to contact me?

    I really dont want to give up hope that Vets that earned these benefits will get them, but the way the system is stacked with the odds against the veteran to be able to confirm these exams in a small windows of opportunity such as this, is quite disappointing.

    I have since restarted the long dark journey of what will be a long drawn out process to try and get my exam scheduled again. In the mean time Im supposed to take the reduced benefit because my condition simply “healed itself”, because you failed to contact me in time to give me an exam.

    Come on Mr. Robert A. McDonald we can do better than this.

    Respectfully submitted.

    Steve Rodriguez, USN Vet.

  5. G Stefanow    

    Mark, thank you for overseeing this and trying to help out. I personally have excellent care at the CBOC I go to. I have no problems with these wonderful folks at all. I agree 100% with the veteran who stated the VA docs who see us should be word enough for claims to be granted, especially when they are our Prime Care physicians. My biggest concern is with VBA. Many of us have appeals that are taking YEARS to complete. The Board of Veterans Appeals is swamped with too much work for too few judges. The whole process of claims, appeals, remands, etc is very disheartening to the veterans. Waiting years only adds stress, anxiety and anger. None of that is any good for us. “Hurry up and wait” is a game many of us thought we left behind upon discharge. I guess we were wrong.

    1. Mark Ledesma    

      G Stefanow, you’re welcome! I also hear your frustration. Please be assured that we’re working hard behind the scenes to remedy the problems.

  6. Daniel T Wilkins    

    on 8/3/2015 I was seen by a physician at the va hospital in Memphis, TN about my claim for cancer and heart diseases as a result of exposure to Agent Orange during the Vietnam War. I have given a lot of evidence to my regional office in Jackson, MS. This was the first person I have seen or talked with about my Prostrate Cancer and residual effects and my Ischemic Heart disease. The evidence submitted is from my Urologist and Cardiologist. The physician with whom I saw at the va does not believe these things are caused by Agent Orange. Is his opinion going to override the law and my claims dismissed as nothing? I am quite concerned about this as I have been waiting since 2010 for a decision on my va claim. V/r RM1 Daniel T Wilkins, USN(Ret). 1960-1980.

    Zz

    1. Mark Ledesma    

      Hi Daniel, I really can’t answer your question without reading the VA examiner’s Disability Benefits Questionnaire (DBQ). Did you every consider having your private provider complete our DBQ? DBQs allow Veterans the option of visiting a private health care provider instead of a VA facility to complete their disability evaluation form. If you want to read more about DBQs visit http://www.benefits.va.gov/compensation/dbq_disabilityexams.asp

      I hope this helps.

  7. ERNEST COKER    

    my qustion is are there a program to help pay for caregivers for a 87 yr. old vet so i can stay in my home ?

    1. Mark Ledesma    

      You may be eligible for Special Monthly Pension. To qualify for the benefit you must meet one of the following conditions:

      •You require the aid of another person in order to perform personal functions required in everyday living, such as bathing, feeding, dressing, attending to the wants of nature, adjusting prosthetic devices, or protecting yourself from the hazards of your daily environment

      •You are bedridden, in that your disability or disabilities requires that you remain in bed apart from any prescribed course of convalescence or treatment

      •You are a patient in a nursing home due to mental or physical incapacity

      •Your eyesight is limited to a corrected 5/200 visual acuity or less in both eyes; or concentric contraction of the visual field to 5 degrees or less

      For more information about this benefit, please visit http://www.benefits.va.gov/pension/aid_attendance_housebound.asp

    2. Mark Ledesma    

      I hope this answers your question, Mr. Coker, and thank you for your service.

      1. DannyG    

        Mr. Ledesma, THANK YOU for answering these questions! Please forgive my skepticism, but I hope your conern is for the veterans, & not just your article, or your department. If you read other posts & comments in this blog, you may have noticed that I try to help when I can, but I am nobody; just another disabled vet. I am not a fan of the VETERANS Health Administration, but one of Secretary McDonald’s supporters. We need more people like him, willing to work their tail-end off for us, sometimes in spite of how we act & talk. Instead of always complaining, We, the Veterans, need to STAND UP FOR OURSELVES !! Thank You, Sir for your help!

        1. Mark Ledesma    

          Danny, I try my best to field questions I can answer. I can assure you that I have a genuine concern for Veterans. I served in the Marines for eight years and was an NCO. The leadership principle that I valued most while I in was ‘know your Marines and look out for their welfare.’ Serving in VA is essentially an extension of that principle, but this time I get to look out for the welfare of all my fellow Veterans.

          There are issues, but we’re working hard behind the scenes to remedy them. Also, thanks for the help!

  8. eddie hansley    

    I went to my examination for a evaluation. My evaluation only took less than five minutes, none of my issues where addressed. I felt like i was just being pushed through the system like always. Every VA evaluation or appointment i go to its not about the patiient its about there time. I can not afford to keep taking time off work or continue to drive 40 miles one way to the VA to go through the same mess so i take over the counter drugs to keep from humiliating myself. Who can i contact to report these people. I have reached my patience with this so called process!

  9. Michael S. Jarrett    

    Dear Mark, first thing is thank you for your service from one veteran to another.
    I submitted a claim for increase of service-conected conditions and was scheduled for an examination. I went to the exam and the doctor asked me for my medical records assuming I had hand carried them to exam. I did not have them and wasn’t told to have them.The doctor said it isn’t unusual for the records to not be given to her for exam purposes. I did get an increase of 20% .
    I have a supplemental insurance with medicare and received a call setting up a wellness check with the insurance company doctor in my home. When the doctor arrived I was shocked to see it was the doctor who did the c&p exam earlier. I asked her if she ever received my medical records and she stated she never did receive them.
    Is this the manner in which a c&p exam is done by regulation/law ?
    What can or should I do about this issue ? (No appeal as of yet).
    Also, can you explain to me why VA physicians refuse to assist veterans with providing statements on service connected disabilities claims even while the VA physician is the primary and/or specialist caring for ALL of the veterans health care ?
    What is a veteran to do about getting the necessary statements ?

    Thank you,

    Mike Jarrett

    1. Mark Ledesma    

      Hi Mike, thank you for your service as well.

      How long ago did you have your appointment? Veterans Benefits Administration’s (VBA)old method of providing examiners with medical records was by mailing physicians claimants’ physical medical file. This method was sluggish and at times posed problems. Since then VA has implemented a multi-faceted Transformation Plan that integrated improvements in people, process and technology. Because of this shift examiners today can electronically access Veterans’ medical records.

      Regarding your question about physician statements – VBA’s Disability Benefits Questionnaires (DBQ) can provide that statement. During Compensation and Pension exams, examiners are required to complete these comprehensive questionnaires. DBQs were also designed as a result of VA’s Transformation Plan. If you’d like to read more about DBQs you can visit http://www.benefits.va.gov/compensation/dbq_disabilityexams.asp

      I hope my answers helped. Semper Fi!

  10. Michael    

    Even if you make hour appointment, it doesn’t matter, the va will go by the code of federal regulations, and what ever the c & p exam doctor says, and he only see you once, and this is not good for any veterans.

  11. Robert E Sloan    

    I read these comment fields on the VA Blog sites. And even though the comment reply section asks for name and email address I NEVER see a reply from a VA representative. Why is that so?

    But if someone from the VA is reading this can you please answer me this . . . why does the VA send me a packet of information and state,

    “How Soon Should You Send What We Need?

    We strongly encourage you to send any information or evidence as soon as you can. If we do not hear from you, we may make a decision on your claim after 30 days.”

    The enclosed letter was dated 26 June 2015.

    And the US Consulate reply’s with this,

    “Dear Bob

    Thank you for your email.

    We shall contact you regarding the a VA examination.

    A representative will contact you in early August, 2015.

    Thank you,
    American Citizens Services
    Melbourne, Australia
    (SW)
    US Consulate General Melbourne
    553 St Kilda Rd
    Melbourne, VIC, 3004
    Australia”

    Come on guys, you’re both getting paid by the same boss. Get your act together.

    1. Mark Ledesma    

      Hi Robert, it sounds like the person reviewing your claim found evidence that leads him or her to think additional evidence is needed to determine your claim through a medical exam.

      The “How Soon Should You Send What We Need” language is part of VBA’s 38 U.S.C. §5103 Notice Response – language that VA is required by law to inform claimants about.

      I hope this answers your question.

  12. Craig Ver Helst    

    Ok, lets try this again, My compensation claim went up to the VA in 2011, it got denied, I appealed in 2012, I was told at that time by the VA, and my congressman that the appeal won’t leave the Denver office until the Board of Veteran Appeals would have time to see it. It was stated that it would be 2017 – 2018 and my compensation for my back has been closed. The E-benefits website doesn’t have anything on my appeal. Maybe instead of giving raises to the staff, you should be putting money in to helping veterans and stop the delay tactics, which I have been told your lawyers often do.

    So much for helping the veteran.

    Craig Ver Helst

  13. Pat jahnke    

    Will but why can’t u cc where doctor, I have call to cc the doctor, the nurse told me what to do and buy meds at a store. This nurse refused to cc me after I hit a deer I call she told me thier was no appt, 5 min later a different nurse told me thier was , 10 days later told thier nothing wrong with ur knee, then I had goto a different va hosp er they made appt to MRI on knee, found. A problem, I notified my Dr, he did brother to look at it 3 days later, I call upper office then he put some paper work in see the doctor I need to see. I was going thru pt it was done and trying to renew to cont pt , Iowa city made the appt, I live more than 100 miles to the hospital, asking get a motel night before, I live 2 1/2 hr drive one way, so I had to get hold of my doc paper for motel rm, the nurse decide to change my appt, we can squeeze u in at 230 pm. I wanted the 9 am appt due to travel time. I got screw over for hotel, by the nurse, I’ve try to change doc, denied. If this nurse refuses to let ccc the doc , then tell me I can’t do choose program, which I’m qualified to use cc a doc once a month . I can’t ccc the doc at va clinic my next choice is is my local Dr know. Thier are some bugs in the system starting with my nurse, she refuses let me c primary doc!!!!!!!!

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