Determining the Need for Review Examinations

Overview

In This Section

This section contains the topic “ Determining the Need for Review Examinations.”

1. Determining the Need for Review Examinations

Introduction

This topic contains information about determining the need for review examinations, including

• criteria for requesting review examinations
• scheduling future review examinations in compensation cases
• timeframes for scheduling review examinations
• when not to schedule review examinations
• considering a Veteran’s age in connection with review examinations
• example of considering a Veteran’s age
• when review examination shows improvement of a stabilized disability
• reexaminations in pension cases
• documenting the cancellation of review examinations, and
• failure to report for a review examination.

Change Date

March 13, 2024

IV.ii.1.A.1.a. Criteria for Requesting Review Examinations

Request a review examination whenever

• there is a need to verify either the continued existence or the current severity of a disability
• it is likely that a disability has improved
• evidence indicates there has been a material change in a disability
• the current rating may be incorrect, or
• it is otherwise required by the regulation or diagnostic code (DC) under which the Veteran is service-connected (SC).

Note: Do not request a review examination solely to confirm evidence listed in 38 CFR 3.326(b) and (c) that is otherwise adequate for rating.

References: For more information on

• the criteria for requesting a review examination, see 38 CFR 3.327, and
• current policy guidance limiting when to request routine future examinations, see Policy Letter 21-01.

IV.ii.1.A.1.b. Scheduling Future Review Examinations in Compensation Cases

Exercise prudent judgment and refer to 38 CFR 3.327(b) in determining the need for review examination. It is the policy of the Veterans Benefits Administration to request future examinations only when absolutely necessary, and every effort should be made to limit cases where future examinations are requested. Consider whether

• the Veteran’s current condition is an acute exacerbation
• the Veteran is still recuperating following hospitalization, and/or
• improvement or recovery can be anticipated.

Important: Medical evidence from any of the sources listed in 38 CFR 3.326(b) and (c) may satisfy the need for reexamination.

References: For more information on

• scheduling review examinations
• following periods of convalescence, see M21-1, Part VIII, Subpart iv, 8.C.3.d, and
• following open-ended hospitalization ratings, see M21-1, Part VIII, Subpart iv, 8.B.4.b, and
• current policy guidance limiting when to request review examinations, see Policy Letter 21-01.

IV.ii.1.A.1.c. Timeframes for Scheduling Review Examinations

Use the table below to determine the interval at which to schedule a future review examination.

Scroll sideways to see the full table.

References: For more information on

• when not to schedule review examinations, see M21-1, Part IV, Subpart ii, 1.A.1.d
• when a review examination shows improvement in a stabilized disability, see M21-1, Part IV, Subpart ii, 1.A.1.g
• evidentiary standards for reduction due to improvement, see M21-1, Part X, Subpart ii, 4.A.1.b, and
• applying the provisions of 38 CFR 3.344, see M21-1, Part X, Subpart ii, 4.A.2.a and b.

IV.ii.1.A.1.d. When Not to Schedule Review Examinations

Do not establish a future examination control in cases when the

• disability is static
• findings and symptoms are shown to have persisted without material improvement over five years or more
• disability is permanent in character and of such nature that there is no likelihood of improvement
• Veteran is over 55 years of age (except under unusual circumstances or where required by regulation)
• evaluation is the prescribed schedular minimum within its DC
• evaluation is 10 percent or less, or
• combined evaluation would not change even if the reexamination resulted in a reduced evaluation for one or more disabilities.

Important:

• When deciding if a disability is static, only order a future examination if there is objective evidence stating clearly a disability is likely to improve.
• The principles expressed in this block apply equally to (1) initial routine future examinations and (2) reexaminations requested in the interest of substantiating sustained improvement. Therefore, where the evidentiary record includes a single examination report (or alternative form of medical evidence) portraying improvement in a disability that has persisted at its assigned level of evaluation for five years or longer, but one or more of the above criteria (that are not directly negated by the presence of evidence showing improvement) are applicable, do not proceed with scheduling an additional reexamination unless doing so is
• required by regulation, or
• warranted in light of unusual circumstances, such as in cases of Veterans over age 55.

References: For more information on

• when not to schedule reexaminations, see 38 CFR 3.327(b)
• current policy guidance limiting when to schedule routine future examinations, see Policy Letter 21-01
• prescribed, schedular minimum ratings, see M21-1, Part V, Subpart ii, 3.D, and
• considering a Veteran’s age in connection with review examinations, see M21-1, Part IV, Subpart ii, 1.A.1.e.

IV.ii.1.A.1.e. Considering a Veteran’s Age in Connection With Review Examinations

As is discussed in M21-1, Part IV, Subpart ii, 1.A.1.d, and with only rare exceptions, Veterans over the age of 55 must not be routinely recalled for reexamination.

In determining whether a Veteran meets the criteria for exemption from reexamination by reason of age, do not limit consideration to the Veteran's age at the time of the rating decision’s preparation. Instead, consider what age the Veteran will have attained by the time the future review examination is actually conducted.

Use the table below to determine the impact of the Veteran’s age on future reexamination efforts and planning.

Scroll sideways to see the full table.

Note: Whether a case is found to involve the “unusual circumstances” described above and in 38 CFR 3.327(b)(2)(iv) is an individual, fact-specific determination left to the discretion of the rating activity. If, however, a future review examination is deemed warranted in light of unusual circumstances, the claims processor must identify and document the nature of the unusual facts found in the form of a

• remark in the SPECIAL NOTATION field on the PROFILE screen in the Veterans Benefits Management System (VBMS) – Rating, or
• permanent VBMS note, if no rating decision is being simultaneously prepared.

IV.ii.1.A.1.f. Example of Considering a Veteran’s Age

Scenario: A Veteran born on March 7, 1963, claims an increase in his SC posttraumatic stress disorder, currently evaluated as 50-percent disabling. Medical evidence amassed in connection with the claim supports an increased evaluation of 70 percent, but also indicates that the Veteran recently began attending weekly counseling sessions with a therapist, and that the prognosis for progress is hopeful and the potential for improvement likely. The claim is forwarded to the rating activity for a decision in February 2017.

Result: The increased evaluation of 70 percent must be awarded and deemed static, with no future review examination scheduled.

Rationale: If pursued, a routine future examination would be scheduled for performance in February 2020, three years following the rating decision’s preparation. The Veteran, though only 53 years old at the time of the claim’s referral to the rating activity, will have surpassed age 55 by the time the examination is conducted.

IV.ii.1.A.1.g. When Review Examination Shows Improvement of a Stabilized Disability

When the results of a review examination show improvement of a stabilized disability, consider the following prior to taking any rating action to reduce the assigned evaluation:

• universal evidentiary standards for reduction, as discussed in M21-1, Part X, Subpart ii, 4.A.1.b, and
• longevity of the assigned evaluation and any consequent need for a showing of sustained improvement, as discussed in M21-1, Part X, Subpart ii, 4.A.2.b.

If an additional reexamination is deemed necessary to demonstrate sustained improvement over time and situation, or to resolve any element of doubt concerning the extent of the disability’s improvement, schedule such examination to occur 18, 24, or 30 months from the date of the current rating decision’s preparation, as discussed in M21-1, Part IV, Subpart ii, 1.A.1.c.

References: For more information on

• stabilization of disability evaluations, see 38 CFR 3.344, and
• reductions in disability evaluations under 38 CFR 3.344, see M21-1, Part X, Subpart ii, 4.A.2.

IV.ii.1.A.1.h. Reexaminations in Pension Cases

Do not routinely request reexamination in disability pension cases.

Note: If a reexamination is scheduled, fully explain the reason for reexamination in the decision narrative.

References: For more information on

• reexaminations, see 38 CFR 3.327, and
• circumstances in which a review examination may be requested in a pension case, see M21-1, Part IX, Subpart ii, 2.B.6.b.

IV.ii.1.A.1.i. Documenting the Cancellation of Review Examinations

If a future examination control described in M21-1, Part IV, Subpart ii, 1.B, is canceled, place a note in VBMS as to the reason for cancellation.

References: For more information on

• action when the control period for the future examination matures, see M21-1, Part IV, Subpart ii, 1.B.1.d, and
• rating action after a future examination is canceled, see M21-1, Part IV, Subpart ii, 2.A.

IV.ii.1.A.1.j. Failure to Report for a Review Examination

For more information on what to do when the claimant fails to report for a review examination, see M21-1, Part IV, Subpart ii, 2.B.

Important: According to VAOPGCPREC 4-1991, a Veteran’s refusal to participate in an examination without the presence of an attorney or a recording device will be considered a failure to report for examination under 38 CFR 3.655.