Overview
This video explains VA regulations regarding scheduling routine future examinations for veterans aged 55 or older, highlighting when the VA is not supposed to require these exams and outlining steps veterans can take if such an exam is incorrectly scheduled.
Routine Future Examinations and Age 55
- VA regulations generally prohibit scheduling routine future examinations (RFEs) for veterans over 55, except in unusual circumstances or when specifically required by regulation.
- The M21-1 manual and 38 CFR 3.327 confirm that future exams should not be scheduled for those 55+ unless the medical condition (like non-terminal cancer) warrants it.
- If the condition is terminal, no routine future exam should be scheduled, regardless of the type.
- RFEs are most commonly seen in cases involving mental conditions or migraines.
Identifying Routine Future Exams in VA Decisions
- Veterans should check the narrative section at the bottom of their rating decisions for sentences indicating a likelihood of improvement, which signals an RFE has been scheduled.
- Veterans should request and review their claims folder and rating code sheet to confirm whether an RFE has been scheduled by looking for a future exam date.
Preventing and Correcting Improper Routine Future Exams
- If an RFE is scheduled after age 55 or set to occur once the veteran is over 55 (except as required by regulation), this can be challenged.
- Veterans can request a Higher Level Review (HLR) using VA Form 0996 or file for a Clear and Unmistakable Error (CUE).
- To check if the HLR has been received, call 800-827-1000, confirm receipt in the VA’s system, and verify establishment of the EP 030 code.
- If a RFE is in error and the veteran is 100%, Chapter 35 benefits and property tax exemptions may have been wrongfully withheld.
Best Practices for Private Medical Evidence
- When submitting a private Disability Benefits Questionnaire (DBQ), ensure the examiner notes the condition is “considered permanent” in the remarks section.
- Permanency should also be included in any accompanying nexus statement.
- Documentation of permanency helps prevent the VA from scheduling unnecessary RFEs.
Key Takeaways for Veterans
- Understand what RFEs are and the criteria for when they should or should not be scheduled after age 55.
- Check your VA documents for any inappropriate scheduling of RFEs and take timely action if errors are found.
- Ensure private examiners document permanency to further safeguard against improper future exams.
Action Items
- TBD – Veterans: Review rating decisions and request code sheets to identify scheduled RFEs after age 55.
- TBD – Veterans: Contact the VA to challenge improper RFEs through HLR or CUE.
- TBD – Veterans: Instruct private examiners to document permanency of the condition on DBQs and nexus statements.