!! Policy letter 21-01 RFE changes !! (routine future examinations)

[brokensoldier244th]

We just had a meeting over this today, and among other things veteran anxiety was brought up several times, as was how to define 'sustained improvement', usually in the context of cancers and other malignancies. That is still being addressed, but the short of this is that there is a National push for creating fewer RFE's, due mainly to statistical analysis that shows they are often unnecessary. I get one, I look at it, I document or obtain all the current medical from the last action on a condition, then send it to an RVSR that then looks it over to determine if an exam is truly warranted, etc etc. The dates for these things are set like 90% by computer based on previous regulations and estimations of medical conditions that are gotten from I have no idea where. No, really, im not kidding. I don't know what went into programming the dates for all the various conditions into the system for assigning RFE dates. 

It takes up a lot of time for me (us, VSRs) and Rvsrs to evaluate these only to have them not even be needed, meanwhile you have gotten a letter about it and are stewing and worrying about it. Well, this says that we (VA) are changing the policy effective date of this letter (7 OCT) forward. RFEs scheduled prior to are being weeded out and evaluated like normal. 

 

Quote

All VBA Regional Offices and Centers                                                  Policy Letter 21-01

Subject:  Updated Guidance on Routine Future Examination Requests

Purpose

This letter provides instruction to regional office claims processors regarding scheduling of routine future examinations (RFEs). Based on a data-driven analysis of outcomes of RFEs over a three-year period, RFEs will not be established or required absent an exception outlined in this policy letter.

Background

Generally, reexaminations will be required if it is likely that a disability has improved, or if evidence indicates there has been a material change in a disability or that the current rating may be incorrect. This principle and other requirements for RFEs is contained in 38 CFR § 3.327. An Office of Inspector General (OIG) report, released July 17, 2018, indicated that further guidance may be needed in this area to ensure consistency in policies pertaining to reexaminations, including more clear direction as to when they are necessary. This OIG report estimated that approximately 37% of RFE requests from March to August 2017 were unnecessary or should not have been requested based on the regulations.

Analysis and Conclusion

Compensation Service analyzed data on all Veterans who had an RFE conducted in fiscal years 2018, 2019, and 2020. The analysis revealed that the majority (77%) of conditions reviewed were confirmed and continued. Only about 10% of conditions were reduced, and the remaining 13% of conditions were increased. 

Furthermore, the data revealed that mental disorder conditions accounted for approximately 40% of all conditions reviewed by RFEs without a VA examination being required under the VA Schedule for Rating Disabilities (VASRD). While accounting for a large volume of RFEs, only 5% of mental disorder conditions were reduced. The majority (75%) were confirmed and continued, and the remaining 20% were increased. 

These trends indicate that RFEs are being requested in circumstances other than when they are required. Unnecessary RFEs are not a demonstration of good stewardship of resources entrusted to VA. Apart from the time and costs to the agency of conducting unnecessary RFEs, there is impact to efficiency and timeliness of claims processing as VA examinations are often an important piece of evidence in claims for original service connection, claims for increase and for new conditions. Equally as important, there are costs to Veterans, including their time to travel and attend. Some Veterans have reported anxiety and fears when receiving RFE notifications. RFEs can involve invasive medical examinations or cause Veterans to re-experience traumatic events associated with their mental health. Therefore, VA must improve consistency and focus on the intended purpose of RFEs.

Guidance

The policy guidance in this letter applies to all regional office claims and appeals processing personnel within the Veterans Service Centers and Decision Review Operations Centers.

Effective immediately, routine future examinations shall only be requested when

• Mandated by a provision found in 38 CFR Part 4 (e.g., 38 CFR §§ 4.28, 4.128, 4.129, and in evaluation criteria found in diagnostics codes like 7528 Malignant neoplasms of the genitourinary system), or
• Necessary to reduce an evaluation in accordance with 38 CFR § 3.344.

Duty to Assist

This policy letter does not alter VA’s duty to assist, including the provisions for providing medical examinations or obtaining medical opinions when necessary to decide a claim.  See 38 CFR § 3.159(c)(4) and 38 USC 5103A(d). Additionally, VA will continue to accept, without further examination, any hospital report or any examination report from any government or private institution, provided that it is otherwise adequate for rating purposes. See 38 CFR § 3.326.

Failure to Report for Examination

This letter also does not alter the provisions, found in 38 CFR § 3.655(c), concerning reexamining a claimant after failing to report for an examination. If an examination has been ordered to assess continuing entitlement when there is a running award and the claimant fails to report but indicates willingness to report for reexamination before payment has been discontinued or reduced, a reexamination shall be rescheduled.