What is a ACE (acceptable clinical evidence exam)

[Mary Mcrorie]

What is a ACE (acceptable clinical evidence exam) and how do I prepare for it.  It will be by phone interview

Edited June 3, 2022 by Tbird
Changed Topic Title to a more specific questions to get more eyes on it.

[Tbird]

 

This is from the VA M21-1, Part IV, Subpart ! Chapter 2 Section A

4.  ACE Examinations

---

Introduction

This topic contains information on ACE examinations, including examinations based on ACE categories of examinations for which the ACE Process is prohibited, and examination requests and ACE.

---

Change Date

May 31, 2022

---

IV.i.2.A.4.a. Examinations Based on ACE

In lieu of scheduling an in-person examination, VHA and contract examiners generally (subject to some limitations) have the option to complete a DBQ based on review of existing paper and/or electronic medical evidence.  They may also conduct an interview with the claimant.  Examinations based upon medical records and history without an in-person clinical examination or testing are known as ACE examinations or the ACE Process.

---

IV.i.2.A.4.b. Categories of Examinations for Which the ACE Process Is Prohibited

The ACE Process is not available in the following categories of examinations: examinations when necessary electronic medical records are not available for examiner review Separation Health Assessments (SHAs) in support of IDES and BDD claims general medical examinations initial and review traumatic brain injury (TBI) examinations, and mental disorder examinations. Exceptions:  The ACE Process may be used to resolve requests for clarification of, or addendum to, an SHA where the service member’s previous General Medical – Separation Health Assessment Disability Benefits Questionnaire was completed in person, or complete individual specialty and/or specialist DBQs for pre-discharge contentions, provided the service member’s General Medical – Separation Health Assessment Disability Benefits Questionnaire was completed in person, and other exclusion principles discussed in this block are not applicable. VBA may also specifically require an in-person examination, but in the interest of expediting the claims process, RO employees should not routinely exclude the use of the ACE Process absent a compelling reason, particularly for homeless Veterans, and/or the following conditions: hearing loss tinnitus cardiac conditions amyotrophic lateral sclerosis (ALS), and any terminal condition. Reference:  For more information on the requirement to identify evidence for the examiner’s review, see M21-1, Part IV, Subpart i, 2.A.8.d.

---

IV.i.2.A.4.c. Examination Requests and ACE

When entering an examination request in CAPRI, ensure that the examination request specifies that the ACE Process is permitted, or clearly states that the ACE Process may not be used, and an in-person examination is required to complete the DBQ.  Note:  VBA has updated the DBQ templates in CAPRI to include the ACE check boxes that contain the rationale for the use of ACE, requiring the clinician to identify the materials relied on when using ACE to prepare the DBQ.   Reference:  For more information on requirements for ACE examinations, see M21-1, Part IV, Subpart i, 3.A.1.m.

[GBArmy]

Hi Mary, welcome to Hadit.

As explained by Tbird, the VA will sometimes use the ACE process when it appears that the C&P exam could be completed by a review of your medical records and evidence already provide and available. They MAY call you, and they may not, so you must be available to receive the call in case they want more detail. For example, when did such and such (symptoms) start, or do you have (additional ? symptoms). The only prep work you should do is know what disability it is you are having the ACE for, and then look up the dbq for the disability. This is just to familiarize yourself with questions that will be asked relative to your symptoms. 

[Mr cue]

Like what did that have to do with what the veteran ask.

T bird this is crazy this veteran ask a ?

Why does ever veteran post have to be a joke to ppl now.

This needs to be check this is a new member. I believe 

14 minutes ago, broncovet said:

An Ace is better than a King, and even better if Aces are wild.  

To prepare:  Try online Poker, and play against the computer.  (for funsies

The ace exam is done by phone and like stated they may or may not call.

 

[Richard1954]

Just some added information concerning ACE

Acceptable Clinical Evaluation C&P Exams.pdf Authority for Acceptibale Clinic Evaluation.docx

[VietNamVet1969]

On 6/3/2022 at 12:57 PM, GBArmy said:

Hi Mary, welcome to Hadit.

As explained by Tbird, the VA will sometimes use the ACE process when it appears that the C&P exam could be completed by a review of your medical records and evidence already provide and available. They MAY call you, and they may not, so you must be available to receive the call in case they want more detail. For example, when did such and such (symptoms) start, or do you have (additional ? symptoms). The only prep work you should do is know what disability it is you are having the ACE for, and then look up the dbq for the disability. This is just to familiarize yourself with questions that will be asked relative to your symptoms. 

GBArmy,

 

Could you kindly explain the acronym in your statement:  The only prep work you should do is know what disability it is you are having the ACE for, and then look up the dbq for the disability. 

 

I have just been called by an outside provider, about my choosing an in-person, or an ACE (Acceptable Clinical Evidence) evaluation, and am being given from 4:30PM on Friday till Monday to get prepared. Seems like a very short window of time. My condition is from a radical protastectomy (sp?) and am rated at 100% currently. 

 

My fear/guess is that they may be using this to reduce benefits. I do have a letter from a nurse within the VA that clearly makes reference, that even though I am and have been for 21 months now showing a 0.10 PSA reading, my condition is not considered cleared up with no chance of cancer returning after surgery and radiation therapy. Also I have conditions which are not going away. 

 

So your dbq acronym is something I should know about I believe.

 

Thanks for your help here

[Dustoff1970]

I recently underwent two separate LHI Optum Serve ACE C&P exams concerning my heart disease increase to 60% from 30% that was approved last year by the BVA on appeal.

I was notified by each NP examiners that this was a records review exam only and my personal attendance was not needed.  Notification was by written letter in the regular USPS mail and the exams were two weeks apart.  The VA VARO raters ordered these exams maybe as an effort to reduce back my 60% to 30% IHD/CAD. 

But no joy for them as I very recently received in regular mail VA Regional Office decision letter continuing my 60% rating level for Nam Agent Orange Ischemic Heart Disease also known as IHD/CAD.  Evidently both examiners agreed that my extensive solid medical evidence record/history for the increase was justified.

DBQ means Disability Benefits Questionnaire and used by C&P examiners and other medical personnel to evaluate in a computer format a veteran's disability picture/snapshot.

Sometimes proper justice is served to deserving vets. Smile.

My comment is not legal advice as I am not a lawyer, paralegal or VSO

Edited November 4, 2023 by Dustoff1970