M21-1-6 Rating Board Procedures

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M21-1-6 Rating Board Procedures

1.01 GENERAL

a. Acceptable Medical Evidence. A statement from any physician that includes clinical manifestations and substantiation of diagnosis by findings of diagnostic techniques generally accepted by medical authorities, such as pathological studies, X-rays, and laboratory tests as appropriate, may be accepted for rating any claim without further examination, provided it is otherwise adequate for rating purposes. See chapter 11 regarding audiological examinations, and 38 CFR 3.326(d) generally.

b. Requests for Examination. Request an examination if the evidence of record is insufficient for rating all of the claimed and noted disabilities. Apply a liberal interpretation of "reasonable probability." The rating activity has sole responsibility to request examination of claimants, except in the following instances:

(1) Adjudication personnel who are not rating specialists may request examinations in connection with claims for pension at the discretion of the Adjudication Officer. See part III, paragraph 5.21.

(2) The Adjudication Officer may authorize an examination in any case in which he or she believes an examination is warranted.

c. Nonveteran Claimants and Beneficiaries. Although field examinations may be authorized as necessary, schedule examination of a nonveteran claimant only at the request of the Adjudication Officer or in the following instances:

(1) To determine if the claimant is entitled to aid and attendance or housebound benefits.

(2) To determine if the claimant was insane at the time he or she caused the death of the veteran. See pt. IV, subpar. 11.10d.

(3) To determine if a child claimant is helpless and/or incompetent.

(4) To determine the competency status of any beneficiary.

d. Disabilities Subject to Periodic Exacerbation and Improvement. Whenever possible, examinations of disabilities subject to periodic exacerbation and improvement, such as skin conditions and other disabilities listed in 38 CFR 3.344, should be scheduled when the conditions would be most disabling. If there is specific information that a disability is worse at predictable times, the examination should be scheduled based on that information. For example: The examining facility may be asked to examine the veteran at the end of the day based on information that the symptoms are worse after work. For a disability subject to periodic flare-ups, where the record contains insufficient information to schedule an examination during a peak period of disability, the veteran should be asked to provide information as to the peak periods of the disability. He or she should also be asked to contact the regional office when the condition worsens. If the veteran received treatment for the worsened condition, he or she should be asked to submit evidence of the treatment. (See Bowers v. Brown, 2 Vet. App. 675, 676 (1992) and Ardison v. Brown, 2 Vet. App. 405 (1994).) Chronic fatigue syndrome, like many other disabilities, is not necessarily stable and may improve. Schedule review examinations to determine residual disability.

e. Accompanying Claims Folders. Claims folders will not routinely accompany requests for examination to the examining facility. Exceptional circumstances, such as POW exams or BVA remands, may warrant claims folder review by the examiner.