How the VA will process your medical claim during the Covid-19 Period

Greetings,

The Veterans Benefits Administration (VBA) is providing information about utilizing alternatives to in-person Compensation and Pension (C&P) examinations during the COVID-19 pandemic to support social distancing and the safety and health of Veterans and clinicians. VBA will continue to complete as many examinations as possible using virtual means that do not involve a face-to-face examination. This message is intended to advise you about the change and provide guidance and resources.

What are C&P Examinations?

• C&P examinations are forensic examinations used to gather evidence used by VBA claims processors in making decisions on Veterans’ claims for disability compensation and pension benefits. C&P exams are scheduled when the evidence already in the Veteran’s record does not contain all the information needed to make a decision on the claim.
• Disability Benefits Questionnaires, or DBQs, are standardized forms used by clinicians when performing C&P exams. The purpose of a DBQ is to ensure the clinician performing the exam captures and records all the information needed by VBA claims processors to make a decision.
• For many years, both Veterans Health Administration (VHA) clinicians and VBA contract vendors have conducted C&P examinations using DBQs. In FY19, VBA completed about 65 percent of the more than 1.6 million examination requests generated by regional office claims processors.

What are the options for conducting C&P Examinations?

• The C&P exam process most familiar to most people is the in-person appointment where the Veteran physically reports to the medical provider’s office. For some disabilities, in-person examinations are required and cannot be completed through an alternate method.
• C&P examinations can also be completed using a process called Acceptable Clinical Evidence (ACE) examinations. ACE examinations can occur after a medical provider reviews the evidence of record and determines that the evidence is sufficient to complete a DBQ without an in-person examination. Sometimes, the examiner may need to call the Veteran and ask for clarification or ask the Veteran to answer some questions. Frequently, the ACE examination can be completed without telephone interaction with the Veteran.
• A third way of completing C&P examinations is through video or tele-C&P examinations. Tele-C&P examinations are suitable for the completion of some DBQ types, most commonly for mental health conditions. Tele-C&P examinations enable the Veteran to remain in his or her home and teleconference with the medical provider so the provider can see and speak to the Veteran.

Why has VA decided to suspend the in-person examination option?

During the COVID-19 pandemic, the VA recognizes the value of social distancing and the need to reduce the amount of face-to-face contact. On April 2, 2020, the VHA temporarily discontinued performing C&P exams in order to prioritize resources for essential and critically needed health care services in this emergency. This directive also eliminates in-person examinations except in urgent care situations and reduces the number of people entering VHA facilities in order to protect employees and patients. VHA will conduct some C&P examinations through tele-exams and ACE where possible. Out of an abundance of caution for Veterans and medical providers, VBA is similarly suspending in-person C&P examinations until further notice and will continue to conduct C&P exams through ACE and Tele-C&P, when possible.

What can I do to assist with my claim?

Make sure your current private medical records are part of your VA claims file. The Department of Veterans Affairs encourages all Veterans to submit their private medical records for consideration during the processing of their benefits claim. VA values evidence from your private treatment providers because they are familiar with your medical history, often over a long period of time. VA appreciates the trusted and special relationship between private treatment providers and their Veteran/patients.

Key methods that private medical records can be submitted are as follows:

• Veteran/Private treatment provider can send medical records directly to the Department of Veterans Affairs, Claims Intake Center, P.O. Box 4444, Janesville, WI., 53547-4444 or submit to VA regional office.
• VA will request your private medical records for you if you submit signed a VA Form 21-4142 and VA Form 21-4142a. You must complete and submit both of these documents.
• Private treatment records can be uploaded as part of an on-line submission of a claim at https://www.va.gov/disability/how-to-file-claim/.

Resources

• We encourage all Veterans to work with an accredited representative for assistance in completing claims for VA benefits. The accredited representative can help guide the Veteran in submitting applicable medical records for consideration on his or her claim.
• A list of accredited organizations can be found on the Office of General Counsel site at this link: Search the VA Office of the General Counsel’s list.

Questions on Claims?

You can start and continue to file claims with no delay.

How to start or continue a claim

• File a claim online at https://www.va.gov/disability/how-to-file-claim/ or https://www.ebenefits.va.gov/
• Fax a claim to VA’s Centralized Mail hub at (844) 531-7818
• Submit completed applications by paper mail

For individuals who need more assistance, VBA offers robust resources through the National Call Center (NCC) at 1-800-827-1000.

Intent to file a claim

• Faxing or mailing a completed VA Form 21-0966
• Calling the NCC at 1-800-827-1000 or Veterans Service Center,
• Starting a claim online, or
• Asking a Veterans Service Organization (VSO) to complete one on a claimant’s behalf.

Note: Intent to file a claim will preserve a potential effective date and allow the Veteran up to one year to submit a completed claim form. Veterans can also work with a local VSO to submit claims electronically or by mail.

A grateful nation thanks you for your service.

Sincerely,

-Veterans Benefits Administration

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