Medical Records Review Can Eliminate In-Person Exam Requirement

WASHINGTON – The Department of Veterans Affairs has launched a new initiative that could eliminate the requirement for an in-person medical examination for some Veterans and shorten the time it takes to process Veterans’ disability compensation claims. 

The initiative is called Acceptable Clinical Evidence (ACE).  This initiative was developed by both the Veterans Health Administration (VHA) and the Veterans Benefits Administration (VBA) in a joint effort to provide a Veteran-centric approach for disability examinations.  Use of the ACE process opens the possibility of doing assessments without an in-person examination when there is sufficient information in the record.

Under ACE practices, a VA medical provider completes a Disability Benefits Questionnaire (DBQ) by reviewing existing medical evidence.  This evidence can be supplemented with information obtained during a telephone interview with the Veteran – alleviating the need for some Veterans to report for an in-person examination.

“ACE is a process improvement that will help us meet our goal to eliminate the claims backlog and provide more timely benefits to our Veterans, their families and survivors,” said Undersecretary for Benefits Allison A. Hickey. “The initiative also saves Veterans the inconvenience and costs associated with attending a medical examination.”

When a VA medical provider determines VA records already contain sufficient medical information to provide the needed documentation for disability rating purposes, the requirement for Veterans to travel to a medical facility for an examination may be eliminated.

If VA can complete a DBQ by reviewing medical records already on file, it will use the ACE process.  This would then expedite the determination of disability ratings – in turn eliminating the wait time to schedule and conduct an exam from the claims process.

During a 15-month pilot test at one VA regional claims processing office, 38 percent of claims submitted were eligible for ACE.

The ACE initiative is a part of the VBA’s agency-wide Transformation Plan – a five-year, multifaceted organizational change that is based on more than 40 personnel, process and technology initiatives designed to improve claims processing. The goal of the Transformation Plan is to eliminate the claims backlog and process all claims within 125 days with 98 percent accuracy in 2015.

To learn more about VBA Transformation Initiatives, visit: http://benefits.va.gov/transformation/.