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Updated Sep 21, 2023

In This Section

  
 This section contains the following topics:

1.  Handling Failure to Report for a Scheduled Examination

Introduction

  
This topic contains information on handling a Veteran’s failure to report for a scheduled examination, including

Change Date

  
August 7, 2023

IV.i.2.F.1.a.   Effect of Non-Cooperation on the Duty to Provide an Examination or Opinion

  
While the Department of Veterans Affairs (VA) is obligated under 38 CFR 3.159(c)(4) to provide medical examinations or obtain medical opinions to assist in substantiating claims, the claimant must cooperate by reporting for such examination.
 
38 CFR 3.655 provides that when entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination and the claimant fails to report without good cause, action will be taken as provided in 38 CFR 3.655(b) and (c).  See the table below for a summary of the actions to take.
 
If the failure to report for examination without good cause is in connection with a(n) …
Then …
  • original compensation claim, or
  • new claim (for a new benefit or new disability)
decide the claim based on the evidence of record.
  • increased evaluation claim
  • supplemental claim for a previously denied benefit, or
  • original claim for a benefit other than compensation
deny the claim.
examination ordered to assess continuing entitlement when there is a running award
 
  • discontinue payment for the benefit, or
  • reduce payment for the disability for which examination was scheduled to a
Notes:
  • Discontinuance or reduction is only finalized after due process, as provided in M21-1, Part IV, Subpart ii, 2.B.
  • Reduction or discontinuance will not be finalized when the claimant submits evidence during the proposed reduction period justifying continuation of the benefit or indicates a willingness to report for examination.
 
Important:
  • For the purpose of the table above, the phrase without good cause means that good cause for a claimant’s failure to report (defined in M21-1, Part IV, Subpart i, 2.F.1.b) was not provided before a decision was issued in the claim for which the examination was necessary.
  • Documentation supporting the good cause offered is generally not required.
  • Although M21-1, Part IV, Subpart i, 2.F.1.f provides that good cause must be accepted at any time before a decision is issued, in cases of repeated (two or more) failures to attend a VA examination, proceed with a decision on the claim.  Clear rationale for rejecting an offer of good cause must be included in the rating narrative.
Note:  If the Veterans Health Administration (VHA) attempted to schedule the exam under their RSVP program, follow the procedures in M21-1, Part IV, Subpart i, 2.F.2.
 
References:  For more information on

IV.i.2.F.1.b.  Definition:  Good Cause

  
Good cause means a reason that justifies failure to report for VA examination.
 
VA will generally accept any reason offered by the individual as good cause for failure to report for an exam.  Examples of good cause include, but are not limited to, illness or hospitalization of the claimant or death of an immediate family member.
 
Exception:  Good cause is not established if the claimant
  • fails to provide any reason for failing to report
  • indicates failure to report was based on general concerns about being exposed to and/or contracting an illness while undergoing examination, or
  • indicates notice of the scheduled examination was not received.
References:  For more information on

IV.i.2.F.1.c.  Review of Returned Mail Notifying the Veteran of a Scheduled Examination

  
Regional offices (ROs) have the duty to ensure that examination notices are sent to the proper address in all situations, including during the traditional claims process as well as when associated with the scheduling of routine future examinations.  If a VA medical facility advises that mail notifying a Veteran of a scheduled VA examination has been returned because the Postal Service reported the letter was undeliverable at the address provided, review the claims folder to determine whether
  • the mail was erroneously addressed
  • a more recent address is of record, or
  • a valid address is available from non-VA sources, such as the Internet or telephone directory assistance.
Notes:
  • VA is authorized to use the Internet address locator service CLEAR (https://clear.thomsonreuters.com/clear_home/index.jsp) to obtain current address information for claimants.
  • If the Veteran receives VA benefits via direct deposit/electronic funds transfer, send a letter to the Veteran’s financial institution asking for a current mailing address.
Reference:  For more information on using the CLEAR service, see the CLEAR Quick-Start Training Guide and Reference Manual.

IV.i.2.F.1.d. Action Taken After Attempting to Locate a Better Address

  
When notification is received from a VA medical facility that an examination could not be scheduled due to notice that was undeliverable at the address provided, use the table below to determine the action to take after attempting to locate a better address.
 
If a better address is …
Then …
identified
  • provide the new address to the VA medical facility
  • request that the VA medical facility
    • reschedule the examination, and
    • notify the Veteran at the new address of the pending examination, and
  • update the corporate record.
not identified
proceed with failure to report analysis under 38 CFR 3.655.
 

IV.i.2.F.1.e.  Allegations of Non-Receipt of Scheduling Notice

  
A Veteran’s allegation that notice of a scheduled VA examination was not received is not considered good cause for failure to report.
 
An assertion that a notice was not received does not rebut the presumption of administrative regularity that VA discharged its duty to schedule an examination and notify the Veteran of the scheduled examination.
 
A copy of an examination scheduling notice from the examining facility does not need to appear in the claims folder for the presumption of regularity to apply.
 
If evidence is available that rebuts the presumption of regularity, such as the failure of VA to timely update the claimant’s address or an assertion that the exam notice was received after the date of the examination, then that evidence must be considered.
 
References:  For more information on

IV.i.2.F.1.f.  Initial Scheduling Problems and Rescheduling Examinations

  
Consider the following guidance on how duty to assist concepts and principles apply when there is
  • a delay or other problems with the medical provider initially scheduling an examination, or
  • the claimant fails to report to a scheduled examination and thereafter
    • offers good cause, or
    • expresses a willingness to attend a previously missed exam.
Notes:
  • Known impediments to scheduling an examination will generally be resolved by the provider and claimant in advance of the scheduled examination date.  This may result in delay of the examination to another date, but is not considered a failure to report and does not implicate claimant non-cooperation with the duty to assist.
  • When notification is received from a VA medical facility that an examination could not be scheduled because a scheduling notice mailed to the claimant’s address of record was returned as undeliverable, take action as specified in M21-1, Part IV, Subpart i, 2.F.1.c and d.  When the claimant’s correct address is subsequently located, request that the medical facility reschedule the examination.
  • If an examinee fails to report for a scheduled examination but offers good cause on or after the examination and before a decision is issued, request that the examination provider reschedule the examination before issuing a decision.  However, see M21-1, Part IV, Subpart i, 2.F.1.a for cases of repeated failure to report.
  • Expressing willingness to report without some reason offered for failing to report to an examination is not the same as good cause.  However, in two situations a claimant expressing a willingness to report for a missed examination is sufficient for another exam to be authorized.
    • When the claimant expresses willingness to report for a previously missed VA examination after a decision is made – even in the context of an allegation of non-receipt of a scheduling notice or other absence of good cause – that statement is sufficient new and relevant evidence for supplemental claim purposes and an examination is authorized.
    • 38 CFR 3.655(c)(3) provides that in cases of failure to report in connection with examination on continuing entitlement, if notice of willingness to report is received before payment has been discontinued or reduced, action to adjust payment should be deferred and the reexamination must be rescheduled.  However, if there is another failure to report final action to reduce or discontinue payments will be taken.
Important:  Apply this block in conjunction with all other blocks in this topic.

2.  Protocol for Scheduling Examinations Using the VHA RSVP Scheduling Program

Introduction

  
This topic contains information on the VHA RSVP program, including

Change Date

  
February 27, 2017

IV.i.2.F.2.a.  VHA RSVP Scheduling Program

  
Based on historical data, when Veterans do not have the opportunity to participate in the scheduling process, they are more likely to fail to report to scheduled examinations.  This results in the non-use of examination appointments that could have been appropriated to other Veterans.
 
Consequently, VHA established an RSVP program to help ensure Veterans attend their scheduled examinations.  Through this program, VHA attempts to reach Veterans by telephone and via mail in order to schedule examinations.
 
Important:  VHA examining facilities are not required to participate in the RSVP scheduling program.

IV.i.2.F.2.b.  VHA RSVP Examination Cancellations

  
When VHA receives VA Form 21-2507, Request for Physical Examination, from an RO that includes the Veteran’s telephone number and address, they will make several attempts to contact the Veteran and schedule the examination.
 
If a claimant fails to respond to the attempts to schedule the examination in the RSVP program, VHA will cancel the examination request.  The cancellation notification will reflect that the cancellation was due to the claimant’s failure to respond to the RSVP scheduling process.
 
The documented information indicating the Veteran failed to RSVP to schedule an examination at a mutually convenient time is considered the same as a failure to report for an examination for the purpose of claims processing.
 
VHA is responsible for ensuring that all procedures and timelines required in the RSVP process were followed.
 
Reference:  For more information on the VHA RSVP scheduling procedure, see the Office of Disability and Medical Assessment Fact Sheet 23-002.

IV.i.2.F.2.c.  Effect of a Veteran’s Failure to RSVP

  
When VHA provides notification that the Veteran failed to RSVP, the
RO must