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Updated Sep 23, 2024

In This Section
This section contains the following topics:

1.    MSC Actions Upon the Conclusion of the Initial Meeting

Introduction
This topic describes the actions MSCs must take following the initial meeting with an IDES participant, including

Change Date
May 23, 2024

X.i.6.F.1.a.  Summary of MSC Actions Upon the Conclusion of the Initial Meeting
The table below describes the actions Military Services Coordinators (MSCs) must take upon the conclusion of the initial meeting with an Integrated Disability Evaluation System (IDES) participant.
Step
Action
1
Perform all required system updates as specified in M21-1, Part X, Subpart i, 6.F.1.b.
2
 Request examinations and records as specified in M21-1, Part X, Subpart i, 6.F.1.c.
3
Provide required documentation to the Physical Evaluation Board Liaison Officer (PEBLO) as specified in M21-1, Part X, Subpart i, 6.F.1.d.
4
Ensure all evidence is handled in accordance with M21-1, Part X, Subpart i, 6.F.1.e.

X.i.6.F.1.b.  Updating Systems
The Veterans Tracking Application (VTA) and Veterans Benefits Management System (VBMS) updates listed in the table below must be completed after the initial meeting.
Step
Action
1
Update the following fields on the MSC tab in VTA as indicated in the table below.
Field Name
User Input
NUMBER OF CLAIMED CONDITIONS
Enter the number of disabilities the participant claimed.
Notes:
  • Include disabilities referred to Department of Veterans Affairs (VA) by the service department.
  • If the participant declined to file a VA claim or failed to return a completed application, enter 0.
MSC/SERVICEMEMBER INTERVIEW DATE
Enter the date of the interview with the participant.
MSC/SERVICEMEMBER INTERVIEW TYPE
Select the manner in which the interview was completed.
VA FORM 21-526EZ OUTCOME
Select the status of the participant’s application submission upon conclusion of the initial meeting.
VA FORM 21-526EZ RECEIVED
VA FORM 21-526EZ RECEIVED DATE
Enter the date the VA Form 21-526EZ was received.
Important:  If an MSC fails to assign an IDES case to themself, VTA will not save any of the other data they enter for the case.
2
Under the end product (EP) 689, enter contentions into VBMS in accordance with M21-1, Part III, Subpart i, 2.F.2.a-e, to include all
Note:  The DATE OF CONTENTION field in VBMS is the date of claim (DOC) of the EP 689 for both referred issues and issues raised as part of the initial meeting.
Exceptions:
  • If the participant is currently service-connected (SC) at a rate of 30 percent or higher, do not list claimed dependents as contentions under EP 689.  After completing the remaining system updates, process a separate EP 130 as explained in Step 5 of this table.
  • Conditions listed on a VA Form 21-526EZ that was not returned within five days of the initial meeting must be entered in VBMS with a date of contention which reflects the date the VA Form 21-526EZ was received.
3
Enter any applicable special issues in VBMS in accordance with M21-1, Part III, Subpart i, 2.F.2.f and g.
Reference:  For more information on available special issue indicators, see M21-4, Appendix E, 2.
 4
Ensure that the MILITARY SERVICE tab in VBMS accurately reflects the participant’s
  • current branch of service, and
  • date of entry into active duty, if the participant is currently on active duty.
Note:  If the participant is currently on active duty, do not check the SERVICE VERIFIED box.  Service should not be marked as verified until after
  • the participant has been discharged, and
  • VA has received verification of the participant’s separation date and character of discharge.
Important:  It is critical that date of entry of the current period of service is entered in all cases involving active duty service members before entering VA exams.  Incomplete service information can prevent the automated return of IDES disability benefits questionnaires (DBQs) to Department of Defense (DoD).
 5
Only if the participant is currently SC at a rate of 30 percent or higher and submitted a completed VA Form 21-686c, Application Request to Add and/or Remove Dependents, to claim dependents
  • establish an EP 130, using
    • the date the VA Form 21-686c was received as the DOC, and
    • a standard (non-IDES) dependency claim label, and
  • list the claimed dependents as contentions under the EP 130.  The MSC takes no action on the EP130.  National Work Queue (NWQ) will route it for processing.  However, if for any reason it is still pending at the time of the IDES final rating, the Disability Rating Activity Site (DRAS) may take action on it as long as all evidence needed to determine the dependency issue is of record.
Note:  All dependency related documents must also be uploaded into the Veteran’s electronic claims folder (eFolder) or shipped to the scanning vendor as indicated in M21-1, Part X, Subpart i, 6.F.1.g.
References:  For more information on
  • using VTA, see the VTA User Guide, and
  • using VBMS, see the VBMS Core User Guide.

X.i.6.F.1.c.  Requesting Examinations and Records

 After the initial meeting is concluded, MSCs must initiate development including
  • inputting examinations requests in accordance with M21-1, Part X, Subpart i, 6.F.2, and
  • requesting records and any other identified evidence in accordance with the duty to assist.
References:  For more information on

X.i.6.F.1.d.  Providing Claim and Examination Information to the PEBLO

 After ordering needed examinations as specified in M21-1, Part X, Subpart i, 6.F.2, provide the participant’s PEBLO with
  • a copy of the completed VA Form 21-526EZ (or notice that the participant declined to submit a VA claim, if applicable), and
  • a list of examinations requested.

X.i.6.F.1.e.  Handling Evidence Submitted by Participants
Use the table below to determine how to handle evidence submitted by a participant after completion of the initial meeting.
If the evidence is in …
Then the MSC must …
electronic format
upload the evidence to the eFolder in accordance with M21-1, Part X, Subpart i, 6.F.1.h.
paper format
forward the documents to the appropriate scanning vendor in accordance with M21-1, Part X, Subpart i, 6.F.1.g.
Exceptions:
  • As provided by M21-1, Part X, Subpart i, 6.F.1.f, MSCs may scan documents locally and upload the files directly to the eFolder instead of sending the documents to the scanning vendor.
  • The MSC must locally scan and upload evidence that may impact the ability of the DRAS to award benefits in a timely manner if possible.
Important:  If the evidence is related to a pending appeal, the MSC must take action to notify the regional office of jurisdiction or Board of Veterans’ Appeals in accordance with M21-1, Part X, Subpart i, 6.G.1.f.
Reference:  For more information on Veterans Claims Intake Program (VCIP) shipping, see M21-1, Part II, Subpart i, 1.B.

X.i.6.F.1.f.  Scanning IDES Evidence Locally

 MSCs are permitted to locally scan evidence or forms submitted by the claimant during or after the initial meeting (such as VA Form 21-686c, dependency documents, private medical evidence, etc.) as an alternative to sending documents to the scanning vendor. Exception:  Local scanning is only permitted if the local scanner has a resolution of at least 300 dots per inch (DPI). After scanning the documents, the MSC must Note:  When documents are scanned and uploaded locally, the actions must be completed within the timeframes outlined in M21-1, Part X, Subpart i, 6.F.1.j.

X.i.6.F.1.g.  Shipping Paper Evidence to the Scanning Vendor

 When paper evidence is shipped to the scanning vendor, MSCs must
  • create a document control sheet (DCS) and record management number (RMN) in VBMS, and
  • forward the documents and DCS to the appropriate scanning vendor according to current VCIP shipping procedures.
Important: References:  For more information on

X.i.6.F.1.h.  Uploading Electronic Documents to the eFolder

 MSCs must upload into participant’s eFolder any electronic  evidence that was
  • submitted to the MSC electronically by an IDES participant
  • provided by a PEBLO via means discussed in M21-1, Part X, Subpart i, 6.E.3.f, or
  • created by scanning paper evidence locally.
When uploading documents to VBMS, the MSC must
  • ensure the documents are associated with the pending EP 689 in VBMS
  • index the files by selecting an appropriate document type
  • update DATE OF RECEIPT field to reflect the date the document first came into VA possession, and
  • after ensuring the upload is successful, delete any locally stored electronic versions of the evidence.
Exception:  The steps above are not applicable for evidence that was transferred directly into the eFolder via automated processes. References:  For more information on

X.i.6.F.1.i.  Returning Paper Evidence
Once documents have been successfully uploaded into the eFolder, as described in M21-1, Part X, Subpart i, 6.F.1.h, the MSC must follow the steps in the table below to return the original paper documents to the participant.
Step
Action
1
 Compose a Return of Documents letter.
2
List the documents that were uploaded into the eFolder and the date they were received.
3
Enclose the original documents and provide the letter to the participant.
4
Upload a copy of the letter into the participant’s eFolder.

X.i.6.F.1.j.  Processing Paper Documents in a Timely Manner
MSCs must ensure that all paper documents either scanned locally or shipped to the scanning vendor as provided in M21-1, Part X, Subpart i, 6.F.1.f and g within the timeframes shown in the table below.
If the documents were provided …
Then shipping or local scanning/upload must be completed within five calendar days of the …
during the initial meeting
initial meeting.
after the initial meeting
date the documents were received.

2.  Examinations for IDES Participants

Introduction

 This topic contains information about requesting examinations for IDES participants, including

Change Date

 May 23, 2024

X.i.6.F.2.a.  Responsible Provider for IDES Examinations

 IDES claims processors will only utilize appropriate examination facilities whose providers are responsible for conducting IDES examinations, including military treatment facilities (MTFs). Important:  When informed by an appropriate examination facility that an examination request involves an examination site employee or employee’s family member, cancel the request and submit another request using a different, appropriate, examination facility with a note providing justification. Reference:  For more information on appropriate examination facilities, see M21-1, Part IV, Subpart i, 2.A.1.b

X.i.6.F.2.b.  Disabilities That Require Examination for IDES Purposes

 VA examinations are generally required for
  • all referred disabilities on the VA Form 21-0819, and
  • all claimed disabilities on a VA Form 21-526EZ that was returned during an initial IDES meeting.
Exceptions:
  • Do not provide an examination for
  • Provide examinations only under the conditions specified in M21-1, Part X, Subpart i, 6.G.1 for
    • previously denied conditions, and
    • issues on appeal or review.
References:  For more information on

X.i.6.F.2.c.  Use of Prior Examination Reports in Lieu of an IDES Examination

 If VA previously examined a Veteran in connection with a claim filed prior to entering IDES, the results of the examination(s) are acceptable for IDES purposes, as long as they are less than one year old. Exception:  VA may use examination reports that are more than one year old if the participant agrees that the severity of the disabilities at issue has not changed since the prior examination. Important:  The MSC remains responsible for ensuring that
  • a General Medical – Separation Health Assessment Disability Benefits Questionnaire is completed, and
  • all claimed and referred disabilities are examined.
Note:  Examinations that were completed prior to IDES will not be transferred to DoD via automated processes.  When previously completed exams are used for IDES purposes, they must be provided to the PEBLO via alternative means discussed in M21-1, Part X, Subpart i, 6.F.3.e.

X.i.6.F.2.d.  DBQs Required for IDES Examinations

 When an IDES examination is required as provided in M21-1, Part X, Subpart i, 6.F.2.b and c, MSCs must request completion of the General Medical – Separation Health Assessment Disability Benefits Questionnaire for every IDES participant. In addition, when at issue, request completion of one or more DBQs corresponding with conditions requiring a specialist examination (as discussed in M21-1, Part IV, Subpart i, 2.A.6).Important:
  • Where a posttraumatic stress disorder (PTSD) examination is required, request completion of the Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire if VA has not yet established SC.  Otherwise request the Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire.
  • When there are claims involving an undiagnosed illness or medically unexplained chronic multi-system illness (MUCMI) due to exposures incurred during Gulf War era service, do not request a Gulf War general medical examination DBQ.  Instead, as part of the request for the Separation Health Assessment (SHA), ensure to
    • select Other in the IS A MEDICAL OPINION NEEDED? drop-down menu in the Examination Management System (EMS), and
    • copy and paste the following examination request language from the Supplemental Language Matrix into the examination scheduling request (ESR):
      • Gulf War Claim Definitions, and
      • SHA for a Gulf War contention.
Note:  If the participant was referred to IDES on the basis of PTSD, and the Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire was completed as part of the current IDES examination (because the participant was previously SC), the MSC must provide a copy of the previously completed Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire along with the current Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire when returning examination results to the PEBLO. References:  For more information on

X.i.6.F.2.e.   Submitting Examination Requests for IDES Participants
The table below describes how an MSC submits examination requests to the provider responsible for completing the examination.
If the examination will be conducted by …
Then the …
  • Veterans Health Administration (VHA), or
  • a Veterans Benefits Administration (VBA) contract provider
MSC uses the appropriate tool/system and its embedded templates to prepare and submit the examination request.
DoD
  • MSC notifies the participant’s PEBLO of the required examination(s), and
  • PEBLO
    • schedules the examination(s)
    • notifies the MSC and participant of the date(s) and time(s) of the examination(s), and
    • ensures the examination(s) is(are) completed.
Important:
  • Separation Health Assessment – Part A Self-Assessment (SHA, Part A) must be in the eFolder before ordering examinations.
  • Examiners must follow VA protocol, to include the use of DBQs, when conducting examinations.
  • MSCs are responsible for providing the appropriate DBQs to DoD examiners if DBQs are not otherwise available to them.
References:  For more information on

X.i.6.F.2.f.  Remarks MSCs Must Include in Examination Requests to VHA

 MSCs must add the following remarks to requests for examination of IDES participants submitted to VHA:
  • Referred Disabilities:  [list all referred disabilities]
  • Claimed Disabilities:  [list all claimed disabilities]
  • Required Specialty Examinations of Referred Disabilities:  [list all specialty examinations that are required to evaluate disabilities the participant’s service department referred to VA]
  • As soon as the examinations are scheduled, please notify the MSC and PEBLO of the dates and times.
  • MSC:  [provide name, title, complete mailing address, phone and fax number, and e-mail address of MSC], and
  • PEBLO:  [provide name, location, phone and fax number, and e-mail address of the participant’s PEBLO].
Important:
  • MSCs must alter their request for notification, according to the instructions in M21-1, Part X, Subpart i, 6.K.2.b, if the participant is a member of the Reserves or National Guard who is not on active duty.
  • MSCs must select IDES as a priority code when submitting a request for examination to VHA unless one of the following higher-priority codes is applicable
    • Terminal, or
    • FPOW (former prisoner of war).
Where an examination involves an undiagnosed illness or MUCMI due to exposures incurred during Gulf War era service, use EMS to generate standardized text by ensuring to
  • select Other in the IS A MEDICAL OPINION NEEDED? drop-down menu in EMS, and
  • copy and paste the following examination request language from the Supplemental Language Matrix into the examination request:
    • Gulf War Claim Definitions, and
    • SHA for a Gulf War contention.
​​​​​​References:  For more information on

X.i.6.F.2.g.  Types of Medical Opinions MSCs Must Request

>
Before requesting examinations, MSCs must identify cases in which a medical opinion is needed.
If a medical opinion is required, and the opinion is straight-forward or routine in nature, then the MSC must request the medical opinion as part of the exam request in accordance with M21-1, Part IV, Subpart i, 2.A.7.  Generally, MSCs are responsible for requesting the following types of medical opinions:
  • direct
  • secondary, and
  • aggravation.
If a complex medical opinion is required, MSCs must follow the procedure outlined in M21-1, Part X, Subpart i, 6.F.2.h.
Reference:  For more information on determining when an examination or medical opinion is necessary under VA’s duty to assist, see M21-1, Part IV, Subpart i, 1.A.

X.i.6.F.2.h.  Handling Complex Medical Opinions
If a complex medical opinion is required, MSCs must send an e-mail to the appropriate DRAS and state
  • a complex medical opinion is necessary
  • the condition which requires a complex medical opinion, and
  • the reason a complex medical opinion is required.
The DRAS must complete the following actions within three business days of the request:
  • review the evidence of record
  • draft the required medical opinion
  • upload the draft into the participant’s eFolder, and
  • notify the MSC by e-mail that the medical opinion is available.
The MSC must copy and paste the draft medical opinion into the exam request and submit the request to the responsible examination provider.
References:  For more information on

X.i.6.F.2.i.  Limitations on the Types of Examinations Examiners May Conduct
Contract examiners are prohibited from conducting certain examination types specified in the Contract Exam Exclusions List, and covered in M21-1, Part IV, Subpart i, 2.A.1.i.
Important:  VHA and contract examiners cannot order hospitalization or surgical evaluation, such as colonoscopy or laparoscopy, and therefore cannot establish diagnoses that would require such workup.  However, examiners may still conduct an examination on a claim if a required test needed to inform a medical assessment was previously performed and in the eFolder.  For example, if a participant underwent a diagnostic laparoscopy in service, a contract examiner could conduct an examination for claimed endometriosis without violating the limitation on ordering surgical procedures.
If the requirements in the above paragraph are met, and an MSC submits the examination request to a contract examiner, the MSC must note in the examination request that proper diagnosis of the named disorder is already a matter of record.
Reference:  For more information on the scope of practice relative to examination, see M21-1, Part IV, Subpart i, 2.A.1.d.

X.i.6.F.2.j.  Uploading Examination Requests Into the eFolder
MSCs must ensure that examination requests have been uploaded to, and appear in, the IDES participant’s eFolder.
Note:  Submission of an ESR through VBMS automates the generation and insertion of a placeholder document into the participant’s eFolder.

X.i.6.F.2.k.  Tracking Examination Requests
After an MSC requests all the examinations an IDES participant requires, they must make updates on the MSC tab in VTA. The table below describes additional entries the MSC must make on the MSC tab.
Step
Action
1
In the SHA PROVIDER field, select the examination provider from which the MSC requested the SHA DBQ.
Notes:
  • This provider will be hereafter referred to as the “SHA provider”
  • It is typical to request additional DBQs from the SHA provider.  However, these will not be entered or tracked separately in VTA.
Is VHA the examination provider?
  • If yes, go to Step 2.
  • If no, go Step 3.
Explanation:  The SHA EXAM SITE field, discussed in Step 2, is only completed when VHA is the examination provider.
2
Complete the SHA EXAM SITE field with the VHA facility that will conduct the examination.
3
In the SHA REQUESTED DATE field, enter the date the examination request was submitted to the SHA provider.
4
Were additional DBQs requested from a provider other than the SHA provider selected in Step 1?
  • If yes, go to Step 5.
  • If no, take no further action in the table.
5
In the OTHER PROVIDER field, select the provider from which the MSC requested only DBQs other than an SHA.
Notes:
  • A provider who completes DBQs in an IDES case, but does not complete the SHA will hereafter be referred to as the “other provider.”
  • When the SHA provider performs all required examinations in an IDES case, the OTHER PROVIDER field is not applicable.
Was VHA the other provider?
  • If yes, go to Step 6.
  • If no, go to Step 7.
Explanation:  The OTHER PROVIDER EXAM SITE field, discussed in Step 6, is only completed when VHA is the examination provider.
6
In the OTHER PROVIDER EXAM SITE field enter the VHA facility that will complete the examinations.
7
In the SHA REQUESTED DATE field, enter the date the examination request was submitted to the SHA provider.
Important:  For all examination request submitted to VHA, MSCs must ensure a DBQ tracked item is created in VBMS under the pending EP 689 for each type of examination.
Reference:  For more information on the automatic generation of tracked items for ESRs submitted in VBMS, see M21-1, Part IV, Subpart i, 2.C.1.a.

X.i.6.F.2.l.  Avoiding Duplication of Effort
In order to avoid a duplication of effort,
  • examiners should use laboratory and x-ray reports that are already of record, as long as
    • the reports are less than six months old, and
    • there is no evidence the related disability has worsened, and
  • examiners should not duplicate diagnostic studies that establish a chronic diagnosis, regardless of the date performed, unless there is clinical evidence of a worsening of the related disability.
Examples:  The term “diagnostic studies” includes
  • sleep studies for obstructive sleep apnea, and
  • magnetic resonance imaging (MRI), computed tomography (CT) scans, and x-rays for confirming degenerative processes.
Important:  MSCs and PEBLOs must work together to ensure the reports and/or studies referenced above are forwarded to the DRAS of jurisdiction.

X.i.6.F.2.m. Examination of Pregnant IDES Participants
M21-1, Part X, Subpart i, 6.K.3 contains instructions for requesting examinations for pregnant IDES participants.

X.i.6.F.2.n.  Handling Cases Involving a Participant Who Is Too Disabled to Travel to an Examination
MSCs, PEBLOs, and physicians at MTFs are responsible for determining whether a participant is too disabled to travel to an examination.
The table below describes the process for handling cases involving a participant who is too disabled to travel to an examination.
Step
Action
1
The participant’s MSC
  • notifies the DRAS of jurisdiction by e-mail that the participant is too disabled to travel to an examination
  • requests that the DRAS make a determination whether all referred conditions can be rated on the basis of the evidence of record, and
  • provides the DRAS with participant’s
    • service treatment records (STRs), and
    • current inpatient/outpatient treatment records that refer to any claimed or referred disability.
2
The rating activity at the DRAS reviews available medical records to determine whether referred conditions can be rated using the evidence of record.
Note:  If the rating activity determines additional, relevant treatment records exist, the MSC is responsible for obtaining them.
3
The DRAS notifies the MSC of the determination within five days of the request.
4
The MSC reviews the determination and takes the action specified in the table below.
If the determination is that the referred conditions …
Then the MSC must …
can be rated on the basis of the evidence of record
  • notify the participant’s PEBLO that the case can move forward without an examination, and
  • update VTA by
    • entering the
      • Medical Evaluation Board (MEB) location in the SHA EXAM SITE field, and
      • the provider who conducted the examination(s) in the SHA PROVIDER field, and
    • selecting the NO NEW EXAMS NEEDED checkbox.
Note:  VTA will auto-populate the current date into the following fields when the NO NEW EXAMS NEEDED checkbox is selected:
  • MEDICAL EVALUATION START DATE
  • SHA EXAM REQUESTED DATE
  • SHA EXAM RETURNED DATE
  • EXAM END DATE, and
  • MEDICAL EVALUATION END DATE.
cannot be rated on the basis of the evidence of record
  • notify Compensation Service of the determination by sending an e-mail to VAVBAWAS/CO/IDES, and
  • await further guidance from Compensation Service.
5
Upon receipt of a request for proposed rating from the physical evaluation board, the DRAS must prepare a proposed rating decision addressing
  • all referred conditions, and
  • any claimed conditions for which the evidence of record supports a favorable decision.
Important:  When a participant is too disabled to report for examinations, it is acceptable for DRAS to defer decisions for claimed conditions on the proposed rating as noted in M21-1, Part X, Subpart i, 6.H.1.d.

X.i.6.F.2.o.  Requirement for Examiner eFolder Review
Any examination conducted in connection with IDES must include a review of the participant’s claims folder.  All STRs provided by the PEBLO, SHA, Part A, and any other pertinent records provided by the participant, must be properly identified and available in the participant’s eFolder prior to requesting the examination.
Important:  IDES examinations should be requested after the initial meeting, once the STRs provided with the referral package has been uploaded and is available in the eFolder. Examination requests should not be delayed for receipt of STRs from previous periods of service.
Reference:  For more information on the requirement to identify relevant evidence for the examiner’s review, see M21-1, Part IV, Subpart i, 2.A.8.d.

X.i.6.F.2.p.  Handling Requests in Which the Examination Provider Is Unable to Provide Required Examinations
When a VHA facility does not have the ability to complete a specific examination needed for an IDES claim, the MSC must submit the examination request to the appropriate contract examination vendor.
If the contract examination provider cancels (or directs cancellation of) the examination because contract support is not yet available in the participant’s area, the MSC should contact their station Exam Liaison, who will coordinate with VAVBAWAS/CO/Contract Examination Inquiries for assistance.

3.  Handling IDES Examination Reports

Introduction
This topic contains information about handling IDES examination reports, including

Change Date

 April 3, 2023

X.i.6.F.3.a.  MSC Responsibility for Monitoring the Status of Examination Requests
At least once each week, MSCs must
  • run the Pending Medical Evaluation Stage Report in VTA, and
  • follow up on any examination requests that the report shows have been pending more than 32 days.

X.i.6.F.3.b.  Transfer of Uploading Examination Reports Into eFolders
When VHA or a contract examiner completes an examination, the corresponding examination report is automatically transferred into the appropriate eFolder in VBMS and will typically require no further action from the MSC.
However, if examination results failed to transfer to the eFolder, MSCs must ensure that copies of all DBQs are uploaded into the eFolder.
Important:  MSCs must not upload examination results completed by contract vendors into VBMS even if the results appear available in the vendor’s portal.  Examination reports completed by contract vendors will transfer once they are approved for release to VA.

X.i.6.F.3.c.  MSC Review of Examination Reports
MSCs must complete a thorough review of examination reports once they become available.  MSCs must ensure the reports are complete before providing results to the PEBLO or updating VTA to reflect the return of examination results.
MSCs must carefully review their examination request and all examination results to confirm that
  • the request included all claimed and referred conditions
  • all issues noted on the examination request have been addressed by the examiner
  • all requested DBQs have been completed by the examiner, and
  • all specific testing required by individual DBQs has been completed.
Notes:
  • It is acceptable for an examiner to cite existing testing or imaging that already exists in the medical record to avoid duplication of medical procedures; however, the previous tests/images must be noted in the DBQ.
  • In cases where the MSC identifies missing, incomplete, or insufficient DBQs, or where examinations were not requested for all claimed and referred conditions, the MSC must obtain the missing or deficient examination information before providing the results to the PEBLO.
  • When reviewing examination results the MSC must solicit a claim for any identified chronic, unclaimed condition potentially subject to SC (particularly in cases involving active duty service members) as discussed in M21-1, Part II, Subpart iii, 2.G.2.e.
References:  For more information on

X.i.6.F.3.d.  Actions MSCs Must Take Once All Examination Reports Are Deemed Complete
MSCs must take the actions described in the table below as soon as all of an IDES participant’s examination reports are available in the eFolder and have been deemed complete.
Step
Action
1
Update the SHA RETURNED DATE on the MSC Tab in VTA to reflect the date that all examinations requested from the SHA provider became available to the MSC.
Notes:
  • The provider the SHA DBQ was requested from is considered the “SHA provider.”
  • When multiple DBQs were requested from the SHA provider, the SHA RETURNED DATE must reflect the date the last DBQ from the SHA provider was returned.
2
Were examination requests submitted to multiple providers?
  • If yes, go to the next step.
  • If no, go to Step 4.
3
Update the OTHER EXAM RETURNED DATE in VTA to reflect the date that all examinations requested from the other provider became available to the MSC.
Notes:
  • A provider who completes DBQs in an IDES case, but does not complete the SHA DBQ is considered the “other provider.”
  • When multiple DBQs were requested from the other provider, the SHA REQUESTED DATE must reflect the date the last DBQ was returned.
4
Update the EXAM END DATE field in VTA to reflect the date when all the participant’s examination reports became available to the participant’s MSC.
5
Review VBMS notes for the message SHA exam results have been successfully transferred to DoD (HAIMS). Important:  If this message is not shown, MSCs must compete the actions outlined in M21-1, Part X, Subpart i, 6.F.3.e before going to the next step.
6
If any previously completed DBQs (i.e., not associated with the current IDES examination request), will be used for IDES purposes, ensure that they have been provided to the PEBLO via acceptable alternative means.
Rationale:  Previously completed DBQs are not transferred to DoD via automated process.
Note:  PEBLOs require copies of previously completed DBQs when
Reference:  For more information about acceptable alternative means of document transfer, see M21-1, Part X, Subpart i, 6.E.3.f.
7
If the claim required development other than VA examinations, ensure that
  • all required development actions have been initiated, and/or
  • any required follow-up requests are made on development items with past due suspense dates
Important:  Go to the next step after ensuring all required development has been initiated.  Do not delay action on the remaining steps in this table because development actions (unrelated to VA examinations) are not yet resolved.
8
Ensure all tracked items have been updated to reflect the appropriate disposition per M21-4, Appendix D, 1.
Notes:
  • All examination tracked items must be marked Closed, Received, or In Error before transferring the case to DRAS.
  • When development remains pending on any other issue (not related to examinations) the associated tracked items must remain open with appropriate suspense dates; DRAS will ensure that these tracked items are resolved.
9
Ensure that the IDES Development Checklist has been completed and incorporated into the eFolder (or forwarded to the scanning vendor under a DCS).
Note:  If the MSC uploads the checklist directly into the eFolder, they must use the indexing values specified on the checklist.
Reference:  For more information on the use of the IDES Development Checklist, see M21-1, Part X, Subpart i, 6.E.3.a.
10
Update the claim status of the EP 689 to Ready for Decision (RFD).
Note:  The claim status must reflect RFD, even if non-exam related tracked items remain open.
11
Apply the Transfer from Intake Site special issue to the first contention listed under the EP 689.
Note:  Applying this special issue will transfer the claim to DRAS via automated NWQ routing.
12
Update the MEDICAL EVALUATION END DATE field according to the table below.
If …
Then, update the MEDICAL EVALUATION END DATE field to reflect …
all examination results were transferred via automated transfer process
the current date.
the MSC had to take action to provide the results to the PEBLO
the date the examination results were sent the PEBLO.
Notes:
  • Entry of the MEDICAL EVALUATION END DATE serves to notify
    • DRAS that the case is ready for rating preparation, and
    • the PEBLO assigned that the results are available in HAIMS.
  • MSCs must make every effort to take the actions outlined in Steps 5 through 12 of this table on the same day.

X.i.6.F.3.e.  Providing Examination Reports to PEBLOs

 Generally, completed DBQs will be transferred to PEBLOs via automated processes with no required action by the MSC.  However, MSCs must confirm that the DBQs have successfully transferred by reviewing VBMS notes and ensuring the following message is displayed: SHA exam results have been successfully transferred to DoD (HAIMS) If the confirmation message is not shown in VBMS, the MSC must complete the actions in the table below.
Step Action
1 Contact the PEBLO assigned by e-mail to
  • explain that the DBQs did not transfer to HAIMS via automated process and will be provided via Department of Defense Safe Access File Exchange (DoD SAFE) transfer, and
  • request the PEBLO submit a trouble ticket to their local HAIMS administrator.
2 If the MSC has a Common Access Card (CAC) and can initiate a DoD SAFE transfer, go to Step 4.
3 Request that the PEBLO initiate the transfer. Note:  If the PEBLO fails to respond or initiate the DoD SAFE transfer before the end of the next business day, notify IDES.VBACO@VA.GOV.
4 Download the DBQs from the eFolder.
5 Send the DBQs to the PEBLO via DoD SAFE.
Reference:  For information about using DoD SAFE to send sensitive records, see M21-1, Part X, Subpart i, 6.K.9.a.

X.i.6.F.3.f.  Considering Sufficiency of IDES Examinations for Rating Purposes
DRAS must consider the sufficiency of exams in accordance with standard VA rating requirements.
If an IDES examination is determined to be insufficient for rating purposes, the DRAS must complete the actions outlined in M21-1, Part X, Subpart i, 6.F.3.h.
Reference:  For more information on reviewing examination reports for rating criteria, see M21-1, Part IV, Subpart i, 3.B.

X.i.6.F.3.g.  Examination Reports That Reveal the Existence of Additional Disabilities
If an examination report reveals the existence of disabilities that the IDES participant did not claim and the service department did not refer to VA, DRASs must follow the instructions in M21-1, Part X, Subpart i, 6.K.1.i.

X.i.6.F.3.h.  DRAS Actions if an Examination Report Is Insufficient
If a DRAS determines an examination report is insufficient, it must
  • complete the fields in the EXAM REVIEW section of the RO/RATING ACTIVITY tab in VTA
  • handle the insufficient examination in accordance with M21-1, Part IV, Subpart i, 3.C
  • upload the examination request, if necessary, in accordance with M21-1, Part X, Subpart i, 6.F.2.j, and
  • add under the pending EP 689 additional tracked items for each type of examination request submitted outside the VBMS examination management environment.
Notes:
  • Updating VTA to indicate an IDES exam has been found to be insufficient will trigger e-mail notification the MSC and PEBLO assigned.
  • To perform the activities described above, a DRAS employee must have nationwide access to CAPRI.
  • If a DRAS requests correction of an examination report or a new examination from a VHA facility, it must prepare the request according to the instructions in M21-1, Part X, Subpart i, 6.F.2.e and f.  The DRAS employee who submits the request must include their contact information in addition to the PEBLO’s and MSC’s contact information.
  • MTFs may perform tests or studies that a DRAS determines are necessary to correct deficiencies the DRAS identified in an examination report.
  • Examination providers will correct any insufficient examination reports or complete any new examinations a DRAS requires within 14 days of notification of an insufficient examination report.

X.i.6.F.3.i.  MSC Actions if an Examination Report Is Insufficient
When DRAS updates VTA to indicate that an IDES examination report has been found insufficient for rating purposes, VTA will send both the PEBLO and MSC assigned a notification via e-mail.
If a PEBLO states that the corrected examination report is required for MEB processing, the MSC must provide the corrected examination report once it becomes available.
Important:  The MSC must not change the change the date initially entered in the EXAM END DATE or MEDICAL EVALUATION END DATE fields in VTA on the basis of an insufficient exam finding made by DRAS.

X.i.6.F.3.j.  Failure of an IDES Participant to Report for Examination
The table below describes the actions MSCs should take when an IDES participant fails to report for an examination without good cause.
If the participant failed to report for examination of a …
Then MSCs should …
referred disability
work with the participant’s PEBLO to determine whether it is more appropriate to
  • reschedule the examination
  • continue the IDES process without examinations, or
  • have the service department disenroll the participant from IDES.
Note:  Before proceeding without examinations for referred conditions, the MSC must obtain documented agreement from the MEB.
claimed disability
consider the circumstances of each case and use their own discretion to decide whether examinations for claimed conditions should be rescheduled. If an examination is rescheduled for a referred disability, then MSCs should reschedule the examination(s) for claimed disabilities as well.
Important:  MSCs must enter a note in VTA stating a new examination has been requested due to the participant missing the original appointment.  Do not change the PREPARE CLAIM START DATE or MEDICAL EVALUATION START DATE in VTA.
Exception:  If the purpose of the missed examination was to evaluate a mental disorder, MSCs should consider rescheduling the examination, especially if there is any indication the participant may have simply forgotten about it.
Reference:  For more information on the definition of good cause, see M21-1, Part IV, Subpart i, 2.F.1.b

X.i.6.F.3.k.  Handling an IDES Participant’s Request to Re-schedule an Examination
MSCs must advise participants who wish to reschedule VA examinations to consult with their PEBLO.
Once an appointment for VA examinations has been scheduled, examination appointments cannot be changed unless the participant’s PEBLO determines that it is necessary.
MSCs may reschedule IDES examinations only after receiving a request (or approval) from the participant’s PEBLO.  MSCs must ensure that the PEBLOs request/approval is noted in VTA.

X.i.6.F.3.l.  Handling PEBLO Reports of Missing Examination Results
If a participant’s PEBLO reports that complete examination results did not transfer to HAIMS in an IDES claim in which the MEDICAL EVALUATION END DATE had been previously entered in VTA, the MSC must
  • provide any missing examination results via an acceptable alternative means, and
  • update the MEDICAL EVALUATION END DATE field in VTA with the date that the missing records were provided to the PEBLO.
Reference:  For more information about acceptable alternative means of document transfer, see M21-1, Part X, Subpart i, 6.E.3.f.