If you have filed a claim for VA disability compensation, you may expect the Department of Veterans Affairs (VA) to schedule you for a Compensation and Pension (C&P) examination. However, what happens when the VA obtains a medical opinion without requiring you to attend an examination โ or even speak directly with the examiner?
This process is known as an Acceptable Clinical Evidence (ACE) examination, or the ACE process.
The ACE process allows the VA’s medical examiner to evaluate certain disability claims by reviewing existing medical records rather than conducting an in-person examination. The examiner may also conduct an interview with the veteran when necessary.
According to the VA Adjudication Procedures Manual, the Veterans Health Administration (VHA) and contract examiners generally have the option, subject to certain limitations, to complete a Disability Benefits Questionnaire (DBQ) based on a review of existing medical evidence.
The VA may use this process for a variety of claim types, including:
- Service connection: Whether a current disability is related to military service.
- Secondary service connection: Whether a disability was caused or aggravated by an existing service-connected condition.
- Increased ratings: Whether the available evidence adequately establishes the severity and functional impairment of a service-connected disability.
However, the ACE process is not available for every type of examination. The following categories are excluded:
- Examinations for which necessary electronic medical records are not available for the examiner’s review.
- General medical examinations.
- Initial and review traumatic brain injury (TBI) examinations.
- Mental disorder examinations.
Additional restrictions apply in specified circumstances, including certain examinations associated with Separation Health Assessments and pre-discharge claims.
Moreover, the ACE process may be used for rating purposes across contentions or examination types when the veteran:
- Has a terminal illness, including terminal cancer.
- Has a catastrophic disability, as defined by the VA.
- Is homeless, appears to be severely disabled, and efforts to contact the veteran have been unsuccessful.
Although the VA is permitted to use this process in appropriate circumstances, an ACE examination raises important questions about whether the available medical evidence is sufficient, whether the examiner has adequately considered the veteran’s history, and whether the resulting opinion provides a reliable basis for deciding the claim.
At Wolf & Brown, one of our mottos is โcontrol what you can in this process.โ
We generally prefer that the VA schedule an in-person C&P examination when direct observation or physical testing may provide important evidence about a veteran’s disability. An in-person examination gives the examiner an opportunity to obtain information that may not be apparent from reviewing medical records alone. This can be especially important when a veteran’s disability involves pain, limited mobility, flare-ups, fatigue, weakness, or other symptoms that affect daily functioning.
However, when an in-person examination is not conducted, veterans can take steps to help ensure that the evidence available for an ACE review is complete and sufficient. These steps include submitting all relevant medical records, providing a Statement in Support of Claim detailing their symptoms and medical history, and documenting functional limitations in a personal diary or through discussions with their treating physicians.
A complete and well-supported record helps ensure that the examiner has the information necessary to provide an accurate and informed medical opinion.
Ultimately, the question is not whether a veteran prefers an in-person examination. It is whether the available evidence is sufficient to evaluate the claimed disability accurately and completely.
If you have questions about an ACE examination, believe the VA relied on an incomplete medical opinion, or need assistance determining the best way to support your disability claim, contact our office to discuss your case and learn how we can help protect your rights and pursue the benefits you deserve.
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NJ Vet-Wire is a publication created by Wolf & Brown Law Offices to help educate veterans on the process of obtaining disability benefits through the Department of Veterans Affairs. Veterans disability compensation is part of a total benefits package to which members of the armed forces may be entitled. In our role as VA accredited attorneys, we help our clients navigate the system to their best advantage. Denied benefits claims are not the end of the road.
Contact us for a free consultation. Learn more about Attorney Matthew Brown.
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Resources:
VA Disability FAQs