What is a VA ACE Exam? 3 Things Veterans Really Need to Know!

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Today, we’ll discuss the three things you really need to know if you get a VA ACE exam.

Recently, the VA has been using the Acceptable Clinical Evidence (ACE) exam process for certain Compensation and Pension (C&P) exams.

A VA ACE exam is a “records only” review of certain disabilities you’ve filed for by a C&P examiner.

The C&P examiner will then complete the electronic Disability Benefits Questionnaire (DBQ) based on a review of your existing paper and/or electronic medical evidence only.

Thus, you won’t get an in-person or telehealth C&P exam—the ACE exam covers that requirement.

Sometimes, the C&P examiner for an ACE exam will call you on the phone and ask you questions about your disabilities, so you need to be prepared!

Okay, let’s explore the ACE exam in more detail.

What is a VA ACE Exam?

A VA ACE exam is a C&P exam conducted by an electronic “records only” review.

Instead of scheduling an in-person or telehealth examination, C&P examiners have the option to complete a DBQ based on review of existing paper and/or electronic medical evidence only. 

The examiner may also choose to conduct a phone interview with you (examiners choice).

I’ve personally had three ACE exams for various disability conditions and have never received a phone call from the examiner.

In our experience, the ACE exam process is a good one and leads to faster claim decisions for veterans.

What C&P Exams Can Be Conducted Using the ACE Exam Process?

Since the use of VA ACE Exams helps expedite the VA claim process, VA Raters (VSRs and RVSRs) should consider using the ACE process for veterans who are at risk of becoming homeless or are homeless.

VA ACE exams are appropriate for the following disability conditions:

• Hearing loss

• Tinnitus

• Migraine (Headaches)

• Sleep Apnea

• Cardiac conditions

• Amyotrophic Lateral Sclerosis (ALS), and

• Any Terminal Condition

Other situations in which the ACE exam process might be appropriate include, but are not limited to:

• Existing medical evidence is adequate as determined for a clinical examiner to assess the level of impairment per the claimed condition’s DBQ (requested by the VSR or RVSR).

• A medical opinion is needed to determine whether a disability was “incurred” or “aggravated” in service.

• A medical opinion is needed to determine the relationship between a claimed disability and a service-connected disability.

• Assessing whether a disability incurred in or aggravated by military service caused or contributed to a veteran’s death.

The ACE exam process is not available in the following categories of C&P exams:

• Examinations when necessary electronic medical records are not available for examiner review.

• Separation Health Assessments (SHAs) in support of IDES and BDD claims.

• Exams required by BVA & CAVC remands.

• General medical examinations.

• Initial and review traumatic brain injury (TBI) examinations, and

• Mental disorder examinations

For any evaluations completed using the VA ACE process, the C&P examiner will:

• Review the existing records provided by VA and/or available in Veterans Benefits Management System (VBMS); and

• Document the use of the ACE process on the DBQ, to include the source of the clinical evidence relied on to complete the DBQ or render the opinion.

3 Things You Must Know to Prepare for Your ACE Exam VA

#1: The VA ACE Exam is a C&P Exam

First, you should recognize that a VA ACE exam is a C&P exam.

However, instead of being an in-person or virtual exam, it’s conducted by the C&P examiner via “records review” only.

Overall, the ACE exam process is a good one and can lead to a favorable claim outcome in less time.

The ACE exam process is usually faster than a traditional C&P exam.

#2: Review Your Submitted Evidence and the Condition Specific DBQ

If you submitted a claim for Migraines, Tinnitus, or Sleep Apnea, you should be on the lookout for an ACE exam.

You’ll know by looking at the C&P exam paperwork mailed to you by a private company: LHI, VES, and QTC.

In our experience, Migraine (Headaches) is the #1 most common disability condition for the ACE exam process.

You should review your submitted evidence in-detail and review the condition specific public use DBQ in-case the examiner calls you for an interview.  

#3: The ACE Examiner Might Call You!

Under the ACE exam process, the C&P examiner might call you on the phone.

You must be ready if the call comes!

Even though the C&P examiner is conducting a records-only review of your VA claim file, you need to be ready in-case he/she calls you on the phone for an interview, which is allowed under the ACE process.  

Again, review your submitted evidence and be ready to discuss your current Diagnosis, “Nexus” for service connection, and Severity of Symptoms in terms of frequency, severity, and duration.

What Should I Expect at a VA ACE Exam for Migraines?

A VA ACE Exam for Migraines is normally conducted via a “records only” review of your submitted evidence.

However, the C&P examiner might call you on the phone for an interview.

If that happens, here’s a common list of verbal questions you can expect to be asked from the DBQ for Migraines.

• When did you Migraines begin?

• How often do you get Migraines?

• How long do your Migraines last?

• Do your Migraines negatively affect your work or life? If yes, please explain.

• Do you get “prostrating” Migraines?

• Do you take medications for your Migraines? If yes, do they help?

• If you filed for Migraines secondary to Tinnitus or Mental Health, you must be able to explain why/how you think they’re connected to each other.

VA ACE Exams Explained – Frequently Asked Questions (FAQs)

1. When is the VA Acceptable Clinical Evidence (ACE) exam process appropriate and who makes the determination?

Unless VA personnel have specifically required a general medical or an in-person examination be conducted, once the VSR/RVSR has requested an examination or opinion and provided all available medical information in VBMS, the vendor (C&P exam contractor) will review the request to determine if the examination can be completed from the current medical records and VA claims file. When the existing medical evidence is found to be adequate, and/or supplemented by a telephone interview with the veteran, if necessary, the request may be completed using the ACE process and will be documented on the DBQ as having been conducted using the ACE exam process.

2. What records will the C&P examiner use to complete the electronic DBQ for an ACE exam?

The C&P examiner will review the existing evidence of record included in the VBMS uploaded veteran’s file and, if needed, information obtained by telephone from the veteran. A telephone interview may not be needed and is at the sole discretion of the C&P examiner.

3. How is the ACE exam process documented?

The examiner will document use of the ACE exam process on the DBQ. The examiner will ensure the appropriate entries are made on the DBQ to report the use of the ACE process and the source of the clinical evidence relied on to complete the DBQ. The examiner must identify the materials reviewed to complete the DBQ or render the opinion. DBQs contain a box that must be checked if the DBQ was completed using the ACE process. All applicable medical evidence used to complete the DBQ identified. DBQs completed using the ACE process will be called insufficient if ACE is not properly documented.

4. Does the ACE process change existing policy on C&P disability examinations?

The ACE process does not replace guidance related to C&P disability exams or DBQs. The ACE process is simply a method for completing the DBQ without an in-person or telehealth exam. A VA ACE exam can result in faster VA claim decisions.

5. Can the ACE exam process be used to provide medical opinions?

Yes, the ACE exam process may also be used to provide medical opinions. Opinions can be provided for:

• A new medical opinion

• Clarifying a previous medical evaluation

• Clarifying a previous medical opinion

6. Are there specific requirements when the C&P examiner obtains additional information over the telephone?

Yes. If the ACE exam process involves obtaining information from a veteran via a telephone interview, the examiner must ensure the veteran is the person being interviewed or is a person authorized to act on the veteran’s behalf.

If a telephone interview is required, the examiner will identify themselves to include providing their unique identification number, state the purpose of the call, and shall authenticate a veteran’s identity using the following questions:

#1. Full legal name, including middle name.

#2. Last four of the Veteran’s social security number or claim number.

#3. Birth Date, including year.

#4. Branch of service and service dates, and

#5. Home address.

It is acceptable if the veteran does not remember their exact service dates but answers all the other questions correctly.

Pro Tip: If a veteran refuses to answer the questions, the VA ACE exam process cannot be completed, and the veteran will need to report for an in-person examination.

7. When can the ACE exam process NOT be used?

The ACE exam process is not available in the following categories of examinations:

• Exams by vendor examiners when necessary electronic medical records are not available for review.

• Exams required by BVA & CAVC remands.

• General medical examinations.

• Mental disorder examinations, including medical opinions for claimed conditions secondary to a service connected (SC) medical disorder. This specifically applies to physical secondary conditions related to SC mental disorders, such as bruxism; initial or residual traumatic brain injury (TBI) DBQs; and

• When the VA specifically requests an in-person or telehealth examination

8. Can the ACE process be used if the examiner determines that the existing medical evidence is inadequate for evaluation purposes?

If the existing medical and other pertinent evidence is found to be inadequate or additional information is required, the veteran will be scheduled for an in-person medical examination or a telehealth examination.

9. Can telehealth technology be used for an ACE exam?

Telehealth is not to be used as part of the ACE exam process. Records review and/or phone interview only.

10. Where can I find more information on VA ACE exams?

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