Private DBQ Training Slides

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 1 - Title – Identifying Insufficient and Potentially Fraudulent Disability Benefits Questionnaires (DBQs) LESSON TIME One hour (60) STUDENT CATALOG LAYOUT Prework | N/A Core Content | Self-Paced Module (45) Assessment (15) Resources | Transcript Testout | N/A SKILLS TBD Level One | One Credit TERMINAL LEARING OBJECTIVE At the end of this module, you will be able to identify exam insufficiencies when reviewing DBQ exam reports and identify the actions to take once an exam insufficiency has been identified. ACCESSIBILITY OPTIONS Access Slide Notes/Hyperlinks (Help): H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow To open checklist and exam case studies: Labeled with Keyboard Shortcut (KS) action. REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 1 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 2 - Navigation Controls TRANSCRIPT You are viewing this module through Adobe Captivate Prime. You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. ACCESSIBILITY OPTIONS Access Slide Notes/Hyperlinks (Help): H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow To open checklist and exam case studies: Labeled with Keyboard Shortcut (KS) action. REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 2 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 3 - Introduction TRANSCRIPT Hello, and welcome to the Identifying Insufficient and Potentially Fraudulent Disability Benefits Questionnaires (DBQs) self-paced module. This sixty-minute training module will introduce you to reviewing the DBQ exam report once it has been completed by the examiner and uploaded into VBMS. Use the buttons to navigate through the module. You will be required to complete all interactive processes before you can continue. Throughout the module, you will be required to answer a series of knowledge check questions. You will receive instant feedback before continuing to the next question. Image: American Flag with coins showing all 6 branches of the military. ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 3 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 4 - Objectives TRANSCRIPT At the end of this module, you will be able to: • Identify exam insufficiencies when reviewing DBQ exam reports. • Identify the actions to take once an exam insufficiency has been identified. Image: Woman pointing to objectives ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 4 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 5 - VSR Responsibilities - Exam Reports TRANSCRIPT While the responsibility to review the DBQ exam report is generally the RVSR’s, a quick review by the VSR can provide added value. An insufficient exam report can cause delays and erroneous decisions. The earlier the insufficiency is identified, the less of an impact it will have on the Veteran and VA. VSR’s can help: • the Pre-Determination (Pre-D) VSR should perform this review before marking the claim as Ready for Decision (RFD). • the Post-Determination (Post-D) VSR will not routinely have the opportunity to review the DBQ(s); however, if the Post-D VSR notices something out of place, further review would be warranted. The Is the DBQ Sufficient? checklist has been created to assist VSRs with these reviews. You can access this checklist by clicking the button below. This checklist can also be found in TMS. Image 1: DBQ Checklist button with a circle drawn around it: Hyperlink: https://vbatraining.adobeconnect.com/phag3ymz50ei/default/connect.pdf Image 2: Green checkmark showing task complete. ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow To open checklist and exam case studies: Labeled with Keyboard Shortcut (KS) action. REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports Disability Benefits Questionnaires Switchboard NWQ Playbook Page 5 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 6 - Common Errors TRANSCRIPT Some common errors discovered over the last year that VSRs can easily identify during a quick review are: 1) the DBQ is incomplete, 2) the rationale for the medical opinion was not provided, 3) the Veteran’s established diagnosis was changed without rationale, 4) the requested medical opinion was not provided, 5) the DBQ contains findings of a disability, but no diagnosis was provided by the examiner, nor a reason given for the lack of a diagnosis, and 6) required tests/findings are missing. Image: Woman covering mouth with hand ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard NWQ Playbook Page 6 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 7 - Exam Report Sufficiency TRANSCRIPT Exam report sufficiency can be broken down into three elements: • the examiner’s signature and credentials, • the examiner’s qualifications, and • the completeness of the DBQ. We will discuss these three elements throughout the rest of this training module. Image: Hands writing on paper at desk ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard NWQ Playbook Page 7 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 8 - Examiner Signature and Credentials TRANSCRIPT The first element of exam report sufficiency that we will discuss is the examiner’s signature and credentials. Depending on who completes the DBQ, there are certain items that VA requires to be included in the exam report. If the DBQ is completed by a: • Veteran Health Administration (VHA) employee, the exam report must contain that employee’s signature, printed name, and credentials. • VA-approved contractor, the exam report must also contain the contractor’s specialty, in addition to the previously mentioned items. • non-VA health care provider, the exam report must also contain the non-VA health care provider’s Phone and/or fax number, medical license number, and National Provider Identifier (NPI) number, in addition to the previously mentioned items. All this information is generally found on the last page of the DBQ exam report. The credentials can generally be found after the signature and/or printed name. These are usually abbreviations; (e.g., MD for medical doctor, PA for physician assistant, or NP for nurse practitioner). The specialty can generally be found after the credentials; (e.g., Dermatology or Internal Medicine). While not a general requirement, if VA regulations require that a specific type of medical professional complete the DBQ, the specialty would be required, even if a VHA employee completed the DBQ. Image: Female doctor pointing to list ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard NWQ Playbook Page 8 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 9 - Publicly Available DBQs TRANSCRIPT Most DBQs are publicly available to the Veteran and their non-VA healthcare provider. However, not all DBQs are publicly available. Those DBQs cannot be completed by a Veteran’s non-VA healthcare provider If a VSR identifies a DBQ, completed by a non-VA healthcare provider, excluding those requested and received from VA- approved contractors, the DBQ should be routed to an RVSR for further review. The RVSR will still review the DBQ for sufficiency, but they will also review the DBQ for authenticity and then decide if another exam is needed. Image: Provider and male Veteran talking ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow To open checklist and exam case studies: Labeled with Keyboard Shortcut (KS) action. REFERENCES M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard NWQ Playbook Page 9 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 10 - Indicators of DBQ Fraud TRANSCRIPT There are six possible indicators of DBQ fraud. These are: 1. Signs of alteration. a. This can include: a different appearance of the text and/or formatting of the type and size as well as the examiners signature and/or b. certification page being visually different. 2. Contact information discrepancies. 3. Examiner’s address is greater than 100 miles away from the Veteran’s address. 4. Other available evidence contradicts the findings of the questionnaire. 5. Veteran refuses to report for a VA examination. 6. Assignment of a 100 percent disability rating without evidence of current medical treatment confirming the severity of the condition. Image 1: People reviewing forms with the words Fraud Detection Methods. Image 2: VA employee with thumbs down and the words VA DBQ Fraud. ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard Page 10 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Page 11 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 11 – Reporting Possible DBQ Fraud - OIG TRANSCRIPT If a claims processor suspects possible fraud is involved with a DBQ, they will need to take the following actions. 1. Weigh the evidence of record. 2. Assign a low or no probative value to the DBQ if there is reason to suspect that the DBQ is inauthentic or fraudulent. 3. Request a new VA examination for the claimed disability. 4. If a claims processor determines that a privately submitted DBQ has a potential to be inauthentic and a new VA examination is needed, a permanent VBMS note must be added. 5. Report the possible fraud to your Regional Office senior leadership and Office of Inspector General for further direction. Image 1: Person in suit pointing at the word Fraud Prevention. Image 2: The word Scam overlaying a computer keyboard. ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard Page 12 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 12 - Exam Case Study #1 TRANSCRIPT Now let’s put our knowledge to the test. A few months ago, VA received a claim for increase for the Veteran’s left shoulder condition. The Veteran is service connected for a left shoulder condition and a scar on his left shoulder. A VSR previously requested an increase exam for the left shoulder condition utilizing a VA-approved contractor. Upon reviewing the claim, you discover that this exam is available in VBMS. Click the button below to launch the DBQ exam report. Review this DBQ for the element of sufficiency that we just discussed. Once you have reviewed the DBQ, the forward arrow will appear at the bottom right of this slide, allowing you to continue to a knowledge check question covering this case study. Image 1: Circle highlighting link to Exam Case Review #1, Hyperlink: https://vbatraining.adobeconnect.com/pho94qxkh92l/default/connect.pdf Image 2: Green Checkmark showing action is complete. Image 3: Doctor with Patient ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow To open checklist and exam case studies: Labeled with Keyboard Shortcut (KS) action. REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 13 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 13 – Knowledge Check Question 1 SLIDE NOTES Now that you have reviewed Exam Case Study #1, why is the exam insufficient? 1) The examiner’s credentials, address, phone number, and NPI number are missing. 2) The examiner’s credentials, signature, printed name, and specialty are missing. 3) The examiner’s address, signature, phone number, and NPI number are missing. 4) The examiner’s signature, specialty, NPI number, and medical license number are missing. Correct answer is number 2. ACCESSIBILITY OPTIONS Select the correct button or press the corresponding number on your keyboard. REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 14 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 14 – Knowledge Check Question 1 - Correct Answer SLIDE NOTES Correct. The examiner’s credentials, signature, printed name, and specialty are missing. Image: Button showing M21-1 reference with hyperlink. ACCESSIBILITY OPTIONS Please see M21-1 IV.i.3.A.1.b. Examiner Qualifications and Signature Requirements. M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports Click here or press H to review. REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 15 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 15 – Knowledge Check Question 1 -Incorrect Answer SLIDE NOTES Incorrect. The examiner’s credentials, signature, printed name, and specialty are missing. Image: Button showing M21-1 reference with hyperlink. ACCESSIBILITY OPTIONS Please see M21-1 IV.i.3.A.1.b. Examiner Qualifications and Signature Requirements. M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports Click here or press H to review. REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 16 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 16 – Exam Case Study #1 Review TRANSCRIPT As you may have noticed, the DBQ exam report was not signed, Section XVII on the Shoulder and Arms Conditions DBQ. Since this exam was completed by a VA- approved contractor, the exam report must contain the contractor’s signature, printed name, credentials, and specialty. VA cannot accept the DBQ without this information. Image: Cut-out of signature blocks on a DBQ ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 17 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 17 - Examiner Qualifications TRANSCRIPT The second element of exam report sufficiency that we will discuss is the examiner’s qualifications. Most DBQs can be completed by any medical professional regardless of their specialty; however, there are certain DBQs or situations that require a specific type of examiner. We will discuss these over the next few minutes. Image1: Two hands holding a clipboard. Image 2: Provider examining a patient’s ear. Image 3: Dentist cleaning patient’s teeth. Image 4: Patient having eye exam. ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Page 18 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 18 – Examiner Qualifications Mental Disorders (Initial Exams) TRANSCRIPT Only the following medical professionals can perform an initial mental examination: board-certified or board eligible psychiatrists and licensed doctorate-level psychologists. The following three medical professionals can also perform an initial mental examination as long as they are under the close supervision of a board- certified or board-eligible psychiatrist or licensed doctorate-level psychologist: doctorate-level mental health providers, psychiatry residents, and clinical or counseling psychologists completing a one-year internship or residency. Image: Patient and provider talking ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 19 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 19 – Examiner Qualifications – Mental Disorders (Review Exams) TRANSCRIPT Once an initial mental diagnosis has been made, additional medical professionals can perform review, or increase mental examinations as long as they are under the close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist. This includes, clinical social workers, nurse practitioners, clinical nurse specialists, and physician assistants. Outside of the medical professionals listed on these two slides, there are no other medical professionals that can perform mental examinations. Image: Four providers smiling ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 20 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 20 - Examiner Qualifications - TBI (Initial Diagnosis) TRANSCRIPT Regardless of what DBQ is used, the initial diagnosis of Traumatic Brain Injury (TBI) must be made be one of the following specialists: physiatrists, psychiatrists, neurosurgeons, and neurologists. Once the initial diagnosis has been made by one of the previously mentioned medical professionals, any qualified general clinician can complete the TBI DBQ. Image: Military vehicle explosion with three skulls showing various trauma angles ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 21 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 21 – Examiner Qualifications – Hearing Loss & Tinnitus TRANSCRIPT All hearing loss examinations must be completed by a state-licensed audiologist. Although tinnitus is generally evaluated using the same DBQ, a non-audiologist clinician can perform a tinnitus examination as long as a prior hearing loss examination is of record. Image: Male placing a hearing aid into ear ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 22 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 22 – Examiner Qualifications Oral and Dental Conditions TRANSCRIPT Only a licensed dentist can complete the Oral and Dental DBQ. Although temporomandibular disorder (TMD) is associated with the jaw, it is considered a musculoskeletal condition and therefore, any qualified general clinician can complete an examination for TMD. Image: False teeth sitting on desk ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 23 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 23 – Examiner Qualifications – Eye Conditions TRANSCRIPT Only a licensed optometrist or licensed ophthalmologist can complete the Eye Conditions DBQ. No other medical professional can complete this DBQ. Image: Patient having an eye exam ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 24 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 24 – Exam Case Study #2 TRANSCRIPT Now let’s put our knowledge to the test. A few months ago, VA received a claim for service connection for posttraumatic stress disorder (PTSD), bilateral hearing loss, and tinnitus. The Veteran is not service connected for any conditions. A VSR previously requested an exam at the VA Medical Center (VAMC) for all claimed conditions. Upon reviewing the claim, you discover that the exams are available in VBMS. Click the button below to launch the DBQ exam reports. Review these DBQs for the element of sufficiency that we just discussed. Once you have reviewed the DBQs, the forward arrow will appear at the bottom right of this slide, allowing you to continue to a knowledge check question covering this case study. Image 1: Circle highlighting link to Exam Case Review #2, Hyperlink: https://vbatraining.adobeconnect.com/p2r68s69bwg2/default/connect.pdf Image 2: Green Checkmark showing action is complete. ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow To open checklist and exam case studies: Labeled with Keyboard Shortcut (KS) action. REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 25 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 25 – Knowledge Check Question 2 SLIDE NOTES Now that you have reviewed Exam Case Study #2’s DBQ, why is the exam report insufficient? 1) The initial PTSD exam is missing the examiner’s qualifications. 2) The Hearing loss and Tinnitus exam is missing the examiner’s qualifications. 3) The initial PTSD exam has the incorrect examiner qualifications. 4) The Hearing loss and Tinnitus exam has the incorrect examiner qualifications. The correct answer is number 3. ACCESSIBILITY OPTIONS Select the correct button or press the corresponding number on your keyboard. REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 26 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 26 – Knowledge Check Question 2 – Correct Answer SLIDE NOTES Now that you have reviewed Exam Case Study #2’s DBQ, why is the exam report insufficient? 1) The initial PTSD exam is missing the examiner’s qualifications. 2) The Hearing loss and Tinnitus exam is missing the examiner’s qualifications. 3) The initial PTSD exam has the incorrect examiner qualifications. 4) The Hearing loss and Tinnitus exam has the incorrect examiner qualifications. The correct answer is number 3. Image: Button showing M21-1 reference with hyperlink to: M21-1 IV.i.3.A.1.i Qualification Requirements of Examiners – Psychological Examinations. ACCESSIBILITY OPTIONS Please see M21-1 IV.i.3.A.1.b. Examiner Qualifications and Signature Requirement REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 27 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 27 – Knowledge Check Question 2 – Incorrect Answer SLIDE NOTES Now that you have reviewed Exam Case Study #2’s DBQ, why is the exam report insufficient? 1) The initial PTSD exam is missing the examiner’s qualifications. 2) The Hearing loss and Tinnitus exam is missing the examiner’s qualifications. 3) The initial PTSD exam has the incorrect examiner qualifications. 4) The Hearing loss and Tinnitus exam has the incorrect examiner qualifications. The correct answer is number 3. Image: Button showing M21-1 reference with hyperlink to: M21-1 IV.i.3.A.1.i Qualification Requirements of Examiners – Psychological Examinations. ACCESSIBILITY OPTIONS Please see M21-1 IV.i.3.A.1.i. Qualification Requirements of Examiners – Psychological Examinations REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 28 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 28 - Exam Case Study #2 Review TRANSCRIPT As you may have noticed, the PTSD-Initial DBQ was not completed by a qualified medical professional. The PTSD-Initial DBQ was completed by a Registered Nurse (RN). However, the Hearing Loss and Tinnitus DBQ was completed by a qualified medical professional, an audiologist. Image 1: Cut-out of DBQ showing the DBQ signed by a RN. Image 2: Cut-out of a DBQ showing the DBQ signed by an Audiologist. ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 29 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 29 - Exam Completeness TRANSCRIPT The third and last element of exam report sufficiency that we will discuss is exam completeness. This last element is a catch-all that includes a number of items. As a VSR, a few of the items on which you should focus your review are the following. 1. Did the examiner address all the contentions listed in the original exam request. 2. Were all relevant questions answered in the DBQ. The DBQ contains many questions and not all of them must be answered during each examination. a. For example, certain questions are related to specific diagnoses and can be skipped if the Veteran is not diagnosed with that condition. Outside of a general review to determine if all relevant questions were answered, the VSR should also specifically review the exam report to determine if the examiner provided Acceptable Clinical Evidence (ACE) rationale, a medical opinion, and a claims folder review. b. If the examiner utilized the ACE process to complete the DBQ, they must provide rationale. c. If a medical opinion was requested, the examiner must provide the medical opinion or provide a rationale for why the medical opinion was not provided. d. If claims folder evidence was identified in the original request, the examiner must review the claims folder. 3. The DBQ must contain a diagnosis, or a statement that a diagnosis could not be provided, accompanied by rationale for the lack of diagnosis. a. If the Veteran has been previously diagnosed with a medical condition and the current examiner feels that a different diagnosis is better suited, rationale must also be provided. b. For example, let’s revisit our second case study where the Veteran was service connected for PTSD. If the examiner felt that a diagnosis of major depressive disorder (MDD) was better suited, they must provide rationale for that change in diagnosis. This could be something like, “The Veteran was misdiagnosed with PTSD and the body of evidence better supports the MDD diagnosis”. 4. Any required additional exams, tests, or findings must be included with the exam report. We will discuss this further on the next slide. Image: Cut-out of a VA Form 21-526EZ showing Veteran’s contentions ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Page 30 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Disability Benefits Questionnaires Switchboard Page 31 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 30 - Additional Exams/Tests/Findings TRANSCRIPT Certain medical conditions require additional exams, tests, or findings to be properly evaluated. Generally, when additional exams are needed the DBQ will direct the examiner to complete these additional DBQs. One of the most common examples of this is when the Veteran is diagnosed with diabetes mellitus and residuals of the disease are identified. For example, if the examiner identified peripheral neuropathy of the lower extremities, the examiner would then be required to complete the Diabetic Peripheral Neuropathy DBQ. If you have some extra time, please review page three of the Diabetes Mellitus DBQ. You can find this DBQ on the Disability Benefits Questionnaires Switchboard. Unlike with additional exams, DBQs do not generally direct the examiner to provide additional testing and as a VSR, you will not necessarily know when additional testing is required. A good rule of thumb is that if the DBQ mentions additional testing, either the form itself or the examiner, the VSR should review the claims folder for that information. Generally, the test itself is not provided but the results are. For example, you will not normally find X-ray images as a part of the DBQ, but you should find a report from the medical professional who reviewed those images. Below is a list of some common scenarios where additional testing may occur. • Cardiovascular — METs • Musculoskeletal — X-rays, MRIs, etc. • Respiratory — PFTs • Scars — measurements • Sleep apnea — sleep study. • Skin — color photos This list is by no means exhaustive nor is additional testing required in all scenarios. Image: Patient and Provider talking ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports Page 32 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 33 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 31 - Exam Case Study #3 TRANSCRIPT Now let’s put our knowledge to the test. A few months ago, VA received a claim for service connection for diabetes mellitus. The Veteran is not service connected for any conditions. A VSR previously requested an exam for diabetes mellitus and identified VAMC records for review. Upon reviewing the claim, you discover that the exam is available in VBMS. Click the button below to launch the DBQ exam report. Review the DBQ for the element of sufficiency that we just discussed. Once you have reviewed the DBQ, the forward arrow will appear at the bottom right of this slide, allowing you to continue to a knowledge check question covering this case study. Image 1: Circle highlighting link to Exam Case Review #3, Hyperlink: https://vbatraining.adobeconnect.com/pw8xfetkszl5/default/connect.pdf Image 2: Green Checkmark showing action is complete. ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow To open checklist and exam case studies: Labeled with Keyboard Shortcut (KS) action. REFERENCES M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 34 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 32 – Knowledge Check Question 3 SLIDE NOTES Now that you have reviewed Exam Case Study #3’s DBQ, why is the exam report insufficient? 1) The provider did not complete the necessary additional DBQ(s) and did not state if the VA eFolder evidence was reviewed. 2) The provider did not provide a medical opinion and did not state if the VA eFolder evidence was reviewed. 3) The provider did not provide ACE rationale and did not perform any necessary additional test(s). 4) The provider did not complete the necessary additional DBQ(s) and did not provide the requested medical opinion. The correct answer is number 1. ACCESSIBILITY OPTIONS Select the correct button or press the corresponding number on your keyboard. REFERENCES M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 35 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 33 – Knowledge Check Question 3 – Correct Answer SLIDE NOTES Now that you have reviewed Exam Case Study #3’s DBQ, why is the exam report insufficient? 1) The provider did not complete the necessary additional DBQ(s) and did not state if the VA eFolder evidence was reviewed. 2) The provider did not provide a medical opinion and did not state if the VA eFolder evidence was reviewed. 3) The provider did not provide ACE rationale and did not perform any necessary additional test(s). 4) The provider did not complete the necessary additional DBQ(s) and did not provide the requested medical opinion. The correct answer is number 1. Image: Button showing M21-1 reference with hyperlink to: M21-1 IV.i.3.C.1.a. Insufficient Examination Reports. ACCESSIBILITY OPTIONS Please see M21-1 IV.i.3.C.1.a. Insufficient Examination Reports REFERENCES M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 36 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 34 – Knowledge Check Question 3 – Incorrect Answer SLIDE NOTES Now that you have reviewed Exam Case Study #3’s DBQ, why is the exam report insufficient? 1) The provider did not complete the necessary additional DBQ(s) and did not state if the VA eFolder evidence was reviewed. 2) The provider did not provide a medical opinion and did not state if the VA eFolder evidence was reviewed. 3) The provider did not provide ACE rationale and did not perform any necessary additional test(s). 4) The provider did not complete the necessary additional DBQ(s) and did not provide the requested medical opinion. The correct answer is number 1. Image: Button showing M21-1 reference with hyperlink to: M21-1 IV.i.3.C.1.a. Insufficient Examination Reports. ACCESSIBILITY OPTIONS Please see M21-1 IV.i.3.C.1.a. Insufficient Examination Reports REFERENCES M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 37 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 35 - Exam Case Study #3 Review TRANSCRIPT As you may have noticed, the examiner did not complete the evidence review portion of the DBQ. In this specific case study, the examiner should have reviewed the VA eFolder as we identified VAMC records for review. Also, the examiner indicated that the Veteran had erectile dysfunction and the condition was as least as likely as not related to diabetes mellitus. As the DBQ directs, a Male Reproductive System DBQ should have been included with the Diabetes Mellitus DBQ. Image 1: Cut-out of DBQ showing Evidence Review section. Image 2: Cut-out of a DBQ showing the section asking the provider if the Veteran has any condition that is related. ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 38 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 36 - Insufficient Exam! What Next? TRANSCRIPT Now that we have covered the three elements of exam sufficiency, let’s discuss what a VSR should do if an insufficient exam is identified. A note before we jump in, these are just general guidelines and local policy can override these guidelines. Before taking any action, confirm the proper steps to take based on local policy at your regional office. If you are a Pre-D VSR and identify an insufficient exam, you should either route the claim to an RVSR for further review or request rework of the insufficient exam. If you are a Post-D VSR and identify an insufficient exam, you should defer the claim back to the RVSR. Image 1: Green arrows pointing in circular fashion. Image 2: The word “Deferred” in a circle and green banner overlay with the same word. ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES 38 CFR 4.2 — Interpretation of examination reports M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations Disability Benefits Questionnaires Switchboard Page 39 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 37 - Knowledge Check TRANSCRIPT The following questions are meant to reinforce the preceding information. Choose the best answer and follow the directions on the screen. You will receive instant feedback to gauge your understanding of the information. Select the forward arrow or use the right arrow key to begin. Image: A pad with boxes showing information to follow while taking the quiz. ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 40 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 38 – Knowledge Check Question 4 SLIDE NOTES In addition to the standard requirements, what other piece of information is required when the examiner is a VA-approved contractor? 1) List the examiner’s NPI number. 2) List the examiner’s address. 3) List the examiner’s specialty. 4) List the examiner’s medical license number. The correct answer is number 3. ACCESSIBILITY OPTIONS Select the correct button or press the corresponding number on your keyboard. REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 41 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 39 – Knowledge Check Question 4 – Correct Answer SLIDE NOTES In addition to the standard requirements, what other piece of information is required when the examiner is a VA-approved contractor? 1) List the examiner’s NPI number. 2) List the examiner’s address. 3) List the examiner’s specialty. 4) List the examiner’s medical license number. The correct answer is number 3. Image: Button showing M21-1 reference with hyperlink to: M21-1 IV.i.3.C.1.a. Insufficient Examination Reports. ACCESSIBILITY OPTIONS Please see M21-1 IV.i.3.C.1.a. Insufficient Examination Reports REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 42 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 40 – Knowledge Check Question 4 – Incorrect Answer SLIDE NOTES In addition to the standard requirements, what other piece of information is required when the examiner is a VA-approved contractor? 1) List the examiner’s NPI number. 2) List the examiner’s address. 3) List the examiner’s specialty. 4) List the examiner’s medical license number. The correct answer is number 3. Image: Button showing M21-1 reference with hyperlink to: M21-1 IV.i.3.C.1.a. Insufficient Examination Reports. ACCESSIBILITY OPTIONS Please see M21-1 IV.i.3.C.1.a. Insufficient Examination Reports REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 43 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 41 - Knowledge Check Question 5 SLIDE NOTES When can a generalist clinician/provider conduct a TBI examination? 1) When can a generalist clinician/provider conduct a TBI examination? 2) A generalist clinician/provider can never complete a TBI examination. 3) All generalist clinician/providers can complete a TBI examination at any time. 4) A generalist clinician/provider who has successfully completed the VA appropriate TBI training module, may conduct the exam, if a diagnosis is of record and it was established by the proper specialty provider. The correct answer is number 4. ACCESSIBILITY OPTIONS Select the correct button or press the corresponding number on your keyboard. REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 44 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 42 - Knowledge Check Question 5 – Correct Answer SLIDE NOTES When can a generalist clinician/provider conduct a TBI examination? 1) When can a generalist clinician/provider conduct a TBI examination? 2) A generalist clinician/provider can never complete a TBI examination. 3) All generalist clinician/providers can complete a TBI examination at any time. 4) A generalist clinician/provider who has successfully completed the VA appropriate TBI training module, may conduct the exam, if a diagnosis is of record and it was established by the proper specialty provider. The correct answer is number 4. Image: Button showing M21-1 reference with hyperlink to: M21-1 IV.i.3.A.1.j. Qualification Requirements of Examiners – TBI Examinations. ACCESSIBILITY OPTIONS Please see M21-1 IV.i.3.A.1.j. Qualification Requirements of Examiners – TBI Examinations. Click here or press H to review. REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 45 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 43 - Knowledge Check Question 5 – Incorrect Answer SLIDE NOTES When can a generalist clinician/provider conduct a TBI examination? 1) When can a generalist clinician/provider conduct a TBI examination? 2) A generalist clinician/provider can never complete a TBI examination. 3) All generalist clinician/providers can complete a TBI examination at any time. 4) A generalist clinician/provider who has successfully completed the VA appropriate TBI training module, may conduct the exam, if a diagnosis is of record and it was established by the proper specialty provider. The correct answer is number 4. Image: Button showing M21-1 reference with hyperlink to: M21-1 IV.i.3.A.1.j. Qualification Requirements of Examiners – TBI Examinations. ACCESSIBILITY OPTIONS Please see M21-1 IV.i.3.A.1.j. Qualification Requirements of Examiners – TBI Examinations. Click here or press H to review. REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 46 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 44 - Knowledge Check Question 6 SLIDE NOTES As a claim’s processor, who do you refer a case of DBQ fraud to? 1) Pension Management Center Manager 2) Office of Inspector General (OIG) 3) Veterans Service Center Manager 4) All of the above The correct answer is number 4. ACCESSIBILITY OPTIONS Select the correct button or press the corresponding number on your keyboard. REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 47 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 45 - Knowledge Check Question 6 – Correct Answer SLIDE NOTES As a claim’s processor, who do you refer a case of DBQ fraud to? 1) Pension Management Center Manager 2) Office of Inspector General (OIG) 3) Veterans Service Center Manager 4) All of the above The correct answer is number 4. Image: Button showing M21-1 reference with hyperlink to: M21-1 IV.i.3.A.2. Handling Cases of Fraud. ACCESSIBILITY OPTIONS Please see M21-1 X.iv.3.A.2 Handling Cases of Fraud Click here or press H to review. REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 48 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 46 - Knowledge Check Question 6 – Incorrect Answer SLIDE NOTES As a claim’s processor, who do you refer a case of DBQ fraud to? 1) Pension Management Center Manager 2) Office of Inspector General (OIG) 3) Veterans Service Center Manager 4) All of the above The correct answer is number 4. Image: Button showing M21-1 reference with hyperlink to: M21-1 IV.i.3.A.2. Handling Cases of Fraud. ACCESSIBILITY OPTIONS Please see M21-1 X.iv.3.A.2 Handling Cases of Fraud Click here or press H to review. REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 49 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 47 - Knowledge Check Question SLIDE NOTES You are a Post-D VSR reviewing a claim. During your review, you identify that one of the exams is insufficient. Which of the below actions is the appropriate next step in the claim process? 1) Refer the claim to an RVSR for further review before finalizing the claim. 2) Defer the claim back to the RVSR for review. 3) Request a rework examination. 4) Ask your coach for assistance. The correct answer is number 2. ACCESSIBILITY OPTIONS Select the correct button or press the corresponding number on your keyboard. REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 50 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 48 - Knowledge Check Question 7 – Correct Answer SLIDE NOTES You are a Post-D VSR reviewing a claim. During your review, you identify that one of the exams is insufficient. Which of the below actions is the appropriate next step in the claim process? 1) Refer the claim to an RVSR for further review before finalizing the claim. 2) Defer the claim back to the RVSR for review. 3) Request a rework examination. 4) Ask your coach for assistance. The correct answer is number 2. Image: Button showing M21-1 reference with hyperlink to M21-1 IV.i.3.C. Insufficient Examination Reports. ACCESSIBILITY OPTIONS Please see M21-1 IV.i.3.C. Insufficient Examination Reports. Click here or press H to review. REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 51 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 49 - Knowledge Check Question 7 – Incorrect Answer SLIDE NOTES You are a Post-D VSR reviewing a claim. During your review, you identify that one of the exams is insufficient. Which of the below actions is the appropriate next step in the claim process? 1) Refer the claim to an RVSR for further review before finalizing the claim. 2) Defer the claim back to the RVSR for review. 3) Request a rework examination. 4) Ask your coach for assistance. The correct answer is number 2. Image: Button showing M21-1 reference with hyperlink to M21-1 IV.i.3.C. Insufficient Examination Reports. ACCESSIBILITY OPTIONS Please see M21-1 IV.i.3.C. Insufficient Examination Reports. Click here or press H to review. REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 52 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 50 - Conclusion TRANSCRIPT Congratulations! You have successfully completed the Identifying Insufficient and Potentially Fraudulent Disability Benefits Questionnaires (DBQs) self-paced module. Now that you have completed this module, you should be able to: • Identify exam insufficiencies when reviewing DBQ exam reports, and • Identify the actions to take once an exam insufficiency has been identified. ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Next Slide: Right Arrow REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 53 of 54

TBD_Identifying Insufficient and Potentially Fraudulent Monday, September 23, 2024 Disability Benefits Questionnaires (DBQs) Slide 51 - Would you like to know more? TRANSCRIPT Would you like to know more? The references on this slide will be helpful when looking for more information regarding exam report sufficiency. After reviewing the references, you may exit the module by clicking the seal. ACCESSIBILITY OPTIONS You can use the navigation buttons at the bottom of each slide to move forward and backward throughout this module. You can also use the following keyboard shortcuts: Access Slide Notes/Hyperlinks: H Closed Caption: C Pause: S Play: P Previous Slide: Left Arrow Exit: Department of Veteran’s Affairs Logo/Eagle or “X” REFERENCES 38 CFR 4.2 — Interpretation of examination reports 38 CFR 4.75 — General considerations for evaluating visual impairment M21-1 IV.i.2.A. — Examination Requests Overview M21-1 IV.i.3.A. — General Criteria for Sufficiency of Examination Reports M21-1 IV.i.3.C. — Insufficient Examinations M21-1 X.iv.3.A - Fraud and Laboratory Analysis of Evidence US Department of Veterans Affairs Office of Inspector General Report Disability Benefits Questionnaires Switchboard NWQ Playbook Page 54 of 54