The Department of Veterans Affairs (VA) uses a specific method called the Acceptable Clinical Evidence (ACE) exam to evaluate disability claims. This process is a specialized review that allows the VA to collect necessary medical opinions and evidence without requiring the veteran to attend a mandatory in-person appointment. The ACE method relies entirely on a review of existing medical documentation already present in the veteran’s file to determine the severity and service connection of a claimed condition. This administrative procedure is designed to streamline the overall claims process, leading to a potentially faster decision when the supporting evidence is complete.
Defining the ACE Exam
The ACE exam is formally defined as a records-only review conducted by a VA or contract medical professional to gather sufficient medical information for a disability rating. Its primary purpose is to assess a veteran’s claimed physical or mental health conditions when the existing evidence is adequate to support a medical opinion. This review is a component of the broader Compensation and Pension (C&P) examination process used by the Veterans Benefits Administration (VBA). The medical examiner scrutinizes all available documentation, including Service Treatment Records, private medical records, and previous examination results, to make an informed medical assessment. The goal is to establish a medical opinion regarding the veteran’s condition, its severity, and its relationship to military service.
The Mechanics of the ACE Review
The ACE review is characterized by the absence of a traditional in-person medical examination, setting it apart from standard C&P appointments. Instead, the assigned medical professional performs a detailed, forensic analysis of the veteran’s complete claims file, which includes all submitted medical and service records. This analysis is then used to complete a Disability Benefits Questionnaire (DBQ), which is the standardized form the VA uses to capture the medical facts of a disability. The examiner documents their findings and provides a medical nexus opinion, which addresses whether the disability is connected to military service or an existing service-connected condition.
In some instances, the examiner may determine that the existing records require clarification from the veteran. The examiner has the option to conduct a brief telephone interview to ask clarifying questions about current symptoms or medical history. This phone call is not a full medical examination, but a supplementary tool used to finalize the DBQ based on the documentation. The examiner must use specific protocols to verify the veteran’s identity during this call. The use of the ACE method is noted directly on the completed DBQ form.
When the VA Utilizes the ACE Process
The VA typically opts for an ACE review when the medical evidence for a claimed condition is sufficient to make a medical determination. This method is commonly utilized for claims where the diagnosis is already well-established by treating physicians and the VA is only seeking a medical opinion on the nexus or severity. Conditions frequently evaluated through the ACE process include hearing loss, tinnitus, migraines, and sleep apnea. These conditions often rely heavily on diagnostic test results and medical history rather than a hands-on physical exam.
The ACE review is also frequently employed for claims involving a request for an increased rating for an already service-connected condition, particularly when new documentation indicates a minor progression of symptoms. The VA may also use ACE to obtain a supplemental medical opinion, such as determining if a claimed disability is secondary to an existing service-connected condition. However, the ACE process is not permitted for all conditions, specifically excluding initial evaluations for mental health disorders and traumatic brain injury (TBI) residuals due to the necessity of a direct clinical interview. The decision to use ACE is made by the examiner after reviewing the request and the available evidence, unless the VBA has specifically mandated an in-person exam.
Preparing for an ACE Evaluation
Since the ACE evaluation is a records review, the outcome is entirely dependent on the quality and completeness of the documentation submitted by the veteran. Before the VA initiates the review, veterans must ensure their claims file contains all current and relevant medical evidence. This involves submitting comprehensive treatment notes from both VA and private healthcare providers, as the examiner will only consider the records that are present in the file.
Veterans should proactively gather and submit any independent medical opinions (IMOs) or Nexus letters from private physicians that support their claim. This documentation should explicitly state the diagnosis, the severity of symptoms, and the physician’s opinion on the service connection. Once the VA assigns the claim for an ACE review, the window for submitting new evidence closes quickly, making early preparation a determining factor.