to established service-connectedness, the most common being to prove one of the following:
the “injury or disease resulting in disability was incurred coincident with service in the Armed Forces” (38 CFR §3.303);
a preexisting injury or disease was aggravated by active service (38 CFR § 3.306);
a presumptive service connection was established by law or VA policy (38 CFR §§3.307, 3.308, or 3.309); or
the condition occurred as a result of an injury or disease that was incurred during the time of service (38 CFR §3.310).
After an application is received, the VBA reviews it for completeness and is responsible—under the so-called duty to assist3—to help a claimant “who files a substantially complete application in obtaining evidence to substantiate his or her claim before making a decision on the claim” (DVA, 2006). Once all of the relevant evidence has been collected and all of the requested (and available) information has been received, depending on the conditions that have been identified a VBA Veterans Service Representative (VSR) or a Rating Veterans Service Representative (RVSR) will request that the Veterans Health Administration (VHA) set up and conduct one or more examinations. These examinations will be conducted either by staff clinicians or by contracted health professionals, depending on the facility used and the need for specialists.
Examinations may also be conducted in other circumstances. These include when:
it is required by regulations;
it is necessary to resolve an uncertainty related to a diagnosis;
there is a need to establish a nexus between an already-diagnosed condition and military service;
a veteran who has a disability that has already been established as being service connected indicates that this disability has worsened or that the level of the disability rating does not accurately reflect his or her condition; or
it is required as part of an adjudication to resolve a compensation-related issue.
According to a procedural handbook, “VHA has a time standard of 35