ACE Exams (Records-Review Exams)

ACE stands for Acceptable Clinical Evidence. In an ACE examination, a clinician completes your Disability Benefits Questionnaire by reviewing the medical evidence already in the file — service treatment records, VA and private treatment notes, imaging, laboratory results — sometimes adding a telephone interview with you, and without conducting an in-person examination. The resulting DBQ is used by the rater exactly as an in-person report would be.

Why the process exists

The insight behind ACE is straightforward: for a fair number of claims, the information the rating criteria require is already sitting in the file. If a veteran has a documented diagnosis, current laboratory values, recent imaging and a stable treatment record, hauling them to a clinic to be told what the notes already say adds delay without adding evidence.

ACE is genuinely useful in three ways:

• Speed. No appointment to schedule, no travel, no waiting for a vendor slot. Weeks or months can come off the timeline.
• Access. Veterans in rural areas, with mobility limitations, or in circumstances that make travel hard are not penalised for it.
• Consistency. Where a condition is measured by numbers that already exist, a records review will report those numbers accurately.

VA's use of ACE expanded substantially during and after the COVID-19 period and it is now a routine part of the examination system, used by both VHA and contract examiners. The procedures governing when ACE may be used are set out in VA's M21-1 Adjudication Procedures Manual and in VHA examination guidance, and they do change — check the current text before relying on any particular provision.

When VA may use ACE

The controlling principle is that the existing evidence must be sufficient to complete the DBQ without an in-person examination. In practice, ACE tends to be selected when:

• The records contain recent, complete findings covering the criteria for the condition claimed;
• The condition is one that is rated primarily on documented objective data — laboratory values, imaging, pulmonary or cardiac testing, treatment frequency;
• The question in front of VA is a medical opinion — nexus, aggravation, causation — rather than current severity;
• The condition is stable and unlikely to have changed materially since the documented findings were taken;
• A telephone interview can supply whatever additional history is needed.

A telephone-supplemented ACE is still an ACE examination. If a clinician calls you and asks about your symptoms without ever seeing you, that is what happened — and it is worth writing down the date, who called, how long the call lasted, and what you were asked. Veterans frequently do not realise the call was the exam.

How to tell whether your exam was an ACE

There is often no announcement. The signs, in rough order of reliability:

• The completed DBQ in your claims file indicates the examination was performed by review of records, or notes that the veteran was not examined in person.
• You were never given an appointment, or an appointment was cancelled and a decision followed anyway.
• A clinician telephoned you, asked questions for fifteen or twenty minutes, and nothing further was ever scheduled.
• The rating decision cites an examination on a date when you did not attend one.

If a clinician does call, treat it as the examination it is. Have your symptom log to hand, describe your worst days and your average days rather than how you happen to feel during the call, and give flare-up frequency, duration and functional loss in concrete terms. Everything on our what to expect page applies to a telephone interview, and applies more strongly, because the examiner has nothing else to go on. Ask directly whether an in-person examination will follow, and write down the answer along with the caller's name and the date.

Why veterans are often unhappy with them

The complaint we hear most often is some version of "nobody ever looked at my knee." That is not merely a grievance about manners. For a large class of conditions it is a genuine evidentiary problem.

Musculoskeletal ratings are built on measurement. The criteria are written in degrees of flexion and extension, and 38 CFR §4.59 requires that painful motion be taken into account, with Correia v. McDonald, 28 Vet. App. 158 (2016) requiring — where possible — testing on active motion, passive motion, in weight-bearing and in non-weight-bearing. None of that can be done over the telephone. If your treatment records do not happen to contain goniometer readings taken in all those conditions, and almost no treatment record does, the ACE report cannot supply them.

The same gap appears elsewhere:

When an ACE exam is not adequate

The adequacy standard does not change because the examination was done on paper. Under Barr v. Nicholson, 21 Vet. App. 303 (2007), an examination VA provides must be adequate for rating purposes. An ACE report is inadequate when:

• It omits a measurement the criteria require, and the omitted measurement cannot be found anywhere in the records reviewed;
• It relies on stale findings — a range-of-motion note from four years ago used to describe your current severity, when you have claimed the condition has worsened;
• It fails to address flare-ups, which for musculoskeletal claims is squarely within Sharp v. Shulkin, 29 Vet. App. 26 (2017);
• It gives an opinion with no rationale, which is a defect regardless of examination format;
• The claim was specifically about worsening and no current assessment of severity was obtained at all.

That last one is the strongest argument in this area. If you filed for an increase because the condition got worse, and VA answered by reviewing records that predate the worsening, the examination did not address the question the claim asked.

What to do about it

1. Get the report. Request your claims file with VA Form 20-10206 and read the completed DBQ. Check for an indication that the examination was completed by ACE, and note the date of every finding the examiner relied on.
2. Compare it to the criteria for your diagnostic code in 38 CFR Part 4. Our index of 158 conditions gives you the governing DBQ and diagnostic code for each condition so you know what should be there. List every required finding that is missing.
3. Choose the lane. Where the defect is visible on the face of the record, a Higher-Level Review can return the claim for correction as a duty-to-assist error — including an order for a proper in-person examination. Where you would rather supply the measurements yourself, a Supplemental Claim with a private DBQ from your own provider does the job directly. The comparison is at HLR vs Supplemental Claim.

The full list of defects worth checking for, across every body system, is on our inadequate examinations page.

Can you ask for an in-person exam instead?

You can ask, and it is worth asking early rather than after the decision. Contact the examination vendor or VA using the details on the examination notice and explain, specifically, why the records cannot answer the question — "my knee range of motion has never been measured and my claim is that it has worsened since 2023" is a reason; "I want to be seen in person" on its own generally is not.

VA is not obliged to grant the request. But the request, and its refusal, become part of the story if the resulting report turns out to be inadequate — and a contemporaneous note that you flagged the gap before the exam was completed is useful. If the decision has already issued and gone against you, start at your claim was denied and work back to which finding was missing.