Fast Letter 07-09-07

[Wings]

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DEPARTMENT OF VETERANS AFFAIRS

Veterans Benefits Administration

Washington, D.C. 20420

April 20, 2007

 

Director (00/21)

All VA Regional Offices and Centers Fast Letter 07-09

 

SUBJ: Claims Filed by Service Members Prior to Discharge

 

This fast letter supersedes fast letter 06-05. This letter provides information and guidance for the processing and rating of claims that are filed by service members. These instructions will remain in effect until the update of M21-1MR due for release in approximately 90 days. It includes updated information on the types of claims filed by active duty personnel, the procedures to follow when processing these claims, and the responsibilities of regional offices (ROs), Benefits Delivery at Discharge (BDD) intake sites, and rating activity sites (RASs).

 

 

Participants

 

Any service member may file a claim for disability compensation if he/she is within 180 days of discharge. For purposes of this fast letter, the term service member means all service members on active duty to include members of the National Guard (title 10 or title 32), Reserves, and service members undergoing medical evaluation board (MEB) or physical evaluation board (PEB) proceedings.

 

 

Categories of Claims Filed By Active Duty Personnel

 

Claims categories do not determine processing priority. The categories assist VA in determining where a claim should be processed to afford the best service to the claimant. The time and place of filing govern the category of a claim.

Pre-Discharge

 

A pre-discharge claim is taken from a service member who has 180 days or less remaining on active duty. A pre-discharge claim may or may not be considered a BDD claim. Service members filing pre-discharge claims may be afforded a VA examination while on active duty. Pre-discharge claims that are not BDD claims are rated at a regional office.

Page 2.

 

SUBJ: Claims Filed by Service Members Prior to Discharge

 

 

Claims From GWOT and OIF/OEF Service Members

 

All claims from service members who have participated in the Global War on Terrorism, to include Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF), will receive priority handling. These cases will be permanently flashed to reflect OIF/OEF status and processed expeditiously. Those cases requiring case management, (such as very serious injury or illness (VSI), serious injury or illness (SI), special category person where there has been a loss of a body part (SPC)), are excluded from the BDD program and will be expeditiously processed in accordance with VBA Letters 20-05-14 and 20-07-04.

 

BDD

A BDD claim is a specific type of pre-discharge claim that is taken from a service member on active duty at a BDD intake site, processed through the BDD program, and rated at a RAS. In order for a claim to be processed as a BDD claim, service members must have 60-180 days remaining on active duty and must be available to attend all required examinations that are scheduled by the local intake site. Service members that file BDD claims at a BDD intake site may also be afforded a single cooperative examination provided they file their claims timely enough to satisfy local memoranda of understanding (MOUs) regarding the single separation exam.

 

 

Responsibilities of the RO

 

 

ROs that do not maintain BDD intake sites will be responsible for outreach, and for taking and developing pre-discharge claims at military installations within their jurisdiction. These are called RO intake sites. ROs with BDD intake sites also have responsibility for taking and developing any pre-discharge claims. Claims should be fully developed and rated by the RO that takes the claim. If the service member will not be available to attend all required examinations, the claim can be forwarded directly to the regional office of jurisdiction (ROJ) for development action and processing. Each intake site will identify at least one point of contact for VA examinations, Vocational Rehabilitation and Employment (VR&E) issues, and general liaison purposes.

 

 

 

 

Page 3.

 

SUBJ: Claims Filed by Service Members Prior to Discharge

 

 

Pre-Discharge Outreach Activities

 

Claims from service members may be received in numerous ways. An important aspect of informing service members about the pre-discharge process is through outreach. ROs should contact returning service members through the following programs, and must work closely with local military bases and reserve/guard units to ensure that VBA is part of the military pre-separation process. Where feasible, a local MOU should be developed to support our outreach programs. It is important that when advertising VA briefings, as described below, service members are advised to bring copies of their service medical records (SMRs) for the claims workshops as defined in the next paragraph.

 

·        Formal Transition Assistance Program (TAP). VA benefit briefings should be four hours in length and Disabled Transition Assistance Program briefings should be two hours in length.

·        Other VA benefit briefings for service members such as separation and retirement briefings.

·        VA benefit briefings for demobilizing reserve/guard members as part of the three to five day military pre-separation process.

·        Reserve/guard “Welcome Home” activities and events (such as Welcome Home Warrior, Family Activity Days, etc.).

·        Outreach to severely injured service members who are patients at a military treatment facility or a VA medical center (VAMC) as outlined in VBA Letter 20-05-14 dated March 8, 2005.

·        Outreach activities jointly sponsored with local VAMCs, National Guard units, and the State Directors of Veterans Affairs as outlined in the October 5, 2005, memorandum co-signed by the Under Secretary for Benefits and the Under Secretary for Health. (Subject: Memorandum of Agreement with the National Guard Bureau.)

 

 

Claims Intake at VA Benefit Briefings

 

“Claims workshops” should be scheduled, where feasible, in conjunction with the various types of benefit briefings listed above. A “claims workshop” provides a forum where RO personnel conduct personal interviews with service members who wish to file a claim at that time. ROs should invite and encourage Veterans Service Organization (VSO) participation in these workshops. Copies of SMRs should be obtained at the time a VA disability compensation claim is taken. This is important to expedite the claim.

 

Page 4.

 

SUBJ: Claims Filed by Service Members Prior to Discharge

 

 

NOTE: VA benefit claims taken for OIF/OEF service members (active duty and reserve/guard members) must be flagged as an “OIF/OEF Claim” so priority will be given to those claims. Additionally, VSI and SPC claims must be identified to ensure that they are “case managed” in accordance with VBA letter 20-05-14.

 

 

Claims Establishment and Development

 

 

The following procedures apply to ROs when establishing pre-discharge claims and to BDD intake sites when establishing pre-discharge (non-BDD) claims.

 

Personnel will use SHARE to establish EP 017, 117, 027, or 297, as appropriate. The “pre-discharge” indicator will be checked on all EPs, which will automatically create a diary. The diary due date will be the day after the anticipated separation date. Service members will be scheduled for a VA examination and receive notification in compliance with the Veterans Claims Assistance Act (VCAA).

 

Note: Whether or not the service member elects to sign the Notice Response, the claims folder must contain a dated copy of the VCAA notice. (See Fast Letter 06-04 regarding special notification provisions for interviews conducted at BDD sites).

 

EPs 111 and 011 are only established by BDD intake sites and those claims are completed by a RAS. The “1” modifier identifies the claim as one processed through the BDD program. All stations will use EP 027 for re-opened pre-discharge claims (BDD and non-BDD). Additionally, the memorandum of agreement signed by VA and the Department of Defense excludes MEB/PEB cases from the single cooperative examination; therefore, these cases will not have a “1” modifier, even if they are accepted at a BDD intake site.

 

If available, personal cell phone numbers and e-mail addresses should be obtained from claimants. This information is supplemental and may be useful in facilitating further development action.

 

A DD Form 214, Certificate of Release or Discharge from Active Duty, is issued at the time of release from active duty. If available to the RO, this document must be reviewed to ensure that the projected date of separation on the VA Form 21-526 coincides with the verified date on the DD Form 214. If the DD Form 214 is not of record at the time of anticipated separation, the RO must verify service by any means available to include the Veterans Information Solution (VIS). As soon as service is verified, the claim will be promulgated and the veteran notified.

Page 5.

 

SUBJ: Claims Filed by Service Members Prior to Discharge

 

 

If the service member remains on active duty for 60 days following the anticipated date of separation, disallow the claim in accordance with M21-1MR, Part III, Subpart ii, Chapter 2.B.8.e.

 

 

Responsibilities of the BDD Intake Sites

 

Establishment and Maintenance of Claims Folders

 

If a claims folder does not already exist, the intake site will establish a red rope claims folder upon receipt of VA Form 21-526 from an eligible claimant. If a claims folder was previously established but is located at another RO or the Records Management Center; the intake site must recall the claims folder. The claim materials may be maintained in a temporary folder pending receipt of the claims folder. If sufficient evidence is of record, claims development action should not be delayed due to the absence of the claims folder.

 

Initial Actions

 

The intake site will ensure VA Form 21-526, Veteran’s Application for Compensation or Pension, is completed, obtain photocopies or originals (preferred) of the SMRs from the claimant or service department, and secure examination results.

 

Upon receipt of an application from a service member who has 60-180 days remaining on active duty and is available to attend all examinations, the intake site will provide VCAA notice and obtain the VCAA Notice Response. Using SHARE, the intake site will establish EP 011, 111, 027, or 297, as appropriate. The “pre-discharge” indicator will be checked, which will automatically create a diary, and the appropriate intake site location will be selected on the Claims Establishment screen.

 

If an intake site receives a claim that does not meet the criteria for handling by a RAS, the intake site should process the claim in accordance with the same procedures that are outlined for ROs under “Claims Establishment and Development”.

 

Additional Responsibilities

 

The BDD intake sites will maintain a functional presence at military installations. Regular BDD intake sites and participating ROs operating itinerant BDD intake sites remain responsible for initial claims processing according to policies already in place. Responsibilities include providing outreach, taking claims, requesting examinations,

 

Page 6.

 

SUBJ: Claims Filed by Service Members Prior to Discharge

 

 

and initiating other development as appropriate. Each BDD intake site will identify at

least one point of contact for VA examinations, Vocational Rehabilitation and Employment (VR&E) issues, and general liaison purposes.

 

 

Shipment of Claims Folders

 

Once all development has been completed and all examinations have been received for a BDD claim, intake sites must ship the claims folder to the RAS. This may be before or after separation. The claims package must be in a ready-to-rate status with the DD Form 214, if available. If the DD Form 214 is not of record at the time the claim package is forwarded for rating action, the intake site must forward it to the appropriate RAS as soon as it becomes available.

 

At least once each week, the intake site must send all ready-to-rate claims to the BDD RAS via FEDEX Ground. Intake sites must use COVERS to transfer claims folders. This will allow ROs to change the Station of Jurisdiction (SOJ) of the claim in VETSNET. (See VETSNET February 2007 Fact Sheet.) If the intake site does not obtain the original SMRs from the claimant or service department until after separation, and has already sent the claim package to the BDD RAS or ROJ, the intake site must forward the original SMRs to that BDD RAS or ROJ. The cost of shipment of the claims folders or claim packages will be borne by the RO with jurisdiction over the BDD intake site. There is no need to send a photocopy or facsimile record of the VA Form 21-526 to the BDD RAS or ROJ prior to submission of the claim package.

 

Intake sites will not transfer claims involving seriously disabled or terminally ill service members, certain special issues, or claims that require prolonged development (e.g., claims involving radiation exposure, Gulf War undiagnosed illness, pregnant service women, or stressor verification) to a BDD RAS. (See M21-1 MR, Part III, Subpart iv, Chapter 3.A.4.) Such cases must be maintained at the intake site or ROJ for processing. Control such claims with the appropriate EP of 110, 010, or 020, unless a different third-digit modifier is required to identify it as a special issue claim.

BDD intake sites will no longer establish EP 684 to control the claims development process of BDD claims. Claims will be controlled via EPs 011, 111, 027, or 297, as appropriate. Upon completion of the intake or development phase and transfer of the claim to the appropriate RAS, the intake site will perform a one-time PCLR of EP 684. If the intake site does not develop the claim, but merely accepts and forwards the VA Form 21-526, it is not entitled to EP 684. The intake site is entitled to credit

 

Page 7.

SUBJ: Claims Filed by Service Members Prior to Discharge

 

 

for an interview if one was conducted. When establishing BDD or pre-discharge claims, intake sites must employ MAP-D tracking. List all claimed conditions in “contentions” and record the dates of all required development actions, including the dates of examination requests and receipt of the examination reports.

 

 

Claims for Resumption of Compensation Received Prior To Separation

 

When a veteran entitled to disability compensation returns to active duty, the ROJ must terminate the veteran’s award. Once the service member is again released from active duty, VBA may resume benefits immediately for any service-connected disability that is considered static. However, the rating activity must re-evaluate any non-static disabilities. (See M21MR, Part III, Subpart v, Chapter 4, Section C.16 “Termination and Resumption of Benefits for Extended Active Service.”)

 

If a service member was previously rated for a compensable service-connected disability that was static in nature, and compensation was terminated due to return to active military service, a claim for resumption of compensation can be filed at a RO or BDD intake site. Upon receipt of such a claim, the RO or BDD intake site will resume benefits immediately following separation for any service-connected disability considered static (no future examination pending); however, the last coded rating sheet must be reviewed.

 

NOTE: If a resumption of benefits for a static disability is the only claim and cannot be processed at the site where it is accepted, the claim should be forwarded to the ROJ for establishment and processing.

 

The proper effective date is the day following release from active duty if the request for resumption of benefits is received within one year from the date of such release. Otherwise, the proper effective date is one year prior to the date of receipt of the request. Under 38 CFR 3.31(b) and 38 CFR 3.654(b)(2), the end-of-month rule does not apply to the resumption of benefits following release from active duty.

 

ROs and BDD intake sites must use EP 297 to resume payment of compensation when the claim is received prior to separation. The EP should be established as a diary. If the service member has both static and non-static disabilities, compensation payments will be resumed for the static conditions upon separation while developing for current medical evidence to evaluate the non-static disabilities.

 

Page 8.

 

SUBJ: Claims Filed by Service Members Prior to Discharge

 

 

For re-opened claims, evaluations for non-static disabilities, claims for new conditions or increases, VBA personnel should refer to the “Claims Establishment and Development” section in this letter.

 

 

Responsibilities of the BDD RAS

 

Initial Actions

 

The BDD RASs have primary responsibility for rating, award, and notification actions of original and reopened claims received from BDD intake sites. Working in cooperation with their corresponding intake sites, the RASs will abide by negotiated MOUs regarding established policies and/or specific procedures to facilitate the expeditious handling of BDD claims.

 

A claim package submitted by a participating intake site will include SMRs, medical examination report(s), VA Form 21-526, and any additional evidence obtained through intake-site development. The claim package should include the red rope claims folder.

 

Upon receipt of claim packages from an intake site, the RAS will receive the claims folder in COVERS, which will transfer the SOJ from the intake site to the RAS. This will allow the RAS to control the EP that was established by the intake site. The RASs should continue to create a special COVERS location for BDD claims.

 

Since the BDD RAS will evaluate the results of requested examinations, it will also be responsible for conducting quality reviews of the examination reports. If an examination report is found to be inadequate; the RAS will refer it back to the VAMC or QTC for appropriate action. However, if the claimant has already been discharged and is no longer available for further examination or tests at the discharge site, the RAS will take partial rating action, if appropriate, and be responsible for scheduling any necessary examinations and rating any deferred issues.

 

Evidence of Separation or Discharge

 

Following VSO review of the rating decision, if appropriate, and receipt of the DD Form 214 or other acceptable verification of service, the RO or RAS will process the rating decision and clear the pending EP upon authorization of the award and notification of the veteran.

 

 

Page 9.

 

SUBJ: Claims Filed by Service Members Prior to Discharge

 

 

If after the anticipated date of release from active duty, no documentary evidence of separation or retirement has been received, check VIS or contact the appropriate separation site or transition facility to determine the claimant’s duty status.

 

If the service member remains on active duty after the anticipated release date but plans to separate within the next 60 days, extend the diary date to the new anticipated release date. If the service member remains on active duty after the anticipated release date and will not separate within the next 60 days take the following actions:

 

·        Processes a disallowance based on the claimant’s active duty status and clear the pending EP, as appropriate. File any unpromulgated rating documents on top of any accumulated evidence (examination reports) in the claims folder and clearly mark the rating document as “unpromulgated.”

·        Notify the claimant that he/she may reopen the claim upon discharge.

 

Post Rating Actions

 

The BDD RAS or RO, as appropriate, will tag the center flap of the claims folder, or left flap of a temporary folder, with a temporary flash to identify the date of the rating decision and release of the notification letter. The flash will be removed after expiration of the one-year appeal period.

 

Following release of the decision notification, the RO or BDD RAS will hold the completed case for two monthly STAR review cycles. This waiting period will afford time for a STAR review. The RO or RAS will then ship the claims folder to the appropriate ROJ, which will manage all subsequent claims activity. The ROJ will not return the claims folder to the BDD RAS, unless the veteran re-enters service and files another BDD claim. In the event of an appeal or receipt of a new claim for additional issues while the claims folder is located at the RAS, the RAS will transfer the claims folder to the ROJ without waiting for expiration of the two STAR review cycles. Either of these events will terminate the BDD RAS’s jurisdiction over the file.

 

NOTE: For claims processed under the Paperless Claims Process the RAS that rates the claim will maintain permanent jurisdiction of the claims folder and any subsequent claims filed by the veteran.

 

 

 

 

Page 10.

 

SUBJ: Claims Filed by Service Members Prior to Discharge

 

 

Handling VR&E Claims

 

ROs or BDD intake sites may receive VR&E claims from service members that are being medically separated and who wish to begin receiving Chapter 31 benefits while on active duty.

 

Upon receipt of VA Form 28-1900, Disabled Veterans Application for Vocational Rehabilitation, an ancillary benefits rating (memorandum rating) will be prepared. If the application is filed in conjunction with a BDD claim, the intake site, its parent

RO, or the RAS may process the application in accordance with the established MOU between the intake site and the RAS.

 

If the application is filed with a non-BDD pre-discharge claim, an ancillary benefits rating may be completed in accordance with M21-1MR, Part IX, subpart i, Chapter 1, Section A.

 

The ancillary benefits rating action will be controlled with EP 095. Only the ROJ may clear this EP at the present time, since doing so triggers automatic establishment of EP 719 by virtue of a link between BDN and CWINNRS. This is an interim limitation pending resolution of technical issues between SHARE, BDN, and CWINNRS. Until then, each RAS must keep track of the number of memorandum ratings it completes.

 

 

Handling Loan Guaranty Issues

 

Veterans who have a compensable service-connected disability and purchase a home using their VA Home Loan Guaranty are eligible for waiver of the funding fee. Service members who are separating may receive an ancillary benefits rating that establishes they will be in receipt of compensation and thus eligible for the funding fee waiver; however, the ancillary benefits rating must be based upon the results of a pre-discharge examination in accordance with 38 U.S.C. § 3729 ©(2). When taking an application for compensation benefits, ROs and BDD intake sites will ask the claimant if he or she plans to use the VA Home Loan Guaranty to purchase a home prior to separation. If so, the claimant will be advised to ensure the lender knows that a pre-discharge or BDD claim is pending with VA.

 

Upon receipt of VA Form 268937, Verification of VA Benefits, the Regional Loan Center (RLC) will send an e-mail to a designated point of contact at the appropriate BDD RAS or RO. If the RAS or RO has not yet decided the claim, the examination

 

Page 11.

 

SUBJ: Claims Filed by Service Members Prior to Discharge

 

 

results will be reviewed to determine if the claimant will be entitled to service connection with a combined evaluation of 10% or greater. The RAS or RO will then prepare an ancillary benefits rating for the file.

 

The BDD RAS or RO will reply to the RLC via e-mail with one of the following certifications:

 

·        If a rating has been completed: “The claimant will receive service-connected disability compensation of $[amount] monthly upon discharge from active duty.”

·        If an ancillary benefits rating has been completed: “The claimant will be entitled to service-connected disability compensation of at least $[10% rate] upon discharge from active duty.”

·        If the examination is not sufficient evidence to rate: “The claimant has a pre-discharge/BDD claim pending; however, the evidence available is not sufficient to determine whether a compensable service-connected disability exists.”

·        If the examination does not establish a compensable service-connected disability: “The claimant’s pre-discharge examination does not support the establishment of a compensable service-connected disability.”

 

The memorandum rating action will be controlled under EP 297.

 

 

Handling Appeals

 

The RO with jurisdiction over the location where the veteran resides following separation from service is responsible for handling all appeals with the exception of claims processed through Virtual VA. Appeals of these claims will fall under the jurisdiction of the RAS where the paperless claim was processed.

 

Each BDD RAS or RO holds claims folder for two STAR review cycles following promulgation of the rating decision and notification. Upon receipt of a valid notice of disagreement (NOD), however, the RAS or RO will forward the claims folder to the appropriate ROJ.

 

The ROJ must ensure that an NOD on a pre-discharge or BDD claim is appropriately identified in VACOLS by checking the “Pre-discharge VA Exam” block selected in the “Special Interest” field on the dispatch screen.

 

 

Page 12.

 

SUBJ: Claims Filed by Service Members Prior to Discharge

 

 

Handling Claimants’ Inquiries

 

Pre-discharge and BDD claimants may direct inquiries about the status of their claims through their BDD intake site with locally provided telephone numbers or through the toll-free VA telephone number: 1-800-827-1000.

 

ROs, BDD intake sites, and RASs must keep MAP-D records, including notes, updated to allow Public Contact teams to provide comprehensive responses to any inquiries from claimants. If a team member cannot answer a question, he or she should create a VAI through IRIS and forward it to the appropriate BDD RAS or RO for reply.

 

ROs and BDD intake sites should not refer telephone inquiries to BDD RASs.

 

 

If You Have Questions

 

Questions about this fast letter should be submitted to the VAVBAWAS/CO/PREDISCHARGE mailbox.

 

 

This Letter Rescinds

 

This letter is rescinded on April 20, 2008.

 

 

/s/

Bradley G. Mayes, Director

Compensation and Pension Service

 

 

 

Enclosure: BDD and Pre-Discharge Flow Chart