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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
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      Fund HadIt.com Veteran to Veteran LLC


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Wings

Use Of Telephone, E-mail And Fax For Claims Development

Question

WARMS - What's New? http://www.warms.vba.va.gov/whatsnew.html

Veterans Benefits Administration M21-1, Part III

Department of Veterans Affairs Change 135

Washington, DC 20420 November 10, 2005

Veterans Benefits Manual M21-1, Part III, “Authorization and Clerical Procedures,” is changed as follows:

Pages 11-III-1 and 11-III-2: Remove these pages and substitute pages 11-III-1 and 11-III-2 attached.

Paragraph 11.17c is amended to clarify that the telephone call must be properly documented, even if the information is advantageous to the beneficiary.

Paragraph 11.18a is revised to show that award action may not be taken on oral information or statements, unless all the requirements cited in this paragraph are met.

Paragraph 11.18a(3)6 is added to show that before ending the call, the VSR should explain to the beneficiary that a notification letter of our decision will be sent, based on the information obtained during the call.

Paragraph 11.18b is revised to show that regardless of whether the information obtained during the call will favorably or adversely affect the award, it should be documented.

Minor editorial corrections were made to the subchapter.

By Direction of the Under Secretary for Benefits

Renée L. Szybala, Director

Compensation and Pension Service

Distribution: RPC: 2068

FD: EX: ASO and AR (included in RPC 2068)

November 10, 2005 M21-1, Part III

Change 135

SUBCHAPTER III. USE OF TELEPHONE, E-MAIL AND FAX FOR CLAIMS DEVELOPMENT

11.17 GENERAL

a. Regional offices should make full use of telephones, e-mail and fax machines as an integral part of claims development procedures for compensation, pension, and burial claims.

b. Issues Suitable for Telephone, E-Mail and Fax Development:

(1) Social Security numbers of dependents, including the Social Security Number Verification Match;

(2) Correct mailing address(es);

(3) Date(s) of birth;

(4) Reserve or National Guard unit information (e.g., address);

(5) Information concerning retired, severance or readjustment pay;

(6) Names and addresses of physicians or medical record numbers;

(7) Employment information (current or past);

(8) Change in dependency status, name and address of person having custody of children, etc.;

(9) Income information (e.g., change in income or date of receipt of first Social Security payment);

(10) Clarification of medical expenses;

(11) Verification of Medicaid-covered nursing home status;

(12) Burial claim clarification information (e.g., status of unpaid bills);

(13) Whether the veteran has service medical or other records.

c. Beneficiaries are not required to advise VA in writing of changes in income, net worth, dependency or marital status. VA may increase or decrease benefit payments based on information submitted orally, or by e-mail, fax or other electronic means. If the change results in adverse action, a predetermination notice is not required but contemporaneous notice must be sent. However, do not take adverse action with contemporaneous notice or favorable action based on oral information unless you follow the specific telephone contact procedures shown in paragraph 11.18a.

11.18 TELEPHONE, E-MAIL AND FAX CONTACT PROCEDURES

a. Sound discretion must be exercised when requesting information by telephone or e-mail to ensure that the source of the information is reliable. Verification of the source is necessary. If the person is unable to furnish the information requested or if the VA employee remains uncertain of the person’s identity, complete development by letter. VA may not take action based on oral information or statements unless the VA employee receiving the information meets the following conditions:

(1) during the conversation identify yourself as a VA employee who is authorized to receive the information or statement (these are VA employees authorized to take actions under 38 CFR 3.100); and

(2) during the conversation verify the identity of the provider as either the beneficiary or his or her fiduciary by obtaining specific information about the beneficiary that can be verified from the VA records, such as Social Security number, date of birth, branch of military service, dates of military service, or other information; and

(3) during or following the conversation document the following information for the beneficiary’s VA records:

1. the specific information or statement provided; and

2. the date such information or statement was provided; and

3. the identity of the provider; and

4. the steps taken to verify the identity of the provider as being either the beneficiary or his or her fiduciary; and

5. that you informed the provider that the information would be used for the purpose of calculating benefit amounts. (38 CFR 3.217(b))

6. before ending the conversation, inform the beneficiary that even though the information was obtained telephonically, a notification letter will be issued.

b. All information received by telephone from the claimant must be completely documented on VA Form 119, “Report of Contact”, or equivalent, regardless of whether the information will favorably or adversely affect the beneficiary’s award. If the veteran has a power of attorney, send the representative a copy of the VA Form 119.

c. All information received by e-mail from the claimant or beneficiary must be printed out on paper and placed in the claims folder.

d. When information received by telephone, e-mail or fax results in an award or denial action, the notification letter must include a statement of this information as well as the date of the telephone call, e-mail or fax.

e. If benefits are reduced, terminated or otherwise adversely affected based on oral information or statements, they will be retroactively restored if, within 30 days of the date that the notification of adverse action is issued, the beneficiary or his or her fiduciary asserts that the adverse action was based upon information or statements that were inaccurate or upon information that was not provided by the beneficiary or his or her fiduciary. (38 CFR 3.103(b)(4))

11.19 DOCUMENTS SUITABLE FOR RECEIPT BY FAX OR E-MAIL

All documents except original applications and separation documents intended for proof of service to establish entitlement to benefits may be accepted via fax or e-mail. However, if there is any question about the validity of any documents received by fax or e-mail, the original should be requested.

11-III-2

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    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
      • 2 replies
    • Exams that were being sent strictly to contractors before, due to VAMCs not being open, are starting to be routed back to VAMCs. This is going forward from last Friday- not sure if prior scheduled exams will be re-created for VAMC vs vendor.
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      M21-1, Part III, Subpart iv, Chapter 3, Section D – Examination Reports III.iv.3.D.2.r. Examiner Statements that an Opinion Would be Speculative Pay careful attention to any conclusion by the examiner that an opinion could not be provided without resorting to mere speculation (or any similar language to that effect). VA may only accept a medical examiner’s … Continue reading
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      Fund HadIt.com Veteran to Veteran LLC


      Give a financial gift to help with the upkeep of HadIt.com. HadIt.com is NOT a non profit. Gifts are not tax deductible, they are just gifts. 
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