Question

[RockyA1911]

I am really confused now as to how the process works from time of receipt of claim to award letter.

Exactly where is the Rating Board in the process? Is there someone on here that knows the actual process steps and in which sequence they fall up to the award notice?

What is the difference between Rating Board and Rating Specialists?

What I am looking for is the numbered steps such as (1) Development Team, (2) Adjudication, (3) Rating Board, etc. This would be great if someone knows the actual sequence and what the functions of each team and the impact on the claim.

Thanks,

RockyA

[Guest DON20906]

When a new claim is recieved at a RO it is supposed to follow the path, according to the latest VA TRIP training manual.

1. Triage Team

Triage teams are an attempt by C&P service to improve overall claims processing times by assessing the difficulty of incoming claims an assigning them to Veteran Service Representatives with the apporopriate levels of experience. Triage basically sorts claims by difficulty. Easy claims requiring little or no development are given to new VSRs, usually right inside the triage team. Claims are tracked on Modern Awards Processing - Development (MAP-D) software in Triage and Pre-D.

2. Pre-Determination Team (formerly Adjudication)

Claims with multiple issues requiring extensive development are given to experienced Veteran Service Representatives in the pre-determination team. The pre-determination team does required development and duty-to-assist actions and reviews claims that are supposedly "ready-to-rate" for completeness before they are sent to Rating VSRs or "the Rating Board."

3. "Rating Board"

In the old days, VSRs were "adjudicators" and Rating Veteran Service Represenatives were "rating specialists." RVSRs make the actual decsions and get the required numbers of signatures, depending on the type of claim. VSOs are given a look at the files on which they have POAs at this stage. Awards with retro payments of $25,000 and over require additional review.

4. Post-Determination Team

Once a rating is complete and has been reviewed and signed off on it is sent to the post-determination team where the decision is made into an award of monetary benefits, pending a final administrative review on things such as character of dicharge, willful misconduct, etc. Is and Ts are dotted and crossed here. The decision is then "promugated" to the claimant in writing. Claims are tracked on Modern Awards Processing - Award (MAP-A) software in Post-D.

The process is supposed to be consistent across ROs but some variation exists.

Hope this helps.

I am really confused now as to how the process works from time of receipt of claim to award letter.

Exactly where is the Rating Board in the process? Is there someone on here that knows the actual process steps and in which sequence they fall up to the award notice?

What is the difference between Rating Board and Rating Specialists?

What I am looking for is the numbered steps such as (1) Development Team, (2) Adjudication, (3) Rating Board, etc. This would be great if someone knows the actual sequence and what the functions of each team and the impact on the claim.

Thanks,

RockyA

[RockyA1911]

Thanks Don,

So if a vet is told their claim is now at the "Rating Board" is step 3 with only the post determination team to go? How much of a delay is there if there is retro involving over $25K?

RockyA

[Berta]

Rocky- I am glad you asked because Don gave a step by step post like this before and I cant remember what I saved it as-I looked for it yesterday and couldnt find it-

As I recall- retro over 25,000 requires 3 signatures.

I dont get it- they told me months ago that three authorizors signed off on one of my claims but they are working on the additional one now-to put it all together-

Authorization used to mean a good thing- but it is hard to tell-so I dont put anything into what they say-

except

the best word they can ever say to a vet at the 800# is that "it is in Finance"!

Also under M21-1 (I think we have a link here) there is more info to the claims format they use but Don says it better.

[Guest DON20906]

You are welcome. It's hard to say on the delay, but the closer the RO is to being able to take an End Product (work credit) for the claim, the quicker they will put it through. Other factors, like how close the end of the fiscal year is, if an RO is running at or over budget, may also play. I'd give it a couple more weeks and call abck.

Thanks Don,

So if a vet is told their claim is now at the "Rating Board" is step 3 with only the post determination team to go? How much of a delay is there if there is retro involving over $25K?

RockyA

[Berta]

End product code- yes -I have had one pending on my claims for quite some time ( it is called a 930 pending).

Something told me to call today and the vet rep said my claims have gone from the rating board to a Supervisor this morning.

I cannot read anything into that but I am always ready to continue the fight-

After I won my last claims- I stayed in that fighting mode for a long time- it was just hard to believe it was finally over.

I have additional evidence but when they really started working the claims- it seemed pointless to send them more-they have more than enough.

I wonder what a supervisor is- the VA nomenclature has changed a lot-

(maybe it is the PAP-paper airplane person)

Men and women you all know I am a civilian but I often feel , as a VA claimant waiting for a decision, like I am awaiting incoming that doesn't come in.You cant react or fight back because you dont know what you are fighting back to.

Edited June 23, 2006 by Berta

[carlie]

Rocky,

Don did you pretty good but if you want more info go here.

http://www.warms.vba.va.gov/admin21/m21_1/...subpti/ch01.doc

Hey Berta, I'll let you carry my M-16 anyday.

carlie