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mags1023

5103 Waiver Overdue From 3Rd Party

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mags1023    9

I checked my ebenefits account yesterday and saw that under my gathering evidence for my claim folder the VA has a note in there saying that a 5103 waiver from a 3rd party is overdue. The due date was Aug 5, 2013. Does anyone know what this might be? Would the 800 people or IRIS be able to tell me who this 3rd party might be?

Thanks, Mags

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Berta    2,808

The 5103 waiver is explained here by Meg:

If you google VA 5103 waiver some more hadit posts will pop up on this.

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harleyman    4

In all fairness to Megh, as I know she is a service officer, and we have talked, it's not quite what she thinks and there is way more involved than people realize. So here goes. If I loose you, I applogize, hopefully we can work through this as this 5103 waiver isnew to the VA, as well as new to the Veterans.

eBenefits pulls it's information from the VBMS (Veteran's Benefits Management system - paperless system) claims processing program. In that program there are what we at VA call suspense reasons.

"suspense reasons" are snippets of explainations of what the VSR or RVSR or Coach or claims assistant,or finance, or authorization, (in other words any one having someting to do with your claim) may have for a reason to "suspend" or is "waiting " for something for som reason or another. For example.....

You file a claim, and you send in a VA FORM 21-4142, Authorizing VA to get medical records from Dr. Smith. We now have a contractor who gets the Veterans private records. So the form goes to the Contractor (DOMA), but the VA puts a "suspense" in the system that says, awaiting 3rd party information. Yor records from your doctor are considered third party. The suspense reason has a space to enter an expected date when the VA should have received the information back from DOMA. Usually the suspense is for 7, 15, 30, 60 or 90 days.

Lately everything has been about 15 days, VA is pushing to get responses within 2 weeks. When that date comes we check the system (through a program called VOR- it's a search spreadsheet system) to see if we got Dr. Smith's records. If VBMS shows we did get the records then we move the case to the next step toward making a decision, if we didn't get the records we do supplemental development, we call the doctor, we email a supervisior who's job it is to kick the contractor (DOMA) in the butt to get the records and we update for another 15 days. This goes on in one form or another for all claims and all issues. Certain claimed issues require different supplemental development. (simply as we request records or inforamtion we put in suspense REASONS and as we receive the information requested we indicate RECEIVED.) We can have many, many different request working at one time depending on the issues claimed and the evidence needed or requested.

I am going to take this one step further. The new 5103 waiver is the name for the old VCAA letter. The newer forms of 21-526 are now 21-526ez forms. and for NSC pension are 21-527EZ form. These forms contain what are called WTEMS. WTEMS is an acronym for "what the evidence must show". These are paragraphs of information that the VA MUST provide to the Veteran to aid the Veteran is his claim. There are WTEMS for direct service, seccondary, increase, N&M, A&A, Pension, IU, SMC, and on and on. WTEMS ARE the duty to assist portion of the %!)# or the OLD VCAA letter attachemnts.

In eBenefits, the phrase " 5103" simply means the application YOU USED for YOUR claim had the standard 3 WTEMS. The standard 3 WTEMS are what the evidence must show for, service connected conpensation, service connection for a secondary, and service connection for an increase. It simply states what type of evidence is needed for each type of claim. The 5103 VA Forms 21-526EZ and 527EZ have the WTEMS built into them in the application, READ THE FINE PRINT in your compensation application about evidence.

This notice in ebenfits that states.... 5103 notice or 5103 waiver simply means you have signed either manually or electronically the 5103 Notice that you have been advised of your rights, per the 5103 waiver when you sign your application.

When the VSR or RVSR looks in the computer and we see 5103, it tells the VSR or RVSR we DO NOT HAVE TO SEND YOU A LETTER ANYMORE to tell you what we are doing on your claim if you file one or more of the BIG THREE types f claims. (remember increase, secondary or direct) as you got the evidence requirements on the applictions and you signed the waiver stating you got the imformatin.

I know this is complicated, but it is important you realize the VA Form 21-526 EZ and 527EZ forms are telling you what is needed in support of your claim.

Please ask any questions you have on this as I know it is new and it's taking VA a bit to adjust to the chage as well.

Edited by harleyman

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TiredCoastie    51

Thanks, Harleyman!

I got the same status in eBenefits and know that my VSO forwarded the 5103 waiver form to the RO at the end of July. At the 30 day due date for the 5103 waiver form in the middle of August, eBenefits started showing that this document was overdue. My guess has been that no one in the RO, other than whomever did data entry (twice, once into the old system then once into VBMS a month later), has actually touched my claim since the 5103 waiver was generated somewhere else within the VA hierarchy. And that's the assumption I've made again today seeing the same status and no movement on my 4 1/2 month old claim at all -- because the RO where my claim rests is in the midst of trying to solve some older and more challenging claims with heat from the top to clear those claims a year older or more. The claim was supposed to be submitted either on line via eBenefits or locally through the RO. Am I making a bad assumption?

According to the Fast Letter describing the 5103 waiver process, it seems as if some entity above the local RO makes a decision based on what it sees within VBMS or some other system that my claim, like many others, can be decided quickly if I certify that I have nothing else to submit.

So what you're saying is that the 5103 waiver system looks at the WTEMS, decides off the cuff that based on the claim being an FDC-style claim that all the pieces are there to make the decision, then generates a decision that if the veteran certifies that there is nothing else that could bear on the decision, the VA will move the claim along as expeditiously as possible? Have I got that right?

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Berta    2,808

Thanks Harleyman!

Let me see if I have this right:

"The new 5103 waiver is the name for the old VCAA letter. "

"as you got the evidence requirements on the applictions and you signed the waiver stating you got the imformatin."

Is this in lieu of the old VCAA response form?

The one we were supposed to sign and mail back to the VA?

I never got one. The BVA said I mitigated the prejudicial damage of the illegal VCAA letter I got (it was all snafued) because I had probative evidence anyhow.

The VARO said I had failed to respond to the response form they did not send me.

I could not get my former reps (to include their director here in NY) to support my contention that my VCAA letter was illegal and prejudicial.

I filed a complaint with the OGC against my reps on that long story with Very good results,

but it appears to me here that TiredCoastie digested all this quite well:

"According to the Fast Letter describing the 5103 waiver process, it seems as if some entity above the local RO makes a decision based on what it sees within VBMS or some other system that my claim, like many others, can be decided quickly if I certify that I have nothing else to submit.

So what you're saying is that the 5103 waiver system looks at the WTEMS, decides off the cuff that based on the claim being an FDC-style claim that all the pieces are there to make the decision, then generates a decision that if the veteran certifies that there is nothing else that could bear on the decision, the VA will move the claim along as expeditiously as possible? Have I got that right?"

And that this is solely regarding FDCs????????????????????

Is that fast letter here at hadit?

Edited by Berta

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mags1023    9

Wow, thanks Harleyman for the thorough answer! I really appreciate you, Berta, Carlie, and the many others who provide us with such great insight. I get much more out of this sight than from my lawyer.

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harleyman    4

Thanks Harleyman!

your welcome

Let me see if I have this right:

"The new 5103 waiver is the name for the old VCAA letter. "

Yes that is correct. Coporate offices (D.C.) decided they wanted call the VA's duty to assist 5103 after the number of the legislation instead of VCAA.

"as you got the evidence requirements on the applictions and you signed the waiver stating you got the imformatin."

Is this in lieu of the old VCAA response form?

NO- - The VCAA response form and the 5103 response form are still part of the process and the forms are exactly alike ...the response form used to say at the top of the form:

VCAA Notification Response .... now the form says

5103 Notification Response

other than that the form is the same as before.

The one we were supposed to sign and mail back to the VA?

Yes, the one the Veteran or claimant signs and sends back indicatin you have more evidence and wait or you have no more evidence and procede.

I never got one. The BVA said I mitigated the prejudicial damage of the illegal VCAA letter I got (it was all snafued) because I had probative evidence anyhow.

The VARO said I had failed to respond to the response form they did not send me.

I could not get my former reps (to include their director here in NY) to support my contention that my VCAA letter was illegal and prejudicial.

The fact that VA said day you failed to respond to the VCAA letter by sending in the response form is BOGUS. We decide claims every day whether the form is returned or not. The fact is, VA really doesn't care if you return the form, because afer thirty days if they don't get the form saying you need more time for submitting evidence, the VA is free to continue to move toward making a rating decision. The only time it really matters is if the Veteran is waiting for private records or a private report or something very detrimental to the claim. The the VBA tries to wait until all the evidence the Vet has to send is recevied. so by the Veteran sending in the form it bides more time. Claims processing have been SO SLOW the Veteran doesn't need to ask for more time. Other than what I have explained here returning the form or not really doesn't have much bearing on the claim. So I think they fed you a line just to get thier butts off the hook for unfairly processing your claim.

Oh also, by signing the response form and returning it to the VBA, it shows we have a current address and you recevied your mail. The VCAA letter is a different matter than the VCAA Reply Notice.

I filed a complaint with the OGC against my reps on that long story with Very good results,

but it appears to me here that TiredCoastie digested all this quite well:

"According to the Fast Letter describing the 5103 waiver process, it seems as if some entity above the local RO makes a decision based on what it sees within VBMS or some other system that my claim, like many others, can be decided quickly if I certify that I have nothing else to submit.

Well you have this partially correct.

it seems as if some entity above the local RO makes a decision based on what it sees within VBMS or some other system that my claim,- no all claims are still handled at the regional office level the AREA Offices or the Coporate Offices give guidelines for implementig changes in processing but the official clais work remains at the RO level.

can be decided quickly if I certify that I have nothing else to submit.- yes, in theory if you have nothing else to submit and IF the VA has obtained all the Veterans federal records and verified the Vets service and obtained your STRs, DD214, verified your treatment and obtained treatment records, obatined military hospital, vet center, any or all VAMC current and archived records and requested at least two times any private records the Veteran has asked us to obtain, then yes, the claim can move forward if the Veteran does not have any more evidence. Remeber VA has a duty to assist in getting the Federal Evidence. If we request SSA records and they don't send them, the VA cannot move forward until the VA gets the records or theVA gets a response from the SSA there are no records. This hlds true for all FEDERAL records. VA has o have received the records or a reply stating no records exist. Before VA can move your claim to the decision process.

So what you're saying is that the 5103 waiver system looks at the WTEMS, decides off the cuff that based on the claim being an FDC-style claim that all the pieces are there to make the decision, then generates a decision that if the veteran certifies that there is nothing else that could bear on the decision, the VA will move the claim along as expeditiously as possible? Have I got that right?"

Well, sorta. - Every claim is entitled to the 5103 Duty to Assist information. The big wigs, in D.C. at the Coporate level, decided VBA spend entirely too much time writing VCAA letters every time a Veteran submitted and claim, and then submitted more claims, and more claims. Each time VBA had to stop the decision process and send out another VCAA letter tellng the Vetern what was needed in support of the claim.

The previous VCAA letter USED to list the conditions currently claimed, and the newly claimed conditions, and then provide the WTEM ENCLOSURES and the VACC response Notice in each letter everytime a Veteran claimed a new condition while a clai was open and not yet decided. Everytime a veteran sent in a new claim this would have to be done. It slowed the claims process down a minium of 60 to 90 days depending on if VA had to obtain more records for the new condition.

SOOOO, the corporate offices felt the Veteran was getting the same information over and over and the Veteran knew what he claimed and we didn't need to tell him that again and this old way of VCAA was redundant and slowed the process down to a crawl.

sooooo, Corportate decided to change the VCAA process to speed things up and to stop sending multiple VCAA letters to the Veteran A decision was made to change the name of these notifications letters to the Veteran. These letters are officially called the "VETERANS SECTION 5103 NOTICE" instead of VCAA.

The 5103 notice has the body of the letter, requesting service records and private records and specialty claims information and then the WTEMS enclosures as well as the 5103 Return Notice.

When the new 5103 notification letters were started, new criteria was also implemented on when and how often these letters would be sent out. Also the VA changed the 21-526 and 527 and made them EZ forms. Thiese forms are now used for ALL claims, original, increase, and secondary claims, and the Duty to Assist known as 5103 WTEMS (formerly known as VCAA letter with enlosures). The enclosures also called WTEMS are actually the required by law Duty to Assist requirement according the the legislation that past , what we all use to call VCAA letter and notification.

So the decision was made to include the Duty to Assist information on the claim form itself. We do not send a letter any more once a claim is received on one of these forms if the claim is for direct service connection, increase service connection or for secondary service connection. The claim form itself is considered Duty to assist.

Once a claim is open, and the Veteran wants to add to his claim more conditions/contensions, he will not received a letter from the VA unless a couple things happen. One is he is filing a claim that needs New and material evidence. Then VA sends a letter with N&M WTEMS and also tells the Veteran when his claim was denied and why and what is needed to get the denied claim reopend. As you know this is for claims denied more than one year or not repoened within a year of the decision. Or the veteran is filing a claim for conditions other than the trifecta, (new,increase, secondary). Like IOU, SMC, loss of use, A%A, SAH/SHA/ auto grant. Also claims for special issues like AO, Radiation, GW Syndrome, and others will need a new letter. But the 5103 will not list all the claimed condtiions any more. They are only concerned you receive the enclosures calledWTEMS.

And that this is solely regarding FDCs????????????????????

FDC is a growing and very favorable program. This program requires the Veteran to certify he hs no other evidence to submit right at the start of the claim. VA can then just do their part getting the federal records or any exams and rate the case. Quick and easy, if the Veteran sends in more evidence or adds more conditions to his claim then his claim is excluded from the FDC program. The 21-526 and 527 have a check box the Veteran can check which will exclude himself from FDC program simply by checking the check box on the EZ form. But the EZ form still gave the Veteran his Duty to Assist WTEMS right on the EZ FORM.

Is that fast letter here at hadit?

I am not sure. But I can get a copy of the 5103 fast letters and get them to T-bird. There have been a couple of 5103 letters that hae been desiminated in the change fom VCAA to 5103.

Edited by harleyman

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