Section C. Decision Review Officer (dro) Review Process

[Guest allan]

This is the html version of the file http://www.warms.vba.va.gov/admin21/m21_1/mr/part1/ch05/ch05_secc.doc.

G o o g l e automatically generates html versions of documents as we crawl the web.

To link to or bookmark this page, use the following url: http://www.google.com/search?q=cache:3nC0w...t=clnk&cd=1

Google is neither affiliated with the authors of this page nor responsible for its content.These search terms have been highlighted: decision review These terms only appear in links pointing to this page: officers <H3 align=right> Section C. Decision Review Officer (DRO) Review Process</H3>

Overview

• • In this Section
    This section contains the following topics:
    
    

• • TopicTopic NameSee Page10Overview of the DRO Review Process5-C-211DRO Duties and Responsibilities5-C-312DRO Jurisdiction and Authority5-C-713De Novo Review</B>5-C-1114Informal Conferences5-C-1515Making the Decision</B>5-C-1816Exhibit 1: Informal Conference Report5-C-2217Exhibit 2: Appeal Response Form5-C-23
    
    

10. Overview of the DRO Review Process

• • Introduction
    This topic contains an overview of the DRO review process.
    
    

• • Change Date
    December 9, 2004
    
    

• • a. DRO Review Process
    The table below describes the stages of the Decision Review Officer (DRO) review process.
    
    

• • StageDescription1The appellant elects the DRO review process.2The DRO conducts a de novo review of the prior decision.
    Reference: For more information on de novo review, see M21-1MR, Part I, 5.C.13.
    
    3Based on a review of the evidence of record, is there enough evidence to make a new decision?
    • If yes, the DRO makes a new decision.
      
    • If no, the DRO
      
    • pursues additional evidence considered necessary to resolve the claim, and/or
      
    • conducts an informal conference to obtain additional evidence from the appellant and his/her representative.
      
      • upholds or overturns the original decision
        
      • works with the appellant and his/her representative to
        
      • focus the issue, and
        
      • fully explain the decision in an effort to resolve the appellant’s disagreement, and
        
      • begins to prepare the appeal for BVA review by sending an SOC, unless there is a full grant of benefits.
        
        Reference: For more information on sending an SOC, see M21-1MR, Part I, 5.D.
        
        

        
        
        
        
        11. DRO Duties and Responsibilities
        
        
      • • • Introduction
            The DRO performs an array of duties with the purpose of resolving issues raised by the appellant and his/her representative. This topic contains a definition of DRO and information on
            • the DRO duties
              
            • the Veterans Service Center Manager (VSCM) duties
              
            • the DRO work measurement responsibilities
              
            • which work measurement codes to take, and
              
            • the acting DRO.
              
              
              

              
              
            • • • Change Date
                  August 19, 2005
                  
                  

              
              
            • • • a. Definition: Decision Review Officer
                  The Decision Review Officer (DRO) is a senior technical expert who is responsible for holding post-decisional hearings and processing appeals. The DRO may have jurisdiction of any appeal.
                  
                  

              
              
            • • • b. DRO Duties
                  The table below lists the duties of a DRO.
                  Notes:
                  
                  • The DRO is a member of the Appeals Team but is under the direct supervision of the Veterans Service Center Manager (VSCM) or assistant VSCM. The Appeals Team Coach may assign work to the DRO.
                    
                  • The composition of the local appeals team may vary. At some ROs, the team may consist of only DROs, while at others, it may include
                    
                  • DROs
                    
                  • RVSRs
                    
                  • VSRs, and
                    
                  • Claims Assistants.
                    
                    
                    

                    
                    
                  • • • DutyDescription1Hold informal conferences and formal hearings.2Evaluate the evidence of record including the need for additional evidence as a result of information obtained during the hearing.3Make a decision.4Make direct contact with appellants and their representatives.
                        
                        

                    Continued on next page

                    
                    
                    
                    
                    11. DRO Duties and Responsibilities, Continued
                    
                    
                    
                  • • • b. DRO Duties (continued)
                        
                        

                    
                    
                  • 10
                  • 9Play a central role in employee development, including
                  • 7Work together with station and service center management and staff to develop consistency and accuracy in first-line decision making.8Perform Master Rating Specialist duties, including
                  • 6Provide feedback to local management about
                    • • DutyDescription5Provide feedback to each Rating Veterans Service Representative (RVSR) as to the cases handled and appealed without regard to whether the decision was
                        • upheld
                          
                        • reversed, or
                          
                        • modified.
                          
                          • trends
                            
                          • general quality, and
                            
                          • areas in need of training.
                            
                            • acting as a resource for other employees, and
                              
                            • directing management of the appellate workload.
                              
                              • mentoring new rating specialists
                                
                              • participating in the training of RVSRs
                                
                              • coordinating training opportunities with BVA and local medical centers, and
                                
                              • providing feedback to Compensation and Pension (C&P) managers at all levels.
                                
                                • Certify appeals prior to transfer to BVA, and
                                  
                                • coordinate the transfer of appeals to BVA.
                                  
                                  
                                  

                                  Continued on next page

                                  
                                  
                                  
                                  
                                  11. DRO Duties and Responsibilities, Continued
                                  
                                  
                                  

                                  • • c. VSCM Duties
                                      The VSCM (or assistant VSCM)

                                      d. DRO Work Measurement Responsibilities

                                      e. Which Work Measurement Codes to Take

                                      If the DRO or VSR …Then he/she takes EP code …prepares an SOC only172.holds an informal conference which results in the withdrawal of the appeal173.

                                      Note: Annotate the informal conference report when taking the EP.

                                      [*]conducts a de novo review and issues a decision

                                      [*]prepares a clear and unmistakable error (CUE) decision, and/or

                                      [*]holds a traditional hearing

                                      174.

                                      f. Acting DRO

                                      When the DRO is temporarily absent or disqualified because he/she participated in the decision under review, the VSCM of the RO where the hearing is scheduled appoints an acting DRO.

                                      The acting DRO

                                      [*]shall have considerable understanding of the issue that is the subject of the hearing

                                      [*]shall not be less than a GS-12, except in extraordinary circumstances, and

                                      [*]cannot have participated in the decision being reviewed.

                                      12. DRO Jurisdiction and Authority

                                      Introduction

                                      The DRO has jurisdiction over several appellant issues. This topic contains information on

                                      [*]the DRO’s jurisdiction over

                                      [*]appellant issues, and

                                      [*]subordinate issues

                                      [*]issues not under the jurisdiction of the DRO

                                      [*]the jurisdiction of the visiting DRO

                                      [*]the DRO’s decisional authority

                                      [*]the DRO’s lack of authority in subsequent hearing requests

                                      [*]how the DRO is bound by a BVA decision, and

                                      [*]how DRO bargaining is prohibited.

                                      Change Date

                                      June 19, 2006

                                      a. DRO Jurisdiction over Appellant Issues

                                      Once the DRO assumes jurisdiction of a case, he/she works in partnership with the appellant and representative to resolve all issues covered by the NOD in accordance with the laws and facts in that particular case. The appeal remains with the DRO until it is forwarded to BVA.

                                      The DRO has jurisdiction over a rating issue that the appellant raises during the hearing provided the issue was part of the rating decision being appealed that is the subject of the formal hearing or informal conference.

                                      Notes: The DRO has

                                      [*]de novo review jurisdiction only over appeals for benefits governed by

                                      [*]38 CFR 3, and

                                      [*]38 CFR 4

                                      [*]limited jurisdiction over a rating issue raised during an informal conference or formal hearing, provided the issue was part of the rating decision that is the subject of the hearing, and

                                      [*]no jurisdiction over an appeal on a rating decision made by the DRO him/herself.

                                      Continued on next page

                                      12. DRO Jurisdiction and Authority, Continued

                                      b. DRO Jurisdiction Over Subordinate Issues

                                      When an issue is favorably decided, the DRO assumes jurisdiction over any subordinate issues, including

                                      [*]evaluation and effective date, and

                                      [*]any inferred or ancillary issues that are encompassed by that favorable decision.

                                      Reference: For more information on inferred or ancillary issues, see

                                      [*]M21-1MR, Part III, Subpart iv, 6.B.3, and

                                      [*]M21-1MR, Part IX, Subpart i.

                                      c. Issues Not Under the Jurisdiction of the DRO

                                      The DRO does not have jurisdiction over

                                      [*]Committee on Waivers and Compromises (COWC) issues

                                      [*]loan guaranty

                                      [*]insurance, and

                                      [*]hearing requests concerning a denial of benefits from a medical determination rendered by a Department of Veterans Affairs (VA) medical activity for

                                      [*]clothing allowance

                                      [*]automobile and adaptive equipment, and

                                      [*]specially adapted housing.

                                      d. Jurisdiction of the Visiting DRO

                                      If the DRO at the host office participated in the decision being reviewed, a visiting DRO may be requested to hold hearings or conduct de novo review. The visiting DRO will render a decision in such claims, but not maintain jurisdiction of the appeal.

                                      However, the VSCM at each RO has the authority to grant the issue on appeal based on a de novo review or CUE without referral to the visiting DRO. The VSCM is not permitted to delegate this authority to anyone else.

                                      Note: Submit a written request to C&P Service when a specific delegation of this authority is necessary.

                                      Continued on next page

                                      12. DRO Jurisdiction and Authority, Continued

                                      e. DRO Decisional Authority

                                      The DRO may

                                      [*]amend, reverse, or modify a decision based on de novo review

                                      [*]amend, reverse, or modify a decision based upon new evidence, or

                                      [*]exercise single signature CUE authority.

                                      Exceptions:

                                      [*]Unless a CUE exists, the DRO cannot revise the decision in a manner that is less advantageous to the appellant than the decision under review.

                                      [*]A decision in which CUE is cited requires the signature of the VSCM if the decision would

                                      [*]reduce a service-connected evaluation(s), or

                                      [*]sever service connection for a disability(ies).

                                      Note: The VSCM’s signature is required on the rating even if the reduction or severance based on a CUE would not cause a reduction or termination of total benefits paid.

                                      Reference: For more information on DRO decisional authority, see 38 CFR 3.2600.

                                      The DRO has no authority to participate in a formal hearing if he/she participated in the decision under appeal.

                                      Example: If the DRO makes a new decision based on de novo review and the appellant subsequently requests a formal hearing, the DRO does not have authority to conduct the formal hearing.

                                      f. No DRO Authority in Subsequent Hearing Request

supervises the DRO
may exercise all duties and authorities of the DRO
assigns duties that are appropriate to the DRO’s grade level and position, as time allows, provided such duties do not conflict with the DRO’s status as an impartial and independent decision-maker
appoints acting DROs during the temporary absence or disqualification of the DRO, and
assigns a rating or authorization panel, whose members did not participate in the decision, to hold a personal hearing in
cases where the traditional appellate review process has been elected by the appellant, and
unusual or emergency circumstances.

The DRO

[*]maintains an accurate record of the actual hours spent performing DRO duties at different regional offices (ROs), should the need arise, and

[*]prepares a report for the VSCM or Appeals Team coach at the RO where the service was performed.

Note: ROs borrow or loan the corresponding amount of time. Charge the DRO’s time against the cost center for the rating activity.

Continued on next page

11. DRO Duties and Responsibilities, Continued

Use the table below to determine which work measurement codes to take.

Note: Complete EP credit continues to be recorded by the RO having jurisdiction of the claim. Maintain these reports under RCS VB-1, Part 1, Item 13-005.000.

Reference: For more information on which EP credit to take, see M21-4, Appendix C.

4Based on evidence gathered, the DRO