**Veterans Benefits Administration M21-1, Part III**

**Department of Veterans Affairs Change 116**

**Washington, DC 20420 March 31, 2004**

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

**Pages 2-I-1 through 2-I-3:** Remove these pages and substitute pages
2-I-1 through 2-I-4 attached.

Paragraph 2.01i is added to provide information on using the
Compensation and Pension Record Interchange (CAPRI) system and
maintaining the privacy and security of claimant records accessed via
CAPRI. Obsolete references to CAPS are deleted throughout the
subchapter.

By Direction of the Under Secretary for Benefits

Ronald J. Henke, Director

> Compensation and Pension Service

Distribution: RPC: 2068

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

LOCAL REPRODUCTION AUTHORIZED

**March 31, 2004 M21-1, Part III**

**Change 116**

**CHAPTER 2. CLAIMS APPLICATIONS AND INITIAL ACTIONS**

**SUBCHAPTER I. CLAIMS PROCESSING**

**2.01 GENERAL**

a\. **Assistance to Claimants.** Extend all reasonable assistance to
claimants in meeting the evidentiary requirements necessary to establish
their claims under the applicable laws and regulations. Give them every
opportunity to establish entitlement to the benefits sought, to include
complete procedural and appellate rights. Provide the claimants complete
information and advice in words the average person can easily
understand. Thoroughly develop information from *all* sources before
making decisions affecting entitlement.

b\. **Date-of-Receipt Stamp.** All claims, applications and associated
evidence should be date stamped on receipt in the regional office
mailroom.

\(1\) Do not affix stamps directly on original documents which are to be
returned such as discharge certificates, court records and papers to be
filed in court, marriage, birth and death certificates, divorce decrees
and similar records. Instead, stamp the date of receipt on a paper tag
and fasten it to the original document by paperclip.

\(2\) Do not routinely require the use of a date stamp in the Veterans
Service Center (VSC), but, if an unstamped document is received in the
VSC, the first person who reviews the claim should date stamp it.

\(3\) The Veterans Service Center Manager or designee, not below the
grade of unit chief, may require the use of the receipt stamp to
document unusual delays in the receipt of documents in the division.

c\. **Initial Screening.** The Triage Team reviews all applications,
claims, correspondence and evidence immediately to determine if:

\(1\) The claim, because of its nature or facts, warrants expedited
action;

\(2\) A prima facie claim is established which can be rated immediately
without the claim file (see paragraphs 3.06, 3.07, and 5.07);

\(3\) A claim is incomplete and requires further development;

\(4\) The claim warrants immediate denial.

d\. **Signature of Claimant**

\(1\) **Unsigned Application.** See subparagraph 2.01f(1)(b).

\(2\) **Signature by Mark.** Forms with signatures by mark or thumbprint
must be witnessed by two persons who give their address. If the mark is
witnessed by a VA employee, notary public or other person having the
authority to administer oaths for general purposes, only that
certification is required.

\(3\) **Signature by Pencil.** A penciled signature is acceptable.

e\. **Defective or Incomplete Application Forms.** If an application is
properly signed but is so incomplete that development for the specific
information is not feasible, make a copy of the application and retain
it as the file copy. Return the original application to the claimant
with a request to complete the indicated items checked in red. If it
appears from the application that there may be additional evidence that
could be relevant to the claim, ask the claimant to submit this
additional evidence with the application.

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**M21-1, Part III March 31, 2004**

**Change 116**

For example, if the claimant indicates medical treatment for a
disability, request him or her to submit the treatment records.
Establish a 60-day Benefits Delivery Network (BDN) control.

f\. **Informal Claims**

\(1\) An informal claim is any communication or action that shows an
intent to apply for benefits under laws administered by VA. If an
original claim has not been initiated under 38 CFR 3.160, the
communication or action must identify the benefit sought (38 CFR 3.155).

\(a\) If a claim is not filed on the prescribed form, it is an informal
claim. For example, a telephone call from a claimant or a claimant\'s
fiduciary indicating an intent to apply for benefits documented on VA
Form 119 is acceptable as an informal claim for date of claim purposes,
but the issue will not be placed under pending-issue control. The
identity of the person providing the information by telephone must be
verified in accordance with chapter 11, paragraph 11.18. If the source
of the information is a claimant's fiduciary, confirm that a fiduciary
agreement is of record which establishes that person's authority to
speak on behalf of the claimant. Send the proper application form and
tell him or her that the completed form must be received in VA within 1
year to receive benefits from the date the telephone call was received.

\(b\) Consider an unsigned application as an informal claim under 38 CFR
3.155. Make a copy for the file and return the application to the
claimant, advising him or her that the signed form must be returned
within 1 year in order to receive benefits from the date the informal
claim was originally received. Concurrently develop for any other
necessary evidence, but do not establish a pending issue control until a
signed application is received.

\(2\) Informal claims provisions for reopening claims or for an
increased evaluation based on reports of examination or hospitalization
by VA or the military are found in 38 CFR 3.157(b). These types of
claims do not have to specify the benefit sought.

\(3\) Any communication concerning the death of the appellant in an
appeal which was submitted to the Court of Veterans Appeals and was
subsequently furnished to VA by the Court may be acceptable as an
informal claim for accrued benefits. See *De Landicho v. Brown* and
*Oseo v. Brown*, 7 Vet. App. 42 (1994).

g\. **Claims Filed and Lost.** If VA loses a claim, the employee having
knowledge of the facts will prepare a statement for the file. The
employee and his or her supervisor will sign the statement. Base the
effective date of the duplicate claim on the date of receipt of the lost
claim as established by the statement.

h\. **The Pre-Determination Team and Claims Development** The primary
function of the Pre-Determination Team is to initiate timely, accurate,
and complete development of claims.

\(1\) **Development**. The Pre-Determination Team determines the
relevant evidentiary sources needed to support a claim, such as service
records, private treatment records, Veterans Hospital Administration
(VHA) records, as well as state and federal records. It requests those
records, performs follow-ups as necessary, and ensures that such
requests and receipts are adequately reflected in Modern Awards
Processing-Development (MAPD) and BDN. The requests may be done via
letter, electronic means (such as Personnel Information Exchange System
(PIES) and Compensation and Pension Record Interchange (CAPRI)), or
through the judicious use of the telephone or facsimile (FAX) (see M21-1
Part III 11.18).

\(a\) **Supporting the Rating Team**. The Pre-Determination Team should
consistently deliver to the Rating Team fully developed, "ready to rate"
claims. These include original and reopened claims for compensation,
disability pension, Death and Indemnity Compensation (DIC), compensation
under 38 U.S.C. 1151, as well as basic eligibility issues which require
rating decisions. The team, under the guidance of a Rating Veterans

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**Change 116**

Service Representative (RVSR), also orders VA examinations and requests
medical opinions. It prints and evaluates the completed examinations for
sufficiency. This includes ensuring that all examinations were performed
as ordered and that there is a response to any requested medical
opinions. (For types of examinations, see M21-1 Part VI Chapter 1.) The
team also reviews other incoming medical evidence for completeness and
adequacy.

\(b\) **Identifying Partial Grants.** Although it is generally the goal
of the Pre-Determination Team to forward to the Rating Team only cases
which are completely "ready to rate," it may forward cases when, in its
judgment, a partial grant may be awarded based upon the evidence already
in hand. If this is done, MAPD cannot be updated to reflect "ready for
decision" until all of the issues involved in the claim have been fully
developed.

\(c\) **Workload and** **Deferred Rating Issues.** The Pre-Determination
Team receives the bulk of its incoming work as claims from the Triage
Team, with some from Congressional liaison or other special interests.
In the latter instance, the Pre-Determination Team is responsible for
establishing appropriate controls (BDN, MAPD, and COVERS). Mail is also
received in response to its prior development. The Team receives further
incoming work from the Rating Team when the latter defers decisions due
to deficient development, and/or identifies inferred or newly raised
issues. If a formal rating decision contains a deferred issue, the
Rating Team will route it directly to the Pre-Determination Team, which
initiates development without delay. Immediately after completing the
action, the Pre-Determination Team will forward the rating decision to
the Post-Determination Team, who will prepare the notification letter
and award. That notification may also include an explanation of any
development requested from a third party as well as that needed from the
claimant.

\(2\) **Controls.** Not only does the Pre-Determination Team ensure that
BDN and MAPD are current, but also that COVERS accurately reflects the
location of the claim files. It controls temporary transfers. It
utilizes WIPP and inventory management reports to maintain control of
pending claims and assure that development and follow-up requests are
being performed timely.

\(3\) **Administrative Decisions.** The Pre-Determination Team's duties
also include the development and preparation of all administrative
decisions (see M21-1 Part IV 11.02). These include character of
discharge, line of duty, willful misconduct, and deemed valid or common
law marriages.

\(4\) **Reviews**. The Pre-Determination Team will also complete reviews
which are mandated by the Compensation and Pension Service.

i\. **CAPRI Access to VA Claimant Records**

\(1\) **General.** Compensation and Pension Record Interchange (CAPRI)
is a VA Automated Information System (AIS) providing electronic access
to multiple Veterans Health Administration (VHA) systems. CAPRI allows
authorized VBA users read-only access to review/print claimant medical
records maintained by VHA medical facilities.

\(2\) **Using CAPRI for Development.** The Pre-Determination Team uses
CAPRI to electronically request/receive C&P medical
examinations/opinions, *Exchange of Beneficiary Information and Request
for Administrative and Adjudicative Actions* (VA Form 10-7131), and VA
medical records for use in determining entitlement to benefits. (See
M21-1, Part VI, 1.03.) It is important to be selective when using CAPRI
to identify and obtain medical evidence which is relevant to the claimed
issue. Generally, relevant medical evidence is that which is necessary
to decide the claim.

\(3\) **CAPRI User Guide.** For help in locating medical evidence in
CAPRI, refer to the CAPRI User Guide at the following website address:
[http://vbaw.vba.va.gov/bl/21/systems/docs/capriug.pdf.]{.underline}
(See Section 7, *CAPRI Locations for Medical Evidence*.)

\(4\) **CAPRI Privacy and Security.** Claimant records accessed via
CAPRI contain individually identifiable, highly sensitive health
information which is protected by Federal statutes, including the
Privacy Act, 5 U.S.C. § 552a, and confidentiality statutes, such as 38
U.S.C. §§ 5701 and 7332. Access to the records is on a need-to-know
basis only,

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**M21-1, Part III March 31, 2004**

**Change 116**

and VBA may use/disclose individually identifiable health information
for business purposes only as authorized by these statutes. Misuse of
CAPRI or unauthorized access to CAPRI may result in disciplinary action
and criminal prosecution. Gaining access to CAPRI requires a specific
application request, completion of VBA and VHA security/privacy
training, and acknowledging receipt of and adherence to the "CAPRI Rules
of Behavior." Contact the local Information Security Officer (ISO) for
more information on CAPRI security/privacy requirements and prevention
of unauthorized disclosure of VHA claimant records.

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