September 28, 1978 CORRECTED COPY M29-1, Part III\
Change 2

CONTENTS

CHAPTER 5. REVIEW DECISIONS-NSLI

PARAGRAPH PAGE

SUBCHAPTER 1. TYPES OF REVIEWS

5.01 Intermediate Review-Purpose and Procedure 5-1\
5.02 Regular Review-Purpose and Procedure 5-1\
SUBCHAPTER 2. BENEFITS TO BE CONTINUED\
5.03 Procedure 5-2\
5.04 Employment 5-2\
5.05 Deferred Statutory 5-2\
5.06 Industrial Review 5-2\
5.07 Anniversary of the 19th Year of Total Disability 5-3

SUBCHAPTER 3. BENEFITS TERMINATED

5.09 Return To Gainful Employment 5-4

5.10 Medical 5-4\
5.11 Failure To Cooperate\
5.12 End Of Premium-Paying Period 5-4\
5.13 Preparation Of Forms 5-4a

5-i

September 28, 1978 CORRECTED COPY M29-1, Part III

Change 2

CONTENTS

CHAPTER 5. REVIEW DECISIONS-NSLI

PARAGRAPH PAGE

**SUBCHAPTER 1. TYPES OF REVIEWS**

5.01 Intermediate Review-Purpose and Procedure 5-1\
5.02 Regular Review-Purpose and Procedure 5-1\
**SUBCHAPTER 2. BENEFITS TO BE CONTINUED\
**5.03 Procedure 5-2\
5.04 Employment 5-2\
5.05 Deferred Statutory 5-2\
5.06 Industrial Review 5-2\
5.07 Anniversary of the 19th Year of Total Disability 5-3

**SUBCHAPTER 3. BENEFITS TERMINATED**

5.09 Return To Gainful Employment 5-4\
5.10 Medical 5-4\
5.11 Failure To Cooperate 5-4\
5.12 End Of Premium-Paying Period 5-4\
5.13 Preparation Of Forms 5-4a

*4.* Page 5-1, paragraph 5.02, delete paragraph 5.02 in its entirety;
insert the following:

**5.02 REGULAR REVIEW - PURPOSE**

a\. The purpose of the Regular Review is to determine if continued
entitlement to disability insurance benefits is justified. The date of
the first Regular Review is determined by the adjudicator at the time
the original decision is prepared.

b\. In conducting the Regular Review, the adjudicator assesses the
evidence of record to determine if the insured has returned to
substantially gainful employment or if the disability has improved
sufficiently to permit return to substantially gainful employment.

**5.03 REGULAR REVIEW - PROCEDURE**

a\. VA Form 29-83l3 will be prepared by the system when the Regular
Review date is reached. It will bear the legend \"Regular Review\". when
the form is received, it will be associated with the folder and routed
to the Claims Examiner for adjudication.

b\. if no reply is received within 45 days, a follow- up RPO (Record
Printout) will be generated with the reason code Reg. Rev. The RPO and
folder will be forwarded to the Claims Examiner and the failure to
cooperate procedure will be followed. (Refer to par. 5.11)

4\. Page 5-1, paragraph 5.02, delete paragraph 5.02 in its entirety;
insert the following:

**5.02 REGULAR REVIEW - PURPOSE**

a\. The purpose of the Regular Review is to determine if continued
entitlement to disability insurance benefits is justified. The date of
the first Regular Review is determined by the adjudicator at the time
the original decision is prepared.

b\. In conducting the Regular Review, the adjudicator assesses the
evidence of record to determine if the insured has returned to
substantially gainful employment or if the disability has improved
sufficiently to permit return to substantially gainful employment.

5.03 REGULAR REVIEW - PROCEDURE

a\. VA Form 29-8313 will be prepared by the system when the Regular
Review date is reached. It will bear the legend \"Regular Review\". When
the form is received, it will be associated with the folder and routed
to the Claims Examiner for adjudication.

b\. If no reply is received within 45 days, a follow- up RPO (Record
Printout) will be generated with the reason code Reg. Rev. The RPO and
folder will be forwarded to the Claims Examiner and the failure to
cooperate procedure will be followed. (Refer to par. 5.11)

September 28, 1978 CORRECTED COPY M29-1, Part Iii\
Change 2

CHAPTER 5. REVIEW DECISIONS-NSLI

SUBCHAPTER I. TYPES OF REVIEWS

5.01 INTERMEDIATE REVIEW-PURPOSE AND PROCEDURE

> The primary purpose of the intermediate review is to check the
> industrial status of the insured. All intermediate review VA Forms
> 29-8313, Disability Benefits Questionnaire, received will be referred
> directly to the Insurance Claims Section without the folders. The
> General Clerk will review the forms, checking to see that lines 1
> through \[4\] of Part I are answered \"No\" and that the forms are
> signed and dated. If all answers are \"No\", the forms will be
> reported for disposal. \[ \] VA Form 29.589c \[Waiver Diary Action\]
> with transaction type 078, will be prepared to change the diary date.
> The diary control character will be Shown as a \"0\" which will
> trigger the release of VA Form 29-8313 at a future date. (See MP-6,
> pt. 11, supp. No. 2.2, for further instructions on the preparation of
> VA Form 29-5895c.) When VA form 29-8313 is received with one of the
> first three questions of Part I checked \"Yes,\" without line 1 of
> Part I com pleted, or and there is no written signature of-the insured
> on the envelope, the General Clerk will route the VA Form 29-8313 to
> the Claims Examiner who will determine if the folder is necessary for
> review. If forms indicate possible substantial employment the examiner
> will request the folder by submitting VA Form 23-5713, Folder Charge
> Card. When a VA Form 29-8313 is received at the time of an
> intermediate review unsigned and the envelope bears the written
> signature of insured it will be attached to the folder and processed
> as if the form were signed.

5.02 REGULAR REVIEW-PURPOSE AND PROCEDURE

a\. The purpose of the regular review is:

\(1\) To determine if continued entitlement to disability insurance
benefits is justified by the industrial and medical evidence of record.

\(2\) To set a future date of review or to terminate benefits in the
event it is found that an insured is no longer totally disabled.

b\. VA Form 29-8313 will be prepared by the system when the regular
review date is reached. The VA Form 29-8313 will bear the legend
\"Regular Review.\" If no reply is received within 45 days, a followup
RPO (record printout) will be generated with the reason code *Reg. Rev.*

c\. The RPO and folder will be forwarded to the Claims Examiner and a
Second Request will be initiated. The second form will be conspicuously
noted \"Second Request\" and released clerically by the \"Claims
Examiner.\" In cases involving guardianship, a copy of the VA Form
29-8313 will also be sent to the Veterans Services Officer of the
appropriate VA regional office. The RPO will be noted to show the action
taken, dated and filed in the DIB (disability insurance benefits)
folder. No action will be taken to change the diary at this time since a
repetitive RPO will be generated in 45 days. Upon receipt of the second
RPO, the folder will be obtained and referred to the Authorizer for
review. The Claims Examiners are responsible for the development of
evidence in connection with review decisions, except in cases involving
TDIP (total disability income provision) benefits or in cases assigned
by the Unit Supervisor to the Authorizers and Senior Authorizers for
review decisions. When VA Form 29-8313 is received at the time of
regular review, both the VA Form 29\--8313 and RPO will be associated
with the folder and routed to the Claims Examiner for adjudication. The
date of the next review will be determined by the medical record and
employment history. The determination must be made on flee basis of the
facts in each individual case.

5-1

M29-1, Part III CORRECTED COPY September 28, 1978

Change 2

SUBCHAPTER 2. BENEFITS TO BE CONTINUED

5.03 PROCEDURE

If benefits are to be continued, a VA Form 29-808b, Review Decision of
Disability Insurance Claims, will be prepared in longhand by the Claims
Examiner. At the time of the initial review of VA Form 29-8313, items 1
through 4 of VA Form 29-808b will be completed. Item 5A, Remarks, can be
left blank unless it is felt that an explanation is necessary. \"Doc 4\"
will be annotated in item 5A and then after every subsequent review
indicating that VA Form 29-8524 \[, Waiver Diary,\] will be prepared to
change the diary control character and advance the review date. The
severity code will initially be shown above item 5B and then after every
subsequent review. Item 5B, Date of Next Review, will reflect the future
review date. Item 5C**,** Approved By, will bear the signature of the
Claims Examiner and title. Item 5E will show the date of review.
Whenever continuance of an award is authorized on VA Form 29-808b,
destroy all intermediate VA Forms 29-8313\'s that may be filed in the
folder.

\(b\) Line 4, sentence 4, delete and insert the following:

\"Doc 12\" or \"Doc 04?t will be annotated in item 5A and then after
every subsequent review

indicating that the scanner input portion of the VA Form 29-8313 or VA
Form 29-8525, Waiver Diary, will be prepared to change the diary control
character and advance the review date. RPO\'s will be Diary, will be
prepared to change the diary control character and advance the review
date.

When a statutory determination has been deferred as to whether the loss
may be considered permanent, a review will be made at a time deemed
appropriate. If necessary, reviews will be made at appropriate intervals
until it is determined that there is no reasonable doubt as to
permanency. When it is so determined, the Authorizer or Senior
Authorizer will line through the word \"deferred\" in the item entitled
\"Statutory Req. Met\" on VA Form 29-1565-3 \[Decision Disability
Insurance Benefits,\] and will show either the date when statutory total
disability requirements are met or the entry \"Not Met,\" followed by
Authorizer\'s initials and date. If the findings of statutory total
disability results in the granting of additional benefits, an amended
award will be prepared. When a finding of statutory total disability was
not deferred at the time of the original decision awarding insurance
benefits and it is later determined that the insured is statutory
totally disabled, the Authorizer or Senior Authorizer with the
concurrence of the Section Chief or designee will authorize decision of
statutory total disability on VA Form 29-808b showing in the appropriate
\"Remarks\" item a statement 19 the effect that the evidence of record
establishes that the insured\'s disability meets the statutory total
disability requirements. In arriving at the decision, the Authorizer
will secure a written opinion from the Medical Consultant as to whether
the insured has suffered the permanent loss of use of members or organs.
At this time, VA Form 29-8524 Doc 4, will be prepared to insert the
statutory code as the primary disability classification code and the
changing of the diary control character to 3 and the severity code to
\"0.\"

5.06 INDUSTRIAL REVIEW

a\. When the insured suffers from impairments which are so severe in
degree and so chronic or progressively deteriorating in nature that
there is reasonable certainly that he or she will remain totally
disabled, the case will be termed \"Industrial Review.\" Age and length
of the period of total disability are factors to be considered in
deciding if the case is to be marked \"Industrial Review.\" If a case
meets \"Industrial Review\" criteria, it will not

5-2

January 14, 1980 M29-1, Part III\
Change 3

4

thereafter be necessary to review the case other than as interim or
clerical review. A case may be made \"Industrial Review\" either as an
original or as a review decision.

b\. The following are guidelines to be used in determining if a case
should be marked \"Industrial Review.\" The guidelines are not to be
applied automatically. The types of cases which may properly be
considered for classification as \"industrial Review\" are:

\(l\) Those cases in which the insured has been totally disabled for 10
or more years.

\(2\) Those cases in which the insured has been totally disabled for 5
or more years and is over age 60.

\(3\) Those cases in which the insured suffers from severe impairments
of such chronic or progressively deteriorating nature that there is
reasonable certainty that the insured will not improve and must be
considered totally disabled if the insured is not, in fact, continuously
following a substantially gainful occupation.

c\. When the Authorizer or Senior Authorizer considers the case to come
within one of these classifications, he or she will write \"industrial
Review\" in the Remarks item of VA Form 29-1565-3, set the review date
for the end of the 19th year of total disability or at the end of the
premium-paying period, whichever is earlier, and will indicate a
severity code 7 calling for interim or clerical review every 2 years. In
review cases, \"industrial Review\" will be stamped on the VA Form
29-808b in items 5A through 10A whenever appropriate. it must be
remembered that these cases will not be placed in this category
automatically. If development, medical or otherwise, is indicated at
this review, such development will be taken as in any other regular
review.

5.07 ANNIVERSARY OF THE 19TH YEAR OF TOTAL DISABILITY

On the anniversary of the 19th year of total disability, an RPO will be
generated with the Reason Code STAREV (statutory review is the next
callup). At this time, the Claims Examiner will review the insurance DIB
folder ensuring that all is in order to becoming a 20-year case. The
Claims Examiner will:

a\. Verify the date of total disability on the VA Forms 29-1565-3 and
29-808b and the RPO for correctness.

b\. See that there is no evidence of employment.

c\. VA Form 29-8524, transaction type 078, will be prepared to change
the callup date to the end of the 20-year period.

5.08 ANNIVERSARY OF THE 20TH YEAR OF TOTAL DISABILITY

On the anniversary of the 20th year of total disability, an RPO will be
generated with the Reason Code STAREV and the message \"Statutory\" in
the callup date field. The insurance DIB folder will be reviewed by the
Claims Examiner ensuring that the beginning date of total disability is
correct. The RPO will be initiated, dated and filed in the right side of
the insurance folder or in the DIB folder if still in use and returned
to file. (See M29-1, pt. I, ch. 31, par. 31.32.)

SUBCHAPTER 3. BENEFITS TERMINATED

5.09 RETURN TO GAINFUL EMPLOYMENT

Whenever a VA Form 29-8313 is received which shows that the insured has
returned to full-time employment, provided the possibility of statutory
disability is not involved, the Claims Examiner will take the necessary
action to terminate the award immediately. in cases in which TDIP (total
disability income \[provisions\]) payments are involved, the Senior
Authorizer will terminate the award.

**5-3**

M29-1, Part III January 14, 1980

Change 3

5.10 MEDICAL

a\. When there is a continuing award in effect and a review decision is
rendered finding the insured no longer totally disabled for insurance
purposes on the basis of evidence received subsequent to the date of the
prior decision, the award will be terminated. (See M29-l, pt. I, ch. 31,
par. 31.27.)

b\. A finding of recovery from total disability may be based on
industrial and/or medical evidence. When the finding of recovery is
based on medical evidence alone, the medical evidence of record must be
recent enough so that it establishes that the insured is presently
capable of continuous substantially gainful employment.

5.11 FAILURE TO COOPERATE

Whenever an insured fails to reply to two employment questionnaires and
neither request is returned by the Postal Service authorities as
undeliverable, the Claims Examiner will refer the case to the Authorizer
for a determination of termination of benefits on the basis of failure
to cooperate. When the disabling condition is not mental, awards will be
terminated when an insured fails to respond to two requests for
employment information. Any deviation from this will require supervisory
approval. When an employment questionnaire is returned unclaimed and
there is an indication that the insured has disappeared, another VA Form
29-8313, conspicuously marked \"Second Request,\" will be released to
the latest address of record. Letters returned unclaimed should be filed
with the envelopes on the right side of the insurance folder! DIB folder
if still in use. The case will be diaried for a 45-day callup. If at the
end of the 45 days no answer is received to the second request, the
award will be terminated. If the insured\'s disability is of a mental or
emotional nature, or if there are any other circumstances which would
indicate that the insured might not be able to act in a responsible
manner, additional development besides a second request VA Form 29-8313
(a copy being sent to the Veterans Services Officer) will be undertaken.
The additional development could include a letter to the spouse or
relative, Retail Credit Corporation report, Postal Service inquiries. In
guardianship cases when no answer is received to a second request, a
letter should be written to the Veterans Services Officer seeking
assistance in getting a reply to the requests for employment reports.
When total disability income provision payment is involved, the
Insurance Awards Unit will be notified to stop payment if mail is
returned unclaimed.

5.12 END OF PREMIUM-PAYING PERIOD

\[a.\] Continuing awards of waiver of premiums on 20-payment life,
30-payment life and endowment policies \[will be terminated as the
premium-paying period ends.\]

\[b. No intermediate or regular review of the insured\'s continued
entitlement to waiver of premiums will be established for a date within
6 months of the date a policy reaches the end of the premium-paying
period or matures.

c\. When it is determined that no further review is required because the
policy becomes paid up or matures, the waiver diary callup date and
review date will be changed to the due date l month after the
premium-paying period ends.

NOTE: The above is not applicable when there is one or more additional
policies which will remain on waiver or the insured is receiving TDIP
benefits.\]

5.13 PREPARATION OF FORMS

a\. The Claims Examiner, Authorizer, or Senior Authorizer when
appropriate, will complete VA Form 29-1568, Review Decision-Termination,
as follows:

5-4

June 25, 1975 M29-I, Part III

Self explanatory.\
2. Insurance File No. Self explanatory.\
3. Name of Insured Self explanatory.\
Correspondence and Symbol Self explanatory.\
5A. Policy No. Self explanatory.

5C. Effective Date of Termination Insert the day prior to the date of
the next premium due\
following preparation date of this form. Refer to M29-l,\
part I, paragraph 31.27.

6\. Reason for Action No longer totally disabled or failure to
cooperate.\
9. C-File Examined Self explanatory.\
10. Date of Birth Self explanatory.\
11. Insured Representative Indicate *Yes* or *No.* If *Yes,* name of
organization.

13\. The decision is that the insured is shown When continuing awards
are terminated because of the\
to have recovered the ability to follow a insured\'s failure to
cooperate, the decision should so state\
substantially gainful occupation. as follows: *The decision is that the
insured has failed to\
submit and there is not of record, evidence to establish\
that the insured continues to be totally disabled.* (See\
M29-1, pt. I, par. 31.29.

14\. Approval Date Date action is completed.

15\. Signature of Authorizer and/or Self explanatory-type name in bottom
of item.\
Senior Authorizer

16\. Signature of Section Chief Self explanatory-type name in bottom of
item.

b\. When the reason for action is no longer totally disabled, the Claims
Examiner or Authorizer, when appropriate, will prepare VA FL 29-22. The
Claims Examiner will terminate the waiver when the termination is based
on a return to full-time gainful employment or active duty. The
Authorizer will terminate the waiver when termination is based on
medical evidence which shows the insured has recovered the ability to
return to full-time gainful employment.

c\. When premiums were previously paid:

\(1\) Direct-the first block will be checked.

\(2\) By deduction from benefits-the second block will be checked
informing the veteran that the deductions will be resumed. (The
Adjustment Claims Clerk will prepare VA Form 29-5926, Request for DFB
Action, input, generating a request to DPC Hines to resume deductions.)

5-5

M29-I, Part III June 25, 1975

\(3\) By deductions from retired or active service pay-the first block
will be checked and a postscript, If you are receiving retired or active
service pay and wish to pay future premiums by monthly Class N deduction
from your pay, please let us know at once, will be added.

d\. When the reason for action is failure to cooperate*,* the Authorizer
will prepare:

\(1\) MTST tape U #10-if the veteran pays premium by direct pay.

\(2\) MTST tape U#11-if the veteran is paying premium by deduction from
benefits.

\(3\) MTST tape U #12 or 13-if the veteran has a fiduciary.

\(4\) VA FL 29-351-if the veteran failed to report for an examination.

e\. After an original and one copy of VA Form 29-1568 is completed, the
insurance folder, VA Form 29-5886b, (RPO) Insurance Record Printout, and
termination letter will be forwarded to the General Clerk. The General
Clerk will authenticate VA Form 29-1568 and release the termination
letter. The General Clerk will route the copy of the VA Form 29-1568 to
the Control Clerk for insertion into the control file. The General Clerk
will route the insurance folder, original VA Form 29-1568 and RPO to the
Adjustment Claims Clerk. The Adjustment Claims Clerk will process the
case, prepare the necessary input document and annotate the action taken
on the VA Form 29-1568. For example, *VA Form 29-8524* or *VA Form
29-5926.* The Adjustment Claims Clerk will file the VA Form 29-1568 in
the insurance folder and route the folder to file.

f\. When the input documents are accepted by the system, an RPO reason
code DELWA will be generated.

g\. Upon receipt of the *DELWA RPO,* the Control Clerk will withdraw the
corresponding VA Form 29-1568 from the control file. The RPO will be
analyzed to determine that the *how paid code* has been changed from how
paid 5 to the appropriate code; the reimbursable control character has
been removed, if applicable, and that the next month due is not prior to
the waiver termination date.

h\. If the RPO shows action has been taken and is correct, the RPO and
VA Form 29-1568 will be disposed of in accordance with the Records
Control Schedule VB-1.

i\. If no DELWA RPO is received by the end of a 2-week period, an RPO
will be requested to determine if the corrective action has been taken.
If the change has not been made, the General Clerk will refer the RPO
and waiver decision copy to the supervisor to expedite action or resolve
the problem.

j\. If the correct action has not been taken or premiums have not been
refunded, the insurance folder will be requested by use of VA Forms
29-5714, Requisition-Photocopy/Folder Request-Temporary Charge Card.
Upon receipt of the folder, the Control Clerk will attach the RPO and
refer the records to the Adjustment Claims Clerk for corrective action.

k\. In termination of cases involving TDIP, the criteria is similar to
that of termination of waiver of premium on basic policies. The
difference is that the VA Form 29-1568 will include the termination date
of the waiver on the TDIP rider and the termination date of the monthly
income payments (the monthly payment due date will be included). The
annotation DIS will be placed after the policy number on the entries
involving TDIP.

l\. In termination of a TDIP, when the reason for action is no longer
totally disabled, the Senior Authorizer will prepare VA FL 29-317.

m\. When premiums were previously paid:

\(1\) Direct-the first block will be checked.

5-6

4

June 25, 1975 M29-I, Part III

\(2\) By deduction from benefits-the second block will be checked
informing the veteran that the deductions will be resumed. (The
Adjustment Claims Clerk will prepare VA Form 29-5926 input, generating a
request to DPC Hines to resume deductions.)

n\. By deductions from retired or active service pay-the first block
will be checked and a postscript, You should contact your finance
officer to reestablish your allotment, will be added.

o\. In termination of cases involving TDIP, when the reason for action
is failure to cooperate, the Senior Authorizer will prepare one of the
appropriate letters:

\(1\) VA FL 29-351-if the veteran failed to report for an examination.

\(2\) MTST tape U #10-if the insured previously paid premiums by direct
pay.

\(3\) MTST tape U #11-if the insured previously paid premiums by
deduction from benefits.

\(4\) MTST Tape U #12 or #13-if the insured has a fiduciary.

p\. The Senior Authorizer will postscript the pertinent data on TDIP
provision payments to the appropriate letter.

q\. The Senior Authorizer will prepare and affix VA Form 3230 to the
insurance folder with the following instructions on the Adjustment
Claims Clerk:

\(I\) Assign control number.

\(2\) Suspend payments.

\(3\) Obtain current VA Form 4-456, Insurance Award Record Printout.

r\. After an original and one copy of VA Form 29-1568 is completed, the
insurance folder and VA Form

4-456 will be forwarded to the Adjustment Claims Clerk by the Senior
Authorizer.

s\. The Adjustment Claims Clerk will prepare VA Form 21-8046, Payment
Notice (Stop-Suspended-Resume), to suspend the award. Block B will be
checked and reason code 02 will be inserted. Block 12, Remarks, will
show *Poss NLTD* (Possibly No Longer Totally Disabled). This form will
be prepared by one Adjustment Claims Clerk and reviewed by another. A
control number will be assigned to the form which will be released
through the Control Clerk to notify the Insurance Awards Unit,
Operations Section, Finance Division. The form will be noted in red ink,
*Return to ICS.* The case will be held by the Adjustment Claims Clerk\'s
desk until the VA Form 21-8046 and a VA Form 4-456 is returned from the
Finance Division. When the suspend VA Form 21-8046 with reason code 02
is returned with the VA Form 4-456 award RPO reflecting suspend action,
the Adjustment Claims Clerk will send the insurance folder, RPO and VA
Form 29-1568 back to the Senior Authorizer for a review of the
termination letter.

t\. The Senior Authorizer will route all of the material to the General
Clerk.

u\. The General Clerk will verify the letter and release it. The General
Clerk will then route a copy of VA Form 29-1568 to the Control Clerk,
forward the insurance folder, RPO\'s (insurance and awards) and original
VA Form 29-1568 to the Adjustment Claims Clerk.

v\. The Adjustment Claims Clerk will prepare a second VA Form 21\--8046.
Block A will be checked and reason code 06 will be inserted. Block 12,
Remarks, will show NLTD (No Longer Totally Disabled). The original VA
Form 21-8046 showing a control number will be sent to Finance Division
through the Control Clerk. The duplicate will be filed in the folder and
returned to file.

5-7