## Section D. Misuse Determinations and Reconsiderations

#### Overview

+------------+---------------------------------------------------------+
| #          | > This section contains the following topics:           |
| #### In th |                                                         |
| is Section |                                                         |
+------------+---------------------------------------------------------+

  ----------- ----------------------------------------------- -----------
  Topic       Topic Name                                      See Page

  12          Misuse Determinations                           5-D-2

  13          Notification of Misuse Determination            5-D-6

  14          Reconsideration Requests and Reports            5-D-7

  15          Exhibit 1: Misuse Determination                 5-D-9
  ----------- ----------------------------------------------- -----------

#### 12. Misuse Determinations

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on misuse             |
| troduction | > determination content and format.                     |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > July 13, 2005                                         |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > A formal misuse determination must be prepared        |
|  Responsib | > whenever a misuse allegation is received and          |
| ility for  | > investigated.                                         |
| Misuse Det |                                                         |
| ermination | > Misuse determinations will be made by the supervisor  |
| s {#a.-res | > of the Fiduciary Activity and approved by the VSCM.   |
| ponsibilit | > Any decision that finds actual misuse must also have  |
| y-for-misu | > concurrence of the station director.                  |
| se-determi |                                                         |
| nations .u | > Misuse determinations will not be reversed by the     |
| nnumbered} | > director in the absence of clear and unmistakable     |
|            | > error at the RO level.                                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > The misuse determination is the official decision     |
|  Purpose o | > document in response to the allegation of misuse. It  |
| f the Misu | > serves to summarize the facts and circumstances upon  |
| se Determi | > which the determination was made. When misuse is      |
| nation {#b | > found, a copy of this document is provided to the     |
| .-purpose- | > fiduciary with notification of the determination.     |
| of-the-mis |                                                         |
| use-determ |                                                         |
| ination .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > The seriousness of the misuse allegation and          |
| ### c. Com | > implications of a finding of factual misuse require   |
| pleteness  | > that the decision maker thoroughly review all         |
| of Review  | > available evidence prior to making a final            |
| {#c.-compl | > determination. This review should include a review of |
| eteness-of | > the PGF, in addition to the Misuse Investigation      |
| -review .u | > Report with supporting exhibits and any other         |
| nnumbered} | > relevant material.                                    |
+------------+---------------------------------------------------------+

Continued on next page

12\. Misuse Determinations, Continued

+------------+---------------------------------------------------------+
| ###        | > Each misuse determination, regardless of the finding, |
| ## d. Requ | > must include the following elements:                  |
| ired Eleme |                                                         |
| nts  {#d.- | -   Statement of Authority (Title 38 U.S.C. 6106)       |
| required-e |                                                         |
| lements .u | -   Identifying information                             |
| nnumbered} |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   VARO                                                |
|            |                                                         |
|            | -   Veteran's name                                      |
|            |                                                         |
|            | -   Claim number                                        |
|            |                                                         |
|            | -   Beneficiary name                                    |
|            |                                                         |
|            | -   Fiduciary name                                      |
|            |                                                         |
|            | -   Fiduciary Social Security Number/Tax Identification |
|            |     Number                                              |
|            |                                                         |
|            | -   Fiduciary category (individual, individual serving  |
|            |     10 or more, or other than an individual regardless  |
|            |     of the number of beneficiaries served)              |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   Statement of allegations                            |
|            |                                                         |
|            | -   Facts, to include any corrective action (i.e.       |
|            |     appointment of successor)                           |
|            |                                                         |
|            | -   Determination                                       |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   conclusion regarding misuse                         |
|            |                                                         |
|            | -   misuse amount, when misuse found, and               |
|            |                                                         |
|            | -   how misuse amount was determined                    |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   Determination date                                  |
|            |                                                         |
|            | -   Signature and concurrence block(s)                  |
+------------+---------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Reference***: For a further description of the required          |
| > elements, as well as an example of suggested format for the misuse  |
| > determination, see [M21-1MR, Part XI,                               |
| > 5.D.15](../pt11_ch05_secD.xml#XI.5.D.15).                           |
+-----------------------------------------------------------------------+

Continued on next page

12\. Misuse Determinations, Continued

+------------+---------------------------------------------------------+
| ####       | > The original determination document will be filed in  |
| # e. Copie | > the PGF. Copies must also be prepared for             |
| s of Deter |                                                         |
| mination { | -   attachment to the notification letter sent to the   |
| #e.-copies |     fiduciary                                           |
| -of-determ |                                                         |
| ination .u | -   attachment to copy of notification letter sent to   |
| nnumbered} |     the successor fiduciary (or beneficiary if there is |
|            |     no fiduciary)                                       |
|            |                                                         |
|            | -   the veteran\'s claims file                          |
|            |                                                         |
|            | -   the station onsite review file (if one exists)      |
|            |                                                         |
|            | -   referral to the Office of Inspector General (OIG),  |
|            |     as appropriate                                      |
|            |                                                         |
|            | -   the station Fiscal Activity when reissuance of      |
|            |     benefits is required                                |
|            |                                                         |
|            | > A copy of each misuse determination, regardless of    |
|            | > the finding, must also be sent to the Fiduciary       |
|            | > Program Staff, VACO. The PGF must accompany this      |
|            | > document when a negligence determination is required. |
|            | >                                                       |
|            | > Decisions that do not require a negligence            |
|            | > determination may be sent electronically to           |
|            | > VAVBAWAS/CO/F&FE, using *"Misuse Determination        |
|            | > Transmittal"* in the subject line.                    |
+------------+---------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Reference***: For information on reissuance of benefits and      |
| > negligence determinations, see [M21-1MR, Part XI,                   |
| > 5.E](../pt11_ch05_secE.xml#XI.5.E).                                 |
+-----------------------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > Misuse determinations are final unless additional     |
| # f. Final | > evidence is received within 30 days of the date of    |
| ity of Det | > the determination. Requests for reconsideration       |
| ermination | > received more than 30 days from the date of the       |
|            | > determination will not be considered.                 |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Any determination that misuse has occurred will       |
| ## g. Requ | > result in a special unscheduled onsite review if the  |
| ired Unsch | > fiduciary is a multi-fiduciary**, regardless of the   |
| eduled Ons | > number of cases managed.**                            |
| ite Review |                                                         |
+------------+---------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Reference***: For procedures involving onsite reviews, see       |
| > [M21-1MR, Part XI, 6.A](../pt11_ch06_secA.xml#XI.6.A).              |
+-----------------------------------------------------------------------+

Continued on next page

12\. Misuse Determinations, Continued

+------------+---------------------------------------------------------+
| ###        | > When funds are recovered from a former fiduciary as a |
| ## h. Acti | > result of a misuse determination, the Fiduciary       |
| on by F&FE | > Activity will instruct the RO Fiscal Activity whether |
|            | > to                                                    |
|            |                                                         |
|            | -   remit recouped funds to the successor fiduciary, or |
|            |                                                         |
|            | -   return them to the current appropriation if VA      |
|            |     previously reissued benefits.                       |
+------------+---------------------------------------------------------+

#### 13. Notification of Misuse Determination {#notification-of-misuse-determination .unnumbered}

+------------+---------------------------------------------------------+
| ##### In   | This topic will contain information on notification     |
| troduction | requirements for misuse determinations.                 |
|  {#introdu |                                                         |
| ction-1 .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > July 13, 2005                                         |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > Any fiduciary who is the subject of a misuse          |
|  Notificat | > investigation must be notified of the decision and    |
| ion Requir | > provided a copy of the misuse determination.          |
| ements {#a | >                                                       |
| .-notifica | > If the fiduciary has been removed, a second copy will |
| tion-requi | > be sent to the successor fiduciary (or beneficiary if |
| rements .u | > there is no fiduciary).                               |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+-----------------------------------------------------------------------+
| > The decision letter must include the following elements:            |
|                                                                       |
| -   decision                                                          |
|                                                                       |
| -   amount of debt, if applicable                                     |
|                                                                       |
| -   instructions for repayment, if applicable, and                    |
|                                                                       |
| -   reconsideration process.                                          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Reference:*** For specific information regarding reconsideration |
| > requirements, see [M21-1MR, Part XI,                                |
| > 5.D.14.c](../pt11_ch05_secD.xml#XI.5.D.14.c).                       |
+-----------------------------------------------------------------------+

#### 14. Reconsideration Requests and Reports {#reconsideration-requests-and-reports .unnumbered}

+------------+---------------------------------------------------------+
| ##### In   | > This topic will discuss reconsideration requests and  |
| troduction | > determinations.                                       |
|  {#introdu |                                                         |
| ction-2 .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > July 13, 2005                                         |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > A misuse determination made under Title 38 U.S.C.6106 |
|  a. No App | > carries no appeal rights. A fiduciary may, however,   |
| eal Rights | > request reconsideration of the determination and/or   |
|            | > the amount determined to have been misused.           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Personal hearings will not be conducted unless deemed |
| b. Persona | > necessary by VA.                                      |
| l Hearings |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > Requests for reconsideration must be received by the  |
| # c. Recon | > Fiduciary Activity within 30 days of the date of the  |
| sideration | > misuse determination. Requests received 30 days or    |
|  Requireme | > more after the date of the determination will not be  |
| nts {#c.-r | > considered.                                           |
| econsidera |                                                         |
| tion-requi |                                                         |
| rements .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Note***: Any request for reconsideration of a misuse             |
| > determination must contain new and material evidence not previously |
| > considered.                                                         |
+-----------------------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d.   | > Reconsideration requests must be reviewed and a       |
|  Reconside | > decision made within 30 days of receipt in the        |
| ration Det | > Fiduciary Activity.                                   |
| ermination |                                                         |
| s {#d.-rec |                                                         |
| onsiderati |                                                         |
| on-determi |                                                         |
| nations .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

14\. Reconsideration Requests and Reports, Continued

+------------+---------------------------------------------------------+
| ##### e    | > Notification of the decision must be sent to the      |
| . Reconsid | > party requesting reconsideration, with copy to the    |
| eration No | > successor fiduciary (or beneficiary if there is no    |
| tification | > fiduciary). This notification must include            |
|            |                                                         |
|            | -   a summary of the new and material evidence          |
|            |     considered                                          |
|            |                                                         |
|            | -   the reconsideration determination, and              |
|            |                                                         |
|            | -   instructions for repayment, if applicable.          |
|            |                                                         |
|            | > When misuse is confirmed, notification will instruct  |
|            | > the fiduciary to submit repayment to the Fiduciary    |
|            | > Activity of jurisdiction, with funds payable to the   |
|            | > Department of Veterans Affairs.                       |
+------------+---------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Note***: A copy of the notification letter will be filed in both |
| > the PGF and the veteran's claims file.                              |
+-----------------------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > When funds are recovered from a former fiduciary as a |
| ## f. Acti | > result of a misuse determination, the Fiduciary       |
| on by F&FE | > Activity will instruct the RO Fiscal Activity whether |
|            | > to                                                    |
|            |                                                         |
|            | -   remit recouped funds to the successor fiduciary, or |
|            |                                                         |
|            | -   return them to the current appropriation if VA      |
|            |     previously reissued benefits.                       |
+------------+---------------------------------------------------------+

#### 15. Exhibit 1: Misuse Determination {#exhibit-1-misuse-determination .unnumbered}

+------------+---------------------------------------------------------+
| ##### C    | > July 13, 2005                                         |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > The exhibit below contains a sample misuse            |
| Misuse Det | > determination.                                        |
| ermination |                                                         |
+------------+---------------------------------------------------------+

  -----------------------------------------------------------------------
  ![](media/image1.jpeg){width="6.209722222222222in" height="6.15in"}

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15\. Exhibit 1: Misuse Determination, Continued

+------------+---------------------------------------------------------+
| a\. Misuse | > ***Note***: When misuse is not found, the approving   |
| Det        | > official will be the VSCM. The misuse determination   |
| ermination | > is to be filed in the PGF with a copy for the claims  |
| (          | > folder. A copy of the [final]{.underline}             |
| continued) | > determination must be sent to CO in [all]{.underline} |
|            | > cases and referred to the OIG, as appropriate, per    |
|            | > VBA Circular 20-84-12, dated May 22, 1984.            |
+------------+---------------------------------------------------------+