Introduction This topic contains special instructions for handling cases involving administrative error, including requirement for an administrative decision and advance notice of adverse action approval of administrative decisions involving administrative error requesting Compensation Service’s approval of administrative decisions actions to take if a beneficiary does not respond to the notice of proposed adverse action actions to take if a beneficiary provides new evidence or requests a hearing, and substituting a Decision Review Officer (DRO) decision for a new administrative decision. Change Date June 19, 2014 a. Requirement for an Administrative Decision and Advance Notice of Adverse Action If, because of administrative error, VA is paying benefits to a beneficiary in an amount that exceeds his/her entitlement, prepare an administrative decision according to the instructions in that proposes to reduce or discontinue benefits under send the beneficiary notice of the proposed adverse action according to instructions in , and do not take action to reduce or discontinue benefits until 65 days after the date of the notice of proposed adverse action. Important: VA may not create an overpayment in a beneficiary’s account when adjusting his/her award to correct an administrative error. Accordingly, there is no need to include language about minimizing an overpayment in the corresponding notice of proposed adverse action. Continued on next page 36. Special Instructions for Handling Cases Involving Administrative Error, Continued b. Approval of Administrative Decisions Involving Administrative Error Use the table below to determine who must approve administrative decisions involving an administrative error that resulted in the payment of excessive benefits to a beneficiary.
If the total amount of excessive benefits paid to the beneficiary is … Then the decision must be approved by … less than $2,000 no one lower than a Coach. between $2,000 and $24,999 a Veterans Service Center Manager (VSCM) or designee no lower than a Coach. $25,000 or more Compensation Service’s Program Review Staff. Reference: For information about obtaining approval from the Program Review Staff, see . Notes: Calculate the total amount of excessive benefits paid to a beneficiary by multiplying the amount of excessive benefits VA paid to the beneficiary each month by the number of months VA had paid the excessive benefits as of the date the administrative decision was prepared. Continued on next page , Continued c. Requesting Compensation Service’s Approval of Administrative Decisions Follow the instructions in the table below if approval of an administrative decision by Compensation Service’s Program Review Staff is necessary according to the instructions in . Step Action 1 Place a paper flash on the front of the affected beneficiary’s claims folder that briefly describes the reason for transferring the claims folder to Compensation Service. Exception: This action is not required if the claims folder is completely paperless. 2 Extend the suspense date of the end product that was established in connection with the administrative decision to a date that is 60 days in the future. 3 Temporarily transfer the claims folder to Department of Veterans Affairs Quality Assurance Attn: Program Review Staff (214B) 3322 West End Ave, Ste 730
Nashville, TN 37203 Exception: If the beneficiary’s claims folder is completely paperless, notify the Program Review Staff by e-mail (VAVBAWAS/CO/214B) that an administrative decision requiring approval is available in the beneficiary’s eFolder. 4 Did the Program Review Staff approve the administrative decision? If yes, send the beneficiary notice of the proposed adverse action according to instructions in . Sixty-five days after mailing the notice, take the actions described in or , whichever applies. If no, take the corrective action(s) prescribed by the Program Review Staff. Continued on next page , Continued d. Actions to Take If a Beneficiary Does Not Respond to the Notice of Proposed Adverse Action Follow the steps in the table below if a beneficiary does not respond to the notice of proposed adverse action referenced in and with the submission of new evidence within 60 days of the date of the notice of proposed adverse action, or a request for a hearing within 30 days of the date of the notice of proposed adverse action. Step Action 1 Adjust the beneficiary’s award so the reduction or discontinuation takes effect the first of the month following the month for which VA last paid the beneficiary. Rationale: VA may not create an overpayment in a beneficiary’s account when adjusting his/her award to correct an administrative error. Note: The actual payment of VA benefits is always one month in arrears. For example, benefits due a beneficiary for the month of October are deposited in the beneficiary’s account at the end of October or the beginning of November. Using this example, “the first of the month following the month for which VA last paid benefits to the beneficiary” would be November 1.