the Appeals Management Center (AMC) vendor immediately, and permanently transfer out (PTO) the claims folder in COVERS to the MSC’s SOJ. Important: Upon notification of the PTO, complete the PTO transfer in COVERS. entirely in VBMS send an e-mail to the VSCM or AMC mailbox, as applicable request the PTO of the COVERS record to the MSC’s SOJ, and handle new evidence associated with the IDES referral in accordance with M21-1, Part III, Subpart i, 2.D.3.g. Important: Upon notification of the PTO, complete the PTO transfer in COVERS. in the temporary custody of Compensation Service’s Systematic Technical Accuracy Review (STAR) Staff send an e-mail to the VSCM mailbox of the SOJ, requesting the claims folder, and IDES program office using the mailbox , stating that the claims folder has been requested from its respective SOJ. in the temporary custody of the Board of Veteran’s Appeals (BVA) follow the instructions in M21-1, Part III, Subpart i, 2.D.3.f. has previously been converted to an electronic record as part of the paperless claims processing (PLCP) program and exists only in the Virtual VA eFolder add a note in VBMS stating that all pre-IDES records are available in VBMS via the VIRTUAL VA DOCUMENTS tab on the DOCUMENTS screen. Important: If an IDES participant already has a claim or appeal pending with VA, see M21-1, Part III, Subpart i, 2.D.15. References: For more information about using COVERS, see the . f. Claims Folders in BVA Custody If an IDES participant’s claims folder is at the BVA, see the table below for instructions. Step Action 1 Submit a request for the claims folder to BVA, in accordance with M21-1, Part I, 5.F.5.c to be sent directly to the MSC’s location. 2 The request should indicate
If an IDES participant … Then MSCs must … chooses not to list any additional disabilities on VA Form 21-0819 ensure the participant annotates Block 11 of VA Form 21-0819 with the following No additional disabilities claimed the participant’s initials, and the current date. lists additional disabilities on VA Form 21-0819 inform the participant that VA will request an examination for and decide the participant’s entitlement to VA benefits based on the referred and claimed disabilities listed on VA Form 21-0819, and VA must share the examination results for referred and claimed disabilities with the participant’s service department. Exception: VA will not examine the types of disabilities listed in M21-1, Part III, Subpart i, 2.D.6.c. lists on VA Form 21-0819, or the participant’s service department refers to VA, a disability for which VA previously granted SC treat identification of the disability by the participant or his/her service department as a claim for an increased disability rating. expresses concern about VA’s disclosure of information to his/her service department regarding any disability the participant lists on VA Form 21-0819 recommend the participant delay submitting a claim to VA that involves the disability(ies) in question until after the participant exits the IDES. currently has a claim or appeal pending with VA that involves a disability the participant listed on VA Form 21-0819 follow the instructions in M21-1, Part III, Subpart i, 2.D.15. c. Claims for SC for PTSD MSCs must take the actions described in the table below during the initial meeting with an IDES participant if the participant is claiming SC for PTSD, and further development regarding the claimed in-service stressor is required under M21-1, Part IV, Subpart ii, 1.D. If an IDES participant is claiming SC for PTSD based Then MSCs must provide the participant with, and assist him/her in
on … completing … personal assault during service VA Form 21-0781a, Statement in Support of Claim for Service Connection for PTSD Secondary to Personal Assault. in-service stressors other than personal assault VA Form 21-0781, Statement in Support of Claim for Service Connection for PTSD. Important: Stressor verification and completion of one of the above forms are not required if the participant was diagnosed with PTSD during service. This includes diagnosis during a VA examination conducted as part of the IDES if the participant is still on active duty at the time of the examination. d. Completing Initial Interviews by Telephone or Video Conference When conducting an initial interview by telephone or video conference, MSCs are responsible for taking all actions described in M21-1, Part III, Subpart i.2.D.3.a-c, and must document the telephone interview on VA Form 27-0820 and upload the VA Form 27-0820 into the participant’s eFolder Important: MSCs must provide the participant with an opportunity to claim any chronic, service-related disabilities (in addition to the conditions referred by the service department) during the initial interview. e. Documenting Conditions Claimed During the Initial Telephone or Video Conference Interview During the initial interview, if an IDES participant claims any conditions his/her service department did not identify in Section 1 of VA Form 21-0819, then MSCs must note the claimed conditions in Section III Number 11 of VA Form 21-0819, and on VA Form 27-0820. Important: VA Form 27-0820 must be uploaded into the participant’s VBMS eFolder. Note: If the claimed conditions will not fit on VA Form 21-0819, it is acceptable to list additional claimed conditions on VA Form 21-4138, Statement in Support of Claim. In these instances, VA Form 21-4138 must be submitted at the time at the time the VA Form 21-0819 is signed, and should be attached to the VA Form 21-0819. f. Obtaining the Participant’s Signature on VA Form As part of the initial interview, MSCs must provide the participant with VA Form 21-0819 and ask the participant to sign and return the form immediately. Note: MSCs may use a secure fax or encrypted e-mail to provide the VA Form 21-0819 to the participant.
Incapacitated witness this action, and provide their own signatures and addresses in Section VII of the form. j. IDES Participants That Refuse to Sign VA Form 21-0819 If an IDES participant refuses to sign VA Form 21-0819, the MSC handling his/her case must advise the participant that in order to file a subsequent claim with VA, he/she must submit (or must have submitted in the past) one of the forms listed in M21-1, Part III, Subpart ii, 2.B.1.b, and inform the participant’s PEBLO that the participant refused to sign VA Form 21-0819 (the PEBLO will refer the participant to his/her command for counseling). If the IDES participant does not sign the form within five calendar days of his/her initial meeting with the MSC, the MSC must annotate the form with the sentence Participant refused to sign sign and date the form below the annotation, and note the participant’s refusal to sign the form in VBMS, and VTA. k. Processing IDES Cases While Awaiting a Signature VA will continue processing an IDES case with an unsigned VA Form until the point in time when it becomes necessary to prepare a rating decision (other than a proposed rating decision) to determine entitlement to disability benefits. If the participant has not signed the form by the time he/she exits the IDES, and none of the forms listed in M21-1, Part III, Subpart ii, 2.B.1.b are of record (and signed), the DRAS of jurisdiction must take the actions described in M21-1, Part I, 1.B.1.e for handling a claim that is not substantially complete enter the date of notification of the participant in the VA BENEFITS DATE field on the RO/RATING ACTIVITY tab in VTA, and add a note on the same tab that explains the date the DRAS entered in the VA BENEFITS DATE field. 5. MSC Actions Immediately Following the Initial Meeting Introduction This topic describes the actions MSCs must take immediately following the initial meeting with an IDES participant, including MSC actions immediately following the initial meeting, and MSC responsibility to notify PEBLOs of claims involving traumatic brain
PEBLO of the dates and times. MSC: [provide name, title, complete mailing address, phone and fax number, and e-mail address of MSC], and PEBLO: [provide name, location, phone and fax number, and e-mail address of the participant’s PEBLO] Important: If VA is processing a participant’s case electronically, MSCs must also indicate in the REMARKS section of the request that the participant has an eFolder instead of a paper claims folder, and the eFolder is accessible through Virtual VA or VBMS (whichever applies). MSCs must alter their request for notification, according to the instructions in M21-1, Part III, Subpart i, 2.D.16.b, if the participant is a member of the Reserves or National Guard who is not on active duty. MSCs must select IDES as a priority code when submitting a request for examination to VHA unless one of the following higher-priority codes is applicable Terminal, or FPOW (former prisoner of war). g. Uploading Examination Requests Into the eFolder MSCs must upload examination requests into the IDES participant’s eFolder, as described in the table of instructions below. If ... Then the MSC ... VHA will conduct the examination submits the examination request through CAPRI copy and pastes the examination request in a Word document saves the document as a Portable Document Format (PDF) file, and uploads the PDF into VBMS. a contract examiner will conduct the examination submits the examination request through CAATS clicks File, then Print, from within the exam request selects the Send to OneNote option from printer options clicks Print (this will send the request to OneNote) from OneNote, saves document as a PDF, and uploads the PDF into VBMS. Note: If Adobe Acrobat Pro is available, then print the request as a PDF instead of using Microsoft OneNote. h. Tracking After an MSC requests all the examinations an IDES participant requires,
reschedule the examination, or disenroll the participant from the IDES. Note: VA has no authority to disenroll a participant from the IDES. disability other than a referred disability consider the circumstances of each case and use their own discretion to decide whether examinations for claimed conditions should be rescheduled. If an examination is rescheduled for a referred disability, then MSCs should reschedule the examination(s) for claimed disabilities as well. Important: MSCs must enter a note in VTA stating a new examination has been requested due to the participant missing the original appointment. Do not change the PREPARE CLAIM START DATE or MEDICAL EVALUATION START DATE in VTA. Exception: If the purpose of the missed examination was to evaluate a mental disorder, MSCs should consider rescheduling the examination, especially if there is any indication the participant may have simply forgotten about it. Reference: For more information regarding failure to report for examination with good cause, see M21-1, Part III, Subpart iv, 8.E. l. Additional Evidence MSCs Receive After Sending the Claims Folder to the Scanning Vendor If additional evidence pertaining to an IDES participant’s case is received after sending the paper claims folder to the scanning vendor, MSCs should handle the evidence in accordance with M21-1, Part III, Subpart i, 2.D.3.g. 8. Effects of MEB and PEB Decisions Introduction This topic contains information about the effects of MEB and PEB determinations, including outcomes of an MEBs review of examination reports
and Controls for Completing Proposed Rating Decisions from a PEB, DRASs must complete the decision, and provide a copy of the decision to the PEB. In order to maintain control of pending requests and ensure they are completed on time, DRASs must make the following updates to VBMS upon receipt of a request for a proposed rating decision set a claim-level suspense under the pending EP 689 that expires 10 days after receipt of the request, and change the suspense reason and claim status to Ready for Decision. d. Examination Reports That Age Because of Delays in the IDES Process If a PEB requests a proposed rating decision more than one year after an IDES participant completes all of his/her IDES-related examinations, it is not necessary to order new examinations unless there is evidence indicating the severity of the his/her disabilities has changed. Example: A participant’s assertion that the severity of his/her disabilities have worsened constitutes evidence that warrants reexamination of the participant. e. Additional Records PEBs May Provide in Connection With A Request for a Proposed Rating Decision Occasionally, PEBs may have additional records to submit to VA when they request a proposed rating decision. If the records are sensitive, PEBs may send them using SAFE. Reference: For information about retrieving records that PEBs send through SAFE, see M21-1, Part III, Subpart i, 2.D.20.c. f. Disabilities DRASs Must Address and Decisions They May Defer in a Proposed Rating Decision DRASs are responsible for preparing proposed rating decisions for PEBs that address every disability an IDES participant indicated on the VA Form 21-0819 during the initial meeting with his/her MSC a participant’s service department referred to VA, found on the examination that is within the scope of a condition referred by the Service Department, and found on the examination that is within the scope of a condition claimed by the participant that can be granted based on the evidence of record. DRASs may defer a decision on a disability only in cases involving a disability found on an examination that is within the scope of a claimed disability but there is not sufficient evidence to decide the issue
Rationale: PEBs take into account an RVSR’s determination that a future examination of a disability is necessary when deciding whether to place a participant on the Temporary Disability Retired List (TDRL) or the Permanent Disability Retired List (PDRL). This information must be included in the proposed rating decision because PEBs do not receive copies of final rating decisions. Coexisting Claimed and Referred Disabilities When preparing a proposed rating decision, DRAS RVSRs must take the additional actions described in M21-1, Part III, Subpart i, 2.D.10.h if coexisting disabilities exist to which the rating schedule requires the assignment of a single disability rating one of the disabilities is a disability the IDES participant claimed, and the other disability is one that the participant’s service department referred to VA. h. Decisions Involving Coexisting Claimed and Referred Disabilities If an IDES participant has coexisting claimed and referred disabilities to which the rating schedule requires the assignment of a single disability rating, DRAS RVSRs must determine the appropriate disability rating for the referred disability alone (as if the coexisting claimed disability did not exist), and note the separate disability rating and the rationale for its assignment in the Reasons for Decision part of the rating decision that discusses the coexisting disabilities. Rationale: PEBs may consider only the disability ratings VA assigns to referred disabilities when deciding a participant’s final disposition. Example: Scenario: A participant claimed SC for sleep apnea. Asthma is among the disabilities the participant’s service department referred to VA. The results of pulmonary function testing warrant the assignment of a disability rating. However, the participant also uses a continuous positive airway pressure (CPAP) machine. VA awards SC for asthma and sleep apnea as coexisting disabilities and assigns a disability rating of 50 percent. Result: The RVSR who prepares the proposed rating decision must indicate in the corresponding Reasons for Decision that the participant’s asthma, if percent
proposed rating decision. r. Efficacy of a Proposed Rating Decision If a Service Department Returns an IDES Participant to Duty VA is not bound by the decisions set forth in an IDES participant’s proposed rating decision if the participant’s service department returns him/her to duty (based on disenrollment or an MEB or PEB determination), and the participant subsequently files a claim for VA benefits, to include a BDD or Quick Start claim. 11. Final Rating Decisions Introduction This topic contains information about final rating decisions, including requirement for verification of service content of final rating decisions codesheet entries on final rating decisions final rating decisions with deferred issues DRAS actions after completing a final rating decision, and appeals of final rating decisions. Change Date January 21, 2016 a. Requirement for Verification of Service Before DRASs prepare final rating decisions for IDES participants that were on active duty at the time of the referral into the IDES, the DRASs must verify the participant’s character of service, and date of discharge. A DD Form 214 satisfies the requirement for verification. If a DD Form 214 is not of record, DRASs must use all available resources to obtain verification. These include the participant’s MSC VA Defense Information Repository (VADIR) data in VTA Defense Personnel Records Information Retrieval System (DPRIS) Veterans Information Solution (VIS), and PIES.
Deferred Issues reasons described in M21-1, Part III, Subpart i, 2.D.10.f, the DRAS must continue the pending rating EP (110, 010, or 020) after promulgating the final rating decision close the record in VTA, and transfer the corresponding claims folder (or jurisdiction over the corresponding eFolder) to the SOJ for development and processing of the deferred decision. e. DRAS Actions After Completing a Final Rating Decision DRASs must complete the final rating decision and take the actions described in Steps 1 through 6 of the table below within five days of verification of a participant’s service separation and character of discharge. Step Action 1 Establish a claim-level suspense in VBMS that expires five days in the future. Change the suspense reason in VBMS to Special Project Team Claim, Awaiting: Promg. 2 Ensure the IDES Participant corporate flash remains attached to the participant’s electronic record. 3 Follow the instructions in M21-1, Part III, Subpart v, Chapter 2 for promulgating the final rating decision, and preparing a decision notice. Important: All IDES Benefit decision notices that are sent with final ratings must include the What is eBenefits paragraph. If the participant or participant’s spouse or mother is entitled to a civil service preference letter, DRASs must notify the participant that the civil service preference letter can be obtained in eBenefits. Reference: For more information about civil service preference letters, see M21-1, Part III, Subpart vi, 7.2. 4 Change the suspense reason in VBMS to Special Project Team Claim, Awaiting: Auth. 5 Authorize/approve the award and decision notice. Important: If a DRAS RVSR deferred a decision on any claimed or referred disability, authorization activity must leave the corresponding rating EP pending. 6 Send the decision notice and its attachments to the participant. 7 Enter the date of the decision notice in the VA BENEFITS DATE field on the RO/RATING ACTIVITY tab in VTA. Ensure the other fields under the RO/RATING ACTIVITY tab
14. Post-Separation Revisions of IDES-Related Rating Decisions Introduction This topic contains instructions for handling post-separation revisions of IDES-related rating decisions, including identifying cases in which post-separation revisions of IDES-related rating decisions are applicable situations that require the application of post-separation revisions of rating decisions, and notifying Veterans whose IDES-related rating decision has changed. Change Date March 26, 2014 a. Identifying Cases in Which Post-Separation Revisions of IDES-Related Rating Decisions are Applicable VA must take the actions described in M21-1, Part III, Subpart i, 2.D.14.c if VA revises a rating decision it prepared for a Veteran who participated in the IDES (These Veterans are identifiable by the presence of the Disability Evaluation System (or PLCP, Disability Evaluation System) corporate flash.), and the revision results in an increase in the disability rating assigned to a disability the Veteran’s service department referred to VA during his/her participation in the IDES. (These disabilities are identifiable on the rating decision code sheet as PEB Referred Proposed DES Service-Connected Disabilities.) Rationale: Rating decisions VA makes as a result of a Veteran’s participation in the IDES directly impact the benefits the Veteran receives from his/her service department. b. Situations That Require the Application of Revisions of IDES-Related Rating Decisions Situations such as those described below require application of the instructions in M21-1, Part III, Subpart i, 2.D.14.c. A Veteran appeals the disability rating VA assigned to a disability that his/her service department referred to VA. VA later resolves the appeal by increasing the disability rating. A Veteran had an appeal pending at the time he/she entered the IDES. The appeal involved the disability rating VA had assigned to a disability the Veteran’s service department later referred to VA. VA eventually resolves the appeal by increasing the disability rating. A quality review team identifies an error on an IDES final rating decision. Correction of the error results in the assignment of a higher disability rating for a disability the Veteran’s service department referred to VA.
with the claim transferring the participant’s claims folder to the MSC. a BDD RAS or Quick Start CPS has jurisdiction over the claim, and sufficient evidence does not exist to decide all issues associated with the claim the RAS or CPS must prepare a rating decision that addresses all issues for which sufficient evidence exists to make a decision, and defers a decision on all remaining issues remove the following from the current EP modifier “1” or “7,” and the BDD/Quick Start claim label, and permanently transfer the participant’s claims folder to the MSC. Note: If a participant has an eFolder instead of a paper claims folder, the intake site, RAS, or CPS must PTO the record in COVERS to transfer jurisdiction over the eFolder. d. IDES Participants With a Pending Claim That Is Not a BDD/Quick Start Claim If an RO receives a request from an MSC for permanent transfer of an IDES participant’s claims folder (or transfer of jurisdiction over the eFolder), and the participant has a claim pending at the RO that is not a BDD/Quick Start claim, the RO must immediately review the evidence of record to determine whether sufficient evidence exists to make a favorable decision on any issue associated with the claim. Within three business days of receipt of the MSC’s request, the RO must report to the MSC whether it routed the participant’s claim to rating activity for rating action, or transferred the participant’s claims folder to the MSC (or transferred jurisdiction over the eFolder). Important: If an RO decides that rating action is in order, it must complete the rating decision, promulgate it, and transfer the claims folder (or transfer jurisdiction over the eFolder) within ten business days of receipt of a request for the folder from an MSC. MSCs and DRASs are responsible for developing and deciding any issues an RO does not address in its rating decision. Unless an RO is able to decide all of the issues associated with a pending claim, the EP that controls the claim must remain pending. This EP and the EP 689 that MSCs establish in Step 2 of the procedures described in M21-1, Part III, Subpart i, 2.D.5.a may run concurrently. If a participant’s service department subsequently determines the participant is unfit for duty, the DRAS of jurisdiction will clear the EP 689, and prepare and promulgate the participant’s final rating decision under the
the examinations at that single facility for the member’s convenience. 12 Do one or more examinations remain that the facilities in the drop-down list referenced in Step 8 are unable to conduct? If yes, proceed to Step 14. If no, proceed to the next step. 13 Are the facilities that are able to conduct the remaining examination(s) located within 50 miles of the member’s current, physical location? If yes, proceed to Step 18. If no, proceed to the next step. 14 Navigate to the for locating VA facilities by ZIP Code. 15 Enter the member’s ZIP Code in the ADDRESS field. Select Hospitals from the drop-down list in the FACILITY field. Select Within 50 Miles in the WITHIN field. Click on the GO button. 16 From the search results, determine which VAMC is next closest to the member’s ZIP Code. 17 Return to Step 3. When the dialog box displaying available connections appears, select the VAMC identified in Step 16. Attempt to request the remaining examination(s) by following the remaining steps in the table. Note: If all of the examinations a member requires cannot be conducted at one or more facilities within 50 miles of his/her ZIP Code, send an email to . 18 Follow the instructions in the for submitting an examination request. Enter the following remarks in the examination request, in addition to those referenced in M21-1, Part III, Subpart i, 2.D.6.f. Claimant requests this exam location. DO NOT CANCEL FOR JURISDICTION If any of the requested examinations cannot be conducted at this facility, please notify: (Insert the user’s name, email address, and phone number.) Important: When MSCs request examination of a member of the Reserve or National Guard at a non-local VHA facility, they must notify the member’s PEBLO keep the PEBLO informed of the status of the examination(s), and