b. Initial Actions to Take Upon Receipt of an FDC for Claims With Claims Folder Take the following actions within one day of receipt of an FDC that has a paper claims folder establish the appropriate EP enter specific contentions of the claim identify the claim as an FDC by attaching the Fully Developed Claim special issue indicator to at least one contention within the FDC claim complete the folder flash shown in M21-1, Part III, Subpart i, 3.B.6 and attach it to the paper claims folder, and deliver the paper claims folder to the designated drop-off point for FDCs that require the development described in M21-1, Part III, Subpart i, 3.B.3. Note: A claims folder is a claims folder that has not yet been scanned into the electronic claims processing system. References: For more information about choosing an appropriate EP, see M21-4, Appendix B establishing an EP in the appropriate system, see M21-1, Part III, Subpart ii, 2.D.2, or drop-off points for FDCs, see M21-1, Part III, Subpart i, 3.A.3.c. 2. Excluding Claims From the FDC Program Introduction This contains information about excluding claims from the FDC Program, including excluding a claim from the FDC Program at claims establishment (CEST) reasons for subsequent exclusion of a claim from the FDC Program submission of additional evidence and FDC exclusion process for excluding a claim from the FDC Program special indicators and required notification text for FDC exclusion erroneous exclusion of a claim from the FDC Program, and applicability of FDC guidance changes. Change Date November 18, 2015 a. Excluding a From the FDC Program at CEST Even though a claimant submits one of the EZ forms listed in M21-1, Part III, Subpart i, 3.A.2.a, the claim must be reviewed at the claims establishment (CEST) stage to ensure it qualifies for FDC processing. Use the table below when establishing a claim submitted on an EZ form to determine if it must be excluded from the FDC Program.
e. Special Indicators and Required Notification Text for FDC Exclusion If it is necessary to exclude a from the FDC Program, use the table below to select the appropriate FDC special issue indicator and the corresponding required notification text. Special Free Text FDC Excluded – Evidence received after FDC CEST We received evidence after the claim was received. FDC Excluded – Claimant declined FDC processing N/A FDC Excluded – FDC certification incomplete You did not sign your FDC application. FDC Excluded – Additional submitted We received an additional after we received your FDC application. FDC Excluded – Claim pending You had a claim pending at the time we received your FDC application. FDC Excluded – Appeal pending You had an appeal pending at the time we received your FDC application. FDC Excluded – Requires INDPT VRFCTN of FTI We need to independently verify your earned and unearned income in regards to Federal Tax Information (FTI) because it was not received with your FDC application. FDC Excluded – Necessary form(s) not submitted You did not submit your on the required form. FDC Excluded – All Required Items Not Submitted, You did not simultaneously submit with your application all items required to process your claim. FDC Excluded – FTR to exam You failed to report for your VA examination and you requested that the examination be rescheduled. f. Erroneous Exclusion of a Claim From the FDC Program When a claim has been erroneously excluded from the FDC Program, VA must remove the FDC exclusion special issue indicator add the Fully Developed Claim special issue indicator back to at least one contention, and continue to process the claim in the FDC Program. Notes: If a claim is erroneously excluded from the FDC Program, the rating activity must still apply all applicable FDC effective date rules.
Notice to the claimant that the claim was erroneously excluded is not required. Any discussion of the effective date awarded in the rating decision and award notification letter is sufficient. g. Applicability of FDC Guidance Changes Use the table below to determine the appropriate action when changes in guidance occur during the processing of an FDC. If during the processing of the FDC, the ... And under new guidance in effect at the time the decision is being made … Then ... was excluded from the FDC program it would not be excluded Examples: National Guard records not submitted with the claim, or fire-related STRs. provided the claim is an original compensation claim, follow the provisions of M21-1, Part III, Subpart i, 3.B.2.f to reinstate the claim into the FDC program. did not meet a reason to exclude the claim would be excluded Examples: Claims processed between March 11, 2015, and August 6, 2015, with additional evidence received that did not require additional development. Claims processed between December 2014 and August 6, 2015, where additional contentions were received that did not require additional development. leave the claimant in the FDC program, and apply the new guidance prospectively to claimed issues not previously reviewed/considered. 3. Development the Department of Veterans Affairs (VA) Undertakes in Connection with FDCs Introduction This topic contains information about development VA undertakes in connection with FDCs, including limitations on the development of FDCs