the RMC, the RMC will forward STRs to the scanning vendor once the claims is established in VBMS, or the NPRC, MSCs must ask the Military Records Specialist (MRS) at their respective ROs to submit a priority request for the STRs through the Personnel Information Exchange System (PIES). Reference: For more information on requesting evidence from souces other than the claimant, see M21-1, Part III, Subpart iii, 1.C. 11 Follow the instructions in the for performing a nationwide search of treatment records in the Veterans Health Administration’s (VHA’s) possession to determine whether any of them refer to treatment of the participant. If such records do exist, save copies of them in the participant’s eFolder. Important: When saving the records, use the following indexing values in the fields named below SUBJECT: VistA Imaging DOCUMENT CATEGORY: Medical Records DOCUMENT TYPE: CAPRI SOURCE: and DATE OF RECEIPT: [Enter the date the records were saved in the eFolder]. Reference: For instructions on uploading documents into the eFolder, see the . 12 Prepare for the initial meeting with the IDES participant by reviewing the contents of the participant’s referral package, and claims folder, and contacting the participant to encourage him/her to bring to the meeting his/her family members, if appropriate, and any documentation M21-1, Part III, Subpart iii, Chapter 5 requires to establish entitlement to additional compensation for dependents. Rationale: By reviewing a participant’s claims folder and referral package before the initial meeting, MSCs become familiar with the participant’s records and medical history, and are better prepared to advise the participant regarding additional disabilities that were manifest during service. Important: If the STRs an MSC receives from a PEBLO are the original STRs, they must remain in the same jacket/folder they were in when the MSC received them from the PEBLO. MSCs must store
Reference: For information on VCIP shipping guidance, see M21-1, Part III, Subpart ii, 1.F. Important: If the evidence is related to a pending appeal, the MSC must take action to notify the ROJ or BVA in accordance with M21-1, Part III, Subpart i, 2.D.15.f. 4. Initial Meeting Between Military Services Coordinators (MSCs) and an IDES Participant Introduction This topic contains information about the initial meeting between MSCs and an IDES participant, including steps of the initial meeting situations MSCs may encounter assisting with the completion of Section III of VA Form 21-0819 claims for service connection (SC) for posttraumatic stress disorder (PTSD) completing initial interviews by telephone or video conference documenting conditions claimed during the initial telephone or video conference interview obtaining the participant’s signature on VA Form 21-0819 MSC actions when a participant does not immediately sign and return VA Form 21-0819 handling additional claimed conditions on VA Form 21-0819 after the deadline signatures by IDES participants that are incompetent or physically incapacitated IDES participants that refuse to sign VA Form 21-0819, and processing IDES while awaiting a signature. Change Date October 2, 2015 a. Steps of the Initial Meeting The table below describes the stages of the initial meeting between MSCs and an IDES participant. Step Action 1 The MSC explains the purpose of IDES and VA’s role in it answers any questions the participant has about IDES, and provides the participant with an overview of the benefits available through VA, as described in the
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 on … Then MSCs must provide the participant with, and assist him/her in 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 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 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. g. MSC Actions When a Participant Does Not Immediately Sign and Return VA Form 21-0819 If a participant indicates he/she is unable, or chooses not to, return the form immediately, then the MSC must notify the participant that the MSC can wait up to five calendar days for return of the signed form after five days, routine IDES processing will continue any issues the participant adds to the VA Form 21-0819 may be deferred until after he/she exits IDES, and unless a signed application is of record, VA will be unable to pay benefits. Important: MSCs should wait to request examinations the signed form is received or the five-day deadline passes, whichever is earlier (unless the participant clearly indicates that he or she will not be claiming additional conditions). Notes: If a participant returns the signed form within five days, then the MSC must treat any new contentions as if the participant added them to the VA Form 21-0819 during the initial interview. If a participant to return the signed VA Form 21-0819 within five days, the MSC must notify the participant’s PEBLO that the form was not signed and proceed with development of the claim. Reference: For more information regarding processing IDES cases while awaiting a signature, refer to M21-1, Part III, Subpart i, 2.D.4.k. h. Handling Additional Claimed Conditions on VA Form After the Five-Day Deadline If a participant returns the signed VA Form 21-0819 after five days of the initial interview and has added new contentions, VA is not obligated to request additional examinations. MSCs must add a note in VBMS and VTA that indicates
examiners should not duplicate diagnostic studies that establish a chronic diagnosis, regardless of the date performed, unless is clinical evidence of a worsening of the related disability. Examples: The term “diagnostic studies” includes studies for obstructive sleep apnea, and magnetic resonance imaging (MRI), computer axial tomography (CAT) scans, and x-rays for confirming degenerative processes. Important: MSCs and PEBLOs must work together to ensure the reports and/or studies referenced above are forwarded to the DRAS of jurisdiction. k. Acceptability of the Results of Examinations Conducted Outside of the IDES If VA previously examined a Veteran in connection with a claim he/she filed prior to entering IDES, the results of the examination(s) are acceptable for IDES purposes, as long as they are less than one year old. Exception: VA may use examination reports that are more than one year old if the reports address all disabilities an IDES participant claimed during the initial meeting with his/her MSC, and the participant’s department referred to VA, and the participant agrees that the severity of the disabilities at issue has not changed since the prior examination. l. Handling the Referral of Additional Disabilities to VA Service departments may add disabilities to those they initially listed in Section I of a participant’s VA Form 21-0819 at any point in the process; VA must treat these disabilities as if they were included in the initial referral package. Unless the participant claimed the same disabilities during the initial meeting with his/her MSC, the submission of additional requests for examination may be required. The responsibility for requesting additional examinations lies with whomever (the MSC or the DRAS) has current jurisdiction over the participant’s case. m. Examination of Pregnant IDES Participants M21-1, Part III, Subpart i, 2.D.17 contains instructions for requesting examinations for pregnant IDES participants. n. Examination of Severely Disabled IDES Participants MSCs, PEBLOs, and physicians at MTFs are responsible for determining whether a participant is too disabled to travel to an examination. The below describes the process for handling cases involving a participant who is too disabled to travel to an examination.
a. MSC Responsibility for Monitoring the Status of Examination Requests At least once each week, MSCs must run the Pending Exam Report in VTA, and follow up on any examination requests that the report shows have been pending more than 35 days. b. MSC Action Upon Return of Claims Folder From Exam Provider If a paper claims folder exists, upon return from the examination provider, MSCs must create a DCS in VBMS secure the DCS to the front of the top volume of the claims folder forward the claims folder to the appropriate scanning vendor according to current VCIP Shipping Procedures, and update the COVERS record to reflect appropriate scanning vendor location, according to the table below. If the claims folder is sent to ... Then the COVERS location should reflect ... SMS in Janesville, WI DCSS1 SMS in Clinton, IA DCSS1 CACI in Newnan, GA DCSC1 CACI in Mt. Vernon, KY Note: MSCs must complete the actions above no later than the end of the first workday following the day the claims folder was returned from the exam facility. c. Process for Uploading Examination Reports into eFolders When VHA or a contract examiner completes an examination, the corresponding examination report is automatically uploaded into the appropriate eFolder in Virtual VA or VBMS. Important: MSCs must ensure a copy of the examination report is uploaded into the participant’s eFolder. d. Actions MSCs Must Take Once All Examination Reports Are Complete MSCs must take the actions described in the below as soon as all of an IDES participant’s examination reports are complete and have been uploaded into the participant’s eFolder. Step Action 1 Update the EXAM END DATE field on the MSC tab in VTA to reflect the date when all of the participant’s examination reports became available to the participant’s MSC.
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 addresses every disability an IDES participant claimed during the initial meeting with his/her MSC a participant’s service department referred to VA, and examiners diagnose (during IDES-related examinations). may defer a decision on a disability only if the disability does not fall within any of the three categories described above, and the evidence of record is insufficient to make a decision, or under the circumstances described in M21-1, Part III, Subpart i, 2.D.17.e. Exception: Situations may arise in which it would be in a participant’s best interest to defer a decision on the types of disabilities referenced in the first paragraph of this block. In such situations, DRASs should e-mail a request for guidance to . Example: VA has determined that a participant is totally disabled due to SC disabilities without considering a disability for VA has insufficient evidence to make a rating decision. In this case, deferring a decision on that disability may be appropriate. Reference: For more information about examination reports that reveal the existence of disabilities an IDES participant did not claim and his/her service department did not refer to VA, see M21-1, Part III, Subpart i, 2.D.13.b. g. Rating Issues That Are Unique to IDES Cases DRAS RVSRs must consider the issues in the table below when preparing proposed rating decisions. Issue Discussion Goniometer Readings RVSRs must use the goniometer readings in examination reports when assigning evaluations for back disorders unless an examiner indicates in a report that the readings do not accurately reflect the IDES participant’s true functional limitations.
Important: When an RVSR does not use the goniometer readings for the reason stated he/she must explain the reason in the narrative section of the corresponding proposed rating decision. Evaluations That Are Subject to Change When RVSRs assign an evaluation to a disability in a proposed rating decision, and the severity of the disability is subject to change, they must explain in the narrative section of the corresponding proposed rating decision that a different evaluation may be warranted when the final rating decision is made. Future Examinations When determine that a future examination of a disability is necessary, they must note this fact in the corresponding proposed rating decision. Rationale: PEBs take into account an RVSR’s determination that a future examination of a disability is necessary when deciding whether to 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.
Scarring, as a residual of the gunshot wound, is noted in an IDES-related examination report. It is appropriate to treat the examination report that revealed the existence of the disability as insufficient because it contained insufficient information about the disability for rating purposes. the disability is unrelated to any disability the participant’s service department referred to VA, or the examination report suggests a disability may exist but does not include a diagnosis must invite a claim from the participant and include a standard VA prescribed form in the BEL referenced in M21-1, Part III, Subpart i, 2.D.10.j, and decision notice referenced in Step 3 of the procedure described in M21-1, Part III, Subpart i, 2.D.11.d. Reference: M21-1, Part IV, Subpart ii, 2.A.1.f contains instructions for inviting a claim from potential claimants. c. Inferred Claims That Require Additional Development If additional development is required to decide a claim a DRAS RVSR infers while preparing a final rating decision, the RVSR must defer a decision on the claim he/she inferred. Example: A DRAS RVSR infers a claim for entitlement to a disability rating based on individual unemployability (IU), or a special allowance for aid and attendance (A&A). The SOJ is responsible for undertaking any development that is necessary to decide an inferred claim that a DRAS RVSR defers in a final rating decision. d. Final Rating Decisions With Deferred Issues If a DRAS RVSR defers a decision in a final rating decision for any of the 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 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. 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 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 26, 2014 a. Identifying 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. A quality review team identifies an error on a proposed rating decision. Correction of the error will result in the assignment of higher disability rating for a disability the Veteran’s service department referred to VA. However, VA is unable to correct the proposed rating decision, because the Veteran has already separated from service. related
BDD/Quick Start Claim close the pending BDD/Quick Start claim, and address all unresolved issues associated with the BDD/Quick Start claim in the decision VA makes in connection with the individual’s participation in the IDES. The below describes other actions that must be taken when a service department refers an individual with a pending BDD/Quick Start claim into the IDES. These actions must be completed within 10 business days of receipt of a request from an MSC for transfer of a participant’s claims folder (or transfer of jurisdiction over an eFolder). If ... And … Then … an IDES participant with a pending BDD/Quick Start claim is still on active duty --- the Pre-Discharge intake site, BDD RAS, or Quick Start CPS (whichever has current jurisdiction over the BDD/Quick Start claim) must administratively deny the Start claim clear the corresponding EP, and permanently transfer the participant’s claims folder to the MSC. Note: MSCs are ultimately responsible for denying the BDD/Quick Start claim and clearing the EP if, for any reason, an intake site, RAS, or CPS fails to take these actions. an IDES participant with a pending BDD/Quick Start claim is not on active duty a BDD/Quick Start intake site has jurisdiction over the claim the intake site must 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. a BDD RAS or Quick Start CPS has jurisdiction over the claim, and sufficient evidence exists to decide all issues associated with the the RAS or CPS must work with the participant’s MSC to verify the character of the participant’s service and his/her date of discharge (if this information is not already of record), and decide the BDD/Quick Start claim before 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 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
the RO the ROJ (via VSCM mailbox) when any evidence/information to the pending appeal is uploaded/scanned into VBMS. BVA Notify BVA (via ) when any evidence/information related to the pending appeal is uploaded or sent for scanning into VBMS. Reference: For more information on determining location of an appeal, see the . 16. IDES Cases Involving Members of the Reserve or National Guard That Are Not on Active Duty Introduction This topic contains instructions that are unique to IDES cases involving members of the Reserve or National Guard that are not on active duty, including references in this section to members of the Reserve or National Guard that are not on active duty requests for examination of members of the Reserve or National that are not on active duty submission of examination requests to VHA facilities handling notice that a member meets retention standards, is fit for duty, or has been disenrolled handling requests from PEBs for a rating decision involving a member who is not on active duty, and requests for reconsideration from members that are not on active duty. Change Date July 31, 2015 a. References in This Section to Members of the Reserve or National Guard That Are Not on Active Duty Any reference in this section to members of the Reserve or National Guard that are not on active duty includes members of the Reserve or National Guard that were returned to active duty for the sole purpose of participating in the IDES. b. Requests for Examination of Members of the Reserve or National Guard The MSC that requests examination of a member of the Reserve or National who is not on active duty must ask the examining facility to notify the following of the date and time of all examinations at least one week prior to the date they are scheduled to occur
continue the pending rating EP (110, 010, or 020) broker the to the SOJ PTO the record in COVERS to the SOJ, and add a note in VBMS regarding the deferred Exception: If a DRAS is unable to prepare a final rating decision because it must defer a decision on all issues in a pregnant participant’s case, the DRAS must establish EP 930 (instead of a rating EP), with a suspense date that is 90 days after the participant’s anticipated delivery date. 18. Handling Evidence That an IDES Participant May Be Incompetent for VA Purposes Change Date July 31, 2015 a. Handling Evidence That an IDES Participant May Be Incompetent for VA Purposes The below provides an overview of the process that must followed after a DRAS RVSR determines the evidence of record indicates an IDES participant may be incompetent per . Important: The information in this block does not apply if a court has appointed a fiduciary to a participant or determined a participant is incompetent. Instructions for handling these types of cases is found in Part III, Subpart v, 9.B.2.e-g. Stage Action 1 An RVSR at the DRAS of jurisdiction prepares a rating decision under EP 689 that proposes a finding of incompetency. Important: The RVSR prepares the decision separate from the proposed rating decision discussed elsewhere in this section. 2 The DRAS notifies the participant’s MSC of the proposed rating decision by e-mail provides a copy of the decision and corresponding advance notice of adverse action directly to the participant, and establishes an EP 600 (to run concurrently with the pending EP 689), with a suspense date that is 65 days in the future. Important: The DRAS does not provide a copy of the decision to the participant’s PEB.
Note: It is acceptable for document names to contain personally identifiable information. 7 Check the box titled “Privacy Act Data.” 8 Enter the recipient’s e-mail address in the field provided for this information under the section titled “Recipient Information.” Click on the ADD button. Reference: See M21-1, Part III, Subpart i, 2.D.20.b for the address of each PEB. 9 Select the following the section titled “E-mail Setting.” FOUO Encrypt e-mail message when possible, and Notify me when files are downloaded. 10 Select the UPLOAD button. 11 e-mail inbox for an e-mail that requests verification of the sender’s e-mail address. Reply to the request. Note: Senders will receive notification via e-mail when the recipient downloads the document(s). b. PEB E-Mail Addresses The table below contains the e-mail address for each PEB. DRASs require this information in order to send proposed rating decisions and benefits estimate letters to PEBs through SAFE. PEB E-Mail Address San Antonio (Ft. Sam) Lewis-McChord National Capital Region Navy Air c. Receiving Sensitive Documents Through SAFE SAFE notification via e-mail to the intended recipient of sensitive documents when a sender uploads the documents into SAFE. The e-mail contains a hyperlink and a password for accessing the documents. Notes: Recipients may not forward the e-mail to anyone else, or use the password more than once. The table below explains how recipients may retrieve documents from SAFE. Step Action 1 Click on the hyperlink in the e-mail.