b. Initial Actions to Take Upon Receipt of an FDC for Claims With Paper Claims Folder Take the following actions within one day of receipt of an FDC that has a 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 paper 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 CEST reasons for subsequent exclusion of a from the FDC Program submission of additional evidence and FDC exclusion process for excluding a claim from the FDC Program special issue 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 Claim 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. If ... Then ... the claimant indicates he/she does not want the Department of Veterans Affairs (VA) to process his/her under the FDC Program (as discussed in M21-1, Part III, Subpart i, 3.A.2) has a claim pending at the time VA receives the EZ form has an appeal pending at the time VA receives the EZ form, or fails to simultaneously submit any of the additional forms required to process his/her specific claim exclude the claim from the FDC Program. Note: Required forms are defined as those forms discussed on the EZ form under “Special Circumstances.” Exception: If evidence submitted with the FDC is sufficient to concede a stressor in a posttraumatic stress disorder (PTSD) claim, such as fear, combat decoration, etc., a VA Form 21-0781, is not required. Reference: For more information on PTSD claims, see M21-1, Part III, Subpart iv, 4.H, and M21-1, Part IV, Subpart ii, 1.D. the requires development for evidence from the claimant, or private medical care provider(s) exclude the claim from the FDC Program. Exception: Special issue claims as discussed in M21-1, Part III, Subpart i, 3.B.3.d. the claim requires development for Federal records Note: This includes development for VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA), if required to obtain Vet Center records. do not exclude the claim from the FDC Program. Reference: For more information on FDCs and Vet Center Records, see M21-1, Part III, Subpart i, 3.B.3.f. the claim requires development for National Guard or reserve unit records do not exclude the claim from the FDC Program. the claim requires completion of NA Form 13055, Request for Information Needed to Reconstruct Medical Data, (by the claimant) because service treatment records (STRs) were do not exclude the claim from the FDC Program.
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 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. 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
FDCs requiring special issue development, see M21-1, Part III, Subpart i, 3.B.3.d, and FDCs and Vet Center records, see M21-1, Part III, Subpart i, 3.B.3.f. h. Determination to Exclude from the FDC Program After a Development Letter Use the below to determine whether a claim should be excluded from FDC processing after sending the required development letter to the claimant. If the claimant ... Then ... provides only the information requested in the development letter Example: VA requested a VA Form 21-4142 from the claimant for Vet Center records. The claimant submits the records in lieu of the form. do not exclude from the FDC Program. submits additional information/evidence not requested in the development letter exclude from the FDC Program. does not respond to the development letter do not exclude from the FDC Program. References: For more information on steps to take when a claim is excluded from the FDC Program, see M21-1, Part III, Subpart i, 3.B.2.d, and special issue development procedures, see the relevant section(s) within M21-1, Part III, Subpart ii. i. Telephone Development and FDC Exclusion A telephone call to a claimant to clarify information will not require exclusion from the FDC Program if the telephone call can be completed at the time the action is being taken on the claim. Example: A claimant submits medical evidence from a physician and attaches a VA Form 21-4142 or VA Form 21-4142a, General Release of Medical Provider Information to the Department of Veterans Affairs (VA). The Veterans Service Representative (VSR) calls the claimant to clarify if the claimant wanted VA to develop for additional records. Provided the VSR reaches the claimant the same day and the claimant provided a negative response, the claim will not be excluded from the FDC Program. Important: Exclusion would be appropriate if
See the table below for considerations when assigning a retroactive effective date to an FDC. If the FDC is ... Then consider entitlement to an effective date prior to date of claim under ... an original compensation claim received between August 6, 2013, through August 5, 2015 PL 112-154, Section 506. an original claim for compensation received within a year after an Intent to File (ITF), and the ITF was received between March 24, 2015, through August 5, 2015 PL 112-154, Section 506. Note: The provisions of Section 506 of PL 112-154 do not apply to informal claims filed prior to March 24, 2015, under historical . a for increase . affected by liberalizing legislation . received from a recently discharged Veteran . Note: PL 112-154, Section 506, an original claim is the initial formal (complete) claim filed by a Veteran for disability compensation. Consequently, a Veteran who has applied for non-service-connected (NSC) pension in the past is potentially eligible for a retroactive date under PL Section 506 upon filing an original compensation disability FDC. b. Instructions for Applying the Provisions of Section 506 of PL 112-154 When application of the provisions of Section 506 of PL 112-154 is in order, the proper effective date for a grant of benefits is one year prior to the date VA receives a formal and complete FDC for the benefit granted one year prior to the date VA receives an ITF, provided a complete FDC is received within one year of the date of receipt of the ITF, or the date entitlement to the claimed benefit whichever is most advantageous based upon the facts of the case.