Select Page

M21-1, Part III, Subpart i, Chapter 1 – Structure of the Veterans Service Center (VSC)

Overview


In This Chapter

This chapter contains the following topics:
Topic
Topic Name
1
2
3
4
5

1.  Basic Components of VBA’s Claim-Processing Model for VSCs


Introduction

This topic contains information about the claims process, including

Change Date

June 6, 2018

III.i.1.1.a. Basic Components of VBA’s Claims-Processing Model for VSCs

This chapter describes the claim-processing model that the Veterans Benefits Administration (VBA) has implemented in each of its Veterans Service Centers (VSCs).  The basic components of this model consist of
  • an intake processing center (IPC)
  • cross-functional teams
  • an Appeals Team, and
  • a Public Contact Team (PCT).
Only the Office of Field Operations  (OFO) may grant a request for deviation from the model described in this chapter.
References:  For more information about

III.i.1.1.b.  Expectations For Processing Claims

VBA’s mission is to serve Veterans and their eligible dependents and survivors in the most timely and accurate manner possible.  It is only appropriate to extend suspense or diary dates if it is necessary for a specific adjudicative action.
Suspense dates must always correspond with specific actions and should not be arbitrarily extended under any circumstance.
Important:  When employees handle a claim, they are expected to take the most full and complete action possible on a claim every time – including development, rating, and promulgation actions – to move a claim forward to accurate completion in the claims process.  Every effort should be made to move the claim to the next processing cycle each time it is handled.

2.  IPCs


Introduction

This topic contains information about IPCs, including

Change Date

May 16, 2018

III.i.1.2.a.  Composition of an IPC

Each IPC is composed of a Coach and one or more
  • Veterans Service Representatives (VSRs)
  • Claims Assistants (CAs)
  • File Clerks or Program Support Clerks (PSCs), and
  • Mail Clerks (only if the VSC is responsible for mailroom operations).
Note:  As a local option, VSCs may add to their IPC one or more
  • Assistant Coaches, and/or
  • Program Support Assistants/PSCs.

III.i.1.2.b.  IPC Roles and Responsibilities

The table below describes the roles and responsibilities in the IPC under the
  • Centralized Mail (CM) process, and
  • initial mail screening process.
Position
CM User Role/Function
Responsibilities
  • Coach, and/or
  • Assistant Coach
Super User (Supervisory)
  • Adapt local workload management plans to accommodate processing in
    • CM, and
    • initial mail screening
  • allocate staff to minimize uncontrolled mail inventory
  • assist users in gaining access to the SMS electronic mail processing portal
  • monitor team performance and capitalize on process improvement opportunities
  • utilize Super User-levelaccess in the CM portal to review the number of mail packets pending in employee work queues
  • assess and appropriately assign/route all incoming mail inventory on a daily basis (all incoming queues including e-mails from National Call Centers), and
  • oversight of completion of records consolidation processing.
References:  For more information on
  • VSR, and/or
  • an experienced CA
Super User (Intake)
  • Using the first-in-first-out (FIFO) workload strategy, route incoming mail on a daily basis to basic users for processing
  • review and process mail that cannot be processed by a basic user due to complexity, and
  • perform daily checks of all incoming queues and the PCT corporate e-mail box to ensure timely processing of all incoming mail.
Reference:  For more information onFIFO workload strategy, see M21-1, Part III, Subpart ii, 1.E.1.c.
CA
Basic User (Control and Mail)
References:  For more information on
  • PSC
  • File Clerk, or
  • CA
CM access optional
Prepares and ships paper claims folders to the scanning vendor according to current Veterans Claim Intake Program (VCIP) procedures.
If claims are processed in paper or paper claims folders are being maintained at the regional office (RO), the PSC/CA/file clerk may have the following additional responsibilities:
  • handle requests for the permanent or temporary transfer of claims folders out of the VSC (including claims folders transferred to other ROs in connection with work-brokering arrangements)
  • update the Control of Veterans Records System (COVERS) to reflect the
    • transfer of claims folders to locations outside of the RO, and
    • receipt of claims folders transferred into the VSC
  • consolidate claims folders that belong to the same Veteran
  • repair damaged claims folders
  • create additional volumes of a claims folder when the size of the claims folder or one of its volumes exceeds two and one-half inches
  • conduct searches for claims folders
  • drop-file mail into claims folders
  • check the sequencing of claims folders in the file bank
  • re-file claims folders that are returned to the file bank
  • ship claims folders to off-site locations, and
  • retire and relocate claims folders.
References:  For more information on

III.i.1.2.c.  Mailroom Responsibilities

If the VSC is responsible for an RO’s mailroom operations, Mail Clerks within the IPC are responsible for
  • retrieving, opening, and date-stamping incoming mail
  • sorting incoming mail by the division in the RO to which the mail is addressed
  • picking up mail from and delivering mail to divisions within the RO
  • sorting and processing outgoing mail that is not transmitted electronically for centralized printing and mailing, and
  • maintaining mail delivery and postal logs.
Important:  Under the CM process all
  • compensation and pension related mail is shipped to the scanning vendor for conversion, regardless of jurisdiction, and
  • non-compensation or pension mail is routed to the appropriate business line location.
References:  For more information about

3.  Cross-Functional Teams


Introduction

This topic contains information about cross-functional teams, including

Change Date

June 6, 2018

III.i.1.3.a.  Composition of Cross-Functional Teams

Each cross-functional team is composed of
  • a Coach, and
  • one or more
    • VSRs that have been cross-trained in both claim development and award promulgation
    • Senior VSRs (SVSRs), GS-12 VSRs and/or certified, GS-11 VSRs, and
    • Rating Veterans Service Representatives (RVSRs).
Note:  As a local option, VSCs may add to a team one or more
  • CAs, and/or
  • Assistant Coaches.

III.i.1.3.b.  Responsibilities of Cross-Functional Teams

Cross-functional teams are responsible for
  • assigning incoming claims to individuals
  • initial and supplemental claim development
  • preparation of a rating decision, if necessary
  • award promulgation, and
  • award authorization.

III.i.1.3.c.  Assigning and Screening of Claims

The coach or assistant coach assigns claims to individuals by
  • assigning terminal digit responsibilities
  • auto assigning claims to work queues in the Veterans Benefits Management System (VBMS), and/or
  • manually assigning claims to work queues.
Notes:
  • When screening claims manually (not auto-assigning) for assignment, the coach/assistant coach reviews Veterans Service Network (VETSNET) Operations Reports (VOR) or other reports and screens the claims status to determine proper assignment.
  • If a VSR or RVSR identifies or discovers the IPC did not make the updates to electronic systems, or if the updates the IPC made were incorrect, he/she must take the actions described in M21-1, Part III, Subpart i, 1.3.d.
  • Coaches or assistant coaches also
    • identify (through VOR) claims for which all evidence has been received but the status is not RFD, and
    • assign whatever action is necessary to move such claims to the next step in the claims process.
References:  For more information on

III.i.1.3.d.  Actions to Take When the IPC Fails to Properly Update VBA Electronic Systems

If a VSR or RVSR discovers the IPC did not make the updates for which it is responsible in VBA electronic systems, or if the updates the IPC made were incorrect, the VSR or RVSR must make the correction at the time the error is identified.
Example:  The IPC fails to
  • place a claim under end product (EP) control
  • assign the correct EP to a claim, or
  • update Modern Award Processing – Development (MAP-D) or VBMS to reflect
    • all contentions raised by a claimant, and/or
    • all evidence received in connection with a claim.

III.i.1.3.e.  Duties of VSRs

The duties of a VSR include, but are not limited to
  • determining what evidence is necessary to decide a claim
  • undertaking development action to obtain necessary evidence
  • ensuring VBA electronic systems accurately reflect
    • suspense dates and reasons
    • contentions associated with a claim
    • development undertaken in connection with a claim
    • evidence received in connection with a claim, and
    • claim status
  • determining when a claim is ready for a decision
  • deciding claims/issues that do not require a rating decision
  • entering award data into VBA electronic systems, and
  • notifying claimants of decisions on their claims to include proposed adverse actions.
Notes:
  • Unless specifically exempted, outbound communications, including those generated in development and decision promulgation, should be sent using the Package Manager in VBMS as provided in the CBCM program.
  • SVSRs and certified GS-11 VSRs are responsible for authorizing/approving award actions.
  • Journey-level VSRs who have completed training specified by Central Office may prepare basic or straightforward medical opinion requests without RVSR or Decision Review Officer (DRO) review.
References:  For more information about

III.i.1.3.f.  Duties of RVSRs

The duties of an RVSR include, but are not limited to
  • preparing complex medical opinion requests
  • determining whether medical evidence received in connection with a claim justifies the granting of entitlement to VA benefits
  • ensuring all recent and relevant treatment records found in the Compensation and Pension Records Interchange (CAPRI) and the Joint Legacy Viewer (JLV) have been associated with the claims folder and if necessary, associating the records, and
  • preparing rating decisions that discuss the evidence reviewed and the decision narrative behind a decision to grant or deny entitlement.
References:  For more information about

III.i.1.3.g.  Determining Whether a Deferred Rating Decision Is Necessary

When an RVSR determines additional development is required in order to decide a claim, he/she should collaborate with a VSR on his/her team to determine how long it will take to complete the development.
  • If the VSR cannot complete the development action quickly, the RVSR must
    • prepare a deferred rating decision, and
    • return the claim to the VSR.
  • If the VSR can complete the development action quickly, the VSR must take the action as soon as possible and notify the RVSR when it is complete.
Examples:
  • Development actions that VSRs can typically complete quickly include
    • obtaining clarification from a VA doctor or contract examiner on the details of a physical examination report, and
    • obtaining a waiver from a claimant of the requirements 38 U.S.C. 5103 places on VA.
  • Development actions that warrant the preparation of a deferred rating decision because they cannot be completed quickly include
    • requesting a VA examination, and
    • initial development of an additional contention that an RVSR identifies upon his/her review of a claim that is otherwise ready for a decision.

4.  Appeals Team


Introduction

This topic contains general information about the Appeals Team, including

Change Date

May 16, 2018

III.i.1.4.a.Function and Responsibilities of the Appeals Team

The primary function of the Appeals Team is the expeditious processing of appeals and remands that do not fall under the jurisdiction of the Appeals Resource Center.  Responsibilities include:
  • developing issues on appeal (including remanded appeals)
  • making decisions on issues on appeal (including remanded appeals)
  • establishing, monitoring, and updating appeals-tracking records in the Veterans Appeals Control and Locator System (VACOLS)
  • making any necessary updates to all applicable VBA electronic systems
  • promulgating any rating decisions stemming from appeals or remands
  • authorizing award actions
  • preparing decision packages, including decision notices, for mailing to appellants, and
  • promptly forwarding to BVA any communication from a claimant that constitutes or could be construed as a
    • notice of appeal of a BVA decision, or
    • motion for reconsideration of a BVA decision.
Note:  Unless specifically exempted, outbound communications (including a statement of the case (SOC) or supplemental statement of the case (SSOC) generated using the legacy SOC/SSOC program) should be added to a package created using the VBMS Package Manager for centralized printing and mailing under the CBCM program.
Reference:  For more information on creating packages for centralized printing and distribution under CBCM, see VBA Learning Catalog – Centralized Benefits Communications Management (CBCM) Phase One – Centralized Printing (4415957).

III.i.1.4.b.  Composition of the Appeals Team

For the most part, the Appeals Team is a self-contained unit that is composed of essentially the same types of employees as a cross-functional team.
Depending on the size of the VSC, an Appeals Team typically has
  • a Coach, and
  • one or more
    • VSRs that have been cross-trained in both claim development and award promulgation
    • SVSRs and/or certified, GS-11 VSRs, and
    • DROs.
Note:  As a local option, VSCs may add to an Appeals Team one or more
  • CAs, and/or
  • Assistant Coaches.
References:  For more information about the duties of

III.i.1.4.c.  Additional Duties of VSRs on an Appeals Team

In addition to the responsibilities described in M21-1, Part III, Subpart i, 1.3.e, VSRs on an Appeals Team are also responsible for
  • notifying beneficiaries of proposed adverse appeals actions
  • deciding appeals issues that do not require a rating decision, and
  • notifying claimants of decisions on their appeals.
Notes:
  • SVSRs and certified GS-11 VSRs are responsible for authorizing/approving award actions.
  • Appeals VSRs must update VBMS/MAP-D in addition to VACOLS.
References:  For more information about

III.i.1.4.d.  Duties of DROs

See M21-1, Part I, 5.C for information about
  • the duties of DROs, and
  • the DRO review process.

III.i.1.4.e.  Determining Whether a  Deferred Rating Decision Is Necessary

When a DRO determines additional development is required in order to make a decision on an appealed issue, he/she should collaborate with a VSR on his/her team to determine how long it will take to complete the development.
  • If the VSR cannot complete the development action quickly, the DRO must prepare a deferred rating decision.
  • If the VSR can complete the development action quickly, the VSR must take the action as soon as possible and notify the DRO when it is complete.
Example:  For examples of the circumstances under which a deferred rating decision is and is not necessary, see M21-1, Part III, Subpart i, 1.3.g.

5.  PCT


Introduction

This topic contains general information about the PCT, including

Change Date

July 14, 2015

III.i.1.5.a.Responsibilities of the PCT

The PCT is primarily responsible for
  • meeting with individuals (typically claimants or beneficiaries) that visit an RO for the purpose of
    • obtaining information about VA benefits, and/or
    • requesting assistance in filing a claim
  • receiving information/evidence that individuals hand-deliver to an RO, and
  • responding to
    • Veterans Assistance Inquiries (VAIs), and
    • inquiries submitted through the Inquiry Routing and Information System (IRIS).
Reference:  For more information about VAIs and IRIS, see M27-1, Part I, Chapter 6.

III.i.1.5.b.  Helping Visitors With Benefit-Related Issues

When an individual visits an RO for the purpose of receiving assistance in filing a claim or requesting an adjustment in a running award, a member of the PCT first meets with the individual in an area that ensures their privacy.
Depending on the individual’s needs and the information/evidence the individual provides to the team member, the team member might take one or more of the following actions:
  • discuss with the individual the eligibility requirements for the benefit he/she is seeking
  • assist the individual in completing the appropriate application(s)/form(s)
  • advise the individual on any additional information/evidence the VSC requires to process his/her claim or adjust his/her award
  • update the corporate record based on new/additional information the individual provides to the team member (such as an updated mailing address, direct deposit information, and/or corrections in date(s) of birth and Social Security number(s))
  • date-stamp any documentation the individual submits to the RO, according to instructions in M21-1, Part III, Subpart ii, 1.C.1, and/or
  • route all documentation that requires action (other than updating the corporate record) to the VSC’s IPC or to the scanning vendor using designated fax lines.
Notes:
  • PCT employees or Veterans service organizations use designated fax lines to transmit documents directly to the scanning vendors.
  • If a VA employee Veteran or their family member submits claim related documents, PCT will complete a Restricted Access Claims Center (RACC) fax cover sheet, attach it to the documents and fax the documents to the scanning vendor.
References:  For more information on

Historical_M21-1MRIII_i_1_7-15-2014.docx May 8, 2019 222 KB
Transmittal-Sheet-M21-1MRIII_i_2_SecA_TS.docx May 8, 2019 38 KB
6-6-18_Key-Changes_M21-1III_i_1.docx May 8, 2019 73 KB
Historical_M21-1III_i_1_5-16-18.docx May 8, 2019 75 KB
Historical_M21-1III_i_1_1-11-18.docx May 8, 2019 84 KB
Historical_M21-1III_i_1_3-3-17.docx May 8, 2019 79 KB
1-11-18_Key-Changes_M21-1III_i_1.docx May 8, 2019 68 KB
5-16-18_Key-Changes_M21-1III_i_1.docx May 8, 2019 71 KB
Change-July-14-2015-Transmittal-Sheet-M21-1III_i_1_TS.doc.docx May 8, 2019 40 KB
Did this article answer your question?

Leave a Reply





Pin It on Pinterest

Share This