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

In This Chapter

Introduction

• basic components of VBA’s claims-processing model for VSCs, and
• expectations for processing claims.

Change Date

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

• an intake processing center (IPC)
• cross-functional teams
• an Appeals Team, and
• a Public Contact Team (PCT).

• IPCs, see M21-1, Part III, Subpart i, 1.2
• cross-functional teams, see M21-1, Part III, Subpart i, 1.3
• Appeals Teams, see M21-1, Part III, Subpart i, 1.4
• PCT, see M21-1, Part III, Subpart i, 1.5, and
• the differences in the claim-processing models that VSCs and pension management centers use, see M21-1, Part V, Subpart iv, 1.3.

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

Introduction

• composition of an IPC
• IPC roles and responsibilities, and
• mailroom responsibilities.

Change Date

III.i.1.2.a.  Composition of an IPC

• 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).

• Assistant Coaches, and/or
• Program Support Assistants/PSCs.

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

• Centralized Mail (CM) process, and
• initial mail screening process.

• handling consolidation of duplicate BIRLS and corporate records, see M21-1, Part III, Subpart ii, 4.E
• processing mail electronically in the CM portal, see M21-1, Part III, Subpart ii, 1.E.5, and
• VCIP shipping procedures, see M21-1, Part III, Subpart ii, 1.F.1.

III.i.1.2.c.  Mailroom Responsibilities

• 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.

• 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.

• date-stamping incoming mail, see M21-1, Part III, Subpart ii, 1.C.1
• receipt, separation and routing of physical mail under the CM process, see M21-1, Part III, Subpart ii, 1.E.2, and
• creating packages using Package Manager for centralized printing and distribution through the Centralized Benefits Communications Management (CBCM) program, see VBA Learning Catalog – Centralized Benefits Communications Management (CBCM) Phase One – Centralized Printing (4415957).

Introduction

• composition of cross-functional teams
• responsibilities of cross-functional teams
• assigning and screening of claims
• actions to take when the IPC fails to properly update VBA electronic systems
• duties of VSRs
• duties of Rating Veterans Service Representatives (RVSRs), and
• determining whether a deferred rating decision is necessary.

Change Date

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

• 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).

• CAs, and/or
• Assistant Coaches.

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

• 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

• 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.

• 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.

• VOR, see the Data and Information Services webpage, and
• workload management in VBMS, see the
  • VBMS Job Instruction Sheet – Assign Claim – Supervisor
  • VBMS Job Instruction Sheet – Assign Claim Priority
  • VBMS Job Instruction Sheet – Workload Management, and
  • VBMS Coaches Corner site.

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

• 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

• 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.

• 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.

• claim development, see
  • M21-1, Part III, Subpart iii, and
  • M21-1, Part IV, Subpart ii, 1
• claim development in VBMS, see the
  • VBMS Job Instruction Sheet – Initial Claim Development, and
  • VBMS Job Instruction Sheet – Supplemental Claim Development
• who may request a medical examination or opinion, see
  • M21-1, Part III, Subpart iv, 3.A.1.a, and
  • M21-1, Part III, Subpart iv, 3.A.7.a
• entering award data in
  • VETSNET, see the Awards User Guide, or
  • VBMS, see the VBMS User Guide
• deciding claims/issues that do not require a rating decision, see M21-1, Part III, Subpart v
• issuing notice of a proposed adverse action, see
  • M21-1, Part I, 2.B, and
  • M21-1, Part IV, Subpart ii, 3.A
• issuing decision notification, see M21-1, Part III, Subpart v, 2.B, and
• creating packages using Package Manager for centralized printing and distribution through CBCM, see VBA Learning Catalog – Centralized Benefits Communications Management (CBCM) Phase One – Centralized Printing (4415957).

III.i.1.3.f.  Duties of RVSRs

• 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.

• who may request a medical examination or opinion, see
  • M21-1, Part III, Subpart iv, 3.A.1.a, and
  • M21-1, Part III, Subpart iv, 3.A.7.a
• analyzing medical evidence to determine entitlement to VA benefits and preparing rating decisions, see
  • M21-1, Part IV, Subpart ii, 2, and
  • M21-1, Part III, Subpart iv
• reviewing CAPRI and JLV for recent and relevant treatment records, see
  • M21-1, Part III, Subpart iii, 1.C.1.c and e
  • M21-1, Part III, Subpart iii, 1.C.2.d, and
• preparing rating decisions in VBMS, see the VBMS User Guide – Rating.

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

• 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.

• 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.

Introduction

• function and responsibilities of the Appeals Team
• composition of the Appeals Team
• additional duties of VSRs on an Appeals Team
• duties of DROs, and
• determining whether a deferred rating decision is necessary.

Change Date

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

• 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.

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

• 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.

• CAs, and/or
• Assistant Coaches.

• VSRs and SVSRs, see M21-1, Part III, Subpart i, 1.3.e, or
• DROs, see M21-1, Part I, 5.C.2.

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

• 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.

• SVSRs and certified GS-11 VSRs are responsible for authorizing/approving award actions.
• Appeals VSRs must update VBMS/MAP-D in addition to VACOLS.

• entering award data in
  • VETSNET, see the Awards User Guide, or
  • VBMS, see the VBMS User Guide
• deciding issues that do not require a rating decision, see M21-1, Part III, Subpart v
• issuing notice of a proposed adverse action, see
  • M21-1, Part I, 2.B, and
  • M21-1, Part IV, Subpart ii, 3.A
• issuing decision notification, see M21-1, Part III, Subpart v, 2.B, and
• use of the VBMS Package Manager to create packages for centralized printing under CBCM, see VBA Learning Catalog – Centralized Benefits Communications Management (CBCM) Phase One – Centralized Printing (4415957).

III.i.1.4.d.  Duties of DROs

• the duties of DROs, and
• the DRO review process.

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

• 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.

Introduction

• responsibilities of the PCT, and
• helping visitors with benefit-related issues.

Change Date

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

• 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).

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

• 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.

• 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.

• faxing documents to the scanning vendors, see M21-1, Part III, Subpart ii, 1.E.3, and
• claims handled by RACCs, see
  • M21-1, Part III, Subpart ii, 4.A.4, and
  • M21-1. Part III, Subpart ii, 1.E.5.c.