Overview
In This Section |
This section contains the following topics:
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1. Purpose and Elements of IDES
Introduction |
This topic contains information about the purpose and elements of IDES, including
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Change Date |
November 20, 2018 |
III.i.2.D.1.g. DRASs |
Disability Rating Activity Sites (DRASs) serve as the PEBs’ primary point of contact with VA. When a PEB informally decides that an IDES participant is unfit for duty, it sends a request to the DRAS of jurisdiction for a proposed rating decision. If the participant is ultimately discharged because he/she is unfit for duty, the DRAS
VA has two DRASs. The table below shows
Reference: For more information on IDES cases involving multiple special missions or circumstances, see M21-1, Part III, Subpart ii, 5.A.1.c.
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III.i.2.D.1.h. VTA |
The Veterans Tracking Application (VTA) is a web-based application PEBLOs, MSCs, DRASs, and PEBs use to track IDES participants as they proceed through the program.
VA employees access VTA through the Veterans Information Portal (VIP). They must have access to VIP before they can request access to VTA. Requests for access to VTA require supervisory approval.
Individual “tabs” for MSCs, DRASs, PEBLOs, and PEBs in VTA contain a field where users may leave notes for a variety of reasons. (There is also a field on the PEBLO tab where staff from the Office of Warrior Care Policy may leave comments.) In certain situations that are described in this section, users arerequired to leave a note in VTA.
Example:
Scenario: An MSC enters into VTA the dates for specific actions he/she took while processing an IDES case. The dates appear to be out of sequence but are, in fact, correct.
Result: To avoid confusion, the MSC should add a note in VTA that explains why the dates are out of sequence.
Reference: For more information about VTA, see the
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III.i.2.D.1.j. Timeliness Goals of the IDES Program |
VA and DoD have a shared goal to process 80 percent of all IDES claims in 230 calendar days or less.
The table below lists the processing time goal for each IDES stage, over which VA has responsibility, for active duty and non-active duty IDES participants.
Notes:
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2. DoD Process for Referring Individuals Into IDES
Introduction |
This topic contains information about referring individuals into IDES, including
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Change Date |
November 15, 2018
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III.i.2.D.2.a. DoD Process for Referring Individuals Into IDES |
The table below describes DoD’s process for referring individuals into IDES.
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III.i.2.D.2.b. Service Department Statement of Complete and Current STRs |
Section III of a completed VA Form 21-0819 contains the PEBLO’s statement of complete and current STRs provided as part of the IDES referral. The statement will:
Important: It is generally not necessary for an MSC to develop for specific elements of the STRs (such as the entrance physical) that have been deemed unavailable by the PEBLO and indicated as such on the VA Form 21-0819. However, when STRs for an entire or extended period are missing, make all appropriate attempts to obtain the records. If the records cannot be obtained, prepare a final notification letter according to the instructions in M21-1, Part III, Subpart iii, 1.C.1.e, detailing the efforts the MSC and PEBLO took to obtain the missing records, as well as the outcome of those efforts.
References: For more information on
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3. Initial Steps in Processing a Referral Package
Introduction |
This topic describes the initial steps in processing a referral package, including
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Change Date |
November 15, 2018
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III.i.2.D.3.a. Use of the IDES Development Checklist |
MSCs must complete an IDES Development Checklist for each IDES case.
MSCs may select to either
The checklist may be completed electronically or printed for completion in hard copy, but in all cases, it must be incorporated into the participant’s electronic claims folder (eFolder) upon completion of development action, as is discussed in Step 8 of M21-1, Part III, Subpart i, 2.D.7.d.
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III.i.2.D.3.b. General Information Regarding Electronic IDES Referral Packages |
Electronic transfer of IDES referral packages should be encouraged to the fullest extent possible. However, at each location, parties must agree on an acceptable electronic medium in consideration of agency/branch-specific security policies.
MSCs may accept electronic IDES referral packages via:
When the referral package is provided electronically, the MSC must
Important: Documents associated with electronic referrals must be uploaded to the eFolder once the claim is established in VBMS.
Note: Air Force sites may require the use of additional encryption when using SAFE transfer. The preferred method is Encryption Wizard.
References: For more information on
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III.i.2.D.3.c. General Information Regarding Paper IDES Referral Packages |
When electronic transfer of IDES referrals is not possible, PEBLOs may provide MSCs with referral packages in hardcopy (paper format); in these instances, MSCs must
Reference: For more information on shipping paper evidence to the scanning vendor, see M21-1, Part III, Subpart i, 2.D.3.j.
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III.i.2.D.3.d. MSC Actions When Processing an IDES Referral Package |
The table below describes the actions MSCs must take when processing a referral package from a PEBLO.
Reference: For more information on VTA, see M21-1, Part III, Subpart i, 2.D.1.h.
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III.i.2.D.3.e. Uploading Electronic Documents to the eFolder |
When MSCs receive electronic documents from PEBLOs or IDES participants, the MSC must
After the document upload is complete, the MSC must delete any locally-stored electronic versions of the evidence.
References: For more information on
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III.i.2.D.3.f. Relevance of the Duty Status of Members of the Reserves or National Guard |
When a PEBLO submits a referral package for a member of the Reserves or National Guard, MSCs should attempt to obtain a copy of the member’s current orders from the PEBLO.
If the PEBLO fails to provide the orders, MSCs will still accept the referral (if otherwise in order). However, they must then contact the member and ask him/her to provide a copy of the orders when they hold their initial meeting.
In the absence of evidence to the contrary, MSCs must accept as credible the statements of members of the Reserves or National Guard regarding their duty status. MSCs must take the actions described in the table below if
Important:
Example: A member of the Reserves or National Guard may be placed on orders for the sole purpose of facilitating his/her participation in the IDES. This is not “active duty” for the purposes of this section.
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III.i.2.D.3.g. Option to Accept an Improper Referral |
When determining whether to reject an improper referral from a PEBLO (Step 5 of the table in M21-1, Part III, Subpart i, 2.D.3.d), the MSC has the option to accept the referral, while working with the PEBLO to resolve deficiency(ies) if doing so will not prohibit or impede further action on the case. The decision should consider the best interest of the claimant.
Example: It would be in an IDES participant’s best interest if an MSC chose not to reject a referral because the participant’s medical records were missing, when the participant has catastrophic disabilities that would allow VA to make a rating decision based solely on the evidence of record.
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III.i.2.D.3.h. IDES Participants With Existing Paper Claims Folders |
MSCs must take the action(s) described in the table below upon receipt of a referral of an IDES participant for whom VA has already created a paper claims folder.
Important: If an IDES participant already has a claim or appeal pending with VA, see M21-1, Part III, Subpart i, 2.D.8.
Reference: For more information about using COVERS, see the COVERS User Guide.
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III.i.2.D.3.i. Claims Folders in BVA Custody |
If an IDES participant’s claims folder is at BVA, see the table below for instructions.
Important: COVERS does not provide for the transfer of temporary claims folders from one site to another. Accordingly
References: For more information about
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III.i.2.D.3.j. Shipping Paper IDES Evidence to the Scanning Vendor |
When paper documents are received as part of the IDES process, MSCs must
Important:
Reference: For more information on the RMN/DCS shipping process, see M21-1, Part III, Subpart ii, 1.F.2.
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III.i.2.D.3.k. Scanning IDES Evidence Locally |
MSCs may only scan documents locally if the local scanner has a resolution of at least 300 dots per inch (DPI).
MSCs are permitted to scan the following items:
Important: MSCs are not permitted to scan complete STRs that are provided by the PEBLO as part of the IDES referral package. When IDES referrals are provided in hard copy, the MSC must handle the STRs in accordance with M21-1, Part III, Subpart i, 2.D.3.c.
After scanning the documents, the MSC must
Note: When documents are scanned and uploaded locally, the actions must be completed within the timeframes outlined in M21-1, Part III, Subpart i, 2.D.3.n.
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III.i.2.D.3.l. Returning Paper Evidence That Has Been Locally Scanned and Uploaded |
Once documents have been successfully uploaded into the VBMS eFolder, as described in M21-1, Part III, Subpart i, 2.D.3.k, the MSC must follow the steps in the table below to return the original paper documents to the participant.
Reference: For more information on the Letter Creator tool, see the Letter Creator User Guide.
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III.i.2.D.3.m. Capturing the Date of Receipt of Electronic Documents |
When documents are provided electronically, the MSC must ensure that the date of receipt is accurately recorded in VBMS. When uploading documents in VBMS, the MSC must make certain that the DATE OF RECEIPT field on the UPLOAD DOCUMENT screen, accurately reflects the date the document first came into VA possession.
Reference: For instructions on uploading documents into the eFolder, see theVBMS Job Aid – Adding Documents in VBMS eFolders.
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III.i.2.D.3.n. Processing Paper Documents in a Timely Manner |
MSCs must ensure that all paper documents either shipped to the scanning vendor in accordance with M21-1, Part III, Subpart i, 2.D.3.j, or scanned locally in accordance with M21-1, Part III, Subpart i, 2.D.3.k and l, are processed within the timeframes indicated in the table below.
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4. Initial Meeting Between MSCs and an IDES Participant
Introduction |
This topic contains information about the initial meeting between MSCs and an IDES participant, including
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Change Date |
November 15, 2018 |
III.i.2.D.4.a. Steps of the Initial Meeting |
The table below describes the steps of the initial meeting between MSCs and an IDES participant.
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III.i.2.D.4.b. IDES Claims That May Require Additional MSC Actions |
The table below describes situations involving IDES claims and/or claimants that require additional MSC actions.
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III.i.2.D.4.c. Claims for SC for PTSD |
Some IDES claims involving PTSD may require stressor development. However, when the record shows an in-service diagnosis of PTSD, or the claimant is currently service-connected for the condition, no stressor development is required.
Further, MSCs must consider the duty status of the participant in IDES cases involving PTSD. If the IDES participant is serving on active duty at the time of application, it is not necessary for the MSC to initiate development for a stressor.
Rationale: Active duty IDES participants will receive VA examinations in-service. An in-service diagnosis of PTSD would be sufficient to support a grant on a direct basis. Alternatively, VA examination results showing no PTSD diagnosis would also make stressor development unnecessary.
In cases involving IDES participants who are not on active duty, in which stressor development is required, the MSC must:
Note: If further stressor development is required in cases involving MST, the MSC must notify the DRAS. The MST Outreach Coordinator at the DRAS is responsible for taking the actions outlined in M21-1, Part IV, Subpart ii, 1.D.5.d and f.
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III.i.2.D.4.d. Completing Initial Interviews by Telephone or Video Conference |
Whenever possible, the initial meeting between MSCs and IDES participants should be face-to-face. If such a meeting is not feasible, MSCs may hold the meeting by video conference or, as a last resort, by telephone.
When conducting an initial interview by telephone or video conference, MSCs must
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III.i.2.D.4.e. Providing Forms to the Participant When the Interview Is Conducted by Telephone |
When conducting the initial interview by telephone or video conference, the MSC must provide all forms indicated in M21-1, Part III, Subpart i, 2.D.4.a, (Steps 6 and 8) and M21-1, Part III, Subpart i, 2.D.4.c, if applicable, to the participant via e-mail. The e-mail must include the current portable document format (PDF) versions of all required forms, or include hyperlinks to the forms.
If hyperlinks are provided, they must be obtained from VA’s public-facing forms page and link to the specific form(s).
Examples:
Exception: If extenuating circumstances exist, these forms can be physically mailed to the participant, at the participant’s request. |
III.i.2.D.4.f. Advising Participants of How to Return Forms |
The MSC should encourage the participant to return the required forms to the MSC in-person. When a participant is unable to return the required forms to the MSC in-person, the MSC must advise the participant to return all required forms to the MSC, via one of the following means:
If the participant is unable or unwilling to submit the forms electronically, the claimant may return them to the MSC by mail; however, returning paper documents by mail is not recommended.
Important: If the participant wishes to file a VA claim, but does not complete theVA Form 21-526EZ during the initial interview, the MSC must take action according to M21-1, Part III, Subpart i, 2.D.4.g.
Reference: For information on using SAFE to send sensitive records, see M21-1, Part III, Subpart i, 2.F.9.a.
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III.i.2.D.4.g. MSC Actions When a Participant Does Not Immediately Return a Completed VA Form 21-526EZ |
If a participant indicates he/she intends to file a VA claim as part of the IDES process, but is unable, or chooses not to, return the VA Form 21-526EZimmediately, then the MSC must notify the participant that
MSCs must wait until the completed VA Form 21-526EZ is received or until the five-day deadline passes (whichever is earlier) before requesting examinations. If extenuating circumstances exist that impact the participant’s ability to return the form, the MSC may defer requesting exams beyond the five-day deadline.
Notes:
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III.i.2.D.4.h. Handling a VA Form 21-526EZ Received After the Five-Day Deadline |
If a participant returns the signed VA Form 21-526EZ 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
Reference: For more information regarding additional disabilities that IDES participants claim after the initial interview, refer to M21-1, Part III, Subpart i, 2.F.1.c and d.
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III.i.2.D.4.i. Signatures by IDES Participants That Are Incompetent or Physically Incapacitated |
If an IDES participant is filing a VA claim, but is unable to sign the VA Form 21-526EZ because he/she is incompetent or physically incapacitated, MSCs must attempt to obtain an acceptable alternative.
Acceptable alternatives include:
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III.i.2.D.4.j.Handling an Unsigned VA Form 21-526EZ |
If an IDES participant returns a VA Form 21-526EZ without a signature, the MSC must concurrently
VA will continue processing an IDES case without a signature until the point in time when it becomes necessary to prepare a rating decision (other than a proposed rating decision) to determine entitlement to disability benefits. If the participant has not signed the form by the time he/she exits IDES, the DRAS of jurisdiction must
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5. MSC Actions Immediately Following the Initial Meeting
Introduction |
This topic describes the actions MSCs must take immediately following the initial meeting with an IDES participant, including
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Change Date |
November 15, 2018 |
III.i.2.D.5.a. MSC Actions Immediately Following the Initial Meeting |
The table below describes the actions MSCs must take immediately following the initial meeting with an IDES participant.
References: For more information about
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III.i.2.D.5.b. MSC Handling Evidence Received After the Initial Interview |
Use the table below to determine how to handle evidence received after completion of the initial interview.
Important: If the evidence is related to a pending appeal, the MSC must take action to notify the RO of jurisdiction or BVA in accordance with M21-1, Part III, Subpart i, 2.D.8.f.
Reference: For more information on VCIP shipping, see M21-1, Part III, Subpart ii, 1.F.
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III.i.2.D.5.c. MSC Responsibility to Notify PEBLOs of Claims Involving TBI and Mental Disorders |
MSCs must notify an IDES participant’s PEBLO if
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6. Requesting Examinations for IDES Participants
Introduction |
This topic contains information about requesting examinations for IDES participants, including
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Change Date |
Novebmer 15, 2018 |
III.i.2.D.6.a. Responsible Provider for IDES Examinations |
At each IDES location, a local agreement between VHA, the Veterans Benefits Administration (VBA), and DoD must be in place, which specifies responsibility for conducting examinations associated with IDES cases. These local agreements may indicate that any of the following may conduct examinations of IDES participants:
MSCs must submit examination requests to the specific providers noted in local agreements.
Exceptions:
Reference: For more information on submitting examination request for IDES participants see M21-1, Part III, Subpart i, 2.D.6.b.
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III.i.2.D.6.b. Submitting Examination Requests for IDES Participants |
The table below describes how an MSC submits examination requests to the provider responsible for completing the examination.
Important: Examiners must follow VA protocol, to include the use of disability benefits questionnaires (DBQs), when conducting examinations. MSCs are responsible for providing the appropriate DBQs to examiners if DBQs are not otherwise available to them.
References: For more information on
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III.i.2.D.6.c. Types of Examinations Required for IDES Claims |
MSCs must request completion of the General Medical – Separation Health Assessment (SHA) Disability Benefits Questionnaire for every IDES participant, including those participants that are not on active duty. Under the circumstances described in M21-1, Part III, Subpart iv, 3.A.6, they must also request specialist examinations.
Exception: M21-1, Part III, Subpart i, 2.D.6.d lists disabilities that are not subject to examination for IDES purposes.
Note: The SHA provides the workup needed to assess claims based on service in Southwest Asia service under 38 CFR 3.317. A Gulf War general medical examination is not needed in addition to the SHA; however, the remarks section of the SHA request must include the
References: For information on
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III.i.2.D.6.d. Disabilities That Are Not Subject to Examination for IDES Purposes |
The following are not subject to examination for IDES purposes:
Note: Regardless of whether or not a claimed or referred dental condition is subject to SC, a DRAS that processes an IDES case involving a dental condition is responsible for forwarding a copy of the corresponding VA Form 21-0819 or VA Form 21-526EZ to the outpatient dental clinic with geographical jurisdiction over the participant’s place of residence.
Reference: For more information about appeals pending before VA that involve a disability a service department refers to VA or a participant claims following his/her referral into IDES, see M21-1, Part III, Subpart i, 2.D.8.e.
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III.i.2.D.6.e. Types of Medical Opinions MSCs Must Request |
Before requesting examinations, MSCs must identify cases in which a medical opinion is needed.
If a medical opinion is required, and the opinion is straight-forward or routine in nature, then the MSC must request the medical opinion as part of the exam request in accordance with M21-1, Part III, Subpart iv, 3.A.7. Generally, MSCs are responsible for requesting the following types of medical opinions:
If a complex medical opinion is required, MSC must follow the procedure outlined in M21-1, Part III, Subpart i, 2.D.6.f.
Reference: For more information on determining when an examination or medical opinion is necessary under VA’s duty to assist, see M21-1, Part I, 1.C.3.
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III.i.2.D.6.f. Handling Complex Medical Opinions |
If a complex medical opinion is required, MSCs must send an email to the appropriate DRAS and state
The DRAS must complete the following actions within three business days of the request:
The MSC must copy and paste the draft medical opinion into the exam request and submit the request to the responsible examination provider.
References: For more information on
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III.i.2.D.6.g. Limitations on the Types of Examinations Contract Examiners May Conduct |
Contract examiners may only conduct certain examination types. This is covered in M21-1, Part III, Subpart iv, 3.A.1.j.
Important: Although a contract examiner cannot order hospitalization or surgical evaluation, such as colonoscopy or laparoscopy, and therefore cannot establish diagnoses that would require such workup, the contract examiner may still conduct an examination on a claim if a required test needed to inform a medical assessment was previously performed and in the eFolder. For example, if a participant underwent a diagnostic laparoscopy in service, a contract examiner could conduct an examination for claimed endometriosis without violating the limitation on ordering surgical procedures.
If the requirements in the above paragraph are met, and an MSC submits the examination request to a contract examiner, the MSC must note in the examination request that proper diagnosis of the named disorder is already a matter of record.
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III.i.2.D.6.h. Remarks MSCs Must Include in Examination Requests to VHA |
MSCs must add the following remarks to requests for examination of IDES participants submitted to VHA:
Important:
Reference: For additional language that must be added to the REMARKS section when using the SHA to work up claims based on service in Southwest Asia service under 38 CFR 3.317, see M21-1, Part III, Subpart i, 2.D.6.c.
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III.i.2.D.6.i. Uploading Examination Requests Into the eFolder |
MSCs must upload examination requests submitted through CAPRI into the IDES participant’s eFolder by following procedural instructions found in M21-1, Part III, Subpart ii, 4.G.2.b.
Note: Submission of an examination scheduling request through VBMS automates the generation and insertion of a placeholder document into the participant’s eFolder.
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III.i.2.D.6.j. Tracking Examination Requests |
After an MSC requests all the examinations an IDES participant requires, he/she must make updates on the MSC tab in VTA. The table below describes additionalentries the MSC must make on the MSC tab.
Important: For all examination request submitted to VHA, MSCs must add a tracked item to VBMS under the pending EP 689 for each type of examination they request outside the VBMS examination management environment.
Reference: For more information on the automatic generation of tracked items for examination scheduling requests submitted in VBMS, see M21-1, Part III, Subpart iv, 3.C.1.a.
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III.i.2.D.6.k. Avoiding Duplication of Effort |
In order to avoid a duplication of effort,
Examples: The term “diagnostic studies” includes
Important: MSCs and PEBLOs must work together to ensure the reports and/or studies referenced above are forwarded to the DRAS of jurisdiction.
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III.i.2.D.6.l. Acceptability of the Results of Examinations Conducted Outside of 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 participant agrees that the severity of the disabilities at issue has not changed since the prior examination.
Important: The MSC remains responsible for ensuring that
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III.i.2.D.6.m. Examination of Pregnant IDES Participants |
M21-1, Part III, Subpart i, 2.F.3 contains instructions for requesting examinations for pregnant IDES participants.
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III.i.2.D.6.n. Handling Cases Involving a Participant Who is Too Disabled to Travel to an Examination |
MSCs, PEBLOs, and physicians at MTFs are responsible for determining whether a participant is too disabled to travel to an examination.
The table below describes the process for handling cases involving a participant who is too disabled to travel to an examination.
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III.i.2.D.6.o. Requirement for Examiner eFolder Review |
Any examination VHA or a VBA contractor conducts in connection with IDES must include a review of the participant’s claims folder. All STRs provided by the PEBLO and any other pertinent records provided by the participant, must be available in the participant’s eFolder prior to requesting the examination.
Important: IDES examinations should be requested after the initial interview, once the STRs provided with the referral package has been uploaded and is available in the eFolder. Examination requests should not be delayed for receipt of STRs from previous periods of service.
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III.i.2.D.6.p. Handling Requests in Which the Examination Provider is Unable to Provide Required Exams |
When a VHA facility is named as the responsible provider in local agreements, but does not have the ability to complete a specific examination needed for an IDES claim, the MSC must:
If the contract examination provider cancels (or directs cancellation of) the examination because contract support is not yet available in the participant’s area, the MSC should contact VAVBAWAS/CO/Contract Examination Inquiries for assistance.
Note: The VHA facility named in the local agreement will continue to complete the parts of the examination as their capacity allows. MSCs should only request the specific examination(s) that cannot be completed by VHA. (This may result in splitting of examination requests between multiple providers).
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III.i.2.D.6.q. Examination Requests for IDES Participants Not Located at or Near the MTF |
Based on capacity at local MEBs, a service department may elect to refer a participant to IDES at an intake site that is a great distance from the participant’s physical location. These participants should not be made to travel to the intake site to report for examinations.
In these cases, the MSC must:
Notes: When using ERRA,
Important: IDES cases are exempt from the mandatory use of ERRA, per M21-1, Part III, Subpart iv, 3.A.1.d. MSCs should only use ERRA in IDES cases involving participants who are not physically located at or near the intake site.
Reference: For more information on use of ERRA, see M21-1, Part III, Subpart iv, 3.A.2.b.
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7. Handling IDES Examination Reports and Other Evidence
Introduction |
This topic contains information about handling IDES examination reports and other evidence, including
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Change Date |
November 15, 2018 |
III.i.2.D.7.a. MSC Responsibility for Monitoring the Status of Examination Requests |
At least once each week, MSCs must
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III.i.2.D.7.b. 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 VBMS.
Important: MSCs must ensure a copy of the examination report is uploaded into the participant’s eFolder.
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III.i.2.D.7.c. MSC Review of Examination Reports |
MSCs must complete a thorough review of examination reports once they become available. MSCs must ensure the reports are complete before providing results to the PEBLO or updating VTA to reflect the return of examination results.
MSCs must carefully review their examination request and all examination results to confirm that
Notes:
References: For more information on
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III.i.2.D.7.d. Actions MSCs Must Take Once All Examination Reports Are Deemed Complete |
MSCs must take the actions described in the table below as soon as all of an IDES participant’s examination reports are complete and have been uploaded into the participant’s eFolder.
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III.i.2.D.7.e. Means of Providing Examination Reports to PEBLOs |
MSCs may print copies of examination reports and hand-deliver them to PEBLOs. It may be faster and more convenient, however, to save the reports in an electronic format and send them to PEBLOs using SAFE or encrypted e-mail.
Reference: For information about using SAFE to send sensitive records, see M21-1, Part III, Subpart i, 2.F.9.a.
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III.i.2.D.7.f. DRAS Review of Examination Reports for Sufficiency |
Within five calendar days of the date an MSC notifies DRASs that reports from requested examinations are available in an IDES participant’s eFolder, the DRASs must take the steps in the table below.
Important: Regardless of the sufficiency of a participant’s examination reports, or whether a new examination or corrected examination report is necessary, an MSC may not
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III.i.2.D.7.g. Updating VTA Following Review of Examination Reports |
After reviewing an IDES participant’s examination report(s) for sufficiency, DRASs must
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III.i.2.D.7.h. Examination Reports That Reveal the Existence of Additional Disabilities |
If an examination report reveals the existence of disabilities that the IDES participant did not claim and the service department did not refer to VA, DRASs must follow the instructions in M21-1, Part III, Subpart i, 2.F.1.i.
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III.i.2.D.7.i. MSC Actions If an Examination Report Is Insufficient |
If a DRAS reports to an MSC that an IDES participant’s examination report is insufficient for rating purposes, the MSC must
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III.i.2.D.7.j. DRAS Actions if an Examination Report Is Insufficient |
If a DRAS determines an examination report is insufficient, it must
Notes:
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III.i.2.D.7.k. Failure of an IDES Participant to Report for Examination |
The table below describes the actions MSCs should take when an IDES participant fails to report for an examination without good cause.
Important: MSCs must enter a note in VTA stating a new examination has been requested due to the participant missing the original appointment. Do not change the PREPARE CLAIM START DATE or MEDICAL EVALUATION START DATE in VTA.
Exception: If the purpose of the missed examination was to evaluate a mental disorder, MSCs should consider rescheduling the examination, especially if there is any indication the participant may have simply forgotten about it.
Reference: For more information on the definition of good cause, see M21-1, Part I, 1.C.3.n.
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III.i.2.D.7.l. Handling an IDES Participant’s Request to Re-schedule an Examination |
MSCs must advise participants who wish to reschedule VA examinations to consult with their PEBLO.
Once an appointment for VA examinations has been scheduled, examination appointments cannot be changed unless the participant’s PEBLO determines that it is necessary.
MSCs may reschedule IDES examinations only after receiving a request (or approval) from the participant’s PEBLO. MSCs must ensure that the PEBLOs request/approval is noted in VTA.
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8. IDES Participants With a Pending Claim, Appeal, or Previously Denied Claim
Introduction |
This topic contains instructions for handling cases involving IDES participants with a pending claim, appeal, or previously denied claim, including
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Change Date |
November 15, 2018 |
III.i.2.D.8.a. IDES Participants With a Prior Finally-Denied Claim |
IDES participants may file claims for benefits that were previously finally denied.
A decision on a claim is final and binding once a determination is made and finally adjudicated after the time limit for filing an appeal has passed. However, a finally denied claim may be
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<iii.i.2.d.8.bIII.i.2.D.8.b. Examination of Disabilities That Were The Subject of a Previously Denied Claim</iii.i.2.d.8.b |
VA is not obligated to examine a disability that was the subject of a previously denied claim that has become final unless
The STRs MSCs receive in referral packages usually satisfy the requirement for new and material evidence. For this reason, MSCs routinely request the examination of claimed disabilities that were the subject of a prior denial if the participant
MSCs should contact their DRAS for guidance regarding the propriety of examining a disability that was the subject of a previous denial if
Reference: For more information about reopening a previously denied claim based on new and material evidence, see M21-1, Part III, Subpart iv, 2.B.3.
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III.i.2.D.8.c. Handling a Pending BDD or Other Pre-Discharge Claim by an Active Duty IDES Participant |
The table below describes the actions that are necessary when a service member who filed a Benefits Delivery at Discharge (BDD) or other pre-discharge claim is referred into IDES before his/her planned discharge date.
Important: If the participant was discharged from active duty, then subsequently referred into IDES as a member of the National Guard or Reserves, handle the case in accordance with M21-1, Part III, Subpart i, 2.D.8.d.
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III.i.2.D.8.d. Handling Pending Claims From Veterans in IDES |
The table below describes the actions that must be taken if a service department refers a Veteran with a pending claim into IDES.
Important: The instructions in the table below apply to cases involving BDD or other pre-discharge claims, provided the Veteran was discharged from service before the IDES referral was made.
If the BDD/pre-discharge claimant was referred into IDES prior to his/her projected discharge date, and remains on active duty at the time of the IDES referral, the claim must be handled in accordance with M21-1, Part III, Subpart i, 2.D.8.c.
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III.i.2.D.8.e. IDES Participants With a Pending Appeal |
If an IDES participant has an appeal pending with VA, and the appeal involves a disability the participant’s service department referred to VA or the participant claimed as a consequence of his/her involvement in IDES, MSCs and DRASs must follow the instructions in the table below.
Important: During the time period that an IDES participant with a pending appeal is involved in IDES, the SOJ is responsible for managing the participant’s appeal.
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III.i.2.D.8.f. Notifying the RO or BVA of New Evidence Related to Pending Appeal |
When new evidence or information related to a pending appeal is uploaded/scanned into VBMS, the MSC or DRAS must take the action outlined in the table below.
Reference: For more information on determining location of an appeal, see theVACOLS User’s Guide.
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