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M21-1, Part III, Subpart i, Chapter 2, Section D – Overview of the Integrated Disability Evaluation System (IDES) and Initial Claims Development

Overview


In This Section

This section contains the following topics:

1.  Purpose and Elements of IDES


Introduction

This topic contains information about the purpose and elements of IDES, including

Change Date

November 20, 2018

III.i.2.D.1.a.  Purpose of IDES

The purpose of the Integrated Disability Evaluation System (IDES) is to save time and resources by combining multiple aspects of the disability evaluation process individuals go through when
  • the service department calls into question the service member’s fitness for duty, and
  • the service member files a claim for Department of Veterans Affairs (VA) benefits.
IDES participants undergo only one examination (or one set of examinations), the results of which meet the needs of both VA and the Department of Defense (DoD).  If, based on the results of the examination(s), a physical evaluation board (PEB) decides a participant is unfit for duty, VA prepares a rating decision to determine the amount of VA benefits to which he/she is entitled.  DoD uses this same decision to determine the amount of DoD benefits to which the participant is entitled.

III.i.2.D.1.b.  MEBs

Medical evaluation boards (MEBs) are DoD entities responsible for evaluating the disabilities of IDES participants for the purpose of
  • documenting medical status and duty limitations
  • determining whether the IDES participants meet medical retention standards, and
  • referring IDES participants to a PEB.

III.i.2.D.1.c.  PEBs

PEBs are DoD entities responsible for evaluating an IDES participant’s fitness for duty for the purpose of determining whether
  • the participant should remain in service, or
  • DoD should
    • medically retire the participant, or
    • separate the participant from service (with or without benefits).
DoD operates five PEBs
  • National Capital Region PEB in Alexandria, Virginia (Army)
  • Joint Base San Antonio at Ft. Sam Houston, Texas (Army)
  • Joint Base Lewis-McChord at Ft. Lewis, Washington (Army)
  • Washington Naval Yard in Washington, D.C. (Navy and Marine Corps), and
  • Joint Base San Antonio at Randolph Air Force Base, Texas (Air Force).

III.i.2.D.1.d.  PEBLOs

A Physical Evaluation Board Liaison Officer (PEBLO) is a DoD employee who is the
  • non-clinical case manager assigned to individuals after a treating physician refers them to IDES
  • MEB’s primary point of contact in the IDES process
  • liaison between DoD and VA’s Military Services Coordinators (MSCs)
  • DoD representative that first meets with each IDES participant and assists him/her in
    • understanding the IDES process, and
    • scheduling required medical examinations (in coordination with an MSC)
  • resource throughout the IDES process for IDES participants and their families with regard to information about IDES, and
  • focal point for consolidation of all pertinent medical information.

III.i.2.D.1.e.  MSCs

MSCs are VA representatives that work at IDES intake sites.  They
  • are typically an employee of the regional office (RO) with geographical jurisdiction over the intake site
  • serve as a resource for IDES participants and their families with regard to information about VA benefits
  • serve as the MEBs’ primary point of contact with VA
  • accept referrals of individuals into IDES from PEBLOs
  • hold a meeting with each IDES participant when the participant first enters the program to assist him/her in
    • filing a claim for VA benefits, and
    • understanding the claims process
  • undertake development to obtain evidence relevant to participants’ claims, to include requesting necessary VA examinations
  • provide examination reports to PEBLOs once they become available, and
  • conduct an exit interview with each IDES participant.

III.i.2.D.1.f.  RO Points of Contact

Each RO must have an IDES point of contact.  This employee’s responsibilities include
  • serving as a subject-matter expert on IDES, and
  • overseeing the handling of IDES-related activities in the RO.

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
  • prepares and promulgates a final rating decision, and
  • sends a decision notice to the participant.
VA has two DRASs.  The table below shows
  • the RO at which the DRASs are located
  • their contact information, and
  • the IDES cases over which each DRAS has jurisdiction.
Seattle RO
Providence RO
Mailing Address
SeaTac Processing Center
17930 International Blvd.
Suite 100
SeaTac, WA 98188
Providence VA Regional Office
380 Westminster Street
Attn: IDES
Providence, RI 02903
E-Mail Address
Fax Number
(206) 965-3995
(401) 223-3680
Jurisdiction
IDES cases from all Army PEBs
IDES cases from the Air Force and Navy PEBs
Reference:  For more information on IDES cases involving multiple special missions or circumstances, see M21-1, Part III, Subpart ii, 5.A.1.c.

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

III.i.2.D.1.i.  IDES Stages of Responsibility

The table below describes the stages in IDES claims processing over which VA has responsibility, defines the starting and ending point of each stage, and lists the VTA indicators for each stage.
Stage
Starting Point
Ending Point
VTA Indicators
Claims Development
The PEBLO provides a proper referral to the MSC.
The MSC submits the examination request.
  • PREPARE CLAIM START DATE, and
  • MEDICAL EVALUATION START DATE.
Medical Evaluation
The MSC submits the examination request.
The MSC provides completed examination reports to the PEBLO.
  • MEDICAL EVALUATION START DATE, and
  • MEDICAL EVALUATION END DATE.
Proposed Rating
The PEB submits a request to the DRAS for a proposed rating.
The DRAS returns a completed proposed rating to the PEB.
  • PROPOSED RATING REQUEST DATE, and
  • THE PROPOSED RATING END DATE.
Rating Reconsideration
The PEB submits a request for reconsideration to the DRAS.
The DRAS returns a response to the PEB.
  • DATE RECONSIDERED RATING REQUESTED, and
  • VA RECONSIDERATION RATING END DATE.
VA Benefits
An active duty IDES participant is discharged from service.
The DRAS provides notification to the participant of the final rating and VA award.
  • DATE OF SEPARATION, and
  • VA BENEFITS DATE.

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.
Stage
Processing Time — Active Duty
Processing Time – Non-Active Duty
Claims Development
5 days
11 days
Medical Evaluation
32 days
32 days
Proposed Rating
20 days
20 days
Rating Reconsideration
4 days
4 days
VA Benefits
20 days
N/A
Notes:
  • All listed periods refer to calendar days.
  • Individuals who are referred to IDES as members of the National Guard or Reserves are considered non-active duty IDES participants.
  • There is no VA Benefits stage or goal for non-active duty IDES participants because they receive final VA ratings during the Proposed Rating stage.

2.  DoD Process for Referring Individuals Into IDES


Introduction

This topic contains information about referring individuals into IDES, including

Change Date

November 15, 2018

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.
Stage
Description
1
A physician at a military treatment facility (MTF) refers an ill or injured individual to an MEB.
2
The individual’s service department assigns him/her a PEBLO.
3
The PEBLO contacts the individual and provides him/her with information about IDES.
4
The PEBLO obtains copies of the individual’s medical records, to include
  • all paper records maintained in the service treatment record (STR) jacket
  • TRICARE referrals and treatment reports from TRICARE providers
  • Armed Forces Health Longitudinal Technology Application records
  • Composite Health Care System records
  • entrance examination record
  • mental health records, and
  • dental records if a dental condition is a referred condition.
5
The PEBLO ensures that all sections of the VA Form 21-0819, VA/DOD Joint Disability Evaluation Board Claim, are complete, including
  • the participant’s demographic and contact information
  • the conditions identified by the referring physician as the basis for the fitness determination (the referred conditions), and
  • a statement of complete and current STRs.
6
The PEBLO provides the individual’s complete STRs and completed VA Form 21-0819 (hereafter referred to as the “referral package”) to the MSC.
Notes:
  • PEBLOs should not refer an individual to an MSC if the individual is
    • unavailable to meet with the MSC within 5 days of the date the referral was made, or
    • if the individual is unable to report for a VA examination within 30 days.
  • If there are special circumstances surrounding the referral of an individual to an MSC, PEBLOs are responsible for communicating them to the MSC, preferably by describing them in the NOTES field on the PEBLO tab in VTA. Examples of such special circumstances include the following:
    • STRs for prior periods of service are already in VA’s possession
    • an individual has special needs and/or requires an escort due to cognitive disorders, or
    • an individual has shown him/herself to be uncooperative.

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:
  • indicate that all known STRs have been provided, or
  • specify any exceptions to the provided STRs completeness, and indicate all PEBLO actions that were taken to obtain the record.
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

3.  Initial Steps in Processing a Referral Package


Introduction

This topic describes the initial steps in processing a referral package, including

Change Date

November 15, 2018

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
  • initiate the checklist at the onset of the claim to help guide development actions, or
  • complete the checklist prior to transferring the case to the DRAS to certify that all appropriate development actions have been taken.
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.

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:
  • encrypted email or Safe Access File Exchange (SAFE) transfer
  • shared local drives, or
  • compact disc (CD) – provided that the intake site has developed a plan for assessing CD media security that is compliant with VA directives.
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

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
  • ensure that the documents are promptly date stamped in accordance withM21-1, Part III, Subpart ii, 1.C.1.a
  • maintain the documents in a secure location until the initial interview
  • forward the referral package, and any paper documentation the participant provided at the interview, to the scanning vendor immediately after the initial interview, in accordance with M21-1, Part III, Subpart i, 2.D.5.a, Step 8, and
  • ensure that the STRs provided with the referral have been scanned and are available in the VBMS eFolder prior to requesting examinations.
Reference:  For more information on shipping paper evidence to the scanning vendor, see M21-1, Part III, Subpart i, 2.D.3.j.

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.
Step
Action
1
Establish an end product (EP) in VBMS following the instructions in M21-1, Part III, Subpart ii, 3.D.2.c.
Important:
  • Use the following:
    • 689 as the EP
    • Disability Evaluation System as the claim label
    • PREDISCHARGE as the claim type indicator
    • IDES as the Pre-Discharge claim type indicator, and
    • MEB MTF as the Intake Site.
  • The date VA first received VA Form 21-0819 from the PEBLO represents the date of claim for claims establishment purposes,even if the MSC determined the initial referral was improper.
Note:  The EP 689 remains pending until
  • the DRAS receives verification of the participant’s medical discharge, or
  • the service department disenrolls the participant in VTA.
Exception:  If the service department disenrolls a participant for the sole purpose of adding new referred conditions and will immediately reenroll the participant in VTA, the EP 689 should remain for a period of 30 days to allow for the reenrollment.
2
Assign the case to the IDES (National) segmented lane in VBMS.
Notes:
  • If the MSC has a VBMS user role that allows for claim assignment, the MSC must assign the case to him/herself (or the MSC who will be responsible for the case)
  • If the MSC does not have the capability to assign the claim, it is recommended that he/she work closely with his/her supervisor to ensure IDES claims are assigned to the appropriate MSC.
Rationale:  The MSC will be able to complete all necessary development actions on a claim regardless of whether it is or is not assigned to his/her individual work queue.  However, if the claim is not assigned to the MSC’s individual work queue, the MSC will not receive new mail indicators associated with the case.
3
Determine if the VA Form 21-0819 was received electronically.
  • If yes, ensure the form is uploaded in VBMS in accordance withM21-1, Part III, Subpart i, 2.D.3.e.
  • If no, annotate the form to show the
    • EP code established (i.e. 689)
    • action taken (claims establishment)
    • date of the action, and
    • initials of the MSC who established the EP.
4
Review the referral package within one day of the date it became available to determine whether the referral was proper. A proper referral package will include
Important:  If any part of the STRs are not provided, it must be indicated in Section III of the form, specifically Blocks 21 and 22.
Note:  Under certain circumstances, which are described in M21-1, Part III, Subpart i, 2.D.3.g, MSCs may choose to accept a referral that is technically improper.
5
Was the referral proper?
  • If yes (or if the MSC concludes it is in the best interest of the claimant to accept an improper referral as provided in M21-1, Part III, Subpart i, 2.D.3.g), proceed to the next step.
  • If no (and the MSC concludes it is not in the best interest of the claimant to accept the improper referral),
    • contact the PEBLO and explain the reason the referral is not considered proper
    • add a note in VTA that provides the reason for rejection of the referral
    • remove the PREPARE CLAIM START DATE entry, and
    • document the return of the referral package in the fields under the CORRECTIVE ACTION tab in VTA.
Important:  Do not proceed to the next step unless/until a proper referral is received.
6
Ensure the PREPARE CLAIM START DATE field on the MSC tab in VTA reflects the date a referral package representing a proper referral became available to the MSC. (This date might be different than the date VA received the referral package if, for example, the MSC was on leave when the package arrived.)
Important:  MSCs must make all possible attempts to schedule and complete the initial interview with the IDES participant within five days of the PREPARE CLAIM START DATE field.
7
Update the following fields on the MSC tab in VTA:
  • MSC ASSIGNED, and
  • VA REGIONAL OFFICE.
8
Does Control of Veterans Records System (COVERS) show that VA has ever created a paper claims folder for the IDES participant?
Reference:  For information about using COVERS, see the COVERS User Guide.
9
Assign the IDES Participant corporate flash in Share.
10
Undertake development to obtain the following, if applicable:
  • STRs located at
    • VA’s Records Management Center (RMC), or
    • the National Personnel Records Center (NPRC)
  • medical records in possession of the Social Security Administration, and
  • privately held treatment records.
Notes:  If a participant’s STRs are located at
  • RMC, RMC will forward STRs to the scanning vendor once the claims is established in VBMS, or
  • NPRC, MSCs must ask the Military Records Specialist at their respective ROs to submit a priority request for the STRs through the Personnel Information Exchange System.
References:  For more information on requesting evidence from
11
Ensure that Participant Profile accurately reflects the participant’s
  • current branch of service, and
  • date of entry into active duty, if the participant is currently on active duty.
Note:  If the participant is currently on active duty, do not check the SERVICE VERIFIED box.  Service should not be marked as verified until after
  • the participant has been discharged, and
  • VA has received verification of the participant’s separation date and character of discharge.
12
If the participant had a prior period of military service that is not yet verified in the corporate record, the MSC must
13
Follow the instructions in the Compensation and Pension Record Interchange (CAPRI) User Manual 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: CAPRI, 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 VBMS Job Aid – Adding Documents in VBMS eFolders.
14
Prepare for the initial meeting with the IDES participant by reviewing the contents of his/her referral package and claims folder.
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 originalSTRs, they must remain in the same jacket/folder they were in when the MSC received them from the PEBLO. MSCs must store copies of STRs in VA Form 21-4582, Service Department Records Envelope.
  • An MSC may not delay meeting with an IDES participant solely because the MSC has not yet received
    • the participant’s claims folder, or
    • records for which the MSC undertook development in Step 10 of this procedure.
15
If possible, contact the participant prior to the initial meeting to
Reference:  For more information on VTA, see M21-1, Part III, Subpart i, 2.D.1.h.

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
  • upload the documents into VBMS
  • ensure the documents are associated with the pending EP 689 in VBMS, and
  • index the files by selecting an appropriate document type.
After the document upload is complete, the MSC must delete any locally-stored electronic versions of the evidence.
References:  For more information on

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
  • a member states he/she is on active duty, and
  • VA’s corporate record shows the member is currently receiving VA benefits.
If the member …
Then MSCs must …
provides orders showing he/she is currently on active duty
provide the station of jurisdiction (SOJ) with a copy of the orders so it can stop the member’s VA benefits according to the instructions in M21-1, Part III, Subpart v, 4.C.7.
fails to provide the MSC with current orders
instruct the SOJ to send a letter to the member that proposes to stop his/her VA benefits effective the day after the last date the evidence of record confirms the member was not on active duty.
Important:
  • M21-1, Part III, Subpart i, 2.F.2 contains instructions that are unique to the handling of IDES cases involving members of the Reserves or National Guard that are not on active duty.
  • Before treating a member of the Reserves or National Guard as an individual who is on active duty, MSCs must ensure the individual is actually performing full-time, active duty service. The fact that a member is “on orders” or in uniform is not a reliable indicator that he/she is on active duty for the purposes shown in the table above.
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.

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.

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.
If the participant has a paper claims folder located at …
Then …
RMC
request the claims folder via COVERS.
Note:  RMC will ship the claims folder to the scanning vendor on the basis of the VBMS flash.
  • an RO, or
  • the Appeals Resource Center (ARC)
send an e-mail to the RO’s Veterans Service Center Manager (VSCM) or ARC mailbox, as applicable, requesting that the claims folder be shipped to the scanning vendor immediately.
in the temporary custody of Compensation Service’s Systematic and Technical Accuracy Review (STAR) Staff
send an e-mail to the
  • VSCM mailbox of the SOJ, requesting the claims folder, and
  • IDES program office (VAVBAWAS/CO/DES), stating that the claims folder has been requested from its respective SOJ.
in the temporary custody of the Board of Veterans’ Appeals (BVA)
follow the instructions in M21-1, Part III, Subpart i, 2.D.3.i.
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.

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.
Step
Action
1
Submit a request to BVA, in accordance with M21-1, Part I, 5.F.5.c, for temporary return of the claims folder directly to the MSC’s location.
2
The request should indicate
  • if any IDES issues or evidence are related to issues on appeal before BVA, and
  • the entire claims folder (including the new evidence associated with the IDES claim) will be made available to BVA in VBMS.
3
Establish EP 400 in VBMS (this will establish an eFolder).
4
Immediately upon receipt of the claims folder from BVA, incorporate the IDES documents into the claims folder and send the claims folder to the appropriate scanning vendor.
5
Check the VBMS APPEAL checkbox in the SPECIAL INTEREST box on the DISPATCH tab in the Veterans Appeals Control and Locator System (VACOLS).
6
Check VBMS for the new mail indicator (if the claim has not been assigned, this will be in the unassigned queue) and verify the folder has been scanned.
7
Clear EP 400 after the supervisor or user identifies the new mail indicator and that the folder was successfully scanned.
8
Notify BVA via the BVA File Transfer mailbox that the claims folder is now available in VBMS. The e-mail should also include
  • a screenshot of the documents page in VBMS which indicates the records are available in VBMS, and
  • the following language if the MSC was not able to update the VACOLS record in Step 5: Due to jurisdiction restrictions, the VACOLS record could not be updated by local users; please check the “VBMS Appeal” checkbox in the Special Interest box on the DISPATCH tab in VACOLS.
Important:  COVERS does not provide for the transfer of temporary claims folders from one site to another.  Accordingly
  • MSCs must add notes in VBMS and VTA that reflect the movement of these types of folders (these notes should include the tracking numbers for shipment of the folders), and
  • any EP an MSC establishes to control an IDES participant’s claim will notautomatically transfer to the site to which the MSC sends a temporary claims folder. This may require the receiving site to
    • cancel the existing EP, and
    • establish a new EP.
References:  For more information about

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
  • create a document control sheet (DCS) and Record Management Number (RMN) in VBMS, and
  • forward the documents and the DCS to the appropriate scanning vendor according to current Veterans Claims Intake Program (VCIP) Shipping Procedures.
Important:
Reference:  For more information on the RMN/DCS shipping process, see M21-1, Part III, Subpart ii, 1.F.2.

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.

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.
Step Action
1 Using the Letter Creator tool, compose a Return of Documents letter (accessible from the IPC menu).
2 List the document(s) that were uploaded into the VBMS eFolder and the date they were received.
3 Enclose the original documents and provide the letter to the participant.
4 Upload a copy of the letter into the participant’s VBMS eFolder.
Reference:  For more information on the Letter Creator tool, see the Letter Creator User Guide.

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.

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.
If the documents were provided …
Then shipping or scanning/upload action must be completed within 5 calendar days of the …
with PEBLO’s referral package or during the initial interview
initial interview.
after the initial interview
date the documents were received.

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

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.
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
2
The MSC informs the IDES participant that he/she has the right to seek the advice of other parties during the claims process, and explains the availability of Veterans service organizations (VSOs).
If the participant expresses interest in being represented by a VSO, the MSC must provide the participant with VA Form 21-22, Appointment of Veterans Service Organization Claimant’s Representative.
Important:  Before providing VA Form 21-22, MSCs must replace the word “Veteran” with “service member” in Block 1 of the form, if the participant is still on active duty.
Note:  Only DoD and its service departments have the authority to initiate the submission of VA Form 21-0819 and refer an individual into IDES.  An individual’s representative may not take either of these actions.
3
The MSC explains that:
  • IDES participants have the opportunity to initiate VA compensation claims as part of the IDES process, and
  • filing a VA claim as part of the IDES process allows VA to
    • begin paying any VA benefits shortly after his/her separation from service (if the participant is found unfit and medically discharged), and
    • share examination reports and rating information for all issues raised in IDES (claimed and referred) with DoD, so that the service department can consider this information when determining the participant’s fitness for continued service.
Note:  If the participant expresses concern about VA’s disclosure of information to the service department regarding disability(ies) he/she claims with VA, the MSC should recommend the participant delay submitting a claim to VA that involves the disability(ies) in question untilafter the participant exits IDES.
4
If the participant would like to submit a VA claim, proceed to Step 6 of this table.
If the participant declines to submit a claim, proceed to the next step.
5
If the participant declines to submit a VA claim, the MSC must:
  • explain
    • that VA will evaluate the conditions referred by the service department for the DoD purposes only, and
    • VA compensation will not be awarded as part of his /her participation in IDES
  • provide the participant with a VA Form 21-4138, Statement in Support of Claim
  • ask the participant to document his/her decision to decline to submit a VA claim on the VA Form 21-4138, and
  • proceed to Step 12 of this table.
Note:  If the participant refuses to complete a VA Form 21-4138, the MSC must document the discussion on a VA Form 27-0820, Report of General Information, noting the participant’s decision to decline to submit a VA claim.
6
The MSC provides the participant with a VA Form 21-526EZ.
Reference:  For information regarding providing forms to participants when initial interviews are conducted by telephone or videoconference, see M21-1, Part III, Subpart i, 2.D.4.d.
7
The MSC assists the participant with completion of the VA Form 21-526EZ.  During this process, the MSC
  • calls attention to evidence tables on the VA Form 21-526EZ, which describe the information and evidence needed to substantiate a claim for VA disability benefits
  • explains that service connection (SC) is limited to chronicdisabilities the participant incurred during service or that service in the military aggravated, and
  • advises the participant to list the following in Section I, Block 13 of the VA Form 21-526EZ:
    • the referred conditions the service department identified on the VA Form 21-0819, and
    • any additional chronic, service-related disabilities his/her service department did not identify.
Note:  When a participant submits a VA Form 21-526EZ during the IDES process, the referred conditions listed by the service department on theVA Form 21-0819 will be considered in the VA rating decision—whether or not the conditions are specifically listed on the VA Form 21-526EZ.  However, listing the referred conditions on the VA Form 21-526EZ is recommended to direct attention to the referred conditions.
Important:  Although MSCs should bring to the attention of an IDES participant additional disabilities they identified during review of the participant’s medical records, the responsibility for formally placing the disabilities at issue ultimately lies with the participant.
8
The MSC provides the participant with
9
The MSC records the date of receipt of any documentation submitted using the instructions in the table below.
If  the documents were provided …
Then the MSC must …
in hard copy
date stamp the documents as provided in M21-1, Part III, Subpart ii, 1.C.1.a.
electronically
handle the documents as provided in M21-1, Part III, Subpart i, 2.D.3.m.
10
The MSC explains the importance of VA having up-to-date mailing address and direct deposit information and asks the participant to immediately notify VA if his/her address or direct deposit information changes at any time during the IDES process or after discharge.
Important:  If a participant notifies VA of a change of address at any point during his/her involvement in IDES, the VA entity that receives the notice is responsible for
  • updating the participant’s address in the corporate record (This includes checking the C&P PAYMENT ADDRESS box if the update is made through Share and the box is available for editing.), and
  • documenting the change of address as a note in VBMS.
11
The MSC explains that if the participant’s service department

  • determines the participant is unfit for duty, VA will
    • determine the participant’s entitlement to VA benefits, and
    • begin paying benefits to the participant (if entitlement exists) shortly after his/her separation from service, or
  • returns the participant to duty, VA will
    • close the participant’s claim, and
    • take no further action until he/she files a claim that is eligible for consideration.
Exception:  If the participant is a member of the Reserves or National Guard who is not on active duty, the MSC explains to the participant that VA will make a decision regarding his/her entitlement to benefits as soon as his/her service department
  • determines the participant is unfit for duty, or
  • returns the participant to duty.
Reference:  For more information about IDES cases involving members of the Reserves or National Guard that are not on active duty, see M21-1, Part III, Subpart i, 2.F.2.
12
The MSC informs the participant that VA will order examinations to evaluate all referred and claimed disabilities.
Exception:  VA will not examine the types of disabilities listed in M21-1, Part III, Subpart i, 2.D.6.d.
13
The MSC closes the meeting with the IDES participant, at which time the MSC
  • informs the participant that
    • the PEBLO will provide the participant with the date and time of any VA examination the MSC schedules
    • the participant must go through the PEBLO to make any changes to the date and time of any scheduled VA examination
    • if he/she wants to initiate a claim with VA for additional issues, he/she should contact their MSC to submit a prescribed form, bearing in mind that VA may not be able to decide those issues until after he/she exits IDES, and
    • the MSC will meet with the participant, regardless of the outcome, when the participant exits IDES, and
  • provides the participant with
    • copies of all documents the participant signed, and
    • the address and driving directions for the facility(ies) where the participant will report for his/her VA examination(s).
14
The MSC documents the initial interview by
  • completing VA Form 27-0820 and uploading it to the participant’s eFolder, or
  • entering a detailed note in VBMS.
The documentation should include a summary of the interview, including the reason for the interview, and any noteworthy information exchanged.
Important:  If the interview is conducted via telephone or video conference, the interview must be documented on a VA Form 27-0820, as discussed in M21-1, Part III, Subpart i, 2.D.4.d.

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.
If …
Then MSCs must …
an IDES claim involves a disability for which VA previously granted SC
treat identification of the disability by the participant or his/her service department as a claim for an increased disability rating.
the participant currently has a claim or appeal pending with VA
follow the instructions in M21-1, Part III, Subpart i, 2.D.8.
the participant wants to claim more issues than can fit in Section I, Block 13 of the VA Form 21-526EZ
Important:  The VA Form 21-4138 must be received along with the VA Form 21-526EZto be considered part of the IDES claim.
Reference:  For more information on processing additional correspondence received with a prescribed form, see M21-1, Part III, Subpart ii, 2.B.1.f.
the participant claims traumatic brain injury (TBI) or any mental health condition that was not listed on the VA Form 21-0819 as a referred condition
notify the participant’s PEBLO per M21-1, Part III, Subpart i, 2.D.5.b.
an IDES claim involves posttraumatic stress disorder (PTSD) or military sexual trauma (MST)
follow the instructions in M21-1, Part III, Subpart i, 2.D.4.c.
the participant is pregnant
follow the instructions in M21-1, Part III, Subpart i, 2.F.3.

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:
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
in-service stressors other than personal assault
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.

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

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:
  • encrypted e-mail
  • SAFE, or
  • secure fax.
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.

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

  • the MSC can wait up to five calendar days for return of the VA Form 21-526EZ
  • if the application is not received within five days, examinations will be ordered only for the conditions identified by the service department on theVA Form 21-0819
  • if the VA Form 21-526EZ is received after five days, any claimed issues may be deferred until after he/she exits IDES, and
  • unless VA receives a completed application, VA will be unable to pay benefits.
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:

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
  • stating that the additional issues were not received until after five days of the initial interview, and
  • specifying if examinations will be ordered/conducted for the new issues as part of the IDES claim.
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.

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:

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

  • process the claim according to standard IDES procedure, and
  • attempt to obtain the participant’s signature.

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

  • take the actions described in M21-1, Part I, 1.B.1.g for handling a claim that is not substantially complete
  • enter the date of notification of the participant in the VA BENEFITS DATE field on the RO/RATING ACTIVITY tab in VTA, and
  • add a note on the same tab that explains the date the DRAS entered in the VA BENEFITS DATE field.

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

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.
Step
Action
1
Update the fields on the MSC tab in VTA, as shown in the table below.
Field Name
User Input
TOTAL CLAIMED CONDITIONS
Enter the number of disabilities the participant claimed.
Important:  Do not include disabilities the participant’s service department referred to VA.
ELECTRONIC STRS
  • Yes, if all STRs were received electronically, or
  • No, if any hardcopy STRs were received.
MSC/SERVICEMEMBER INTERVIEW DATE
Enter the date of the interview with the participant.
SERVICE MEMBER FILING VA CLAIM
Enter yes, if the participant is filing a VA claim.  Otherwise select no.
Important:  If an MSC fails to assign an IDES case to him/herself, VTA will not save any of the other data he/she enters for the case.
2
If a hard copy VA Form 21-526EZ was completed/submitted, annotate it with the following:
  • IDES Claim—Controlled under Existing EP689
  • the date of claim of the EP 689
  • the MSCs initials, and
  • the current date.
Note:  If the application was completed/submitted electronically, it is not necessary to make the annotations listed above.  However, the MSC must ensure that when the application is uploaded it is associated with the EP 689 in VBMS per M21-1, Part III, Subpart i, 2.D.3.m.
3
Enter all conditions listed on the VA Form 21-0819 and the VA Form 21-526EZ as contentions under the EP 689 in VBMS; the date of contention must reflect the date stamp on VA Form 21-0819.
Exception:  Conditions listed on a VA Form 21-526EZ that was not returned within five days of the initial interview must be entered in VBMS with a date of contention which reflects the date the VA Form 21-526EZ was received.
4
Enter any applicable special issues in VBMS in accordance with M21-1, Part III, Subpart iii, 1.F.2.
Reference:  For more information on available special issue flashes, see M21-4, Appendix C, Section III.
5
Request all examinations and/or medical opinions necessary to evaluate both the referred and claimed disabilities, with the exception of those noted in M21-1, Part III, Subpart i, 2.D.6.d.
Important:  Do not request examinations until all STRs are available in VBMS.
Note:  Because MSCs notify participants during their initial meeting that VA will examine their disabilities, there is no need for them to send a letter restating this fact to participants.
References:  For more information on
6
Did the participant notify VA of additional, relevant evidence that is not already of record?
  • If yes, proceed to the next step.
  • If no, proceed to Step 8.
7
Undertake development to assist the participant in obtaining any additional evidence that is relevant to his/her case according to the instructions in M21-1, Part III, Subpart iii.
8
Forward any paper documentation, including the referral package (if provided in hard copy) and any paper documents submitted by the participant during the interview to the scanning vendor in accordance with M21-1, Part III, Subpart i, 2.D.3.j.
Note:  Under circumstances described in M21-1, Part III, Subpart i, 2.D.3.k, MSCs may scan documents locally and upload them directly into the VBMS eFolder as an alternative to sending the paper documentation to the scanning vendor.
9
Upload any documents the participant submitted electronically to the participant’s VBMS eFolder, according to specifications outlined inM21-1, Part III, Subpart i, 2.D.3.e.
10
Provide to the participant’s PEBLO
  • a copy of the completed VA Form 21-526EZ (or notice that the participant declined to submit a VA claim, if applicable),and
  • a list of the examinations requested in Step 5 of procedure described in this table.
References:  For more information about

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.
If the new evidence is received in …
Then the MSC must …
electronic format
upload the evidence to the VBMS eFolder in accordance with M21-1, Part III, Subpart i, 2.D.3.e.
paper format
forward the documents to the appropriate scanning vendor in accordance with M21-1, Part III, Subpart i, 2.D.3.j.
Exceptions:
  • As provided by M21-1, Part III, Subpart i, 2.D.3.k, MSCs may scan documents locally and upload the files directly to the VBMS eFolder instead of sending the documents to the scanning vendor.
  • The MSC must locally scan and upload evidence that may impact the ability of the DRAS to award benefits in a timely manner if possible.
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.

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
  • the participant claimed during the initial meeting with an MSC that he/she suffers from
    • the residuals of TBI, or
    • any mental disorder, and
  • the participant’s service department did not list the residuals of TBI or a mental disorder in Section I of VA Form 21-0819.

6.  Requesting Examinations for IDES Participants


Introduction

This topic contains information about requesting examinations for IDES participants, including

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:
  • VHA, to include VHA fee-basis examiners
  • physicians under contract with VBA to perform examinations (contract examiners), and/or
  • DoD, to include MTFs and TRICARE providers.
MSCs must submit examination requests to the specific providers noted in local agreements.
Exceptions:
  • When the participant is not physically located at or near the referring MTF, the MSC should submit the examination request in accordance with M21-1, Part III, Subpart i, 2.D.6.q.
  • When the provider specified in the local agreement is unable to conduct the necessary examination(s), the MSC must submit the request in accordance with M21-1, Part III, Subpart i, 2.D.6.p.
Reference:  For more information on submitting examination request for IDES participants see M21-1, Part III, Subpart i, 2.D.6.b.

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.
If the examination will be conducted by …
Then the …
  • VHA, or
  • a VBA contract provider
MSC uses the appropriate tool/system and its embedded templates to prepare and submit the examination request.
Note:  As discussed in M21-1, Part III, Subpart iv, 3.A.2.e, use of the Exam Request Builder tool is mandatory when creating an examination and/or medical opinion request for a compensation claim in CAPRI.
DoD will conduct the examination
  • MSC notifies the participant’s PEBLO of the required examination(s), and
  • PEBLO
    • schedules the examination(s)
    • notifies the MSC and participant of the date(s) and time(s) of the examination(s), and
    • ensures the examination(s) is(are) completed.
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

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

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:
  • any dental condition an IDES participant claims unless it is subject to SC under 38 CFR 4.150
  • a disability that was the subject of a prior VA denial that has become final, as defined in M21-1, Part III, Subpart i, 2.D.8.aunless
    • a participant’s service department referred the disability to VA, or
    • a participant provides VA with new and material evidence to justify reopening the previously denied claim, and
  • a disability that is the subject of a pending appeal unless a participant’s service department referred the disability to VA.
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.

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:
  • direct
  • secondary, and
  • aggravation.
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.

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
  • a complex medical opinion is necessary
  • the condition which requires a complex medical opinion, and
  • the reason a complex medical opinion is required.
The DRAS must complete the following actions within three business days of the request:
  • review the evidence of record
  • draft the required medical opinion
  • upload the draft into the participant’s eFolder, and
  • notify the MSC by e-mail that the medical opinion is available.
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

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.

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:
  • Referred Disabilities:  [list all referred disabilities]
  • Claimed Disabilities:  [list all claimed disabilities]
  • Required Specialty Examinations of Referred Disabilities:  [list all specialty examinations that are required to evaluate disabilities the participant’s service department referred to VA]
  • As soon as the examinations are scheduled, please notify the MSC and PEBLO of the dates and times.
  • MSC:  [provide name, title, complete mailing address, phone and fax number, and e-mail address of MSC], and
  • PEBLO:  [provide name, location, phone and fax number, and e-mail address of the participant’s PEBLO].
Important:
  • MSCs must alter their request for notification, according to the instructions in M21-1, Part III, Subpart i, 2.F.2.b, if the participant is a member of the Reserves or National Guard who is not on active duty.
  • MSCs must select IDES as a priority code when submitting a request for examination to VHA unless one of the following higher-priority codes is applicable
    • Terminal, or
    • FPOW (former prisoner of war).
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.

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.

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.
Step
Action
1
In the SHA PROVIDER field, select the examination provider (VHA, QTC, VES, or MTF) from which the MSC requested the SHA DBQ.
Notes:
  • This provider will be hereafter referred to as the “SHA provider”
  • It is typical to request additional DBQs from the SHA provider.  However, these will not be entered or tracked separately in VTA.
Is VHA the examination provider?
  • If yes, go to Step 2.
  • If no, go Step 3.
Explanation:  The SHA EXAM SITE field, discussed in Step 2, is only completed when VHA is the examination provider.
2
Complete the SHA EXAM SITE field with the VHA facility that will conduct the examination.
3
In the SHA REQUESTED DATE field, enter the date the examination request was submitted to the SHA provider.
4
Were additional DBQs requested from a provider other than the SHA provider selected in Step 1?
  • If yes, proceed to Step 5.
  • If no, take no further action in the table.
5
In the OTHER PROVIDER field, select the provider from which the MSC requested only DBQs other than an SHA.
Notes:
  • A provider who completes DBQs in an IDES case, but does not complete the SHA will hereafter be referred to as the “other provider.”
  • When the SHA provider performs all required examinations in an IDES case, the OTHER PROVIDER field is not applicable.
Was VHA the other provider?
  • If yes, go to Step 6.
  • If no, go to Step 7.
Explanation:  The OTHER PROVIDER EXAM SITE field, discussed in Step 6, is only completed when VHA is the examination provider.
6
In the OTHER PROVIDER EXAM SITE field enter the VHA facility that will complete the examinations.
7
In the SHA REQUESTED DATE field, enter the date the examination request was submitted to the SHA provider.
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.

III.i.2.D.6.k.  Avoiding Duplication of Effort

In order to avoid a duplication of effort,
  • examiners should use laboratory and x-ray reports that are already of record, as long as
    • the reports are less than six months old, and
    • there is no evidence the related disability has worsened, and
  • examiners should not duplicate diagnostic studies that establish a chronic diagnosis, regardless of the date performed, unless there is clinical evidence of a worsening of the related disability.
Examples:  The term “diagnostic studies” includes
  • sleep studies for obstructive sleep apnea, and
  • magnetic resonance imaging (MRI), computed tomography (CT) 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.

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

  • an SHA DBQ is completed, and
  • all claimed and referred disabilities are examined.

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.

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.
Step
Action
1
The participant’s MSC
  • notifies the DRAS of jurisdiction by e-mail that the participant is too disabled to travel to an examination
  • requests that the DRAS make a determination whether all referred conditions can be rated on the basis of the evidence of record, and
  • provides the DRAS with participant’s
    • STRs, and
    • current inpatient/outpatient treatment records that refer to any claimed or referred disability.
2
The rating activity at the DRAS reviews available medical records to determine whether referred conditions can be rated using the evidence of record.
Note:  If the rating activity determines additional, relevant treatment records exist, the MSC is responsible for obtaining them.
3
The DRAS notifies the MSC of the determination within five days of the request.
4
The MSC reviews the determination and takes the action specified in the table below.
If the determination is that the referred conditions …
Then the MSC must …
can be rated on the basis of the evidence of record
  • notify the participant’s PEBLO that the case can move forward without an examination, and
  • enter the date of notification into the following fields on the MSC tab in VTA
  • MEDICAL EVALUATION START DATE
  • EXAM END DATE, and
  • MEDICAL EVALUATION END DATE.
cannot be rated on the basis of the evidence of record
  • notify Compensation Service of the determination by sending an e-mail toVAVBAWAS/CO/DES, and
  • await further guidance from Compensation Service.
5
Upon receipt of a request for proposed rating from the PEB, the DRAS must prepare a proposed rating decision addressing
  • all referred conditions, and
  • any claimed conditions for which the evidence of record supports a favorable decision.

Important:  When a participant is too disabled to report for examinations, it is acceptable for DRAS to defer decisions for claimed conditions on the proposed rating as noted in M21-1, Part III, Subpart i, 2.E.3.f.


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.

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:
  • submit the examination request to the appropriate contract examination vendor, and
  • indicate in the REMARKS section of the request, that the request is related to an IDES claim, and that VHA is unable to complete the required exam.
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).

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,
  • enter the Participant’s zip code, and
  • select Yes for the Pre-Discharge/IDES Claim option.
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.

7.  Handling IDES Examination Reports and Other Evidence


Introduction

This topic contains information about handling IDES examination reports and other evidence, including

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
  • run the Pending Exam Report in VTA, and
  • follow up on any examination requests that the report shows have been pending more than 32 days.

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.

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
  • the request included all claimed and referred conditions
  • all issues noted on the examination request have been addressed by the examiner
  • all requested DBQs have been completed by the examiner, and
  • all specific testing required by individual DBQs has been completed.
Notes:
  • It is acceptable for an examiner to cite existing testing or imaging that already exists in the medical record to avoid duplication of medical procedures; however, the previous tests/images must be noted in the DBQ.
  • In cases where the MSC identifies missing, incomplete, or insufficient DBQs, or where examinations were not requested for all claimed and referred conditions, the MSC must obtain the missing or deficient examination information before providing the results to the PEBLO.
  • When reviewing examination results the MSC must solicit a claim for any identified chronic, unclaimed condition potentially subject to SC (particularly in cases involving active duty service members) as discussed in M21-1, Part IV, Subpart ii, 2.A.1.e.
References:  For more information on

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.
Step
Action
1
Update the SHA RETURNED DATE on the MSC Tab in VTA to reflect the date that all examinations requested from the SHA provider became available to the MSC.
Notes:
  • The provider (VHA, QTC, MTF or VES) to which the SHA DBQ was requested from is considered the “SHA provider.”
  • When multiple DBQs were requested from the SHA provider, the SHA RETURNED DATE must reflect the date the last DBQ from the SHA provider was returned.
2
Were examination requests submitted to multiple providers (e.g. both QTC and VHA)?
  • If yes, proceed to the next step.
  • If no, proceed to Step 4.
3
Update the OTHER EXAM RETURNED DATE in VTA to reflect the date that all examinations requested from the other provider became available to the MSC.
Notes:
  • A provider who completes DBQs in an IDES case, but does not complete the SHA DBQ is considered the “other provider.”
  • When multiple DBQs were requested from the other provider, the SHA REQUESTED DATE must reflect the date the last DBQ was returned.
4
Update the EXAM END DATE field in VTA to reflect the date when allthe participant’s examination reports became available to the participant’s MSC.
5
Provide copies of examination reports for all claimed and referred disabilities to the participant’s PEBLO according to the instructions inM21-1, Part III, Subpart i, 2.D.7.e.
Important:  If CAPRI contains records that are related to VHA’s examination of an IDES participant but are not included in his/her examination report (such as the results of a neuropsychological evaluation conducted in connection with an examination of a head injury), MSCs must provide a copy of these records to the participant’s PEBLO in addition to the corresponding examination report(s). These records are usually accessible by selecting Progress Notes on the VISTAWEB tab in CAPRI.
6
Ensure that the entire examination is available in VBMS.
Note:  Examinations completed by VHA or QTC should be automatically uploaded into VBMS; however, MSCs must ensure the entire examination has been uploaded before proceeding to the next step.
7
Update the MED EVAL END DATE field on the MSC tab in VTA to reflect the date the MSC sent the examination report(s) to the participant’s PEBLO.
Important:  MSCs must complete Steps 5-7 of this table on the same day.
Rationale:  These actions are critical to ensure the timely identification of insufficient examinations. VA has committed to notifying the MEB of examination insufficiencies within five days of the date examination results are provided to the PEBLO.  For VA to meet this commitment, it is critical that MSCs ensure the examinations are available in VBMS and update VTA on the day the examination is provided to the PEBLO.
8
Are all necessary development actions complete?
  • If yes, proceed to Step 10.
  • If no, proceed to the next step.
9
  • Follow up on any outstanding development requests
  • set appropriate suspense reasons and dates in VBMS to control development actions, and
  • proceed to the next step when all development actions are complete.
10
Ensure all tracked items have been updated to reflect the appropriate disposition per M21-4, Appendix D, Section I.
Note:  All tracked items must be marked ClosedReceived, or In Errorbefore transferring the case to DRAS.
11
Ensure that the IDES Development Checklist has been completed and incorporated into the eFolder (or forwarded to the scanning vendor under a DCS).
Note:  If the MSC uploads the checklist directly into the eFolder, he/she must use the indexing values specified on the checklist.
Reference:  For more information on the use of the IDES Development Checklist, see M21-1, Part III, Subpart i, 2.D.3.a.
12
Broker the EP 689 to the DRAS per instructions in the VBMS Job Instruction Sheet – Broker Claim.

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.

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.
Step
Action
1
Review the reports to determine whether they are sufficient for rating purposes.
2
Document the results of the review in VTA.
VTA will notify the MSC of the results of the sufficiency review.
Reference:  For more information on documenting the review in VTA, see Veterans Tracking Application – Completing Corrective Action Fields.
3
Was the examination sufficient?
If yes, add a custom tracked item Awaiting PEB Request under the pending EP 689 with a suspense date of 30 days.
If no,
  • take action as required by M21-1, Part III, Subpart i, 2.D.7.j, and
  • when a corrected examination report or new examination is received that is deemed sufficient, add a custom tracked itemAwaiting PEB Request under the pending EP 689 with a suspense date of 30 days.
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
  • postpone sending an examination report to a PEBLO pending completion of a DRAS’s review of the report, or
  • change the date the MSC initially entered in the EXAM END DATE or MED EVAL END DATE fields in VTA.

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
  • check the DRAS ASSIGNED field on the RO/RATING ACTIVITY tab to ensure it contains the name of the DRAS that is handling the participant’s case, and
  • complete the fields in the EXAM REVIEW section of the RO/RATING ACTIVITY tab in VTA.

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.

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
  • notify the participant’s PEBLO of the DRAS’s findings, and
  • provide the PEBLO with a copy of the new or revised VA examination report that replaces the insufficient report.

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
  • handle the insufficient examination in accordance with M21-1, Part III, Subpart iv, 3.D.3
  • upload the examination request, if necessary, in accordance with M21-1, Part III, Subpart i, 2.D.6.i, and
  • add under the pending EP 689 additional tracked items for each type of examination request submitted outside the VBMS examination management environment.
Notes:
  • To perform the activities described above, a DRAS employee must have nationwide access to CAPRI.
  • If a DRAS requests correction of an examination report or a new examination from a VHA facility, it must prepare the request according to the instructions in M21-1, Part III, Subpart i, 2.D.6.h.  The DRAS employee who submits the request must include his/her contact information in addition to the PEBLO’s and MSC’s contact information.
  • MTFs mayl perform tests or studies that a DRAS determines are necessary to correct deficiencies the DRAS identified in an examination report.
  • Examination providers will correct any insufficient examination reports or complete any new examinations a DRAS requires within 14 days of notification of an insufficient examination report.

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.
If the participant failed to report for examination of a …
Then MSCs should …
referred disability
work with the participant’s PEBLO to determine whether it is more appropriate to
  • reschedule the examination
  • continue the IDES process without examinations, or
  • have the service department disenroll the participant from IDES.
Note:  Before proceeding without examinations for referred conditions, the MSC must obtain documented agreement from the MEB.
claimed disability
consider the circumstances of each case and use their own discretion to decide whether examinations for claimed conditions should be rescheduled. If an examination is rescheduled for a referred disability, then MSCs should reschedule the examination(s) for claimed disabilities as well.
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.

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.

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

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
  • reopened and readjudicated if new and material evidence is provided, or
  • set aside and allowed if the prior decision contained a clear and unmistakable error.

<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 service department referred the disability to VA, or
  • the IDES participant provides VA with new and material evidence to justify reopening the claim.
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
  • is currently on active duty, or
  • has been on active duty since VA denied his/her claim.
MSCs should contact their DRAS for guidance regarding the propriety of examining a disability that was the subject of a previous denial if
  • it is unclear whether new evidence received since VA denied the claim is material
  • the participant with the previously denied claim
    • is a member of the Reserves or National Guard
    • is not currently on active duty, and
    • has not been on active duty since VA denied his/her claim, or
  • the previous denial was based on the absence of evidence of a relationship between service and the claimed disability.  (If a DRAS determines examination of the disability is necessary in order to determine whether the current or most recent period of service aggravated the disability, it should assist the MSC in composing the corresponding examination request.)
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.

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.
Responsible Party
Description of Necessary Action(s)
IDES/MSC
  • Explain to the participant that because he/she will not be discharge as planned,
    • the BDD/pre-discharge claim will be closed, and
    • he/she will have an opportunity to submit a claim via the IDES process.
  • Notify the RO with jurisdiction over the BDD/pre-discharge claim that the claimant has been retained on active duty and referred to IDES.
  • Process the IDES claim in accordance with standard IDES procedures.
SOJ/rating activity site
Process the BDD/pre-discharge EP in accordance withM21-1, Part III, Subpart i, 2.B.4.i.
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.

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.
Responsible Party
Description of Necessary Actions
MSC
  • Explain to the participant that VA will continue to process the pre-IDES claim separately.
  • Do not request transfer of or broker the pre-IDES EP(s).
  • Establish EP 689 and develop the IDES claim in accordance with standard IDES procedures.
  • Ensure all IDES development actions are clearly documented in VBMS.
  • Consider development actions taken by the RO working the pre-IDES EP, and avoid duplicative actions and examinations to the extent possible.
  • Ensure examinations are completed for all issues raised in IDES.
  • Take the following actions upon completion of IDES development:
    • broker the EP 689 to the appropriate DRAS, and
    • leave any pending pre-IDES EP to remain under the jurisdiction of the assigned RO.
Reference:  For additional information on the acceptability of examinations completed outside of IDES, see M21-1, Part III, Subpart i, 2.D.6.l.
RO with jurisdiction of the pre-IDES EP(s)
  • Identify rating-related cases with a concurrent IDES claim by the presence of a pending EP 689.
  • Consider development actions taken by the IDES MSC, and avoid duplicative actions/examinations to the extent possible.
  • Continue to process the pre-IDES EPs in accordance with standard procedures, making all efforts to resolve the claim and EP as expeditiously as possible.
  • Take no action on EP 689.
Assigned DRAS
  • Prepare the IDES rating under the existing rating EP.
  • Attempt to address all contentions (to include any undecided pre-IDES issues) within the IDES rating.
Notes:
  • If the pre-IDES EP has been resolved prior to DRAS rating action, the DRAS must establish a new rating EP in accordance with M21-1, Part III, Subpart i, 2.F.2.d.
  • The DRAS may defer any issue associated with a pre-IDES EP on the IDES rating if
    • the evidence of record is not sufficient to decide the issue, and
    • the issue was not claimed or referred as part of the IDES claim.

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.
If …
Then MSCs must …
And DRASs must …
a participant’s pending appeal involves a disability the participant’s service departmentreferred to VA
request examination of the referred disability
  • complete a separate proposed rating for the PEB (even in non-active duty Veteran cases)
  • assign a disability evaluation for PEB purposes only, and include a clear indication that the evaluation is for PEB purposes only, and
  • note that the issue remains on appeal for the purpose of entitlement to VA benefits and that the evaluation of the appeal issue reflected on the proposed rating does not impact the existing appeal.
Important:
  • The final rating shouldnot adjudicate issues on appeal to VA.
  • The final decision notice(s) should inform the participant that the issue(s) on appeal will be addressed as part of the ongoing appeal.
a participant’s pending appeal involves a disability the participantclaimed during IDES
  • use the Letter Creator tool to select the Duplicate Documents letter under the APPEALS tab
  • delete the document body and enclosure line, and
  • insert the following text into the body of the letter:

Your claim for[claimed condition(s)] [is/are] already on appeal and will proceed in accordance with the appellate process. [It/They] will not be addressed in the rating decision prepared in connection with IDES.

An IDES examination will not be conducted on the condition on appeal.

note in the participant’s proposed rating decision that the disability is currently under appeal and will not be addressed by IDES.
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.

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.
If the appeal is at …
Then notify …
the RO
the SOJ (via VSCM mailbox) when any evidence/information related to the pending appeal is uploaded/scanned into VBMS.
BVA
Notify BVA (via BVAVBMSMail@va.gov ) 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 theVACOLS User’s Guide.
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