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M21-1, Part III, Subpart i, Chapter 2, Section E – Department of Veterans Affairs (VA) Responsibilities Based on Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) Outcomes

Overview


In This Section

This section contains the following topics:

1.  Effects of MEB and PEB Decisions


Introduction

This topic contains information about the effects of MEB and PEB determinations, including

Change Date

November 29, 2018

III.i.2.E.1.a.  Outcomes of an MEB’s Review of Examination Reports

After receiving an Integrated Disability Evaluation System (IDES) participant’s examination report(s) from a Military Services Coordinator (MSC)
  • the participant’s Physical Evaluation Board Liaison Officer (PEBLO) forwards the report(s) to a physician
  • the physician uses the report(s) to prepare the IDES case for the Medical Evaluation Board (MEB), and
  • the MEB determines whether the participant is below established standards for retention in service.
The table below describes the actions that take place after an MEB makes its determination.
If …
Then …
the MEB determines the participant is below the standards for retention
  • the PEBLO notifies the MSC
  • the MEB refers the participant’s case to a Physical Evaluation Board (PEB), and
  • the MSC notifies the Disability Rating Activity Site (DRAS) of jurisdiction by e-mail to
    • set a claim-level suspense in the Veterans Benefits Management System (VBMS) under the pending end product (EP) 689 that expires 120 days in the future, and
    • update the suspense reason in VBMS to Special Project Team Claim, Awaiting: DES IPEB.
Note:  The MEB physicians prepare a narrative summary (NARSUM) for IDES participants who are referred to the PEB.  The NARSUM is intended to inform the PEB’s fitness determination.  It
  • summarizes the history and severity of medical conditions, and
  • describes the impact of those conditions on the participant’s ability to perform in his/her assigned duties.
References:  For more information on
  • the MEB determines the participant meets or exceeds the standards for retention, and
  • the participant has exhausted his/her appeal rights
  • the participant’s service department returns him/her to duty
  • the PEBLO notifies the MSC, and
  • the MSC conducts an exit interview with the participant according to the instructions in M21-1, Part III, Subpart i, 2.E.5.b.
Reference:  M21-1, Part III, Subpart i, 2.E.2.adiscusses the specific actions VA must take when an MEB determines a participant meets or exceeds standards for retention.

III.i.2.E.1.b.  PEB Actions Upon Receipt of a Referral From an MEB

After an MEB refers an IDES participant’s case to a PEB, the PEB makes a decision as to whether the service department-referred disabilities render him/her unfit for duty.
The table below describes the actions that take place after a PEB makes its decision.
If …
Then …
  • the PEB decides the participant is fit for duty, and
  • the participant has exhausted his/her appeal rights
  • the participant’s service department returns him/her to duty, and
  • the MSC conducts an exit interview with the participant according to the instructions inM21-1, Part III, Subpart i, 2.E.5.b.
Reference:  M21-1, Part III, Subpart i, 2.E.2.a discusses the specific actions VA must take when a PEB determines a participant is fit for duty.
the PEB decides the participant is unfitfor duty
the PEB sends a request to the DRAS of jurisdiction for a proposed rating decision.

2.  Processing MEB/PEB Decisions


Introduction

This topic contains instructions for processing MEB/PEB determinations, including

Change Date

February 15, 2017

<iii.i.2.e.2.a< strong=””>III.i.2.E.2.a. Processing Notice That an IDES Participant Meets Retention Standards, Is Fit for Duty, or Has Been Disenrolled</iii.i.2.e.2.a<>

The table below describes the steps MSCs and DRASs must follow when a PEBLO notifies an MSC that an IDES participant’s
  • MEB determined the participant meets the standards for retention
  • PEB determined the participant is fit for duty, or
  • service department disenrolled the participant from IDES.
Exception:  If the participant is a member of the Reserves or National Guard who is not on active duty, after a participant’s MSC and DRAS take the actions described in Steps 1 through 9 of the table below, the MSC or DRAS with current jurisdiction over the participant’s case must follow the instructions in M21-1, Part III, Subpart i, 2.F.2.d.
Step
Action
1
The MSC schedules and holds an exit interview with the participant.
Reference:  For more information about exit interviews, see M21-1, Part III, Subpart i, 2.E.5.
2
If the participant is
  • on active duty, the MSC proceeds to the next step, or
  • not on active duty, the MSC proceeds to Step 4.
3
The MSC sends the participant an e-mail containing a hyperlink to theVA webpage that discusses claims for disability benefits a service member may file prior to separation.
4
  • If a DRAS has current jurisdiction over the participant’s case, the MSC proceeds to the next step.
  • If the MSC has current jurisdiction over the participant’s case, the MSC proceeds to Step 6.
5
The MSC notifies the DRAS of the
  • participant’s disenrollment, or
  • MEB or PEB determination (whichever applies).
6
The MSC forwards any documents in his/her possession that belong in the participant’s claims folder to the appropriate scanning vendor.
Note:  Under circumstances described in M21-1, Part III, Subpart i, 2.D.3.k, MSCs may scan documents locally and upload the files directly into the VBMS electronic claims folder (eFolder) as an alternative to sending the paper documentation to the scanning vendor.
7
The MSC
  • prepares the letter according to the instructions in M21-1, Part III, Subpart i, 2.E.2.b
  • mails the letter to the participant or, if possible, provides it to him/her in person, and
  • uploads the letter into the participant’s eFolder.
8
The MSC clears the pending EP 689.
Important:  If the participant’s service department disenrolled him/her from IDES, the MSC or DRAS must also add a note in VBMS that documents the disenrollment.
9
The MSC or DRAS ensures the claims folder contains
  • a copy of the letter referenced in Step 7, and
  • documentation relating to the participant’s disenrollment or a copy of the MEB or PEB findings (whichever applies).
Reference:  For information about how PEBs document their findings, see M21-1, Part III, Subpart i, 2.E.2.e.

III.i.2.E.2.bContent of Letter to Participants Who Are Returned to Duty or Disenrolled

The instructions in Step 7 of the procedure described in M21-1, Part III, Subpart i, 2.E.2.a indicate MSCs must prepare a letter for IDES participants whose service department returned them to duty.  MSCs must follow the instructions in the table below when preparing the letter.
If the participant is …
Then MSC must …
returned to activeduty
use the Letter Creator tool to compose an IDES Return to Active Service letter (accessible from the VSC menu).
a member of the Reserves or National Guard and not on active duty
use the Letter Creator tool to compose an IDES Return to Reserves/National Guard Letter (accessible from the VSCmenu).
discharged administratively under conditions other than honorable
use the Letter Creator tool to compose an IDES Disenrollment OTH Discharge Letter (accessible from the VSC menu).
Reference:  For more information on the Letter Creator tool, see the Letter Creator User Guide.

III.i.2.E.2.c.  Handling Returned Mail

If the letter an MSC delivered or mailed to an IDES participant in Step 7 of the procedure described in M21-1, Part III, Subpart i, 2.E.2.a is returned as undeliverable, the MSC must follow the instructions in M21-1, Part III, Subpart ii, 1.B.6.d.

III.i.2.E.2.d.  Processing Notice That an IDES Participant Has Accepted a PEB Decision That He/She Is Unfit for Duty

An IDES participant may appeal a PEB’s decision that he/she is unfit for duty.  After a participant accepts a PEB decision that he/she is unfit for duty, the participant’s PEBLO is responsible for notifying the participant’s MSC.
Note:  Sometimes, PEBLOs concurrently provide MSCs with a copy of the participant’s
  • final PEB decision
  • separation/retirement orders, and/or
  • DD Form 214, Certificate of Release or Discharge from Active Duty.
After an MSC receives notification that a participant has accepted a PEB decision, MSCs and DRASs must follow the steps in the table below.
Exception:  The instructions in the table below apply only to participants who were on active duty when their service department referred them into IDES.
Step
Description
1
The MSC schedules and holds an exit interview with the participant.
Reference:  For more information about exit interviews, see M21-1, Part III, Subpart i, 2.E.5.
2
If the MSC has documentation of the participant’s discharge date, he/she must enter the date in the DATE OF SEPARATION field in the Veterans Tracking Application (VTA).
3
The MSC forwards a copy of all relevant documentation (such as PEB findings, a copy of the participant’s orders and/or DD Form 214, evidence that establishes a dependent for VA purposes, etc.) to the appropriate scanning vendor.
Note:  Under circumstances described in M21-1, Part III, Subpart i, 2.D.3.k, MSCs may scan documents locally and upload the files directly into the VBMS eFolder as an alternative to sending the paper documentation to the scanning vendor.
Reference:  For information about how PEBs document their findings, see M21-1, Part III, Subpart i, 2.E.2.e.
4
If the participants’s separation date has passed and the DRAS is able to verify the participant’s date and character of discharge, the DRAS proceeds to Step 6. Otherwise, the DRAS proceeds to the next step.
5
The DRAS
  • updates the pending EP 689 by setting a VBMS claim-level suspense that expires on the earlier of the following dates:
    • 30 days from the current date, or
    • the anticipated date of separation, as shown on the participant’s separation/retirement orders, and
  • changes the suspense reason in VBMS to Requested/Awaiting Other Evidence.
Once the participant’s date and character of discharge have been verified, the DRAS proceeds to the next step.
6
The DRAS
  • clears the pending EP 689
  • establishes the appropriate rating EP (110, 010, or 020), unless one is already pending
  • prepares and promulgates a final rating decision according to the instructions in M21-1, Part III, Subpart i, 2.E.4, and
  • updates VTA by entering on the RO/RATING ACTIVITY tab
    • the date the participant separated from service in the DATE OF SEPARATION field, and
    • the date of the DRAS notification to the participant of the final rating decision in the VA BENEFITS DATE field.
Note:  When establishing the rating EP, the DRAS must use
  • the first day after the participant separated from service as the date of claim, and
  • the Disability Evaluation System claim label.
References:  For more information about
Reference:  For more information about handling IDES cases involving members of the Reserves or National Guard who are not on active duty, see M21-1, Part III, Subpart i, 2.F.2.

III.i.2.E.2.e.  How PEBs Document Their Findings

The table below lists the forms PEBs use to document their findings regarding an IDES participant’s fitness for duty.
Service Department
Name of Form
Army
DA Form 199, Physical Evaluation Board Proceedings
Air Force
AF Form 356, Findings and Recommended Disposition of the USAF Physical Evaluation Board
  • Navy, and
  • Marine Corps
Findings of the Physical Evaluation Board Proceedings
Note:  PEBLOs must provide VA with one of the above forms when a PEB determines a participant is fit for duty.

3.  Proposed Rating Decisions


Introduction

This topic contains information about proposed rating decisions, including

Change Date

November 29, 2018

III.i.2.E.3.a.  EP Credit for Proposed Rating Decisions

Upon completion of a proposed rating decision, DRASs must complete a one-time clear of EP 310 (with the IDES Rating – Proposed claim label).  DRASs must use the date the proposed rating request is received from the PEB as the date of claim.
Exception:  The one-time clear of EP 310 is not appropriate if the rating decision is for an IDES participant who is a member of the Reserves or National Guard and is not on active duty.  Under these circumstances, DRASs must follow the instructions in M21-1, Part III, Subpart i, 2.F.2 or if any decision is deferred on the proposed rating for the reasons outlined in M21-1, Part III, Subpart i, 2.E.3.f.

III.i.2.E.3.b.  Updating VTA to Reflect Receipt of a Request for a Proposed Rating Decision

When DRASs receive a request for a proposed rating decision from a PEB, they must enter the date they received the request in the VA PROPOSED RATING START DATE field on the RO/RATING ACTIVITY tab in VTA.

III.i.2.E.3.c.Timeliness Goals and Controls for Completing Proposed Rating Decisions

When the DRAS receives a request for a proposed rating decision from a PEB the DRAS must
  • complete the decision, and
  • provide a copy of the decision to the PEB.
In order to maintain control of pending requests and ensure they are completed on time, DRASs must make the following updates to VBMS upon receipt of a request for a proposed rating decision
  • set a claim-level suspense under the pending EP 689 that expires 10 days after receipt of the request, and
  • change the suspense reason and claim status to Ready for Decision.
Reference:  For more information on timeliness goals of the IDES program, seeM21-1, Part III, Subpart i, 2.D.1.j.

III.i.2.E.3.d.  Examination Reports That Age Because of Delays in the IDES Process

If a PEB requests a proposed rating decision more than one year after an IDES participant completes all of his/her IDES-related examinations, it is not necessary to order new examinations unless there is evidence indicating the severity of the his/her disabilities has changed.
Example:  A participant’s assertion that the severity of his/her disabilities have worsened constitutes evidence that warrants reexamination of the participant.

III.i.2.E.3.e.  Additional Records PEBs May Provide in Connection With a Request for a Proposed Rating Decision

Occasionally, PEBs may have additional records to submit to VA when they request a proposed rating decision.  If the records are sensitive, PEBs may send them using Safe Access File Exchange (SAFE).
The PEB may also send a copy of the NARSUM with its request for a proposed rating.
References:  For information about

III.i.2.E.3.f.  Disabilities DRASs Must Address and Decisions They May Defer in a Proposed Rating Decision

DRASs are responsible for preparing proposed rating decisions for PEBs that address every disability

DRASs may defer a decision on a disability only in cases involving

  • a disability found on an examination that is within the scope of a claimed disability but there is not sufficient evidence to decide the issue
  • pregnant participants as described in M21-1, Part III, Subpart i, 2.F.3.e
  • participants who are too disabled to report for examinations as described in M21-1, Part III, Subpart i, 2.D.6.n, and
  • issues associated with claims that were pending prior to the participant’s referral to IDES, but were not raised as part of the IDES claim, as described in M21-1, Part III, Subpart i, 2.D.8.d.
Exception:  Situations may arise in which it would be in a participant’s best interest to defer a decision on the types of disabilities referenced in the first paragraph of this block.  In such situations, DRASs should e-mail a request for guidance toVAVBAWAS/CO/DES.
Example:  VA has determined that a participant is totally disabled due to service-connected disabilities without considering a disability for which VA has insufficient evidence to make a rating decision.  In this case, deferring a decision on that disability may be appropriate.
Reference:  For more information about handling disabilities found on examination that were not specifically claimed or referred, see M21-1, Part III, Subpart i, 2.F.1.i.

III.i.2.E.3.g.  Use of the NARSUM in the Proposed Rating Decision
The NARSUM is not required to complete proposed rating decisions.  Do not delay a rating to obtain the NARSUM when the complete service treatment records (STRs) and all associated disability benefits questionnaires (DBQs) are of record.
When the NARSUM is of record, it must be considered with all the evidence of record.  However, NARSUM findings alone are not a sufficient basis for a decision.  The findings must be supported by the evidence of record.
Important:  VA examination/DBQ results are the primary means to evaluate the current level of disability.
References:  For more information on

III.i.2.E.3.h.  Rating Issues That Are Unique to IDES Cases

DRAS decision makers must consider the issues in the table below when preparing proposed rating decisions.
Issue
Discussion
Goniometer Readings
Use the goniometer readings in examination reports when assigning evaluations for back disorders unless an examiner indicates in a report that the readings do not accurately reflect the IDES participant’s true functional limitations.
Important:  When goniometer readings do not accurately reflect the IDES participant’s true functional limitations, provide an explanation in the narrative of the proposed rating decision
Evaluations That Are Subject to Change
When the evaluation assigned to a disability in a proposed rating decision is subject to change, explain in the narrative of the proposed rating decision that a different evaluation may be warranted when the final rating decision is made.
Future Examinations
When a future examination of a disability is necessary, note this in the proposed rating decision.
Rationale:  PEBs take the determination that a future examination of a disability is necessary into account when deciding whether to place a participant on the Temporary Disability Retired List or the Permanent Disability Retired List.  This information must be included in the proposed rating decision because PEBs do not receive copies of finalrating decisions.
Coexisting Claimed and Referred Disabilities
When preparing a proposed rating decision, take the additional actions described in M21-1, Part III, Subpart i, 2.E.3.i if
  • coexisting disabilities exist to which the rating schedule requires the assignment of a singledisability rating
  • one of the disabilities is a disability the IDES participant claimed, and
  • the other disability is one that the participant’s service department referred to VA.

III.i.2.E.3.i.  Decisions Involving Coexisting Claimed and Referred Disabilities

If an IDES participant has coexisting claimed and referred disabilities to which the rating schedule requires the assignment of a single disability rating, the DRAS decision maker must
  • determine the appropriate disability rating for the referred disability alone (as if the coexisting claimed disability did not exist), and
  • note the separate disability rating and the rationale for its assignment in the Reasons for Decision part of the rating decision that discusses the coexisting disabilities.
Rationale:  PEBs may consider only the disability ratings VA assigns to referreddisabilities when deciding a participant’s final disposition.
Example:
Scenario:
  • A participant claimed service connection (SC) for sleep apnea.
  • Asthma is among the disabilities the participant’s service department referred to VA.
  • The results of pulmonary function testing warrant the assignment of a 10-percent disability rating.  However, the participant also uses a continuous positive airway pressure (CPAP) machine.
  • VA awards SC for asthma and sleep apnea as coexisting disabilities and assigns a disability rating of 50 percent.
Result:  The individual who prepares the proposed rating decision must indicate in the corresponding Reasons for Decision that the participant’s asthma, if rated alone, would warrant the assignment of a 10-percent disability rating based on the results of pulmonary function testing.

III.i.2.E.3.j.  Required Information on the Codesheet of a Proposed Rating Decision

DRAS decision makers must select the appropriate decision when entering a proposed rating decision into VBMS-Rating, either
  • Proposed DES Service Connected, for proposed grants of SC, or
  • Proposed DES Not Service Connected, for proposed denials of SC.
Important:  Do not use
  • PEB Referred Proposed Service Connected, or
  • PEB Referred Proposed Not Service Connected.

III.i.2.E.3.k.  Notification Letter to Accompany Proposed Rating Decisions

The DRAS must prepare a notification letter in conjunction with proposed rating decisions according to the table below.

If the participant is …

Then the DRAS must prepare a…

on active duty
benefits estimate letter (BEL) shown in M21-1, Part III, Subpart i, 2.E.6.
Rationale:  The purpose of the BEL is to provide the participant with a proposed estimate of VA benefits to assist him/her with financial planning following discharge from active duty.
is not on active duty standard Veteran’s notification letter in accordance with M21-1, Part III, Subpart i, 2.F.2.d.
Exception:  If the participant declined to file a VA claim as part of the IDES process, the DRAS must prepare the notification letter as indicated in  M21-1, Part III, Subpart i, 2.F.10.b.

III.i.2.E.3.l.  Including Dependents on the BEL

The DRAS must include dependents on the BEL when VA Form 21-686c,Declaration of Status of Dependents, is of record and complete.
If the VA Form 21-686c of record is incomplete or the participant did not submit VA Form 21-686c, the DRAS must add the following information to the dependency section of the BEL:
If you have submitted a complete VA Form 21-686c, Declaration of Status of Dependents, this information will be considered on your final rating. If you have eligible dependents, but have not yet submitted the VA Form 21-686c, please contact your Military Services Coordinator (MSC).

III.i.2.E.3.m.  Distribution of the Proposed Rating Decision

Upon completion of a proposed rating decision, DRASs are responsible for providing a copy of the decision, along with the notification letter indicated in M21-1, Part III, Subpart i, 2.E.3.k to the corresponding IDES participant’s MSC and PEB.
Members of the PEB with access to VBMS may elect to obtain the documents directly from the VBMS eFolder; otherwise, DRAS personnel must provide the rating decision and notification letter to the PEB via SAFE, as discussed in M21-1, Part III, Subpart i, 2.F.9.
The table below describes the pattern that must be followed as these two documents travel between a DRAS, PEB, PEBLO, and IDES participant.  No deviations are allowed.
Only a …
May provide the documents to a …
DRAS
PEB.
PEB
PEBLO.
PEBLO
participant.
Exception:  If a participant indicates during the exit interview described in M21-1, Part III, Subpart i, 2.E.5.e that he/she never received a notification letter, his/her MSC may provide a copy of the letter to the participant at that time.
Important:  Neither a DRAS nor an MSC may provide the documents referenced above to a participant’s power of attorney.

III.i.2.E.3.n.  Identification of Errors in a Proposed Rating Decision

The table below describes the necessary actions to take when an error is identified in a proposed rating decision.
If the …
And …
Then the DRAS must …
MSC identifies an error
DRAS agrees that an error exists
take corrective action and notify the MSC of the correction.
DRAS disagrees that an error exists
respond to the request by indicating that no change will be made to the proposed rating.
PEB requests a correction
DRAS agrees with the correction requested
correct the proposed rating prior to release to the service member.
DRAS disagrees with the correction requested
respond to the request by indicating that no change will be made to the proposed rating.
Note:  A DRAS’s failure to address or properly defer a decision on all claimed and referred disabilities is considered an error.

III.i.2.E.3.o.  System Updates Following Release of a Proposed Rating Decision

After releasing a proposed rating decision and notification letter to an IDES participant’s MSC and PEB, the DRAS must update VTA.
In the RO/RATING ACTIVITY tab complete
  • the COMBINED DEGREE FOR ALL CONDITIONS field, and
  • the VA PROPOSED RATING END DATE field, according to the table below.
If the DRAS provides the notification letter and proposed rating decision to the PEB via …
Then the DRAS must update the PROPOSED RATING END DATE to reflect …
SAFE transfer
the date the documents were sent via SAFE.
the VBMS eFolder
the current date.
Important:  If the DRAS fails to update this field on the date the documents became available in the eFolder, it cannot be backdated.
Rationale:  This entry serves to notify the PEB of the documents’ availability in the eFolder.
Important:  In all cases involving IDES participants on active duty, the DRAS must
  • one-time clear EP 310
  • set the VBMS claim-level suspense of the EP 689 to expire 30 days in the future, and
  • change the VBMS suspense reason to Awaiting Guidance from PEB.
Exceptions:
  • DRASs are not entitled to a one-time clear of EP 310 if they defer any decision on the proposed rating for the reasons outlined in M21-1, Part III, Subpart i, 2.E.3.f.
  • If the participant declined to file a claim for VA benefits as part of the IDES process, the DRAS must clear the pending EP 689.

III.i.2.E.3.p.  Proposed Rating Decisions for Members of the Reserve or National Guard That Are Not on Active Duty

For instructions unique to requests for a proposed rating decision for members of the Reserves or National Guard who are not on active duty, see M21-1, Part III, Subpart i, 2.F.2.
Important:  A final rating decision and notification letter can be provided to the PEB in lieu of a proposed rating and notification letter for non-active duty cases.  The document provided to the PEB must meet all specifications prescribed to the “proposed rating” under M21-1, Part III, Subpart i, 2.E.3, unless otherwise noted.
Note:  The DRAS must prepare a separate proposed rating document when evaluations are needed for PEB purposes only, including those involving participants who are not on active duty.  Examples of cases where an evaluation is needed for PEB purposes only include

III.i.2.E.3.q.  Presentation of the Proposed Rating Decision and Notification Letter to an IDES Participant

To facilitate transparency in the process, MSCs should attend the briefing during which an IDES participant’s PEBLO presents the participant with the proposed rating decision and notification letter, if the MSC’s schedule allows it.
When MSCs are unable to attend these briefings, PEBLOs advise participants that they may schedule a meeting with their MSC to discuss the proposed rating decision.
MSCs must make every effort to meet or speak with participants who have questions about their proposed rating decision within 48 hours of receiving a request.

III.i.2.E.3.r. Requests for Reconsideration of a Proposed Rating Decision

IDES participants may submit a one-time request for reconsideration of a proposed rating decision regarding any disability the participant’s service department referred to VA.  A proposed rating decision regarding a claimed disability is not subject to reconsideration.
Participants must submit a request for reconsideration to their PEB.  If the PEB approves the request, it forwards the request to the DRAS that made the proposed rating decision.
DRAS Decision Review Officers (DROs) are responsible for deciding all requests for reconsideration of a proposed rating decision.  If a DRO decides revision of a proposed rating decision
  • is warranted
    • the DRO prepares either
      • a new proposed rating decision for active duty cases, or
      • a new final rating decision for non-active-duty cases, and
    • the DRAS forwards the decision to the appropriate PEB, or
  • is not warranted
    • the DRO prepares a memorandum that states this fact, and
    • the DRAS forwards the memorandum to the appropriate PEB.
Important:
  • If a PEB submits a request for reconsideration that has not been initiated by the service member, then notify the PEB that no action will be taken and indicate the reason the request failed to meet the criteria for a formal reconsideration.
  • The only acceptable bases for revision of a proposed rating decision are:
    • receipt of new evidence, and/or
    • error on the part of the individual who made the decision.
  • See M21-1, Part III, Subpart i, 2.F.2 for instructions that are unique to requests for reconsideration from participants that are
    • members of the Reserves or National Guard, and
    • not on active duty.

III.i.2.E.3.s.  System Updates Upon Receipt of a Request for Reconsideration

Upon receipt of a request for reconsideration of a proposed rating decision, the DRAS must update
  • VTA by entering the date the DRAS received the request in the VA RECONSIDERATION RATING START DATE field on the RO/RATING ACTIVITY tab, and
  • VBMS by changing
    • the claim-level suspense so it expires seven days in the future
    • the suspense reason to Special Project Team Claim, Awaiting:  RD, and
    • the claim status to Ready for Decision.

III.i.2.E.3.t.  System Updates After Processing a Request for Reconsideration

After processing a request for reconsideration, the DRAS must
  • update VTA by entering the date the DRAS sent a new proposed rating decision or a memorandum to an IDES participant’s PEB in the VA RECONSIDERATION RATING END DATE field on the RO/RATING ACTIVITY tab
  • complete a one-time clear of
    • EP 310 (with the IDES Reconsideration Request – Active Dutyclaim label) for active duty cases, or
    • EP 020 (with the IDES Reconsideration Request – Not on ADclaim label) for non-active-duty cases, and
  • update VBMS by changing
    • the claim level suspense so it expires 30 days in the future, and
    • the suspense reason to Awaiting Guidance from:  PEB.
Important:  If a DRAS prepares a new proposed rating decision, it must also update VTA by selecting one of the following entries from the drop-down box in the REVISED VA RATING RESULTS field on the RO/RATING ACTIVITY tab:
  • No change
  • Increased evaluation, less than 30%, or
  • Increased evaluation, 30% or more.

III.i.2.E.3.u.  Efficacy of a Proposed Rating Decision if a Service Department Returns an IDES Participant to Duty

VA is not bound by the decisions set forth in an IDES participant’s proposed rating decision if
  • the participant’s service department returns him/her to duty (based on disenrollment or an MEB or PEB determination), and
  • the participant subsequently files a claim for VA benefits, to include a Benefits Delivery at Discharge (BDD) or other pre-discharge claim.

4.  Final Rating Decisions


Introduction

This topic contains information about final rating decisions, including

Change Date

November 29, 2018

III.i.2.E.4.a.  Requirement for Verification of Service

Before DRASs prepare final rating decisions for IDES participants that were on active duty at the time of the referral into IDES, the DRASs must verify the participant’s
  • character of service, and
  • date of discharge.
DD Form 214 satisfies the requirement for verification.  If a DD Form 214 is notof record, DRASs must use all available resources to obtain verification.  These include the
  • participant’s MSC
  • VA Defense Information Repository data in VTA
  • Defense Personnel Records Information Retrieval System (DPRIS)
  • Veterans Information Solution (VIS), and
  • Personnel Information Exchange System (PIES).
References:  For information about

III.i.2.E.4.b.  Content of Final Rating Decisions

The final rating decision must mirror the decisions set forth in the correspondingproposed rating decision.
Exception:  The decisions reflected in the final rating decision may differ from those set forth in the proposed rating decision only if
  • a clear and unmistakable error exists in the proposed rating decision, and/or
  • VA receives new evidence after issuing the proposed rating decision that justifies changing one or more of the decisions set forth in it.
Important:
  • Under no circumstances may DRASs make a different decision based solely on a difference of opinion or a different interpretation of rating criteria.
  • When a final rating decision differs from the corresponding proposed rating decision based on the exceptions described above, the decision maker must add a note in VTA.
    • The note must describe the reason(s) for changing the decision.
    • No note is required if a final rating decision addresses additionaldisabilities that were not at issue in the proposed rating decision.
Reference:  For more information on post-separation revisions of IDES-related rating decisions, see M21-1, Part III, Subpart i, 2.F.8.

III.i.2.E.4.c.  Codesheet Entries on Final Rating Decisions

When preparing a final rating decision, on the codesheet, note those disabilities for which a participant received/will receive disability severance pay.  Service departments provide this information to DRASs in the NOTES field on the PEB ADMIN tab in VTA.
Notes:
  • When information in the NOTES field is used for the purpose described above, save a screen shot of the PEB ADMIN tab and upload a copy of the screen shot into the participant’s eFolder.
  • When converting to the final rating decision, add special issue flashes for referred conditions only, including when these flashes were not included on the proposed rating previously.  Use the IDES Special Issue PEB Referred when preparing the final rating.  This is required for data collection purposes.

III.i.2.E.4.d.
Final Rating Decisions With Deferred Issues

If the decision maker defers a decision in a final rating decision for any of the reasons described in M21-1, Part III, Subpart i, 2.E.3.f, the DRAS must
  • continue the pending rating EP (110, 010, or 020) after promulgating the final rating decision
  • close the record in VTA, and
  • transfer the corresponding claims folder (or jurisdiction over the corresponding eFolder) to the station of jurisdiction (SOJ) for development and processing of the deferred decision.

III.i.2.E.4.e.  DRAS Actions After Completing a Final Rating Decision

The table below lists the steps and associated actions that DRAS claims processors must take after completing a final rating decision.
Timeliness goals for completion of the VA benefits stage of IDES claims processing, as applicable, are listed in M21-1, Part III, Subpart i, 2.D.1.j.
Step
Action
1
  • Establish a claim-level suspense in VBMS that expires five days in the future.
  • Change the suspense reason in VBMS to Special Project Team Claim, Awaiting: Promg.
2
Ensure the IDES Participant corporate flash remains attached to the participant’s electronic record.
3
Follow the instructions in M21-1, Part III, Subpart v, 2.A and B for
  • promulgating the final rating decision, and
  • preparing a decision notice.
Important:  All IDES Benefit decision notices that are sent with final ratings must include the What is eBenefits paragraph. If the participant or participant’s spouse or mother is entitled to a civil service preference letter, DRASs must notify the participant that the civil service preference letter can be obtained in eBenefits.
Reference:  For more information about civil service preference letters, see M21-1, Part III, Subpart vi, 7.2.
4
Change the suspense reason in VBMS to Special Project Team Claim, Awaiting: Auth.
5
Authorize/approve the award and decision notice.
Important:  If a decision on any claimed or referred disability is deferred, the deferral must be handled in accordance with M21-1, Part III, Subpart i, 2.E.4.d.
6
Send the decision notice and its attachments to the participant.
7
  • Enter the date of the decision notice in the VA BENEFITS DATE field on the RO/RATING ACTIVITY tab in VTA.
  • Ensure the other fields under the RO/RATING ACTIVITY tab contain accurate dates.
8
Ensure all relevant documents are uploaded into the participant’s eFolder.
References:  For instructions on

III.i.2.E.4.f.  Appeals of Final Rating Decisions

If a former IDES participant appeals a final rating decision, the SOJ over his/her claims folder is responsible for processing the appeal.

5.  Exit Interviews


Introduction

This topic addresses exit interviews that MSCs must conduct with IDES participants, including

Change Date

November 29, 2018

III.i.2.E.5.a.  General Information About Exit Interviews

MSCs must conduct an exit interview with all IDES participants, regardless of whether their service department ultimately returns them to duty or a PEB finds them unfit for duty.
The interview should take place after a
  • participant is disenrolled, or
  • PEBLO notifies a participant that his/her
    • MEB has determined the participant meets or exceeds retention standards, or
    • PEB has made a final determination regarding the participant’s fitness for duty.
Important:  MSCs must complete the exit interview within 10 business days of the FINAL DISPOSITION DATE in VTA or notification that the participant was returned to duty.
Notes:
  • If VTA cannot be updated due to disenrollment, a note must be added in VBMS.
  • MSCs should regularly check VTA for the presence of a date in the FINAL DISPOSITION DATE field on the PEBLO tab, as this is the best indicator that a participant’s service department has completed all the actions it must take prior to the exit interview.
  • Except as noted in M21-1, Part III, Subpart i, 2.E.5.b, MSCs must make every effort to hold the exit interview in person.  If a participant is physically unavailable to attend, MSCs may conduct the interview over the telephone.
  • If an MSC is unable to hold an exit interview either in person or over the telephone, the MSC must add a note in both VBMS and VTA that describes the attempts he/she made to conduct the interview.

III.i.2.E.5.b.  Interviews With IDES Participants Whose Service Department Returned Them to Duty

When an MSC holds an exit interview with an IDES participant whose service department returned him/her to duty (because of disenrollment or any other reason), the MSC must inform the participant that he/she may file a subsequent claim for benefits by completing a formal application.
The MSC must also provide the information in the table below to the participant during the exit interview.
If the participant is …
Then the MSC must inform the participant that …
on active duty
  • he/she may file a claim for VA disability benefits
    • following separation from service, or
    • up to 180 days prior to separation, and
  • he/she will receive an e-mail containing a hyperlink to a VA Pre-Discharge page that discusses claims for disability benefits a service member may file prior to separation.
Important:  If the participant is within 180 days of separation, the MSC should encourage him/her to submit a pre-discharge claim. If the participant files one of these claims, the MSC must follow the instructions in M21-1, Part III, Subpart i, 2.E.5.c and d.
a member of the Reserves or National Guard who is not on active duty
a regional office (RO) will determine the participant’s entitlement to VA benefits based on the disabilities the participant claimed and his/her service department referred to VA.
Important:  There is no requirement to conduct in-person exit interviews with participants whose service department returned them to duty. MSCs may choose to conduct these interviews over the telephone according to the instructions in M21-1, Part III, Subpart i, 2.E.5.f.
Reference:  For more information on formal applications, see M21-1, Part III, Subpart ii, 2.B.

III.i.2.E.5.c.  Who Has Responsibility for the Initial Processing of BDD Claims

The table below shows who has responsibility for the initial processing of a BDD claim that an MSC receives from a former IDES participant whose service department returned him/her to duty.
If …
Then …
  • the MSC has custody of the former participant’s claims folder, or
  • the former participant has an eFolder instead of a paper claims folder
the MSC may
  • undertake initial processing of the claim, or
  • forward the claim to the Pre-Discharge Coordinator at the MSC’s RO for initial processing.
DRAS has custody of the former participant’s eFolder
the MSC must notify the DRAS that a BDD claim has been received and
  • request jurisdiction of the eFolder, and
  • undertake initial processing of the claim.
Important:  MSCs are responsible for the initial processing of a BDD claim, and DRASs must transfer jurisdiction of the claim to the appropriate MSC, if
  • examination of the former participant is necessary, and
  • the former participant will remain near the IDES intake site long enough to attend the necessary examination(s).
Reference:  For more information about the initial processing of BDD claims, see the roles and responsibilities of intake sites outlined in M21-1, Part III, Subpart i, 2.A and B.

III.i.2.E.5.d. Policies That Are Unique to BDD Claims From Former IDES Participants

The following policies are unique to BDD claims from individuals whose service department returned them to duty after referral into IDES.
  • Former IDES participants may submit a BDD claim by completing a formal application.
  • Reexamination of a former participant is unnecessary unless
    • relevant examinations were conducted more than one year prior to receipt of the BDD claim, or
    • the former participant
      • raises a claim that was not at issue during his/her participation in IDES
      • claims his/her disabilities have increased in severity since the last examination, or
      • has undergone surgery, given birth, or been pregnant or hospitalized since the last examination.
References:  For more information about

III.i.2.E.5.e.  Interviews With IDES Participants That a PEB Determined Are Unfit for Duty

MSCs must take the actions described in the table below when they conduct an exit interview with an IDES participant that a PEB determined is unfit for duty.
Step
Action
1
If the participant requests it, provide him/her with
  • a copy of his/her notification letter, and/or
  • a detailed explanation of his/her
    • proposed rating decision, and/or
    • notification letter.
Important:  An MSC may not provide a copy of a proposed rating decision to a participant. Participants must receive this document from their PEBLO.
2
Confirm with the participant that his/her address has not changed.
Notes:
  • If the participant’s address has changed,
    • update the corporate record with the new address, and
    • document the change of address in a VBMS note.
  • When updating an address in Share, check the C&P PAYMENT ADDRESS box if it is available.
3
Confirm with the participant that the entries in Section III (Military Retired Pay) and Section IV (Direct Deposit Information) of VA Form 21-526EZ are still accurate.
4
Ask the participant to complete one or both of the forms listed in the table below, if applicable, unless the forms are
  • already of record, and
  • up-to-date.
If the participant has …
Then ask the participant to complete …
  • a spouse, and/or
  • child(ren)
a child that is
  • between the ages of 18 and 23, and
  • attending school.
Note:  At this time, MSCs should also attempt to obtain any evidence VA requires to establish a relationship between the participant and his/her dependents.
Reference:  M21-1, Part III, Subpart iii, 5 describes the evidence VA requires to establish a relationship between a Veteran and his/her dependents.
5
Brief the participant on Vocational Rehabilitation and Employment (VR&E) benefits and provide him/her with
Reference:  For information about handling applications for VR&E benefits from an IDES participant, see M21-1, Part III, Subpart i, 2.F.7.a.
6
Brief the participant on Loan Guaranty benefits. Inform the participant that Loan Guaranty Service will accept either the proposed or final rating decision as the basis for waiving the home loan funding fee.
If the participant indicates he/she intends to use Loan Guaranty benefits prior to or immediately following his/her separation from service, advise the participant to
Reference:  For information about handling an RLC’s request for a rating decision to determine entitlement to a waiver of the home loan funding fee, see M21-1, Part III, Subpart i, 2.F.7.e.
7
Note:  Provide the participant with VA Form 10-10EZ and instruct him/her to submit the completed form to the VA health care facility closest to his/her place of residence if he/she does not wish to submit the application online.
8
Unless the participant’s PEBLO has already provided copies of the following documents to VA, ask the participant to provide his/her
  • final PEB decision
  • separation/retirement orders, and
  • DD Form 214.
Important:  If the participant provides a PDF copy of the above documents, then the MSC should upload the documents into the participant’s eFolder.
9
Thank the participant for his/her service to the country.
10
The MSC documents the exit interview by
Note:  The documentation should include a summary of the interview, including the reasons for the interview, and any noteworthy information exchanged.

III.i.2.E.5.f.  Exit Interviews by Telephone

MSCs must make every effort to hold exit interviews in person.  If an IDES participant is physically unavailable to attend, MSCs may conduct the interview over the telephone according to the instructions in the table below.
Step
Action
1
Attempt to contact the participant by telephone to schedule the interview. If the participant cannot be reached by telephone, attempt to contact the participant by e-mail.
2
After scheduling the appointment, send a follow-up e-mail to the participant that confirms the date and time of the interview.
3
Did a PEB determine the participant is unfit for duty?
4
One week prior to the telephone interview, mail or e-mail the participant the VA forms referenced in Steps 4 through 7 of the procedure described in M21-1, Part III, Subpart i, 2.E.5.e.
5
Review the forms with the participant during the interview and assist him/her in completing them, if necessary.
6
Instruct the participant to take the following actions as soon as possible
  • complete the forms referenced in Steps 4 and 5 of the procedure described in M21-1, Part III, Subpart i, 2.E.5.e, and
  • return the forms and any evidence required to establish a relationship between the participant and his/her dependents online through one of the following means:
    • encrypted e-mail
    • SAFE
    • secure fax, or
    • upload directly through eBenefits.
Note:  Although it is recommended that the participant return the forms via the above means, if the participant does not wish to submit the forms electronically
  • provide the participant with the mailing address of the evidence intake center, and
  • instruct the participant to mail the completed forms/evidence to the intake center.
Reference:  For intake site information, see M21-1, Part III, Subpart i, 2.B.
7
Complete the remaining actions described in M21-1, Part III, Subpart i, 2.E.5.e.
8
Document the telephone interview on VA Form 27-0820, and ensure it is associated with the participant’s claims folder.

III.i.2.E.5.g.  Updating VTA to Reflect Completion of an Exit Interview

After completing an exit interview, MSCs must update the following fields in the MSC tab in VTA:
  • SERVICEMEMBER EXIT INTERVIEW, and
  • EXIT INTERVIEW DATE.
If the MSC is unable to reach the service member and has determined that the service member is not available, the MSC should update the exit interview date to reflect the date that the service member was not available.
Important:  If a PEBLO updates VTA to reflect disenrollment of a participant beforean MSC can conduct the exit interview, the MSC will not be able to update VTA to reflect completion of the interview.  If this occurs, the MSC is still obligated to hold the interview.  However, he/she must document that the interview took place in a VBMS note.
In cases where an exit interview is still required, request that the PEBLO defer disenrollment action for 48-96 hours to allow sufficient time to conduct and log the exit interview.

6.  Exhibit:  Benefits Estimate Letter (BEL) for IDES Participants


Introduction

This topic contains a sample of the various pages and paragraphs that make up a BEL.

Change Date

September 14, 2016

III.i.2.E.6.a.  Sample BEL

The images displayed below represent a sample BEL.
image of page 1 of a Benefits Estimate Letter
image of pg 2 of a sample Benefits Estimate Letter
image of pg 3 of a sample Benefits Estimate Letter
image of pg 4 of a sample Benefits Estimate Letter
image of pg 5 of a sample Benefits Estimate Letter
image of pg 6 of a sample Benefits Estimate Letter
image of pg 7 of a sample Benefits Estimate Letter
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