Select Page

M21-1, Part III, Subpart i, Chapter 2, Section F – Special Situations Related to the Integrated Disability Evaluation System (IDES)

Overview

In This Section
This section contains the following topics:

1.  Handling Added Conditions and Re-enrolled IDES Cases

Introduction
This topic discusses benefit-entitlement issues that arise after a Military Servcies Coordinator (MSC) holds the initial meeting with an IDES participant, including

Change Date
February 15, 2017

III.i.2.F.1.a.  Requirement for a Prescribed Form to Add Claimed Conditions
Integrated Disability Evaluation System (IDES) participants have the opportunity to raise claimed conditions by submitting a VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, during their initial interview with the Military Services Coordinator (MSC).  Conditions identified on a VA Form 21-526EZ that is submitted to the MSC during the initial interview must be considered as part of the IDES process.
IDES participants who wish to claim additional conditions after completion of their initial interview with the MSC must submit the claim on a prescribed form as indicated in M21-1, Part III, Subpart ii, 2.B (a VA Form 21-526EZ is preferred). The form must be signed by the claimant or authorized representative to be considered a complete claim for benefits.
Note:  Any issue formally claimed after the initial meeting with the MSC must be handled in accordance with M21-1, Part III, Subpart i, 2.F.1.b.
Important:  Any request for benefits that is not submitted on a prescribed form must be handled in accordance with M21-1, Part III, Subpart ii, C.2.a and b   The Disability Rating Activity Site (DRAS) must ensure that any request for benefits is properly addressed when preparing the final rating notification.  However, both MSCs and DRASs are encouraged to make reasonable attempts to obtain a complete prescribed form via telephone development at the earliest opportunity (i.e., once the request for benefits is raised/identified) when doing so is feasible and beneficial to the participant.

III.i.2.F.1.b.  General Information on Claimed Conditions Added After Initial Meeting With the MSC
When an IDES participant submits a prescribed form with new claimed conditions after the initial meeting with the MSC has been completed, the MSC or DRAS employee who identifies the new conditions must list the contentions under the end product (EP) 689.  A new EP should not be established.
If an EP is established erroneously while the EP 689 is pending, the MSC or DRAS employee who identifies the new EP must
  • ensure that any new conditions on the new application are added as contentions under the EP 689, and
  • cancel the new EP established in connection with the new application.
References:  For more information on

III.i.2.F.1.c.  Examination Requests Addressing Claimed Conditions Added After Initial Meeting With the MSC
The Department of Veterans Affairs (VA) is not obligated to request additional examinations solely because an IDES participant claims a condition after the initial meeting with the MSC is completed.
Important:  Occasionally, situations may arise that warrant examination of the additional disabilities referenced above.  When submitting an examination request under these circumstances, MSCs and DRAS employees should not
Exception:  The instructions in this block do not apply to additional disabilities
  • a participant’s service department refers to VA, or
  • examiners identify during IDES-related examinations that are related to disabilities a participant’s service department referred to VA.

III.i.2.F.1.d.  Rating Decisions Addressing Claimed Conditions Added After Initial Meeting With the MSC
Unless the evidence of record is sufficient to make a decision regarding the additional conditions, DRAS Rating Veterans Service Represenatitives (RVSRs) should
  • not address the additional conditions in the proposed rating decision, and
  • defer a decision on the additional conditions in the final rating decision.
Exceptions:  Instructions in this block do not apply to additional disabilities
  • a participant’s service department refers to VA, or
  • examiners identify during IDES-related examinations that are related to disabilities a participant’s service department referred to VA.
Reference:  For more information on deferring issues raised during the IDES process, see

III.i.2.F.1.e.  Handling the Addition of Referred Conditions That Were Previously Claimed
If the service department adds new referred conditions that were previously claimed by the participant during the initial meeting with the MSC, the MSC or DRAS must
  • ensure the communication from the service department is documented in the claims folder, and
  • continue routine IDES processing.
These conditions will continue to be examined and evaluated by DRAS according to standard IDES procedures.  No additional action or prescribed form is required.

III.i.2.F.1.f.  Handling the Addition of Referred Conditions That Were Not Previously Claimed
The service department is required to provide a new VA Form 21-0819, VA/DoD Joint Disability Evaluation Board Claim, to VA in order to refer a new and previously unclaimed condition.
References:  For more information on

III.i.2.F.1.g.  Handling New Referred Conditions Added Before Completion of the Medical Evaluation Stage
When an MSC receives a new VA Form 21-0819 from the service department, adding new referred conditions to a pending IDES claim before VA exams have been completed, the MSC must
  • request exams to address the new conditions as needed
  • provide exam results to the Physical Evaluation Board Liaison Officer (PEBLO) for all conditions, including the newly referred conditions, prior to closing out the medical evaluation stage in VTA, and
  • handle the new VA Form 21-0819 in accordance with M21-1, Part III, Subpart i, 2.D.5.a, Step 8.
Important:  New referred conditions that are added before examinations are conducted will not require the case to be disenrolled in VTA.  Continue processing under the original Case ID.

III.i.2.F.1.h.  Handling New Referred Conditions Added After the Completion of the Medical Evaluation Stage
If the service department intends to refer a new and previously unclaimed condition(s) after the medical evaluation stage has been completed, the case must be disenrolled from VTA and reenrolled under a new Case ID number.
Upon receipt of a new VA Form 21-0819 from the service department, the reenrolled case will move through the claims development and medical evaluation stages again under the new Case ID.  Examinations will be completed for the new referred condition(s).
Exception:  The service department will not disenroll the case if the new referred condition(s) can be addressed without any additional VA examinations.  These cases will remain at the DRAS for processing.  However, the DRAS must receive a new VA Form 21-0819 so that the new issue(s) can be considered as part of the claim for VA benefits.
References:  For more information on

III.i.2.F.1.i.  Handling Additional Disabilities Noted During Examination
If an IDES participant’s examination report reveals the existence of a condition that was neither part of a complete claim on a prescribed form nor referred by the service department, then the DRAS should address the condition only when the condition is reasonably within the scope of the issues enumerated in the complete claim in accordance with 38 CFR 3.155(d)(2).
DRASs must follow the instructions in the table below if an IDES participant’s examination report reveals the existence of a disability that neither the participant claimed nor his/her service department referred to VA.
If the disability is …
Then the DRAS of jurisdiction must …
related to any disability the participant’s service department referred to VA
Example:
  • A participant’s service department refers to VA a disability identified as “gunshot wound.”
  • Scarring, as a residual of the gunshot wound, is noted in an IDES-related examination report.
address the disability in the proposed rating decision.
Important:
  • If the evidence of record is insufficient to make a decision regarding the disability, the DRAS must request another examination.
  • It is appropriate to treat the examination report that revealed the existence of the disability as insufficient because it contained insufficient information about the disability for rating purposes.
  • within the scope of any disability the participant claimed, and
  • the record includes sufficient evidence to decide the issue
address the disability in the proposed rating decision.
  • within the scope of any disability the participant claimed, and
  • additional evidence is required to decide the issue
  • add the new issue to the list of contentions, and
  • defer the issue on the proposed rating.
Important:  If the issue cannot be decided before completion of the final IDES rating, it must be handled in accordance with M21-1, Part III, Subpart i, 2.E.4.d
  • not within the scope of any claimed or referred disability, but
  • the evidence suggests the potential for entitlement exists
invite a claim from the participant as indicated in M21-1, Part IV, Subpart ii, 2.A.1.f.

III.i.2.F.1.j. Handling IDES Cases Disenrolled Due to Additional Referred Conditions
Use the table below to determine how to process IDES cases that are disenrolled due to the addition of new referred conditions.

If the service department …

Then …
reenrolls the participant in VTA within 30 days of the disenrollment
  • the service department is required to provide the MSC with a new VA Form 21-0819 that indicates the new referred condition(s)
  • all conditions listed on both the original VA Form 21-0819and the new form should be considered a complete claim for VA purposes and addressed in the IDES process
  • referred conditions added by the service department can be addressed for VA purposes whether or not the participant signs the second VA Form 21-0819 (provided that the participant had signed the initial form), and
  • it is not necessary to send the IDES disenrollment letter or clear the pending EP 689, as the IDES claim will continue to be controlled under the EP 689 that was established in response to the original VA Form 21-0819.

If the participant adds additional claimed conditions to the new VA Form 21-0819, the new form must be signed by the participant for the claimed conditions to be considered a complete claim.

Important:  If the reenrolled record in VTA reflects a PREPARE CLAIM START DATE, but a new VA Form 21-0819 has not been provided by the service department, the MSC must handle the case as an improper referral in accordance with M21-1, Part III, Subpart i, 2.D.3.b.
does not reenroll the participant in VTA within 30 days of the disenrollment
the MSC/DRAS will process the disenrollment in accordance withM21-1, Part III, Subpart i, 2.E.2.a.
Important:  If the participant is on active duty, VA will take no further action on the claim.  If the participant is not on active duty, VA must process the claim in accordance with M21-1, Part III, Subpart i, 2.F.2.c.
reenrolls the participant in VTA more than 30 days after the disenrollment
  • the MSC will handle the case as a new IDES referral, and
  • only the conditions listed on the current VA Form 21-0819should be addressed.

2.  IDES Cases Involving Members of the Reserve or National Guard That Are Not on Active Duty

Introduction
This topic contain instructions that are unique to IDES cases involving members of the Reserve or National Guard that are not on active duty, including

Change Date
February 15, 2017

III.i.2.F.2.a. References in This Section to Members of the Reserve or National Guard That Are Not on Active Duty
Any reference in this section to members of the Reserve or National Guard that arenot on active duty includes members of the Reserve or National Guard that were returned to active duty for the sole purpose of participating in IDES.

III.i.2.F.2.b. Requests for Examination of Members of the Reserve or National Guard That Are Not on Active Duty
The MSC that requests examination of a member of the Reserve or National Guard who is not on active duty must ask the examining facility to notify the following of the date and time of all examinations at least one week prior to the date they are scheduled to occur
  • member
  • MSC, and
  • the member’s
    • PEBLO, and
    • unit (if the PEBLO provided contact information to the MSC, and the MSC included the information in the examination request).
Rationale:  Following this practice ensures the member’s unit has ample time to prepare orders allowing the member to attend the examinations.
Reference:  For information on routing examination requests, see M21-1, Part III, Subpart iv, 3.A.2.b.

III.i.2.F.2.c.Handling Notice That a Member Meets Retention Standards, Is Fit for Duty, or Has Been Disenrolled
The MSC or DRAS having current jurisdiction over the IDES case of a member of the Reserve or National Guard who is not on active duty must take the actions described in the table below when the member’s
  • Medical Evaluation Board (MEB) determines the member meets retention standards
  • Physical Evaluation Board (PEB) determines the member is fit for duty, or
  • service department disenrolls the member from IDES.
Step
Action
1
Complete the actions described in Steps 1 through 9 of the procedure outlined in M21-1, Part III, Subpart i, 2.E.2.a.
2
Is EP 110, 010, or 020 already pending?
  • If yes, proceed to Step 4.
  • If no, proceed to the next step.
3
Establish the appropriate rating EP (110, 010, or 020), using the
  • date shown in the FINAL DISPOSITION DATE field in VTA as the date of claim, and
  • Disability Evaluation System claim label.
Reference:  For more information about selecting the appropriate rating EP, see M21-4, Appendix B.
4
Update the Veterans Benefits Management System (VBMS) to reflect the contentions that originated from the member’s involvement in IDES.
5
Permanently transfer the member’s claims folder to the station of jurisdiction (SOJ).
Notes:
  • The SOJ assumes responsibility for determining the member’s entitlement to VA benefits based on the disabilities the member claimed and his/her service department referred to VA.
  • If the SOJ grants entitlement to benefits, it must use the date stamped on VA Form 21-0819 (the date VA received the form from the PEBLO) as the effective date of entitlement.
  • If the member has an electronic claims folder (eFolder)instead of a paper claims folder, transfer jurisdiction over the eFolder.

III.i.2.F.2.d.Requests From PEBs for a Rating Decision Involving Member Who Is Not on Active Duty
Upon receipt of a request from a PEB for a rating decision involving a member of the Reserve or National Guard who is not on active duty, DRASs must follow the steps in the table below.
Step
Action
1
Update the PROPOSED RATING START DATE in VTA in accordance with M21-1, Part III, Subpart i, 2.E.3.b.
2
Clear the pending EP 689.
3
Is EP 110, 010, or 020 already pending?
  • If yes, proceed to Step 5.
  • If no, proceed to the next step.
4
Establish the appropriate rating EP (110, 010, or 020), using the
  • date VA received the request for a rating decision from the PEB as the date of claim, and
  • Disability Evaluation System claim label.
5
Prepare a rating decision and notification letter that
Note:  Generally, the final rating decision and notification letter can be sent to the PEB in lieu of a proposed rating and benefits estimate letter.
Important:
  • If the DRAS grants entitlement to benefits, the date stamp onVA Form 21-0819 (the date VA received the form from the PEBLO) will generally serve as the effective date of entitlement.
  • DRASs are not entitled to an EP 310 for preparation of a rating decision for a member of the Reserve or National Guard that is not on active duty.
6
Complete the actions outlined in the table shown in M21-1, Part III, Subpart i, 2.E.4.e.
7
Provide a copy of the rating decision to the member’s PEB.
8
Update the PROPOSED RATING END DATE in VTA, as discussed inM21-1, Part III, Subpart i, 2.E.3.n.
 
References:  For more information on

III.i.2.F.2.e.  Requests for Reconsideration From Members That Are Not on Active Duty
The rating decision that DRASs provide PEBs for members of the Reserves or National Guard that are not on active duty serves as both a proposed rating decision and a final rating decision.  As a result, these members may
  • request a one-time reconsideration of the rating decision, and/or
  • appeal the rating decision.
DRASs must carefully review requests for reconsideration under these circumstances to determine whether they also constitute a notice of disagreement (NOD) according to M21-1, Part I, 5.B.3.
Reference:  For more information about handling requests for reconsideration, seeM21-1, Part III, Subpart i, 2.E.3.q-s.

3.  Handling Cases Involving Pregnant IDES Participants

Introduction
This topic contains instructions unique to cases involving pregnant IDES participants, including

Change Date
September 14, 2016

III.i.2.F.3.a.  Information MSCs Must Provide to Pregnant Participants During Their Initial Meeting
When holding the initial meeting with a pregnant IDES participant, MSCs must advise the participant of the following:
  • medical professionals that examine participants in connection with IDES may, at their discretion, defer some or all examinations because the participant is pregnant
  • without the medical evidence an examination provides, VA may have to defer a decision on some or all of the participant’s disabilities when preparing its proposed and final rating decisions
  • deferral of a decision will not adversely affect the ultimate outcome of the participant’s claim
  • the participant must notify VA of any changes in her address or telephone number, which will ensure VA can follow up with the participant on any deferred decisions after her anticipated delivery date, and
  • the participant should contact VA if VA defers any decisions then fails to follow up with her within 90 days after her delivery date.

III.i.2.F.3.b.  Requesting Examinations for Pregnant Participants
MSCs must include the following remarks in any examination request for a pregnant IDES participant:
Please be advised that this individual has indicated that she is currently pregnant.  If the examining physician determines that this examination (or any part of this examination) is medically contraindicated, please clearly indicate which parts of the examination were not completed due to the pregnancy.
  
Further, the examiner should indicate the earliest point (in days following  delivery) that the examination may be safely completed.
  
Important:  The contract with QTC Services (a company that conducts examinations for the Veterans Benefits Administration stipulates that its physicians will not examine pregnant claimants.  Accordingly, IDES sites that QTC Services supports must coordinate with local Veterans Health Administration medical facilities to establish a contingency plan for examining pregnant IDES participants (when medically practicable).

III.i.2.F.3.c.  Handling Examination Reports Involving Pregnant Participants
Once all examination reports that MSCs request for a pregnant IDES participant are available, MSCs must take the following actions, even if some or all of the reports indicate the participant could not be examined because of her pregnancy:
  • provide the examination reports to the participant’s PEBLO, and
  • update the MEDICAL EVALUATION END DATE field on the MSC tab in VTA to reflect the date they provided the examination reports to the PEBLO.

III.i.2.F.3.d. PEBLO or MEB Requests for Examination After Pregnancy Ends
MSCs will make a second request for examination of an IDES participant after her pregnancy ends if
  • the participant’s PEBLO or MEB requests the examination, and
  • the time period has passed during which previous examiners indicated examination was contraindicated due to pregnancy.

Important:  Under the circumstances described above, MSCs should

  • not update any of the following fields in VTA unless a participant was disenrolled from IDES due to pregnancy and reenrolled with a new case ID number:
    • MEDICAL EVALUATION START DATE
    • EXAM END DATE, or
    • MEDICAL EVALUATION END DATE, and
  • record as a note in VTA the date the MSCs
    • made the second request for examination, and
    • provided the corresponding examination report(s) to the participant’s PEBLO.

III.i.2.F.3.e.  DRAS Deferral of a Decision in a Pregnant IDES Participant’s Case
DRASs may defer a decision on any issue in a pregnant IDES participant’s case if the evidence of record is insufficient to decide that issue because the participant was unable to undergo some or all of her examinations due to pregnancy.
If a DRAS defers a decision on one or more issues in a final rating decision, it must
  • continue the pending rating EP (110, 010, or 020)
  • broker the claim to the SOJ
  • permanently transfer out the record in the Control of Veterans Records System to the SOJ, and
  • add a note in VBMS regarding the deferred issue.

Exception:  If a DRAS is unable to prepare a final rating decision because it must defer a decision on all issues in a pregnant participant’s case, the DRAS must establish EP 930 (instead of a rating EP), with a suspense date that is 90 days after the participant’s anticipated delivery date.

4.  Handling Notice or Evidence That an IDES Participant May Be Incompetent for VA Purposes

Change Date

 February 15, 2017

III.i.2.F.4.a.  Handling Evidence That an IDES Participant May Be Incompetent for VA Purposes
The table below provides an overview of the process that must followed after a DRAS RVSR determines the evidence of record indicates an IDES participant may be incompetent per 38 CFR 3.353(a).
Important:  The information in this block does not apply if a court has appointed a fiduciary to a participant or determined a participant is incompetent.  Instructions for handling these types of cases is found in M21-1, Part III, Subpart v, 9.B.2.e-g.
Step
Action
1
An RVSR at the DRAS of jurisdiction prepares a rating decision under EP 689 that proposes a finding of incompetency.
Important:  The RVSR prepares the decision separate from theproposed rating decision discussed elsewhere in this section.
2
The DRAS
  • notifies the participant’s MSC of the proposed rating decision by e-mail
  • provides a copy of the decision and corresponding advance notice of adverse action directly to the participant, and
  • establishes an EP 600 using the DRAS Incompetency Determination claim label (to run concurrently with the pending EP 689), with a suspense date that is 65 days in the future.
Important:  The DRAS does not provide a copy of the decision to the participant’s PEB.
Reference:  For more detailed information about due process requirements for incompetency determinations, see M21-1, Part III, Subpart v, 9.B.3.
3
The DRAS clears the EP 600 when either of the following occur:
  • the participant returns to duty, or
  • the suspense date referenced in Stage 2 of this process passes.
Note:  If a participant returns to duty at this point, the process stops at this stage; the DRAS of jurisdiction takes no further action on the proposed rating of incompetency.
4
An RVSR at the DRAS makes a decision regarding the participant’s competency and incorporates it into the participant’s final rating decision.
Note:  If an RVSR determines a participant is competent at this point, the process stops at this stage.
5
The DRAS promulgates the final rating decision according to the instructions in M21-1, Part III, Subpart i, 2.E.4.
6 The DRAS establishes an EP 290 with the Fiduciary Adjustment claim label.
7
The DRAS must follow the steps in the table in M21-1, Part III, Subpart v, 9.A.1.c for preparing VA Form 21-592, Request for Appointment of Fiduciary, Custodian, or Guardian for the fiduciary hub.
8
Upon receipt of VA Form 21-555, Certificate of Legal Capacity to Receive and Disburse Benefits, from the fiduciary hub, the DRAS

5.  Handling Notice or Evidence That an IDES Participant Has Died on Active Duty

Change Date

 September 14, 2016

III.i.2.F.5.a.  Handling Notice That an IDES Participant Has Died
MSCs and/or DRAS personnel must follow the steps in the table below upon receipt of notification or evidence indicating that an IDES participant has died during the IDES process.
Step
Action
1
Document the report of the participant’s death by adding a detailed note in VBMS.
2
Has the case been disenrolled in VTA?
  • If yes, proceed to Step 7.
  • If no, proceed to the next step.
3
Document the report of the participant’s death by adding a note in VTA.
4
Complete any required VTA fields associated with actions that were completed prior to the participant’s death.
5
If information about the participant’s death is received by a(n) …
Then he/she must …
MSC
  • notify the PEBLO and request that he/she initiate disenrollment of the case in VTA, and
  • send e-mail notification to the DRAS (if the case has been transferred to a DRAS).
DRAS employee
notify appropriate parties using the Request DoD Research for Possible Disenrollmenthyperlink in VTA.
Note:  The Request DoD Research for Possible Disenrollment hyperlink is found on the bottom of the RO/RATING ACTIVITY tab in VTA.  Selecting this hyperlink will generate an e-mail addressed to all appropriate parties.
6
Document all steps taken to notify appropriate parties with notes in VTA and VBMS.
7
Cancel the pending EP 689.
 
Important:  If the participant was referred into IDES as a member of the National Guard or Reserves and was not on active duty, the potential for accrued benefits may exist.  The MSC or DRAS with jurisdiction of the claim is responsible for completing the actions outlined in M21-1, Part VIII, 3.1.c.
Note:  If the participant was on active duty at the time of death, the service department will provide VA with a DD Form 1300, Report of Casualty, which will be routed to the Casualty Assistance Officer (CAO) at the SOJ.  The CAO will contact the survivor to provide the necessary information and facilitate the application process for appropriate VA benefits.

6.  Handling Notice or Evidence That an IDES Participant Has Been Discharged Under Conditions Other Than Honorable

Change Date

 September 14, 2016

III.i.2.F.6.a.  Handling Notice of a Participant’s Discharge Under Conditions Other Than Honorable
MSCs and/or DRAS personnel must follow the steps in the table below upon receipt of notification or evidence that an IDES participant has been (or will be) discharged with an administrative discharge under conditions other than honorable.
Step
Action
1
Document the report of the participant’s discharge by adding a detailed note in VBMS.
2
Has the case been disenrolled in VTA?
  • If yes, proceed to Step 7.
  • If no, proceed to the next step.
3
Document the report of the participant’s discharge by adding a note in VTA.
4
Complete any required VTA fields associated with actions that were completed prior to the participant’s discharge.
5
If information about the participant’s discharge is received by a(n) …
Then he/she must …
MSC
  • notify the PEBLO and request that he/she initiate disenrollment of the case in VTA, and
  • send e-mail notification to the DRAS (if the case has been transferred to a DRAS).
DRAS employee
notify appropriate parties using the Request DoD Research for Possible Disenrollmenthyperlink in VTA.
Note:  The Request DoD Research for Possible Disenrollment hyperlink is found on the bottom of the RO/RATING ACTIVITY tab in VTA.  Selecting this hyperlink will generate an e-mail addressed to all appropriate parties.
6
Document all steps taken to notify appropriate parties with notes in VTA and VBMS.
7
Process the disenrollment in accordance with M21-1, Part III, Subpart i, 2.E.2.a.

7.  Ancilary Benefits for IDES Participants

Introduction
This topic contains information on the processing of Vocational Rehabilitation and Employment (VR&E) and Loan Guaranty claims for IDES participants, including

Change Date
September 14, 2016

III.i.2.F.7.a.  Handling VR&E Claims Received From IDES Participants
Intake sites may receive claims from IDES participants for Vocational Rehabilitation and Employment (VR&E) benefits under 38 U.S.C. Chapter 31 that they may use while on active duty or after separation.
When a MSC at an intake site receives a VA Form 28-1900, Disabled Veterans Application for Vocational Rehabilitation, while an IDES claim is pending, he/she must take the following actions within 24 hours of receipt.
Exception:  If a pending IDES claim does not exist or a proposed rating is not of record, MSCs must broker the VR&E claim to the SOJ, based on his/her current address, to prepare the memorandum rating decision and forward any evidence received to the scanning vendor.
Reference:  For more information about forwarding rating decisions to VR&E, seeM21-1, Part IX, Subpart i, 1.B.3.d.
Step
Action
1
Establish EP 095 with the claim label Pre-D Memo Rating for Ch31 Purposes.
2
Ensure the claimant’s service treatment records are available in VBMS.
3
Add a note in VTA and VBMS that states VA Form 28-1900 was received and sent to the scanning vendor.
4
Is a proposed rating of record?
  • If yes, go to Step 7.
  • If no, go to Step 5.
5
Broker EP 095 to the DRAS with jurisdiction over the IDES claim.
6
Forward VA Form 28-1900 to the appropriate scanning vendor and take no further action.
7
Send an encrypted e-mail to the VR&E mailbox of the local regional office (RO) with the claimant’s
  • name
  • claim number
  • date of the proposed rating decision, and
  • date VA Form 28-1900 was sent for scanning.
Note:  The encrypted e-mail will alert VR&E personnel to retrieve the documents from the eFolder.

III.i.2.F.7.b.  Actions DRAS Must Take Upon Receipt of VR&E Claim
If the PEB of a service member who is participating in IDES determines the service member is unfit for duty, the proposed rating decision that the DRAS prepares is acceptable for use in determining whether a service member is eligible for VR&E benefits.
Upon completion of the proposed rating, DRASs must send an encrypted e-mail to the VR&E mailbox of the local RO with the claimant’s
  • name
  • claim number, and
  • date of the proposed rating decision.
Note:  The encrypted e-mail will alert VR&E personnel to retrieve the documents from the eFolder.
Reference:  For more information about forwarding rating decisions to VR&E, seeM21-1, Part IX, Subpart i, 1.B.3.d.

III.i.2.F.7.c.  Service Members’ Eligibility for Home Loan Guaranty
A Veteran who has a compensable, service-connected (SC) disability and purchases a home using VA’s Home Loan Guaranty is eligible for a waiver of the VA home loan funding fee.
A service member who is separating from service may be eligible for the funding fee waiver if the evidence of record establishes he/she will be in receipt of VA disability compensation after separation.

III.i.2.F.7.d.  Handling VA Form 26-1880 Received From IDES Participants

Upon receipt of VA Form 26-1880, Request for a Certificate of Eligibility, MSCs must

  • forward the form to the appropriate Regional Loan Center (RLC)
  • ask the service member whether he/she plans to use VA’s Home Loan Guaranty to purchase a home prior to separation, and, if so,
  • advise the service member to ensure his/her lender knows a pre-discharge claim is pending with VA.

III.i.2.F.7.e.      RLC Action Upon Receipt of VA Form 26-8937 From a Service Member
Upon receipt of VA Form 26-8937, Verification of VA Benefits, from a service member, RLCs request an eligibility determination from the DRAS of jurisdiction by sending an e-mail to a designated point of contact at the appropriate site.

III.i.2.F.7.f.  DRAS Responsibility for Preparing Memorandum Rating Decisions

Upon receipt of a request for an eligibility determination from an RLC, DRASs must prepare a memorandum rating decision for inclusion in the service member’s claims folder if the

  • service member’s proposed rating has not been completed yet, and
  • evidence of record shows the service member is at least 10–percent disabled due to an SC disability(ies).

III.i.2.F.7.g.  DRAS Responsibility for Responding to a Request for an Eligibility Determination
DRASs must establish EP 290 with the claim label, Pre-Discharge – LGY Determination, to control an RLC’s request for an eligibility determination.
The table below shows the text that DRASs must use when responding to a request for an eligibility determination from an RLC.
If …
Then the DRAS must include the following text in the e-mail response to the RLC …
a proposed rating decision already exists
The claimant will receive service-connected disability compensation of $[amount] monthly upon discharge from active duty.
the DRAS prepared a memorandum rating decision
The claimant will be entitled to service-connected disability compensation of at least $ [10% rate] upon discharge from active duty.
the evidence of record is insufficient for rating purposes
The claimant has an IDES claim pending; however, the evidence available is not sufficient to determine whether a compensable service-connected disability exists.
the evidence of record is sufficient for rating purposes but does not show that a compensable, SC disability exists
The evidence of record does not show the claimant has a service-connected disability that is compensable.

8.  Post-Separation Revisions of IDES-Related Rating Decisions

Introduction
This topic contains instructions for handling post-separation revisions of IDES-related rating decisions, including

Change Date

 September 29, 2016

III.i.2.F.8.a.  Identifying Cases in Which Post-Separation Revisions of IDES-Related Rating Decisions Are Applicable
VA must take the actions described in M21-1, Part III, Subpart i, 2.F.8.c if
  • VA revises a rating decision it prepared for a Veteran who participated in IDES (These Veterans are identifiable by the presence of the IDES Participant corporate flash)
  • the revision specifically involves a decision that was made as part of a rating used for IDES purposes, and
  • the revision results in a more favorable decision.
Rationale:  Rating decisions VA makes as a result of a Veteran’s participation in IDES directly impact the benefits the Veteran receives from his/her service department.
Notes:
  • It is not necessary to consider whether the revision impacts a “claimed” or “referred” IDES condition.  A favorable revision of any decision for IDES purposes will require application of the instructions in M21-1, Part III, Subpart i, 2.F.8.c.
  • The instructions in M21-1, Part III, Subpart i, 2.F.8.c are not applicable when a revision results in a less favorable decision.
  • Direct questions related to revisions of ratings in cases associated with previous IDES participants to VAVBAWAS/CO/DES.

III.i.2.F.8.b.  Situations That Require the Application of Post-Separation Revisions of IDES-Related Rating Decisions
Examples of situations that would require application of the instructions in M21-1, Part III, Subpart i, 2.F.8.c are described below.
  • VA conducts a special review of previous decisions.  As a result of this review, VA revises a decision issued in a rating used for IDES purposes by issuing a more favorable decision.
  • A Veteran appeals a decision issued in a VA rating used for IDES purposes.  VA later resolves the appeal by issuing a more favorable decision.
  • A Veteran had an appeal pending at the time he/she entered IDES related to an issue that was raised during the IDES process.  VA eventually resolves the appeal by issuing a more favorable decision.
  • A quality review team identifies an error on an IDES final rating decision.  Correction of the error results in a more favorable decision.
  • A quality review team identifies an error on a proposed rating decision.  Correction of the error will result in a more favorable decision.  However, VA is unable to correct the proposed rating decision, because the Veteran has already separated from service.
  • An RVSR identifies a clear and unmistakable error (CUE) in an IDES final rating decision.  Correction of the error results in a more favorable decision.

III.i.2.F.8.c.  Notifiying Veterans Whose IDES-Related Rating Decision Has Changed

When VA revises an IDES-related rating decision under the circumstances described in M21-1, Part III, Subpart i, 2.F.8.a, VA must

  • include the below text in the corresponding decision notice, and
  • attach to the notice DD Form 149, Application for Correction of Military Record.
This decision represents a change to a rating originally assigned as part of the Integrated Disability Evaluation System. 
  
This decision could potentially warrant a change to your military record and/or an adjustment to the disability separation benefits you received from your service department.
  
Each service department operates an agency or board for correction of records.  In light of the change in your VA disability rating, it may be to your benefit to request a review of your discharge to the appropriate board.  A DD Form 149, Application for Correction of Military Record, is enclosed for this purpose. 
  
Please see the reverse side of the form for instructions and additional information.  The completed form, along with a copy of this letter and enclosed rating decision, should be mailed to the appropriate address indicated on the DD Form 149.

9.  Using SAFE to Securely Send and Receive Sensitive Documents

Introduction
This topic contains information about SAFE, to include

Change Date

 September 14, 2016

III.i.2.F.9.a.  Sending Sensitive Documents Through SAFE
The table below contains instructions for sending sensitive documents through Safe Access File Exchange (SAFE).
Step
Action
1
Access the SAFE website.
2
On the SAFE home page, select the Non-CAC Users option.
3
On the next page, complete all of the fields under the section titled “Personal Information.”
4
In the DESCRIPTION OF FILE(S) field under the section titled “File Information,” enter
  • the identification number that VTA assigned to the participant whose documents are being sent through SAFE, and
  • a brief description of each document being sent.
Example:  22999 Examination Report.
Important:  Do not enter any personally identifiable information in this field.
5
Click on the BROWSE button.
6
Locate and select the document(s) to be sent through SAFE.
Important:  Before uploading documents into SAFE,
  • open each document to ensure it
    • is among the documents intended for delivery, and
    • belongs to the participant whose documents are being sent, and
  • ensure the name given to each document accurately reflects its content.
Note:  It is acceptable for document names to contain personally identifiable information.
7
Check the box titled “Privacy Act Data.”
8
  • Enter the recipient’s e-mail address in the field provided for this information under the section titled “Recipient Information.”
  • Click on the ADD button.
Reference:  For the e-mail address of each PEB, see M21-1, Part III, Subpart i, 2.F.9.b.
9
Select the following under the section titled “E-mail Setting”:
  • FOUO
  • Encrypt e-mail message when possible, and
  • Notify me when files are downloaded.
10
Select the UPLOAD button.
11
  • Check e-mail inbox for an e-mail that requests verification of the sender’s e-mail address.
  • Reply to the request.
Note:  Senders will receive notification via e-mail when the recipient downloads the document(s).

III.i.2.F.9.b.       PEB E-Mail Addresses
The table below contains the e-mail address for each PEB.  DRASs require this information in order to send proposed rating decisions and benefits estimate letters to PEBs through SAFE.

III.i.2.F.9.c.  Receiving Sensitive Documents Through SAFE
SAFE sends notification via e-mail to the intended recipient of sensitive documents when a sender uploads the documents into SAFE.  The e-mail contains a hyperlink and a password for accessing the documents.
Notes:  Recipients may not
  • forward the e-mail to anyone else, or
  • use the password more than once.
The table below explains how recipients may retrieve documents from SAFE.
Step
Action
1
Click on the hyperlink in the e-mail.
2
Copy the password from the email and paste it into the PASSWORD field on the PACKAGE DOWNLOAD page.
3
Save a document by
  • right-clicking on the document
  • selecting the Save Target As option, and
  • selecting the desired location for saving the document.

10.  Proposed Ratings for IDES Participants Who Decline to Submit a VA Claim

Introduction

This topic contains information about processing PEB requests for proposed  ratings in cases in which the participant declined to submit a VA claim, including

Change Date

 February 15, 2017

III.i.2.F.10.a.  Requirement for Issuance of a Proposed Rating to the PEB

When an IDES Participant declines to submit a claim, VA must still provide proposed evaluations to the PEB for the referred conditions.  In these instances, DRAS must:

  • prepare a proposed rating decision in accordance with the procedures outlined in M21-1, Part III, Subpart i, 2.E.3; however, the rating decision must clearly indicate the evaluations are provided for Department of Defense (DoD) purposes only
  • prepare the notification letter described in M21-1, Part III, Subpart i, 2.F.10.b  (Do not prepare a Benefits Estimate Letter (BEL).)
  • provide a copy of the notification letter and proposed rating decision to the  MSC and PEB in accordance with M21-1, Part III, Subpart i, 2.E.3.l
  • upload the notification letter to the participant’s VBMS eFolder
  • perform the appropriate system updates in accordance with M21-1, Part III, Subpart i, 2.E.3.o, and
  • clear the pending EP 689.

Important:  In these cases, DRAS will not complete a final rating.  The DRAS is not responsible for any further action in these IDES cases, except when the participant requests reconsiderations of the proposed decision as described inM21-1, Part III, Subpart i, 2.E.3.q.

III.i.2.F.10.b.  Required Notification Letter to the IDES Participant
DRAS must prepare a notification letter to IDES participants who have declined to file a claim for VA benefits during the IDES process.  The notification letter must include the following language and be uploaded into the participant’s eFolder:
Thank you for your service to our country.
  
Your military Service Department requested a disability assessment from VA as part of your participation in the Integrated Disability Evaluation System (IDES).  We have provided the attached proposed rating decision to your Service Department.
  
Our records indicate that you declined to submit a claim for VA benefits as part of the IDES program; therefore, the attached proposed rating decision will be used for Department of Defense purposes only. VA compensation will not be awarded as a result of your participation in IDES. 
  
If you would like to submit a claim for VA Benefits, you can do so at the appropriate time.  You can file a Pre-Discharge claim once you are within 180 days of your projected separation or retirement date. You can also file a VA claim at any time after your discharge from service.
 
References:  For more information regarding
Historical_M21-1III_i_2_SecF_11-8-16.doc May 8, 2019 256 KB
Historical_M21-1III_i_2_SecF_9-29-16.doc May 8, 2019 258 KB
2-15-17_Key-Changes_M21-1III_i_2_SecF.docx May 8, 2019 93 KB
Historical_M21-1III_i_2_SecF_9-14-16.doc May 8, 2019 258 KB
9-29-16_Key-Changes_M21-1III_i_2_SecF.docx May 8, 2019 85 KB
11-8-16_Key-Changes_M21-1III_i_2_SecF.docx May 8, 2019 85 KB
9-14-16_Key-Changes-M21-1III_i_2_SecF.docx May 8, 2019 100 KB
in Chapter 2 Pre-Discharge Claims, Part III General Claims Process, Subpart i Overview of Claims Processing and Structure of the Veterans Service Center (VSC)
Did this article answer your question?

Related Articles

Leave a Reply





Pin It on Pinterest

Share This