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M21-1, Part III, Subpart i, Chapter 3, Section A – General Information About the Fully Developed Claim (FDC) Program

Overview


In This Section

This section contains the following topics:
Topic
Topic Name
1
2
3

1.  Overview of the FDC Program


Introduction

This topic contains an overview of the FDC Program, including the

Change Date

September 12, 2017

III.i.3.A.1.a.  Purpose of the FDC Program

The Department of Veterans Affairs (VA) designed the Fully Developed Claim (FDC) Program for the purpose of
  • reducing its backlog of pending claims, and
  • improving claims-processing timeliness.

III.i.3.A.1.b.  Benefits of and Criteria for Participation in the FDC Program

In order to streamline the claims process, the FDC Program requires claimants that choose to participate in this program to
  • submit their claim on a specific form that contains language which satisfies the general notice requirements of 38 U.S.C. 5103
  • simultaneously submit all private medical treatment records with their claim
  • identify any relevant treatment records at a Federal facility, and
  • submit any additional forms or treatment records required under special circumstances that support their specific claim.
In addition to reduced claims processing time, FDC claimants who filed an original compensation claim between August 6, 2013, through August 5, 2015, potentially benefit from the retroactive effective date temporarily established by Section 506 ofPublic Law 112-154.
Note:  Service members who do not meet the requirements for pre-separation claim processing through the Benefits Delivery at Discharge (BDD) program may file an FDC claim from one to 180 days prior to discharge.
References:  For information about

2.  Forms Claimants Must Use When Submitting an FDC


Introduction

This topic contains information about the forms claimants must use when submitting an FDC, including

Change Date

February 27, 2019

III.i.3.A.2.a.  List of Forms Claimants Must Use to Participate in the FDC Program

The table below lists the forms claimants must complete, sign, and return to VA in order to participate in the FDC Program.
Exception:  VA does not require a “wet” signature on forms claimants submit through the Veterans Online Application (VONAPP), VONAPP Direct Connect (VDC), or www.Vets.gov (Vets.gov).  The certification that a wet signature provides on paper versions of these forms is captured electronically when claimants submit forms through authorized web portals, such as eBenefits.
If the claimant is seeking …
Then the claimant must use the current version of …
disability compensation
Veterans Pension
survivors benefits
Notes:
  • Follow the instructions in M21-1, Part III, Subpart i, 3.B.2.d for excluding a claim from the FDC Program if a claimant
    • requests processing of his/her claim under the FDC Program, using a form other than those listed in the table above, or
    • uses an outdated version of an EZ form as defined in M21-1, Part III, Subpart ii, 1.C.8 to apply for benefits.
  • A Veteran who simultaneously claims entitlement to both compensationand pension under the FDC Program must submit both
  • The EZ forms identified in this block
    • are considered valid forms for submission of an original claim, as defined by 38 CFR 3.160(b), but
    • must be submitted by claimants each time they file a claim for respective benefits under the FDC Program.

III.i.3.A.2.b.  Use of EZ Forms by Claimants Who Do Not Want to Participate in the FDC Program

Claimants who do not want VA to process their claim under the FDC Program may also use the EZ forms listed in M21-1, Part III, Subpart i, 3.A.2.a to apply for benefits.  They notify VA of their choice by checking the box next to the statement near the end of each form that reads:  I DO NOT want my claim considered for rapid processing under the FDC Program because I plan to submit further evidence in support of my claim.
Reference:  For more information about excluding claims from the FDC Program, see M21-1, Part III, Subpart i, 3.B.2.d.

III.i.3.A.2.c.  Unique Characteristics of the EZ Forms

38 U.S.C. 5103 requires VA to notify claimants of the evidence they must submit in order to establish entitlement to the benefit(s) they are seeking.  The forms listed inM21-1, Part III, Subpart i, 3.A.2.a are unique in that they provide this notice along with the application for benefits, thereby eliminating the need for VA to
  • provide the notice after receiving the application, and
  • allow time for claimants to respond to the notice.
The forms listed in M21-1, Part III, Subpart i, 3.A.2.a also contain an explanation of the general differences between the FDC process and the standard claim process, to include what the claimant needs to do and when the claimant should submit information and evidence.
References:  For more information about the notice VA provides to claimants in

III.i.3.A.2.d.  Notice Claimants Receive in VA Form 21-526EZ

VA Form 21-526EZ provides claimants with the notice 38 U.S.C. 5103 requires for the following types of disability compensation claims:
  • service connection (SC) for disabilities related to the following types of service:
    • active duty
    • active duty for training, or
    • inactive duty training
  • secondary SC
  • increased disability rating
  • individual unemployability
  • temporary total disability rating due to
    • hospitalization, or
    • surgical or other treatment
  • compensation under 38 U.S.C. 1151
  • special monthly compensation based on the
    • need for aid and attendance (A&A), or
    • status of being housebound
  • additional benefits for a spouse who needs A&A
  • specially adapted housing or special home adaption
  • automobile allowance or adaptive equipment, and
  • additional compensation for a Veteran with a child incapable of self-support.
Exception:  Certain special issue claims require additional notification as outlined in M21-1, Part I, 1.B.1.f.  In these cases, follow the procedures outlined in M21-1, Part III, Subpart i, 3.B.3 for providing a subsequent development letter.

III.i.3.A.2.e.  Notice Claimants Receive in VA Form 21P-527EZ

VA Form 21P-527EZ provides claimants with the notice 38 U.S.C. 5103 requires for the following types of Veterans Pension claims:
  • Veterans Pension
  • special monthly pension based on the
    • need for A&A, or
    • status of being housebound, and
  • additional Veterans Pension benefits for a Veteran with a child incapable of self-support.

Note:  VA accepts electronically filed versions of VA Form 21P-527EZ submitted through on-line applications.

Reference:  For more information on processing on-line applications without a signature, see M21-1, Part III, Subpart ii, 1.A.2.d.


III.i.3.A.2.f.  Notice Claimants Receive in VA Form 21P-534EZ

VA Form 21P-534EZ provides claimants with the notice 38 U.S.C. 5103 requires for claims for the following types of survivors benefits:
  • accrued benefits
  • Dependency and Indemnity Compensation (DIC) for death related to the following types of service:
    • active duty
    • active duty for training, or
    • inactive duty training
  • DIC under 38 U.S.C. 1318
  • DIC under 38 U.S.C. 1151
  • Survivors Pension and parents’ DIC
  • additional survivors benefits based on the
    • need for A&A, or
    • status of being housebound, and
  • benefits for a deceased Veteran’s child incapable of self-support.

III.i.3.A.2.g.  Handling an Incomplete EZ Form

Follow the instructions in the table below if a claimant who requests processing of his/her claim under the FDC Program submits an EZ form that is incomplete.
If the EZ form …
Then …
does not contain enough information to identify any of the claimant’s contentions
use the table below to determine the proper course of action.
If the EZ form was received …
Then …
prior to March 24, 2015
on or after March 24, 2015
contains enough information to identify some, but not all, of the claimant’s contentions
If telephone contact with the claimant is unsuccessful or further attempts to obtain clarification would result in a delay of more than one business day, follow the instructions in M21-1, Part III, Subpart i, 3.B.2.a for excluding the claim from the FDC Program.
does not contain enough information to identify the claimant
follow the instructions in M21-1, Part III, Subpart ii, 1.B.5 for handling unidentified mail.

III.i.3.A.2.h.  Handling an Unsigned EZ Form

Follow the instructions in the table below if a claimant who requests processing of his/her claim under the FDC Program submits an EZ form that is unsigned.
Important:  VA does not require a signature on forms claimants submit through VONAPP, VDC, or, Vets.gov.
If …
Then …
  • the EZ form represents anoriginal claim for benefits, and
  • the claimant did not sign the form
follow the instructions in M21-1, Part I, 1.B.1.g.
  • the EZ form does notrepresent an original claim for benefits, and
  • the claimant or authorized representative did not sign the form
use the table below to determine the proper course of action.
If the EZ form was received …
Then …
prior to March 24, 2015
on or after March 24, 2015
Important:  If the EZ form is signed by the authorized representative only, send the claimant a Section 5103 notice and continue processing the claim under the FDC Program.
References:  For more information about

III.i.3.A.2.i.  Identifying an Incomplete FDC

Prior to the March 24, 2015, regulatory change, an incomplete FDC was a communication from the claimant or his or her authorized representative that
  • identified a claimant’s intent to apply for benefits under the FDC Program, but
  • did not identify
    • the benefit(s) sought, or
    • the specific contentions on which the benefit(s) would be based.
There was no specific requirement regarding the format or means a claimant must use to communicate his/her intent to apply for benefits under the FDC Program.
Important:
  • Historically, the term “informal FDC” was erroneously used to describe an incomplete FDC.
  • VA created the nonregulatory concept of an incomplete FDC in order to drive participation in the FDC Program; consequently, the requirement for informal claims to identify the benefit sought as stated under historical 38 CFR 3.155 did not apply to incomplete FDCs.
References:  For more information about

III.i.3.A.2.j.  Handling an Incomplete FDC Prior to March 24, 2015

Upon receipt of an incomplete FDC, as described in M21-1, Part III, Subpart i, 3.A.2.i
  • establish an EP 400
  • send the claimant the Incomplete FDC Claim Letter, using Modern Awards Processing – Development to generate the letter
  • associate the letter and the documentation representing the claimant’s communication of his/her intent to apply for benefits with the appropriate traditional claims folder or electronic claims folder (eFolder)
  • clear the EP 400, and
  • take no further action until the claimant responds to the letter.
Notes:
  • If the claimant has neither a traditional claims folder nor an eFolder, create an eFolder in the Veterans Benefits Management System (VBMS) unlessthe corresponding claim, if formalized, cannot be processed in a paperless environment.
  • If a claimant responds to the Incomplete FDC Claim Letter by submitting a formal claim, use the date of receipt of the formal claim as the date of claim for claims establishment purposes.
  • VA may award entitlement to benefits effective the date of receipt of an incomplete FDC (if entitlement otherwise exists), as long as the claimant submits a formal claim within one year of the date VA notified the claimant of the incomplete FDC.

Reference:  For more information about the assignment of effective dates for benefits claimed and awarded under the FDC Program, see M21-1, Part III, Subpart i, 3.B.4.


3.  RO Responsibilities


Introduction

This topic contains information about the responsibilities ROs have with regard to the FDC Program, including

Change Date

July 5, 2015

III.i.3.A.3.a.  Designation and Responsibilities of an FDC Program Coordinator

The Veterans Service Center Manager (VSCM) at each regional office (RO), and Pension Management Center Manager (PMCM) at each pension management center (PMC) are responsible for designating an employee to serve as the FDC Program Coordinator.  This employee is responsible for
  • ensuring the integrity of the FDC Program
  • reviewing the Veterans Benefits Administration workload reports to identify and monitor pending FDCs, and
  • case managing any FDC that has been pending 90 days or more.
Case management of an FDC requires personal involvement of the FDC Program Coordinator in all steps of the claims process to ensure the RO completes the claim quickly and efficiently.  As an FDC nears or reaches the 90-day mark referenced above, the FDC Program Coordinator must take the steps described in the table below.
Step
Action
1
Locate and retrieve the claims folder associated with the FDC.
2
Review development actions taken on the claim to ensure they were done timely and properly.
3
Ensure compliance with the requirements in M21-1, Part III, Subpart i, 3.B.1 to
  • attach an FDC folder flash to each paper claims folder associated with an FDC, if applicable, and
  • identify an FDC in VBMS by applying the Fully Developed Claim special issue indicator to at least one contention under the EP controlling the FDC claim.
4
Hand-carry the claims folder to the drop-off point for the next phase in the claims process, if appropriate.
Reference:  See M21-1, Part III, Subpart i, 3.A.3.c for more information about
  • drop-off points for FDCs, and
  • the routing of FDCs in a paperless environment.
5
Continue monitoring the status of the claim, intervening, when necessary, to prevent any unnecessary delays in the claims process.

III.i.3.A.3.b.  Timeliness Targets for Processing FDCs

The table below shows the timeliness targets for the various activities involved in processing an FDC.
If the activity is …
Then the timeliness target will be …
intake processing, as described in M21-1, Part III, Subpart i, 3.B.1
within one day of claim receipt.
development, as described inM21-1, Part III, Subpart i, 3.B.3.a
  • within 10 days of receipt of a claim that requires scanning (conversion to an electronic format), or
  • within three days of receipt of a paperless claim that requires no scanning.
rating
within 10 days of designation as Ready for Decision.
award promulgation/authorization
within five days of generation of the rating decision.

III.i.3.A.3.c.  Designation of Drop-Off Points

The VSCM at each RO and PMCM at each PMC are responsible for designating drop-off points for FDCs that are awaiting action in the next phase of the claims process.  This will ensure speedy identification and retrieval by personnel responsible for handling claims in that next phase.
The table below
  • identifies the drop-off points the VSCM and PMCM must designate, and
  • explains how RO personnel must use the drop-off points.
As soon as …
RO personnel must deliver the corresponding claims folder to a drop-off point for FDCs that are awaiting …
intake processing is complete
the development described in M21-1, Part III, Subpart i, 3.B.3.a.
the claim is ready for a decision
a rating decision.
the rating decision is complete
award promulgation/authorization.
Note:  Before processing FDCs in a paperless environment, VSCMs and PMCMs must establish electronic work queues
  • that correspond to the physical drop-off points referenced above, and
  • to which users may assign cases that are awaiting action in the next phase of the claims process.
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