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M21-1, Part III, Subpart i, Chapter 3, Section C – General Information About the Decision Ready Claim (DRC) Initiative

Overview


In This Section

This section contains the following topics:
Topic
Topic Name
1
2
3 Exhibit:  DRC Documents Coversheets

1.  Overview of the DRC Initiative


Introduction


Change Date

August 30, 2018

III.i.3.C.1.a.  Purpose of the DRC Initiative

The Department of Veterans Affairs (VA) designed the Decision Ready Claim (DRC) Initiative for the purposes of

  • improving both
    • claims-processing timeliness, and
    • the claimant’s experience, and
  • offering expedited decisions on certain types of claims for disability compensation and original claims for Dependency and Indemnity Compensation (DIC).

III.i.3.C.1.b.  General Requirements for Participation in the DRC Initiative

In order to participate in the DRC Initiative, a claimant must
  • be represented by an accredited representative, to include a(n)
    • Veterans service organization
    • private attorney, or
    • agent
  • submit his/her claim on a specific form that contains language satisfying the general notice requirements of 38 U.S.C. 5103, and
  • simultaneously submit all relevant Federal and private medical evidence needed to render a decision.
References:  For more information on

III.i.3.C.1.c.  DRC Participation Criteria Specific to Benefit Claim Type

Currently, participation in the DRC Initiative is limited to
  • Veterans and service members filing certain types of claims for disability compensation, and
  • surviving spouses submitting original claims for DIC.
Use the table below to determine what participation criteria and claim type parameters apply, depending upon the benefit sought.
If the DRC type is …
Then the claimant must …
disability compensation (other than pre-discharge)
  • have previously filed a claim for disability compensation, received a decision, and notreentered a subsequent period of military service, and
  • be filing a claim for one or more of the following benefit types:
    • increased evaluation
    • direct service connection (SC)
    • secondary SC, and/or
    • presumptive SC under
      • 38 CFR 3.309(e), where the Veteran has documented proof of service in the Republic of Vietnam (RVN)
      • 38 CFR 3.317 for fibromyalgia, chronic fatigue syndrome, and/or a functional gastrointestinal disorder, and/or
      • 38 CFR 3.318 for amyotrophic lateral sclerosis (ALS).
pre-discharge
  • have less than 90 days remaining on active duty at the time of the DRC’s initiation
  • be filing a claim for one or more of the following benefit types:
    • increased evaluation
    • direct SC
    • secondary SC, and/or
    • presumptive SC under
  • submit
    • copies of all service treatment records for all periods of military service at the time the intent to file is communicated, and
    • a certified copy of DD Form 214, Certificate of Release or Discharge from Active Duty, for all periods of military service at the time the formal claim is submitted.
Note:  Any service member with less than 90 days remaining on active duty may initiate a pre-dishcarge DRC.  This includes
  • Reservists serving in the Active Guard Reserve (AGR) under 10 U.S.C.
  • full-time National Guard members serving in AGR roles under 32 U.S.C., and
  • service members undergoing medical evaluation board or physical evaluation board proceedings who are not currently enrolled in the Integrated Disability Evaluation System (IDES).
DIC
submit an original DIC claim in which the
  • Veteran’s death certificate lists at least one of his/her service-connected (SC) conditions, or
  • Veteran was rated totally disabled due to SC conditions (via either a 100-percent combined disability evaluation or award of individual unemployability (IU)) for 10 years prior to death.
 
Note:  If claiming secondary SC for a non-service-connected (NSC) condition that has been aggravated beyond natural progression by an SC condition, the Veteran or service member must provide medical evidence indicative of the NSC condition’s baseline level of severity.

III.i.3.C.1.d.  Claim Types Excluded From DRC Processing

The types of claims and submissions identified in the table below are currently excluded from processing under the DRC Initiative.
Important:  All claims for pension benefits (including both Veterans Pension and Survivors Pension) must be excluded from DRC processing.
If the DRC type is …
Then exclude any of the following from DRC processing:  …
disability compensation (other than pre-discharge)
  • claims for
    • posttraumatic stress disorder (PTSD)
    • traumatic brain injury (TBI)
    • Gulf War undiagnosed illness
    • conditions already assigned the schedular maximum evaluation (e.g. active cancers evaluated 100-percent disabling, tinnitus evaluated 10-percent disabling under 38 CFR 4.87, diagnostic code 6260, etc.)
    • compensation under 38 U.S.C. 1151
    • Chapter 18 benefits
    • IU
    • disabilities whose evaluations are
      • on appeal, or
      • subject to proposed reduction, and/or
    • previously denied conditions
  • claims based on exposure to the specific environmental hazards outlined in M21-1, Part IV, Subpart ii, 2.C.5.a
  • claims for presumptive SC under a provision of 38 CFR 3.309 not explicitly allowed in M21-1, Part III, Subpart i, 3.C.1.c
  • claims for disabilities incurred during a prior period of active duty for training or inactive duty for training
  • freestanding claims for special monthly compensation
  • claims of
    • incarcerated Veterans
    • former prisoners of war
  • claims involving non-Veteran beneficiaries (e.g. helpless child, spousal aid and attendance (A&A), etc.)
  • restricted access claims, as discussed in M21-1, Part III, Subpart ii, 4.A.4.a
  • submissions received while another rating-related claim is concurrently pending (unless the concurrently pending claim was initiated via the Benefits Delivery at Discharge Program), and/or
  • benefit applications signed by the representative, but not the Veteran.
pre-discharge
  • claims involving one or more of the factors outlined in the cell above
  • claims in which the service member has 90 or more days remaining on active duty
  • claims in which the service member is currently
    • enrolled in IDES
    • awaiting discharge while hospitalized in a VA or military treatment facility, or
    • pregnant
  • claims requiring a character of discharge determination, and/or
  • claims for aggravation of a condition that pre-existed service or was noted at the time of entry into service (unless evidence of pre-service baseline severity is provided).
Exception:  Pre-discharge claims involving a Gulf War undiagnosed illness, PTSD, and/or TBI may be processed under the DRC Initiative if an in-service diagnosis has been documented on examination.
DIC
claims involving
  • in-service death
  • Parents DIC
  • accrued benefits, and/or
  • spousal A&A and/or housebound benefits.
  

2.  Forms Used in Connection With the DRC Initiative


Introduction

This topic contains information about the forms used in connection with DRC submissions, including


Change Date

April 19, 2018

III.i.3.C.2.a.  Form Claimants Must Use to Participate in the DRC Initiative 

Claimants wishing to participate in the DRC Initiative must complete, sign, and submit the current version of
Note:  Follow the instructions in M21-1, Part III, Subpart i, 3.D.3.b for excluding a claim from the DRC Initiative if a claimant
References:  For more information on

III.i.3.C.2.b.  DRC Documents Coversheet

All DRC document submissions should be accompanied by one or more of the coversheets displayed in M21-1, Part III, Subpart i, 3.C.3 in order to ensure that regional office intake personnel can properly identify, prioritize, and control DRCs in light of their attributes.
Important:  In order to ensure proper claims routing, pre-discharge DRCs must be accompanied by both the

III.i.3.C.2.c.  Form Representatives Must Use to Request a Contract Examination

In order to initiate a request for one or more contract examinations, representatives will submit, in addition to the DRC Documents Coversheet pictured in M21-1, Part III, Subpart i, 3.C.3VA Form 21-4138, Statement in Support of Claim, utilizing the following standardized language:
Decision Ready Claim (DRC) Contract Exam Information
  
The conditions listed below are being provided in support of my DRC submission:
  
[condition(s)]
 
If you have any questions or need clarification, please contact: [representative name, e-mail address, and telephone number]
  
Evidence to be reviewed by examiner:
  
[condition]:  [evidence description].
Example:
Image of VA Form 21-4138 with VSO request for contract examination in conjunction with DRC.
 
Note:  Contract examinations will not be warranted in or authorized for DIC claims submitted under the DRC Initiative.

3.  Exhibit:  DRC Documents Coversheets


Introduction
This exhibit contains the document coversheets used in connection with DRC claims, including DRC documents coversheets for

Change Date

December 8, 2017

III.i.3.C.3.a.  Exhibit:  DRC Documents Coversheet for Compensation Clalims

The document coversheet used in connection with all compensation DRC submissions is shown below.
Image of the DRC coversheet.

III.i.3.C.3.b.  Exhibit:  DRC Documents Coversheet for DIC Claims

The document coversheet used in connection with all DIC DRC submissions is shown below.
Image of a DIC DRC Documents Coversheet

III.i.3.C.3.c.Exhibit:  DRC Documents Coversheet forPre-Discharge Claims

The document coversheet used in connection with all pre-discharge DRC submissions is shown below.
Image of Pre-Discharge DRC Documents Coversheet
Historical_M21-1III_i_3_SecC_12-8-17.docx May 8, 2019 508 KB
8-30-18_Key-Changes_M21-1III_i_3_SecC.docx May 8, 2019 481 KB
12-8-17_Key-Changes_M21-1III_i_3_SecC.docx May 8, 2019 495 KB
12-14-17_Key-Changes_M21-1III_i_3_SecC.docx May 8, 2019 485 KB
Historical_M21-1III_i_3_SecC_9-19-17.docx May 8, 2019 310 KB
9-19-17_Key-Changes_M21-1III_i_3_SecC.docx May 8, 2019 291 KB
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