Overview
In This Section |
This section contains the following topics:
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1. Pre-Claim Process for DRCs
Introduction |
This topic contains information on the pre-claim process for DRCs, including
|
Change Date |
April 19, 2018
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III.i.3.D.1.a. Declaration of Representation |
In order to successfully initiate processing under the Decision Ready Claim (DRC) Initiative, a claimant must be represented by an accredited representative.
If no representative relationship has been previously established, a 38 U.S.C 7332-compliant version of VA Form 21-22, Appointment of Veterans Service Organization as Claimant’s Representative, or VA Form 21-22a, Appointment of Individual as Claimant’s Representative, must accompany the DRC package submission.
Important: Accredited representatives and Veterans may also utilize existing Stakeholder Enterprise Portal (SEP) and eBenefits functionality to establish representation in lieu of submitting VA Form 21-22 (or 21-22a) through the Direct Upload portal.
References: For more information on
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III.i.3.D.1.b. Communication of an ITF |
Prior to submitting a claim under the DRC Initiative, a claimant or his/her accredited representative may communicate an intent to file (ITF) via any of the acceptable means identified in M21-1, Part III, Subpart ii, 2.C.2.a in order to preserve the earliest possible effective date for any benefits subsequently awarded.
Communication of an ITF may not be warranted if the
However, an active ITF must be of record if a representative requests performance of one or more contract examinations, as provided in M21-1, Part III, Subpart i, 3.D.1.f.
Reference: For more information on situations in which DRC contract examinations will not be requested, see M21-1, Part III, Subpart i, 3.D.1.g.
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III.i.3.D.1.c. Digitization of Paper Claims Folders |
If a DRC is being considered or initiated on the behalf of a claimant for whom a paper claims folder exists, the representative must notify the regional office (RO) that the
Important: DRC contract examinations, if elected, cannot be requested until the Veteran’s claims folder has been converted into electronic format.
Note: Whenever possible, utilize the local RO Intake Processing Center (IPC) Coach to facilitate the paper claims folder conversion process.
Reference: For more information on
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III.i.3.D.1.d. Pre-Claim Evidence Gathering |
Prior to formal DRC submission, representatives must
Exception: If non-disability benefits questionnaire (DBQ) medical evidence submitted in support of the DRC is deemed independently sufficient for rating purposes, no contract examination request or privately-prepared DBQ submission is necessary.
Important:
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III.i.3.D.1.e. Methods of DRC Examination |
Representatives have two options for ensuring that appropriate DBQs are completed in support of DRCs for compensation. They may either
Notes:
Use the table below to determine how examinations are secured in conjunction with either method.
Important: All evidence and contract examination requests submitted in support of the DRC Initiative must include the appropriate DRC documents coversheet(s) pictured in M21-1, Part III, Subpart i, 3.C.4.
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III.i.3.D.1.f. Handling DRC Contract Examination Requests |
Follow the steps in the table below upon receipt of a VA Form 21-4138 identifying DRC contentions in need of contract examinations.
Notes:
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III.i.3.D.1.g. Situations in Which a DRC Contract Examination Will Not Be Requested |
Do not request a DRC contract examination if any of the following conditions are applicable:
Use the table below to determine the next action if a DRC contract examination is incompatible with one or more of the criteria outlined in this block.
Exceptions:
Notes:
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2. Intake Process for DRCs
Introduction |
This topic contains information on the intake process for DRCs, including
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Change Date |
April 19, 2018
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III.i.3.D.2.a. Submission of Compensation DRCs |
Compensation DRCs must be submitted by an accredited representative on behalf of the Veteran or service member. Accredited representatives will use the DRC Direct Upload portal to submit a DRC electronically.
In order to initiate a DRC, the representative may
Exception: In pre-discharge cases, if the representative is unable to upload STRs to the Direct Upload portal due to size or volume, he/she should attach both the general DRC Documents coversheet and the pre-discharge DRC Documents coversheet to the hard-copy STRs or STR compact disc (whichever is provided) and submit them to the Centralized Mail (CM) vendor. All other DRC documents, including the ITF and the formal claim application, must be submitted through the Direct Upload portal.
Important:
Reference: For more information on DRC Documents coversheets, see M21-1, Part III, Subpart i, 3.C.2.b.
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III.i.3.D.2.b.Submission of DIC DRCs |
DIC DRCs must be submitted by an accredited representative on behalf of the surviving spouse. Accredited representatives will use the DRC Direct Upload portal to submit a DRC electronically.
In order to initiate a DRC, the representative may
Important: The VA Form 21-534EZ must be signed by the surviving spouse. If only the accredited representative has signed the application, exclude the claim from the DRC Initiative by following the instructions in M21-1, Part III, Subpart i, 3.D.3.b.
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III.i.3.D.2.c. Vendor Review of DRCs |
Upon receipt of a DRC through the DRC Direct Upload portal, the scanning vendor conducts a preliminary review to ensure that all required documents and evidence are included with the submission and substantially complete.
Based upon its review of the DRC submission, the scanning vendor takes action as outlined in the table below.
Reference: For more information on the DRC Direct Upload portal, see the VSO Direct Upload/DRC User Guide.
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3. Taking Initial Action on DRCs
Introduction |
This topic contains information on initial actions to take on DRCs, including |
Change Date |
April 19, 2018
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III.i.3.D.3.a. Establishing and Readying a DRC for Decision |
Upon assignment of an eligible DRC mail package from an IPC Super User, follow the steps in the table below to review the submission’s eligibility, establish EP control, and ready the claim for decision, as warranted.
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III.i.3.D.3.b. Excluding Claims From DRC Processing |
Follow the steps in the table below to exclude a claim from DRC processing if, at the time of submission or at any point thereafter, any of the following are found to be true:
Reference: For more information on the Letter Creator tool, see the Letter Creator User Guide.
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4. Rating Review of DRCs
Introduction |
This topic contains information on the rating activity’s review of DRCs, including |
Change Date |
April 19, 2018
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III.i.3.D.4.a. Issuing a Decision on a DRC |
Upon assignment of a DRC in Ready for Decision status, the rating activity must review the claim submission and all associated evidence to ensure that preparation of a rating decision, to include a partial rating decision, is possible and appropriate.
Use the table below to determine the proper rating action to take on a DRC.
Important: If review of the claim reveals that it should have been excluded from DRC processing, but the existing evidence supports completion of a full or partial rating decision, prepare the appropriate decision in accordance with the instructions provided in the table above. References: For more information on
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III.i.3.D.4.b. Resolving Examination Insufficiencies in DRCs |
The general standards for examination report sufficiency, as discussed in M21-1, Part III, Subpart iv, 3.D, are equally applicable to DRCs. Because the timely processing of DRCs is of critical importance, the rating activity must, to the extent possible, utilize available methods of recourse to mitigate DBQs or examination reports that are insufficient for rating purposes or require additional clarification. Such methods include
If, however, efforts to expeditiously resolve DBQ or contract examination insufficiencies are unsuccessful or impractical,
Reference: For more information on returning examination reports, see M21-1, Part III, Subpart iv, 3.D.3.
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4-19-18_Key-Changes_M21-1III_i_3_SecD.docx | May 8, 2019 | 107 KB |
Historical_M21-1III_i_3_SecD_12-8-17.docx | May 8, 2019 | 125 KB |
Historical_M21-1III_i_3_SecD_9-19-17.docx | May 8, 2019 | 123 KB |
2-23-18_Key-Changes_M21-1III_i_3_SecD.docx | May 8, 2019 | 99 KB |
12-8-17_Key-Changes_M21-1III_i_3_SecD.docx | May 8, 2019 | 104 KB |
9-19-17_Key-Changes_M21-1III_i_3_SecD.docx | May 8, 2019 | 95 KB |
in Chapter 3 Fully Developed Claim (FDC) Program and Decision Ready Claim (DRC) Initiative, Part III General Claims Process, Subpart i Overview of Claims Processing and Structure of the Veterans Service Center (VSC)
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