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M21-1, Part III, Subpart i, Chapter 4, Section D – Claims to Add a Dependent That Are Filed Through eBenefits or Processed by a Contractor

Overview 


Introduction
This section contains the following topics:

1.  Rules-Based Processing of Claims to Add a Dependent


Introduction

This topic contains information about the rules-based processing of claims to add a dependent, including

Change Date

March 28, 2018

III.i.4.D.1.a.  Purpose of RBPS

In order to shorten the amount of time it takes to add a dependent to a Veteran’s award, the Department of Veterans Affairs (VA) developed the Rules-Based Processing System (RBPS), which automatically processes claims with minimal user involvement.

III.i.4.D.1.b.  How RBPS Receives Data Necessary to Process a Claim

RBPS currently accepts only those claims that Veterans submit through eBenefits for additional disability compensation for a dependent.
The table below describes how RBPS receives the data necessary to process this category of claim.
Stage
Description
1
A Veteran accesses Veterans Online Application (VONAPP) Direct Connect (VDC) through eBenefits.
References:  For more information about
2
VDC utilizes a question-and-answer, interview-style interface to guide the Veteran in completing one of the following forms:
3
RBPS pulls data from the entries the Veteran made on the forms listed in Step 2 and attempts to process the claim based on that data, per the process described in M21-1, Part III, Subpart i, 4.D.1.c.

III.i.4.D.1.c.  How RBPS Sorts and Processes Claims

The table below describes the process that is triggered when a Veteran accesses VDC through eBenefits and submits VA Form 21-686c or VA Form 21-674.
Stage
Description
1
VDC uploads into the Veteran’s electronic claims folder (eFolder) in the Veterans Benefits Management System the completed form and any other documentation the Veteran submitted.
2
RBPS pulls data from the entries the Veteran made on the form and determines whether the claim is eligible for automated processing.
If the claim is …
Then …
eligible for automated processing
  • RBPS
    • establishes an end product (EP) 130 and assigns one of the following claim labels to the EP, as applicable:
      • eBenefits Dependency Adjustment, or
      • eBenefits Request for Approval of School Attendance
    • uses rules-based programming to decide the claim, and
    • processes the decision through the Veterans Service Network (VETSNET)
  • VETSNET clears the EP 130, and
  • the Hines Information Technology Center
    • generates a decision notice, and
    • uploads the corresponding award print and decision notice into the Veteran’s eFolder.
not eligible for automated processing
  • RBPS establishes an EP 130 and assigns one of the following claim labels to the EP, as applicable:
    • eBenefits Dependency Adjustment Reject, or
    • eBenefits Request for Approval of School Attendance Reject, and
  • the EP remains in the inventory of the station of origination (SOO) until the SOO processes the claim manually.
Reference:  For a list of claims that are not eligible for automated processing through RBPS, see M21-1, Part III, Subpart i, 4.D.1.d.
 
Notes:
  • If an EP 130 is already pending when RBPS places a claim under EP control, RBPS will establish an incremental EP, such as EP 131 or EP 132.
  • Veteran Service Centers (VSCs) are responsible for generating a VETSNET Operations Report (VOR) each week that displays the EPs 130 that remain pending and represent claims that were not eligible for automated processing.
Reference:  For more information about using VOR, see the VOR Desk Reference.

III.i.4.D.1.d.  Claims That Are Not Eligible for Automated Processing Through RBPS

The following types of claims are not eligible for automated processing through RBPS:
  • claims to add
    • an adopted child
    • a child over age 18 that is permanently incapable of self-support
    • a child over age 18 that is homeschooled, or
    • a school child whose tuition is being paid by the Federal government, or
  • claims to add a dependent when
    • the payment of benefits may be subject to a withholding for attorney fees, or
    • the claimant or Veteran has a foreign address.
References:  For more information on

III.i.4.D.1.e.  Handling Claims That Are Not Eligible for Automated Processing Through RBPS

The table below describes the process for handling claims that are not eligible for automated processing through RBPS.
Stage
Description
1
Once each week, a designated VSC employee generates the report of pending EPs 130 described in the note box under the table inM21-1, Part III, Subpart i, 4.D.1.c.
2
A designated VSC employee uses the report of pending EPs 130 to identify claims that, according to the associated claim label, RPBS “rejected” because the claim was not eligible for automated processing.
3
If VDC established an incremental EP 130 (as described in the note box under the table in M21-1, Part III, Subpart i, 4.D.1.c), the designated VSC employee
  • consolidates all the claims for which a 130 series EP is pending under a single EP 130, and
  • cancels any incremental EPs under the reason Worked Under Proper EP.
4
The designated VSC employee
  • reviews all
    • system notes, and
    • documentation contained in the Veteran’s claims folder, and
  • follows existing procedures for processing a claim for additional benefits for a dependent, as contained in M21-1, Part III, Subpart iii, 5.
Reference:  For more information about processing claims that a Veteran submits through VDC, see M21-1, Part III, Subpart i, 4.C.

III.i.4.D.1.f.  Handling Claims From a Veteran With a Paper Claims Folder

If a Veteran has a paper claims folder, then
  • send any documents from the paper claims folder that were used to process the Veteran’s claim to a scanning vendor (for conversion to an electronic format and upload into the Veteran’s eFolder), and
  • do not print out (for the purpose of filing down in the paper claims folder) the documents VDC uploaded into the Veteran’s eFolder.
Reference:  For more information about sending documents to a scanning vendor, see M21-1, Part III, Subpart ii, 1.E.2.c.

III.i.4.D.1.g.  Handling Claims With Missing Claim Documents

Follow the failure-to-upload procedures in M21-1, Part III, Subpart ii, 4.D.6 upon discovering that documents associated with a claim to add a dependent to a beneficiary’s award are not available in the beneficiary’s eFolder.

III.i.4.D.1.h. Automatic  Release of Decision Notices That Reflect a Denial of Entitlement to Additional Benefits

VA systems automatically release decision notices that reflect a denial of entitlement to additional disability compensation for a dependent when the claimant is a Veteran with a combined disability rating that is less than 30 percent and 
  • a 130-series EP is pending without a concurrently pending rating EP, or
  • an EP 020 and a 130-series EP are concurrently pending.
Upon release of a decision notice, the system that generated the notice
  • clears the 130-series EP, and
  • uploads a copy of the decision notice into the Veteran’s electronic claims folder.
Reference:  For information about rating EPs, see M21-4, Appendix B, Section II.

2.  Additional Claim and Correspondence Processing Support


Change Date
 March 28, 2018

III.i.4.D.2.a.  VA Contract for Processing Claims for and Correspondence Affecting Entitlement to Benefits for Dependents

VA has a professional services contract for the processing of certain claims for and correspondence affecting a beneficiary’s entitlement to benefits for dependents.
In combination with RBPS, the professional services contract
  • allows regional offices to allocate more resources to the reduction of claims in their inventory that require a rating decision, and
  • ensures timely award adjustments for the addition or removal of dependents from a beneficiary’s award.
Reference:  For more information about RBPS, see M21-1, Part III, Subpart i, 4.D.1.
Historical_M21-1III_i_4_SecD_11-6-15.docx May 8, 2019 49 KB
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