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M21-1, Part III, Subpart ii, Chapter 1, Section D – Claims That Require Priority Processing

Overview


In This Section

This section contains the following topics:
Topic
Topic Name
1
2
3
4
5
6 Priority Processing of Claims From Former Prisoners of War (FPOWs)
7 Priority Processing of Claims Associated With Award of the Medal of Honor or Purple Heart
8

1.  General Information About Claims That Require Priority Processing


Introduction

This topic contains general information about claims that require priority processing, including


Change Date

April 1, 2019

III.ii.1.D.1.a.  Types of Claims That Require Priority Processing

Listed below are the types of claims that require priority processing:

  • claims from any claimant who is
    • a participant in the Fully Developed Claim Program
    • homeless or experiencing extreme financial hardship
    • terminally ill
    • more than 85 years old, or
    • a survivor of a former prisoner of war (FPOW).
  • claims from any current or former member of the Armed Forces who
    • became very seriously ill or injured/seriously ill or injured (VSI/SI) during service and is not already receiving Department of Veterans Affairs (VA) disability benefits
    • is diagnosed with Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s Disease
    • is an FPOW
    • received the Medal of Honor, or
  • the following types of claims from any current or former member of the Armed Forces or a claimant whose claim is based on the death of a service member or former service member who received the Purple Heart:
    • original compensation or pension claims, or
    • an original claim for Dependency and Indemnity Compensation (DIC).
Note:  Veterans who have appealed a VA decision and have filed a substantive appeal with the Board of Veterans’ Appeals (BVA) can request advancement on BVA’s docket for good cause.  BVA determines whether good cause exists to warrant advancing a case on the docket.
 
References:  For more information about

III.ii.1.D.1.b.  Managing Claims That Require Priority Processing

Upon receipt or assignment of one of the types of claims identified in M21-1, Part III, Subpart ii, 1.D.1.a, regional offices (ROs) must take any action on the claim that is necessary to move it to the next stage in the claims process before taking action on any other non-priority claim received by or assigned to the RO.
To ensure a claim requiring priority processing is expedited at all stages of the claims process, ROs must also case-manage such claims by
  • utilizing appropriate flashes or claim attributes, when indicated
  • frequently following up on pending actions
  • utilizing issue-specific coordinators, such as Military Records Specialists, when applicable
  • using the telephone to
    • contact homeless Veterans, and
    • conduct development activities with other types of claimants, whenever possible
  • collaborating with the Veterans Health Administration and other involved counterparts
  • reviewing any available medical evidence early in the claims process to determine its potential adequacy for rating purposes, and
  • sympathetically considering the claimant’s level of impairment (particularly where evidence is suggestive of terminal illness) so as to
    • solicit for disability benefits questionnaires completed by his/her primary care provider in lieu of examination, and/or
    • request medical opinions based solely on records review when available evidence is otherwise sufficient to assign an evaluation.
Reference:  For more information on utilizing and maintaining claim attributes, see

III.ii.1.D.1.c.  Handling Claims Folders That Have Not Yet Been Converted Into an Electronic Format

Adjudicate a claim that requires priority processing before sending any associated documentation to a vendor for conversion into an electronic format (scanning) if
  • the claim is in paper form, or
  • the claimant still has a traditional claims folder.
Exception:  Follow the guidance in M21-1, Part III, Subpart ii, 1.D.8 when the
  • claimant has a legacy appeal pending, and
  • corresponding paper claims folder is located at a decision review operations center (DROC).
Reference:  For more information about the scanning process referenced in this block, see M21-1, Part III, Subpart ii, 1.F.

2.  Priority Processing of Claims From Homeless Veterans


Introduction

This topic contains information on handling claims from homeless Veterans, including


Change Date

April 6, 2015

III.ii.1.D.2.a.  Definition: Homelessness

The detailed legal definition of homelessness is found in 42 U.S.C. 11302.
 
References:  For more information on determining whether a Veteran is

III.ii.1.D.2.b.   Flashing a Homeless Veteran’s Record

For information on how to appropriately flash a homeless Veteran’s record, seeM27-1, Part II, 3.m.

III.ii.1.D.2.c.  Handling Applications From Veterans That Might Be Homeless

Upon receipt of an application for benefits that contains a telephone number but no mailing address, attempt to contact the claimant by telephone to obtain a current mailing address.
If neither a mailing address nor a telephone number are provided on the application, follow the instructions in M21-1, Part III, Subpart ii, 1.B.6.m.
 
Reference:  For information about the delivery of benefit payments (including undeliverable checks) and correspondence to homeless Veterans, see

III.ii.1.D.2.d.   Homeless Veterans Coordinators

All ROs are required to have either a Homeless Veterans Claims Coordinator (HVCC) or a Homeless Veterans Outreach Coordinator (HVOC).
Claims from homeless Veterans and from Veterans who are at immediate risk of homelessness are monitored and tracked by the local HVCC or designee.
 
Reference:  For information about the duties of HVCCs/HVOCs, see M27-1, Part II, 3.g-i and l.

3.  Claims Requiring Priority Processing Because of Extreme Financial Hardship


Change Date

April 6, 2015

III.ii.1.D.3.a.  How a Claimant Establishes He/She Is Experiencing Extreme Financial Hardship

If a claimant states that he/she is experiencing extreme financial hardship and submits documentation to support the assertion, accept the claimant’s statement as factual.
Documentation to support the assertion of extreme financial hardship includes, but is not limited to,
  • an eviction notice or statement of foreclosure
  • notices of past-due utility bills, and/or
  • collection notices from creditors.
Important:  A Veterans Service Center Manager (VSCM) or Pension Management Center Manager (PMCM) may designate that a claim requires priority processing because of extreme financial hardship even though the documentation described in this block does not exist.
 
Remember:  Append the Hardship corporate flash to a claimant’s record when extreme financial hardship has been adequately demonstrated.
 
Reference:  For more information on appending the Hardship flash, see the Share User Guide.

4.  Priority Processing of Claims From VSI/SI Claimants


Introduction

This topic contains information on handling claims from VSI/SI claimants, including


Change Date

April 1, 2019

III.ii.1.D.4.a.  Definition: Serious Illness or Injury

For the purposes of this topic, a serious illness or injury is defined as a disability that
  • occurred as a result of participation in a military operation, and
  • will likely result in discharge from military service.
The Department of Defense (DoD) determines whether a service member is:
  • VSI
  • SI, or
  • not seriously ill or injured (NSI).
Notes:
  • All service members categorized by DoD as VSI or SI are considered seriously disabled for VA purposes.
  • In the absence of an indicator from DoD that a claimant is VSI/SI, a VSI/SI Coordinator may decide whether a claimant has a serious illness or injury.
  • Although VSI/SI Coordinators should contact and assist individuals that DoD has categorized as NSI, their claims do not require case management and priority processing unless they are one of the other types of claims identified in M21-1, Part III, Subpart ii, 1.D.1.a.
Reference:  For more information about VSI/SI Coordinators, see M21-1, Part III, Subpart ii, 1.D.4.b.

III.ii.1.D.4.b.  Management of Claims From VSI/SI Claimants

All ROs must designate a VSI/SI Coordinator, and VSCMs/PMCMs are responsible for ensuring claims from VSI/SI claimants are case-managed by the Special Operations Team.
Duties of the VSI/SI Coordinator include, but are not limited to,
  • ensuring the Seriously Injured/Very Seriously Injured corporate flash is appended to the claimant’s record
  • acting as a liaison with VA medical facilities, military facilities, and other RO divisions, and
  • acting as a direct point of contact for VSI/SI claimants and their dependents.

Reference:  For more information on adding the VSI/SI flash, see the Share User Guide.


III.ii.1.D.4.c.  Handling a Claim From a VSI/SI Service Member Who Is Not Yet Discharged

Prior to awarding benefits to a claimant, ensure he/she is discharged from service.
 
Notes:
  • A service member may receive treatment at a VA or DoD medical facility for several months before actual separation from service.
  • Pre-discharge sites do not process claims requiring case management, including claims from VSI/SI claimants.
References:  For more information on

III.ii.1.D.4.d.  Requesting a VSI/SI Claimant’s Claims Folder from VA’s RMC

If a VSI/SI claimant’s claims folder is located at VA’s Records Management Center (RMC), submit an expedited request through the RMC Source Material Tracking System (SMTS) Portal.
Reference:  For more information on use of the RMC SMTS Portal, see

III.ii.1.D.4.e.Rating Considerations When Processing a Claim From a VSI/SI Claimant

Follow the procedures in the table below if a VSI/SI claimant is released from service while hospitalized or convalescing.
If the …
Then prepare a rating decision that grants entitlement to …
medical evidence of record shows
  • the existence of an unstabilized condition with severe disability, and
  • substantially gainful employment is not feasible or advisable
a prestabilization rating under 38 CFR 4.28.
 
Important:  It is not necessary to request a VA examination or service treatment records, or undertake other routine development, if the evidence of record is sufficient to justify a pre-stabilization rating.
medical evidence of record shows
  • the existence of an unstabilized condition with unhealed or incompletely healed wounds or injuries, and
  • employability is likely impaired because of the condition
  • claimant was discharged from service while hospitalized for a service-connectable disability, and
  • the period of hospitalization exceeded 21 days
benefits under 38 CFR 4.29.
 
Important:  Do not postpone rating action simply because a claimant is discharged from service while hospitalized.
claimant requires convalescence following a period of hospitalization for a service-connected disability
benefits under 38 CFR 4.30.

 

 

5.  Claims Requiring Priority Processing Because of Terminal Illness

 

  


Change Date

August 2, 2016

III.ii.1.D.5.a.  Prioritization of Claims From Terminally Ill Claimants

Upon receipt of medical evidence showing a claimant has an illness that is likely terminal in nature, present the evidence to a coach or assistant coach for a determination as to whether or not priority processing of the associated claim is warranted.
When determining whether priority processing is warranted, consider
  • the likelihood the claimant will pass away before completion of the claims process, and
  • the probable need for additional benefits, such as the benefits payable based on a claimant’s need for aid and attendance.
When priority processing of a claim based on terminal illness is warranted, follow the guidance in the table below.
If the claimant has …
Then …
a paper claims folder
  • attach a paper flash to the front of the claims folder that reads Process Next – Terminal Illness
  • append the Terminally Ill flash to the corporate record using Share, and
  • follow the instructions in M21-1, Part III, Subpart ii, 1.D.1.c.
an electronic claims folder (eFolder) only
  • append the Terminally Ill flash to the corporate record using Share, and
  • change the claim priority in the Veterans Benefits Management System (VBMS) to High.
Reference:   For information about using flashes in Share, see the Share User Guide.

 6.  Priority Processing of Claims From FPOWs


Introduction

This topic contains information on handling claims from FPOWs, including

Change Date

November 9, 2017

III.ii.1.D.6.a.  Definition:  FPOW

Refer to M21-1 Part III, Subpart v, 1.C.1.a for the definition of former prisoner of war (FPOW).
 
Reference:  For more information on verifying FPOW status, see

III.ii.1.D.6.b.  Flashing an FPOW’s Record 

FPOW claims require priority processing.  Add the POW flash (when it is not already present) when a claim is received from a
  • Veteran or survivor who claims FPOW status, or
  • Veteran whose FPOW status has been previously verified, or the Veteran’s survivor.
The FPOW flash will result in prioritization of the FPOW claim within the National Work Queue and cause the claim to be routed to the RO nearest in geographical location to the Veteran or claimant.
 
Reference:  For more information on adding a flash, see the Share User Guide.

III.ii.1.D.6.c.  FPOW Coordinators 

All ROs are required to have a FPOW Coordinator.
 
Reference:  For more information on the role and duties of the FPOW Coordinator, see M27-1, Part II, 10.c-d.

7.  Priority Processing of Claims Associated with Award of the Medal of Honor or Purple Heart


Introduction
This topic contains information on handling claims from Veterans who earned the Medal of Honor or Purple Heart, including

Change Date
 April 1, 2019

III.ii.1.D.7.a.  Award Criteria for the Medal of Honor

The Medal of Honor is the highest and most prestigious personal military decoration that may be awarded to recognize Veterans who have distinguished themselves by acts of valor during specifically defined combat or combat-related service.  It is awarded by the President of the United States on behalf of Congress.
References:  For more information on

III.ii.1.D.7.b.  Award Criteria for the Purple Heart

The Purple Heart is awarded in the name of the President of the United States to members of the Armed Forces of the United States who have been wounded, were killed, or who have died or may hereafter die of wounds received during specifically defined combat or combat-related service.
Reference:  For more information on award of the Purple Heart, see 10 U.S.C. 1129.

III.ii.1.D.7.c.  Flashing a Veteran’s Record to Expedite Based on Receipt of Medal of Honor or Purple Heart

Priority processing is required for
  • all claims for Veterans or service members who have earned the Medal of Honor
  • original compensation or pension claims for a Veteran or service member who earned the Purple Heart, and
  • original DIC claims based on the death of a Veteran or service member who earned the Purple Heart.
Add the Medal of Honor or Purple Heart flash (when it is not already present) when a claim is received from a Veteran, service member, or survivor and receipt of the Purple Heart or Medal of Honor is documented.
Notes:
  • The Medal of Honor or Purple Heart flash will result in prioritization of the claim, as described in the categories above, within the National Work Queue.
  • When the claimant has a paper claims folder, also add a attach a paper flash to the front of the claims folder that reads Process Next – Purple Heart/Medal of Honor and follow the procedures at M21-1, Part III, Subpart ii, 1.D.1.c.
References:  For more information on

8.  Accessing the Content of Claims Folders That Are Located at a DROC

 


Introduction

This topic contains instructions for accessing the content of claims folders that are located at a DROC, including


Change Date

April 1, 2019

III.ii.1.D.8.a.Circumstances Under Which the Instructions Contained in This Topic Apply

The instructions contained in this topic are for application when

  • an RO receives a claim that requires priority processing, and
  • the corresponding paper claims folder is located at a DROC.

For the purpose of this topic, claims that require priority processing include those listed in M21-1, Part III, Subpart ii, 1.D.1.aas well as

  • claims that have been pending for more than one year
  • BDD claims
  • Integrated Disability Evaluation System claims, and
  • Dependency and Indemnity Compensation claims.

III.ii.1.D.8.b.  Instructions for Obtaining Access to the Contents of Paper Claims Folders Located at a DROC

ROs must follow the instructions in the table below when the circumstances described in M21-1, Part III, Subpart ii, 1.D.8.a arise.
Step
Action
1
Send an e-mail to the DROC with jurisdiction of the folder requesting access to the contents of the claims folder based on receipt of a claim that requires priority processing.
  • Enter Priority-Processing Claim in the subject line of the e-mail.
  • Include the following in the body of the e-mail:
    • claimant’s name and claims folder number
    • type of end product (EP) established
    • date of claim, and
    • type of claim (such as BDDhomeless Veteran, orFPOW).
  • DROC e-mail addresses are as follows:
Note:  A DROC must send the paper claims folder to a vendor that will scan the documents contained in the claims folder and upload them into the appropriate eFolder.
Exception:  If the claims folder must be maintained as a paper folder, do not send the claims folder for scanning.  Follow the procedures inM21-1, Part III, Subpart ii, 1.D.8.d.
 
References:  For more information on
2
Follow the instructions in M21-1, Part III, Subpart ii, 1.F.2 for shipping to the appropriate vendor all documents the RO possesses (to include documents in a temporary file) that have not yet been scanned and uploaded into the corresponding eFolder.
 
Exception:  Do not send documents containing Federal tax information (FTI) to a vendor for scanning.
 
References:  For more information about
3
As soon as the contents of the claims folder, as well as the documents the RO sent to the vendor referenced in Step 2, appear in the claimant’s eFolder, process the pending claim.
 
Note:  Use VBMS-Rating (VBMS-R) to prepare a rating decision, if one is necessary.
 
Reference:  For information about new-mail indicators in VBMS that alert users to the availability of newly scanned documents, see theVBMS User Guide.
4
Upload any documents generated outside of VBMS into the eFolder, if the claim was not being processed in VBMS.

III.ii.1.D.8.c.  DROC Actions Upon Receipt of a Request From an RO for Access to the Contents of a Paper Claims Folder

A DROC must take the actions described in the table below upon receipt of a request from an RO for access to the contents of a paper claims folder that the
  • DROC has in its custody, and
  • RO needs based on receipt of a claim that requires priority processing.
Exception:  If the claims folder must be maintained as a paper folder, do not send the claims folder for scanning.
Step
Action
1
Follow the instructions in M21-1, Part III, Subpart ii, 1.F.2 for shipping the paper claims folder to the appropriate vendor, who will
  • scan the contents of the claims folder, and
  • upload the scanned records into the appropriate eFolder.
2
Continue processing the legacy appeal or request for higher-level review (HLR) as soon as the contents of the claims folder appear in the eFolder.
Notes:
  • Use VBMS-R to prepare a rating decision if one is necessary.
  • A DROC’s Intake Processing Center is responsible for
    • monitoring the progress of the claims folder through the scanning process, and
    • notifying the employee that is working on the legacy appeal or request for HLR when the contents of the claims folder are available in the appellant’s eFolder.
Reference:  For more information about using the INTAKE tab in VBMS to monitor the progress of a claims folder through the scanning process, see the VBMS Job Aid—Reviewing Shipping Manifests and Document Control Sheets.
3
Legacy appeals or requests for HLR processed
  • outside of VBMS require uploading of all documents (created during the legacy appeals process, such as supplemental statements of the case or other decisions) into the eFolder, and
  • in VBMS require no additional action.
References:  For more information on

III.ii.1.D.8.d.  Requesting Temporary Transfer of Paper Claims Folders Located at a DROC
When a claimant submits a claim requiring priority processing as described in M21-1, Part III, Subpart ii, 1.D.8.a and the claims folder must be maintained in paper and is located at a DROC, the RO may request a temporary 21-day transfer of the claims folder.
The RO may send a request via e-mail for temporary transfer to the DROC with jurisdiction of the claims folder.
  • Enter Priority-Processing Claim in the subject line of the e-mail.
  • Include the following in the body of the e-mail:
    • claimant’s name and claims folder number
    • type of EP established
    • date of claim, and
    • type of claim (such as BDDhomeless Veteran, or FPOW).
  • DROC e-mail addresses are as follows:
The DROC will determine whether the paper claims folder can be returned to the RO.  If the DROC cannot return the paper claims folder timely, it will indicate the anticipated date of return.
If mitigating circumstances prevent a paper claims folder from being returned to a DROC within this 21-day time frame, the RO must submit an extension request to the DROC via e-mail.
References:  For more information on maintaining paper claims folders for
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