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M21-1, Part III, Subpart ii, Chapter 4, Section D – Lost Paper Claims Folders, Reconciliation of Duplicate Records in the Beneficiary Identification and Records Locator Subsystem (BIRLS), and Misplaced Claims Documents

Overview


In This Section

This section contains the following topics:

1.  Searching for Lost Paper Claims Folders

 


Introduction

This topic contains information on searching for lost paper claims folders, including

Change Date

May 2, 2019

III.ii.4.D.1.a.  General Search Procedure

Make an exhaustive search of the entire office upon discovering that the paper claims folder of a living or deceased Veteran, a notice of death (NOD) folder, or Dependents’ Educational Assistance (DEA) folder is
  • missing, or
  • was sent to a vendor to be converted to an electronic record and the documents contained within the folder are unavailable.
Note:  If the folder was
  • sent to a vendor to be converted to an electronic record, follow the guidance in M21-1, Part III, Subpart ii, 1.F.4 to locate the source materials and request a folder rescan, or
  • located at the regional office (RO) and is now missing, follow the steps in the table below.
Step
Action
1
Conduct a name search of the entire drawer where the folder should be filed.
2
Add the claims folder number to the search list.
3
Check the
  • pending files of the transfer and correspondence activities, and
  • principal guardianship files.
4
If the computer system shows an active compensation, pension, or education record, check the records of recent payment history. If these records show payment of benefits by another RO, contact that RO to determine whether or not the folder is located there.
5
If completion of the preceding steps fails to result in locating the missing folder, consider the folder lost.
Note:  The RO that has mail for the folder and is requesting the folder should report the folder missing, if applicable.
6
Maintain the pending end product (EP) with a 30-day suspense that begins on the date the Department of Veterans Affairs (VA) received the claim.  After the 30-day period ends,
  • create a rebuilt claims folder for processing the claim, and
  • continue any incomplete search efforts to find the original folder.

III.ii.4.D.1.b.  Rebuilding Lost Paper Claims Folders

Follow the steps in the table below if the missing folder is a paper claims folder.
Step
Action
1
Consider the following message a negative response for records: “File not found.”  Save a screenshot of the message for association with the claims folder.
References:  For more information on
2
Request a physical check for the claims folder in the file bank by
  • sending an e-mail message to the Veterans Service Center Manager (VSCM) of any RO where there is reason to believe the folder may be located, and
  • requesting a response within a specific period of time.
Note:  For claims that require priority processing, request a response time of 24 hours.  For routine requests, request a response time of five work days.
References:  For more information on
3
Upon receipt of negative replies from all locations, rebuild the claims folder according to the instructions in the table below.
If the rebuilt claims folder will be in a(n) …
Then …
electronic format
  • create an electronic claims folder (eFolder) in the Veterans Benefits Management System (VBMS), if one does not already exist
  • upload the negative responses to the eFolder
  • request from the claimant copies of any relevant evidence or documentation in his/her possession and, if applicable, the possession of his/her power of attorney (POA)
  • update the Beneficiary Identification and Records Locator Subsystem (BIRLS) FOLDER LOCATION screen to reflect that the eFolder at the RO is a rebuilt eFolder, and
  • append the Rebuilt Folder corporate flash.
References:  For more information on
paper format
  • prepare a rebuilt folder
  • associate the negative responses with the paper claims folder
  • request from the claimant copies of any relevant evidence or documentation in his/her possession and, if applicable, the possession of his/her POA
  • update the BIRLS FOLDER LOCATION screen to reflect that the folder at the RO is a rebuilt folder, and
  • prominently mark the cover of the rebuilt folder with the words Rebuilt Folder.
Reference:  For more information on standard notations for paper claims folders, see M21-1, Part III, Subpart ii, 3.B.6.b.

III.ii.4.D.1.c.  Rebuilding Lost NOD or DEA Folders

Use the table below if a NOD or a DEA folder cannot be located after
  • completing internal searches, and
  • receiving responses to requests for searches at any other ROs where the folder might be located.
If the rebuilt NOD or DEA folder will be in a(n) …
Then …
electronic format
  • create an eFolder
  • upload the negative responses to the eFolder, and
  • append the Rebuilt Folder corporate flash.
References:  For more information on
paper format
  • rebuild the folder
  • associate the negative responses with the paper claims folder
  • if necessary, include copies of documents from available claims folders, fiscal records, and education records in the DEA folder, and
  • prominently mark the cover of the rebuilt folder with the words Rebuilt Folder.
Reference:  For more information on standard notations for paper claims folders, see M21-1, Part III, Subpart ii, 3.B.6.b.

III.ii.4.D.1.d.  Combining Folders When the Original Folder Is Located

Use the table below to determine the appropriate actions to take after locating a lost paper claims folder.
If the rebuilt folder is in a(n) …
Then …
electronic format
  • consolidate documents that were obtained from the original folder into the rebuilt eFolder by sending the paper claims folder to the scanning vendor
  • remove the rebuilt folder indicator in BIRLS, and
  • remove the Rebuilt Folder corporate flash.
paper format
  • combine the rebuilt folder and the original folder
  • remove the rebuilt folder indicator in BIRLS, and
  • forward the folder to the controlling operational element for review.
 
References:  For more information on

2.  Requests for 24-Hour Searches

 


Introduction

This topic contains information about 24-hour searches for missing claims folders, including

Change Date

May 2, 2019

III.ii.4.D.2.a.  General Policy on 24-Hour Searches

Request 24-hour searches for missing claims folders
  • by e-mail, and
  • only for claims that require priority processing.
Reference:  For more information on claims that require priority processing, seeM21-1, Part III, Subpart ii, 1.D.1.

III.ii.4.D.2.b.  Procedure for Requesting a 24-Hour Search

Follow the steps in the table below to request a 24-hour search.
Step
Action
1

Compose an e-mail that

  • provides the
    • Veteran’s name
    • claims folder number, and
    • type of mail that necessitates the search, and
  • clearly requests
    • a physical check for the folder in the file banks (if applicable)
    • the folder to be sent to the scanning vendor if found, and
    • a response within 24 hours providing the outcome of the search.
2
Send the e-mail to the VSCM of the
  • RO that BIRLS shows has custody of the folder, and
  • RO where it is reasonable to believe the folder is located (if different than the RO shown in BIRLS).
3
Upon receipt of negative responses from all the ROs that received requests in Step 2, prepare a rebuilt folder.

3.  Claims Folder Number Reconciliation and Cancellation

 


Introduction

This topic contains information on claims folder number reconciliation and cancellation, including

Change Date

May 2, 2019

III.ii.4.D.3.a.  Requirements for Consolidation of Duplicate BIRLS Records and Claims Folders

The RO that is performing the consolidation must have custody and jurisdiction of both corresponding claims folders to consolidate the duplicate BIRLS records.
If the RO that discovered the duplicate records does not have custody of, or hold jurisdiction over, the claims folder(s)/eFolder(s) involved, that RO must request a permanent transfer of the absent claim folder/eFolder.
Exception:  A permanent transfer of the physical claims folder should only be conducted when the folder is located at a Federal records center (FRC).
Reference:  For more information on requesting a claims folder from an FRC, seeM21-1, Part III, Subpart ii, 5.E.3.

III.ii.4.D.3.b.  RO Action When Two BIRLS Records Exist for the Same Veteran

After discovering that two BIRLS records exist for the same Veteran, forward all corresponding documentation, including claims folders and applications, if applicable, to the local intake processing center (IPC).
The IPC is responsible for consolidating the records.  This is accomplished by using the duplicate claim (DUPC) command, which users access through the Benefits Delivery Network.
Exceptions:
  • Do not forward finance activity records to the IPC.
  • Compensation Service will perform the consolidation if the paper claims folder is located at Control of Veterans Records System (COVERS) locations 376 or 101-ICMHS.  The IPC is responsible for preparing the records for consolidation, following the instructions in M21-1, Part III, Subpart ii, 4.D.3.c.
Reference:  For information about using the DUPC command, see M21-1, Part III, Subpart ii, 4.E.

III.ii.4.D.3.c.  Preparing the Records for Consolidation by Compensation Service

The IPC supervisor, or designee, is responsible for following the steps in the table below when one or more of the claims folders are located at COVERS locations 376 or 101-ICMHS.
Step
Action
1
Request expedited scanning of the claims folder using the RMC SMTS Portal.
2
Add to each pending EP associated with the duplicate BIRLS records, the
  • Duplicate Record Consolidation (DUPC) special issue indicator to one contention, and
  • File Requested tracked item.
3
E-mail the National Work Queue (NWQ) staff atVAVBAWAS/CO/NWQ to request transfer of any pending EPs associated with the duplicate records to the Central Office VBMS work queue.
4
Submit an e-mail request for record consolidation toVAVBAWAS/CO/215A.  The e-mail’s
  • subject line must say BDN DUPC Correction, and
  • body must specifically identify which file number/Social Security number is to be
    • retained, and
    • merged or removed.
5
Associate a copy of the e-mail with the claims folder.
Note:  Compensation Service will complete the consolidation and remove the special issue indicator.  The claim will be routed to the appropriate station by NWQ once the special issue indicator has been removed.
References:  For more information on

4.  Missing Claims Material That Were Previously of Record


Introduction

This topic describes the actions to take when claims materials that were previously of record go missing, including


Change Date

January 18, 2017

III.ii.4.D.4.a.  Identifying Missing Claims Material That Was Previously of Record

In some situations, there may be indications that claims materials were previously of record and viewed by RO personnel.  Identify lost claims of this type through review of diaries in the

  • pending issues in the workload management reports, and
  • Modern Awards Processing-Development (MAP-D) system.
Consider a claim lost if there is an electronic record (in Share, MAP-D, or VBMS) of a pending claim but the claims folder contains no documents related to the claim.
References:  For more information regarding

III.ii.4.D.4.b.  Replacing Missing Claims Material That Was Previously of Record

Follow the steps in the table below upon identification of missing claims material that RO personnel may have previously viewed.
Step
Action
1
Ask any employee having knowledge of the facts surrounding the claim, including the date VA received it, to prepare a signedmemorandum for the file containing this and any other relevant information for retention in the claims folder.
Notes:
  • A memorandum with electronic signature capability can be created in the Letter Creator tool under VSC > Lost Claim Letter > GENERATE LOST CLAIM MEMO.
  • The “employee” referenced in this step would include the employee responsible for creating the electronic record referenced in M21-1, Part III, Subpart ii, 3.D.  It might also include any employee who has taken action on the claim and remembers relevant details about it.
2
Ask the employee’s supervisor to sign the memorandum.
3
Determine what claimed issues the pending EP is being used to control.
If the EP is …
Then …
only controlling issues for the lost claim
change the controlling EP to an EP 400,Correspondence.
controlling additional claimed issues
  • continue processing the additional issues, and
  • address the lost claim under the currently pending EP.
4
Send the claimant the Lost Claim Letter from the Letter Creator tool, or equivalent letter from Personal Computer Generated Letters (PCGL).
Note:  The PCGL letter should
  • inform the claimant that his/her claim was lost
  • request that the claimant submit another application as evidence of
    • his/her intent to file a claim, and
    • the scope of the claim
  • request that the claimant resubmit any evidence previously submitted with the claim, and
  • notify the claimant that if the requested evidence is not furnished within one year after the date of the letter, the claim may be considered abandoned under the provisions of 38 CFR 3.158.
5
Clear the EP 400, if one was established, after sending the letter.
 
Note:  If, within one year of the date of the letter referenced in Step 4, a claimant resubmits a claim that VA lost, use the date of receipt of the initial (lost) claim as the date of claim (DOC) when reestablishing EP control.  Otherwise, use the date of receipt of the resubmitted claim.
Reference:  For more information on using the Letter Creator tool, see the Letter Creator User Guide.

5.  Claims Materials That Are Misplaced in the CM System


Introduction

This topic contains information on allegations from claimants or their representatives of lost claims associated with the CM system, including


Change Date

July 27, 2018

III.ii.4.D.5.a.  Fax Confirmation Page the CM Scanning Vendor Provides to Claimants

The scanning vendor provides a single confirmation page to claimants for documents the vendor receives via the designated intake fax number.
The confirmation page
  • is faxed to the claimant’s fax number, and
  • consists of a VA date-stamped copy of the first page of the claimant’s fax transmission.
Note:  The first page of a claimant’s fax transmission is generally, but notnecessarily, a cover sheet.
Reference:  For more information on the intake fax number for the CM scanning vendor, see the VA Mailing Addresses for Disability Compensation Claimswebpage.

III.ii.4.D.5.b.  Resubmission of a Lost Claim With Copy of Fax Confirmation Page

Claimants may resubmit a lost claim, but the claim must be accompanied by a copy of the original fax confirmation page referenced in M21-1, Part III, Subpart ii, 4.D.5.a.
To retain the original DOC, the following must be provided in addition to a copy of the original fax confirmation page:
  • statement from the claimant or his/her representative attesting to timely filing of the original documents, and
  • copies of all the originally faxed documents that match the page count from the original fax confirmation page.
Example:  If the confirmation page shows 10 pages received, including the cover sheet, more than 9 pages of resubmitted documents will not be accepted as eligible to receive the original VA date stamp provided by the CM vendor.
Reference:  For more information on the confirmation page provided to claimants by CM vendors, see M21-1, Part III, Subpart ii, 4.D.5.a.

III.ii.4.D.5.c.  Resubmission of Alleged Lost Claims Absent VA Date Stamped Fax Confirmation Page

If a CM vendor fax confirmation page with a VA date stamp is not provided by the claimant alleging a lost claim, then the original DOC associated with the alleged lost claim cannot be accepted.
References:  For more information on the

6.  Claims Materials Submitted Using a VA Electronic Application Process That Fail to Upload to the eFolder


Introduction

This topic contains information on locating missing claims documents submitted using a VA electronic application process, including


Change Date

July 27, 2018

III.ii.4.D.6.a.  Identifying Claims Submitted Using a VA Electronic Application Process That Failed to Upload to the eFolder

In rare situations, a technical error in the Enterprise Veterans Self Service (EVSS) system, which supports electronic transmission of claims material through eBenefits, Stakeholder Enterprise Portal, and Veterans Online Application Direct Connect, results in the failure of a claims document to upload to the eFolder.  These cases can be identified by
  • an automatically established EP
  • an eBenefits claim label, and
  • the absence of claims documents for the current claim in the eFolder.

 Notes:

  • Claims documents submitted through the Digits-2-Digits (D2D) submission process cannot be recovered when transmission failure occurs.  Upon identifying such a case, follow the instructions in M21-1, Part III, Subpart ii, 4.D.6.d.
  • Claims submitted through D2D can be identified by the D2D claim labels.

III.ii.4.D.6.b.Allowing Time for Automatic Retransmission of Documents That Failed to Upload

In most situations, if claims documents failed to upload through EVSS to the eFolder, the documents will be retransmitted within two weeks without any RO action.
Follow the steps in the table below when a claim is received without supporting claims documents.
Step
Action
1
Add a new contention in VBMS with the following attributes:
In the field …
Enter …
CONTENTION
EVSS
CLASSIFICATION
Administrative Issue
DATE OF CONTENTION
(default to DOC)
TYPE
New
MEDICAL
No
2
Add EVSS Issue as a custom tracked item and set the tracked item suspense to 15 days.
3
Add a note that states:  eBenefits source documents missing.
 
Important:  Ensure the claim goes to Ready to Recall – Yes status.

III.ii.4.D.6.c.  Requesting Retransmission of Claims Documents That Failed to Upload

Follow the steps in the table below if claims documents fail to upload after the 15-day period referenced in Step 2 of the procedure outlined in M21-1, Part III, Subpart ii, 4.D.6.b, ends.
Step
Action
1
Close the EVSS Issue tracked item.
2
Send an encrypted e-mail to the EVSS Help Desk.
  • Enter the following in the subject line of the e-mail:Requesting retransmission of eBenefits documents that failed to upload.
  • Provide the following in the body of the e-mail:
    • date the EP was established
    • claim label
    • VBMS claim identification (ID) number
    • claimant’s name, and
    • an indication of what documents are missing.
3
Upload a copy of the e-mail to the eFolder.
4
Add EVSS Upload Error as a custom tracked item and set the tracked item suspense to 15 days.
5
Add a note that states:  EVSS Help Desk contacted for assistance in obtaining documents that failed to upload.
6
After the 15-day period referenced in Step 4 ends,
  • review the eFolder to determine if the missing documents have been uploaded, and
  • follow the instructions in the table below.
If the documents are …
Then …
available
  • continue processing the claim, and
  • disregard the remaining steps in this table.
not available
follow-up with the EVSS Help Desk until
  • the claims documents are uploaded successfully, or
  • a negative response from the EVSS Help Desk is received, indicating that the claims documents cannot be uploaded.
 
Notes:
  • Extend the suspense date of the EVSS Error tracked item by one week after each follow-up until the
    • claims documents are uploaded successfully, or
    • EVSS Help Desk provides a negative response.
  • Reference the COM ticket number in the follow-up emails.  Upload a copy of all e-mail communication with the EVSS Help Desk to the eFolder.
7
Follow the lost claims procedures in M21-1, Part III, Subpart ii, 4.D.4.b if the EVSS Help Desk provides a negative response.
8
Upload the negative response to the eFolder, if applicable.
  

III.ii.4.D.6.d. Notifying a VSO That Claims Documents Submitted Through D2D Failed to Upload

The D2D application submission process does not have functionality to re-transmit documents that have failed to upload.  Follow the instructions in the table below when claims documents submitted through D2D fail to upload.
Step
Action
1
Add a new contention in VBMS with the following attributes:
In the field …
Enter …
CONTENTION
D2D
CLASSIFICATION
Administrative Issue
DATE OF CONTENTION
(default to DOC)
TYPE
New
MEDICAL
No
2
Send an encrypted e-mail to the Veterans service organization (VSO) that submitted the claims documents.
  • Enter the following in the subject line of the e-mail:  Requesting resubmission of D2D documents that failed to upload.
  • Provide the following in the body of the e-mail:
    • date the EP was established
    • claim label
    • VBMS claim ID number
    • claimant’s name, and
    • an indication of what documents are missing.
3
Upload a copy of the e-mail to the eFolder.
4
Add D2D Upload Error as a custom tracked item and set the tracked item suspense to 15 days.
5
Add a note that states:  VSO contacted for assistance in obtaining documents that failed to upload.
6
Follow the lost claims procedures in M21-1, Part III, Subpart ii, 4.D.4.b if the documents are not uploaded within 15 days.
 
Notes:
Historical_M21-1III_ii_4_SecD_6-3-15.docx May 11, 2019 52 KB
4-14-17_Key-Changes_M21-1III_ii_4_SecD.docx May 11, 2019 71 KB
Historical_M21-1III_ii_4_SecD_7-27-18.docx May 11, 2019 69 KB
5-26-16_Key-Changes_M21-1III_ii_4_SecD.docx May 11, 2019 64 KB
Historical_M21-1III_ii_4_SecD_5-26-16.docx May 11, 2019 67 KB
5-2-19_Key-Changes_M21-1III_ii_4_SecD.docx May 11, 2019 62 KB
Change-June-3-2015-Transmittal-Sheet-M21-1III_ii_4_SecD_TS.docx May 11, 2019 39 KB
1-18-17_Key-Changes_M21-1III_ii_4_SecD.docx May 11, 2019 62 KB
Change-May-8-2015-Transmittal-Sheet-M21-1MRIII_ii_4_SecD_TS.docx May 11, 2019 39 KB
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