Overview
In This Section |
This section contains the following topics:
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1. Routine Review of eFolder Documents and Corporate Flashes
Introduction |
This topic contains information on the review of eFolder documents and adding flashes to a claimant record, including
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Change Date |
September 17, 2018 |
III.iii.1.F.1.a.Routine Review of eFolder Documents |
During routine review of the electronic claims folder (eFolder), all claims processorsmust conduct eFolder maintenance to ensure
Note: To manage the documents associated with the Veteran’s eFolder in VBMS, click the DOCUMENT link on the VETERAN PROFILE screen.
References: For more information on
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III.iii.1.F.1.b.Corporate Flashes |
Corporate flashes are claimant-specific indicators that represent an attribute, fact, or status that may occasionally change (such as former prisoner of war, blind Veteran, homeless, and so on). Regional offices (ROs) are responsible for
Most flashes are added by the end user, but some are generated by the system. Flashes will exist on a claimant’s record until the flash is manually removed. Afterward, new scenarios may arise that necessitate the addition of a new flash. ROs are responsible for identifying and updating flashes when applicable.
Examples:
Corporate flashes may be reviewed on the VETERAN PROFILE screen in VBMS.
Example:
Note: Corporate flashes must be added using Share. Currently, VBMS only contains functionality to view corporate flashes.
Reference: For more information on adding corporate flashes in Share, see theShare Users Guide.
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2. Utilizing Contentions and Special Issue Indicators Associated With the Claimed Issues
Introduction |
This topic contains information on utilizing contentions and special issue indicators associated with claimed issues, including
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Change Date |
February 19, 2019 |
III.iii.1.F.2.a.Identifying Contentions |
Enter issues as contentions when they are
Important:
Examples:
References: For more information on
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III.iii.1.F.2.d.Associating Claims Types to Contentions |
Each contention must have the correct claim type associated with it. When multiple claim types apply, base the contention type on the current theory of entitlement being asserted.
Examples:
References: For more information on
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III.iii.1.F.2.e. Entering a Claim-Specific Special Issue |
The RO has a responsibility to identify any contention that may have a special issue associated to it. Once the RO identifies the contention as having a special issue, the RO must enter a claim-specific special issue indicator that provides additional details about the contention and claim.
Use of special issues is mandatory when the claim meets the criteria for application of the special issue. ROs are responsible for identifying and inputting special issues as required by M21-4, Appendix C, III.b. If a special issue exists and applies to the claim, it is required.
Example: The claimant files a claim for diabetes mellitus due to Agent Orange exposure while serving in Vietnam. Since Agent Orange is identified as a special issue, the diabetes mellitus contention must contain an Agent Orange-Vietnamspecial issue indicator.
Special issues may need to be updated throughout the life of a claim. It is important that claims processors are vigilant in identifying when the circumstances of the claim require the addition, removal, or editing of special issue indicators.
Example: The claimant submits a fully developed claim (FDC), and the claims processor properly applies the FDC special issue indicator to one of the contentions associated with the claim. The claim is later excluded from the FDC Program based on evidence received after claims establishment, so the claims processor changes the FDC special issue from Fully Developed Claim to FDC Excluded – Evidence Received After FDC CEST.
Follow the steps in the table shown below when entering a claim-specific special issue indicator to a contention in VBMS.
Note: To delete a special issue indicator from a contention, click on the CLAIM DETAILS screen and then select the TRASH CAN icon next to the special issue to be deleted.
Reference: For more information on how to apply a special issue indicator to a contention in VBMS, see the VBMS Job Aid – Adding Special Issues in VBMS.
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III.iii.1.F.2.f.Properly Applying Special Issues |
Special issues must be applied or updated after they are identified. Use the table below to determine how to apply special issues to contentions.
References: For more information about
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3. Utilizing Tracked Items to Document Development
Introduction |
This topic contains general information on utilizing tracked items to document development, including
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Change Date |
September 17, 2018 |
III.iii.1.F.3.b. Creation of Tracked Items |
Tracked items are established automatically for corresponding development actions when creating and finalizing development letters in VBMS or MAP-D. Custom tracked items can be manually established by the claims processor; however, custom tracked items may not be used if a standard tracked item for the claim action already exists.
References: For more information on
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III.iii.1.F.3.c. Tracked Item Dispositions |
Tracked items must be updated with the appropriate date and disposition to reflect the status of the corresponding request or development action. Use the table below to determine the appropriate date and disposition to use when updating tracked items.
References: For more information on
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III.iii.1.F.3.d. Tracked Item Automation |
If the suspense date for an open, non-actionable tracked item has expired, and no response, either positive or negative, was received in reply to the request, VBMS will automatically close the tracked item by entering the suspense date into theClosed disposition. A tracked item is considered non-actionable if no action is required at the expiration of the suspense date.
If the last remaining tracked item is manually updated by adding a date in theClosed, Received, or In Error disposition, VBMS automatically sets the status and claim-level suspense reason to
References: For more information on
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4. Updating Claim Status
Introduction |
This topic contains information on updating the status of a claim, including
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Change Date |
September 17, 2018 |
III.iii.1.F.4.a. Claim Status |
Claim status is used to determine actions that are pending on a claim and provide more accurate customer service. Claims processors are responsible for updating claim status to indicate the approximate stage at which a claim is in the claims process.
Use the table below to determine the appropriate claim status.
References: For more information on updating the claim status in
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5. Advancing Suspense or Diary Dates
Change Date |
September 17, 2018 |
III.iii.1.F.5.a. Managing Suspense and Diary Dates Through the Claims Process |
The Veterans Benefits Administration’s mission is to serve Veterans and their eligible dependents and survivors in the most timely and accurate manner possible. It is only appropriate to extend suspense or diary dates if it is necessary for a specific adjudicative action.
Suspense dates must always correspond with specific actions and may not be arbitrarily extended under any circumstance.
Important: When employees handle a claim, they are expected to take the most full and complete action possible on a claim every time – including development, rating, and promulgation actions – to move a claim forward to accurate completion in the claims process. Every effort must be made to move the claim to the next processing cycle each time it is handled.
References: For more information on
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Historical_M21-1III_iii_1_SecF_1-11-18.docx | May 12, 2019 | 142 KB |
Historical_M21-1III_iii_1_SecF_10-27-17.docx | May 12, 2019 | 140 KB |
Historical_M21-1III_iii_1_SecF_2-1-18.docx | May 12, 2019 | 131 KB |
Historical_M21-1III_iii_1_SecF_9-17-18.docx | May 12, 2019 | 135 KB |
2-19-19_Key-Changes_M21-1III_iii_1_SecF.docx | May 12, 2019 | 110 KB |
9-17-18_Key-Changes_M21-1III_iii_1_SecF.docx | May 12, 2019 | 115 KB |
10-27-17_Key-Changes_M21-1III_iii_1_SecF.docx | May 12, 2019 | 118 KB |
2-1-18_Key-Changes_M21-1III_iii_1_SecF.docx | May 12, 2019 | 119 KB |
in Chapter 1 Rules and Process, Part III General Claims Process, Subpart iii General Development and Dependency Issues
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