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M21-1, Part III, Subpart iii, Chapter 1, Section F – Record Maintenance During the Development Process

Overview


In This Section

 
This section contains the following topics:
Topic
Topic Name
1
2
3
4
5

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

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
  • end product (EP) controls are consistent with the claims document, including use of the correct
    • date of claim
    • EP series, and
    • claim label
  • information regarding the Veteran’s service dates and character of discharge in VA systems are consistent with the evidence in the eFolder, including
    • the Veterans Benefits Management System (VBMS)
    • Benefits Identification and Records Locator Subsystem (BIRLS), and
    • Participant Profile
  • the claims folder contains proper documentation of claimant representation, including system updates of
    • Share, and
    • VBMS
  • any documents identified as duplicate upon review are managed in accordance with M21-1, Part III, Subpart ii, 4.G.2.q
  • any documents reviewed are indexed properly in accordance with M21-1, Part III, Subpart ii, 4.G.2.r
  • any misfiled document(s) are removed and transferred to the proper claims folder(s) following the procedures outlined in M21-1, Part III, Subpart ii, 4.G.2.c, and
  • all pertinent evidence is properly noted, bookmarked, and/or annotated, following the respective guidance found in
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

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
  • identifying claimants’ records that require flashes
  • inputting the flashes when required, and
  • removing the flash when it no longer applies.
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:
  • Add the Foreign Claim flash when the claimant resides in a foreign country and remove it when the scenario changes.
  • Add the Homeless flash when the case involves a homeless Veteran and remove it when the scenario changes.  The Formerly Homeless flash may then be applied, as indicated in M27-1, Part II, 3.m.
Corporate flashes may be reviewed on the VETERAN PROFILE screen in VBMS.
Example:

Flash screen from VBMS

 

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.

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

Change Date

February 19, 2019

III.iii.1.F.2.a.Identifying Contentions

 
Enter issues as contentions when they are
  • expressly claimed by the claimant/Veteran/authorized representative, and/or
  • put at issue and require development.
Important:
  • This information will be made available via eBenefits and should be easy to understand and in the claimant’s own words, as appropriate.
  • The use of contentions for each claim is mandatory; claims processors must enter them as they identify issues associated with a claim.
  • Each issue, including non-rating issues, must be entered as a separate contention.
  • Non-rating contentions must relate to the specific benefit being sought.
  • Mandatory language and format must be used for dependency claims.  An example of the mandatory language and format is presented below.
  • A claim for total disability due to individual unemployability is treated as a claim for increase in the service-connected (SC) disabilities that the Veteran identifies as causing unemployability.  Therefore, the identified SC disabilities must be entered as individual contentions.
Examples:
  • A Veteran submits a claim for ringing in the ears.  The contention should be entered as ringing in the ears.
  • A Veteran submits a claim to add a spouse and a child to a running award.  Create separate contentions for the spouse and child as follows:
    • Dependency claim for [name of spouse], and
    • Dependency claim for [name of child].
  • VA receives a claim for “increase in diabetes mellitus to include heart, depression, and numbness in hands.”   The contentions should be entered as
    • diabetes mellitus
    • heart condition
    • depression, and
    • numbness in hands.
  • A Claims Assistant establishes a claim for “bilateral knees.”  A review of the corporate record indicates the Veteran is SC for right knee patellofemoral pain syndrome and was previously denied service connection (SC) for a left knee strain.  The contentions should be entered as
    • right knee patellofemoral pain syndrome (claimed as bilateral knees), and
    • left knee strain (claimed as bilateral knees).
References:  For more information on

III.iii.1.F.2.b.Verifying Contentions

 
 
All contentions must be verified in order for them to be available via eBenefits.
Contentions automatically entered by the system that are missing critical information, such as the contention classification, will be marked as unverified.  The claims processor must update the missing/incorrect information and select the SAVE button.  The contention will then be marked as verified and viewable in eBenefits.  All employees reviewing a claim are responsible for ensuring all contentions are correct and verified.

III.iii.1.F.2.c.  Contention Classification and Examination Management

 
The CLASSIFICATION and MEDICAL fields are required components when entering a contention.
  • When selecting a classification, use
    • appropriate medical verbiage that corresponds to the claimed medical condition, instead of the claimant’s original language, and
    • the Administrative classification only for non-rating issues, such as dependency.
  • Select Yes in the MEDICAL field if the contention may require an examination or medical opinion to make a determination.  Otherwise, select No.
Exception:  Individual unemployability as a contention must be identified by
  • selecting Unemployability as a classification in order to complete necessary specific development actions in VBMS, and
  • selecting Yes in the MEDICAL field.

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:
  • A Veteran claims an increase in her SC peripheral neuropathy of the left lower extremity.  SC was previously granted on a secondary basis associated with the Veteran’s SC diabetes mellitus, type II.  Although SC was originally granted on a secondary basis, the current claim is for an increased evaluation.  Therefore, the correct contention claim type isIncrease.
  • VA receives a claim for a right knee disability from an altered gait, due to the Veteran’s SC left ankle fracture.  The claim was previously denied on a direct basis because the evidence did not show the disability occurred in service.  Although the claim was originally claimed on a direct basis, the current claim is based on a secondary SC theory of entitlement and should be labeled Secondary.
  • A Veteran is SC for migraines.  An examiner indicates the condition is likely to improve.  A diary date for a review examination is set.  When the EP is established for the routine future examination, the contention type for migraines would be RFE.
References:  For more information on

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.
Step
Action
1
Under the CONTENTION tab, select the SPECIAL ISSUES drop-down arrow.
Example:
 adding a special issue screen under a contention in VBMS
2
Select the appropriate special issue to be associated to the contention.
Example:
 selecting the appropriate special issue to be associated with the contention
3
Select the SAVE button to save the special issue or the CANCEL button to discard the changes.
Note:  To add another contention after adding special issues, select the SAVE AND ADD button.
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.

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.
If the special issue applies to …
Then apply the special issue to …
the claim
one contention.
Examples:
  • Special Ops Claim
  • Fully Developed Claim
  • FDC Excluded – Needs Non-Fed Evidence Development
a contention
each applicable contention.
Examples:
  • Agent Orange – Vietnam
  • Asbestos
  • Burn Pit Exposure
References:  For more information about

 

3.  Utilizing Tracked Items to Document Development

 


Introduction

 
This topic contains general information on utilizing tracked items to document development, including

Change Date

September 17, 2018

III.iii.1.F.3.a.Purpose of Tracked Items

The purpose of tracked items is to control receipt or non-receipt of information/evidence requested from the claimant, beneficiary, or other information/evidence provider.  The status of individual tracked items will be visible through eBenefits.

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

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.
Tracked Item Disposition
Description
Received
Use this when requested information/evidence is received or a negative response from the information/evidence provider is received.  For a negative response, create a system note to communicate this information.
Closed
Use this to administratively close a tracked item for non-receipt. Generally, the earliest date an item can be closed is upon review that the suspense date has expired and the timeframe given for a response has elapsed. This includes any necessary follow-ups.
Note:  If a tracked item is closed due to non-receipt but the evidence is received later, while the claim is still pending, the new “received” date will supersede the prior “closed” date.
In Error
Use this to administratively close tracked items that were erroneously created or evidence that was requested in error.
Follow Up 1 or Follow Up
Use this to track the date evidence was requested for a second time.
Follow Up 2 or 2ndFlwUp
Use this to track the date evidence was requested for a third time.
References:  For more information on

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 theClosedReceived, or In Error disposition, VBMS automatically sets the status and claim-level suspense reason to
  • Ready for Decision for rating claims, and
  • Ready to Work for non-rating claims.

References:   For more information on


III.iii.1.F.3.e.  Accuracy of Tracked Items

 
It is the responsibility of the claims processor reviewing or taking action on a claim to ensure that
  • the necessary tracked items have been generated
  • all suspense dates are accurate, and
  • the disposition of all tracked items have been accurately managed, to include any automated tracked item actions.
Important:  The accuracy of the claim-level suspense reason and date is dependent on properly generated and managed tracked items.

III.iii.1.F.3.f. Determining That a Claim Is Ready for a Decision

 
The receipt or closing of all tracked items does not necessarily mean that the claim is ready for a decision.  This determination must be based on an analysis of the evidence of record.  A claim is considered ready for a decision after all the requested evidence has been received or otherwise accounted for, ensuring VA’s obligations to assist the claimant have been met.

4.  Updating Claim Status


Introduction

 
This topic contains information on updating the status of a claim, including

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.
Claim Status
Definition
Open
Default status for claims not in any other status. Claims typically stay in this status during claims development.
Ready for Decision
Signifies that the claim is ready for a rating decision.
Ready for Work
Signifies that the claim is ready for a non-rating decision.
Rating Decision Complete
Signifies that a rating decision has been completed and is awaiting promulgation.
Rating Correction
Signifies that a rating decision correction is needed.
Rating Incomplete
Signifies that a rating decision was returned to corporate from the work pending column.
Closed
The claim is complete with no further action possible.
Cancelled
The claim is cancelled with no further action possible.
References:  For more information on updating the claim status in

III.iii.1.F.4.b.  Claim-Level Suspense

 
The claim-level suspense reason and date will automatically update based on tracked items when a claim is in Open status.
Each tracked item will automatically map to a claim-level suspense reason.
When the claim status is a status other than Open, and a tracked item is added or an existing tracked item is opened, the system will automatically set the claim status to Open and update the claim-level suspense reason and date based on the opened tracked item(s).
The claim-level suspense reason and date will be updated by the claim status when the claim status is anything other than Open.

 

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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