III.v.1.G.2.b. Actions to Take When VA Is Paying Benefits to a Dependent Under 38 CFR 3.656
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Follow the steps in the table below if VA is paying benefits to a dependent under 38 CFR 3.656 at least seven years after the Veteran’s disappearance.
Step
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Action
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1
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Does an explanation exist for the Veteran’s absence?
Note: Claims processors may conclude an explanation for a Veteran’s absence exists even though there is no evidence the Veteran is still alive.
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2
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Determine whether all of the following conditions are evident:
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The Veteran failed to claim benefits to which he/she is likely entitled.
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The Veteran’s age, were he/she alive, exceeds average life expectancy (at birth, based on the Veteran’s gender) by at least 10 years.
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No evidence that the Veteran is still living exists.
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3
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Are all of the conditions described in Step 2 evident?
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4
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5
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Of the conditions described in Step 2, is the second one (the Veteran’s age, were he/she alive) the only condition that is not evident?
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6
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7
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Within the 60-day period referenced in the preceding step, did VA receive VA Form 21P-1775 from each of the three individuals to whom the form was sent for completion?
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If yes, go to Step 12 after
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completing any additional development that is necessary to determine whether an explanation for the Veteran’s absence exists, and
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requesting and reviewing the results of a field examination, if a field examination is necessary and appropriate.
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If no, go to the next step.
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prior to March 24, 2015, treat it as an informal claim for survivors benefits, or
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on or after March 24, 2015, treat it as a request for an application for survivors benefits.
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8
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Prepare and send a notice of proposed adverse action that contains the elements set forth in M21-1, Part I, 2.B.2.
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9
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Did the dependent submit all three of the forms referenced in Step 6 within 65 days of the notice referenced in Step 8?
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10
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Discontinue the Veteran’s award (including the payment of insurance premiums and benefits under 38 CFR 3.656) effective the date in the LAST PAID DATE field on the AWARD INFORMATION tab in Share.
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11
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12
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Does an explanation for the Veteran’s absence now exist?
Note: Claims processors may conclude an explanation for a Veteran’s absence exists even though there is no evidence the Veteran is still alive.
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13
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Are all of the conditions described in Step 2 evident?
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14
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15
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16
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Notes:
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A Veterans Service Center Manager (VSCM) or Pension Management Center Manager (PMCM) must approve administrative decisions that establish a presumption of death.
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VSCMs and PMCMs may delegate the authority to approve the referenced administrative decision to a supervisor not lower than a coach.
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17
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Prepare and send a notice of proposed adverse action that contains the elements set forth in M21-1, Part I, 2.B.2.
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Go to the next step unless the dependent submits evidence within 65 days that shows VA should continue paying benefits to him/her under 38 CFR 3.656.
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18
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Discontinue the Veteran’s award (including the payment of insurance premiums and benefits to the dependent) effective the date in the LAST PAID DATE field on the AWARD INFORMATION tab in Share.
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19
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Notify the dependent of the action taken.
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20
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Invite other eligible survivors to submit VA Form 21P-534EZ if their names and addresses are of record.
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21
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E-mail a copy of the administrative decision to Director, Compensation Service (211B), for administrative review.
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22
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Was VA deducting benefits from the Veteran’s award for the payment of insurance premiums?
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If yes, send a copy of the administrative decision to Insurance Service.
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If no, take no further action.
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References: For more information on
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