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M21-1, Part III, Subpart v, Chapter 2, Section B – Decision Notices

Overview


In This Section

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

1.  Notification Requirements


Introduction

This topic contains information on notification requirements, including


Change Date

February 19, 2019

III.v.2.B.1.a.  Notifying a Claimant or Beneficiary of a Potentially Adverse Decision

In most cases, the Department of Veterans Affairs (VA) must give a claimant or beneficiary advance notice of a decision that might adversely affect him/her.  The legal term for this is “due process.”  Decisions that may require advance notice include, but are not limited to, those involving the
  • character of a former service member’s discharge
  • competency of a claimant or beneficiary to manage his/her financial affairs, and
  • reduction or discontinuation of a VA benefit.
Follow the guidance in M21-1, Part I, 2.B.1 and M21-1, Part I, 2.D.1 to determine whether VA
  • must issue notice before taking an adverse action, or
  • may issue notice at the same time it takes the adverse action (also known as “contemporaneous notice”).
Reference:  For more information about due process, see M21-1, Part I, 2.A.1.

III.v.2.B.1.b.   Decision Notice Requirements

After making a decision on a claim, prepare a decision notice that
independently, or in combination with its enclosures (such as a rating decision or administrative decision),
  • informs the claimant of the issues adjudicated
  • summarizes the
    • evidence VA considered
    • laws and regulations applicable to the claim, and
    • applicable review options the claimant may use to seek further review of the decision
  • explains how to obtain or access evidence used in making the decision
  • identifies, if applicable, the criteria required to grant service connection (SC) or the next-higher level of compensation, and/or
  • identifies
    • for denied claims, the element(s) required to grant the claim that were not met, and
    • a listing of findings that are favorable to the claimant under 38 CFR 3.104(c), if any.
If the enactment of a decision resulted in the creation of an overpayment in a beneficiary’s account, notify the beneficiary of the overpayment and his/her right to request
  • a waiver of the overpayment, and/or
  • a repayment plan.
When VA grants entitlement to a benefit, or makes an adjustment to a running award, the decision notice must also notify the claimant of
  • the monthly rate of payment
  • the effective dates of entitlement and payment
  • the amount of any benefits VA is withholding and the reason for the withholding, and
  • information about any additional benefits to which the claimant may be entitled.
Notes:
  • Although the effective date of entitlement must be identified in conjunction with any decision to grant a benefit (compensable or otherwise), a decision notice need only specify monthly rates of payment and effective dates of payment if it is intended to communicate a(n)
    • initial award of monetary benefits, or
    • subsequent award of benefits that
      • modifies the affected Veteran’s combined disability rating, or
      • otherwise alters the current rate of payment.
  • Adjustments of benefits, such as for receipt of drill pay or incarceration, unassociated with an active claim for disability compensation, pension, death benefits, or dependency, does not require a listing of findings that are favorable to the claimant under 38 CFR 3.104(c).
  • When preparing a decision notice regarding a pension or Parents’ Dependency and Indemnity Compensation (DIC) claim, claims processors must include in the notice
    • rate tables, and
    • information about the claimant’s income and medical expenses.
  • Follow the guidance in M21-1, Part V, Subpart iii, 1.G.4.k when providing notice to claimants regarding prospective medical expenses.
References:  For more information on

III.v.2.B.1.c.  Failure to Issue a Decision Notice 

If a regional office (RO) decides a claim but fails to notify the claimant of the decision, the claim remains open, legally, even if the RO clears the corresponding end product (EP).  Under such circumstances, if VA denied entitlement to a benefit, failed to notify the claimant of the denial, and then granted entitlement to the same benefit years later, the claimant might be entitled to benefits retroactive to the initial date of claim, because the decision on the initial claim never became binding.
In order to avoid the situation described in the preceding paragraph, claims processors must follow the
If VA made a decision on a claim, but a corresponding decision notice cannot be located in the claimant’s claims folder, proceed as if the claimant was never notified of the decision.
References:  For more information on

III.v.2.B.1.d.  Requirement to Use a Single Decision Notice

Use a single decision notice to notify a claimant of a VA decision, even if the decision involves both an award and a denial of benefits.
Important:  All decision notices must meet the requirements of M21-1, Part III, Subpart v, 2.B.1.b.
Examples:  The following illustrate decisions that involve both an award and a denial of benefits:
  • VA awards SC for one disability but denies SC for another.
  • VA awards entitlement to pension but denies entitlement to special monthly pension (SMP).

III.v.2.B.1.e.  Rules for Preparing a Decision Notice

When preparing a decision notice
  • use
    • clear and concise wording, and
    • a customer-friendly and compassionate tone
  • provide complete and accurate information concerning the issue(s) addressed, and
  • avoid using VA jargon, to include
    • abbreviations with no accompanying definition, and
    • phrases such as
      • service connection not found
      • disability not due to service, or
      • wanton and reckless disregard of the probable consequences.

III.v.2.B.1.f.   Requirement  to Provide a Summary of Evidence in a Decision Notice

Claims processors must summarize (for the benefit of the claimant) the evidence VA considered in reaching a decision in the corresponding decision notice.
Notes:
  • If a decision notice was preceded by a notice of proposed adverse action, as described in M21-1, Part III, Subpart v, 2.B.1.a, there is no need to re-summarize in that decision notice any evidence referenced in the notice of proposed adverse action.
  • The list of evidence provided in the decision notice must identify individual documents deemed relevant to the determination at hand and may notrely solely on general references to review of the claims folder.
  • Rating decisions contain a summary of the evidence VA considered when deciding any rating-related issues.  As long as the claimant will receive a copy of the rating decision, there is no need to summarize this same evidence in the decision notice.
  • Decision notices regarding a VA rating decision that claims processors generated using Automated Decision Letter (ADL) did not include a copy of the rating decision.  In order to comply with the requirement to provide claimants a summary of the evidence the rating activity considered, ADL copied the evidence the rating activity listed in the rating decision and pasted it into the decision notice.  This approach changed on December 11, 2017, when Redesigned ADL (RADL) was deployed.  Now, decision notices that notify a claimant of a rating decision include a copy of the rating decision.
Reference:  For detailed guidance on summarizing evidence in a decision notice, see the Veterans Benefits Management System (VBMS) Awards User Guide.

III.v.2.B.1.g.  Rules for Summarizing Evidence in a Decision Notice

When formulating a summarized list of relevant evidence for inclusion in the decision notice,

  • use descriptive identifiers, such as
    • form names
    • document types (for example, divorce decree or birth certificate), and/or
    • date of receipt, and
  • refer to the evidentiary naming conventions discussed in M21-1, Part III, Subpart iv, 6.C.4.c.

Note:  Do not use a form number without also providing the title of the form.


III.v.2.B.1.h.   Rules for Providing the Reason(s) for a Decision in a Decision Notice

The table below describes the action claims processors must take in order to meet the requirement to provide in a decision notice the reason(s) for a decision.
Type of Decision
Action
rating decision
The rating activity is responsible for explaining the basis for its decisions in the Reasons for Decision section of each rating decision.  The attachment of a copy of the rating decision to the corresponding decision notice satisfies the requirement for providing in the decision notice the reason(s) for the rating decision.
Reference:  For more information on the rating decision narrative, see M21-1, Part III, Subpart iv, 6.C.
decision made by the authorization activity that doesrequire an administrative decision
The authorization activity is responsible for explaining in the body of the administrative decision the reasons and bases for said decision.  The attachment of a copy of the administrative decision to the corresponding decision notice satisfies the requirement for providing in the decision notice the applicable elements identified in M21-1, Part III, Subpart v, 2.B.1.b.
Reference:  For a sample format for an administrative decision, see M21-1, Part III, Subpart v, 1.A.3.g.
decision made by the authorization activity that does not require an administrative decision
The authorization activity must provide in the decision notice sufficient detail regarding the rationale used in reaching the decision to ensure the claimant will understand its basis.  (This might require restating applicable regulation(s) in laymen’s terms.)
Reference:  For more information on decision notice requirements, see M21-1, Part III, Subpart v, 2.B.1.b.

III.v.2.B.1.i.  Denials of Entitlement to One Benefit That Imply a Denial of Entitlement to Other Benefits

There is no requirement to specifically address in a decision notice the issue of entitlement to additional benefits for one or more dependents if VA ultimately denies the underlying claim for disability or survivors benefits.
Example:
Scenario:  A Veteran submits an original claim for SC for six disabilities and additional compensation for a spouse and minor child.  The rating activity subsequently renders a decision denying SC for all six disabilities.
Result:  The associated decision notice must adequately communicate the denial of SC for the six disabilities but need not separately or specifically address entitlement to (or summarize evidence submitted in support of a claim for) additional compensation for dependents.
Rationale:  The decision to deny SC carries with it an implied denial of additional compensation for dependents.  It is reasonable to conclude the Veteran comprehends that a principal denial of disability compensation precludes entitlement to additional compensation for dependents.
Reference:  For information on handling claims for additional compensation for dependents from Veterans with a combined disability rating that is less than 30 percent, see M21-1, Part III, Subpart iii, 5.L.1.e.

III.v.2.B.1.j.Providing Review Rights in a Decision Notice

To meet the requirement to provide review rights in a decision notice,
Important:  The instructions in this block primarily apply to decision notices claims processors generate using Personal Computer Generated Letters (PCGL).  RADL automatically
  • inserts text into decision notices under the heading What You Should Do If You Disagree With Our Decision, and
  • attaches to decision notices the form referenced above.
Reference:  For more information on appellate decisions that award all or some of the benefits sough, see M21-1, Part I, 5.D.2.b and c.

III.v.2.B.1.k.  Notifying Claimants of Potential Entitlement to Additional Benefits

When preparing a decision notice, notify the claimant of any additional benefit(s) to which potential entitlement exists and, if applicable, the form or web site available for applying for the benefit(s).
The table below lists
  • additional benefits to which a claimant may be entitled
  • the form for applying for each benefit, and
  • references to additional information about these benefits.
Benefit
Form
Reference(s)
Veterans’ Group Life Insurance
vocational rehabilitation
health care forservice-connected (SC) disabilities
automobile or adaptive equipment
special adaptive housing
clothing allowance
Dependents’ Educational Assistance (DEA)
SMP
additional benefits for a spouse/children
 
Note:  It is unnecessary to solicit a claim for additional benefits for dependents in a decision notice when
  • the decision notice already makes reference to a decision VA made regarding the claimant’s entitlement to additional benefits for a dependent or dependents, or
  • the decision notice includes a request for information/evidence to establish entitlement to additional benefits for a dependent or dependents.
increased pension based on unreimbursed medical expenses
accrued benefits
substitution in case of death of claimant
 
Important:  RADL-generated decision notices automatically inform claimants of
  • additional benefit(s) to which they might be entitled
  • the forms they must submit to apply for the additional benefit(s), and
  • phone numbers and web sites they may use to obtain additional information.

III.v.2.B.1.l.  Other Decision-Related Issues to Consider

The table below lists
  • issues authorization activity commonly faces when
    • processing an award or denial of benefits, and
    • preparing a decision notice, and
  • references to additional information about the issues.
Issue(s)
Reference(s)
  • elections between benefits
  • waivers of VA benefits
  • recoupment of separation pay, and
  • adjustments based on receipt of military retired pay.
apportionments
awards to incompetent beneficiaries through a fiduciary or guardian
adjustments or reductions due to hospitalization
adjustments based on incarceration
reduction of pension based on residence in a Medicaid-covered nursing home
effect of income and net worth on pension entitlement
entitlement to DEA for the dependent(s) of a severely injured service member who is still on active duty

III.v.2.B.1.m.  Steps to Follow After Preparing a Decision Notice

After preparing a decision notice,
  • review it for completeness and accuracy, making corrections as needed
  • ensure the notice date reflects the expected date of mailing
  • ensure that the notice is addressed to the
    • claimant or beneficiary at the most recent address of record, or
    • claimant’s or beneficiary’s fiduciary, if VA has appointed one
  • ensure that the notice and any other associated documents that must be provided to the claimant or beneficiary are included in a package, created in VBMS Package Manager, and transmitted for centralized printing and mailing, and
  • confirm that a copy of the decision notice has been included in the eFolder.
Exception:  Locally print and mail the decision notice and any associated documents where centralized printing is not permitted, such as in cases involving Federal tax information (FTI).
Important:  When preparing a decision notice, ensure that the decision notice is copied to
  • a claimant’s or beneficiary’s power of attorney (POA), if he/she selected one that VA recognizes, and
  • the claimant or beneficiary, if VA has appointed him/her a fiduciary.
References:  For more information on

III.v.2.B.1.n.  Erroneous Notification of SC

If VA mistakenly notifies a claimant that it has established SC for a claimed disability then later corrects the notice to state VA denied SC, the decision review period begins on the date VA sent the corrected decision notice to the claimant.
Important:  The Supreme Court held in OPM v. Richmond, 496 U.S. 414 (1990) that
payments of money from the Federal Treasury are limited to those authorized by statute, and erroneous advice given by a Government employee to a benefit claimant cannot stop the Government from denying benefits not otherwise permitted by law.
Note:  Since the rating decision is not in question, the
  • authority to sever SC is absent
  • error was not in the decision, but in the communication of that decision, and
  • claimant never met the statutory requirements for the benefit.

III.v.2.B.1.o.  Restrictions Placed on the Disclosure of Draft Rating Decisions

Draft rating decisions and decision notices are not intended to be binding on VA and must not be shared with or transmitted to VA claimants or beneficiaries.
Important:  ROs and call centers must ensure that decisions and notices that havenot yet been finalized are not provided or communicated to claimants.
References:  For more information on

III.v.2.B.1.p.  Forgoing Notice of Backfill Rating Decisions

Do not prepare or release a decision notice or rating decision that is generated solely for the purpose of
  • backfilling converted rating data, or
  • updating the beneficiary’s corporate record without substantively altering it.
Such rating decisions are internal record-keeping mechanisms undertaken to facilitate proper award processing and do not, in and of themselves, constitute new or free-standing entitlement determinations.

 

2.  Special Requirements for Visually Impaired Veterans


Introduction

This topic contains information on identifying and providing notification to visually impaired Veterans, including


Change Date

December 14, 2018

III.v.2.B.2.a.  Recognition and Decision Notice Preparation

visually impaired Veteran is any Veteran
  • with visual impairment (SC or non-service-connected) for which VA has assigned a disability rating of at least 70 percent, or
  • who has expressly requested that VA accommodate his/her visual impairment (whether VA has evaluated the disability or not) with modified correspondence and communication methods.
Claims processors are responsible for ensuring that visually impaired Veterans’
  • claims folders and corporate records are appropriately flashed for ease of recognition, and
  • decision notices are formatted with enlarged font to enhance visibility.
When processing a decision made on the claim of a visually impaired Veteran,
  • reverse file VA Form 21-0178, Visually Impaired Veteran, in the center section of the Veteran’s paper claims folder, if one exists
  • add the Blind Veteran flash to the Veteran’s corporate record in Share, and
  • prepare a decision notice using 18-point font.
Note:  Text in the right sidebar of letters generated using RADL will remain in 8-point font.
Reference:  For information about adding a flash to a Veteran’s record, see

III.v.2.B.2.b.  Attempting Telephonic Contact 

Once the decision notice discussed in M21-1, Part III, Subpart v, 2.B.2.a is finalized and submitted for mailing, a claims processor must make a minimum of three attempts to contact the visually impaired Veteran by telephone to explain the substance of the decision.
The claims processor responsible for disposing of the associated EP must
  • provide to the Veteran a general summary of the decision(s) VA made
  • inform the Veteran that

    • the decision notice is forthcoming, and
    • any additional questions concerning the notice’s content may be directed to the National Call Center, and
  • document

3.  Decision Notices Containing FTI


Introduction

This topic contains information about decision notices containing FTI, including

Change Date

May 16, 2018

III.v.2.B.3.a.  Protecting FTI

Agencies or agents that legally receive FTI directly from the Internal Revenue Service, or secondary sources such as the Social Security Administration, musthave adequate programs in place to protect the data received.
Reference:  For more information on safeguarding FTI, see M21-1, Part X, 9.B.

III.v.2.B.3.b.  Process for Handling Decision Notices Containing FTI

The table below describes the process for handling decision notices that contain FTI.
Stage
Who Is Responsible
Actions
1
Veterans Service Representative (VSR)
  • Ensures the notice contains a header in bold font on every page with the text CONTAINS FTI
  • prints one copy of the notice but does not scan the barcode
  • delivers the notice directly to a Senior VSR (SVSR) for review and approval, and
  • updates the corresponding FTI security log to reflect movement of the notice once it is either delivered to the SVSR or stored securely.
Note:  If the VSR is unable to deliver the notice directly to an SVSR, the VSR must store the notice in a secure location until he/she can make the delivery.
 
Reference:  For information on using PCGL with Veterans Service Network (VETSNET) Awards, see theLetter Generation section of the VETSNET Awards Handbook.
2
SVSR
Follows the instructions in the table below.
If the …
Then …
  • notice is appropriate for release to the claimant, and
  • claimant has a valid POA of record (executed within the past five years)
  • prints another copy of the letter for the POA
  • ensures the
    • delivery address is correct for the
      • claimant, and
      • POA, and
    • envelope is sealed, unless local procedures state otherwise
  • delivers the envelopes directly to a designated, secure mail drop-off point for pickup by a mailroom employee
  • prints an additional copy of the letter and places it in a secure location for pickup by an imaging employee, and
  • updates the FTI security logs for each of the secure locations.
  • notice is appropriate for release to the claimant, and
  • claimant does nothave a valid POA of record (executed within the past five years)
  • ensures the
    • delivery address is correct for the claimant, and
    • envelope is sealed, unless local procedures state otherwise
  • delivers the envelope directly to a designated, secure mail drop-off point for pickup by a mailroom employee
  • prints an additional copy of the notice and places it in a secure location for pickup by an imaging employee, and
  • updates the FTI security log for each of the secure locations.
notice is notappropriate for release to the claimant
  • places all paper copies of the rejected notice in a secure location for destruction, and
  • updates the corresponding FTI security log.
 
Notes:
  • ROs may immediately destroy decision notices that an SVSR decides are not appropriate for release to a claimant.  There is no minimum waiting period for destruction.
  • If a VSR/SVSR is unable to deliver a decision notice directly to a designated, secure drop-off point for destruction, he/she must ensure it is stored securely until delivery is possible.
3
Imaging Employee
  • Scans the notice into Legacy Content Manager (LCM) using a cover sheet with the bar code that inserts documents into the restricted FTI folder in LCM
  • stores the notice in a secure location pending its destruction, and
  • updates the corresponding FTI security log to reflect the
    • status of the notice, and
    • scheduled date for destruction.
Note:  A minimum of 90 days (from the date of imaging) must pass before an RO may destroy an imaged document.
4
Mailroom Employee
  • Delivers the sealed envelope(s) containing the notice(s) to the U.S. Postal Service, or
  • stores the sealed envelopes in a secure location until delivery to the U.S. Postal Service is possible.
Important:  Centralized printing is not approved for decision notices that include FTI.
Reference:  For more information on creating packages using Package Manager for centralized printing and distribution through CBCM, see VBA Learning Catalog – Centralized Benefits Communications Management (CBCM) Phase One – Centralized Printing (4415957).

4.  Decision Notices Prepared Using the RADL Process


Introduction

This topic contains information on decision notices generated using RADL, including

Change Date

 February 19, 2019

III.v.2.B.4.a.  Overview of RADL

The RADL functionality within the VBMS – Awards (VBMS-A) provides for the automated generation of decision notices. Rules-based logic inserts into decision notices system-generated language based on the specific decision(s) VA made on a claim.
The use of system-generated language allows for the standardization of decision notices, while streamlining the process for the end-user.
Important:
  • Pension management centers (PMCs) may use ADLs for burial claims; however, PMCs are not currently authorized to use RADLs or ADLs to generate decision notices for pension claims.
  • The promulgation of a decision (rating or otherwise) in VBMS-A must occur before claims processors may generate a decision notice using RADL. This includes decisions that – in the past – VA has processed without making entries in an award-processing system, including
    • confirmed and continued decisions, and
    • denials on non-original claims.
  • When RADL fails to generate a decision notice that contains the elements set forth in M21-1, Part III, Subpart v, 2.B.1.b (even after the entry of free text),
    • use PCGL to create the notice, and
    • follow the instructions under the heading in the National Work Queue (NWQ) Phase 1 & 2 Playbook titled Non-ADL Letters if the claim associated with the decision notice is subject to routing via NWQ.
Reference:  For more information on the requirement to distribute copies of a rating decision narrative and codesheet with a decision notice to

III.v.2.B.4.b.  Types of Decisions for Which Claims Processors May Use RADL to Generate a Decision Notice

Claims processors may use RADL to generate a decision notice for the following types of decisions:
  • decisions that resolve claims controlled under most EPs
    • 010
    • 020
    • 110
    • 130
    • 160 (ADL)
    • 290
    • 310
    • 320
    • 600
    • 687
    • 689
    • 690, and
    • 930
  • decisions regarding legacy appeals controlled under EPs
    • 070, and
    • 170, and
  • administrative denials based of pension on incompatible military service, to include
    • no active duty service
    • no wartime service
    • less than 90 days of service, and/or
    • minimum service requirements not met (24 months of service, after September 7, 1980).
Exceptions:  Use PCGL instead of RADL when preparing a decision notice regarding a legacy appeal controlled under EP 070 or 170 if the decision on appeal is one of the types listed in M21-1, Part III, Subpart v, 2.B.4.c.
Example:  Claims processors must use PCGL to prepare a decision notice regarding a legacy appeal of a decision to deny entitlement to DIC or accrued benefits.

III.v.2.B.4.cTypes of Decisions for Which Claims Processors May Not Use RADL to Generate a Decision Notice

Claims processors may not use RADL to generate decision notices for the following types of decisions:
  • decisions associated with EPs other than those listed in M21-1, Part III, Subpart v, 2.B.4.b
  • decisions on claims for pension (with the exception of the administrative denials referenced in M21-1, Part III, Subpart v, 2.B.4.b), to include “dual” claims (claims for both compensation and pension)
  • final rating decisions to rate a beneficiary incompetent
  • decisions to adjust an award based on review of an audit error worksheet (AEW)
  • rare ancillary decisions, such as those involving
    • civil service preference
    • discharge of an education loan
    • extension of delimiting dates for education benefits under 38 U.S.C. Chapter 303132, or 1606
    • gratuitous insurance
    • loan guaranty benefits, or
    • Restored Entitlement for Survivors
  • decisions regarding the eligibility of a Veteran’s child for an appointment to a service academy, as explained in M21-1, Part III, Subpart vi, 7.5, and
  • decisions on contested claims.
Note:  Use Letter Creator’s AEW Assistant to generate a decision notice regarding an award adjustment that is based on review of an AEW worksheet.  Under all the other circumstances described in this block, use PCGL.

Reference:  For more information about using the AEW Assistant, see M21-1, Part III, Subpart v, 5.A.8.t.


III.v.2.B.4.d.  Sections of an RADL-Generated Decision Notice

The table below describes the purpose/content of individual sections of an RADL-generated decision notice.
Section
Purpose/Content
Your Benefits Information
  • Lists the specific decision(s) VA made.
  • Shows the combined disability rating VA assigned (if applicable).
How VA Combines Percentages
  • Describes how VA calculates the combined disability rating.
  • Lists a website claimants may visit to learn more about how VA combines the disability ratings it assigns to individual disabilities to arrive at a combined disability rating.
Information About Dependents
Describes
  • any decision VA made regarding a claimant’s entitlement to additional benefits for a dependent or dependents, including
    • laws and regulations relevant to the claim
    • element(s) necessary to grant the claim that were not met, if any, and
    • findings that are favorable to the claimant under 38 CFR 3.104(c), if any, and
  • evidence/information VA requires to establish entitlement to additional benefits for a dependent or dependents.
Monthly Entitlement Amount (if applicable)
  • Displays a table showing the
    • total amount of VA benefits to which the claimant is entitled
    • amount of benefits VA withholds each month (if applicable)
    • amount of benefits VA pays the claimant each month (if applicable)
    • date payments start and change (if applicable), and
    • reason for any change in the amount of monthly payments.
  • Includes a statement indicating whether payments are based on
    • a beneficiary with no dependents, or
    • a beneficiary with one or multiple dependents.
Evidence Considered
Lists the evidence entered by the user onthe AWARD LETTER INTERVIEW screen in VBMS-A.
Accept, Appeal, and/or Ask for Help About Other Choices
Describes the review rights for the decision(s) VA made.
Explanation of Payment
Describes
  • the amount of benefits VA withheld (if applicable) and the reason for the withholding(s)
  • the claimant’s entitlement to concurrent receipt of disability compensation and military retired pay (if applicable)
  • factors that affect the claimant’s right to payment, and
  • additional benefits to which the claimant might be entitled.
Where to Send Your Written Correspondence
Describes
  • how to contact VA, and
  • where to send written correspondence.

III.v.2.B.4.e.  Using RADL to Prepare a Decision Notice in VBMS-A

The table below describes the steps for using RADL to prepare a decision notice regarding a rating decision VA made.
Step
Action
1
Verify that the award has been generated in VBMS-A.
2
Select the GEN LETTER button at the bottom of the PROPOSED AWARD tab in VBMS-A.
3
If additional award/authorization actions are needed, utilize the following fields to insert the appropriate information into the RADL-generated decision notice:
  • DEPENDENCY DEVELOPMENT
  • SOLICITING CLAIMS
  • EVIDENCE LIST (specific to a decision or decisions the authorization activity made), and
  • FREE TEXT.
4
Preview the decision notice to ensure it is complete and accurate.
5
Route the claim to an SVSR for review and approval.
 
Reference:  For more information about generating a decision notice in VBMS-A, see the VBMS-Awards User Guide.

III.v.2.B.4.f.  Development Functionality Within RADL

Claims processors may use a feature within RADL that allows them to include in decision notices a request for
  • completion of a VA Form 21-686c
  • a marriage certificate
  • (a) divorce certificate(s)
  • (a) birth certificate(s)
  • (a) Social Security number(s), and/or
  • information regarding a
    • child’s school attendance, and/or
    • step child’s relationship to a Veteran.
Important:  As stated in M21-1, Part III, Subpart iii, 5.A.1.h, any development that is necessary to establish an individual as a Veteran’s dependent must be undertaken during the initial, development phase of claims processing rather than at the end (in the decision notice).
References:
  • For detailed instructions for including in an RADL-generated decision notice a request for the evidence/information described in the first paragraph of this block, see the VBMS Awards User Guide.
  • For more information about

III.v.2.B.4.g.  Soliciting Claims in an RADL-Generated Decision Notice

Follow the instructions in the VBMS Awards User Guide to solicit a claim in an RADL-generated decision notice.
Reference:  For more information about soliciting claims for chronic, unclaimed disabilities, see M21-1, Part IV, Subpart ii, 2.A.1.e.

III.v.2.B.4.h.  Including in an RADL-Generated Decision Notice a Summary of the Evidence the Authorization Activity Considered in Making a Decision

Follow the instructions in the VBMS Awards User Guide to include in an RADL-generated decision notice a summary of the evidence the authorization activity considered in making a decision (such as entitlement to additional benefits for a dependent).

III.v.2.B.4.i.  Adding Free Text to an RADL-Generated Decision Notice

Follow the instructions in the VBMS Awards User Guide to add free text to an RADL-generated decision notice.

Limit the use of free text to those situations in which

  • regulatory or procedural guidance requires it, or
  • the decision notice — without the free text — fails to
    • provide information that is relevant to the claimant or would help him/her better understand an action VA took, and/or
    • comply with the requirements set forth in M21-1, Part III, Subpart v, 2.B.1.b.

5.  Exhibit:  Review Rights Language for PCGL


Introduction

This exhibit contains required PCGL decision notice language addressing claimants’ decision review rights, including paragraphs addressing review rights for

Change Date

February 19, 2019

III.v.2.B.5.a.  Review Rights Language for Contested Claims

Paragraphs addressing review rights for contested claims are shown below.
What You Should Do If You Disagree With Our Decision
If you do not agree with this contested claim decision, you have 60 days from the date of this letter to seek further review in order to preserve your earliest effective benefit date.
Please see the enclosed VA Form 20-0998Your Rights To Seek Further Review Of Our Decision.  It explains your options for an additional review.  You may obtain any of the  required applications by downloading them from www.va.gov/vaforms/ or by contacting us.  You can also learn more about the disagreement process at www.va.gov/decision-reviews.   If you would like to obtain or access evidence used in making this decision, please contact us as noted below.   Some evidence may be obtained by signing in at www.va.gov.

III.v.2.B.5.b.  Review Rights Language for Non-Contested Claims

Paragraphs addressing review rights for non-contested claims are shown below.
What You Should Do If You Disagree With Our Decision
If you do not agree with our decision, you have one year from the date of this letter to select a review option to preserve your earliest effective benefit date.  The review options and their proper applications are as follows for a(n):
  • Supplemental Claim, complete VA Form 20-0995, Decision Review Request: Supplemental Claim
  • Higher-Level Review, complete VA Form 20-0996, Decision Review Request: Higher-Level Review
  • Appeal to the Board of Veterans’ Appeals, complete VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement)
Please see the enclosed VA Form 20-0998Your Rights To Seek Further Review Of Our Decision.  It explains your options for an additional review.  You may obtain any of the  required applications by downloading them from www.va.gov/vaforms/ or by contacting us.  You can also learn more about the disagreement process at www.va.gov/decision-reviews/.   If you would like to obtain or access evidence used in making this decision, please contact us as noted below.   Some evidence may be obtained by signing in at www.va.gov.
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