Overview
In This Section |
This section contains the following topics:
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1. Notification Requirements
Change Date |
February 19, 2019
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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
Follow the guidance in M21-1, Part I, 2.B.1 and M21-1, Part I, 2.D.1 to determine whether VA
Reference: For more information about due process, see M21-1, Part I, 2.A.1.
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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),
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
When VA grants entitlement to a benefit, or makes an adjustment to a running award, the decision notice must also notify the claimant of
Notes:
References: For more information on
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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
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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:
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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:
Reference: For detailed guidance on summarizing evidence in a decision notice, see the Veterans Benefits Management System (VBMS) Awards User Guide.
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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,
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.
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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.
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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
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.
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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
Important: RADL-generated decision notices automatically inform claimants of
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III.v.2.B.1.m. Steps to Follow After Preparing a Decision Notice |
After preparing a decision notice,
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
References: For more information on
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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
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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
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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
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.
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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 |
A visually impaired Veteran is any Veteran
Claims processors are responsible for ensuring that visually impaired Veterans’
When processing a decision made on the claim of a visually impaired Veteran,
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
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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
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3. Decision Notices Containing FTI
Introduction |
This topic contains information about decision notices containing FTI, including
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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.
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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.
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).
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4. Decision Notices Prepared Using the RADL Process
Introduction |
This topic contains information on decision notices generated using RADL, including
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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:
Reference: For more information on the requirement to distribute copies of a rating decision narrative and codesheet with a decision notice to
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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:
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.
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III.v.2.B.4.c. Types 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:
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.
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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.
Reference: For more information about generating a decision notice in VBMS-A, see the VBMS-Awards User Guide.
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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
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:
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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.
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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).
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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
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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
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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.
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III.v.2.B.5.b. Review Rights Language for Non-Contested Claims |
Paragraphs addressing review rights for non-contested claims are shown below.
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Historical_M21-1III_v_2_SecB-3-7-18.docx | May 16, 2019 | 426 KB |
Historical_M21-1III_v_2_SecB_12-14-18.docx | May 16, 2019 | 407 KB |
Historical_M21-1III_v_2_SecB_10-26-2016.doc | May 16, 2019 | 601 KB |
Historical_M21-1III_v_2_SecB_9-13-16.doc | May 16, 2019 | 596 KB |
Historical_M21-1III_v_2_SecB_7-11-16.doc | May 16, 2019 | 584 KB |
Historical_M21-1III_v_2_SecB_12-12-17.docx | May 16, 2019 | 421 KB |
Historical_M21-1III_v_2_SecB_5-30-18.docx | May 16, 2019 | 405 KB |
12-11-15_Key-Changes_M21-1III_v_2_SecB.docx | May 16, 2019 | 387 KB |
Change-June-1-2015-Transmittal-Sheet-M21-1III_v_2_SecB_TS.docx | May 16, 2019 | 40 KB |
Change-July-29-2015-Tranmittal-Sheet-M21-1III_v_2_SecB_TS.docx | May 16, 2019 | 39 KB |
4-25-19_Key-Changes_M21-1III_v_2_SecB.docx | May 16, 2019 | 75 KB |
3-24-17_Key-Changes_M21-1III_v_2_SecB.docx | May 16, 2019 | 400 KB |
9-2-16_Key-Changes_M21-1III_v_2_SecB.docx | May 16, 2019 | 396 KB |
3-7-18_Key-Changes_M21-1III_v_2_SecB.docx | May 16, 2019 | 399 KB |
1-4-18_Key-Changes_M21-1III_v_2_SecB.docx | May 16, 2019 | 405 KB |
Transmittal-M21-1MRIII_v_2_SecB_TS.doc | May 16, 2019 | 64 KB |
5-16-18_Key-Changes_M21-1III_v_2_B.docx | May 16, 2019 | 398 KB |
in Chapter 2 Decision Authorization and Notification, Part III General Claims Process, Subpart v General Authorization Issues and Claimant Notification
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