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M21-1, Part III, Subpart vi, Chapter 6, Section C – Authorizing and Notifying Claimants of a Decision on a Contested Claim

Overview


In This Section

This section contains the following topics:
Topic
Topic Name
1
2
3
4
5
6

1.  Preparing an Administrative Decision and Notifying Claimants


Introduction

This topic contains information on preparing an administrative decision and notifying claimants, including

Change Date

February 25, 2019

III.vi.6.C.1.a.  When to Prepare an Administrative Decision

Make an administrative decision after completely developing the facts associated with a contested claim.
Exception:  Document decisions on apportionment claims in accordance with the instructions in M21-1, Part III, Subpart v, 3.A.3.
Reference:  For more information on preparing an administrative decision, seeM21-1, Part III, Subpart v, 1.A.3.

III.vi.6.C.1.b.  Responsibility for Approving Administrative Decisions

Veterans Service Center Managers (VSCMs) and Pension Management Center Managers (PMCMs) are responsible for approving all administrative decisions regarding a contested claim.
VSCMs and PMCMs may delegate authority to approve these decisions to a supervisor not lower than a coach.

III.vi.6.C.1.c.  Actions to Take When One Claimant Establishes Entitlement

If one of the claimants in a contested claim establishes entitlement,
  • deny the claim of the other claimant(s), and
  • notify all claimants and other interested persons of the actions taken.

2.  Deferring Award Action and Notifying Successful Claimants


Introduction

This topic contains information on

Change Date

February 25, 2019

III.vi.6.C.2.a.  Deferring Award Action on a Contested Claim

To allow an unsuccessful claimant an opportunity to initiate an appeal to the Board of Veterans’ Appeals (BVA), and to provide for due process procedures in cases of running awards, defer award action for 60 days on a contested claim.
Exceptions:  When an apportionment claim is
  • denied, restore all funds in withholding to the primary beneficiary, or
  • granted, release the apportioned benefits to the claimant without waiting for the 60-day appeal period to expire.
References:  For more information on
  • time limits for filing appeals to BVA in simultaneously contested claims, see 38 CFR 20.402, and
  • processing apportionment claims, see M21-1, Part III, Subpart v, 3.

III.vi.6.C.2.b.  Sending Notice to a Successful Claimant

Furnish notice containing the following paragraphs to the successful claimant in a contested claim.
We have determined that you are entitled to [type of benefit] as the Veteran’s [relationship to the Veteran].  [relevant regulation(s)]
We considered the following evidence in our decision:  [evidence considered].
We cannot release payments to you at this time because [name of other claimant] has also applied for this benefit and has the right to initiate an appeal by filing a notice of disagreement with our disallowance within 60 days from this date.
If notice of disagreement is not filed by [name of other claimant] within 60 days, we will take appropriate award action.  We will notify you if a notice of disagreement is filed.
The attached VA Form 20-0998 describes your right to appeal our decision.
Notes:
  • Attach VA Form 20-0998 to the decision notice.
  • BVA notifies the successful claimant if the unsuccessful claimant files a notice of disagreement.

3.  Notifying Unsuccessful Claimants


Change Date

February 25, 2019

III.vi.6.C.3.a.  Notifying Unsuccessful Claimants

Furnish a notice containing the following paragraphs to unsuccessful claimants in a contested claim.
Your claim for [type of benefit] as the Veteran’s [relationship to the Veteran] has been denied because [reason(s) for the denial].  [relevant regulation(s)]
We considered the following evidence in our decision:  [evidence considered].
We have determined that [name of successful claimant] is entitled to [type of benefit].  Payment will be withheld, however, for a period of 60 days from the date of this letter to provide you an opportunity to file a notice of disagreement with our decision.
The attached VA Form 20-0998 describes your right to appeal our decision.
Note:  Attach VA Form 20-0998 to the decision notice.

4.  Actions to Take After Issuing Notice of a Decision on a Contested Claim


Introduction

This topic describes the actions to take after issuing notice of a decision on a contested claim, including

Change Date

February 25, 2019

III.vi.6.C.4.a.  Action to Take if an Unsuccessful Claimant Fails to Respond to the Decision Notice

If an unsuccessful claimant fails to submit a notice of disagreement within 60 days of the date of the notice described in M21-1, Part III, Subpart vi, 6.C.3.a, pay benefits to the successful claimant.

III.vi.6.C.4.b.  Action to Take if VA Is Already Paying Benefits to a Party in a Contested Claim

In addition to the notices described in M21-1, Part III, Subpart vi, 6.C.2 and 3, send notice of proposed adverse action to any current beneficiary whose benefits the Department of Veterans Affairs (VA) might adjust or discontinue as a result of a contested claim.
If, within 30 days of the date of the notice of proposed adverse action, the beneficiary requests a personal hearing, VA may not make a final decision until it conducts the hearing or the beneficiary fails, without good cause, to appear.
Reference:  For more information about preparing a notice of proposed adverse action, see M21-1, Part I, 2.B.

III.vi.6.C.4.c.  Reducing or Discontinuing a Running Award as a Result of a Contested Claim

If it becomes necessary to reduce or discontinue a running award based on the outcome of a contested claim,
  • reduce or discontinue the award effective the date in the LAST PAID DATE field on the AWARD INFORMATION tab in Share, per 38 CFR 3.500(f), and
  • award benefits to the successful claimant effective the date of entitlement.
Follow the instructions in 38 CFR 3.657 if the outcome of a contested claim results in the reduction or discontinuation of a running award to an individual (as a Veteran’s surviving spouse) because another individual has established himself/herself as the legal surviving spouse of the same Veteran.
Reference:  For information that is unique to the awarding of benefits in a contested claim involving a deemed-valid marriage, see VAOPGCPREC 1-1996.

5.  Effect of an Insurance Interpleader on Death Claims


Change Date

July 5, 2015

III.vi.6.C.5.a.  Effect of an Insurance Interpleader on Death Claims

If there is a dispute about the person(s) entitled to the payment of insurance benefits, refer the matter to Office of General Counsel (OGC).
OGC may file suit in the nature of a bill of interpleader action, which may be brought by VA in the name of the United States against all persons having, or claiming to have, any interest in the insurance, in order to determine the rights of the parties to the insurance proceeds.
Note:  If an insurance matter has been submitted to OGC for a bill of interpleader, do not, as a general rule, delay a final determination on a claim for Survivors Pension, compensation, Dependency and Indemnity Compensation, or accrued benefits pending the outcome of the submission to OGC.

6.  Handling Legacy Appeals of a Decision on a Contested Claim


Introduction

This topic contains information on handling legacy appeals of a decision on a contested claim, including

Change Date

February 25, 2019

III.vi.6.C.6.a.  Impact of the Appeals Modernization Act on Contested Claims

Effective February 19, 2019, the date VA implemented the Appeals Modernization Act, all appeals filed under the previous appeals framework are known as legacy appeals.  The procedures described in this topic apply to these legacy appeals only.  Decisions on contested claims that were made on or after February 19, 2019, can only be appealed to BVA.

III.vi.6.C.6.b.  Handling a Request for an Extension of the Time Limit for Filing a Legacy Substantive Appeal

The time limit for filing a legacy substantive appeal may be extended if the appellant shows good cause.  38 CFR 20.504 provides that a request to extend the time limit must be made in writing before the time limit has elapsed but does notdefine “good cause.”
If VA decides to grant an extension of the time limit, it must notify the other parties involved in the contested claim.
Notes:
  • Under the legacy appeal framework, an appellant may appeal to BVA a denial of a request for an extension of the time limit.
  • When determining whether or not to extend the time limit for filing a legacy substantive appeal in the case of a contested claim, take into consideration the interests of the other parties involved.

III.vi.6.C.6.c.  Handling a Timely Filed Legacy Substantive Appeal of a Decision on a Contested Claim

Follow the steps in the table below upon receipt of a timely filed legacy appeal of a decision on a contested claim.
Step
Action
1
Is additional evidence needed to perfect the legacy substantive appeal?
  • If yes,
    • notify the appellant that he/she must submit the additional evidence within 60 days
    • notify the successful claimant that the appellant has filed a legacy substantive appeal and advise him/her that VA will send notice of the substance of the legacy appeal after receiving additional evidence from the appellant
    • control the case for 30 days, and
    • after the 30-day period ends, go to Step 2.
  • If no, go to Step 2.
2
Notify all parties, except the appellant, of the substance of the legacy appeal by sending a letter containing the sample language below.
We are referring further to your claim for [type of benefit] as the Veteran’s [relationship to the Veteran].
[Name of the appellant] has appealed the denial of [his/her]claim on the grounds that [describe the substance of the appeal]. You are allowed a period of 30 days from the date of this letter to file a brief or argument in response to the contentions made in the appeal. If you intend to rely on the evidence of record, please notify this office that you do not intend to submit a response to the appellant’s contentions.
At the end of the 30 days, all evidence will be considered. If our decision does not change, the appeal will be forwarded to the Board of Veterans’ Appeals for a decision.
3
Notify the appellant of the status of his/her legacy appeal by sending a letter to him/her containing the sample language below.
We have received your appeal of our decision to deny your claim for [type of benefit] as the Veteran’s [relationship to the Veteran].
We have informed [name(s) of the successful claimant(s)] of the filing of your appeal. [He/She/They] will be allowed a period of 30 days from the date of our notification letter to file a brief or argument in answer to your contentions.
At the end of the 30 days, all evidence will be considered. If our decision does not change, the appeal will be forwarded to the Board of Veterans’ Appeals for a decision.
Historical_M21-1III_vi_6_SecC_11-6-15.doc May 18, 2019 114 KB
Historical_M21-1III_vi_6_SecC_7-5-15.doc May 18, 2019 108 KB
5-9-18_Key-Changes_M21-1III_vi_6_SecC.docx May 18, 2019 58 KB
2-25-19_Key-Changes_M21-1III_vi_6_SecC.docx May 18, 2019 52 KB
Change-July-5-2015-Transmittal-Sheet-M21-1III_vi_6_SecC_TS.docx May 18, 2019 40 KB
11-6-15_Key-Changes_M21-1III_vi_6_SecC.docx May 18, 2019 53 KB
Historical_M21-1III_vi_6_SecC_5-9-18.docx May 18, 2019 52 KB
Transmittal-05_10_07.doc May 18, 2019 32 KB
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