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M21-1, Part V, Subpart iv, Chapter 2 – Pension Management Center (PMC) Procedures

Overview


In This Chapter

This chapter contains the following topics:

1.  PMC Jurisdiction of Cases


 Introduction

This topic contains information on the jurisdiction of cases at the PMCs, including

Change Date

February 19, 2019

V.iv.2.1.a.  Type of Work Performed by the PMCs

The pension management centers (PMCs) perform work related to pension awards and all survivors claims.  Limited disability compensation issues may be processed at the PMCs.
The type of pension work performed by the PMCs includes
  • Veterans and Survivors Pension claims
  • higher-level reviews (HLR) of Veterans and Survivors Pension claims
  • Dependency and Indemnity Compensation (DIC) claims
  • burial benefits
  • accrued benefits
  • income adjustments, including adjustments based on VA Form 21P-8416,Medical Expense Report
  • changes in dependency for pension and/or DIC awards
  • awards of special monthly pension
  • income verification matches
  • Federal tax Information (FTI) matches related to upfront verification and post award audits for pension and/or DIC awards
  • Social Security verification matches
  • Social Security number (SSN) matches
  • prison and fugitive felon matches
  • adjustments based on VA Form 20-6560, Notice of Benefit Payment Transaction, or VA Form 20-8270, C&P Master Record-Audit Writeout not requiring a rating decision
  • incompetency and competency determinations
  • Loan Guaranty claims based on service-connected death, and
  • hospital adjustments to pension awards.
Notes:
  • The Veterans Service Center (VSC) of the Philadelphia Regional Office (RO) has jurisdiction over original DIC claims involving in-service death.
  • Part of the Committee on Waivers and Compromises (COWC) is consolidated at ROs that contain PMCs.
Reference:  For more information about COWC procedures, see the Office of Resource Management (Finance Staff) COWC references page.

V.iv.2.1.b.  Type of Work Not Performed by the PMCs
The PMCs do not perform work which requires establishing service connection for living Veterans.  VSCs must process these claims.
Types of cases generally not performed by the PMCs include
  • compensation claims, and
  • claims for both compensation and pension entitlement, sometimes calleddual claims.
Note:  PMCs may broker in compensation claims when workload permits.

V.iv.2.1.c.  eFolders

The PMCs maintain electronic claims folders (eFolders) in the Legacy Content Manager (LCM) and the Veterans Benefits Management System (VBMS).  This allows images scanned from original source documents to be stored electronically.

V.iv.2.1.d.  Mandatory Use of eFolders

It is mandatory that ROs review the eFolder in LCM and/or VBMS before contacting PMCs to request PMC-related documentation, or respond to PMC claim inquiries.  PMCs will not provide information by fax or telephone if the documentation needed is in the eFolder.
If an RO is unable to answer a PMC inquiry after reviewing the eFolder, the RO should request PMC personnel at one of the following e-mail addresses to respond to the inquiry:

V.iv.2.1.e.  Compensation Claims Received After Veterans Pension Entitlement Is Established

VSCs are responsible for processing claims for compensation, even if the paper claims folder, if applicable, is located at a PMC, and the claimant is receiving pension.
When a PMC receives a compensation claim with a paper claims folder in its possession, the PMC will send the folder to the scanning vendor using the Veterans Claims Intake Program (VCIP) Shipping process in their co-located VSC.  If the claim is contained in a centralized mail (CM) packet in the CM portal, the PMC will transfer the claim to the appropriate VSC CM portal queue.
References:  For more information on

V.iv.2.1.f.       Claims for Both Compensation and Veterans Pension

When a Veteran claims entitlement to both Veterans Pension and compensation benefits, the claim and claims folder will remain in the VSC’s possession unless and until the PMC requests transfer of the paper claims folder, if applicable.  This applies even when pension is awarded as the sole benefit entitlement.

V.iv.2.1.g.      PMCs Generate Pension-Related Hospital Adjustment Reports

The Hospital Adjustment Coordinator (HAC) at each PMC will be responsible for generating hospitalized Veterans reports.  The designated representative will
  • generate reports for the preceding month no later than the third business day of each month
  • send an e-mail no later than the fifth business day of each month to the Pension Policy and Procedures mailbox (VAVBAWAS/CO/PENSION POL & PROC) to confirm that all reports were generated
  • ensure pension-related hospital reports are identified, to include
    • aid and attendance (A&A) admissions
    • pension admissions (Section 306 Pension)
    • pension admissions (Old-Law Pension)
    • discharges (current-law pension), and
    • readmissions, and
  • maintain a master log that
    • identifies each type of report generated
    • shows the date generated
    • reflects the period covered, and
    • reports any problems noted.
Note:  The HAC reports should be generated for the preceding month.  For example, if the current month is December, the report range is from November 1st through November 30th.

V.iv.2.1.h.      PMCs Adjust Pension Awards Based on Hospital Reports

PMCs are responsible for making hospital adjustments to pension awards.
The HAC will
  • generate pension-related hospital reports for all VA medical centers in the PMCs jurisdicition, and
  • ensure the reports are reviewed and/or referred for timely adjustment action.
References:  For more information on the

V.iv.2.1.i.      Burial Claims

PMCs are responsible for processing burial claims.
A burial claim received in the CM portal queue at an RO will be transferred to the appropriate PMC queue.  If physical mail is received, forward the mail to the scanning vendor.  If a paper claims folder is available, the RO must send it to the scanning vendor.
References:  For more information on

V.iv.2.1.j.  Claims for Parents’ DIC Claims

Parents’ DIC claims are under the jurisdiction of the PMC.  VSCs will forward these claims and the paper claims folders, if requested, to the PMC, for resolution of the Parents’ DIC claim.
The VSC will retain possession of the paper claims folder unless the PMC requests transfer.
Note:  Parents’ DIC claims involving original in-service deaths are processed at the VSC of the Philadelphia RO.

V.iv.2.1.k.Matching Program Reports Processed by PMCs

The PMCs receive and process all reports from matching programs involving pension and survivor benefit recipients. Matches involving compensation entitlement must be processed at a VSC.
Reference:  For more information on matching program processing, see  M21-1, Part X.

2.  PMC Reporting Requirements


Change Date

December 14, 2017

V.iv.2.a.  PMC Reporting Requirements 
PMCs are required to provide Pension and Fiduciary (P&F) Service with periodic reports and logs.  The following chart shows which reports and logs are due and when they are due.
Report/Log
Frequency of Reporting
Reference
hospitalized Veteran reports
monthly
erroneous payments log
quarterly
Social Security Administration (SSA) death match
quarterly
SSN verification
quarterly
return to active duty match
quarterly
Bureau of Prisons (BOP)/SSA prison matches
quarterly
training compliance report
quarterly
Systematic Technical Accuracy Review (STAR) correction report
quarterly
duplicate payments report
semi-annually
FTI internal inspections report
triannually

3.  PMC Legacy Appeal and Remand Procedures


 Introduction

This topic contains information on appeal and remand procedures, including

Change Date

February 19, 2019

V.iv.2.3.a.      PMC Legacy Appeal and Remand Workload Responsibilities

The PMCs are responsible for the legacy appellate workload generated by their actions and for the remands the Board of Veterans’ Appeals (BVA) issues to them, unless the legacy appeal or remand
  • requires a travel board hearing, and/or
  • involves entitlement to both compensation and Veterans Pension.
In these instances, the PMC will
  • temporarily transfer the case to the RO of jurisdiction, and
  • transfer the Veterans Appeals Control and Locator System (VACOLS) record to the RO of jurisdiction.

V.iv.2.3.b.  PMC VACOLS Identifier for Legacy Appeals

BVA has designated a separate VACOLS identifier for each PMC.  These identifiers should be used to properly identify and track PMC appeals separate from RO legacy appeals.
  • Philadelphia PMC – 81
  • Milwaukee PMC – 82
  • St. Paul PMC – 83

V.iv.2.3.c.     DRO Reviews for PMC  Legacy Appeals

Effective December 1, 2014, the PMCs will retain jurisdiction of PMC legacy appeals in which a Decision Review Officer (DRO) review is requested.
Exception:  The RO of jurisdiction will decide legacy appeals that require a travel board hearing.

V.iv.2.3.d.  Tele-Video Conference Hearings for PMCs

When a claimant requests a local hearing, the PMC will schedule a tele-video conference hearing with the claimant (and representative if applicable) and a PMC employee(s).
The PMC will coordinate the tele-video conference with the Assistant Veterans Service Center manager or designee at the claimant’s local RO.

V.iv.2.3.e.  Reviewing Legacy Information Stored in Electronic Format

Legacy appeal information stored in an electronic format will be reviewed electronically by the PMC or RO of jurisdiction.
Note:  If review of the actual paper claims folder is necessary, the office of jurisdiction will request that the paper claims folder be forwarded to the scanning vendor.

V.iv.2.3.f.       PMCCertification of Legacy Appeals to BVA

The table below shows the action needed when a legacy appeal under a PMC’s jurisdiction is ready to be certified to BVA, but requires a local power of attorney (POA) review.
Step
Action
1
The PMC
  • temporarily transfers the paper claims folder, if applicable, to the RO of jurisdiction for local POA review via the Control of Veterans Records System (COVERS).
Notes:
  • COVERS should be updated to show the date of temporary transfer to the RO of jurisdiction and the date of expected return to the PMC.
  • The VACOLS record should remain with the PMC when the legacy appeal is ready to be certified.
Reference:  For more information on VACOLS, see the VACOLS User’s Guide
2
The POA at the RO of jurisdiction
3
The RO of jurisdiction permanently transfers the paper claims folder, if applicable, back to the PMC via COVERS.
4
The PMC
  • reviews VA Form 646
  • updates the VACOLS record
  • notifies the claimant of the certification and transfer, and
  • routes the claims folder for transfer to BVA.

V.iv.2.3.g.Storage of Printed eFolder Documents During Claims Folder Transfers

The station of jurisdiction is responsible for storing, in a manila folder marked “eFolder documents,” any eFolder document printed in conjunction with shipment of the claims folder to BVA or a higher appellate level.
The outside of the manila folder containing the eFolder material should be annotated with the claim file number for identification purposes.  The folder should not be entered into COVERS.
Note:  eFolder documents should not be incorporated into the paper claims folder because they would duplicate information available to the PMC and RO of jurisdiction electronically.

V.iv.2.3.h.Destruction of eFolder Prints

Once the legacy appeal is final or action on the BVA remand has been completed, the information printed from an eFolder will be destroyed.

V.iv.2.3.i. Storage of Documents Pertaining to the Legacy Appeal

Upon resolution of the legacy appeal, all documents pertaining to the alegacy ppeal will be inserted into the eFolder by the office of jurisdiction.  This includes evidence and decision documents.

4.  PMC Decision Review Request Procedures


Introduction

This topic contains information on procedures for reviewing decisions made on or after February 19, 2019, including
  • PMC HLR and supplemental claim workload responsibilities
  • EPs associated with HLRs and supplemental claims
  • jurisdiction of HLRs
  • reviewing new information stored in electronic format
  • definition of informal conferences
  • processing requests for an informal conference
  • scheduling informal conferences
  • conducting informal conferences
  • addressing evidence presented at an informal conference
  • remands from higher-level reviewers, and
  • an example of the HLR informal conference worksheet

Change Date

February 19, 2019

V.iv.2.4.a.  PMC HLR and Supplemental Claim Workload Responsibilities

PMCs are responsible for the HLR and supplemental claims generated by the actions and for remands from BVA.
Examples of BVA remands that will be processed by the PMC are issues due to Section 5103 errors, requests for independent medical opinions, and/or identification of a statutory or regulatory errors.
Notes:
  • A HLR is a review of the same evidence by a higher-level adjudicator.
  • A supplemental review is a review of new and relevant evidence in conjunction with a supplemental claim to the station of origination (SOO).

V.iv.2.4.b.  EPs Associated with HLRs and Supplemental Claims

VA has designated end product (EP) 030 for HLRs and EP 040 for supplemental claims.
Examples:
  • EP 030 – PMC Higher Level Review Non-Rating
  • EP 040 – PMC Supplemental Claim Rating

V.iv.2.4.c.  Jurisdiction of HLRs

38 CFR 3.2601(3) states that HLRs will be conducted at a different PMC than the PMC that processed the initial claim.
Exception:  If the claimant requests that the HLR be conducted at the PMC that rendered the prior decision, VA will grant the request unless there is good cause to deny.
Reference:  For more information on HLR jurisdiction for PMCs, see M21-1, Part V, Subpart iv, 1.3.d.

V.iv.2.4.d.  Reviewing New Information Stored in Electronic Format

Initial claims, supplemental claims, and HLRs will have information stored in an electronic format will be reviewed electronically by the PMC.
Note:  If a review of the paper claims folder is necessary, the PMC will request that the paper claims folder be forwarded to the scanning vendor.

V.iv.2.4.e.  Definition: Informal Conference

Along with the request for HLRs, a claimant and/or his or her representative can request an informal conference.
An informal conference is defined as contact with a claimant and/or his or her representative, telephonically, or as determined by the VA, for the sole purpose of allowing the claimant or representative to identify any errors of law or fact in a prior decision.
Note:  The PMC will only conduct one informal conference per request for HLR, regardless of the number of issues that will be adjudicated upon the HLR.

V.iv.2.4.fProcessing Requests for Informal Conference

VA Form 20-0996, Decision Review Request: Higher-Level Review, allows the claimant and/or his or her representative to indicate a time to receive a phone call to schedule the informal conference.  This is the primary method claimants will communicate a request for an informal conference, but the claimant/representative can also submit the request in writing, along with the submission of VA Form 20-0996.
Important:  In order for an informal conference request to be considered timely received, any request made in writing must be submitted along with VA Form 20-0996, per 38 CFR 3.2601(h)
References:  For more information on informal conferences for HLRs, see 38 CFR 3.2601(h).

V.iv.2.4.gScheduling Informal Conference

The higher-level reviewer with determinative authority over the issue(s) will schedule and conduct the informal conference unless extenuating circumstances prevent the higher-level reviewer from participating in the conference at the agreed upon time and date.  In that case, another higher-level reviewer from the same PMC will conduct the conference in his or her place.
The higher-level reviewer will make two attempts to contact either an unrepresented claimant or his or her representative to schedule the informal conference.  If contact is successful, schedule the informal conference within the next seven business days from successful contact.  Extensions beyond the seven business days from contact may be granted on a case by case basis.
Upon first attempt, if contact cannot be made, the higher-level reviewer will
  • if possible, leave a voicemail message requesting a call back at 1-877-294-6380,
  • add to the existing informal conference tracked item the date of the first attempt under Follow Up 1 (not the closure date)
  • document on VA Form 27-0820, Report of General Information and add a permanent note in VBMS, documenting the reason for the call and requesting the National Call Center representatives document the Veteran’s or representative’s availability if the person calls back (see approved text below), and
  • suspend the EP 040 for three business days.
For the permanent note in VBMS, indicate if a voicemail was left or not, and use the following text:
I called the Veteran or his or her representative regarding a request for an informal conference for the pending HLR.  When he or she returns my call, please complete a formatted VA Form 27-0820 and capture a telephone number and a date and time when the Veteran or representative is available to receive a call to conduct the informal conference in the next week during regular business hours (i.e. 9:00am to 3:00pm EST).
Upon second attempt, If contact cannot be made, the higher-level reviewer will
  • document the unsuccessful contact on VA Form 27-0820, and associate it with the eFolder.
  • add to the existing informal conference tracked item the date of the second attempt under Follow Up 2
  • close the associated tracked item, and
  • add a permanent note in VBMS
Note:  Email communication with a representative is allowed for scheduling of the informal conference.  Ensure that any personally identifiable information (PII) is sent encrypted.  If utilized, all email communications must be uploaded to the Veteran’s eFolder.
Important:  Any expenses incurred by the claimant in connection with the informal conference are the responsibility of the claimant.

V.iv.2.4.hConducting the Informal Conference

An informal conference may be conducted with the authorized representative.  The Veteran is not required to be present on the call when he/she has an authorized representative.
During the informal conference, provide the claimant and/or his/her representative the opportunity to identify any errors of law or fact from the prior decision.  Upon completion of the conference, document the conference on a HLR Informal Conference Worksheet, close the associated tracked item, and if applicable, provide a copy of this documentation to the claimant’s accredited representative and associate it with the eFolder.
Reference:  For an example of the HLR Informal Conference Worksheet, see M21-1, Part IV, Subpart iv, 2.4.k.

V.iv.2.4.iAddressing Evidence Presented at an Informal Conference

If, during the informal conference, a claimant and/or his/her representative indicates a desire to add to the evidentiary record or requests review of evidence outside the scope of the HLR, inform the claimant and/or representative that he/she may submit the evidence; however, the higher-level reviewer will be unable to consider it in the HLR.
In order for the evidence to be considered, the claimant or representative must withdraw the HLR request and submit a supplemental claim within one year of the decision notice that led to the HLR.  Otherwise, upon issuance of the HLR decision, the Veteran or representative may submit another claim in order to have the evidence considered.

V.iv.2.4.j.  Remands From Higher-Level Reviewers

When a Section 5103 error is discovered during a HLR process, the higher-level reviewer
  • drafts an explanation of the Section 5103 error using a deferred rating decision
  • changes the special issue to the appropriate error category, and
  • remands the claim back to the SOO that rendered the prior decision.
Exception:  If the maximum benefit for the claim can be granted, the higher-level reviewer will process the claim without remanding for a Section 5103 error.  For pension benefits, burial benefits (except transporation reimbursement), or dependents indemnity compensation, the maximum benefit means granting the highest rate payable.  For transportation reimbursement, it means granting the benefit.

V.iv.2.4.k.  HLR Informal Conference Worksheet Example

HLR informal conference worksheet example


5.  Claims Folder and Mail Handling Procedures


Introduction

This topic contains information on claims folder and mail handling procedures, including the

Change Date

June 22, 2016

V.iv.2.5.a.  Transfer of Claims Folders to a PMC

Unless otherwise noted in this chapter, when a PMC requests a paper claims folder, the RO will send the folder to the scanning vendor.  No folders are to be physically transferred to the PMC unless specifically requested. If an RO receives mail relating to a PMC issue, the mail should be forwarded to the scanning vendor.
Note:  COVERS will be used for the transfer of paper claims folders between all PMCs and ROs.

V.iv.2.5.b.  Handling of Mail between ROs and PMCs

The table below shows the action required when a PMC or an RO receives mail.
If the mail is received by a (an) …
And the …
Then the …
RO
mail involves PMC issues
RO will send the mail and paper claims folder, if available, to the scanning vendor.
PMC
mail involves
  • compensation, or
  • other non-PMC issues
PMC will send the mail to the scanning vendor.
PMC
paper claims folder is located at an RO, and mail
  • involves PMC issues, and
  • requires the review of the paper claims folder for processing
PMC will
  • send the mail to the scanning vendor, and
  • request transfer of the paper claims folder from the RO to the scanning vendor.
Note:  If CM packets are received at the wrong facility, it will be transferred to the appropriate CM portal queue.
References:  For more information on

6.  Disposition of PMC Documents Scanned into the LCM eFolder


Introduction

This topic contains information on the following topics, including

Change Date

October 3, 2016

V.iv.2.6.a.Requirements for Destruction of PMC Documents Scanned Into the LCM eFolder

The following requirements exist for the destruction of PMC documents scanned into the LCM eFolder.
The Records Management Officer (RMO) must
Contracts to destroy records should include specific clauses to ensure that personally identifiable information (PII) and other sensitive temporary records are properly secured prior to destruction, and
Destruction of records must be completed by pulping, macerating, shredding, or otherwise definitively destroying the information contained in the records in accordance with VBA Letter 20-08-63.
Important:  Records pertaining to FTI should be

V.iv.2.6.b.Disposition of Documents That Require Retention

All service treatment records and personnel records, including all media (such as microfiche, CDs, x-rays, and photos) will be removed from the records management box and transferred to the VA Records Management Center.

V.iv.2.6.c.  Disposition of Vendor Scanned or Previously Scanned Documents

The current quality control processes utilized by contract scanning vendors, for LCM only, are sufficient to allow for the destruction of vendor-scanned documents without any additional quality assurance review.
Note:  All PMC documents scanned into LCM and reviewed under quality assurance procedures in place prior to November 2, 2009, whether scanned by a vendor or a VA scanning site, may be destroyed without further review.

V.iv.2.6.d.  Quality Assurance Reviews During the Scanning Process

PMC Capture Units will conduct quality reviews each week during the scanning process.
The following sample selection procedures apply for each weekly review:
  • randomly select a sufficient number of imaged document batches in order to ensure a weekly sampling of 385 documents, and
  • perform a 100 percent review of the documents in each batch until 385 documents have been reviewed for that week’s sampling.
The following accuracy requirements apply for each valid sample review of scanned documents on a weekly basis:
  • a 99 percent or higher accuracy rate is required, and
  • for any week that the accuracy rate is below 99 percent, all documents scanned during that sample week must be reviewed before any documents may be destroyed.
Scanning sites will correct any scanning errors found during quality assurance reviews.

V.iv.2.6.e.  Document Retention Requirement for Scanned Documents

PMC Capture Units must retain all paper documents scanned into LCM that meet the criteria for destruction for 90 days, after which they will be destroyed, according to the guidance contained in M21-1 Part V, Subpart iv, 2.6.a.

V.iv.2.6.f.  Weekly Accuracy Logs for Quality Assurance Reviews of Scanned Documents

PMC Capture Units will maintain a weekly scanning accuracy log for a period of three years.
A supervisor at the PMC Capture Unit who has direct knowledge of the process shall certify the accuracy of the scanning log.
Reference:  For a sample weekly accuracy scanning log, see M21-1, Part V, Subpart iv, 2.6.g.

V.iv.2.6.g. Sample Weekly Scanning Accuracy Log

A sample weekly scanning accuracy log for quality assurance reviews during the process of scanning documents into the LCM eFolder is shown below.
This is an image of a sample scanning accuracy log.
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