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M21-1MR Part 3. General Claims Process

Contents Part 1 Part 2 Part 3 Part 4 Part 5 Part 6 Part 7 Part 8 Part 9 Part 10 Part 11

Subpart I - Overview of Claims Processing and Structure of the Veterans Service Center

Chapter 1 - Structure of the Veterans Service Center (VSC)

  • Chapter 1 - Structure of the Veterans Service Center (VSC) - Updated 07/15/14  

Chapter 2 - Pre-Discharge Claims

  • Section A - General Information on Pre-Discharge Claims - Updated6-5-15
  • Section B - Divison of Responsibilities for Processing Benefits Delivery at Discharge (BDD) and Quick Start Claims - Updated 7/14/14
  • Section C - Ancillary Claims and Miscellaneous Pre-Discharge Issues - Updated 6/18/15
  • Section D - Integrated Disability Evaluation System (IDES) - 3/26/14

Chapter 3 - Fully Developed Claim (FDC) Program 

  • Section A - General Information about the Fully Developed Claim (FDC) Program - Updated 1/6/15
  • Section B - Processing Fully Developed Claims (FDCs) - Updated 12/19/14

Chapter 4 - Veterans Online Application(VONAPP) Direct Connect(VDC)and the StakeHolders Enterprise Portal(SEP)

  • Section A - The Veterans Online Application (VONAPP)Direct Connect(VDC) Program- 6/11/15
  • Section B - The Stakeholder Enterprise Portal (SEP)Role In The Veterans Online Application(VONAPP)Direct Connect (VDC)Process - 6/19/15
  • Section C - Overview of Veterans Online Application (VONAPP) Direct Connect (VDC) Rating Claims - Updated 6/26/15
  • Section D - Claims to Add a Dependent That a Veteran Files Through eBenefits -6/25/15

Chapter 5 - Quick Pay Disability(QPD) Claims

Changes

Subpart II - Initial Screening and Determining Veterans Status

Chapter 1 - Initial Screening Process

  • Section A - Process Overview - Updated 9/17/14
  • Section B - Mail Management - Updated 9/16/14
  • Section C - Initial Screening Policies - Updated 9/16/14
  • Section D - Claims That Require Priority Processing - Updated 5/21/15
  • Section F - Veterans Claims Intake Program(VCIP) Shipping - 6/25/15

Chapter 2 - Benefit Programs and Types of Claims

  • Section A - Department of Veterans Affairs (VA) Benefit Programs - Updated 6/21/15
  • Section B - Original Disability Claims - Updated 6/21/15
  • Section C - Original Death Claims - Updated 4/7/14
  • Section D - Informal Claims - Updated 3/24/15
  • Section E - Reopened Claims - Updated 3/24/15
  • Section F - Claims for Increase - Updated 9/30/10
  • Section G - Requests for Reconsideration Updated 3/24/15

Chapter 3 - Folder Establishment

  • Section A - File Numbers - Updated 6/16/15
  • Section B - Folders and Charge Cards - Updated 10/11/11
  • Section C - Filing and Removal of Material - Updated 2/13/12
  • Section D - Title Here - Updated 6/30/15
  • Section F - Handling and Routing of Waiver Requests and Survivor Benefit Claims - Updated 6/28/15

Chapter 4 - Files and Folder Control

  • Section A - Folder Storage - Updated 6/11/15
  • Section B - Handling Mail - Updated 12/16/10
  • Section C - Processing Requests for the Delivery of Paper Claims Folders - Updated 5/1/15
  • Section D - Lost Folders - Updated 6/3/15
  • Section E - Duplicate Claim (DUPC) Transactions - Updated 6/16/15
  • Section F - Segregated Folders and Deceased Veterans’ Claims Folders - Updated 8/22/14
  • Section G - Folder Maintenance - Updated 08/21/14
  • Section H - File Types - Updated 12/16/10
  • Section I - Folders Meeting the Criteria for Review by the United States Court of Appeals for Veterans Claims (CAVC) - Updated 5/28/14
  • Section J - Exhibits - Updated 12/16/10

Chapter 5 - Jurisdiction and Transfer

  • Section A - Jurisdiction Over Claims Folders - Updated 5/21/15
  • Section B - Jurisdiction Over Deceased Veterans Claims Folders - Updated 6/15/15
  • Section C - Jurisdiction Over Education and Rehabilitation Claims - Updated 5/14/15
  • Section D - General Policies for Permanent Transfer - Updated 9/19/14
  • Section E - Permanent Transfer Out or Transfer In of Claims Folders - Updated 6/23/15
  • Section F - Temporary Transfer - Updated 9/2/10
  • Section G - Transfer of Folders Subject to Review by the United States Court of Appeals for Veterans Claims (CAVC) - Updated 8/6/14

Chapter 6 - Determining Veteran Status and Eligibility for Benefits

  • Chapter 6 - Determining Veteran Status and Eligibility for Benefits - Updated 6/8/15

Chapter 7 - Referrals to the Rating Activity

  • Chapter 7 - Referrals to the Rating Activity - Updated 4/24/15

Chapter 8 - First Notice of Death (FNOD) Processing

  • Section A - General Policies for FNOD Processing - Updated 6/29/15
  • Section B - System Information - Updated 6/18/15
  • Section C - Interaction with the Records Management Center (RMC) - Updated 6/12/15
  • Section D - Miscellaneous (FNOD) Issues - Updated 6/12/15

Changes

Subpart III - General Development and Dependency Issues

Chapter 1 - Rules and Process

  • Section A - Initial Considerations Regarding the Development Process - Updated 6/14/15
  • Section B - Evidence Requested from the Claimant - Updated 6/26/15
  • Section C - Requesting Evidence from Other Sources - Updated 6/16/15

Chapter 2 - Developing for Service Records

  • Section A - General Information on Service Records - Updated 5/18/15
  • Section B - Service Record Migration - Updated 12/19/14
  • Section C - Beneficiary Identification and Records Locator Subsystem (BIRLS), Records Management Center (RCM) and the Service Treatment Record (STR) Folder - Updated 5/28/15
  • Section D - Requesting Information/Records Through the Personnel Information Exchange System (PIES) - Updated 6/19/15
  • Section E - Unique Claims and Situations that Require Special Handling - Updated 6/11/15
  • Section F - Merchant Marine Service Records - Updated 5/20/15
  • Section G - Prisoners of War (POW) Service Records - Updated 5/11/15
  • Section H - Record Exchanges between the Department of Veterans Affairs (VA) and the Service Departments - Updated 6/15/15
  • Section I - Control and Follow-up on Record Requests - Updated 6/18/15
  • Section J - Service Department Organzational Structures and service Record Address Codes - Updated 6/1/15
  • Section K - Other Contact and Reference Information - Updated 6/12/15

Chapter 3 - Information Requests to and from the Social Security Administration (SSA)

  • Section A - Department of Veterans Affairs (VA) Requests for Information from the SSA - Updated 6/26/15
  • Section B - SSA Requests for Information from VA - Updated 6/14/15

Chapter 4 - Information Requests to or from Other Federal and State Agencies

  • Chapter 4 - Information Requests to or from Other Federal and State Agencies - Updated 6/11/15

Chapter 5 - Relationship and Dependency

  • Section A - General Information on Relationship and Dependency - Updated 6/8/15
  • Section B - General Information on Establishing Marital Relationship - Updated 6/4/15
  • Section C - Establishing Common Law Marriages - Updated 3/18/15
  • Section D - Establishing Other Types of Marriages - Updated 5/21/15
  • Section E - Establishing Marital Relationship in Death Cases - Updated 4/26/15
  • Section F - Establishing a Child's Age and Relationship and Adjusting Awards for Dependents - Updated 3/24/15
  • Section G - Establishing relationship for a Biological Child, Adopted Child, and Stepchild - Updated 9/19/14
  • Section H - Marriage of a Child - Updated 5/1/15
  • Section I - Establishing Parental Relationship - Updated 6/3/15
  • Section J - Establishing Parental Dependency - Updated 10/11/10
  • Section K - Verification of Marital Status and the Status of Dependents - Updated 5/12/15

Chapter 6 - School Attendance

  • Section A - Notification of Potential Entitlement and School Attendance Policies - Updated 6/25/15
  • Section B - Awards and Adjustments Based Upon School Attendance - Updated 5/26/15
  • Section C - Dependents' Educational Assistance (DEA) - Updated 6/25/15
  • Section D - Exhibits - RESCINDED 3/18/15

Chapter 7 - Childs Permanent Incapacity for Self Support

  • Chapter 7 - Childs Permanent Incapacity for Self Support - Updated 3/24/15

Chapter 8 - Evidence Required to Change or Correct Existing Vital Information About a Beneficiary

  • Chapter 8 - Evidence Required to Change or Correct Existing Vital Information About a Beneficiary - Updated 5/6/15

Changes

Subpart IV - General Rating Process

Chapter 1 - General Information on the Rating Activity

  • Chapter 1 - General Information on the Rating Activity - Updated 5/6/15

Chapter 2 - Reviewing Claims

  • Section A - Preliminary Review of Claims - Updated 2/22/2012
  • Section B - Revision of Decisions - Updated 6/24/15

Chapter 3 - Examinations

  • Section A - Examination Request - Updated 12/19/14
  • Section B - Scheduling Examinations - Updated 5/8/15
  • Section C -Control of Examinations - Updated 5/1/15
  • Section D - Examination Reports - Updated 6/5/12
  • Section E - VA Medical Facilities - Updated 4/6/15

Chapter 4 - Rating Specific Disabilities

  • Section A - Musculoskeletal Conditions - Updated 5/11/15
  • Section B - Conditions of the Organs of Special Sense - Updated 5/7/15
  • Section C - Infectious Diseases, Immune Disorders, and Nutritional Deficiencies - Updated 4/24/15
  • Section D - Respiratory Conditions - Updated 4/15/15
  • Section E - Cardiovascular System Conditions - Updated 5/8/15
  • Section F - Endocrine Conditions - Updated 4/8/15
  • Section G - Neurological Conditions and Convulsive Disorders - Updated 6/15/15
  • Section H -Mental Disorders - Updated 5/1/15
  • Section I - Conditions of Other Body Systems - Updated 6/12/15
  • Section J - Skin Conditions - Updated 6/1/15

Chapter 5 - Evaluating Evidence and making a Decision

  • Chapter 5 - Evaluating Evidence and making a Decision - Updated 5/7/12

Chapter 6 - The Rating Decision

  • Section A - Intermediate Rating Decisions and Deferred Issues - Updated 4/8/2015
  • Section B - Determining the Issues - Updated 6/30/15
  • Section C - Documenting the Decision - Updated 6/18/15
  • Section D - Codesheet Section - Updated 4/3/15
  • Section E - Coded Conclusion - Updated 6/1/15
  • Section F -  Automated Decision Letter (ADL) Rating Procedures - Updated 5/18/15

Chapter 7 - Finalizing and Reviewing the Rating Decision

  • Section A - Finalizing the Rating Decision - Updated 4/27/15
  • Section B - Reviewing the Rating Decision - Updated 5/19/15

Chapter 8 - Competency, Due Process and Protected Ratings

  • Section A - Evaluating Competency - Updated 9/22/14
  • Section B - Proposed rating Decisions - Updated 5/1/15
  • Section C - Protected Ratings - Updated 4/22/15
  • Section D - Reductions in Awards - Updated 6/12/15
  • Section E - Other Due Process Concerns - Updated 5/20/15

Changes

Subpart V - General Authorization Issues and Claimant Notifications

Chapter 1 - Administration Decisions

  • Section A - General Information - Updated 4/10/15
  • Section B - Statutory Bar to Benefits and Character of Discharge - 5/28/15
  • Section C - Former Prisioner of War (POW) Status - Updated 3/24/15
  • Section D - Willful Misconduct and Line of Duty - Updated 6/4/15
  • Section E - Determinations of Insanity - Updated 4/23/15
  • Section F - Considering Eligibility When Homicide is Involved - Updated 4/23/15
  • Section G - Presumption of Death - Updated 6/10/15
  • Section H - Finding of Fact and Date of Death - Updated 3/10/15
  • Section I - Reversal of Prior Determinations and Administrative Errors - Updated 6/8/15

Chapter 2 - Decision Authorization and Notification

  • Section A - Decision Authorization - Updated 4/6/15
  • Section B - Decision Notices - Updated 6/1/15

Chapter 3 - Apportionments

  • Section A - Apportionment Process - Updated 3/24/15
  • Section B - Adjusting Apportioned Awards - Updated 5/3/12
  • Section C - Special Issues in Apportionment Cases - Updated 4/14/15
  • Section D - Garnishment of Disability Compensation in Lieu of Military Retired Pay to Pay Alimony or Child Support - Updated 4/10/15

Chapter 4 - Elections, Waivers, and Recoupments

  • Section A - General Information on Elections - Updated 5/18/15
  • Section B - Recoupment of Readjustment, Separation, and Severance Pay - Updated 6/12/15
  • Section C - Adjusting Department of Veterans Affairs (VA) Benefits Based on a Veteran's Receipt of Active Service Pay - Updated 4/20/15
  • Section D - Federal Employees' Compensation (FEC) - Updated 5/1/15
  • Section E - Two Parent Cases - Updated 6/9/15
  • Section F - Miscellaneous Election Issues - Updated 5/1/15

Chapter 5 - Military Retirement Pay

  • Section A - Elections and Waivers in Military Retirement Pay Cases - Updated 6/25/15
  • Section B - Preparing and Adjusting Awards in Military Retirement Pay Cases - Updated 11/21/06
  • Section C - Coordinating Military retirement Pay Cases With retired Pay Centers and Service Departments - Updated 4/28/15
  • Section D - Reconciliation of Department of Veteran Affairs (VA), Department of Defense (DoD), and Department of Transportation (DoT) Records - Updated 3/24/15

Chapter 6 - Hospitalization at Department of Veterans Affairs (VA) Expense

  • Section A - Information Exchange Between VA Regional Offices (ROs) and Medical Facilities - Updated 4/20/15
  • Section B - Adjustments Under 38 CFR 3.551 and 3.556 - Updated 5/11/15
  • Section C - Adjusting Awards Involving Aid & Attendance (A&A) Allowance - Updated 4/21/15
  • Section D - Adjusting Compensating When a Veteran is Hospitalized in Excess of 21 Days - Updated 5/28/15
  • Section E - Institutional Awards Specific to Incompetent Veterans - Updated 8/29/11
  • Section F - Estate limitations - Updated 4/24/15
  • Section G - Compensation and Pension Record Interchange (CAPRI) - Updated 5/14/15

Chapter 7 - Eligibility for Department of Veterans Affairs (VA) Medical and Dental Treatment

  • Section A - Eligibility for Hospital, Nursing Home, Domiciliary, and Medical Care - Updated 8/29/11
  • Section B - Overview of Classes of Eligibility for Dental Treatment - Updated 4/23/14
  • Section C - Processing Dental Claims - Updated 5/11/15

Chapter 8 - Incarceration

  • Section A - General Information on the Payment of Benefits During Incarceration - Updated 5/21/09
  • Section B - Apportioning Benefits of an Incarcerated Veteran - Updated 6/29/15
  • Section C - Incarceration of a Dependent - Updated 3/4/15

Chapter 9 - Authorizing Awards for Incompetency and Fiduciary Cases

  • Section A - General Information on Incompetency and Fiduciary Cases - Updated 7/26/07
  • Section B - Processing Awards to Incompetent Beneficiaries - Updated 12/19/14
  • Section C - Authorizing Awards for Fiduciary Cases - Updated 2/23/11

Changes

Subpart VI - Special Authorization Issues

Chapter 1 - Central Office Guidance, Equitable Relief, and Other Requests

  • Section A - Compensation and Pension (C&P) Service Guidance - Updated 4/16/15
  • Section B - Equitable Relief and Other Request - Updated 5/1/15

Chapter 2 - Processing Awards Involving Indebtedness

  • Section A - Simultaneous Award Adjustments - Updated 5/28/15
  • Section B - Fiscal Authorization (FISA) - Updated 6/19/15
  • Section C - Debt Collection - Updated 6/18/15

Chapter 3 - Special Act and Foreign Resident Beneficiaries

  • Section A - Jurisdiction - Updated 4/27/15
  • Section B - Awards in Foreign Resident Beneficiaries - Updated 5/28/15

Chapter 4 - Philippine Cases

  • Section A - General Information on Philippine Cases - Updated 4/28/15
  • Section B - Eligibility for Benefits - Updated 5/11/15
  • Section C - Development of Philippine Cases - Updated 5/22/15
  • Section D - Awards and Payments - Updated 5/28/15
  • Section E - Unique Circumstances - Updated 5/13/15

Chapter 5 - Fraud and Forfeiture

  • Section A - Fraud - Updated 5/22/15
  • Section B - Forfeiture Discontinuance Provisions - Updated 5/12/15

Chapter 6 - Contested Claims

  • Section A - General Information on Contested Claims - Updated 5/5/15
  • Section B - Contested Claims Development - Updated 5/7/15
  • Section C - Authorization and Notification - Updated 5/10/07

Chapter 7 - Certifications for Special Purposes

  • Chapter 7 - Certifications for Special Purposes - Updated 5/14/15

Chapter 8 - Miscellaneous Authorization Issues

  • Chapter 8 - Miscellaneous Authorization Issues - Updated 11/13/14

Changes

go Part 2 | Part 4