M21-1 Manual  /  Part X, Subpart i, Chapter 1

Priority Processing Programs and Special Requirements

M21-1, Part X, Subpart i, Chapter 1

Overview

In This Chapter

This chapter contains the following topics:
TopicTopic Name
1General Information About Claims That Require Priority Processing
2Priority Processing of Claims From Homeless Veterans
3Claims Requiring Priority Processing Because of Extreme Financial Hardship
4Priority Processing of Claims From Very Seriously Ill or Injured/Seriously Ill or Injured (VSI/SI) Claimants
5Claims Requiring Priority Processing Because of Terminal Illness
6Priority Processing of Claims From Former Prisoners of War (FPOWs)
7Priority Processing of Claims Associated With Award of the Medal of Honor or Purple Heart
8Special Handling of Claims From the Visually Impaired

1. General Information About Claims That Require Priority Processing

Introduction

This topic contains general information about claims that require priority processing, including

  • types of claims that require priority processing
  • managing claims that require priority processing
  • handling claims folders that have not yet been converted into an electronic format, and
  • use of VA Form 20-10207, Priority Processing Request.

Change Date

November 7, 2024

X.i.1.1.a. Types of Claims That Require Priority Processing

Listed below are the types of claims that require priority processing:

X.i.1.1.b. Managing Claims That Require Priority Processing

Upon receipt or assignment of one of the types of claims identified in M21-1, Part X, Subpart i, 1.1.a, regional offices (ROs) must take any action on the claim that is necessary to move it to the next stage in the claims process before taking action on any other non-priority claim received by or assigned to the RO. To ensure a claim requiring priority processing is expedited at all stages of the claims process, ROs must also case-manage such claims by
  • utilizing appropriate flashes or claim attributes, when indicated
  • frequently following up on pending actions
  • utilizing issue-specific coordinators, such as Military Records Specialists, when applicable
  • using the telephone to
    • contact homeless Veterans, and
    • conduct development activities with other types of claimants, whenever possible
  • collaborating with the Veterans Health Administration and other involved counterparts
  • reviewing any available medical evidence early in the claims process to determine its potential adequacy for rating purposes, and
  • sympathetically considering the claimant’s level of impairment (particularly where evidence is suggestive of terminal illness) including
    • developing for and considering available private medical evidence, and/or
    • requesting medical opinions based solely on records review when available evidence is otherwise sufficient to assign an evaluation.
Reference: For more information on utilizing and maintaining claim attributes, see

X.i.1.1.c. Handling Claims Folders That Have Not Yet Been Converted Into an Electronic Format

Adjudicate a claim that requires priority processing before sending any associated documentation to a vendor for conversion into an electronic format (scanning) if
  • the claim is in paper form, or
  • the claimant still has a traditional claims folder.
Reference: For more information on the scanning process referenced in this block, see M21-1, Part II, Subpart i, 1.B.

X.i.1.1.d. Use of VA Form 20-10207

VA Form 20-10207, Priority Processing Request, is available for a claimant, a claimant’s authorized third-party representative, or a claimant’s authorized power of attorney for use to bring to the VA’s attention an assertion that a priority status may apply. Important: Use of this form is not a requirement to request priority processing.


2. Priority Processing of Claims From Homeless Veterans

Introduction

This topic contains information on handling claims from homeless Veterans, including

  • definition of homelessness
  • flashing a homeless Veteran’s record
  • handling applications from Veterans that might be homeless, and
  • Homeless Veterans Coordinators.

Change Date

April 6, 2015

X.i.1.2.a. Definition: Homelessness

The detailed legal definition of homelessness is found in 42 U.S.C. 11302.Reference: For more information on determining whether a Veteran is homeless, formerly homeless, or at imminent risk of homelessness, see M27-2, Part I, 2.04.c.

X.i.1.2.b. Flashing a Homeless Veteran’s Record

For information on how to appropriately flash a homeless Veteran’s record, see M27-2, Part I, 2.04.d.

X.i.1.2.c. Handling Applications From Veterans That Might Be Homeless

Upon receipt of an application for benefits that contains a telephone number but no mailing address, attempt to contact the claimant by telephone to obtain a current mailing address. If neither a mailing address nor a telephone number are provided on the application, follow the instructions in M21-1, Part II, Subpart i, 2.C.6.m. Reference: For information on the delivery of benefit payments (including undeliverable checks) and correspondence to homeless Veterans, see

X.i.1.2.d. Homeless Veterans Coordinators

All ROs are required to have either a Homeless Veterans Claims Coordinator (HVCC) or a Homeless Veterans Outreach Coordinator (HVOC). Claims from homeless Veterans and from Veterans who are at immediate risk of homelessness are monitored and tracked by the local HVCC or designee.Reference: For information on the duties of HVCCs/HVOCs, see M27-2, Part I, 2.04.b.

3. Claims Requiring Priority Processing Because of Extreme Financial Hardship

Change Date

October 15, 2019

X.i.1.3.a. How a Claimant Establishes Extreme Financial Hardship

If a claimant states that they are experiencing extreme financial hardship and submits documentation to support the assertion, accept the claimant’s statement as factual. Documentation to support the assertion of extreme financial hardship includes, but is not limited to,
  • an eviction notice or statement of foreclosure
  • notices of past-due utility bills, and/or
  • collection notices from creditors.
Important: A Veterans Service Center Manager (VSCM) may designate that a claim requires priority processing because of extreme financial hardship even though the documentation described in this block does not exist.Remember: Append the Hardship corporate flash to a claimant’s record when extreme financial hardship has been adequately demonstrated.Reference: For more information on appending the Hardship flash, see the VBMSCore User Guide.

4. Priority Processing of Claims From VSI/SI Claimants

Introduction

This topic contains information on handling claims from VSI/SI claimants, including

  • definition of a serious illness or injury
  • case management of claims from VSI/SI claimants
  • handling a claim from a VSI/SI service member who is not yet discharged
  • requesting a VSI/SI claimant's claims folder previously held at VA's Records Management Center (RMC), and
  • rating considerations when processing a claim from a VSI/SI claimant.

Change Date

May 31, 2023

X.i.1.4.a. Definition: Serious Illness or Injury

For the purposes of this topic, a serious illness or injury is defined as a disability that
  • occurred as a result of participation in a military operation, and
  • will likely result in discharge from military service.
The Department of War (DOW) determines whether a service member is:
  • VSI
  • SI, or
  • not seriously ill or injured (NSI).
Notes:
  • All service members categorized by DOW as VSI or SI are considered seriously disabled for VA purposes.
  • In the absence of an indicator from DOW that a claimant is VSI/SI, a VSI/SI Coordinator may decide whether a claimant has a serious illness or injury.
  • Although VSI/SI Coordinators should contact and assist individuals that DOW has categorized as NSI, their claims do not require case management and priority processing unless they are one of the other types of claims identified in M21-1, Part X, Subpart i, 1.1.a.
Reference: For more information on VSI/SI Coordinators, see M21-1, Part X, Subpart i, 1.4.b.

X.i.1.4.b. Management of Claims From VSI/SI Claimants

All ROs must designate a VSI/SI Coordinator, and VSCMs/Pension Management Center Managers are responsible for ensuring claims from VSI/SI claimants are case-managed by the Special Operations Team. Duties of the VSI/SI Coordinator include, but are not limited to,
  • ensuring the Seriously Injured/Very Seriously Injured corporate flash is appended to the claimant’s record
  • acting as a liaison with VA medical facilities, military facilities, and other RO divisions, and
  • acting as a direct point of contact for VSI/SI claimants and their dependents.
Reference: For more information on adding the VSI/SI flash, see the VBMS Core User Guide.

X.i.1.4.c. Handling a Claim From a VSI/SI Service Member Who Is Not Yet Discharged

Prior to awarding benefits to a claimant, ensure the individual is discharged from service. Notes:
  • A service member may receive treatment at a VA or DOW medical facility for several months before actual separation from service.
  • Pre-discharge sites do not process claims requiring case management, including claims from VSI/SI claimants.
References: For more information on

X.i.1.4.d. Requesting a VSI/SI Claimant's Claims Folder Previously Held at VA's RMC

If a VSI/SI claimant's claims folder was previously located at VA’s Records Management Center (RMC) prior to the File Bank Extraction project, submit an expedited request through the Source Material Tracking System (SMTS) Portal. References: For more information on

X.i.1.4.e. Rating Considerations When Processing a Claim From a VSI/SI Claimant

Follow the procedures in the table below if a VSI/SI claimant is released from service while hospitalized or convalescing.
If the ...Then prepare a rating decision that grants entitlement to ...
medical evidence of record shows
  • the existence of an unstabilized condition with severe disability, and
  • substantially gainful employment is not feasible or advisable
a prestabilization rating under 38 CFR 4.28.Important: It is not necessary to request a VA examination or service treatment records, or undertake other routine development, if the evidence of record is sufficient to justify a pre-stabilization rating.
medical evidence of record shows
  • the existence of an unstabilized condition with unhealed or incompletely healed wounds or injuries, and
  • employability is likely impaired because of the condition
  • claimant was discharged from service while hospitalized for a service-connectable disability, and
  • the period of hospitalization exceeded 21 days
benefits under 38 CFR 4.29.Important: Do not postpone rating action simply because a claimant is discharged from service while hospitalized.
claimant requires convalescence following a period of hospitalization for a service-connected (SC) disabilitybenefits under 38 CFR 4.30.

5. Claims Requiring Priority Processing Because of Terminal Illness

Change Date

November 7, 2024

X.i.1.5.a. Prioritization of Claims From Terminally Ill Claimants

Upon receipt of medical evidence showing a claimant has an illness that is likely terminal in nature, present the evidence to a coach or assistant coach for a determination as to whether or not priority processing of the associated claim is warranted. When determining whether priority processing is warranted, consider
  • the likelihood the claimant will pass away before completion of the claims process, and
  • the probable need for additional benefits, such as the benefits payable based on a claimant's need for aid and attendance (A&A).
When priority processing of a claim based on terminal illness is warranted
  • append the Terminally Ill flash to the corporate record using VBMS, and
  • change the claim priority in VBMS to High.
Reference: For information on using flashes, see the VBMS Core User Guide.

6. Priority Processing of Claims From FPOWs

Introduction

This topic contains information on handling claims from FPOWs, including
  • definition of FPOW
  • flashing an FPOW’s record, and
  • FPOW Coordinators.

Change Date

November 9, 2017

X.i.1.6.a. Definition: FPOW

Refer to M21-1, Part VIII, Subpart iv, 2.A.1.a for the definition of former prisoner of war (FPOW). Reference: For more information on verifying FPOW status, see

X.i.1.6.b. Flashing an FPOW’s Record

FPOW claims require priority processing. Add the POW flash (when it is not already present) when a claim is received from a
  • Veteran or survivor who claims FPOW status, or
  • Veteran whose FPOW status has been previously verified, or the Veteran’s survivor.
The FPOW flash will result in prioritization of the FPOW claim within the National Work Queue (NWQ) and cause the claim to be routed to the RO nearest in geographical location to the Veteran or claimant. Reference: For more information on adding a flash, see the VBMS Core User Guide.

X.i.1.6.c. FPOW Coordinators

All ROs are required to have a FPOW Coordinator. Reference: For more information on the role and duties of the FPOW Coordinator, see M27-2, Part I, 2.03.c-e.

7. Priority Processing of Claims Associated With Award of the Medal of Honor or Purple Heart


IntroductionThis topic contains information on handling claims from Veterans who earned the Medal of Honor or Purple Heart, including
  • award criteria for the
    • Medal of Honor, and
    • Purple Heart, and
    • flashing a Veteran’s record to expedite processing based on receipt of the Medal of Honor or Purple Heart.
Change Date April 1, 2019

X.i.1.7.a. Award Criteria for the Medal of Honor

The Medal of Honor is the highest and most prestigious personal military decoration that may be awarded to recognize Veterans who have distinguished themselves by acts of valor during specifically defined combat or combat-related service. It is awarded by the President of the United States on behalf of Congress. References: For more information on

X.i.1.7.b. Award Criteria for the Purple Heart

The Purple Heart is awarded in the name of the President of the United States to members of the Armed Forces of the United States who have been wounded, were killed, or who have died or may hereafter die of wounds received during specifically defined combat or combat-related service. Reference: For more information on award of the Purple Heart, see 10 U.S.C. 1129.

X.i.1.7.c. Flashing a Veteran’s Record to Expedite Based on Receipt of the Medal of Honor or Purple Heart

Priority processing is required for
  • all claims for Veterans or service members who have earned the Medal of Honor
  • original compensation or pension claims for a Veteran or service member who earned the Purple Heart, and
  • original DIC claims based on the death of a Veteran or service member who earned the Purple Heart.
Add the Medal of Honor or Purple Heart flash (when it is not already present) when a claim is received from a Veteran, service member, or survivor and receipt of the Purple Heart or Medal of Honor is documented. Notes:
  • The Medal of Honor or Purple Heart flash will result in prioritization of the claim, as described in the categories above, within NWQ.
  • When the claimant has a paper claims folder, also add a attach a paper flash to the front of the claims folder that reads Process Next – Purple Heart/Medal of Honor and follow the procedures at M21-1, Part X, Subpart i, 1.1.c.
References: For more information on

8. Special Requirements for Visually Impaired Claimants

Introduction

This topic contains information on identifying and providing notification to visually impaired Veterans and survivors, including
  • legal requirements to provide accommodations for visually impaired claimants
  • definition of visually impaired claimant
  • requirement to identify visually impaired claimants
  • enlarged font requirements, and
  • attempting telephonic contact.

Change Date

May 31, 2023

X.i.1.8.a. Legal Requirements to Provide Accommodations for Visually Impaired Claimants

Federal law requires that visually impaired individuals have “meaningful access” to Federal programs, including benefit programs operated by the Veterans Benefits Administration. Claims processors must provide meaningful access for visually impaired claimants by making communications of benefits-related information accessible. This includes the following required accommodations:
  • ensuring all development letters, rating decisions, and decision notices are formatted with enlarged font to enhance visibility, and
  • completing the telephonic contact requirements outlined in M21-1, Part X, Subpart i, 1.8.e.

X.i.1.8.b. Definition: Visually Impaired Claimant

For the purposes of providing accommodations and accessibility, a visually impaired claimant includes
  • 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 a visual impairment (whether VA has evaluated the disability or not) with modified correspondence and communication methods, and
    • any survivor claimant
      • with visual impairment that corresponds to a need for A&A, or
      • who has expressly requested that VA accommodate a visual impairment (whether VA has evaluated the disability or not) with modified correspondence and communication methods.

X.i.1.8.c. Requirement to Identify Visually Impaired Claimants

Every visually impaired claimant’s record must be identified with the following attributes:Important: A claimant may be found via rating decision to qualify for A&A when visual impairment is of such severity as to automatically establish eligibility to A&A, as set forth in 38 CFR 3.351(c)(1). Requirements for A&A status are described in M21-1, Part IX, Subpart ii, 1.A.1.b. Reference: For information on adding a flash to a Veteran’s record, see

X.i.1.8.d. Enlarged Font Requirements

All communications generated by a claims processor for a visually impaired claimant must include the enlarged 18-point font. This includes all
  • development letters
  • rating decisions, and
  • decision notices.
Use the table below to ensure the relevant claimant communication is generated with the requisite enlarged font.
If generating a ...Then ...
development letter ordecision notice in VBMSthe Blind corporateflash will automatically trigger the enlarged font in the generated letter. Note: Text in the right sidebar of letters generated using Redesigned Automated Decision Letter will remain in 8-point font.
development letter or decision notice in any other system, such as Personal Computer Generated Lettermanually enlarge the font to the required size.
rating decisionthe VISUALLY IMPAIRED field on the DOCUMENTS tab in VBMS-Rating must be manually selected to generate a rating narrative with enlarged font.

X.i.1.8.e. Attempting Telephonic Contact

Once a development letter or decision notice is finalized and submitted for mailing, a claims processor must make a minimum of three attempts to contact the visually impaired claimant by telephone to explain the substance of the letter. The claims processor must
  • provide to the claimant a general summary of the development letter or decision(s) VA made
  • inform the claimant that
    • the letter is forthcoming, and
    • any additional questions concerning the letter’s content may be directed to the National Call Center, and
    • document

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part X, Subpart i, Chapter 1 (U.S. government work, reproduced for reference). Browse all sections →