M21-1 Manual  /  Part X, Subpart i, Chapter 2, Section B

Processing Fully Developed Claims (FDCs)

M21-1, Part X, Subpart i, Chapter 2, Section B

Overview

In This Section

This section contains the following topics:
TopicTopic Name
1 Intake Process for FDCs
2 Excluding Claims From the FDC Program
3 Development the Department of Veterans Affairs (VA) Undertakes in Connection with FDCs
4 Effective Date Provisions Unique to the FDC Program

1. Intake Process for FDCs

Change Date

November 9, 2022

X.i.2.B.1.a. Initial Actions to Take Upon Receipt of an FDC

Identify a fully developed claim (FDC) by attaching the Fully Developed Claim special issue indicator to at least one contention within the FDC claim. References: For more information on


2. Excluding Claims From the FDC Program

Introduction

This topic contains information about excluding claims from the FDC Program, including
  • excluding a claim from the FDC Program at claims establishment
  • reasons for subsequent exclusion of a claim from the FDC Program
  • submission of additional evidence and FDC exclusion
  • process for excluding a claim from the FDC Program
  • special issue indicators for FDC exclusion
  • erroneous exclusion of a claim from the FDC Program
  • applicability of FDC guidance changes, and
  • handling disputes with exclusion from the FDC Program.

Change Date

November 9, 2022

X.i.2.B.2.a. Excluding a Claim From the FDC Program at Claims Establishment

Even though a claimant submits one of the EZ forms listed in M21-1, Part X, Subpart i, 2.A.2.a, the claim must be reviewed at the claims establishment stage to ensure it qualifies for FDC processing. Use the table below when establishing a claim submitted on an EZ form to determine if it must be excluded from the FDC Program.
If ...Then ...
the claimant
  • indicates they do not want the Department of Veterans Affairs (VA) to process their claim under the FDC Program (as discussed in M21-1, Part X, Subpart i, 2.A.2.b)
  • has a claim pending at the time VA receives the EZ form
  • has a legacy appeal, higher-level review (HLR), or notice of disagreement (NOD) with the Board of Veterans’ Appeals (BVA) pending at the time VA receives the EZ form, or
  • fails to simultaneously submit any of the additional forms required to process the specific claim
exclude the claim from the FDC Program. Note: Required forms are defined as those forms discussed on the EZ form under “Special Circumstances.” Exception: If evidence submitted with the FDC is sufficient to concede a stressor in a posttraumatic stress disorder (PTSD) claim, such as fear, combat decoration, etc., a VA Form 21-0781, Statement in Support of Claimed Mental Health Disorder(s) Due to an In-Service Traumatic Event(s), is not required. Reference: For more information on PTSD claims, see M21-1, Part VIII, Subpart iv, 1.A-E.
the claim requires development for evidence from
  • the claimant, or
  • private healthcare provider(s)
exclude the claim from the FDC Program. Exception: Special issue claims, as discussed in M21-1, Part X, Subpart i, 2.B.3.b.
a claim for disability compensation requires development forVA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA), and/or VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA), to obtain Vet Center recordsexclude the claim from the FDC Program. Rationale: The current version of VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, notifies claimants that FDC Program participation requires simultaneous submission of VA Form 21-4142 for Vet Center records. Exception: Exclusion from the FDC Program is not required if the development discussed in this row is needed in connection with a claim for Veterans Pension or survivors benefits. Reference: For more information on pension and survivor FDCs and Vet Center records, see M21-1, Part X, Subpart i, 2.B.3.d.
the claim requires development for Federal recordsdo not exclude the claim from the FDC Program.
the claim requires development for National Guard or Reserve unit recordsdo not exclude the claim from the FDC Program.
the claim requires completion of NA Form 13055, Request for Information Needed to Reconstruct Medical Data, (by the claimant) because service treatment records (STRs) were destroyed by a fire at the National Personnel Records Center (NPRC) in 1973do not exclude the claim from the FDC Program.
the claim requires a character-of-discharge (COD) determinationexclude the claim from the FDC Program.
the claim requires a telephone call to a claimant to clarify informationdo not automatically exclude from the FDC Program. Reference: For more information on telephone contact and FDC exclusion, see M21-1, Part X, Subpart i, 2.B.3.f.
  • VA requires a claimant to simultaneously submit an additional form with the FDC, and
  • the claimant submits an incomplete form
exclude the claim from the FDC Program. Note: Required forms are defined as those forms discussed on the EZ form under “Special Circumstances.”
VA requires independent verification of earned and unearned income from Federal tax information (FTI) received for upfront verificationexclude the claim from the FDC Program.
  • a claimant submits a dual claim for compensation and pension on the required EZ forms, and
  • one of the claims requires further development
the claim that does not require development should still be processed in the FDC Program.
Notes:
  • Benefits Delivery at Discharge (BDD) claims are excluded from the FDC Program. However, claims that are excluded from the BDD program (including BDD-excluded claims received from 180 to 1 day prior to discharge, and claims or additional contentions received less than 90 days prior to discharge) can be processed through the FDC Program, subject to FDC Program requirements.
  • The steps described in M21-1, Part X, Subpart i, 2.B.2.d do not apply when excluding a BDD claim.
References: For more information on the
  • only development VA will undertake in connection with an FDC, see M21-1, Part X, Subpart i, 2.B.3.a, and
  • required procedure for excluding a claim from the FDC Program, see M21-1, Part X, Subpart i, 2.B.2.d.

X.i.2.B.2.b. Reasons for Subsequent Exclusion of a Claim From the FDC Program

If at any time during the processing of an FDC, a reason for exclusion is met, the claim must be excluded from the FDC Program.See the table below for a description of the reasons for subsequent exclusion of a claim from the FDC Program.Important: When guidance on excluding an FDC has changed during the processing of the FDC, follow the instructions in M21-1, Part X, Subpart i, 2.B.2.g.
Exclude a claim from the FDC Program if the claimant or power of attorney (POA) ...Except ...
submits additional evidence, even if it does not require additional developmentas provided in M21-1, Part X, Subpart i, 2.B.2.c.
  • fails to report for a VA examination, and
  • asks VA to reschedule before the FDC is decided
if VA is solely at fault.Example: VA did not provide the examining facility with the claimant’s correct mailing address.
submits an additional claim, even if it does not require additional development
  • when a survivor’s FDC is either preceded or followed by a burial or accrued claim, or
  • when there is an unclaimed issue that is found to be within the scope of the claim as defined in 38 CFR 3.155(d)(2). Any issue within the scope of the claim will be developed in accordance with current policies and procedures and will not be excluded for any non-Federal records development.
Reference: For more information on issues within the scope, see M21-1, Part V, Subpart ii, 3.A.1.c.
submits a(n)
  • legacy appeal
  • request for HLR, or
  • NOD to BVA.
---

X.i.2.B.2.c. Submission of Additional Evidence and FDC Exclusion

In some cases, the submission of additional evidence does not require an automatic exclusion from the FDC Program. Do not exclude a claim from the FDC Program if the claimant or POA submits
  • duplicate evidence already of record, including records not in the claims folder but in other VA systems, such as the Compensation and Pension Record Interchange
  • a response limited to only the information requested in a required development letter
  • status or other inquiries, or
  • information received in response to a matching/data transfer program between VA and another government entity.
Reference: For more information on the determination to exclude from the FDC Program after sending a development letter, see M21-1, Part X, Subpart i, 2.B.3.e.

X.i.2.B.2.d. Process for Excluding a Claim From the FDC Program

If it becomes necessary to exclude a claim from the FDC Program, regional offices (ROs) must follow the steps in the table below. Exception: The steps in the table below do not apply when excluding a BDD claim. These claims do not require an FDC exclusion special issue indicator.
StepAction
1Remove the FDC folder flash, if one exists.
2Replace the Fully Developed Claim special issue indicator with the appropriate special issue indicator from the list in M21-1, Part X, Subpart i, 2.B.2.e.
3Continue processing the claim under standard claims-processing procedures.
Note: After excluding a claim from the FDC Program, provide the claimant with the notice 38 U.S.C. 5103 required only if VA excluded the claim because the claimant
  • did not submit the claim on one of the EZ forms – or the appropriate EZ form – listed in M21-1, Part X, Subpart i, 2.A.2
  • submitted a non-original claim on the appropriate EZ form before March 24, 2015, but did not sign the form, or
  • submitted another claim after VA received the FDC and VA has not provided Section 5103 notice (to include the notice the EZ forms provide) within the last year that covers the issue(s) in the subsequent claim.
Important: An unsigned application for benefits received on or after March 24, 2015, must be handled as an incomplete application as instructed in M21-1, Part II, Subpart iii, 1.C.1.a. References: For more information on

X.i.2.B.2.e. Special Issue Indicators for FDC Exclusion

If it is necessary to exclude a claim from the FDC Program, assign the appropriate FDC special issue indicator. Use the table below to select the appropriate special issue.
Exclusion ReasonSpecial Issue
Claimant declines FDC processingFDC Excluded – Claimant declined FDC processing
Claim is pending at the time VA receives the FDCFDC Excluded – Claim pending
Legacy appeal, HLR, or NOD to BVA is pending at the time VA receives the FDCFDC Excluded – Appeal pending
Claimant fails to simultaneously submit any of the additional forms required to process the specific claimFDC Excluded – All Required Items Not Submitted
The claim requires
  • development for evidence, or
  • a COD determination
FDC Excluded –Needs Non-Fed Evidence Development
VA requires independent verification of earned and unearned income from FTI received for upfront verificationFDC Excluded – Requires INDPT VRFCTN of FTI
The claimant or POA submits additional evidenceFDC Excluded – Evidence received after FDC CEST
The Veteran
  • fails to report for a VA examination, and
  • asks VA to reschedule before the FDC is decided
FDC Excluded – FTR to exam
The claimant or POA submits an additional claimFDC Excluded – Additional claim submitted
The claimant or POA submits a(n)
  • legacy appeal
  • request for HLR, or
  • NOD to BVA
FDC Excluded—Appeal Submitted

X.i.2.B.2.f. Erroneous Exclusion of a Claim From the FDC Program

When a claim has been erroneously excluded from the FDC Program, VA must
  • remove the FDC exclusion special issue indicator
  • add the Fully Developed Claim special issue indicator back to at least one contention, and
  • continue to process the claim in the FDC Program.
Notes:
  • If a claim is erroneously excluded from the FDC Program, the rating activity must still apply
    • all pertinent effective date rules discussed in M21-1, Part V, Subpart ii, 4.A, and
    • if appropriate to the case/situation, effective date provisions unique to the FDC Program, as discussed in
      • M21-1, Part X, Subpart i, 2.B.4, and
      • the attachment, Historical_M21-1III_i_3_SecB_2-19-19.docx.
  • Notice to the claimant that the claim was erroneously excluded is not required. Any discussion of the effective date awarded in the rating decision and award notification letter is sufficient.

X.i.2.B.2.g. Applicability of FDC Guidance Changes

Use the table below to determine the appropriate action when changes in guidance occur during the processing of an FDC.
If during the processing of the FDC, the claim ...And under new guidance in effect at the time the decision is being made …Then ...
was excluded from the FDC Programit would not be excludedExamples:
  • National Guard records not submitted with the claim, or
  • fire-related STRs.
provided the claim is an original compensation claim, follow the provisions of M21-1, Part X, Subpart i, 2.B.2.f, to reinstate the claim into the FDC Program.
did not meet a reason to excludethe claim would be excludedExamples:
  • Claims processed between March 11, 2015, and August 6, 2015, with additional evidence received that did not require additional development.
  • Claims processed between December 2014 and August 6, 2015, where additional contentions were received that did not require additional development.
  • leave the claim in the FDC Program, and
  • apply the new guidance prospectively to claimed issues not previously reviewed/considered.

X.i.2.B.2.h. Handling Disputes With Exclusion From the FDC Program

VA may not accept as valid a legacy NOD or request for decision review submitted in response to notice that a claim was excluded from the FDC Program. Upon receipt of such communication, send notice to the claimant that the submission is not considered valid, as no final decision had been made at the time the claimant expressed disagreement. If the claimant timely disagrees with or requests decision review regarding exclusion from the FDC Program after receiving the decision notice associated with the underlying, excluded claim,
  • accept the submission as a valid legacy NOD or request for decision review, where other procedures allow, and
  • address, in the review decision, whether the appropriate effective date was originally assigned.
References: For more information on
  • the definition of a legacy NOD, see M21-5, Chapter 7, Section A.1.d, and
  • legacy NODs, see M21-5, Chapter 7, Section B.

3. Development VA Undertakes in Connection with FDCs

Introduction

This topic contains information about development VA undertakes in connection with FDCs, including
  • limitations on the development of FDCs
  • FDCs and special issue development
  • military sexual trauma (MST) protocol and FDCs
  • pension and survivors FDCs and Vet Center Records
  • determination to exclude from the FDC Program after sending a development letter, and
  • telephone development and FDC exclusion.

Change Date

November 9, 2022

X.i.2.B.3.a. Limitations on the Development of FDCs

The only development VA undertakes in connection with an FDC is to request
  • Federal records in the custody of the Federal government, including
    • FTI as described in M21-1, Part XIV, 4.A.1
    • records in the custody of VA medical centers
    • relevant records at a military treatment facility (MTF)
    • records that were destroyed by a fire at NPRC in 1973, and
    • records in the custody of a Veteran’s Reserve/Guard unit(s)
  • VA Form 21-4142 and/or VA Form 21-4142a when needed to obtain Vet Center records in support of a claim for Veterans Pension or survivors benefits
  • information needed for special issue claims
  • clarifications by telephone contact with the claimant, and/or
  • VA examination(s).
Note: When submitting a request for records from a Federal records custodian in connection with an FDC, do not concurrently request the same records from the claimant.Reference: For more information on requesting records from an MTF, see M21-1, Part III, Subpart ii, 1.A.3.

X.i.2.B.3.b. FDCs and Special Issue Development

If an FDC includes one of the special issues that require a subsequent development letter as noted in M21-1, Part III, Subpart i, 2.B.1.e, FDC exclusion is not appropriate at claims establishment, as there was no prior noticeto the claimant to provide the additional information/evidence necessary to develop and adjudicate the claim. Exception: Claims falling under one of the “Special Circumstances” noted on VA Form 21-526EZ, such as PTSD or individual unemployability, must be excluded from the FDC Program if filed without the necessary additional form(s) and adequate supporting evidence is not already of record.

Important: Do not send the development letter if the evidence of record
  • provides the information the letter solicits, or
  • is otherwise sufficient to decide the claim.
Example: If a Veteran claiming service connection for hepatitis C submits medical records that address risk factors for the disease, do not send a letter soliciting hepatitis risk factors, as this information is addressed by the evidence of record.References: For more information on
  • military sexual trauma (MST) protocol and FDCs, see M21-1, Part X, Subpart i, 2.B.3.c, and
  • exclusion from the FDC Program at claims establishment, see M21-1, Part X, Subpart i, 2.B.2.a.

X.i.2.B.3.c. MST Protocol and FDCs

MST claims require special handling and contact with the claimant. Development to a claimant that aligns with MST protocol will not be an exclusion from the FDC Program. Do not exclude MST claims from the FDC Program based on
  • a telephone call to a claimant to inquire as to whether or not any other claims of the MST have been filed, or
  • development to a claimant for an incident report.
Reference: For more information on notification requirements for special issue claims, see M21-1, Part III, Subpart i, 2.B.1.e.

X.i.2.B.3.d. Pension and Survivors FDCs and Vet Center Records

Do not exclude an FDC involving Veterans Pension or survivors benefits at claims establishment when a claimant identifies Vet Center records that require completion of a VA Form 21-4142 and/or VA Form 21-4142a, as there is no prior notice to the claimant that these Federal records require a release form. RO personnel should request that the claimant provide the VA Form 21-4142 and VA Form 21-4142a for the Vet Center records, when required. Important:
  • If the claimant responds with only the requested form or the related records, the claim will remain in the FDC Program.
  • As noted in M21-1, Part X, Subpart i, 2.B.2.a, claims involving disability compensation must be excluded from the FDC Program if VA Form 21-4142(and/or VA Form 21-4142a) development is needed to secure Vet Center records.
Reference: For more information on the determination to exclude from the FDC Program after sending a development letter, see M21-1, Part X, Subpart i, 2.B.3.e.

X.i.2.B.3.e. Determination to Exclude From the FDC Program After Sending a Development Letter

Use the table below to determine whether a claim should be excluded from FDC processing after sending the required development letter to the claimant.
If the claimant ...Then ...
provides only the information requested in the development letterdo not exclude from the FDC Program.
submits additional information/evidence not requested in the development letterexclude from the FDC Program.
does not respond to the development letterdo not exclude from the FDC Program.
References: For more information on
  • notification requirements for special issue claims, see M21-1, Part III, Subpart i, 2.B.1.f, and
  • steps to take when a claim is excluded from the FDC Program, see M21-1, Part X, Subpart i, 2.B.2.d.

X.i.2.B.3.f. Telephone Development and FDC Exclusion

A telephone call to a claimant to clarify information will not require exclusion from the FDC Program if the telephone call can be completed at the time the action is being taken on the claim. Exclusion would be appropriate when contact with the claimant is unsuccessful and the need for clarification would require the initiation of additional development.Example: A claimant submits medical evidence from a physician and attaches a VA Form 21-4142orVA Form 21-4142a. A claims processor calls the claimant to clarify if the claimant wanted VA to develop for additional records. Provided the claims processor reaches the claimant the same day and the claimant provided a negative response, the claim will not be excluded from the FDC Program.Important: Exclusion would be appropriate if
  • the claimant cannot be reached at the time of the action being taken on the claim, and
  • VA then had to send a letter to the claimant to request the necessary information.

4. Effective Date Provisions Unique to the FDC Program

Change Date

June 6, 2019

X.i.2.B.4.a. Effective Date Provisions Unique to the FDC Program

Existing VA regulations and procedures, including 38 CFR 3.400 and M21-1, Part V, Subpart ii, 4.A, apply equally to FDCs and claims submitted through the standard process. Unique to the FDC Program, however, were provisions implemented in Public Law (PL) 112-154, Section 506, which permitted the assignment of an effective date prior to date of claim for original compensation FDCs received
  • between August 6, 2013, and August 5, 2015, and/or
  • within one year of communication of an intent to file received between March 24, 2015, and August 5, 2015.
During the finite timeframe to which PL 112-154, Section 506, was applicable, decision makers granting claims under the FDC Program considered its provisions in concert with other regulatory effective date rules and principles in order to
  • determine which single, applicable effective date rule was most advantageous to the claimant, per individual issue, and
  • use only that effective date rule to award benefits for the issue in question.
Notes: The provisions of PL 112-154, Section 506,
  • did not apply to informal claims filed prior to March 24, 2015, under historical 38 CFR 3.155, and
  • characterized an “original claim” as the initial formal (complete) claim filed by a Veteran for disability compensation, such that Veterans who had previously applied for non-service-connected pension retained potential eligibility to the retroactive effective date upon filing an initial compensation FDC.
References: For more information on
  • applying provisions of PL 112-154, Section 506, generally and as a matter of decision revision, to include examples of proper application, see the attachment, Historical_M21-1III_i_3_SecB_2-19-19.docx, and
  • additional examples of the interaction of PL 112-154, Section 506, provisions with other effective date rules and principles, see the attachment, Historical_M21-1III_iv_5_SecC_2-19-19.docx.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part X, Subpart i, Chapter 2, Section B (U.S. government work, reproduced for reference). Browse all sections →