X.i.6.C.1.b. Special Claims-Handling Procedures for BDD Claims | | In addition to the responsibilities described in M21-1, Part X, Subpart i, 6.B.3, intake sites are responsible for following the steps in the table below when handling a BDD claim.| Step | Action |
|---|
| 1 | Did the service member file the claim on the current version of VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits? | | 2 | Does a Beneficiary Identification and Records Locator Subsystem (BIRLS) record exist?- If yes, go to the next step.
- If no,
- establish a BIRLS record, and
- go to the next step.
| | 3 | Enter military service information in the Veterans Benefits Management System (VBMS), to include branch of service and future RAD as unverified. | | 4 | Establish the BDD claim in VBMS using the correct diary EP and BDD claim label as specified inM21-1, Part X, Subpart i, 6.B.2. | | 5 | Ensure all evidence is secured together, including- the completed and signed VA Form 21-526EZ
- service treatment records (STRs) (photocopies, on compact disk, or images received through other electronic avenues such as e-mail or Department of Defense (DoD) Secure Access File Exchange)
- a Separation Health Assessment - Part A Self Assessment (SHA, Part A), and
- any other evidence and information submitted in support of the claim.
| | 6 | Ensure that documents are forwarded for Veterans Claims Intake Program (VCIP) scanning or scan the documents locally if the local scanner has a resolution of at least 300 dots per inch (DPI). If forwarding for VCIP scanning the following must be completed within five calendar days of receipt of the claim: - Follow VCIP shipping procedures and local vendor protocols.
- Add the appropriate tracked item and suspense date as specified in M21-4, Appendix D.
Important: - Do not send documents for scanning or scan the documents locally unless a BDD claim has been established in VBMS.
- BDD claims documents must not be sent to Centralized Mail (CM). Only BDD-excluded claims documents may be sent to CM.
- If the intake site scans claims documents locally, the intake site must scan all claims documents and upload those into the electronic claims folder (eFolder) within 10 calendar days of receipt of a claim.
Once documents have been successfully uploaded into the eFolder, return the original paper documents to the service member. Complete the Return of Documents letter and upload a copy to the eFolder. Notes: - It is recommended that the claims processor scan and return the original paper documents the same day as receipt. The Return of Documents letter still needs to be generated if the documents are scanned locally, but it can be hand-delivered to the service member during the interview.
- STRs received electronically should be uploaded directly to the eFolder.
- Electronic signatures are acceptable.
References: For more information on | | 7 | Are the documents available in VBMS within 10 days?- If yes, go to Step 9.
- If no,
- extend the suspense for an additional five days, and
- go to Step 8.
| | 8 | Are the documents present after the five-day extension?- If yes, go to Step 9.
- If no, contact your local intake processing center for resolution.
| | 9 | Ensure the service member is available for examinations at the provided current or forwarding address. Contract examination vendors may schedule examinations as soon as examination requests are received. | | 10 | Determine whether a contract examination or Veterans Health Administration (VHA) examination is required by utilizing the Examination Request Routing Assistant (ERRA) as noted below.Use the ERRA tool unless at the BDD intake site there is an existing agreement specifying the provider(s) responsible for local BDD examinations. Within the ERRA tool, select the radial button YES next to the text BDD/IDES Claim? as shown below:Important: - A SHA, Part A, must be part of the eFolder prior to requesting the examination.
- Request the General Medical - Separation Health Assessment Disability Benefits Questionnaire (SHA) for all BDD claimants still on active duty at the time of the examination request, along with any necessary specialist examinations. (Do not request specialist examinations for conditions that are not subject to service connection (SC).) If the examination is requested after the service member is no longer on active duty, do not request the SHA. Instead,
- request a general medical examination disability benefits questionnaire (DBQ) along with any applicable specialist DBQs, or
- follow the procedures in M21-1, Part VIII, Subpart ii, 1.B.2.o if the claim involves an undiagnosed illness or medically unexplained chronic multi-symptom illness (MUCMI) due to exposures incurred during Gulf War era service.
- Be sure to review the VA Form 21-526EZ for effective dates of any forwarding addresses provided by the service member. This will ensure the request is routed to the service member’s current location. This is most critical if the exam request is a re-input of an original request that was rejected via the Examination Management System (EMS) or Compensation and Pension Record Interchange (CAPRI).
References: For more information on- mandatory use of ERRA and the exceptions, see M21-1, Part IV, Subpart i, 2.A.1.c
- examinations requested in VBMS through EMS, see M21-1, Part IV, Subpart i, 2.A.10
- examinations that must be performed by a specialist, see M21-1, Part IV, Subpart i, 2.A.6
- when a specialist examination is not warranted for conditions that are not subject to SC, see M21-1, Part IV, Subpart i, 2.A.6.a
- conditions that are legally ineligible for SC, see
- the action to take when a service member’s initial examinations are requested after discharge, see M21-1, Part X, Subpart i, 6.B.3.f
- general information on presumptive SC for Persian Gulf Veterans, see M21-1, Part VIII, Subpart ii, 1.A, and
- the SHA and when to select it versus a general medical examination, see M21-1, Part IV, Subpart i, 2.E.3.b and c.
| | 11 | Enter an examination request for all required examinations at the same time using - EMS, if a contract examination is required, or
- CAPRI, if a VHA examination is required.
Important- Prior to entering the examination request ensure
- that SHA, Part A is in the record, and
- all of the service member’s military service information is entered correctly in VBMS including the anticipated future discharge date. If the anticipated discharge date is not included, it will be rejected by the contract vendor.
- When entering an examination request in CAPRI, the Military Services Coordinator (MSC) must
- select the BDD-DOD SHA claim type, and
- upload a copy of the examination request into the eFolder after submitting the examination request.
- Non-military service system modifications in Share, such as adding flashes, may change the MILITARY SERVICE fields in VBMS.
- Examination requests, including the SHA and any other necessary specialist examinations, must be entered within five calendar days of claim documents being uploaded into VBMS (see Steps 6 and 7). When examinations are not requested the same day that the BDD claim is established, it is critical to ensure that the EP is 336. If a rating EP (110, 010, or 020) was assigned to a BDD claim before all development actions have been taken, NWQ will pull the EP the evening following claims establishment.
- An intake site must have been entered when the claim was established to prevent a contract examination from being rejected.
- If there is not an intake site shown in the corporate record in Share
- change the EP to an EP 400
- cancel the EP 400, and
- re-establish the EP in VBMS with the proper intake site
- The intake site location should be indicated on the date stamp on the claim form. If the claims processor is unable to determine an intake site location, the claims processor may enter the RO location nearest to the service member’s address for the intake site.
- If the service member later submits additional contentions within 90 to 180 days before the anticipated discharge date, and the SHA was already completed, do not request another SHA. Request the individual exams for any contention that was not already examined.
- If a basic or straightforward medical opinion is required, it will be ordered as part of the examination request in accordance with M21-1, Part IV, Subpart i, 2.A.7. MSCs are responsible for requesting opinions on
- SC
- secondary SC, and
- in-service aggravation of a pre-service disability.
- If a complex medical opinion is required
- the MSC will inform the station’s rating activity of the condition(s) requiring the complex medical opinion and the reasons why
- the rating activity will, within three days
- review the evidence of record
- draft the required medical opinion
- upload the draft opinion to the eFolder, and
- notify the MSC by e-mail that the medical opinion request is available, and
- the MSC will copy and paste the draft medical opinion into the examination request before submitting it.
Notes: References: For more information on- entering contract examination requests using VBMS and responding to a request for clarification, see
- inputting examination requests in CAPRI, see M21-1, Part IV, Subpart i, 2.A.9
- examinations requiring claims folder review by the examiner, see M21-1, Part IV, Subpart i, 2.A.8.b
- determining whether an examination or opinion is necessary, see M21-1, Part IV, Subpart i, 1.B
- the requirement that a disability or symptoms be potentially subject to SC to warrant an examination, see M21-1, Part IV, Subpart i, 1.B.1.b
- follow-up requirements for examinations, see M21-1, Part X, Subpart i, 6.C.1.e
- presumptive SC for Persian Gulf Veterans, see M21-1, Part VIII, Subpart ii, 1.A
- how to identify, verify, classify, and associate claimed contentions, see M21-1, Part III, Subpart i, 2.F.2, and
- documenting the status of examination review, see M21-1, Part IV, Subpart i, 1.A.1.e.
| | 12 | Ensure that all development actions have been performed, including- requesting all evidence identified by the service member, and
- if there is more than one period of service, requesting the other period’s STRs from the service member, National Personnel Records Center (NPRC), or other necessary location.
If records exist at a Federal records center, manually request the records for scanning.Go to the next step. References: For more information on - migration of STRs, see M21-1, Part III, Subpart ii, 2.A.3
- procedures for obtaining STRs, see M21-1, Part III, Subpart ii, 2.B, and
- NPRC, see M21-1, Part III, Subpart ii, 2.A.4.
| | 13 | Go to M21-1, Part X, Subpart i, 6.C.1.d. | Notes:- The SHA and associated DBQs are provided to the service department via an electronic exchange process. If contacted by a military treatment facility (MTF) requesting examination results, inform the MTF these results are available in the
- Healthcare Artifacts and Image Management Solution (HAIMS) system for examinations requested through EMS, or
- Joint Longitudinal Viewer (JLV) for examinations requested through CAPRI.
- The station performing post intake site actions (i.e. ready for decision (RFD) review or rating action) is responsible for obtaining examination results.
- Intake sites
- must ensure VBMS images are available for review by the examining facility under the circumstances described in M21-1, Part IV, Subpart i, 2.A.8.b
- are entitled to credit for an interview if the intake site conducted one in connection with a pre-discharge claim, and
- are responsible for creating tracked items to document completed development actions as indicated in M21-1, Part X, Subpart i, 6.B.3.j.
References: For more information on- placing BDD claims under EP control, see M21-1, Part X, Subpart i, 6.B.2
- VBMS, see the VBMS Core User Guide
- the ERRA tool, see
- what the SHA examination covers, see M21-1, Part IV, Subpart i, 2.E.3.b
- selecting the general medical examination vs. the SHA for pre-discharge claims, see
- how to verify military service, see M21-1, Part II, Subpart iii, 3.B.3.a and b.
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