Presentation on theme: "Fully Developed Claim (FDC): Procedures & Advantages Version 1 2-25-14 CONTROLLED UNCLASSIFIED INFORMATION."— Presentation transcript:
Fully Developed Claim (FDC): Procedures & Advantages Version 1 2-25-14 CONTROLLED UNCLASSIFIED INFORMATION
Fully Developed Claim (FDC) Program: Procedures & Advantages Elements of the FDC program FDC program vs. standard claims process VA’s duty to notify and duty to assist claimants VA EZ Forms Type of benefits processed in the FDC program Exclusion from the FDC program Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012 Electronic filing of compensation FDCs Questions 1
What Is the Fully Developed Claim Program? 2 The Fully Developed Claim (FDC) program is an optional, expedited claims processing and adjudication system that offers Veterans and survivors faster decisions on VA disability compensation, pension, and survivor benefit claims.
Why Use the FDC Process? 3 Veterans and survivors take charge of their claim by gathering and providing all the evidence at once VA can issue a decision faster There is no risk for claimants to participate
FDC Program Meet the FDC criteria: –Submit signed & completed VA EZ form; –Submit all private medical records and identify all Federal records; and –Report to any VA exam necessary to decide the claim. Standard Claim Process Veteran must identify evidence not in possession so VA can request such evidence. FDC Program vs. Standard Claim Process 4 Required from Veteran: Required from VA: When Veteran Must Send Evidence: Simultaneously with the claim. VA must retrieve relevant Federal records such as a VA medical center which Veteran identifies; and VA must provide a medical examination if necessary to decide the claim. Anytime up to 1 year from date of receipt of claim. Same as FDC Program; AND Make every reasonable effort to obtain records not held by a Federal facility that Veteran identified & authorized VA to obtain.
How Claimants Can Participate in the FDC Program (FDC Criteria): 5 Claimants must: 1.File a completed VA EZ-Form for the appropriate benefit; 2.Sign the form and certify that that they have no further evidence to submit; 3.Submit all relevant (private) records in their possession and identify any Federal records that VA can obtain at the time they file their claim; and 4.Report to any VA medical exam if necessary to decide the claim.
VA’s Statutory Duty to Notify and to Assist Under 38 U.S.C. § 5103, VA has a duty to provide the claimant electronic or written notice of any information and medical or lay evidence necessary to substantiate the claim. Under 38 U.S.C. § 5103A, VA has a duty to assist claimants in obtaining evidence necessary to substantiate the claim. VA must make reasonable efforts to obtain relevant private records that claimant adequately identifies (38 U.S.C. 5103A(b)(1)). VA must obtain claimant’s service treatment records, treatment records, and relevant records held by any Federal department or agency (38 U.S.C. 5103A(c)). VA must provide a medical examination or opinion if necessary to make a decision on the claim (38 U.S.C. 5103A(d)). 6
VA EZ Forms: The three required application forms, i.e., the EZ forms, both in paper and electronic format, for participation in the FDC Program: VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits for disability claims VA Form 21-527EZ, Application for Pension for pension claims VA Form 21-534EZ, Application for DIC, Death Pension, and/or Accrued Benefits for survivor benefits are comprised of two parts: (1) the notification of the evidence necessary to substantiate a claim as required by 38 U.S.C. § 5103; and(2) the application. Available at www.va.gov/formswww.va.gov/forms 7
VA EZ Forms: The 3 EZ forms also contain a certification section where claimant must: Authorize release of information to VA; Certify that the statements in the document are true and complete to the best of claimant’s knowledge; Certify the receipt of notice under 38 U.S.C. § 5103; and Certify that all information or evidence in support of the claim is enclosed, to include the identification of relevant Federal records; or, that no evidence is being submitted. 8
FDC Program Claimant receives notification at the time the claim is submitted via EZ form. Standard Claim Process If a claim is submitted on a non-EZ form, VA must send the claimant §5103 notice. VA’s Duty to Notify FDC Program vs. Standard Claim Process 9 VA is able to adjudicate the claim immediately once all Federal records and examinations are received. VA waits for claimant’s submission of evidence or response identifying evidence to be retrieved by VA. VA sends additional letters to identified sources for unanswered requests for evidence.
Types of FDCs: 10 Original Claim – initial claim for VA benefits New Claim – claim for a new disability that has not been awarded Reopened Claim – reconsideration of a claim that was previously denied for which new and material evidence exists Claim for Increase – claim for an increased rate of a benefit being paid under a current award Secondary Claim – claim for compensation based upon an additional disability that was caused or aggravated by a service-connected disability
Types of Compensation Benefits Processed in FDC Program on VA Form 21-526EZ: 11 Claim for Compensation for Post-Traumatic Stress Disorder (PTSD) Total Disability Rating Based on Individual Unemployability Specially Adapted Housing or Special Home Adaptation Automobile Allowance or Adaptive Equipment Special Monthly Compensation such as increased benefits based on: Need for aid and attendance; Being bedridden; Additional disability or being housebound; or Based on spousal need for aid and attendance Temporary Total Disability Rating, i.e., 100 percent Due to hospitalization, or Due to surgical or other treatment of a service-connected disability Compensation Under 38 U.S.C. 1151 Seriously Disabled Child Benefits
Exclusion of Claim from FDC Program: 12 Claimant indicated a desire not to have the claim processed in the FDC program by checking the box on the EZ form; Claimant has a claim pending at the time of receipt of the EZ form; Claimant has an appeal pending at the time of receipt of the EZ; or Claimant failed to report to for a VA examination and requests that VA reschedules the exam, unless VA is solely at fault for claimant missing the exam.
Exclusion of Claim from FDC Program: Claim requires a character of discharge determination; Claim requires development for records in the custody of Guard/Reserve units(s); Claim requires development for further evidence from claimant or an identified private medical provider; Claim requires any development for evidence, but excluding development for: Federal records in custody of the Federal government; Claimant-identified Federal treatment records such as VA medical center treatment records; VA examination or DBQ. After receipt of an FDC, a supplemental claim, additional evidence, or a notice of disagreement (to initiate an appeal) is received. 13
Exclusion of Claim from FDC Program: A claim that does not meet or no longer meets the FDC criteria is removed from the FDC program and processed in the standard claims processing where further development and all necessary action is taken to adjudicate the claim. An original compensation claim received by a VA from August 6, 2013 through August 5, 2015 that does not meet or no longer meets the FDC criteria will not receive the potential one-year retroactive effective date pursuant to section 506 of Public Law 112-154. 14
Original (Initial) Compensation FDCs Received from August 6, 2013 through August 5, 2015 15 On August 6, 2012, the President signed a comprehensive legislative package, the “Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012,” Public Law 112-154. Section 506 of this Act amends 38 U.S.C. § 5110 to allow up to a one-year retroactive effective date for awards of disability compensation based on fully developed original compensation claims received from August 6, 2013 through August 5, 2015. The purpose of this Act was to provide an incentive to Veterans and Veterans Service Organizations (VSOs) to submit fully developed claims by allowing up to one year retroactive effective date for awards of disability compensation claims. Example: Claimant begins the application for an original FDC compensation claim electronically on January 1, 2013 (considered the date of claim), but does not submit the completed electronic application until September 1, 2013. The effective date of any compensation benefit award would be September 1, 2012, (provided the disability existed on that date) the date the claimant submits the completed FDC.
Other Benefits Processed in FDC Program on Other EZ Forms: 16 Types of Pension Benefits in FDC Program on VA Form 21-527EZ: Non Service-Connected Pension Non Service-Connected Pension with Aid and Attendance of Housebound Benefits Benefits Based on a Veteran’s Seriously Disabled Child Death Pension Dependency Indemnity Compensation (DIC) DIC under 38 U.S.C. 1151 Increased Survivor Benefits Based on Need for Aid and Attendance or Being Housebound Accrued Benefits Benefits Based on a Veteran’s Seriously Disabled Child Types of Survivor Benefits in FDC Program on VA Form 21-534EZ: For more information on the FDC Program: www.benefits.va.gov/fdc/
eBenefits Online Filing 17 What is eBenefits? A web portal resource that provides Service members and Veterans seeking self-service benefit information and services from VA and Department of Defense (DoD) as well as other Federal and State agency benefits programs where Service members and Veterans can: Access the online application; Check the status of compensation and pension claims; View payment history of received VA benefits; Access healthcare resources; and Access and obtain copies of military records.
eBenefits Online Filing: Advantages 18 Uses interview-style questions like TurboTax; Guides and navigates Veterans through the entire claims process; Pre-populates information that Veteran provides into a VA claims application; Allows Veterans to submit a claim with a click of a button; Increases accuracy of information submitted to VA; Reduces the time it takes a Veteran to complete and submit applications; Significantly reduces VA data errors for more accurate decisions; and Processes claims faster for expeditious delivery of benefits.
eBenefits Online Filing: How To File an Electronic FDC For Compensation Benefits 19
eBenefits Online Filing: Home Page 20 Login/Register Authenticate with a basic or premium account Apply and View Claims Status Features View all Features available to eBenefits users Features View all Features available to eBenefits users
eBenefits Online Filing: Overall Process FDC Walkthrough - How it Works Steps of the FDC Electronic Process: Detailed Instructions on the FDC process: 1.Navigate to eBenefits.va.gov and click on Login.eBenefits.va.gov 2. Click Apply for Benefits. Before applying, Veterans can also appoint aVeterans Service Officer or authorized representative as a Power of Attorney (POA) who can help in the collection of required documents and evidence needed to submit with the claim. 21
eBenefits Online Filing: Screen Shot – Starting the Application Landing page to start the application process 22
Claims can be created by Veterans and are electronically signed and submitted by the Veteran eBenefits Online Filing: Screen Shot – Claims Submission 23