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Fully Developed Claims

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Presentation on theme: "Fully Developed Claims"— Presentation transcript:

1 Fully Developed Claims

2 The “TYPICAL” claim processing time nears 24 to 28 months.
The “AVERAGE” claim processing time at the Chicago Regional Office is over 300 days. The “TYPICAL” claim processing time nears 24 to 28 months. What can we do to influence the time it takes to process a “typical” claim? We can consider the “Fully Developed Claim” Process!

3 In December 2008 the VA announced a pilot project to test the FDC program in 10 VA Regional Offices to evaluate the impact it would have on the pending claim backlog nationwide. The Chicago RO was one of the pilot sites. In June 2010 the VA implemented the FDC program nationwide. (PR and FL 10-22)

4 The FDC program is a formalization of what we have all done informally as part of our daily activity all along: bring to the VA team a complete claim that may be processed immediately with little or no development. These situations still required VA to fulfill DTA and VCAA requirements.

5 Each RO Service Center Manager has the ability to establish the FDC process within their own management formats but must follow the Department’s basic guidelines. Initially at the Chicago RO FDCs were processed by a separate unit. In January 2012 this unit was dissolved and FDCs are now processed as “priority” within each team.

6 Separate EP Codes are not used to identify and track these claims
Separate EP Codes are not used to identify and track these claims. Rather the claims are identified as FDC in the contentions in MAPD allowing VA managers to track and measure the progress of the claims identified from the time they are Cest’ed.

7 The program uses two new forms:
VA Form EZ for compensation claims, original or reopening VA Form EZ for pension claims, original or reopening

8 By definition, a “Fully Developed Claim” is one submitted with ALL
of the evidence which would be required to prove the claim, EXCEPT FEDERAL RECORDS such as service medical records and VA treatment records.

9 A FDC must be submitted using the proper EZ form which must be complete and must include a certification form signed by the veteran, which is part of the new claim form, certifying that the submitted claim is complete for all non- federal evidence required.

10 The purpose of the FDC certification is to allow the VA to process the claim without further development, without issuing a “Duty to Assist” letter and without requiring a VCAA Notice Response.

11 A FDC may be: A new / original claim. A claim for a new disability. A claim for a new disability secondary to an existing service connected disability. A claim for increased evaluation of an existing service connected disability.

12 FDC Criteria (evidence required):
All relevant private medical treatment records for the claimed disabilities. Identification of any Federal (Military or VA) treatment records.

13 For current NG and Reserve members, ALL service treatment records and relevant personnel records in the custody of the Veteran’s unit must be submitted by the claimant. The veteran MUST report for any VA medical examinations as requested.

14 If the claim is NEW, the veteran:
Must submit certified copies of all DD214s. Must submit a completed VA Form c if claiming dependents.

15 A FDC will be kicked out & VA will process the claim traditionally IF:
All identified private treatment records are not submitted with the claim. The VA determines that additional supporting documents or records are required.

16 IF: The veteran submits any additional supporting information or documentation after the submission of the FDC. The veteran fails to appear for an ordered VA examination.

17 The submission of a proper and complete DBQ with the FDC will contribute to a quicker decision by supplanting the need for a C&P examination. Use discipline in making the decision to use a DBQ. Make sure you are using the correct one. Will the nature of the claim require a medical opinion? Will you need to delay filing the FDC in order to obtain a DBQ?

18 If the VA kicks a FDC out of the program it will be processed traditionally based on original date of claim. This administrative processing decision by the VA is not appealable. The VA will notify the veteran that the FDC has been kicked out and the reason it does not qualify for the program.

19 A veteran may not mix a FDC with a separate claim for other disabilities using either a or b, or may not file an FDC if there is a separate pending claim (or pending appeal on an issue related to the new issue being claimed).

20 Likewise, if the veteran files a new claim after filing a FDC, the FDC will be kicked out and both claims will be processed in the traditional method unless the FDC has been advanced to Ready for Decision status.

21 You probably should not try to not use the FDC process to reopen a claim for a previously denied disability unless the new claim is based on newly discovered federal records or on a change in law such as a newly added presumptive disability. A N&M evidence claim to reopen will be difficult to meet the FDC criteria.

22 Due to the FDC evidence limitations a FDC for a non-presumptive disability which had it’s origin in service filed more than 12 months after discharge is not impossible but may be difficult because of the requirement for medical evidence of continuity of treatment.

23 The veteran may file an informal FDC by submitting “only” the following statement:
“I intend to apply for compensation (or pension) benefits under the FDC Program. This statement is submitted to preserve my effective date for entitlement to benefits. I am in the process of assembling my claim package for submission.”

24 If the veteran uses the informal FDC option he has one year within which to submit a VA Form EZ or 21-527EZ which MUST be complete at time of submission. If an incomplete claim is submitted within the one year it will be processed traditionally and the date of the informal claim statement establishes the date of claim.

25 If the informal claim is an original claim it should include a certified copy of the separation document, DD214 or equivalent, so that a claims folder may be established.

26 Because of the FDC limitations, the veteran considering filing a new claim should carefully consider the benefits of filing a FDC if the full criteria for FDC can be met. This may demand delaying the filing of a formal FDC in order to obtain the required evidence.

27 The discussion and preparation of a FDC with the client requires discipline in evaluating the available evidence and the issues being claimed. Submitting the claim as a FDC only to have to have it kicked out to be processed traditionally will be unnecessarily frustrating to the veteran and uses valuable VA resources.

28 Because many of our claims come from state or county agencies, over which we have little direct control, this program demands that we establish good relationships with those remote office managers. You must control what you submit.

29 FDC Lessons Learned? Identification of disabilities. Failure to disclose all medical treatment. Failure to provide all treatment records. Incomplete c or Claims not good for FDC’s: IU Hearing loss or tinnitus Increase for orthopedic disabilities Incomplete PTSD claims

30 The sole purpose of the FDC option is to reduce processing time!
We have had great success with fully documented claims using the FDC option with claims being resolved within 60 to 180 days (most under 120) at the Chicago Regional Office. This has been a cooperative effort between VSO’s, VA VSR’s, RVSR’s and management.

31 If you are not aware of how your Service Center is set up to process FDC’s, find out.
With discipline and good counseling I believe that you will find this program to be a valuable tool to serve many of your veterans reducing processing time.


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