VSO Lesson 1-6

FSM?

(FSM) Former Service Member

What is the function of the (VSC) Veterans Service Center?

(VSC) Veterans Service Center- largest division, handles all compensation and pensions claims from initial recipient to final decision

What are the divisions of an (RO) VBA Regional Benefits Office?

1. (VSC) Veterans Service Center- largest division, handles all compensation and pensions claims from initial recipient to final decision 2. Loan guaranty 3. Voc Rehabilitation and employment

What are the 3 components of proving a Direct Service Connection?

1. Current Disability 2. An event, injury, or disease in service 3. A link or nexus establishing that a current disability had its onset or inception in service.

RO?

1. Regional Office 2. VBA Regional Benefits Office

Examples of Primary Evidence?

1. Service records, including the DD-214 and service medical records 2. VA Health Care records, such outpatient treatment reports, diagnostic test findings, and hospital summaries 3. VA exam 4. Other Federal Records, such as Social Security Administration disability decisions 5. Private physician treatment records or private hospital reports 6. Third-party records 7. Lay statements that relate to an event the observer is qualified to observe 8. The Veterans statement as it relates to events he or she is qualified to observe 9. Marriage, divorce, birth and death records

How do you establish a link or nexus that a current disability had its onset or inception in service?

1. Show Chronicity and continuity 2. Continues symptoms or a medical nexus opinion

Name the 3 Administrations that comprise The Department of Veterans Affairs?

1. Veterans Health Administration 2. National Cemetery Administration 3. Veterans Benefits Administration

In order for a claim for VA compensation to be successful, what three things must be established?

1. there must have been an in-service event that caused the disability 2. there must be evidence of a current disability 3. there must be a link between the current disability and military service

Veteran completes an application for original conversation on the VA form 21-526EZ and signs it on 10/05/ 2016. Putting it in the mail at the US post office one 10/10/2016. It is received by Department of Veterans Affairs on 10/17/2016. Based on the scenario what is the date of the receipt of the claim?

10/17/2016, the receipt date is the date the DVA receives the application

What form do you use to request a higher level review?

20-0996 Decision Review Requests

What form do you use to apply for (TDIU) total disability based on individual unemployability?

21-256EZ or 21-8940

What form is used for applying for auto allowance benefits?

21-4502

What form do you use to request Temporary Total Disability

21-526EZ

What form is used for applying for burial benefits?

21P-530 Application for Burial Benefits

What form is used for applying for (SMC) Special monthly compensation for housebound/ (A&A) Aid and attendance including spousal A&A benefits?

21P-534EZ / 21-0779 (Nursing Home patients only)

What form is used for applying for (SAH) special adapted housing or (SHA) special housing adaptation benefits?

26-455

The Department of Veterans Affairs is comprised of how many Administrations?

3 1. Veterans Health Administration 2. National Cemetery Administration 3. Veterans Benefits Administration

What is a (VSO) Veterans Service Officer authorized to do for a claimants claim?

A VSO is authorized to prepare, present, and prosecute a claimants claim and has the authority to review the claimant records, present evidence on behalf of the claimant, submit an intent to file, non-original claim, a notice of disagreement, or a substantive appeal on behalf of the claimant, and withdraw an appeal.

What is a (VSO) Veterans Service Officer not authorized to do for a claimants claim?

A VSO may not sign original applications for veterans benefits or other forms requiring claimant certification such as eligibility verification report

Reasonable Raised Claims?

A claim that is not explicitly identified by a claimant on a standardized VA form, but is identified upon review of the claim folder during the decision-making process for an expressly claimed issue.

Abandoned Claims?

A claim will be considered abandoned when evidence requested in connection with an original claim, a claim for increase or to reopen or for the purpose of determining continued entitlement is not furnished within 1 year after the date of request.

Secondary Service Connection?

A disability, which is proximately due to, or the result of a service-connected disease or injury. It is not necessary to prove that secondary condition is a current or presume to have been occur during service or aggravated by service. It is necessary to prove that there is a casual relationship between the primary and secondary condition.

What is the eligibility exception for someone with a dishonorable discharge (COD) Charter of Discharge??

A dishonorable discharge or statutory bar is not binding on VA if it is determined that the individual was INSANE when committing the acts that resulted in the discharge.

If a (VSO) Veteran Service Officer suspects the claimant has provided fraudulent information he or she should do what?

Advise the Claimant that this is against the law

(BVA) The Board of Veterans Appeals?

An independent body that decides appeals in questions regarding all Veterans Benefits

21-526EZ

Application for Disability Compensation and Related Compensation Benefits

How do you define a VA Claim?

Claim means a written communication requesting a determination of entitlement or evidencing a belief of entitlement, to a specific benefit under the laws of the DVA submitted on an application.

Who is ultimately responsible for providing VA with evidence to substantiate a claim?

Claimant

What type of claim is eligible for processing in the FTC program?

Claims filed in an EZ dated after August 2011 and claimant requests processing in the FDC Program.

Evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions is what type of evidence?

Competent medical evidence.

Direct Service Connected?

Direct Service Connected means that a particular disease or injury was incurred in service.

Competent medical Evidence

Evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It would also include statements contained in authoritative writings such as medical and scientific articles and research reports or analyses.

What does the (BVA) Board of Veterans Appeals have jurisdiction over?

Final decision on Appeals and on any non-medical decision made elsewhere in the VA

Primary Evidence?

First hand evidence, created by someone who has a personal knowledge of a fact they are qualified to observe. Example: Entry in the service medical record

VA Form 21-22

In an order for a Service organization to represent a veteran, the Veteran must complete documentation bestowing power of attorney rights to the organization. This authorization is documented on VA Form 21-22 Appointment of Service Organization as Claimants (POA)

Why did congress decide to charter Veterans Organizations whos sole purpose was to provide assistance to veterans at no cost?

In order to offset the loss of attorneys, after a limit was placed on attorney fees for representing veterans..

When did the VA establish a more formal process for filing (Intent to File) a claim, eliminating the informal claim?

March 24, 2015

If the VA feels it is not required to assist a claimant in obtaining identified records, it is most likely because?

No reasonable possibility exists that such assistance would aid in substantiating the claim.

When is Jurisdictions of an appeal transferred from the VBA RO to the BVA

Once the appeal has been certified to BVA then jurisdiction is transferred to BVA located in Washington DC.

Date of Receipt?

Refers to the date on which a claim, information or evidence was received by the DVA.

Ancillary Benefits?

Secondary Benefits that are considered when evaluating claims for Compensation, Pension, Dependence and Indemnity Compensation (DIC) entitlement Examples: Chapter 35 Dependent Education Assistance, Automobile Allowance

Secondary Evidence?

Secondary evidence would be a statement from someone who did not actually observe an event, but had knowledge of it. Example: Veterans' mother could testify that the Veteran told her he was treated for arthritis in service.

What is section I (one) of VA Form 21-526EZ?

Section I, IDENTIFICATION AND CLAIM INFORMATION

What is section II (two) of VA Form 21-526EZ?

Section II, CHANGE OF ADDRESS

What is section III (three) of VA Form 21-526EZ?

Section III, HOMELESS INFORMATION

What is section IV (four) of VA Form 21-526EZ?

Section IV, CLAIM INFORMATION

What is section IX (nine) of VA Form 21-526EZ?

Section IX, WITNESS TO SIGNATURE Note: If the Veteran signs with an "X," this section is where the two witnesses must sign and print their names and addresses. If the Veteran was able to sign his or her valid signature, this section does not need to be completed.

What is section V (five) of VA Form 21-526EZ?

Section V, SERVICE INFORMATION

What is section VI (six) of VA Form 21-526EZ?

Section VI, SERVICE PAY (Retired Pay, Separation Pay, and Disability Severance Pay)

What is section VII (seven) of VA Form 21-526EZ?

Section VII, DIRECT DEPOSIT INFORMATION

What is section VIII (eight) of VA Form 21-526EZ?

Section VIII, CLAIM CERTIFICATION AND SIGNATURE Notes: 1. If the Veteran signs with an "X", then he or she must have 2 people witness the signature. They must then print their names and addresses and sign the form as well. 2. Remember, a service officer cannot sign for the Veteran on an original application.

What is section X (Ten) of VA Form 21-526EZ?

Section X - ALTERNATE SIGNER CERTIFICATION AND SIGNATURE Note: Alternate signature on behalf of claimants or beneficiaries who are under age 18, lack the mental capacity to provide substantially accurate information needed to complete a form or to certify that the statements made on a form are true and complete, or are physically unable to sign a form.

What is section XI (eleven) of VA Form 21-526EZ?

Section XI, POWER OF ATTORNEY (POA) SIGNATURE

What are the steps in a VA Claim?

Step 1- Claim Received- (FSM) Former Service Member files a claim , claim is forwarded to (VBA) Veterans Benefits Administration Step 2- Evidence Gathering- VBA will requests all required Federal records from the military, to include personal and medical records; Notice is sent to FSM or survivor to provide due process and request info to FSM discharge; Notice e explains the right to a personal hearing before decision is made; FSM has 60 days to respond. Step 3- Decision- VBA reviews the evidence and decides if the FSM's characterization of discharge is a bar for benefits Step 4- Notification- notification is sent to the FSM or survivor.

How long does the Claimant have from the date of the notification letter was sent to him or her from VA to submit evidence or information not previously provided that is necessary to substantiate the claim?

The law provides that VA can make a decision at any time after 30 days from the ignition notice has expired. However, if the claimant provides additional evidence any time within one year after this notification, VA must reconsider the claim.

Duty to assist?

Under 38 U.S.C. 5103, VA must make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate a claim. This assistance includes obtaining relevant federal records, relevant private records, adequately identified by the claimant, and a medical examination, if necessary to decide the claim.

VA Duty to Notify?

VA must notify the claimant of information necessary to substantiate claim; Historical the required 5103 notice in a paper-based letter, currently most section 5103 notice obligations are met through filing on the actual claims application themselves.

Duty to assist "Private Records"?

VA will make no less than two (2) attempts to obtain these records. Additionally, VA will notify the claimant of its efforts as well as encourage him or her to submit relevant private medical records if such submission is not burdensome. In most cases VA will allow for 30 days for these records to be obtained (first attempt provides 15 days for response; second attempt provides 15 days to respond). If the records do not reach VA within 15 days after the second attempt to obtain them, VA will decide the claim without them.

When the appeals process begins, for the first steps of the process the appeals remain where?

VBA Regional Office

VBA?

Veterans Benefits Administration

Presumptive Service Connection?

When VA assumes that the veterans disability was caused by their military service, usually due to certain exposure. This means that the veteran does not have to provide a medical nexus or a link between an event in-service and their current disability. VA has a list of presumptive service-connected conditions that apply to certain groups of veterans.

Expressly Claimed Issues?

When a disability and the benefit sought are both explicitly identified on a standardized VA form.

When does the VA's Duty to Assist Ends?

When based on the merits of the claim and evidence of record, there is sufficient evidence to make a decision on the claim.

Under what circumstances can an accredited VSO discuss the veterans claims information with someone else?

When permission to do so has been obtained from the veteran.

Injury or Disease Noted at Entry?

When there is a claim for (SC) Service connection for aggravation and pre-service injury or disease was noted on enlistment the claimant initially bears the burden of proving that the pre-existing condition worsen in service. When a claim disorder was not noted on the entrance examination and the presumption of soundness applies, only evidence showing the disorder clearly and unmistakably existed prior to enlistment may establish pre-existence of the claimed condition

Service Connection based on Aggravation?

When there is an increase in severity of a particular (NSC) non-service connected disease or injury, that is a attributable to aggravation by a service connected disability, and not the natural progression of the NSC disability, the NSC injury or disease may have existed prior to entering active duty, or after military separation

When does Duty to Assist Not Apply?

When there is no reasonable possibility that rendering assistance would substantiate his or her claim. Examples: A claimant is ineligible for benefits because he/she: lacks qualifying service fails to meet other legal, eligibility requirements A claimant submits a claim that clearly lacks merit