Module 5: Stages of a Claim Lesson 1: Stages of a Claim
10.Which of the following should be included in the notification letter sent to a Veteran once an award has been determined and input into the system? (Select all that apply.)
A.Appeal rights B.Evidence used to make the decision D.Address claimed disabilities/issues
1.The notification letter should inform the Veteran of which type of decision?
A.Award
10.The notification letter should inform the Veteran of which type of decision?
A.Award
7.Verification of which of the following is required to establish Veteran status? (Select all that apply.)
A.Branch of service B.Dates of service D.Character of discharge
9.The need for additional or missing evidence is most commonly identified in which stage of a claim?
A.Claims development
3.Which system is used during the initial screening of a claim to determine if a search has been initiated or if there is any search mail associated with the C-file?
A.Control of Veterans Record System (COVERS)
1.During the Award Determination stage of a claim, what is the first system or screen that a VSR should review to verify a Veteran's personal information?
A.Pending Issue File (PIF) in Share
2.Which of the following require special handling in the initial screening process of claim? (Select all that apply.)
A.Spina bifida C.Global War on Terrorism D.Hardship
9.Which of the following require special handling in the initial screening process of claim? (Select all that apply.)
A.Spina bifida C.Global War on Terrorism D.Hardship
7.Into which system does a VSR input a Veteran's award information?
A.Veterans Service Network (VETSNET)
8.Into which system does a VSR input a Veteran's award information?
A.Veterans Service Network (VETSNET)
VETSNET Awards
After the Rating Decision is finalized, input the award into the Compensation and Pension (C&P) Award application. This application is commonly known as VETSNET Awards and is part of the Veterans Service Network (VETSNET).
10.During the initial screening stage of a claim, DD Form 214 is reviewed to determine which of the following?
B.Character of discharge
4.What information is reviewed in the rating decision for accuracy and completeness prior to an input of the award? (Select all that apply.)
B.Claim type C.Conditions listed in rating D.Claimed disabilities/issues
3.During the initial screening process for a claim, which system is used to determine if a search has been initiated or if there is any search mail associated with the C-file?
B.Control of Veterans Record System (COVERS)
8.During the initial screening process for a claim, which system is used to determine if a search has been initiated or if there is any search mail associated with the C-file?
B.Control of Veterans Record System (COVERS)
6.The notification letter should inform the Veteran of which type of decision?
B.Denial
5.In addition to the Veteran, which other individual associated with the Veteran should receive the notification letter, if applicable? (Select all that apply.)
B.Power of attorney D.Fiduciary
8.After the VSR checks the Pending Issue File (PIF) in Share, what should be checked in BIRLS to electronically verify a Veteran's service information?
B.Veterans Assistance Discharge System (VADS)
6.Once the rating decision has been reviewed for accuracy and completeness, what is the next action to be performed by the VSR?
C.Input the award information
7.Each of the following should be included in the award notification letter to the Veteran EXCEPT?
C.New evidence to be submitted for additional benefits
4.Each of the following are sources from which missing evidence is requested or obtained EXCEPT?
C.Notification letter
6.During the Award Determination stage, the VSR should perform which action once all information in the Share PIF has been confirmed as accurate?
C.Review the rating decision
1.The Veteran Identification (VID) screen in Share may be used to verify what information from the Veteran?
C.Service information
4.The Veteran Identification (VID) screen in Share may be used to verify what information from the Veteran?
C.Service information
2.Name, address, Social Security Number (SSN), and claimed disabilities are some of the information used to determine which of the following during the initial screening process of a claim?
C.Substantial completeness of a claim
Which items are verified after receipt of the Rating Decision? (Select all that apply.)
Claim Type Rating Decision conditions Claimed Issues
9.Receipt of a rating decision initiates the start of which stage of a claim?
D.Award determination
3.Determining whether a claim is original or non-original is most important in which stage of a claim?
D.Claim development
5.Amount of payment, date(s) of payment, evidence used to make the decision, and appeal rights are communicated to the Veteran using which of the following?
D.Notification letter
2.Foreign address, Homelessness, Hardship, and Prisoner of War are all examples used in the determination of which process in the initial screening stage of a claim?
D.Special handling
What is the final step in the initial screening process?
Determine Character of Discharge.
claim type
First verify and confirm the type of claim.
What action initiates development of a received claim?
Generating a letter to the claimant
rating decision
Next, ensure all conditions listed on the Rating Decision are addressed.
Award Determination
Once you receive the final rating decision, analyze the claim to confirm all development is accurate and complete. This process begins with verifying that the rating decision and the C-file match; and preparing the award for input into the system.
Which application is checked to verify the Veteran's name and address prior to an award being input into the system?
Share Pending Issue File (PIF)
The Award data section is accessed in VETSNET through the following path:
Start\All Programs\VBAPPS\VETSNET\C&P Awards
Awards Handbook
The VETSNET Awards Handbook is the reference for awards data and is accessed on the Compensation Service Homepage through the following path: Business Management (215)\VETSNET\Awards\Award User Guide\VETSNET Awards Handbook
Initial Development Action
The claim is considered to be an original claim if it is the first claim submitted by the Veteran or other claimant. It is considered to be a non-original claim if the Veteran or other claimant previously submitted a claim. In addition, the claim is handled as a priority case if there are special issues associated with it.
Character of Discharge (step 4 Initial Screening)
The final step in the initial screening process is to determine Character of Discharge (COD). This is done by reviewing the Veteran's DD Form 214 to verify that the Veteran's COD was other than dishonorable. In addition, the Veteran's service information is verified for accuracy on the Veteran Identification (VID) screen in Share
claimed issues
Then, check to ensure that all claimed issues have been addressed and properly developed via Duty to Assist (DTA) based on the type of claim. It is important to remember this: the method the Veteran used to submit his or her claim determines if proper DTA was administered.
Combined Award and Denial Letter Forward the Notification Letter to ___________________. The VSR Authorizer may ___________________________. __________ after all issues have been addressed.
VSR Authorizer for review; return the letter to you for corrections resubmit
Share Pending Issue File Second, check
Veteran Identification Data (VID) information to determine that service has been verified through the Veterans Assistance Discharge System (VADS).
Which information should be included in a Notification Letter? (Select all that apply.)
Which information should be included in a Notification Letter? (Select all that apply.)
Claims Development
You initiate development of the received claim by generating a letter to the claimant. The information you include in the letter will vary based on the evidence that was submitted with the claim application. Subsequent development may be needed to ensure the claim is sufficient for a Rating Decision. Once you feel the development is complete, use your local procedure to schedule a final review of the claims folder prior to sending it to the rating board. Once the review is complete and development is deemed complete, send the claim and the evidence to the rating board for a decision.
Correcting Errors and Completion Any errors found in evaluations are corrected by
a controlled process by the RVSR.
If the rating has not been promulgated
a new Rating Decision is created, and the erroneous ones are destroyed in accordance with Veterans Benefits Administration (VBA) directives.
Once the Rating Decision has been finalized
be sure to send a copy to any designated POA or Service Organization for review, if applicable.
5.Each of the following are sources from which missing evidence is requested or obtained EXCEPT?
notification letter
The Screening Process
scanning the Control of Veterans Record System (COVERS) to determine if a search has been initiated for the claims folder (C-file) or if any search mail is associated with the C-file. If there is an active search, make contact with the Veterans Service Representative (VSR) who initiated the action. If applicable, request any associated search mail and attach it to the C-file.
if service cannot be electronically verified what do you use
the Veteran's DD Form 214 is used to verify service or Personnel Information Exchange Systems (PIES) code S01 is used.
Initial Screening
you will evaluate the claim application and submitted evidence to determine if there is sufficient information to begin the claims process. Once you deem the claim substantially complete, determine which development actions are necessary.
Veteran Status (Step 3 Initial Screening) Establish Veteran status by verifying the following service information:
•Branch of service •Character of Discharge (COD) •Dates of service •Service number
Rating Decision Review After you confirm the accuracy of the Share PIF, verify that the following areas of the claim are correct:
•Claim Type •Rating Decision Conditions •Claimed Issues
Special Handling (step 1 Initial Screening) Screen the C-file for circumstances that dictate a requirement for special handling and priority status. These include
•Foreign address •Hardship •Homelessness •Global War on Terrorism (GWOT) •Prisoner of War (POW) •Seriously injured and very seriously injured •Spina Bifida •Terminal illness
Development Process The initial development action is determined by the following conditions:
•Is it an original claim? •Is it a non-original claim? •Are there any special issues?
Share Pending Issue File First, check the Share Pending Issue File (PIF) for the following:
•Is the name correct? •Is the address current? •If there is a designated Power of Attorney (POA), is there a VA Form 21-22? •If there is a private attorney, is there a VA Form 21-22a? •Is the Veteran in receipt of military separation pay?
Generating The Letter Once you enter the award, generate a Notification Letter to send to the claimant along with a copy of the Rating Decision. Make sure the Notification Letter contains:
•Issues that were addressed •Evidence used to make the decision •Dates of payment •Rates of payment •Requirements for additional benefits (if eligible) •Appeal rights
Combined Award and Denial Letter Create a Notification Letter that informs the claimant of the decision (award or denial) concerning each condition listed on their claim. Ensure the letter meets the notification requirements found in:
•M21-1MR, Part III, Subpart v, 2.B.9.b.
Completeness of Claim (step 2 Initial Screening) Ensure the claim is substantially complete by verifying the following information:
•Name, address, and Social Security Number (SSN) •Disability or disabilities •Benefit claimed •Service information •Signature
POA/Fiduciary Cases Also send a copy of all Notification Letters to the claimant's:
•Power of Attorney (POA), if the claimant has one •Fiduciary, if the claimant is incompetent and assigned someone to supervise his or her VA benefits
Missing Evidence During development of a claim, you may identify the need for additional or missing evidence. Missing evidence is gathered through these sources:
•Veteran •Federal records •Non-federal records •Development letters •Department of Veterans Affairs (VA) examinations •Follow-up on development actions
