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Updated Dec 05, 2024

In This Section

  
This section contains the following topics:
 
Topic
Topic Name
1
2
3
4
5
 

 

1.  Routine Review of eFolder Documents and Corporate Flashes

Introduction

  
This topic contains information on the review of eFolder documents and adding flashes to a claimant record, including

Change Date

   April 1, 2022

III.i.2.F.1.a.  Routine Review of eFolder Documents

  
During routine review of the electronic claims folder (eFolder), all claims processors must conduct eFolder maintenance to ensure
  • end product (EP) controls are consistent with the claims document, including use of the correct
    • date of claim
    • EP series, and
    • claim label
  • information regarding the Veteran’s service dates and character of discharge in the Veterans Benefits Management System (VBMS) is consistent with the evidence in the eFolder
  • the claims folder contains proper documentation of claimant representation, including system updates of
    • Share, and
    • VBMS
  • any documents reviewed are indexed properly in accordance with M21-1, Part II, Subpart ii, 2.A.1.d, and
  • any misfiled document(s) are removed and transferred to the proper claims folder(s) following the procedures outlined in M21-1, Part II, Subpart ii, 2.A.2.a.
Note:  To manage the documents associated with the Veteran’s eFolder in VBMS, click the DOCUMENT link on the VETERAN PROFILE screen.
 
References:  For more information on

III.i.2.F.1.b.  Corporate Flashes

  
Corporate flashes are claimant-specific indicators that represent an attribute, fact, or status that may occasionally change (such as former prisoner of war, blind Veteran, homeless, and so on).  Regional offices (ROs) are responsible for
  • identifying claimants’ records that require flashes
  • inputting the flashes when required, and
  • removing the flash when it no longer applies.
Most flashes are added by the end user, but some are generated by the system.  Flashes will exist on a claimant’s record until the flash is manually removed.  Afterward, new scenarios may arise that necessitate the addition of a new flash.  ROs are responsible for identifying and updating flashes when applicable.
 
Examples:
  • Add the Foreign Claim flash when the claimant resides in a foreign country and remove it when the scenario changes.
  • Add the Homeless flash when the case involves a homeless Veteran and remove it when the scenario changes.  The Formerly Homeless flash may then be applied, as indicated in M27-2, Part I, 2.04.d.
Corporate flashes may be reviewed, added, or removed on the VETERAN PROFILE screen in VBMS.
 
Example:

Image of Corporate Flashes in VBMS.
Reference:  For more information on when to use corporate flashes, including the Foreign Claim flash, see M21-4, Appendix E, 1.b.

2.  Utilizing Contentions and Special Issue Indicators Associated With the Claimed Issues

Introduction

  
This topic contains information on utilizing contentions and special issue indicators associated with claimed issues, including

Change Date

  
October 11, 2022

III.i.2.F.2.a.  Identifying Contentions

  
Enter issues as contentions when they are
  • expressly claimed by the claimant/Veteran/authorized representative, and/or
  • put at issue and require development.
Important:
  • This information will be made available via Department of Veterans Affairs (VA) claims-submission service websites and should be easy to understand and in the claimant’s own words, as appropriate.
  • The use of contentions for each claim is mandatory; claims processors must enter them as they identify issues associated with a claim.
  • Each issue, including non-rating issues, must be entered as a separate contention.
  • Non-rating contentions must relate to the specific benefit being sought.
  • Mandatory language and format must be used for dependency claims.  An example of the mandatory language and format is presented below.
  • A claim for total disability due to individual unemployability is treated as a claim for increase in the service-connected (SC) disabilities that the Veteran identifies as causing unemployability.  Therefore, the identified SC disabilities must be entered as individual contentions.
Examples:
  • A Veteran submits a claim for ringing in the ears.  The contention should be entered as ringing in the ears.
  • A Veteran submits a claim to add a spouse and a child to a running award.  Create separate contentions for the spouse and child as follows:
    • Dependency claim for [name of spouse], and
    • Dependency claim for [name of child].
  • VA receives a claim for “increase in diabetes mellitus to include heart, depression, and numbness in hands.”  The contentions should be entered as
    • diabetes mellitus
    • heart condition
    • depression, and
    • numbness in hands.
  • A Claims Assistant establishes a claim for “bilateral knees.”  A review of the corporate record indicates the Veteran is SC for right knee patellofemoral pain syndrome and was previously denied service connection (SC) for a left knee strain.  The contentions should be entered as
    • right knee patellofemoral pain syndrome (claimed as bilateral knees), and
    • left knee strain (claimed as bilateral knees).
Reference:  For more information on the Veteran’s responsibility to specify a disability or disabilities that cause unemployability, see M21-1, Part VIII, Subpart iv, 3.B.1.e.

III.i.2.F.2.b.  Verifying Contentions

 
  
All contentions must be verified in order for them to be viewable in VA claims-submission service websites.
 
Contentions automatically entered by the system that are missing critical information, such as the contention classification, will be marked as unverified.  The claims processor must update the missing/incorrect information and select the SAVE button.  The contention will then be marked as verified and viewable in VA claims-submission service websites.  All employees reviewing a claim are responsible for ensuring all contentions are correct and verified.

III.i.2.F.2.c.  Additional Fields for Examination Management

  
The contention screen contains additional fields that assist with identification and exam management functionality in VBMS.  The CLASSIFICATION and MEDICAL fields are required components when entering a contention.  The ALTERNATE CONTENTION NAME field is required for Caseflow-managed end products (EPs) but can be used for other claims as well.
 
The following table describes how to utilize each field.
 
Contention Field
Application
CLASSIFICATION
Use appropriate medical verbiage that corresponds to the claimed medical condition, instead of the claimant’s original language.  The Administrative classification is only for non-rating issues, such as dependency and non-service-connected burial.
MEDICAL
Select Yes in the MEDICAL field if the contention may require an examination or medical opinion to make a determination.  Otherwise, select No.
ALTERNATE CONTENTION NAME
Use when the contention name, as stated by the claimant or required for Caseflow-managed EPs, results in grammatically incorrect or confusing exam request language when the contention is listed in the standardized exam request paragraphs (e.g., the contention name states the prior decision).
 
Result:  “Entitlement to service connection for bilateral pes planus, to include as secondary to a service-connected right and/or left foot disability is remanded” would utilize “bilateral pes planus” as an alternate contention name for use in the Exam Management System.
 
Exceptions:
  • Individual unemployability as a contention must be identified by
    • selecting Unemployability as a classification in order to complete necessary specific development actions in VBMS, and
    • selecting Yes in the MEDICAL field.
  • Specific contentions and classifications must be associated for issues being processed at a pension management center (PMC), as detailed in M21-1, Part III, Subpart i, 2.F.2.d.

III.i.2.F.2.d.  Relating Contentions to Specific Classifications in the PMC

  
The table below lists the contentions used for tracking PMC claims and the associated classification that must be selected.
 
Contention
Classification
  • Dependency and Indemnity Compensation (DIC), or
  • Service Connected Burial
Service Connected Death
  • Veterans Pension, or
  • Survivors Pension
Pension
Accrued
Administrative
Special Monthly Pension
Pension – Aid and Attendance/Housebound
Special Monthly DIC
Service-Connected Death – A&A/HB
 
Note:  If special monthly benefits are being claimed for both Survivors Pension and DIC, use the Service-Connected Death – A&A/HB contention classification.
 

III.i.2.F.2.e.  Associating Claim Types to Contentions

  

Each contention must have the correct claim type associated with it.  When multiple claim types apply, base the contention type on the current theory of entitlement being asserted.

Examples:
  • A Veteran claims an increase in their SC peripheral neuropathy of the left lower extremity.  SC was previously granted on a secondary basis associated with the Veteran’s SC diabetes mellitus, type II.  Although SC was originally granted on a secondary basis, the current claim is for an increased evaluation.  Therefore, the correct contention claim type is Increase.
  • VA receives a claim for a right knee disability from an altered gait, due to the Veteran’s SC left ankle fracture.  The claim was previously denied on a direct basis because the evidence did not show the disability occurred in service.  Although SC was originally claimed on a direct basis, the current claim is based on a secondary SC theory of entitlement and should be labeled Secondary.
  • A Veteran is SC for migraines.  An examiner indicates the condition is likely to improve.  A diary date for a review examination is set.  When the EP is established for the routine future examination, the contention type for migraines would be RFE.
References:  For more information on

III.i.2.F.2.f.  Entering a Claim-Specific Special Issue

  
The RO has a responsibility to identify any contention that may have a special issue associated with it.  Once the RO identifies the contention as having a special issue, the RO must enter a claim-specific special issue indicator that provides additional details about the contention and claim.
 
Use of special issue indicators is mandatory when the claim meets the criteria for their application.  ROs are responsible for identifying and inputting special issue indicators as required by M21-4, Appendix E, 2.  If a special issue exists and applies to the claim, use of the corresponding indicator is required.
 
Example:  The claimant files a claim for diabetes mellitus due to Agent Orange exposure while serving in Vietnam.  Since Agent Orange is identified as a special issue, the diabetes mellitus contention must contain an Agent Orange-Vietnam special issue indicator.
 
Special issues indicators may need to be updated throughout the life of a claim.  It is important that claims processors are vigilant in identifying when the circumstances of the claim require the addition, removal, or editing of special issue indicators.
 
Example:  The claimant submits a fully developed claim (FDC), and the claims processor properly applies the FDC special issue indicator to one of the contentions associated with the claim.  The claim is later excluded from the FDC Program based on evidence received after claims establishment, so the claims processor changes the FDC special issue indicator from Fully Developed Claim to FDC Excluded – Evidence Received After FDC CEST.
 
Reference:  For more information on how to add or remove a special issue indicator in VBMS, see the VBMS Core User Guide.

III.i.2.F.2.g.  Properly Applying Special Issues

  
Special issue indicators must be applied or updated after a special issue is identified.  Use the table below to determine how to apply special issue indicators to contentions.
 
If the special issue applies to …
Then apply the special issue indicator to …
the claim
one contention.
 
Examples:
  • Character of Discharge
  • Fully Developed Claim
  • FDC Excluded – Needs Non-Fed Evidence Development
a contention
each applicable contention.
 
Examples:
  • Agent Orange – Vietnam
  • Asbestos
  • Burn Pit Exposure
 
References:  For more information on
  • inputting special issue indicators into VBMS, see the VBMS Core User Guide, and
  • appropriate use of special issue indicators, see M21-4, Appendix E.2.

3.  Utilizing Tracked Items to Document Development

Introduction

  
This topic contains general information on utilizing tracked items to document development, including

Change Date

  
December 5, 2024

III.i.2.F.3.a.  Purpose of Tracked Items

  
The purpose of tracked items is to control receipt or non-receipt of information/evidence requested from the claimant, beneficiary, or other information/evidence provider.  The status of individual tracked items will be visible through VA claims-submission service websites.

III.i.2.F.3.b.  Creation of Tracked Items

  
Tracked items are established automatically for corresponding development actions when creating and finalizing development letters.  Separate from the process of creating development actions through correspondence, custom tracked items may be manually established by the claims processor, subject to corresponding claims-processing system functionality and limitations.  However, custom tracked items may not be used if a standard tracked item for the claim action already exists.
 
References:  For more information on
  • available standard tracked items, see M21-4, Appendix D, 1.b, and
  • creating tracked items in VBMS, see the VBMS Core User Guide.

III.i.2.F.3.c.  Tracked Item Dispositions

  
Tracked items must be updated with the appropriate date and disposition to reflect the status of the corresponding request or development action.  Use the table below to determine the appropriate date and disposition to use when updating tracked items.
 
Tracked Item Disposition
Description
Received
Use this when requested information/evidence is received or a negative response from the information/evidence provider is received.  For a negative response, create a system note to communicate this information.
Closed
Use this to administratively close a tracked item for non-receipt. Generally, the earliest date an item can be closed is upon determining that the suspense date has expired and the timeframe given for a response has elapsed. This includes any necessary follow-ups.
 
Note:  If a tracked item is closed due to non-receipt but the evidence is received later, while the claim is still pending, the new “received” date will supersede the prior “closed” date.
In Error
Use this to administratively close tracked items that were erroneously created or evidence that was requested in error.
Follow Up 1 or Follow Up
Use this to track the date evidence was requested for a second time.
Follow Up 2 or 2ndFlwUp
Use this to track the date evidence was requested for a third time.
 
References:  For more information on

III.i.2.F.3.d.  Tracked Item Automation

  
If the suspense date for an open, non-actionable tracked item has expired, and no response, either positive or negative, was received in reply to the request, VBMS will automatically close the tracked item by entering the suspense date into the Closed disposition.  A tracked item is considered non-actionable if no action is required at the expiration of the suspense date.
 
If the last remaining tracked item is manually updated by adding a date in the Closed, Received, or In Error disposition, VBMS automatically sets the status and claim-level suspense reason to
  • Ready for Decision for rating claims, and
  • Ready to Work for non-rating claims.

III.i.2.F.3.e.  Accuracy of Tracked Items

  
It is the responsibility of the claims processor reviewing or taking action on a claim to ensure that
 
  • the necessary tracked items have been generated
  • all suspense dates are accurate, and
  • the disposition of all tracked items have been accurately managed, to include any automated tracked item actions.
 
Important:
  • The accuracy of the claim-level suspense reason and date is dependent on properly generated and managed tracked items.
  • If a request submitted through the Personnel Information Exchange System (PIES) is subsequently deemed unnecessary,
    • close the tracked item associated with the unnecessary development action, and
    • cancel the pending PIES request.

III.i.2.F.3.f.  Determining That a Claim Is Ready for a Decision

  
The receipt of requested information/evidence or closing of all tracked items does not necessarily mean that the claim is ready for a decision.  This determination must be based on an analysis of the evidence of record.  A claim is considered ready for a decision after all the requested evidence has been received or otherwise accounted for, ensuring VA’s obligations to assist the claimant have been met.
 
 

4.  Updating Claim Status

Introduction

  
This topic contains information on updating the status of a claim, including

Change Date

   December 30, 2020

III.i.2.F.4.a.  Claim Status

 

  
Claim status is used to determine actions that are pending on a claim and provide more accurate customer service.  Claims processors are responsible for updating claim status to indicate the approximate stage at which a claim is in the claims process.
 
Use the table below to determine the appropriate claim status.
 
Claim Status
Definition
Open
Default status for claims not in any other status. Claims typically stay in this status during claims development.
Ready for Decision
Signifies that the claim is ready for a rating decision.
Ready to Work
Signifies that the claim is ready for a non-rating decision.
Rating Decision Complete
Signifies that a rating decision has been completed and is awaiting promulgation.
Rating Correction
Signifies that a rating decision correction is needed.
Rating Incomplete
Signifies that a rating decision was returned to corporate from the work pending column.
Closed
The claim is complete with no further action possible.
Cancelled
The claim is cancelled with no further action possible.
 
Reference:  For more information on updating the claim status in VBMS, see the VBMS Core User Guide.

III.i.2.F.4.b.  Claim-Level Suspense

  
The claim-level suspense reason and date will automatically update based on tracked items when a claim is in Open status.
 
Each tracked item will automatically map to a claim-level suspense reason.
 
When the claim status is a status other than Open, and a tracked item is added or reopened, the system will automatically set the claim status to Open and update the claim-level suspense reason and date based on the opened tracked item(s).
 
The claim-level suspense reason and date will be updated by the claim status when the claim status is anything other than Open.

 

5.  Advancing Suspense or Diary Dates

Change Date

   September 17, 2018

III.i.2.F.5.a.  Managing Suspense and Diary Dates Through the Claims Process

 

  
The Veterans Benefits Administration’s mission is to serve Veterans and their eligible dependents and survivors in the most timely and accurate manner possible.  It is only appropriate to extend suspense or diary dates if it is necessary for a specific adjudicative action.
 
Suspense dates must always correspond with specific actions and may not be arbitrarily extended under any circumstance.
 
Important:  When employees handle a claim, they are expected to take the most full and complete action possible on a claim every time – including development, rating, and promulgation actions – to move a claim forward to accurate completion in the claims process.  Every effort must be made to move the claim to the next processing cycle each time it is handled.