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Benefits Assistance Service
Introduction to Standard Forms and Intent to File for VSOs This lesson will provide an introduction to modifications to the VA claims process resulting from a change to VA regulations. On September 25, 2014, VA published a final rule called “Standard Claims and Appeals” (RIN 2900-AO81). This final rule, effective March 24, 2015, requires that all claimants filing for disability compensation, pension, and survivor benefits use VA’s standard forms. In addition, in those cases where VA provides the claimant with a Notice of Disagreement (NOD) form with VA’s decision on a claim, the claimant’s use of the form to initiate his or her appeal is mandatory. We are going to discuss the required use of standard VA Forms for submitting claims and appeals and the new “Intent to File” process. March 2015
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Objectives After training, you should be able to:
Understand the basics of the standard claim and appeal forms rule Understand the basics of the “Intent to File” (ITF) process Understand the impact of the ITF process on potential effective dates Discuss impacts on the current VBA process Identify the VA Standard Forms After this training, you should be able to: Understand the basics of the standard claim and appeal forms rule Understand the basics of the “Intent to File” process Understand the impact of the ITF process on potential effective dates Discuss impacts on the current VBA process
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What is the new rule? Regulation Identifier Number (RIN) 2900-AO81 refers to VA’s final rulemaking titled “Standard Claims and Appeals” Published on September 25, 2014 in the Federal Register Delayed effective date is March 24, 2015 In an effort to make it as fast and as easy as possible for Veterans and their survivors to file for and receive accurate decisions on their claims, VA is updating its regulations to require the use of standard claim and appeal forms. Requiring the use of standard forms enables Veterans, survivors, and their representatives to clearly state what benefits they are seeking. This helps to bring VA processes in line with other government agency processes like those of the Social Security Administration and the Internal Revenue Service, which also require submissions on standard forms before they can pay benefits or issue refunds. This update is necessary because the lack of a standardized process contributed to delays in claim processing and the potential for inaccuracies. The regulation change will help enable VA to deliver benefits more efficiently. The rule was published in the Federal Register on September 25, 2014 and will take effect on March 24, 2015.
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Major Components of the New Rule
Immediate changes for claims and appeals received on or after March 24, 2015: All claims must be submitted on VA-prescribed forms 38 CFR 3.157, Report of examination or hospitalization as a claim for increase or to reopen, is eliminated; potential retroactive effective dates based on treatment are still allowable where supported by medical evidence “Intent to File” process replaces informal claims An intent to file serves as a potential effective date placeholder, provided a complete claim for the corresponding benefit is received within 1 year. Compensation appeals must be initiated on VA Form , Notice of Disagreement May be extended to pension and other claims in the future There are four major components of the new rule. It is important to remember these components only apply to claims and appeals received on or after March 24, 2015. The major components include: Requiring all claimants to submit claims on VA-prescribed forms Eliminating 38 CFR 3.157, Report of examination or hospitalization as a claim for increase or to reopen, but allowing for a potential one-year retroactive effective date for claims for increase based on medical evidence of record. Creating an “intent to file” process to replace the historical informal claim process. An intent to file will serve as a potential effective date placeholder, provided the required claim form for the corresponding benefit is received within 1 year. Using a Notice of Disagreement (NOD) form when VA provides the form with a decision letter. The NOD form is currently available for compensation claims only.
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New Terms Request for Application (38 CFR 3.155(a))
Any communication or action expressing a desire to file for benefits under the laws administered by VA that does not meet the standards of a complete claim Intent to File (3.155(b)) Written, oral, or electronic notice to VA of an intent to file a claim for compensation, pension, or survivors benefits (see slides 8 and 9 for details) Incomplete application (3.155(c)) Any submission on a prescribed form that is not a complete claim as defined in 3.160(a) The new regulation introduced some new terms. Submissions on a form other than a prescribed form are requests for application. Written, oral, or electronic notice delivered in the manner prescribed is an intent to file (ITF). Submissions on a prescribed form that do not meet the requirements for a complete claim are incomplete applications. Complete claims are submitted on required forms or online through eBenefits or SEP, and contain enough information to identify the claimant, and the Veteran (if not the claimant), and the benefit sought. For compensation claims, there must be a description of the symptom(s) or medical conditions for which benefits are sought, and for needs-based programs there must be a statement of income.
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New Terms, Cont’d Complete claim (3.160(a))
A signed submission on a prescribed application form (paper or online) that identifies the Veteran, the claimant, and the benefit sought (for compensation, including a description of the symptoms or medical conditions associated with the claimed disability; for needs-based benefits, a statement of income) Notice of disagreement (compensation claims only) (19.24(b)(2), ) A signed, timely submission of VA Form , Notice of Disagreement, that identifies the claimant, the appealed claim, and the specific nature of the disagreement The new regulation introduced some new terms. Submissions on a form other than a prescribed form are requests for application. Written, oral, or electronic notice delivered in the manner prescribed is an intent to file (ITF). Submissions on a prescribed form that do not meet the requirements for a complete claim are incomplete applications. Complete claims are submitted on required forms or online through eBenefits or SEP, and contain enough information to identify the claimant, and the Veteran (if not the claimant), and the benefit sought. For compensation claims, there must be a description of the symptom(s) or medical conditions for which benefits are sought, and for needs-based programs there must be a statement of income.
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Required Forms All claims must be submitted on prescribed forms:
Compensation: VA Form EZ, Application for Disability Compensation and Related Compensation Benefits Pension: VA Form EZ, Application for Pension Survivors Pension and Dependency and Indemnity Compensation: VA Form EZ, Application for DIC, Death Pension, and/or Accrued Benefits Dependency: VA Form c, Declaration of Status of Dependents; VA Form , Request for Approval of School Attendance And more… (slides 20-23) All compensation appeals must be submitted on VA Form , Notice of Disagreement, when it is issued to the claimant with the decision notification letter: May be extended to pension and other claims in the future The specified forms are designed to capture the information necessary to identify and support compensation, pension, and survivor benefit claims. The required form depends on the type of benefit the claimant is requesting: Compensation claims must be filed online through eBenefits or the Stakeholder Enterprise Portal, or filed on paper with VA Form EZ, Application for Disability Compensation and Related Compensation Benefits. Pension claims must be filed on VA Form EZ, Application for Pension. Survivors claims for dependency and indemnity compensation (DIC), survivors pension, and accrued benefits must be filed on VA Form EZ, Application for DIC, Death Pension, and/or Accrued Benefits. Dependency claims must be filed on VA Form c, Declaration of Status of Dependents or VA Form , Request for Approval of School Attendance, as appropriate. Note: The VA Forms , b, , and are still acceptable claim forms; however, we want to promote the use of the EZ series forms along with the Fully Developed Claim program. Additionally, Veterans must initiate an appeal by using the notice of disagreement (NOD) form when it is issued with a decision letter. Right now, this is only in use for compensation claims by using VA Form , Notice of Disagreement.
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Elimination of 38 CFR 3.157 Eliminates use of documents other than the standard claim forms, e.g., medical records and reports of hospitalization, to establish compensation and pension claims Changes to effective date rules allow VA to pay retroactive benefits as early as the date of treatment if, within one year of treatment, VA receives: a complete claim, or an ITF and, within one year after the ITF is received, a complete claim for the corresponding benefit Beginning March 24, 2015, this rule change eliminates 38 CFR 3.157, “Report of examination or hospitalization as claim for increase or to reopen.” Provisions of 38 CFR allowed VA to consider various documents other than claims forms, specifically, VA reports of hospitalization or examination and other medical reports, as claims for compensation or pension. These provisions have been eliminated. In short, as of March 24, 2015, if it is not on a required form, it is not a claim. Although VA has eliminated section 3.157, VA will still consider medical evidence when determining the effective date of an award, if either a claim or an intent to file for requested benefits is received within one year of the date of treatment and, if an intent to file is submitted, the required claim form is received within one year of the date of the ITF. This allows VA to potentially assign a potential retroactive effective as early as the date of treatment, much like authorized. This provision has been added to 38 CFR 3.400, the effective date regulation. Example: A Veteran is hospitalized on May 1, 2015 for his service-connected knee condition. In order for VA to award an effective date of May 1, 2015 for an increase in the disability rating of the knee, VA must receive one of the following no later than May 1, 2016: A claim for increased compensation on a VA Form 526EZ, or An intent to file for compensation benefits* *Note: The intent to file will only be recognized for effective date purposes if a complete claim (i.e., VA Form 526EZ) is received within one year of the intent to file.
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The Intent to File Process
The new intent to file (ITF) process applies to the following claim types: Compensation Pension Survivors Pension and Dependents Indemnity Compensation (DIC) Does not apply to benefits that pay a one-time benefit (e.g., burial) The ITF reserves a potential effective date for compensation, pension, and survivors benefits, provided the complete claim for the corresponding benefit is received within 1 year. Only one ITF per general benefit (compensation, pension, or survivors benefits) can be active at any time. The new rule introduces an “intent to file” (ITF) process to replace informal claims. The change is effective March 24, 2015. The ITF process will be used for compensation, pension, and survivors benefits. An ITF will serve as a potential effective date for benefits, provided the required claim form is received within 1 year. Only one ITF per general benefit can be “active” at any given time, and only the first claim received will correspond to an active ITF for that type benefit. While VA is requiring the use of certain claim forms, use of ITFs is optional. An ITF allows claimants who plan to file a fully developed claim, but may not have gathered all the evidence, to save the potential effective date for up to one year. Claimants and representatives who are ready to submit a fully developed claim should do so without first submitting an ITF.
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Intent to File Process, Cont’d
An active ITF only applies to the first claim of that type received. Methods of filing an ITF: Paper form (new VA Form , Intent to File a Claim for Compensation and/or Pension, or Survivors Pension, and/or DIC) Telephone call to or in-person interview at a VA regional office or other claim intake center First-time “Save” of online application (eBenefits, SEP, D2D) Methods of filing a corresponding claim: VA standard paper form online through eBenefits, SEP, or D2D An individual’s statement of his or her “intent to file a claim” must be submitted using one of the following methods: 1) The new intent to file form ( , Intent to File a Claim for Compensation and/or Pension, or Survivors Pension, and/or DIC) 2) Telephone call to the VA call center or in-person interview with public contact personnel at the regional office 3) Initiating and saving an online claim through eBenefits or the Stakeholder Enterprise Portal Submitting an (ITF) secures the a potential effective date and provides the claimant up to one year to complete the required claim form and gather and submit evidence to support the claim. Upon receipt of an intent to file, VA will send a letter notifying the claimant of the required claim form along with an explanation that the required form must be received within one year of the intent to file date in order to retain the potential effective date. The claimant or representative may complete the required claim form in either paper or an electronic application tool, regardless of the intent to file method used, but VA strongly encourages the use of electronic filing whenever possible. If an individual submits a communication that does not meet the requirements of an ITF or a claim for benefits, VA will consider it a request for application, and will provide the claimant the required claim form(s), if appropriate, but will not save a potential effective date.
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NOD Process Effective March 24, 2015, VA requires VA Form , Notice of Disagreement, to initiate an appeal when that form is enclosed with the decision notification letter If VA receives an incomplete NOD, VA will provide claimants 60 days, or the remainder of the 1-year appeal period, to respond to any request by VA to complete the incomplete NOD. If a compensation claimant appears to disagree in a format other than the required form, VA will notify the claimant to submit a Notice of Disagreement on the required form. The completed NOD form must be received within 1 year from initial notice of the claim decision. Also effective March 24, 2015, the new rule mandates the use of a notice of disagreement (NOD) form when a claimant wishes to initiate an appeal of a VA decision and VA provided a copy of that form. Currently, only compensation claims require the use of VA Form , Notice of Disagreement. If the original compensation decision notification was mailed prior to March 24, 2015, then use of VAF is recommended, but not required. Upon the receipt of a timely, but incomplete, VA Form , VA will inform the claimant (and representative) that he or she has 60 days or the remainder of the first year after notice of the decision to return a completed NOD form. If disagreement is expressed outside of a required form after March 24, 2015, there will be no extension to the one year appeal period to submit the NOD, but VA will notify the claimant that they must submit a timely NOD to initiate an appeal. If a completed NOD form is not received within one year of the claim decision notification, VA’s decision on the claim becomes final.
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Impacts on Claim Process
All compensation, pension, and survivors claims, ITFs, and all compensation appeals must be filed on prescribed forms Intent to File is only used to save a potential effective date VA will follow existing regulations to establish, develop, rate, and authorize complete claims Benefits to Veterans and their Families: Veterans and survivors better understand the evidence and information needed to assist VA in quickly and accurately processing their claims and appeals Helps VA deliver decisions to Veterans and survivors sooner by increasing the efficiency of the claims process You may be asking “How do these changes affect our current claims process?” Informal claims and appeals no longer exist. VA will require claimants to submit all compensation and pension claims, and all compensation appeals, on prescribed forms. Upon receipt of an ITF, VA will notify the ITF submitter that they have one year to submit the corresponding claim(s). Upon receipt of the required form(s), VA will follow existing regulations to establish, develop, rate, and authorize claims. There will be no other change to the claims process. This change benefits veterans and other claimants by helping them better understand the information and evidence necessary to process their claim, and helps VA expedite identification, and therefore accurate resolution, of claims. In turn, VA will be better poised to serve all Veterans.
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Examples Example 1: Veteran submits VA Form for compensation on June 1, 2015 and submits paper VA Form EZ on January 1, 2016. Intent to File date = June 1, 2015 Potential effective date of benefits = June 1, 2015 Example 2: Representative saves EZ in SEP on June 1, Veteran begins online application in eBenefits on November 1, 2015 and submits online application through eBenefits on January 1, 2016. November 1st online application save = duplicate intent to file Let’s review some examples of how the intent to file process impacts the potential effective date for benefits. In the first example, compensation benefits, if awarded, may be retroactive back to June 1, 2015, the day that VA received the ITF. In the second example, compensation benefits, if awarded, may also be retroactive back to June 1, 2015, the day that VA received the active ITF. The duplicate ITF, triggered by online initiation of a claim, has no bearing on any potential effective date(s). Remember, VA must receive the required claim form(s) within one year of the date the ITF was received. The sooner VA receives the required form, the sooner VA can begin processing the claim. VSOs should also keep in mind the benefits of filing a Fully Developed Claim (FDC). VSOs can contact their local Change Management Agent for more information on FDCs.
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Examples, Cont’d Example 3: Veteran submits an ITF for compensation through the National Call Center on June 1, The VSO initiates an online application in SEP on November 1, 2015 and submits the online application on January 1, 2016, for knee disability. The VSO submits a second online application, this one for back disability, through SEP on February 1, 2016. Intent to File date = June 1, 2015 November 1st online application save = duplicate intent to file Potential effective date of benefits for knee disability= June 1, 2015 Potential effective date of benefits for back disability = February 1, 2016 In the third example, knee benefits, if awarded, may also be retroactive back to June 1, 2015, the day that VA received the active ITF. The duplicate ITF, triggered by online initiation of a claim, has no bearing on any potential effective date(s). Benefits for the back disability, if awarded, are not potentially retroactive to the June 1, 2015 ITF, because it is “consumed” by the knee claim submitted in January 2016. In order to secure the earliest possible effective date for your claimant who has secured a date with an ITF, make sure you file all of his or her claims at once. Second and subsequent claims will not relate back to an ITF.
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Frequently Asked Questions
IF A CLAIM WAS DENIED DUE TO FAILURE TO REPORT FOR AN EXAM, DOES THE CLAIMANT NEED TO SUBMIT A NEW INTENT TO FILE AND/OR REQUIRED CLAIM FORM TO HAVE THE CLAIM RECONSIDERED? No. Within one year of the rating decision, claimants or their representatives can contact VA and indicate he/she is able and willing to report for an exam. VA will re-order the examinations if they are still necessary to decide the claim. After one year, the claimant will need to submit new and material evidence and the required form to reopen the claim. IF A CLAIM WAS DENIED DUE TO FAILURE TO REPORT FOR AN EXAM, DOES THE CLAIMANT NEED TO SUBMIT A NEW INTENT TO FILE AND/OR REQUIRED CLAIM FORM TO HAVE THE CLAIM RECONSIDERED? No. Within one year of the rating decision, claimants or their representatives can contact VA and indicate he/she is able and willing to report for an exam. VA will re-order the examinations if they are necessary to decide the claim. After one year, the claimant will need to submit new and material evidence and the required form to reopen the claim.
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Frequently Asked Questions
CAN A HOSPITAL ADMISSIONS REPORT BE USED TO OPEN A CLAIM, INCLUDING CLAIMS UNDER PARAGRAPH 29 OR 30? No. Hospital reports and medical evidence cannot be used to open a claim. The claimant or representative must submit a complete claim. Medical evidence will, however, be used when VA determines the effective date for an award as long as VA receives the complete claim or an ITF followed by a complete claim within one year of the date of the medical treatment. This allows for a potential retroactive effective date as early as the date of treatment. CAN A HOSPITAL ADMISSIONS REPORT BE USED TO OPEN A CLAIM, INCLUDING CLAIMS UNDER PARAGRAPH 29 OR 30? No. Hospital reports and medical evidence cannot be used to open a claim. The claimant or representative must submit the required claim form. Medical evidence will, however, be used when VA determines the effective date for an award as long as VA receives the claim or an ITF followed by the required claim form within one year of the date of the medical treatment. This allows for a potential retroactive effective date as early as the date of treatment.
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Frequently Asked Questions
IS A REQUEST TO RESUME BENEFITS AFTER RELEASE FROM ACTIVE DUTY CONSIDERED A CLAIM REQUIRING USE OF THE ITF AND/OR REQUIRED CLAIM FORM? No. A request to resume benefits after release from active duty is not considered a claim for benefits and therefore does not require any particular form. However, if a Veteran is claiming increased benefits for an existing service-connected disability or service-connected benefits for a new disability, ITF and claim rules and procedures apply. In this instance, if a Veteran submits a new complete claim, and informs VA that he or she is no longer on active duty, VA will consider the submission to be both a claim and a request to resume the discontinued benefits. IS A REQUEST TO RESUME BENEFITS AFTER RELEASE FROM ACTIVE DUTY CONSIDERED A CLAIM REQUIRING USE OF THE ITF AND/OR REQUIRED CLAIM FORM? No. A request to resume benefits after release from active duty is not considered a claim for benefits and therefore does not require any particular form. However, if a Veteran is claiming increased benefits for an existing service-connected disability or service-connected benefits for a new disability, ITF and claim rules and procedures apply. In this instance, if a Veteran submits the new claims on the required form, and informs VA that he or she is no longer on active duty, VA will consider the submission to be both a new claim and a request to resume the discontinued benefits.
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Frequently Asked Questions
CAN A CLAIMANT SUBMIT AN INTENT TO FILE FOR BOTH COMPENSATION AND PENSION BENEFITS? Yes. A claimant or representative may select both compensation and pension when submitting a single ITF. The claimant must then submit the required claim forms for both types of benefits within one year of the intent to file. CAN A CLAIMANT SUBMIT AN INTENT TO FILE FOR BOTH COMPENSATION AND PENSION BENEFITS? Yes. A claimant or representative may select both compensation and pension when submitting a single ITF. The claimant must then submit the required claim forms for both types of benefits within one year of the intent to file.
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Frequently Asked Questions
WHAT HAPPENS TO THE CLAIMS OR APPEALS FILED UNDER THE OLD REGULATIONS? WILL THE CLAIMANT NEED TO RE-FILE? No, a claimant who, prior to March 24, 2015, filed claims or notices of disagreement using the former process does not need to re-file. WHAT HAPPENS TO THE CLAIMS OR APPEALS FILED UNDER THE OLD REGULATIONS? WILL THE CLAIMANT NEED TO RE-FILE? No, a claimant who, prior to March 24, 2015, filed claims or notices of disagreement using the former process does not need to re-file.
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Standard VA Forms Benefit Type Prescribed Form
Service connection (original) 21-526EZ Service connection (new or reopen) Increased evaluation Temporary Total Disability Rating Highlight some of the forms (21-526EZ, EZ) and stress the importance of the use of required forms and how it will enable VA to process claims timely, while supporting VA’s transformation efforts. For example: 21-526EZ can be used for all compensation claims, though some claims such as TDIU will require additional forms. 21-527EZ can be used for all Veterans pension claims. 21-534EZ can be used for all survivors claims, except burial. 21-686c can be used to add a dependent to any award. can be used to retain a schoolchild over 18 on an award. And more…
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Standard VA Forms, cont’d
Benefit Type Prescribed Form Individual Unemployability (IU) is required for grant of benefits, IU can be filed on any of the following forms as well 21-526EZ Helpless Child benefits 21-686c 21-527EZ 21-534EZ NSC Pension (original, new, or reopen)
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Standard VA Forms, cont’d
Benefit Type Prescribed Form DIC, Death Pension & Accrued Benefits 21-534EZ Specially Adapted Housing (SAH) or Special Home Adaptation (SHA) is required for grant of benefits, Auto Allowance can be filed on any of the following forms as well 21-526EZ Auto Allowance is required for grant of benefits, Auto Allowance can be filed on any of the following forms as well c is required for supplemental SAH/SHA benefits
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Standard VA Forms, cont’d
Benefit Type Prescribed Form Housebound/Aid and Attendance (including spousal A&A) 21-526EZ 21-527EZ is required if based on nursing home attendance Spina Bifida Apportionment Dependents c
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Recall Objectives Now you should be able to:
Understand the basics of the standard claim and appeal forms rule Understand the basics of the “Intent to File” (ITF) process Understand the impact of the ITF process on potential effective dates Discuss impacts on the current VBA process Identify the VA Standard Forms Now that we have discussed an overview of the new rule, you should be able to explain the basics of the standard claim and appeal forms rule, understand the concept of the intent to file process and its impact on potential effective dates, and realize the impact this will have on claim processing.
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Questions?
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