DI 11005.007: Field Office (FO) Instructions for Identifying Claims, Applicable Terms, and Scheduling Appointments for Claimants with a Veterans Affairs 100 Percent Permanent and Total (VAPT) Disability Compensation Rating
Effective Dates: 07/17/2017 - Present TN 49 (07-17) DI 11005.007 Field Office Instructions for Claimants with a Veteran’s Affairs 100 Percent Permanent and Total (VAPT) Disability Compensation Rating A. Background on VAPT disability cases On March 17, 2014, the Social Security Administration (SSA) began expediting disability claims for veterans with a Veteran’s Affairs 100% permanent and total (VAPT) disability compensation rating. We expedite these cases through all levels of development, adjudication, and appeal. The VAPT rating does not guarantee an allowance for SSA disability benefits. These veterans must meet SSA disability medical eligibility and entitlement requirements. Field Office (FOs), Disability Determination Services (DDS), and Office of Disability Adjudication and Review (ODAR) employees must be aware of when to apply the expedited procedure. Expedited claims processing: * applies to all veterans with a VA 100% P&T disability compensation rating; and * does not apply to veterans with a VA 100% P&T disability pension rating. NOTE: VA disability compensation rating is to compensate veteran’s for service connected injuries and illnesses. The VA pension program is a needs based program for disabled veterans if their service coincided with a period of war and the veteran has limited income and resources. B. VA Information Exchange Alert Beginning September 25, 2015, SSA and the Veteran’s Administration (VA) initiated a weekly data exchange agreement in which the VA provides SSA with information concerning veterans who received the VAPT disability compensation rating. When a veteran contacts SSA to file for disability benefits, and our database indicates the 100% P&T rating, users receive an immediate alert that we must expedite the case. Theses alerts are found on the following systems screens: * National 800 Number Appointment/Referral System (NUMBR800) generates the alert “VA 100% P&T – Schedule Appointment Within Three Days”; * Customer Service Record Query (CSQR) generates the alert “VA 100% P&T – Use Expedited Procedures” in both Visitor Intake Process Re-write (VIPr) and Customer Information Control SystemCICS; * Modernized Claims Systems (MCS) adds an ISSUE “100% PT” and the remark “VA 100% Perm and Total” to the Remarks field on the MCS DW01 Screen; * Electronic Disability Collect System (EDCS) adds Flag #38 “100%P&T” to pending cases and initiated cases tahat have a data match; * Case Processing and Management System (CPMS) adds the case characteristic “VPAT” (effective 07/15), and * Appeals Review Processing System (ARPS) adds the case characteristic “VPAT” When an alert indicates the VAPT compensation rating, no additional proof is necessary to expedite the case. C. Verification (proof) of VAPT We receive VAPT rating status directly from the VA; therefore, the claimant has no additional burden to provide proof to expedite the claim. The data exchange with the VA is sufficient to verify 100% VAPT. In rare situations, a veteran may self-identify as rating 100% VAPT, but there is no system alert. For these cases, the veteran must provide proof of 100% VAPT. Acceptable proof of a veteran’s rating is normally a VA notification letter to the veteran. For cases without the VA 100% P&T systems alert, make a copy of the VA Notification Letter and retain a copy in file. Cases should not be expedited without verification or proof of VA PT rating. Example of VA Notification Letter View PDF Version Printer Friendly Version Printer Friendly Version Printer Friendly Version Printer Friendly Version D. Field office action 1. Appointments and interviews When to schedule an appointment: * Referrals from the National 800 Number Network (N8NN) but no appointment made -- Contact the individual and schedule an appointment within 3 business days; * Direct phone calls from the individual -- Schedule an appointment within 3 business days; and * Walk-In Claimants -- If the individual cannot stay and complete an application, schedule an appointment within 3 business days. NOTE: If the individual alleges 100% VAPT, but there is no alert, see Verification in DI 11005.007C in this section. 2. FO claims processing To process the claim, take the following steps: * Enter all claims on Modernized Claims System (MCS), following applicable Program Operations Manual System (POMS) and Modernized System Operations Manual (MSOM) instructions; * Follow normal interviewing guidelines, which includes entering the information in the Electronic Disability Collect System (EDCS). Complete the application as thoroughly as possible to avoid unnecessary recontact with the claimant; * If non-medical requirements are not met, process the claim as a technical denial. For Title II claimants meeting all non-medical requirements, process a non-medical completion following instructions in DI 11010.115; and * If the veteran is working and the work is determined to be substantial gainful activity (SGA), we will find that the veteran is not disabled regardless of his or her medical condition, age, education, or work experience. For a full discussion of SGA, see subchapter DI 10501.000. NOTE: Based on income and resource limits for Supplemental Security Income (SSI) eligibility, receipt of VA benefits normally result in a technical denial for SSI. For more information on VA compensation and SSI income, see SI 00830.304. 3. FO flagging and tracking of the claim Carefully control and monitor all claims through completion as follows: · MCS: Upon receipt of VA alert, MCS establishes a“100% PT” issue on the MCS DW01 screen to track claims processing.The Claim Specialist (CS) establishes a Unit Code of ___P&T. These claims receive expedited processing through all levels of development, adjudication, and appeal. The expedited processing is similar to the process currently used with priority cases. NOTE: If a veteran is Military Casualty, wounded warrior and 100% P&T, whichever classification is identified first will be reflected in the unit code. · For more information on priority cases see DI 23020.001. EDCS/eView: EDCS automatically adds flag #38 “100%P&T”. · EDCS exclusions (paper claims): Attach the “100% Perm & Total” flag to the front of the modular disability folder (MDF) to alert the DDS to expedite processing of these claims. Send the paper claim in a priority mail envelope with a “100% P&T” designation on the outside of the envelope. For a list of EDCS exclusions and limitations, see DI 81010.030. Flag Sample: View PDF Version 4. FO action after DDS determination Upon receipt of a favorable DDS determination, take the following action: If the claimant is not in pay via the non-medical completion process, use the EDCS Actions Page and the Workload Management Information System/Workload Management System (WMI/WMS) listings to identify claims with the Unit Code “___ P&T” to trigger payment as soon as possible. 5. Requests for appeal Process requests as follows: * Reconsideration requests - Process requests from non-prototype states using the same procedures outlined in this subsection for initial claims; and * Hearing requests - Send the request directly to the appropriate hearing office. If there is no flag on the case, add the 100% P&T flag in eView to electronic cases and the paper flag for paper cases (see Exhibit) with the date the claim is sent to ODAR. For EDCS exclusions, send a copy of the annotated flag to the Regional Office (RO) to initiate tracking through the hearing process as explained in DI 11005.601D.6.b.
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