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DI 11005.003: Field Office (FO) Instructions for Identifying Claims, Applicable Terms, and Scheduling Appointments for Military Casualty (MC)/Wounded Warrior (WW) Cases

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  • Effective Dates: 08/31/2012 - Present
  • Effective Dates: 06/26/2018 - Present
  • TN 36 (08-12)
  • DI 11005.003 Field Office (FO) Instructions for Identifying Claims, Applicable Terms, and Scheduling Appointments for Military Casualty (MC)/Wounded Warrior (WW) Cases
  • This section provides field office (FO) instructions for identifying disability claims for military service members who incurred an injury, illness, or wound (regardless of how or where it occurred) while on active duty on or after October 1, 2001.
  • We flag Military Casualty (MC)/Wounded Warrior (WW) cases as MC/WW. We process these cases using the expedited terminal illness (TERI) instructions through all stages of case development and adjudication. The case must indicate a terminal illness before we classify it as TERI. (For TERI processing instructions, see DI 11005.601 The Disability Interview-Identifying Terminal Illness (TERI) Cases.)
  • NOTE: We process survivor claims associated with military service related deaths under the disaster/emergency instructions in GN 00207.055 Expedited Claims Procedures for Military Service Casualties-Survivors Applications.
  • A. MC/WW terms and definitions
  • 1. MC/ WW claim
  • MC/ WW is a claim involving any current or former member of a military service who
  • * sustained an illness, injury, or wound;
  • * is alleging a physical or mental impairment, regardless of how the impairment occurred, or where it occurred (i.e., United States or on foreign soil); and
  • * sustained the impairment while on active duty status on or after October 1, 2001.
  • There are physical and mental impairments (e.g., post traumatic stress disorder, traumatic brain injury) that a military service member can sustain while on active duty status. These impairments may not become disabling until after the claimant leaves the military. Thus, the claimant may not file a disability application until after he or she leaves the military. In this situation, as long as the claimant meets the above definition, adjudicators will flag the claimant as a MC/WW and follow the expedited processing procedures.
  • 2. Active duty
  • The following defines active duty:
  • * Claimants on full-time duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard, including those on active duty for training;
  • * Students at U.S. Military academies and pre-deployment training facilities; claimants in the National Guard (Army or Air Force) ordered to active federal full-time duty by the President of the United States in times of war or national emergency;
  • * Claimants in reserve components of the U.S. Army, Navy, Air Force, Marine Corps, and Coast Guard called to active duty, including those claimants performing full-time training, annual training, or attending school designated as a Military Service School by law or by the applicable Secretary.
  • B. Identifying MC/WW cases using SSA/Department of Defense data exchange information
  • The Department of Defense (DoD) identifies wounded military service members and provides SSA with weekly information on this population through an automated data exchange.
  • We verify the Social Security Numbers (SSNs) and other data (such as, name, date of birth, and gender) that DoD provides against the NUMIDENT. The information DoD provided may not be a comprehensive list of all wounded, ill, and injured military service members. Therefore, during the initial interview, we must be alert to possible MC/WW claimants.
  • We store the SSN of only verified wounded service members in the SSA Integrated Client Data Base (ICDB), also known as CLIENT. We do not take any action on the information in this database until a service member contacts us to file a claim; we cannot use this information for leads purposes.
  • When a record from DoD matches the SSN, we add a Wounded Warrior indicator to the SSN record. We do not take any action on the information in this database until a service member contacts us to file a claim; we cannot use this information for leads purposes.
  • 1. Claimant’s SSN matches the SSA ICDB
  • If a service member files a claim, follow these procedures:
  • * When the claimant’s SSN matches the information in the SSA ICDB, an alert may appear in either one of or all of the following:
  • * Visitor Intake Program (VIP)
  • * Customer Service Record (CSR)
  • * Customer Help and Information Program (CHIP)
  • * During case creation, when the SSN is present in the CLIENT military casualty segment, the Electronic Disability Collect System (EDCS) automatically attaches an MC/WW flag.
  • If the SSN match occurs after initial case creation, the MC/WW flag re-propagates into EDCS during case creation at any adjudicative level.
  • 2. Claimant’s SSN does not match the SSA ICDB
  • If the claimant’s SSN does not match the information in the SSA ICDB (i.e., no alert is present in VIP, CSR, or CHIP), but the claimant alleges a disability resulting from an illness, injury, or wound that occurred while on active duty status on or after October 1, 2001:
  • * Manually establish an MC/WW flag in EDCS.(For instructions on manually establishing a flag, see DI 81010.080 Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS))
  • * If the case is a paper modular disability folder (MDF), attach a paper MC/WW flag to the MDF. See an exhibit of the paper flag in DI 11005.006I.
  • * Manually establish an MC/WW flag in EDCS. (For instructions on manually establishing a flag, see DI 81010.080 Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS))
  • * If the case is a paper modular disability folder (MDF), attach a paper MC/WW flag to the MDF. See an exhibit of the paper flag in DI 11005.006I.
  • C. Scheduling an MC/WW appointment
  • 1. Claimant contacts the FO
  • To ensure expeditious handling, be alert to the possibility of disability claims resulting from military service casualties. When a claimant contacts the FO to file a disability claim
  • * Identify if the claimant is alleging his or her disability occurred while on active duty status on or after October 1, 2001.
  • * Have the claimant file the application that day, if possible. If the claimant is unable to file an application on the day of initial contact, take the following steps to expedite the appointment process:
  • * Have the claimant file the application that day, if possible. If the claimant is unable to file an application on the day of initial contact, take the following steps to expedite the appointment process:
  • * Schedule an appointment within three business days after contact; and
  • * Add the remark “Military Casualty/Wounded Warrior Case” on the Leads/Protective Filings and Proofs (LPFP) screen in the 800# System (For information on LPF Proofs/Appointment (LPFP), see MSOM APPTS 001.007.).
  • 2. Claimant contacts the National 800 Number Network (N8NN) and agent transfers referral to FO
  • If the claimant contacts the N8NN for an appointment and the agent cannot schedule an appointment with the servicing FO within three business days, he or she transmits a referral to the FO via the LPFP screen with “Military Casualty/Wounded Warrior Case” in remarks.
  • Upon receipt of the N8NN referral, contact the claimant within two business days to schedule an appointment.
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