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- Effective Dates: 06/12/2018 - Present
TN 49 (07-17)- TN 52 (06-18)
DI 11005.007 Field Office Instructions for Claimants with a Veteran’s Affairs 100 Percent Permanent and Total (VAPT) Disability Compensation Rating- 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
A. Background on VAPT disability cases- This section provides FO instructions for identifying disability claims for veterans with a Veterans Affairs 100 Percent Permanent and Total (VAPT) disability compensation rating. We flag the disability folder for these cases as VAPT to alert the components to the special case processing and development requirements. We process these cases using the expedited terminal illness (TERI) instructions through all stages of case development and adjudication. The case must indicate that the claimant’s condition is terminal before we classify it as TERI. (For TERI processing instructions, see DI 11005.601.)
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: We process survivor claims associated with military service related deaths under the disaster/emergency instructions in GN 00207.055.
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.- A. VAPT terms and definitions
B. VA Information Exchange Alert- VAPT claim
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”- VAPT is a claim involving any veteran of a military service who has a VA 100% P&T disability compensation rating and is alleging a physical or mental impairment, regardless of how the impairment occurred.
When an alert indicates the VAPT compensation rating, no additional proof is necessary to expedite the case.- NOTE: The U.S. Department of Veterans Affairs (VA) disability compensation rating is to compensate veterans 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.
C. Verification (proof) of VAPT- B. Identifying VAPT cases using the Social Security Administration (SSA)/VA data exchange information
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.- The VA identifies veterans with a VAPT disability compensation rating, and provides SSA with weekly information on this population through an automated data exchange.
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.- We verify the Social Security Numbers (SSNs) and other data (such as, name, date of birth, and gender) that the VA provides against the NUMIDENT. The information VA provided may not be a comprehensive list of all VAPT disability compensation recipients, therefore we must be alert to the possibility of new VAPT claimants during the initial interview.
Example of VA Notification Letter- We store the SSN of only verified disability compensation recipients in the SSA Integrated Client Data Base (ICDB), also known as PERSON. We do not take any action on the information in this database until the veteran contacts us to file a claim; we cannot use this information for leads purposes.
View PDF Version- 1. Claimant’s SSN matches the SSA ICDB
Printer Friendly Version- If a veteran files a claim, follow these procedures:
- * When the claimant’s SSN matches the information in the ICDB, an alert may appear in either one of or all of the following:
- * 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 System (CICS);
- * 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 “Disabled Veteran Rated 100% Permanent and Total” to pending cases and initiated cases that 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.”
- * During case creation, when the SSN is present in the PERSON VAPT segment, the EDCS automatically attaches a VAPT flag.
Printer Friendly Version- If the SSN match occurs after initial case creation, the VAPT flag re-propagates into EDCS during case creation at any adjudicative level.
Printer Friendly Version- 2. Claimant’s SSN does not match the SSA ICDB
Printer Friendly Version- If the claimant’s SSN does not match the information in the SSA ICDB (i.e., no alert is present), but the claimant alleges a VAPT disability compensation rating:
- * Manually establish a VAPT flag in EDCS.
D. Field office action- (For instructions on manually establishing a flag, see DI 81010.080 )
- * If the case is a paper modular disability folder (MDF), attach a paper VAPT flag to the MDF. See an exhibit of the paper flag in DI 11005.012H.
1. Appointments and interviews- C. Scheduling a VAPT appointment
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.- 1. Claimant contacts the FO
NOTE: If the individual alleges 100% VAPT, but there is no alert, see Verification in DI 11005.007C in this section.- 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 a VAPT disability compensation rating.
- * 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 “100% VAPT” 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. FO claims processing- 2. Claimant contacts the National 800 Number Network (N8NN) and agent transfers referral to FO
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.- 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 “100% VAPT” in the remarks.
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 claimCarefully 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 Version4. FO action after DDS determinationUpon 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 appealProcess 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.- Upon receipt of the N8NN referral, contact the claimant within two business days to schedule an appointment.
x
← This means that the line
was removed and
was added – in other words, the "Effective Dates" line at the top of the document has been updated to reflect that the new version is effective as of the date the change was made.