DI 22505.023: Developing Medical Evidence of Record (MER) from Military Health Sources

changes
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~~Effective Dates: 03/27/2017 - Present~~
Effective Dates: 05/30/2018 - Present
TN 21 (07-16)
DI 22505.023 Developing Medical Evidence of Record (MER) from Military Health Sources
A. Sources for military MER
1. The Department of Defense (DoD) Military Health System
The DoD Military Health System includes hundreds of hospitals and clinics called military treatment facilities (MTF). MTFs provide inpatient and outpatient medical care worldwide to active duty personnel, eligible military retirees, dependent family members, and other eligible individuals.
MTFs currently maintain both paper-based and electronic records for their patients. We have arranged for expedited transfer of most military health system electronic records via the Medical Evidence Gathering and Analysis through Health Information Technology (MEGAHIT) system or the DoD central location system. These processes allow the Disability Determination Services (DDS) to send one request to obtain available MER from all MTFs.
We automatically receive MER from the DoD through MEGAHIT at case transfer from the field office to the DDS in most claims at the initial level. The DDS should first check the folder to see if we already received this evidence electronically through MEGAHIT before requesting MER from the DoD.
2. The Department of Veterans Affairs (VA)
When the military discharges or retires a service member, the Military Health System transfers his or her outpatient treatment records to the VA. If the veteran files a Veterans Benefits Administration disability claim, the VA Regional Office (VARO) keeps his or her records. Otherwise, the VA Records Management Center (VARMC) archives the records. For instructions about developing MER from the Veterans Health Administration (VHA) Medical Facilities, see DI 22505.022.
3. The National Personnel Records Center (NPRC)
MTFs hold inpatient and outpatient medical records for at least 2 years after they last treated the patient. Eventually, the MTFs transfer the inactive medical records to the NPRC archives.
B. Requesting MER from military health sources
The guidelines for requesting MER from military health sources supplement general instructions for requesting MER in DI 22505.000. Use these guidelines to develop initial claims, reconsideration claims, and continuing disability reviews:
If…
Follow…
The claim file is electronic, you need evidence from the DoD, and one of the following:
* There is no evidence from the DoD in the medical records (yellow) section of the electronic folder (EF),
* There is a health information technology (HIT) response document in the blue section of the EF indicating the MEGAHIT evidence transfer did not occur successfully, or
* You need new or updated evidence from the DoD that is not already in the EF
DoD User Trigger request procedures in DI 22505.023C in this section.
The claim file is electronic, you need evidence from the DoD, and both of the following:
* You already used the User Trigger request to receive evidence from the DoD but did not receive the needed evidence per procedures in DI 22505.023C (in this section), and
* Your office uses the electronic Outbound Request (eOR) feature of electronic records express (ERE)
DoD central location request procedure in DI 22505.023D in this section.
Any of the following applies:
* The claim file is paper,
* You need military health records from the VA or NPRC, or
* You still need additional evidence from the DoD after you followed, as appropriate:
* The User Trigger procedures in DI 22505.023C in this section, and
* DoD central location request procedures in DI 22505.023D in this section
Initial mailed request procedures in DI 22505.023E and follow-up procedures in DI 22505.023F in this section.
C. Procedure for using a User Trigger to request MER from the DoD
1. How to initiate a User Trigger request
To initiate a User Trigger request to obtain evidence from DoD:
* Ensure the SSA-827 (Authorization to Disclose Information to the Social Security Administration) is correct and complete;
* Use your legacy system or the standalone web-based application;
* Identify and select the Social Security Number;
* Search the medical facilities list for “DoD Central Location” and select it;
* Enter the requested date range; and
* Click on the “Initiate Request” button to make the User Trigger request.
NOTE: You will receive a confirmation notice in the EF blue section that a request has been submitted to DoD for processing. Allow 5 hours for the response.
2. Reasons for DDS to initiate a User Trigger request
There are several reasons why DDS may need to request DoD evidence using the User Trigger, including:
* A HIT source was not originally identified by MEGAHIT;
* A HIT source is identified after case transfer;
* HIT MER in file needs to be updated;
* HIT MER is needed for an adjudicative level other than the initial level,
* A HIT response document indicates a time out error; and
* Additional medical evidence is needed for dates outside of the initial MEGAHIT request timeframe.
D. Procedure for using ERE to request electronic MER from the DoD central location
1. Initial request to the DoD central location
Send an initial request for medical records to the DoD central location using the ERE eOR function. Allow 10 calendar days for the response. Include a copy of the claimant's SSA-827.
2. Follow up to the DoD central location
If you do not receive a response from the DoD central location within 10 calendar days, send a follow up request to the DoD central location using the ERE eOR function. Allow 10 calendar days for a response.
3. Insufficient or no response from the DoD central location
In rare instances, after sending a follow up request, you may not receive a response from the DoD central location. Alternatively, the DoD central location may provide an incomplete medical history that does not cover all sources identified by the claimant or provides records that suggest supplemental development is necessary. In these circumstances, request military MER by mail using the instructions in DI 22505.023E in this section.
E. Procedure for initial mailed requests for military MER
1. Requesting MER from a DoD MTF
Regardless of the claimant’s military status (e.g., active duty, veteran, retired, dependent) take the following actions:
a. Outpatient records
Request outpatient records only from the MTF where the claimant last received outpatient care. The last treating MTF either has the cumulative military outpatient records, or can identify the location of records if it no longer maintains them. To request outpatient records:
* Mail a MER request letter(s) to the correspondence section of the appropriate MTF(s).
* Include a copy of the claimant’s SSA-827.
* Do not offer to pay for MER from a Federal source (For more information, see DI 22505.040B.4.).
NOTE: For MTF addresses and telephone numbers, use the TRICARE Military Treatment Facilities Locator.
b. Inpatient records
To request inpatient records:
* Request inpatient records directly from each MTF where the claimant was hospitalized.
* Mail a MER request letter(s) to the correspondence section of the appropriate MTF(s).
* Include a copy of the claimant’s SSA-827.
* Do not offer to pay for MER from a Federal source (For more information, see DI 22505.040B.4.).
EXCEPTION: The Walter Reed Army Medical Center closed in September 2011. If these instructions direct you to send a MER request to the former Walter Reed Army Medical Center:
* Request records for hospitalizations prior to 2010, directly from the NPRC (For more information, see DI 22505.023E.2. in this section).
* Separately request all outpatient records and records for hospitalizations in 2010 or 2011 from: Walter Reed National Military Medical Center ATTN: Correspondence Section Building 3, Room 1051 8901 Wisconsin Avenue Bethesda, MD 20889
Call: (301) 319-4783 (inpatient records) (301) 295-5150 (outpatient records)
2. Requesting MER directly from a VARO, the VARMC, or the NPRC
Request military MER directly from VARO, VARMC, or NPRC only if the claimant’s records were transferred to one of these facilities.
NOTE: You may be able to verify the location of a former service member’s paper-based outpatient records (the service treatment record) that the VA holds at a VARO or VARMC, by calling the VA customer service line at 1-800-827-1000 (press #000 to reach a benefits counselor).
* Send a MER request letter.
* Include a copy of the claimant’s SSA-827.
* Do not request a medical opinion. (For more information, see DI 22505.007C.).
* Do not offer to pay for MER from a Federal source (For more information, see DI 22505.040B.4.).
* Use the following address information
* Requesting MER from a VARO
~~For a list of VARO addresses, use the Regional Benefit Office Website.~~
~~* Requesting MER from the VARMC VA Records Management Center P.O. Box 5020 St. Louis, MO 63115~~
* Requesting MER from the NPRC National Personnel Records Center 1 Archives Drive St. Louis, MO 63138
* Requesting MER from a VARO and from the VARMC Department of Veteran Affairs Claims Intake Center P.O. Box 4444 Janesville, WI 53547–4444 (Fax: 844-531-7818)
* Requesting MER from the NPRC National Personnel Records Center 1 Archives Drive St. Louis, MO 63138
F. Procedure for follow up on mailed requests for military MER
Determine follow up requirements based on the type of facility that has the MER request.
1. Follow up with an MTF
If you do not receive a response from the MTF within 20 calendar days, send a MER follow up letter. Allow at least 15 calendar days for the MTF to respond to the follow up letter.
a. Telephone contacts with military sources
Follow these instructions to contact military sources by telephone:
* You may contact an MTF by telephone to assist with locating records or to expedite a MER request.
* If you need special assistance with a military MER request (such as when the claimant is a current inpatient and you want to expedite the release of certain records or test results), speak with an MTF patient relations representative.
* Do not routinely contact military treating sources by telephone.
EXCEPTION: In the rare case where the claimant is a current patient at an MTF and an SSA or DDS medical or psychological consultant (MC/PC) determines that a complex medical issue could be resolved by discussion with a treating source, the MC/PC may attempt to contact a medical source at the MTF by telephone. For documenting medical evidence obtained by telephone, see procedure in DI 22505.030C.
b. When the MTF cannot provide requested records
If the MTF informs you that it no longer holds, or cannot identify, requested records, determine subsequent development action(s) from the information provided by the MTF.
If the MTF forwarded the MER request to another facility that now holds the records:
* Do not initiate another MER request letter;
* Follow up with the location where the MTF transferred the request; and
* Allow response time based on the date when the MTF forwarded the request to the other facility.
2. Follow up with a VARO
Follow up directly with the appropriate VARO. If you do not receive a response from the VARO within 20 calendar days, send a follow up letter. To expedite MER development, you may use locally developed contacts and procedures.
3. Follow up with the VARMC
Follow these instructions to follow up with VARMC by telephone:
* Follow up by telephone between 10 and 20 calendar days after the initial request.
* Call VARMC Customer Service at (888) 533-4558.
* Ask whether the requested records are available and, if so, when we should expect to receive them.
* Do not routinely send follow up letters.
4. Follow up with NPRC
Follow these instructions to follow up with NPRC by telephone:
* Follow up by telephone between 10 and 20 calendar days after the initial request.
* Call NPRC Customer Service at (866)272-6272.
* Ask whether the requested records are available and, if so, when we should expect to receive them.
* Do not routinely send follow up letters.
G. References
* DI 11005.006 Field Office (FO) Instructions for Claims Development and Processing for Military Casualty (MC)/Wounded Warrior (WW) Cases
* DI 22505.000 Development of Medical Evidence of Record (MER)
* DI 22505.022 Developing Medical Evidence of Record (MER) from the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Medical Facilities
* DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS)
* DI 81020.020 Electronic Case Development
* DI 81020.060 Receiving Evidence in Disability Determination Services (DDS)

POMS Reference

DI 22505.023: Developing Medical Evidence of Record (MER) from Military Health Sources