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Title: Welcome to the


1
Welcome to the 2012 Post Service Officers
Seminar
2
This is the fourth annual training seminar that I
have conducted since I have arrived in
Illinois. The first concentrated on the basics
of Compensation. The second concentrated on the
basics of Pension. The third concentrated on the
VA Medical programs. Along the way we have also
discussed the duties of the Post Service Officer
in assisting veterans. Today we will review the
duties of the Post Service Officer and will then
build on what we previously learned about the
basics of VA Compensation.
3
  • Topics for today
  • Review of the Role of VFW Post Service Officer
  • The Basic VA Claim Process
  • The Fully Developed Claim Process
  • Presumptive Disabilities for Compensation
    Benefits
  • The VA Appeal Process

4
Duties Responsibilities Authority Of the VFW Post
Service Officer
5
The VFW National Veterans Service Program (NVS)
is supervised by the National Veterans Service
Advisory Committee which performs its duties
under the supervision of the National Council of
Administration.
6
The National Veterans Service Advisory
Committee establishes the NVS Policies and
Procedures Manual which dictates the rules under
which all Department and Post Service Officer
perform their duties.
7
The Post Service Officer must be a VFW Post
member in good standing. Is an Officer of the
Post, appointed by the Post Commander. Unless
restricted by Post Bylaws many also serve the
Post in other elected or appointed positions.
8
The duties responsibilities of the Post
Service Officer are generally defined in the VFW
Manual of Procedure, Section 218 (a) (12)
9
  • Shall assist members of the Post, their
  • widows, and orphans.
  • 2. Shall assist other worthy cases brought to
    their attention.
  • 3. Shall perform their duties in accordance with
    the instructions contained in the VFW Guide for
    Service Officers.
  • 4. Shall perform their duties under the general
    supervision of the Department Service Officer.

10
  • The VFW Guide for Post Service Officers further
    provides that the Post Service Officer
  • Should have access to the latest copy
  • of the VFW Guide for Post Service Officers.
  • Must route claims and supporting
  • evidence and all inquires to the Department
    Service Officer.

11
3. Should have an adequate supply of current VA
Forms (either by hard copy or VA website). 4.
Should keep members informed of veterans
entitlements and benefits offered and
administered by local, state and federal
agencies. 5. Is not allowed to request or accept
remuneration for their services.
12
6. Shall not refuse to assist any claimant unless
it is clear that the claim is fraudulent (in
which case the Department Service Officer will be
the final authority as to whether the VFW will
provide representation). 7. Shall not refuse to
assist any claimant because they do not feel the
claimant is eligible for the benefit sought.
13
8. Shall forward without delay all applications
to the Department Service Officer. (we
encourage Post Service Officers to utilize local
professional contacts such as IDVA or VAC offices
for claim development assistance)
14
9. Shall not keep original documents provided to
them but are to transmit such documents to the
Department Service Officer. (may maintain
records of claims prepared activity and
submitted to the DSO but may not maintain claims
files)
15
Note Public Law 93-579 restricts the release of
confidential information to parties other than
the claimant. An accredited representative of a
Veterans Service Organization may only release
information necessary for development of a
specific claim to a local Post Service Officer,
if authorized by the claimant in writing by
either letter or form created for that purpose.
16
10. Shall not make direct contact with any office
or representative of the Department of Veterans
Affairs concerning a pending benefit claim or
as a request for personal information regarding a
claimant except in the case of an emergent ill
veteran to a VA Medical Center in which case the
Department Service Officer will be informed
when time permits.
17
  • Must attend all training conducted
  • within the Department in service work by the
    Department Service Officer, especially the annual
    Department Post Service Officer School and any
    service officer training conducted at District
    meetings or by the District Service Officer.

18
Any VFW member may offer their assistance to a
potential claimant. However, only an appointed
Post Service Officer may present themselves as
such to either a claimant or government
department or agency. Any VFW member offering
their assistance to a claimant must accept the
responsibility to act under the same rules as an
appointed Post Service Officer.
19
In 2011, a VFW Post Service Officer in Maine
filed a complaint to the VA District Counsel
through his Department Service Officer that a
private attorney properly accredited by the VA
was acting unethically in the preparation of VA
claims for residents of a nursing home at which
the Post SO volunteered.
20
The attorney filed a counter complaint that the
Post SO, acting as a volunteer, violated VA
regulations, in as much as he was not
accredited by the VA, but was advising and
assisting residents of the nursing home in VA
benefit claims. He further claimed that the
National VFW directive that Post SOs work under
the general supervision of the Department
Service Officer did not offer adequate control of
qualifications and conduct.
21
After reviewing the complaints and the policies
of the VSOs relating to the activities of Post
Service Officers the VA General Counsel agreed
with the attorney!
22
In an agreement reached between the VA General
Counsel and the VSOs in July 2011 the directives
to Post Service Officers were revised. Post SOs
may not advise potential clients on VA
benefits. They may assist clients in completing
VA forms by acting solely as recorders of
information. They may not advise on the legal
criteria for eligibility for benefits but may
inform and provide information on that criteria
such as printed material for use and
interpretation by the client.
23
As a result of this agreement with the VA General
Counsel the VFW NVS Policy and Procedure Manual
was amended by the NVS Advisory Committee and the
National Council of Administration at the
National Convention in August 2011. As it
relates to the Post Service Officer the Manual
now states in paragraph 7 D
24
When acting as a recorder, the PSO is simply
transcribing information provided by the
claimant. At no time should the PSO make
suggestions on how to frame information to make
it appear more favorable or less harmful to the
claimant.
25
Paragraph 7 E Under no circumstances should a
PSO counsel a claimant on their individual claim.
While a PSO provides information concerning
various government benefit programs, he/she
should not offer any guidance or opinion as to
the individual claim itself.
26
General statements about the types of evidence
necessary to support a claim can be described
however, a PSO must not discuss the nature or
merits of any particular claim.
27
  • So, what do we expect from a Post Service
    Officer?
  • We expect that he has a desire to assist his
    fellow veterans without prejudice.
  • We expect that he will establish a working
    relationship with other key Post and Auxiliary
    officers.
  • Hospital Chairman
  • Chaplain
  • Military Assistance Service Chairman

28
  • We expect that he will establish a working
    relationship with key community service providers
    and agencies such as
  • Churches
  • Homeless Shelters
  • Food Pantries
  • Funeral Directors
  • State County Social Workers
  • Hospital Social Workers

29
  • We expect that he will establish a working
    relationship with key members of the veteran
    service network in his area
  • County Veterans Assistant Commission
  • Illinois Department of Veterans Affairs
  • Other Veterans Service Organizations
  • Family Support Organizations

30
  • We expect that he will become familiar with basic
    eligibility requirements for VA benefits to
    include
  • Medical Care
  • Disability Compensation
  • Disability Pension
  • Survivor DIC and Pension
  • Education Benefits
  • Burial Benefits

31
We expect that he will acquaint himself with
basic VA forms required to apply for VA benefits
and the procedures for filing claims. We do
not normally train Post Service Officers to
prepare claims forms. Although Post Service
Officers may prepare claims for submission to the
Department Service Office within their level of
expertise we encourage them to establish a good
working relationship with the local professionals
in their area such as IDVA and VAC offices.
32
Standard VA Forms for Post Service
Officers 21-22 Appointment of Accredited
Representative 21-526 Application for
Compensation or Pension 21-526b Application to
Reopen Compensation 21-526EZ Fully Developed
Compensation Claim 21-527 Application to
Reopen Pension 21-534 Application for DIC or
Death Pension 21-686c Report of Dependents
Status 21-4138 Statement in Support of
Claim 21-4142 Authorization to Release
Information 21-8940 Application for Individual
Unemployability 20-572 Change of
Address 10-10EZ Application for Medical Benefits
33
Post Service Officers are not insured against
improper or inadequate advice subjecting
themselves to personal liability if they give
improper advice regarding benefit
eligibility. Know your Department Service Office
contact information. Know your local assistance
resources for referrals. Be prepared to provide
assistance of all kinds.
34
Accreditation The US Department of Veterans
Affairs accredits persons to represent claimants
in the presentation of claims. Persons
affiliated with (employed by) Veterans Service
Organizations must be certified (verification of
training) to the VA General Counsel by that VSO
for accreditation to be granted.
35
The VFW does not certify that any VFW member
or any other person involved in assisting
veterans has been trained or is authorized to
provide services to veterans under the authority
or supervision of the VFW except as is required
to certify that a qualified person has been
properly trained for the purposes of VA
accreditation.
36
It is the policy of the VFW National Veterans
Service that only full time employees of the
Department VFW Service Office who are endorsed by
the State Commander will be certified by NVS to
VA General Counsel for accreditation by the US
Department of Veterans Affairs under the VFW
banner.
37
The only exception to this policy are full time
employees of local (county) or state entities who
provide services to veterans and are certified by
the Department Service Officer that they have
received proper annual training to maintain
accreditation. Recommendations made by the State
Service Officer must be endorsed by the State
Commander and the National Director of Veterans
Service.
38
All Service Officers and other representatives
accredited by the VA under the VFW banner are
insured for errors and omissions by the national
VFW organization.
39
QUESTIONS?
40
  • The VA Claims Process
  • Or,
  • How I learned to hate the government!

41
VA BENEFITS?
  • Compensation Monetary benefit paid for
    disability proven to be the result of military
    service
  • Pension Monetary benefit paid for disability
    not the result of military service (total
    disability, wartime service income based)

42
The Beginning
  • VA Form 21-526 Once in a lifetime form,
    required for original compensation or pension
    claim
  • VA Form 21-527 Claim for Pension at some time
    AFTER original 21-526
  • VA Form 21-534 Once in a lifetime form,
    required for original death benefit claim

43
Types of Compensation claims?
  • Original claim
  • Reopened - Increased rating of recognized service
    connected disability
  • Reopened Disability previously denied
  • AmendedNew disability
  • Amended-New disability secondary to existing
    service connected disability

44
Evidence?
  • DD214 or equivalent Original or certified copy
  • Rational for claim on proper form
  • Medical evidence supporting rational
  • Dependency documents as indicated

45
Compensation CLAIM Rational(methods of service
connection)
  • Direct
  • Presumptive
  • Secondary
  • Aggravated
  • Result of negligent VA Medical Care

46
Medical Evidence
  • Type of Medical evidence required by VA is
    dictated by the RATIONAL for the claim
  • In all cases - Evidence of Current Disability
  • Service Medical Records (SMRs or STRs)
  • Evidence of Continuity or NEXUS
  • Evidence may be VA or private treatment
  • Depending on condition, lay statement may suffice
    to establish current disability

47
The Beginning of the Process
  • Proper claim submitted to VA Regional Office
  • Direct mail to VA or thru VSO or electronic
  • Mail is logged into the VFW Service Office
  • Reviewed for completeness and accuracy
  • Service Officer creates three submission letters,
    two of which accompany the claim(1 for VA, 1
    stamped returned to VFW)
  • The claim is submitted to the VARO via inner
    office mail system

48
Regional Office Mailroom
  • VARO employee date stamps the evidence which
    verifies receipt by the VARO
  • (date stamp establishes date of claim)
  • (effective date of award is based on DOC)
  • Mailroom returns the VFW copy of the submission
    letter to the Service Office
  • Claim is then forwarded to the Triage Team or to
    the proper Regional Office

49
Other VA Regional Offices
  • Live Pension claims to Milwaukee
  • Dual Pension Compensation claims remain at
    Chicago RO
  • Death Pension claims to Milwaukee
  • DIC claims to Milwaukee
  • Insurance claims to Philadelphia
  • Education claims to St Louis
  • Veteran lives in another state

50
Mail to Triage Team
  • Cest the claim (enters it in the VA computer
    system for control purposes- DATE OF CLAIM TYPE
    OF CLAIM)
  • Create or request transfer for Claims Folder
  • Forward established claim to the processing team
    VSR for pre-determination development
  • Triage may process simple requests such change of
    address, direct deposit changes.

51
Pre-DeterminationDevelopment by VSR
  • Review the claim and all supporting documentation
  • Identify issues (disabilities) claimed
  • If this is an original claim, request the service
    medical records (SMRs) and/or personnel file and
    determine what additional evidence is required

52
Pre-D VSR cont
  • If this is reopened claim for increase verify
    what additional evidence is required
  • If this is a reopened claim for a new condition
    secondary to a SC disability verify what evidence
    is required
  • If this is a reopened claim on prior denied
    disability verify previous decision and what new
    material evidence is required

53
Pre-D VSR Cont
  • If this is an amended claim for a new issue
    verify what evidence is required
  • Establish MAPD evidence tracking
  • Issue Duty to Assist Letter (DTA) with VCAA
    Notice
  • Request evidence identified in the claim
  • (greatest delay in the claim process)

54
DTA Letter from VSR
  • Notifies claimant of issues as interpreted from
    the claim
  • Notifies claimant of additional evidence required
  • Generally describes what will happen next
  • May identify additional evidence being requested
    by VA
  • May provide Disability Benefit Questionnaire
  • (DBQ disability specific)

55
Pre-D VSR cont
  • VARO will wait 60 days for a response to the DTA
    letter. Attached to the DTA letter is a response
    form, VCAA Notice, which will allow the veteran
    to waive the 60 day wait if there is no
    additional evidence to submit.
  • Accredited representative may submit a statement
    to the VARO on behalf of the veteran in response
    to DTA letter.

56
Pre-D VSR cont
  • After the DTA requirement has been
  • met, the VA may request the veteran be examined
    by a VA physician IF
  • it is determined that the claim is likely to be
    proven by the identified evidence.

57
VA Exams
  • Exam will not be ordered
  • If an exam will not prove the claim.
  • If there is sufficient medical evidence of
    record, private or VA, to rate the claim.
  • If an adequate Disability Benefit Questionnaire
    has been submitted.

58
VA Exams cont
  • When an exam is requested, the claims folder
    should be sent to the VAMC for the examiner to
    review. There are some cases in which the file
    is not required by the examiner.
  • The VSR-RVSR team identifies the issues to be
    examined and any medical opinions required.

59
VA Exams cont
  • If an examination is requested, it is required
    for the claimant to attend.
  • The RO orders the exam at the nearest VAMC
    capable of completing the exam.
  • The VAMC CP unit schedules the exam for the
    first available time with an examiner certified
    to complete the exam as ordered by the RO.

60
VA Exams cont
  • If the veteran requests the exam to be
    rescheduled the CP unit may do so depending on
    the timing of the request.
  • If the timing of the request to reschedule would
    not allow the exam to be completed within 30 days
    of the date of order from the RO, OR the request
    is for a change of location, the request will be
    denied by the VAMC and the request to reschedule
    must be sent to the RO.

61
VA Exams cont
  • If the veteran fails to appear for examination
    without notice or request to be rescheduled the
    claim will be denied.
  • Address changes, work schedules, short notices
    from VAMC and bad attitudes are the most common
    reasons for failure to appear.

62
VA Exams cont
  • Examinations begin as soon as the veteran steps
    into the CP clinic. The examiner may observe the
    veteran while in the waiting room.
  • The examination will only include those
    conditions for which the RO has requested the
    examination.

63
VA Exams cont
  • Examinations are conducted using a disability
    exam worksheet which specifies what must be
    covered in the examination.
  • After the examination is completed, the physician
    has 60 days to complete his report.

64
VA Exams cont
  • The VAMC will return the claims folder (c-file)
    to the RO. The VSR will hold the c-file in the
    AWAITING EVIDENCE BIN to await release of the
    report.
  • In order for the exam report to be released to
    the RO, the VAMC Chief of CP service must review
    and sign off on the report that it covers all
    requested exams.

65
  • VA EXAMS CONT
  • The VA examiner may not be a doctor. The Chief
    of Service at the VAMC may assign any medical
    professional deemed qualified to conduct the
    requested examination. The examiner may be
  • Doctor, MD or DO
  • Psychologist
  • Nurse
  • Physician Assistant

66
VA CP examinations are not treatment events.
It is a report of medical facts as they exist at
the time of the exam. History may be obtained by
the examiner and is pertinent only to the extent
that it gives the examiner an understanding of
how the current condition has changed over time.
(nature of original injury, surgeries, secondary
injuries, etc)
67
It is inappropriate for a VA CP examination to
be conducted by the veterans treatment provider.
It is a confliction of interest. It is
inappropriate for an examiner in the context of
the exam to comment on the propriety of treatment
or to recommend a course of treatment.
68
It is inappropriate for an examiner to offer
advice on the pursuit of a claim, suggest the
time frame of a future decision, suggest whether
a decision will be favorable, or suggest what
disability evaluation may be assigned by the
Rating Board.
69
Back to Pre-DETERMINATION VSR
  • The Pre-D VSR will print out the exam report once
    it has been released by VAMC.
  • The exam will be reviewed to ensure that all
    necessary exam elements were covered.
  • The VSR will verify that all legal procedures
    were completed and will then forward the claim to
    the RVSR.

70
The Rating Board - RVSR
  • The claim will be assigned to a rating specialist
    who handles that particular digit. The terminal
    digits are the last two numbers in the claim
    number.
  • In Chicago we have five Rating Teams with 20
    digits each

71
RVSR cont
  • Claims are primarily worked by the rating
    specialist (RVSR) in date of claim order. Certain
    circumstances may place a greater priority on a
    particular case such as terminal illness,
    homelessness, financial hardship, POW claims,
    etc.
  • Financial hardship must be demonstrated by
    supporting documentation such as eviction
    notices, utility shut-offs, etc.

72
RVSR cont
  • The RVSR will review the evidence and adjudicate
    the claim.
  • Some cases may require additional evidence or
    opinions to be obtained.
  • Depending upon the experience of the rater or
    type of claim, two RVSRs may be required to sign
    the claim.

73
RVSR cont
  • RVSRs are not physicians. In regards to medical
    findings, the RVSR will rely upon the VA
    examination and private physician statements and
    records. He cannot render a medical opinion.
  • The RVSR makes a decision based the legal and
    medical merits of the evidence.
  • Once a rating decision is made, the claim is
    placed on the Service Review Table

74
Service Review Table
  • The rating decision is placed on the VSO table
    for a 72 hour period to allow the service officer
    to review the decision prior to promulgation.
    (In Chicago 24 hours.)
  • The VSO Service Officer can review the rating and
    evidence used and determine if, in his opinion,
    the decision is proper.

75
Service Review Table cont
  • If the Service Officer disagrees or identifies an
    error, he can, in most cases, speak with the RVSR
    for clarification. Depending upon the rater and
    the issue, a change in the decision may be made.
    The SO may not appeal a decision at this time.

76
  • After his review of the decision, the Service
    Officer signs off on the rating and the c-file
    is placed on a post decision review desk.
  • This sign off by the Service Officer is not an
    acceptance of the decision but is an
    acknowledgement of having reviewed the decision.

77
Service Review Table cont
  • After 72 hours (24 hours in Chicago) if the
    rating has not been reviewed by a SO, the VSR
    will take the c-file and continue on with the
    claims process without VSO review and without
    notification to the VSO.
  • Note We do have an on-going issue with some
    RVSRs who do not place decisions for review by
    VSO and some coaches who pull decisions without
    waiting 24 hours.

78
Post determination VSR
  • The Post-D VSR is responsible for the
    promulgation of the rating decision.
  • Promulgation is the updating of the VA computer
    system and creating the written notification to
    the claimant of the decision.

79
Post determination VSR cont
  • The Post VSR will update the VA computer system
    with the results of the rating decision.
  • If the decision was favorable, the VSR computer
    update will include the rating changes and the
    addition of dependents to the veterans award as
    appropriate.

80
Post determination VSR cont.
  • Award actions must be signed off on by an
    authorizer who reviews the award for accuracy.
  • Once the authorizer reviews and signs off on the
    award action, the c-file is returned to the VSR.

81
Post determination VSR cont
  • If a grant of benefits will result in a large
    retro benefit (over 25,000), the claim must be
    submitted to the Director of the RO or his
    designated representative for approval before
    release.
  • (This approval is part of a checks and balance
    system to prevent any fraud by VA employees.)

82
Post determination VSR cont
  • The VSR will finalize the award action upon
    return from the authorizer.
  • The VSR releases the notice of decision to the
    claimant. A copy of the decision will be provided
    to the VSO.
  • Depending upon the issues granted, additional
    information will be provided or requested with
    this notification.

83
Post DETERMINATION VSR cont
  • In general, payment of an award occurs 5-8
    working days after the decision is released by
    the VSR.
  • Direct Deposit may be initiated at any time by
    providing the necessary banking information (name
    of institution, routing number, account number)
    (DD will become mandatory)

84
POST DETERMINATION VSR CONT
If the RVSR has ordered development for any
additional issues that have come up either from
the veteran or as part of the claim decision the
file will be referred to Development VSR for the
required action and the process starts all over
again.
85
Elapsed PROCESSING Time
  • Currently in Chicago Average 24 months
  • VA target in 2015 125 days

86
QUESTIONS?
87
Fully Developed Claims (FDC)
88
The AVERAGE claim processing time at the
Chicago Regional Office is over 300 days. The
TYPICAL claim processing time nears 24 to 28
months. What can we do to influence the time it
takes to process a typical claim? We can
consider the Fully Developed Claim Process!
89
In 2009 (announced in December 2008) the VA
introduced a pilot project to test the FDC
program in 10 VA Regional Offices to evaluate the
impact it would have on the pending claim backlog
nationwide. The Chicago RO was one of these. In
June 2010 the VA implemented the FDC program
nationwide. (PR 6-15-10 and FL 10-22)
90
The FDC program is a formalization of what we
have all done informally as part of our daily
activity all along Bring to the VA team a
complete claim that may be processed immediately
with little or no development.
91
Each RO Service Center Manager has the ability to
establish the FDC process within their own
management formats but must follow the
Departments basic guidelines. Initially at the
Chicago RO FDCs were processed by a separate
unit. In January 2012 this unit was dissolved
and FDCs are now processed as priority within
each team.
92
The program uses two new forms VA Form 21-526EZ
for compensation claims, original or
reopening VA Form 21-527EZ for pension claims,
original or reopening
93
By definition, a Fully Developed Claim is
submitted with ALL of the evidence which would be
required to prove the claim, EXCEPT FEDERAL
RECORDS such as service medical records and VA
treatment records.
94
An FDC must be submitted using the proper EZ form
which must be complete and must include a
certification statement, which is part of the new
claim form, that the submitted claim is complete
for all non-federal evidence required.
95
The purpose of FDC certification is to allow the
VA to process the claim without further routine
development and without issuing a Duty to
Assist letter and without requiring a VCAA
Notice Response.
96
A FDC may be A new / original claim. A claim
for a new disability. A claim for a new
disability secondary to an existing service
connected disability. A claim for increased
evaluation of an existing service connected
disability.
97
FDC Criteria (evidence) All relevant private
medical treatment records for the claimed
disabilities. Identification of any Federal
(Military or VA) treatment records.
98
For current National Guard and Reserve members,
ALL service treatment records and personnel
records in the custody of the Veterans
unit. The veteran MUST report for any VA medical
examinations as requested.
99
If the claim is NEW, the veteran Should submit
certified copies of all DD214s. Must submit a
completed VA Form 21-686c if claiming dependents.
100
A FDC will be kicked out VA will process the
claim traditionally IF All identified private
treatment records are not submitted with the
claim. The VA determines that additional
supporting documents or records are required.
101
IF The veteran submits any additional
supporting information or documentation after the
submission of the FDC. The veteran fails to
appear for an ordered VA examination.
102
If the VA kicks a FDC out of the program it will
be processed traditionally based on original date
of claim. This administrative processing
decision by the VA is not appealable. The VA
will notify the veteran that the FDC has been
kicked out and the reason it does not qualify for
the program.
103
A veteran may not mix an FDC with a separate
claim for other disabilities using either a
21-526 or 21-526b, or may not file an FDC if
there is a separate pending claim (or pending
appeal on an issue related to the new issue being
claimed).
104
Likewise, if the veteran files a new claim after
filing an FDC, the FDC will be kicked out and
both claims will be processed in the traditional
method unless the FDC has been advanced to Ready
for Decision status.
105
A veteran may not use the FDC process to reopen a
claim for a previously denied disability unless
the new claim is based on newly discovered
federal records or on a change in law such as a
newly added presumptive disability. A New and
Material evidence claim to reopen will probably
not meet the FDC evidence criteria.
106
Due to the FDC evidence limitations an FDC for a
non presumptive disability which had its origin
in service filed more than 12 months after
discharge is not impossible but may be difficult
because of the requirement for medical evidence
of continuity of treatment.
107
The veteran may file an informal FDC by
submitting only the following statement I
intend to apply for compensation (or pension)
benefits under the FDC Program. This statement
is submitted to preserve my effective date for
entitlement to benefits. I am in the process of
assembling my claim package for submission.
108
If the veteran uses the informal FDC option he
has one year within which to submit a VA Form
21-526EZ which MUST be complete at time of
submission. If an incomplete claim is
submitted within the one year it will be
processed traditionally and the date of the
informal claim statement establishes the date of
claim.
109
If the informal claim is an original claim it
should include a certified copy of the separation
document, DD214 or equivalent, so that a claims
folder may be established.
110
Because of the FDC limitations the veteran
considering filing a new claim should carefully
consider the benefits of filing a FDC if the full
criteria for FDC can be met. This may demand
delaying the filing of a formal FDC in order to
obtain the required evidence.
111
The discussion and preparation of an FDC with the
client requires discipline in evaluating the
evidence and the issues. Submitting the claim as
an FDC only to have to have it kicked out to be
processed traditionally will be unnecessarily
frustrating to the veteran and uses valuable VA
resources.
112
The sole purpose of the FDC option is to reduce
processing time! We have had great success
with fully documented claims using the FDC option
with claims being resolved within 60 to 180 days
(most under 120) at the Chicago Regional Office.
This has been a cooperative effort between field
offices of IDVA and VACs, VSOs, VA VSRs, RVSRs
and management.
113
QUESTIONS?
114
Presumptive Disability Criteria
115
  • In all cases Service Connection for a disability
    requires three components be proven to exist
  • Evidence of current disability
  • An in service event
  • 3. Causal link (nexus) between 1 2

116
Methods of Service Connection
Direct
Presumption
Secondary
Aggravation
Of a Pre-existing condition
Of a Non SC condition
Other factors
Result of VA Treatment
Result of Voc Rehab
117
Presumption
  • A veteran may be presumed to have contracted a
    listed chronic or tropical disease within the
    dates of his/her military service. Due to the
    different natures of certain diseases, there may
    be different presumptive periods in which a
    disease must be found to exist to a compensable
    degree for the purpose of service connection.

118
38CFR 3.307 (a)(1) Service. The veteran must have
served 90 days or more during a war period or
after December 31, 1946. The requirement of 90
days' service means active, continuous service
within or extending into or beyond a war period,
or which began before and extended beyond
December 31, 1946, or began after that date. Any
period of service is sufficient for the purpose
of establishing the presumptive service
connection of a specified disease under the
conditions listed in 3.309(c)(POW) and
(e)(herbicide).
119
Presumptive Service Connection
38CFR 3.307 (a), 3.309, 3.311, 3.317, 3.318
Chronic Disease
Tropical Disease
Former Prisoner of War
Herbicide Exposure
Radiation Exposure
Persian Gulf War Undiagnosed illness
120
CHRONIC DISEASES
121
PRESUMPTIVE CHRONIC DISEASES
38CFR 3.307(a)(3) The disease must have become
manifest to a degree of 10 percent or more within
1 year (for Hansen's disease (leprosy) and
tuberculosis, within 3 years multiple sclerosis,
within 7 years) from the date of separation from
service....
122
38CFR 3.309(a) Chronic diseases. The following
diseases shall be granted service connection
although not otherwise established as incurred in
or aggravated by service if manifested to a
compensable degree within the applicable time
limits under 3.307 following service in a period
of war or following peacetime service on or after
January 1, 1947, provided the rebuttable
presumption provisions of 3.307 are also
satisfied.
123
  • Anemia, primary.
  • Arteriosclerosis.
  • Arthritis.
  • Atrophy, Progressive muscular.
  • Brain hemorrhage.
  • Brain thrombosis.
  • Bronchiectasis.
  • Calculi of the kidney, bladder, or gallbladder.

124
  • Cardiovascular-renal disease, including
    hypertension.
  • (This term applies to combination involvement of
    the type of arteriosclerosis, nephritis, and
    organic heart disease, and since hypertension is
    an early symptom long preceding the development
    of those diseases in their more obvious forms, a
    disabling hypertension within the 1-year period
    will be given the same benefit of service
    connection as any of the chronic diseases
    listed.)

125
  • Cirrhosis of the liver.
  • Coccidioidomycosis.
  • Diabetes mellitus.
  • Encephalitis lethargica residuals.
  • Endocarditis. (This term covers all forms of
    valvular heart disease.)
  • Endocrinopathies.
  • Epilepsies.
  • Hansen's disease (leprosy). (3 years)
  • Hodgkin's disease.

126
  • Leukemia.
  • Lupus erythematosus, systemic.
  • Myasthenia gravis.
  • Myelitis.
  • Myocarditis.
  • Nephritis.
  • Other organic diseases of the nervous system.
  • Osteitis deformans (Paget's disease).
  • Osteomalacia.
  • Palsy, bulbar.

127
  • Paralysis agitans.
  • Psychoses.
  • Purpura idiopathic, hemorrhagic.
  • Raynaud's disease.
  • Sarcoidosis.
  • Scleroderma.
  • Sclerosis, amyotrophic lateral (ALS). (open)
  • Sclerosis, multiple (MS). (7 years)
  • Syringomyelia.
  • Thromboangiitis obliterans (Buerger's disease).
  • Tuberculosis, active.
  • Tumors, malignant, or of the brain or spinal cord
    or peripheral nerves.
  • Ulcers, peptic (gastric or duodenal)

128
What is missing from this list of Chronic
Disabilities?
129
TROPICAL DISEASES
130
PRESUMPTIVE TROPICAL DISEASES
3.307 (a)(4) Tropical disease. The disease must
have become manifest to a degree of 10 percent or
more within 1 year from date of separation from
service as specified in paragraph (a)(2) of this
section, or at a time when standard accepted
treatises indicate that the incubation period
commenced during such service. The resultant
disorders or diseases originating because of
therapy administered in connection with a
tropical disease or as a preventative may also be
service connected.
131
38CFR 3.309 (b) Tropical diseases. The following
diseases shall be granted service connection as a
result of tropical service, although not
otherwise established as incurred in service if
manifested to a compensable degree within the
applicable time limits under 3.307 or 3.308
following service in a period of war or following
peacetime service, provided the rebuttable
presumption provisions of 3.307 are also
satisfied.
132
Amebiasis. Blackwater fever. Cholera. Dracontiasis
. Dysentery. Filariasis. Leishmaniasis, including
kala-azar. Loiasis. Malaria. Onchocerciasis.
133
Oroya fever. Pinta. Plague. Schistosomiasis. Yaws.
Yellow fever. Resultant disorders or diseases
originating because of therapy administered in
connection with such diseases or as a
preventative thereof.
134
QUESTIONS?
135
RADIATION EXPOSURE
136
RADIATION EXPOSURE
There are two citations which define diseases
specific to radiation exposed veterans. The
diseases listed in paragraphs 3.309 (d)(2) or
3.311(b)(2) shall be service connected if they
become manifest to a compensable degree within
applicable time periods in a radiation exposed
veteran as defined.
137
QUESTIONS?
138
FORMER POW
139
FORMER POW PRESUMPTIONS 38CFR 3.307(5) Diseases
specific as to former prisoners of war. The
diseases listed in 3.309(c) shall have become
manifest to a degree of 10 percent or more at any
time after discharge or release from active
service.
140
FORMER POW PRESUMPTIONS There are two listings
of disabilities subject to presumptive service
connection if manifest to a compensable degree,
one based on POW experience of less than 30 days
and the other listing disabilities that require
POW confinement in excess of 30 days.
141
  • Any period of POW confinement.
  • Psychosis.
  • Any of the anxiety states.
  • Dysthymic disorder (or depressive neurosis).
  • Organic residuals of frostbite, if it is
    determined that the veteran was interned in
    climatic conditions consistent with the
    occurrence of frostbite.
  • Post-traumatic osteoarthritis.
  • Atherosclerotic heart disease or hypertensive
    vascular disease (including hypertensive heart
    disease) and their complications (including
    myocardial infarction, congestive heart failure,
    arrhythmia).
  • Stroke and its complications.
  • On or after October 10, 2008, Osteoporosis, if
    the Secretary determines that the veteran has
    posttraumatic stress disorder (PTSD).

142
  • POW Confinement of more than 30 days.
  • Avitaminosis.
  • Beriberi (including beriberi heart disease).
  • Chronic dysentery.
  • Helminthiasis.
  • Malnutrition (including optic atrophy associated
    with malnutrition).
  • Pellagra.
  • Any other nutritional deficiency.
  • Irritable bowel syndrome.
  • Peptic ulcer disease.
  • Peripheral neuropathy except where directly
    related to infectious causes.
  • Cirrhosis of the liver.
  • On or after September 28, 2009, Osteoporosis.

143
HERBICIDES
144
HERBICIDE EXPOSURE The term Agent Orange
refers to the whole family of tactical herbicides
deployed by the Department of Defense.
Exposure in Vietnam Exposure in Korea Exposure
in Thailand Other locations in the US and
worldwide Occupational and accidental exposure
145
If military service is determined by VA in one of
the listed areas during the listed time periods
and by qualifying duty, exposure is conceded and
does not require evidence of exposure. All
others claims of exposure (occupational) require
a specific description of the circumstances of
exposure and a formal determination that the
circumstances described are consistent with the
veterans military duties and did result in
exposure.
146
Exposure in Vietnam 38CFR 3.307(6) Diseases
associated with exposure to certain herbicide
agents. (i) For the purposes of this section,
the term herbicide agent means a chemical in an
herbicide used in support of the United States
and allied military operations in the Republic of
Vietnam during the period beginning on January 9,
1962, and ending on May 7, 1975.
147
3.307(6)(iii) A veteran who, served in the
Republic of Vietnam during the period beginning
on January 9, 1962, and ending on May 7, 1975,
shall be presumed to have been exposed during
such service to an herbicide agent, . Service
in the Republic of Vietnam includes service in
the waters offshore and service in other
locations if the conditions of service involved
duty or visitation in the Republic of Vietnam.
148
Proving military service in Vietnam continues to
be a great challenge for many Air Force, Navy
and Marine Corps veterans. Official (on orders)
TDY service or other temporary duty is often
difficult to prove. The greatest issue in these
cases is poor memories not lack of records.
For Navy veterans, evidence of service on ships
acknowledged by DOD to be in Vietnam waters is
also a challenge. That last DOD update of the
ship list was in January 2012. Claims to add
ships continue to be reviewed by DOD. (see list
of ships)
149
Exposure in Korea 3.307(6)(iv) A veteran
whoserved between April 1, 1968, and August 31,
1971, in a unit that, as determined by the
Department of Defense, operated in or near the
Korean DMZ in an area in which herbicides are
known to have been applied during that period,
shall be presumed to have been exposed during
such service to an herbicide agent (see list of
units)
150
Exposure in Thailand The majority of troops in
Thailand during the Vietnam era were stationed at
the Royal Thai Air Force Bases of U-Tapao, Ubon,
Nakhon Phanom, Udorn, Takhli, Korat, and Don
Muang. If a US Air Force Veteran served on one
of these air bases as a security policeman,
security patrol dog handler, member of a security
police squadron, or otherwise served near the air
base perimeter, as shown by MOS, performance
evaluations, or other credible evidence, then
herbicide exposure should be acknowledged on a
facts found or direct basis. However, this
applies only during the Vietnam era, from
February 28, 1961 to May 7, 1975.
151
Other Herbicide Exposure Worldwide list of DOD
locations. (see list of locations) Occupational
exposure on a case by case basis.
152
Disabilities Due To Herbicide Exposure
3.307(6)(ii) The diseases listed at 3.309(e)
shall have become manifest to a degree of 10
percent or more at any time after service, except
that chloracne or other acneform disease
consistent with chloracne, porphyria cutanea
tarda, and acute and subacute peripheral
neuropathy shall have become manifest to a degree
of 10 percent or more within a year after the
last date on which the veteran was exposed to an
herbicide agent during active military, naval, or
air service.
153
  • Herbicide Exposure Presumptive Disabilities
  • 3.309(e) If a veteran was exposed to an herbicide
    agent during active military, naval, or air
    service, the following diseases shall be
    service-connected . (see list)
  • AL - amyloidosis
  • Chloracne or other acneform disease consistent
    with chloracne
  • Type 2 diabetes (also known as Type II diabetes
    mellitus or adult-onset diabetes)
  • Hodgkin's disease
  • Ischemic heart disease (including, but not
    limited to, acute, subacute, and old myocardial
    infarction atherosclerotic cardiovascular
    disease including coronary artery disease
    (including coronary spasm) and coronary bypass
    surgery and stable, unstable and Prinzmetal's
    angina (note 3)

154
  • All chronic B-cell leukemias (including, but not
    limited to, hairy-cell leukemia and chronic
    lymphocytic leukemia)
  • Multiple myeloma
  • Non-Hodgkin's lymphoma
  • Parkinson's disease
  • Acute and subacute peripheral neuropathy (note 2)
  • Porphyria cutanea tarda
  • Prostate cancer
  • Respiratory cancers (cancer of the lung,
    bronchus, larynx, or trachea)
  • Soft-tissue sarcoma (other than osteosarcoma,
    chondrosarcoma, Kaposi's sarcoma, or
    mesothelioma) (note 1)

155
  • Note 1 The term soft-tissue sarcoma includes
    the following
  • Adult fibrosarcoma
  • Dermatofibrosarcoma protuberans
  • Malignant fibrous histiocytoma
  • Liposarcoma
  • Leiomyosarcoma
  • Epithelioid leiomyosarcoma (malignant
    leiomyoblastoma)
  • Rhabdomyosarcoma
  • Ectomesenchymoma
  • Angiosarcoma (hemangiosarcoma and
    lymphangiosarcoma)

156
  • Proliferating (systemic) angioendotheliomatosis
  • Malignant glomus tumor
  • Malignant hemangiopericytoma
  • Synovial sarcoma (malignant synovioma)
  • Malignant giant cell tumor of tendon sheath
  • Malignant schwannoma, including malignant
    schwannoma with rhabdomyoblastic differentiation
    (malignant Triton tumor), glandular and
    epithelioid malignant schwannomas

157
  • Malignant mesenchymoma
  • Malignant granular cell tumor
  • Alveolar soft part sarcoma
  • Epithelioid sarcoma
  • Clear cell sarcoma of tendons and aponeuroses
  • Extraskeletal Ewing's sarcoma
  • Congenital and infantile fibrosarcoma
  • Malignant ganglioneuroma

158
Note 2 For purposes of this section, the term
acute and subacute peripheral neuropathy means
transient peripheral neuropathy that appears
within weeks or months of exposure to an
herbicide agent and resolves within two years of
the date of onset. Note 3 For purposes of this
section, the term ischemic heart disease does not
include hypertension or peripheral manifestations
of arteriosclerosis such as peripheral vascular
disease or stroke, or any other condition that
does not qualify within the generally accepted
medical definition of Ischemic heart disease.
159
On August 10, 2012 the VA published in the
Federal Register /Vol. 77, No. 155 / page 47795
proposed rules to change the criteria for service
connection for peripheral neuropathy as the
result of exposure to herbicides. This change
will have limited impact on a small number of
veterans previously denied service connection for
this disability.
160
This amendment would clarify that presumptive
service connection for early-onset peripheral
neuropathy will not be denied solely because the
peripheral neuropathy persisted for more than two
years after the date of last herbicide exposure.
However, this amendment would not change the
current requirement that peripheral neuropathy
must have become manifest to a degree of 10
percent or more within one year after the date of
last exposure in order to qualify for the
presumption of service connection. In Update
2010, the NAS found that evidence did not
indicate an association between herbicide
exposure and delayed-onset peripheral neuropathy,
which NAS defined as peripheral neuropathy having
its onset more than one year after exposure.
161
The Secretary of the VA has recently requested a
study to be conducted by researchers of the Army
Chemical Corps on the question of a relationship
(either statistical or causal) between exposure
to herbicides and the conditions of Chronic
Obstructive Pulmonary Disease (COPD) or
hypertension. At this time there is not an
announced date for this report.
162
Service connection is granted for disabilities
conceded to be the result of AO exposure.
Service connection is not granted for exposure to
AO. Exposure is not a disability. There must a
confirmed diagnosis of a conceded medical
condition with evidence of compensable
disability. Cancer conditions must be
primary. Once granted service connection,
disabilities are evaluated based on the level of
impairment as indicated by on going treatment or
post treatment residuals.
163
A claim for a condition (disability) not on the
conceded list requires a medical opinion from a
treatment provider that the condition is as
likely as not to a probability of greater than
50 that the condition in the instant case is
the result of herbicide exposure. Such an
opinion must contain medical reference that
supports the opinion. Such a medical opinion
must be concurred in by either a VA physician or
a BVA ordered Independent Medical Opinion (IMO).
164
The VA is still working on the large influx of
claims that came into the system in the fall /
winter of 2010. These claims are processed in
date of claim order. The large number of claims
that were received and determined to be have had
prior denials have been processed under NEHMER.
We continue to find isolated cases that are
potentially eligible for retroactive awards under
NEHMER. These claims will continue to be
processed in date of claim order. Our largest
retro benefit paid under NEHMER was 526,000.
165
QUESTIONS?
166
GULF WARUNDIAGNOSED ILLNESSPRESUMPTIVE
DISEASES
167
38CFR 3.317 Compensation for certain
disabilities due to undiagnosed
illnesses. Compensation for disability due to
undiagnosed illness and medically unexplained
chronic multisymptom illnesses. (1) Except as
provided in paragraph (a)(7) of this section, VA
will pay compensation in accordance with chapter
11 of title 38, United States Code, to a Persian
Gulf veteran who exhibits objective indications
of a qualifying chronic disability.
168
Compensation shall not be paid under this section
for a chronic disability if there is affirmative
evidence that the disability was not incurred
during active military, naval, or air service in
the Southwest Asia theater of operations or if
there is affirmative evidence that the disability
was caused by a supervening condition or event
that occurred between the veteran's most recent
departure from active duty in the Southwest Asia
theater of operations and the onset of the
disability or if there is affirmative evidence
that the disability is the result of the
veteran's own willful misconduct or the abuse of
alcohol or drugs.
169
The term Persian Gulf veteran means a veteran
who served on active military, naval, or air
service in the Southwest Asia theater of
operations during the Persian Gulf War (after
August 2, 1990). The Southwest Asia theater of
operations refers to Iraq, Kuwait, Saudi Arabia,
the neutral zone between Iraq and Saudi Arabia,
Bahrain, Qatar, the United Arab Emirates, Oman,
the Gulf of Aden, the Gulf of Oman, the Persian
Gulf, the Arabian Sea, the Red Sea, and the
airspace above these locations or a period of
active military, naval, or air service on or
after September 19, 2001, in Afghanistan.
170
chronic disability became manifest either during
active military, naval, or air service in the
Southwest Asia theater of operations, or to a
degree of 10 percent or more not later than
December 31, 2016 and by history, physical
examination, and laboratory tests cannot be
attributed to any known clinical diagnosis.
171
For purposes of this section, disabilities that
have existed for 6 months or more and
disabilities that exhibit intermittent episodes
of improvement and worsening over a 6-month
period will be considered chronic. The 6-month
period of chronicity will be measured from the
earliest date on which the pertinent evidence
establishes that the signs or symptoms of the
disability first became manifest.
172
For purposes of this section, the term medically
unexplained chronic multisymptom illness means a
diagnosed illness without conclusive
pathophysiology or etiology, that is
characterized by overlapping symptoms and signs
and has features such as fatigue, pain,
disability out of proportion to physical
findings, and inconsistent demonstration of
laboratory abnormalities.
173
Chronic multisymptom illnesses of partially
understood etiology and pathophysiology, such as
diabetes and multiple sclerosis, will not be
considered medically unexplained. For purposes
of this section, objective indications of
chronic disability include both signs, in the
medical sense of objective evidence perceptible
to an examining physician, and other, non-medical
indicators that are capable of independent
verification.
174
For purposes of this section, a qualifying
chronic disability means a chronic disability
resulting from any of the following (or any
combination of the following) (A) An undiagnosed
illness (B) A medically unexplained chronic
multisymptom illness that is defined by a cluster
of signs or symptoms, such as ( 1 ) Chronic
fatigue syndrome ( 2 ) Fibromyalgia ( 3 )
Irritable bowel syndrome.
175
For the purposes of this section, signs or
symptoms which may be manifestations of
undiagnosed illness or medically unexplained
chronic multisymptom illness include, but are not
limited to (1) Fatigue. (2) Signs or symptoms
involving skin. (3) Headache. (4) Muscle
pain. (5) Joint pain.
176
(6) Neurological signs or symptoms. (7)
Neuropsychological signs or symptoms. (8) Signs
or symptoms involving the respiratory system
(upper or lower). (9) Sleep disturbances. (10)
Gastrointestinal signs or symptoms. (11)
Cardiovascular signs or symptoms. (12) Abnormal
weight loss. (13) Menstrual disorders.
177
Presumptive service connection for infectious
diseases. A disease listed in this section will
be service connected if it becomes manifest (to
a compensable degree) in a veteran with a
qualifying period of service. The diseases
referred to in this section are the following
178
(i) Brucellosis. (ii) Campylobacter
jejuni. (iii) Coxiella burnetii (Q
fever). (iv) Malaria. (v) Mycobacterium
tuberculosis. (vi) Nontyphoid
Salmonella. (vii) Shigella. (viii) Visceral
leishmaniasis. (ix) West Nile virus.
179
The diseases listed in this section will be
considered to have been incurred in or aggravated
by service under the circumstances outlined in
this section even though there is no evidence of
such disease during the period of service. With
three exceptions, the disease must have become
manifest to a degree of 10 percent or more within
1 year from the date of separation from a
qualifying period of service.
180
Malaria must have become manifest to a degree of
10 percent or more within 1 year from the date of
separation from a qualifying period of service or
at a time when standard or accepted treatises
indicate that the incubation period commenced
during a qualifying period of service. There is
no time limit for visceral leishmaniasis or
tuberculosis to have become manifest to a degree
of 10 percent or more.
181
Long-term health effects potentially associated
with infectious diseases. A report of the
Institute of Medicine of the National Academy of
Sciences has identified certain long-term health
effects that potentially are associated with the
infectious diseases listed in this section. If a
veteran who has or had one of the identified
infectious diseases and also has a condition
identified as potentially related to that
infectious disease, VA must determine whether the
condition was caused by the infectious disease
for purposes of paying disability compensation.
This list is not all inclusive. (see list)
182
If a veteran is presumed service connected for
one of the presumptive diseases listed in this
section and is diagnosed with one of the long
term health effects listed within the time period
specified for the disease, if a time period is
specified or, otherwise, at any time, VA will
request a medical opinion as to whether it is at
least as likely as not that the condition was
caused by the veteran having had the associated
disease.
183
The Follow-up Study of a National Cohort of Gulf
War and Gulf Era Veterans is the third in a
series of surveys to find out how the health of
1990-91 Gulf War-era Veterans has changed over
time. The study began in May 2012, and results
are expected mid 2014. Resea
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