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20-13-05 Special Project FL to Eliminate 2yr Old Cases -WH-GC Approved Final

20-13-05 Special Project FL to Eliminate 2yr Old Cases -WH-GC Approved Final

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Published by Jim
Fast Letter
Fast Letter

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Published by: Jim on Apr 19, 2013
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06/03/2013

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DEPARTMENT OF VETERANS AFFAIRSVeterans Benefits AdministrationWashington, D.C. 204239
April 19, 2013VBA Letter 20-13-05Director (00)VA Regional OfficesSUBJ: Guidance Regarding Special Initiative to Process Rating Claims Pending Over Two Years
Purpose
This initiative is the first in a series of efforts to address VA’s oldest claims. This letter focuseson those rating claims pending for over two years. Further guidance will be provided regardingclaims pending less than two years. The intent of this initiative is to work all claims pending for more than two years within 60 days from the date of this letter. Regional Offices (RO) mustimmediately begin to process these claims based on the below guidance. For the claims at issue,this guidance supersedes all other guidance from other offices or personnel. It does not affectthose claims that already require priority processing (Homeless, Terminally Ill, Medal of Honor recipients, Former POWs, and Fully Developed Claims).
Guidance for Processing Claims Pending More Than Two Years
Identifying Claims
This guidance applies to claims received on or before July 1, 2011. The date of claim of theoldest pending claim in the file will be used to identify claims addressed under this specialinitiative. Use the Special Issue indicator “OCR – Old Claim Review” to identify these claimselectronically in VETSNET Operations Reports (VOR). Follow the Brokering/ShippingInstructions provided in the enclosure.
Use of RO Personnel
ROs will devote all RVSRs and as many VSRs as are needed to ensure that all two-year oldclaims are processed within 60 days from the date of this letter.
 
Upon receipt of this guidance, immediately identify two-year old cases and develop anaggressive plan to complete these cases as soon as possible but no later than 60 days from thedate of this letter.
Rating Actions
Raters will immediately begin to process two-year old rating claims and develop an aggressive plan based on the “available evidence” in the claims file. The rating decision produced will beconsidered a provisional rating unless ALL evidence in support of the claim has been received(and the claim is considered ready-to-rate) or the rating assigned provides the highest levelevaluation authorized for the particular diagnostic code for each claimed issue. The End Product(EP) will be cleared for any rating completed as a result of this special initiative and no issueswill be deferred on a rating decision.Category 1 Cases: ROs will issue rating decisions, as normal, for ready-to-rate cases that meetthe two-year old criteria and for cases where the rating assigned provides the highest evaluationauthorized in VA’s Schedule for Rating Disabilities for each claimed issue. These will beFINAL decisions and appeal rights will be provided.Category 2 Cases: ROs will issue “provisional” rating decisions for other two-year old caseseven if VA is still waiting for certain evidence. RVSRs will complete these claims based on theavailable evidence of record as long as the appropriate Section (§) 5103 notice (formerly VCAAnotice) was provided to the claimant UNLESS the following requests for evidence areoutstanding:
Service Treatment Records (STRs) for original claims;
VA medical records;
Any evidence needed to establish Veteran status and/or pertinent service dates, if available evidence is not otherwise sufficient;
VA examinations, if such exams are pending at the time the case is reviewed or if oneis required in order to issue a decision.The above minimal level of evidence must be available before a Category 2 rating is completed.Therefore, in order to meet the required completion date for these cases, ROs must expedite procedures to secure this evidence and decide the claim.In any Category 2 case where the RO is awaiting VA exam results, ROs will contact theappropriate VHA facility or contract examination provider to expedite completion of the requiredexam(s) so that a decision may be issued promptly. Only order a new exam when one is requiredto decide the claim.RVSRs will rate on the available Service Treatment Records (STR) of record, to include copiessupplied by the claimant. If no STRs are of record or no STRs have been developed, immediately
 
develop for such records, and ensure they are available at the time of the rating (unless it isreasonably certain that such records do not exist or that further efforts to obtain those recordswould be futile)
.
RVSRs should make a provisional decision based on the evidence of record. If required Federalrecords outside of STRs have not been received, issue the provisional decision and then requestthe Federal records. If private records have been requested only once, issue the provisionaldecision and then request the private records again unless it is clear a second request would befutile. Establish an EP 400 using the special indicator "OCR – Old Claim Review" to make therequest for Federal and/or private records
.
RVSRs will accept Acceptable Clinical Evidence (ACE) evaluations where possible, and rate onthe medical evidence of record in accordance with 38 C.F.R. § 3.326.Because the decision notification for Category 2 cases will inform claimants that a provisionaldecision has been made, it is not necessary to include such language in the rating document.In the “evidence” section of the Rating Decision, RVSRs will list all evidence considered, asnormal. The RVSR will also list evidence identified but not available at the time of the provisional rating. No issue(s) will be deferred on a rating document.
Other rating considerations for Category 2 claims:
 
For claims falling within the provisions of this guidance, the prohibitions against certain partialrating decisions found in M21-1MR III.iv.6.A.1.b do not apply.RVSRs will grant entitlement to service connection for the claimed disability at the highest justifiable evaluation level of disability based upon the evidence of record, as warranted.One year from the date of notification of the provisional decision, ROs will assess all Category 2claims and provide notice of a final decision to include appeal rights. Compensation Service will provide additional guidance in the future regarding procedures for the review of Category 2 casesafter the one-year period has ended.
Authorization Actions
All Category 1 cases will be processed as normal.For Category 2 cases, the following procedures shall be followed:
Before promulgation of the decision, local Veterans Service Organizations will be given afull 48-hours to review the rating decision. In addition, a POC (and alternate POC) shall be

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Reuben Castro Acosta added this note
same old con games played on vets
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