Identification Number:
DI 11005 TN 52
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Disability Interviews
Type:POMS Transmittals
Program:Title XVI (SSI)
Link To Reference:
 
PROGRAM OPERATIONS MANUAL SYSTEM
Part 04 - Disability Insurance
Chapter 110 - Initial Claims Processing
Subchapter 05 - Disability Interviews
Transmittal No. 52, 06/2018

Audience

FO/WSU/TSC: CS, CS TII, CS TXVI, DRT, FR, OA, OS, RR, CSR, TA, CTE, TSC-CSR
PSC: CA, SCPS, CS, TSA, TST, DE, DEC, DTE, ICDS, IES, ISRA, RECONR
OCO-ODO: BET, BTE, CR, CST, CTE, CTE TE, DE, DEC, DS, PAS, PETE, PETL, RCOVTA, RECONE, RECOVR
OCO-OEIO: BET, CR, CTE, ERE, FCR, FDE, FDEC, RECONE, RECONR, RECOVR
ODD-DDS: REF

Originating Component

ODPROG

Effective Date

Upon Receipt

Background

The Office of Disability Policy (ODP) responded to a clarification request from Congress about the agency’s veteran policies. As a result, ODP aligned the Veterans Affairs 100 Percent Permanent and Total Disability Compensation Rating cases policy by providing parallel language to the Military Casualty/Wounded Warrior cases policy. We divided the current Program Operations Manual System (POMS) section for the Veterans Affairs policy into two POMS sections to mirror the two POMS sections of the Military Casualty/Wounded Warrior policy.

Summary of Changes

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

Renamed the title of the POMS section

    • Removed most of the Background and rewrote an overview
    • Moved some of the Background to section A.
    • Moved section C to new POMS DI 11005.012A.4.
    • Moved section D.1. to section C.1 through C.2
    • Moved section D.2 and D.3 to new POMS DI 11005.012

DI 11005.012 Field Office (FO) Instructions for Claims Development and Processing for Veterans Affairs 100 Percent Permanent and Total (VAPT) Disability Compensation Rating Cases

Moved section DI 11005.007.C. to section A.4.

Moved sections DI 11005.007D.2 and D.3 to sections A and C



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

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.)

NOTE: We process survivor claims associated with military service related deaths under the disaster/emergency instructions in GN 00207.055.

A. VAPT terms and definitions

VAPT claim

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.

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.

B. Identifying VAPT cases using the Social Security Administration (SSA)/VA data exchange information

The VA identifies veterans with a VAPT disability compensation rating, 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 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.

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.

1. Claimant’s SSN matches the SSA ICDB

If a veteran files a claim, follow these procedures:

  1. 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.”

  2. During case creation, when the SSN is present in the PERSON VAPT segment, the EDCS automatically attaches a VAPT flag.

    If the SSN match occurs after initial case creation, the VAPT 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), but the claimant alleges a VAPT disability compensation rating:

  • Manually establish a VAPT flag in EDCS.

    (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.

C. Scheduling a VAPT 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:

  1. Identify if the claimant is alleging a VAPT disability compensation rating.

  2. 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. 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 “100% VAPT” in the remarks.

Upon receipt of the N8NN referral, contact the claimant within two business days to schedule an appointment.

DI 11005.012 Field Office (FO) Instructions for Claims Development and Processing for Veterans Affairs 100 Percent Permanent and Total (VAPT) Disability Compensation Rating Cases

A. Claims development

To ensure expeditious handling of Veterans Affairs 100 Percent Permanent and Total (VAPT) cases, complete the claimant’s disability application as thoroughly as possible to avoid unnecessary recontact.

The claimant’s residence address, not their mailing address determines the Disability Determination Services’ (DDS) jurisdiction.
For determining residence address, see DI 11010.255.

1. Modernized Claims System/Modernized Supplemental Security Income Claims System (MCS/MSSICS)

  • Enter all claims using MCS or MSSICS, or both.

  • Take full (not deferred) Title XVI applications.

2. Electronic Disability Collection System (EDCS)

Follow the normal interviewing guidelines in DI 11005.000, which includes recording the information into EDCS.

For instructions on establishing a claim in EDCS and EDCS exclusions, see DI 81010.020.

3. Curtailing completion of the disability report

If you have any doubt as to whether the claim will result in an allowance, it is in the claimant’s best interest to complete an entire SSA-3368-BK (Disability Report – Adult). This action may help to avoid unnecessary recontact.

If the claimant’s impairment(s) does not meet a presumptive disability category but seems particularly severe, and curtailing completion of the disability report might be appropriate, refer to:

  • DI 11005.020 Curtailing Completion of the SSA-3368 (Disability Report-Adult) or the SSA-3820 (Disability Report-Child) Forms

  • DI 81010.020F. Curtailing completion of the EDCS 3368 or EDCS 3820

  • The appropriate Regional Center for Disability Programs for guidance on curtailment, if necessary.

4. Verification (proof) of VAPT

We receive the 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 VAPT.

In rare situations, a veteran may self-identify as having a VAPT rating, but there is no system alert. For these cases, the veteran must provide proof of a VAPT rating. Acceptable proof of a veteran’s rating is normally a VA notification letter to the veteran. For cases without the VA100% P&T systems alert, make a copy of the VA Notification Letter and retain a copy in file. Do not expedite a case without verification or proof of the VAPT rating.

Example of VA Notification Letter

G-DI_11005.007C-2

G-DI_11005.007C-3

G-DI_11005.007C-4

G-DI_11005.007C-5

B. Additional VAPT considerations

1. Disability insurance benefit (DIB) offset

Military disability benefits do not offset DIB if all military service is after December 31, 1956. For more information on military disability benefits, see DI 52130.015.

2. Closed period of disability

Be alert to the possibility of a closed period of disability. Based on the evidence, a disability adjudicator may find that the claimant disabled for a continuous period of at least 12 months, but at the time of adjudication, the claimant is no longer disabled. In order to establish a closed period, the evidence must show a period of disability that has a definite beginning and ending date. In this situation, if he or she meets all other requirements, the claimant may be entitled to a closed period of disability.

For additional information on closed period of disability, see DI 25510.010 and DI 25510.015.

Evaluating a closed period of disability always requires careful consideration of the medical improvement review standard. Additionally, adjudicators cannot establish a closed period of disability based on a finding of substantial gainful activity (SGA) alone, as the claimant may be entitled to work incentives. For return to work issues, see DI 13010.110.

3. Potential onset date (POD)

When appropriate, develop for an earlier POD. The POD may be the same, earlier or later than the alleged onset date (AOD). When evaluating a claimant’s work, make sure to consider work incentives (e.g., impairment-related work expenses (IRWE), subsidies, special conditions) when determining the reasonable worth of the work. When the POD is earlier than the AOD, develop and document any work issues after the AOD, or after the POD, using form SSA-821-BK (Work Activity Report – Employee), or the SSA-820-BK (Work Activity Report – Self-Employment).

Complete the SSA-823 (Report of SGA Determination-For SSA Use Only) in all initial claim determinations that require an SSA-820-BK or SSA-821-BK.

  • DI 10505.035 Documenting Employment Cases Using FORMS SSA-821-BK (Work Activity Report-Employee) and SSA-823 (Report of SGA Determination-For SSA Use Only),

  • DI 10510.025 Documenting Self-Employment Cases Using the SSA-820-BK (Work Activity Report-Self-Employment) and the SSA-823 (Report of SGA Determination- For SSA Use Only),

  • DI 10005.005 Field Office (FO) Disability Development, and

  • DI 11005.045 Completing the 3367 (Disability Report-Field Office).

C. Claim documentation

1. Development worksheet (DW01) screen in MCS/MSSICS

  • Establish a UNIT code of “___P&T” on the DW01 screen for claimants who meet the VAPT definition in DI 11005.007.

  • Use the first three characters of the unit code per local instructions (e.g., unit number, initials).

  • Establish an ISSUE of “VAPT Case” to track the case, following the instructions about tracking TERI cases in DI 11005.601D.3.d.

    Although VAPTs are expedited following the same procedures as terminal illness (TERI) cases, do not use the TERI flag unless the claim meets the TERI guidelines in DI 11005.601 The Disability Interview-- Identifying Terminal Illness (TERI) Cases; i.e., there is evidence that the claimant’s condition is terminal.

2. VAPT flag

a. Certified electronic folder

If the VAPT flag does not automatically propagate to the claim in EDCS, follow instructions in DI 81010.080B to create a “Disabled Veteran rated 100% permanent and total” flag in EDCS. The flag will alert the DDS to expedite processing of the claim.

b. Paper modular disability folder (i.e., EDCS exclusion)

Attach a VAPT flag to the front of the folder before sending to the DDS. (See an exhibit of the VAPT flag in DI 11005.012H. in this section.)

D. Sending a VAPT to the DDS and tracking status

For information on determining the DDS with jurisdiction of the claim, see DI 11010.255.

1. Sending a VAPT claim to the DDS

When sending a VAPT claim to the DDS, take the following steps:

a. EDCS claims:

Annotate the EDCS remarks section with the words “VAPT Case.” For instructions on transferring an EDCS case, see DI 81010.085.

b. EDCS exclusions:

Send the paper case in a priority mail envelope with a “VAPT Case” designation on the outside of the envelope. For a listing of EDCS exclusions and limitations, see DI 81010.030.

2. Verifying DDS receipt and tracking status of the claim

  • Obtain a DDS Query (DDSQ) two days after the claim transfer to verify DDS received the claim. For paper cases, obtain a DDSQ seven days after the claim transfer. If the claim is not on the DDSQ, contact the DDS by telephone or fax to verify receipt.

  • Use the guidelines and procedures for tracking TERI cases in DI 11005.601D.3.d.

E. DDS makes a determination

For favorable DDS determinations, expedite payment action for Title II and Title XVI claims. If a Title II allowance is an earnings computation processing exclusion, take the following actions:

  1. Complete an A101/EF101 and route to the appropriate processing center (PC).

  2. Annotate the A101/EF101 in remarks indicating that it is a VAPT case.

  3. Monitor the claim(s) through all stages of development and adjudication.

NOTE: PCs follow the special handling procedures for TERI cases. For identifying TERI cases, see DI 11005.601E. The PC Inquiry and Expediting staff is responsible for payment processing.

F. VAPT appeals process

All VAPT appeals receive priority handling and should be coded as instructed in DI 11005.012C.1 through DI 11005.012C.2 in this section.

1. EDCS claims process

a. Reconsideration request process

Process the request using the same instructions for initial claims.

b. Hearing request process

Follow these steps for processing hearing requests:

  • Send the request directly to the Office of Hearings Operations (OHO) as indicated in DI 81010.085 .

  • If there is no VAPT flag attached to the case in EDCS, attach the flag to alert OHO to expedite appeal processing (See DI 11005.012C.2.a. in this section).

c. Request for Appeals Council (AC) review process

To process requests for AC review:

  • Send the request directly to the AC as indicated in DI 81010.150 and DI 12020.001.

  • If the VAPT flag did not automatically propagate to the case in EDCS, attach the flag to alert the AC to expedite review (for information on VAPT flagging, see DI 11005.012C.2 in this section).

2. EDCS exclusions process

Complete and add the VAPT flag to the front cover of the claims paper folder. (See an exhibit of the flag in DI 11005.012.H. in this section.)

  1. Reconsideration request process: Refer to DI 12005.005 and DI 12005.010 .

  2. Hearing request process: Follow assembly and routing instructions in DI 12010.010 .

  3. Request for Appeals Council (AC) review: Follow instructions in DI 12020.001 .

G. Exhibit of VAPT flag

To flag VAPT cases, use the following printable flag.

G-DI_11005.007D

H. References

DI 10005.005 Field Office (FO) Disability Development

DI 10505.001 Evaluation and Development of Employment

DI 10505.020 Evaluation Guides

DI 10505.023 Military Service

DI 10505.035 Documenting Employment Cases Using Forms SSA-821-BK (Work Activity Report-Employee) and SSA-823 (Report of SGA Determination-For SSA Use Only)

DI 10510.025 Documenting Self-Employment Cases Using the SSA-820-BK (Work Activity Report-Self-Employment) and the SSA-823 (Report of SGA Determination- For SSA Use Only)

DI 11005.000 Disability Interviews

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

DI 11005.020 Curtailing Completion of the SSA-3368 (Disability Report-Adult) or the SSA-3820 (Disability Report-Child) Forms

DI 11005.045 Completing the SSA-3367 (Disability Report-Field Office)

DI 11005.601 The Disability Interview – Identifying Terminal Illness (TERI) Cases

DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determinations Services (DDS)

DI 12005.005 Processing a Reconsideration Request for a Medically Denied Initial Disability Claim

DI 12005.010 Processing a Reconsideration Request for an Initial Non-Medical or Technical Denial

DI 12020.001 Appeals Council (AC) Review

DI 12010.010 Assembly and Routing of Folders for Administrative Law Judge (ALJ) Hearing

DI 13010.110 Return to Work Within A Year Of Onset (Title XVI)

DI 25510.010 Establishing a Closed Period of Disability and Protecting a Closed Period Freeze Under Title II

DI 25510.015 Closed Period of Disability Under Title XVI

DI 52130.015 Military Disability Benefits

DI 81010.020 Creating Electronic Disability Collect System (EDCS) Cases

DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations

DI 81010.080 Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS)

DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS)

DI 81010.150 Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS)

GN 00301.310 The Non Disability Repository for Evidentiary Document (NDRed) Application—Overview

GN 01040.100 Listing Codes

MSOM EVID 001.002 Shared Processes Menu (SPMN)


DI 11005 TN 52 - Disability Interviews - 06/13/2018