Identification Number:
DI 11005 TN 65
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Disability Interviews
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 110 – Initial Claims Processing
Subchapter 05 – Disability Interviews
Transmittal No. 65, 10/21/2020

Audience

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

Originating Component

ODP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

 

Summary of Changes

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

An introductory paragraph was added indicating that these cases are identified as priority cases and that the FO expedites appointment scheduling for these cases. The link to TERI POMS was removed.

DI 11005.006 Field Office (FO) Instructions for Claims Development and Processing for Military Casualty (MC)/Wounded Warrior (WW) Cases

An introductory paragraph was added indicating that these cases are identified as priority cases and how the FO expedites their processing.

D. 1 TERI reference was removed.

E. 2 TERI reference was removed.

F. The NOTE was removed because it directed the technician to follow TERI procedures.

G. Prototype state instructions were removed.

H. DI 11005.601 was removed as a reference.

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

An introductory paragraph was added indicating that these cases are identified as priority cases and that the FO expedites appointment scheduling for these cases. The link to TERI POMS was removed.

A. The title of this section was changed.

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

Introductory text was added to demonstrate how the FO expedites their processing.

C.1 TERI reference was removed.

D. The title of this section was changed.

D.2 TERI reference was removed.

E. The NOTE was removed because it directed the technician to follow TERI procedures.

H. DI 11005.601 was removed as a reference.

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

This section provides field office (FO) instructions for identifying disability claims for military service members who incurred an injury, illness, or wound (regardless of how or where it occurred) while on active duty on or after October 1, 2001.

MC/WW cases are identified as priority cases under DI 23020.001 and are given priority processing through all levels of case development and adjudication. We flag the disability folder for these cases as MC/WW to alert the components to the special case processing and development requirements. We also provide expedited appointment scheduling.

NOTE: We process survivor claims associated with military service related deaths under the disaster/emergency instructions in GN 00207.055 Expedited Claims Procedures for Military Service Casualties-Survivors Applications.

A. MC/WW terms and definitions

1. MC/ WW claim

MC/ WW is a claim involving any current or former member of a military service who

  • sustained an illness, injury, or wound;

  • is alleging a physical or mental impairment, regardless of how the impairment occurred, or where it occurred (i.e., United States or on foreign soil); and

  • sustained the impairment while on active duty status on or after October 1, 2001.

There are physical and mental impairments (e.g., post traumatic stress disorder, traumatic brain injury) that a military service member can sustain while on active duty status. These impairments may not become disabling until after the claimant leaves the military. Thus, the claimant may not file a disability application until after he or she leaves the military. In this situation, as long as the claimant meets the above definition, adjudicators will flag the claimant as a MC/WW and follow the expedited processing procedures.

2. Active duty

The following defines active duty:

  • Claimants on full-time duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard, including those on active duty for training;

  • Students at U.S. Military academies and pre-deployment training facilities;

  • Claimants in the National Guard (Army or Air Force) ordered to active federal full-time duty by the President of the United States in times of war or national emergency;

  • Claimants in reserve components of the U.S. Army, Navy, Air Force, Marine Corps, and Coast Guard called to active duty, including those claimants performing full-time training, annual training, or attending school designated as a Military Service School by law or by the applicable Secretary.

B. Identifying MC/WW cases using SSA/Department of Defense data exchange information

The Department of Defense (DoD) identifies wounded military service members 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 DoD provides against the NUMIDENT. The information DoD provided may not be a comprehensive list of all wounded, ill, and injured military service members. Therefore, during the initial interview, we must be alert to possible MC/WW claimants.

When a record from DoD matches the SSN, we add a Wounded Warrior indicator to the SSN record. We do not take any action on the information in this database until a service member contacts us to file a claim; we cannot use this information for leads purposes.

1. Claimant’s SSN matches the SSA ICDB

If a service member files a claim, follow these procedures:

  1. 1. 

    When the claimant’s SSN matches the information in the SSA ICDB, an alert may appear in either one of or all of the following:

    • Visitor Intake Program (VIP)

    • Customer Service Record (CSR)

    • Customer Help and Information Program (CHIP)

  2. 2. 

    During case creation, when the SSN is present in the CLIENT military casualty segment, the Electronic Disability Collect System (EDCS) automatically attaches an MC/WW flag.

If the SSN match occurs after initial case creation, the MC/WW 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 in VIP, CSR, or CHIP), but the claimant alleges a disability resulting from an illness, injury, or wound that occurred while on active duty status on or after October 1, 2001:

  • Manually establish an MC/WW flag in EDCS.
    (For instructions on manually establishing a flag, see DI 81010.080 Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS))

  • If the case is a paper modular disability folder (MDF), attach a paper MC/WW flag to the MDF.
    See an exhibit of the paper flag in DI 11005.006I.

C. Scheduling an MC/WW 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. 1. 

    Identify if the claimant is alleging his or her disability occurred while on active duty status on or after October 1, 2001.

  2. 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:

    1. a. 

      Schedule an appointment within three business days after contact; and

    2. b. 

      Add the remark “Military Casualty/Wounded Warrior Case” 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 “Military Casualty/Wounded Warrior Case” in remarks.

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

DI 11005.006 Field Office (FO) Instructions for Claims Development and Processing for Military Casualty (MC)/Wounded Warrior (WW) Cases

MC/WW cases are identified as priority cases under DI 233020.001 and are given priority processing through all levels of case development and adjudication. These cases are tracked by the FO to ensure that the Disability Determination Services (DDS) receives the case timely. Favorable DDS determinations will result in expedited payment action.

A. Claims development

Contacting military personnel can be difficult due to frequent residence changes. To ensure expeditious handling of MC/WW cases, complete the claimant’s disability application as thoroughly as possible to avoid unnecessary re-contact:

  • obtain a permanent mailing address and phone number, and

  • obtain the claimant’s residence address.

The claimant’s residence address, not mailing address determines the Disability Determination Services’ (DDS) jurisdiction.
For determining residence address, see DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determination Services (DDS).

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 Disability Interviews, which includes recording the information into EDCS.

For instructions on establishing a claim in EDCS and EDCS exclusions, see DI 81010.020 Creating Electronic Disability Collect System (EDCS) Cases.

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 re-contact.

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. DD Form 214 (Certificate of Release or Discharge from Active Duty)

Department of Defense issues a DD Form 214 for each period of active duty service. It contains important information for claims development.

If the claimant submits a DD Form 214(s), place a copy into the Shared Evidence Screen (EVID) or the Non-Disability Repository for Evidence (NDRed), or both.

IMPORTANT: To expedite handling of MC/WW claims, do not delay forwarding these claims to the DDS, even when the DD Form 214 is not readily available. Accept the claimant’s allegation that the disability occurred during military service without the DD Form 214 or other documentation.
For additional information, see GN 00301.310 The Non-Disability Repository for Evidentiary Documents (NDRed) Application—Overview and MSOM EVID 001.002 Shared Processes Menu (SPMN).

B. Military pay and substantial gainful activity (SGA)

Do not evaluate the claimant’s work activity based solely on military wages, without making an SGA determination, since active duty service members usually continue to receive full military pay while receiving medical treatment (for more information on evaluation and development of employment, see DI 10505.001). For example, the claimant may be working in a designated therapy program or on limited duty while receiving treatment. Instead, determine the reasonable worth of a claimant’s actual work activity by comparing it to work activities from people in the civilian work force. Always take into consideration any applicable work incentives (e.g., impairment-related work expenses [IRWE], subsidies or special conditions).

For additional information, see DI 10505.020 Evaluation Guides and DI 10505.023 Military Service.

C. Additional MC/WW 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 was 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 Closed Period Under Title II and DI 25510.015 Closed Period Under Title XVI.

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 SGA alone, as the claimant may be entitled to work incentives. For return to work issues, see DI 13010.110 Return to Work.

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., IRWEs, 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.

For more information on completing work activity reports and claims development, see:

  • DI 10505.035 Documenting Employment Cases Using the SSA-821-BK (Work Activity Report-Employee) and the 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 Paper Form SSA–3367–F5 (Disability Report-Field Office)

D. Claims documentation

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

  • Establish a UNIT code of “___XRQ” on the DW01 screen for claimants who meet the MC/WW definition in DI 11005.003A.1.

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

  • Establish an ISSUE of “MC/WW Case” to track the case.

2. Decision input (DECI) screen in MCS

Establish a listing code of 108 (for a list of the codes see GN 01040.100).

3. MC/WW flag

a. Certified electronic folder

If the MC/WW flag does not automatically propagate to the claim in EDCS, follow instructions in DI 81010.080B Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS) to create an MC/WW 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 an MC/WW flag to the front of the folder before sending to the DDS. (See an exhibit of the MC/WW flag in DI 11005.006I in this section.)

E. Sending an MC/WW to the DDS and tracking status

MC/WW claimants may be hospitalized when you are ready to transfer the claim to the DDS. To ensure that you send the claim to the correct DDS office, verify the claimant’s actual or last known physical residence address. DDS jurisdiction is not based on the claimant’s mailing address.
For information on determining the DDS with jurisdiction of the claim, see DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determination Services (DDS).

1. Sending an MC/WW claim to the DDS

When sending an MC/WW claim to the DDS, take the following steps:

  1. a. 

    EDCS claims: Annotate the EDCS remarks section with the words “Military Casualty/Wounded Warrior Case.” For instructions on transferring a EDCS case, see DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS).

  2. b. 

    EDCS exclusions: Send the paper case in a priority mail envelope with a “Military Casualty/Wounded Warrior Case” designation on the outside of the envelope. For a listing of EDCS exclusions and limitations, see DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations.

2. Verifying DDS receipt

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

F. 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. 1. 

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

  2. 2. 

    Annotate the A101/EF101 in remarks indicating that it is an MC/WW case.

  3. 3. 

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

G. MC/WW appeals process

All MC/WW appeals receive priority handling and should be coded as instructed in DI 11005.006D.1 through DI 11005.006D.3 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 Disability Adjudication and Review (ODAR) as indicated in DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS).

  • If the MC/WW flag is not automatically attached to the case in EDCS, attach the flag to alert ODAR to expedite appeal processing (See DI 11005.006D.3. 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 Processing Claims Appeals of Medical Decision in Electronic Disability Collect System (EDCS) and DI 12020.001 Appeals Council (AC) Review.

  • If the MC/WW flag did not automatically propagate to the case in EDCS, attach the flag to alert the AC to expedite review (for information on MC/WW flagging, see DI 11005.006D.3. in this section).

2. EDCS exclusions process

Complete and add the MC/WW flag to the front cover of the claims paper folder. (See an exhibit of the flag in DI 11005.006I in this section.)

  1. a. 

    Reconsideration request process: Refer to DI 12005.005 Processing a Reconsideration Request for a Medically Denied Initial Disability Claim, and DI 12005.010 Processing a Reconsideration Request for an Initial Non-Medical or Technical Denial.

  2. b. 

    Hearing request process: Follow assembly and routing instructions in DI 12010.010 Assembly and Routing of Folders for Administrative Law Judge (ALJ) Hearing.

  3. c. 

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

H. References

DI 10005.005 Field Office (FO) Disability Development

DI 10505.001 General – Evaluation and Development of Employment

DI 10505.020 Evaluation Guides

DI 10505.023 Military Service

DI 10505.035 Documenting Employment Cases Using the SSA-821-BK (Work Activity Report-Employee) and the 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 Paper Form SSA-3367–F5 (Disability Report-Field Office)

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 13010.110 Return to Work

DI 25510.010 Closed Period Under Title II

DI 25510.015 Closed Period Under Title XVI

DI 52130.015 Military Disability Benefits

DI 81010.020 Creating Electronic Disability Collect System (EDCS) Cases

DI 81010.020 Curtailing Completion of the EDCS 3368 or EDCS 3820

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)

MSOM EVID 001.002 Shared Processes Menu

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

GN 01040.100 Listing Codes

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

I. Exhibit of MC/WW flag

To flag MC/WW cases, use the following printable flag.

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.

VAPT cases are identified as priority cases under DI 23020.001. They are given priority processing through all levels of case development and adjudication. We flag the disability folder for these cases as VAPT to alert the components to the special case processing and development requirements. We also provide expedited appointment scheduling.

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

A. VAPT definition

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. a. 

    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. b. 

    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. a. 

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

  2. b. 

    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

VAPT cases are identified as priority cases under DI 233020.001 and are given priority processing through all levels of case development and adjudication. These cases are tracked by the FO to ensure that the Disability Determination Services (DDS) receives the case timely. Favorable DDS determinations will result in expedited payment action.

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.

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.

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

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

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

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. 1. 

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

  2. 2. 

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

  3. 3. 

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

 

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. a. 

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

  2. b. 

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

  3. c. 

    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.

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 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 65 - Disability Interviews - 10/21/2020