Identification Number:
DI 11005 TN 68
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Disability Interviews
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 110 – Initial Claims Processing
Subchapter 05 – Disability Interviews
Transmittal No. 68, 12/07/2020

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

C. 1 - Leads/Protective Filings and Proofs (LPFP) screen in the 800# System (For information on LPF Proofs/Appointment (LPFP), see MSOM APPTS 001.007) was replaced with Leads and Protective Filing Information (LPF1) screen in the Enhanced Leads and Appointment System (eLAS). For information on the LPF1 screen in eLAS, see MS 00601.006.

C.2 - LPFP was replaced with LPF1.

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

C. 1 - Leads/Protective Filings and Proofs (LPFP) screen in the 800# System (For information on LPF Proofs/Appointment (LPFP), see MSOM APPTS 001.007) was replaced with Leads and Protective Filing Information (LPF1) screen in the Enhanced Leads and Appointment System (eLAS). For information on the LPF1 screen in eLAS, see MS 00601.006.

C.2 - LPFP was replaced with LPF1.

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 and Protective Filing Information (LPF1) screen in the Enhanced Leads and Appointment System (eLAS). For more information on the LPF1 screen in eLAS, see MS 00601.006.

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 LPF1 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 11005.007 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 and Protective Filing Information (LPF1) screen in the Enhanced Leads and Appointment System (eLAS). For information on the LPF1 screen in eLAS, see MS 00601.006.

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 LPF1 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 TN 68 - Disability Interviews - 12/07/2020