Part II, Subpart iii, Chapter 3, Section AClaims Establishmen

Check for a previously established claims folder number.

M21-1, Part II, Subpart ii, 1.A.1.c.

Determine the current claims folder location and request scanning of paper claims folders (if necessary).

• M21-1, Part II, Subpart ii, 1.A.2.d, and
• M21-1, Part II, Subpart ii, 1.A.2.f.

Review the VBMS exclusions to determine the system in which to place the claim under control.

M21-1, Part II, Subpart iii, 3.A.1.a.

Place EP under control using the appropriate system.

For

• VBMS, see M21-1, Part II, Subpart iii, 3.A.1.d, and
• Share, see M21-1, Part II, Subpart iii, 3.A.1.e.

Open Share and select the CORPORATE INQUIRY command..

Enter the claimant’s Social Security number (SSN) or claims folder number into the FILE NUMBER OR SSN field and click the SUBMIT button.

Click on the AWARD/RATING box in the menu bar and navigate to the RATING INFORMATION tab. Has the claimant previously received a rating determination?

• If yes, go to the next step.
• If no , go to Step 5.

Determine if any of the claimed issues have been previously denied. For each issue that has been previously denied, follow request for application procedures located in M21-1, Part II, Subpart iii, 2.G.1 before going to the next step. Important:

• If the claim for a previously denied issue is received on VA Form 20-0995, Decision Review Request – Supplemental Claim, route it to the decision review operations center mail queue, where it will be processed as provided in M21-5, Chapter 4, 2.
• If all the claimed issues have previously been denied, no further action in this table is required.

• Click the READY button to return to the main Share screen.
• Select the Beneficiary Identification & Records Locator Subsystem (BIRLS) INQUIRY command and click the SUBMIT button.

Select the INACTIVE COMP & PEN tab. Determine if there any entries in the

• DIAGNOSTIC table
• ENTITLEMENT CODE field, or
• Reason for Termination or Disallowance field.

a rating EP from the 020 series.

an original rating EP from the

• 110 series, if there are seven or fewer claimed contentions, or
• 010 series, if there are eight or more claimed contentions.

1

Navigate to the Veteran’s profile and select New Claim from the ACTIONS drop-down menu.

2

On the NEW CLAIM screen verify the following:

• the claimant’s first and last names are correct
  • the CONTACT INFORMATION field is current, including the
    • address
    • telephone number, and
    • e-mail, and
  • check for open claims in the EXISTING CLAIMS field.

Notes :

• If a rating claim is already pending
  • update the contentions, and
  • manage evidence.
• Contact information updates must be made using the EDIT VETERAN function, as indicated in M21-1, Part II, Subpart iii, 3.B.1.b.

3

Complete the required CLAIM INFORMATION fields (indicated by red asterisk), all applicable optional fields, and click SUBMIT.

4

For certain EPs, VBMS will ask if the claim was submitted on a VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, dated August 2011 or later.

• If no is selected, a Section 5103 notice will generate and must be sent to the claimant.
• If yes is selected, VBMS will transition to the CONTENTIONS screen.

5

Enter the claimant’s contentions, completing the required fields as described in M21-1, Part III, Subpart i, 2.F.2.

6

Use the table below to document the claims establishment process. If processing the mail in a(n) ... Then ...

paper format

annotate the claim document with the

• EP
• establishment date, and
• initials of the individual establishing the EP.

electronic format

an annotation is not required, but the creation of a VBMS note documenting the EP established is recommended.

7

Return to the VETERAN PROFILE screen and select Manage Evidence in the ACTIONS drop-down menu. Example :

8

Add each piece of mail or mail packet by

• selecting the ADD unsolicited tab
• entering the required information and clicking the ADD EVIDENCE button, repeating until all evidence has been entered, and
• selecting COMPLETE.

1

Does a BIRLS record exist?

• If yes , go to the next step.
• If no ,
  • follow guidance in M21-1, Part II, Subpart ii, 1.A.1.c to ensure a duplicate record would not be created
  • create a record using the BIRLS ADD command, and
  • go to the next step.

2

Select the CLAIMS ESTABLISHMENT C+P command on the Share READY screen and using the table below, submit the information needed to start the claims establishment process in Share. Required Fields Optional

FILE NUMBER

MIDDLE NAME AND SUFFIX

BENEFIT TYPE

DATE OF BIRTH

PAYEE NUMBER

SERVICE NUMBER

CLAIM TYPE

BRANCH OF SERVICE

FIRST NAME

EOD AND RAD

LAST NAME

REGIONAL OFFICE

Example :

Note : The command establishes an EP for a pending claim or appeal.

3

Complete the following actions while on the VETERAN'S IDENTIFICATION DATA screen:

• review the data for accuracy and completeness
  • correct any erroneous data and enter any missing data, and
  • select CONTINUE ESTABLISHMENT.

Example :

4

Using the table below to complete the PENDING ISSUE/CORPORATE CONTROL ESTABLISHMENT screen. Field Name Description

INCREMENTAL

Select a third digit incremental/modifier other than zero, if the claim meets the criteria outlined in M21-4, Appendix B, 1.f. Note: The default third digit incremental (also called a modifier) is zero.

• ADDRESS
• TELEPHONE, and
• EMAIL

Update based on current correspondence (as necessary).

DATE OF CLAIM

For claims establishment purposes, the date of claim is the earliest date of receipt in any VA facility, to include scanning vendor sites and through VA claims submission service websites. Identify this date from the earliest VA date stamp or equivalent.

SUSPENSE DATE

Set suspense date to 15 days from the current date.

SECTION/UNIT

Enter 21 for compensation and pension claims.

• POWER OF ATTORNEY SEARCH
• AUTHORIZED POA ACCESS, and
• CADD AUTH'D

Update POA information (if applicable).

SUPPRESS ACKNOWLEDGEMENT LETTER

Ensure the SUPRESS ACKNOWLEDGEMENT LETTER field is deselected.

5

Select CREATE ESTABLISHMENT.

6

Update any appropriate corporate flashes, as required by M21-4, Appendix E.

7

Open the Veteran’s record in VBMS and from the CLAIMS drop-down menu select Claim Established in Share.

8

Enter the Veteran’s claimed contentions, completing the required fields as described in M21-1, Part III, Subpart i, 2.F.2.

9

• Return to the VETERAN PROFILE screen.
  • Select Manage Evidence in the ACTIONS drop-down menu.

Example :

10

Add each piece of mail or mail packet by

• selecting the ADD unsolicited tab
  • entering the required information and clicking the ADD EVIDENCE button, repeating until all evidence has been entered, and
  • selecting COMPLETE.

Example :

11

Use the table below to document the claims establishment process. If processing the mail in a(n) ... Then ...

paper format

annotate the claim document with the

• EP
• establishment date, and
• initials of the individual establishing the EP.

electronic format

an annotation is not required, but the creation of a VBMS note documenting the EP established is recommended.

12

Route for scanning to appropriate location.

1

• Open the claimant’s profile in VBMS, and
• select New Claim from the ACTIONS drop-down menu.

2

When necessary, update the claimant’s information, including

• address
• telephone number, and
• POA.

3

Determine if the hearing is for a legacy appeal or pending claim. If the hearing is for … Then …

a pending legacy appeal

• select the EP 170, and
• add the Local Hearing special issue indicator to each contention that requires a hearing.

a legacy appeal that has not been established

• establish EP 170, and
• add the Local Hearing special issue indicator to each contention that requires a hearing.

a pending claim

• select the EP controlling the issue that requires the hearing, and
• add the Local Hearing special issue indicator to each contention that requires the hearing.

an issue that is no longer pending as part of a legacy appeal or claim

follow request for application procedures located in M21-1, Part II, Subpart iii, 2.G. No further action in this table is required.

4

Add a tracked item that corresponds to the type of hearing request with a one-day suspense period.

5

Add a note providing details of the hearing request using the following format: [Type of hearing (informal, DRO, pre-decisional, etc.)]hearing request via[method of request (phone call, written correspondence, on VA Form 21-0958, etc.)]received on[date request was received].

6

From the PROFILE screen, select Manage Evidence in the ACTIONS drop-down menu. Example:

7

Add each piece of mail or mail packet by

• selecting the ADD unsolicited tab
• entering the required information and clicking the ADD EVIDENCE button, repeating until all evidence has been entered, and
• selecting COMPLETE.

Date stamp

Claim forms can be submitted by sending paper documents to the intake facility or by submitting electronic documents using VA-approved document submission services such as QuickSubmit (previously the Direct Upload tool). Auto-Establish claim forms will bear one of two distinct date stamps depending on the method of submission. Example: Below is an example of a date stamp placed on a paper form that has been digitally scanned. Example: Below is an example of a date stamp placed on a document submitted using the Direct Upload tool. Note : Documents submitted via QuickSubmit will have a correspondingly named date stamp.

Claim label

An Auto-Establish claim will use one of the following claim labels:

• 110 - D2D-Initial Live Comp <8 Issues (110)
• 010 - D2D-Initiatial Live Comp >8 Issues (110)
• 020 - D2D-Supplemental, or
• 400 - D2D-Supplemental.

System source / Uploading user role

Example : Below is an example of an Auto-Establish claims form in the eFolder. Example: Below is an example of the document properties screen of an Auto-Establish claims form.

II.iii.3.A.3.e. Reporting Consistent Errors With Auto-Establish Claims

Notify RO leadership and the District Director when consistent new errors with Auto-Establish claims (such as an incorrect corporate flash being applied to a homeless claim) are identified. The RO Director will forward the e-mail to the Office of Field Operations mailbox with a request to expedite the resolution of the issue. All reports must

• include
  • example file numbers
  • a description of the issue, and
  • the information technology ticket number, and
• be sent via encrypted e-mail.