© Copyright 2014 Jan Dils Attorneys at Law

Veteran’s Disability

Claim Manager

User Manual

Rev: 5/21/2018

Table of Contents

Introduction ..................................................................................................................................... 1 

Terms & Definitions ........................................................................................................................ 1 

Accessing your Account .................................................................................................................. 5 

Changing a Forgotten Password ...................................................................................................... 5 

Software Features ............................................................................................................................ 6 

Account Permissions ....................................................................................................................... 7 

The Home Screen ............................................................................................................................ 8 

The 38CFR - Part 4 Schedule for Rating Disabilities ..................................................................... 9 

Rating Policy Charts ...................................................................................................................... 10 

Searching for Rating Condition Content ....................................................................................... 11 

Combined Ratings Calculator ....................................................................................................... 12 

Working with Claimant Records ................................................................................................... 14 

Searching for Existing Claimant Records ..................................................................................... 14 

Using Column Filters .................................................................................................................... 15 

Using the Training Mode .............................................................................................................. 16 

Conducting a New VA Claimant Screening ................................................................................. 17 

Services Description & Fee Agreement ........................................................................................ 17 

Explaining the Process .................................................................................................................. 19 

Creating a New Claimant Record .................................................................................................. 20 

Claimant Information .................................................................................................................... 20 

Zip Code ........................................................................................................................................ 21 

Lead Source ................................................................................................................................... 21 

Severance Pay ............................................................................................................................... 21 

Discharge Type ............................................................................................................................. 22 

Claim Type .................................................................................................................................... 22 

New VA Claimant - Eligibility ..................................................................................................... 24 

Working with an “IU” Claim ........................................................................................................ 25 

Working with Non-Service Connection Claims ............................................................................ 25 

Using the Sub-forms ...................................................................................................................... 26 

Service Connection Screening Sections ........................................................................................ 28 

Comment Boxes ............................................................................................................................ 28 

Screening Controls ........................................................................................................................ 28 

Screening Form Sections ............................................................................................................... 29 

Conducting a Service Connection Screening ................................................................................ 32 

Out-of-Home Area Screening Criteria .......................................................................................... 33 

Current Claim Condition(s) ........................................................................................................... 34 

Treatment Information .................................................................................................................. 35 

Employment After Service ............................................................................................................ 37 

Military Employment .................................................................................................................... 38 

Foreign Service ............................................................................................................................. 39 

Presumptive Conditions ................................................................................................................ 42 

TSGLI Checklist ........................................................................................................................... 45 

Follow-up & Submission .............................................................................................................. 46 

Submitting a Completed Screening Application ........................................................................... 47 

Working with Results .................................................................................................................... 48 

Conducting a New Client Intake ................................................................................................... 50 

Conducting a New Client Intake ................................................................................................... 51 

Completing the Intake ................................................................................................................... 55 

Using the Claim Analyzer ............................................................................................................. 56 

Using the Claim Analyzer ............................................................................................................. 57 

Appendix A: VA Acronyms & Resources .................................................................................... 58 

1

Introduction

Welcome to the Veteran’s Disability Claim Manager. This manual provides information and instructions about using the software application. The software application is designed to assist with processing specific Veteran’s Disability claims. The software application provides useful tools for determining Veteran benefit program eligibility and keeping track of all the details associated with representing a VA Disability claim. The online web application is updated when VA disability claim laws and policy lists change to ensure access to the most current VA disability claim information.

The software application is especially useful for standardizing the way Veteran disability claims are assessed for representation and processed. The software application is intended to be used by trained “Users” that possess a basic understanding of the Veteran’s disability claim process and knowledge of the information collected. Software Users must be knowledgeable of different Veteran benefit programs, claim types, and VA disability hearing decision levels, claim processing policies, and regulations.

The software application provides tools that help VA Legal Representatives select and file a Veteran’s Disability claim. The software is not intended to make any decisions for any individual about whether a VA disability Claimant should be represented or whether a claim should be filed with the Veteran Affairs Administration.

Terms & Definitions

The following defines the terms and jargon used within this manual:

Borderline Score: Any claim strength score that is close to any score threshold.

Claim Analyzer: The software feature that allows Users to examine details of a claim and edit a submitted form. The claim analyzer is a useful tool that allows a User to understand how a score was calculated by examining the individual parts of a specific record entry.

Claimant: This is the Veteran or Spouse/Dependent of a Veteran that the screening was conducted for.

Claim Strength Score: The calculated, standardized score that represents the quality or strength of a disability claim.

Compensation: Also referred to as “Service Connection,” this monetary Veterans benefit program is awarded for medical conditions that were incurred, or agitated, during military service.

Dependents Indemnity Compensation (DIC): Dependency and Indemnity Compensation (DIC) is a tax free monetary benefit paid to eligible survivors of military service members who died in the line of duty or eligible survivors of Veterans whose death resulted from a service-related injury or disease.

2 Diagnosis (Dx): Abbreviated “Dx,” this healthcare acronym is used in relation to any professionally diagnosed medical or psychological condition.

Home Screen: This is the first screen/web page that appears when a user logs into the software application. From this screen, a user can submit a new screening or intake application form, generate client forms, and access the software User’s manual.

Individual Unemployability (IU): Individual Unemployability (IU) is a program that allows Claimants to be paid at the 100% rating due to the inability to sustain gainful employment due to their service-connected disability(ies). In most cases, to be eligible for an IU award, the Claimant must have one disability rated at 60% or if the Claimant has an overall combined rating of 70% for multiple disabilities and at least one rated at 40% in addition to the inability to sustain gainful employment.

In-home/Not-in-home: This is used to describe a Claimant’s geography. “In-home” is a pre-defined group of Cities/States/Counties where preferred claim types or claim characteristics are represented. For example, VA Pension only Claims may be filed within just a few Cities and Camp Lejeune Claims may be accepted in every State. “Not-in-home” Claimant criteria may be more restrictive than “In-home” criteria.

Military Sexual Trauma (MST): Military Sexual Trauma (MST) is sexual assault or repetitive, threatening sexual harassment that occurred during military service. In order to qualify for MST benefits, a Claimant must be able to prove the following: An incident of military sexual trauma occurred while on active duty and the Claimant is currently diagnosed with a mental or physical disability and their disabilities were caused by, or were worsened by, the military sexual trauma they suffered while serving in the military.

New VA Claimant: This is the software component used to screen a potential new VA Claimant and standardize the process of selecting VA disability claims for representation. This component allows a User to gather information regarding new VA claims for purposes of determining Compensation or Pension benefit program eligibility and appropriateness of legal representation. For completed screenings only, this component also allows a “new client intake” to be conducted. The intake process consists of gathering required new client information that was not obtained during the screening.

Pension: This monetary Veterans benefit program is based upon age and income and is awarded for non-service medical conditions. There are two types of pension programs (Veteran’s Pension and Survivor’s Pension); each program has unique qualification criteria.

Psychological Stressors: Factors that contribute to symptoms of anxiety and depression are referred to as psychological stressors. Psychological stressors are often identified in relation to filing military psychological disability claims; this is especially true of filing Post-Traumatic Stress Disorder (PTSD) and Military Sexual Trauma (MST) disability claims. Specific military trauma related stressors are often the result of experiencing, or being exposed, to the following: Accidents (Fire, Motor-vehicle, training, etc.), Ambush, Firing weapons, Hazing, Injuries to self or others, Mines

3 and/or booby traps, Participation in firefights, Rocket and/or mortar attacks, Sniper fire, witnessing others being killed or dying.

Post-Traumatic Stress Disorder (PTSD): Abbreviated “PTSD,” this psychological claim condition results when a person is traumatized by experiencing psychological stressors. The American Psychiatric Association identifies PTSD by the presence of the following factors:

A Traumatic event occurred in which the person experienced, witnessed, or was confronted by actual or threatened serious injury, death, or threat to the physical integrity of self or other and, as a response to such trauma, the person experienced intense helplessness, fear, and horror.

The person re-experiences such traumatic events by intrusive thoughts, nightmares, flashbacks, or recollection of traumatic memories and images.

Avoidance and emotional numbing emerge, expressed as detachment from others; flattening of affect; loss of interest; lack of motivation; and persistent avoidance of activity, places, persons, or events associated with the traumatic experience.

Symptoms are distressing and cause significant impairment in social, occupational, and interpersonal functioning.

The symptoms last more than one-month.

The person has increased Arousal, usually manifested by startle reaction, poor concentration, irritable mood, insomnia, and hypervigilance.

Score Threshold: Also referred to as a “cut score,” this is any pre-defined Claim Strength Score and claim detail preferences that determine whether or not a VA disability claim is appropriate for representation. The score threshold, and all Claimant representation preferences are defined by the account holder and can be adjusted at any time.

Service Connection (S/C): Abbreviated as “S/C” and often referred to as “compensation,” this is a monetary Veterans benefit program awarded for medical or psychological conditions that were incurred, or agitated, during military service.

Social Security Number (SSN): Abbreviated “SSN,” the software only collects a claimant’s last four digits of a Claimant’s SSN during the screening process for purpose of identifying a previously completed record.

Survivor’s Pension: The Survivors Pension benefit, which may also be referred to as “Death Pension,” is a tax-free monetary benefit payable to a low-income, un-remarried surviving spouse and/or unmarried child(ren) of a deceased Veteran with wartime service.

Treatment (Tx): Abbreviated (Tx), this healthcare term is used in relation to the professional treatment of a diagnosed medical or psychological condition.

4 User: The name of any VDCM account holder that uses the software.

5

Accessing your Account

The first step to accessing your account is by navigating to: http://vaclaimman.com and logging in using the account Username and password provided by your account administrator. For security reasons, you should change your password regularly and not give it out to anyone. If you ever forget your password, click on the “Forgot your Password?” link. You will receive an automated email containing a link that will allow you to change your account password.

It’s important that the email address provided to reset a forgotten password is always the same one registered with the client account.

Changing a Forgotten Password

Clicking on the “Forgot your password?” link on the “Login Page” will provide you with an opportunity to change your password through email. When selecting a password, ensure that it contains the following:

At least Six Characters

At least One Upper-case

At Least One Lower-Case

At Least One Number

It is recommended to use at least one special character in all passwords.

6

Software Features

The software application consists of components; each one with a specific purpose. Some software components use the data entered from other components; therefore, the order they are used in can be important. The components are defined below:

New VA Claimant: A VA disability screening tool used to collect new VA Claimant information regarding VA disability program eligibility and apply VA disability claim preferences.

This component is always the first to be used when starting a new Claimant record.

Once a screening is complete, a new client intake may be conducted to collect additional information when accepting to represent a new Veteran’s disability claim. Much of the information required to conduct a client intake is obtained through the “New VA Claimant” component. For this reason, a VA Claimant screening is always completed before conducting a new “Client Intake.”

C-File Review: Used to review the C-File of an existing VA Claimant. This component uses most of the information collected from the previous two components; therefore, both must be completed before starting a C-File Review.

Case Development: Used to keep track of Client claim status and modify claim details according to evidence. As the claim details change over time, this component allows for a second Claim Strength Score to be created before hearing for comparison with the initial score created from the initial VA Claimant screening.

This component can be used in conjunction with the C-File Review; however, a New Client Intake must have been completed in order to use the Case Development component.

Electronic 38CFR: This is the “Part 4 Schedule for Rating Disabilities” used to

reference VA Disability Claim conditions, rating criteria, and associated rating policies.

Total Combined Ratings Calculator: Used to calculate a total combined disability rating from up to twenty individual disability ratings. This component also allows for bilateral factors to be included in combined rating calculations.

Claim Analyzer: Used to view completed form details.

Report Center: Used to create, save, and view an unlimited number of reports on all submitted records.

7 Account Permissions

Each User is assigned a “User Role” by the Client Account Administrator. The User Role determines what software components can be accessed. The following explains account User roles from the most restrictive/limited account roles to least restrictive:

1. Client Agent: The permissions of this role include the use of the New VA Claimant, Client

Intake, 38CFR, and Total Combined Ratings Calculator components.

2. VA Specialist: The permissions of this role include all the features of the VA Claim Manager

with exception of using the “VA Decision Analyzer” and “Decision Reports

within the Decisions component.

3. Manager: The permissions to this role include the use of all the software components

including the VA Decisions component and C-File compensation reporting features.

4. Account Administrator: The permissions to this role are unlimited; it includes the ability to

use all software components in addition to the ability to create, delete, or modify Screening

result menus, Lead Sources, User roles, define geography settings, and adjust screening cut-

scores.

o More than one Account Administrator can be designated for a single account.

8

The Home Screen

After successfully logging in, the first screen is known as the “Home Screen” and is where all the features can be accessed. Clicking on the “Home” icon will always return the User to the “Home” screen illustrated below.

From the home screen, Users have the option to complete a new claimant entry form, access

the Claim Analyzer to search and review previously completed records. o Each component is accessible depending on the User account permissions. o The “Administrative Tools” component is reserved for account administrators.

The top header bar of the home page contains useful functions including the User Manual, Change Account Password function, and link for logging out of the account.

It’s important that all Users click the “Log off” link when they are not using their account.

Clicking the account name will allow the User to change their password.

9

The 38CFR - Part 4 Schedule for Rating Disabilities

The 38CFR – Part 4 Schedule for Rating Disabilities is used throughout many of the software components and is intended to serve as a reference for anyone working with the Part 4 Schedule for Rating Disabilities. Because the Schedule for Rating Disabilities contains useful information such as diagnostic codes and rating condition criteria, the 38CFR content has been made available as a stand-alone software component. Just as with a printed copy of the 38CFR, Users are able to view all the possible claim condition ratings, what is required to be awarded specific rating percentages, any policy notes associated with the claim condition, and the diagnostic code. Rating disability content can be quickly referenced using a variety of full-text search and filtering methods.

For each 38CFR claim condition, if a policy note is referenced, the note is provided at the bottom of the claim condition. A full list of policy sections 4.1 through 4.73 is provided by clicking on the hyperlink at the top-right of the screen.

The electronic version is updated with each new 38CFR policy revision.

10

Rating Policy Charts

Rating polices provide details about how ratings are assigned. Some rating policies have images associated with them. The images can be viewed full screen by selecting the image link as illustrated below:

11 Searching for Rating Condition Content

The grid format of Part-4 Schedule for Rating Disabilities is arranged from the broadest factor (Claim Domain) to the most specific (Rating Criteria Note). Clicking on a column arrow will drop down a filter list to select column criteria.

The printed 38CFR version use different terms to differentiate between the right and left sides of the body (Scope Eye vs. Non-Scope Eye, Preferred Hand vs. Non-Preferred Hand, Dominate Side vs. Non-Dominate Side, etc.). This electronic version of the 38CFR standardizes the sides of the body to a simple “P” indicating the primary side and an “S” that indicates the secondary side of the body.

P = Primary side of the body.

o Dominate, preferred, “scope eye,” etc.

S = Secondary side of the body.

o Non-dominate, less favored, weaker, etc.

12

Combined Ratings Calculator

The amount of benefit compensation depends on how disabled a Claimant is rated. The Veterans Administration determines the severity of Veteran disability based on the submitted evidence or that the VA obtains from Claimant military records. The VA rates a disability from 0% to 100% in ten percent increments. Disability ratings are not cumulative; two disability ratings of ten and ten do not equal a total combined rating of 20%. For claimants that are assigned multiple disability ratings, the VA provides a “Combined Ratings Table” to calculate a combined disability rating. The table can be cumbersome to “hand-score” and this software application features a combined ratings calculator that takes the work out of determining a Claimant’s combined rating.

The Combined Ratings Calculator can be opened from the Home screen. The first step to calculating combined rating is entering the number of ratings you want to calculate (up to 20 ratings may be entered).

The next step is to enter the rating percentages in each field using the drop down menus. Ratings do not have to be entered from highest to lowest (the application ranks them during the calculation process).

To calculate a bilateral rating, the rating number can be entered manually within the drop

down menu fields.

13

Clicking the “calculate” button produces a Combined Ratings percent.

14

Working with Claimant Records

The most common User function is retrieving existing claimant records; the process is the same for all the VA Claim Manager components. The first step requires entering “Claimant Identifiers” for a record search. If a record had been previously completed using the same claimant identifiers, the record could be opened and edited.

It’s important that Users verify the spelling of Claimant’s last name, last 4SSN, and date of birth when creating or modifying records to ensure a previous record had not been created for the Claimant.

The process of searching for existing records is an especially important part of conducting a new Claimant screening because the screening process is comprehensive and can result in incomplete screening records. For any new Claimant screening, a lot of time can be saved by retrieving the original record that was partially completed (not to mention the Claimant doesn’t have to answer the same questions again.) For this reason, the “New VA Claimant” component requires Users to verify if a screening record had been previously completed before the option is provided to start a new Claimant record.

Searching for Existing Claimant Records

Identifying whether or not a record has been created consists of entering the Claimant’s last name, last four digits of their social security number, and their date of birth.

Upon entering a Claimant’s information as in the illustration above, if no previously entered record matches the search criteria, nothing will be presented in the box below, and a “New Form” should be opened.

The “New Form” button only appears after the claimant last name, last four of SSN, and DOB fields are completed.

15 If the Claimant information matches a previously completed record, the record information is displayed below and the User should verify the accuracy of the information, then click the “Select” link to edit the existing record with updated information. Notice that for records that have been previously created, the record icons indicate whether or not the screening was completed, passed an organizational cut-score, and whether or not the intake was completed.

Both software components (Screening & Intake) are accessed from this table. If a screening had been started, but not completed, the screening can be opened by selecting “Screening” from the “Edit Screening” column; doing so would open the screening record at the last section that was completed. If a record had been completely screened, the intake could be conducted or continued by clicking on the “Intake” link from the “Open Intake” column.

Using Column Filters

Some of the record selection table columns may be filtered. The arrows at the top of each header label will present a filter selecting listing every record within the specific column. The illustration below depicts all the records that have the word “test” in the “Last Name” field.

16

The “Record Date” field exists for instances where not all record criteria are known; it may be useful to examine all the records created on a specific date. The illustration below depicts the “Record Date” filter list with all the record creation dates. Selecting any of the dates would present only the records created on the selected date.

More advanced record search options are available by using custom filter features.

Using the Training Mode

The “Training Mode” feature that enables Users to create records that are kept separate from the “working records.” This feature should be used when a User wants to complete a record for training purposes. The benefit of using “Training Mode” is that records created in this mode are kept separate from actual “working” records. The “Claim Analyzer” and “Report Center” also keep training records separate from the “real records.” To use the training feature, the “training mode” check-box at the start of completing any new record.

17

Conducting a New VA Claimant Screening

The purpose of the New VA Claimant Screening component is to ensure appropriate fit between a VA Legal Representative and a VA disability Claimant. Appropriateness is often determined by geography of the Claimant and the Legal Representative, the Representative’s services and fees, and claim benefits eligibility. The screening process is very comprehensive; questions are asked about military history, claim conditions, as well as employment and healthcare treatment after military service. The new VA Claimant Screening consists of dynamic form fields meaning form items are presented to the User based upon previous form item responses.

The screening process involves completing a collection of forms that relate to details of a new VA claim. Upon completion, a Claim Strength Score is calculated in addition to a Summary Report. The Summary Report is a useful supervisory tool that provides a quick summary of claim details including the Claim Strength Score and other Claim details such as Claimant geographic location, Lead Source. In order for the calculated score to be accurate, it is important that the information entered accurately reflect claim details.

It’s important that Users be properly trained to complete screening form items the way they were intended.

The New VA Claimant is component is always the first to be used before a conducting new Client intake.

Most fields are completed using drop down menus and “yes/no” radio buttons making completing the forms quick and easy. Not all form items need to be completed in order for a submission to be made; however, the accuracy of a Claim Strength Score depends on comprehensive claim information. Upon submission of a completed claimant form, the Claim Strength Score is calculated and Users have the option to edit the form they just submitted or complete the record and return to the home page/screen.

It’s important to note that a new VA Claimant screening only determines if a new Client Intake is conducted. If a new VA Claimant screening reveals a Claimant is eligible for benefits, and is an appropriate client for organizational representation, a new client intake may be conducted or appointment may be set.

Applicants do not become organizational clients until a new client intake is completed.

Services Description & Fee Agreement

The first step before obtaining information from a new VA Claimant is to explain any representation services and fee structure. All new VA screening Claimants should be provided a statement that would communicate the representation services and fee structure before any information is collected. Clicking on the link in the upper banner bar will display any custom message.

18

The following is a generic services and fee agreement that could be displayed when the “Services & Fees” link is selected:

Who we are:

We have been fighting for disability benefits for years. We have helped thousands of people get the benefits they deserve.

What we do:

We have the resources to help and the people who care. Every Veteran is assigned a personal contact throughout representation of your disability

claim. From opening new claims, to filing appeals, and of course, representing you at hearings, we

represent you, and your VA disability claim throughout the entire process.

Fees:

There is no upfront cost for the services we provide. Our attorney’s fee is _____% of whatever back pay you receive.

o If we are charged for medical records, or schedule you for an independent medical exam via our network of doctors, we will cover this expense up front.

Once your case is over, you are responsible of these fees regardless of the outcome. o These medical expenses are separate from the attorney’s fees.

After the information is explained to the Claimant, the message is finalized with a general statement of: “If you agree, we will conduct a new VA Claim Screening to make sure about claim type and eligibility. The result of the screening is either an intake appointment being conducted or scheduled.”

Clicking on the “User Manual” button in the top header bar opens this User Manual.

Adobe Acrobat Reader must be installed on the User’s PC to view the manual.

19 Explaining the Process

The process of screening a new VA Claimant can be extensive depending on the Claimant’s length of service history and number claim conditions. To prepare the Claimant for the process of answering all the form items, Users should communicate a message similar to the following:

“I’m going to ask a series of questions to determine the type of program benefits you may be eligible for and to get information about current or past claims.

I will be asking you several questions about your military service and your work history since your military discharge. If you are unsure of any answers just let me know.

This process takes approximately 15-30 minutes depending on the number of claims you have or plan to file.

If you are unable to complete the entire process for any reason, we can continue at a later time and you won’t have to start from the beginning; we can continue with the last question we ended with.

During this process, it is helpful to have with you any recent correspondences or decisions rendered by the VA, but if these items are unavailable we can still continue.”

20

Creating a New Claimant Record

Given no previous record had been previously created, the “New Form” button opens a blank entry form with the Claimant identifiers already completed. Basic Claimant contact and geographic information is entered. If the “Spouse/Dependent” radio button is selected in the “Claimant” field, fields are presented to obtain the Spouse or Dependent contact information.

The City, State, and County is automatically populated when the claimant zip code is entered. A valid zip code is required.

o In the event the Claimant does not reside in the U.S. and does not have a valid zip code, then use five zeros “00000” in the zip code field.

Claimant Information

The Claimant Information fields collect basic information beginning with identifying the Claimant’s name, last for of their SSN, and birthdate; these fields are the “record identifiers.” The applicant can be either the veteran, or a spouse/dependent of the veteran.

21 While applicant screening data collection is relatively simple, the following are some data entry requirements of specific fields in this section:

Zip Code

This field is used for reporting purposes and represents the potential Claimant’s five digit zip code. Using the zip code, the software automatically populates the associated city, state, and county. In the event that the Claimant does not reside in the U.S., Users are to enter five zeroes “00000” in the zip code field.

Lead Source

The lead source is the outreach method used to obtain the potential client for whom the form is being completed. Lead sources could be traditional (Radio, TV, Billboard, etc.) or could be through professional referral services or other paid lead source provider.

The account administrator determines the lead source menu options.

Severance Pay

Some Veterans receive severance pay upon completion of their military service. Sometimes severance pay must be returned when collecting disability benefits. Legal Representatives should be aware of any outstanding Claimant severance pay balance before representation. The next part of the Claimant Information section obtains information about Claimant severance pay.

22 Discharge Type

The forms fields collect basic demographic information including the veteran’s discharge type located on their DD214 form. The following table illustrates the military discharge type menu options and benefits:

Military Discharge Type Action

Honorable Proceed

General: Uncharacterized, Medical, or Under Honorable Conditions

Proceed

Other than Honorable Present Borderline Items

Undesirable Present Borderline Items

Bad Conduct Present Borderline Items

Entry Level Separation (ELS) <180 days of service Present Borderline Items

Dishonorable Ineligible

"Dismissal Notice" (Officer Discharge) Ineligible

Benefits do not apply to any dishonorable discharge or officers that receive a dismissal

notice.

For “Borderline discharge types,” the Claimant may be required to answer a series of questions in order to determine eligibility. Borderline discharge type eligibility questions require a negative response to the following “Yes/No” questions associated with getting the borderline discharge type:

1. Is there a felony conviction associated with the discharge? 2. Willful and persistent misconduct associated with the discharge? 3. Inappropriate or illegal sexual behavior associated with the discharge? 4. Mutiny or spying associated with the discharge? 5. Agreed to the discharge to avoid a general court martial?

After a “No” response to each of the borderline eligibility items, Claimants are asked if they have ever filed to get an administrative decision about whether or not they were entitled to benefits. The Claimant will be eligible to proceed if they have not received an “Administrative Decision” stating they are not entitled to benefits.

Claim Type

After eligibility is determined, the User makes a selection about the type of benefit the Claimant wants to apply for. If a Claimant is the Veteran, the possible claim type options are:

23

Service Connection; Camp Lejeune; Veteran Pension.

If a Claimant is the Spouse or Dependent of the Veteran, the claim type options are:

Dependent Indemnity Claim (DIC); and/or Camp Lejeune; Survivor’s Pension.

Once program eligibility has been verified, instructions are presented to either reference an updated pension table for monthly program payment amount or to schedule an appointment for a new client intake.

24

New VA Claimant - Eligibility

Claimant “eligibility” generally refers to the program criteria the Veteran is applying for including the Veteran’s type of military service discharge. Eligibility also refers to geography and claim type. This type of Claimant eligibility is determined by a VA Legal Representative, or group of VA Legal Representatives using the Administrative Controls panel.

Information is organized in table format. Clicking on “New” or “Edit” enables the table to be updated using the “Edit Form” illustrated below.

Fields that are “greyed out” are inactive and not editable.

Clicking “Update” at the bottom of the form closes the form and updates the associated table.

25 Working with an “IU” Claim

When a claim condition is “IU,” click “Yes” to in-service treatment and click the “Annual/Every 12-months” option for treatment frequency.

The reason for this is to so points are not removed from the total score. If “No” is selected and treatment frequency is “None” it looks as if a claim exists for a condition that never received treatment.

Do not click “Yes” to any other items besides “In-service Tx.” Do not click any other treatment frequency besides “Annual/Every 12-months”

Working with Non-Service Connection Claims

The software application is able to screen for Veteran and Survivor’s Pension program eligibility and Dependents Indemnity Claims (DIC). Selecting any of these claim types will result in presenting a series of VA defined, benefit-related form items. The screening process is quick and the User is presented with instructions to reference a current VA monthly program payable amount table if the

26 Clamant is eligible for benefits. With DIC Claim types, eligible Claimants are asked to schedule an appointment for a new VA client intake.

If eligible, the option to select a “Camp Lejeune” claim screening is available. The screening form items that relate to “Camp Lejeune” claim eligibility would be completed and whether the Claimant is eligible for a Camp Lejeune disability claim, the Service Connection component is presented directly after the screening to obtain more complete screening details.

The Pension and Camp Lejeune claim type options are only available with eligible military service dates and geographical preferences.

Clicking one or more claim conditions in the Camp Lejeune component will result in the Claimant being accepted for representation regardless of score at the end of the screening.

Using the Sub-forms

The entry forms used to populate the main table grids on each screen are called “sub-forms.” These forms contain fields that can be populated by drop-down lists and by manually typing in data. Clicking the “Update” button at the bottom of each sub-form updates the applicable table/grid it belongs to. For some fields, if the incorrect type of information is entered, a pink bar with text stating “Input string was not in a correct format” appears. This means the wrong type of information was entered

27 into a field. For example, typing numbers where letters were expected or vice versa. If this happens, simply correct whatever incorrect information was entered and select “update” again.

In this example, a “Yes/No” response from the drop-down menu was expected instead of manually typing in a date.

28

Service Connection Screening Sections

The VA Claimant Screening component is very comprehensive; detailed information is gathered about claim conditions and military service history. The screening process allows Users to navigate the application form items easily by categorizing the information into manageable “sections.” The “Application Manager” provides quick access to all the screening sections.

The VA Claim Manager’s Screening items are organized into sections.

Clicking on the screening section in the collapsible “Application Manager” will display the form items within that group.

In order to effectively navigate within the Service Connection screening component, it’s important to be familiar with the screening sections and understand the type of screening items each section contains.

Comment Boxes

At the end of every screening section, there is an optional comment box. The box is intended to be used to type additional notes relating to the responses in the related section.

Screening Controls

There are three buttons, at the bottom of each screening section page. The “Next Section” button progresses to the following screening section; the “Save for Later” stops the screening process and saves all the record information entered; the “End Screening” is used to end the screening process, and not save any information entered.

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Screening Form Sections

The form items are conveniently organized into sections. The screening sections are always available on the left hand side of every screen. The following table provides the Service Connection screening section labels and the form items available in each section.

Screening Section Description

Existing Service Connected Disabilities

This form item group obtains the name of any existing service connected claim conditions. Claim conditions are selected from the 38CFR. For each claim condition listed, current disability rating is obtained. Depending on how items are answered in this section, convalescent compensation eligibility may be determined for each claim condition listed. Also for each existing service connected condition listed, the maximum allowable disability rating is presented.

The total combined disability rating is also calculated from existing service connected disabilities and the total is provided in the New Claimant Screening Summary.

Current Disability Claim(s), Level, and Status

In this group, the User identifies what the Claimant wants to do regarding application for program benefits. An unlimited number of claim conditions can be listed for each claimant. The type of action a Claimant wants to take is identified by selecting one of the following for each of the current claim conditions:

Increase an existing disability rating; or New claim condition; or Re-Open a previously applied for disability claim; or Appeal a disability claim decision.

Claim condition(s) are selected from the 38CFR. For each current claim condition listed, the User has the option to provide previous claim filing history. Previous claim filing levels include: RD, SOC, SSOC, BVA, and CAVC. In this group, Users may be instructed to remove specific disability claims at levels identified to be organizationally inappropriate for representation.

Current Disability Claim(s) Treatment

This group contains items relating to the treatment of each current claim condition. The items relate to past exams, treatment frequency, and C & P exams. Within this group, Users may be instructed to remove claims identified as having very large treatment gaps.

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Employment After Military Service

This group contains items relating to the Veteran’s current employment status and general job history since military service. General occupation is obtained as well as any work related disability claims. Disability claim options presented are: Social Security and Worker’s Compensation.

General claim condition(s) are also identified for any work-relevant disability program claim.

Military Occupation

This group contains items relating to the Veteran’s Military Occupation(s). Often referred to as Military Occupational Specialty (MOS) or Area of Concentration (AOC), this is the job a military service member was trained for and performed. Only the job name is required. Job specialty codes are not required; however, assigned units and approximate dates are helpful. Users are asked to identify any specific Job categories and duties the Veteran may have performed. An unlimited number of occupations may be added.

Foreign Service

This group contains items relating to any foreign service; specifically, combat zones the Veteran may have served in. An unlimited number of locations may be identified. For each combat zone, claimants are asked about associated combat commendations such as an infantry badge or combat medals and ribbons. For each combat zone identified, approximate service dates are required. This form section contains items relating to POW status and any associated combat services medals/commendations.

If the Claimant did not serve during combat, or their claim condition does not relate to foreign military service, this form section would not be used.

Presumptive Conditions

This group contains items relating to service locations inside and outside the United States. The presumptive conditions include conditions linked to assigned Ships & Waterways. Depending on previous form item responses, there may be questions relating to specific ships and waterways from menus relating to specific presumptive claim conditions. For each location, approximate dates are required. An unlimited number of ships, locations, and waterways may be provided in the Foreign Service screening item group.

Follow-up & Application Submission

The items in this group are presented based upon how previous screening form items were completed. Items in this group ask for additional claim

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details. The Follow-up group items relate to traumatic claim benefit eligibility, claim condition details, and military service period history.

This section of the screening component provides the final opportunity for a User to add / edit claim details before a Claim Strength Score is calculated and a New VA Claimant Summary Report is generated. It’s important to verify all claim details in this component before the “Submit” button is clicked.

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Conducting a Service Connection Screening

In our example, we have already determined eligibility criteria and screened for VA Pension and Camp Lejeune claim types. The Service connection component would be the next step to finalizing the screening. For our example, the Claimant’s zip code is “in-home” and the Service Connection screening component begins with asking about any existing claim conditions.

Claimant geography is dependent on the response to this item. If the Claimant’s zip code was not “in-home,” a series of custom screening items

would begin to determine if the claim is organziationally appropriate.

Since our example Claimant is “in-home,” a response of “Yes” presents the “Existing Service Connected Disabilities” section.

“Claim Action” describes the type of action that is to be

taken on the claim (i.e. Increase, Re-open, New, Appeal)

33 Out-of-Home Area Screening Criteria

Each VA Claim Manager software account is customizable to use geography as additional screening criteria. A “Home Area” is defined upon account set-up. Claimants with a zip code that is “in-home” may have different organizational eligibility requirements than Claimants that are not “in-home.” If a Claimant’s zip code is “Not-in-home,” the appropriate screening criteria are presented in this section. The example below depicts an account that has two criteria for applicants from zip codes that are not defined as “not-in-home.”

A Claimant from a zip code that is defined as “not-in-home” must meet at least one of the “Out of “Home Area” Eligibility Items” in order to proceed with the screening.

An unlimited number of geographical regions may be defined. o Each region may have an unlimited number of “rules” about whether or not the Claimant may file a VA Disability claim with the

Legal Representative/Organization.

34 Current Claim Condition(s)

After the current existing claim conditions section, the next section asks what the claimant wants to do with the claim(s); this is their “Claim Action.” The different types of Claim action are: New, Re-open, Appeal, or Increase. In this example, the Claimant would like to “Increase” the single condition they are already service connected for.

The claim condition should be selected if possible; however, the 38CFR Claim condition category is the only required field. o Entering the diagnostic code would auto-populate the

Claim condition and category fields. For psychological claim conditions, passing your mouse over

the “Psych Stressors” field will present a pop-up list of custom defined “Acceptable Psychological Stressors.”

Decision levels include: RD, SOC, SSOC, BVA, and CAVC.

Depending on decision level, Users may be instructed to remove specific disability claims at levels pre-defined to be organizationally inappropriate for representation.

35 Treatment Information

This section contains items relating to the treatment of each current claim condition listed in the previous section. The items relate to the diagnosis, and treatment frequency of claim conditions. Within this group, Users may be instructed to remove claims identified as having very large treatment gaps. Since our example only contains one claim condition, we have only one condition to place treatment information on.

For each Current Claim Condition entered, the treatment for each would be entered using these edit forms.

36 Depending on a Claimant’s service period and claim condition(s), there may be a presumptive condition checklist presented at the end of the “Treatment Information” section. In our example, the Claimant has served in Vietnam and Non-Combat service periods. The information entered so far has resulted in confirming the diagnosis of any applicable presumptive condition lists illustrated below:

If the Claimant had been diagnosed with any of the conditions on any presumptive condition lists, the condition(s) should be “checked” and clicking “OK” would close the “Presumptive Lists” form.

The “Within 12 Months Presumptive List” was illustrated for educational purposes and is presented whenever a Claimant has an enlistment period shorter than one-year.

37 Employment After Service

The Screening component contains two employment sections. The first is “Employment After Service.” In both of employment sections, depending on what is entered, where the Claimant resides, and their combined disability rating, some items appear and/or become activated so they can be clicked on.

For educational purposes, all items are displayed in this illustration.

For any SS Disability or Workers Compensation awards, a general description is required for condition awarded (i.e. Back, Knee, Heart, etc.).

For each a “Yes/No” question must be answered as to whether the awarded condition was the same as any of the VA claim condition(s) they are currently pursuing.

38 Military Employment

This group contains items relating to the Veteran’s Military Occupation(s). Often referred to as Military Occupational Specialty (MOS) or Area of Concentration (AOC), this is the job a military service member was trained for and performed. Job specialty codes are not required; however, the job name is (assigned units and approximate dates are helpful.) Users are asked to identify any specific Job categories and duties the Veteran may have performed. An unlimited number of occupations may be added.

If the Claimant had served in the Air Force within a specific date range, a question is asked about whether or not the Claimant had served as a “ground or flight crew on a C-123 Aircraft.”

o A “Yes” response to this item will result in an herbicide exposure presumptive condition list presented in the “Presumptive” section.

Using Presumptive conditions lists is explained in detail within the “Presumptive Conditions” section of this manual.

39 Foreign Service

The Foreign Service section obtains information relating to any assigned military service outside of the United States. A “Yes” response to questions about foreign military service, ship assignments, and other assigned military bases will result in displaying a sub-form to provide more details about the claimant’s foreign military service as illustrated below:

The enlistment dates are used to create the “Presumptive Locations” menu item. o In this example, the Claimant served in the Vietnam era.

40 A “Yes” response to the question about ship assignment will present a sub-form asking about the ship name. Just as with the “Service Outside the U.S.” sub-form, there is also a field representing any possible presumptive items. Depending on the service dates, an assigned Ship sub-form a naval ship list is presented in the “Presumptive Ship List” field as illustrated below:

Just as with all presumptive fields, the option to select “Other” is always available. o When “Other” is selected, the User must enter additional information describing the “Other” selection.

41 A “Yes” response to the question of “Assigned to U.S. bases results in displaying the sub-form illustrated below:

Depending on the service dates, the “Presumptive U.S. Base List” field will display a “Chemical Storage Outside the U.S.” list. o Just as with the other presumptive lists, an option is available to select “Other.”

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Presumptive Conditions

After the “Foreign Service” section is the presumptive conditions. Presumptive conditions are the result of attributing a certain period of time with a physical location that result in a medical/psychological condition. For this reason, the form questions and menus available in the “Presumptives” section depends on how previous screening sections have been completed. If a Claimant’s service era, military occupation, and assigned service locations “trigger” any applicable presumptive condition lists. In an example below, the Gulf War Presumptive conditions list is presented.

If any of the conditions or symptoms, match the Claimant’s, “Yes” should be selected to the question of “Do any of the Claimant’s conditions match any of the following?”

o When responding “Yes,” to a presumptive claim condition, or symptom, a check should be placed in the associated box(es).

43 Some presumptive claim conditions can also be symptoms associated with diagnosable claim conditions. For example, the P.O.W. presumptive list contains “psychosis” which is a symptom of some diagnosable psychological conditions.

44 Presumptive lists are also presented given specific time period and military job. For example, the herbicide conditions list will be presented in the “Presumptives” section if the Claimant responds “Yes” to the item of working as a ground or flight crew on a C-123 Aircraft given certain time periods.

45 TSGLI Checklist

Given specific service period and claim conditions, the Servicemembers’ Group Life Insurance Traumatic Injury Protection (TSGLI) checklist may be presented in the “Presumptives” section. This insurance policy provides automatic traumatic injury coverage to all Servicemembers covered under the SGLI program. It provides short-term financial assistance to severely injured Servicemembers and Veterans to assist them in their recovery from traumatic injuries. TSGLI is not only for combat injuries, but provides insurance coverage for injuries incurred on or off duty. The TSGLI checklist is illustrated in the “Presumptives” section below:

46 Follow-up & Submission

The final section of the screening process asks about accessibility to healthcare provider and “buddy statements.” Then Claimants are asked standard eligibility questions regarding how their Claim Conditions were incurred. A positive response would result in deleting the claim condition because of ineligibility. (Removing the claim condition removes any applicable points from affecting the calculated “claim strength score.”)

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Submitting a Completed Screening Application

When the “Calculate” button is selected from the “Follow-up & Submission” section, a Claim Strength Score is created and depending on where the pre-defined cut scores were set, one of three indicators are displayed.

Upon calculation, a message will appear prompting the User to either schedule an intake appointment or not. For custom thresholds, a message prompting the Leads Specialist to obtain supervisory approval means that the primary cut-score was met; however, certain claim details make the claim “borderline” and requires supervisory approval before scheduling, or conducting a new client intake.

The “green checkmark” indicator means that the pre-defined, primary cut-score was met.

The Leads Specialist should offer to either conduct, or schedule, a new client intake.

The “Red X” indicator means the primary cut score, or other critical claim criteria, was not met.

The Leads Specialist should tactfully communicate that they are “unable to assist with claims of this type.”

The “Ask for Approval” indicator means that eligibility and primary cut score was met; however, something about the claim requires supervisory approval in order to represent the claim.

A policy should be created for the approval process when such records should be examined.

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Working with Results

The indicator messages are created by the account holder and should be followed. It is also recognized that there may be times when something else may be done with the claim regardless of the indicator message. The last set step of screening a VA disability claim is reporting what the User did as a result of the screening record they just submitted.

The screening questions, and menu lists are completely customizable by the Client Account Holder.

The questions and menu options below are for example purposes only.

“Completing” the record means the User does

not want to edit the form they just submitted.

The second option of this initial menu will immediately re-open the record just submitted so it could be edited and resubmitted.

If the User wants to complete the record, the next item asks what they did as a result of the screening.

“Inappropriate Claim” might be selected for a claim that may have received a passing score, but for some other reason, the claim is organizationally inappropriate.

In another scenario, if “Conduct Instant Intake” is selected, the Intake component intake will be opened to conduct an “instant intake.”

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If “Inappropriate Claim” is selected, then the next item presented is “Why is this an inappropriate claim?”

In this example, any of the options in this last screening result question would end the screening.

The User would be returned to the original “VA Claimant Identification” screen.

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Conducting a New Client Intake

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Conducting a New Client Intake

A new client intake may be conducted after every completed new client screening. The purpose of the new client intake is to obtain the client information required for representing a VA Disability claim. For example, the client’s social security number is required; the screening only captured that last four digits. The names and locations of treatment facilities are also obtained during the new client intake. Because the screening process is thorough, the new client intake only takes a few minutes.

If the intake process is not conducted immediately from the screening, a new client intake can be conducted by opening the client’s record from the selection table by selecting the “Intake” link as illustrated below.

52 When the Intake form opens, much of the information collected from the screening process is represented in the form fields. The empty fields have been highlighted yellow to identify them quickly.

53 Some of the information in the Intake screen is for reference in the event that the individual conducting the intake did not conduct the screening.

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55 Completing the Intake At the end of each intake screen, there are two buttons; the one labeled “Create PDF” is used to create an electronic PDF file of the completed screening and intake process forms; the file is automatically labeled with the Claimant’s last name and last four digits of their SSN then deposited on the User’s desktop.

The second button at the bottom of the intake screen is labeled “Submit” and is used to submit and complete the intake form. Upon submission, the User is returned back to the record selection table to conduct another VA screening or new client intake.

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Using the Claim Analyzer

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Using the Claim Analyzer

For each screening record completed, a detailed summary of a Claimant screening can be viewed by accessing the Claim Analyzer. The Claim Analyzer is useful for viewing daily screening volume and to quickly analyze “borderline” claims. Clicking on the “Claim Analyzer” icon from the Home screen will open the Claim Analyzer search screen that allows for Users to recall records according to many different criteria. The illustration below is of the claim Analyzer main search screen:

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Appendix A: VA Acronyms & Resources

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Helpful VA Acronym Definitions

The following acronyms are useful when working with VA Claim materials.

VA Acronyms

A/O Agent Orange AAFC Alternate Attorney Fee CoordinatorAFC Attorney Fee Coordinator AFD Attorney Fee Decision APFT Army Physical Fitness Test AGE Acute GastroenteritisBLH Bilateral Hearing LossBOS Branch of Service BVA Board of Veterans Appeals C&P Compensation and Pension C/W Consistent With

CABG Coronary Artery Bypass Graft SurgeryCAD Coronary Artery Disease

CAVC Court of Appeals for Veterans Claims CE Consultative Evaluation CFS Chronic Fatigue Syndrome CHF Congestive Heart Failure CLS Central Legal StaffCUE Clear and Unmistakable Error CXR Chest X-ray DD Dishonorable Discharge

DDD Degenerative Disc Disease DJD Degenerative Joint Disease DM Diabetes Mellitus

DMII Diabetes Mellitus Type II DMZ Demilitarized Zone (combat) DOB Date of BirthDOD Date of DeathDOS Dates of Service DRO Decision Review Officer Dx Diagnosis

EAJA Equal Access to Justice ActECF Electronic Case FilingEcho Echocardiogram EKG Electrocardiogram

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FOIA Freedom of Information ActFTP File Transfer Protocol Server FTR Failure to Report Fx Fracture GE Gastroenteritis

GRREG Graves RegistrationHD Honorable Discharge HI Homicidal Ideation HL Hearing LossHPI History of Present Illness HTN Hypertension IHD Ischemic Heart Disease IME Independent Medical EvaluationIMO Independent Medical OpinionIR Increased Rating IU Individual Unemployability

IVDS Intervertebral Disc Syndrome JD Jurisdictional Document

JSRRC Joint Services Resource and Research CenterKUB Kidney, ureters, & bladder x-rayLOD Line of Duty LTD Long Term Disability

LVEF Left Ventricular Ejection Fraction MACE Military Acute Concussion EvaluationMCP Metacarpophalangeal Joint MDD Major Depressive Disorder MEB Medical Evaluation BoardMET Metabolic EquivalentMOS Military Occupational Specialty MST Military Sexual Trauma MTP Metatarsalphalangeal Joint MVA Motor Vehicle Accident NOA Notice of Appeal (CAVC) or

NOApp Notice of Appearance (CAVC)NOD Notice of Disagreement NOA Notice of Action (RO) NPRC National Personnel Records Center OEF Operation Enduring Freedom OGC Office of General Counsel OIF Operation Iraqi Freedom

OMPF Official Military Personnel File

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OPC Out Patient Clinic ORIF Open Reduction and Internal FixationOSA Obstructive Sleep Apnea

OTHD Other Than Honorable Discharge P&T Permanent and Total PCP Private Care Physician

PDHA Post Deployment Health AssessmentPEB Physical Evaluation BoardPFB Pseudofolliculitis PN Peripheral Neuropathy

PTSD Post Traumatic Stress Disorder R&B Reasons and Basis RBA Record Before the AgencyRD Rating Decision RO Regional Office

ROM Range of Motion RVN Republic of Vietnam S/C Service Connection S/P Status PostSI Suicidal Ideation

SMC Special Monthly Compensation SMR Service Medical Record SOC Statement of the Case SOR Statement of Clients RightsSTR Service Treatment Record STS Significant Threshold Shift

TBSA Total Body Surface AreaTx Treatment

URI Upper Respiratory Infection UTI Urinary Tract Infection

VCAA Veterans Claims Assistance Act VGE Viral GastroenteritisVSO Veterans Service Officer

Abbreviations

AD Right Ear AS Left Ear AU Both Ears OD Right Eye OS Left Eye

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OU Both Eyes C with a line over it With S with a line over it Without P with a line over it After

Forms

21-22a Appointment of Representation

21-4138 Statement in Support of Claim (can be used for anything, NOD, buddy statements, etc.)

*10-5345 Medical Records Release3288 Used for C-File Release Form

21-8940 Application for Unemployability21-686c Dependents Form21-526 Veterans Application for Compensation and/or Pension

21-4142 VA’s Authorization to Release Information from Private Medical Files

SF180 NPRC Release Form (Standard Form 180)VAF 9 VA Form 9 – Appeal to BVA21-534 DIC Application21-0781 Veterans Stressor Statement21-4192 Employment Information

The following military website is also useful: http://www.militarywords.com/