II.ii.2.A.3.b. Replacing Missing Claims Materials That Were Previously of Record | | Follow the steps in the table below upon identification of missing claims materials that RO personnel may have previously viewed. | Step | Action |
|---|
| 1 | Ask any employee having knowledge of the facts surrounding the claim, including the date VA received it, to prepare a signed memorandum for the file containing this and any other relevant information for retention in the claims folder. Note: The “employee” referenced in this step would include the employee responsible for creating the electronic record referenced in M21-1, Part II, Subpart iii, 3.A. It might also include any employee who has taken action on the claim and remembers relevant details about it. | | 2 | Ask the employee’s supervisor to sign the memorandum. | | 3 | Determine what claimed issues the pending EP is being used to control. | If the EP is ... | Then ... |
|---|
| only controlling issues for the lost claim | change the controlling EP to an EP 400, Correspondence. | | controlling additional claimed issues | - continue processing the additional issues, and
- address the lost claim under the currently pending EP.
| | 4 | Send the claimant the Lost Claim Letter. Note: The letter should- inform the claimant that the claim was lost
- request that the claimant submit another application as evidence of the
- intent to file a claim, and
- scope of the claim
- request that the claimant resubmit any evidence previously submitted with the claim, and
- notify the claimant that if the requested evidence is not furnished within one year after the date of the letter, the claim may be considered abandoned under the provisions of 38 CFR 3.158.
| | 5 | Clear the EP 400, if one was established, after sending the letter. | Note: If, within one year of the date of the letter referenced in Step 4, a claimant resubmits a claim that VA lost, use the date of receipt of the initial (lost) claim as the DOC when reestablishing EP control. Otherwise, use the date of receipt of the resubmitted claim. |
4. Claims Materials That Are Misplaced in the CM System
Introduction | | This topic contains information on allegations from claimants or their representatives of lost claims associated with the CM system, including - fax confirmation page the CM scanning vendor provided to claimants, and
- resubmission of
- a lost claim with copy of the fax confirmation page, and
- alleged lost claims absent the VA date-stamped fax confirmation page.
|
Change Date | | November 30, 2020 |
II.ii.2.A.4.a. Fax Confirmation Page the CM Scanning Vendor Provided to Claimants | | The scanning vendor provided a single confirmation page to claimants when the vendor received documents via the designated intake fax number. The confirmation page - was faxed back to the claimant’s fax number, and
- consisted of a VA date-stamped copy of the first page of the claimant’s fax transmission.
Note: The first page of a claimant’s fax transmission was generally, but not necessarily, a cover sheet. Reference: For more information on the intake fax number for the CM scanning vendor, see the How to File a VA Disability Claim webpage. |
II.ii.2.A.4.b. Resubmission of a Lost Claim With Copy of the Fax Confirmation Page | | Claimants may resubmit a lost claim, but the claim must be accompanied by a copy of the original fax confirmation page referenced in M21-1, Part II, Subpart ii, 2.A.4.a. To retain the original DOC, the following must be provided in addition to a copy of the original fax confirmation page: - statement from the claimant or the appointed representative attesting to timely filing of the original documents, and
- copies of all the originally faxed documents that match the page count from the original fax confirmation page.
Example: If the confirmation page shows 10 pages received, including the cover sheet, more than 9 pages of resubmitted documents will not be accepted as eligible to receive the original VA date stamp provided by the CM vendor. Reference: For more information on the confirmation page provided to claimants by CM vendors, see M21-1, Part II, Subpart ii, 2.A.4.a. |
II.ii.2.A.4.c. Resubmission of Alleged Lost Claims Absent the VA Date- Stamped Fax Confirmation Page | | If a CM vendor fax confirmation page with a VA date stamp is not provided by the claimant alleging a lost claim, then the original DOC associated with the alleged lost claim cannot be accepted. References: For more information on the- confirmation page provided by the CM vendor, see M21-1, Part II, Subpart ii, 2.A.4.a, and
- resubmittal of a lost claim with a copy of the confirmation page, see M21-1, Part II, Subpart ii, 2.A.4.b.
|
5. Claims Materials Submitted Using a VA Electronic Application Process That Fails to Upload to the eFolderIntroduction | | This topic contains information on locating missing claims documents submitted using a VA electronic application process, including - identifying claims submitted using a VA electronic application process that failed to upload to the eFolder
- allowing time for automatic retransmission of documents that failed to upload
- requesting retransmission of claims documents that failed to upload, and
- notifying a Veterans service organization (VSO) that claims documents submitted through Digits-2-Digits (D2D) failed to upload.
|
Change Date | | February 5, 2021 |
II.ii.2.A.5.a. Identifying Claims Submitted Using a VA Electronic Application Process That Failed to Upload to the eFolder | | In rare situations, a technical error in the Enterprise Veterans Self Service (EVSS) system, which supports electronic transmission of claims material through VA claims submission service websites, results in the failure of a claims document to upload to the eFolder. These cases can be identified by- an automatically established EP
- an eBenefits claim label, and
- the absence of claims documents for the current claim in the eFolder.
Notes: - Claims documents submitted through the Digits-2-Digits (D2D) submission process cannot be recovered when transmission failure occurs. Upon identifying such a case, follow the instructions in M21-1, Part II, Subpart ii, 2.A.5.d.
- Claims submitted through D2D can be identified by the D2D claim labels.
|
II.ii.2.A.5.b. Allowing Time for Automatic Retransmission of Documents That Failed to Upload | | In most situations, if claims documents failed to upload through EVSS to the eFolder, the documents will be retransmitted within two weeks without any RO action. Follow the steps in the table below when a claim is received without supporting claims documents. | Step | Action |
|---|
| 1 | Add a new contention in VBMS with the following attributes: | In the field … | Enter … |
|---|
| CONTENTION | EVSS. | | CLASSIFICATION | Administrative Issue. | | DATE OF CONTENTION | (default to DOC). | | TYPE | New. | | MEDICAL | No. | | 2 | Add a tracked item to indicate the failure-to-upload issue is pending resolution. | | 3 | Add a note that states: Source documents missing. | Important: Ensure the claim goes to Ready to Recall – Yes status. References: For more information on- creating a tracked item in VBMS, see the VBMS Core User Guide, and
- the appropriate tracked item for claims documents failing to upload, see M21-4, Appendix D.1.
|
II.ii.2.A.5.c. Requesting Retransmission of Claims Documents That Failed to Upload | | Follow the steps in the table below if claims documents fail to upload after the 15-day period referenced in Step 2 of the procedure outlined in M21-1, Part II, Subpart ii, 2.A.5.b, ends. | Step | Action |
|---|
| 1 | Send an encrypted e-mail to the EVSS Help Desk. - Enter the following in the subject line of the e-mail: Requesting retransmission of VA claims submission service website documents that failed to upload.
- Provide the following in the body of the e-mail:
- date the EP was established
- claim label
- VBMS claim identification (ID) number
- claimant’s name, and
- an indication of what documents are missing.
| | 2 | Upload a copy of the e-mail to the eFolder. | | 3 | Update the track item to indicate the first follow-up has been completed. | | 4 | Add a note that states: EVSS Help Desk contacted for assistance in obtaining documents that failed to upload. | | 5 | After the 15-day period referenced in Step 4 ends, - review the eFolder to determine if the missing documents have been uploaded, and
- follow the instructions in the table below.
| If the documents are … | Then … |
|---|
| available | - continue processing the claim, and
- disregard the remaining steps in this table.
| | not available | follow-up with the EVSS Help Desk until- the claims documents are uploaded successfully, or
- a negative response from the EVSS Help Desk is received, indicating that the claims documents cannot be uploaded.
| Notes:- Extend the suspense date of the tracked item by one week after each follow-up until the
- claims documents are uploaded successfully, or
- EVSS Help Desk provides a negative response.
- Reference the COM ticket number in the follow-up emails. Upload a copy of all e-mail communication with the EVSS Help Desk to the eFolder.
| | 6 | Follow the lost claims procedures in M21-1, Part II, Subpart ii, 2.A.3.b if the EVSS Help Desk provides a negative response. | | 7 | Upload the negative response to the eFolder, if applicable. |
|
II.ii.2.A.5.d. Notifying a VSO That Claims Documents Submitted Through D2D Failed to Upload | | The D2D application submission process does not have functionality to re-transmit documents that have failed to upload. Follow the instructions in the table below when claims documents submitted through D2D fail to upload. | Step | Action |
|---|
| 1 | Add a new contention in VBMS with the following attributes: | In the field … | Enter … |
|---|
| CONTENTION | D2D. | | CLASSIFICATION | Administrative Issue. | | DATE OF CONTENTION | (default to DOC). | | TYPE | New. | | MEDICAL | No. |
| | 2 | Send an encrypted e-mail to the Veterans service organization (VSO) that submitted the claims documents. - Enter the following in the subject line of the e-mail: Requesting resubmission of D2D documents that failed to upload.
- Provide the following in the body of the e-mail:
- date the EP was established
- claim label
- VBMS claim ID number
- claimant’s name, and
- an indication of what documents are missing.
| | 3 | Upload a copy of the e-mail to the eFolder. | | 4 | Add a tracked item to indicate the failure-to-upload issue is pending resolution. | | 5 | Add a note that states: VSO contacted for assistance in obtaining documents that failed to upload. | | 6 | Follow the lost claims procedures in M21-1, Part II, Subpart ii, 2.A.3.b if the documents are not uploaded within 15 days. | Notes: - Telephone contact can be substituted for e-mail notification and is encouraged. Document successful contact on VA Form 27-0820.
- Upload all e-mail(s) or VA Form(s) 27-0820 to the eFolder, if applicable.
References: For more information on- creating a tracked item in VBMS, see the VBMS Core User Guide, and
- the appropriate tracked item for claims documents failing to upload, see M21-4, Appendix D.1.
|
Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part II, Subpart ii, Chapter 2, Section A (U.S. government work, reproduced for reference). Browse all sections →
|
|