What is The Veterans Claims Assistance Act of 2000?
From: "Bruce K. Melson" <doc32751@cookeville.com>1.
What is The Veterans Claims Assistance Act of 2000?
<?fontfamily><?param
Times New Roman>On November 9, 2000, the President signed into law P.L.
106-475, superseding<?color><?param 0100,0100,0100> the decision
of the Court of Appeals for Veterans Claims in Morton
v. West, which held that VA cannot assist in the development of a
claim that is not well grounded. This law eliminates the concept of a well
grounded claim, and redefines our duty to assist. In view of this new
legislation, VBA Letter 20-99-60, Fast Letter 99-89, and Fast Letter 99-99 are
rescinded.
P.L. 106-475 enables and defines VBA’s duty to assist claimants who file
substantially complete claims for VA benefits. That statutory duty to assist
includes:
<?paraindent><?param out>developing for all relevant evidence in
the custody of a federal department or agency, including VA medical records,
SMRs, Social Security Administration records, or evidence from other federal
agencies,<?/paraindent>
<?paraindent><?param out>developing for private records and lay or
other evidence,<?/paraindent>
<?paraindent><?param out>a duty to examine veterans or obtain a
medical opinion if the examination or opinion is necessary to make a decision
on a claim for compensation. <?/paraindent>
Compensation and Pension Service is developing proposed regulations to
implement the new law. This letter is intended as guidance only for claims
processing until those regulations are finalized.
<?fontfamily><?param Arial>2.
How Does This Law Affect Claims Currently Pending And Those Received Before
Implementing Regulations Are Final?
<?fontfamily><?param Times New Roman>We should review pending
claims and new claims and apply the duty to assist criteria of the new
law.
When an application is received, we should determine if it is substantially
complete. In the interim period before a final regulation is effective,
consider a substantially complete application to include:
<?paraindent><?param out>name,<?/paraindent>
<?paraindent><?param out>identifying service information,<?/paraindent>
<?paraindent><?param out>benefit claimed,<?/paraindent>
<?paraindent><?param out>disability(ies) for which the benefit is
claimed in compensation claims,<?/paraindent>
<?paraindent><?param out>signature, and <?/paraindent>
<?paraindent><?param out>income information for pension
claims.<?/paraindent>
If the application is not substantially complete, we should notify the
claimant and the claimant’s representative, if any, of the information he or
she needs to give us in order to complete the application. Our procedures
regarding formal and informal claims (M21- 1, Part III, 2.01) have not changed
for end product control purposes.
We may defer assistance in developing evidence if the application is not
substantially complete.
If the application is substantially complete, the statute requires that we
notify the claimant and the claimant’s representative, if any, of:
<?paraindent><?param out>any information or evidence including
medical and lay evidence, that is necessary to substantiate the claim; and
<?/paraindent>
<?paraindent><?param out>what information or evidence he or she is
to submit to us, and <?/paraindent>
<?paraindent><?param out>what evidence we are going to attempt to
obtain on the claimant’s behalf. <?/paraindent>
That notice should be in writing and should also request that the claimant
give us information we need to help obtain supporting evidence. An example of
such information would be a completed VA form 21-4142 so that we can request
private medical records on behalf of the claimant.
That notice must also inform the claimant that if the information requested
from the claimant to substantiate the claim is not received within one year
from the date of the notice, no benefit may be paid on that application.
Note: Before forwarding any cases to the BVA we need to ensure that we
have fulfilled our duty to assist as it exists under this new legislation.
<?fontfamily><?param Arial>3.
How Does The Duty To Assist Affect Us When Requesting Non- Federal Records?
<?fontfamily><?param Times New Roman>The statute states
that the Secretary shall make “reasonable efforts” to assist a claimant in
obtaining the evidence necessary to substantiate a claim. Pending publication
of a final rule, the determination as to what constitutes “reasonable
efforts” will be based on the circumstances of the case. We believe that
“reasonable efforts” to obtain documentary evidence that is not under the
jurisdiction of a Federal department or agency would ordinarily require an
initial request for such evidence, and at least one follow-up request if no
response is received from the custodian of the records.
When requesting records from non-federal sources we should routinely allow 60
days for a response to our initial request. We should allow a minimum of 30
days for a response to our follow-up request.
At the time of the follow-up request, we should send a letter to the claimant
advising that he or she is ultimately responsible for providing the evidence,
but that we are making a follow-up attempt. We should also advise the claimant
that if we are unable to obtain the requested evidence, we will process the
claim based on the evidence of record.
We should make additional efforts to obtain the requested evidence where there
is reason to believe that subsequent requests will result in obtaining the
documents.
Documents encompassed within the scope of this development include medical
records from all sources that the claimant adequately identifies. We should
request that the claimant identify the type of record to be obtained, its
custodian, the medical condition to which these records relate, and the
approximate time frame covered by these records. These requirements apply to
all types of records, other than service medical records. If necessary, the
claimant must complete a medical release.
Note: The letter to the claimant sent at the same time as the follow-up
request does not fulfill the duty to notify the claimant described in
Paragraph 5 below. Accordingly, if the requested information is not received
in response to the follow-up response, further notification as required in
Paragraph 5 must be sent.
<?fontfamily><?param Arial>4.
What if The Records Are Under The Jurisdiction of A Federal Department or
Agency?
<?fontfamily><?param Times New Roman>Where the records
requested are in the custody of a Federal department or agency, the statute
obligates us to continue our attempts to obtain these records until we obtain
them or until it is reasonably certain that the records do not exist, or that
further efforts by VA to obtain them would be futile.
A conclusion that further attempts would be futile should be determined case
by case based on the type of response we receive from the custodian of the
record. We must receive a response from the custodian before assuming we
have met our duty to assist. We can be reasonably certain that the records
do not exist or that further attempts would be futile in cases where we
receive a reply from the custodian of the records stating that it does not
have the requested records and does not know where to obtain them.
Documents included within this provision of the statute include, but are not
limited to:
<?paraindent><?param out>service medical records and other
relevant identified records pertaining to the claimant’s active military,
naval, or air service that are held by a governmental entity,<?/paraindent>
<?paraindent><?param out>records of relevant VA medical treatment
or examination or treatment or examination at a non-VA facility if authorized
by VA, provided the claimant adequately identifies the records and,<?/paraindent>
<?paraindent><?param out>any other relevant records held by any
Federal department or agency that the claimant adequately identifies and
authorizes us to obtain.<?/paraindent>
In claims for disability compensation the statute requires that we obtain all
these records if relevant.
It is essential for us to frame our initial and follow-up requests for
these records in a complete and specific way so that the necessary
information, evidence or a negative reply is received.
<?fontfamily><?param Arial>5.
What If We Are Unable To Obtain All The Relevant Records?
<?fontfamily><?param Times New Roman>If we have made
reasonable efforts to obtain relevant non-Federal records, but have not
received some or all of them, and/or we have concluded that it is<?fontfamily><?param
Arial><?bigger> <?fontfamily><?param Times New
Roman><?smaller>reasonably certain that further<?fontfamily><?param
Arial><?bigger> <?fontfamily><?param Times New
Roman><?smaller>efforts would be futile, the statute requires that we
notify the claimant that we were unable to obtain the records. This
notification should be sent after all development efforts have been exhausted.
This notification must:
<?paraindent><?param out>identify the records we were unable to
obtain,<?/paraindent>
<?paraindent><?param out>briefly explain the efforts we made to
obtain those records, and<?/paraindent>
<?paraindent><?param out>describe any further action that we will
take with respect to the claim including processing the claim based on the
evidence of record. <?/paraindent>
<?fontfamily><?param Arial>6.
When Should We Request An Examination or Opinion?
<?fontfamily><?param Times New Roman>In claims for
disability compensation the statute requires that we assist the claimant by
providing a medical examination or obtaining a medical opinion when the
examination or opinion is necessary to make a decision on the claim.
Pending publication of final regulations, we may consider an examination or
opinion as necessary when, after
we develop all other relevant evidence, including statements of the claimant,
the file contains:
<?paraindent><?param out>competent medical evidence that the
claimant has a current disability, or competent evidence that the claimant has
persistent or recurrent symptoms of disability. A claimant is competent to
describe symptoms of disability that he or she is experiencing, such as a pain
in the knee; however, because a claimant ordinarily lacks medical training and
experience, he or she would not be competent to diagnose his or her own
medical condition or offer a medical opinion; and <?/paraindent>
<?paraindent><?param out>supporting evidence from service records
or other sources that the claimant suffered an event(s), injury or disease in
service that may be associated with the claimant’s current disability or
symptoms of disability; but<?/paraindent>
<?paraindent><?param out>does not contain sufficient medical
evidence for us to make a decision on the claim.<?/paraindent>
We should request a medical examination or opinion when it is necessary to
make a decision on the claim, such as when the medical examination or opinion
will address the final issue necessary to be resolved before determining
whether the claim should be granted or denied. When seeking a medical opinion,
it is essential to be very clear as to what information or opinion we are
seeking in our request. We should send the claims file or excerpts of
pertinent information from the claims file with the opinion request and direct
the medical examiner to review it and provide a rationale for any opinion.
Attached to this letter are some sample case scenarios to provide a guide as
to when an examination or opinion should be requested pending final
regulations addressing this issue.
We do not need to request an examination or opinion if there is medical
evidence of record that is adequate to rate the case.
<?fontfamily><?param Arial>7.
What Happens with Cases Previously Denied As Not Well Grounded?
<?fontfamily><?param Times New Roman>If a claim was
denied using the Morton
procedures, the claimant has a right to request re-adjudication whether the
denial or dismissal was by a regional office, the Board of Veterans' Appeals,
the United States Court of Appeals for Veterans Claims, or the United States
Court of Appeals for the Federal Circuit. This applies to any claim denied or
dismissed which
<?paraindent><?param out>became final during the period beginning
on July 14, 1999 (Morton v. West Decision), and ending on November 9, 2000, and
<?/paraindent><?paraindent><?param out>was denied or
dismissed as not well grounded.<?/paraindent>
We will re-adjudicate these cases as if the denial or dismissal had not
been made. A claim may not be re-adjudicated unless a request for
re-adjudication is filed by the claimant, or a motion is made by the
Secretary, no later than two years from November 9, 2000, the date of
this Act. We are not required to initiate a special review to locate and
re-adjudicate claims denied as not well grounded during this period in the
absence of a timely request by the claimant. However, if such a case is
discovered, our policy is to develop it and re-adjudicate it on our own
initiative.
We should anticipate that claims previously disallowed as not well grounded
will be reopened.
<?fontfamily><?param Arial>8.
How Will We Control and Take Work Credit for Re-adjudicated Cases?
<?fontfamily><?param Times New Roman>The
reconsideration requests stem from a change in the law. We should initiate
review and development of these claims within 45 days of receipt of the
request. The appropriate end product control for these requests is under the
020 series (i.e. 020, 024, 029).
To help track the re-adjudication requests, establish end product 684 to run
concurrent with the end product 020. The date of claim on the EP 684 should be
the same as the controlling end product and should remain pending until we
take final action on the re- adjudicated issue. We will monitor the EP 684
data to assist in tracking the number of reconsideration claims received and
the length of time it takes to resolve them. This additional end product is
only for use with reconsideration of a claim denied as not well- grounded
under the Morton procedures
during the period beginning July 14, 1999 and ending October 19, 2000 (the
date of the Under Secretary’s letter advising to discontinue Morton
denials).
Note: The requirement and authority to take a one-time EP 684 credit to track Morton
denials ended October 19, 2000.
<?fontfamily><?param Arial>9.
How Do We Handle Pending Claims Developed Under Previous Guidelines?
<?fontfamily><?param Times New Roman>We will encounter
many claims which were properly developed under guidelines in effect before
this legislative change. We must ensure that the actions we took, to prepare a
claim for a decision, conform with the duty to assist guidelines explained in
this letter. If we have all the evidence that is necessary to substantiate the
claim, we have complied with our duty to assist. If we do not have all of the
evidence the claimant identified, we must make the reasonable efforts, as
explained in this letter, including the notice requirements, before making a
decision on the claim.
If our review identifies a need for additional development, take action to
request the evidence. Continue controlling the claim under the existing end
product. To help us track the impact of rehabilitating these claims, establish
end product 690 to run concurrently with the controlling end product. The
date of claim for EP 690 should be the date of the change in law, November 9,
2000, and should remain pending until you take final action on the
rehabilitated claim. This additional end product is only for use on claims
where initial development action was taken prior to the date of this letter.
Note: The requirement and authority to take a one-time EP 684 credit to track Morton
denials ended October 17, 2000. This letter supersedes any other directive
regarding use of EP 690. EP 690 may only be used to track claims requiring
rehabilitation due to this legislation, as discussed above.
<?fontfamily><?param Arial>10.
When Can We Expect Further Information Concerning Our Duty to Assist?
<?fontfamily><?param Times New Roman>Compensation and
Pension Service will be working hard to incorporate this new legislation into
our regulations and manuals. C&P Service will work with our stakeholders
to assure the proper implementation of this Act and will provide further
information as it is developed. In the interim, we should err on the side of
caution and examine veterans or request opinions where we are unsure of the
need for such examination or opinion. A conference call and/or satellite
broadcast will be scheduled shortly to discuss this new legislation in further
detail.
Questions regarding our duty to assist should be submitted to the Q&A
mailbox at VAVBAWAS/CO/21Q&A
by the station Question Coordinator. (Fast Letter 99-126).
The implementation of P.L. 106-475 is going to be very challenging for all of
VBA and is an opportunity for us to show our commitment to serving veterans.
This new legislation may not only mean that cases pending and completed in the
past year will have to be re-worked by those of us in the Service Center, but
the increase in our workload due to these claims will also have an impact on
veterans, medical center employees, and service officers. However, we need to
remember that this legislation is intended to afford every veteran the
opportunity to establish entitlement to benefits and this is what our mission
is all about.
This letter will be rescinded November 1, 2001.
/S/
Robert J. Epley, Director
Compensation and Pension Service
<?center>VA Examination/Opinion
Guides<?/center>
The following are some sample case scenarios that may be helpful in
determining when to request a medical examination or opinion, pending
publication of a final regulation.
1. Service medical records for a peace time veteran show an acute situational
reaction treated in service related to his divorce followed by treatment for
anxiety. Post-service treatment records show mental health counseling for
family problems and for depression. Ten years after discharge, as shown by the
evidence, he was diagnosed with paranoid schizophrenia. He claims that the
treatment in service was for beginning manifestations of this schizophrenia.
Examine? Yes. There is evidence
of treatment for a psychiatric condition in service, and competent evidence of
a current medical condition. There is also evidence that between the time of
discharge and the present, the veteran was treated for psychiatric conditions.
The issue of whether the condition in service may be associated with the
current condition, or was the onset of the current diagnosis of paranoid
schizophrenia is a medical question that requires either a medical opinion
upon review of all the evidence of record and, if necessary, a VA examination.
2. Service medical records for a Korean veteran show that he sustained a back
strain during service in 1951, and had subsequent treatment for chronic low
back pain. He was honorably separated in 1953, with the condition noted as
resolved. Medical evidence of record shows that in 1980 he sustained a
lumbosacral strain while lifting boxes at work. In 1990, an L4-5 discectomy is
performed. Current medical evidence shows a diagnosis of postoperative
residuals of L4-5 discectomy with degenerative changes. The veteran alleges
that the current back problem had its onset in service.
Examine? Yes. There is evidence
of an in-service incurrence, a competent evidence of a current condition, and
evidence of treatment between the time of discharge and the present. The issue
of whether the current condition is associated with the in-service condition
or is possibly associated with the work-related injury would necessitate
either a request to the examiner for a medical opinion on this issue or an
opinion with an examination of the veteran, depending on the evidence of
record as to the current status of the back condition.
3. Service medical records for a Vietnam veteran show complaints of gastric
distress and gastrointestinal complaints, and indicate that she was treated
with Tagamet. Service medical records indicate that the condition was
resolved. Post-service medical records contain several entries showing
treatment for various gastrointestinal complaints over the past 20 years, with
a current diagnosis of gastroesophageal reflux disorder. The veteran files a
claim for service connection for a gastrointestinal condition, unspecified.
Examine? Yes. There is evidence
of a gastrointestinal complaints in service, even though at discharge they
were noted to be resolved. There is also competent evidence of a current
condition involving the digestive system. In addition, there is evidence of
continuity of symptoms indicating that it is possible that the current
condition may be associated with the condition noted in service.
4. Service medical records for a Vietnam veteran show complaints of gastric
distress and gastrointestinal complaints, and indicate that she was treated
with Tagamet. Post- service medical records contain no evidence of treatment
for any gastrointestinal condition. The veteran files a claim for service
connection for an ulcer. Full development results in no medical evidence
showing a current diagnosis of an ulcer.
Examine? No. There is no
competent evidence of a current condition, lay or medical. The veteran is not
competent to diagnose an ulcer; that is a medical diagnosis for which the
statute requires competent evidence. If development had uncovered competent
evidence, lay or medical, then
an examination would be warranted in this case.
5. Veteran submits a claim five years after discharge from military service
for chronic left hip pain. He states that he served as an airborne ranger
participating in multiple parachute drops. He indicates that he landed
awkwardly, injuring his left hip but did not seek medical treatment, rather
completing the field exercise. He indicates that afterwards he continued to
feel discomfort particularly following subsequent jumps but did not seek
treatment. He reports continuing discomfort which he treats with over the
counter medications. He also submits a statement from his wife testifying that
he had continued to complain of hip pain since service and that he had quit
jogging because of his hip complaints. Service medical records do not show
treatment for a hip condition. However, service personnel records do document
duty as an airborne ranger and confirm participation in twenty parachute
drops.
Examine? Yes. There is credible
evidence of an in-service event based on the veteran’s testimony and
documented nature of duty (participation in multiple parachute drops). There
is credible evidence of persistent symptomatology based on the veteran’s and
his wife’s testimony. Examination should include a request that if a current
chronic condition is diagnosed, the examiner should provide a medical opinion
as to whether or not the current disability is related to a history of
multiple parachute drops.
6. Service records show the veteran was a POW. There is competent evidence of
a current POW-related presumptive condition.
Examine? Yes. There is an event
in service and a condition, that by regulation, may be presumptively
associated with that event in service.