Veterans Outreach Claims Standard Operational Procedure
Objective: To assist Veterans in obtaining all eligible benefits through effective claims management and communication.
1. Initiate contact with the Veteran and explain the claims process.
2. Obtain power of representation from the Veteran. Have the veteran complete and return the power of representation form (21–22a) and the release of medical information forms (21-4142 and 21-4142a).
3. Submit an intent to file a claim on behalf of the Veteran to the VA, setting a backpay date for the compensation claim.
4. Gain access to the Veterans Benefits Management System electronic database, VBMS.
5. A nurse practitioner will review the Veteran's military service treatment records and identify all illnesses, injuries, and diseases treated during the Veteran's military service.
6. The nurse practitioner will determine if the Veteran has symptoms or a diagnosis of presumptive illnesses related to their military service due to certain exposures.
7. If symptoms are present but no diagnosis, the nurse practitioner will advise the Veteran to visit their primary care physician for the required diagnosis. If the primary care physician is unable to assist the Veteran, a claims support specialist will help the Veteran in obtaining a diagnosis by connecting them with a medical professional. Please note that these services are not free, and the Veteran will have to pay for them.
8. The claims support specialist will gather medical information from the Nurse Practitioner, as well as information from service treatment records and private medical treatment records. They will then prepare a statement in support of the claim, connecting all relevant medical information to substantiate the link between the conditions and military service.
9. The claims file will be sent to the accredited Claims Agent for a final review.
10. The Claims Agent will then submit a fully developed claim electronically through the Department of Veterans Affairs Benefits system.
11. If needed, the Veteran will be asked to call the VA hotline at 1-800-827-1000 to put in a dependency claim.
12. Inform the Veteran about upcoming compensation exams.
13. Send VA compensation exam coaching videos to the Veteran to familiarize them with the questions that will be asked during the exam. This will enable them to provide proper responses.
14. The videos will emphasize VA law regarding pain and frozen joints, guiding the Veteran in effectively communicating their symptoms and ensuring they do not do anything at the compensation exam that may cause pain or injury.
15. Ensure the Veteran relates their mental health condition back to military service or demonstrates that they are secondary to service-connected medical conditions.
16. Encourage the Veteran to communicate all relevant mental health symptoms by providing them with the disability benefit questionnaire for mental health. This will help them understand the symptoms the compensation exam evaluator will be evaluating.
17. Monitor the Veterans Benefits Management electronic system for claim decisions and contact the Veteran when a pre-decision has been made. This will keep the Veteran informed about the possible outcome of their claim.
18. Once the claim has been decided, contact the Veteran to set up an appointment to discuss the decision made by the Department of Veterans Affairs Benefits system.
19. Initiate a new intent to file to establish a backpay date for new claims.
20. Review the claim with the Veteran to identify conditions that require appeal.
21. Submit a 20-0996 high-level review for a higher-level reviewer to identify errors in the decision.
22. If conditions were denied due to a lack of medical diagnosis or VA's disbelief in the relationship to military service, submit a supplemental claim (20-0995) with new and material evidence. Include a medical Nexus letter from a qualified medical professional stating the direct link between the conditions and military service.
23. File a new claim for secondary conditions related to the primary service-connected conditions.
24. Repeat the claims process until the Veteran achieves a 100% service-connected permanent and total rating or reaches the highest possible rating. Note: It is crucial to follow all legal and ethical guidelines when assisting Veterans with their claims.
