Overview of
the Fully
Developed
Claims (FDC)
Program and
Provisional
Decisions
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FDC OVERVIEW
What is an FDC Claim?

VA claims that it will process FDC claims
within 90 days

In general, it is a claim filed on the proper
form (an EZ form) that is either ready to
rate, or would be ready to rate after the VA
obtains federal records and/or conducts a
VA examination.

If Guard or Reserve records are needed,
the claim will not qualify for the FDC
program.
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FDC OVERVIEW

EXCEPTIONS






EZ FORM NOT SIGNED
NON-FDC CLAIMS PENDING
NON-FDC CLAIMS ARRIVE WITH FDC CLAIM
APPEAL PENDING (and file is not at home RO)
NEEDS CHARACTER OF DISCHARGE DETERMINATION
DEVELOPMENT BEYOND VA OBTAINING FED RECORDS IN
POSSESSION OF FED GOV’T OR CONDUCTING VA EXAM
MOST OTHER CLAIMS QUALIFY

Example – Vet correctly asserts that he was exposed to a
toxic agent in service and now has symptoms that
he/she thinks are linked to that exposure
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FDC OVERVIEW
VA Forms and Guidance
 VA Forms to Use:
 21-526EZ (Application for Disability
Compensation and Related Compensation
Benefits) – Most recent version Jan 2014
 21-527EZ (Application for Pension)
 21-534EZ (Application for DIC, Death
Pension, and/or Accrued Benefits)
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FDC OVERVIEW
VA Forms and Guidance (continued)

Only claims filed on the EZ forms can qualify
for the FDC program.



Always use the most recent version of the form
DO NOT USE THE 2/2010 EZ FORM.
Fast Letters (FL) on the FDC Program: 13-17,
12-25 and 10-22.

NOTE – FL 10-22 was rescinded by FL12-25.
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Filing an FDC Claim
 Vets
can file FDC claims electronically
through the VA eBenefits portal, but
service reps do not have access to this
program.
 All EZ forms have a notice section.
 This section covers claims for most
compensation, pension, and DIC/Accrued
claims.
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Filing an FDC Claim
 Claimants
must sign the certification
on the appropriate VA form.
 The
1)
2)
claimant has two options:
Submit the claim as FDC, or
Check the box indicating they have
additional information to submit.
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Filing an FDC Claim
 If
“2” on the prior slide is checked –
indicating claimant has add’l info to
submit – then the claim will be
adjudicated in the traditional fashion

BUT VA will not send out a 38 U.S.C. § 5103 notice
and the claimant may obtain a decision at an
earlier time – relative to claims adjudicated after
“5103” notice is provided.
 The
VA will likely take several months less
time to process even if the box is
checked.
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Filing an FDC Claim
 If
the vet indicates that he/she wants
to file a claim through the FDC
program (in a letter or on VAF 214138), the VA will send an EZ form to
the claimant.
 This
policy extends to both informal
claims and incomplete applications

see 38 U.S.C. § 5102 and 38 C.F.R. § 3.109
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Filing an FDC Claim
 The
VA will accept:
 Claims for compensation on Form 21-526EZ as
an FDC claim,
 Claims for pension on Form 21-527EZ as an
FDC claim,
 Claims for both pension and compensation
when Forms 21-526EZ and 21-527EZ are both
filed simultaneously, and
 Claims for DIC, death pension, and/or
accrued benefits are filed on Form 21-534EZ.
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EFFECTIVE DATE ISSUES
VA Instructions on “Incomplete FDC
Claims”
 Page 4 of FL 12-25
“Consider any communication or action
that identifies intent to file a compensation,
pension, or survivor claim for processing in
the FDC Program as an incomplete FDC
application.”
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EFFECTIVE DATE ISSUES
VA Instructions on “Incomplete FDC Claims”
 Page 4 of FL 12-25 (this is not an exhaustive reci
Upon receipt of an incomplete FDC application:
 Establish EP 400
 Send the claimant the Incomplete FDC Claim Letter
(see Enclosure 3) generated via MAP-D (important)
and enclose the appropriate EZ form.
 Associate the incomplete FDC application with the
claims folder or the eFolder, as appropriate.
 PCAN the EP 400
 No further action on the incomplete FDC application
is required at this time
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EFFECTIVE DATE ISSUES
VA Instructions on “Incomplete FDC
Claims”
 Page 4 of FL 12-25
 If
a claims folder does not exist, and
eFolder is not appropriate, establish
a claims folder

see M21-1 MR, Part III, Subpart ii, Chapter 3.
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EFFECTIVE DATE ISSUES
VA Instructions on “Incomplete FDC Claims”
Important: If a claimant in a communication
identifies a specific contention (e.g., left leg,
diabetes, etc.) for consideration and a signed,
completed VA Form 21-526 or EZ form is of
record, consider it a formal application. Place
the claim under end product control (e.g., EP
110, 020, 010) effective the date of receipt of
the completed application, and forward it for
processing.
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FDC AUTHORITIES
38 U.S.C. § 5102
Application forms furnished upon request;
notice to claimants of incomplete applications.
(a) Furnishing forms. Upon request made by
any person claiming or applying for, or
expressing an intent to claim or apply for, a
benefit under the laws administered by the
Secretary, the Secretary shall furnish such
person, free of all expense, all instructions and
forms necessary to apply for that benefit.
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FDC AUTHORITIES
38 U.S.C. § 5102
Application forms furnished upon request;
notice to claimants of incomplete applications.
(b) Incomplete applications. If a claimant's
application for a benefit under the laws
administered by the Secretary is incomplete,
the Secretary shall notify the claimant and the
claimant's representative, if any, of the
information necessary to complete the
application.
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FDC AUTHORITIES
38 U.S.C. § 5102
Application forms furnished upon request; notice to
claimants of incomplete applications.
(c) Time limitation.
(1) If information that a claimant and the
claimant's representative, if any, are notified
under subsection (b) is necessary to complete an
application is not received by the Secretary within
one year from the date such notice is sent, no
benefit may be paid or furnished by reason of the
claimant's application.
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FDC CLAIMS PROCESSING
AND NEW 38 U.S.C. § 5110(b)
The statute states:
(2)(A) The effective date of an award of
disability compensation to a veteran who
submits an application therefore that sets forth
an original claim that is fully-developed (as
determined by the Secretary) as of the date of
submittal shall be fixed in accordance with the
facts found, but shall not be earlier than the
date that is one year before the date of receipt
of the application.
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38 U.S.C. Section 5110(b)


(B) For purposes of this paragraph, an original
claim is an initial claim filed by a veteran for
disability compensation.
(C) This paragraph shall take effect on the
date that is one year after the date of the
enactment of the Honoring America’s
Veterans and Caring for Camp Lejeune
Families Act of 2012 and shall not apply with
respect to claims filed after the date that is
three years after the date of the enactment
of such Act. [Date range is 8/6/13-8/6/15]
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FAQ
1.
What is an incomplete FDC application?
[See 38 U.S.C. § 5102]
 Where
the documents provided to the VA
do not constitute a claim – simply a
somewhat vague intent to file a claim.
 Example: unsigned application, or “I want
compensation benefits.”
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FAQ – INCOMPLETE
APPLICATIONS

If the application is not substantially
complete then:

Notify claimant (and the claimant's rep, if
any)
 Of
the information VA needs to consider
the application complete, and
 That failure to submit a substantially
complete application within one year will
result in no benefit being paid or
furnished by reason of that application.
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Retro Benefits for FDC

38 U.S.C. § 5110 allows up to a one-year
retroactive effective date for awards of disability
compensation, for claims received 8/6/13 –
8/6/15.

FL 13-17 clarifies VA’s position regarding the
effective date for claims eligible for the 1 year
retro benefit.

In general, otherwise continue to follow guidelines
outlined in FL 12-25 to determine whether the
claim is eligible for the FDC program (discussed in
previous slides).
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Retro Benefits for FDC
(per FL 13-17)

To be eligible for a retroactive effective date,
the following requirements must be met:



The claim must be for compensation – no other
types of claims are eligible (i.e. pension, etc.);
Claim must original; an original claim is defined
in FL 13-17 as the initial formal (complete) claim
filed by vet for disability compensation; and
Any applications submitted or filed subsequently
will be considered new or supplemental claims,
and therefore not eligible for a retroactive
effective date.
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Retro Benefits for FDC
(per FL 13-17)
To be eligible for a retroactive effective date, the
following requirements must be met:
• Informal (incomplete) claims are not eligible for an
additional retroactive effective date;
 The claim must be received on a VA Form 21526 EZ. Veterans can also apply through eBenefits;
 Vet must have separated from his/her last period
of active duty service more than one year ago;
and
 The claim must be received from 8/6/2013 –
8/5/2015

Note – per the statute, the end date is 8/6/2015.
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Retro Benefits for FDC
(per FL 13-17)



Claims eligible for the retro benefit, will have the
effective date calculated as whichever is the earlier of
1)
the date up to one year prior to receipt of the complete FDC if
the facts support such an effective date as explained in the
paragraph below, or
2)
the date of receipt of an informal claim for which a formal
(complete) FDC was subsequently received.
In either case, the effective date may not be more
than one year prior to the date the formal (complete)
FDC claim is received.
Note that the effective date will only be calculated based on the
date of receipt of the formal claim and NOT the incomplete
claim (even if a formal claim was later filed – the date the formal
claim was filed will control for the retro benefit)
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Provisional Decisions
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Introduction

VA’s initiative to make a “provisional”
decision based on the evidence of record,
unless the requests for the following types of
evidence are outstanding:




(1) SMRs for original claims;
(2) VA medical records;
(3) Any evidence needed to establish vet status
and/or pertinent service dates, if available
evidence is not otherwise sufficient; and
(4) VA exams, if such exams are pending at the
time the case is reviewed or required to issue a
decision.
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Evidence

The rating decision produced will be
considered a provisional rating unless ALL
evidence in support of the claim has been
received
And the claim is considered Ready To Rate
(RTR)
 Or the rating assigned provides the highest level
evaluation authorized for the particular DC for
each claimed issue.
The End Product (EP) will be cleared for any rating
completed as a result of this special initiative and
no issues will be deferred on a rating decision.

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Category 1 Cases
 ROs
will issue rating decisions, as normal,
for RTR cases that meet the 2-year old
criteria and for cases where the rating
assigned provides the highest evaluation
authorized in the Rating Schedule for
each claimed issue.
 These
will be FINAL decisions and appeal
rights will be provided.
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Category 2 Cases
 ROs
will issue “provisional” rating decisions
for other 2-year old cases even if VA is still
waiting for certain evidence.
 RVSRs
will complete these claims based
on the available evidence of record as
long as the appropriate Section (§) 5103
notice (formerly VCAA notice) was
provided to the claimant
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Category 2 Cases

UNLESS the following requests for evidence
are outstanding:




STRs for original claims;
VA medical records;
Any evidence needed to establish Vet status
and/or pertinent service dates, if available
evidence is not otherwise sufficient;
VA exams, if such exams are pending at the
time the case is reviewed or if one is required in
order to issue a decision.
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Category 2 Cases
 The
above minimal level of evidence must
be available before a Category 2 rating is
completed.
 Therefore,
in order to meet the required
completion date for these cases, ROs
must expedite procedures to secure this
evidence and decide the claim.
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Development

In any Category 2 case where the RO is
awaiting VA exam results, ROs will contact the
appropriate VHA facility or contract
examination provider to expedite completion
of the required exam(s) so that a decision
may be issued promptly.

VA has instructed that ROs should only order a
new exam when one is required to decide
the claim.
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Provisional Ratings

In the “evidence” section of the Rating
Decision, RVSRs will list all evidence
considered, as normal.

The RVSR will also list evidence identified but
not available at the time of the provisional
rating.

No issue(s) should be deferred on a rating
document
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Other Rating Considerations

For claims falling within the provisions of this
guidance, the prohibitions against certain
partial rating decisions found in M21-1MR
III.iv.6.A.1.b do not apply.

RVSRs should grant entitlement to SC for the
claimed disability at the highest justifiable
percentage of disability based upon the
evidence of record, as warranted.
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Special Rules

Upon promulgation of this provisional decision, the
VA will clear the controlling EP.

No appeal rights will be provided to the claimant
since the decision rendered is considered a
provisional decision.

After 1 year (or earlier if the claimant requests), the
claimant will be notified that the claim has become
final and provided appeal rights.

This only applies to cases worked under this special
initiative.
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Congressional Attention

6/20/13 - U.S. Senators Heller and Casey wrote
to USB Hickey with concerns

The Senators noted VA’s June 2013
announcement that 97% of all claims over 2
years old had been eliminated from the
backlog

Concerns were raised regarding the
accuracy of reporting the number of claims
being closed as well as quality
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Questions Posed to USB Hickey

Question 1: Of the claims cleared from the
backlog, were any of these claims considered
provisional—with provisional being defined as
“any aspect of the claim still remaining
open”?

Question 2: Is there any way a claim, with
issues still pending and in the ratings process,
can be deemed by the Veterans Benefit
Administration (VBA) to be closed solely for
reporting purposes?
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Questions Posed to USB Hickey

Question 3: Given the strict deadline for
completing all claims older than two years, did
Rating Veterans Service Representatives (RVSR’s)
have enough time to ensure the rating was the
correct decision for the veteran? If so, what was
the accuracy of the recently adjudicated claims?

Question 4: VBA was able to adjudicate the two
year old claims relatively quickly. Were any of
these claims unnecessarily delayed during the
claim development and ratings process? If so,
what was the cause of this delay?
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Advocacy Advice

USB Hickey never responded to the Senators’ letter

We have been advised by senior VA officials that
nearly all 2-year old cases are being processed
traditionally

We are watching the provisional decision-making
process carefully to ensure that it is not used as an
easy means to prematurely deny claims

It remains to be seen how VA will respond at the
end of the 1-year period following a provisional
decision if requested evidence remains
outstanding at that time
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