Standard Operating Procedure for Veterans Outreach Ministries Claims
Objective: Facilitate Veterans in securing all eligible benefits through efficient claims management and communication.
Veterans Service Representative Division
1. Initiate Contact: Reach out to the Veteran to clarify the claims process and establish expectations.
2. Enter Veterans Demographics into Electronic Systems: Obtain the Veteran's power of representation by having them complete and return the power of representation form (21-22a). Submit an intent to file (20-0966) claim on the Veteran's behalf to the VA, establishing a backpay date for the compensation claim.
3. Gather Information: Contact the Veteran to collect relevant information regarding their past VA claims history and assist in completing medical release forms (21-4142 and 21-4142a).
Gather medical documentation and personal statements related to the Veteran's medical conditions stemming from military service from the Veteran and other sources.
Claims Support Specialist Division
4. Access VBMS: The Veteran’s claims support staff will obtain access to the Veterans Benefits Management System (VBMS) electronic database.
Medical Division
5. Nurse's Medical Documentation Review: A nurse will access VBMS to retrieve military and VA medical documents, rating decision code sheets, Tera memorandum, and prior claims decision decisions and generate a medical (AI) report through Super Insight. This report will assist in reviewing the Veteran's military service treatment records and personnel records and VA medical records. Identifying all illnesses, injuries, and diseases treated during their service.
6. Assess Presumptive Illnesses: The Nurse will evaluate if the Veteran shows symptoms or has a diagnosis of presumptive illnesses related to military service due to specific exposures. Veterans should be guided to understand what constitutes a presumptive illness and discuss symptoms they may not initially recognize.
7. Diagnosis Guidance: If symptoms are present without a diagnosis, the Nurse will recommend that the Veteran schedule a tele-health appointment with one of our nurse practitioners for the necessary diagnosis. These telehealth appointments are the Veteran’s responsibility for paying for. The medical division will send their findings over to the Veterans Service Representative Medical Division.
Veterans Service Representative Division
8. Prepare Support Statement: The Veterans Service Representative Medical Division will compile medical information from the Nurse's initial interview, service treatment records, and private medical treatment records. They will prepare an (AI) statement in support of the claim, linking pertinent medical information to substantiate the connection between conditions and military service and forward the information to the Claims Support Specialist Division.
Claim support specialist division
9. Final Review: The Claims Support Specialist Division will conduct a final review.
Claims Agent and Attorneys Division
10. Submit Claim: The Claims Agent or Attorney will electronically submit a fully developed claim through the Department of Veterans Affairs Benefits system. If necessary, submit a Dependency Claim.
Medical Division
11. Compensation Exams: Notify the Veteran about upcoming compensation exams and coach them on their medical conditions.
12. Provide Coaching Videos: Send VA compensation exam coaching videos to the Veteran to help them understand the questions they will encounter during the exam, enabling them to respond appropriately.
13. Guidance on Pain: Highlight VA laws regarding pain and frozen joints, helping the Veteran effectively communicate their symptoms and avoid activities that could exacerbate pain or injury during the compensation exam.
14. Mental Health Conditions: Ensure the Veteran connects their mental health condition to military service or demonstrates its relation to service-connected medical conditions.
Claims Support Specialist Division
15. Discuss Decision: After the claim decision is made, contact the Veteran to schedule an appointment to discuss the outcome from the Department of Veterans Affairs Benefits system.
16. New Intent to File: Immediately initiate a new intent to file to establish a backpay date once a claims decision has been made, setting a new backpay date for any new claims. Put the Veteran on the list to go through the nurse interview again with the Medical Division to see if any new medical conditions can be claimed.
17. Review for Appeals: Review the claim to identify conditions that may warrant an appeal.
18. High-Level Review: Submit a 20-0996 high-level review if era in law has been discovered on claims decision made by VA. Remember 70% of all claims are decided incorrectly by VA.
19. Supplemental Claim: If conditions were denied due to lack of medical diagnosis or disbelief in the relationship to military service, submit a supplemental claim (20-0995) with new and material evidence. Include a telehealth consultation with a qualified medical professional providing a Nexus statement linking the conditions to military service.
Medical Division
20. Re-interview Veteran: Re-interview the Veteran to identify new and secondary medical conditions and send findings back to the Veterans Service Representative Medical Division.
Veterans Service Representative Medical Division
21. Create New AI Medical Support Statement: Create a new AI medical support statement and forward it to the Claims Support Specialist Division.
Claims Support Division
22. File New Claim: File a new claim for secondary conditions related to the primary service-connected conditions and any new medical conditions.
23. Repeat Process: Continue the claims process until the Veteran achieves a 100% service-connected permanent and total rating or the highest possible rating.
Adherence to all legal and ethical guidelines is essential when assisting Veterans with their claims.
