The National Service Program and the Department/Chapter Service Program

Transcription

1 The National Service Program and the Department/Chapter Service Program Pat Byers American Lake VA Medical Center 9600 Veterans Drive Building 16, Room 110 Lakewood, WA Voice (253) Fax (253)

2 Roles & Responsibilities The NSD is responsible for all service programs with the Military Order of the Purple Heart and issues all Service Officers Policies, Procedures and Directives. They are responsible for the training and accreditation of the National Service Officer. Department and Chapter Service Officers are appointed by their respective Department/Service Commanders, however; they must adhere to all directives of the NSD with respect to veterans claims. This compliance is to ensure uniformity of service and to prevent liability issues from non-compliance. 2

3 Service Officers Code of Ethics MOPH Accredited National Service Officers and Non-Accredited Department and Chapter Service Officers are obligated to operate under a strict Code of Ethics. The Code of Ethics are: Ensure compliance with the Federal Privacy Act and HIPPA Regulations. Prepare and Perfect all claims to the best of their ability that affords the claimant the benefits they have an entitlement. Maintain high professional standards in in dealing with other service officers, persons, and agencies as necessary to service his or her client. 3

4 Service Officers Code of Ethics Provide services without prejudice to all persons making a claim with the DVA. To the best of their ability, maintain a working knowledge of all rules and regulations concerning veteran s benefits and strive to keep such knowledge updated of the constantly changing laws and regulations. Shall not under any circumstances, accept remuneration in cash or other form for services rendered. Shall not under any circumstances, serve as guardians, committees, or fiduciaries for any other individuals receiving benefits from the DVA or any other agency. 4

5 National Service Officers MOPH Service Officers are employee of the organization who have been accredited by the DVA to act as advocate representatives for veterans and dependent clients. As employees, only NSO s are covered by MOPH liability insurance for any errors and omissions made in the course of representing their clients before the DVA. This is the reason accredited NSO s are the only type of service officer allowed to formally accept Power of Attorney (POA) on behalf of MOPH. The duties of the accredited NSO, as outlined in the MOPH National Service Officer Policy and Procedure Manual, include, but is not limited to, providing free assistance, service and representation to all eligible US Veterans, their dependents, survivors, widows, and orphans. 5

6 Department and Chapter Service Officers The DSO/CSO with guidance from the NSD and working with the nearest MOPH accredited NSO, advise and assists veterans and dependents with claims for benefits from any government agency and assists veterans in securing suitable employment. The DSO/CSO is important to the success of MOPH s support to veterans, but it is critical that DSO s appreciate the somewhat limited role they play in assisting veterans with the claims process. The distinct difference in the responsibilities of a DSO/CSO and the NSO is that the DSO/CSO shall advise and assist veterans, their dependents, and survivors in the technical preparation of claims and submit them to the nearest MOPH accredited NSO. 6

7 Department and Chapter Service Officers The DSO s other major responsibility is to assist and cooperate with the subordinate Chapter Service Officers (CSO) as listed in the Department / Chapter Service Program Policy Manual. A DSO/CSO should never formally accept, sign, or enter any information in Blocks 3b, 3c, 11, 17, and18 of VA Form This information will be completed by the Accredited NSO if they accept the claim. It is the responsibility of the DSO/CSO to maintain open communications and a professional working relationship with the NSO s and the NSO s RFS. The CSO is the front line contact for most veterans in the community. Many times, this is the first contact a veteran or the family member has with an established service organization. 7

8 Accredited NSO Points of Contact Region III Regional Field Supervisor Darlene Davis (406) National Service Officers Roslyn Miller & Jolonda Terry nd Avenue Room 1062D Seattle, WA (206)

9 The Claims Process Service Officers Goals Definition of a claim Time Limits Identify Evidence & potential benefits for claimant Claim Presentation Basic Forms Completion 9

10 Scenario I A Vietnam Veteran has contacted you and wants to file an increase for his S/C Diabetes II. His doctor has provided him a Medical Statement verifying that he went from Oral Medication to Insulin. What issues do you explore? Is the veteran entitled to an increase based on the information provided above? 10

11 Scenario II A OIF/OEF Veteran that you have contact with was denied S/C for her Lower Back Strain due to no nexus for the claimed condition. She has new medical evidence that shows her diagnosis for the Lower Back Strain and that the condition is now affecting her right hip. She wants to reopen her lower back claim and also claim the right hip condition. What issues do you explore? Is the veteran able to reopen her claim for the back condition and also claim the hip condition? 11

12 Service Officers Goal The goal of the National Service Officer is to obtain all possible VA Benefits for the Veteran, Survivor and Claimant in the shortest possible time. This is accomplished by having a thorough understanding of the Statute and Regulations that govern the Adjudicative Procedures of VA Claims, and the understanding of the internal VBA Claims Process. The MOPH National Service Officer Customer Service Standards are; M O P H Maximum Effort Operational Effectiveness Professional Attitude Honest Communication 12

13 The Claims Process Every veteran has a right to file a claim for a VA benefit. Every veteran may not have a right to our organization s representation! Generally, good NSO s accept claims that have a reasonable chance of success and that are substantially complete. 13

14 Appointment as Representative The VA Form (Appointment of Veterans Service Organization as Claimant s Representative) is used by the VA to recognize which Veteran Service Organization (VSO) is the organization of record to represent the veteran s claim. The Moph POA must also be included with the Claim Packet to the Accredited Service Officer. The accredited NSO will become the Service Officer for the veteran if the representation is accepted. If the DSO/CSO wishes to inquire into specifics of the claim, include a Release of Information with the claim. 14

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17 The Claims Process Definition of a claim Claim -- Application means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement, to a benefit. 17

18 Applications Original Claim Non-Original Claim Informal Claims Other Methods 18

19 Original & Non-Original Claims An original claim is an initial formal application on a form prescribed by the Secretary of the Department of Veterans Affairs (VA). Depending on the claimants request and the interpretation by the VSR of the claimants intent, VA Form or the variants of this form, constitutes an original claim for: Disability Compensation Disability Pension, or Both A Non-Original claim is a claim that has been previously adjudicated. 19

20 Informal Claim o (a) Any communication or action, indicating an intent to apply for one or more benefits under the laws administered by the Department of Veterans Affairs, from a claimant, his or her duly authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui juris may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within 1 year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. 20

21 Informal Claim o (b) A communication received from a service organization, an attorney, or agent may not be accepted as an informal claim if a power of attorney was not executed at the time the communication was written. o (c) When a claim has been filed which meets the requirements of disability or death benefits, an informal request for increase or reopening will be accepted as a claim. 21

22 Fully Developed Claim Must Submit with VA Form ez or ez form along with the FDC Certification. The FDC Certification is now a part of the new ez. Must be a Claim for Live Compensation or Live Pension. All Private Medical Treatment Records and an identification of any treatment records from a Federal Treatment Facility must accompany the claim. Attach VA Form c if the veteran has dependents. For PTSD claims, attach VA Form No VA Form is allowed. For Guard and Reserve members, any and all Service Treatment Records in custody of their unit. 22

23 Fully Developed Claim For pension claims, include all necessary income and net worth Information. For Special Monthly Pension claims, completed VA Form , examination for household status or permanent need for regular aid and attendance, Or if claiming Special Monthly Pension based on nursing home attendance, a VA Form Must be able to report for a VA examination. Claims submitted should be Adjudicated within 90 days from date of application. 23

24 Fully Developed Claim If the FDC is informal, enter the following statement only; I intend to apply for compensation/pension benefits under the FDC Program. This statement is to preserve my effective date for entitlement to benefits. I am in the process of assembling my claim package for submission. 24

25 Time Limits There is no time limit for a veteran to file an original claim. It is easier to show a medical nexus or continuity of symptoms between service event and current disability the sooner a claim is filed. There is no time limit to file for an increase of current Service Connected Conditions. Evidence that the condition has worsened generally does not support an increase for benefits. The evidence required to support the increase must show that the condition has worsened to the next degree of severity on the Schedule of Rating for the Diagnostic Medical Code that the condition was rated under. 25

26 Time Limits There is no time limit for a veteran to reopen a claim that was previously denied. To reopen a previously denied claim, the veteran must submit New and Material Evidence. A claimant may reopen a finally adjudicated claim by submitting new and material evidence. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 26

27 Claims Presentation What should a claim look like? Professional Complete Simple Skip boiler plate Ensure that Client is aware of their responsibilities 27

28 Identify & Explore Issues from Scenarios I & II 28

29 Identify Issues Scenario I A Vietnam Veteran has contacted you and wants to file an increase for his S/C Diabetes II. His doctor has provided him with a Medical Statement verifying that he went from Oral Medication to Insulin. What issues do you explore? Is the veteran entitled to an increase based on the information provided above? NO 29

30 Identify Issues Scenario II A OIF/OEF Veteran that you have contact with was denied S/C for her Lower Back Strain due to no nexus for the claimed condition. She has new medical evidence that shows her diagnosis for the Lower Back Strain and that the condition is now affecting her right hip. She wants to reopen her lower back claim and also claim the right hip condition. What issues do you explore? Is the veteran able to reopen her claim for the back condition and also claim the hip condition? NO 30

31 Identify Issues Scenario III A OIF/OEF Veteran has recently left the service in the last 40 days with an honorable discharge. He has his entire Service Medical Records that includes diagnoses for PTSD, Right Shoulder Pain & Arthritis. He also states that he has a GSW in the Right Shoulder, Shrapnel in his Right Shoulder, and his Right Elbow makes a popping sound occasionally. He has had no other medical treatment. His DD 214 shows he did not receive a Dental Examination prior to discharge. What issues do you explore? Is there anything we can do to assist this veteran? Yes 31

32 Army Review Boards Agency The address for the Army Review Boards Agency (ARBA) and its boards changed to: Army Review Boards Agency th Street South, Suite 385 Arlington, VA Applications to the following Army boards should be mailed to this address: Army Board for Correction of Military Records (ABCMR) - DD Form 149 Army Discharge Review Board (ADRB) - DD Form 293 Department of the Army Suitability Evaluation Board (DASEB) Army Grade Determination Review Board (AGDRB) Mail previously sent to the prior 1901 S. Bell Street address is being forwarded by the various mail services to the new address. 32

33 VA & DOD Forms Links to VA & DOD Forms in PDF Format are listed on this slide. Remember, some of the DSO s and CSO s may have never seen these forms before! 33

34 Questions If there are any questions about a claim, a National Service Officer is available and will be more than happy to answer your questions. Thank You 34

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36 Questions & Comments Thank You and enjoy your week of Annual Training Pat Byers (253)