The Fully Developed Claim (FDC) Program
VETERANS BENEFITS ADMINISTRATION
Topics
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Types of revised EZ Forms
Parts of the new forms
Types of claims to be filed on VA Form 21-526EZ
Types of claims to be filed on VA Form 21-527EZ
Types of claims to be filed on VA Form 21-534EZ
Incomplete Claims
Exclusions from the FDC Program
Development
Retroactive effective dates
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Types of New Forms
• VA Form 21-526ez Fully Developed Claim (Compensation)
• VA Form 21-527ez Fully Developed Claim (Pension)
• VA Form 21-534ez Fully Developed Claim (Application for
Dependency and Indemnity Compensation, Death Pension,
and Accrued Benefits)
Only a claim filed on an EZ form is potentially eligible for processing in the FDC
Program. If a claimant requests processing in the FDC Program but did not file their
claim on an EZ form, the claim will be excluded from the FDC Program.
Please note: The new forms are dated August 2013. Only the forms dated August
2013 or later will be accepted into the FDC program .
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Parts of the New Form
The updated VA Forms 21-526EZ, 21-527EZ, and the new VA
Form 21-534EZ are comprised of two bound parts:
– The Notice
– The Application
Please note: The application part of the new forms needs to be
completely filled out and submitted to the centralized mail
facility.
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Centralized Mail Facility
Missouri, Kansas, and Illinois Veterans should send all
correspondence, evidence, etc., to:
Department Of Veterans Affairs
Evidence Intake Center
PO BOX 4444
Janesville WI 53547-4444
Fax:
Toll Free: 844-822-5246
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Local: 608-373-6690
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The notice section of the new VA Form 21-526EZ provides the
claimant §5103 notice (Duty to Assist) for the following live
compensation claims:
1. Service connection (original, new, secondary, and reopened)
2. Service connection based on a period of active duty for training or inactive duty
training
3. Increased disability compensation
4. Individual Unemployability
5. Temporary total disability rating due to hospitalization or due to surgical or other
treatment
6. Compensation under 38 U.S.C. 1151
7. Increased benefits based on the need for aid and attendance or based on an
additional disability or housebound status (SMC)
8. Specially adapted housing or special home adaptation
9. Automobile allowance or adaptive equipment
10. Benefits based on a Veteran’s helpless/seriously disabled child
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Excluded FDC Claims
• A few types of claims are not specifically covered by the FDC
notice. Examples include:
• Claims for Permanent & Total status
• Claims for Hepatitis C
• Claims for a higher level of SMC (i.e. R-2)
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The notice section of the new VA Form 21-527EZ provides the
claimant §5103 notice (Duty to Assist) for the following live
pension claims:
1. Improved Pension
2. Special Monthly Pension (aid and attendance or housebound
benefits)
3. Improved Pension benefits based on a Veteran’s
helpless/seriously disabled child
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The notice section of the new VA Form 21-534EZ provides the claimant §5103
notice (Duty to Assist) for the following survivor (dependency and indemnity
compensation (DIC), death pension, and/or accrued) claims:
1.
2.
3.
4.
5.
6.
7.
8.
Accrued benefits
DIC based on service-connected cause of death
DIC based on 38 U.S.C. §1318
DIC based on active-duty-for-training or inactive-duty-training
death
Death pension and Parents’ DIC
38 U.S.C §1151 DIC
Increased survivor benefits (aid and attendance or
housebound)
Benefits for a Veteran’s helpless/seriously disabled child
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Intent to File
• To submit an intent to file, the claimant must use VA Form 210966.
- Replaces “informal” or “incomplete” claims.
• VA Form 21-0966 protects the effective date until a formal
claim is submitted.
• After March 24, 2015, no claims will be accepted unless on an
official form.
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Exclusion from the FDC Program
• The claimant indicated a desire not to have the claim processed in the FDC
Program by checking the box in:
– Item 21 of the VA Form 21-526EZ (AUG 2013); Item 32 of the VA Form
21-527EZ (AUG 2011); Item 44 of the VA Form 21-534EZ (AUG 2013)
• The claimant has a claim pending at the time of receipt of the EZ form
• The claimant has an appeal pending at the time of receipt of the EZ form
• The claim requires a character of discharge determination
• The claim requires any development except:
– Federal records in the custody of the Federal government
– Claimant-identified Federal treatment records such as VA medical
center (VAMC) treatment records
– A VA examination/DBQ
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Exclusion from the FDC Program (cont.)
In addition to being excluded at receipt, the claim can be
subsequently excluded if:
•The Veteran fails to report for a VA exam (and the fault is not
with the VA due to using an incorrect address)
•A supplemental claim, additional evidence, or an NOD on any
claim is received after receipt of the FDC
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Exclusion from the FDC Program (cont.)
When a claim is excluded from the FDC program, either at initial
receipt or subsequently, the Veteran is notified using language
such as:
“We cannot process your claim under the Fully Developed Claim
(FDC) Program because…”
…we received evidence requiring further development after
the claim was received.
…you did not report for a scheduled VA examination.
…you did not sign your FDC application.
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Fully Developed Claims: Development
Despite the name, FDC claims should not be expected to be
ready for a decision immediately upon receipt. VA will still
complete the following development on an FDC:
•Request any identified federal records. These records include
service treatment records (except Guard/Reserve), VAMC
records, personnel records, Social Security records, etc.
•Request a VA exam and opinion if necessary to decide the claim
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Fully Developed Claims: Development (cont.)
There are some circumstance where VA will still send a development
letter to the Veteran under the FDC program:
•When VA determines that federal records are unavailable.
•When VA determines additional information is needed related to
special issues, i.e. Agent Orange, Asbestos, radiation, etc.
•When NA Form 13055 is needed for fire-related cases.
VA will request the information and notify the Veteran that s/he will be
removed from the FDC program if s/he submits anything other than the
information requested.
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Unavailable Federal Records
If the Veteran identifies federal records, and VA is unable to obtain them, VA
will send the Veteran a notification of the unavailability of those records, with
the following paragraph attached:
“We received your claim and your request to participate in the Fully Developed Claim (FDC)
Program. Though you indicated you have no other information or evidence to give VA to
support your claim, we are required to send you this notice. If you have information or
evidence not previously submitted to VA that supports your claim, we recommend you
submit it. As a reminder, if you submit any additional information or evidence at this point,
VA will remove your claim from the FDC Program Expedited Process and process it in the
Standard Claim Process.”
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Private Medical Evidence
In the FDC program, the Veteran must submit copies of the nonVA treatment records for VA to consider in order to remain
eligible for the FDC program.
If the Veteran submits a completed 21-4142 for a private
provider along with their claim, the claim will be excluded and
VA will develop for the medical records under the standard
claims process, unless the 21-4142 is for VA treatment records or
Vet Center records.
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Federal Records
If the Veteran identifies federal records, VA will proceed to
develop for those records, just as in the standard claims process.
However, if the Veteran has copies of the federal records in
question, VA strongly encourages him/her to submit the records
with the claim. Attempts to obtain federal records can
significantly delay the claim, so by submitting the records, the
Veteran will expedite the claim process.
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Public Law 112-154 Section 506
Amends 38 U.S.C. § 5110 to allow up to a one-year retroactive
effective date for awards of disability compensation based on
fully-developed original claims for compensation received
between August 6, 2013, and August 5, 2015.
Prior to March 24, 2015, VA could not grant an effective date
under this law more than one year prior to receipt of the formal
FDC.
On or after March 24, 2015, VA could grant an effective date
under this law up to one year prior to the receipt of the intent to
file.
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Eligibility for one-year retroactive date
• The claim must be for compensation – no other types of
claims are eligible,
• The claim must be formal and original; incomplete claims are
not eligible for an additional retroactive effective date
• The claim must be received on a VA Form 21-526 EZ, and
• The claim must be received between August 6, 2013, and
August 5, 2015.
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Calculating the one-year retroactive date
• The evidence of record must support the evaluation
assigned from the effective date.
• For example, if evidence submitted with the FDC shows
the level of disability existed for one year prior to
submission of the claim, then VA will process the award
with a one-year retroactive effective date.
• If, however, the evidence of record supports less than oneyear of disability, VA will process the award accordingly
• Unless there is evidence clearly supporting a staged rating,
the rating should be consistent through the entire
retroactive period.
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Questions
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Miscellaneous Appeals Information
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New and Material Evidence / Reconsideration
vs. Filing an Appeal
• 38 CFR 3.400(q)(1): New and material evidence (3.156) other
than service department records received within the appeal
period … the effective date will be as though the former
decision had not been rendered.
• 38 CFR 3.156(b): New and material evidence received prior to
the expiration of the appeal period … will be considered as
having been filed in connection with the claim which was
pending at the beginning of the appeal period. (Authority: 38
U.S.C. 501(a))
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New and Material Evidence / Reconsideration
vs. Filing an Appeal
• 38 CFR 3.160(c): Pending claim: An application, formal or
informal, which has not been finally adjudicated.
• 38 CFR 3.160(d): Finally adjudicated claim. An application,
formal or informal, which has been allowed or disallowed by
the agency of original jurisdiction, the action having become
final by the expiration of 1 year after the date of notice of an
award or disallowance, or by denial on appellate review,
whichever is the earlier. (See §§20.1103 and 20.1104 of this
chapter.)
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New and Material Evidence / Reconsideration
vs. Filing an Appeal
Additional evidence received
allowing us to grant left
knee arthritis 03/31/2012
Left knee arthritis claimed
05/05/2010
Left knee arthritis denied
04/03/2011
Effective date of grant: 05/05/2010.
New and material evidence allowing for a grant was received within the appeal period,
so the evidence is considered as if it was filed in connection with the prior claim;
therefore, we can go back to the date of claim associated with the prior denial.
(THINK: Continuous prosecution.)
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Miscellaneous
• Wait times for BVA hearings.
• Waters vs. Shinseki (2010) denials.
• Incorrect exclusions from FDC affecting PL 112-154 earlier
effective date grants.
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Questions
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