What this means
m21-1:X.i.6.G explains integrated disability evaluation system (ides) pending claims, appeals, and previously denied issues. In plain terms, the official guidance says integrated Disability Evaluation System (IDES) participants who are already Veterans might have previously filed claims for VA compensation and either It also addresses for supplemental claims submitted after the initial meeting with the MSC, examinations are ordered only under the conditions specified in M21-1, Part X, Subpart i, 6.E.4.h.
How this may help with a claim
Use m21-1:X.i.6.G to audit how VA handled integrated disability evaluation system (ides) pending claims, appeals, and previously denied issues. Start with the decision date, the issue being reviewed, and the evidence VA was allowed to consider, then compare the record with this rule: Integrated Disability Evaluation System (IDES) participants who are already Veterans might have previously filed claims for VA compensation and either For supplemental claims submitted after the initial meeting with the MSC, examinations are ordered only under the conditions specified in M21-1, Part X, Subpart i, 6.E.4.h. Cite the exact document and page when raising a factual or procedural error, and use the review rights in the actual notice for any deadline.
What to review in your file
- Check the file against this official condition: notifying the regional office (RO) or Board of Veterans’ Appeals (BVA)of new evidence related to a pending appeal or higher-level review (HLR).
- Confirm that the record or notice addresses this source point: However, claims and referrals involving previously denied issues can be developed and decided in the IDES program when
- Document how this stated step or exception applies: As specified in M21-1, Part X, Subpart i, 6.H.2.d determinations ultimately made on referrals will be for PEB purposes only when the referral is for an issue currently on appeal or HLR, or when the individual declines to file a claim.
Important limits
m21-1:X.i.6.G explains VA guidance for integrated disability evaluation system (ides) pending claims, appeals, and previously denied issues; it does not guarantee an award or replace the statutes, regulations, binding decisions, and review instructions that control an individual claim. Conditions and exceptions still matter, including this source point: Integrated Disability Evaluation System (IDES) participants who are already Veterans might have previously filed claims for VA compensation and either If the participant was discharged from active duty, then subsequently referred into IDES as a member of the National Guard or Reserves, handle the case in accordance with M21-1, Part X, Subpart 1, 6.G.1.e.
Search terms when useful
Phrases that may help when searching your claim file or this library.
- Integrated Disability Evaluation System (IDES) Pending Claims, Appeals, and Previously Denied Issues
- m21-1:X.i.6.G
- Integrated Disability Evaluation
- System IDES Pending
- IDES Participants Pending Claim
- handling IDES claims referrals
- examination disabilities that were
- addressing previously denied issues
Original VA guidance
The official VA text of this section
Overview
In This Section
This section contains the topic “ IDES Participants With a Pending Claim, Appeal, or Previously Denied Claim."
1. IDES Participants With a Pending Claim, Appeal, or Previously Denied Claim
Introduction
This topic contains instructions for handling cases involving IDES participants with a pending claim, appeal, or previously denied claim, including
- handling IDES claims or referrals involving previously denied issues
- examination of disabilities that were the subject of a previously denied claim
- addressing previously denied issues in IDES ratings
- handling a pending Benefits Delivery at Discharge (BDD) or other pre-discharge claim by an active duty IDES participant
- handling pending claims from Veterans in IDES, and
- notifying the regional office (RO) or Board of Veterans’ Appeals (BVA)of new evidence related to a pending appeal or higher-level review (HLR).
Change Date
June 7, 2021
X.i.6.G.1.a. Handling IDES Claims or Referrals Involving Previously Denied Issues
Integrated Disability Evaluation System (IDES) participants who are already Veterans might have previously filed claims for Department of Veterans Affairs (VA) compensation and either
- have a higher-level review (HLR) or appeal currently pending with respect to a previously denied claim, or
- simply wish to file another claim for a previously denied condition.
Appeals and HLRs, as well as supplemental claims filed by Veterans who are currently not on active duty, are processed outside of the IDES program.
However, claims and referrals involving previously denied issues can be developed and decided in the IDES program when
- an active duty IDES participant files a supplemental claim for previously denied issues on VA Form 20-0995, Decision Review Request: Supplemental Claim, or
- the previously denied issues are referred by the service department (i.e., included on VA Form 21-0819, DOD Referral to Integrated Disability Evaluation System (IDES)) even though the claimant does not file a claim.
Note: As specified in M21-1, Part X, Subpart i, 6.H.2.d determinations ultimately made on referrals will be for PEB purposes only when the referral is for an issue currently on appeal or HLR, or when the individual declines to file a claim.
References: For more information on
- handling previously denied issues in pre-discharge claims, see M21-1, Part X, Subpart i, 6.A.2
- the effect of a claimant filing IDES claims for previously denied issues on VA Form 21-526EZ rather than VA Form 20-0995, see M21-1, Part X, Subpart i, 6.A.2.a
- examinations of IDES disabilities that were subject of a previously denied claim, see M21-1, Part X, Subpart 1, 6.G.1.b
- considering previously denied issues in IDES rating decisions, see M21-1, Part X, Subpart 1, 6.G.1.c
- supplemental claim procedures, see
- M21-1, Part II, Subpart iii, 2.B, and
- M21-1, Part X, Subpart ii, 2.A
- VA appeals and reviews, see M21-5, and
- required application forms, see M21-1, Part II, Subpart iii, 1.A.1.a.
X.i.6.G.1.b. Examination of Disabilities That Were the Subject of a Previously Denied Claim
For previously denied disabilities appropriately processed in IDES (as specified in M21-1, Part X, Subpart 1, 6.G.1.a) examinations are required for the
- referred previously denied condiitons listed on VA Form 21-0819 (for a Physical Evaluation Board (PEB) purposes determination only), or
- the previously denied conditions claims on VA Form 20-0995 submitted during the initial meeting with the Military Services Coordinator (MSC) when new and relevant evidence exists.
Reference: For more information about readjudicating a previously decided claim after February 19, 2019, see M21-1, Part X, Subpart ii, 2.A.3.
Note: For supplemental claims submitted after the initial meeting with the MSC, examinations are ordered only under the conditions specified in M21-1, Part X, Subpart i, 6.E.4.h.
MSCs should contact their disability rating activity site (DRAS) for guidance regarding the propriety of examining a disability that was the subject of a previous denial if it is unclear whether new and relevant evidence exists.
X.i.6.G.1.c. Addressing Previously Denied Issues in IDES Ratings
An issue previously denied by VA will be rated as for PEB purposes only if
- referred to IDES by the service department but there is an appeal or HLR on the matter currently pending, or
- there is a referral without an appeal or HLR but the participant declines to file a supplemental claim.
When the participant is a Veteran on active duty and completes a supplemental claim on VA Form 20-0995 follow the guidance in M21-1, Part X, Subpart i, 6.A.2.d.
References: For more information on
- when a referred condition that was previously denied by VA is appropriately processed through IDES, see M21-1, Part X, Subpart 1, 6.G.1.a, and
- addressing referred conditions for PEB purposes only, see M21-1, Part X, Subpart i, 6.H.2.d.
X.i.6.G.1.d. Handling a Pending BDD or Other Pre-Discharge Claim by an Active Duty IDES Participant
The table below describes the actions that are necessary when a service member who filed a Benefits Delivery at Discharge (BDD) or other pre-discharge claim is referred into IDES before the planned discharge date.
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| Responsible Party | Description of Necessary Action(s) |
|---|---|
| IDES/MSC | Explain to the participant that because they will not be discharge as planned, the BDD/pre-discharge claim will be closed, and they will have an opportunity to submit a claim via the IDES process. Notify the regional office (RO) with jurisdiction over the BDD/pre-discharge claim that the claimant has been retained on active duty and referred to IDES. Process the IDES claim in accordance with standard IDES procedures. |
| station of jurisdiction (SOJ)/rating activity site | Process the BDD/pre-discharge end product (EP) in accordance with M21-1, Part X, Subpart i, 6.C.3.i. |
Important: If the participant was discharged from active duty, then subsequently referred into IDES as a member of the National Guard or Reserves, handle the case in accordance with M21-1, Part X, Subpart 1, 6.G.1.e.
X.i.6.G.1.e. Handling Pending Claims From Veterans in IDES
The table below describes the actions that must be taken if a service department refers a Veteran with a pending claim into IDES.
Important: The instructions in the table below apply to cases involving BDD or other pre-discharge claims, provided the Veteran was discharged from service before the IDES referral was made.
If the BDD/pre-discharge claimant was referred into IDES prior to the projected discharge date, and remains on active duty at the time of the IDES referral, the claim must be handled in accordance with M21-1, Part X, Subpart i, 6.G.1.d.
Scroll sideways to see the full table.
| Responsible Party | Description of Necessary Actions |
|---|---|
| MSC | Explain to the participant that VA will continue to process the pre-IDES claim separately. Do not request transfer of or broker the pre-IDES EP(s). Establish EP 689 and develop the IDES claim in accordance with standard IDES procedures. Ensure all IDES development actions are clearly documented in the Veterans Benefits Management System (VBMS). Consider development actions taken by the RO working the pre-IDES EP, and avoid duplicative actions and examinations to the extent possible. Ensure examinations are completed for all issues raised in IDES. Take the following actions upon completion of IDES development: broker the EP 689 to the appropriate DRAS, and leave any pending pre-IDES EP to remain under the jurisdiction of the assigned RO. Reference: For more information on the acceptability of examinations completed outside of IDES, see M21-1, Part X, Subpart i, 6.F.2.c. |
| RO with jurisdiction of the pre-IDES EP(s) | Identify rating-related cases with a concurrent IDES claim by the presence of a pending EP 689. Consider development actions taken by the IDES MSC, and avoid duplicative actions/examinations to the extent possible. Continue to process the pre-IDES EPs in accordance with standard procedures, making all efforts to resolve the claim and EP as expeditiously as possible. Take no action on EP 689. |
| Assigned DRAS | Prepare the IDES rating under the existing rating EP. Attempt to address all contentions (to include any undecided pre-IDES issues) within the IDES rating. Notes: If the pre-IDES EP has been resolved prior to DRAS rating action, the DRAS must establish a new rating EP in accordance with M21-1, Part X, Subpart i, 6.K.2.d. The DRAS may defer any issue associated with a pre-IDES EP on the IDES rating if the evidence of record is not sufficient to decide the issue, and the issue was not claimed or referred as part of the IDES claim. |
X.i.6.G.1.f. Notifying the RO or BVA of New Evidence Related to a Pending Appeal or HLR
When new evidence or information related to a pending appeal or HLR is uploaded/scanned into VBMS, the MSC or DRAS must take the action outlined in the table below.
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| If the appeal is at the... | Then notify... |
|---|---|
| RO | the SOJ (via the appropriate mailbox) of evidence/information related to the pending HLR (or legacy appeal). |
| Board of Veterans’ Appeals (BVA) | BVA (via BVAVBMSMail@va.gov) of any evidence/information related to the pending appeal. |
Reference: For more information on determining location of an appeal, see the VACOLS User's Guide.