Special Situations Related to Integrated Disability Evaluation System (IDES)

Overview

In This Section

This section contains the following topics:

Scroll sideways to see the full table.

1. Handling Added Conditions and Reenrolled IDES Cases

Introduction

This topic discusses benefit-entitlement issues that arise after a Military Services Coordinator (MSC) holds the initial meeting with an IDES participant, including

• requirement for a prescribed form to add claim conditions
• general information on claimed conditions added after the initial meeting with the MSC
• examination requests addressing claimed conditions added after the initial meeting with the MSC
• rating decisions addressing claimed conditions added after the initial meeting with the MSC
• handling the addition of referred conditions that were
• previously claimed, and
• not previously claimed
• handling new referred conditions added
• before completion of the medical evaluation stage, and
• after completion of the medical evaluation stage
• handling additional disabilities noted during examination, and
• handling IDES cases disenrolled due to additional referred conditions.

Change Date

February 16, 2024

X.i.6.K.1.a. Requirement for a Prescribed Form to Add Claimed Conditions

Integrated Disability Evaluation System (IDES) participants have the opportunity to raise claimed conditions by submitting a VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, during their initial interview with the Military Services Coordinator (MSC). Conditions identified on a VA Form 21-526EZ that is submitted to the MSC during the initial interview must be considered as part of the IDES process.

IDES participants who wish to claim additional conditions after completion of their initial interview with the MSC must submit the claim on a prescribed form as indicated in M21-1, Part II, Subpart iii, 1.A (a VA Form 21-526EZ is preferred). The form must be signed by the claimant or authorized representative to be considered a complete claim for benefits.

Note: Any issue formally claimed after the initial meeting with the MSC must be handled in accordance with M21-1, Part X, Subpart i, 6.K.1.b.

Important: Any request for benefits that is not submitted on a prescribed form must be handled in accordance with M21-1, Part II, Subpart iii, 2.G (or M21-1, Part II, Subpart iii, 2.H for claims received prior to March 24, 2015). The disability rating activity site (DRAS) must ensure that any request for benefits is properly addressed when preparing the final rating notification. However, both MSCs and DRASs are encouraged to make reasonable attempts to obtain a complete prescribed form via telephone development at the earliest opportunity (once the request for benefits is raised/identified) when doing so is feasible and beneficial to the participant.

X.i.6.K.1.b. General Information on Claimed Conditions Added After the Initial Meeting With the MSC

When an IDES participant submits a prescribed form with new claimed conditions after the initial meeting with the MSC has been completed, the claims processor who identifies the new conditions must list the contentions under the end product (EP) 689. A new EP should not be established.

If an EP is established erroneously while the EP 689 is pending, the claims processor who identifies the new EP must

• ensure that any new conditions on the new application are added as contentions under the EP 689, and
• cancel the new EP established in connection with the new application.

References: For more information on

• examination requests addressing added claimed conditions, see M21-1, Part X, Subpart i, 6.K.1.c, and
• rating decisions addressing added claimed conditions, see M21-1, Part X, Subpart i, 6.K.1.d.

X.i.6.K.1.c. Examination Requests Addressing Claimed Conditions Added After the Initial Meeting With the MSC

The Department of Veterans Affairs (VA) is not obligated to request additional examinations solely because an IDES participant claims a condition after the initial meeting with the MSC is completed.

Important: Occasionally, situations may arise that warrant examination of the additional disabilities referenced above. When submitting an examination request under these circumstances, MSCs and DRAS employees should not

• use the IDES priority code referenced in M21-1, Part X, Subpart i, 6.F.2.f, or
• add any remarks that associate the examination request with IDES.

Exception: The instructions in this block do not apply to additional disabilities

• a participant’s service department refers to VA, or
• examiners identify during IDES-related examinations that are related to disabilities a participant's service department referred to VA.

X.i.6.K.1.d. Rating Decisions Addressing Claimed Conditions Added After the Initial Meeting With the MSC

Unless the evidence of record is sufficient to make a decision regarding the additional conditions, DRASs should defer a decision on the additional conditions in the final rating decision.

Exceptions: Instructions in this block do not apply to additional disabilities

• a participant's service department refers to VA, or
• examiners identify during IDES-related examinations that are related to disabilities a participant's service department referred to VA.

Reference: For more information on deferring issues raised during the IDES process, see

• M21-1, Part X, Subpart i, 6.H.1.c and d, and
• M21-1, Part X, Subpart i, 6.J.1.e.

X.i.6.K.1.e. Handling the Addition of Referred Conditions That Were Previously Claimed

If the service department adds new referred conditions that were previously claimed by the participant during the initial meeting with the MSC, the MSC or DRAS must

• ensure the communication from the service department is documented in the electronic claims folder (eFolder), and
• continue routine IDES processing.

These conditions will be examined and evaluated by DRAS according to standard IDES procedures. No additional action or prescribed form is required.

X.i.6.K.1.f. Handling the Addition of Referred Conditions That Were Not Previously Claimed

The service department is required to provide a new VA Form 21-0819, DoD Referral to Integrated Disability Evaluation System (IDES), to VA in order to refer a new and previously unclaimed condition.

References: For more information on

• the service department's responsibilities when added new referred conditions, see the Veterans Tracking Application (VTA) User Guide, and
• handling previously unclaimed issues that were referred
• before completion of the medical evaluation stage, see M21-1, Part X, Subpart i, 6.K.1.g, and
• after completion of the medical evaluation stage, see M21-1, Part X, Subpart i, 6.K.1.h.

X.i.6.K.1.g. Handling New Referred Conditions Added Before Completion of the Medical Evaluation Stage

When an MSC receives a new VA Form 21-0819 from the service department, adding new referred conditions to a pending IDES claim before VA examinations have been completed, the MSC must

• request examinations to address the new conditions as needed
• provide examination results to the Physical Evaluation Board Liaison Officer (PEBLO) for all conditions, including the newly referred conditions, prior to closing out the medical evaluation stage in VTA, and
• handle the new VA Form 21-0819 in accordance with the instructions in M21-1, Part X, Subpart i, 6.F.1.

Important: New referred conditions that are added before examinations are conducted will not require disenrollment of the case in VTA. Continue processing under the original case identification (ID) number.

X.i.6.K.1.h. Handling New Referred Conditions Added After Completion of the Medical Evaluation Stage

If the service department intends to refer a new and previously unclaimed condition(s) after the medical evaluation stage has been completed, the case must be disenrolled from VTA and reenrolled under a new case ID number.

Upon receipt of a new VA Form 21-0819 from the service department, the reenrolled case will move through the claims development and medical evaluation stages again under the new case ID number. Examinations will be completed for the new referred condition(s).

Exception: The service department will not disenroll the case if the new referred condition(s) can be addressed without any additional VA examinations. These cases will remain at the DRAS for processing. However, the DRAS must solicit an application for the new condition on a prescribed form so that the new issue(s) can be considered as part of the claim for VA benefits.

References: For more information on

• the service department’s responsibility when adding new referred conditions, see the VTA User Guide, Section 3.4, and
• handling cases that are disenrolled due to additional referred conditions, see M21-1, Part X, Subpart i, 6.K.1.j.

X.i.6.K.1.i. Handling Additional Disabilities Noted During Examination

If an IDES participant’s examination report reveals the existence of a condition that was neither part of a complete claim on a prescribed form nor referred by the service department, then the DRAS should address the condition only when the condition is reasonably within the scope of the issues enumerated in the complete claim in accordance with 38 CFR 3.155(d)(2).

DRASs must follow the instructions in the table below if an IDES participant’s examination report reveals the existence of a disability that neither the participant claimed nor the service department referred to VA.

Scroll sideways to see the full table.

X.i.6.K.1.j. Handling IDES Cases Disenrolled Due to Additional Referred Conditions

Use the table below to determine how to process IDES cases that are disenrolled due to the addition of new referred conditions.

Scroll sideways to see the full table.

2. IDES Participants in the Reserve or National Guard Who Are Not on Active Duty

Introduction

This topic contains instructions that are unique to cases involving IDES participants in the Reserve or National Guard but not on active duty, including

• references to participants in the Reserve or National Guard who are not on active duty
• requests for examination of participants in the Reserve or National Guard who are not on active duty
• handling notice that a Veteran will not be medically separated via IDES
• preparing rating decisions in cases involving participants who are not on active duty
• providing evaluations for PEB purposes only when participants are not on active duty, and
• requests for reconsideration from participants who are not on active duty.

Change Date

June 9, 2022

X.i.6.K.2.a. References to Participants in the Reserve or National Guard Who Are Not on Active Duty

Any reference in this section to participants in the Reserve or National Guard who are not on active duty includes individuals returned to active duty for the sole purpose of participating in IDES.

X.i.6.K.2.b. Requests for Examination of Participants in the Reserve or National Guard Who Are Not on Active Duty

The MSC that requests examination of a participants who are in the Reserve or National Guard but not on active duty must ask the examining facility to notify the following of the date and time of all examinations at least one week prior to the date they are scheduled to occur

• member
• MSC, and
• member's
• PEBLO, and
• unit (if the PEBLO provided contact information to the MSC, and the MSC included the information in the examination request).

Rationale: Following this practice ensures the member’s unit has ample time to prepare orders allowing the member to attend the examinations.

Reference: For information on routing examination requests, see M21-1, Part IV, Subpart i, 2.A.1.b.

X.i.6.K.2.c. Handling Notice That a Veteran Will Not Be Medically Separated via IDES

When a member of the National Guard or Reserve who is not serving on active duty (a “Veteran,” for the purpose of this block) submits a claim for VA benefits as an IDES participant, VA must fully resolve the Veteran’s claim regardless of the outcome of the IDES process.

Follow the steps in the table below if a service department removes a Veteran from the IDES program and disenrolls them from VTA because the service department decided not to medically separate the Veteran (this includes Veterans that a service department determined meet retention standards or are fit for duty).

Scroll sideways to see the full table.

Notes:

• NWQ will route the claim to a Veterans Service Center (VSC) for standard processing.
• The VSC is responsible for taking any required actions on the Veteran’s claim in accordance with standard claims-processing procedures.
• If the VSC grants entitlement to benefits, it must use the date stamped on VA Form 21-0819 (the date VA received the form from the PEBLO) as the effective date of entitlement.

X.i.6.K.2.d. Preparing Rating Decisions in Cases Involving Participants Who Are Not on Active Duty

In cases involving IDES participants in the Reserve or National Guard who are not on active duty, when VA examinations are complete, DRASs must prepare a rating decision following the steps in the table below.

Exception: Do not complete the actions in the table below if the participant declined to file a VA claim. In these instances, DRAS must complete the actions outlined in M21-1, Part X, Subpart i, 6.K.10.a.

Scroll sideways to see the full table.