What this means
m21-4:appendix-d.2 explains purpose of claim statuses. In plain terms, the official guidance says claim status is used to determine the current phase of the claims process and can potentially control the claim level suspense reasons. Claim status must be properly updated to indicate the accurate stage of processing. It also addresses for claims that require either no additional development or due process prior to rating, the claims processor must manually update the claim to reflect RFD claim status.
How this may help with a claim
Use m21-4:appendix-d.2 as a lookup tool for purpose of claim statuses. Match the exact label, code, condition, or table row in your records to the official entry; one useful point is: Claim status is used to determine the current phase of the claims process and can potentially control the claim level suspense reasons. For claims that require either no additional development or due process prior to rating, the claims processor must manually update the claim to reflect RFD claim status. Keep the notice or screen that uses the term so you can distinguish an internal status label from a filing deadline or entitlement rule.
What to review in your file
- Check the file against this official condition: Claim status is used to determine the current phase of the claims process and can potentially control the claim level suspense reasons. Claim status must be properly updated to indicate the accurate stage of processing.
- Confirm that the record or notice addresses this source point: Use the table below to determine the appropriate claim status.
- Document how this stated step or exception applies: Current auto-RFD/RTW functionality within VBMS will move a non-rating claim to the incorrect lifecycle phase which could trigger National Work Queue to misroute non-rating claims that require a rating decision.
Important limits
m21-4:appendix-d.2 helps decode purpose of claim statuses, but a code, tracked item, or table entry is not proof that VA has granted or denied the underlying benefit. Use the governing notice and controlling law for rights and deadlines. The official context includes: Claim status is used to determine the current phase of the claims process and can potentially control the claim level suspense reasons. When possible and in accordance with proper procedures, all necessary actions should be completed concurrently, rather than piecemeal.
Search terms when useful
Phrases that may help when searching your claim file or this library.
- Purpose of Claim Statuses
- m21-4:appendix-d.2
- Purpose Claim Statuses
- Claim Statuses
- index claim statuses
- claim status updates non-rating
- actions non-rating claim ready
- actions non-rating claims.
Original VA guidance
The official VA text of this section
2. Claim Statuses
Introduction
This topic contains information about claim statuses, including
- purpose of claim statuses
- index of claim statuses
- claim status updates for non-rating end products (EPs) requiring a rating decision
- actions for non-rating claim ready for rating action, and
- actions for RTW non-rating claims.
Change Date
December 11, 2024
D.2.a. Purpose of Claim Statuses
Claim status is used to determine the current phase of the claims process and can potentially control the claim level suspense reasons. Claim status must be properly updated to indicate the accurate stage of processing.
D.2.b. Index of Claim Statuses
Use the table below to determine the appropriate claim status.
Scroll sideways to see the full table.
| Claim Status | Definition |
|---|---|
| Open | Default status for claims not in any other status. Typically stays in this status during claims development. |
| RFD | Signifies that the claim is ready for a rating. |
| Ready to Work | Signifies that the claim is ready for a non-rating decision. |
| RDC | Signifies that a rating decision has been completed and is awaiting promulgation. |
| Rating Correction | Signifies that a rating correction is needed. |
| Rating Incomplete | Signifies that a rating decision was returned to corporate from the work pending column. |
| Closed | The claim is complete with no further action possible. |
| Cancelled | The claim is cancelled with no further action possible. |
D.2.c. Claim Status Updates for Non-Rating EPs Requiring a Rating Decision
Current auto-RFD/RTW functionality within VBMS will move a non-rating claim to the incorrect lifecycle phase which could trigger National Work Queue to misroute non-rating claims that require a rating decision. To prevent these claims from moving to the incorrect lifecycle phase and to ensure proper routing, a claims processor must take the appropriate action.
References: For the appropriate actions for non-rating claims that
- require either no additional development or due process prior to rating, see M21-4, D.2.d, or
- require a period of suspense prior to rating, see M21-4, D.2.e.
D.2.d. Actions for Non-Rating Claim Ready for Rating Action
For claims that require either no additional development or due process prior to rating, the claims processor must manually update the claim to reflect RFD claim status.
When a claims processor determines a claim is ready for rating action
- do not add a tracked item, and
- manually updates claim status to RFD by clicking the COMPLETE WORK ITEM icon and selecting READY FOR DECISION from the drop-down menu.
Note: If a claims processor accidentally closes the last tracked item prior to updating the claim status, the claim will automatically move to RTW status and VBMS will remove the claim from the claims processor’s work queue. In this scenario, the claims processor must select the EDIT CLAIM DETAIL icon and update the claim suspense to READY FOR DECISION.
This action will update the claim status to RFD and ensure proper routing.
D.2.e. Actions for RTW Non-Rating Claims
When possible and in accordance with proper procedures, all necessary actions should be completed concurrently, rather than piecemeal. When all development or due process is complete for a non-rating claim that does not require rating action, the appropriate and necessary next action for the claims processor is to update the status to RTW and generate the award.
I mportant: Claims processors should strive to work all actionable end products (EPs) within the scope of work.
Exception: Per M21-1, Part VII, Subpart i, 1.C.1.e, if a claim that might result in the assignment of a combined disability evaluation of at least 30 percent is concurrently pending, postpone a decision on the claim for additional compensation for a dependent until after the rating activity decides the disability claim.