What this means
m21-4:appendix-d.3 explains purpose of claim level suspense reasons. In plain terms, the official guidance says claim level suspense reasons provide a concise explanation of the pending action taken on a claim within a particular claim status. Claim level suspense reasons and suspense dates are controlled by pending tracked items, claim statuses, or other variables. It also addresses use the table below to reference claim level suspense reasons, the controlling element, and corresponding suspense date.
How this may help with a claim
Use m21-4:appendix-d.3 as a lookup tool for purpose of claim level suspense reasons. Match the exact label, code, condition, or table row in your records to the official entry; one useful point is: Claim level suspense reasons provide a concise explanation of the pending action taken on a claim within a particular claim status. Use the table below to reference claim level suspense reasons, the controlling element, and corresponding suspense date. 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 level suspense reasons provide a concise explanation of the pending action taken on a claim within a particular claim status.
- Confirm that the record or notice addresses this source point: Claim Level Suspense Reasons — Suspense Reason Set By — Claim Level Suspense Date; Awaiting Contract SME Opinion — Tracked Item — Tracked Item Suspense Date Rules;
- Document how this stated step or exception applies: Award Action Returned by Authorizer — Trainee Completes Development Action User indicates an administrative decision is ready for second signature, or Tracked Item — 3 Days if not linked to pending tracked item, or Tracked Item Suspense Date Rules if linked to pending tracked item
Important limits
m21-4:appendix-d.3 helps decode purpose of claim level suspense reasons, 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 level suspense reasons provide a concise explanation of the pending action taken on a claim within a particular claim status. Claim Level Suspense Reasons — Suspense Reason Set By — Claim Level Suspense Date; Awaiting Contract SME Opinion — Tracked Item — Tracked Item Suspense Date Rules;
Search terms when useful
Phrases that may help when searching your claim file or this library.
- Purpose of Claim Level Suspense Reasons
- m21-4:appendix-d.3
- Purpose Claim Level
- Suspense Reasons
- Claim Level Suspense Reasons
- purpose claim level suspense
- index claim level suspense
- D.3.a. Purpose Claim Level
Original VA guidance
The official VA text of this section
3. Claim Level Suspense Reasons
Introduction
This topic contains information about claim level suspense reasons, including
- purpose of claim level suspense reasons, and
- index of claim level suspense reasons.
Change Date
October 2, 2018
D.3.a. Purpose of Claim Level Suspense Reasons
Claim level suspense reasons provide a concise explanation of the pending action taken on a claim within a particular claim status. Claim level suspense reasons and suspense dates are controlled by pending tracked items, claim statuses, or other variables. Claim level suspense reasons not automatically generated must be properly updated to indicate the pending claim action.
D.3.b. Index of Claim Level Suspense Reasons
Use the table below to reference claim level suspense reasons, the controlling element, and corresponding suspense date.
Scroll sideways to see the full table.
| Claim Level Suspense Reasons | Suspense Reason Set By | Claim Level Suspense Date |
|---|---|---|
| Awaiting Contract SME Opinion | Tracked Item | Tracked Item Suspense Date Rules |
| Awaiting SME Assignment | Tracked Item | Tracked Item Suspense Date Rules |
| Awaiting VHA SME Opinion | Tracked Item | Tracked Item Suspense Date Rules |
| Award Action Returned by Authorizer | Trainee Completes Development Action User indicates an administrative decision is ready for second signature, or Tracked Item | 3 Days if not linked to pending tracked item, or Tracked Item Suspense Date Rules if linked to pending tracked item |
| Award Action Returned by User | Claim Status becomes RDC, Claimant has a POA | 2 Days |
| Continued at Authorization | Claim Status | 5 days |
| Deferred | Tracked Item | Tracked Item Suspense Date Rules |
| Development to the Claimant | Tracked Item | Tracked Item Suspense Date Rules |
| Exam Scheduling Request Transaction in Progress | Tracked Item | Tracked Item Suspense Date Rules |
| File Transfer | Set whenever claim is established without the Automated 5103 Notice Response tracked item | 10 days |
| Needs Rating Board Attention | Tracked Item | 10 Days (differs from corresponding tracked item) |
| Pending Authorization | Upon receipt of a Clarification Request from the EMS where the Exam Management System is "VHA", the system shall update the claim level suspense reason to "VHA Request of Clarification" | 0 days; the suspense date should be set to the day the suspense reason is assigned |
| Pending Concur | Upon receipt of a Clarification Request from the EMS where the Exam Management System is a VBA Contractor, the system shall update the claim level suspense reason to “VBA Contractor Request for Clarification" | 0 days; the suspense date should be set to the day the suspense reason is assigned |
| Pending Initial Development – Std 5103 Notice Not Required | Tracked Item | Tracked Item Suspense Date Rules |
| Pending Initial Development – Std 5103 Notice Sent | Claim Status | 2 days |
| POA Review Needed | Claim Status | 5 days |
| Rating Decision Complete | Claim Status | 5 days |
| Ready for Decision | Tracked Item | Tracked Item Suspense Date Rules |
| Ready to Work | Claim Status | 5 Days |
| Request for Federal Records | Award action | 30 days |
| Request for Non-Federal Records | Claim Status | 5 days |
| Requested/Awaiting Other Evidence | Claim Status | 30 days |
| Second Signature Review | Claim Status | 30 days |
| VA/Contract Exam Requested, Awaiting Results | Tracked Item | Tracked Item Suspense Date Rules |
| VBA Contractor Request for Clarification | Tracked Item | Tracked Item Suspense Date Rules |
| VHA Request for Clarification | Tracked Item | Tracked Item Suspense Date Rules |