M21-1MR, Part V, Subpart iii, Chapter 7, Section C
Section C. Second Stage EVR Processing by Veteran’s Service Representatives (VSRs)
Overview
In this Section
/ This section contains the following topics:Topic / Topic Name / See Page
18 / General Information on Second Stage EVR Processing / 7-C-2
19 / Award Adjustment: Change in Income or Net Worth / 7-C-6
20 / Award Adjustments: Itemizing Medical Expenses / 7-C-9
21 / Examples of Situations in Which VA Form 21-8416, Medical Expense Report, Is or Is Not Required / 7-C-16
22 / Failure to Report Recurring Medical Expenses / 7-C-18
23 / Converting Awards to a Calendar Year / 7-C-20
24 / EVR Exempt and Special Monthly Pension (SMP) Cases / 7-C-23
25 / Dependency Change Reported on EVR / 7-C-25
26 / Adjustment of Parents’ Dependency and Indemnity Compensation (DIC) Cases: Income / 7-C-29
27 / Parents’ DIC–Potential Entitlement to Aid and Attendance (A&A) Benefits and Dependency Changes / 7-C-32
28 / Parents’ DIC and VA Form 21-8416 / 7-C-34
29 / Adjustment of Parents’ DIC: Medical Expenses / 7-C-36
30 / Time Limits for Filing Amended EVR Information / 7-C-39
18. General Information on Second Stage EVR Processing
Introduction
/ This topic contains general information on second stage Eligibility Verification Report (EVR) processing, including· when EVRs are referred for further action
· handling incomplete or questionable EVRs
· locating Social Security numbers (SSNs) on EVRs
· the action taken when SSNs are missing
· requesting a SSN from the beneficiary
· handling dual payees, and
· processing EVRs in dual-payee cases.
Change Date
/ September 21, 2006a. When EVRs Are Referred for Further Action
/ An Eligibility Verification Report (EVR) is referred for further action when· an award adjustment is required
· a problem or question needs to be resolved, and
· missing information on the EVR must be requested.
b. Handling Incomplete or Questionable EVRs
/ If an EVR is incomplete or not properly signed, initiate development and establish an end product (EP) 155 pending issue file (PIF) with a suspense date 60 days from the date of the development letter.Note: Telephone and fax may be used for developing incomplete EVRs.
There is no authority to
· clear EVRs that are incomplete or not properly signed, or
· code “NONE” on a 306 screen if the payee has left the corresponding block blank on the EVR.
Reference: For more information on using telephone, e-mail, or fax for development, see M21-1MR, Part II, 5 (TBD) or M21-1, Part III, Chapter 11, Subchapter III.
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18. General Information on Second Stage EVR Processing, Continued
c. Locating SSNs on EVRs
/ The Social Security number (SSN) of the payee and, if applicable, the veteran and/or the payee’s spouse are preprinted on EVR forms generated by the Hines Information Technology Center (ITC).The preprinted SSN are the numbers that were in the Compensation and Pension (C&P) master record at the time the EVR was produced.
d. Action to Take When SSNs Are Missing
/ When an EVR is referred for a missing SSN, if· the SSN can be determined
- enter the SSN on the 306 screen, or
- do a correction of master record (CORR) to the M15 screen
· the payee’s SSN or his/her spouse’s SSN is not of record or if there is conflicting information as to a payee’s or spouse’s SSN, initiate development
· other information necessary to clear the EVR is of record
- enter the information, and
- establish a separate EP 150 for the required SSN information, or
· other issues must be developed, control for receipt of SSN information by continuing the same EP 155.
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18. General Information on Second Stage EVR Processing, Continued
e. Requesting an SSN From the Beneficiary
/ Advise the beneficiary that· disclosure of the SSN is mandatory under 38 CFR 3.500(w) as a condition of continued receipt of benefits, and
· failure to furnish the SSN will result in termination of the award.
When conflicting information has been furnished about an individual’s SSN, ask the beneficiary to furnish a statement from the Social Security Administration (SSA) identifying the correct SSN for the person in question.
If the beneficiary fails to furnish the requested Social Security (SS) information, discontinue benefits effective the last day of the month during which the 60-day period following the date of the VA request expires.
Example:
Situation: A veteran fails to respond to VA’s letter dated April 19, 2006, requesting him to furnish his wife’s SSN.
Result: Use the STOP command to terminate the veteran’s award effective the first day of nonentitlement, July 1, 2006.
f. Handling Dual Payees
/ The following question appears on veteran, surviving spouse, and parent EVRs: “Do you receive any other VA benefits as a veteran, parent, or surviving spouse?”If the beneficiary answers “YES,” cross-reference the files on the M15 screen. If one of the other benefits is Improved Pension, ensure that any compensation, DIC, or other benefits are being counted as income on the Improved Pension award.
Important: 38 CFR 3.700(a)(4) prohibits simultaneous payment of any other pension to a beneficiary who is entitled to Improved Pension as a veteran.
References: For more information on
· processing EVRs in dual-payee cases, see M21-1MR, Part V, Subpart iii, 7.C.18.g, and
· cases requiring correction, see M21-1MR, Part X, 6.
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18. General Information on Second Stage EVR Processing, Continued
g. Processing EVRs in Dual- Payee Cases
/ Use the table below to determine how to process EVRs in dual-payee cases.If the beneficiaries are … / And they are paid on … / Then …
two veterans married to each other / separate awards / process their EVRs concurrently per M21-1MR, Part V, Subpart iii, 1.E.30 (TBD) or M21-1, Part IV, 16.21c(2).
two veterans married to each other / the same award / accept the signature of either veteran on the EVR
a veteran’s mother and father living together / separate awards / · process their EVRs concurrently, and
· count the same amount of unreimbursed medical expenses on both awards, regardless of which parent claimed them per M21-1MR, Part V, Subpart iii, 1.D.21 (TBD) or M21-1, Part IV, 16.14a(4)(a).
a veteran’s mother and father not living together / separate awards / there is no need to process their EVRs concurrently.
the same person / separate awards / process the EVRs concurrently.
Notes:
· Review the e-files to ensure the beneficiary is entitled to dual payments. Adjust the award(s) for countable income, if applicable.
· The same VSR should process both EVRs.
19. Award Adjustment: Change in Income or Net Worth
Introduction
/ This topic contains general information on award adjustment based on a change in income. It includes information on· the action to take when an increase in income is reported but no date for the increase is shown
· an example of an unknown date of income increase
· when an increase in benefits is effective, and
· interest/net worth development.
Change Date
/ September 21, 2006a. Action to Take When No Date for Increase is Shown
/ The table below describes what to do when a beneficiary reports an increase in income on the EVR but does not show the date of increase.Note: Whenever possible, develop for income information via telephone, fax, or e-mail. For more information on these methods of development, see M21-1MR, Part III, Subpart iii, 1.B.2.
If the increase in income is … / And … / Then …
$800 or more from any single source / · the date is unclear, and
· counting the income will cause a decrease and/or overpayment in the award / · reduce date of last payment and develop for date of receipt of the increase, and
· advise the beneficiary that failure to furnish the requested information will result in adjustment from the beginning of the EVR reporting period.
less than $800 / --- / count the income from the beginning of the EVR reporting period in which the increase occurred.
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19. Award Adjustment: Change in Income or Net Worth, Continued
b. Example: Unknown Date of Income Increase
/ Situation:· The veteran’s EVR dated February 17, 2006, reports receipt of a $1,500 inheritance. No date of receipt is shown.
· The VSR writes to the veteran requesting the exact date that the $1,500 was received.
· The veteran responds, “I received it last year.”
Outcome: Adjust the award effective January 1, 2005, to count the $1,500 inheritance for the period January 1, 2005, through December 31, 2005.
c. When Increase in Benefits Is Effective
/ The table below describes when an increase in benefits is effective after a beneficiary reports a decrease in income.When the beneficiary reports a decrease in … / Then the increase in benefits is effective …
recurring income / the day after the decrease in income occurred
Notes:
· To ensure that the beneficiary is reporting the gross amount of income, as opposed to the net amount, request documentation showing when the decrease in income occurred.
· The payment date is subject to 38 CFR 3.31.
irregular income / from the beginning of the EVR reporting period
Note: The payment date is subject to 38 CFR 3.31.
· nonrecurring, or
· short-term income / from the date the nonrecurring or short-term income was counted against the payee.
Reference: For more information on how 38 CRF 3.31 affects these types of adjustments, see
· M21-1MR, Part V, Subpart iii, 1.A.7 (TBD) or M21-1, Part IV, 16.05a, and
· M21-1MR, Part V, Subpart iii, 1.A.8 (TBD) or M21-1, Part IV, 16.05b.
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19. Award Adjustment: Change in Income or Net Worth, Continued
d. Interest/Net Worth Development
/ Under 38 CFR 3.652, initiate development if· a beneficiary reports interest-bearing assets of $5,000 or more and does not report any interest income
· assets are reported which may be earning interest, but it is not clear whether or not they are
· a beneficiary reports interest or dividend income of over $20, but does not report the source of the dividends or interest as net worth
· reported interest and net worth are the same amount, as the beneficiary most likely confused the two fields, or
· reported net worth increases by $10,000 or more over the previous EVR reporting period, and the increase cannot be explained by the evidence of record.
Important: Advise the beneficiary that failure to respond to the request for information will result in termination of the award. Continue the pending EP 155 for 60 days.
Note: If the EVR shows that net worth may be excessive
· develop for a possible net worth determination per
- M21-1MR, Part V, Subpart iii, 1.A.5 (TBD) or M21-1, Part IV, 16.04c
- M21-1MR, Part V, Subpart iii, 1.H.51 (TBD) or M21-1, Part IV, 16.36, and
- M21-1MR, Part V, Subpart iii, 1.J (TBD) or M21-1, Part IV, 16.39
· continue the pending EP 155 for 60 days, and
· at the end of the 60-day period, terminate or continue benefits, as appropriate.
20. Award Adjustments: Itemizing Medical Expenses
Introduction
/ This topic contains general information on award adjustment concerning itemizing medical expenses. It includes information on· when to itemize medical expenses
· cases in which there are no continuing medical expenses in the master record
· “date paid” information that must be reported on VA Form 21-8416, Medical Expense Report
· cases in which there are continuing medical expenses in the master record
· determining if VA Form 21-8416 is required for Improved Pension beneficiary with continuing medical expenses in the master record
· reduction in continuing medical expenses
· an example of an adjustment based on medical expenses, and
· the action to take when the anticipated medical expenses reported on the EVR differ from those reported on VA Form 21-8416.
Change Date
/ September 21, 2006a. When to Itemize Medical Expenses
/ Use the table below to determine if medical expenses must be itemized on a special form.When continuing medical expenses were … / Then …
in the master record at the time the EVR was selected / it may be possible to continue an existing medical expense deduction without an itemization of medical expenses.
Reference: For more information on when VA Form 21-8416, Medical Expense Report, is not required, see
· M21-1MR, Part V, Subpart iii, 7.C.20.e, and
· M21-1MR, Part V, Subpart iii, 7.C.21.
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20. Award Adjustments: Itemizing Medical Expenses, Continued
When continuing medical expenses were … / Then …
not in the master record at the time the EVR was selected / do not allow a deduction for medical expenses other than Medicare Part B as verified by SHARE unless the beneficiary has itemized medical expenses on VA Form 21-8416, Medical Expense Report, or equivalent.
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