VA EA 4.2
 
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Products...As-Is...Business Line...Compensation

Compensation

The major functions within this business line are the seven items denoted surrounding "VBA" (the agency responsible for carrying out these actions): Eligibility Determination, Appeals, Customer Service, Program Management, Program Integrity, Outreach, and Account Maintenance. This diagram shows the major stakeholders and some of the relationships between those stakeholders, the agency, and its denoted functions.

Scroll down for descriptions of objects shown in this diagram. Clicking over a function name can directly bring up related process diagrams and activity descriptions.

Compensation Goto Outreach Goto Program Integrity Goto Program Management Goto Customer Service Goto Appeals Goto Eligibility Determination Goto Account Maintenance

 

Links to Z11 (listed alphabetically)
NameDescription
Account Information

Vocational Rehabilitation and Employment Services (Master Record)

 

Specific information related to a veteran’s account with a VA program, which is used to support the delivery of services to the veteran and management of the overall program. Information will include: name (identity) of the veteran (to link to personal data); contact address (for the purpose of contacting the veteran for Chapter 31 related benefits); case/account number; name (identity) of beneficiary; veteran contact history; eligibility determination information; and benefit information.

Agency Funding Requests

Budget proposals and other forms of requests for funding that VA sends to Congress and other funding approval bodies.

Agency Reports

Standard and ad-hoc reports about VA operations that are prepared and submitted to external organizations and oversight groups.

Appeals

Formal requests for reconsideration of eligibility for benefits and services administered by the Department of Veterans Affairs.

Compensation

Enterprise financial and monetary output products intended for program beneficiaries, service partners, and other entities outside the VA organization.

Entitlement Information

Information relating to the applicant’s entitlement. This information includes the number of months of original entitlement and the number of months of remaining entitlement.

Information on Veterans and Beneficiaries

 Demographic and personal information provided by veterans and other program beneficiaries that are part of VA’s information resource.

Legislation and Executive Orders

Laws and Executive Orders that either define or limit the scope of VA activities, products and services.

 

Military Service Information

 Information about a military person provided by the Department of Defense that are part of VA’s information resource.

Official Government Guidance

Government circulars and other official guidance from external organizations that affect VA’s operations.

Program Information

Information about programs administered or implemented by VA .

Public Opinion

Feedback from the general public regarding the operations of the VA or ideas about any of the products and services that VA provides.

Requests for VA Actions

 Information contained in requests for VA action coming from sources external to VA .

VA Program Funds

 Monetary resource products from external sources for use in funding VA programs.


Links to Z12 (listed alphabetically)
NameDescription
Account Maintenance

This function includes activities associated with account maintenance and payment of supplemental claims.

Appeals

This function includes activities associated with claimant appeals. Claimants have the right to appeal VA's decisions.

Customer Service

The function performed by Compensation Service as it provides program and claim information to program participants and others seeking information about the compensation program. 

Eligibility Determination

This function focuses on the receipt, evaluation, and first payment for all original claims.

Outreach

Title 38 requires VA to inform veterans, service personnel, reservist, dependents, and other eligible persons about all VA benefits he/she may be eligible to receive.  The Outreach program is designed to provide this information, as well as any changes to this information, through many different mediums.  These include briefings to service personnel before and upon separation, mail outs, web sites, etc.

Program Integrity

Program integrity is primarily the detection and prevention of fraud by claimants and staff in claims processing.  There is a responsibility for reviewing internal controls to ensure accountability against fraud.

Program Management

Planning, leading, organizing, and monitoring various compensation benefit programs.


Links to Z14 (listed alphabetically)
NameDescription
Department of Defense

An executive department of the U.S. Government consisting of the Secretary of Defense and his office, the War Council, the Joint Chiefs of Staff, Joint Staff and joint agencies, as well as the Departments of the Army, the Navy, and the Air Force.  It is headed by the Secretary of Defense.

 

Dependents

Qualifying dependents for VA benefit purposes who may be a veteran’s spouse or child (natural child, adopted child, or stepchild).  A veteran’s mother or father may also be considered a dependent generally if there is financial need and he or she is otherwise entitled.

 

Government Policy Makers (Owners)

A category of VA stakeholders. Stakeholders falling under this category possess the authority to create and enforce major government policies and regulations that affect the Department of Veterans Affairs.

 

Ineligible Beneficiaries

Discharged military persons and members of their families who, for various reasons, are not entitled to certain VA benefits and services at a particular point in time.

Program Beneficiaries (Customers)

A category of VA stakeholders. This group of stakeholders is composed of people who are directly served by the VA.

 

Public

A category of V A stakeholders. Stakeholders falling under this category possess the power to elect people who hold public offices, the ability to pay government taxes, and assist government in other ways.

 

Survivors

Surviving spouse and children of a deceased veteran.

 

Veterans

A person who served in the active military, naval, or air service, and who was discharged or released under conditions other than dishonorable.

Veterans Benefits Administration (VBA)

The VBA is one of the three Administrations under the VA. VBA provides benefits and services to the veteran population through 58 VA regional offices.  Some of the benefits and services provided by VBA to veterans and their dependents include compensation and pension, education, loan guaranty, and insurance.


Links to Z22 (listed alphabetically)
NameDescription
Account Maintenance

This function includes activities associated with account maintenance and payment of supplemental claims.

Appeals

This function includes activities associated with claimant appeals. Claimants have the right to appeal VA's decisions.

Customer Service

The function performed by Compensation Service as it provides program and claim information to program participants and others seeking information about the compensation program. 

Eligibility Determination

This function focuses on the receipt, evaluation, and first payment for all original claims.

Outreach

Title 38 requires VA to inform veterans, service personnel, reservist, dependents, and other eligible persons about all VA benefits he/she may be eligible to receive.  The Outreach program is designed to provide this information, as well as any changes to this information, through many different mediums.  These include briefings to service personnel before and upon separation, mail outs, web sites, etc.

Program Integrity

Program integrity is primarily the detection and prevention of fraud by claimants and staff in claims processing.  There is a responsibility for reviewing internal controls to ensure accountability against fraud.

Program Management

Planning, leading, organizing, and monitoring various compensation benefit programs.


Eligibility Determination

Compensation Eligibility - Link to HTML Table Below

 

Reference(s):

Links to Z22 (listed alphabetically)
NameDescription
Create Pending Issues File

Create pending issues file (CEST) for veterans and populate it with information available in the Beneficiary Identification and Resource Locator System (BIRLS).

Establish Facts of Service

Review the veteran's military service information and verify key data that indicate eligibility for veteran compensation.

Establish Service Connection of Disability

The Rating board makes a decision on service connection of the disability.

Formalize Compensation Award

Case goes to veteran’s service representative to create award based on case-specific circumstances.  Letter of notification is sent to veteran and his/her representative.

 

Process Incoming Compensation Claims

Veteran applies for compensation benefits via mail, in person, or online.  VA acknowledges receipt of compensation claims/applications.  Send application to the Records Management Center (RMC).  Personnel Information Exchange System (Pies) request to archived information.

Receive Service Data from DOD

Receive and record incoming military service data from the Deptartment of Defense.  DOD provides service member data at start of service (creates Beneficiary Identification and Resource Locator System (BIRLS) record).  DOD sends form DD214 to the VA Office in Austin, TX when separation occurs.

Verify Veterans Disabilities

Conduct physical examination and compile other medical records of veterans applying for disability compensation.


Appeals

Compensation Appeals - Link to HTML Table Below

 

Reference(s):

Links to Z22 (listed alphabetically)
NameDescription
Decide Appeal Cases

Board of Veterans Appeals (BVA) receives case, also reviews and issues decision, including DRO action, using entire claims file (sustain, reverse, remand).

Receive Notices of Disagreements (NODs)

Receive, review and record formal appeals from veterans and their family members.

Recommend Action on the Appeal

Decision Review Officer (DRO) performs review and issues new decision, at Regional Office.

Route and Track NODs

Board of Veteran’s Appeals and Regional Office (RO) track case after NOD received.


Customer Service

Compensation Customer Service - Link to HTML Table Below

 

Reference(s):

Links to Z22 (listed alphabetically)
NameDescription
Assist Veterans in Obtaining State-level Benefits

Coordination with States on State-level benefits for disabled veterans.

 

Respond to Called-in Requests and Inquiries

Support for incoming 800 calls to regional offices

Respond to Requests and Inquiries Coming in via Email and Websit

Send email responses to Incoming emails from Consumer Affairs and Regional Office websites.

Serve Walk-In Customers

Provide assistance and service to veterans and their family members who visit the VA Regional Offices and other VA sites.


Program Management

Compensation Program Management - Link to HTML Table Below

 

Reference(s):

Links to Z22 (listed alphabetically)
NameDescription
Coordinate with Program Partners

Perform inter-department Liaison (DOD, SSA, DOJ, other countries, and cooperation with Census on veteran issues.

Evaluate Program Performance

Conduct physical folder review, implement quality assurance programs, conduct station surveys on Regional Office operations, conduct customer surveys, and perform recommendation tracking on Inspector General (IG)/GAO/other actions.

Prepare Program Reports

Prepare Systematic and Technical Accuracy Report (STAR).  (Get a better definition for this process.)

 

Train Program Personnel

Implement employee training and development programs.

Update Program Plans & Budgets

Develop plans and budgets, analyze BIRLS information, and provide financial cost inputs to legislation.  (Need to clarify the last sub-process.)


Program Integrity

Compensation Program Integrity - Link to HTML Table Below

 

Reference(s):

Links to Z22 (listed alphabetically)
NameDescription
Check Veteran Accounts in Matching Programs

Check other agency records on veteran financial status, and for possible duplication of benefits with IRS (financial), Department of Defense (on reserve activity), and with SSA (on death notices.)

Perform Code 18 Review

TBD

Perform Criminal Record Checks

Perform prison and fugitive felons matching. Search for possible criminal records.

Perform Data Integrity Audits

Perform data integrity on regional office activities.

Verify True Addresses of Beneficiaries

Address checking with postal records.

 

Verify True Medical Status of Beneficiaries

Routine Futures: scheduling exams for cases for which improvement is expected.


Outreach

Compensation Outreach - Link to HTML Table Below

 

Reference(s):

Links to Z22 (listed alphabetically)
NameDescription
Brief New Veterans on VA Benefits and Assistance Programs

Conduct Transition Assistance Program (TAP), Disability TAP (DTAP) briefings right after separation from military service.

Reach Out to Special Veteran Populations

This process of the compensation program provides specific outreach to individual veterans, e.g., Agent Orange, Gulf War, other special categories.  VA representatives who attend public/veterans group events also perform in-person outreach.

 

Send VA Benefits Information to Veterans

Termination from active duty triggers mailing of Veterans Assistance Discharge System (VADS) package – For all VA benefits.  Initial mailings are done through VADS and initial outreach is performed under the "Veterans Right to Know Act.”  This process provides general information via various media for the benefit of new and old veterans.


Account Maintenance

Compensation Account Maintenance - Link to HTML Table Below

 

Reference(s):

Links to Z22 (listed alphabetically)
NameDescription
Process Requests for Increased Disability Compensation

 

Process Requests for Increased Disability Compensation

Track Changes in Dependency Status

Gather up-to-date information about veteran dependents relevant to compensation claims.

 

Update Compensation Remittance Information

Keep payment information such as name, address, and Electronic Fund Transfer (EFT) information up-to-date.


Process Requests for Increased Disability Compensation

 

Compensation Process Requests for Increased Compensation - Link to HTML Table Below

Reference(s):

Links to Z22 (listed alphabetically)
NameDescription
Develop Claims

TBD

Perform Rating Board Reviews

The Rating Board reviews requests for increased disability compensation.

Recalculate Compensation Awards

Determine the updated compensation amount based on the recalculations by the Veterans Service Representative (VSR).

Send Decision Notifications

Send a formal notice to the veteran of the decision on compensation benefit changes.