Summary of Ingram Guidance for Pre-Development Claims Processors

Summary of Interim Ingram Guidance for all Pre-Discharge Claims Processors to include Military Services Coordinators (MSCs) On October 10, 2025, procedural guidance pertaining to the Ingram court decision was sent from the Office of Field Operations (OFO) to the District Offices. This guidance includes MSCs, Veterans Service Representatives (VSRs) and Rating Veterans Service Representatives (RVSRs) who process Pre-Discharge claims (Integrated Disability Evaluation System (IDES), Benefits Delivery at Discharge (BDD), and BDD-excluded) effective October 13, 2025. Although the original guidance was directed towards RVSRs, the following portions of the Ingram claims processing guidance apply to all Pre-Discharge (BDD, BDD- excluded, and IDES claims) claims processors, including MSCs. New examination requests All new Examination Scheduling Requests (ESRs) submitted on or after October 13, 2025, will include the Ingram language. Musculoskeletal Disability Benefits Questionnaires (DBQs) All Pre-Discharge claims processors, including MSCs and VSRs, must review the remarks section of every musculoskeletal DBQ, to confirm if the responses to the Ingram language have been provided prior to making a claim Ready for Decision (RFD), • If responses to the Ingram language questions are provided, no action is needed. • If responses to the Ingram language questions are not provided, MSCs and all Pre-Discharge claims processors are required to: o Request a new ESR – Request the appropriate DBQ for the musculoskeletal condition (not the Separation Health Assessment (SHA), the Ingram language will need to be applied to each musculoskeletal DBQ and add the following language:  “The Service member/Veteran does not need to be seen again unless deemed necessary by the examiner.”  The Ingram language questions will automatically populate with the new ESR. o Note: A rework ESR should not be submitted for missing Ingram language as the necessary language was not originally requested o Do not request the medical opinion DBQ Important: Claims Processors/MSCs must ensure this new ESR is routed to the same vendor that completed the original examination request. If the correct vendor is not

Summary of Interim Ingram Guidance for all Pre-Discharge Claims Processors to include Military Services Coordinators (MSCs) populated when submitting the ESR, the field should use the “View Alternate Destinations” option and select the original vendor. In the “Reason” block, the field should include “Ingram Language Required”. Language will automatically be added to the ESR for musculoskeletal DBQs or musculoskeletal contention classifications, however if the language is needed and not included, the language can be found in the Supplemental Language Matrix. Additional information: • Cases in which the claim has already been moved to the DRAS site as RFD (end product (EP 689), should not move backwards to the MSC for review. • If the examination vendor requests clarification asking to cancel the examination, MSCs should return these ESRs to the vendors and state the following: o “Guidance on processing Ingram-related examination requests was distributed to all medical disability examination vendors on October 10, 2025, with an expected implementation date of October 13, 2025.” Vendors are expected to process these examinations in accordance with this guidance. • The language is triggered when both a musculoskeletal (MUSC) classification is entered for the contention and a MUSC DBQ is selected. Where do I submit questions? • Examination Vendor questions and concerns:, ContractExam.VBAVACO@va.gov, and copy the 219 Pre-Dis Mailbox. • Compensation Service questions on policy regarding examinations: 211_Policy.Vbavaco@va.gov, and copy ContractExam.VBAVACO@va.gov. • Rating evaluations: 218VASRDPMO.VBACO@va.gov • Pre-Discharge (IDES and BDD) policy questions: 219 Pre-Dis Mailbox. ***Please note this is interim guidance, additional guidance will be provided at a later date.