CLAIMS DEVELOPMENT GUIDE

JANUARY 2014

Department of Veterans AffairsRegional Office

Denver, Colorado

INTRODUCTIONThis guide is designed to provide basic guidelines for development of compensation claims, and compensation & pension dual claims.

The purpose of this guide is to promote consistent and timely claims development. To that extent, this guide outlines policies and procedures to be followed with regard to development of claims. However, this guide does not take precedence over Federal statutes, regulations, Office of Field Operations publications or Compensation Service publications.

This guide has been compiled and edited by Stephen Brantley. Recommendations for improvements, corrections, or additions may be sent to stephen.brantley@va.gov; telephone (303) 914-5943; FAX (303) 914-5903; mailing address:

Department of Veterans AffairsDenver Regional Office

155 Van Gordon StLakewood, CO, 80228

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T A B L E O F C O N T E N T SIntroduction & Acknowledgements.......................................................................................ii

Section

1. Initial Review Actions (*Revised May 20, 2014)

Complete Requirements for Claims Establishment Prescribed Form for Original Claims Determine Eligibility for Benefit Claimed Verification of System Data Entries End Product Codes, Modifiers Review VA Form 21-526 for Claimed Disabilities Substantially Complete Application Claims Not Substantially Complete Claims Expressly Claimed, Implied, Informal, Potential, Mandated, or

Ambiguous Original Claim Received Without VA Form 21-526 Veteran’s Supplemental Claim, VA Form 21-526b When a Signature is Not Required Review of Service Treatment Records Separation Documents Service Verified & Honorable? Determine Types of Military Service Special Category Tags Protection of Service Records Handling and Storage Requirements for the DoD STR Folder Visually Impaired Veterans Dependency Development of Compensation Claims Acceptance of Previous Versions of VA Form 21-526EZ, Application for

Disability Compensation and Related Compensation Benefits Criteria for Hardship Claims

2. Formal & Informal Claims (*revised March 25, 2014)

Formal or Informal Claim - 38CFR 3.1(p) Informal Claims - 38CFR 3.155(a) Informal Claims Must Be In Writing Requirements for Informal Claims Claims Made By Telephone – Informal Claim – Date of Claim Claims Made By Telephone – Recognized Claimants

3. VONAPP Direct Connect eClaims (*Revised August 20, 2013)

4. VA Benefits & Active Duty Service (Revised June 17, 2013)

Claims Filed Prior to, or at the Time of Discharge from Active Duty Status of Pending Claims Upon Veteran’s Return to Active Duty

5. 5103 Notice Letters (Revised March 25, 2014)

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1 – 5103 Notice Letter Requirements...................................................................5.2 Elimination of Requirements to Specify Evidence Received in 5103 Notices Changes to Our Duty to Notify and Duty to Assist – Implementation of

Sections 504 and 505 of Public Loaw 112-154 38 USC § 5103 (§ 5103) Notices Produced in Modern Award Processing-

Development (Map-D) Supplemental Guidance Fast Letter 13-06 and Veterans Benefits Management System (VBMS) Exception to the Notification Requirement 5103 Notice Before Decision When Subsequent VCAA Notice Is Required or Not Required Dingess/Hartman v. Nicholson Can Individual Stations Amend the Wording and/or Formatting within the

Main 5103(a) Notice Letter(s) and Templates? What Should Be Done if there is No Authorized 5103(a) Template for a

Particular Type of Claim? Identifying and Listing “What the Evidence Must Show” Enclosures Has C&P Service Provided 5103(a) Templates for Non-Rating Claim

Decisions? Correction to the Increased Evaluation What the Evidence Must Show

(WTEMS) for Claims Processed by the Veterans Benefits Management Assistance Program (VBMAP)

Fast Letter 13-06 (5103 Notice) Questions and Answers

2 – When 5103 Notice is Not Required..............................................................5.17

Veteran’s Complaints Noted on Medical Evidence Claims Involving Clear and Unmistakable Error Claims Involving Competency Claims Involvoing an Earlier Effective Date Pre-Stabilization Ratings Under 38 C.F.R. 4.28

6. Issues Not Usually Granted Service Connection (revised March 25, 2014)

7. Correspondence – General (January 1, 2011)

Nuisance Mail – Redundant and Repetitious Letters PCGL Letters Follow-Up or Subsequent MAPD Letters Required Annotations Reverse Filing Documents

8. Unclaimed Conditions & Conditions Raised During Examination (January 1, 2011)

Unclaimed Chronic Conditions Conditions or Issues Raised During Examination

9. Presumptive Conditions (Revised July 19, 2013)

1 – Chronic Diseases..............................................................................................9.2

2 – Tropical Diseases..............................................................................................9.5

3 – Former Prisoners of War................................................................................9.6

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4 – Herbicide Diseases...........................................................................................9.8

5 – Cancer.............................................................................................................9.10

10. Lost Claim – Rebuilt Folder (Revised March 12, 2012)

11. Fully Developed Claim Program (FDC ) (Revised May 20, 2014)

Update to Procedures for Processing Fully Developed Claims Reminder Regarding Fully Developed Claims (FDC) and Requesting Evidence Revised Process Steps VA EZ Forms and the VCAA Notice Expiration of February 2010 EZ Forms Processing Fully Developed Original Claims Received from August 6, 2013

through August 5, 2015 Response to Fully Developed Claim Question Regarding Special Circumstances Guidance on Proper Use of Fully Developed Claim (FDC) Exclusion Special

Issues Determining the Effective Date of Fully Developed Claims (FDCS) Under Fast

Letter 13-17, Processing Fully Developed Original Claims (FDCS) Received from August 6, 2013 through August 3, 2015

12. BDD & Quick Start Claims (Revised July 1, 2011)

13. Original Compensation/Pension Claims (Dual) (Revised May 20, 2014)

Initial Review of Claims for Pension No Specific Disability Claimed Service Verification – Compensation Claims Service Verification – Dual Claims Service Treatment Records Fire-Related Cases Medical Evidence VA Examination Guidelines Presumptive Conditions Claimed Continuity Administrative Entitlement to Pension Benefits (Rating Decision Not Required) Pension – Other Development Considerations Employment

14. New Claims (Revised October 17, 2007)

Claimant’s Signature Service Verification Service Treatment Records Presumptive Conditions Claimed Continuity Medical Evidence VA Examination Guidelines SSA Medical Evidence Needed

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15. Claims for Increase (Revised June 14, 2011)

Claimant’s Signature Continuity vs. Recent Treatment Medical Evidence VA Examination Guidelines SSA Medical Evidence Needed

16. Claims to Reopen (Revised July 18, 2010)

Definitions VCAA Notification Issue: New and Material Evidence VCAA Requesting New and Material Evidence Duplicate Claims Source of Medical Evidence Indicated in Claim? Submission of New and Material Evidence New and Material Evidence Not Submitted VA Examination Guidelines SSA Medical Evidence Needed Conditions Previously Denied Administratively PTSD Previously Denied Hearing Loss Previously Denied Individual Unemployability Previously Denied Claims Denied as Not Well Grounded

17. Reconsideration of Claims Based on Additional Evidence (Revised May 20, 2014)

Unassociate Service Treatment Records (STRs) Received from the Records Management Center or Other Sources

Medical Evidence is Received but a Claim Has Not Been Received from the Veteran

Requests for Reconsideration Based on Medical Evidence Duplicate Evidence Submitted by the Claimant Medical Opinions for Conditions Found

18. Resumption of Compensation Benefits (Revised November 13, 2006)

5103 Notice Requirements Resuming Benefits Terminated for Reentry into Active Service Resumption – Disability Static at Time of Entry on Active Duty Resumption – Disability Not Static at Time of Entry on Active Duty

19. Claims for Secondary Service Connection (Revised January 20, 2012)

Issue: VCAA Claims for a Condition Secondary to Conditions That Are Not Service Connected VCAA Notification Claims for a Condition as Secondary to a Service-Connected Disability VA Examination & Opinions Guidelines Alcohol and Drug Abuse Claims for Secondary Service Connection by Aggravation

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Complications of Corticosteroid Therapy

20. Claims Due to Aggravation (Revised June 29, 2012)

1 – Determining In-Service Aggravation of Pre-Service Disability..........20.2 Request for Medical Opinion

2 – Determining Secondary Service Connection, Including by Aggravation.......20.3 General Guidelines Request for Medical Opinion

21. Issue of Permanence (Permanent & Total) (Revised August 28, 2011)

Definitions Statutory Requirements VA Examination Guidelines VCAA Considerations

22. Incompetency Issues (Revised July 22, 2013)

1 – General Guidelines........................................................................................21.2

2 – Processing an Issue of Incompetency...........................................................21.4

3 – Deferred Issues, Incompetency.....................................................................21.7

4 – Decisions Proposing Incompetency..............................................................21.9

5 – Decisions Establishing Incompetency........................................................21.11

23. Telephone and FAX Development (Revised September 19, 2013)

VCAA Follow-Up Telephone Contact on Original Claims Use VA Form 21-0820, Report of Contact Application Partially Complete Claims Made By Telephone - Informal Claim - Date of Claim

24. Verification of Service (Revised April 16, 2013)

Acceptable Documentation Photocopies of Documents That Confirm Military Service VADS (Veterans Assistance Discharge System) as Proof of Service Veterans Information Solution (VIS) – Electronic Service Member Discharge

Data Requesting Verification of Service Merchant Marine Service SHARE Updates for Multiple Periods of Service

25. Character of Discharge Determinations (Revised July 18, 2012)

Discharge is Other Than Honorable or Otherwise Questionable Action Taken on Undeliverable Essential Mail if Address is Proper Entry Level Separation Separation Due to Misconduct More Than 2 Years Service or Multiple Periods of Service

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VA Examination Guidelines Statutory Bar to Benefits Determinations for Health CareStatements and Affidavits

26. Administrative Decisions (Revised October 4, 2007)

Issues Requiring Admin Decisions General Guidelines Administrative Decision Elements Preparation and Approval of Authorization Determinations Reasonable Doubt Reversal of Prior Determinations Update SHARE/BDN Administrative Decision for Health Care

27. Effective Dates and Bad Periods of Service (Revised August 29, 2012)

References Rudd v. Nicholson Claims for an Earlier Effective Date

28. Service Records - General (Revised April 10, 2014)

Updates to Time Frames for Federal Records Requests Certification of Completeness of Service Treatment Records (STRs) Automated Distribution of DD Form 214 and DD Form 215 and Digital

Signatures Reminders Regarding Submitting Requests for Joint Records Research Center

(JSRRC)

29. Service Records Development & PIES (Revised June 4, 2014)

1 – Development for Service Treatment Records.............................................29.2

2 – Development for Verification of Service......................................................29.5

3 – PIES Request S02 Screen Prompt................................................................29.7

4 – Fire-Related Case Development...................................................................29.8

5 – Development for Other Service Records...................................................29.10

6 – PIES Helpful Hints......................................................................................29.15

7 – Service Department Codes..........................................................................29.21

8 – Follow-Up Requests.....................................................................................29.22

9 – Verification of PTSD Stressor Events........................................................29.24

10 – Protection of Service Records...................................................................29.27

11 – Contacting the PIES Mailboxes................................................................29.28

12 – Coast Guard Records................................................................................29.30

13 – Procedures for Requesting Federal Records from RMC or NPRC for VBMS Claims.................................................................................................................29.32

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14 - Certification of Completeness of Service Treatment Records (STRs)...29.35

15 - New Personnel Information Exchange System (PIES) Request Codes for Claims Processed in VBMS...............................................................................29.36

30. Defense Personnel Record Information Retrieval System (DPRIS) Request (Revised July 22, 2013)

31. Willful Misconduct & Vehicle Accident Injuries (December 12, 2006)

32. Line of Duty Determinations (January 1, 2011)

33. Facts and Circumstances (January 1, 2011)

34. Reserve & National Guard Development (revised January 20, 2014)

1 – General Guidelines........................................................................................34.2

2 – Reserve Records Development......................................................................34.3

3 – National Guard Records Development........................................................34.6

35. Marine Corps Records System (Revised November 1, 2006)

1 – Marine Corps Unit Records..........................................................................35.2

2 – Marine Corps Records Users Guide............................................................35.4

36. Verification Of Participation In “Special Operations” Incidents (June 20, 2013)

37. Bureau of Naval Personnel Records - Code 31 (January 1, 2011)

38. Records Loaned to Department of the Army Review Board and Army Discharge Review Board (January 1, 2011)

39. Military Service Academy Development (Revised November 30, 2009)

40. Medical Evidence Development (*Revised April 17, 2014)

1 – General Guidelines........................................................................................40.2

2 – VA Medical Evidence....................................................................................40.4

3 – Post-Service Military Treatment Records...................................................40.6

4 – Vet Center Treatment Records.....................................................................40.8

5 – Military Dependent Treatment Records....................................................40.10

6 – Private Medical Evidence............................................................................40.13

7 – Colorado Workman Compensation Evidence...........................................40.17

41. Social Security Administration (SSA) Requests (Revised January 20, 2014)

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VA Requests for Records from Social Security Administration (SSA) Development Guidelines Follow-Up Requests

42. Alternative Sources - Service Records (Revised February 21, 2014)

Alternative Sources Alternate Sources for Verification of Service Prior VA Claim

43. Final Attempt Letter (Revised February 21, 2014)

New Final-Attempt Letter in Lieu of Formal Finding or Record Unavailability VAMC Records Determined to be Unavailable

44. Administrative Denials (January 1, 2011)

Administrative Denials Failure to Report for VA Examination Situations in Which a VSR May Deny a Claim Appeal Rights

45. VA Examinations (Revised May 20, 2014)

1 – General Guidelines........................................................................................45.2

2 – Disabilities Not To Examine........................................................................45.10

3 – Preparing a VA Exam Request...................................................................45.14

4 – Medical Opinion Guidelines.......................................................................45.17

5 – Preparing a Medical Opinion.....................................................................45.24

6 – Exam Notification & System Requirements..............................................45.26

7 – Subsequent Exam Requests........................................................................45.27

8 – Transfer of Claims Folders for VA Examinations....................................45.29

9 – Failure to Show for Examination & VHA RVSP Program.....................45.30

10 – Insufficient Examinations.........................................................................45.32

11 – Combat Injuries.........................................................................................45.33

12 – Ordering Examinations and Medical Opinions for Claims with

Documentation Needing Examiner Review in the eFolder............................45.34

13 - Ordering Exams at an Appropriate Facility............................................45.40

46. Disability Benefits Questionnaires (DBQs) (Revised January 20, 2014)

Private Disability Benefits Questionnaire (DBQ) Current Questionnaires Development Actions Completed Questionnaires VCAA Letter Standard Text

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DBQ Use by Contract Examiners Medical Opinion DBQ Guidance on Requesting Medical Opinions Guidance on Use of Disability Benefits Questionnaire (DBQ) Using Acceptable Clinical Evidence (ACE) Disability Benefits Questionnaire (DBQ) Changes Based on Mitchell v. Shinseki

47. Disabilities Requiring Mandatory Examination (January 1, 2011)

48. Routine Future Examinations (EP 310) (Revised April 17, 2014)

Schedule for Routine Future Examinations Scheduling Routine Future Examinations Notification Requirements Cancellation of Routine Future Exams Routine Future Exams Following Medical Events or Procedures

49. Examination of Specific Disabilities & Issues (January 1, 2011)

50. Signature & Qualifications for Examiners Performing C&P Mental Disorders

Examinations (August 28, 2012)

51. Entering New Patients in CAPRI (January 1, 2011)

52. Specific Disability Considerations (Revised April 17, 2014)

1 – AL Amyloidosis..............................................................................................52.2

2 – Amyotrophic Lateral Sclerosis.....................................................................52.3

3 – Cardiovascular Claims..................................................................................52.4

4 – Chronic Lymphocytic Leukemia..................................................................52.8

5 – Diabetes Mellitus..........................................................................................52.10

6 – HIV & AIDS Claims....................................................................................52.13

7 – Hypertension................................................................................................52.14

8 – Ischemic Heart Disease................................................................................52.16

9 – Insomnia.......................................................................................................52.17

10 – Malaria Claims...........................................................................................52.18

11 – Medical Consequences of Diving..............................................................52.19

12 – Meniere’s Syndrome..................................................................................52.20

13 – Mental Disorders That Led to Release from Service .............................52.21

14 – Multiple Myeloma - Plasmacytoma..........................................................52.22

15 – Muscle Injuries...........................................................................................52.23

16 – Non-Hodgkin’s Lymphoma & Subcategories.........................................52.24

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17 – Positive Tuberculin Claims.......................................................................52.26

18 – Radical Prostatectomy...............................................................................52.27

19 – Respiratory Cancers Due to Agent Orange.............................................52.28

20 – Scars............................................................................................................52.29

21 – Traumatic Brain Injury............................................................................52.30

22 – Sleep Apnea................................................................................................52.32

23 – Carpal Tunnel Syndrome..........................................................................52.33

24 – Female Sexual Arousal Disorder (FSAD)................................................52.34

53. Gulf War Claims (Revised January 20, 2014)

Priority Processing GWOT and VSI/SI GWOT Veterans Disability Claims Based on Exposure to Environmental Hazards During Service

in Southwest Asia Definitions No Specific Disability Claimed Specific Disability Claimed Evidence of Southwest Asia Service Southwest Asia Service Verification Southwest Asia Service Medal Previously Denied Claims VA Examination & Opinion Guidelines Brain Cancer in GW Veterans Presumptions of Service Connection for Persian Gulf Service Gulf War Regulations and EP 698

54. Environmental Hazards in Iraq, Afghanistan, and Other Military Installations (Revised August 21, 2012)

55. Homeless Veteran (Revised February 18, 2012)

Definition Procedures for Processing Claims for Homeless Veterans Flash Submission of PIES Requests References

56. Claims Related to Exposure to Herbicide Agents (Revised June 20, 2013)

Development Guidelines No Specific Disability Claimed Claimed Condition is Not a Qualifying Disability Verification of Service in Vietnam Development of Herbicide Claims for Navy & Coast Guard Veterans MAPD Development Letters for Veterans Who Served In Vietnam MAPD Development Letters for Veterans Who Served Outside Vietnam Herbicide Related Claims from Veterans Who Served in Thailand or Korea

During the Vietnam Era

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Herbicide Related Claims from Veterans with Thailand Service Herbicide Related Claims from Veterans with Korean Service Applying Presumption of Disease to Herbicide Exposure Outside of Vietnam Herbicide Related Claims from Veterans Who Served in Guam Presumption of Agent Orange Exposure for Korean Service Veterans Temporary Duty (TDY) in Vietnam during the Early Years New Personnel Information Exchange System (PIES) O39 Request for Claims

Involving Temporary Duty (TDY) to Vietnam Adjudicating Certain Agent Orange Exposure-Related Claims (Ranch Hand

Operations in SEA)

57. Haas Claims (Revised November 1, 2010)

Vietnam Era Herbicide Exposure Claims Administrative Review Evidence for Ship Docking on Shore Improper Termination of Benefits Already Granted for Haas Related Claims Use of APO Numbers as Evidence Ships’ Muster Rolls or Deck Logs

58. Nehmer Claims & Fast Track Processing System (Revised May 29, 2013)

59. Verification of Service in Vietnam (Revised March 7, 2009)

General Guidelines Review Service Records and Service Treatment Records Review DD Form 214 for Evidence of RVN Service Development to Service Records Centers Responses from NPRC – PIES Request Code O34

60. Verification of Service in Vietnam for Navy and Coast Guard Veterans (Revised

April 18, 2013)

Development Procedures for Claims from Vietnam Era Navy Veterans Additional Development Guidelines Regarding Vietnam Era Navy Veterans Clarification on Evidence Requirements in Haas Blue Water Navy Claims –

When Evidence Shows “Mouth of a River” Vietnam Era Navy Ship List Naval Vessels That Operated In Vietnam Waterways New Website and Development Procedure for Herbicide Exposure Related

Claims from Vietnam Era Navy Veterans Herbicide Exposure Presumption Extended to USS Ingersoll Crewmembers Review of Agent Orange exposure evidence for Veterans of USS Stormes (DD-

780) and USS Henderson (DD-785) by VACO Compensation Service PIES “Maybe” Response Received – Navy Veterans PIES Request O43 Screen Prompt Agent Orange Exposure Among Naval Aviation Veterans of the Vietnam Era

61. Vietnam APO/FPO Listing (Revised January 1, 2004)

62. Vietnam Era Dates (Revised March 13, 2006)

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63. Exposure to Asbestos (Revised March 30, 2009)

1 – Development Guidelines................................................................................61.3

2 – Asbestos Claims Memorandum....................................................................61.5

64. POW Claims (Revised October 30, 2009)

Former Prisoner of War Verification Internment in Neutral or Allied Country Presumptive Disability Claimed Claimed Disability Not Presumptive POW Protocol Examination POW Presumptive Conditions Ischemic Heart Disease Requests for Prisoner of War Records World War II Record Groups Korean Conflict Record Groups POW Records for Periods Other Than World War II and Korean Conflict Former Prisoner of War - Definition

65. Post-Traumatic Stress Disorder (PTSD) - Combat (Revised July 3, 2013)

1 – General Guidelines.......................................................................................63.2

2 – Confirmed Combat-Related Stressors........................................................63.6

3 – Decorations Which May Confirm Combat-Related Stressors..................63.8

4 – Unconfirmed Stressor Events....................................................................63.10

5 – Requests for VA Examinations..................................................................63.17

6 – Marine Corps Records...............................................................................63.19

7 - Relaxation of Evidentiary Standard for Establishing In-Service Stressors in

Claims for Posttraumatic Stress Disorder..............................................63-20

8 – PTSD Not Diagnosed at VA Exam............................................................63-24

9 - Service Connection for In-service Posttraumatic Stress Disorder (PTSD) as

Related to a Pre-service Stressor.............................................................63-25

66. Post-Traumatic Stress Disorder (PTSD) - Personal Assault (Revised January 20, 2014)

Military Sexual Trauma Reference Improper Development of Military Sexual Trauma (MST) Claims Initial Development Actions Alternative Sources of Information Obtaining Police Reports Subsequent Development PTSD Questionnaire/Stressor Statement Not Received Creating a Tracked Item for MST Coordinator Reviews Requests for VA Examination

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In-Service Diagnosis of PTSD

67. 1151 Claims – Claims for Compensation Due to Treatment at a VA Facility (Revised Dmay 5, 2011) MAP-D Entries (VCAA Notification, Claims Requirements & Development of

Claims) VA Records Requests for Service Records VA Examination Guidelines No Specific Disability Claimed

68. Chemical, Biological, Radiological, Nuclear, and Explosives Claims (Revised October 30, 2009) No Specific Disability Claimed Specific Disability Claimed Toxic Chemical Claims Claims Based on Service at Naval Air Facility, Atsugi, Japan

69. Project 112/SHAD Claims (Revised August 10, 2009)

No Specific Disability Claimed Specific Disability Claimed

70. Total Disability Individual Unemployability (TDIU) Claims (Revised March 25, 2014)

General Guidelines Scheduler Requirements Section 5103 Notice Requirement Handling Receipt/Non-Receipt of VA Form 21-8940 Administrative Denials Development for Medical Evidence VA Form 21-4192, Request for Employment Information in Connection with

Claim for Disability Using Websites to Verify Employment Follow-Up Development for Employment Information Vocational Rehabilitation Records or Social Security Disability Records Examinations for Individual Unemployability Do Not Ask for Legal Opinions Self-Employment or Tightly Held Corporation Unemployability as an Inferred Issue Appeals Involving TDIU Total Disability due to Individual Unemployability (TDIU) and Volunteering

71. Hearing Loss & Tinnitus Claims (Revised March 28, 2012)

Audio Medical Opinion Request (VERIS Version) Hearing Loss Criteria Medical Examinations & Opinions – Disability Benefits Questionnaire Medical Examinations & Opinions – General Service Connection Based on Noise Exposure Due to Military Specialty (i.e.

MOS, AFSC) Presumption of Service Connection Hensley Decision

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Do Not Ask for Legal Opinions Tinnitus, Rated at 10 Percent Disabling Hearing Loss Previously Denied Selecting the Appropriate Worksheet

72. Hepatitis Claims (Revised July 6, 2012)

1 – Development Guidelines................................................................................72.2

3 – Sample Request for Medical Opinion..........................................................72.4

73. Cold Weather Injury Claims (Revised November 15, 2011)

Chronic Effects of Exposure Battle of the Bulge Chosin Reservoir Campaign Service Records Development VA Examination Guidelines

74. Dental Claims (Revised August 21, 2012)

No Specific Disability Claimed Eligibility Requests for Dental Treatment Received from the Veteran Processing of VA Form 10-7131 for Dental Outpatient Treatment - 38 U.S.C.

1712(a)(1) Claims for Service Connection - Compensation Claims for Dental Treatment Notification to the Claimant Temporomandibular Joint Disorders (TMJ)

75. Paragraph 29/30 Claims (Revised March 25, 2014)

EP 320 Proper Use Paragraph 29 Entitlement Paragraph 30 Entitlement Claim Initiated by the Veteran Hospital Report Processing

76. Merchant Marine Claims (Revised November 20, 2006)

Verification of Service Service Records Development Continuity of Treatment

77. Ionizing Radiation Claims (Revised August 19, 2010)

General Guidelines Radiation Claims Processing

78. Mustard Gas Claims (Revised August 26, 2006)

General Guidelines Pending Claims

79. Smoking Claims (Revised January 1, 2006)

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Claims Based on the Effects of Tobacco Products Most Commonly Expected Claims Development Guidelines

80. Guidance on Intertwined Issues (Appeals) (Revised April 16, 2009)

81. Helpless Child Claims (Revised February 4, 2011)

82. Spina Bifida & Other Birth Defects Claims (Revised January 31, 2011)

Jurisdiction of Chapter 18 Claims Initial Eligibility Verification Development Process Overview Vietnam Service and Date of Conception Requirements and Development Korean Service and Date of Conception Requirements and Development Disability Requirements for Spina Bifida Benefits Disability Requirements for Spina Bifida Benefits Disability Requirements for Other Covered Birth Defects Developing for Medical and Lay Evidence Benefits for Children with Spina Bifida of Veterans of Certain Service in Korea Other Birth Defects Eligibility & Development Accrued Benefits Fact Sheet

83. Special Monthly Compensation (Revised January 20, 2014)

Development and Evidence Requirements Aid and Attendance (A&A) Qualified Nursing Homes Special Monthly Compensation (SMC) Under 38 U.S.C.§ 1114(S) (Statuatory

Housebound) and a Total Rating Based Upon Individual Unemployability (TDIU) Special Adaptive Housing and Special Home Adaptation Grants (Public Law 112-

154, Sections 202/203)

84. Original Pension Claim (Revised April 28, 2012)

Pension Consolidation at the PMC Administrative Grant of Pension

85. Reopened Pension Claim (Revised April 28, 2012)

Pension Consolidation at the PMC Administrative Grant of Pension

86. Death Benefits (Revised June 16, 2010)

Application Forms Basic DIC Evidentiary Requirements Checklist Determining DIC Entitlement Establishing Entitlement as the Surviving Spouse Accrued Benefits Death Pension Eligibility

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Reviewing the Application Review the Evidence – Develop, Ready to Rate, or Finalized? Manual References for Development, M21-1MR, Part IV, Subpart III, Chap 1 What the Evidence Must Show for Death Benefits

87. Institutionalized Veteran (Revised January 1, 2004)

Pension Compensation Adjustment of Allowances

88. Power of Attorney (POA) Appointments (Revised January 27, 2013)

Power of Attorney Designations & Revocations Power of Attorney Revocations Guidance Regarding VA Form 21-22 Searchable Internet-Based Listing of Accreditied Attorneys, Agents, and Veterans

Service Organizations RepresentativesClaimant Representative Roles Use of VA Form 21-0845, Authorization to Disclose Personal

Beneficiary/Claimant Information to a Third Party Attorney Representation Language in PCGL and SOC Letters Updating SHARE to Reflect Power of Attorney (POA) Authorized Access to

Sensitive Information

89. Writeouts – Pending Message Work Items (EP 810 Series) (Revised March 23, 2011)

Guidelines for 631 Diary Due Notifications Issue: VA Form 21-4140 Review for Return of VA Form 21-4140 Telephone Development for VA Form 21-4140 Future Physical Examination References

90. Veterans Living at a Foreign Residence (Revised April 26, 2013)

Jurisdiction of Pre-Discharge Claims Processing for Service Members Requiring Examinations in Foreign Countires

Foreign Residence Change of Address Medical Examinations for Foreign Beneficieares

91. Routing Claims to Central Office (Revised February 4, 2008)

92. Whereabouts Unknown & Returned Mail (Revised December 14, 2009)

General Guidelines New Address Provided Procedures for Destruction of Returned Mail with No Evidentiary Value

93. Withdrawn Claims (Revised August 22, 2011)

Acceptable Notice Issue: Withdrawal of Claim by the Claimant Disposing of End Product

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94. VETSNET Participant Profile Flashes (Revised August 24, 2006)

95. Understanding Combined Evaluations (Revised April 28, 2005)

96. Ready to Rate Review Checklist (Revised January 13, 2012)

97. VCAA Law Attachments (Revised July 22, 2013)

1 – SC Death.........................................................................................................95.2

2 – Spina Bifida....................................................................................................95.3

3 – Dependency.....................................................................................................95.4

4 – Hepatitis C......................................................................................................95.5

5 – Burial...............................................................................................................95.6

6 – Permanent & Total........................................................................................95.7

7 – Incompetency & Competency.......................................................................95.8

8 – Extraschedular...............................................................................................95.9

9 – Loss of Use....................................................................................................95.10

10 – 10-Percent Rating for Multiple SC Disabilities.......................................95.11

11 – Specially Adapted Housing and Special Home Adaptation Claims......95.12

98. Abbreviations & Acronyms (Revised September 15, 1999)

99. Terms & Definitions (Revised January 8, 2011)

Continuity Direct Service Connection Duty to Assist First Treatment Hearing Loss Inferred Issue Informal Claim Multiaxial System Presumptive Service Connection Recent Treatment Service Connection VCAA Act of 2000 Attachments Wartime Service Periods – 38 CFR 3.2

100. Addendum (Revised May 30, 2014)

A – Request for Report of Investigation..........................................................100.3

B – Statement for Self-Employment Case (Unemployability Cases)............100.4

C – Sample PTSD Medical Opinion – No Medal, No Diagnosis in Service. .100.5

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D – Sample PTSD Medical Opinion – PTSD Diagnosed in Service .............100.6

E – Sample Combat Injury Medical Opinion..................................................100.7

F – Medical Statement for Housebound or A&A............................................100.9

G – Character of Discharge Administrative Decision..................................100.11

H – Sample Letter for Dependent Records....................................................100.13

I – Sample Letter – Solicit Claim-Add’l Evid Rcvd......................................100.14

J – Reserved......................................................................................................100.16

K – Gulf War Opinion Format.......................................................................100.17

L – Reserved.....................................................................................................100.18

M – Failure to Prosecute - VA Exam.............................................................100.19

N – Incompetency Notification.......................................................................100.20

O – Sample Final Attempt Letter...................................................................100.21

P – Sample Letter for Routine Future Examinations...................................100.23

Q – Sample Audio Medical Opinion Request (VERIS Version)..................100.24

R – DBQ Exam Worksheet.............................................................................100.25

S – Pension Checklist.......................................................................................100.28

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Change 26May 20, 2014

Section 1

Initial Review Actions_______

The following reference provide guidance on screening and processing original applications.

M21-1MR, Part III, Subpart ii, Chapter 2, Section B, and

M21-1MR, Part III, Subpart ii, Chapter 2, Section C,

COMPLETE REQUIREMENTS FOR CLAIMS ESTABLISHMENT

As the Veterans Benefits Administration (VBA) begins implementation of the National Work Queue (NWQ), uniform claims establishment is essential.

The following attributes are required for claims establishment:

Address Claim Label Claim Level Suspense Reason Claim Status Corporate Flashes Contentions Date of Claim End Product Military Service Data Power of Attorney Special Issues Segmented Lane Assignment

In order to ensure consistency across all regional offices (ROs), claims processors must enter all attributes at the time of claim establishment as accurately and completely as possible.

Reference: Compensation Service Bulletin, May 2014

PRESCRIBED FORM FOR ORIGINAL CLAIMS

A specific claim in the form prescribed by the Secretary (VA Form 21-526) must be filed in order for benefits to be paid to any individual under the laws administered by VA. See 38 CFR 3.151 for further details.

If the Veteran or service member submits VA/DOD Joint Disability Evaluation Board Claim, VA Form 21-0819, a VA Form 21-526 series application is not required to reopen a claim, file a claim for increase or a subsequent claim for service connection. Any communication

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Change 26May 20, 2014

or action that shows an intent to apply for benefits under VA law (informal claim), must be treated as a claim when a signed VA Form 21-0819 is a matter of record. The VA Form 21-0819 represents a formal claim and therefore, the claimant is not required to complete another formal application. See 38 CFR 3.151 and 38 CFR 3.155(c) for further details.

DETERMINE ELIGIBILITY FOR BENEFIT CLAIMED

VA should not continue assistance with a claim if there is no reasonable possibility that assistance would substantiate the claim. See 38 CFR 3.159(d).

If Character of Discharge is other than honorable, see Character of Discharge Determinations Section in this development guide for further details.

Minimum Active Duty Requirement Met? See M21-1MR.III.ii.6 and 38 CFR 3.12a for further details.

VERIFICATION OF SYSTEM DATA ENTRIES

Verify the following items in SHARE –corrections/updates must be made in SHARE in order to update BDN and the corporate database

Check for the proper signature.

Determine the benefit sought and the type of claim.

Check for character of discharge.

Check for service verification.

Check for basic eligibility for the benefit sought.

Check the application for blank spaces or insufficient information.

Check for acceptable dependency information.

Reference: M21-1MR.III.ii.1.A.2.

CLAIMS ESTABLISHMENT , END PRODUCT CODES , MODIFIERS

CLAIMS ESTABLISHMENT 38 CFR 3.1 (r) (Date of Receipt) M21-1MR III.ii.1.C.10 (Recording the Date of Receipt) M21-1MR III.i.2.A.2 (End Products and Dates of Claim for Pre-Discharge Claims) M21-1MR, Part III, Subpart ii, Chapter 1, Section B (Mail Management)

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M21-1MR, Part III, Subpart iii, Chapter 2, Section C, Topic 20(h) (CEST Processing When No BIRLS Record Exists)

M21-1MR, Part III, Subpart iii, Chapter 2, Section C, Topic 20(i) (Action if a BIRLS Record Exists at CEST)

M21-4, Appendix C (End Product Codes) SHARE User’s Guide Fast Letter 12-03 (Revised VETSNET Business Rules) and Fast Letter 12-03

Enclosure

For a list of end product codes and descriptions, see M21-4, Appendix C, End Product Codes.

THIRD DIGIT MODIFIERS.1 - Benefits Delivery at Discharge (BDD)2 - Radiation6 - Foreign Case7 - Quick Start/PMC9 - PMC dual claims and reopened service-connected death claims (see Veterans Service Center Manager’s Conference Call, February 2009

REVIEW VA FORM 21-526 FOR CLAIMED DISABILITIES

Review the application for claimed disabilities by reviewing each of the following areas:

A. VAF 21-526, Part B: Compensation, Section 1, Item 1 (What disability are you claiming). Be sure to check this area for any disabilities the Veteran is claiming.

B. Veteran Claims Exposure as a Disability (e.g. exposure to agent orange, exposure to asbestos, exposure to radiation, etc.) Pay particular attention to VAF 21-526, Section 2, Items 5a, 5b (herbicides), 6a, 6b (asbestos), 7a, 7b (mustard gas), 8a, 8b (ionizing radiation), and 9a, and 9b (environmental hazards).

Any time the Veteran checks “yes” to being exposed to any of these hazards, send the Veteran the VCAA notification letter and specify the disability.

If the Veteran does not specify the disability, inform the Veteran that exposure, in and of itself, is not a disability for which service connection can be granted. The Veteran needs to provide the specific disability being claimed as due to such exposure.

Fully develop any other claimed conditions.

If the Veteran fails to respond, then the claim for exposure will be denied administratively. Refer to the Administrative Denials Section in this development for further details.

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C. VAF 21-526, Part B: Compensation, Section III (Explanation). In this box, the Veteran very often lists additional disabilities or sets forth a narrative that must be read carefully for any claimed disabilities.

D. VAF 21-526, Part A: General Information, Section X (Remarks). This is a very large blank space in which the Veteran is told to mention any questions or comments about a specific item on the form. This box needs to be checked for any potential claims.

E. VAF 21-526, Part D: Pension. Check this area of the application to see if the Veteran is claiming pension.

Note: Pay particular attention to claims transferred-in from another Regional Office. Don’t assume the other office properly identified all the issues and/or disabilities.

This topic is a compilation of issues noted on STAR Error Reports.

SUBSTANTIALLY COMPLETE APPLICATION

An application for benefits, VA Form 21-526, is considered an original claim when received for the first time. Before initiating development on the claim, the application must be substantially complete.

Refer to M21-1MR.I.1.B, for specific guidelines regarding “Criteria for Substantially Complete Applications.”

Note: The claimed disabilities should be diagnosed conditions. Exposure to certain agents, such as Agent Orange and anthrax, are not considered a disability.

Note: See M21-1MR.III.ii.1.C11, (Checking for Signature of Claimant).

CLAIMS NOT SUBSTANTIALLY COMPLETE

If the application is not substantially complete, refer to M21-1MR.I.1.A.2e, for specific guidelines regarding “Circumstances Where VA Will Refrain from or Discontinue Providing Assistance.”

If the application is not substantially complete, refer to M21-1MR.I.1.B.3b, for specific guidelines regarding “Notification Requirements for Complete or Incomplete Applications.”

CLAIMS EXPRESSLY CLAIMED , IMPLIED , INFORMAL , POTENTIAL , MANDATED , OR AMBIGUOUS

Recognizing Issues When Preparing a Decision

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Clarification of a claim may be required since the Rating Veterans Service Representative (RVSR) must prepare a rating decision that recognizes and decides all issues, whether expressly claimed, implied, informal, potential, mandated, or ambiguous. Reference M21-1MR.III.iv.6.B.2a

Clarifying Issues and ClaimsWhenever the intent of the claimant is unclear, and/or the benefit sought is not clearly identified, ask the claimant to clarify the issue to ensure appropriate development and accurate decisions. Inform the claimant that VA will take no action pending clarification of intent. Reference M21-1MR.III.iv.6.B.2.c

ORIGINAL CLAIM RECEIVED WITHOUT VA FORM 21-526 (OR THE PRESCRIBED FORM) AND CLAIMS MADE BY TELEPHONE

If a Veteran makes his/her intentions known that they want to submit a claim for benefits, but has never provided a VA Form 21-526 (or the prescribed form), and/or made a claim by telephone, refer to M21-1MR.III.ii.2.D.16 for guidance.

VETERAN’S SUPPLEMENTAL CLAIM , VA FORM 21-526B

VA Form 21-526b is designed to assist Veterans in submitting a supplemental claim. The form allows Veterans to list disabilities, provide the locations of certain treatment records, and request ancillary benefits. However, there is no requirement to use a VA Form for a claim to reopen. (M21-1MR.III.ii.2.E)

Only Veterans who have already filed original claims for compensation and/or pension can use VA Form 21-526b. If an original claim is not of record, accept VA Form 21-526b as an informal claim and follow current procedures (see M21-1MR.III.ii.2.D).

WHEN A SIGNATURE IS NOT REQUIRED

If a VA Form 21-526 is on file, the claimant’s signature is not required on any subsequent claim for increase or for service connection, including claims to reopen. There is no regulation or statute that requires a signature on an informal claim. Also, 38 CFR § 3.155(c) makes clear that once a formal application has been filed, any subsequent informal claim will be accepted as a claim. See 38 CFR §3.155 for further details regarding Informal Claims. Source: C&P Service Home Page, FAQ link, Informal Claims for Increase.

While normal development procedures and rules of evidence apply to on-line application claims, the signature requirement for a substantially complete claim is set aside when a claim is filed electronically through on-line application. Reference: M21-1MR.III.ii.1.A.3c.

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SEPARATION DOCUMENTS

File DD Form 214, the military separation document or its equivalent, on the right flap in reverse filing order to ensure these forms appear above the training material and under the VA Form 21-22, “Appointment of Veterans Service Organization as Claimant's Representative,” or VA Form 2-22a, “Appointment of Attorney or Agent as Claimant's Representative,” at all times. If necessary, add an ACCO fastener to the right flap of an existing folder to accommodate this method of filing. See M21-1MR.III.ii.3.C for further details.

SERVICE VERIFIED AND HONORABLE?

Make sure military service is verified and honorable. Use the SHARE program to update the military service data since this program will update both BDN and the corporate database.

Refer to Verification of Service Section in this development guide for further details regarding acceptable documentation.

Refer to the Service Records Development & PIES Section in this development guide for further details regarding development actions.

Is service is not verified, correct procedures should include the following:

Send a request to the service records center for verification of service;

Send a request to the claimant for a separation document;

If the service records center provides a negative reply, send a request to the claimant for alternative sources; send NA Form 13075, Questionnaire About Military Service.

If the form is provided (with sufficient information), a PIES Request S02 should be submitted.

DETERMINE TYPE OF MILITARY SERVICE

Fire-Related Cases, see Service Records Development & PIES Section in this development guide for further details.

Reserve or National Guard development, see Reserve & National Guard Service Development Section in this development guide for further details.

REVIEW OF SERVICE TREATMENT RECORDS

HOW TO EFFICIENTLY REVIEW RECORDS

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In order to review Service Treatment Records and Private Treatment Records efficiently you should:

Limit your review as much as possible. Locate and tab the entrance and separation physical exams in the STRs. Review the body of the STRs only if the claimed condition(s) are not listed on the

separation examination or one or more are listed on the entrance examination. Tab where a claimed condition is located if it is not mentioned on the separation

physical exam. Tab post service records only to show the claimed condition exists. Refer to the Service Treatment Record and Post Service Treatment Record Crib Notes

for additional tips and strategies.

Reference: Advanced Development Course (ADC) 103 – Review of Service Medical Records and Post Service Medical Records (TMS #79201)

DO NOT sort STRs by claimed disabilities or put them in chronological order.

Note. If STRs are on file and the claimant was discharged more than one year prior to the date of claim, and the claimant is requesting service connection for a new condition, review the STRs prior to proceeding with the development of the claim.

Determine if the Veteran was treated for the claim conditions during military service. If the STRs show the claimant received treatment during military service, consider requesting a VA examination. See VA Examination Section in this development guide for further details. For further details regarding the requirement for federal records, see M21-1MR.I.1.C.5.

OBTAIN ALL STRs. Service treatment records (STRs) are required for all periods of service. If the STRs are not complete, attempt to obtain all available records. Attempt to obtain the original STRs, however, copies submitted from the Veteran are adequate for rating purposes.

Ascertain the alleged disabilities and any dental conditions from the claim, including the dates and places of examination or treatment. Carefully review any available service medical/dental records in the claims folder to find treatment reports supporting the claimed disabilities.

STR FOLDER RECEIVED BY RO – SYSTEM UPDATE. Refer to M21-1MR.III.iii.2.C.19f for guidance regarding system updates when the STRs are received (updating the SMR Indicator Field on the SHARE Location Screen).

REQUESTING STRs FROM THE VETERAN. If photocopies of STRs are received from the Veteran, acknowledge receipt of the photocopies; inform the Veteran the original STRs will be requested from the service records center; ask the Veteran for original copies.

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DEVELOPING FOR STRs. Refer to Service Records Development & PIES Section for further guidance.

SPECIAL CATEGORY TAGS

Attach special tags as appropriate, such as:

POW

70 Yrs Old

Homeless Veteran

Gulf War

Appeals

PROTECTION OF SERVICE RECORDS

The STR folder (received from the service department) is maintained in the VA claims folder and placed in VA Form 21-4582, “Service Department Records Envelope,” which must be filed down to prevent loss or damage.

Reference: M21-1MR.III.iii.2.A.2, Protecting Service Records.

HANDLING AND STORAGE REQUIREMENTS FOR THE DOD STR FOLDER

When a servicemember leaves the military, his or her Service Treatment Records (STRs) are transferred to VA on a long-term loan. The Department of Defense (DoD) is the owner of the STRs and the STR folder.

The DoD Records Custodians have raised the issue that VA is destroying their STR folders, which contain some medical documentation on the servicemember/Veteran, thus destroying the integrity of the total STR.

The M21-1 Manual Rewrite(MR), specifically M21-1MR..III.iii.2.A, details handling and storage requirements for STRs. The M21-1MR does not authorize the destruction of the STR folder. Under no circumstances should the STR folder be destroyed.

Some specifics related to handling and storing DoD STRs on loan to VA include: Avoid marking on, date stamping, or punching holes in any records received from the

service department. Avoid removing STRs from the STR folder unless necessary for photocopying (M21-1MR III.iii.2.A.2.a).

STRs belong to the respective service departments and are on loan to VA. As such, the STRs are subject to recall by a service department (M21-1MR III.iii.2.A.2.c).

While in VA’s possession (M21-1MR III.iii.2.A.2.c):

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Place the STR folder neatly within the claims folder Do not remove or rearrange documents from the STR folder unless necessary for

photocopying Do not place the STR folder in a VA Form 21-4582, Service Department Records

Envelope Establish a separate volume of the claims folder in which to maintain the STR

folder or STR envelope if the thickness is more than one inch, or more than two and one-half inches when combined with the claims folder

Additionally, when a service department requests return of the STR folder, VA must: Photocopy the STRs Stamp the copies to show they are copies of the originals and that the original

STRs were returned. Place photocopies of STRs in VA Form 21-4582. File VA Form 21-4582, with STR copies in the center flap of the claims folder. Return the original STR folder and the original STRs to the service department

Reference: C&P Service Bulletin, May 2010

VISUALLY IMPAIRED VETERANS

If a Veteran has been evaluated as 70 percent or more disabling for visual impairment, VA Form 21-0178 should be backfiled in the center flap of the claims folder.

When communicating with a visually impaired Veteran or sending correspondence, refer to M21-1-MRIII.v.2.B for further guidance.

DEPENDENCY DEVELOPMENT OF COMPENSATION CLAIMS

Dependency is not a factor for entitlement to compensation.

Development for dependency information should only be completed when a rating shows a combined evaluation of 30 percent or more or when it is apparent the Veteran's SC disability will warrant at least a 30 percent evaluation.

Example: The Veteran lost both legs in service.

Reference: M21-1MR.III.iii.5.A.1h.

REVISION OF VA FORM 21-526EZ, APPLICATION FOR DISABILITY COMPENSATION AND RELATED COMPENSATION BENEFITS

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Compensation Service revised VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. The new form, dated January 2013, is designed to provide a single application for use by both Veterans and Servicemembers. The new VA Form 21-526EZ will replace VA Forms 21-526, Veterans Application for Compensation and/or Pension, 21-526b, Veteran's Supplemental Claim for Compensation, and 21-526c, Pre-Discharge Compensation Claim. Significant changes include:

Adding Servicemember to the form title and revising language to address pre-discharge claims.

Adding a “forwarding address” block for pre discharge claimants. Revising the “list of disabilities” block to allow for separate contention entries. Revising “military retired pay language” for clarity.

The form is now available online at http://vaww4.va.gov/vaforms/. Regional offices (ROs), Pension Management Centers (PMCs), and other locations that accept claims are encouraged to use the VA Form 21-526EZ in all public contact work; however, they should continue to accept claims submitted on any approved older versions of the form.

E-mail questions to the VAVBAWAS/CO/212A mailbox.

Reference: Compensation Service Bulletin, March 2013

ACCEPTANCE OF PREVIOUS VERSIONS OF VA FORM 21-526EZ, APPLICATION FOR DISABILITY COMPENSATION AND RELATED COMPENSATION BENEFITS

Fast Letter 12-25 (Revised 8-13-2013), The Fully Developed Claim Program (Rescinded), allowed a 30-day grace period in which claims personnel would continue to consider a claim received on the FEB 2010 versions of the VA Form 21-526EZ or VA Form 21-527EZ (EZ forms) as potentially eligible for expedited processing under the Fully Developed Claim (FDC) Program.

In the December 2012 Compensation Service Bulletin, Compensation Service announced the expiration of that 30-day grace period.

Please remember, as stated in the bulletin, the AUG 2011 and later versions of the EZ forms are the required forms to participate in the FDC Program.

Claims personnel must consider a claim received on a FEB 2010 EZ form before December 21, 2012, as potentially eligible for processing in the FDC Program.

Claims personnel must follow established procedures in Fast Letter 12-25 to exclude a claim received on a FEB 2010 EZ form on or after December 21, 2012 from the FDC Program.

Reference: Compensation Service Bulletin, June 2013

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CRITERIA FOR HARDSHIP CLAIMS

VA Regional Offices (ROs) will provide priority processing on those claims received from claimants who are experiencing extreme financial hardship. ROs should consider these claims on the same priority level as homeless claims.

In order to consider a claim for priority processing based on financial hardship, VBA will accept the claimant’s statement together with some documentation indicating that there is an extreme financial hardship. Some examples of documentation of extreme hardship include, but not limited to:

• eviction notice or statement of foreclosure,• past due utilities notice,• collection notices from creditors, or• the designation of the Veterans Service Center Manager (VSCM).

When a financial hardship claim is identified, append the Hardship Flash to the record for tracking purposes. Claims processors will case-manage priority claims through frequent follow-ups, telephone contacts, and collaboration with the Veterans Health Administration (VHA) and other counterparts to ensure the claim is expedited at all stages of the claims process. In addition, BVA allows advancement on the appeals docket for claimants who are terminally ill, of advanced age, or experiencing financial hardship.

Reference: Compensation Service Bulletin, December 2013

CHANGES

Change 3, February 16, 2005, incorporated guidance regarding special handing requirements for Veterans who served in OEF and OIF.

Change 4, April 13, 2005, added guidance regarding system updates for designated representatives (POA); incorporated references within each topic.

Change 5, April 18, 2005, guidance regarding OEF/OIF claims was moved to Section 45.

Change 6, September 6, 2005, added guidance regarding correspondence with visually impaired Veterans.

Change 7, September 23, 2005, corrected the reference cited in the topic entitled, Claim Not Substantially Complete.

Change 8, December 8, 2006, added guidance regarding release of confidential information only after the Veteran has provided VA Form 21-22a.

Change 9, March 27, 2008, deleted guidance regarding the use of the “9” modifier per FL 08-07.

Change 10, October 18, 2008, added guidance regarding appointment of individual as claimant’s representative; guidance regarding searchable internet-based listing of accreditied attorneys, agents, and Veterans service organizations.

Change 11, July 27, 2009, removed Power of Attorney Designations & Revocations to Section 16.

Change 12, November 23, 2009, added guidance regarding sequential EPs.

Change 13, February 2, 2010, added guidance regarding review of STRs and post-service medical records.

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Change 14, May 20, 2010, added guidance storage of DoD STRs.

Change 15, June 25, 2010, added guidance regarding the discontinuance of sequential EPs (FL 10-23).

Change 16, January 25, 2011, added guidance regarding claims that are expressly claimed, implied, informal, potential, mandated, or ambiguous.

Change 17, February 14, 2011, added guidance regarding development for dependency.

Change 18, January 4, 2012, added guidance regarding VA/DOD Joint Disability Evaluation Board Claim, VA Form 21-0819.

Change 19, March 27, 2012, added guidance regarding “Service Verified & Honorable?” and “Determine Types of Military Service” and general guidelines regarding review of STRs from Section 28.

Change 20, May 29, 2012, updated guidance regarding original claims received without a VAF 21-526 (or the prescribed form).

Change 21, June 23, 2012, added guidance regarding updating the VADS “DEV” entry to read “SAT.”

Change 22, March 27, 2013, added guidance regarding Revision of VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits.

Change 23, June 19, 2013, added guidance from the June 2013 Compensation Service Bulletin regarding acceptance of previous versions of VA Form 21-526EZ. Removed the reference to FL 10-23, Discontinuance of Sequential EPs.

Change 24, January 20, 2014, added guidance from the December 2013 Compensation Service Bulletin regarding the criteria for hardship claims.

Change 25, February 21, 2014, deleted guidance regarding NA Form 13042; updated references and hyperlinks.

Change 26, May 20, 2014, added guidance from the May 2014 Compensation Service Bulletin regarding complete requirements for claims establishment.

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Section 2

Formal & Informal Claims_______

There are both formal and informal communication that may constitute claims and determine effective dates.

FORMAL OR INFORMAL CLAIM - 38CFR 3.1(P)

Under application of §38 CFR 3.1 (p): a “claim” – “application”, means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit.

A pending issue should be established for the following formal claims:

Receipt of VA Form 21-526 application form establishes a formal claim; photocopies are acceptable. The application may be received by mail or fax.

After a VA Form 21-526 is on file, any indication or action reflecting an intent to apply for one or more benefits from a claimant, his or her representative, or a member of Congress may be accepted as a informal claim provided the claimant identifies the benefits sought. (38 CFR 3.155)

Claims from a Next of friend can only be accepted in situations where claimants do not have the capacity to manage their own affairs or do not have the ability to act for themselves.

VONAPP applications are considered formal claims from date of submission. Refer to the section entitled VONAPP Applications for further guidance.

Note: If the claimant reports having filed an informal claim but it is not of record, attempt to locate the claim by checking search mail bins, the charge card folder, etc. Document all attempts to locate the informal claim.

INFORMAL CLAIMS - 38CFR 3.155(A)

Any communication or action, indicating an intent to apply for one or more benefits under the laws administered by the Department of Veterans Affairs may be considered an informal claim. See 38 CFR 3.155, Informal claims.

We should provide the Veteran an opportunity to file a claim for the injury or disability. Therefore, send a letter to the Veteran asking if he or she would like to claim service connection for the injury or disability identified.

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Change 4March 25, 2014

Under §38 CFR 3.157, a report of examination or hospitalization may be accepted as an informal claim once a formal claim for pension or disability compensation has been allowed or a formal claim for disability compensation disallowed for the reason that the service-connected disability is not compensable in degree. This also applies in cases of retired members of uniformed services whose formal claims for pension or disability compensation have been disallowed because of receipt of retirement pay, as well as in cases when entitlement to pension was previously denied because the disability was not permanently and totally disabling.

Likewise, under §38 CFR 3.157 nonservice connected disabilities and conditions documented in treatment records or noted in examination reports which are not consistent with the criteria delineated in this section cannot be considered informal claims.

However, in cases of documented references to disabilities which may have resulted from service for which no claim as defined in §38 CFR 3.1(p) or §38 CFR 3.155, has been submitted, we should contact the Veteran and ask if he or she desires to file a claim for the condition(s).

INFORMAL CLAIMS MUST BE SUBMITTED IN WRITING

The Court of Appeals for Veterans Claims and the Court of Appeals for the Federal Circuit have determined that informal claims must be submitted in writing. The March 2009 Addendum to the C&P Service Bulletin clarified this rule. C&P Policy has described an informal claim as any ―communication or action, transcribed in written form, that requests a determination of entitlement or evidences a belief in entitlement to a benefit, and adequately identifies the benefit sought.

Take, for example, the case of a Veteran who is scheduled for a VA Exam for increased evaluation of his service-connected right knee condition. During the exam, the Veteran tells the examiner that he believes his right hip pain is due to his right knee condition. Once this is documented in the written exam report, the Veteran has effectively filed an informal claim for benefits for his right hip pain secondary to his service-connected right knee condition. This approach is also in line.

Reference: QA Times, Volume 1, Issue 1, January 2011

If during a VA exam a statement is made by a Veteran that a condition (not currently claimed) began in service, is due to service, or is due to a service connected condition, a claim should be solicited from the Veteran.

Clarification regarding the issue of claims raised during examination (noted in the QA Times of January 2011) was sought and the following guidance was provided:

“We have reviewed the QA Times section on informal claims and believe that this is a correct interpretation on informal claims, consistent with Ellington. Please refer to the December 2008 VSCM conference call briefing titled “Impact of the Ellington v. Nicholson and Ellington v. Peake Decisions on Inferred Claims.” This information trumps guidance contained in the

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Change 4March 25, 2014

May 2008, STAR Reporter. As such, we believe that, consistent with Ellington and related jurisprudence, that once the “communication or action” is transcribed in writing, such as via a VA Form 119 or the transcription of the VA examination report, and the transcribed communication requests a determination of entitlement or evidence a belief in entitlement to a benefit, and adequately identifies the benefit sought, an informal claim has been raised.”

“In the scenario presented in the QA times, the Veteran communicated a belief that his right hip condition was related to his service-connected right knee condition. The communication has been transcribed; thus, it is now “in writing.” Consistent with our duty to sympathetic consider a Veteran’s pleadings, an informal claim has been raised for service connection for a right hip disability secondary to service-cponnected right knee and should be adjudicated.”

Reference: Email From:VAVBAWAS/CO/21Q&A; Sent: Monday, February 14, 2011 6:03 AM; Subject: RE: The QA Times.

It should be noted that this guidance is regardless of whether or not the benefit will ultimately be granted. The focus must be on whether or not there is an indication that the Veteran is filing a claim, and not whether or not the claim will be granted.

REQUIREMENTS FOR INFORMAL CLAIMS

The United States Court of Appeals for Veterans Claims held that a reference to “all disabilities of record” was insufficient to satisfy the requirement for informal claims under 38 C.F.R. § 3.155(a) that the claim must “identify the benefit sought.” The Court explained that in identifying the benefit sought, the Veteran must describe the nature of the disability for which he is seeking benefits, which may be satisfied by referring to the body part or system that is disabled or by describing symptoms of the disability. Reference: Decision Assessment Document, Brokowski v. Shinseki, 23 Vet.App. 79 (2009)

38 CFR 3.155(a) specifies the requirements that must be met, which include identifying the benefit sought, in order for an informal claim to be accepted as the effective date of claim in the event that benefits are granted. The Veterans Court, in Brokowski v. Shinseki, 23 Vet.App. 79 (2009), held that in identifying the benefit sought, the Veteran must describe the nature of the disability for which he is seeking benefits, which may be satisfied by referring to the body part or system that is disabled or by describing symptoms of the disability.

The Brokowski requirement is applicable to claims to reopen and for increased evaluation.However, in the context of an original disability compensation claim, if an informal claim only contains a general indication of seeking entitlement to compensation benefits and the claimant completes a formal application for benefits, which identifies the nature of the disability for which benefits are sought, within a year from the date that a formal application is sent to the claimant, the date of the informal claim with a general request for compensation benefits may be established as the effective date of entitlement in the event that compensation benefits are granted. See 38 U.S.C. 5102(c).

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Change 4March 25, 2014

For example, a Veteran writes to Veterans Affairs (VA) that he wants “compensation for injuries incurred in service.” VA, in concert with its duty under section 5102(c), provides the Veteran with a VA Form 21-526, which the Veteran completes and identifies specific conditions for which compensation is sought, and returns the formal application to VA within a year from the date of receipt of the form. In the event that VA awards compensation benefits, the date that the informal claim, which only contained a general request for compensation, was received will be established as the effective date of claim.

These requirements regarding informal claims under § 3.155(a) are applicable to all claims to include fully developed claims (FDC). (Reference: Compensation Service Bulletin, March 2014)

CLAIMS MADE BY TELEPHONE – INFORMAL CLAIM – DATE OF CLAIM

A telephone call from a claimant indicating intent to apply for benefits, documented on 21-0820, Report of General Information, is acceptable as an informal claim for the purpose of establishing a date of claim. Reference: M21-1MR.III.ii.2.D16.

CLAIMS MADE BY TELEPHONE – RECOGNIZED CLAIMANTS

Issue: Informal claims received by telephone

Question

If someone other than the Veteran, surviving beneficiary, or fiduciary calls to file a claim on behalf of the claimant and this request is documented on VA Form 21-0820, will this be accepted as an informal claim by the Regional Office?

Answer

Claims received by telephone may only be submitted by only one of the individuals - claimant, representative, Member of Congress, or next friend - who are identified under 38 CFR 3.155. Normally, these claims via telephone will have to be submitted by the claimant or the claimant's authorized representative, such as a VSO representative, attorney, or agent.

A family member or friend cannot execute a claim, to include by telephone, for a claimant before VA unless the family member or friend has Power-of-Attorney over the claimant. The "next friend of a claimant" language under 38 CFR 3.155 applies only if the claimant has less than full legal rights or capacity. Sui juris is defined as having full legal rights or capacity; thus, under 38 CFR 3.155, a claimant who is not sui juris does not have full rights or legal capacity. Typically, this may be done for an incompetent claimant.

Reference: Q&A Commitee - Questions and Answers [Thursday, February 28, 2013]

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Change 4March 25, 2014

CHANGES

Change 1, January 12, 2011, added guidance regarding telephone calls as informal claims.

Change 2, February 18, 2012, added guidance regarding Informal Claims Must Be In Writing.

Change 3, February 28, 2013, added guidance regarding claims made by telephone..

Change 4, March 25, 2014, added guidance from the March 2014 Compensation Service Bulletin regarding informal claims.

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Change 6August 20, 2013

Section 3

VONAPP Direct Connect eClaims_______

VONAPP applications will be treated as formal claims from date of submission/receipt.

GENERAL DEVELOPMENT GUIDELINES

As of August 20, 2013, VDC is now linked with VBMS, and is no longer linked to Virtual VA. The VONAPP Direct Connect eClaims Adjudication Guide is effective August 20, 2013, and applies only to VDC claims received in VBMS, and not to VDC claims received in Virtual VA. For VDC claims received in Virtual VA, ROs should process those claims to completion using the guidance in Fast Letter 12-26, Procedures for Processing VONAPP Direct Connect Disability Claims. However, claims personnel should, for all claims, review any evidence available in paper, the VBMS eFolder, and the Virtual VA eFolder (as applicable).

On November 8, 2012, Compensation Service released Fast Letter 12-26, Procedures for Processing VONAPP Direct Connect Disability Claims, which provides guidance on handling disability compensation claims filed through Veterans Online Application (VONAPP) Direct Connect (VDC), the electronic claim processing system used to expedite delivery of benefits. It also provides detailed instructions on maintaining claims in the paper-electronic “hybrid” environment.

VDC streamlines the claims process with electronically automated actions such as populating VA Form 21-526EZ, generating the appropriate rating end product (EP), establishing the date of claim, and transferring claimed contentions to Modern Awards Processing-Development (MAP-D). To further expedite the claims process, VDC claimants can also file claims in the FDC program.

Reference: Compensation Service Bulletin, November 2012

CHANGES

Change 1, January 1, 2006, incorporated references within the topic Change 2, August 26, 2006, added M21-1MR reference; deleted reference to FL and M21-1.

Change 3, June 2, 2008, added guidance regarding the elimination of having to have a wet signature on VONAPP applications.

Change 4, September 18, 2012, updated M21-1MR reference.

Change 5, December 9, 2012, added guidance regarding VONAPs submitted through VDC.

Change 6, December 9, 2012, added guidance regarding VONAP Direct Connect eClaims.

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Section 4

VA Benefits & Active Duty Service_______

CLAIMS FILED PRIOR TO, OR AT THE TIME OF DISCHARGE FROM ACTIVE DUTY

Development guidelines are outlined in M21-1MR, Part III, Subpart ii, Chapter 2, Section B, Topic 8, entitled “Claims Filed Prior to, or at the Time of Discharge From Active Duty.”

STATUS OF PENDING CLAIMS UPON VETERAN’S RETURN TO ACTIVE DUTY

General Counsel Opinion 10-2004 holds that the Veteran’s return to active duty generally does not alter the legal rights and responsibilities of the Veteran and VA with respect to pending claims. A person who has attained the status of a Veteran based on separation from service does not lose that status merely because he or she has entered into a new period of active duty. The Veteran is potentially entitled to benefits for at least the period between the date of the claim and the date of return to active service. The return to active duty is merely a bar against the Veteran receiving both active service pay and VA compensation/pension for the same period.

Note: A Veteran who reenters active duty may elect to receive VA benefits in lieu of active service pay.

VA should process the claim of such Veterans in the same fashion as it would had the Veteran not returned to active duty.

General Counsel was asked what the VA should do when the Veteran’s return to active duty limits the VA’s ability to develop and adjudicate the claim (e.g. we are unable to obtain a VA exam/opinion). GCOP 10-2004 states the VA generally may not deny a claim solely because the Veteran’s return to active duty temporarily prevents VA from conducting an examination or other required procedure. VA may have to defer action on a claim until the Veteran becomes available for examination. If a Veteran’s return to active duty temporarily prevents VA from providing a necessary medical exam or taking other action necessary to make a proper decision on the claim, VA may suspend or defer action on the claim until the necessary actions can be accomplished. VA may not deny a claim solely because the Veteran returned to active duty or is temporarily unavailable for an exam due to the Veteran’s return to active duty.

REMANDED CLAIMS. If a Veteran’s claim is remanded to the regional office for an exam and the Veteran is not available because of the Veteran’s return to active duty, the VA

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may defer action on the claim until the required exam can be conducted. The VA may no deny the claim solely because of the Veteran’s temporary unavailability due to a return to active duty.

VETERAN IS ABLE TO ATTEND SCHEDULED EXAM. If the Veteran has a pending claim and is able to attend a scheduled exam while on active duty, the VA should process the Veteran’s claim in the same manner as it would if the Veteran had not returned to active duty. The Veteran’s return to active duty does not alter the status of the Veteran’s claim.

VETERAN DIES ON ACTIVE DUTY. If a Veteran with a pending claim returns to active duty and dies while on active duty, the pending claim may provide the basis for an award of accrued benefits to the survivor. Accrued benefits consists of amounts “due and unpaid” to the deceased beneficiary. Therefore, accrued benefits may not include compensation and pension amounts for any period for which the Veteran received active service pay.

For further guidance, refer to General Counsel Opinion 10-2004, entitled “Effect of Return to Active Duty upon Claims for VA Benefits,” dated September 21, 2004.

SERVICEMEMBERS CIVIL RELIEF ACT (SCRA) WEBSITE

Users may submit a Single Record Request to obtain a report certifying Title 10 active duty status for provisions under SCRA. This military website could be used to verify active duty status. The website will provide a certificate that can be printed (see the User’s Guide on the SCRA website).

https://www.dmdc.osd.mil/appj/scra/welcome.xhtml

CHANGES

Change 1, January 1, 2005, incorporated guidance from GCOP 10-2004 with regard to the status of a pending claim when the Veteran returns to active duty.

Change 2, March 14, 2005, updated the references for service members on active duty who are not under BDD.

Change 3, April 21, 2005, incorporated guidance from M21-1MR regarding claims filed prior to, or at the time of discharge from active duty.

Change 4, January 1, 2006, incorporated references within each topic.

Change 5, June 17, 2013, added hyperlink for the SCRA website which can be used to verify a servicemembers active duty status.

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Section 5

5103 Notice Letters_______

1 – 5103 Notice Letter Requirements...................................................................5.2

2 – When 5103 Notice is Not Required................................................................5.7

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Section 5.15103Notice Letters

5103 Notice Letter Requirements_______

ELIMINATION OF REQUIREMENTS TO SPECIFY EVIDENCE RECEIVED IN 5103 NOTICES

In PL 110-389, Congress provided VA the authority to provide generalized, rather than specialized, §5103 notices. ROs are no longer required to specify evidence received in §5103 notices. Currently, VBMS automatically adds the “What Have We Received” paragraph to §5103 notices. Until this paragraph is removed from VBMS, VSRs should add the following sentence to the evidence list, using the date of the letter as the receipt date: “All evidence received to date has been incorporated into your electronic record.”

For notices created in MAP-D, VSRs should delete the “What Have We Received” paragraph.

Email questions to the VAVBAWAS/CO/212A mailbox. (Reference: Compensation Service Bulletin, March 2014)

CHANGES TO OUR DUTY TO NOTIFY AND DUTY TO ASSIST – IMPLEMENTATION OF SECTIONS 504 AND 505 OF PUBLIC LAW 112-154

Sections 504 and 505 of Public Law 112-154 (the “law”) became effective February 2, 2013. No rework of claims handled prior to receipt of this e-mail will be required as a result of this amended law.

The purpose of the law is to streamline our duty to notify and duty to assist responsibilities.

It should be noted that Central Office has replaced the term “VCAA notice” with “Section 5103 notice”, and Central Office will revise this language in all applicable materials.

It is important to remember that VA Forms 21-526EZ, 21-527EZ and 21-534EZ, contain all the information that we used to include in our 5103 notice (e.g. what the claimant must do and what VA will do).  Specifically, in the 526EZ (the August 2011 and January 2013 versions), there are two sections titled “What the Evidence Must Show to Support Your Claim” and “Evidence Tables.”  These sections are equivalent to the law attachments that were previously attached to the Section 5103 notice.  The following is a list of the laws covered by these two sections.  You may want to use this list, or an actual copy of the 526EZ, for a reference.

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Direct service connection Secondary service connection Increased disability compensation Temporary total disability ratings (Pars. 29 and 30) Individual unemployability Compensation under 38 U.S.C. 1151 Special monthly compensation Special adapted housing or special home adaptation Auto Allowance Aid and attendance of a spouse Helpless child

Please note that the February 2010 version of the 526EZ only addresses service connection, secondary service connection and increases.

Also, please note that claims filed through the VONAPP Direct Connect (VDC) through eBenefits provide the claimant with the same notifications as are found in the January 2013 EZ forms.

Section 1:  Flexibility in how and when VA delivers the 5103 notice

Current Practice:  We send the 5103 notice AFTER a claimant submits a substantially complete claim.

New Practice:  The 5103 notice no longer has to be sent after receipt of a claim.  The 5103 notice is now available to the claimant prior to the filing of the claim.  This is accomplished two different ways.

a. VA Forms 21-526EZ, 21-527EZ or 21-534EZ, contain all the information that we used to send to the claimant after a claim was filed.  Therefore, the 5103 notice requirements are satisfied with the filing of these claims.   Note:  Although these three forms are currently designated for Fully Developed Claims (“FDC”), the 5103 notice requirements are satisfied for a claim filed on one of these forms, even if the claim is found not to meet FDC criteria.

Regional Offices are being encouraged to promote the use of the EZ forms for ALL types of claims that are specific to these forms.

b. If a claimant files a claim through VDC through eBenefits, the claimant will be provided with the necessary 5103 notice.  The VDC portal allows a claimant to file a paperless claim using VA 21-526EZ.  Note:  The electronic filing of a claim through VDC provides the veteran with sufficient notification, whether or not the claim is found to meet FDC criteria

New and material evidence:  In accordance with Kent v. Nicholson, our 5103 notices have always had to contain information advising the claimant when he was previously

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denied the benefit and the basis for the previous denial.  This requirement remains in effect, even though we are streamlining our duty to notify.  Accordingly, even if a claim is filed on an EZ Form or through VDC, we must still send the claimant notification containing “What the evidence must show” specific to new and material evidence and a discussion of the date and reason for the prior denial.

Section 2:  5103 Notices not required under certain circumstances

Current Practice:  We issue separate 5103 notices for subsequent claims, even while the same type of issue from a previous claim is still pending.

New Practices: 

a. When a prior claim was filed on an EZ form or through VDC, we are no longer required to send a 5103 notice for a subsequently filed claim that was filed while the prior claim was still pending, as long as the EZ form or VDC (this contains the same information as is found on the January 2013 EZ forms) contained the information necessary to substantiate the subsequently filed claim (please refer to above discussion about information contained in the different 526EZ forms).  E.g.  Veteran submits a claim for increased evaluation for low back condition on a VA Form 21-526EZ.  Nine months later, while the previous claim is still pending, the Veteran submits a new claim for service connection for migraine headaches on a VA Form 21-526b.  In this case, no § 5103 notice is required for the claim for migraine headaches because the previous notice (i.e., attachment on the VA Form 21-526EZ) contains sufficient notice of the information necessary to substantiate a claim for service connection.

b. When a prior claim was not filed on an EZ form or through VDC, we are no longer required to send a 5103 notice for a subsequently filed claim that is filed while a previous claim is pending, if the previous claim is the same type of claim as the subsequent claim and the previous notice provided sufficient notice of the information and evidence necessary to substantiate the claim.   E.g. Veteran submits a claim for increased evaluation for left knee condition on a VA Form 21-4138.  VA sends initial § 5103 notice to claimant.  After three months and while the claim for left knee is pending, the claimant sends in a claim for increase for right hip.  A second § 5103 notice for the right hip claim is not required

Note 1:  Please see Fast Letter 13-06 for additional examples of this new practice (on page 4 of the Fast Letter).

Note 2:  We must send a 5103 notice if more than 1 year has passed between when the prior notice was sent and the subsequent claim is received.

Note 3:  Central Office will be updating MAP-D and VBMS with acknowledgment language in the future.  In the meantime, VSRs should include the following language in the notice letter: “We are continuing to work on your previous claim(s) and have received your additional claim(s).  Our previous letter(s) provided you with sufficient information

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regarding the evidence needed to support your claim, as well as what VA will do.”  (We are seeking further clarification from Central Office as to when this language must be used.  When we receive a response, we will send a follow-up e-mail).

Section 2(a):  Including three specific “What the evidence must show (WTEMS)” in every 5103 notice that is given

Current Practice:  When a claimant presents new arguments in support of a claim or adds new issues to an existing claim, we send subsequent 5103 notices.

New Practice:  For every claim for service connection or increased evaluation for which VA has not sent a 5103 notice, we should include the law attachments for original service connection (also referred to as “continuity” WTEMS), secondary service connection and increased ratings.

a. It is NOT necessary to make selections in the MAP-D letter that will include the text for those three items in the body of the 5103 notice.

b. By address service connection, secondary service connection and increases, we will reduce the need for additional notices when new conditions are claimed or when a new legal bases for   entitlement is presented.   We do not have to send new 5103 notices in accordance with this guidance when sufficient notice was sent prior to this guidance.

c. We must continue to include relevant WTEMS (e.g.1151, new and material, Pars. 29 and 30) as well as VCAA Notice Response and other relevant text for the body of the 5103 notice as appropriate for each particular claim.

Section 2(b):  Terminating the practice of specifying contentions in 5103 notices

Current Practice:  We typically list all of the claimant’s contentions.

New Practice:  We no longer have to list all of the claimant’s contentions for service connection (We are checking with Central Office if this guidance is limited to claims for service connection.  Once we receive a response, there will be a follow-up e-mail).

Section 2(c):  Terminating the practice of sending initial development letters in certain cases

Current Practice:  When a claim is submitted on EZ forms or through VDC, we are still sending development letters that contain such information as the scheduling of VA exams, VA’s toll-free number and listing the claimant’s contentions. 

New Practice:  We are no longer to send development letters when the claim was received on an EZ form or through VDC.  However, we will continue to send development letters to the claimant or 3rd party if information is needed to support the claim.

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Section 3: Duty to assist

This section confirms our current practice of making two requests for private treatment records, unless it is evident that a second request would be futile. 

In addition, we will be receiving additional training on our duty to assist responsibilities.

Section 4:  Revised STAR Checklist to include “timeliness” errors

The STAR checklist has been revised to implement new quality elements for timeliness.  These new elements will address obvious deficiencies in the timeliness of a claim, such as when the development was improper or unnecessary to complete a claim.  The new checklist elements are 1) “was the end product selected for review over-developed” and 2) “did unnecessary development delay a decision on any claim associated with the EP under review”.  The following are two examples of such errors:

a. A 5103 was unnecessarily provided after a sufficient notice was previously provided through an EZ form or VDC filing.

b. A 5103 notice was unnecessarily provided based on a subsequent claim that was filed while a previous claim      was filed for the same type of claim and less than a year has lapsed between the previous notification and the subsequent claim

Reference: Fast Letter 13-06, Implementation of Sections 504 and 505 of Public Law 112-154

38 USC § 5103 (§ 5103) NOTICES PRODUCED IN MODERN AWARD PROCESSING-DEVELOPMENT (MAP-D) SUPPLEMENTAL GUIDANCE

There are three standard paragraphs (listed below) that must be included in every § 5103 Notice (formerly known as Veterans Claims Assistance Act of 2000 (VCAA) letter). In order for MAP-D to automatically populate these paragraphs in a § 5103 Notice, users must select at least one development action that populates under the “What Do We Still Need From You?” section of the notice. Due to development changes implemented as a result of Fast Letter 13-06, Implementation of Sections 504 and 505 of Public Law 112-154, many § 5103 Notices will not require any development actions to go under the “What Do We Still Need From You?” section.

Until we update MAP-D to always include the required paragraphs, users must manually insert them into every § 5103 Notice that does not automatically populate them. Insert these paragraphs under the “Is There Anything Else You Need To Send?” section of the § 5103 Notice.

The three required paragraphs are as follows:

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Send us any treatment records related to your claimed condition(s). This includes reports or statements from doctors, hospitals, laboratories, medical facilities, mental health clinics, x-rays, physical therapy records, surgical reports, etc. These should include the dates of treatment, findings, and diagnoses. If you want us to try to obtain any doctor, hospital or medical reports on your behalf, please complete and return the attached VA Form 21-4142, Authorization and Consent to Release Information

If you have received treatment at a Department of Veterans Affairs (VA) facility or treatment authorized by VA, please tell us the dates and places of treatment. We will then obtain the necessary records if you give us enough information to locate them

You may also send us your own statement or statements from people who have witnessed how your claimed disabilities affect you. All statements submitted on your behalf should conclude with the following certification: "I hereby certify that the information I have given is true to the best of my knowledge and belief."

Reference: Compensation Service Bulletin, May 2013

FAST LETTER 13-06 AND VETERANS BENEFITS MANAGEMENT SYSTEM (VBMS)

To produce a § 5103 Notice in VBMS, VSRs must follow all guidance in Fast Letter 13-06 excluding two known issues. Please adhere to the following procedures:

1. Leave the contentions at the top of the letter. The contentions cannot be manually removed in VBMS.

2. Leave the text in the body of the letter that corresponds with the original, increase, and secondary service connection What The Evidence Must Show (WTEMS). If you try to delete the paragraph from the body of the letter, the system will eliminate essential WTEMS.

Please note that the contentions and the language will be removed from the § 5103 Notice in a future VBMS release.

Reference: Compensation Service Bulletin, May 2013

EXCEPTION TO THE NOTIFICATION REQUIREMENT

Exception: In cases where the evidence is sufficient to substantiate the claim and grant the benefit sought it is unnecessary to send the “notice statement” of what it takes to substantiate a claim. This exception only applies in cases where there can be a complete grant of the benefit claimed. Reference: M21-1MR.I.1.B.3k

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5103 NOTICE BEFORE DECISION

The 5103 requires VA to “. . . notify the claimant and the claimant’s representative, of any information, and medical or lay evidence, not previously provided . . . that is necessary to substantiate the claim.”

The claimant must also be informed of what information or evidence the claimant must provide and which portion the VA will attempt to obtain on the claimant’s behalf. It is essential that in every single case we provide the claimant with this notice (unless all benefits sought can be immediately granted). Notice must be provided even for cases we are re-adjudicating or cases already partially developed ” (38 C.F.R. § 3.159(b)(1)).

5103 LAW ATTACHMENTS. The initial VCAA notification letter must include the pertinent VCAA law attachments entitled, “What the Evidence Must Show.” For example, if the issue is both a new issue and a claim for an increased evaluation, the appropriate 5103 law attachments for each issue must be attached to the notification letter.

WHEN SUBSEQUENT 5103 NOTICE IS REQUIRED OR NOT REQUIRED

VA must provide notice only “[u]pon receipt of a complete or substantially complete application.” 38 U.S.C. 5103(a)(1). Section 5103(a)(1) does not require VA to provide notice after a claim has been decided. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); see Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006) (notice provided after a VA decision does not meet the requirements of section 5103(a)(1)). If evidence is submitted more than one year from the date of notice of the VA decision, VA must give notice if the evidence constitutes a claim to reopen under 38 C.F.R. 3.157.

There are two relevant one-year periods: one starting from the date of VA’s initial VCAA notice on the claim and one starting from the date of VA’s notice of its decision on the claim.

38 U.S.C. § 5103(b) requires the VA to notify the claimant of information or evidence that the claimant is to provide and the information or evidence must be received by VA within one year of the date such notice is sent. If the claimant submits additional evidence within this one-year period and VA has already decided the claim, VA must “readjudicate the claim” (38 C.F.R. § 3.159(b)(1)). If the claimant submits additional evidence after this one-year period expires, VA need not “readjudicate the claim” unless the evidence is new and material. However, nothing requires VA to provide VCAA notice again if VA receives evidence after this one-year period (unless the evidence constitutes another “complete or substantially complete application” on a claim other than the one pending).

If new and material evidence is submitted within one year of the date VA notified the claimant of its decision on the claim, then the evidence must be considered as having been filed in connection with the claim still pending (38 C.F.R. § 3.156(b)), on which VCAA notice was already given. Because the evidence is filed in connection with a pending claim on which VA has already given VCAA notice, VA need not give VCAA notice again.

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DINGESS/HARTMAN V. NICHOLSON

Dingess/Hartman v. Nicholson (2006) and the subsequent Fast Letter 06-04, established VCAA requirements to include new required language regarding the degree of disability and the effective date of the disability. Consequently, the Veteran has since that time been receiving VCAA notice regarding the effective date of his/her claimed disability.

CAN INDIVIDUAL STATIONS AMEND THE WORDING AND/OR FORMATTING WITHIN THE MAIN 5103(A) NOTICE LETTER(S) AND TEMPLATES?

The wording, and often times the formatting, within the 5103(a) notification templates was established based on consultation between Compensation and Pension (C&P) Service, The Office of General Counsel (OGC), and the Board of Veterans' Appeals (BVA). The wording of the new and revised 5103(a) templates and the notice letters is designed to comply with our current understanding of our statutory notice requirements under 5103(a).

For further instructions, refer to the C&P Service Home Page, FAQ link, VCAA - Duty to Notify .

WHAT SHOULD BE DONE IF THERE IS NO AUTHORIZED 5103(A) TEMPLATE FOR A PARTICULAR TYPE OF CLAIM?

C&P Service is working to identify all claims subject to 38 USC 5103 that require a 5103(a) notice. To date, only claims subject to a decision based on a rating action have been provided a 5103(a) notice.

If a claim for which no authorized 5103(a) notice exists, formulate and provide the claimant an appropriate notice that fulfills the requirements of 38 USC 5103. The failure to provide an adequate notice is considered an error if identified under STAR review.

Source: C&P Service Home Page, FAQ link, VCAA - Duty to Notify

IDENTIFYING AND LISTING “WHAT THE EVIDENCE MUST SHOW” ENCLOSURES

Ensure all of the "What the Evidence Must Show" enclosures (VCAA law attachments) are listed under the block entitled "Enclosures." C&P Service recommends that a notice containing multiple "What the Evidence Must Show Enclosures" be formatted as follows:

Enclosures:What the Evidence Must Show For:

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Service-connected CompensationNonservice-Connected PensionIndividual Unemployability

This will allow the user to properly identify the name of the enclosure and its purpose without repeatedly entering the phrase "What the Evidence Must Show."

Ensure that all the "What the Evidence Must Show" templates listed as enclosures are included in the notification sent to the claimant, the notification sent to the claimant representative, if any, and the notification placed in the claimant's file. Failure to comply will result in the notice being legally deficient, potential STAR errors, and remands from all appellate level reviewers.

Source: C&P Service Home Page, FAQ link, VCAA - Duty to Notify

HAS C&P SERVICE PROVIDED 5103(A) TEMPLATES FOR NON-RATING CLAIM DECISIONS?

No. The current consensus between C&P Service, BVA and OGC, is that development letters issued in conjunction with our non-rating claims are sufficient to comply with currently understood requirements under 38 USC 5103.

Source: C&P Service Home Page, FAQ link, VCAA - Duty to Notify

CORRECTION TO THE INCREASED EVALUATION WHAT THE EVIDENCE MUST SHOW (WTEMS) FOR CLAIMS PROCESSED BY THE VETERANS BENEFITS MANAGEMENT ASSISTANCE PROGRAM (VBMAP)

Compensation Service has received a number of questions about the adequacy of the increased evaluation WTEMS used in Veterans Claims Assistance Act (VCAA) notices issued through VBMAP.

The correct language to use is:

What the Evidence Must Show for an Increased Evaluation

To support your claim for an increased evaluation of your service-connected disability, medical or lay evidence must show a worsening or increase in severity and the effect that worsening or increase has on your ability to work.

However, we have determined that VBMAP VCAA notices containing one of the two WTEMS listed below are sufficient for notification purposes with respect to informing the Veteran what the evidence must show to support his/her claim: 

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1. What the Evidence Must Show for an Increased Evaluation

To support your claim for an increased evaluation of your service-connected disability, medical or lay evidence must show a worsening or increase in severity and the effect that worsening or increase has on your employment and daily life.

2. What the Evidence Must Show for an Increased Evaluation

To support your claim for an increased evaluation of your service-connected disability, medical or lay evidence must show a worsening or increase in severity. *

Thus, ROs do not need to send a new letter correcting this notice.

*WTEMS number two above is sufficient because, although the impact of the condition and symptoms on employment is not mentioned in that sentence, the impact of the condition and symptoms on employment is mentioned under the section of the VBMAP VCAA notice titled “How VA Determines the Disability Rating.”

Reference: Compensation Service Bulletin, September 2010

FAST LETTER 13-06 (5103 NOTICE) QUESTIONS AND ANSWERS

Introduction: Compensation Service released Fast Letter (FL) 13-06 on March 26, 2013. The FL explained the changes resulting from sections 504 and 505 of Public Law 112-154, which amended 38 U.S.C. §§ 5103 and 5103A to streamline the Department of Veterans Affairs' (VA) duty-to-notify and duty-to-assist responsibilities. After implementation of this FL, several questions were received from regional offices. We have consolidated some of these questions in this document. Please disseminate and/or conduct training on these Questions and Answers to ensure consistency and standardization within Service Centers. Send any additional questions or concerns to: VAVBAWAS/CO/21Q&A

Question 1: FL 13-06 states that stations should make every effort to promote the use of EZ forms for all types of claims. When the Veteran checks the space on the EZ form (block 21) indicating he/she has additional evidence/information to submit (thus excluding them from the Fully Developed Claim program), are regional offices (RO) required to send an additional letter to the Veteran with the "You are excluded from the FDC" paragraph?

Answer 1: No. In light of the increased volume of traditional claims received on the VA Form 21-526EZ and to enhance efficiency, ROs are NOT required to send this since the claimant is acknowledging (in block 21) that they DO NOT want their claim considered for rapid processing. Compensation Service will amend procedural guidance to clarify this policy.

Question 2: Since we are not required to send a § 5103 notice when a claim is filed on an EZ form, what is the suspense period in waiting for the evidence before deciding the claim? For example, when

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the Veteran checks box 21 indicating he or she will submit additional evidence, is there a mandatory wait period before VA can decide the claim?

Answer 2: In these instances, claimants should be afforded 30 days from the date of receipt of the EZ application to submit evidence in support of their claim. Compensation Service will modify the EZ forms in the future to clarify, in instances where the claim is NOT under the FDC program, that they have 30 days from the date of receipt of the EZ forms to submit evidence.

Question 3: In reference to question 2 above when box 21 is checked….Is it necessary to send a follow-up letter to the claimant if he or she does not submit any evidence after the 30-day period?

Answer 3: No. Follow-up requests to the claimant are NOT required for these situations.

Question 4: When including the three specific What the Evidence Must Show (WTEMS) attachments in the 5103 notice letter (from section 2(a) of the FL), VBMS automatically inserts the text in the letter. Should ROs delete the continuity, increase and secondary paragraphs that are auto generated by VBMS?

Answer 4: No. VBMS users should leave the text in the body of the letter that corresponds with the original, increase, and secondary service connection WTEMS until VBMS is updated in the future to reflect the changes from FL 13-06.

Question 5: Is it necessary to list the contentions in the § 5103 Notice letter?

Answer 5: No. The law does not require VA to list contentions in the § 5103 Notice letter. For claims to reopen, the contention will be listed in the body of the letter when describing the date and reasons for the prior denial.  Note: VBMS was recently modified to prevent contentions from populating the letter.

Question 6: Under section 2 of FL 13-06, ROs are no longer required to send a § 5103 notification for a subsequent claim(s) that is filed while a previous claim is pending if the previous notice was sent within the last year and is sufficient to cover the subsequent claim(s). Can we apply this provision if the previous claim was pending prior to the effective date of the law on February 2, 2013?

Answer 6: Yes. If a current pending claim was established prior to February 2, 2013, and another claim of the same type was received within one year of the previous § 5103 Notice, then another notice is NOT required. It is important that all VSRs carefully review the file when a claim is pending and a new claimed issue is received to determine if this provision can be applied.

Question 7: In reference to section 2 of the FL, it does not address what to do if the claim has been adjudicated and is no longer pending at the time the second claim of the same type is received or if the claim resulted in an appeal. How should we handle these situations?

Answer 7: Please read the following response carefully as it represents new policy developed after release of FL 13-06. The FL will be amended to reflect this change. After consultation with the Office of

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General Counsel, it is determined that, in the context of 38 USC 5103(b)(4), the word "pending" can be interpreted more broadly. Therefore, another § 5103 notification may not be required when the previous claim has been initially adjudicated by the regional office, (i.e., EP is no longer pending) and is still within the one-year appeal period, (i.e., not finally adjudicated per 38 CFR § 3.160). The § 5103 notification may also not be required if the previous claim is pending on appeal.

When the previous claim is still within the one-year appeal period or is on appeal, a new § 5103 Notice is not required if the § 5103 Notice was provided within one year prior to the new claim and if that notice was sufficient to cover the new claim. Consider the following examples:

Claim for increased evaluation for left knee is received on March 1, 2012. § 5103 Notice is sent on April 1, 2012. Rating is completed and end product is cleared on June 5, 2012. Claim for increased evaluation for headaches is received on August 9, 2012. A new § 5103 Notice does NOT need to be provided for the claim for increase for headaches because of the following reasons:

o The § 5103 Notice for left knee adequately covers the claim for headaches since it represents the same type of claim as the left knee claim; and

o The claim for headaches was received within one year of the § 5103 Notice for left knee; and

o The claim for left knee has not been finally adjudicated.

Claim for original service connection for PTSD is received on January 4, 2010. § 5103 Notice is sent on January 28, 2010. Rating is completed and end product is cleared on August 2, 2010. Notice of Disagreement for PTSD is received on December 2, 2010. An original claim for coronary artery disease (CAD) is received on January 2, 2011. A new § 5103 Notice does NOT need to be provided for the claim for CAD for the following reasons:

o The § 5103 Notice for PTSD adequately covers the claim for CAD; and o The claim for CAD was received within one year of the § 5103 Notice for PTSD; and o The claim for PTSD is under appeal, and, therefore, is not finally adjudicated.

Question 8: Consider the following scenario: A new claim for service connection for left knee is received on 4/01/13. § 5103 notice is sent on 4/15/13 for left knee. On 5/16/13 another claim for service connection for left elbow is received as the RVSR is making a decision on the left knee. Review of the file does not warrant an examination or development to a third party for the left elbow. Is there a need to wait another 30 days from the 5/16/03 claim before rendering a decision on the left elbow?

Answer 8: Because the § 5103 notice for the left knee sufficiently covers the left elbow issue, and since there is no indication that the Veteran requests our assistance in procuring evidence for the left elbow, there is NO need to wait another 30 days before rendering a decision for the left elbow issue.

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Change 5August 15, 2013

Question 9: For DIC claims filed on a VAF 21-534EZ, are ROs required to send a detailed § 5103 Notice to comply with instructions stated in FL 09-05, specifically to include a statement of the conditions, if any, for which a veteran was service connected at the time of death .

Answer 9: No. It is generally NOT necessary to send an additional § 5103 notice when a claim for DIC is received on a VA Form 21-534EZ. See FL 12-25. Note: FL 09-05 was rescinded on May 16, 2013.

Question 10: The Fast Letter indicates that the term "5103 Notice" will replace "VCAA Notice" when discussing the notice required under 38 U.S.C. § 5103. For clarification, is the term "5103 Notice" to replace "VCAA Notice" in all VCAA letters? Should ROs modify the old terminology in the notice letters to reflect the new terminology?

Answer 10: Compensation Service is in the process of changing the terminology, when applicable, in instances where we reference "VCAA notice." This includes M21-1MR and other internal sources. It also includes letters that contain references to "VCAA." However, it is not necessary at this time for regional offices to manually change such language in letters to claimants.

Question 11: Previously, Guard and Reserve members who had submitted a claim were sent the active duty for training/inactive duty WTEMS in the letters. If there is a claim from a Guard/Reserve member, is a 5103 letter required with those WTEMS?

Answer 11: If a claim is received on the VA Form 21-526EZ or through eBenefits, then manually sending Active Duty for Training and Inactive Duty for Training WTEMs is NOT necessary since the appropriate language is contained on the form or generated through eBenefits. However, for claims for service connection based on Active Duty for Training or Inactive Duty for Training received on non-EZ forms, you should ensure that claimants receive the appropriate WTEMS as part of VA's duty to notify, unless the evidence of record is sufficient to grant the benefit.

Question 12: Do certain special development paragraphs need to be added to the § 5103 Notices?

Answer 12: EZ Forms: Information contained on the EZ form or through eBenefits generally provides adequate information to the claimant regarding evidence needed to substantiate his or her claim. By utilizing the EZ forms for ALL claimants, it is VBA's vision that any additional information such as a VA Form 21-0781 for PTSD claims would be received upfront along with the EZ form when a claimant submits his or her claim. ROs should work extensively with Veterans Service Organizations to ensure it is standard protocol that any special issue information and/or evidence is included with claims they submit to the RO. If required additional information is not received along with the EZ application, then VA is obligated to send the claimant such information to assist in substantiating his or her claim. This includes any special issue development paragraphs and/or questionnaires or forms required to substantiate the claim, (e.g., Radiation, Hepatitis C, etc.).

Non-EZ Forms: Section 2 (a) of FL 13-06 instructs ROs to provide 3 WTEMS when a claim for service connection on any basis is claimed. This includes the original service connection, secondary service connection, and increased rating WTEMS. Although information contained in these WTEMS will cover

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Change 5August 15, 2013

many of the issues claimed by the claimant, there will be special issues claimed that are not covered by the 3 WTEMS. Therefore, as described above for EZ forms, VA is obligated to send the claimant any additional special issue development paragraphs and/or questionnaires or forms necessary to substantiate the claim.

Question 13: Does the Fast Letter also apply to the Pre-Discharge program?

Answer 13: The established pre-discharge procedures should continue to be followed. However, if the Service Member or Veteran submits a new claimed issue(s) while the open pre-discharge claim is pending, then sending an additional § 5103 notice will not be necessary if the previous notice was sent within a year. See section 2 of FL 13-06.

Question 14: Are we required to obtain private medical evidence identified by the claimant if we can grant an increase even if it is not the maximum schedular evaluation

Answer 14: Compensation Service will issue a future fast letter that addresses the "maximum benefit" provision of sections 504 and 505 of Public Law 112-154. Please do not implement the maximum benefit provision until guidance is received from Compensation Service. Until such time, follow all current procedures regarding VA's duty to assist.

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Change 5August 15, 2013

Section 5.25103 Letters

When 5103 Notice Is Not Required_______

VETERAN’S COMPLAINTS NOTED ON MEDICAL EVIDENCE

If a treatment report or VA examination noted the Veteran’s complaints about various illnesses or injuries but makes no reference to the condition being related to military service or to a service-connected disability, DO NOT send a VCAA notification letter.

If a recently discharged Veteran raises additional issues during the general medical examination, Central Office noted that the Veteran’s statement regarding the additional “disabilities” does not meet the criteria for a claim, therefore, DO NOT send a VCAA notification letter.

However, if there is a "reasonable possibility that benefits would be granted with additional information," an additional paragraph should be included in the decision notification letter that notifies the Veteran that a review of the evidence suggests entitlement to a particular benefit was identified.  We should also furnish the Veteran a VA Form 21-4138 to complete and return so that action may be taken on the claim.  We are NOT to construe the existence of evidence showing potential entitlement as an informal claim for benefits, because for an informal claim to exist, there must be some intent by the claimant to apply for a benefit.   In addition, we should NOT control for the return of the VA Form 21-4138 or develop the solicited claim prior to receiving the form back from the claimant. Refer to Section entitled, Reconsideration of Claims Based on Additional Evidence, for further guidance.

CLAIMS INVOLVING CLEAR AND UNMISTAKABLE ERROR

If the claim is in regard to clear and unmistakable error (CUE), DO NOT send a VCAA notification letter.

CLAIMS INVOLVING COMPETENCY

Sims v. Nicholson held that an application for restoration of competency does not constitute a claim for benefits, therefore, VCAA notification is not required.

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Change 5August 15, 2013

CLAIMS INVOLVOING AN EARLIER EFFECTIVE DATE

VCAA notice specifically addressing effective date will only be required in the event that the claim is substantiated, i.e., service connection is granted, and the initial VCAA notice was not compliant with Dingess v. Hartman court decision concerning the effective date.

VCAA notice should be adequate as it relates to an earlier effective date claim if the Dingess requirements, via Fast Letter 06-04, were incorporated into the notice sent in response to the service connection claim.

Reference: C&P Service Home Page, FAQ link, VCAA notification requirements in claim for earlier effective date.

PRE-STABILIZATION RATINGS UNDER 38 C.F.R. 4.28

Prestabilization ratings under 38 CFR 4.28 are provided to assure earliest payment to those Veterans separated from service with a significant disability at a time when they are most likely in need and least likely to be self-sufficient.

Reference: M21-1MR IV.ii.2.J.59

CHANGES

Change 1, October 28, 2012, added guidance regarding Correction to the Increased Evaluation What the Evidence Must Show (WTEMS) for Claims Processed by the Veterans Benefits Management Assistance Program (VBMAP).

Change 2, April 16, 2013, added guidance regarding Changes to Our Duty to Notify and Duty to Assist - Implementation of Sections 504 and 505 of Public Law 112-154

Change 3, May 17, 2013, added guidance from the May 2013 Compensation Service Bulletin regarding 5103 Notices, Map-D supplemental guidance, and guidance from FL 13-06 regarding VBMS cases.

Change 4, June 20, 2013, deleted reference to FL 09-49 which has been rescinded.

Change 5, August 15, 2013, added FL 13-06 Questions & Answers.

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Change 2March 25, 2014

Section 6

Issues Not Usually Granted Service Connection_______

NO SERVICE CONNECTION FOR BRUXISM

Bruxism – Exception: bruxism may be considered on a secondary basis as a symptom of a service-connected disability, such as an anxiety disorder, TMJ dysfunction, etc. for rating purposes. (Reference: Compensation Service Bulletin, March 2014)

NO SERVICE CONNECTION FOR OSTEOPENIA

Osteopenia is clinically defined as mild bone density loss that is often associated with the normal aging process. The National Osteoporosis Foundation indicates that low bone density does not necessarily mean that an individual is losing bone. A lower bone density may be considered normal for some individuals, who may never have had normal bone density for a variety of reasons, such as genetics, body size, or certain diseases and conditions. Older persons are more likely to have low bone density. Also, the Foundation for Osteoporosis Research and Education states that osteopenia is not a disease, but a term created by the World Health Organization to describe low bone mass.

Osteoporosis, in contrast to osteopenia, is considered a disease entity and is characterized by severe bone loss that may interfere with the mechanical support structure function of the bone.

Accordingly, the Department of Veterans Affairs (VA) does not consider osteopenia to be a disability for VA compensation purposes. Osteopenia is essentially comparable to a laboratory finding, which is not subject to service-connected compensation.

Reference: Compensation Service Bulletin, December 2013

CONDITIONS NOT USUALLY GRANTED SERVICE CONNECTION

The following issues/conditions will not usually be granted service connection.

1) Test Results – high cholesterol, pregnancy, etc., are not normally subject to service connection. Test results are not considered a disability. If the Veteran claims positive TB test, refer to the section in this guide regarding Positive Tuberculin Claims for further details.

2) Congenital/Developmental Defects – Some conditions such as developmental loss of visual acuity (near sighted or far sighted) and personality disorders would have

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Change 2March 25, 2014

occurred regardless of military service and are not subject to service connection. Develop as a new condition.

3) Alcohol and Drug Abuse - Claims for alcohol and/or drug abuse are not normally subject to service connection, however, evidence of substance abuse, such as alcohol or drugs could be considered as part of some mental conditions, i.e., personal trauma and PTSD (M21-1MR,III.iv.4.H.30). The rating team must dispose of the issue.

DEVELOPMENT ACTIONS

If a Veteran submits a claim for any of the conditions related to issues listed above, complete the following actions:

Send the Veteran a VCAA notification letter for the claimed issue/condition(s), however, DO NOT inform the Veteran the claimed condition is denied; if a denial is warranted, the denial must be accomplished through a formal rating decision.

When the Veteran claims cholesterol, high cholesterol, hypercholesterolemia, or hyperlipidemia, the VCAA notice should ask the claimant to identify a specific disability that is causing the cholesterol issue.

DO NOT request a VA examination for these issues. For specific issues/disabilities refer to the topic entitled, “Disabilities/Conditions Not to Examine,” in the VA Examination Section in this development guide.

If verification of service and service treatment records have not been obtained, refer to the Service Records Development & PIES Section in this development guide for further details.

When all evidence is of record and the VCAA period has expired, forward the claim to the Rating Team.

When the Rating Team is not able to take jurisdiction of the claim, refer to the Administrative Denials Section in this development guide for further details.

CHANGES

Change 1, January 20, 2014, added guidance regarding no service connection for osteopenia from the December 2013 Compensatio Service Bulletin.

Change 2, March 25, 2014, added guidance from the March 2014 Compensatio Service Bulletin regarding bruxism.

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January 1, 2011

Section 7

Correspondence - General_______

All development actions must be completed in MAPD including development letters.

NUISANCE MAIL – REDUNDANT AND REPETITIOUS LETTERS

A request was made for a “nuisance mail” policy decision. When the manual and VA Direc-tives provide procedures, a policy decision is not required. Although most of the manual is rewritten in the M21-1 manual rewrite (MR), those portions of the M21-1 that are not added to M21-1 MR and have not been rescinded are still applicable as the current guidance. The following manual reference and directive provide procedures for handling “nuisance mail”:

M21-1 Part III Chapter 11.04 Redundant and Highly Repetitious Letters:

If a claimant or other correspondent who has been informed repeatedly of the status of a case persists in writing to VA and further response would serve no useful purpose, annotate additional correspondence on the same subject "NAN" and file it in the claims folder. All such correspondence must be reviewed to ensure that new issues are not raised. Authority to initial such correspondence "NAN" shall not be delegated to a supervisor lower than the Assistant Adjudication Officer.

NOTE: If a request for information under the provisions of the Privacy Act of 1974 or the Freedom of Information Act is received, such request MUST be answered notwithstanding the above paragraph.

VA Directive 6340, Dated October 11, 1996

(9) Complaint Mail and Anonymous, Obscene, and Threatening Communications.

Complaint mail is any correspondence received containing allegations or complaints of a serious nature, or adversely reflecting upon VA or its employees involving internal administration; management and functioning of any office or activity, including mail administration; violation of Federal statutes, regulations, and VA policies; the conduct or actions of a VA official or employee, or organizations or individuals having official dealings or relationships with VA.

Complaint mail received at field facilities will be processed as follows:

(a) Complaint mail, and anonymous, obscene, and threatening communications will be given priority handling and forwarded directly to the field facility director.

(b) The field facility director will:

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January 1, 2011

1. Establish a single point for control and analysis of complaint mail and anonymous, obscene, and threatening communications.

2. Refer those communications, which require VACO action through the Administration Heads to the Assistant Inspector General for Investigation (51).

3. Refer those communications that in any way threaten the life of the President of the

United States, the Secretary of VA or any other Cabinet Level Official to the Deputy Assistant Secretary (DAS), Security and Law Enforcement.

Reference: C&P Service Bulletin October 2008

PCGL LETTERS

PCGL will not be used for development. PCGL may only be used to correct a MAPD letter/paragraph (e.g. N&M evidence paragraph, PTSD paragraph, alternative source paragraph) PCGL may be used to supplement a MAPD letter/paragraph in those instances in which there is no canned MAPD letter/paragraph (e.g. alternative sources for verification of military service). In these instances, use the MAPD “Add” function (see MAPD User’s Guide, page 45).

FOLLOW-UP OR SUBSEQUENT MAPD LETTERS

After the initial VCAA letter is sent, subsequent MAPD letters DO NOT need to include the VCAA attachments (What Is the Status of Your Claim, What the Evidence Must Show, etc.). Reference VBAVACO e-mail dated June 19, 2003, 9:34 AM, quoted in part below:

So far, we only need to alert the claimant of the status of his/her claim with the first development letter. The law states that we should send notice “upon receipt of a complete, or substantially complete, application…” The notification should tell what information “not previously provided…is necessary to substantiate the claim.” It also notifies the claimant what part of that information he/she must get and what part VA must get (the Quartuccio requirements). So far, VA has interpreted the VCAA notice to be an initial, one-time action.

REQUIRED ANNOTATIONS

Correspondence must be annotated with the end product, initials and date.

Reference: M21-1.III.11.06

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January 1, 2011

REVERSE FILING DOCUMENTS

DO NOT reverse file (flip-file) letters and deferred rating decisions. Letters and deferred rating decisions should be flat-filed in date-order. Rather than reverse filing letters and deferred ratings, the use of a “Post-It” note or flag would be appropriate to identify these documents within the claims folder.

Reference: M21-1MR.III.ii.3.C

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January 1, 2011

Section 8

Unclaimed Conditions & Conditions Raised During Examination

_______

When giving consideration to unclaimed conditions/issues, the following guidelines should be followed as to whether or not to raise them on the VCAA notification or request an examination.

UNCLAIMED CHRONIC CONDITIONS

If a chronic condition (other than a presumptive condition) is found in the STRs (and service connection is probable), send the Veteran notice and ask if he/she wants to file a claim for service connection.

If the condition is refractive error, myopia, fibrocystic breast disease, etc. (refer to the section entitled Issues Not Usually Granted Service Connection), do not invite a claim since service connection would not be warranted.

CONDITIONS OR ISSUES RAISED DURING EXAMINATION

If during a VA examination the Veteran raises an issue or complaint and service connection is not probable, do not invite a claim. See explanation above.

If during a VA examination the Veteran raises an issue or complaint and service connection is probable (e.g. the illness, injury, or disease is shown in the STRs), send the Veteran notice and ask if he/she wants to file a claim for service connection.

If during a VA examination the Veteran raises an issue or complaint and contends that it is related to military service (e.g. tinnitus), send the Veteran notice and ask if he/she wants to file a claim for service connection.

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Change 4February 21, 2014

Section 9

Presumptive Conditions

1 – Chronic Diseases.............................................................9.2

2 – Tropical Diseases............................................................9.5

3 – Former Prisoners of War..............................................9.6

4 – Herbicide Diseases..........................................................9.8

5 – Cancer...........................................................................9.10

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Change 4February 21, 2014

Section 9.1Presumptive Conditions

Chronic Diseases_______

Chronic conditions claimed by the Veteran that are subject to presumptive service connection.

Send the Veteran 5103 notification (if applicable).

Include language regarding presumptive conditions

Request a VA examination, if applicable – refer to the VA Examination Section in this development guide for further details.

When soliciting a claim for chronic, unclaimed disabilities, refer to M21-1MR.IV.ii.2.A.1b

CHRONIC DISEASES

The following provides the presumptive period for chronic diseases subject to presumptive service connection; for further details see 38 CFR 3.307, Presumptive service connection for chronic, tropical or prisoner-of-war related disease, or disease associated with exposure to certain herbicide agents; wartime and service on or after January 1, 1947 and 38 CFR 3.309, Disease subject to presumptive service connection.

Disease Presumptive Period

Anemia, primary 1 yrArteriosclerosis 1 yrArthritis 1 yrAtrophy, Progressive muscular 1 yrBrain hemorrhage 1 yrBrain thrombosis 1 yrBronchiectasis 1 yrCalculi of the kidney, bladder, or gallbladder 1 yrCardiovascular-renal disease, including hypertension. (This term applies to combination involvement of the type of arteriosclerosis, nephritis, and organic heart disease, and since hypertension is an early symptom long preceding the development of those diseases in their more obvious forms, a disabling hypertension within the 1-year period will be given the same benefit of service connection as any of the chronic diseases listed.)

1 yr

Cirrhosis of the liver 1 yrCoccidioidomycosis 1 yrDiabetes mellitus 1 yrEncephalitis lethargica residuals 1 yr

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Change 4February 21, 2014

Endocarditis (This term covers all forms of valvular heart disease) 1 yrEndocrinopathies (Diabetes insipidus, hypothyroidism, hypothalamic lesions) 1 yrEpilepsies 1 yrHansen’s disease (leprosy) 3 yrsHodgkin’s disease 1 yrLeukemia 1 yrLupus erythematosus, systemic 1 yrMyasthenia gravis 1 yrMyelitis 1 yrMyocarditis 1 yrNephritis 1 yrOther organic diseases of the nervous system (includes sensorneural hearing loss, glaucoma, carpal tunnel syndrome, peripheral neuropathy, migraine headaches)

1 yr

Osteitis deformans (Paget’s disease) 1 yrOsteomalacia 1 yrPalsy, bulbar 1 yrParalysis agitans (Parkinson’s Disease) 1 yrPsychoses 1 yrPurpura idiopathic, hemorrhagic 1 yrRaynaud’s disease 1 yrSarcoidosis 1 yrScleroderma 1 yrSclerosis, amyotrophic lateral (anytime after service as provided by 3.318, Presumptive Service Connection for Amyotrophic Lateral Sclerosis Amyotrophic Lateral Sclerosis)

Anytime after service

Sclerosis, multiple 7 yrsSyringomyelia 1 yrThromboangiitis obliterans (Buerger’s disease) 1 yrTuberculosis, active 3 yrsTumors, malignant, or of the brain or spinal cord or peripheral nerves 1 yrUlcers, peptic (gastric or duodenal) (A proper diagnosis of gastric or duodenal ulcer (peptic ulcer) is to be considered established if it represents a medically sound interpretation of sufficient clinical findings warranting such diagnosis and provides an adequate basis for a differential diagnosis from other conditions with like symptomatology; in short, where the preponderance of evidence indicates gastric or duodenal ulcer (peptic ulcer). Whenever possible, of course, laboratory findings should be used in corroboration of the clinical data.

1 yr

CHRONIC DISABILITY IDENTIFIED IN STRS UPON RATING DECISION OR FOLLOWING AN INITIAL RATING DECISION

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Change 4February 21, 2014

When deciding an original claim for compensation or when supplemental service treatment records (STRs) are received following promulgation of an original rating decision, the RVSR will identify any chronic disabilities (implied claims) shown in the service treatment records.

If chronic disabilities are identified by the RVSR upon Rating Decision, refer to the reference below when soliciting a claim for service connection of a chronic, unclaimed disability.

Reference: M21-1MR.IV.ii.2.A.1a.

ISSUE: DEGENERATIVE DISC DISEASE

Question:Is DDD a presumptive condition?

Answer:The answer to this question has to be that it depends on the fact of the case. Too often, the term degenerative disc disease is used interchangeably with arthritis. It is important to remember that there is no presumption of service connection for degenerative disc disease. There is a presumption for arthritis, (38 CFR 3.309(a)). So, if there is a diagnosis of DDD and it includes arthritis of the spine, then yes, it is presumptive unless the DDD and associated arthritis is the result of trauma not related to service. If there is simply desiccation of the disc(s) or other degenerative changes without any radiographic evidence of arthritic changes, then no, it would not be presumptive.

Source: Star Rating Call, Q&As for the February 2010 Quality Call

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Change 4February 21, 2014

Section 9.2Presumptive Conditions

Tropical Diseases_______

If the Veteran submits a claim for a tropical disease that may be subject to presumptive service connection, complete the following actions:

Send the Veteran 5103 notification (if applicable).

Include language regarding presumptive conditions

Request a VA examination, if applicable – refer to the VA Examination Section in this development guide for further details.

TROPICAL DISEASES

The following provides the presumptive period for tropical diseases subject to presumptive service connection; for further details see 38 CFR 3.307, Presumptive service connection for chronic, tropical or prisoner-of-war related disease, or disease associated with exposure to certain herbicide agents; wartime and service on or after January 1, 1947 and 38 CFR 3.309, Disease subject to presumptive service connection.

Disease Presumptive Period

Amebiasis 1 yrBlackwater fever 1 yrCholera 1 yrDracontiasis 1 yrDysentery 1 yrFilariasis 1 yrLeishmaniasis, including kala-azar 1 yrLoiasis 1 yrMalaria 1 yrOnchocerciasis 1 yrOroya fever 1 yrPinta 1 yrPlague 1 yrSchistosomiasis 1 yrYaws 1 yrYellow fever 1 yr

Section 9.3Presumptive Conditions

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Change 4February 21, 2014

Former Prisoners of War_______

Refer all POW claims to the POW Rating Board; the board is responsible for directing all development actions.

DISEASES SPECIFIC TO FORMER PRISONERS OF WAR

The following provides the presumptive period for diseases specific as to former prisoners of war subject to presumptive service connection; for further details see 38 CFR 3.307, Presumptive service connection for chronic, tropical or prisoner-of-war related disease, or disease associated with exposure to certain herbicide agents; wartime and service on or after January 1, 1947 and 38 CFR 3.309, Disease subject to presumptive service connection.

Disease Presumptive PeriodPsychosis. (See Note 1 below) Anytime after discharge or

release from active serviceAny of the anxiety states. Anytime after discharge or

release from active serviceDysthymic disorder (or depressive neurosis). Anytime after discharge or

release from active serviceOrganic residuals of frostbite, if it is determined that the Veteran was interned in climatic conditions consistent with the occurrence of frostbite.

Anytime after discharge or release from active service

Post-traumatic osteoarthritis Anytime after discharge or release from active service

Atherosclerotic heart disease or hypertensive vascular disease (including hypertensive heart disease) and their complications (including myocardial infarction, congestive heart failure, arrhythmia)

Anytime after discharge or release from active service

Stroke and its complications Anytime after discharge or release from active service

Avitaminosis. Anytime after discharge or release from active service

Beriberi (including beriberi heart disease). Anytime after discharge or release from active service

Chronic dysentery. Anytime after discharge or release from active service

Helminthiasis. Anytime after discharge or release from active service

Malnutrition (including optic atrophy associated with malnutrition).

Anytime after discharge or release from active service

Pellagra. Anytime after discharge or release from active service

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Any other nutritional deficiency. Anytime after discharge or release from active service

Irritable bowel syndrome. Anytime after discharge or release from active service

Peptic ulcer disease. Anytime after discharge or release from active service

Peripheral neuropathy except where directly related to infectious causes.

Anytime after discharge or release from active service

Cirrhosis of the liver. Anytime after discharge or release from active service

Note 1: A final rulemaking adding a new 38 CFR 3.384 was published in the Federal Register on July 28, 2006, at 71 FR 42758. This rulemaking provides a definition of "psychosis" for purposes of presumptive service connection and certain other regulations. This new regulation is effective for all claims filed on or after August 28, 2006. For purposes of this part, the term "psychosis" means any of the following disorders listed in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, of the American Psychiatric Association (DSM-IV-TR):

(a) Brief Psychotic Disorder;(b) Delusional Disorder;(c) Psychotic Disorder Due to General Medical Condition;(d) Psychotic Disorder Not Otherwise Specified;(e) Schizoaffective Disorder;(f) Schizophrenia;(g) Schizophreniform Disorder;(h) Shared Psychotic Disorder; and(i) Substance-Induced Psychotic Disorder

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Change 4February 21, 2014

Section 9.4Presumptive Conditions

Herbicide Diseases_______

Refer the section in this development guide entitled, Exposure to Herbicide Agents, regarding guidance on all development actions.

HAIRY CELL AND OTHER B-CELL LEUKEMIAS, PARKINSON’S DISEASE , AND ISCHEMIC HEART DISEASE INTERIM PROCEDURES

On October 13, 2009, Secretary Shinseki announced that hairy cell and other B-cell leukemias, Parkinson’s disease, and ischemic heart disease will be added to the list of diseases presumptively associated with exposure to certain herbicide agents.

DISEASES ASSOCIATED WITH EXPOSURE TO CERTAIN HERBICIDE AGENTS

The following provides the presumptive period for disease associated with exposure to certain herbicide agents that are subject to presumptive service connection; for further details see 38 CFR 3.307, Presumptive service connection for chronic, tropical or prisoner-of-war related disease, or disease associated with exposure to certain herbicide agents; wartime and service on or after January 1, 1947 and 38 CFR 3.309, Disease subject to presumptive service connection.

Disease Presumptive PeriodAL Amyloidosis - On July 27, 2007, the National Academy of Sciences (NAS) Institute of Medicine issued its most recent report on its formal review of the scientific and medical literature on health effects potentially related to exposure to herbicides and related materials used during the Vietnam War, Veterans and Agent Orange: Update 2006. The Secretary announced that the evidence warrants establishment of a presumption of service connection based on service in the Republic of Vietnam for primary AL Amyloidosis (Reference: C&P Service Bulletin, June 2008)

Anytime after service

Chloracne or other acneform disease consistent with chloracne Within a year after last date on which exposed

Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes)

Anytime after service

Hodgkin’s disease Anytime after serviceIschemic heart disease (including, but not limited to, acute, Anytime after service

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Change 4February 21, 2014

subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina)All chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia)

Anytime after service

Multiple myeloma Anytime after serviceNon-Hodgkin’s lymphoma - (evidence of service in the Republic of Vietnam and/or the waters offshore is sufficient) (Reference: C&P Service Bulletin, June 2008)

Anytime after service

Parkinson's disease Anytime after serviceAcute and subacute peripheral neuropathy. For purposes of this section, the term acute and subacute peripheral neuropathy means transient peripheral neuropathy that appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset.Porphyria cutanea tarda (PCT) (a skin condition) Within a year after last

date on which exposedProstate cancer Anytime after serviceRespiratory cancers (cancer of the lung, bronchus, larynx, or trachea) - see Public Law 107-103 - Veterans Education and Benefits Expansion Act of 2001

Anytime after service

Soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma). The term soft-tissue sarcoma includes the following:Adult fibrosarcomaDermatofibrosarcoma protuberansMalignant fibrous histiocytomaLiposarcomaLeiomyosarcomaEpithelioid leiomyosarcoma (malignant leiomyoblastoma)RhabdomyosarcomaEctomesenchymomaAngiosarcoma (hemangiosarcoma and lymphangiosarcoma)Proliferating (systemic) angioendotheliomatosisMalignant glomus tumorMalignant hemangiopericytomaSynovial sarcoma (malignant synovioma)Malignant giant cell tumor of tendon sheathMalignant schwannoma, including malignant schwannoma with rhabdomyoblastic differentiation (malignant Triton tumor), glandular and epithelioid malignant schwannomasMalignant mesenchymomaMalignant granular cell tumorAlveolar soft part sarcomaEpithelioid sarcoma

Anytime after service

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Change 4February 21, 2014

Clear cell sarcoma of tendons and aponeurosesExtraskeletal Ewing’s sarcomaCongenital and infantile fibrosarcomaMalignant ganglioneuroma

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Change 4February 21, 2014

Section 9.5Presumptive Conditions

Cancer_______

CANCER AS A PRESUMPTIVE CONDITION

The Rating Team may consider all claims for cancer as presumptive for service connection within one year.  Cancers fall under the following category on the 38CFR 3.309 list of chronic conditions:

"Tumors, malignant, or of the brain or spinal cord or peripheral nerves."

Therefore, the VCAA notification on claims for cancer should include the the presumptive language for cancer within one year.

Send the Veteran 5103 notification (if applicable).

Include language regarding presumptive conditions

Request a VA examination, if applicable – refer to the VA Examination Section in this development guide for further details.

EVALUATION OF CANCER

The evaluations for most cancers in the Rating Schedule include instructions for the rater to assign a temporary 100% evaluation, order a future examination sometime after the completion of treatment, and then evaluate the condition based on residuals. We have received several inquiries asking when a permanent 100% evaluation for cancers, such as Non-Hodgkin’s Lymphoma, can be assigned, rather than continuing to order future examinations. For future examinations, follow the guidance provided by Fast Letter 10-14, Procedural Change Regarding Routine Future Examinations, and 38 CFR §3.344 .

Under 38 CFR §3.327(b) (2) no periodic examination will be ordered if: (i) the disability is established as static; (ii) when findings and symptoms shown by examinations and hospital reports have persisted without material improvement for a period of five years or more; (iii) where the disability from disease is permanent in character and of such nature that there is no likelihood of improvement. (Please note there are additional provisions iv, v, and vi not listed here.)

Some of the rules outlined in Training Letter 00-02, Prostatic Hypertrophy and Prostate Cancer, can be considered in rating all types of cancer. The Training Letter noted that palliative and adjuvant therapies would not cure prostate cancer, and a permanent 100%

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Change 4February 21, 2014

evaluation could be assigned. Antineoplastic treatments, such as a radical prostatectomy, would be evaluated following the Rating Schedule guidelines. As stated in Training Letter 00-02, “You may need to ask the examiner to clarify whether certain treatments are palliative, antineoplastic, adjuvant, etc., so you can rate properly. The difference can be between a temporary and permanent 100% and can determine the need for a follow up exam. You may also need to ask whether cancer is still present if that is not clear.”

Reference: Compensation Service Bulletin, June 2013

CHANGES

Change 1, August 8, 2012, added Ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina); All chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia); and Parkinson's disease to the presumptive list for herbicide exposure

Change 2 ,June 19, 2013, added guidance from the June 2013 Compensation Service Bulletin regarding the evaluation of cancer.

Change 3, July 19, 2013, added guidance from the July 2013 Compensation Service Bulletin regarding the migraine headaches being considered an “organic disease of the nervous system” under 3.309(a).

Change 4, February 21, 2014, updated references.

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Change 2March 12, 2012

Section 10

Lost Claim - Rebuilt Folder_______

When having to work from a rebuilt folder, always try to obtain as much prior documentation as possible.

Ask the employee having knowledge of the facts, including the date the last claim was received, to prepare a signed statement for the file; the employee’s supervisor will sign the statement.

Check with POA, if applicable, for any documentation they may have on file.

Send the Veteran MAPD Claimant Letter, General Letter, “Resubmit claim - VA lost claim document”

Search the I drive or O drive for rating decisions that were completed by the Denver VARO. However, rating decisions prior to 1996 are not available.

For rating decisions completed by VAROs other than Denver, the RBA 2000 SuperUser can obtain a copy of rating decisions completed after February 2007.

Submit PIES Request Code O09 (Used when trying to rebuild a file when the original file is missing and copies of prior 3101s could be helpful.) Print a copy of the PIES request to be flip-filed in the center section of the C-file.

OR

Send a DPRIS request (see Defense Personnel Record Information Retrieval System (DPRIS) Request section for further guidance).

Send a request to RMC for STRs if necessary (see Development for Service Treatment Records section for further guidance).

Reference: M21-1MR.III.ii.2.D.17

LOST CLAIMS FOLDER SYSTEM UPDATES AND SEARCHES

For cases that have been on search for 14 days, Coaches will update the Claim Level Suspense to “File Requested from Triage”, set a 14-day suspense and send a list to the Triage Coach. Triage will actively search for the file in the files bank; FIT CAs will actively search for the file with in their FIT team locations on the floor and will special search as needed. After 14 days in “File Requested from Triage” status, Coaches will update the Claim Level Suspense to “Last Search for Claims Folder”, set an additional 14-day suspense and provide a

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Change 2March 12, 2012

list of cases to the Triage Supervisor. Triage will finalize search and rebuild the folder as necessary

CHANGES

Change 1, August 19, 2011, added guidance regarding Lost C-File system updates and search procedures.

Change 2, March 12, 2012, added guidance regarding submission of DPRIS requests and requesting STRs from RMC.

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Change 13May 20, 2014

Section 11

Fully Developed Claim Program (FDC)_______

UPDATE TO PROCEDURES FOR PROCESSING FULLY DEVELOPED CLAIMS

M21-1MR, Part III, Subpart i, Chapter 3, Section A and B (M21-1MR III.i.3.A) which creates a new chapter to incorporate and rescind Fast Letter (FL) 12-25, The Fully Developed Claim Program (Processing Claims Received on VA Forms 21-526EZ, 21-527EZ, and 21-534EZ)

An informal claim is generally defined as any communication or action indicating intent to apply for one or more benefits that must indicate the benefit sought. (See 38 CFR 3.155(a)). However, for purposes of the FDC program, an informal FDC refers to a communication or action that identifies intent to apply for benefits under the FDC program, but does not identify the benefit(s) sought or specific contention(s) on which the benefit is sought. In Fast Letter (FL) 12-25, The Fully Developed Claim Program (Processing Claims Received on VA Forms 21-526EZ, 21-527EZ, and 21-534EZ), this is described as an “incomplete FDC.”

In the electronic world, an informal FDC is established when a claimant saves, but does not submit, an online application for benefits through the VONAPP Direct Connect (VDC) tool on the benefits portal. In the paper world, an informal FDC may be submitted in any format so long as it meets the criteria described above and outlined in FL 12-25. If a completed and signed application is of record and the claimant submits an FDC that identifies the specific contention or benefit sought, such FDC will be considered a formal FDC instead of an informal (or incomplete) FDC. (See FL 12-25.) We will update the M21-1MR to reflect the procedures governing informal FDCs.

For effective date purposes, if a claimant submits an informal FDC and submits a formal and complete FDC within one year of filing the informal FDC, then the earliest possible effective date of any award granted would generally be the date VA received the informal FDC.

However, as announced in Fast Letter 13-17, Processing Fully Developed Original Claims Received from August 6, 2013 through August 5, 2015, § 506 of Public Law 112-154 amends 38 U.S.C. § 5110 to allow up to a one-year retroactive effective date for awards of original FDC disability compensation for claims received from August 6, 2013 through August 5, 2015. Per FL 13-17, the one-year retroactive effective date should be calculated using the date VA received the formal and complete FDC. If an informal FDC is of record, the RVSR should assign the effective date that would be most advantageous to the claimant. (Reference: Compensation Service Bulletin, March 2014)

GUIDANCE ON REOPENED CLAIMS UNDER THE FDC PROGRAM

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Change 13May 20, 2014

In order to comply with the notice requirements set forth in Kent v. Nicholson, 20 Vet.App.1 (2006), Compensation Service has determined that a claimant should be allowed 30 days to respond to the subsequent development letter sent for the reopened claim before ROs move forward with a decision. After the 30 days has expired, if the claimant has submitted additional evidence, the claim must be excluded from the FDC program.

If 30 days has expired and the claimant has not submitted additional evidence, ROs must continue processing the claim under the FDC program.

Email questions to the VAVBAWAS/CO/212A mailbox. (Reference: Compensation Service Bulletin, March 2014)

REMINDER REGARDING FULLY DEVELOPED CLAIMS (FDC) AND REQUESTING EVIDENCE

For claims meeting FDC criteria, do not request any information or evidence from the claimant. For example, when requesting records in Federal custody or notifying the claimant when a VA examination is requested, do not also request these records or solicit additional evidence from the claimant. On the signed EZ form, the claimant certified that he or she has enclosed all the information or evidence to support the FDC or has no other information or evidence to give VA to support the claim.

Note: There are only two exceptions to the above stated rule: (1) when a claim involves a reopened contention and (2) when Federal records are unavailable. See Fast Letter 12-25 (Revised 8-13-2013), The Fully Developed Claim Program, for more information.

Reference: Compensation Service Bulletin, April 2013

REVISED PROCESS STEPS

On November 8, 2012, Compensation Service released Fast Letter 12-25 (Revised 8-13-2013), The Fully Developed Claim Program (Processing Claims Received on VA Forms 21-526EZ, 21-527EZ, and 21-534EZ), which revises previous Fully Developed Claim (FDC) Program guidance and assembles the FDC process into steps. It also introduces revised VA Forms 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, and 21-527EZ, Application for Pension and a new VA Form 21-534EZ, Application for DIC, Death Pension, and/or Accrued Benefits. The new EZ forms notify the claimant, upon application, of the evidence necessary to substantiate any appropriately-filed claim. Per 38 U.S.C §5103, the duty to notify requirements are satisfied for a claim filed on the appropriate claimant-signed EZ form, regardless of whether or not the claim is ultimately found to meet FDC criteria. The forms are now available at www.va.gov/vaforms.

Reference: Fast Letter 12-25 (Revised 8-13-2013), The Fully Developed Claim Program (Processing Claims Received on VA Forms 21-526EZ, 21-527EZ, and 21-534EZ)

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Change 13May 20, 2014

Reference: Compensation Service Bulletin, November 2012.

VA EZ FORMS AND THE VCAA NOTICE

Both the 526EZ and 527EZ include 3 parts: The FDC Notice, the FDC Claim, and the FDC Certification.

The FDC Notice informs the Veteran of the requirements of the FDC program. It also provides the Veteran notice prior to filing the claim of What the Evidence Must Show for different claim types. This differs from the normal claim process where Veterans are informed, after they apply, in the VCAA letter of What the Evidence Must Show to support their claims. The 526EZ includes the WTEMS language for service connected compensation claims, including service connection based on both active duty for training and inactive duty for training, increase claims, and secondary service connection claims. The 527EZ includes the WTEMS for pension and special monthly pension.

As a result of providing Veterans the WTEMS up front, most FDC claims do not require a VCAA letter or other typical notifications to the Veteran. This helps speed the processing of the claims, and means the VA is not required to wait 30 days for some actions.

The FDC Claim is a condensed version of the normal 526 form. It asks for the Veterans ID information, what disabilities are being claimed, service information, direct deposit information, and the standard signature section. Please note: despite the FDC certification page, the 526EZ must still be signed for all original claims for compensation (110s and 010s).

One particular note of interest is that the 526EZ doesn’t ask a Veteran directly about exposure or treatment. If a Veteran is trying to claim diabetes as due to Agent Orange exposure, it must be explicitly written on the application instead of just checking a box. It also does not include a space for describing where treatment has been received, so it is important to clarify where a Veteran has received treatment for any claimed conditions (either a VAMC or private provider).

The FDC Certification is the last page in the both EZ forms. It asks the Veteran to certify that no additional evidence is to be submitted, that all federal records have been identified, and asks us to decide the claim as soon as possible. The certification page must be signed and included with all FDC submissions.

EXPIRATION OF FEBRUARY 2010 EZ FORMS

Fast Letter 12-25 (Revised 8-13-2013), The Fully Developed Claim Program (Processing Claims Received on VA Forms 21-526EZ, 21-527EZ, and 21-534EZ) allowed a 30-day grace period in which claims personnel would continue to consider a claim received on the FEB 2010 versions of the as potentially eligible for expedited processing under the Fully Developed Claim (FDC) program. This grace period has now expired.

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Change 13May 20, 2014

Effective for a claim received on a FEB 2010 EZ form on or after December 21, 2012, do not consider the claim as eligible for the FDC Program. For such a claim, claims personnel must follow established procedures in Fast Letter 12-25 to exclude the claim from the FDC Program. However, continue to process an FDC received on a FEB 2010 EZ form prior to this date in the FDC Program as instructed by Fast Letter 12-25. The AUG 2011 and later versions of the EZ forms are now the required forms to participate in the FDC Program.

Reference: Compensation Service Bulletin, December 2012

PROCESSING FULLY DEVELOPED ORIGINAL CLAIMS RECEIVED FROM AUGUST 6, 2013 THROUGH AUGUST 5, 2015

Fast Letter 13-17, outlines the procedures for determining the effective date of fully developed original compensation claims received on VA Form 21-526 EZ, Application for Disability Compensation and Related Compensation Benefits, and online through VONAPP Direct Connect (VDC), received from August 6, 2013, through August 5, 2015

RESPONSE TO FULLY DEVELOPED CLAIM QUESTION REGARDING SPECIAL CIRCUMSTANCES

Any Fully Developed Claim for Compensation filed on a VA Form 526 EZ , Application for Disability Compensation and Related Compensation Benefits , which falls under one of the “Special Circumstances” noted on page one of the form instructions must be excluded from the Fully Developed Claim program if filed without a necessary additional form, unless adequate substitute evidence is already of record.

For example, if a claimant files a Fully Developed Claim for PTSD on a VA Form 21-526 EZ, and does not simultaneously submit a VA Form 21-0781, Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder, the claim requires additional development unless the record already contains adequate evidence of a stressor.

FL 12-25, The Fully Developed Claim Program, states on page seven that, should a claim require further development of evidence from the claimant, it must be excluded from the Fully Developed Claim program. Therefore, in this case, exclude the claim and send the claimant a VA Form 21-0781. In addition, if further development of evidence is required from a claimant related to another special issue not included in “Special Circumstances,” the claim should also be excluded from the Fully Developed Claim program. 

These special issues include, but are not limited to: herbicide exposure, exposure to Hepatitis C, and exposure to radiation.  Send the claimant a development letter explaining why the claim was excluded and what evidence is needed to decide the claim.

Reference: Compensation Service Bulletin, September 2013

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Change 13May 20, 2014

GUIDANCE ON PROPER USE OF FULLY DEVELOPED CLAIM (FDC) EXCLUSION SPECIAL ISSUES

Compensation Service is revising the guidelines regarding the proper use of FDC Exclusion Special Issues in Modern Awards Processing-Development (MAP-D) and VBMS. Data analysis from the Office of Performance Analysis and Integrity (PA&I) shows that the “VBA administrative reason” exclusion is the most frequently used exclusion, but the most common explanations do not correspond with the reasons provided in M21-1 Manual Rewrite (MR) Part III, Subpart i, Chapter 3, Section B (M21-1MR III.i.3.B), for use of the “VBA administrative reason” exclusion.

Compensation Service has added new exclusion reasons to MAP-D and VBMS. We will remove the special issue, “FDC Excluded-VBA administrative reason”, from these systems shortly. Until that time, employees should not use this reason. Employees must use only the exclusion reasons that are generated in the system as follows:

FDC Excluded – Needs non-Fed evidence development FDC Excluded – Evidence received after FDC CEST FDC Excluded – Claimant declined FDC processing FDC Excluded - FDC certification incomplete FDC Excluded – Additional claim submitted FDC Excluded – Claim pending FDC Excluded – Appeal pending FDC Excluded – Necessary form(s) not submitted FDC Excluded – FTR to exam

Claims personnel should follow the guidance in the table at the end of the bulletin when determining which exclusion reason to apply.

Compensation Service will update M21-1MR III.i.3 to include this guidance.

If users receive an FDC and the exclusion reason does not fall under any of the special issues that are generated in the system, they should email the VAVBAWAS/CO/212A mailbox.

Reference: Compensation Service Bulletin, May 2014

DETERMINING THE EFFECTIVE DATE OF FULLY DEVELOPED CLAIMS (FDCS) UNDER FAST LETTER FL 13-17, PROCESSING FULLY DEVELOPED ORIGINAL CLAIMS (FDCS) RECEIVED FROM AUGUST 6, 2013 THROUGH AUGUST 5, 2015

Due to questions we received during the Veterans Service Center Manager (VSCM) conference call, we would like to provide further clarification of the potential one-year retroactive effective date assignment for original, disability compensation FDCs received from August 6, 2013 through August 5, 2015.

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Change 13May 20, 2014

When determining effective dates for original, disability compensation FDCs received from August 6, 2013 through August 5, 2015, RVSRs should continue to apply current effective date guidance as governed by 38 CFR 3.400. However, RVSRs should treat the claim as if it was received one-year prior to when VA actually received the FDC and assign the effective date as they normally would have had the claim been received on that date. The only change in assigning effective dates for these cases is that for effective date purposes we consider the claim as if it were received one year prior to the actual date of receipt.

For example, we receive an original, compensation FDC on August 10, 2013, for a right knee condition. No medical evidence is submitted in conjunction with the FDC. Service treatment records show treatment for a right knee injury in service. A Disability Benefits Questionnaire (DBQ) and medical opinion dated May 13, 2014, show that the current right knee disability is related to military service. RVSRs should consider the FDC as if we had received it one-year prior to the actual date of claim, i.e., August 10, 2012, and then assign the appropriate evaluation as of August 10, 2012.

Although the one-year retroactive effective date is not automatic, RVSRs should apply the provision unless there is clear evidence to the contrary. For example, if there is medical evidence clearly showing that the claimed medical condition did not exist, or had not manifested to a compensable degree, either during the one year prior to the date of claim, or following the date of claim, and evidence is received supporting the disability while the claim is pending, then RVSRs should assign the effective date based on the specific facts in the case.

If the evidence supports less than one year of disability, process the award assigning the effective date as of the date the evidence shows the evaluation is warranted.

See FL 13-17 for additional information.

Reference: Compensation Service Bulletin, May 2014 Addendum

CHANGES

Change 1, June 10, 2010, added FL reference.

Change 2, June 21, 2010, added new FL reference.

Change 3, January 17, 2011, added additional information/guidance.

Change 4, December 9, 2012, added guidance regarding new FDC process steps.

Change 5, January 27, 2013, added guidance regarding expiration of Feb 2010 VA Form 21-526EZ or VA Form 21-527EZ.

Change 6, April 26, 2013, added reminder regarding fully developed claims and requesting evidence from the April 2013 Compensation Bulletin.

Change 7, June 20, 2013, deleted guidance & reference to FL 10-22.

Change 8, July 22, 2013, added guidance from the Addendum Compensation Service Bulletin, June 2013.

Change 9, August 15, 2013, added guidance from FL 13-17, Processing Fully Developed Original Claims Received from August 6, 2013 through August 5, 2015.

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Change 13May 20, 2014

Change 10, September 19, 2013, updated guidance from the September 2013 Compensation Service Bulletin regarding FDC claims and special circumstances.

Change 11, January 20, 2014, added guidance from M21-1MR regarding a new reference for FDC.

Change 12, March 25, 2014, added guidance from the March 2014 Compensation Service Bulletin regarding informal/in complete FDC and reopened claims under the FDC program.

Change 13, May 20, 2014, added guidance from the May 2014 Compensation Service Bulletin regarding special exclusions issues in MAPD & VBMS, and effective dates under the FDC program.

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Change 4July 1, 2011

Section 12

BDD & Quick Start Claims_______

INITIAL REVIEW OF PRE-DISCHARGE CASES

MUST HAVE THE FOLLOWING TO BE PRE-DISCHARGE:1. VA Form 21-526c 2. Service Treatment Records (copies are okay)3. Pre-printed Veterans Claims Assistance Act Notice (see Fast Letter 10-24) (optional

for Denver since BDD site will issue in letter)4. Signed VCAA Notice Response (optional for all sites)5. Known Separation date

IF Less Than 60 Days Prior to Separation

Between 60-180 Days Prior to Separation

Claim received with no STR’s

CEST EP 110, 010, 020 and work in Denver as a normal claim requesting STRs and requesting general medical examination (see Fast Letter 10-29)

CEST EP 110, 010, 020 and work in Denver as a normal claim requesting STRs and requesting general medical examination (see Fast Letter 10-29)

Claim received from another Station with all required documents listed above

Send to CPS site in San Diego (This should not have came to Denver UNLESS a VSI/SI case)(See Fast Letter 09-31)

Send to CPS site in San Diego (This should not have came to Denver UNLESS a VSI/SI case)(See Fast Letter 09-31)

Claim received on VONAPP

Electronically transfer case to CPS site in San Diego

Electronically transfer case to CPS site in San Diego

Claim received within 10 days of separation

Send to CPS site in San Diego (cannot Cest these cases, put paper FLASH on packet, see Fast Letter 09-31)

Send to CPS site in San Diego(cannot Cest these cases, put paper FLASH on packet, see Fast Letter 09-31)

Claim received in Denver but claimant did not get out of service in Colorado

Send to CPS site in San Diego (Fast Letter 09-31)

Send to CPS site in San Diego (Fast Letter 09-31)

Claim received with all required documents listed above

SEND TO FT. CARSON ASAP!!!

SEND TO FT. CARSON ASAP!!!

NOTE: Mail received needs to be forwarded to where the file is located

If at STN 951 send to St. Paul for scanning.

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Change 4July 1, 2011

PARTICIPANT REQUIREMENTS

Any servicemember, whether from the active duty or reserve component, who is within 1 to 59 days from separation from active duty or does not meet the BDD criteria requiring availability to attend all examinations prior to leaving his/her point of separation, may file a Quick Start pre-discharge claim for disability compensation. This includes Reservists serving on active duty in an Active Guard Reserve (AGR) role under 10 U.S.C., or full-time National Guard members serving as AGRs under 32 U.S.C. Both active duty and full-time National Guard duty are defined as “active service” under 10 U.S.C. 101(d).

Note: Claims from terminally ill servicemembers, those with certain special issues (e.g. case managed, very seriously ill, seriously ill, and special person category), and claims that require prolonged development (e.g., claims involving radiation exposure, Gulf War undiagnosed illness, or those that may require prolonged stressor verification when an in-service mental health diagnosis is not of record), must be maintained at the ROJ for processing. Control such claims with end product (EP) 110, 010, or 020, unless a different third-digit modifier is required to identify it as a special-issue claim.

Refer to Fast Letter 09-31 for further information and guidance on the Quick Start Pre-Discharge Claims.

CHANGES

Change 4, July 1, 2011, added decision-chart regarding the Initial Review of Pre-Discharge Cases.

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Change 11May 20, 2014

Section 13

Original Compensation/Pension Claims (Dual)(EP 110/010 series)

_______

An original compensation claim is any claim received on the form (VA Form 21-526) prescribed by the Secretary. See 38 CFR 3.151, Claims for Disability Benefits, for further details.

Pension is a benefit paid to a Veteran because of permanent and total nonservice-connected disability or to a surviving spouse or child because of a Veteran's nonservice-connected death. Basic eligibility is based on wartime service and recipients must meet specific income and net worth limitations. See 38 CFR 3.3 for more specific information

M21-1MR, Part III, Subpart ii, Chapter 2, Section B&C (M21-1MR III.ii.2.B&C), provides guidance on screening and processing original applications.

INITIAL REVIEW OF CLAIMS FOR PENSION

A substantially complete application must include the benefit claimed. Reference M21-1MR.I.1.B.3b

If a claimant claims to be totally disabled and furnishes information about employment, and income, then consider the application to be a claim for pension. Reference M21-1MR.III.ii.2.B.6c

A review of all incoming material must determine whether is a claim or evidence in support of a claim and depending on the nature of the material, determine whether is necessary to obtain additional evidence. Reference M21-1MR, III.ii.A.1b

When checking an application determine the benefit sought and the type of claim; and check the application for blank spaces or insufficient information. Reference M21-1MR.III.ii.1.A.2b

Determine the type of benefit the claimant seeks based on the application form, any additional information provided on the application and other supporting evidence. Reference M21-1MR.III.ii.1.A.3a

Since a claim for one benefit can also be a claim for other benefits, consider entitlement to other benefits, if applicable. Reference M21-1MR.III.ii.1.A.3a

Depending on the claimant’s manner of preparation and the interpretation by the Veterans Service Representative (VSR) of the claimant’s intent, VA Form 21-526 constitutes an original claim for disability compensation, disability pension, or both. If any doubt exists as to which benefit the claimant seeks, ask the claimant for clarification. Reference M21-1MR.III.ii.2.B.6b

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Change 11May 20, 2014

For further guidance, refer to Addendum E, Pension Checklist.

CHECKING FOR THE PROPER SIGNATURE

An original claim for any type of benefit must be signed by the claimant, the parent or guardian of a minor, or the fiduciary of a claimant who is incompetent.

Reference: M21-1MR.III.ii.1.A.3b

NO SPECIFIC DISABILITY CLAIMED

If the Veteran does not provide a specific disability,

Send development letter requesting the name of the disability.

If no response in 30 days, refer to Administrative Denials Section of this guide for further details.

Note: If “exposure” is the only allegation, the claim is not substantially complete and should not be controlled. (See M21-1MR.I.1.B.3b, for information on handling incomplete claims.)

SERVICE VERIFICATION – COMPENSATION CLAIMS

Refer to Verification of Service Section in this development guide for specific development actions.

SERVICE VERIFICATION – DUAL CLAIMS

ACCEPTABLE SERVICE FOR PENSION: Additional requirements for pension claimants, 38 CFR 3.203(b).

1) 90 days of active military service, any of which is wartime service or;

2) Service in the active military, naval, or air service during a period of war with a discharge or release from service for a disability found to be service connected without presumptive provisions of law, or at time of discharge had a service-connected disability, shown by official service records, which in medical judgment would have justified a discharge for disability or;

3) Service in the active military, naval, or air service for an aggregate of 90 days or more in two or more separate periods of service during more than one period of war.

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Change 11May 20, 2014

4) Veterans who enlisted after September 7, 1980 must also complete a minimum active-duty service requirement that is the shorter of either twenty-four months of continuous active duty or completion of the full period for which the Veteran was called or ordered to active duty.

WARTIME SERVICE - PERIOD OF WAR: For guidance regarding period of war, refer to 38 CFR 3.2.

VIETNAM ERA DATES: Section 505 of Public Law 104-275 (signed into law effective 10-9-96), moves the beginning of the Vietnam Era….

to February 28, 1961, for Veterans who actually served in the Republic of Vietnam between February 28, 1961, and May 7, 1975,

from January 9, 1962, to May 7, 1975, the beginning date of service in Vietnam for purposes of the presumption of exposure to herbicides.

If the Veteran does not meet any of the above service requirements, no development is needed, unless the Veteran has 80 to 89 days of service.

VETERAN HAS 80 TO 89 DAYS OF SERVICE. Do not routinely request a certification of travel time if the record shows that the Veteran had less than 80 days of active service. In such a case request certification only if travel time is raised as an issue by the claimant or unusual circumstances exist such as an overseas discharge.

Submit PIES Request Code O07 for verification of travel time

Request Code O33 for a 90 day statement. Print a copy of the PIES request to be flip-filed in the center section of the C-file.

DOES VETERAN HAVE 90 TO 120 DAYS OF SERVICE? If it cannot be determine if the Veteran has 90 to 120 days of service, submit a request to NPRC.

Submit PIES Request Code O33. Print a copy of the PIES request to be flip-filed in the center section of the C-file.

TRAVEL TIME & MINIMUM ACTIVE DUTY REQUIREMENT. Consider travel time: By adding traveltime as certified by the service department, the requisite period of active service may be met See Traveltime Under 38 U.S.C. 106(c), M21-1, Part III, 2.08(c).

CONSIDER MINIMUM ACTION DUTY REQUIRMENT. (after 9-7-80). See Minimum Active Duty Service Requirement, M21-1, Part III, 2.08d.

SERVICE TREATMENT RECORDS

Refer to Service Records Development & PIES Section in this development guide for specific development actions.

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Change 11May 20, 2014

FIRE-RELATED CASES

The fire at NPRC in 1973 may have destroyed the service treatment records (STRs) if the Veteran served in the Army from November 1, 1912 to January 1, 1960 and Air Force Veterans with surnames from Hubbard thru Z, discharged between September 25, 1947 and January 1, 1964, and had no retired or Reserve Status. (M21-1MR.III.iii.2.E.26)

Refer to Service Records Development & PIES Section in this development guide for specific development actions.

GENERAL DEVELOPMENT ACTIONS – DUAL CLAIMS

CONTINUITY – Compensation Claims. The continuity paragraph must be inserted into 5103 notice letters for all claims for service connection. Reference M21-1MR.IV.ii.1.A.2d.

For further information regarding Continuity, refer to the Terms & Definitions Section in this development guide.

PENSION CONSIDERATIONS. If the claim lacks evidence showing qualifying service, evidence showing income and net worth, and medical evidence, complete the following action.

MEDICAL EVIDENCE

Medical evidence may be any of the following: 1) private medical evidence, 2) VA medical treatment reports, 3) Vet Center treatment reports, or 4) military medical facility treatment reports.

If the Veteran is not administratively entitled to pension benefits and sufficient medical evidence was not submitted with the application . . .

Refer to Medical Evidence Development Section in this development guide for further details regarding development for medical evidence.

PRESUMPTIVE CONDITIONS CLAIMED

If the Veteran is claiming a presumptive condition:

Send the Veteran 5103 notification (if applicable).

Include language regarding presumptive conditions

Request a VA examination, if applicable – refer to the VA Examination Section in this development guide for further details.

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Change 11May 20, 2014

For a complete list of presumptive conditions see 38 CFR 3.309 (Disease subject to presumptive service connection). For additional guidance, see the section entitled, Presumptive Conditions.

CONTINUITY

The continuity paragraph must be inserted into 5103 notice letters for all claims for service connection. Reference M21-1MR.IV.ii.1.A.2d.

For further information regarding Continuity, refer to the Terms & Definitions Section in this development guide.

PENSION – OTHER DEVELOPMENT CONSIDERATIONS

SOCIAL SECURITY ADMINISTRATION RECORDS: Develop for Social Security Administration records if noted on the Veteran’s claim:

Reference: Requests for SSA records needs to be completed in accordance with M21-1MR.III.iii.3.A, change date March 26, 2013. This section of the manual provides the new SSANRC-15 form as Exhibit 1; the new form includes an entry for the Veteran’s date of birth.

INCOME INFORMATION: Check for income information. (Computation of income,  38 CFR 3.260) If income is not complete, return the application for completion. If additional information is required,

INCOME DETERMINATION: If income is excessive, claim should be denied as basic eligibility does not exist.

Reference: Applicability of various dependency, income and estate regulations,  38 CFR 3.270

Reference: Requests for Income and Net Worth Evidence, M21-1MR.V.I.3

Reference: Income and Net Worth M21-1MR.V.iii.1

NETWORTH DETERMINATION: If Net Worth is $50,000 or greater,

Send MAPD Income/Net Worth Claimant Letter, Insurance - 21-8049 needed.

Reference: Requests for Income and Net Worth Evidence, M21-1MR.V.iii.1

Reference: Income and Net Worth M21-1MR.V.iii.1

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Change 11May 20, 2014

ADMINISTRATIVE ENTITLEMENT TO PENSION BENEFITS (RATING DECISION NOT REQUIRED)

Effective September 17, 2001, if a Veteran meets the military service and income/net worth requirements for non-service connected pension benefits, the claimant is eligible as if the Veteran were determined to be permanently and totally disabled in the follow circumstances:

Veteran is age 65 or over

Veteran is a patient in a nursing home for long-term care due to disability

Veteran was determined to be disabled for purposes of Social Security Administration benefits.

Reference: Public Law 107-103, Veterans Education and Benefits Expansion Act of 2001

EMPLOYMENT INFORMATION (PENSION CLAIMS)

Inform the Veteran we need the date the last worked and the name and complete address of all employers for whom the Veteran worked within the last twelve months. Complete Section 1 of VAF 21-4192 before sending to employer.

Send MAPD Pension Claimant Letter, Employment info needed – 21-4192 to Veteran.

If VAF 21-4192 is sent to a VA medical center to verify employment, follow-up with the VA medical center if the VAF 21-4192 is not received; do not tell the Veteran to obtain the form.

VA EXAMINATION GUIDELINES

A general medical examination is designed to provide a comprehensive baseline physical examination with particular emphasis on any claimed or identified disabilities. This type of examination is usually only appropriate for someone in the BDD (pre-discharge) program, someone who has been discharged from military service for less than a year, a pension claim, or an individual unemployability claim when there are indications of non-service connected disabilities that may impact on employability.

Reference: Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

ORIGINAL OR NEW CLAIMS: A VA examination is warranted if there is competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability (Veteran's statement is generally sufficient to meet this requirement).

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Change 11May 20, 2014

ORGINAL CLAIMS RECEIVED WITHIN 1 YEAR OF DISCHARGE: If the Veteran was discharged LESS than one year prior to the date of claim, request a general medical examination; DO NOT delay requesting the examination pending receipt of the service treatment records; an exception may be circumstances in which the claims folder may need to be reviewed by the examiner (e.g. mental disorders, traumatic brain injury, formal medical opinion, etc.) (M21-MRIII.iv.3.A). A general medical examination should be requested for all BDD claims and all original claims received within one year of discharge from military service regardless of presence or absence of evidence of current disability.

ORGINAL CLAIMS RECEIVED MORE THAN 1 YEAR AFTER DISCHARGE: If the Veteran was discharged MORE than one year prior to the date of claim, request an examination ONLY for the claimed conditions providing the medical evidence shows the Veteran was treated during military service for the disability or the evidence shows the disability may be related to military service.

When ordering a general medical examination for pension purposes, list all the disabilities for which the Veteran is receiving treatment. The medical treatment records will indicate at least some of the Veteran’s disabilities and these should be noted on the request. If we have no treatment records, call the Veteran and ask what disabilities are being claimed.

Refer to the VA Examinations Section in this development guide for further details.

CHANGES

Change 3, January 1, 2005, corrected the dates involved with fire-related cases.

Change 4, May 16, 2005, added guidance with regard to requesting recent treatment when the Veteran has been discharged more than one year after discharge.

Change 5, October 17, 2007, added guidance from OFO Letter 20F-06-23 regarding continuity for all claims for service connection.

Change 6, November 4, 2009, added guidance regarding pension development.

Change 7, August 26, 2011, added guidance regarding the initial review of claims for pension.

Change 8, February 29, 2012, added guidance regarding requests for general medical exams that may need to be delayed because the claims folder may need to be reviewed by the examiner (e.g. mental disorders, traumatic brain injury, formal medical opinion, etc.).

Change 9, April 28, 2012, added hyperlink for the Pension Checklist (Addendum E).

Change 10, July 22, 2013, added guidance from M21-1MR regarding checking for proper signature.

Change 11, May 20, 2014, added M21-1MR reference regarding guidance on screening and processing original applications.

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Change 6October 17, 2007

Section 14

New Claims(EP 020 series)

_______

A new issue is a claim for illness, injury, or disease for which service connection has not been previously denied.

CLAIMANT’S SIGNATURE

The claimant’s signature is NOT required on reopened claims. Once a VA Form 21-526 has been filed, any subsequent claim for increase or for service connection, including claims to reopen, DO NOT need the claimant’s signature.

There is no regulation or statute that requires a signature on an informal claim. The statute, 38 CFR 3.155(c), makes clear that once a formal application has been filed, any subsequent informal claim will be accepted as a claim. Source: C&P Service Home Page, FAQ link, Informal Claims for Increase.

SERVICE VERIFICATION

Refer to Verification of Service Section in this development guide for specific development actions.

SERVICE TREATMENT RECORDS

Refer to Service Records Development & PIES Section in this development guide for specific development actions.

PRESUMPTIVE CONDITIONS CLAIMED

For a complete list of presumptive conditions see 38 CFR 3.309 (Disease subject to presumptive service connection). For additional guidance, see Section 4.2, Presumptive Conditions.

If the Veteran is claiming a presumptive condition:

Send the Veteran 5103 notification (if applicable).

Include language regarding presumptive conditions

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Change 6October 17, 2007

Request a VA examination, if applicable – refer to the VA Examination Section in this development guide for further details.

CONTINUITY

The continuity paragraph must be inserted into VCAA notice letters for all claims for service connection. Reference M21-1MR.IV.ii.1.A.2d.

For further information regarding Continuity, refer to the Terms & Definitions Section in this development guide.

MEDICAL EVIDENCE

Medical evidence may be any of the following: 1) private medical evidence, 2) VA medical treatment reports, 3) Vet Center treatment reports, or 4) military medical facility treatment reports.

For specific development actions, refer to Medical Evidence Development Section in this development guide.

VA EXAMINATION GUIDELINES

Request an examination for new conditions if the medical evidence shows the Veteran was treated during military service for the disability or it is shown the disability is related to military service.

Reference: Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

For specific guidance, refer to the VA Examinations Section in this development guide.

SSA MEDICAL EVIDENCE NEEDED

If the Veteran reports being in receipt of Social Security Disability and it started within the last two years, request the medical records from Social Security.

For specific development actions, refer to Social Security Administration Requests Section in this development guide.

CHANGES

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Change 6October 17, 2007

Change 4, January 1, 2005, the title of this section was changed to be more in line with M21-1 terminology.

Change 5, May 16, 2005, added guidance with regard to requesting recent treatment when the Veteran has been discharged more than one year after discharge.

Change 6, October 17, 2007, added guidance from OFO Letter 20F-06-23 regarding continuity for all claims for service connection.

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Change 6June 14, 2011

Section 15

Claims for Increase(EP 020 series)

_______

Correspondence from a claimant asking for reconsideration or an increased evaluation is a reopened claim. See M21-1MR.III.ii.2.F (Claims for Increase) for further details.

CLAIMANT’S SIGNATURE

The claimant’s signature is NOT required on reopened claims. Once a VA Form 21-526 has been filed, any subsequent claim for increase or for service connection, including claims to reopen, DO NOT need the claimant’s signature.

There is no regulation or statute that requires a signature on an informal claim. The statute, 38 CFR 3.155(c), makes clear that once a formal application has been filed, any subsequent informal claim will be accepted as a claim. Source: C&P Service Home Page, FAQ link, Informal Claims for Increase.

CONTINUITY VS . RECENT TREATMENT

DO NOT request continuity - continuity is not an issue for a condition which is already service connected. A claim for increase will only require “recent” treatment.

MEDICAL EVIDENCE

The Veteran must provide copies of medical evidence and/or tell us when and where treatment was received.

Refer to Medical Evidence Development Section in this development guide for specific details regarding requests for VA Form 21-4142, initial requests, and follow-up requests.

VA EXAMINATION GUIDELINES

A VA examination is warranted when there is evidence of increased disability (including Veteran's statement that his condition is worse).

As to whether an examination or medical opinion is necessary, depends on whether we have competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability (38 CFR 3.159 (c)(4)).

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Change 6June 14, 2011

An examination of service-connected conditions is usually required. However, check with an RVSR prior to requesting an examination since any of the following may preclude the necessity for another examination:

Veteran was hospitalized during the last 12 months, whether at a VA or private facility for claimed condition(s)

Veteran underwent surgery on an outpatient/inpatient basis during the last 12 months, whether at a VA or private facility for claimed condition(s)

When requesting a VA examination for service-connected disabilities, the issues must be listed in the request verbatim from the rating decision.

Reference: Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

Refer to the VA Examinations Section in this development guide for further details

SSA MEDICAL EVIDENCE NEEDED

If the Veteran reports being in receipt of Social Security Disability and it started within the last two years, request the medical records from Social Security. Refer to Social Security Administration Requests Section in this development guide for further details .

CHANGES

Change 4, January 1, 2005; Guidance was provided to list disabilities on the VA exam request verbatim from the rating decision.

Change 5, November 27, 2007; deleted requirement to send MAPD Recent Treatment paragraph.

Change 6, June 14, 2011; reformatted text regarding VA Examination Guidelines and added the 38 CFR reference.

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Change 10July 18, 2010

Section 16

Claims to Reopen(EP 020 series)

_______

New and material evidence is required to reopen a finally adjudicated claim. For further information, refer to 38 CFR 3.156.

A claimant must submit "new and material" evidence to reopen a claim which has become final because the appeal period has expired or the appellate review has been completed. For further information, refer to M21-1MR.III.ii.2.E.19. and M21-1MR.III.iv.2.B.5.

DEFINITION

Reopened Claim –is considered any of the following:

Any statement indicating the claimant's desire to file a claim may be accepted.

Claims filed by the claimant, a Member of Congress, or the claimant’s accredited representative.

Reference: 38 CFR 3.155

Reopened Claim – any claim received after the appeal period has expired; any claim received from Veteran who was recalled to active duty and was discharged. See 38 CFR 3.109 for further details.

A claim for which a decision was rendered, appeal rights were provided, and the 1 year appeal period has expired is considered a finally adjudicated claim. A decision that was appealed and that decision was affirmed by the Board of Veterans Appeals (BVA) or Court of Appeals for Veterans Claims (CAVC) is also considered a finally adjudicated claim.

Note: Pay particular attention to claims transferred-in from another Regional Office. Don’t assume the other office properly identified all the issues and/or disabilities.

New Evidence – New evidence means existing evidence not previously submitted. Material evidence means existing evidence that relates specifically to the reason why the claim was last denied.

Note: If additional evidence is received from a VA medical facility or military hospital, refer to the section entitled Reconsideration of Claims Based on Additional Evidence, for information about Newly Received Medical Evidence.

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Change 10July 18, 2010

VCAA NOTIFICATION

In Quartuccio v. Principi, the Court explained that VA's duty to notify, as mandated by the Veterans Claims Assistance Act (VCAA), applies to claims to reopen and requires that VA notify the claimant about the type of evidence that is needed to substantiate the claim. For further information regarding our duty to notify, see the Compensation & Pension Manager’s Conference Call, VSCM Conference Call, March 20, 2003

If the Veteran submits a claim for service connection of a previously denied condition, and the decision has become final, the VCAA notification only needs to include the new and material attachment.  STAR has advised that VCAA notification letters do not need to contain the service connection law attachment, even if it is determined that new and material evidence was submitted and the claim will be denied on the merits. [Comment]

ISSUE: NEW AND MATERIAL EVIDENCE VCAA

Question:Our question is on VCAA notice requirements on claims involving new and material evidence. At the Feb 2010 STAR Quality Call, in response to a question, the STAR staff appeared to state that if a claimant attempts to reopen a previous, finally adjudicated claim, then the only notice required was the "new and material" notice. VCAA notice on the underlying claim, i.e. direct SC, was not required. Is the guidance provided in the February 2010 STAR call the accepted policy in all cases or only in those cases where the VCAA notice provided in the prior, finally adjudicated claim meets all current VCAA notice content requirements? (Please see CAVC decision in Kent v. Nicholson (2006) and from an informal 2006 memorandum from General Counsel.)

Answer:In Kent, the Court held that in claims to reopen for service connection on the basis of new and material evidence, the Veterans Claims Assistance Act (VCAA) requires VA, in crafting a legally compliant notification letter, to review the bases for denial in the prior decision and respond with a notice letter that describes what evidence would be necessary to substantiate the element or elements required to establish service connection that were found insufficient in the previous denial. So, the language required to comply with VCAA would depend upon the element(s) necessary to establish service connection found insufficient in the previous denial.

The answer provided during the February Quality Call was not incorrect, what may have been misunderstood is what is required in a VCAA compliant “new and material” evidence notice. To be proper, the new and material language is required to include discussion of all evidence necessary to establish the previously unestablished facts resulting in the denial.

Source: Star Rating Call, Q&As for the March 2010 Quality Call

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Change 10July 18, 2010

REQUESTING NEW AND MATERIAL EVIDENCE

Locate and review the last Rating Decision which decided the issue under consideration. Look for the last denial of service connection – not a decision that declined to reopen the claim based on lack new and material evidence. However, reviewing a decision that declined to reopen a claim for lack of new and material evidence may help you to understand why the initial claim was denied, especially if the initial decision is very old and lacks a statement of reasons and bases.

Review the Reasons and Bases section of the Rating Decision so as to ascertain the precise reason(s) for the denial. Specifically, look for evidence sufficient to establish:

An in-service event, injury or disease;

A current disability; and

A relationship between an in-service event, injury or disease and the current disability.

The Veteran must be informed the issue was previously disallowed, the date of the disallowance and the reasons for disallowance; DO NOT inform the Veteran the claim was denied as Not Well Grounded. Instead, cite the precise reason(s) for the denial.

The Veteran must be advised that new and material evidence should be submitted within 30 days. The claim should be kept under end product control.

DUPLICATE CLAIMS

Consider a claim a duplicate claim if the application is based on the same conditions for which a prior claim for service connection was denied and the Veteran does not furnish new and material. For further information, refer to M21-1MR.III.ii.2.E.20d & e.

SUBMISSION OF NEW AND MATERIAL EVIDENCE

If the claimant submits evidence in response to a request for new and material evidence, refer the claim to an RVSR (rating Veterans service representative) for a determination as to whether the evidence is new and material.

If a claimant provides a statement which describes a condition in sufficient detail, which is within his or her ability to describe, such as his or her own symptoms, the statement may to that extent constitute the best evidence obtainable.

Refer to M21-1MR.III.ii.2.E.19 & 20 and M21-1MR.III.iv.2.B.5 & 6 for further details.

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Change 10July 18, 2010

NEW AND MATERIAL EVIDENCE NOT SUBMITTED

If the claimant does not submit the requested evidence during the allotted control period, disallow the claim for failure to prosecute. Notify the claimant of the disallowance, and provide notice of procedural and appellate rights. For further guidance, refer to Administrative Denials Section in this development guide.

Reference: M21-1MR.III.iii.1.B.7i.

VA EXAMINATION GUIDELINES

A VA examination is warranted when new and material evidence is received. Note: The VA’s general duty to assist on all previously denied claims means the VA will assist the claimant in obtaining medical evidence. However, a VA examination will not be requested unless new and material evidence is received.

Reference: Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

For further guidance, refer to the VA Examinations Section in this development guide.

SOURCE OF MEDICAL EVIDENCE INDICATED IN CLAIM?

The VA’s general duty to assist on all previously denied claims means the VA will assist the claimant in obtaining private and federal evidence.

Develop for any medical treatment indicated in the claim if it is not already of record

Medical Evidence is considered private medical evidence, VA medical treatment reports, Vet Center treatment reports, military medical facility treatment reports.

For further guidance, refer to Medical Evidence Development Section in this development guide.

SSA MEDICAL EVIDENCE NEEDED

If the Veteran reports being in receipt of Social Security Disability and it started within the last two years, request the medical records from Social Security.

For further guidance, refer to the Social Security Administration Requests Section in this development guide.

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Change 10July 18, 2010

CONDITIONS PREVIOUSLY DENIED ADMINISTRATIVELY

Condition previously denied administratively without a rating - If service connection for a disability was denied administratively (without a rating), the issue should be developed as a new condition. New and material evidence is not required to reopen the claim.

PTSD PREVIOUSLY DENIED

If the previous denial was for the lack a diagnosis, new and material evidence is NOT required to reopen the claim.

For claims to reopen a previously denied service connection PTSD claim, new and material evidence will be required as the regulatory amendment is not considered a liberalizing rule under 38 C.F.R. § 3.114. To reopen a claim under new § 3.304(f)(3), VA will accept a Veteran’s lay statement regarding an in-service stressor – “fear of hostile military or terrorist activity” – as sufficient to constitute new and material evidence for the purpose of reopening a previously denied claim, if the Veteran’s record otherwise shows service in a location involving exposure to “hostile military or terrorist activity.” If review of the record discloses a previously submitted lay statement demonstrating “fear of hostile military or terrorist activity,” such statement will be sufficient for reopening a claim if the Veterans’ record otherwise demonstrates service in a location involving exposure to “hostile military or terrorist activity.”

HEARING LOSS PREVIOUSLY DENIED

For further details regarding claims for hearing loss which were previously denied, see the section on Hearing Loss & Tinnitus Claims is this development guide.

INDIVIDUAL UNEMPLOYABILITY PREVIOUSLY DENIED

If the Veteran files a claim for individual unemployability, new and material evidence is NOT required to reopen the claim.

CLAIMS DENIED AS NOT WELL GROUNDED

A claim denied as not well grounded between July 14, 1998 and November 9, 2000, required a new rating decision and possible redevelopment. These claims are considered Re-Adjudicated Claims.

The Veterans Claims Assistance Act of 2000 does not allow us to either accept claims for or initiate the readjudication of “not well grounded” claims after November 9, 2002. The Act

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Change 10July 18, 2010

prohibits readjudication of those denied claims unless a request was received prior to November 10, 2002, or we started readjudication on our own initiative prior to that date.

If a claim has been denied because it was not well grounded, the claimant is required to submit new and material evidence with any subsequent claim on the same issue.

CHANGES

Change 3, June 22, 2004, Hearing Loss Previously Denied, provided clarification that a Veteran must provide current evidence which shows hearing that meets VA criteria before requesting a VA examination and opinion.

Change 4, August 5, 2004, deleted referral to addendum J for New & Material Evidence language to be used in MAPD letters; the text generated by MAPD is correct.

Change 5, January 1, 2005, the title of this section was changed to be more in line with M21-1 terminology.

Change 6, January 1, 2006, incorporated references within each topic; added guidance regarding receipt of a duplicate claim.

Change 7, December 20, 2006, added M21-1MR references.

Change 8, February 26, 2010, added guidance regarding VCAA law attachments requirements when a claim is final and new & material evidence is required.

Change 9, April 30, 2010, added guidance regarding VCAA notification requirements from the STAR Rating Call Q&As.

Change 10, July 18, 2010, deleted the topic PTSD Previously Denied and moved it to Section 33.4

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Change 16May 20, 2014

Section 17

Reconsideration of Claims Based on Additional Evidence

_______

UNASSOCIATED SERVICE TREATMENT RECORDS (STRS) RECEIVED FROM THE RECORDS MANAGEMENT CENTER OR OTHER SOURCES

Refer to Fast Letter 10-17, Unassociated Service Treatment Records (STRs) Received from the Records Management Center (RMC) or other sources, dated May 5, 2010, for procedural guidance on handling unassociated STRs.

Note: If the Veteran has never filed a claim (VA Form 21-526), PCHG the end product to EP 330 and PCLR the end product (reference: M21-1MR, Part III, Subpart ii, Chapter 2, Section D, Topic 15c); file the STRs with the claims file and return the file to Triage.

ADDITIONAL STRs – MAPD REQUIREMENTS. When the RVSR determines that a rating decision is required based on additiaonal STRs, complete the following actions:

Update the contentions screen to show the disability as the contention.

Complete 3rd Party development by selecting the NPRC radial button; from the NPRC development list, scroll down and select “SMRs from service dept”

Click Final Print (a tracked item for STRs will be created)

Update the status to “Ready for Decision.”

Go to the tracked items screen; enter the current date in the “Closed” column on the tracked items screen for the STRs

VETERAN REQUESTS RECONSIDERATION (WITHIN ONE YEAR OF THE DECISION) - ADDITIONAL MEDICAL EVIDENCE HAS NOT BEEN RECEIVED

When a statement is received requesting reconsideration or to reopen a claim, and it is within one year of the rating decision notification letter and additional evidence is not submitted, inform the claimant/POA that

additional evidence, which has not been previously considered, must be submitted before the claim can be reconsidered (reopened),

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Change 16May 20, 2014

if additional evidence is not submitted, reconsideration of the claim cannot be completed at this time, and

if the claimant disagrees with the decision, a written Notice of Disagreement must be submitted within one year of the date of the Notification Letter.

As to whether an examination or medical opinion is necessary, depends on whether we have competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability (38 CFR 3.159 (c)(4)).  Therefore, if the claimant wants their claim reconsidered, the claimant must have persistent or recurrent symptoms that differ from when the claim was last decided.

Complete the following actions:

PCHG EP 020 to EP 400

Send a MAPD Compensation Claimant Letter and insert the following paragraphs.

On [Date], we received your request to reconsider or reopen your claim for [Disability]. Since your request did not include additional evidence which has not been previously considered, we cannot reconsider your request at this time.

If you want your claim reconsidered, please submit additional evidence which has not been previously considered. Medical evidence should show that you have persistent or recurrent symptoms that differ from when the claim was last decided. Our rating decision dated [Date] lists the evidence that was used to decide your claim.

Your claim was denied and you were notified of the decision on [Date]. Our notification letter advised you of your Rights to Appeal the decision. If you have no additional evidence to submit, you may exercise your right to appeal the decision by submitting a written Notice of Disagreement (NOD). Please download and complete VA Form 21-0958, “Notice of Disagreement.”  You can download the form at http://www.va.gov/vaforms or you can call us at 1-800-827-1000.  The Notice of Disagreement must be received within one year of our notification letter dated [Date].

PCLR EP400 - The request will not be controlled as a claim until the Veteran submits additional evidence.

MEDICAL EVIDENCE IS RECEIVED - CLAIM FROM THE VETERAN HAS NOT BEEN RECEIVED

When federal or private medical evidence is received, and the evidence is not accompanied by a claim from the Veteran for an increased evaluation or claim to reopen, and a rating decision has not been recently rendered, complete the following actions:

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Change 16May 20, 2014

Inform the claimant/POA by telephone that medical evidence has been received; in order to proceed further, we need a claim specifying the medical condition(s) the claimant would like us to evaluate or consider as a result of these medical records.

If the claimant specifies a medical condition/disability, complete VA Form 21-0820, Report of Contact, and complete the required development actions.

If obtaining clarification by telephone is unsuccessful, complete the following actions:

CEST EP400

Send development letter requesting the name of the disability. Refer to Addendum I for a sample letter.

PCLR EP400 - The evidence will not be controlled as a claim until the Veteran submits a claim for increase or request to reopen.

Note 1: Federal records described above involves medical evidence other than STRs (see the topic, Unassociated Service Treatment Records (STRs) Received from the Records Management Center, for guidance on additional STRs).

Note 2: A formal claim will be established when the Veteran submits a claim requesting an increased evaluation or claim to reopen.

Note 3: If a rating decision was completed recently, and the VCAA notification was sent within a year from the date of receipt of the evidence, the newly received medical evidence may only require reconsideration (additional rating decision).

REQUESTS FOR RECONSIDERATION BASED ON MEDICAL EVIDENCE

If medical evidence received is not a duplication (identical) of evidence already in file or there is a question as to whether reconsideration by the rating board is warranted, refer the evidence to the rating board. For further guidance regarding newly received evidence, refer to M21-1MR.III.ii.2.E.21, Handling Newly Received Evidence. The topic includes information on:

1. Referring medical evidence

2. Actions to take if the claimant submits duplicate medical evidence

3. Handling

supplemental service records

VA hospital reports

claimant statements, and

affidavits and statements

4. Descriptions of symptoms

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Change 16May 20, 2014

5. Handling correspondence from a former prisoner of war (POW), and

6. Handling information from a Veteran with a psychiatric disability

The submission of evidence should not be construed as a notice of disagreement (NOD). An NOD is defined by what is written by a claimant or his/her representative, and not by what is attached to, or not attached to a claimant's correspondence.  Therefore, if correspondence is received indicating the claimant would like "reconsideration" of a prior decision and this correspondence does not clearly express disagreement or dissatisfaction with the prior decision, follow manual procedures for requesting clarification of an NOD, regardless of whether or not evidence is attached.

DUPLICATE EVIDENCE SUBMITTED BY THE CLAIMANT

If the claimant submits duplicate medical records or any other duplicate evidence:

Send PCGL letter RO-ACK3, Return Material.

PCLR the 699 end product.

Fast Letter 10-17, Unassociated Service Treatment Records (STRs) Received from the Records Management Center (RMC) or other sources, dated May 5, 2010, for procedural guidance on handling unassociated STRs.

MEDICAL OPINIONS FOR CONDITIONS FOUND

SAMPLE VA EXAMINATION FOR CONDITIONS FOUND IN THE STRs: Is the current condition of [insert specific disability, if known, otherwise claimed condition] that the Veteran has now related to [identify the Veteran's complaints and/or treatment or specific injury] in service, or to another etiology?  Please provide a rationale for your opinion.

CHANGES

Change 3, July 26, 2005, change references from M21-1 to M21-1MR; updated link to C&P Service Home Page, FAQ link, Issue: Rating unsolicited STRs; removed topic related to evidence received on a claim denied as not well grounded.

Change 4, January 1, 2006, incorporated references within each topic.

Change 5, February 6, 2006, added guidance regarding required actions when additional STRs are received and the case must be referred to the rating team.

Change 6, June 23, 2007, added guidance regarding receipt of newly received federal or private medical evidence and the Veteran has not submitted a claim for increase or request to reopen.

Change 7, August 15, 2007, added guidance regarding receipt of STRs following promulgation of an original rating decision.

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Change 16May 20, 2014

Change 8, August 29, 2007, added guidance regarding receipt of newly received federal or private medical evidence.

Change 9, October 13, 2007, deleted guidance regarding receipt of dental records (STRs) which would no be covered by the guidance provided in M21-1MR, Part IV, Subpart ii, Chapter 2, Section A, Topic 1c.

Change 10, February 25, 2008, added guidance regarding referral of supplemental STRs to the rating activity.

Change 11, October 31, 2008, added guidance regarding supplemental STRs received from RMC (FL 08-37).

Change 12, November 10, 2008, added guidance regarding MAPD updates for supplemental STRs.

Change 13, March 8, 2009, added sample text for medical opinions for conditions found in the STRs.

Change 14, December 14, 2009, added additional guidance regarding claims for “reconsideration” that are submitted with or without additional medical evidence; updated reference for return of STRs to the Veteran.

Change 15, June 11, 2011, added additional guidance regarding claims for “reconsideration” that are received without additional medical evidence.

Change 16, May 20, 2014, modified sample paragraph text to include the use of VA Form 21-0958, Notice of Disagreement.

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Change 4November 13, 2006

Section 18

Resumption of Compensation Benefits_______

5103 NOTICE REQUIREMENTS

A claim for increase or a new claim received with a claim for resumption of benefits is to be processed concurrently, observing all 5103 notice and development requirements.

Partial grants are to be made whenever possible. However, the EP must be continued until all issues resolved.

Reference: 38 CFR 3.654(b)(2)

Reference: M21-1MR.III.v.4.C, Waiver of VA Benefits During Reserve Training or Guard Drill

RESUMING BENEFITS TERMINATED FOR REENTRY INTO ACTIVE SERVICE

Reference: M21-1MR.III.v.4.C.16e

RESUMPTION – DISABILITY STATIC AT TIME OF ENTRY ON ACTIVE DUTY

Reference: M21-1MR.III.v.4.C.16f

RESUMPTION – DISABILITY NOT STATIC AT TIME OF ENTRY ON ACTIVE DUTY

Reference: M21-1MR.III.v.4.C.16g

CHANGES

Change 1, January 1, 2005, changed the section from “Previously Denied Claims” to resumption of compensation. The guidance on previously denied claims was incorporated into Section 8, “Claims to Reopen.”

Change 2, April 25, 2005, added guidance as provided in FL 04-25; changed section title.

Change 3, January 1, 2006, incorporated references within each topic.

Change 4, November 13, 2006, M21-1MR reference added to replace rescinded FL 04-25.

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Change 8January 20, 2012

Section 19

Claims for Secondary Service Connection_______

Refer to M21-1MR.IV.ii.2.B.6 for information on determining secondary service connection, including by aggravation, including

the provisions for service connection under 38 CFR 3.310(a) and (b)

the medical evidence required to show a nonservice-connected (NSC) disability was aggravated by an SC disability

developing claims based on aggravation of an NSC disability by an SC disability

information that must be included in the examiner’s report, and

determining the extent to which an NSC disability was aggravated by an SC disability.

ISSUE: VCAA

Question:

If a Veteran claims a condition on the basis of secondary SC, would the VCAA letter be considered deficient if the letter contained only the What the Evidence Must Show attachment for secondary S/C, but did not include the attachment for direct service connection?

Response:

M21-1 MR IV.ii.1.A.2.d. states: Request evidence of continuity of symptoms for each disability claimed when developing claims for service connection. The reference applies to each disability on all claims for service connection. This provides a basis for sending the WTEMS for direct service connection in all claims for service connection. We are responsible for reviewing all potential avenues of service connection regardless of a specific claim, so the VCAA notice should address the requirements for direct, presumptive, and secondary service connection.

Source: Star Rating Call, Q&As for the February 2010 Quality Call

CLAIMS FOR A CONDITION SECONDARY TO CONDITIONS THAT ARE NOT SERVICE CONNECTED

Review the STRs, if available, before proceeding with the claim. Identify what condition(s) are shown in the STRs. If the conditions are shown in the STRS and/or the Veteran has submitted medical evidence which shows a relationship to military service, both issues will be considered for service connection.

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The claim will be developed as if it were an original claim for service connection.

VCAA NOTIFICATION

If the Veteran has raised the issue of secondary service connection, the VCAA notification letter should include both the service connection law as well as the secondary law language. Both laws should be included whenever the Veteran claims a secondary issue even if the primary issue is not service-connected since the primary condition may be granted and the secondary condition may not be found to be secondary. For example, the Veteran files a claim for diabetes and hypertension and the diabetes is granted but the evidence does not show the hypertension is secondary.

CLAIMS FOR A CONDITION AS SECONDARY TO A SERVICE-CONNECTED DISABILITY

Determine if the claimed condition is an increase in the service-connected condition or is really a secondary condition. The condition being claimed as secondary may be a part of the “disease process” and therefore evaluated under the current diagnostic code.

Review the STRs, if available, before proceeding with the claim. If the claimed condition(s) is shown in the STRS and/or the Veteran has submitted medical evidence which shows a relationship to military service, the issue(s) may be considered for service connection.

Send MAPD Claimant Letter, Compensation Letter, Continuity – med evid since service needed.

Send MAPD Compensation Claimant Letter, Secondary disability.

Send MAPD Compensation Claimant Letter, Presumptive SC - med evid within time limit needed (if applicable).

Note: Whenever the Veteran raises the issue of secondary service connection, the VCAA notification letter must include the VCAA “What The Evidence Must Show” attachments for both the service connection law and secondary service connection law.

In cases where a Veteran is service-connected for hypertension and claims secondary conditions of any of the following, DO NOT ask for a medical opinion.

Coronary artery disease

Arteriosclerotic heart disease

Stroke

Arteriosclerotic peripheral vascular disease

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DO NOT ask for a medical opinion as to the relationship between the service-connected hypertension and one of the above listed conditions. 

VA EXAMINATION & OPINION GUIDELINES

When asking if a condition is secondary to an service-connected condition, be specific as to what the service-connected condition is; for example, do not ask if the left knee is due to the right knee without providing the specific right knee disability and whether or not the right knee is service-connected.

Note:  Per 38 CFR 3.159 (c)(4)(i)(A), if there is no current medical evidence of a diagnosed condition but there is lay or medical evidence of persistent or recurrent symptoms, refer the claim the RVSR to determine the need for an opinion and the appropriate opinion language.

A Veteran may claim a condition as secondary to a service-connected condition, however, a VA medical opinion may be required to establish the secondary issue as being related to the service-connected disability. When in doubt, refer the case to an RVSR.

Examples of Issues Generally Not Requiring an Opinion:

Veteran is SERVICE-CONNECTED for diabetes and claims diabetic neuropathy, peripheral neuropathy, or impotence following the onset of diabetes.

Veteran is SERVICE-CONNECTED for hypertension and claims coronary artery disease or other arteriosclerotic manifestations.

Veteran is SERVICE-CONNECTED for sciatica or disc syndrome and claims leg pain or foot drop.

Examples of Issues May Require an Opinion:

Veteran is SERVICE-CONNECTED for diabetes and claims glaucoma, cataracts, etc.

Veteran is SERVICE-CONNECTED for hypertension and claims a cardiac condition other than CAD.

Veteran is SERVICE-CONNECTED for head injury and claims tinnitus or seizure disorder.

Veteran is SERVICE-CONNECTED for degenerative disc disease and claims number of lower extremities but the treatment reports show a history of diabetes which is not service-connected.

EXAMPLE OPINION:

MEDICAL OPINION

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Type of medical opinion requested: Secondary service connection

Contention: Claimed Condition:

Secondary service connection

The Veteran is claiming that his/her (insert “claimed condition”) was proximately due to or the result of his or her (insert “service connected condition”).

Secondary service connection

Is the Veteran’s (insert “claimed condition”) at least as likely as not (50 percent or greater probability) proximately due to or the result of (insert “service connected condition”). Rationale must be provided in the appropriate section below. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion.

Potentially Relevant Evidence:Tab A: Tab B: Tab C: Tab D:

ALCOHOL AND DRUG ABUSE

We must fully develop all claims for alcohol and drug abuse disabilities claimed to have been acquired as secondary to, or as a symptom of, a Veteran’s service connected disability.

Send development letter requesting the name of the disability, if a specific disability is not claimed.

These claims involve service connection for conditions secondary to drug/alcohol use/abuse. Regulations already exist by which VA must deny direct service connection for drug/alcohol use (though it can still be service connected as being secondary to a service connected condition such as PTSD). However, denials of service connection for conditions secondary to drug/alcohol abuse, such as liver damage due to alcohol abuse, are being deferred.

Send deferral letter when the deferred rating is completed.

CLAIMS FOR SECONDARY SERVICE CONNECTION BY AGGRAVATION

Claims for secondary service connection by aggravation (Allen vs Brown) – see the Claims Due to Aggravation section of this guide for further details.

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COMPLICATIONS OF CORTICOSTEROID THERAPY

Peptic ulcer

Infections

Mental disturbances

Osteoporosis (compression vertebra)

Diabetes mellitus

Hypertension and edema

Purpura

Vasculitis and neuropathy

Hypercortisonism

Induced adrenal insufficiency

Cushingold features

Withdrawal syndrome

Pancreatitis

Nephrolithiasis and nephrocalcinosis

Aseptic necrosis of bone

Posterior cortical cataracts

CHANGES

Change 3, August 10, 2004, modified the topic “Claims for a Condition as Secondary to a Service-Connected Disability;” added requirement to send the continuity and presumptive paragraphs; added a reminder to include both the service connection law and secondary service connection law attachments.

Change 4, March 14, 2005, added guidance regarding requests for examinations; added topic entitled, “Complications of Corticosteroid Therapy.”

Change 5, January 1, 2006, added topic entitled, “Complications of Corticosteroid Therapy.”

Change 6, February 24, 2006, clarified that development for “Claims for a Condition as Secondary to a Service-Connected Disability,” should include the MAPD Claimant Letter, Presumptive SC – med evid within time limit needed, if applicable.

Change 7, April 30, 2010, added guidance regarding VCAA requirements.

Change 8, January 20, 2012, added a medical opinion example.

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Section 20

Claims Due to Aggravation_______

1 – Determining In-Service Aggravation of Pre-Service Disability...............20.2

2 – Determining Secondary Service Connection, Including by Aggravation.........20.5

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Section 20.1Claims Due to Aggravation

Determining In-Service Aggravation of Pre-Service Disability

_______

Refer to M21-1MR, Part IV, Subpart ii, Chapter 2, Section B, Topic 5 for information on determining aggravation of pre-service disability, including

considering the presumption of soundness at entry into service the records needed to determine baseline level of disability determining whether a preexisting disability was aggravated by service considering flare-ups of preexisting injury or disease considering the usual effects of medical or surgical treatment, and additional considerations under Splane v. West

REQUEST FOR MEDICAL OPINION

EXAMPLE:MEDICAL OPINION

Type of medical opinion requested: Aggravation of preexisting condition.

Contention:

Claimed Condition:

Aggravation of a pre-existing disabilityThe Veteran is claiming that his/her (insert “claimed condition”) existed prior to service and was aggravated beyond its natural progression by (insert “claimed in-service injury, event, or illness”).

Aggravation of a pre-service disabilityWas the Veteran’s (insert “claimed condition”), which clearly and unmistakably existed prior to service, aggravated beyond its natural progression by (insert “claimed in-service injury, event, or illness”) during service? Rationale must be provided in the appropriate section below. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion.

Potentially Relevant Evidence:Tab A: Tab B:Tab C: Tab D:

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Section 20.2Claims Due to Aggravation

Determining Secondary Service Connection, Including by Aggravation

_______

Refer to M21-1MR, Part IV, Subpart ii, Chapter 2, Section B, Topic 6 for information on determining secondary service connection, including by aggravation, including

the provisions for service connection under 38 CFR 3.310(a) and (b) the medical evidence required to show a nonservice-connected (NSC) disability was

aggravated by an SC disability developing claims based on aggravation of an NSC disability by an SC disability information that must be included in the examiner’s report, and determining the extent to which an NSC disability was aggravated by an SC disability.

GENERAL GUIDELINES

Claims for secondary service connection by aggravation may also be referred to as an Allen v. Brown claim.

Disabilities which are proximately due to or the result of a service-connected condition may be service connected. An increase in nonservice-connected disability caused by aggravation from a service-connected disability may also be service connected. For further guidance, refer to , M21-1MR.IV.ii.2.B.6 and 38 CFR 3.310(a).

Ask the Veteran to furnish medical evidence showing the current level of severity of the NSC disability, and its level of severity before aggravation by the SC disability, or as soon as possible after aggravation. (M21-1MR.IV.ii.2.B.6.c)

Note: Both the issue of secondary service connection and direct service connection will be considered when evaluating claims for secondary service connection due to aggravation. Therefore, both letter types, as noted above, are required and the VCAA Law attachment regarding service connection and the VCAA Law attachment for secondary service connection must be attached.

In order to adjudicate a claim for secondary service connection for an incremental change in an otherwise nonservice-connected disability, first establish the baseline level of nonservice-connected disability and the level of additional disability which is considered proximately due to the service-connected disability. The baseline is acquired by obtaining all the medical evidence available for these disabilities. (M21-1MR.IV.ii.2.B.6.e)

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Scenario: The Veteran had two heart attacks (CAD) in 1991 and service connected diabetes was diagnosed in 1992. He had a third heart attack in 1994, a fourth in 1997 and a fifth in 1999. He has had four angioplasties.

If the service-connected diabetes aggravated the nonservice-connected CAD, the case must be considered under the Allen court case which addresses the aggravation of a non-service connected condition. Based on those findings, an Allen opinion request is warranted.

In this particular case, treatment reports will be needed to establish the baseline level of disability of the Veteran’s heart condition prior to aggravation and the current level of the CAD due to aggravation by the service-connected diabetes.

A medical report that fails to address the issues noted above will not be considered sufficient for rating this type of claim.

REQUEST FOR MEDICAL OPINION

Upon receipt of this evidence, request a medical examination and opinion, to include a review of the claims folder by the examiner, to establish whether increased manifestations of the NSC disability are proximately due to an SC disability. (M21-1MR.IV.ii.2.B.6.c)

Do not request an examination if the Veteran has failed to furnish medical evidence establishing a baseline level of the severity of the NSC disability.

The examiner must have all available evidence for review when providing an opinion on the issue of aggravation.

Identify the evidence of particular relevance in the claims folder for the examiner.

REQUEST FOR MEDICAL OPINION

EXAMPLE:MEDICAL OPINION

Type of medical opinion requested: Aggravation of nonservice-connected disability.

Contention:

Claimed Condition:

Aggravation of a nonservice connected disability by a service connected disabilityThe Veteran contends that his/her (insert “claimed condition”) was aggravated beyond natural progression by his or her (insert “service connected condition”).

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Aggravation of a nonservice connected disability by a service connected disabilityWas the Veteran’s (insert “ claimed condition”) at least as likely as not aggravated beyond its natural progression by (insert “service connected condition”)? Rationale must be provided in the appropriate section below. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion..

Potentially Relevant Evidence:Tab A: Tab B:Tab C: Tab D:

CHANGES

Change 3, February 22, 2005, added the requirement to send both VCAA law attachments for direct service connection and secondary service connection when developing claims for secondary service connection.

Change 4, May 10, 2005, added guidance regarding requests for evidence of secondary disabilities and continuity so as to address both the issue of direct service connection and secondary service connection.

Change 5, January 1,. 2006, references incorporated within each topic.

Change 6, November 14, 2006, added M21-1MR references.

Change 7, January 20, 2012, added guidance/references for Determining Secondary Service Connection, Including by Aggravation.

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Section 21

Issue of Permanence (Permanent & Total)_______

DEFINITIONS

Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. A total disability may or may not be permanent (38 CFR 3.340(a)(1)).

Permanent and total(P&T) disability. Permanence of total disability will be taken to exist when such impairment is reasonably certain to continue throughout the life of the disabled person (38 CFR 3.340(b)).

STATUTORY REQUIREMENTS

If the Veteran has a 100 percent evaluation for any disability, develop for medical evidence which shows the impairment is reasonably certain to continue throughout the life of the disabled person (38 CFR 3.340(b)(2)).

If the Veteran has less than 100 percent evaluation for any disability, a permanent total disability may be warranted if the following are met:

(1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable,

(2) Disabilities resulting from common etiology or a single accident,

(3) Disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric,

(4) Multiple injuries incurred in action, or

(5) Multiple disabilities incurred as a prisoner of war.

Reference: 38 CFR 4.16, Total disability ratings for compensation based on unemployability of the individual.

VA EXAMINATION GUIDELINES

Do not send requests to the VA medical centers for medical opinions of "permanent and total status." This is a rating determination, not a determination which would be made by the VA

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examiner/physician. An examination will need to be requested regarding an increased evaluation of the specific disability that is claimed by the Veteran to be permanent and total.

If the Veteran was not specific as to which disability should be rated permanent and total, ask the Veteran for clarification.

Claims from Veterans for permanent and total evaluation, who are already evaluated at 100% due to a grant of individual unemployability (IU) with Chapter 35 benefits AND no future exam are already considered to be permanent and total. In these cases, the issue of P&T is moot.

Examination requests should include a statement that asks the examiner to comment on the prognosis for improvement of the disability or disabilities in question.

When requesting a VA examination and medical treatment reports are not available or do not exist, make a note in the remarks section to let the examiner know that records are not available.

Do not request an opinion.

VCAA CONSIDERATIONS

When the Veteran submits a request for a “permanent” evaluation, send a VCAA notice using 38 CFR 3.340 as appropriate.

Note: The increased evaluation VCAA Attachment will not suffice in these types of cases.

In the case of a compensation claim, an extract from 38 CFR 3.340 would suffice as the VCAA law attachment; refer to the section entitled VCAA Law Attachments for a sample VCAA law attachments.

Obtain all pertinent treatment reports prior to requesting a VA examination. The medical examiner will need to review the claimant’s medical history in order to provide an opinion.

Send MAPD Claimant Letter, Compensation Letter, Claim for a specific evaluation.

You have claimed a specific evaluation for your service-connected condition(s).  According to the rating schedule, we consider the following criteria when evaluating your condition(s):

Permanence of total disability will be taken to exist when such impairment is reasonably certain to continue throughout the life of the disabled person. The permanent loss or loss of use of both hands, or of both feet, or of one hand and one foot, or of the sight of both eyes, or becoming permanently helpless or bedridden constitutes permanent total disability. Diseases and injuries of long standing which are actually totally incapacitating will be regarded as permanently and totally disabling when the probability of permanent improvement under treatment is remote. Permanent total disability ratings may not be granted as a result of any incapacity from acute infectious disease, accident, or injury, unless there is present one of the recognized combinations or permanent loss of use of extremities or sight, or the person is in the strict sense permanently helpless or bedridden, or when it is reasonably certain that a subsidence of the acute or temporary symptoms will be followed by irreducible totality of

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disability by way of residuals. The age of the disabled person may be considered in determining permanence.

For additional information on the rating schedule, see 38 CFR, Book C, schedule for rating disabilities, at http://www.warms.va.vba.gov/bookc.html.

CHANGES

Change 1, March 28, 2005, added guidance regarding the requirement to obtain treatment reports.

Change 2, May 1, 2005, added general guidelines outlining statutory requirements for total and permanent evaluations; added guidance regarding requests for medical evidence and requests for VA examinations.

Change 3, August 26, 2005, modified the topic, VA Examination Guidelines; the requirement for an opinion has been eliminated.

Change 4, December 21, 2009, change guidance regarding VCAA notification.

Change 5, August 28, 2011, added guidance regarding examination guidelines.

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Section 22

Incompetency Issues_______

1 – General Guidelines.....................................................................21.2

2 – Processing an Issue of Incompetency........................................21.4

3 – Deferred Issues, Incompetency..................................................21.7

4 – Decisions Proposing Incompetency...........................................21.9

5 – Decisions Establishing Incompetency.....................................21.11

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Section 22.1Incompetency Issues

General Guidelines

REQUIREMENT FOR EVIDENCE

Incompetency is not an issue until evidence is received.

In order to adjudicate the issue of incompetency, medical evidence or court documentation regarding a beneficiary's competency must be received.

If court documents are received that do not indicate guardianship, such as an assigned Power of Attorney (POA), develop for further evidence of incompetency.

If a notification of incompetency is received and no evidence is received:

Take EP 400 credit, and

Develop for evidence from the individual who sent the original notice of incompetency. Reference: EPSS VSR Assistant Program, http://cds.vba.va.gov/vsr_assistant/.

EPSS VSR ASSISTANT PROGRAM

Further guidance is available in the EPSS VSR Assistant Program regarding incompetency issues when there is a running award, a pending claim with no running award, or no pending claim or running award; http://cds.vba.va.gov/vsr_assistant/.

INCOMPETENCY NOTICES AND REQUESTS FOR RELIEF FROM FIREARMS PROHIBITIONS

As discussed in the Compensation and Pension Service Bulletin of February 2008, the National Instant Criminal Background Check Systems (NICS) Amendments Act of 2007 mandated certain changes regarding notification as to the effect incompetence has on the ability to purchase firearms.

Until guidance was finalized, we asked that you follow current procedures regarding incompetence and notice, including the use of the “Brady Bill,” paragraph available in both MAP-D (Incompetency Brady Bill Notice) and PCGL (What Could Be Affected, paragraph M09b). Effective November 7, 2008, we will release two new paragraphs (for proposed and actual notices of adverse action in PCGL) discussing the impact of incompetency on firearms purchasing. For letters of proposed adverse action in MAP-D, users must auto-text the

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paragraphs (see attachment on page 11) and be sure to enclose VA Form 21-4138, Statement in Support of Claim.

Reference: C&P Service Bulletin, October 2008

UPDATED PROCEDURES FOR HANDLING NATIONAL INSTANT CRIMINAL BACKGROUND CHECK SYSTEM (NICS) RELIEF REQUESTS (AD DE ND U M

CO MP EN SAT IO N SERV ICE BU LL E TI N , JU NE 2013 )

The following document provides step-by-step procedures for handling NICS relief requests. Follow these guidelines until the new FL is released. This procedure will be used for any NICS relief requests that are received up to, and including June 20, 2013.

Process:

Please follow the procedures outlined in current FL 10-51, Processing Requests for Relief from the Reporting Requirements of the National Instant Criminal Background Check System (NICS) dated November 22, 2010, in addition to the below procedures:

1. After reviewing the Veteran’s or beneficiary’s evidence, if you believe a grant of relief is warranted, you must first e-mail the NICS point of contact (POC) at the NICS mailbox. In the e-mail, note all evidence considered for the possible grant of relief, prior to sending out any notification to the Veteran, beneficiary, or veterans service officer (VSO).

2. The POC will then review the e-mail and the criminal history, and contact you if further review of evidence used in your decision-making is necessary.

3. The POC will inform you if Central Office concurs with the grant.4. Ultimately, the RO Director must also sign off on any grants of relief. 5. Continue to hold requests received after June 20, 2013 pending further guidance.

Reference: Addendum Compensation Service Bulletin, June 2013

CHECKING FOR THE PROPER SIGNATURE

An original claim for any type of benefit must be signed by the claimant, the parent or guardian of a minor, or the fiduciary of a claimant who is incompetent.

Reference: M21-1MR.III.ii.1.A.3b

ISSUE: INCOMPENTENCY

Question:DIC spouse has a court order of incapacitation. Is a court order of incapacitation the same as a court finding of incompetency?

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Response:Incapacitation and incompetency are not the same. For VA purposes, incompetency is found when the evidence of record shows that claimant is unable to manage VA benefits. Incapacitation may be caused by many factors to include physical or mental incapacity. And it is certainly possible that a claimant may be incapacitated, yet be fully competent to properly manage VA benefits. The determination must be made based on the VA definition of incompetency and whether the claimant is competent to properly manage VA benefits payments. The determination as to whether the issue of incompetency is specifically or reasonably raised must be based on the facts found in the individual case.

Source: Star Rating Call, Q&As for the February 2010 Quality Call

LANGUAGE AND ENCLOSURES FOR MAP-D INCOMPETENCY DUE PROCESS LETTERS

Compensation Service has updated the language and enclosures for the MAP-D development action entitled "Incompetency, alleged – develop to claimant", under the "Predetermination" development type. The language and enclosures for this development action now reflect the more accurate and thorough language and enclosures that are in the Personal Computer-Generated Letters (PCGL). Use this development action for generating the incompetency due process letter. Reference: Compensation Service Bulletin, November 2012.

.

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Section 22.2Incompetency Issues

Processing an Issue of Incompetency

TYPES OF EVIDENCE

The type of evidence received will determine how to proceed with processing the issue of incompetency. A formal rating is required to deem a Veteran incompetent for VA purposes.

However, if the beneficiary is a spouse and court documents indicating a general guardianship are present, then a rating decision on the incompetency issue is not required. General guardianship, also known as plenary guardianship, means that a beneficiary has been deemed incompetent through the Court and a guardian of the person and property has been appointed.

Note: Local courts may use a term other than 'Plenary Guardianship', such as court appointed fiduciary, conservator, committee, trustee, or curator, to indicate that a beneficiary has been deemed incompetent. Consult with the Fiduciary Activity or Regional Counsel for clarification.

REFERENCE

M21-1MR.III.v.9.B, Authorizing Awards for Incompetency Cases.

RECEIPT OF EVIDENCE

Upon receipt of medical evidence and/or court documentation, establish an EP:

Establish EP 120 if the beneficiary is in receipt of Pension, or

Establish EP 020 if the beneficiary is in receipt of Compensation.

RECEIPT OF COURT DOCUMENTS ONLY

If medical evidence is not received, but court documents are received indicating a general guardianship,

Complete VA Form 21-592, Request for Appointment of a Fiduciary, Custodian, or Guardian using information from the Veteran's claims folder and the electronic database.

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Establish an EP 290 to control the appointment process.

If a claim for Compensation/Pension is pending, wait until entitlement to benefits is established before submitting the VA Form 21-592.

When the Fiduciary Activity receives the VA Form 21-592, it generally conducts a field exam to evaluate the beneficiary's circumstances and to identify an appropriate fiduciary.

RECEIPT OF VA FORM 21-555. Upon completion of the field exam, the Fiduciary Activity will provide a VA Form 21-555, Certificate of Legal Capacity to Receive and Disburse Benefits. This form allows the VSR to release benefits to the beneficiary or to his or her payee.

Upon receipt of VA Form 21-555 from the Fiduciary Activity:

Update the Master Record using the change fiduciary (CFID) command,

Inform the beneficiary, and

PCLR EP 290

RECEIPT OF MEDICAL EVIDENCE ONLY

If only medical evidence is received, forward the case to the Rating Team for a rating decision on incompetency.

If there is an original claim for Compensation or Pension pending, associate the incompetency evidence with the pending claim. The Rating Team may address all issues with one rating decision.

RECEIPT OF MEDICAL EVIDENCE AND COURT DOCUMENTS

If the beneficiary is the Veteran, and both medical evidence and court documents are received, a rating decision on the issue of incompetency is always required.

However, if the beneficiary is the spouse/parent, and both medical evidence and court documents are received, first determine if the court documents indicate a general guardianship based on incompetency. If so, a rating decision on the issue of incompetency is not required.

If the medical evidence submitted deals only with the claimant or beneficiary's ability to handle his or her own financial affairs, file it down in the claims folder. If, however, there are any other issues, either directly stated or inferred, the medical evidence must be sent to the Rating Team.

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If the court documents do not establish a general guardianship based on incompetency, submit the medical evidence and the claims folder to the Rating Team for a decision on the issue of incompetency. The court documents will be filed down in the claims folder.

PRINCIPAL GUARDIANSHIP FOLDER

If a principal guardianship folder (PGF) has been established, the file should be associated with the claims folder prior to sending the case to the Rating Activity.

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Section 22.3Incompetency Issues

Deferred IssuesIf a deferred rating on the issue of incompetency is received from the Rating Team, further development or a VA examination may be required.

ORIGINAL CLAIMS

If the rating activity rates the case but defers the issue of incompetency

Send notification letter to the Veteran.

When furnishing the notice of proposed adverse action (declaring the claimant incapable of handling financial affairs), clear any pending EP (010, 110, 180, 140, 190, 020, or 120). Establish an EP 600 with a suspense date 65 days following the release date of the notice of proposed adverse action. Reference: Fast Letter 07-13, End Product Control for Due Process, May 25, 2007.

Note: Benefits will not be awarded until the incompetency issue is finalized.

VA EXAMINATION GUIDELINES

The VA examiner does not have to provide an opinion regarding competency. Instead, the VA examiner is responsible for providing the factual information needed to make the determination of competency. Refer to M21-1MR.III.iv.8.A, for further guidance.

FIELD EXAMINATION REQUIREMENTS

A field examination should be ordered if determined to be appropriate, but the examination is generally not required. A field examination is usually only required in cases where money was withheld under and the issue is restoration of competency. Refer to M21-1MR.III.iv.8.A for further guidance.

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REQUESTING A VA EXAMINATION

If a field examination was conducted, obtain a copy of the report prior to requesting a VA examination.

If a field examination is conducted after the completion of the VA examination, refer the claim to an RVSR for a determination as to whether the VA examination needs to be “recycled.”

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Section 22.4Incompetency Issues

Decisions Proposing IncompetencyUpon receipt of a proposal of incompetency, due process procedures are required to inform the beneficiary of the adverse action. Refer to M21-1MR.III.iv.8.A, for further guidance.

Note: If there is an original claim for Compensation or Pension pending, benefits cannot be awarded until a final rating on the incompetency issue is received and a payee is established. The original EP should be continued until a final action is taken on the claim.

NOTIFICATION LETTER

If a preliminary rating is made proposing incompetency and the beneficiary is a Veteran:

Send MAPD Claimant Letter, Predetermination Letter, Incompetency, alleged - develop to vet. Send the letter to the Veteran.

OR

If a preliminary rating is made proposing incompetency and the beneficiary is a patient in a medical center (including Veterans in non-bed-care status, on authorized or unauthorized absence or a domiciliary member):

Send MAPD Claimant Letter, Predetermination Letter, Incompetency, alleged - develop to claimant, or Incompetency, alleged - develop to vet. Send the letter to the beneficiary or to a recognized custodian.

Send a copy of the notice to the Chief Officer of the institution, requesting that the patient also be informed orally about the proposed action and of due process rights by a psychiatric social worker or other professional staff member designated by the Chief Officer of the institution. For Veterans institutionalized by VA, hospital staff should record an appropriate entry describing the action in the Veteran's medical record.

NOTE: Exercise discretion in dealing directly with the beneficiary as this type of notice could have undesirable consequences.

OR

If a preliminary rating is made proposing incompetency and payments were previously made on behalf of a minor child and an incompetency rating is needed when the child reaches age 18:

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Send MAPD Claimant Letter, Predetermination Letter, Incompetency, alleged - develop to claimant. Send the letter to the fiduciary previously certified by the VSO to receive payments because of the child's minority or to a recognized parent.

SYSTEM CONTROLS & UPDATES

When furnishing the notice of proposed adverse action (declaring the claimant incapable of handling financial affairs), clear any pending EP (010, 110, 180, 140, 190, 020, or 120). Establish an EP 600 with a suspense date 65 days following the release date of the notice of proposed adverse action.

Reference: Fast Letter 07-13, End Product Control for Due Process, May 25, 2007.

RETURNING THE CASE TO THE RATING ACTIVITY

At the end of the control period or after a hearing and receipt of evidence developed through the hearing, whichever is later, refer the case to the rating activity for a final decision on the competency issue.

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Change 8July 22, 2013

Section 22.5Incompetency Issues

Decisions Establishing IncompetencyThe final rating on incompetency will determine if a beneficiary is incompetent for VA purposes. If the Rating Team decides that a beneficiary is incompetent for VA purposes, a VA Form 21-592 must be sent to the Fiduciary Activity.

NOTIFICATION LETTER

If a rating is made establishing incompetency and the beneficiary is a Veteran:

Send Central Office PCGL Letter (Postdetermination-Incompetency) to the beneficiary or to a recognized custodian.

OR

If a rating is made establishing incompetency and the beneficiary is a patient in a medical center (including Veterans in non-bed-care status, on authorized or unauthorized absence or a domiciliary member)

Send Central Office PCGL Letter (Postdetermination-Incompetency) to the beneficiary. Send a copy of the notice to the Chief Officer of the institution.

NOTE: Exercise discretion in dealing directly with the beneficiary as this type of notice could have undesirable consequences.

OR

If a rating is made establishing incompetency and payments were previously made on behalf of a minor child and an incompetency rating is needed when the child reaches age 18

Send Central Office PCGL Letter (Postdetermination-Incompetency) to the fiduciary previously certified by the VSO to receive payments because of the child's minority or to a recognized parent.

SYSTEM CONTROLS & UPDATES

Clear the EP 600 when the final rating and notification on the competency issue are completed and establish an EP 290 to control the appointment of a fiduciary. Reference: Fast Letter 07-13, End Product Control for Due Process, May 25, 2007.

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Change 8July 22, 2013

REQUEST FOR APPOINTMENT OF A FIDUCIARY, CUSTODIAN , OR GUARDIAN

Establish an EP 290 to control the appointment of a fiduciary. Prepare a VA Form 21-592, Request for Appointment of a Fiduciary, Custodian, or Guardian, for use by the Fiduciary activity, using information from the Veteran's claims folder and the electronic database.

CERTIFICATE OF LEGAL CAPACITY TO RECEIVE AND DISBURSE BENEFITS

Upon completion of the field exam, the Fiduciary Activity will provide a VA Form 21-555, Certificate of Legal Capacity to Receive and Disburse Benefits. This form allows the VSR to release benefits to the beneficiary or to his or her payee.

Upon receipt of VA Form 21-555 from the Fiduciary Activity:

Update the Master Record using the change fiduciary (CFID) command,

Inform the beneficiary, and

PCLR EP 290

CHANGES

Change 1, April 5, 2005, grammatical errors corrected in Section 27.1, Field Examination Requirements topic.

Change 2, July 22, 2005, additional guidance provided regarding types of evidence, processing medical evidence and court documentation, completion of VA Form 21-592, and receipt of VA Form 21-555; formatting changes made to reduce redundancy.

Change 3, December 20, 2006, added M21-1MR references.

Change 4, May 29, 2007, added guidance regarding EP control (FL 07-13).

Change 5, October 18, 2008, added guidance regarding notices and relief from firearms prohibitions.

Change 6, April 30, 2010, added guidance regarding incompetency versus incapacitation.

Change 7, December 9, 2012, added guidance regarding Map-D paragraphs.

Change 8, July 22, 2013, added guidance from the Addendum Compensation Service Bulletin, June 2013, regarding requests to NICS. Added guidance from M21-1MR regarding checking for proper signature.

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Change 5September 19, 2013

Section 23

Telephone and FAX Development_______

Regional offices should make full use of telephones, e-mail and fax machines as an integral part of claims development procedures for compensation, pension, and burial claims. For further information, refer to M21-1, Part III, Subchapter III, 11.18, Use of Telephone, E-Mail and FAX for Claims Development.

Effective February 17, 2012, stations no longer need to undertake telephone contact or development at specific points in time. Upon expiration of a suspense date, stations should attempt telephone contact with the claimant and/or other providers of information (e.g., private physicians, Reserve/Guard units, etc.) if doing so might help bring the claim closer to resolution.

For further guidance, refer to Fast Letter 12-04, Revised Procedures for Telephone Contact and Development.

VCAA FOLLOW-UP TELEPHONE CONTACT ON ORIGINAL CLAIMS

This requirement was rescinded by Fast Letter 12-04, Revised Procedures for Telephone Contact and Development.

USE VA FORM 21-0820, REPORT OF CONTACT

Use VA Form 21-0820, Report of General Information, to document all information received by telephone.

Reference: M21-1MR.III.iii.1.B.2d, e, f

APPLICATION PARTIALLY COMPLETE

Contact claimant if a pertinent part of the application is incomplete. This includes but is not limited to the following:

Social security numbers (Veteran or dependents)

Commanding Officer and complete address of reserve or national guard unit

CLAIMS MADE BY TELEPHONE – INFORMAL CLAIM – DATE OF CLAIM

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Change 5September 19, 2013

A telephone call from a claimant indicating intent to apply for benefits, documented on 21-0820, Report of General Information, is acceptable as an informal claim for the purpose of establishing a date of claim.

Example: A telephone call from a claimant indicating intent to apply for benefits, documented on 21-0820, Report of General Information, is acceptable as an informal claim for the purpose of establishing a date of claim. (If the claimant is a minor, the call could be accepted if placed by a parent or legal guardian.)

Reference: M21-1MR.III.ii.2.D16.

CHANGES

Change 1, January 1, 2006, incorporated references within each topic.

Change 2, October 30, 2009, added guidance regarding VA Fm 21-0820, report of contact form.

Change 3, January 12, 2011, added guidance regarding telephone calls as informal claims.

Change 4, February 18, 2012, added guidance regarding telephone development as prescribed by FL 12-04.

Change 5, September 19, 2013, updated reference regarding the us of VAF 21-0820.

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Change 7April 16, 2013

Section 24

Verification of Service_______

All periods of service must be verified unless there is a running award for that period.

ACCEPTABLE DOCUMENTATION

DIGITALLY SIGNED SEPARATION DOCUMENTS AND OTHER EVIDENCE OF SERVICE. All VBA business lines will accept as proof of service from a Veteran, or a national service officer representing a Veteran, a digitally signed DD Form 214 or DD Form 215, Correction to DD Form 214, received from DoD, a military service branch, or a State Adjutant General as prima facie evidence of military service without additional verification. Refer to VBA Letter 20-09-14, Digitally Signed Separation Documents and Other evidenc of Service, dated March 13, 2009 for guidance regarding the acceptance of digitally signed separation documents. Further guidance is available from 38 CFR 3.203 Service records as evidence of service and character of discharge.

Refer to M21-1MR.III.ii.6.6a for guidance regarding “Acceptable Forms of Evidence.”

For information on forms of evidence of character of discharge, see M21-1MR, Part III, Subpart ii, 6.6.

For information on evidence requested from the claimant, see M21-1MR.III.iii.1.B

VA FORM 21-3101. VAF 21-3101 with notation from a service records center (NPRC, ARPERSCOM, etc.) or service department (Air Force Personnel Center, Bureau of Naval Personnel Center, etc.), indicating verification of military service (e.g. dates of service and/or character of discharge)

PHOTOCOPIES OF DOCUMENTS THAT CONFIRM MILITARY SERVICE

VA accepts photocopies of original documents that confirm a Veteran’s military service if the Veteran’s service department issued the original document and an accredited agent, attorney, or service organization representative who has successfully completed VA-prescribed training on military records certifies the authenticity of the photocopy by signing and dating the following statement:

“I [name, title, organization] certify that I have completed the VA-prescribed training on certification of evidence for proof of service and that this is a true and exact copy of either an original document or of a copy issued by the service department or public custodian of records.”

Reference: M21-1MR.III.iii.1.B.6.b, Determining the Acceptability of Photocopies

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Change 7April 16, 2013

VADS (VETERANS ASSISTANCE DISCHARGE SYSTEM) AS PROOF OF SERVICE

VADS service input in BIRLS (“Y” or “D” in the VADS field) is acceptable proof of service.  The entry “D” is added from Defense Manpower Data Center (DMDC) processing. Also acceptable is regional office or Records Management Center input of service data (shown by the Y in VER field). Refer to VBA Letter 20-09-14, Digitally Signed Separation Documents and Other evidenc of Service, dated March 13, 2009 for guidance regarding the acceptance of digitally signed separation documents.

Refer to M21-1MR.III.ii.6 for further guidance on “Using the BIRLS VID Screen as Proof of Service.”

If military service is VADS verified (indicator coded as Y), and the Veteran claims an injury or disease was incurred or aggravated during the “verified” period of service, do not delay routing claim to the Rating Team if all other development is complete.

VETERANS INFORMATION SOLUTION (VIS) – ELECTRONIC SERVICE MEMBER DISCHARGE DATA

Service verification information may be obtain through the VIS system. For further guidance, refer to Fast Letter 04-32, Subj: Regional Office and VA Medical Center Access to the Veterans Information Solution (VIS) for Electronic Service Member Discharge Data, dated November 17, 2004.

REQUESTING VERIFICATION OF SERVICE

Development actions may be found in the Service Records Development & PIES Section in this development guide.

MERCHANT MARINE SERVICE

Refer to the section entitled Merchant Marine Claims for guidance regarding verification of service.

SHARE UPDATES FOR MULTIPLE PERIODS OF SERVICE

You can add as many periods of service as you want through the SPP application. All periods of service recorded will be stored in corporate and viewable through Corporate Inquiry, Military button, Military Tour/Theater tab.

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Change 7April 16, 2013

In SPP, go to Profile, then Periods of Service. Click Add and provide the details of the service. Ok your way out of SPP.

The information is displayed in Share as:

And in BIRLS as:

So you can store all you want in corporate but BIRLS will still only display the original 3 periods of service.

CHANGES

Change 3, May 1, 2005, added cross-reference to for verification of Merchant Marine service; incorporated references within each topic.

Change 4, January 1, 2006, added cross-reference for verification service through the VIS system as dictated by FL 04-32.

Change 5, March 2, 2009, added guidance for adding multiple periods of service in SHARE.

Change 6, March 19, 2009, added guidance provided by VBA Letter 20-09-14 regarding digitally signed separation documents and other evidence of service.

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Change 7April 16, 2013

Change 7, April 16, 2013, added guidance regarding acceptability of photocopies of documents that confirm military service.

4

Change 7July 18, 2012

Section 25

Character of Discharge Determinations

_______

DISCHARGE IS OTHER THAN HONORABLE OR OTHERWISE QUESTIONABLE

A character of discharge determination is required if the discharge is Other Than Honorable (OTH) or Otherwise Questionable; OR if the Service Records Center (Code 11, 13, etc.) Reports Service as Not Honorable:

For further guidance, refer to M21-1MR.III.v.1.A and M21-1MR.III.v.1.D.

Develop for STRs and all available medical evidence simultaneously.

ACTION TAKEN ON UNDELIVERABLE ESSENTIAL MAIL IF ADDRESS IS PROPER

If the notification is returned as undeliverable, the address is proper, and no better address available, the claim should be disallowed, end product cleared, and the correspondence filed down. For further guidance, refer to M21-1MR, III, iii, 1, B, 11d.

Due process notifications regarding a claimant's character of discharge are considered essential mail since the notification provides legal and procedural rights.

ENTRY LEVEL SEPARATION

For guidance regarding entry level separations, refer to M21-1MR.III.v.1.B and 38 CFR 3.12(k)

No development for character of discharge determination (e.g. development for facts and circumstances) is required for an uncharacterized discharge if the discharge certificate shows the type of separation as Entry Level Separation.

Update SHARE/BDN to show “UHC” and “SAT”, and put a “Y” in the verified field.

SEPARATION DUE TO MISCONDUCT

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Change 7July 18, 2012

The Pre-Determination Team is responsible for developing and determining if an “other than honorable” discharge was granted under conditions other than dishonorable for purposes of eligibility for all VA benefits.

Refer to M21-1MR.III.v.1.B for guidance regarding requests for proceedings due to such offenses as moral turpitude, conviction of a felony, willful and persistent misconduct, etc.

If the narrative reason for separation is misconduct, complete the following actions:

Submit PIES Request Code O10. Print a copy of the PIES request to be flip-filed in the center section of the C-file; create a tracked item.

If facts and circumstances are not available and there is no indication the discharge was due to willful and persistent misconduct, consider the service to have been honorable for VA purposes. No administrative decision is necessary in the absence of any indication that the discharge was due to willful and persistent misconduct (M21-1MR, Part III, Subpart v, Chapter 1, Section B, Topic 5b)

MORE THAN 2 YEARS SERVICE OR MULTIPLE PERIODS OF SERVICE

If the Veteran had more than 2 years of active duty service or had multiple periods of service and the enlistment period is not listed on the DD Form 214, request the date when the Veteran would have been eligible for complete separation.

Submit PIES Request Code O01. Print a copy of the PIES request to be flip-filed in the center section of the C-file.

VA EXAMINATION GUIDELINES

Order a VA exam (if applicable) only if a conditional discharge is indicated (if there is probable entitlement). Refer to the VA Examination Section in this development guide for further details.

STATUTORY BAR TO BENEFITS

Refer to M21-1MR.III.v.1.B, 38 CFR 3.12(c) and 38 CFR 3.12(d) for guidance regarding instances in which there is a statutory bar to benefits.

DETERMINATIONS FOR HEALTH CARE

A former service person with an other than honorable conditions discharge who files a claim for any VA benefit, to include health care, must have a character of discharge determination

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Change 7July 18, 2012

made by the regional office. Refer to the section entitled Administrative Decisions for further guidance.

For more information on serviceperson eligibility for the health care and related benefits, see 38 U.S.C. Chapter 17 and M21-1MR.III.v.1.B.5b.

STATEMENTS AND AFFIDAVITS

Statements and affidavits attesting to the claimant’s good character since his/her release from active duty are irrelevant, if the issue is the character of the claimant’s military service. Reference: M21-1MR.III.iii.1.B.

PUBLIC LAW 95-126 CONSIDERATION

DD Form 214 may shows DOD DISCHARGE REVIEW PROGRAM (SPECIAL) SPD

Most of the discharged personnel were AWOL for extended periods of time.

DD Fomr 215s were issued to those individuals whose discharges were upgraded under this program.

VA was required to review all military discharges that were upgraded.

Most DD Form 215s show the following:

DISCH REVIEWED UP PL 95-126 AND A DETERMINATION MADE THAT CHARACTERIZATION OF SERVICE WAS WARRANTED UP DOD SDRP 4 APR 77

The VA had to review the military discharge and make another decision if . . .

After the word SERVICE

WAS DOD SDRP 4 APR 77 – this meant that the upgrade was denied and VA had to review the case again.

IS DOD DIRECTIVE – this meant that the upgrade is okay and VA did not have to review the case.

RECONSIDERATION OF DECISIONS

Reconsideration of an administrative decision is warranted if an unfavorable decision has already been made, but there have been legislative or regulatory changes affecting the reason for the original unfavorable decision. Reference: M21-1MR.III.ii.1.A.3.e

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Change 7July 18, 2012

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Change 7July 18, 2012

Remember: conditional periods must also be evaluated to determine if they

are HVA

5

Change 7July 18, 2012

U n i f o r m C o d e o f M i l i t a r y J u s t i c ePunitive Articles 77-134

77 Principles78 Accessory after the fact79 Conviction of lesser included offenses80 Attempts81 Conspiracy82 Solicitation83 Fraudulent enlistment, appointment, or separation84 Effecting unlawful enlistment, appointment, or separation85 Desertion86 Absence without leave (AWOL)87 Missing movement88 Contempt toward officials89 Disrespect toward a superior commissioned officer90 Assaulting or willfully disobeying superior commissioned officer91 Insubordinate conduct toward warrant officer, non-commissioned or petty officer92 Failure to obey order or regulation93 Cruelty or maltreatment94 Mutiny and sedition95 Resistance, breach of arrest and escape96 Releasing prisoner without proper authority97 Unlawful detention98 Noncompliance with procedural rules99 Misbehavior before the enemy

100 Subordinate compelling surrender101 Improper use of countersign102 Forcing a safeguard103 Captured or abandoned property104 Aiding the enemy105 Misconduct as a prisoner106 Spies106a Espionage107 False official statements108 Military property of the United States--sale, loss, damage, destruction, or wrongful

disposition109 Property other than military property of the United States--waste, spoilage, or

destruction110 Improper hazarding of vessel111 Drunken or restless driving112 Drunk on duty, 112a, Wrongful use, possession, etc., of con-trolled substance113 Misbehavior of sentinel or lookout114 Dueling115 Malingering116 Riot or breach of peace

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Change 7July 18, 2012

117 Provoking speeches or gesture118 Murder119 Manslaughter120 Rape and carnal knowledge121 Larceny and wrongful appropriation122 Robbery123 Forgery123a Making, drawing, or uttering check, draft, or order without sufficient funds124 Maiming125 Sodomy126 Arson127 Extortion128 Assault129 Burglary130 Housebreaking131 Perjury132 Frauds against the United States133 Conduct unbecoming an officer and gentlemen134 General article--includes:

abusing public animal, adultery, assault-indecent, assault-with intent to commit murder, voluntary manslaughter,

rape, robbery, sodomy, arson, burglary, or housebreaking, bigamy, bribery and graft, burning with intent to defraud, check, worthless,

making and uttering-by dishonorably failing to maintain funds, cohabitation, wrongful, correctional custody offenses against, debt, dishonorably failing to pay, disloyal statements, disorderly conduct, drunkenness, drinking liquor with prisoner, drunk prisoner, drunkenness-

incapacitation for performance of duties through prior wrongful indulgence in intoxicating liquor or any drug,

false or unauthorized pass offenses, false pretenses, obtaining services under, false swearing,

firearm, discharging through negligence, firearm, discharging willfully, under circumstances as to endanger human life,

fleeing the scene of an accident, fraternization, gambling with subordinate, homicide, negligent, impersonating a commissioned, warrant or non-commissioned, or petty officer, or

an agent or official, indecent acts or liberties with a child, indecent exposure, indecent language,

indecent acts with another, jumping from vessel into the water, kidnapping, mail: taking, opening, secreting, destroying, or stealing, mails: depositing or

causing to be deposited obscene matters in,

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Change 7July 18, 2012

misprision of serious offense, obstructing justice, wrongful interference with an adverse administrative

proceeding, pandering and prostitution, perjury: subornation of, public record: altering, concealing, removing, mutilating, obliterating, or

destroying, quarantine: medical, breaking, requesting commission of an offense, restriction, breaking, seizure: destruction, removal, or disposal to prevent, sentinel or lookout: offenses against or by, soliciting another to commit an offense, stolen property: knowingly receiving, buying, concealing, straggling, testify: wrongful refusal, threat or hoax, bomb, threat, communicating, unlawful entry, weapon: concealed, carrying, wearing unauthorized insignia, decoration, badge, ribbon, device, or lapel button.

CHANGES

Change 2, June 24, 2004, added a Character of Discharge flow chart and tables; Uniform code of Military Justice Punitive Articles were added.

Change 3, January 1, 2006, references incorporated within each topic; incorporated topics regarding uncharacterized discharges.

Change 4, December 12, 2006, references updated.

Change 5, October 4, 2007, added guidance regarding determinations for health care.

Change 6, March 2, 2011, added guidance regarding Action Taken on Undeliverable Essential Mail if Address is Proper.

Change 7, July 18, 2012, added guidance regarding reconsideration of decisions.

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Change 6October 4, 2007

Section 26

Administrative Decisions_______

ISSUES REQUIRING ADMIN DECISIONS

When required by a VA regulation or other provision of M21-1MR, an administrative decision must be prepared. For further information, refer to M21-1MR.III.v.1.A.

GENERAL GUIDELINES

In any case in which a character of discharge determination is necessary, including dishonorable discharges, complete the following actions:

Submit PIES Request Code O10, for facts and circumstances. Print a copy of the PIES request to be flip-filed in the center section of the C-file.

Send notice letter to the claimant. Include include the following enclosures:

VAF 21-0789, Your Rights/Repsntn and Hrng

Veteran’s Service Organization Information (if applicable)

ADMINISTRATIVE DECISION ELEMENTS

For guidance on the elements of an administrative decision, refer to M21-1MR.III.v.1.A.

PREPARATION OF ADMINISTRATIVE DECISIONS

An administrative decision template is available at Local Apps + ALL FORMS + Admin Decision VSC. To complete the administrative decision, click on each of the tabs which are entitled Admin Decision; Issues; Evid; Decision; and Reasons.

A sample administrative decision and suggested language is located in Addendum E, Character of Discharge Administrative Decision Sample.

PREPARATION AND APPROVAL OF AUTHORIZATION DETERMINATIONS

For guidance on the preparation and approval of authorization determinations, refer to M21-1MR.III.v.1.A.2.

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Change 6October 4, 2007

REASONABLE DOUBT

Every person involved in the adjudication of compensation and pension claims must be thoroughly familiar with the reasonable doubt rule. Reference M21-1MR.III.v.1.A.4.

For further information, refer to 38 CFR, 3.102.

REVERSAL OF PRIOR DETERMINATIONS

Once a determination is made, it is binding unless reversed on the basis of new and material evidence or clear and unmistakable error. For reversals on the basis of clear and unmistakable error, cite 38 CFR 3.105(a). These must be certified by the Adjudication Officer or designee to the effect that the entire record has been reviewed and a clear and unmistakable error was found.

For further guidance, refer to M21-1MR.III.iv.2.B.1, Administrative Decisions, Reversal of Prior Determinations.

UPDATE SHARE/BDN

Update SHARE/BDN after Character of Discharge Admin Decision has been finalized. See BIRLS Input Procedures, M21-1MR.III.v.1.A.3

a) DVA - Dishonorable for VA purposes

b) HVA - Honorable for VA purposes

ADMINISTRATIVE DECISION FOR HEALTH CARE

Effective October 8, 1977, any serviceperson who is discharged under other than honorable conditions is eligible for the health care and related benefits for any disability incurred or aggravated in the line of duty during active service, provided that he/she was not discharged by reason of a bad conduct discharge, or under one of the statutory bars of 38 CFR 3.12(c). Consider any claim which requires review of a statutory bar or preparation of a character of discharge determination as a claim for this benefit. For more information on serviceperson eligibility for the health care and related benefits, see 38 U.S.C. Chapter 17. Reference: M21-1MR.III.v.1.B.5d.

A former service person with an other than honorable conditions discharge who files a claim for any VA benefit, to include health care, must have a character of discharge determination made by the regional office and, if the discharge is found to be unqualifying except for Chapter 17 benefits, a rating done to determine what if any conditions would be service connected and thus permitting health care under Chapter 17.  There is no requirement for the individual to file a claim with the regional office.  A referral from VHA is sufficient for us to

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Change 6October 4, 2007

request the Board Proceedings, get the STRs, establish a claims folder if one doesn't exist, send due process, decide, rate if needed and notify the former service person and the requesting VA medical center. (VBA, VA Central Office, Tom Pamperin, e-mail, Wednesday, October 3, 2007, 6:45 AM)

Send MAPD Claimant Letter, Predetermination Letter, Character of discharge – due process. Include include the following enclosures:

VAF 21-0789, Your Rights/Repsntn and Hrng

Veteran’s Service Organization Information (if applicable)

CHANGESChange 2, June 24, 2004, added the topic entitled “Reasonable Doubt Restated” taken from the C&P Website, VSR Training, VSR Curriculum, Administrative Decision Process.

Change 3, January 1, 2005, deleted Addendum D and placed the Administrative Decision Format explanations.

Change 4, January 1, 2006, incorporated references within each topic.

Change 5, December 20, 2006, added M21-1MR references.

Change 6, October 4, 2007, added guidance regarding administrative decisions for health care; updated reference regarding admin decision elements.

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Change 2August 29, 2012

Section 27

Effective Dates and Bad Periods of Service_______

REFERENCES

Refer to the following regarding guidance on effective dates and bad periods of service:

C&P Service Home Page, FAQ link, Effective Dates and Bad Periods of Service and

Star Reporter , Volume 5, Issue 1, dated May 20, 2008.

RUDD V. NICHOLSON

Rudd v. Nicholson (2006) basically established that “if a decision has become final, the only way to overcome the finality of that decision and to be awarded an earlier effective date is to claim clear and unmistakable error in the assignment of the initial effective date. In accordance with the Rudd v. Nicholson case, if the Veteran claims an earlier effective date in a decision that has already become final, this is a claim for CUE and no VCAA notification is required.”

CLAIMS FOR AN EARLIER EFFECTIVE DATE

Rudd v. Nicholson (decided 8-06) provides that if a decision has become final, the only way to overcome the finality of that decision and to be awarded an earlier effective date is to claim clear and unmistakable error in the assignment of the initial effective date.

M21-1MR I.1.B provides the following procedures for when a Veteran files a claim for an earlier effective date regarding a finally decided claim and he does not claim clear and unmistakable error:

"Upon receipt of a freestanding claim for an earlier effective date, send the claimant a letter including the following language:

We received your claim for an earlier effective date. We notified you of our prior decision for [insert contention] on [insert date]. Since you did not appeal, the decision is now final. VA cannot accept a claim for an earlier effective date on a final regional office decision. However, you may request revision based on clear and unmistakable error (CUE) with respect to the assignment of the effective date in the unappealed decision.

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Change 2August 29, 2012

A CUE is an error that is undebatable in that a reasonable mind can only conclude that the original decision was fatally flawed at the time it was made. For VA to consider your request for revision based on CUE, you must specify the factual or legal error you believe VA made with regard to assigning the effective date in our prior decision. We will take no further action on your request until we receive this information.

Note: If the only issue on the claim is the request for an earlier effective date, change the end product (EP) credit to a 400 EP (correspondence) and do not control for receipt of a response."

VCAA NOTICE REQUIREMENTS FOR AN EARLIER EFFECTIVE DATE

VCAA notice specifically addressing effective date will only be required in the event that the claim is substantiated, i.e., service connection is granted, and the initial VCAA notice was not compliant with Dingess v. Hartman court decision concerning the effective date.

VCAA notice should be adequate as it relates to an earlier effective date claim if the Dingess requirements, via Fast Letter 06-04, were incorporated into the notice sent in response to the service connection claim.

Reference: C&P Service Home Page, FAQ link, VCAA notification requirements in claim for earlier effective date.

CHANGESChange 1, December 14, 2009, added guidance from court cases.Change 2, August 29, 2012, added guidance regarding claims for an earlier effective date.

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Change 5April 10, 2014

Section 28

Service Records - General_______

UPDATES TO TIME FRAMES FOR FEDERAL RECORDS

Effective immediately (from the December 2013 Addendum Compensation Service Bulletin), Compensation Service is reducing the time frames for federal record requests as follows:

Initial request: 30 days (instead of 60) Follow-up request: 15 days (instead of 30)

Please note that the final request to the Veteran, prior to documenting the records as unavailable, continues to be 10 days.

Changes to M21-1 Manual Rewrite (MR) Part III, Subpart iii, Chapter 2, Section I (M21-1MR III.iii.2.I) and M21-1MR I.1.C have been published. Please see the Web Automated Reference Material System (WARMS) for the most recent MR content. Additionally, a brief training video is available here showing users how to complete these changes in the applicable systems.

A patch to the Veterans Benefits Management System (VMBS) was completed on Tuesday, December 17, 2013. This patch includes the following updates:

Letter language updated to reflect 30 (instead of 60) day suspense:o Federal Third Party Reserve or Guard unit records o Initial Federal 3rd Party Letter - PTSD request copy of Vet Center records o Initial Federal 3rd Party Letter - PTSD obtain Investigative Reports o Initial Federal 3rd Party Letter - PTSD diagnosed, confirm stressor, to MC

Historical Letter language updated to reflect 15 (instead of 30) day suspense:

o Federal 3rd Party Follow Up Letter

Important: Though the language for the above letters has been updated, the corresponding default Tracked Item Suspense has not. This update will be in a future patch/release. In the meantime, users must manually update the Tracked Item Suspense in VBMS-Core.

In circumstances when it is necessary to complete development for federal records through Modern Awards Processing-Development (MAP-D), users must do the following:

Select desired development action item in MAP-D; Click view (located in center portion of the screen); Under the heading titled “suspense” manually, change the number of days to the

required suspense days (30 or 15 as appropriate);

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Change 5April 10, 2014

Click “ok” to save changes; and Continue MAP-D development as usual.

Reference: Addendum Compensation Service Bulletin, December 2013

CERTIFICATION OF COMPLETENESS OF SERVICE TREATMENT RECORDS (STRS)

Effective January 1, 2013, all five military services began full implementation of the STR certification letter without the name and last four of the SSN. The military services are working on becoming compliant with the February 22, 2013, agreement and will begin issuing STR certification letters with the Servicemember’s name and last four of their SSN as soon as possible.

The final medical treatment facility at each military service, including the National Guard and Reserves, will now certify the completeness of all paper STRs at the point of separation from military service, eliminating the need for unnecessary additional development.

Development for additional paper STRs should only be conducted on these certified STRs when:

1. The Veteran alleges treatment at a specific military treatment facility for a specific time frame and,

2. That treatment information is not included within the certified paper STRs.

For further guidance, refer to Fast Letter 13-09, Certification of Completeness of Service Treatment Records (STRs), dated April 25, 2013

AUTOMATED DISTRIBUTION OF DD FORM 214 AND DD FORM 215 AND DIGITAL SIGNATURES

The Department of Army has fully automated its distribution of the Certificate of Release or Discharge from Active Duty (DD-214) and the Correction of the Certificate of Release or Discharge from Active Duty (DD-215). With only a few exceptions, there will no longer be any "wet signatures" on DD-214s and DD-215s issued by the Army. Please note that these are official forms, which can be used to verify service; however, when submitted by the service member or other persons such as service organizations, procedures which govern what constitutes a certified form as outlined in M21-1MR.III.ii.6, Determining Veteran Status and Eligibility for Benefits, must be followed. To authenticate these forms, initiate a request via PIES or DPRIS Web for record purposes.

In an effort to transition towards paperless processing, when these forms are retrieved via PIES or DPRIS Web, they should be inserted into the Virtual VA eFolder. The document type to assign is “DD 214 Certified Original-Certificate of Release or Discharge.” If an

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Change 5April 10, 2014

eFolder does not exist, one should be established. Please refer to the Virtual VA User Guide for instructions on establishing eFolders and instructions for document insertion.

Reference: C&P Service Bulletin, October 2008

RATING CLAIMS USING COPIES OF SERVICE TREATMENT RECORDS (STRS)

BDD CLAIMS

An inquiry was received asking if copies of Service Treatment Records (STRs) can be used to complete a rating in lieu of original STRs. M21-1MR.III.i.2.B.4e addresses that VA “obtain copies or original (preferred) service treatment records from the service member”. Additionally, Fast Letter 08-20, “Benefits Delivery at Discharge Expansion and Pre-Discharge Claims Consolidation and Fast Letter 08-21, Paperless Processing Procedures for BDD”, notes we ask servicemembers for the copies of, or the original STRs to process their claim. The service departments keep STRs at the service member’s final separation point for approximately 30 days to ensure any loose documents are associated with the claim. For the VA to accomplish its goal of the pre-discharge program, copies of STRs must be used to rate the claim. Of course, when loose medical documents or original STRs are received, the records are to be reviewed in the event any evidence was missing when the initial claim was being considered.

Reference: C&P Service Bulletin, October 2008

REMINDERS REGARDING SUBMITTING REQUESTS FOR JOINT RECORDS RESEARCH CENTER (JSRRC)

When requesting research from JSRRC, you must submit all Agent Orange and Post-Traumatic Stress Disorder (PTSD) requests using the Defense Personnel Records Information Retrieval System (DPRIS) web application. However, we do realize that there are exceptions. If you must submit a written (paper) request, coordinate with Renea Baker prior to submission to the JSRRC. Also, please make sure to list a point of contact on all paper JSRRC requests.

If you are unsure or have questions, feel free to contact Renea Baker at 703-428-6870.

Please remember that the JSRRC does not research Marine Corps records except if the Veteran served onboard a Navy vessel. All other Marine Corps requests should be researched locally by the regional offices (ROs).

To assist JSRRC in conducting optimal research, please review the following guidance and prepare your JSRRC requests accordingly. This applies to Agent Orange and PTSD JSRRC requests:

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1. Provide complete UNIT DESIGNATION information:

• ARMY requests - provide full UNIT DESIGNATION to the company level, Example: HHC, 1st Brigade, 2d Armored Division (vice: 2d Armored Division).

Example: Company C, 1st Battalion, 14th Infantry, 1st Brigade Combat Team, 4th Infantry Division

• NAVY requests - provide the full UNIT DESIGNATION AND HULL NUMBERS for ships. Example: USS FRANKLIN D. ROOSEVELT (CVA-42) (vice USS ROOSEVELT). Reminder: Some of the ships/units have similar names.

• AIR FORCE requests, need at a minimum SQUADRON and GROUP designations. Example: 366th Field Maintenance Squadron, 366th Combat Support Group (vice: 366th Tactical Fighter Wing). Providing just the WING is insufficient because there are numerous units under a Wing and various unit locations.

Military records are organized by units. Unit records are further organized by date. Therefore, JSRRC must know the unit designation down to the lowest possible level and most specific date(s) of the incidents.

2. In addition to the 60-day research window you provide, please include the Veteran's complete tour dates related to the unit of assignment when the incident/exposure occurred in the write up field.

3. In the "PTSD Stressor" block, list one stressor only per 040, 041, and 042. Do not submit requess with three or four stressors listed in same block. In the "Unit Location" block, provide more concise locations (i.e. Fallujah, Iraq, vice just Iraq, Seoul, Korea vice Korea).

4. For Agent Orange cases, provide the circumstances surrounding the Veteran's exposure rather then the statement that the Veteran was exposed..

Several offices have been submitting multiple requests for deck logs research. JSRRC and VA have an agreement that JSRRC will research deck logs up to 60 days and under certain circumstances JSRRC has agreed to research an additional 60 day time period if needed. If additional deck logs are needed beyond the 120 days, VSRs should request additional deck logs from NARA College Park.

In recent months a number of individuals have been asking that JSRRC expedite their requests. Please realize that JSRRC has a very small staff and services more than just the VA. JSRRC’s goal is to research and complete a case within 45-60 days. If you have already input a request and have not received a response please do not input a new request as a follow-up. Doing this only delays your case if it is not finalized yet.

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Please contact Renea Baker at the VAVBAWAS/CO/JSRRC mailbox for follow-ups on research requests already submitted to JSRRC. She will provide you with the status of your requests. (Reference: Compensation Service Bulletin, March 2014)

CHANGES

Change 1, March 27, 2012, added guidance regarding system updates when STRs are received.

Change 2, April 26, 2013, added guidance regarding Certification of Completeness of Service Treatment Records (STRs) from FL 13-06.

Change 3, January 20, 2014, added guidance regarding timeframes for requesting federal records from the December 2013 Addendum Compensation Service Bulletin.

Change 4, March 25, 2014, added guidance from the March 2014 Compensation Service Bulletin regarding JSRRC requests.

Change 5, April 10, 2014, removed outdated e-mail guidance from October 2010 regarding a memo of unavailability and copies of STRs.

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Section 29

Service Records Development & PIES_______

1 – Development for Service Treatment Records.............................................29.2

2 – Development for Verification of Service......................................................29.5

3 – PIES Request S02 Screen Prompt................................................................29.7

4 – Fire-Related Case Development...................................................................29.8

5 – Development for Other Service Records...................................................29.10

6 – PIES Helpful Hints......................................................................................29.15

7 – Service Department Codes..........................................................................29.21

8 – Follow-Up Requests.....................................................................................29.22

9 – Verification of PTSD Stressor Events........................................................29.24

10 – Protection of Service Records...................................................................29.27

11 – Contacting the PIES Mailboxes................................................................29.28

12 – Coast Guard Records................................................................................29-30

13 – Procedures for Requesting Federal Records from RMC or NPRC for VBMS

Claims.................................................................................................................29-32

14 – Certification of Completeness of Service Treatment Records (STRs) .29-35

15 – New Personnel Information Exchange System (PIES) Request Codes for

Claims Processed in VBMS .............................................................................29-36

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Section 29.1Service Records Development & PIES

Development for Service Treatment Records_______

TRANSITION TO ELECTRONIC SERVICE TREATMENT RECORDS (STRS) (FAS T LET T ER 14-04 )

The new procedures outlined in the fast letter:

Apply only to STRs for periods of military service (active duty, National Guard, and Reserve) ending on or after January 1, 2014.

Do not affect USCG, Public Health Service, and National Oceanographic and Atmospheric Administration (NOAA) STRs.

Do not apply to pre-separation claims (do not delay pre-separation claims processing for the purpose of obtaining STRs).

Do not apply for processing of Dependency and Indemnity Compensation (DIC) claims (see DIC Claims section).

For procedural guidance, refer to Fast Letter 14-04, Transition to Electronic Service Treatment Records (STRs), dated May 23, 2014.

REMINDERS FOR FEDERAL RECORDS DEVELOPMENT (AD DE ND U M CO MP EN SAT IO N SERV ICE BU LL E TI N , JU NE 2013 )

VistaWeb/DoD Records – STR/Military Treatment Facility (MTF) records available 2004 to present

o When STRs are unavailable VSRs need to check the VistaWeb/DoD records sections in CAPRI to extract any partial STRs

o When a Veteran indicates treatment as a military retiree or military dependent at a MTF the VSR can use the VistaWeb/DoD records sections in Compensation and Pension Record Interchange (CAPRI) to extract these records.

Reference: Addendum Compensation Service Bulletin, June 2013

REQUESTS FOR ENTRANCE/EXIT PHYSICALS AND MEBS/PEBS VIA PIES OR DPRIS

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Military service departments do not maintain the entire STR in image repositories. NPRC VA Liaison can pull out the entrance/exit physical and MEB/PEBs because these records are considered to be part of both the OMPF and the STRs.

When using the DPRIS Web application, the entrance/exit physicals and MEB/PEB can be retrieved by clicking the AG5 radio button. These types of requests should not go through PIES. When to submit the request via DPRIS Web is still based on the DPRIS Web dates.

REQUESTS TO RECORDS MANAGEMENT CENTER (RMC) FOR SERVICE TREATMENT RECORDS

The VA Records Management Center (RMC) receives and maintains service treatment records (STRs); the RMC does not receive or maintain any other service records.

Check BIRLS LOC screen - consider one of the following actions:

Scenario 1 - Location Screen Reflects an STR Folder Located at 376 St Louis.

If the Location Screen reflects an In-transit date, and, the records have been in-transit for more than two weeks:

Send an e-mail to the VA RMC requesting the status of the STRs (VAVBASTL/RMC/RCD); the subject line should read: DENVER STR REQUEST.

Send notice letter to the claimant.

Scenario 2 - Location Screen Does Not Reflect an STR Folder.

For recently discharged Veterans and if it has been at least 45 days since the Veteran’s RAD:

Send an e-mail to the VA RMC requesting a physical search be conducted for the STRs (VAVBASTL/RMC/RCD); the subject line should read: DENVER STR REQUEST.

Send notice letter to the claimant.

Scenario 3 - Location Screen Does Not Reflect an STR folder and the Veteran was discharged PRIOR to the cut-off dates, request the STRs via PIES.

The VA RMC began accepting STRs from the service departments on the following dates: Army - October 16, 1992; Navy - January 31, 1994; Air Force - May 1, 1994; Marine Corps - May 1, 1994; and Coast Guard - May 1, 1998.

Submit PIES Request Code M01. Print a copy of the PIES request to be flip-filed in the center section of the C-file.

Send development letter requesting service medical records from the Veteran.

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FOLLOW-UP TO VA RECORDS MANAGEMENT CENTER (RMC) FOR SERVICE TREATMENT RECORDS

NO RESPONSE. After sending an e-mail to the VA RMC requesting the status of the STRs and no response is received after 30 days, complete the following actions:

Send a follow-up e-mail request;

NEGATIVE RESPONSE. If a negative response is received from the VA RMC complete the following actions:

Submit a DPRIS request (see Defense Personnel Record Information Retrieval System (DPRIS) Requests for further guidance). Print a copy of the request to be flip-filed in the center section of the C-file.

Select MAPD Third Party Development pick, STRs not at RMC – NPRC check for STRs required, to create a tracked item.

Send development letter requesting service medical records from the Veteran (this letter will inform the Veteran we are requesting the STRs from the service department). This may not be necessary if we asked the Veteran for STRs in the initial VCAA notification letter.

Send the Veteran a request for alternative sources; refer to the section entitled Alternative Sources - Service Records for specific details.

DEVELOPMENT FOR RESERVE AND NATIONAL GUARD RECORDS

ARMY. Refer to the section entitled Reserve & National Guard Development (Army Service Records – STRs or Verification of Service) of this development guide for guidance on requesting STRs or verification of service on Army Veterans.

MARINE CORPS. Refer to the section entitled Reserve & National Guard Development (Marine Corps Service Records – STRs or Verification of Service) of this development guide for guidance on requesting STRs or verification of service on Marine Corps Veterans.

AIR FORCE & NAVY. Refer to the section entitled Reserve & National Guard Development (Air Force & Navy Service Records – STRs or Verification of Service) of this development guide for guidance on requesting STRs or verification of service on Air Force & Navy Veterans.

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Section 29.2Service Records Development & PIES

Development for Verification of Service_______

INITIAL REQUEST FOR VERIFICATION OF SERVICE

Submit PIES Request Code S01. When submitting request code S01 (verify period of service), the character of discharge (COD) field must reflect “UNK” versus “HON.”

Use of Request Code O21 (Separation Document) is required for authorization of VA benefits. A separation document is rarely needed for compensation or pension benefits. See M21-1MR, Part III, Subpart iii, Chapter 2, Section D, Information on Personnel Information Exchange System (PIES) Requests, Reports, and Codes.

Print a copy of the PIES request to be flip-filed in the center section of the C-file.

Send notice letter to the claimant

See PIES Helpful Hints for more details.

Note: When requesting verification of service, either submit an S01 (service verification) or O21 (separation document) DO NOT submit a request for both at the same time. However, as noted above, the separation document (Request code O21) is required for authorization of VA benefits and is rarely needed for compensation or pension benefits (Reference: M21-1MR.III.iii.2.D.23c).

Note: If the entire personnel record is requested (e.g. PTSD claims), there is no need to submit any other request for other information that can be found in the personnel record. NPRC will copy and send everything on file when submitting an O18 request. For example, requesting the O18 and O21 at the same time. NPRC will send all available DD 214s when submitting the O18 request so there is no need to request second copies of the DD 214s by submitting an O21 request with the O18 request. Review the PIES Participant Guide and the PIES help screens to determine if additional request codes are required in conjunction with the O18 request code. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Note: Submitting a PIES request in which the request code O21 and S01 are submitted together should not be done. A review of the claims folder should determine whether or not a DD 214 from NPRC is needed. If the DD 214 is needed, then request the O21. If a copy of the DD 214 is received by the RO from NPRC, the RO can verify the Veteran's service with that DD 214. If the RO has a copy of the DD 214 in the claims folder, then the RO should not submit a request to NPRC for another copy of the DD214 (O21), but submit a request to verify the service (S01). Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

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DEVELOPMENT FOR RESERVE AND NATIONAL GUARD RECORDS

ARMY. Refer to the section entitled Reserve & National Guard Development (Army Service Records – STRs or Verification of Service) of this development guide for guidance on requesting STRs or verification of service on Army Veterans.

MARINE CORPS. Refer to the section entitled Reserve & National Guard Development (Marine Corps Service Records – STRs or Verification of Service) of this development guide for guidance on requesting STRs or verification of service on Marine Corps Veterans.

AIR FORCE & NAVY. Refer to the section entitled Reserve & National Guard Development (Air Force & Navy Service Records – STRs or Verification of Service) of this development guide for guidance on requesting STRs or verification of service on Air Force & Navy Veterans.

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Section 29.3Service Records Development & PIES

PIES Request S02 Screen Prompt

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Section 29.4Service Records Development & PIES

Fire-Related Case Development_______

The fire at NPRC in 1973 may have destroyed the service treatment records (STR) if the Veteran served in the Army from 1941 to 1960 and Air Force Veterans with surnames from Hubbard thru Z, discharged prior to 1964 with no retired or Reserve Status. See M21-1MR, Part III, Subpart iii, Chapter 2, Section E, Topic 26, Alternative Sources for Service Records in Fire-Related Cases.

Request to the service records center for STRs; request to the claimant for service treatment records; request to the claimant for alternative sources; request to the claimant for NA From 13055, Request for Information Needed to Reconstruct Medical Data. If the form was provided (with sufficient information), a PIES request (M05) was submitted.

Fire-Related Cases: Use Programmed Request Code M05 to submit an initial request for records on fire-related cases. You will need information from one of the following:

NA Form 13075 - assists in identifying personnel records

NA Form 13055 - assists in reconstructing medical records

When requesting CLINICAL RECORDS on a fire-related case, use request code 020, Morning Reports. This is because the actual clinical records were destroyed along with the STRs and the unit records of Morning Reports are the only source of information regarding treatment.

The following actions should be completed at the time the initial VCAA notification letter is completed.

FIRE-RELATED SERVICE TREATMENT RECORDS DEVELOPMENT

Submit PIES Request Code M01. Print a copy of the PIES request to be flip-filed in the center section of the C-file.

Send development letter regarding fire-related service and be sure to enclose the NA Form 13055, Request for Information Needed to Reconstruct Medical Data.

Send development letter regarding STRs not being available and that substitute documents are needed. This paragraph will provide the Veteran with alternative sources of evidence (M21-1MR, Part III, Subpart iii, Chapter 2, Section E, Topic 26).

Send development letter requesting service medical records from the Veteran.

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Create a tracked item.

Any alternative sources that may have been identified on the application should be developed at the same time.

FIRE-RELATED SERVICE VERIFICATION DEVELOPMENT

Submit PIES Request Code S01. Print a copy of the PIES request to be flip-filed in the center section of the C-file; create a tracked item.

Any alternative sources that may have been identified on the application should be developed at the same time.

Reference: M21-1MR, Part III, Subpart iii, Chapter 2, Section E

FIRE-RELATED FOLLOW-UP DEVELOPMENT FOR SERVICE TREATMENT RECORDS

If a negative reply is received from NPRC for STRs and the Veteran provided a complete NA Form 13055 (this form is ONLY for use when working fire-related claims).

Submit PIES Request Code M05. Print a copy of the PIES request to be flip-filed in the center section of the C-file; create a tracked item

Note: NPRC will search for STRs to include secondary sources (sick calls and morning reports). In order for them to search secondary sources, they will need the treatment dates (not to exceed a 3 month search), organization to which assigned, and name and location of facility where treated.

FIRE-RELATED FOLLOW-UP DEVELOPMENT FOR SERVICE VERIFICATION

If a negative reply is received from NPRC for verification of service.

Submit PIES Request Code S02 (see the section entitled, Service Records Development & PIES, for information regarding the S02 Screen Prompt and the required entries). Print a copy of the PIES request to be flip-filed in the center section of the C-file; create a tracked item.

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Section 29.5Service Records Development & PIES

Development for Other Service Records_______

REQUEST FOR PERSONNEL RECORDS – OFFICIAL MILITARY PERSONNEL FILE (OMPF)

Submit PIES Request Code O18 or O19. Print a copy of the PIES request to be flip-filed in the center section of the C-file ; create a tracked item.

Do not request entire personnel file except in the case of personal assault cases. If a request for PIES O18 (entire personnel file) is submitted and the VCAA letter does not address MST, an email must be sent to the PIES Coordinator; the e-mail needs to explain why the entire personnel file was requested; this will preclude the station from receiving a PIES error. In addition, make a note in Map-D detailing the reason for the entire personnel file.

Request Code O19 (PTSD) is a request for the entire personnel file, therefore, DO NOT simultaneously submit request code O21 (separation document) or request code O18 (units of assignment) since the separation document and units of assignment are part of the personnel file.

If the entire personnel record is requested, there is no need to submit any other request for other information that can be found in the personnel record. NPRC will copy and send everything on file when submitting an O18 request. For example, requesting the O18 and O21 at the same time. NPRC will send all available DD 214s when submitting the O18 request so there is no need to request second copies of the DD 214s by submitting an O21 request with the O18 request. Review the PIES Participant Guide and the PIES help screens to determine if additional request codes are required in conjunction with the O18 request code. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

NPRC has requested on numerous occasions that requests for the entire personnel file be limited to personal trauma cases. If it is determined that the case requires the entire personnel file and is not a personal trauma case, send an e-mail to the PIES Help Desk (VAVBAWAS/CO/PIES), with the PIES ID number, stating why the file is needed so that it won't be marked as an error on the PIES Error Report. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

The term "201 file" is vague and does not make it clear what the requester wants. Replies are therefore inconsistent and may not provide information the requester needs. This phrase was omitted from the canned request codes to avoid confusion. The requester should insure there is no canned request code describing what he/she wants. If not, he/she should explain exactly

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what type of information is needed. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

MILITARY PERSONNEL RECORD FORM NUMBERS

USAF: AF Fm 7; AF Fm 11 (Officers)

USA: DA Fm 20 (Enlisted); DA Fm 66 Officers)

USN: NAVPERS 601 – 4 & 5

USMC: NAVMC 118 (3, 9) PD

REQUEST FOR LINE OF DUTY DETERMINATION

Submit PIES Request Code O12. Print a copy of the PIES request to be flip-filed in the center section of the C-file; create a tracked item.

REQUEST FOR IN-PATIENT CLINICAL RECORDS

Review the PIES Participant Guide and the PIES help screens as to when clinical records are retired to NPRC. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Before requesting clinical records, check the STRs to see if clinical records are already of record. Request must provide the condition, the year(s) of treatment, the full name of the last facility at which treated, and allegation (hypertension, asthma, lumbar strain, etc.). Requests for clinical records should be made separately from requests for any other service record. When requesting inpatient clinicals, be sure to provide the period of hospitalization, not to exceed a one year period. DO NOT use the period of service as a period of hospitalization.

Submit PIES Request Code C01. Print a copy of the PIES request to be flip-filed in the center section of the C-file; create a tracked item.

REQUEST FOR RETIREE OUTPATIENT CLINICAL RECORDS

Review the PIES Participant Guide and the PIES help screens as to when clinical records are retired to NPRC. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Before requesting clinical records, check the STRs to see if clinical records are already of record. Request must provide the condition, the year(s) of treatment, the full name of the last facility at which treated, and allegation (hypertension, asthma, lumbar strain, etc.).

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Requests must be limited to a 1 year time frame and the time frame should be within the same calendar year. Requests for clinical records should be made separately from requests for any other service record.

Submit PIES Request Code C02. Print a copy of the PIES request to be flip-filed in the center section of the C-file; create a tracked item.

REQUEST FOR MENTAL HEALTH (HYGIENE) RECORDS

The STRs do not include inpatient treatment (clinical) records (clinicals), finance records, mental health records or the Military Personnel Record Jacket (MPRJ), which may contain physical profiles and medical board proceedings.

Review the PIES Participant Guide and the PIES help screens as to when clinical records are retired to NPRC. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Before requesting clinical records, check the STRs to see if clinical records are already of record. The allegation should be stated as Mental Hygiene Record; request must provide the year(s) of treatment, the full name of the last facility at which treated, and the type of treatment (hosp). When requesting mental health records, do n ot to exceed a one year period.

Submit PIES Request Code C01. Print a copy of the PIES request to be flip-filed in the center section of the C-file; create a tracked item.

Reference: M21-1MR.III.iii.2.A.1a

REQUEST FOR MORNING REPORTS

Review the PIES Participant Guide and the PIES help screens to determine which branch of service generated morning reports and the time frame in which the branch of service generated morning reports. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Morning reports are available for Army personnel who served during the period November 1, 1912 – 1974 (some units discontinued morning reports in 1972, other continued them until 1980); morning reports are available for Air Force personnel who served during the period September 1947 – June 30, 1966. For further information, refer to the PIES Help feature in the PIES program. When requesting morning reports, do n ot to exceed a 90-day period .

Submit PIES Request Code O20. Print a copy of the PIES request to be flip-filed in the center section of the C-file; create a tracked item.

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REQUEST FOR SICK REPORTS

Sick reports are available for Army and Air Force personnel from 1913 – 1953. The request for records must NOT exceed a three month period. For further information, refer to the PIES Help feature in the PIES program. When requesting sick reports, not to exceed a 90-day period.

Submit PIES Request Code M05. Print a copy of the PIES request to be flip-filed in the center section of the C-file; create a tracked item.

REQUEST FOR SURGEON GENERAL OFFICE (SGO) RECORDS

Surgeon General Office records are hospital admission abstracts for the period 1942-1945 and 1950-1954. Patients with extended hospitalization may be on file if they had treatment as early as 1940 or as late as 1958. Patients with limited hospitalization during the period 1940-1941, 1946-1949, 1955-1958 will probably not be on file. For further information, refer to the PIES Help feature in the PIES program. When requesting SGO records, not to exceed a 90-day period.

Submit PIES Request Code M06. Print a copy of the PIES request to be flip-filed in the center section of the C-file; create a tracked item.

REQUEST FOR AIR FORCE INVESTIGATIVE REPORTS

Air Force criminal investigative reports are maintained at the Air Force Office of Special Investigation or AFOSI (Air Force Office of Special Investigation). This agency will provide records to the VA if a request is received on VA letterhead. No special authorization is required. The Air Force will accept a faxed request. The fax request must accompany a letter head request that includes victims name, SSN, and the date of incident.

Address for AFOSI records:

HQ’s, AFOSI/SCR

500 Duncan AveRoom 1009Bolling AFB, Washington DC 20332-6000

FAX number: (301) 870-1116

Point of Contact: Anne Costa at (301) 870-1110. The Air Force does have a security requirement for these records. A warning protective cover will be provided.

PUBLIC HEALTH SERVICE RECORDS

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When requesting information or medical records from the Public Health Service, refer to M21-1MR.III.iii.2.K.77a, for guidance.

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Section 29.6Service Records Development & PIES

PIES Helpful Hints_______

REMINDERS FOR FEDERAL RECORDS DEVELOPMENT (AD DE ND U M CO MP EN SAT IO N SERV ICE BU LL E TI N , JU NE 2013 )

Personnel Information Exchange System (PIES) – Responses are provided in two formats; paper and electronic.

o For Veterans Benefits Management System (VBMS) claims a PIES O50 is submitted and the entire Service Treatment Record (STR) and OMPF are scanned into the VBMS eFolder.

o For legacy claims when a record is requested the original STRs or copies of the OMPF will be forwarded to requesting station.

o When the request is verification of service or exposures in service the response is posted by Veterans Affairs Records Management Center Liaison Office (VALO) in the PIES request. There is currently no notification to the VSR when the response is available, this requires review by the VSR typically triggered by a suspense date in Modern Awards Processing-Development (MAP-D) and the VSR must manually print out the response and add it to the claims folder/VBMS eFolder.

Prior to VSRs submitting a request for service verification (PIES SO1) they should follow guidance set in VBA Letter 20-09-14

The BIRLS VID screen will be used as acceptable proof of service if all of the following apply:  character of service is HON or UHC, branch of service code is not ARNG or ANG, separation reason is SAT, there is a “Y” or “D” in the VADS field, or there is a “Y” in the VER field

Reference: Addendum Compensation Service Bulletin, June 2013

MISCELLANEOUS HELPFUL HINTS

Review Canned Request Codes: Review of the claims folder, BIRLS, and the list of canned request codes (which is located in M21-1MR.III.iii.2.D.23) prior to creating the PIES request will reduce requests with invalid request codes. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Service Data on the Branch of Service TAB. There is a TAB for each branch of service. On page two of the PIES request, the program automatically defaults to the Army TAB unless a branch of service is specified in BIRLS. When a Veteran has multiple periods of

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service or served in more than one branch of service, be sure to include only the service dates for that period service for which the military information is needed. If necessary, highlight the period of service by clicking on it and then click on “Remove POS” (Period of Service).

Review of the claims folder, BIRLS, and VIS should help ascertain the correct branch of service. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Service Dates. Review of BIRLS and the claims folder is needed to ensure that EOD and RAD dates are provided. PIES will automatically route a request based on the RAD date. If no date or an incomplete date is provided, then the request will go to an incorrect location. See the PIES Participant Guide and the PIES help screens regarding the use of EOD and RAD dates. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Making a Request Using the Same Request Code. Review of all previous PIES request should be conducted prior to submitting a new PIES request. Someone may have previously submitted a PIES request for that specific request code and NPRC may have already provided an answer. If NPRC has already provided an answer, whether positive or negative, then another request should not be submitted. Review of the claims folder, the M21-1MR and prior guidance's should provide the user with the next course of action. If the proper course of action cannot be ascertained by the Military Records Specialist (MRS) then the MRS should contact the PIES Help Desk for guidance. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

If the first request is still pending, a second request for the same information should not be submitted. Follow NPRC follow up procedures. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

To submit a request for evidence or information that may have been previously submitted, make a PIES request by changing the EP (i.e., 110 pending, change to 111).

When Sending Additional or Multiple Requests: Make your first request in PIES Create. For your subsequent requests, return to PIES Create, enter the C# and click on submit to PIES. You will get a returned match under “Submit to PIES;” ignore it, and click on “Submit to BIRLS” button to continue with your request.

PIES was designed so that multiple request codes to multiple branches can be submitted in one PIES request. Review the PIES Participant Guide and the PIES help screens for the proper procedures as to when and how to submit PIES requests for multiple request codes and branches of services. Review the exceptions when requests for Navy and Marine must be request separately. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Deleting PIES Requests: You can delete or amend a PIES request if it is still in Overall Status Code SU (Submitted). The entire request can be deleted by selecting the "X" icon.

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The Overall Status Code is located on either the "Existing 3101 Search" Screen or the Branch of Service tab which is on page 2 of the PIES 3101 request (PIES User's Guide page 25).

If you no longer need the information requested, mark the request for deletion

Amending PIES Requests: If the request is still in Overall Status Code SU, the request can be amended by going to page 2 of the PIES 3101, highlight the request to be deleted and click "Remove Request." Then, select a new request code and click "Add Request." (PIES User's Guide page 25). What do you do if the Overall Status Code is something other than SU, and you want to delete or amend your PIES request? You can find the answer on page 25 of your PIES User's Guide.

If the overall status code shows 'IC" (the branch status code will show "IP") - you will need to make a supplemental PIES request or cancel the first request and resubmit the request with all the requested information at one time.

If you need to ask for something more than you originally asked for, make a new request listing only those additional items needed.

Service Records at ARPERSCOM: Requests for service records from ARPERSCOM (Code 11), use the following procedures:

1. Submit the initial request through PIES

2. If no response is received after 120 days, the military records specialist (MRS) should send an e-mail to the VA Liaison. For further guidance, refer to the section on Follow-up Development.

Numeric fields must contain numbers only. Do not enter any alpha characters or zero's. If you do not have the "numbers," leave the field blank.

Composed Requests: Be careful when using O99 (composed request code) because it will slow-up the response time; an O99 request has to be pulled out to be worked by-hand. Also, do not use O99 to do a follow-up request since that will really bog-down the system and delay the response.

Reserve Obligation Dates: Be sure to provide the reserve obligation date if available/appropriate. This will actually assist in identifying the proper location of the records. In addition, we should fill in any other field that may help them to locate records (even if it's not highlighted in red).

Financial Information: NPRC (code 13) DOES NOT maintain financial information on Veterans. Send address requests for information on military (financial) benefits to the proper financial address codes. A list of address codes is located in the M21-1MR.III.iii.2.K.76 Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007

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Severance/Separation/Readjustment Pay: DO NOT LEAVE the address element blank. Requests for financial information must be addressed to the appropriate Finance Center (See PIES User’s Guide, Chapter 8).

Veteran’s Who Served Under A Different Last Name: Leave the BIRLS information on page 1 in tact. On page 2 of the PIES request, enter the Veteran's name next to the period of service in the service grid area. There is a field for Last Name, First Name, and MI for each period of service. You can enter different names for the same period of service or different names for various periods of service. Just click on Add POS, Modify POS, or Remove POS as appropriate.

Review of BIRLS and the claims folder to ensure the correct name is submitted. If the name and service number and/or social security number in the PIES request does not match the record requested, then the record cannot be sent to the RO because the identifying information does not match. This is especially true when submitting a PIES request through DPRIS. If there are multiple names, then use the name the Veteran was discharged under. If the request is going to NPRC (Code 13), you may submit an O99 request supplying the additional names with your canned request. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Duty Status Codes: Duty status codes are used as indicated below:

RSV - Veteran is currently assigned to a Reserve unitRET - Veteran is retiredACT - Veteran is still on active duty (primarily for education claim issues)NG - Veteran is currently in the National GuardDED - Veteran died in service

When Only Dental Records are Received from RMC

E-mail RMC and inform them only dental records were received; ask them to search for any service treatment records; ask them to provide you with a negative reply if they do not have the service treatment records.

Because the STR Indicator Field will have been updated to “C,” PIES will not allow any of the “M” series request codes, and DPRIS will not allow Request Code O99, the only option would be to submit an S01 which should provide the enlistment examination because it is part of the enlistment package.

If the Veteran was discharged for a disability, Request Code O08, Reason for Separation…, should provide the MEB/PEB since these are part of the discharge package.

For further guidance, refer the case to the military records specialist.

STRs Located at RMC: Review of BIRLS prior to submitting a PIES request. If BIRLS indicates that the STRS are located at 376 RMC, please follow the procedures in the M21-1MR.III.iii.2.A.4g for contacting RMC for a Veteran's service treatment records. If the STRS have not been received by the RO, then follow-ups to RMC should be sent to

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RMC via e-mail. Guidance has been provided on the proper e-mail addresses for requesting STRS from RMC. PIES does not interface with RMC; therefore, PIES should not be used to request STRS from RMC. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Time Periods: All time periods for PIES requests are limited to a 90 day time frame with the exception of clinicals. Clinicals are limited to a one year time frame. When making a request for clinical records that span more than two calendar years, the request should be submitted as shown by the example below:

Knee condition – 06/13/94 to 12/31/94 – Blachfield Army Community Hospital

Knee condition – 01/01/95 to 04/17/95 – Blachfield Army Community Hospital(etc.)

The example shown above could be sent as two separate requests or as a combined request.

NPRC (code 13) needs specific details as to what information to locate. Requesting all records for a 90 day period is unacceptable. This type of request is too vague and requires additional resources. By stating a specific incident, NPRC can narrow their search to a few pages to answer your request. NPRC will search a 90 day period, but will not provide copies of all records for a 90 day period. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Requests for Unit Records: NPRC (Code 13) requires the complete organizational structure to effectively and efficiently search for unit records. Without this information, NPRC cannot search for the records you are requesting. Please see M21-1MR.III.iii.2.J for information needed to submit a request with the complete organizational structure. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Service Numbers and Social Security Numbers: Make sure that BIRLS is updated with the Veteran’s service number before making a PIES request. If the Veteran served in different branches of service, make sure the correct service number is associated with the appropriate branch of service.

If a PIES request is submitted without a service number and the Veteran's service falls in the dates of when service numbers were used, an email is sent to PIES Coordinator. The e-mail must detail the attempts made to obtain the service number; in addition, enter a Map-D note. Some records are filed by the service number and not providing the service number could result in the record not being found.

Service numbers with 8 digits were used prior to Social Security Numbers as identifiers.

Army - with RAD before 7/1/1969 Navy - with RAD before 1/1/1972 Air Force - with RAD before 7/1/1969 Marine Corps - with RAD before 1/1/1972

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Coast Guard - with RAD before 10/1/1974

Review BIRLS and the claims folder to ensure BIRLS reflects the proper service number prior to creating a PIES request. NPRC filed Veteran's records according to the Veteran's service number prior to switching to social security numbers. If the Veteran has a service number provide it in the PIES request. Without the service number, NPRC may be unable to locate the records. Review the PIES Participant Guide and PIES help screens to determine when service numbers are required. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Review BIRLS and the claims folder to ensure BIRLS reflects the proper social security number prior to creating a PIES request. NPRC switched from filing the Veteran's records according to the Veteran's service number to the Veteran's social security number. If the incorrect social security number is not provided in the PIES request, NPRC may be unable to locate the records. Review the PIES Participant Guide and PIES help screens to determine when service numbers are needed. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

Navy and Marine Corps Records Prior to 1965: Navy and Marine Corps medical records for persons who served before 1965 are usually filed by name and date of birth. If you do not furnish the date of birth, you will cause your request to be delayed in most cases, and possibly returned for more information if the name is common.

Marine Corps PTSD or Agent Orange Claims: U.S. Army and Joint Services Records Research Center (JSRRC) does not research any Marine Corps records except for a Marine who served on a Navy ship. PIES will give you an error message if any of the PTSD codes or Agent Orange codes are submitted based on service in the Marine Corps. NOTE: If you have a Marine who was stationed on a Navy ship and verification of PTSD stressors or Agent Orange exposure is required, a written request must be sent to JSRRC. Verification of these types of claims cannot be sent through PIES.

Self-Addressing Requests: Self addressing a request to NPRC (code 13) when the RAD indicates the request should have gone to a DPRIS address code. Review the PIES Participant Guide, the PIES help screens, and M21-1MR.III.iii.2.B to determine where records are located based on the Veteran's RAD date and how to submit the PIES request to the correct location. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

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Section 29.7Service Records Development & PIES

Service Department Codes_______

PIES REQUEST CODES

See Requesting Information/Records Through the Personnel Information Exchange System (PIES), M21-1MR.III.iii.2.D.23

SERVICE DEPARTMENT CODES & ADDRESSES

See Service Department Organizational Structures and Service Record Address Codes, M21-1MR.III.iii.2.J.

See Other Contact and Reference Information, M21-1MR.III.iii.2.K for specific addresses and phone numbers.

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Section 29.8Service Records Development & PIES

Follow-Up Requests_______

Refer to M21-1MR.III.iii.2.I , for guidance regarding Circumstances Necessitating Follow-Up by a Military Records Specialist; and for guidance regarding general information on control of and follow-up on records requests.

PIES FOLLOW-UP REQUESTS

In general, the NPRC/RMC tries to complete PIES requests within 10-15 days of submission IF the records requested are readily available. Unfortunately, in many cases records cannot be obtained easily (i.e., the record(s) is/are at a Review Board, are charged out, are Hazmat documents, etc). In these instances it can take up to 6 months before a PIES request is answered.

The Records Management Center (RMC) is working diligently with the National Personnel Records Center (NPRC) and other record holders to minimize the 6 months follow-up requirement. RMC understands that doing so will help Regional Offices (ROs) in effectively meeting the Secretary’s goal of 125 day claim processing.

Question: When I submit a request in JSRRC or PIES for a Remand case I tell them that this is a Remand Court order and I need an answer for all my questions. Often times they only answer one of the questions and the others they say see the above response or they give me a canned response (Fire related), which Remand will not accept and I have to end up sending another request (which prolongs the case). How do you recommend these requests be made so I can quickly get the answer that the judge will accept?

Answer: Please contact the PIES helpdesk as we can directly contact VBA’s JSRRC POC for assistance. In the event you receive a response from PIES, such as the above message, please send a follow-up email to the VAVBASTL/RMC/ERROR mailbox advising them of the situation and that you need specific answers to these questions per the BVA remand.

Reference: PIES Conference Call Agenda (Notes)-Quarter 4, dated October 25, 2011.

FOLLOW-UP TO NPRC (CODE 13)

If the PIES request is pending (Overall Status Code IC - Incomplete) at the end of the 60 day control period, refer to Alternative Sources - Service Records for further guidance regarding requests for alternative source of evidence.

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Follow-up requests should not be submitted to NPRC via PIES. Refer to M21-1MR.III.iii.2.I , or contact the PIES Help Desk for guidance.

FOLLOW-UP TO ARPERSCOM (CODE 11)

A. If the PIES request is pending (Overall Status Code IC - Incomplete) at the end of the 60 day control period, refer to Alternative Sources - Service Records for further guidance regarding requests for alternative source of evidence.

B. If the PIES request is pending (Overall Status Code IC - Incomplete) at the end of the 120 day control period:

Give the claim to the Military Records Specialist at the end of the second control period (30 days) and the request has been pending more than 120 days without a response, the military records specialist should e-mail VAVBASTL/RMC/LNO (VA Liaison) with the subject line displaying “Veteran’s last name, first name, and claim number or Social Security number.” The military records specialist will explain that follow-up action is being taken because the request has been pending at ARPERSCOM more than 120 days. The VA Liaison Office (VALNO) will investigate and provide a status response. See M21-1MR, Part III, Subpart iii, Chapter 2, Section I, Control of and Follow-Up on Record Requests.

FOLLOW-UP TO DPRIS ADDRESS CODES 11, 21, 22, 31, 36, 41, AND 42

A. If PIES indicates the request was forward to another Service Records Center and a 60 day control period has expired:

Send a follow-up PIES request to the appropriate service records center.

B. Refer to Alternative Sources - Service Records for further guidance regarding requests for alternative source of evidence.

Note: NPRC does not have the capability of providing images from DPRIS request codes or forwarding requests to DPRIS address codes. Requests should be re-submitted to the DPRIS address for the necessary images. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

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Section 29.9Service Records Development & PIES

Verification of PTSD Stressor Events_______

The JSRRC Coordinator is personally responsible for submitting all of the RO’s requests for stressor corroboration. Reference M21-1MR.IV.ii.1.D.15j.

PIES REQUEST CODES O40, O41, & O42

The PIES/DPRIS/ARIMS interface with U.S. Army and Joint Services Records Research Center (JSRRC) should be used to submit requests for verification of PTSD stressor events. Up to three different stressor events can be submitted for one Veteran.

Code O40 is for stressor number 1 Code O41 is for stressor number 2, & Code O42 is for stressor number 3.

All preliminary development must be completed prior to submitting a request to JSRRC.

Once the necessary information is obtained, it will be used to populate the fields in the template.

NOTE: Refer to the CURR PTSD Research Guide for tips on how to submit a valid request.

PIES REQUEST CODE O40, O41 & O42 USERS GUIDE 1. Click inside the first cell under the Tour of Duty: Assignment column heading.

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All fields need to be completed in the template in order for the request to be accepted. Each field has a pop-up display to assist the user in populating the values correctly. Once the template is completed, it is sent via PIES to address code 55.

2. A second pop-up screen will appear.

3. In the Assignment field, enter the name of the unit to which the Veteran was assigned during his/her first tour of duty in Vietnam.

4. In the Location field, enter the geographic location of the unit identified in the Assignment field.

5. In the From Date field, enter the date the Veteran began his/her first tour of duty in Vietnam. In the To Date field, enter the date the Veteran’s first tour of duty in Vietnam ended.

6. If the claimed stressor occurred while the Veteran was assigned to the unit identified in step 3, and during the dates specified in step 5, enter a Y in the Stressor Y/N field. Otherwise, enter an N. Click OK.

7. Revisit steps 1 through 7 above if the Veteran served with more than one unit or had additional tours of duty (up to three) in Vietnam.

NOTE: One Y must be entered for one of the tours of duty displayed on the first pop-up screen, but no more than one Y may be used per stressful incident claimed. If the Veteran reports additional stressors that occurred during the same or other tours of duty, information relevant to these stressors must be input using request code 41 and, if necessary, 42.

Example:

Veteran claims the in-service stressor to which his PTSD is attributed occurred during his tour of duty with the 147th Transportation Company in Vietnam, which

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began 01-13-1968 and ended 01-12-1969. His unit was primarily located in Da Nang.

Assignment: 147th Transportation Company (Provide higher headquarters, if known.)

Location: Da Nang

From Date: 01/13/1968 To Date: 01/12/1969

Stressor Y/N: Y

8. Enter the Veteran’s military occupation in the Military Occupational Specialty (MOS) field. This information is available in the Veteran’s personnel records, where it may be described and/or identified numerically.

9. Provide a full description of the claimed in-service stressor in the Stress Creating Experience field. This is a free-text area where any details regarding the stressful event that may assist JSRRC in conducting meaningful research should be included.

10. At a minimum, enter the month and year in which the stressful event occurred in the Date field. JSRRC staff will research records covering one month before and one month after the date input in this field.

Example: If the date 01/01/1968 is entered, JSRRC will research records covering the period 12/01/68 to 02/01/1968.

The remainder of the grid is self-explanatory and requires completion only if the stressful incident involved a casualty.

Helpful Hints

1. In order to conduct meaningful research, JSRRC needs to know the beginning and ending dates of the Veteran's entire tour of duty in Vietnam AND the date (within 60 days) the in-service stressor occurred. This is why the pop-up screen contains two separate date fields.

2. If the Veteran had a period of temporary duty (TDY) during which he was assigned to a different unit AND the stressful event occurred during that period of time, first complete steps 1 through 7 above for the parent unit, then follow the same steps again to enter information about the unit to which the Veteran was temporarily assigned. When taking the latter action, however, enter only the time period during which the Veteran was TDY in the From Date and To Date fields. This will alert JSRRC researchers that the Veteran was attached to another unit during his tour of duty.

3. If there are details about the Veteran's unit of assignment during the period the stressful event occurred that requires explanation, include them in the free text area. (Example: The Veteran was assigned to Company B “on paper,” but he/she claims the stressful event occurred while he/she was temporarily assigned to Company C.) This will alert JSRRC researchers that they must expand their research to include records from other units.

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Section 29.10

Service Records Development & PIES

Protection of Service Records_______

Service medical and other service department records in the claims folder are to be maintained in VA Form 21-4582, “Service Department Records Envelope,” which must be filed down to prevent loss or damage. It is the responsibility of all personnel handling claims folders to ensure that protective envelopes which have been damaged or are unusable because of wear and tear are repaired or replace. The sides of bottoms of the envelopes should never be slit to remove records. See M21-1MR, Part III, Subpart iii, Chapter 2, Section A, Topic 2, Protecting Service Records.

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Section 29.11

Service Records Development & PIES

Contacting the PIES Mailboxes_______

WHEN TO USE THE PIES ERROR AND LNO MAILBOXES

Only the MRS can send an email to the Error mailbox (VAVBASTL/RMC/ERROR) when a PIES response is received that is incorrect, inaccurate, incomprehensible, or incomplete. The MRS will also use this mailbox when documents are received that are for the wrong Veteran or the PIES response says documents were mailed but were never received.

Only the MRS can send emails to the LNO mailbox (VAVBASTL/RMC/LNO). This mailbox is used to request expedited PIES requests for the following types of cases: Homeless, Terminally ill; Hardship; POW; and Congressional inquiries. In addition, the MRS can use the LNO mailbox to request expedition of Nehmer cases if a request has been submitted and a response has not been received within 15 – 20 days of the submission. Please note: the Southern Area Office (SAREA) requests, on a weekly basis, a list of all Nehmer cases that have been submitted for a response.

Reference: PIES Conference Call Agenda (Notes)-Quarter 4, dated October 25, 2011.

ACTIONS REQUIRED PRIOR TO CONTACTING THE PIES HELP DESK

Before contacting the PIES Help Desk (VAVBAWAS/CO/PIES), please do the following:

1) Review any requests in PIES, both open and closed, to ensure that correct information was provided. Check the responses provided in the closed requests to verify if additional action was required or if the response was adequate.

2) Review the claims folder (DD 214, 21-526 and other documentation available). The Veteran may not indicate that he/she served in the reserves or National Guard. If the Veteran is assigned to a unit, his/her records will be available through his/her unit. These types of requests should not be routed through the PIES Help Desk.

3) Verify his/her service information through the Veterans Information Solution (VIS) website. There may be additional information available that will assist in locating records. For example, the Veteran may have indicated that he/she served in the reserves. A check of VIS, however, indicates the Veteran served in the National Guard. Information obtained through VIS can also help to verify if the records are located at the National Personnel Records Center (NPRC). The information in VIS can also provide you with the last name that the records are located under. When using DPRIS, the request is matched against the last name and the Social Security Number. If the Veteran

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changed their last name (is in most cases with female Veterans due to marriage or divorce), VIS will provide you with the last name the records are under.

When contacting the PIES Help Desk, please specify that the PIES request(s) was reviewed and all information was verified as correct. Also indicate that the c-file was reviewed, and no additional information is available, and that a review of the information available through VIS provided no additional information.

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Section 29.12

Service Records Development & PIES

Coast Guard Records_______

IF THE VETERAN IS ON ACTIVE DUTY

For the STRs contact the unit the service member is assigned. For personnel records, fax your request to Mr. John Evans at Code 51 at 202-493-

1675

Note:  Code 51 will not have the STRs so please do not ask them for the STRs.

IF THE VETERAN IS SEPARATED FROM ACTIVE DUTY AND ATTACHED TO A RESERVE UNIT

For the STRs and Personnel Records - contact the Reserve Unit.

Note 1: Code 51 may have some of the information in the imaged personnel record if the information has been scanned into the CG's imaging system, however, the Veteran's record may not be complete.  Therefore, your best option is to contact the reserve unit first. 

Note 2:  Code 51 will NOT have the STRs in this situation, so please do not contact them for the STRs.

IF THE VETERAN IS SEPARATED FROM ACTIVE DUTY BUT HAS A RESERVE OBLIGATION THAT HAS NOT EXPIRED AND IS NOT ASSIGNED TO A RESERVE UNIT

For the STRs and personnel records contact the Reserve Personnel Command (RPC) at code 51.  You can fax request to Senior Chief Succi at 202-493-1776.

IF THE VETERAN IS COMPLETELY DISCHARGED FROM THE COAST GUARD - NOT ON ACTIVE DUTY - NOT ASSIGNED TO A RESERVE UNIT - AND THE RESERVE OBLIGATION (IRR) HAS EXPIRED

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For the STRs contact the VA RMC via e-mail at VAVBASTL/RMC/RCD if date of discharge was on or after May 01, 1998 or NPRC (code 13) via the PIES Application if date of discharge was prior May 01, 1998

For the personnel records, do one of the following:

- If you are requesting the personnel records within 6 months from the date of expiration of military service then fax a request to Mr. John Evans at (202) 493-1675

- If you are requesting the personnel records anytime after 6 months from the date of expiration of military service, then submit a request via PIES to code 13 (NPRC- National Personnel Records Center).

IMPORTANT:  When submitting a fax request to Mr. John Evans or Senior Chief Succi, please include the following in your request:

        1)  Veteran's Name         2)  Veteran's SSN         3)  Your name         4)  Your RO's Mailing address         5)  Your e-mail address         6)  Your Phone Number to include any extensions         7)  Spell out exactly what you need.  Please do NOT ask for the 201 file or ask for a PIES request code (i.e., O19, O36, etc.).  Mr. Evans and Senior Chief Succi will not know what you are requesting. 

When you put YOUR phone number on your fax request, please DO NOT USE the 1-800-827-1000 phone number as your phone number.  If Mr. Evans or Senior Chief Succi dial 1-800-827-1000 - they will reach the VA Roanoke Regional Office.  They will not be able to reach any other state's VA regional office using that number. 

If you need further clarification or the records that you need are not where the records are suppose to be when the above situations apply, contact the PIES Help Desk for assistance.

Reference: E-mail dated Thursday, December 06, 2007 9:22 AM, subj: Contacting the Coast Guard, from Andrew P. Bodyk, Interagnecy Data Analyst.

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Section 29.13

Service Records Development & PIES

Procedures for Requesting Federal Records from RMC or NPRC for VBMS Claims

PROCEDURES FOR REQUESTING FEDERAL RECORDS FROM RMC OR NPRC FOR VBMS CLAIMS

The following document provides step-by-step procedures for requesting Federal records from the Records Management Center (RMC) or the National Personnel Records Center (NPRC) for Veterans Benefits Management System (VBMS) claims, including VONAPP Direct Connect (VDC) claims filed in VBMS. A prerequisite to these procedures is that a VBMS eFolder is established.

Primary Audience: Claims Assistants (CAs) Intake Analysts (IAs) Veteran Service Representatives (VSRs) Rating Veteran Service Representatives (RVSRs) Decision Review Officers (DROs), and Management personnel responsible for claims processing.

This guide provides two procedures:

Part I: Personnel Information Exchange System (PIES) Requests for VBMS Claims Part II: RMC Requests for VBMS Claims

PART I: PIES REQUESTS FOR VBMS CLAIMS

Stations must ensure the “VBMS” Corporate Flash is added to every claimant’s profile that has a VBMS claim, including VONAPP Direct Connect (VDC) claims filed in VBMS.

Notes: After submitting a PIES request, make an annotation in the e-Folder to confirm the request

has been submitted. Please follow the VBMS Job Aid guidelines to make an annotation. When the PIES request is completed, the records and/or completed 3101 request are being

directly sent for scanning. No other action is needed by the Regional Office.

Table A: PIES RequestsIf… Then…A PIES request is required for service Use the PIES O50 request code.

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treatment and/or personnel-related records, including PIES O34, O18, O19, M01, S01, etc.,

The single O50 request will notify the NPRC to acquire all of the claimants’ available Service Treatment Records (STRs) and Official Military Personnel File (OMPF) records and scan and upload these records into the VBMS eFolder.

A PIES request is required for clinical records and/or morning reports requests,

Follow standard procedures.

NPRC will use the “VBMS” Corporate Flash as an indicator to ship the records for scanning and ensure the records are uploaded into the VBMS eFolder.

PART II: RMC REQUESTS FOR VBMS CLAIMS Stations must ensure the “VBMS” Corporate Flash is added to every claimant’s profile that has a VBMS claim, including VONAPP Direct Connect (VDC) claims.

Table B: RMC RequestsIf… Then…A claims folder is located at RMC, The station must request the claims folder via

COVERS.

RMC will use the “VBMS” Corporate Flash as an indicator to ship the claims folder for scanning and ensure the claims folder is uploaded into the VBMS eFolder.

STRs are located at RMC, The station must request the STRs by sending an email to the RMC’s new mailbox: VAVBASTL/RMC/RCD. The SUBJECT line of the email should read “VBMS STR.”

RMC will use the “VBMS” Corporate Flash and the station’s email as indicators to ship the STRs for scanning and ensure the STRs are uploaded into the VBMS eFolder.

Important: Stations may experience delays in receiving images in a claimant’s VBMS eFolder due to

various factors. Only submit a follow-up STR and/or personnel records (PIES) request to the VAVBASTL/RMC/VBMS mailbox if the request status shows “Open” and the response is not received within 45 days. Do not submit duplicate O50 PIES requests. Do not submit a follow-up request to the RMC VBMS mailbox if the request status shows “Closed.”

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If a station erroneously receives paper STRs from the RMC for a VBMS claim, send those records to the station’s assigned vendor for scanning. Continue to follow other established guidance when STRs are received, including guidance under M21-1MR.III.ii.2.E.21c, for handling supplemental service treatment records.

Summary of Substantive Changes to this TIP Sheet

The table below provides a summary of the substantive changes made to this TIP Sheet since the last version:

Change ReasonAdded guidance regarding using an annotation in the eFolder to confirm when a PIES request is submitted.

Added a note stating that once the PIES request is completed, the records and/or completed 3101 request are being directly sent for scanning. No other action is needed by the Regional Office.

Added a 45 day timeframe for submitting a follow-up on PIES O50 requests.

To improve process efficiency and consistency.

Reference: VBMS Tip Sheet, Procedures for Requesting Federal Records from RMC or NPRC for VBMS Claims

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Section 29.14

Service Records Development & PIES

Certification of Completeness of Service Treatment Records (STRs)

The purpose of Fast Letter 13-09 is to inform VA Regional Offices of the Department of Defense (DoD) policy on certifying the completeness of paper service treatment records (STRs).

This fast letter was amended September 10, 2013, to introduce the new Department of Defense Form (DD Form) 2963 “Service Treatment Record (STR) Transfer or Certification” for certification of the STRs.

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Change 37February 21, 2014

Section 29.15

Service Records Development & PIES

New Personnel Information Exchange System (PIES) Request Codes for Claims Processed in VBMS

Nine new request codes have need added to the PIES in order to assist the VA Liaison Office (VALO) determine which records need to be sent to the VA Regional Office (RO) and which records need to be sent to the VBMS scanning contractor. These requests codes are for clinical (inpatient records), Surgeon General Office (SGO) records, Morning Reports, Sick Reports, and Affiant “Buddy” records. These new request codes should be used when processing a claim within VBMS.

The new PIES request codes are listed in PIES as follows:

C01-V Clinical Records for VBMS Cases, Furnish active duty inpatient clinical records for <<alleg>> from <<fd>> to <<td>> at <<clinic/hosp>>.

C02-V Military Retiree Outpatient for VBMS Cases, Furnish records for <<alleg>> from <<fd>> to <<td>> at <<hosp>>.

C03-V Inpatient Dependent Medical Records for VBMS Cases, Furnish inpatient dependent medical records for <<alleg>> <<hospital>> from <<mm/dd/yyyy>> to <<mm/dd/yyyy>> <<sponsor name>> <<sponsor ssn/sn>> <<sponsor branch of service>> <<relationship to sponsor>>

C04-V Outpatient Dependent Medical Records for VBMS Cases, Furnish outpatient dependent medical records for <<alleg>> <<clinic/hospital>> <<date last year treated at this facility - mm/dd/yyyy>> <<sponsor name>> <<sponsor ssn/sn>> <<sponsor branch of service>> <<relationship to sponsor>>

M05-V Medical/Dental and SGOs, Furnish medical/dental records and SGOs (Potential Fire-Related Case). If no medical/dental records or SGOs, please search sick/morning reports. Sick/morning reports for <<org>> from <<fd>> to <<td>> for remarks pertaining to <<alleg>>

M06-V SGO, Furnish any SGO records

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Change 37February 21, 2014

O20-V Morning Reports for VBMS Cases, Search Morning Reports of <<org>> from <<fd>> to <<td>> containing remarks regarding <<rem>> (note: morning reports were rarely created after 1974)

O38-V Verifying Service of Affiants - Buddy Records

S02-V Service, Verify All Periods Of Service. The information provided in the pop-up grids is furnished to help in identifying or reconstructing a record that could not be located. Note: before you complete the grids, be sure to verify the: name served under, SSN, and provide SN, if applicable.

Reference: Compensation Service Bulletin, September 2013

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Change 37February 21, 2014

CHANGES Change 5, June 24, 2004, clarified procedures for requesting STRs when only dental records are received from the VA RMC.

Change 6, July 9, 2004, consolidated follow-up procedures for verification of military service.

Change 7, July 26, 2004, clarified follow-up procedures to the VA RMC; added notes from July 2004 PIES Teleconference notes regarding PIES Request Codes O40, O41, O42, and O43.

Change 8, August 5, 2004, reflects change made to M21-1, Part III, Chapter 4 regarding contacting US Armed Services Center for Unit Records Research (USASCURR) for verification of Vietnam service only after the Veteran and the service department have been unable to determine such service.

Change 9, August 31, 2004, added screen shot of PIES O40 request code dialog box.

Change 10, February 17, 2005, incorporated the PIES Request Codes O40, O41 and O42 “mini” training guide; added guidelines for requesting Navy records from Address Code 31, Bureau of Naval Personnel.

Change 11, March 1, 2005, provided guidance regarding requests for morning reports, sick reports, and SGO records being limited to a 90-day period; clarified development guidelines for service treatment records for fire-related cases and non-fire related cases.

Change 12, March 14, 2005, divided the section into sub-sections; incorporated references within each appropriate topic; clarified guidance with regard to follow-up action and moved guidance regarding alternative sources to section 21.

Change 13, June 27, 2005, added Section 17.11, PIES Request S02 Screen Prompt

Change 14, February 27, 2006, added guidance for printing multiple DPRIS images.

Change 15, October 12, 2006, added guidance for requesting Air Force Office of Special Investigation reports (Section 17.4).

Change 16, November 26, 2006, added e-mail address for RMC points-of-contact when requesting STR’s; added DPRIS Dates.

Change 17, December 20, 2006, added M21-1MR references.

Change 18, January 10, 2007, added M21-1MR references regarding requests for separation documents which is required for authorization of benefits but is rarely needed for compensation or pension benefits.

Change 19, April 10, 2007, updated sections (Development of Service treatment records, Development for Service Verification, PIES Helpful Hints) with guidance regarding the submission of PIES requests. Added sections on Service Records Codes and Records Loaned to Department of the Army Review Board/Army Discharge Review Board. Added M21-1MR reference for follow-up development. Deleted POC e-mail addresses at VA RMC for requesting STRs.

Change 20, April 16, 2007, added a section on contacting the PIES Help Desk; added DPRIS follow-up procedures for Army, Navy, Marine Corps and Air Force OMPF records.

Change 21, December 7, 2007, added guidance regarding requests for Coast Guard service records.

Change 22, May 18, 2008, added guidance regarding DPRIS requests (received with the January 15, 2008 PIES Conference Call Notes).

Change 23, June 12, 2008, added guidance regarding on locating line of duty determinations.

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Change 37February 21, 2014

Change 24, April 16, 2009, added guidance regarding verification of participation in “special operations” incidents.

Change 25, September 3, 2009, added M21-1MR reference regarding mental health records.

Change 26, November 23, 2009, deleted guidance regarding DPRIS request through PIES.

Change 27, December 13, 2009, added guidance regarding verification of participation in “special operations” incidents per FL 09-52.

Change 28, December 14, 2009, added guidance regarding requests for entrance/exit physicals and MEBs/PEBs via PIES or DPRIS.

Change 29, January 25, 2010, added guidance regarding requests for Public Health Service records.

Change 30, May 19, 2010, added guidance regarding requests for facts and circumstances.

Change 31, February 14, 2011, added guidance regarding instances when an e-mail to the PIES Coordinator is requested; 1) requests for the entire personnel file (O18) and 2) sending requests without service numbers when only service numbers were utilized during specific periods.

Change 32, November 28, 2011, added guidance regarding PIES Mailboxes.

Change 33, April 17, 2013, added a reference for PIES Request Codes.

Change 34, July 22, 2013, added guidance from the Addendum Compensation Service Bulletin, June 2013, regarding PIES requests and availability of STRs usng VistaWeb/DoD Records.

Change 35, August 19, 2013, added guidance from the VBMS Tips Sheets regarding “Procedures for Requesting Federal Records from RMC or NPRC for VBMS Claims.”

Change 36, September 19, 2013, added guidance FL 13-09 regarding certification of STRs by DOD agencies; added guidance from the September 2013 Compensation Service Bulletin regarding new PIES request codes for VBMS.

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Change 4July 22, 2013

Section 30

Defense Personnel Record Information Retrieval System (DPRIS) Requests

REMINDERS FOR FEDERAL RECORDS DEVELOPMENT (AD DE ND U M CO MP EN SAT IO N SERV ICE BU LL E TI N , JU NE 2013 )

A recent analysis of claims in the backlog that were identified as having outstanding requests for Department of Defense (DoD) records was conducted. Below are some of the reminders for development processes:

Defense Personnel Records Image Retrieval System (DPRIS) – Used for requesting Official Military Personnel Files (OMPF) and Joint Services Records Research Center (JSRRC) responses.

o Notification of response available is sent in an email to the requestor.o Response is available for 35 days, then purged from DPRIS.

If OMPF is not retrieved with 35 days, request must be re-submitted through DPRIS.

If JSRRC is not retrieved within 35 days, an email must be sent to VAVBAWAS/CO/JSRRC asking for a copy of the response (Do not submit another request.).

E-mail request must contain DPRIS Web ID, Veteran’s last name and date request was added.

Reference: Addendum Compensation Service Bulletin, June 2013

DPRIS IMAGES (DEFENSE PERSONNEL RECORDS IMAGING SYSTEM)

Requests for service records to any service records center other than NPRC, Air Force and Coast Guard, must be submitted as though the only records available will be imaged records (DPRIS images).

The following PIES request codes cannot be used when directing a PIES request to any service records center other than NPRC, Air Force and Coast Guard: M01, M05, M06, O03, O04, O20, O23, O26, and O99.

NPRC does not have the capability of providing images from DPRIS request codes (11, 21, 22, 31, 36, 41, and 42) or forwarding requests to DPRIS address codes. Requests should be re-submitted to the DPRIS address for the necessary images. Reference: VAVBAWAS/CO/OFO E-mail, Subj: PIES Error Reports, dated April 6, 2007.

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Change 4July 22, 2013

ARMY DPRIS FOLLOW-UP REQUESTS

All Army DPRIS follow-up requests should now only be sent to the following email address: hrc.tagd.Veterans@conus.army.mil.

The perms.records@conus.army.mil  e-mail address is now used for the indexing section and they do not have the ability to respond to requests. PLEASE DO NOT SEND REQUESTS TO THIS ADDRESS!

Please remember, these email addresses are NOT encrypted and if your ISO allows you to send requests to the hrc.tagd.Veterans@conus.army.mil email address DO NOT send the full social security number as this is a security violation. For those offices where your ISO does not allow you to send such emails, forward those requests to Willis Conner, VBAVACO, or to the VAVBAWAS/CO/PIES mailbox for assistance in transmitting the follow-up request.

Reference: E-mail From: Conner, Willis, VBAVACO, Sent: Friday, August 19, 2011 12:24 PM, Subject: Army DPRIS Follow-up Record Requests

ACRONYMS

DPRIS – Defense Personnel Record Information Retrieval SystemPIES – Personnel Information Exchange SystemSTR – Service Treatment RecordsMEB – Medical Evaluation Board ProceedingsPEB – Physical Evaluation Board ProceedingsOMPF – Official Military Personnel File

DPRIS DATES

The availability of OMPF records are through DPRIS for service members separated on or after the following dates has been updated as of May 17, 2012 (reference email dated May 17, 2012, Subject: Validating the Army/Navy OMPFs available via DPRIS, From: Bodyk, Andrew, VBAVACO).

Army: October 1, 1994

Air Force: October 1, 2004

Navy: January 1, 1995

Marine: January 1, 1999

Coast Guard is currently not available through DPRIS

If the date is within 2 weeks of the above dates, submit your request through DPRIS first and if you receive a negative response, submit your request through PIES.

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Change 4July 22, 2013

If a Veteran’s military service, which includes reserve and National Guard service, ends on or after the above dates, then the Veteran’s OMPF should be available via DPRIS.

There are no STRs available through DPRIS. The only medical records available through DPRIS are the entrance physical, separation physical, and depending on the military service, the MEB/PEB. Guidance regarding MEB/PEB proceedings has been provided to the Military Records Specialists.

Please see the M21-1MR.III.iii.2.B for the proper flow of STRs from the military services to the VA Records Management Center (RMC).

NPRC stopped receiving STRS for service members separated on or after the following: Navy: January 31, 1994 Army: October 16, 1992 Marine Corps: May 01, 1994 Air Force: January 01, 1994 Coast Guard: May 01, 1998

Note: The Air Force Reserve Command (ARPC – code 21) does not receive STRSs. The exit and/or entrance physicals may be part of the OMPF. Please do not contact them for the entire service medical record.

HOW DPRIS WORKS

PIES/DPRIS requests are complied and stored throughout the workday. During the evening, the batched PIES/DPRIS requests are sent to DPRIS.

DPRIS sorts the requests by address codes and submits them to the requested military service’s image repository.

The image repository receives these requests, processes the request for the specified documents, and returns the request with the requested images or with a negative response.

DPRIS stores the responses throughout the workday. During the night, the responses are transferred from DPRIS to PIES and made viewable for the requester. The requester will also receive an automated e-mail stating that a particular response will be viewable with 24 hours.

The requester should be able to access the response to their request through the PIES application.

Important: Once the response is purged, the response is no longer viewable or retrievable. If the requester or DPRIS Super User failed to print out the images, another request will need to be submitted.

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Change 4July 22, 2013

GENERAL INFORMATION ON DPRIS FOLLOW-UP REQUESTS

BEFORE A FOLLOW-UP REQUEST IS SUBMITTED:

A review of the claims folder should be conducted.

A review of the information submitted in PIES/DPRIS request should be conducted.

A search for images that have been printed and put in search mail should be conducted.

If unsure if a follow-up request is warranted – see your Military Records Specialist.

FOLLOW-UP REQUESTS:

Can only be submitted during the 76 days the response is viewable.

When submitting a follow-up request, please spell out in detail what is needed.

Do not state that you need the information for request code S01 or O19 – as an example, do not ask for the 201 file, and do not ask for a specific form number (If you ask for the AF 180 and the Air Force is now using the AF 180-A, and the Veteran’s OMPF has the AF 180-A and not the AF 180, you will get a response from the action officer that there is no AF 180 in the Veteran’s file).

Supply your name, phone number, fax number, and RO mailing address in your follow-up request.

Submitted follow-up request is routed to an action office at that particular military service’s image repository.

Action officer will respond to your request by making the information available via DPRIS or by mailing/faxing it to you. The action officer should also inform you if the information cannot be located or reconstructed.

WHERE TO SUBMIT YOUR FOLLOW-UP REQUEST:

Address code 11:

Army Enlisted Records: e-mail: Tony Eclavea at antonio.b.eclavea@us.army.mil

Army Officer Records: e-mail: Diane Mitchell at queen.mitchell@conus.army.mil or via fax at 703-325-5204

Army Reserve or Retiree Records: Fax the U.S. Army Human Resources Command at 314-592-0532

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Change 4July 22, 2013

Address Codes 21 and 22 (Air Force): submit follow-up through DPRIS using the follow-up button.

Address code 31 (Navy): submit follow-up through DPRIS using the follow-up button.

Address code 41 (Marine Corps): submit follow-up through DPRIS using the follow-up button.

Important: If your PIES/DPRIS request does provided the needed information and the follow-up request is not answered or does not provide the needed information, please see your Military Records Specialist. You may need to contact the PIES Help Desk at VAVBAWAS/CO/PIES for further assistance.

Important: Since privacy act data, which includes social security numbers can not be sent to these e-mail accounts, please ensure that you provide the following in the e-mail:

Veteran’s Full name (Last, First, MI)

For Officers please include Rank as well

Be very specific as what you need

ADDITIONAL NOTES

All DPRIS requests are computer automated. These requests cannot be expedited.

Code 13 does not maintain or have access to ANY of the military service’s image repositories. Do not contact them for DPRIS images or any other DPRIS related issue. This includes e-mailing the LNO Mailbox (VAVBASTL/RMC/LNO), and the PIES Error Box (VAVBASTL/RMC/Error).

The VA Records Management Center (RMC) does not maintain or have access to ANY of the military service’s image repositories. Do not contact them for DPRIS images or any other DPRIS related issue.

Do not submit an O99 request to code 13 requesting DPRIS images.

DPRIS FOLLOW-UP FOR NAVY, MARINE CORPS AND AIR FORCE OFFICIAL MILITARY PERSONNEL FILE (OMPF) RECORDS

Use the DPRIS follow up system for Navy, Marine Corps, and Air Force.

Please review M21-1MR.III.iii.2.I for the procedure on follow-up requests

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Change 4July 22, 2013

TECHNICAL PROBLEMS WITH DPRIS

Contact IRM for technical problems associated with DPRIS. These include, but are not limited to:

Images received, but cannot be viewed.

Receiving e-mails that images will be available to view in 24-48 hours and no images are arriving to include the negative responses for images.

CHANGES Change 1, August 29, 2011, added guidance regarding follow-up requests for Army records; received from VACO.

Change 2, November 28, 2011, added Quations & Answer regarding the availability of personnel records prior to the established DPRIS dates.

Change 3, May 20, 2012, added guidance regarding new DPRIS dates for OMPF records.

Change 4, July 22, 2013, added guidance from the Addendum Compensation Service Bulletin, June 2013, regarding DPRIS requests.

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Change 3December 12, 2006

Section 31

Willful Misconduct & Vehicle Accident Injury_______

WILLFUL MISCONDUCT DETERMINATIONS

Service connection will not be granted if a disease or injury is the result of the Veteran’s own willful misconduct.

Refer to M21-1MR.III.v.1.D15 for guidance regarding general information on willful misconduct determinations, including information on

the definition of the term willful misconduct

when to make a willful misconduct determination

when not to make a willful misconduct determination

responsibility for determinations

cases in which additional development is required, and

cases in which willful misconduct must be proximate or direct cause of injury.

WILLFUL MISCONDUCT DETERMINATIONS & ALCOHOL DETERMINATIONS

Refer to M21-1MR.III.v.1.D16 for guidance regarding information on willful misconduct determinations and alcohol consumption. It includes information on

proximate and immediate effects of alcohol consumption

making determinations of willful misconduct involving alcohol

standards set by the National Safety Council, and

organic diseases and disabilities resulting from chronic use of alcohol.

WILLFUL MISCONDUCT DETERMINATIONS & VEHICULAR ACCIDENTS

Do not develop for line of duty or willful misconduct in cases involving motor vehicle accidents unless there is positive evidence of record showing potential willful misconduct, such as medical records or police reports showing intoxication of the Veteran at the time of the accident.

Refer to M21-1MR.III.v.1.D17 for guidance regarding information on willful misconduct determinations and vehicular accidents. It includes information on

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Change 3December 12, 2006

when to make willful misconduct determinations in regards to vehicular accidents

considering evidence of wanton and reckless disregard

affording appropriate weight to service department findings, and

combined factors to be considered.

Request Line of Duty (LOD) determination from the service department if it appears line of duty is an issue.

Submit PIES Request Code O12; Select MAPD Third Party Development pick, Furnish Line of Duty for accident, to create a tracked item.

If civilian authorities may have been involved, send a request for the police report. Send MAPD Third Party Development Letter, Request report of accident investigation.

After development for service department information, if it is determined that further development concerning an accidental injury is necessary, send the vetean VA Form 21-4176, Report of Accidental Injury in Support of Claim for Compensation or Pension.

Send MAPD Claimant Letter, Compensation Letter, Accidental injury - 21-4176 needed.

When you have all of the evidence required to make a determination, complete an administrative decision. The evidence could be any or all of the following:

Response received from the service records center

VA Form 21-4176 from the Veteran

Police report – if necessary, send MAPD Third Party Development Letter, Request report of accident investigation.

Medical evidence, especially lab results

Testimony from the claimant or others

Do not wait for other evidence for the compensation claim, which may not be pertinent to the determination.

PROHIBITION OF PAYMENT OF COMPENSATION FOR A DISABILITY RESULTING FROM ALCOHOL OR DRUG ABUSE FOR CLAIMS FILED AFTER OCTOBER 31, 1990

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Change 3December 12, 2006

Refer to M21-1MR.III.v.1.D18 for guidance regarding information on the prohibition of payment of compensation for a disability resulting from alcohol or drug abuse for claims files after October 31,1990. It includes information on

the provisions of 38 U.S.C. 105, 38 U.S.C. 1110, and 38 U.S.C. 1131

considering effective dates

the definition of the terms- alcohol abuse, and- drug abuse

considering the accidental or careless use of prescription or non-prescription drugs, and

determining- when Dependency and Indemnity Compensation (DIC) is or is not payable, and- service connection for secondary conditions.

CHANGES

Change 2, January 1, 2006, incorporated references within each topic

Change 3, December 12, 2006, references updated.

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January 1, 2011

Section 32

Line of Duty Determinations_______

LINE OF DUTY DETERMINATIONS

Refer to M21-1MR.III.v.1.D19 for guidance regarding information on line-of-duty determinations, including information on

the responsibility for line-of-duty determinations

preparing an administrative decision for approval

when line-of-duty determinations are required

when a line-of-duty determination is not required, and

a line-of-duty determination when death occurred on or after January 1, 1957.

IF THE VETERAN IS ON ACTIVE DUTY

Navy (MC) LOD investigations may or may not be in the health jacket or in the personnel file, so it makes sense to begin your search with a PIES request for LOD. This request is accepted for DPRIS time frames as well as earlier dates, but LOD determinations are unlikely to be part of an imaged record. If you get several imaged records back in response to a PIES/DPRIS request for LOD but what you want isn't among the images, it isn't in there at all. Do not bother to send follow-ups or second requests via PIES. Instead, contact one of the following:

For LODs from 1918 through 1995

Office of the Judge Advocate General Code 15 - Claims and Torte LitigationAttn: Investigative Branch9620 Maryland AvenueSuite 100Norfolk, VA 23511-2989

For LODs after 12-31-95

First Flag Officer at the command where the incident occurred.

Note: All hard copy requests to the First Flag Officer at the command where the incident took place or to the Office of the Judge Advocate General should contain the requestor’s name, phone, fax number, and their RO mailing address.

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January 1, 2011

Air Force LOD investigations are supposed to be part of the personnel jacket or the health jacket or both, so it makes sense to begin your search with a PIES request for LOD. This request will be accepted for DPRIS time frames as well as earlier dates, and LOD determinations are supposed to be part of an imaged record. If you get several imaged records back in response to a PIES/DPRIS request for LOD but what you want isn't among the images, you can send a follow-up to the AF.

Army LOD investigations should be in the personnel jacket and often there are copies in the health jacket, too. So, it makes sense to begin your search with a PIES request for LOD. This request is accepted for DPRIS time frames as well as earlier dates, and LOD determinations are usually in the imaged record (if it was imaged within the last year).

Note: For the period from about 1996 to 2001, LOD records often did not make it into the personnel jacket. Code 11 has thousands of these which are currently being interfiled/ drop filed by NPRC personnel into the records ARPERSCOM has transferred to code 13. The only thing you can do in these cases is hope the LOD is in the file at code 13 when you request it.

When making requests to the Navy and Marine Corps branch include in the correspondence the requestors name, phone number, fax number and RO mailing address.

If after 60 days a response has not been received, send a 30 day follow-up letter.  If there is still no response after 30 days, contact the PIES Help Desk for further guidance.

Finally, if a mailing address for the First Flag Officer at the command at which the incident occurred cannot be located, contact the PIES Help Desk.  Please do your own research first before contacting the PIES Help Desk for assistance.

Reference: E-mail dated Tuesday, May 13, 2008, 1:31 PM, subj: Locating Line of Duty Determinations, from Andrew P. Bodyk, Interagnecy Data Analyst

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January 1, 2011

Section 33

Facts and Circumstances_______

Per M21-1, Part III, Chapter 4, Addendum A, write the appropriate JAG office to obtain the details of a service member's discharge that resulted in an other than honorable discharge.

Transcripts of courts martial that result in an other than honorable discharge, undesirable discharge, or bad conduct discharge are kept at the respective Judge Advocate General (JAG) office. Send a letter requesting the copies to the appropriate office. Do not use PIES. The request should include the service member's name, VA file number, social security number, service number (if applicable), and dates of service.

If the individual was discharged from the National Guard, submit a written request to the Adjutant General's from the state in which the Veteran was discharged. These addresses are located in M21-1, Part III, Chapter 4, Addendum F.

Transcripts of a court martial that resulted in an other-than-honorable discharge, undesirable discharge, or bad conduct discharge are kept at the respective Judge Advocate General (JAG) offices.

Send a letter requesting the copies to the appropriate office and include in the request the service member's

Name VA file number Social Security number (SSN) Service number, if applicable, and Dates of service.

Note: Do not use PIES to make this request.

The table below lists the addresses and telephone numbers for the JAG offices of each service departments.

Department of Service

Address Telephone Number

Army Office of the Clerk of CourtU.S. Army Judiciary901 N. Stuart StreetArlington, VA 22203-1837

Fax only at(703) 696-8777

Air Force AFLSA/JACL1501 Wilson Boulevard

(703) 696-9147

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January 1, 2011

Department of Service

Address Telephone Number

Arlington, VA 22209

Navy/Marine Corps Appellate Review ActivityOffice of the Judge Advocate GeneralDepartment of the NavyWashington, DC 20370

(202) 685-7070

Note: Requests for court martial transcripts and proceedings for Navy/Marine Corps Veterans may be faxed to the Officer in Charge of the Appellate Review Activity at (202) 685-7687. Fax number for the Army is (703) 696-8777.

Reference: E-mail Subject: Updated Army JAG HQ address and fax, dated May 19, 2010, A. Bodyk, VBAVACO

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Change 24January 20, 2014

Section 34

Reserve & National Guard Development_______

1 – General Guidelines...........................................................34.2

2 – Reserve Records Development........................................34.3

3 – National Guard Records Development..........................34.5

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Change 24January 20, 2014

Section 34.1Reserve & National Guard Development

General Guidelines

PRIVATE TREATMENT RECORDS FOR RESERVE/GUARD SERVICE

VA generally pays compensation for a disability incurred in or aggravated during active military service. However, the law also provides that VA may pay compensation for a disability resulting from a disease or injury incurred in or aggravated by active duty for training, an injury incurred in or aggravated by inactive duty for training, or resulting from a covered disease manifesting during inactive duty for training.

We have discovered cases in which service connection was denied because there was no evidence of treatment for an injury or disease in the official service records relating to Reserve or National Guard duty; however, the individual received private medical treatment for a condition related to such duty during or in close proximity to the time frame in which the Reserve/National Guard duty was conducted. The private treatment records were not obtained for consideration.

Please ensure that the claimant is informed of the necessity of providing private treatment records related to Reserve/National Guard service in support of a claim for disability benefits. If private medical records are obtained showing treatment for a condition related to Reserve/National Guard duty and there is competent evidence of a current disability, a VA examination may be required if the available record does not contain sufficient competent medical evidence to decide the claim. See 38 CFR 3.159(c)(4).

Reference: Compensation Service Bulletin, December 2013

QUICK REFERENCE GUIDE FOR GUARD AND RESERVE RECORDS

In order to facilitate locating Service Treatment Records (STRs) and official military personnel records for individuals in the Reserves or National Guard, we have posted a quick reference guide in the User’s Guides section of the C&P Service Intranet Publications page. You can find the guide under “N” (for National Guard) as well as “R” (for Reserve). Direct any questions or comments about this guide to the pies help desk at VAVBAWAS/CO/PIES.

Reference: C&P Service Bulletin, April 2008.

NO SPECIFIC DISABILITY CLAIMED

If the Veteran does not provide a specific disability:

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Change 24January 20, 2014

Send development letter requesting the specific disability.

If no response in 30 days, refer to Administrative Denials section of this guide for further details.

Note: If “exposure” is the only allegation, the claims is not substantially complete and should not be controlled. (See M21-1MR.I.1.B.3.b, for information on handling incomplete claims.)

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Change 24January 20, 2014

Section 34.2Reserve & National Guard Development

Reserve Records Development

CONTROL OF AND FOLLOW-UP ON REQUESTS TO RESERVE UNITS

If no response is received from the Reserve unit 60 days after the date of the original request, contact the unit by telephone, document the call on VA Form 21-0820, and extend the suspense date 30 days if receipt of the records is expected.

If the Reserve unit fails to respond to a follow-up request, contact the claimant by telephone and advise him/her of the records requested, what records are required, the records VA was unable to obtain, and that he/she should ask the unit to send the records within 30 days. Don’t forget to document the call on VA Form 21-0820. If an attempt to contact the claimant by telephone is unsuccessful, provide written notification.

If the records cannot be obtained at the end of 30 days, complete a Formal Finding of Record Unavailability as indicated in M21-1MR.III.iii.2.I.59.

Reference: M21-1MR.III.iii.2.I for further guidance.

DUTY STATUS AND ELIGIBILITY OF RESERVISTS

Refer to M21-1MR.III.ii.6, Duty Status and Eligibility of Reservists, for guidance regarding

1) duties of the Reservist

2) the eligibility of the Reservist for compensation and pension

3) Reserve programs in which members serve full-time in the Uniformed Services

4) developing claims submitted by Reservists

MARINE CORPS SERVICE RECORDS – STRS OR VERIFICATION OF SERVICE

Service member has a reserve obligation after being released from active duty and is assigned to a Reserve unit:

Send a letter to the unit of assignment using the MAPD Third Party Development Letter, Service information from Reserve or Guard Unit.

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Change 24January 20, 2014

OR

“MOBCOM is no longer maintaining STRs for Marines who are in the IRR.  All STRs that were being maintained at MOBCOM have now been transferred to the VA RMC.  If any Marine Corps unit sends the Veteran's STR to MOBCOM, MOBCOM will immediately send the STR to the VA RMC.” E-mail from Andrew Bodyk, VBAVACO, Subject: STRs located at MOBCOM, dated February 7, 2008, 7:24 AM.

Service member has a reserve obligation after being released from active duty but is either inactive or has not yet been assigned to a Reserve unit, the STRs will be sent to MOBCOM in Kansas City, MO. These STRs cannot be requested through the PIES/DPRIS interface. The only option is to fax a request to MOBCOM

Send a FAX to (816) 843-3077 or 3002 using the MAPD Third Party Development Letter, Service information from Reserve or Guard Unit.

Note: Customer Service number is (816) 843-3395; e-mail address is csc@cdc.usmc.mil

AIR FORCE & NAVAL SERVICE RECORDS – STRS OR VERIFICATION OF SERVICE

Currently assigned to a reserve unit:

Send a letter to the unit of assignment using the MAPD Third Party Development Letter, Service information from Reserve or Guard Unit.

If the Navy veteran is still in a Navy reserve unit in Colorado, his/her STRs are at:

NOSC DenverAttn: Medical Records7 N. Snowmass St.Bldg 1301, Stop 62, Rm 4-211Aurora, CO 80011

Phone: 720-847-7881 (people will answer the phone most of the time)Fax: 720-847-7889

OR

Separated/retired from the a reserve unit:

If the Veteran is recently separated/retired from a reserve unit, send a letter to the unit of assignment using the MAPD Third Party Development Letter, Service information from Reserve or Guard Unit.

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For specific guidance regarding development to a service records center, refer to the section entitled Service Records Development & PIES for further guidance.

Once the service member is separated from the reserves, the STRs are sent to RMC within a couple months of separation.

The Navy Manpower Office phone number is 720-847-7182. They just have a skeleton jacket of each reservist’s personnel records. All records are being stored electronically and the Manpower office reported that they cannot access the records. Each Veteran/serviceman/reservist has an account number and PIN that they can access their records on-line with. The Veteran will have to go in and submit an electronic or printed copy of their records. It may be necessary to inform the Veteran that by telephone or by letter.

SAIC – SCANNING OF RESERVE STRS

SAIC, the Reserves contractor for scanning STRs, enters the records into a database and returns the original STRs as directed.

If the original STRs are received from SAIC, review the STRs and validate the Veteran is a Reservist via VIS. If the Veteran is a reservist, make a copy of the originals and send the records to the reserve unit.

If VIS shows the Veteran is discharged or retired, then the original STRs should be retained with the claims folder and/or forwarded to RMC.

The STRs may need to be request from the reserve unit. The reserve units may be keeping the original STRs even after the individual was discharged or retired from the reserves. (e-mail From: Bodyk, Andrew, VBAVACO, Sent: Wednesday, December 15, 2010 12:11 PM, Subject: Reserve Records sent to the RO by SAIC)

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Change 24January 20, 2014

Section 34.3Reserve & National Guard Development

National Guard Records Development

NATIONAL GUARD RECORDS DEVELOPMENT

National Guard (NG)/Reserve military records development.

Reference: M21-1MR.III.iii.2.I.57)

WAITING PERIODS

The waiting period after making requests for Federal Records: Allow 30 days for a response to the initial request; 15 days for follow-up requests.

Reference: M21-1MR.I.1.C.5d, Requesting Federal Records

ACTIONS TO TAKE WHEN ATTEMPTS TO OBTAIN FEDERAL RECORDS ARE UNSUCCESSFUL

If the records cannot be obtained, prepare a “final-attempt letter” per M21-1MR.III.iii.2.I.59.

DUTY STATUS AND ELIGIBILITY OF PERSONNEL IN THE NATIONAL GUARD SERVICE

Refer to M21-1MR.III.ii.6, Duty Status and Eligibility of Personnel in the National Guard Service, for guidance regarding 1) service by National Guard personnel in ACDUTRA which does not qualify as active duty; 2) qualifying service under 10 U.S.C.; 3) qualifying service under 32 U.S.C.; 4) verification of National Guard Service, and 5) cases in which National Guard personnel are discharged for a disability.

ARMY NATIONAL GUARD & AIR NATIONAL GUARD RECORDS

Air & Army National Guard records are maintained at the Colorado National Guard Military Records Archives.  Limited medical records, to include some LODs, and some summary medical documents may be available. To request records, send a letter (to include an SF 180), fax , or email to the Colorado National Guard Archives-Administrator (Cindi Williams).

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For all Army National Guard and Air National Guard personnel records (retired and actively with a unit), first Cindi Williams; her contact information is noted below. She has access to personnel records for Air National Guard personnel who have been retired and to Army National Guard records.

In MAPD choose the “Service Records from National Guard” pick in “3rd Party”.

Here’s how to get there: Once you have the veteran’s record pulled up in MAPD, left click on “Contentions” at bottom right. Next left click on “3rd Party” at the bottom. At the top of the next page choose Request type “Letter”. Scroll down and pick “Service records from National Guard”. Left click on “Add/Edit” and add the address below for Cindi Williams. Then left click on “To Continue”. Check the circle next to “Service records from National Guard” and left click on “Word” at the bottom right.

Insert a paragraph at the beginning of the MAPD letter to Cindi Williams telling her exactly what you have and what you need if you don’t need the whole file (just like you would if you emailed her). Include your name, phone number, email and fax. If you don’t include at least an email and fax, Cindi Williams won’t be able to get it to you.

Fax the letter to the number below. File all copies in file, and don’t mail them.

Cindi Williams will likely email you the scanned documents within two or three days, or she will tell you she does not have any records.

If the scanned copies are unreadable, call Cindi Williams and she will fax them.

Send MAPD Third Party Development Letter, to the following address (include a VA telephone number and point of contact in the letter). Attach SF 180 (see note below).

Archives - Administrator Attn:  Cindi Williams6848 S. Revere ParkwayCentennial, CO 80112-6709

Telephone: (720) 250-1560 (Cindi Williams, Archives Administrator)Fax: (720) 250-1589E-mail: cindi.williams@dmva.state.co.us

Note: An SF 180 must be signed by a VSR, as an authorized government agent, is required in order for copies to be furnished.

ARMY NATIONAL GUARD PERSONNEL RECORDS - COLORADO

If the Colorado National Guard Archives-Administrator (Cindi Williams) cannot obtain the personnel records for an Army National Guard member, follow the following guidelines.

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Army National Guard personnel records ranging in date from 1970s to present can best be obtained by mail.  

CURRENTLY ASSIGNED TO A NATIONAL GUARD UNIT:

Send MAPD Third Party Development Letter, Service records from National Guard to the following address (include a VA telephone number and point of contact in the letter ). Attach SF 180 (see note below). These are records for National Guard soldiers that are still on the active rolls of a National Guard unit.  

Colorado National GuardAttn: MILPO/iPERMS6848 Revere PkwyCentennial, CO 80112-6709

Telephone: (720) 250-1335

Note: Development to the address shown above should ONLY be for verification of service and/or other personnel related evidence. If an entrance or separation examination is needed, it may be possible to obtain a copy from the Colorado State Adjutant General, but that would be the extent of any medical records.

Note: Army National Guard regulations require that an SF 180 be signed by a VSR, as an authorized government agent, in order for copies to be furnished.

DISCHARGED/RETIRED – NO LONGER ASSIGNED TO A UNIT:

Send MAPD Third Party Development Letter, Service records from National Guard to the State Adjutant Generals Office at the following address (include a VA telephone number and point of contact in the letter):

Colorado Army National GuardAttn: MILPO/Discharge6848 Revere PkwyCentennial, CO 80112-6709

Telephone: (720) 250-1309

Note: Development to the address shown above should ONLY be for verification of service and/or other personnel related evidence. If an entrance or separation examination is needed, it may be possible to obtain a copy from the Colorado State Adjutant General, but that would be the extent of any medical records.

Note: The MILPO/Discharge office requires a specific statement in the body of the MAPD letter that copies of DD Form 214s or NGB Form 22s are requested.  The MILPO/Discharge office will only provide an RPAM which shows number of days Guard duty was performed each year with the code identifying the type of duty.  The RPAM does not clearly state whether or not the period was active duty without knowing

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the codes. The following statement should also be inserted in the MAPD letter: "If you do not have the records mark the appropriate box below." 

Note: CVA may be able to provide copies of original DD Form 214s for most Colorado Veterans who retired/separated from 1990 to present.  CVAs telephone number at their Lowry Office is (303) 284-6077.

Send a PIES request - when requesting verification of active duty for training dates from the National Personnel Records Center or other Service Department, use the PIES request code O99, Composed Request and note that the request is for active duty for training dates.

Note: For Enlisted personnel separated from the national guard - send PIES request to Code 11; For Officers separated from the national guard - send PIES request to Code 90

For further guidance regarding development to the service records centers, refer to to the section entitled Service Records Development & PIES.

DISCHARGED/RETIRED – NO LONGER ASSIGNED TO A UNIT, BORN PRIOR TO 1952:

Send MAPD Third Party Development Letter, Service records from National Guard to the following address (include a VA telephone number and point of contact in the letter ):

Colorado State Archives1313 Sherman St Rm 1B20Denver, CO 80203

Telephone: (303) 866-2358 or 2390Fax (303) 866-2257Lance.christensen@state.co.us

The office is closed on Wednesdays

ARMY NATIONAL GUARD SERVICE TREATMENT RECORDS (STRS) - COLORADO

Army National Guard service medial records need to be requested from the Deputy State Surgeons Office:

RECENTLY DISCHARGED OR CURRENTLY ASSIGNED TO A NATIONAL GUARD UNIT:

Send MAPD Third Party Development Letter, Service records from National Guard to the following address (include a telephone number and point of contact in the letter):

Colorado National GuardDeputy State Surgeons Office

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Change 24January 20, 2014

19070 E. Sunlight WayBldg 1000 Mail Stop 7Buckley AFB, CO 80011-9552

Telephone: (720) 847-8622Fax: (720) 847-8645

DISCHARGED/RETIRED – NO LONGER ASSIGNED TO A UNIT:

Check BDN LOC Screen for an STR folder located at VA RMC – if necessary send an e-mail to VAVBASTL/RMC/RCD (RMC) requesting the status of the STRs

If necessary, submit a PIES request - for specific guidance regarding development to the service records centers, refer to the section entitled Service Records Development & PIES.

Note: Do not request service treatment records from the Colorado Army National Guard, (Colorado Adjutant General); the Colorado Adjutant General WILL NOT have medical records. Medical records must be request through PIES or from the Colorado National Guard, Deputy State Surgeons Office (address shown above).

AIR NATIONAL GUARD SERVICE TREATMENT RECORDS

For Air National Guard STRs, Darla Hurlbut with the 140th Medical Group, (720) 847-7919, may be able to assist with the location of the STRs. These records are eventually sent to RMC after separation. Check BDN LOC Screen for an STR folder located at VA RMC – if necessary, send an e-mail to VAVBASTL/RMC/RCD (RMC) requesting the status of the STRs.

Medical records for service members who are Active Guard Reserve (AGR), contact Brittney Laque with the 460th Medical Group, Telephone (720) 847-7235, FAX (720) 847-7486, email at brittney.laque@us.af.mil, or call the 460th Medical Group Well Line, (720) 847-WELL or (720) 847-9355.

AIR NATIONAL GUARD PERSONNEL RECORDS

If the Colorado National Guard Archives-Administrator (Cindi Williams) cannot obtain the personnel records for an Air National Guard member, follow the following guidelines.

FOR PERSONNEL RECORDS OF AIR NATIONAL GUARD VETERANS BORN PRIOR TO 1952, SEND A REQUEST TO:

Colorado State Archives1313 Sherman St. Rm. 1B20Denver, CO  80203

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Telephone: (303) 866-2358 or 2390Fax (303) 866-2257Lance.christensen@state.co.us

Note: The office is closed on Wednesdays.

CURRENTLY ASSIGNED TO A NATIONAL GUARD UNIT OR RECENTLY SEPARATED/RETIRED:

1. ALL requests should be addressed to Buckley AFB, 460 MDG Outpatient Records, 275 S. Aspen Street, Stop 89, Buckley AFB, CO 80011. Outpatient medical records for service members currently on AD and empanelled to MTF. If there is a need for mental health records specifically in addition to the outpatient medical record, the records room will then pass the request on to our clinic. Otherwise, the records room will be able to immediately address the entire request for most patients. The request for records must include contact information; an email and/or a phone number.

2. Verify with the service members whether or not they were empanelled at the 460th MDG and/or where their medical records were located. If the service member was empanelled at the 460th MDG, hardcopy records will not be available.

3. Hard copy outpatient records are not housed for traditional Guardsmen or Reservists unless they are currently on extended active duty orders and, even then, it would only cover the timeframe they were on AD status. Just because they were stationed at Buckley does not mean they were eligible for care in the clinics (traditional Guard and Reserve usually do not have records here because they are not eligible for routine care). Traditional Guard and Reserve medical records are usually kept with the Guard/Reserve unit.

4. For those who have been released from active duty for a while (i.e., 1 year), it is likely their records have already been sent for permanent storage. Please make sure you ask the last date of active duty so that you know whether or not to contact the storage facility in St. Louis directly. As for mental health records, the clinic only keeps records on-site for 3 years after the termination date and then they are housed another 2 years on base, so anything older than 5 years would be in permanent storage in St. Louis or possibly destroyed (up until 2010 MH records were not sent for permanent storage).

POC: Capt Emily Eschbacher, TOPA Flight Commander, 460th MDG, Buckley AFB, telephone 720-847-9355.

NATIONAL GUARD SERVICE RECORDS OTHER THAN COLORADO

CURRENTLY ASSIGNED TO A NATIONAL GUARD UNIT,

* If the Veteran is currently assigned to a national guard unit, send a letter to the unit of assignment using the MAPD Third Party Development Letter, Service records from National Guard.

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Change 24January 20, 2014

* Send a letter to the appropriate State Adjutant General (see M21-1MR, Part III, Subpart iii, Chapter 2, Section K) using the MAPD Third Party Development Letter, Service records from National Guard.

SEPARATED/RETIRED FROM THE NATIONAL GUARD,

The Transition Assistance Advisors (TAA) internet site (TAA Contact List for each STATE / TERRITORY / DISTRICT) may be useful in providing a name/unit and address for National Guard units. http://www.taapmo.com/TAAprogram.htm Some addresses are incorrect and have not been updated on the internet site; known addresses are indicated below.

* If the Veteran is recently separated/retired from a national guard unit, send a letter to the unit of assignment using the MAPD Third Party Development Letter, Service records from National Guard.

* Submit a PIES request - for specific guidance regarding development to the service records centers, refer to the section entitled Service Records Development & PIES for further guidance.

NOTE: For Enlisted personnel separated from the national guard - send PIES request to Code 11; For Officers separated from the national guard - send PIES request to Code 90

REQUESTS FOR RECORDS FROM THE WYOMING ARMY AND AIR NATIONAL GUARD:

Wyoming National GuardTAG WYAttn: J1 / Medical Records (Mr Jerry Hill)5500 Bishop BlvdCheyenne, WY 82009-3320 E-mail: jerry.p.hill@us.army.mil

REQUESTS FOR RECORDS FROM THE MONTANA NATIONAL GUARD:

Montana National GuardATTN: J1 – PSS, TAA Dave Lake1956 Mount Majo StreetPO Box 4789Ft Harrison, MT 59636-4789

REQUESTS FOR RECORDS FROM THE ALASKA NATIONAL GUARD:

Alaska Army Ntl Guard State Surg and Medical Readiness Attn: case management PO Box 5800 Ft Richardson, AK 99505

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Change 24January 20, 2014

Contact person: Suzanne HuntPhone 907-428-7540 Fax 907-428-6485

CHANGES

Change 5, July 8, 2005, reformatted the section and added additional guidance regarding requests for reserve and national guard records when the claimant is currently assigned to a Colorado Army National Guard unit.

Change 6, September 20, 2005, modified section 18.2 regarding development for service records on Reservists currently assigned to a unit or Reservists who are separated or retired from the Army, Air Force, Navy, or Marine Corps reserves.

Change 7, November 25, 2006, added MOBCOM customer service telephone number and e-mail address.

Change 8, August 29, 2007, added address for requesting personnel records from the Wyoming Air National Guard.

Change 9, February 7, 2008, added e-mail message received from VBAVACO regarding the migration of Marine Corps STRs (MOBCOM is no longer maintain STRs)

Change 10, October 1, 2008, added guidance for the Quick Reference Guide for Guad and Reserve Records; guidance regarding PIES requests for active duty for training dates.

Change 11, November 24, 2008, updated references.

Change 12, December 5, 2008, added address for Montana National Guard

Change 13, January 13, 2010, added address for obtaining reserve records.

Change 14, September 22, 2010, updated POC (Molly Williams) for Colorado National Guard, Deputy State Surgeons Office

Change 15, January 17, 2011, added address and phone number for the Alaska National Guard.

Change 16, February 14, 2011, added guidance regarding SAIC – government contractor for scanning reserve STRs.

Change 17, July 5, 2011, added guidance regarding requests for Air National Guard medical records.

Change 18, September 29, 2011, updated POC regarding requests for Army National Guard medical records.

Change 19, December 1, 2011, updated Army National Guard FAX number.

Change 20, December 9, 2012, updated guidance regarding requests for Air & Army national guard records.

Change 21, March 6, 2013, updated guidance regarding follow-up requests for National Guard and Reserve records and points-of-contact.

Change 22, April 15, 2013, updated CVAs telephone number to (303) 284-6077; CVA may being able to furnish copies of original DD Form 214s.

Change 23, July 22, 2013, added guidance from the Addendum Compensation Service Bulletin, June 2013, regarding requests for National Guard records.

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Change 2November 1, 2006

Section 35

Marine Corps Records System_______

1 – Marine Unit Corps Records............................................66.2

2 – Marine Corps Records Users Guide...............................66.4

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Change 2November 1, 2006

Section 35.1Marine Corps Records System

Marine Corps Unit RecordsMarine Corps unit records for the Vietnam Era are searchable and viewable through a specially designed user interface in Virtual VA (VVA). The Virtual VA address is http://virtualva.vba.va.gov/; from the main screen, Station Number is the regional office number, Username is the network logon name (i.e. adjsbran), and Password is the CSUM password.

The Marine Corps database is accessible from the following screen by clicking on the Marine Corps link.

Most of the records span a one-month period of time and are several hundred pages in length. C&P Service has received reports from some regional offices that RVSRs are requiring VSRs and claims development clerks to print out every page within a unit record, regardless of its size. C&P Service discourages this approach for at least two reasons:

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Change 2November 1, 2006

1. If review of unit records covering a two-month period of time is required, the VSR or claims development clerk may end up printing out the equivalent of an entire ream of paper. Only those pages that verify the claimed in-service stressor will actually be filed in the claims folder for future reference.

2. Each page within a unit record must be printed out separately; a user may not print out all pages that comprise a unit record with the single press of a button. The VVA interface was purposely programmed this way to eliminate unnecessary printing and the wasting of paper. Printing these pages one by one requires an enormous amount of time and takes employees away from tasks that are more worthy of their time.

Reference: C&P Service Manager’s Conference Call, April 21, 2005.

VSRs and claims development clerks (including RVSRs who may be assigned this task) must have sufficient expertise and knowledge to search through unit records for the purpose of verifying claimed in-service stressors. C&P Service recommends these individuals complete the computer-based training lesson from within the Virtual VA site. It is short, easy to follow, and may be accessed from the initial logon page.

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Change 2November 1, 2006

Section 35.2Marine Corps Records System

Marine Corps Records Users GuideMarine Corps unit records covering the Vietnam Era are available for your review (for the purpose of verifying in-service stressors) through an interface within Virtual VA. Your CSS password and the password you use to log into Virtual VA are the same.

Marine Corps Records Overview

The Marine Corps Records feature provides you with online access to Marine Corps unit records using an interface that allows you to search and view these records. You can search for specific documents by filtering on the Veteran’s unit and the event date.

Search & View Marine Corps Records

To search and view Marine Corps unit records, follow these steps:

1. Click on the Marine Corps navigation tab on the Navigation Bar.

Marine Corps Tab

2. The Marine Corps Records dialog box displays.

Marine Corps Records Dialog

Enter your search criteria. You can search the records by specifying a military unit (required) and a date (optional).

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Military Unit o Both standard abbreviations (e.g. MARDIV, MAW) and long descriptions (e.g.

Marine Division, Marine Aircraft Wing) can be used to perform a search. o Fragments of unit names can be used to perform searches (e.g. “Aircraft” will find

all units with the word “Aircraft”)

Note: Searches are performed only on the names of military units and not document titles or document types.

Dateo You can specify a date to limit the number of results you get. Any document that

has your specified date within its date range will be displayed in the results list. For example, if a document has the date range 04/06/1952 – 11/19/1952, you can enter ANY date that falls between these two dates, such as 08/18/1952.

3. Click the Search button. A list of military units matching your criteria displays in the middle portion of the Marine Corps Records dialog box.

Military Unit Search Results

If you would like to narrow your search results, you can refine your search by entering new search criteria and search again. You can filter through your search results by clicking on the column titles to sort in ascending or descending order.

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4. Click on the name of one of the units listed in the Standardized Unit Name column to view the documents associated to that specific unit.

Document Search Results

The first fifty documents associated with that particular unit are displayed. You can navigate among these documents by clicking the navigation arrows located at the bottom of the document search results.

Document Results Navigation Arrows

5. To view a document, click on its title within the Doc Title column. The document displays to the right of your search criteria.

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View Marine Corps Document

While viewing a document, you can zoom in, zoom out, rotate, and print the document using the icons located to the right of the document.

Note: Only the specific page being viewed is printed when the print icon is depressed.

You can jump to a specific page in the document by clicking on the page navigation buttons (located at the bottom left of the document viewer) and entering the desired page number.

Page Navigation

You can hide the document viewer to fully display your search results by clicking on the arrow indicted in the following graphic:

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Change 2November 1, 2006

Hide Document Viewer Arrow

6. To close the Marine Corps Records dialog box click the ‘X’ located in the upper right hand corner.

Military Unit List

If you do not know the name of the unit, you can browse and select one from a list of units by clicking on the Unit List icon.

List Icon

The Military Unit List is categorized by the unit types.

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Military Unit List – Collapsed

At the top of the dialog box, you have the option to browse the list by viewing the short name or the long name of the units.

Short Name – displays the abbreviations or acronyms(e.g. MARDIV, MAW)

Long Name – displays the entire names(e.g. Marine Division, Marine Aircraft Wing)

Military Unit Short Name View Military Unit Long Name View

You can filter through the Military Unit List by clicking on a unit type. The unit type expands and allows you to further filter the units.

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Change 2November 1, 2006

Military Unit List – Expanded

Once you have found the unit you are looking for, click on its name. The Military Unit List dialog box will close and the unit name you selected appears in the appropriate field of the Marine Corps Records dialog box.

Marine Corps Records Dialog Box with Unit Field Populated

Click the Search button to complete the search on the Military Unit.

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Change 2November 1, 2006

CHANGES

Change 1, April 25, 2005, added guidance regarding C&P Service policy on printing Marine Corps Unit Records.

Change 2, November 1, 2006, added guidance regarding accessing the Virtual VA site.

11

Change 1June 20, 2013

Section 36

Verification Of Participation In “Special Operations” Incidents

_______

When a Veteran claims that an injury or disability occurred during a Special Operations assignment, the Veterans Service Representative (VSR) must send a section 5103 notice to the Veteran that includes the language shown in M21-1MR, Part IV, Subpart ii, 1.H.31c.

If the Veteran fails to respond within 30 days, send a 10-day follow-up letter explaining what information is missing and why the information is needed.

If the Veteran responds and provides at least the location (city/province and country) where the incident took place and the approximate date (within a two-month period) of the incident, the VSR will route the claims folder to the Military Records Specialist (MRS). The MRS will complete the Special Operations Forces Incident document and send it via encrypted e-mail to VAVBASPT/RO/SOCOM.

Reference: M21-1MR.IV.ii.1.H.31

CHANGES

Change 1, June 20, 2013, deleted reference to FL 09-52; updated guidance contained in M21-1MR.IV.ii.1.H.31.

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January 1, 2011

Section 37

Bureau of Naval Personnel Records - Code 31_______

KEY POINTS TO REMEMBER

The Bureau of Naval Personnel (BNP) has never stored service treatment records.  Furthermore, STRs are rarely available through DPRIS. Because service treatment records (STRs) are rarely maintained at BNP, do not routinely submit requests for STRs. STRs belonging to Veterans separated prior to 1995 are located at the National Personnel Records Center (NPRC). STRs belonging to Navy Veterans separated during or after 1995 are located at VA’s Records Management Center (RMC).

Requests for personnel records from the BNP need to be requested through PIES/DPRIS rather than mailing or faxing requests to the Navy Personnel Command (address code 31). BNP no longer responds to mailed or faxed requests for records.

If DPRIS images are not available, use the follow-up feature in PIES to make further inquiries rather than following-up by telephone, email, or fax. If problems are experienced with the follow-up messaging feature, the MRS should contact the PIES Help Desk (VAVBAWAS/CO/PIES).  The help desk staff has points of contact within the Navy who may be able to offer guidance and assistance.

After submitting a DPRIS request and receiving a negative response, self-address a PIES request to NPRC/Code 13 for personnel records belonging to a Navy Veteran separated during or after 1995 only.

Line-of-duty documents are typically not filed in the Official Military Personnel Folder (OMPF) and should be requested from the Judge Advocate General (JAG) office of the command where the incident in question took place. If the JAG determines that the records have been archived, obtain the name and address of the facility where the records are stored and submit a request to that facility.

No financial records of any kind are maintained at address BNP/Code 31. Never submit a request for financial information (severance pay, separation pay, etc.) to this address code. Submit these types of requests to DFAS – Cleveland/Code 35.

Send requests for Medical/Physical Evaluation Board (MEB/PEB) findings to the Navy Council of Personnel Records in Washington, DC. MEB/PEB findings have not been maintained at BNP/Code 31 since 1998.

Court martial memorandums and facts and circumstances associated with an other-than-honorable discharge that led to an administrative discharge are maintained at the JAG office where the service member was discharged.

Do not send requests for verification of exposure to asbestos to BNP/Code 31.

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January 1, 2011

Section 38

Records Loaned to Department of the Army Review Board or Army Discharge Review Board

_______

When NPRC States that Records are Loaned to the Department of the Army Review Board or the Army Discharge Review Board, the regional office should submit the request for records to the RMC via PIES.

The RMC will identify who has custody and will obtain copies of the required records. Use 13 as the address code for the PIES request. Submit a new pre-addressed PIES request using Code O99. Indicate which Board the record was sent (per NPRC) so that RMC will know where to forward the request.

See M21-1MR.III.iii.2.H, Record Exchanges Between the Department of Veterans Affairs and the Service Departments.

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Change 3November 30, 2009

Section 39

Military Service Academy Development_______

In your letter to all of the academies, please provide the following information:

Name

Social Security Number

Date of Birth

Dates of attendance or at least the date of graduation (if known). You can usually get this information from the DD Form 214 for active service. The date of entry is the date they graduate or take their oath of office.

Include the Privacy Act Paragraph in your letter.

UNITED STATES NAVAL ACADEMYOffice of the RegistrarUSNA589 McNair Rd.Annapolis MD 21402-5031

1965 to the present- If the Veteran were a midshipman at the Academy from 1965 to the present, call the Bursar’s Office at (410) 293-6382. Fax number is (410) 293-2327.

Prior to 1965- If the Veteran was at the Naval Academy prior to 1965, call the Archive Section at (410) 293-6922. Fax number is (410) 293-3889.

If you have all the information, fax your letter to the academy. There is no need to call first.

UNITED STATES MILITARY ACADEMYATTN: Graduate RecordsOffice of the DeanUnited States Military AcademyWest Point NY 10996-5000

Telephone: (845) 938-3708

FAX: (845) 938-5438

If you have all the information, fax your letter to the academy. There is no need to call first.

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Change 3November 30, 2009

UNITED STATES AIR FORCE ACADEMYUSAFA/DFRR2354 Fairchild Dr.Suite 6D 106USAF Academy, CO 80840-6210

FAX: (719) 333-6650.

If a cadet withdrew from the academy for medical reasons, the Office of the Registrar should have the discharge records as well as the medical records.

If service/attendance verification is required for a Veteran who graduated from the program, the Office of the Registrar can verify that information over the phone. The main number for the Air Force Academy is (719) 333-3970.

UNITED STATES COAST GUARD ACADEMY Office of the RegistrarUS Coast Guard Academy15 Mohegan Ave.New London CT 06320-4195

Telephone: (860) 701-6795

No FAX.

The Coast Guard Academy requires a release from the Veteran.

REFERENCES

Definitions,  38 CFR 3.1

Duty periods,  38 CFR 3.6

Computation of service,  38 CFR 3.15

Service records as evidence of service and character of discharge,  38 CFR 3.203

Verification of Service, M21-1MR, Part III, Subpart ii, Chapter 6

Veteran Status, M21-1MR, Part III, Subpart ii, Chapter 6

CHANGES

Change 1, December 20, 2006, added M21-1MR references.

Change 2, July 13, 2007, updated the area code for the West Point telephone and FAX number

Change 3, November 30, 2009, updated the main telephone number for the USAF Air Force Academy.

2

Change 23April 17, 2014

Section 40

Medical Evidence Development_______

1 – General Guidelines.....................................................................40.2

2 – VA Medical Evidence.................................................................40.4

3 – Post-Service Military Treatment Records................................40.6

4 – Vet Center Treatment Records.................................................40.8

5 – Military Dependent Treatment Records................................40.10

6 – Private Medical Evidence........................................................40.13

7 – Colorado Workman Compensation Evidence.......................40.17

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Change 23April 17, 2014

Section 40.1Medical Evidence Development

General Guidelines

FULL AND COMPLETE DEVELOPMENT

FEDERAL RECORDS. The VCAA established that the VA has a nearly unlimited duty to obtain any federal records adequately identified by the claimant. VA has fulfilled its legal duty to assist only when federal records are received or when VA concludes that the records do not exist or that further efforts to obtain those records would be futile. A decision that further efforts would be futile must be clearly documented in the claims folder.

PRIVATE MEDICAL RECORDS. VA must make reasonable efforts (try at least twice unless a definitive response to an initial request is received) to obtain private medical records if the source is adequately identified and the claimant provides an acceptable release. The claimant must be notified of the second effort and his/her ultimate responsibility to obtain the records. See VCAA Implementation, Star Reporter, Volume 2, Issue 3, dated August 23, 2001.

NON-FEDERAL RECORDS - WAITING PERIOD AFTER MAKING REQUESTS

When requesting records from non-Federal sources, allow

15 days for a response to the initial request, and

15 days for a response to a follow-up request.

Reference: M21-1MR.I.1.C.6d .

FEDERAL RECORDS - WAITING PERIOD AFTER MAKING REQUESTS

When requesting records from Federal sources, allow:

30 days for a response to the initial request, and

15 days for follow-up requests.

Reference: M21-1MR.I.1.C.5d .

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Change 23April 17, 2014

ORIGINAL CLAIMS WITH NO HISTORY OF TREATMENT

If the Veteran submits an original claim for compensation and pension, was discharged more than one year ago, but did not show a history of treatment received after military service, complete the following actions:

Send development letter request information regarding recent treatment.

Send development letter requesting continuity - med evid since service needed.

3

Change 23April 17, 2014

Section 40.2Medical Evidence Development

VA Medical Evidence

RECORDING CAPRI VA MEDICAL EVIDENCE IN VIRTUAL VA

M21-1MR.III.v.6.A and M21-1MR III.v.6. G, provides an introduction to the Advanced Web Image Viewer (AWIV).

Using CAPRI for Claims Development

Selecting and Storing Records From CAPRI

Accessing Veteran-Specific Information in CAPRI

Accessing Reports of Hospital and Nursing Home Admissions

WAITING PERIODS

When requesting records from Federal sources, allow:

30 days for a response to the initial request, and

15 days for follow-up requests.

Reference: M21-1MR.I.1.C.5d, Requesting Federal Records.

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Change 23April 17, 2014

Section 40.3Medical Evidence Development

Post-Service Military Treatment Records

REQUESTING TREATMENT RECORDS FROM MILITARY FACILITIES

Treatment facilities such Evans Army Community, USAF Academy, etc. See M21- 1MR.I.1.C.5.

INITIAL REQUEST:

Send VAF 8359

Flip-file a copy of the VA Form 21-8359 in the center section of the C-file.

Select MAPD Third Party Development pick, Mil – Info Re Vet in Uniformed Svcs Hosp (21-8359).

FOLLOW-UP REQUEST. Follow-up requests for treatment records will be made on VAF 8359.

Send VAF 8359

Flip-file a copy of the VA Form 21-8359 in the center section of the C-file.

REQUESTS FOR EVANS ARMY COMMUNITY HOSPITAL TREATMENT RECORDS:

In an effort to expedite receipt of records from Evans Army Community Hospital, the VSC has established a mailbox to send all requests.

The mailbox address is VAVBADEN/RO/EVANS.

Once development has been completed, send the VA Form 21-8359 to the above mailbox.

If a response has not been received by the suspense date, send a follow-up email to the above mailbox and the status of the request will be provided.

REQUESTING OUTPATIENT CLINICAL RECORDS (RETIREE RECORDS)

Outpatient Clinical Records (Retiree Records) may no longer be available at the military treatment facility; before requesting clinical records, check the STRs to see if clinical records are already of record. Refer to the section entitled Service Records Development & PIES,

5

Change 23April 17, 2014

topic Request for In-Patient Clinical Records and Request for Retiree Outpatient Clinical Records, for further details.

WAITING PERIODS

When requesting records from Federal sources, allow:

30 days for a response to the initial request, and

15 days for follow-up requests.

Reference: M21-1MR.I.1.C.5d .

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Change 23April 17, 2014

Section 40.4Medical Evidence Development

Vet Center Treatment Records

DISCLOSURE OF INFORMATION FROM VET CENTERS

Vet Centers require VAF Fm 21-4142s to release records. If necessary, send a VA Form 21-4142 to the claimant.

FEDERAL RECORDS - WAITING PERIOD AFTER MAKING REQUESTS

When requesting records from Federal sources, allow:

30 days for a response to the initial request, and

15 days for follow-up requests.

Reference: M21-1MR.I.1.C.5d .

7

Change 23April 17, 2014

Section 40.5Medical Evidence Development

Military Dependent Treatment Records

DEPENDENTS TREATED AT ARMY & AIR FORCE FACILITIES

Treatment records for dependents of service members treated at Army and Air Force military medical facilities and Veterans married to a serviceperson NOT assigned to a reserve unit can be submitted through PIES – limit the request to a 1 year time frame and the time frame should be within the same calendar year; refer to the guidance shown on the following pages for requesting inpatient or outpatient treatment records.

Reference: M21-1MR, Part III, Subpart iii, Chapter 2, Section E

DEPENDENTS TREATED AT NAVAL & MARINE CORPS FACILITIES

Treatment records for dependents of service members treated at Naval and Marine Corps military medical facilities can be submitted through PIES – limit the request to a 1 year time frame and the time frame should be within the same calendar year; refer to the guidance shown on the following pages for requesting inpatient or outpatient treatment records.

Reference: M21-1MR, Part III, Subpart iii, Chapter 2, Section E

8

Change 23April 17, 2014

INPATIENT TREATMENT RECORDS

PIES request code C03 should be used to request inpatient dependent medical records; the following dialog box depicts the required entries:

9

Change 23April 17, 2014

OUTPATIENT TREATMENT RECORDS

Request Code C04 should be used to request outpatient dependent medical records; the following dialog box depicts the required entries:

FEDERAL RECORDS - WAITING PERIOD AFTER MAKING REQUESTS

When requesting records from Federal sources, allow:

30 days for a response to the initial request, and

15 days for follow-up requests.

Reference: M21-1MR.I.1.C.5d .

10

Change 23April 17, 2014

Section 40.6Medical Evidence Development

Private Medical EvidenceVA Form 21-4142, “Authorization for Release of Information”, dated May 2004, is required to enable VA to request private medical records on behalf of a claimant.

NEW REVISION TO WAITING PERIOD AFTER MAKING REQUESTS FROM NON-FEDERAL SOURCES

Note: Compensation Service has updated this content for clarification, and to provide additional guidance. This revision replaces the content in the July 2012 Compensation Service Bulletin.

Compensation Service is revising the current procedures stated in M21-1MR I.1.C.6.d regarding the waiting period after making requests from non-Federal sources.

Effective immediately, when requesting records from non-Federal sources, to include private treatment records, ROs and PMCs must allow 15-days for a response to the initial request, AND 15-days for a response to a follow-up request.

Continue processing the claim after sending the follow-up request, by ordering an examination or medical opinion, as needed, or taking any further needed action, which may include preparing and promulgating a rating decision addressing any issues for which benefits may be granted based on the evidence of record. Offices should continue to follow all other established procedures pertaining to requests made to non-Federal sources.

This change redefines “reasonable efforts” regarding VA’s duty to assist claimants in obtaining records not in the custody of a Federal department or agency, per 38 CFR 3.159(c)(1). However, this change does not affect the 30-day notice response period as set forth under VA’s duty to notify in 38 CFR 3.159(b)(1) (and provided in the Veterans Claims Assistance Act (VCAA) Notice Response). Follow the instructions at the end of the bulletin for requests for non-Federal records sent at the same time as a VCAA notice.

All requests for non-Federal records sent after the 30-day notice response period has expired must adhere to the revised 15-day response periods described herein.

When requesting non-Federal records, Veterans Service Representatives (VSRs) must ensure that the claimant letter in Modern Awards Processing- Development (MAP-D) reflects a 15-day response period, as well as the suspense date for the corresponding tracked item. Since the claimant letter is used for both Federal and non-Federal record requests, Compensation Service will not update this letter to reflect a 15-day response period, and VSRs must update the letter and suspense date manually.

Compensation Service will update the M21-1MR to reflect this change.

11

Change 23April 17, 2014

Reference: Compensation Service Bulletin, August 2012.

DEFINITION OF RELEVANT RECORDS

Refer to M21-1MR.I.1.B.3, for guidance on the necessity of requesting medical records that do not have a reasonable possibility of helping to substantiate a disability claim.

HANDLING VA FORM 21-4142 OR EQUIVALENT FORM

Refer to M21-1MR.I.1.B.3i, if the VA Form 21-4142 or equivalent form

is unsigned (or unwitnessed, if the records custodian requires a witnessed signature), and identifies records that may possibly help substantiate the claim,

is signed, identifies records that may possibly help substantiate the claim, but does not contain enough information to obtain records,

identifies multiple record sources on the same VA Form 21-4142 or equivalent form,

does not indicate whether the records identified on the VA Form 21-4142 or equivalent form are for the current condition claimed, but there appears to be a reasonable possibility they could help substantiate the claim.

CAN THE VAF 21-4142 BE CONSTRUED AS A CLAIMS FORM?

According to VACO, a VA Form 21-4142 is not a claim for service connection. Therefore, if the Veteran is merely listing the medical conditions, other than the claimed disability, for which treatment has been received, do not take these conditions at issue.  Reference: M21-1MR.I.1.B.3i.

However, if the Veteran clearly notes that treatment for the additional disability was during military service, contact the Veteran to ascertain whether or not service connection is being claimed.  If the Veteran lists dates of treatment that fall within a period of military service, consider this as an informal claim for service connection.

INITIAL REQUEST & FOLLOW-UP REQUEST

Reference: M21-1MR, Part I, Chapter 1, Section C, Topic 6

. Waiting Period After Making Requests From Non-Federal Sources 15 days for a response to the initial request, and

15 days for a response to a follow-up request

12

Change 23April 17, 2014

Use the Telephone, Fax, or E-mail to Obtain Evidence From the Claimant.

Notify the Claimant at the Time of the Follow-Up Request for Non-Federal Records.

Notify the Claimant When VA’s Reasonable Efforts to Obtain Non-Federal Records Are Unsuccessful

VAF 21-4142 NOT RECEIVED

If the Veteran reports having received private medical treatment but does not provide authorization for release of private medical evidence (PME), send the Veteran the necessary number of copies of VA Form 21-4142, Authorization for Release of Information.

13

Change 23April 17, 2014

Section 40.7Medical Evidence Development

Colorado Workman Compensation EvidenceIf a veteran files a claim and states he also filed a Colorado Workman Compensation claim, a request for that evidence must be requested using the Division of Workers Compensation Release Form. The form does not include a line for the Workman’s Compensation number, but this will be needed as well (see form on next page).

Once a signed release form is received from the veteran, mail it to:Division of Workers Compensation633 17th St #400Denver, CO 80202

Or FAX the form to: 303-318-8710

The telephone number is: 303-318-8700

14

Change 23April 17, 2014

STATE OF COLORADODEPARTMENT OF LABOR AND EMPLOYMENT

DIVISION OF WORKERS COMPENSATION

AUTHORIZATION FOR RELEASE OF INFORMATION

Social Security Number: __________________________________

Claimant Name: __________________________________

Requestor Name: __________________________________

The claimant named in the above captioned matter hereby authorizes the above mentioned requestor to have access to this workers’ compensation file. This authorization shall remain in effect for ninety days from the date of claimant’s signature, unless claimant notifies the Division of Workers’ compensation in writing before such time, that claimant is revoking said authorization. Access to information is as follows: (check applicable section or sections).

_______________ Complete access

_______________ All information except for medical or vocational rehabilitation reports

_______________ Other ________________________________________________

_____________________________________ _________________________________ Claimant’s Signature Date Signed (to be completed by claimant)

Authorization must be signed and dated by claimant.

Notarization is required:

STATE OF ______________) ) ss. When using an embossed seal, please shade before faxingCOUNT OF _____________)

Subscribed and sworn to me before this

____________ day of _______________, 20_____

by _______________________________________ (print name of claimant)

__________________________________________ Signature of Notary Public

My commission expires: ______________________01/27/10

15

Change 23April 17, 2014

CHANGES

Change 4, July 30, 2004, modified the number of days from 30 to 60 for which follow-up action should be initiated if the doctor or hospital does not respond.

Change 5, March 1, 2005, added guidance regarding requests for military dependent treatment records through PIES.

Change 6, March 28, 2005, added guidance regarding follow-up actions; letter text provided when a request for evidence is negative or the address was inadequate.

Change 7, April 25, 2005, incorporated information regarding the disclosure of progress notes versus process notes from the Vet Centers.

Change 8, September 22, 2005, modified Section 23-6, Private Medical Evidence; changed the date of the VA Form 21-4142 from September 2003 to May 2004.

Change 9, May 18, 2006, corrected typographical error in Section 23.5, Military Dependent Treatment Records; Request Code O03 and O04 should have read C03 and C04.

Change 10, July 26, 2006, added references to Section 23.6, Private Medical Evidence, regarding timeframes on requests for private medical evidence.

Change 11, December 7, 2006, added guidance regarding requests for dependent records for dependents treated at Army and Air Force medical facilities.

Change 12, May 16, 2007, added guidance regarding disabilities noted on VA Form 21-4142.

Change 13, September 18, 2007, per telecon with Rose West, VA Liaison (314-538-4939) all dependent records should be requested using PIES request code C03 or C04.

Change 14, June 30, 2008, added guidance from FL 08-18 regarding notification requirements being changed from 60 to 30 days.

Change 15, September 21, 2010, added M21-MR references; modified Section 23-6, Private Medical Evidence (formatting changes).

Change 16, October 27, 2010, added M21-MR references regarding the necessity of requesting medical records that do not have a reasonable possibility of helping to substantiate a disability claim; Handling VA Form 21-4142 or equivalent form.

Change 17, November 13, 2011, added guidance regarding the Revised Procedures Related to Printing Veterans Health Administration Electronic Medical Records, FL 11-28.

Change 18, April 27, 2012, added guidance regarding the submission of requests for treatment records to Evans Community Hospital.

Change 19, August 21, 2012, added guidance regarding the new revision to waiting period after making requests from non-federal sources.

Change 20, February 27, 2013, added guidance regarding requests to the Division of Workers Compensation office.

Change 21, May 24, 2013, added guidance regarding Obtaining and Storing Veterans Health Administration (VHA) Electronic Medical Records from FL 13-11.

Change 22, January 20, 2014, added guidance regarding waiting periods for federal records.

Change 23, April 17, 2014, added the requirement to obtain a VAF 21-4142 for all requests sent to Vet Centers.

16

Change 12January 20, 2014

Section 41

Social Security Administration (SSA) Requests_______

SOCIAL SECURITY ADMINISTRATION GOVERNMENT TO GOVERNMENT SERVICES ONLINE (SSA-GSO)

Fast Letter 13-22 provides procedural instruction on using the Social Security Administration Government to Government Services Online (SSA-GSO) system to obtain claimants’ SSA disability records.

Fast Letter 13-25, Upfront Verification of Income Using Internal Revenue Service and Social Security Administration Records, dated October 30, 2013.

VA REQUESTS FOR RECORDS FROM SOCIAL SECURITY ADMINISTRATION (SSA)

Requests for SSA records needs to be completed in accordance with M21-1MR, Part III, Subpart iii, Chapter 3, Section A, change date March 26, 2013. This section of the manual provides the new SSANRC-15 form as Exhibit 1; the new form includes an entry for the Veteran’s date of birth.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Most of the records the Department of Veterans Affairs (VA) requests from SSA are stored electronically or are currently located at the Social Security Administration National Records Center (SSANRC/The Caves). Requests for records already stored at this facility are not affected by this consolidation. All requests, must be submitted to SSANRC, which is processing requests as timely as possible. Sites piloting Government Services Online (GSO) must submit all requests to NRC via the GSO portal.

Paper record folders currently located at the Megasite will not be accessible until they are received at SSANRC and unpacked. However, SSA expects only a small number of folders will be unavailable until June 2013. The SSANRC will begin unpacking and filing folders as soon as each shipment arrives, beginning on June 1, 2012, at which time the files will be available for request.

Reference: Addendum Compensation Service Bulletin, May 2012

DEVELOPMENT GUIDELINES

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Change 12January 20, 2014

The correct routing of a request for SSA disability records depends on the claimant’s mailing address. Refer to M21-1MR, Part III, Subpart iii, Chapter 3, Section A for further guidance.

Notification to Veteran.

Send notice letter to the claims.

When sending MAPD Third Party Development Letter, Pension – to SSA for med evid used in disab dec; according to the Social Security Administration, the Section 03310.015 cited in the MAPD letter is obsolete; the correct number is 03313.045.

FOLLOW-UP REQUESTS

Refer to M21-1MR.III.iii.3.A.2d for guidance regarding follow-up requests.

CHANGES

Change 2, July 16, 2004, changed the initial suspense from 60 days to 75 days.

Change 3, April 28, 2006, added the M21-1MR reference regarding follow-up development.

Change 4, May 8, 2006, provided clarification of development using sample request form letters and follow-up guidelines; added SSA Liaison e-mail address.

Change 5, November 25, 2006, added guidance regarding Section number cited in the MAPD letter used to request SSA records.

Change 6, October 16, 2007, added guidance regarding the use of the VARO FAX Cover Sheet which now includes a privacy statement.

Change 7, May 20, 2012, added guidance regarding requests for records from the SSA National Records Center.

Change 8, June 6, 2012, added additional guidance regarding requests for records from the SSA National Records Center.

Change 9, October 28, 2012, added guidance regarding Requests to the Social Security Administration (SSA) National Records Center.

Change 10, March 28, 2013, added guidance regarding Requests to the Social Security Administration (SSA) National Records Center based on the updated guidance contain in M21-1MR, Change date March 26, 2013.

Change 12, January 20, 2014, added FL 13-25 reference..

2

Change 5February 21, 2014

Section 42

Alternative Sources - Service Records_______

In those cases in which records needed to resolve the claim cannot be secured from the service department, assist the claimant in obtaining evidence from alternate or collateral sources. See M21-1MR.III.iii.2.E, Alternative Sources of Service Records and Special Situations.

If the service department has not responded after 30 days, assist the claimant in obtaining alternate sources. Reference: Addendum Compensation Service Bulletin, December 2013

ALTERNATIVE SOURCES

Refer to M21-1MR.III.iii.2.E for guidance regarding alternate sources for any of the following:

Alternative Sources for Service Records in Fire-Related Cases Alternative Sources for STRs Surgeon General’s Office (SGO) Extracts Requesting Records from the SGO Extracts Sources for Dependents’ Medical Treatment Records Alternative Sources for Proof of Service and Character of Discharge Records Other Alternative Sources for Service Records Verifying Republic of Vietnam (RVN) Service in Connection with Claims Involving

Herbicide Exposure Verifying Philippine Service Other Claims Requiring Verification

Also refer to the section in this guide entitled Service Records Development & PIES, and the topic Fire-Related Case Development for further guidance.

ALTERNATE SOURCES FOR VERIFICATION OF SERVICE

Note: Remember to review BIRLS thoroughly for verification of service information. The VID Screen must be reviewed to determine the existence of a VERIFIED record which is considered adequate verification of service.

Reference: SHARE User’s Guide

Reference: M21-1MR, Part III, Subpart ii, Chapter 6, Forms of Evidence for Verification of Service and Character of Discharge, for a list of alternative sources for proof of service and character of discharge.

1

Change 5February 21, 2014

PRIOR VA CLAIM

If there is any indication that a claim for VA benefits has been previously filed, use BIRLS to the fullest extent in an effort to locate the Veteran's records.

CHANGES

Change 2, March 14, 2005, retitled the section; incorporated references within the appropriate topics; clarified guidance regarding requests for alternative sources.

Change 3, May 1, 2005, added guidance for creating a tracked items when submitting requests through PIES for verification of service or clinical records.

Change 4, October 18, 2008, updated guidance regarding negative responses from service departments.

Change 5, February 21, 2014, updated guidance and references.

2

Change 9February 21, 2014

Section 43

Final Attempt Letter_______

NEW FINAL-ATTEMPT LETTER IN LIEU OF FORMAL FINDING OF RECORD UNAVAILABILITY

The Veterans Benefits Administration will no longer be preparing and completing a Formal Finding of Record Unavailability for any Federal record it cannot obtain because the record does not exist or is irretrievable.

Effective immediately (from the December 2013 Addendum Compensation Service Bulletin), if efforts to obtain records from a Federal entity are ultimately unsuccessful, regional offices (ROs) and pension management centers (PMCs) must prepare a “final-attempt letter,” send the letter to the claimant, and allow the claimant 10 days to respond. The final-attempt letter must:

detail the- efforts VA made to obtain the Federal records, and- response(s) it received from records custodians, if any;

contain a statement confirming- there is documentation in the claims folder of the written and telephonic efforts the

RO made to obtain the records,- the RO correctly followed all procedures for obtaining the records,- all efforts to obtain the records have been exhausted,- further efforts to obtain the records would be futile, and- based on the facts, the records do not exist or are irretrievable; and

inform the claimant - of the requirement that he/she submit any relevant records in his/her possession, and

VA will make a decision based on the evidence of record if it does not receive the requested records within 10 business days.

As with the Formal Finding of Record Unavailability, the following preparation guidelines still apply:

VSRs may prepare final-attempt letters for any type of Federal record except service records.

Only Military Records Specialists (MRSs) may prepare final-attempt letters for service records.

Until a final-attempt letter is available in the Veterans Benefits Management System (VBMS) and Modern Awards Processing-Development (MAP-D), users must complete the following steps in MAP-D to create the final-attempt letter: 1. On the customer service screen, select “contentions” in the lower right side corner of the

screen.

1

Change 9February 21, 2014

2. On the contentions screen, select “Claimant Ltr” on the lower right side corner of the screen.

3. Under Development Type, located on the upper left side corner of the screen, select “General.”

4. Under Available Development Actions, select “Waiting for a reply from claimant” and carrot over this development action item into selected development actions.

5. While “waiting for reply from claimant” is still selected, select “view” located in the center of the screen.

6. Under Suspense, change the days to 10 and then select “ok” on the bottom left side of the screen.

7. Click “To Continue.”8. Select appropriate Salutation on the center left side of the screen.9. Under Claimant Letter Format, on the center left side of the screen, select “Subsequent

Contact.”10. Click “Word” on the bottom left side of the screen. A word document will generate. 11. Copy and paste “Final-Attempt Letter Text” into the generated word document and add

any additional information required*. 12. Save changes and close word document. 13. Click “Final Print.”

*Users must ensure that they have properly completed all the claim specific information, seen in the “Final-Attempt Letter Text” as bold text highlighted in yellow, prior to issuing the letter.

Changes to M21-1 Manual Rewrite (MR) Part III, Subpart iii, Chapter 2, Section I (M21-1MR III.iii.2.I) and M21-1MR I.1.C have been published. Please see the Web Automated Reference Material System (WARMS) for the most recent MR content.

Additionally, a brief training video is available here showing users how to complete these changes in the applicable systems.

Reference: Addendum Compensation Service Bulletin, December 2013

VAMC RECORDS DETERMINED TO BE UNAVAILABLE

It is not necessary for ROs and PMCs to complete a Formal Finding of Record Unavailability for VAMC records. For further guidance, refer to M21-1MR.III.iii.2.I.59d, VAMC Records Determined to be Unavailable.

CHANGES

Change 2, March 14, 2005, incorporated references within the appropriate topics; clarified guidance regarding proper procedures with respect to requests for service records.

2

Change 9February 21, 2014

Change 3, October 10, 2006, updated M21-1MR references regarding procedures to follow when completing a formal finding and 10-day notice.

Change 4, December 9, 2006, removed guidance regarding procedures to follow when records are in the possession of a government entity; added guidance regarding the formal finding and 10-day notice as addendums to the development guide.

Change 5, October 18, 2008, added manual reference for the Formal Finding example; removed reference to the Sample Formal Finding.

Change 6, January 14, 2010, added informational note regarding alternative sources being provided in the 10-day notice.

Change 7, February 26, 2013, added guidance regarding formal findings not being required for unavailability of VAMC records.

Change 8, January 20, 2014, replaced prior guidance regarding formal findings with guidance provided by VACO, from the December 2013 Addendum Compensation Serivce Bulletin.

Change 9, February 21, 2014, added guidance regarding the Final Attempt Letter.

3

Change 7January 1, 2011

Section 44

Administrative Denials_______

Claims requiring a rating decision must first be referred to the rating activity.

DO NOT send the Veteran a VCAA notification letter denying service connection for a claimed condition; the RVSR will address all claimed conditions in a rating decision. Denial of a claim may be appropriate if the Veteran fails to respond to a request for information/evidence.

If a request was submitted to the Veteran for new and material evidence based on the Veteran’s statement, refer the claim to the rating activity. Refer to M21-1MR.III.iv.2.B for further guidance.

FAILURE TO PROSECUTE - SITUATIONS IN WHICH A VSR MAY DENY A CLAIM

A VSR may deny a claim for service-connected (SC) disability or death benefits without a rating decision if any of the following conditions exist:

there is a legal bar to entitlement

the claimant does not respond within 30 days to a request for evidence needed to determine whether or not there is a legal bar to payment, such as in cases involving continuous cohabitation

a previously decided claim requires new and material evidence to reopen it, but no evidence pertaining to the claimed issue has been received, or the only evidence submitted is clearly duplicate of evidence already of record and considered in a previous decision, or

in death cases, the claim is one in which service connection was not specifically claimed, and there is no reasonable probability that the cause or contributory cause of death was related to service (for example, but not limited to death due to accident or natural disaster, homicide, or execution for a crime).

Reference: M21-1MR.III.ii.7.2b, Situations in Which a VSR May Deny a Claim

If no evidence pertaining to the claimed issue has been received, or the only evidence submitted is clearly duplicate of evidence already of record and considered in a previous decision.

Send PCGL Central Office letter, GD2, Failure to Prosecute.

1

Change 7January 1, 2011

Note: The Failure to Prosecute letter must include the appeal paragraph and the VAF 4107. Since a decision is being rendered, the claimant has a right to appeal the decision to deny the claim. Reference M21-1MR.III.iii.1.B.7.

FAILURE TO REPORT FOR VA EXAMINATION

Refer to the VA Examination section for further guidance.

Reference: Failure to report for Department of Veterans Affairs examination, 38 CFR §3.655 and M21-1MR.III.iv.8.E.

SITUATIONS IN WHICH A VSR MAY DENY A CLAIM

Reference: M21MR.III.ii.7.2b.

APPEAL RIGHTS

Appeal rights must be provided when making a decision not to reopen a claim because the evidence submitted is not new and material. Furnish a notice of procedural and appellate rights to the claimant. Reference: M21-1MR.III.iii.1.B.7

CHANGES

Change 1, June 21, 2004, modified the “Notification Guidelines” to include the using the MAPD Add function to insert specific text when a Veteran fails to appear for a VA examination.

Change 2, January 7, 2005, clarified “Notification Guidelines” involving new claims versus original claims.

Change 3, May 10, 2005, revised guidelines regarding notifications and referrals to the rating activity.

Change 4, December 7, 2006, references updated.

Change 5, May 18, 2008, guidance added regarding issues of new & material evidence.

Change 6, Aug 12, 2008, references added and updated.

Change 7, January 1, 2011, renamed section from “Failure to Prosecute” to “Administrative Denials.”

2

Change 54May 20, 2014

Section 45

VA Examinations_______

1 – General Guidelines.....................................................................45.2

2 – Disabilities Not To Examine....................................................45.10

3 – Preparing a Request.................................................................45.14

4 – Medical Opinion Guidelines....................................................45.17

5 – Preparing a Medical Opinion..................................................45.24

6 – Exam Notification & System Requirements..........................45.26

7 – Subsequent Exam Requests.....................................................45.27

8 – Transfer of Claims Folders for VA Examinations................45.29

9 – Failure to Show for Examination............................................45.30

10 – Insufficient Examinations......................................................45.32

11 – Combat Injuries......................................................................45.33

12 – Ordering Examinations and Medical Opinions for Claims with Documentation Needing Examiner Review in the eFolder.........45.34

13 – Ordering Exams at the Appropriate Facility.......................45.40

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Section 45.1VA Examinations

General Guidelines_______

ORDERING MEDICAL EXAMINATIONS INVOLVING EFOLDER REVIEW

The VBMS eFolder is considered a complete record, and therefore, physicians conducting examinations may render opinions based on the evidence of record. ROs should not submit exam requests until all documents are scanned into VBMS. Do not ask examiners to review STRs or other records that are pending scanning, or for which there is a pending evidence request, “if they become available at the time of the examination.” In addition, ROs should not schedule an exam prior to sending a folder for scanning. The Veterans Health Administration (VHA) will consider these to be submission of an incomplete record and cancel the requests due to lack of evidence.

RO personnel requesting an exam for a sensitive level case should add the following annotation at the top of the exam request to ensure the exams are conducted and evidence in the eFolder reviewed by personnel with proper access:

SENSITIVE FILE– Review needed by authorized personnel.

Email questions to the VAVBAWAS/CO/212A mailbox. (Reference: Compensation Service Bulletin, March 2014)

REQUIREMENTS FOR ORDERING EXAMINATIONS/MEDICAL OPINIONS

Compensation Service has received questions on when an examination/opinion is required or when a decision may be completed without an examination.

A training letter (TL) is forthcoming that will provide additional details and examples.

Per 38 C.F.R. 3.159(c)(4)(i), an examination or medical opinion is necessary when the evidence of record does not contain sufficient medical evidence to decide the claim, but the following three parts are present:

• competent medical or lay evidence of current symptoms or a disability,

• an injury, disease, or event in service (can consist of a single entry in service treatment records (STRs) or a lay statement that is credible and otherwise consistent with the circumstances of the Veteran’s service), and,

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• an indication that the in-service injury, disease, or event may be associated with the current disability or symptomatology.

The last requirement for an “indication of association” can be satisfied by lay testimony. The Veteran’s indication that his/her condition has existed “since service” satisfies the requirement. However, without a medical or lay indication of association, no examination would be warranted in most cases.

Example 1: The Veteran claimed “back condition” and had only one complaint of a sore back during service with no evidence of a back disability at separation. The Veteran’s current claim provided no medical evidence of continuity and no statement that the current disability persisted since military service. A denial decision can be made without an examination/opinion, as there is no “indication of association.”

Example 2: Using the same fact pattern as the example above, if the Veteran claimed “I hurt my back unloading a truck in service, and it has hurt ever since that time,” an examination with a nexus opinion would be warranted, as all of the requirements of 38 C.F.R. 3.159(c)(4)(i) have been met.

Reference: Compensation Service Bulletin, December 2013

MEDICAL ELECTRONIC PERFORMANCE SUPPORT SYSTEM (MEDICAL EPSS)

Diagnostic codes, disability definitions, etiology, signs & symptoms, tests, treatment, residuals, and special considerations (e.g. presumptive consideration) can be found at the C&P Medical EPSS website (http://epss.vba.va.gov/mepss/).

EXAMS OVER ONE YEAR OLD

The Compensation Service noted that multiple sources have reported that as claims are aging, ROs are scheduling new Compensation and Pension (C&P) examinations if the first examination conducted in connection with the pending claim is more than one year old. There appears to be a misconception in the field that rating a case based on a VA examination more than one year old will result in a Systematic Technical Accuracy Review (STAR) error. This is not the case. STAR does not call errors for deciding the claim based on an examination conducted in the past, unless that examination or any associated medical opinion is insufficient for making a rating determination, or other evidence indicates that the condition has changed since the prior examination. Do not delay the disposition of a claim by ordering another examination simply because the medical evidence contained in the examination report is more than one year old.

Reference: Compensation Service Bulletin, November 2012.

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STANDARDIZED EXAM FORMAT

Start with any special remarks, such as:

"General Medical exam is required for _________________ (e.g., recently discharged Veteran, pension purposes, IU claim)." OR"Exam is for addendum purposes only." OR"Recall of the Veteran is at the examiner's discretion."

Please examine the following SC: Back condition

Please examine the following NSC: PTSD GERD Hypertension

Medical opinion: (text of medical opinion, or opinions)

C-file to follow (or not to follow) BXXXX (first letter of Veteran's last name, last four of SSN) POA: XXX Prepared by: _____________Input by _____________, ext XXXEnd

SIGNATURE REQUIREMENTS

On September 1, 2010, C&P Service released Fast Letter 10-32, Removal of Certain Co-Signature Requirements and Ordering Specialist Examinations. As reported in the July conference Call, RO and PMC staff may accept examination reports signed by a nurse practitioner or physician’s assistant that are not co-signed by a physician. This change in signature requirements does not apply to examinations conducted by specialists, such as mental health, dental, audiology and optometry. For all other types of examinations, a generalist clinician may perform the examination. For example, an office may order a cardiac examination, but it should not generally request that a cardiologist (a specialist) conduct it. C&P will revise M21-1MR accordingly to reflect this change in policy.

The VCAA requires the VA to request an examination or medical opinion for a disability compensation claim “. . . when such an examination or opinion is necessary to make a decision on the claim.” See VCAA Implementation, Star Reporter, Volume 2, Issue 3, dated August 23, 2001.

EXAMINATIONS FOR VETERANS LIVING AT A FOREIGN RESIDENCE

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Refer to the section entitled Veterans Living at a Foreign Residence for further guidance regarding examinations for Veterans living a a foreign residence.

WHEN AN EXAMINATION SHOULD BE REQUESTED

An examination should be scheduled only when the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but the evidence establishes that the Veteran suffered an event, injury or disease during military service or during any applicable presumptive periods and . . .

DURING APPEAL PERIODS: An examination should be requested when review indicates existing medical evidence fails to meet VCAA standard of sufficiency or when additional evidence establishes a new basis for examination.

Reference: Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide. And M21-1MR, I.1.C.7.b.

WHEN A GENERAL MEDICAL EXAMINATION IS APPROPRIATE

A general medical examination is designed to provide a comprehensive baseline physical examination with particular emphasis on any claimed or identified disabilities. This type of examination is usually only appropriate for someone in the BDD (pre-discharge) program, someone who has been discharged from military service for less than a year, a pension claim, or an individual unemployability claim when there are indications of non-service connected disabilities that may impact on employability.

Reference: Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

VA EXAMINATION FOR COMPENSATION & PENSION CLAIMS

When the claim is for both compensation and pension, a general medical examination will be required for pension purposes. Be sure to list all the disabilities for which the Veteran is receiving treatment.

If medical treatment reports have been received, the records will indicate at least some of the Veteran’s disabilities. If we have no treatment records, call the Veteran and ask what disabilities are being treated.

REQUESTING GENERAL MEDICAL EXAMINATION WITHOUT STRS

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In the interest of timeliness and production, general medical examinations can be requested immediately without waiting for STRs for Veterans who have been discharged less than a year. However, some claims require review of the STRs, and in those cases the general medical examination should not be requested until the Veteran’s STRs are received, OR a formal finding has been completed and we have requested alternative sources for STRs. Examples of cases which must be delayed for receipt of the STRs are those in which the following issues are claimed:

Mental

Dental

Vision

Audio

TBI

Gulf War Issues

A request for general medical examination should also be postponed for receipt of STRs if there is an indication that a medical opinion is needed.

Reference: M21-MR, III.iv.3.A.1.e and M21-MR, III.iv.3.A.9

REQUESTING EXAMS & TREATMENT REPORTS

When requesting non-federal records, and after waiting 60 days for requested medical evidence, continue processing the claim, ordering an examination or a medical opinion, or taking any further needed action, including rating the claim based on the evidence of record. See Requesting Non-Federal Records, M21-1MR.I.1.C, Requesting Records.

Ordinarily, you should wait to schedule a VA examination until requested Federal and non-Federal records indicate there was an event, injury or disease in service that may be associated with the claimed current condition.

If an affirmative statement is received from a Federal records custodian that the requested records do not exist or are not in their possession, send the Veteran a request for alternative sources of evidence and give an additional 30 days. If the 30-day extension expires and no additional evidence has been received, continue processing the claim based on the evidence of record. Schedule an examination or request a medical opinion if it is necessary to decide the claim. See M21-1MR, Part I, Chapter 1, Section C, Requesting Records.

COMPENSATION & PENSION CLAIMS

When the claim is for both compensation and pension, a general medical examination will be required for pension purposes. Be sure to list all the disabilities for which the Veteran is receiving treatment.

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If medical treatment reports have been received, the records will indicate at least some of the Veteran’s disabilities. If we have no treatment records, call the Veteran and ask what disabilities are being treated.

EXAMINATION OF CONDITIONS RELATED TO SERVICE-CONNECTED DISABILITIES

If a review of the medical evidence shows the Veteran has a condition(s) known to be related to a service-connected disability, and an examination is being requested for another disability, request an examination for the condition(s) noted in the treatment reports. For example, if the medical evidence shows treatment for neuropathy and the Veteran is service-connected for diabetes, request an examination of the peripheral nerves.

ISSUES OF PERMANENCE

Refer to the Issues of Permanence section in this guide for further details, topic VA Examination Guidelines.

INCOMPETENCY ISSUES

Refer to the Incompetency Issues section in this guide for further details, topic Examination Guidelines.

PTSD CLAIMS

Refer to the PTSD (Combat) and PTSD (Personal Assault) sections in this guide for further details.

1151 CLAIMS

Before requesting a VA examination, obtain all treatment reports (original or certified). Refer to the 1151 Claims section in this guide for further details, topic VA Examination Guidelines.

PROJECT 112/SHAD CLAIMS

When verification of Project 112/SHAD participation is received, determine the need for a physical examination. Refer to the Project 112/SHAD Claims section in this guide for further details, topic.

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GULF WAR CLAIMS

A general medical will be required. Refer to the Gulf War Claims section in this guide for further details, topic VA Examination Guidelines.

INDIVIDUAL UNEMPLOYABILITY CLAIMS

Refer to the Individual Unemployability Claims Section in this development guide for further details, topic Examinations for Individual Unemployability.

HEARING LOSS CLAIMS

There are several decisions to make as to whether to request an examination, and what opinions to request based on the evidence. Refer to the Hearing Loss and Tinnitus Claims Section in this development guide for further details, topic Hearing Loss & Tinnitus Claims.

EXAMINATION OF INCARCERATED VETERANS

When requesting an examination for incarcerated Veterans, it must be noted in the comments section: Veteran Incarcerated. Also provide the name of the prison and a point of contact at the prison.

When an examination of an incarcerated Veteran is required, the RO and/or the local VHA Medical Examination Coordinator should confer with prison authorities to determine whether the Veteran can be examined.

Refer to M21-1MR.III.iv.3.A.11d, for guidance on examinations of incarcerated Veterans

VHA must either:

examine incarcerated Veterans, or

provide evidence of substantial efforts to conduct a scheduled compensation examination.

The Veterans Benefits Administration (VBA) must assist incarcerated Veterans by:

working with prison officials in obtaining prison facility medical records or other relevant medical records, and

scheduling examinations when warranted.

VBA must document all efforts to obtain records and schedule examinations.

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When ordering examinations for incarcerated Veterans, Veterans Service Representatives (VSRs) must follow current development guidance for:

original claims;

claims for increased evaluation; and

review examinations.

VSRs must document all efforts to obtain medical evidence from prison and other sources. VSRs must document all efforts to schedule examinations for incarcerated Veterans, including identifying and requesting the assistance of the appropriate prison officials.

Reference: Fast Letter 11-22, Examinations for Incarcerated Veterans and Veterans Health Administration (VHA) Fact Sheet DMA-11-001, Examinations for Incarcerated Veterans, dated September 8, 2011

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Section 45.2VA Examinations

Disabilities Not To Examine_______

DO NOT order a VA psychiatric examination while a Veteran is still on active duty pending release from active service because of a mental disorder that resulted from a highly stressful event during military service. In such cases, the examination must be performed within six months of discharge. For further guidance, refer to the section entitled Specific Disability Considerations for guidance on Mental Disorders That Led to Release from Service.

DO NOT request a VA examination for the following conditions, to include laboratory findings, test results, congenital defects, developmental defects, alcohol abuse, or drug abuse.

o Human papilloma virus - If the service treatment records show a laboratory finding of human papilloma virus (HPV), then no examination is needed because service connection would not be warranted.

Cervical dysplasia is often, but not always, associated with HPV. There are over 60 types of HPV infection, which is a sexually transmitted disease, and only certain ones are associated with high-grade Cervical Dysplasia and cancer.

Usually, HPV infections are asymptomatic and identified only as a finding on a Pap smear. Most resolve spontaneously without residuals, requiring only periodic Pap smears for follow-up. In these cases, there is an abnormal laboratory finding but no disability, and service connection would not be warranted.

Certain types of HPV infection are associated with genital warts. Service connection may be appropriate in these cases because there is a disability. Other types of HPV results in persistent infection that may progress to cervical dysplasia. A medical opinion would be required to determine the relationship between an in-service HPV infection and a cancer that developed later. If the nexus can be established, service connection may be warranted.

o Fibrocystic breast disease

Fibrocystic disease of the breast, more appropriately called fibrocystic conditions of the breast, is not a pathologic condition, but a physiologic (or normal and nonpathologic) finding, occurring in about two-thirds of women. As a physiologic finding, it does not warrant service connection.

o Cervical dysplasia, amenorrhea - Cervical dysplasia most often will not be examined because it is not a disease or disability. Cervical dysplasia, often called Cervical Intraepithelial Nelplasia or CIN, is neither a disease or injury, but a cellular abnormality of the cervix revealed by a Pap smear.

The more severe cases of cervical dysplasia, while also oftenasymptomatic, may require treatment by cauterization, laser surgery, cryosurgery, or Loop Electrosurgical Excision

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Procedure (LEEP). When cervical dysplasia requires treatment, service connection might be in order if there are residuals as a result of post-treatment.

Severe cervical dysplasia may also be a precursor of cancer. If a woman develops cervical dysplasia in service and cervical cancer after military service, it is possible the cancer would warrant service connection, particularly if continuity is shown between the cervical dysplasia in service and the later-diagnosed cancer.

In-service cervical dysplasia that resolved without residuals is less likely to be related to later-developing cervical cancer. However, these cases require a medical opinion to determine whether a relationship between them exists which warrants service connection.

o Elective surgery residuals (e.g. vasectomy, tubal ligation, PRK etc.)

o Refractive error, correctable vision, myopia, etc.

o High cholesterol (hypercholesterolemia, hyperlipidemia, etc.)

o Elevated triglycerides

o Elevated prostate specific antigen (PSA), in the absence of a diagnosis of prostate cancer

o Premature ventricular contractions (PVCs)

o Amenorrhea

o Uncomplicated pregnancy/childbirth

o Obesity

o Sinus bradycardia, abnormal EKG finding, unless

a) There is medical evidence in the file of an underlying chronic heart condition which is causing the sinus bradycardia, such as sick sinus syndrome. In such case, the underlying heart condition needs to be examined with the sinus bradycardia; or

b) The Veteran reports that he/she has symptoms associated with sinus bradycardia. In such case, obtain a medical opinion whether the Veteran’s reported symptoms are due to an underlying chronic heart condition which is causing the sinus bradycardia, or to some other etiology.

o Abnormal laboratory tests followed by normal results

o Positive PPD (TB Tine test)

o Pregnancy

o Personality disorders

o Alcohol and drug abuse – Exception: Alcohol and drug abuse may be service-connected secondary to PTSD; refer claim to an RVSR for guidance.

o Bruxism – Exception: bruxism may be considered on a secondary basis as a symptom of a service-connected disability, such as an anxiety disorder, TMJ dysfunction, etc. for rating purposes. (Reference: Compensation Service Bulletin, March 2014)

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HEADACHES, GASTRITIS, EAR ACHES, SINUSITIS OR RHINITIS: Do not request an examination for such issues as headaches, gastritis, ear aches, sinusitis, or rhinitis unless specifically claimed by the Veteran. If the Veteran was discharge more than a year ago, we must first have medical evidence which shows the event, injury, or disease occurred or is related to military service before requesting a VA examination. See M21-1MR, Part I, Chapter 1, Section C.

DISABILITIES REQUIRING MANDATORY EXAMINATION: Do not request an examination for any of the following if the disease process is still active or immediately following surgery and time period before a mandatory examination has not expired (see topic “Disabilities Requiring Mandatory Examination” for further details). For example, an examination would not be requested if the Veteran’s cancer is still active or if the Veteran recently completed treatment and the time period before a mandatory examination has not expired.

o Agranulocytosis, acute

o Aneurysm, any large artery

o Aortic aneurysm

o Aplastic anemia

o C-cell hyperplasia of the thyroid

o Cardiac transplantation

o Heart valve replacement (prosthesis)

o Hodgkin’s disease

o Joint replacement (prosthesis)

o Kidney transplant

o Leprosy (Hansen’s Disease)

o Leukemia

o Liver transplant

o Malignant melanoma

o Malignant neoplasms of the digestive system, exclusive of skin growths

o Malignant neoplasm of the ear (other than skin only)

o Malignant neoplasm, any specified part of the endocrine system

o Malignant neoplasms of the genitourinary system

o Malignant neoplasms of gynecological system or breast

o Malignant neoplasm of the Muscle (excluding soft tissue sarcoma)

o Malignant neoplasms of any specified part of respiratory system

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o Malignant skin neoplasms (other than malignant melanoma)

o Non-Hodgkin’s lymphoma

o Pulmonary Tuberculosis, chronic, inactive

o Soft tissue Sarcoma (of muscle, fat, or fibrous connective tissue)

o Soft tissue sarcoma (of vascular origin)

o Ventricular arrhythmias (sustained)

o Visceral Leishmaniasis

SERVICE-CONNECTED CANCER: If the Veteran is service-connected for cancer and the evidence suggests the Veteran is terminal (or in a hospice), do not order an examination. If medical evidence is received showing the cancer is active, a 100 percent evaluation is warranted. For example, it is not necessary to request an examination for a Vietnam Veteran who has lung cancer and is terminal.

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Section 45.3VA Examinations

Preparing a VA Exam Request_______

EXAMINATION WORKSHEET

Complete VA examination requests using the green exam worksheet or print a copy of the exam from CAPRI after input.

Flip-file the worksheet in the center section of the claims folder. Upon receipt of the VA examination, the green worksheet will be flat-filed below the completed VA examination report.

Be sure to select the necessary disability-specific worksheets for the service-connected conditions (see topic “Selecting Disability Specific Worksheets” for further guidance).

When requesting a general medical examination, make a note in the remarks section, “General medical required – vet discharged less than one year,” or “General medical required for pension purposes,” etc.

USE OF ABBREVIATIONS

DO NOT assume the Veteran Health Administration C&P program clerk or examiner understands VBA acronyms, abbreviations, or legal terms. For example, do not use STRs, SC, A&A/HB, IU or uncommon abbreviations or medical abbreviations. Reference: Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

LISTING DISABILITIES

Be as specific as the evidence available allows. If there is an already established diagnosis, you should quote that diagnosis in the request. Do not substitute the generic phrase found on the M-13 BDN screen for an established diagnosis. If a diagnosis has not yet been established but the Veteran has established a current condition based on lay testimony, you should include enough of the Veteran's statement to clearly identify the nature of the condition claimed. When an extremity, paired organ, vision or hearing condition is at issue, you must clearly identify whether the claimed condition affects the right, left, or both. For scars, to the extent possible, identify the scar’s location. Reference: Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

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SELECTING DISABILITY-SPECIFIC WORKSHEET

Disability-specific examination worksheets should be requested whenever a general medical examination is not appropriate. With the exception of vision, audio, dental, and psychiatric examinations, disability-specific examination worksheets should not be requested in combination with a general medical examination worksheet. The general medical examination worksheet instructs examiners to refer to and follow all appropriate additional worksheets for any claimed, found or suspected but unclaimed conditions, encountered during the general medical examination. See Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

If the Veteran submits a claim more than one year after discharge, request the disability-specific exam worksheets for each disability claimed; do not request a general medical.

If the Veteran submits a new claim within one year of discharge, but has already had a general medical examination, request the disability-specific exam worksheets; do not request a general medical.

DISABILITY-SPECIFIC EXAMINATION WORKSHEETS: Disability examination worksheets can be found on the C&P Service Home Page.

SPECIALIST EXAMINATIONS

Examinations conducted by persons with specific qualifications (specialist examinations) are required for vision, audio, dental, and psychiatric examinations (mental, dental, eyes, & ears). Therefore, separate worksheets should be requested for these issues. This is true even when a general medical examination is requested.

In all other cases, specialists exams (e.g. podiatrist, gastroenterologist, etc.) should only be requested when specified by the Board of Veterans’ Appeals or in very unusual, complex cases with conflicting medical opinions of record. In no circumstance should the examination request specify “Board certified specialist” unless by direction of BVA remand. Reference: Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

Board of Veterans Appeals Remands: the entire remand text should be copied from VACOLS and inserted into the remarks section of the exam.

Social and Industrial Survey: If a social and industrial survey is required, select the disability-specific worksheet for the appropriate body system; insert a comment in the remarks section that a social and industrial survey is required; add a comment to clarify any specific information that may be required. These exams are not the same as a fiduciary field exam.

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PROTOCOL EXAMS

GULF WAR EXAM: Gulf War protocol exams are completed at a VA medical center based on the Veteran’s request. However, if a Veteran is claiming a disability as a result of duty in the Gulf War, determine if a protocol exam was conducted and obtain a copy if necessary.

Send MAPD Claimant Letter, Special Issues Letter, GW – Registry Exam?

POW EXAM: POW exams will be directed by the POW Rating Board.

COLD INJURY EXAM: Cold Injury protocol exam should be used for initial and subsequent exams. X-rays (feet and hands, as applicable) should be part of the exam.

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Section 45.4VA Examinations

Medical Opinion Guidelines_______

THRESHOLD FOR EXAMINATION WITH MEDICAL OPINION

The Compensation Service wants to remind decision-makers that the “theory that medical examinations are to be routinely and virtually automatically provided to all Veterans in disability cases involving nexus issues” was rejected in Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010 )

The proper standard for obtaining examination with nexus opinion, contained in 38 CFR 3.159(c)(4)(i) requires that the evidence of record “indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service or with another service-connected disability.” The Veteran’s claim, in and of itself, unenhanced by either medical nexus evidence or lay testimony does not establish such “indication.”

However, the evidentiary threshold remains quite low. A Veteran’s assertion of continuity of symptoms from service to the present would generally satisfy the requirement, as would private medical opinion even if based upon incomplete data. ( McLendon v. Nicholson, 20 Vet.App. 79 (2006   ) .

Reference: Compensation Service Bulletin, April 2013

WHO MAY REQUEST A MEDICAL OPINION

In accordance with M21-MR.III.iv.3.A, a VSR assigned to the Predetermination Team may request a straight forward medical opinions if he/she has completed the Advanced Development Course.  However, an RVSR must review and approve any medical opinion request initiated by a VSR.

Standardized, pre-approved language will be used for all medical opinion requests that pertain to hearing loss, tinnitus, unemployability, basic secondary opinions, and treatment for conditions noted in the STRs, but for which there is no clear diagnosis.

Complicated medical opinions will be written by RVSRs.  Complicated medical opinions will include opinions which contain "Allen" language, opinions needed in 1151 claims, and unanticipated opinions that result after an RVSR reviews a case and determines

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that a deferral is necessary because a medical opinion is required.

For those opinions that fall somewhere in between, the VSR will write the medical opinion, then refer the opinion to the Senior VSR for review and/or discussion.  The SVSR and the VSR will discuss why an opinion is necessary and write a brief paragraph as to why, then finalize the opinion.  The VSR will then hand carry the file with the Medical Opinion to the RVSR to whom the file will be assigned (based on digit assignments). The RVSR will review the paragraph and the Medical Opinion and approve or revise the opinion as necessary, or write a brief explanation as to why a medical opinion is unnecessary.  Any necessary revisions should be explained to the VSR and/or the Senior VSR.  The opinion will be revised as directed, and the exam and the opinion will then be input by the VSR.

Reference: Quality Review Committee minutes dated January 9, 2008.

WHEN A MEDICAL OPINION IS REQUIRED

A medical opinion should be requested only when the evidence establishes the basis for an issue that can reasonably be resolved by a medical opinion. Reference: Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

A medical opinion is required when there is evidence of a disability, disease, or event during military service (or within an applicable presumptive period), in addition to evidence of a current disability but the available evidence is insufficient to either establish or deny such a relationship. Available records must be made available to the examiner. Pertinent evidence should be identified and presented in a neutral manner. See VCAA Implementation, Star Reporter, Volume 2, Issue 3, dated August 23, 2001.

Note: This may be particularly important if the Veteran was discharged several years ago, and the available evidence does not clearly establish whether or not there is a relationship between the current disability and the illness, injury or disease that occurred during military service.

Note: If the Veteran’s claim was stated as, “Disabilities are due to……” or “Disabilities are caused by…,” a medical opinion may be required.

REQUESTING MEDICAL NEXUS OPINIONS

C&P Service has recently received inquiries from Congressional staff members questioning the propriety of denying service connection because of the lack of a nexus between a current disability and an event or injury shown in military service without first requesting a VA examination and/or a medical opinion.

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VA has a duty to assist the claimant by providing a medical examination and/or an opinion if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim. The following must be demonstrated for VA to schedule an examination:

competent medical or lay evidence that the claimant has a current diagnosed disability, or persistent or recurrent symptoms of disability,

supporting evidence from service records or other sources that the claimant suffered an event(s), injury, or disease in service or symptoms of disease recognized as a presumptive disease within the applicable presumptive period, and

the evidence indicates that the claimed disability or symptoms may be associated with the in-service injury, event, or disease or with another service-connected disability.

The requirement that the evidence indicates that there “may” be a nexus between a current disability and in-service injury, event, or disease is a low threshold. Nonetheless, if the aforementioned elements are not satisfactorily demonstrated by the evidence, VA has the authority by law to deny such a service connection claim without scheduling a VA examination.

Guidance on requesting a VA examination or medical opinion may be found in the following:

38 CFR 3.159(c)(4),

M21-1MR.I.1.C.7 and

M21-1MR. III.iv.3.A.

Reference: C&P Service Bulletin, Addendum, September 2008

NEXUS OPINIONS MAY NOT BE REQUIRED

If the issue is “nexus” or relationship between current claimed condition and military service, an opinion should not be requested until or unless there is evidence of a current disability AND an event, injury, or disease during military service that could be related to the current disability. In the absence of evidence of an event, injury, or disease during military service, the claim should be denied without requesting a medical opinion. Reference: Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

OBTAINING MEDICAL NEXUS OPINIONS AND OUR DUTY TO ASSIST

The following describes circumstances when we must provide the Veteran with a medical nexus examination and/or opinion in connection with a claim for service connection. The

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duty to assist regulation, 38 C.F.R. § 3.159, says the VA will obtain a medical opinion when there is competent evidence of a current disability and the evidence "establishes the Veteran suffered an event, injury or disease during military service."

Whether an examination or opinion request is "necessary" involves a factual determination that must be made based on all of the evidence of record.

Lay evidence could be sufficient to establish that a Veteran suffered a claimed in-service event or injury. For instance, a Veteran claims residuals of a gunshot wound related to combat. The service treatment records are silent regarding the injury, but the Veteran has provided current medical evidence of the claimed disability. The provisions of 38 U.S.C. § 1154(b) provides that a Veteran's uncorroborated statement concerning how a particular injury was sustained in combat is proof of service incurrence, if this statement is consistent with the circumstances, conditions or hardships of such service. A medical opinion relating that injury to combat service is not necessary.

However, in other claims, where the combat Veteran's statement establishes that he or she suffered a less specific event or injury in service, such as a twisted ankle from a fall, a nexus opinion may be required to relate the claimed current condition to the combat event/injury.

Competent lay evidence that corroborates the Veteran's lay statements (such as "buddy" statements) could be sufficient to establish that a Veteran suffered an in-service injury or event. In some cases, the detail, quality, and quantity of the Veteran's lay testimony alone may be sufficient to establish the in-service injury or event. This may involve hearing testimony. The VCAA does not preclude establishing incurrence by lay testimony alone.

The Veteran’s military occupation can establish the "events" during military service. The Veteran's statements, including testimony at a hearing, further describing the military occupation, may shed further light on his activities in service even if they did not cause injuries at that time. At issue then is the relationship between the in-service activities and the claimed current condition. For instance, if the Veteran was a paratrooper during military service and has current knee problems, a medical opinion would be appropriate. Likewise, if the Veteran was a jet mechanic in service and now claims a current hearing loss, a medical opinion would be appropriate.

Continuity of treatment after service could establish that a Veteran suffered an event during military service. For instance, if there was no evidence of an injury occurring during military service, but the Veteran provide medical evidence which shows treatment for the condition in the year immediately following service, our duty to assist would require that we obtain a medical nexus opinion.

If the evidence does not establish the Veteran suffered an event or injury in service and the evidence does not show incurrence or aggravation during military service, there is no reason to get a medical nexus opinion. The opinion will not establish the in-service event, injury, or disease.

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If the evidence does not establish that the Veteran suffered an event or injury in service, it would be unreasonable to require a claimant to report for an VA examination or to request a review of the record.

See Obtaining Medical Nexus Opinions and Our Duty to Assist, VSCM Conference Call, March 20, 2003.

Note: Refer to M21-1MR, Part III, Subpart iii, Chapter 2, Section E, 35d for guidance regarding verification of affiant (buddy) statements.

DO NOT ASK FOR LEGAL OPINIONS

Do not request a medical authority to assume any responsibility inherent to the rating activity. Reference: M21-1MR.III.iv.3.A.9.f.

It is not appropriate to ask the examiner whether a disability is related to service. Rather the request should identify the in-service event(s) that is claimed to be the basis of the current disability; such as when a Veteran is claiming hearing loss and has served two years as a jet engine mechanic. Reference: Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

LOSS OF USE CONDITIONS. It is not appropriate to ask the examiner, “. . . is there loss of use of . . .” or “. . . is the left knee arthritis service connected . . .” Instead, the examiner should be asked to describe the remaining function when considering loss of use. For example, it would be more appropriate to ask the examiner, “Is it as least as likely as not that the Veteran’s left knee disability is the direct or proximate result of the service-connected right knee traumatic arthritis” or “Describe in detail the remaining function in the Veteran’s left leg.” See Exam Requests, Star Reporter, Volume 2, Issue 6, dated April 2, 2002.

When seeking a “nexus” opinion, ask the examiner to provide an opinion as to the relationship between a current disability and an identified injury, disease, or event in military service. See Exam Requests, Star Reporter, Volume 2, Issue 6, dated April 2, 2002.

UNEMPLOYABILITY. Do not ask, “. . . is the Veteran unemployable?” Do not state the opinions as, "Veteran is claiming individual unemployability, please provide opinion." Instead ask the examiner to comment on the Veteran’s ability to function in his normal occupational environment and to describe functional limitations. NOTE - Asking the examiner to discuss the Veteran's functional impairment and effect on normal occupation is basically an examination question and not a formal medical opinion request. Accordingly, this question may properly be asked in the remarks section without using the formal medical opinion request form.

The examiner could be asked to “describe the extent of functional impairment due to the service-connected disability and how that impairment impacts on physical and sedentary employment.” See Exam Requests, Star Reporter, Volume 2, Issue 6, dated April 2, 2002.

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HEARING LOSS. Do not ask the examiner if the Veteran’s hearing loss is at least as likely as not related to military service. Rather the request should identify the in-service event(s) that is claimed to be the basis of the current hearing loss; such as having served two years as a jet engine mechanic. In this particular instance, it would be more appropriate to phrase the opinion as, "Is it at least as likely as not that the Veteran’s current hearing loss is due to or caused by the acoustic trauma of having worked for two years as a jet engine mechanic during military service?”

HEPATITIS C. Do not ask the examiner if the Veteran’s hepatitis C is at least as likely as not related to military service.” Rather the request should ask the examiner to opine as to the most likely etiology of the Veteran’s hepatitis C.

The examination must be specific and identify the specific incident or disability/disease that occurred during military service.  Asking the examiner if the hepatitis C is related to service can lead to misleading medical opinions.  For example, a Veteran may have engaged in IV drug use during military service.  If the examiner is asked if it is at least as likely as not that the Veteran's hepatitis C is related to service and the examiner believes the IV drug use caused the hepatitis C, the examiner would likely offer an opinion that the hepatitis C is related to service.  However, service connection would not be warranted because drug use is considered willful misconduct.

PSYCHIATRIC CONDITIONS

Do not ask the VA examiner if a Veteran’s psychiatric condition is permanent. The RVSRs should make this determination upon a review of the records in the Veteran’s file.

MEDICAL OPINIONS REGARDING AGGRAVATION

Refer to the section entitled Claims Due to Aggravation for specific development guidelines regarding claims due to aggravation.

MEDICAL OPINIONS FOR SECONDARY SERVICE CONNECTION

Refer to the section entitled Claims for Secondary Service Connection for specific development guidelines regarding claims for secondary service connection.

CLAIMS FOR SECONDARY CONDITIONS DUE TO SERVICE-CONNECTED HYPERTENSION

In cases where a Veteran is service-connected for hypertension and claims secondary conditions of

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Coronary artery disease

Arteriosclerotic heart disease

Stroke

Arteriosclerotic peripheral vascular disease

DO NOT ask for a medical opinion as to the relationship between the service-connected hypertension and one of the above listed conditions. 

MEDICAL OPINIONS FOR HEARING LOSS & TINNITUS

Refer to the section entitled Hearing Loss & Tinnitus Claims for specific development guidelines.

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Section 45.5VA Examinations

Preparing Medical Opinions_______

WHO SHOULD REQUEST A MEDICAL OPINION?

While some straight-forward medical opinions may be requested by the Pre-D Team, most potential medical opinion requests should be referred to the RVSR on the Pre-D or Rating Team to prepare the request. Reference: Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

COMPLETING THE MEDICAL OPINION

DO NOT request an opinion without first obtaining ALL pertinent medical treatment records.

Prepare a medical opinion in the proper format; see M21-1MR.III.iv.3.A.9. The medical opinion format is not required for Deluca exams or I.U. exams.

The medical opinion must specify the issue(s) under review, the claimant’s contention(s), and, opinion requested, and provide a summary of evidence available in the case – provide approximate dates covered by the evidence; see M21-1MR.III.iv.3.A.9. Don’t forget to advise the examiner that the review is not limited to the evidence identified on the request form or tabbed in the claims folder.

Note: The medical evidence must be tabbed in the claims folder.

If the medical evidence needed to support a request for an opinion cannot be obtained, include a statement in the remarks section that a request/search was made for the records but the medical evidence could not be obtained.

If the service treatment records are not available, include a statement in the remarks section that service treatment records could not be obtained.

If the service treatment records include no pertinent evidence regarding the claimed disability, include a statement in the remarks section that service treatment records contain no pertinent evidence.

Be sure to ask the examiner to include a rationale for their opinion. See Exam Requests, Star Reporter, Volume 2, Issue 6, dated April 2, 2002.

Save medical opinions to the Medical Opinion directory on the I drive.

Refer the exam request to a rating specialist for signature/initials

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Attach a routing slip to send the claims folder to the appropriate VA medical center. The claims folder must accompany the examination when requesting an opinion.

DO NOT use VBA acronyms, abbreviations, or legal terms.

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Section 45.6VA Examinations

Exam Notification & System Requirements_______

NOTIFICATION REQUIREMENTS

When requesting a VA examination, the following outlines minimum notification requirements:

Create a tracked item.

Suspense date should be 30 days from the date of request.

Send notice to the claimant.

SYSTEM REQUIREMENTS

CAPRI INPUTS – Last Rating Exam Date. CAPRI allows for input of the Last Rating Exam Date, which defaults to the current date. This field needs to be updated accurately. Refer to the CAPRI User's Guide can be found for further details.

CURRENT ADDRESS & TELEPHONE NUMBER. Make sure CAPRI shows the Veteran’s current address and telephone number; if the current address and telephone number are not correct, add the information to the remarks section.

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Section 45.7VA Examinations

Subsequent Exam Requests_______

MAKING CHANGES AFTER SUBMISSION

If a change must be made to a VA examination request after it has been submitted, DO NOT do so without calling the VA medical center, C&P Exam Unit. DO NOT make changes to the exam in CAPRI unless requested to do so by the C&P Exam Unit.

REQUESTING ADDITIONAL COMMENTS, OPINIONS OR CLARIFICATIONS (ADDENDUM)

When requesting additional comments, opinions or clarifications from a VAMC examiner, return the claims folder to the VAMC for an addendum. Make a note in the "remarks" section of the examination request that the Veteran has been recently examined and include the date of the most recent VAMC exam. At the top of the remarks section, indicate the date the Veteran was last examined and state that re-examination is at the discretion of the examiner.

When preparing an addendum/clarification request based on a previously completed VA examination, please include the following information in the request:

1. The name of the VA Examiner who performed the exam in question

2. Date of the examination

3. Identify the Veteran by using at least the last name and last four digits of his/her social security number

4. Specific if it is medical or psychiatric condition which is the subject of your inquiry

5. Question for the VAE examiner

REQUESTS TO RESCHEDULE

Do not routinely delay or reschedule exams based on the Veteran’s request. If there is good cause such as illness or hospitalization of the claimant, death of an immediate family member, etc., the examination should be rescheduled. See Failure to report for Department of Veterans Affairs examination, 38 CFR §3.655.

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If the Veteran wants his examination rescheduled in a few months because he’s out of town, or just can’t make the scheduled appointment at the time, this is considered failure to report. The claims file should be forwarded to the rating team for decision or send the FTP letter as appropriate. Refer to the Administrative Denials Section in this development guide for further details.

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Section 45.8VA Examinations

Transfer of Claims Folders for VA Examinations

WHEN TO SEND THE CLAIMS FOLDER WITH AN EXAMINATION REQUEST

In accordance with M21-1 MR III.iv.3.A.1.e, the claims folder should be sent to the examining facility only in circumstances that may require claims folder review by the examiner.

In general, the claims folder should be sent for the examiner's review in any case involving the following:

request for a mental disorders examination

request for a traumatic brain injury examination

request for a formal medical opinion, or

Board of Veterans' Appeals remand.

Note 1. When the claims folder must accompany the request for examination, make sure ALL private and federal treatment reports are on file before requesting the examination.

Note 2. If a medical opinion is being requested, all pertinent evidence should also be tabbed (M21-1MR.III.iv.3.A.9.c)

EXAMINATIONS USING ACE

Compensation Service revised Fast Letter 12-22, Using Acceptable Clinical Evidence (ACE) on August 27, 2013 The Fast Letter was revised to extend the timeframe for sending the claims folder or notice that an e-folder exists in Virtual VA or the Veterans Benefits Management System (VBMS), as applicable, with every Veterans Health Administration (VHA) compensation evaluation examination request. See the highlighted text under the paragraph titled Ordering Disability Evaluations, Mandatory Claims Folder Review, and Documenting ACE for Each Applicable Issue for the changes.

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Section 45.9VA Examinations

Failure to Show for Examination & VHA RSVP Program

_______

When a claimant fails to report for an examination in conjunction with an . . .

ORIGINAL CLAIM

When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. When all other evidence is of record (verification of service, service treatment records, etc.), forward the claim to the Rating Team.

Reference: Failure to report for Department of Veterans Affairs examination, 38 CFR §3.655 and M21-1MR.III.iv.8.E.

ANY OTHER ORIGINAL CLAIM , REOPENED CLAIM , OR CLAIM FOR INCREASE

If a Veteran fails to appear for an examination, refer the claim to the rating activity.

When an examination is scheduled in conjunction with any other original claim, a reopened claim for a benefit which was previously disallowed, or a claim for increase, the claim shall be denied (38 CFR §3.655).

38 CFR 3.655(a) requires VA to discontinue a Veteran's disability compensation or pension payments if the Veteran fails to report for a VA examination without adequate reason. If the rating board finds evidence is insufficient to support continued payment because a Veteran failed to report for examination, the board will prepare a memorandum rating proposing a reduced evaluation. Reference: M21-1MR.IV.ii.3.B, Failure to Report for Review Examination.

Reference: Failure to report for Department of Veterans Affairs examination, 38 CFR §3.655 and M21-1MR.III.iv.8.E.

VETERANS HEALTH ADMINITRATION (VHA) RSVP PROGRAM

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Historically, VHA has found that in circumstances where a Veteran is scheduled for an examination, VHA has not been able to reach him/her by phone to confirm the appointment time, resulting is a higher rate of failure to report for the scheduled examination.

Consequently, VHA is implementing an RSVP Program in which it attempts to reach the Veteran by phone and through the mail in order to schedule the examination. If within 10 calendar days, VHA is successful in reaching the Veteran they will schedule an examination at a time convenient to the Veteran’s schedule. If VHA is not successful in reaching the Veteran within 10 calendar days, they will cancel the examination request indicating that the Veteran failed to RSVP.

Under the RSVP program, ROs and PMCs must follow the instructions below:

Upon receipt of information from VHA about the Veteran’s failure to RSVP, ROs and PMCs will verify that the Veteran’s address and phone number are current.

If there is an updated address and/or phone number, the office will resubmit the updated examination request to the appropriate examination facility.

If there is no new address or phone number of record, then the office will make a decision on the claim and provide notification to the Veteran. o If no additional evidence has been provided, deny the claim due to failure to

cooperate with the examination process.o If additional evidence has been provided, other than the evidence which may have

been obtained from an examination, decide the claim based on evidence of record.

E-mail questions to VAVBAWAS/CO/21Q&A.

Reference: Reference: Compensation Service Bulletin, March 2013

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Section 45.10VA Examinations

Insufficient Examinations_______

Return an examination report as insufficient for rating purposes to the clinic or health care facility Director with a statement describing the deficiencies in the report. For further guidance refer to M21-1MR.III.iv.3.D.18g.

If an examination appears to be insufficient, refer the case to a Coach for review/approval. If the examination is determined to be insufficient for rating purposes, prepare a AMIE Compensation and Pension Exam Worksheet to be signed-off by the Coach; add the following comment in the "Remarks" section of the of the exam request worksheet and when entering the exam request in CAPRI: 

"Exam was approved as insufficient by ___________." 

Input the exam request in CAPRI as insufficient; do not e-mail exam request as an addendum request; the following statement must also be noted in the remarks section of the exam request:

"C-file review is needed,"  or  "Review of the C-file is not required."

An exam may be considered insufficient if any of the following conditions exist:

All disabilities requested were not examined

A rationale was not provided for differing opinions

Laboratory reports, x-ray report, audiology reports, etc. were not provided or were not reviewed or referenced the examining physician

Diagnosis or opinion is not provided or clearly expressed

Exam does not include objective findings or test results

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Section 45.11VA Examinations

Combat Injuries_______

REQUESTS FOR VA EXAMINATION

Complete the following actions if an examination for injuries due to combat is warranted:

Send notice letter to the claimant. See VA Examination section for further details.

Create a tracked item.

Note: If the Veteran reported receiving treatment, obtain all medical evidence prior to requesting an examination.

Refer to Addendum E for a sample medical opinion.

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Section 45.12VA Examinations

Ordering Examinations and Medical Opinions for Claims with Documentation Needing Examiner Review

in the eFolder_______

ORDERING EXAMINATIONS AND MEDICAL OPINIONS FOR CLAIMS WITH DOCUMENTATION NEEDING EXAMINER REVIEW IN THE EFOLDER

The following is a step-by-by step procedure for ordering examinations and medical opinions for claims with documentation needing examiner review in the VBMS and/or Virtual VA eFolder.

Important Notes The Compensation and Pension Record Interchange (CAPRI) application has been enhanced

to include an interface and web service to Virtual VA, which provides VHA personnel access to VBA’s electronic document repository in Virtual VA. All VHA facilities now have direct access to Virtual VA records.

Please note that the below procedures:o Do not change the established guidance in M21-1MR III.iv.3.A.1.e. and Fast Letter

(FL) 12-22, Using Acceptable Clinical Evidence (ACE) , regarding when claims folder review by the examiner is necessary.

o Do not change the established guidance for sending a paper claims folder to an examination facility for a claim solely in paper format.

Prior to ordering an exam involving such a paper claims folder, the user must continue to select “YES” in the “Claim Folder Required?” drop down box in CAPRI.

Ordering Examinations and Medical Opinions for Claims with Documentation Needing Examiner Review in the VBMS and/or Virtual VA Efolder

Step Description

Step 1

Verify Exam Facility System Access

Prior to ordering an exam and/or medical opinion for a claim with documentation needing examiner review in the VBMS and/or Virtual VA eFolder, VBA claims personnel should verify that the examination facility has access to VBMS and/or Virtual VA, as applicable, depending on the location of the pertinent documentation.

If the examination facility has access to VBMS and/or Virtual VA, as applicable, proceed to Steps 2 and 3.

If the examination facility does not have access to VBMS and/or

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Ordering Examinations and Medical Opinions for Claims with Documentation Needing Examiner Review in the VBMS and/or Virtual VA Efolder

Step Description

Virtual VA, as applicable, proceed to Step 4.

Reminder: All VHA facilities now have direct access to Virtual VA records.Step 2

Ordering an Exam at an Examination Facility that has Access to VBMS and Virtual VA

When ordering an exam at an examination facility that has access to VBMS and/or Virtual VA, as applicable, for a claim that has documentation needing review in the VBMS and/or Virtual VA eFolder, follow established procedures unless otherwise stated in the below table.

Step

Action

1 Ensure all pertinent paper evidence is uploaded into the VBMS and/or Virtual VA eFolder, as applicable.

2 If pertinent evidence is in the Virtual VA eFolder, ensure the Social Security Number (SSN) field in Virtual VA is populated with the claimant’s correct SSN.

If the field is blank or incorrectly populated, VBA claims personnel must update the field by selecting the “Edit Folder” button to modify the claimant’s SSN.

Important: VHA C&P personnel search and retrieve electronic documents in Virtual VA through a SSN search; therefore, it is critical that claims personnel ensure the SSN field in Virtual VA is populated with the claimant’s correct SSN when pertinent evidence in the Virtual VA eFolder needs examiner review.

3 Include the applicable following statement on the examination request:

1. All evidence needed for review is available electronically through VBMS, or

2. All evidence needed for review is available electronically through Virtual VA, or

3. All evidence needed for review is available electronically through a combination of both VBMS and Virtual VA, or

4. All evidence needed for review is available electronically through ((VBMS)/(Virtual VA)/(VBMS and Virtual VA)) and in the paper claims folder.

Important: Only use option 4, if documents cannot be uploaded to the VBMS and/or Virtual VA eFolder. Such paper documents, upon return from the examination facility, must be properly associated with the claims folder.

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Ordering Examinations and Medical Opinions for Claims with Documentation Needing Examiner Review in the VBMS and/or Virtual VA Efolder

Step Description

4 If the exam is at a VHA facility, select “NO” in the “Claim Folder Required” drop down box in CAPRI.

5 Do not provide the examination facility paper copies of information available in the VBMS and/or Virtual VA eFolder.

See Step 3, for guidance on tabbing evidence related to a medical opinion request at an examination facility that has access to VBMS and Virtual VA.

Step 3

Tabbing Evidence Related to a Medical Opinion Request at an Examination Facility that has Access to VBMS and Virtual VA

Follow the instructions below for tabbing the evidence in the VBMS eFolder:

Step Action1 Use text annotations in VBMS to electronically “tab” the evidence

in the VBMS eFolder with notes.

For more information on annotating, please refer to the VBMS Job Aid titled “Working with Annotations.”

2 Within each pertinent document in the VBMS eFolder, add the

Manual Reference Regarding Medical OpinionRequests and Tabbing Evidence

Per M21-1MR III.iv.3.A.9.c, when requesting a medical opinion, a veterans service representative (VSR) or rating VSR (RVSR) must identify the evidence to be reviewed by:

Stating on the medical opinion request theo Source of the evidence (provider or facility)o Subject matter involved, ando Approximate dates covered by the evidence, and

Tabbing the evidence in the claims folder.

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Ordering Examinations and Medical Opinions for Claims with Documentation Needing Examiner Review in the VBMS and/or Virtual VA Efolder

Step Description

required notes to identify the evidence needing review.3 On the medical opinion request, indicate that relevant evidence is

annotated and available in the VBMS eFolder.4 Do not provide the examination facility paper copies of

information available in the VBMS and/or Virtual VA eFolder.

Follow the instructions below for directing the C&P examiner to the pertinent electronic documents in the Virtual VA eFolder:

Step Action1 Within the body of the medical opinion request, direct the C&P

examiner to the pertinent electronic document in Virtual VA, by referring to the following document attributes for each document referenced:

Page number(s) of document(s); Document ID; Date of Receipt (DOR); and Document Type.

See “Medical Opinion Request Instructions,” in the Publications tab of the Disability Benefits Questionnaire Switchboard webpage, for a sample of a medical opinion.

2 On the medical opinion request, indicate that relevant evidence is identified and available through the Virtual VA eFolder.

3 Do not provide the examination facility paper copies of information available in the eFolder.

Step 4

Ordering an Exam at an Examination Facility that Does Not Have Access to VBMS and/or Virtual VA

When ordering an exam at an examination facility that does not have access to VBMS and/or Virtual VA, as applicable, for a claim that has documentation needing review in the VBMS and/or Virtual VA eFolder, follow established procedures unless otherwise stated in the below table.

Stage Who Does What1 VSR Prints all pertinent evidence related to the

pending claim from the VBMS and/or Virtual VA eFolder.

For examinations requiring review of the entire electronic claims folder at a facility that does not have access to VBMS and/or Virtual VA, the VSR

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Ordering Examinations and Medical Opinions for Claims with Documentation Needing Examiner Review in the VBMS and/or Virtual VA Efolder

Step Description

must complete a “Certification of All Records Printed for VA Examination” (see the last page of this TIP Sheet) and staple it to the outside of the manila folder.

2 Includes the following statement on the examination request when sending paper evidence from the eFolder(s):

“Please do not add to or remove anything from the manila folder associated with this exam containing the claimant’s medical/claims documentation.”

3 Provides the manila folder to the eClaims processor in IPC/Triage for transfer to the examining facility.

4 eClaims processor in IPC/Triage

Transfers the manila folder to the examining facility, per existing procedures.

5 Reviews the manila folder for new evidence when it is received back from the examining facility.

There should be no new evidence in the folder. Route the paper evidence for shredding per VBA Letter 20-08-63 Revised (3 rd ) .

6 Triage/IPC coach

Sign off on the duplicate printed evidence per VBA Letter 20-08-63 Revised (3 rd ) , and route for shredding.

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Certification of All Records Printed From VBMS for VA Examination

Claim #:______________Claimant’s name:___________________

I certify that I printed all evidence in the claimant’s VBMS eFolder as of: Date:__________ Printed name, job title:______________Signature:_________________

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Section 45.13VA Examinations

Ordering Exams at an Appropriate Facility_______

M21-1MR III.iv.3.A provides guidance on requesting examinations at an appropriate facility.

C&P EXAMINATION REQUEST ROUTING ASSISTANT (ERRA)

Compensation Service’s DEMO staff has updated the C&P Examination Request Routing Assistant (ERRA) tool to include additional details about routing locations. Hover your mouse pointer over any row of results to view approximate workload values for a routing location. ERRA is linked on the DEMO homepage.

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CHANGES

Change 6, January 1, 2005, changed the topic “Development Actions” to read “Notification Requirements;” referring Veterans requiring only audio exams who reside in El Paso or Pueblo counties to the Colorado Springs Clinic was deleted; the topic “Complaints Noted During Examinations” was moved to Section 76, Review for Ready to Rate.

Change 7, February 22, 2005, provided the reference to FL 05-01 with regard to qualifications for examiners performing C&P mental disorders examinations. VA examination guidelines/requirements for individual unemployability were moved to the section in this development guide for Individual Unemployability Claims.

Change 8, March 1, 2005, reformatted the section to eliminate redundancy; provided guidance on specifying which joints to examine when the Veteran is service-connected for DJD of multiple joints; added exam priority codes; added additional information regarding specialist exams; changed the location storing electronic copies of medical opinions; added reference to FL 05-01; references incorporated into the applicable topic.

Change 9, March 14, 2005, added guidance regarding disabilities not to examine; examination of conditions known to be related to service-connected disabilities.

Change 10, April 13, 2005, added guidance regarding medical opinions pertaining to aggravation and secondary service connection; added guidance regarding requests for legal opinions.

Change 11, April 25, 2005, added information about specific types of claims in the general guidelines section; added guidance regarding qualification requirements for examiners performing C&P mental disorders examinations.

Change 12, June 13, 2005, modified Section 28.13, Specific Disabilities & Issues, Topic: Diabetes Mellitus Cases; added guidance regarding issues which have been previously evaluated as not related to SC diabetes. Included a topic on chronic lymphocytic leukemia.

Change 13, June 14, 2005, modified Section 28.9, Failure to Show for Examination, Topic: Any Other Original Claim, Reopened Claim, or Claim for Increase; added guidance to send these claims to the Rating Activity.

Change 14, June 27, 2005, modified Section 28.4, Medical Opinion Guidelines, topic entitled Do Not Ask for Legal Opinions, provided additional guidance regarding requests for opinions regarding hepatitis C.

Change 15, July 5, 2005, modified Section 28.13, Specific Disabilities & Issues; removed the topic entitled PTSD - Initial Evaluation for PTSD versus Review Examination for PTSD.

Change 16, July 19, 2005, Modified Section 28.11, Veterans Living in Foreign Countries; change guidance to show Pittsburgh RO handles requests for medical examinations to be performed by the Department of State for foreign beneficiaries with two exceptions: Mexican, South and Central American and Caribbean cases, which are handled by the Houston RO, and Canadian cases, which are handled by the White River Junction VAM&ROC.

Change 17, September 14, 2005, Modified Section 28.1, General Guidelines - editing and formatting changes. Modified Section 28.3, Preparing A Request – eliminated the requirement to have the green exam worksheet signed-off by the POA.

Change 18, January 1, 2006, references incorporated within each topic.

Change 19, February 9, 2006, added guidance regarding entering new patients into CAPRI (Section 28.15).

Change 20, April 4, 2006, added M21-1MR reference to Section 28.5 regarding medical opinion format; added FL reference to Section 28.14 regarding qualifications of examiners conducting C&P mental disorder exams.

Change 21, July 25, 2006, added disabilities not to examine (hypercholesterolemia, hyperlipidemia, elevated triglycerides, elevated prostate specific antigens, premature ventricular contractions, amenorrhea, uncomplicated pregnancy/childbirth, and obesity).

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Change 22, October 19, 2006, deleted topic “Examination Priorities;” added a reference for the C&P Medical EPSS website.

Change 23, November 23, 2006, modified Section 28.13, Specific Disabilities & Issues; added the topic entitled PTSD - Initial Evaluation for PTSD versus Review Examination for PTSD

Change 24, December 7, 2006, M21-1MR references added/updated.

Change 25, April 17, 2007, added reference to FL 06-25 which requires VSRs/RVSRs to remind examiners to base all Deluca findings on at least three repetitions of range of motion; deleted the requirement to enter the DeLuca statement on exam requests; added M21-1MR reference regarding when to send the claims folder to the examining facility; added M21-1MR reference regarding examinations for incarcerated Veterans.

Change 26, January 22, 2008, updated references.

Change 27, March 7, 2008, updated references and added notes regarding the preparation of medical opinions.

Change 28, October 18, 2008, guidance added regarding secondary conditions due to service-connected hypertension; guidance regarding requests for medical nexus opinions.

Change 29, November 10, 2008, added guidance regarding VA psychiatric exams for service members pending release from active duty due to highly stressful events during military service.

Change 30, February 20, 2009, changed guidance regarding review of insufficient examinations by a Rating Team DRO or Rating Team Coach.

Change 31, March 7, 2009, amended guidance regarding instances in which the claims folder should be sent to the VAMC.

Change 32, July 28, 2009, updated reference regarding Qualifications for Examiners Performing Compensation and Pension (C&P) Mental Disorder Examinations (FL 06-03).

Change 33, September 14, 2009, added guidance regarding request for general medical examination when STRs have not been received on Veteran discharged less than a year.

Change 34, January 20, 2010, added guidance regarding insufficient (inadequate) exam requests.

Change 35, February 3, 2010, information on medical examinations for foreign beneficiaries to Section 59.

Change 36, February 24, 2010, added guidance about additional information on exam requests when making an addendum request for clarification.

Change 37, December 3, 2010, added additional instances in which the C-file is to accompany the request for examination.

Change 38, June 10, 2011, edited text regarding exam requests for insufficient exam.

Change 39, August 29, 2011, edited text regarding the transfer of the claims folder for TBI and mental disorder exams; added BVA remand exams.

Change 40, September 8, 2011, added guidance from FL 11-22 regarding examinations for incarcerated Veterans.

Change 41, October 26, 2011, added requirement for sending the C-file to the VAMC for exams on TDIU.

Change 42, November 19, 2011, added additional guidance regardidng sinus bradycardia (Disabilities Not to Examine).

Change 43, January 19, 2012, added additional guidance regardidng exam requests for incarcerated Veterans.

Change 44, January 26, 2012, added guidance regardidng standardized examination formats.

Change 45, March 28, 2012, removed guidance regarding the transfer of the C-file to the VAMC for TDIU claims.

Change 46, June 26, 2012, added guidance regarding the transfer of claims folders for VA exams.

Change 47, September 5, 2012, added guidance regarding combat injury exam/opinions.

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Change 54May 20, 2014

Change 48, December 9, 2012, added guidance regarding exams that are over one year old.

Change 49, March 27, 2013, added guidance regarding the Veterans Health Adminitration (VHA) RSVP Program.

Change 50, July 23, 2013, added guidance from FL 13-015 regarding interim procedures for psychiatric exams following the release of DSM-V.

Change 51, August 19, 2013, added guidance from VBMS Tips Sheet, Ordering Examinations and Medical Opinions for Claims with Documentation Needing Examiner Review in the eFolder.

Change 52, January 20, 2014, added guidance from the December 2013 Compensation Bulletin regarding requests for examinations, and ordering exams at an appropriate facility. Added guidance regarding the transfer of the claims folder or notification of the e-folder when examinations are based on ACE.

Change 53, March 25, 2014, added guidance from the March 2014 Compensation Bulletin regarding bruxism and ordering exams involving eFolders.

Change 54, May 20, 2014, added guidance regarding the ERRA facility locator on the C&P website.

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Section 46

Disability Benefits Questionnaires (DBQs)_______

GENERAL

Compensation Service has noted that when VA Medical Centers (VAMC) contact Veterans regarding a scheduled examination, numerous Veterans state that they intend to submit a DBQ completed by his/her primary care physician.  Accordingly, VAMCs cancel the exams. When this occurs prior to a rating decision, offices must attempt to contact the Veteran via telephone. Document the call and either inform the Veteran that he/she has 30 days to provide the DBQ or, if telephone contact is unsuccessful, send a follow up letter explaining that we are giving him/her 30 days to submit the DBQ.  Include the following text in the follow up letter to the Veteran:

"[Insert name of VAMC] advised us that they attempted to schedule you for an examination. However, you informed them that you would be submitting a DBQ from your primary care provider and would not be attending an examination.  Please provide this information within 30 days.  If we do not receive the evidence within 30 days from the date of this letter, we will rate your claim with the evidence we have.  If this is incorrect information, please notify us and we will reschedule your examination."

Reference: Compensation Service Bulletin, May 2012. Note: These procedures do not take into account that a private physician will not be aware of medical opinions that may have been requested as part of the VARO Exam Request.

The Veterans Benefits Administration (VBA), in coordination and cooperation with the Veterans Health Administration (VHA), the Board of Veterans’ Appeals (BVA), and the VA Office of General Counsel (OGC), developed 81 DBQs. DBQs standardize VHA exam reports and, once approved for public use, enable private physicians to provide sufficient disability assessment information. DBQs from private physicians will preclude the need for VA exams in many cases. The DBQs listed below are currently approved by OMB for public use. Reference: FL12-11, Disability Benefits Questionnaire Update: March 2012.

DBQs can be viewed on the VA website at: http://benefits.va.gov/disabilityexams.

INADEQUATE QUESTIONNAIRES

Regional Offices (ROs) are no longer required to get Compensation Service approval or feedback prior to returning a DBQ report as insufficient. However, if a completed DBQ is not sufficient for rating, fax or scan the inadequate DBQ and include reasons that explain your finding of inadequacy to Compensation Service via encrypted email at the following address: VAVBAWAS/CO/DBQCOMMENTS. Regardless of whether or not the DBQ

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Change 11January 20, 2014

exam report is returned as “insufficient for rating proposes” within CAPRI, the encrypted email is required. This information will be used to assess DBQ-related issues and drive future enhancements. Reference: FL12-11, Disability Benefits Questionnaire Update: March 2012.

DEVELOPMENT

Do NOT send the MAPD Compensation Claimant Letter, Disability Benefits Questionnaire Notification. Neither the DBQ Fact Sheet, nor the MAP-D paragraph should be included with the VCAA letter. VACO is working on updating the MAP-D paragraph (Email dated 03-26-12 from VAVBAWAS/CO/21Q&A).

Note: Do not enclose DBQs or the DBQ Fact Sheet with Section 5103 (i.e., VCAA) letters. Do not insert any DBQ-specific “copy and paste” development text (as called for in Fast Letters 10-53 and 11-36) into Section 5103 letters. Reference: FL12-11, Disability Benefits Questionnaire Update: March 2012.

DBQ USE BY CONTRACT EXAMINERS

Not all disability benefits questionnaires (DBQs) are available to contract examiners at this time. However, when available, contract examiners must use DBQs in lieu of or in addition to the standard examination worksheets, as appropriate.

The DBQs currently available to contract examiners include:

Ischemic Heart Disease Parkinson’s Disease Hairy Cell Leukemia Hemic Disorders Prostate Cancer Eating Disorders

We anticipate the following DBQs will be available for contract examiner use in the next 30 days:

Kidney Conditions (Nephrology) Male Reproductive System Conditions

Reference: C&P Service Bulletin, Addendum, July 2011

PRIVATE DISABILITY BENEFITS QUESTIONNAIRE (DBQ)

VA may accept a DBQ as adequate for rating purposes if the DBQ is completed by a licensed health care professional who is not a medical doctor.

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The Veterans Court, in Cox v. Nicholson, 20 Vet.App. 563 (2007), noted that medical examinations under 38 U.S.C. 5103A are not required to be conducted by physicians and held that VA may satisfy its duty to assist if the DBQ is completed by a person able to provide “competent medical evidence” as defined under 38 CFR 3.159(a)(1). The regulation defines competent medical evidence as “evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions.”

In Cox, the Veterans Court found that a nurse practitioner, having completed medical education and training, fits into § 3.159(a)(1)’s requirement of a person qualified to provide “competent medical evidence.” Accordingly, the Veterans Court held that an examination conducted by a nurse practitioner satisfies the duty to assist.

Accordingly, DBQs completed by licensed health care professionals, such as a nurse-practitioner or physician’s assistant, are acceptable for rating purposes, as the requirements of § 3.159(a)(1) have been met.

An exception to this rule concerns initial, review, and examinations for an increase in a mental disorder. FL 06-03 , Qualifications for Examiners Performing Compensation and Pension (C&P) Mental Disorder Examinations (March 15, 2006) contains specific instructions regarding the qualifications of mental health examiners performing VA mental disorder examinations. Also, if a claim for service connection for posttraumatic stress disorder (PTSD) is based upon a stressor claimed as related to the Veteran’s fear of hostile military or terrorist activity, 38 CFR 3.304(f)(3) directs that the examination must be conducted by a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted. The instructions contained in FL 06-03 and § 3.304(f) (3) must also be followed for the mental health and PTSD DBQs.

Reference: Compensation Service Bulletin, December 2013

GUIDANCE ON REQUESTING MEDICAL OPINIONS

Because of unforeseen system limitations, we have received significant feedback and questions regarding the use of the Medical Opinion DBQ. Until programming changes can be made to this DBQ, Compensation Service has developed interim procedures to improve the process of requesting medical opinions. The complete instructions for requesting a Medical Opinion DBQ or multiple medical opinions are listed below.

Reference: Compensation Service Bulletin, August 2011

Reference: M21-1MR.III.iv.3.A.9, Medical Opinions

Reference: DBQ intranet site, Medical Opinion Request Instructions)

Medical Opinion Request Instructions

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Change 11January 20, 2014

For Medical Opinions, due to systematic challenges pertaining to multiple medical opinions, ROs are to temporarily accept multiple medical opinions on the old legacy medical opinion template instead of the medical opinion DBQ response from the C&P clinic.

All other DBQs will continue to be used, when available in CAPRI.

AMC's, as well as Appeals Team personnel, will continue to request Medical Opinions either by using the copy/paste options provided in the attached Medical Opinion DBQ instructions or by copy/pasting the exact instructions as requested by BVA.

These instructions are designed to guide the RVSR/VSR in developing the medical opinion request notes in CAPRI (2507). The RVSR/VSR will first indicate that they are requesting a Medical Opinion and then the type of opinion being requested. Following the instructions included with each option, the RVSR/VSR will direct the examiner to the appropriate section of the Medical Opinion DBQ. Furthermore, the RVSR/VSR will complete the appropriate template sentences or sections based on the Veteran’s claim. The RVSR/VSR will then copy the completed template sentences or sections verbatim into the request for the Medical Opinion DBQ or appropriate examination type, when multiple opinions are being requested. The RVSR/VSR must also include directions as to the hierarchy of requests.

To reduce the chance that a medical opinion request is missed by an examiner, always paste the opinion request(s) as the first entry in the remarks section of the appropriate examination type and always use ALL CAPS for the words “MEDICAL OPINION” as the first line.

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Example of a Medical Opinion DBQ request for direct service connection copy/pasted into CAPRI (2507) remarks section:

MEDICAL OPINION

Type of medical opinion requested: Direct service connection

Contention: left knee sprain

The Veteran is claiming that “his/her” left knee sprain was incurred in or caused by “his/her” fall from a humvee that occurred while in Iraq on July 1, 2006.

Opinion Requested:Is the Veteran’s left knee sprain at least as likely as not (50 percent or greater probability) incurred in or caused by his fall from a humvee that occurred while in Iraq on July 1, 2006. Rationale must be provided in the appropriate section below. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion.

Potentially Relevant Evidence:Tab A: Sick Call notes dated July 1, 2006Tab B: Chronological Records of Medical Care dated July 3, 2006Tab C: Chronological Records of Medical Care dated July 10, 2006Tab D: Medical Evaluation Board dated August 5, 2008

Note: Additional instructions can be added, when deemed necessary by the rater, as well as an opinion regarding conflicting evidence (item #4).

Below are all of the options that you have to copy/paste and fill in the blanks when requesting a Medical Opinion DBQ:

1. Type of medical opinion(s) requested Direct service connection Secondary service connection Aggravation of preexisting condition Aggravation of nonservice-connected disability Reconciliation of conflicting medical evidence

2. Contention

Claimed Condition:

Direct service connectionThe Veteran is claiming that his/her (insert “claimed condition”) was incurred in or caused by (insert “claimed in-service injury, event, or illness”) that occurred (insert “estimated date or time frame”).

Secondary service connection The Veteran is claiming that his/her (insert “claimed condition”) was proximately due to or the result of his or her (insert “service connected condition”).

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Aggravation of a pre-existing disabilityThe Veteran is claiming that his/her (insert “claimed condition”) existed prior to service and was aggravated beyond its natural progression by (insert “claimed in-service injury, event, or illness”).

Aggravation of a nonservice connected disability by a service connected disabilityThe Veteran contends that his/her (insert “claimed condition”) was aggravated beyond natural progression by his or her (insert “service connected condition”).

3. Opinion request

Direct service connectionIs the Veteran’s (insert “claimed condition”) at least as likely as not (50 percent or greater probability) incurred in or caused by (insert “claimed in-service injury, event, or illness”) that occurred (insert “estimated date or time frame”). Rationale must be provided in the appropriate section below. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion.

Secondary service connection Is the Veteran’s (insert “claimed condition”) at least as likely as not (50 percent or greater probability) proximately due to or the result of (insert “service connected condition”). Rationale must be provided in the appropriate section below. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion.

Aggravation of a pre-service disabilityWas the Veteran’s (insert “claimed condition”), which clearly and unmistakably existed prior to service, aggravated beyond its natural progression by (insert “claimed in-service injury, event, or illness”) during service? Rationale must be provided in the appropriate section below. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion.

Aggravation of a nonservice connected disability by a service connected disabilityWas the Veteran’s (insert “claimed condition”) at least as likely as not aggravated beyond its natural progression by (insert “service connected condition”)? Rationale must be provided in the appropriate section below. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion.

4. Opinion regarding conflicting medical evidenceThere is conflicting medical evidence. We are asking that you review this medical evidence and provide an opinion. The following is a summary of the conflicting medical evidence as it relates to the Veteran’s claim: ______________________________________________________

Rationale must be provided in the appropriate section below. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion.

5. Potentially relevant evidence

NOTE: The examiner’s review of the record is NOT restricted to the evidence listed below. This list is provided in an effort to assist the examiner in locating potentially relevant evidence.

Tab A: _________________________Tab B: _________________________Tab C: _________________________

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Tab D: _________________________Tab E: _________________________Tab F: _________________________

6. Insert additional instructions to clinician as necessary (e.g. hierarchy of contingent opinions)_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

GUIDANCE ON USE OF DISABILITY BENEFITS QUESTIONNAIRE (DBQ)

As previously announced, use of many DBQs has become mandatory, both by VBA personnel requesting Compensation and Pension (C&P) Examinations via CAPRI, as well as by Veterans Health Administration (VHA) C&P examiners.

Instructions published by the VHA Office of Disability and Medical Assessment (DMA) require C&P examiners to conduct and record examinations on the new DBQs once they are available for use in CAPRI, even if the examination request was submitted prior to the “Go-Live Date” for a particular DBQ and requested the traditional exam worksheet.

We have received reports from VHA that RO personnel are going into CAPRI and changing examination requests from the selected worksheet to the new DBQs. Because DBQ use by examiners is required, if available, changing examination requests in CAPRI is unnecessary and creates a management and tracking burden for the C&P Clinic administrative staff.

Therefore, if an examination request was submitted in CAPRI indicating a traditional worksheet, and the associated DBQ becomes available and mandatory for use after the request was submitted, there is no need to change the request to the new DBQ.

Reference: Compensation Service Bulletin, August 2011

USING ACCEPTABLE CLINICAL EVIDENCE (ACE)

Compensation Service revised Fast Letter 12-22, Using Acceptable Clinical Evidence (ACE) on August 27, 2013 The Fast Letter was revised to extend the timeframe for sending the claims folder or notice that an e-folder exists in Virtual VA or the Veterans Benefits Management System (VBMS), as applicable, with every Veterans Health Administration (VHA) compensation evaluation examination request. See the highlighted text under the paragraph titled Ordering Disability Evaluations, Mandatory Claims Folder Review, and Documenting ACE for Each Applicable Issue for the changes.

VHA will use the ACE process where it determines it is appropriate, unless otherwise requested by VBA. For example:

VBA specifically requires an in-person examination A claim for pension

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A remand by the Board of Veterans’ Appeals ordering an examination The disability at issue is a mental condition A predischarge claim (e.g., Benefits Delivery at Discharge (BDD), Quick Start, or

Integrated Disability Evaluation System (IDES), or A claim that involves electronic medical records not available to VHA

Complete procedures for ordering disability evaluations, documenting the use of ACE in Rating Board Automation (RBA) 2000, and notifying claimants that an ACE review was performed in lieu of examination are provided in Fast Letter 12-12.

Reference: Compensation Service Bulletin, October 2012

DISABILITY BENEFITS QUESTIONNAIRE (DBQ) CHANGES BASED ON MITCHELL V. SHINSEKI

In Mitchell v. Shinseki, 25 Vet.App. 32 (2011), the Veterans Court held that if pain is associated with movement, the examiner must give an opinion on whether pain could significantly limit functional ability during flare-ups or when the joint is used repeatedly over a period of time and that such opinion, if feasible, be expressed in terms of the degree of additional range of motion (ROM) loss due to pain on use or during flare-ups.

The Court’s holding requires revisions to joints (DBQs which are required to address functional loss and additional loss of motion after repetitive use. If functional loss or additional loss of motion manifests following repetitive use, the DBQ directs the examiner to identify if any of the factors contained in 38 C.F.R. §§ 4.40 and 4.45 contribute to functional loss or additional loss of motion.

As a result of the Mitchell decision, if any of the §§ 4.40 or 4.45 factors are associated with movement, the examiner must also give an opinion on whether pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups or when the joint is used repeatedly over a period of time and that opinion, if feasible, should be expressed in terms of the degrees of additional ROM loss due to “pain on use or during flare-ups.” The examiner must also describe any such additional limitation due to pain, weakness, fatigability or incoordination during flare-ups or when the joint is used repeatedly over time.

Suggested text for entry into Remarks for any musculoskeletal DBQ

When completing any musculoskeletal DBQ, additional information is required to comply with a recent US Court of Appeals for Veterans Claims (CAVC) decision in the case of Mitchell v. Shinseki, relating to functional limitations. In the section of the DBQ titled “Functional loss and additional limitation in ROM,” additional questions must be addressed. For each joint examined, please provide an opinion.

1. Whether pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time, and

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2. Describe any such additional limitation due to pain, weakness, fatigability or incoordination, and if feasible, this opinion should be expressed in terms of the degrees of additional ROM loss due to “pain on use or during flare-ups”.

3. If such opinion is not feasible, please state and provide an explanation as to why the opinion cannot be rendered.

Reference: Compensation Service Bulletin, March 2013

CHANGES

Change 1, March 2, 2011, added guidance regarding Inadequate Questionnaires; specific DBQs were added to the list of available DBQs.

Change 2, July 5, 2011, deleted list of current DBQs.

Change 3, August 9, 2011, added guidance from C&P Service Bulletin, Addendum, July 2011, regarding use of DBQs by contract examiners and the medical opinion DBQ.

Change 4, August 18, 2011, added guidance from Compensation Service Bulletin, August 2011, regarding use of DBQs.

Change 5, February 27, 2012, added guidance from FL 10-53 VCAA standard letter text.

Change 6, March 23, 2012, added guidance from FL 12-11 amd removed guidance contained in FL 10-53 which was rescinded.

Change 7, May 20, 2012, added guidance regarding cancellation of exams in lieu of receiving a DBQ from a private physician.

Change 8, October 28, 2012, added guidance Using Acceptable Clinical Evidence (ACE)

Change 9, March 27, 2013, added guidance regarding changes required for DBQs with regard to the Mitchell v. Shinseki court decision.

Change 10, October 8, 2013, added guidance regarding the revised FL 12-22, Using Acceptable Clinical Evidence (ACE).

Change 11, January 20, 2014, added guidance from the December 2013 Compensation Service Bulletin regarding Private DBQs.

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Section 47

Disabilities Requiring Mandatory Examination_______

Note: The rating schedule describes when schedular temporary total evaluations are to be assigned for an open-ended period, and when others are for a specified, closed-end period. For further guidance, refer to C&P Service Bulletin, May 2010.

Shoulder replacement (prosthesis) – Diagnostic Code 5051. A scheduler 100 percent evaluation is provided for one year following the surgical prosthesis. Request a VA examination 13 months from the date of surgery. If the Veteran underwent a surgical prosthesis within the past year for a joint, do not schedule an examination, rather, be sure to obtain all medical reports before sending the claim to the Rating Team.

Elbow replacement (prosthesis) – Diagnostic Code 5052. A scheduler 100 percent evaluation is provided for one year following the surgical prosthesis. Request a VA examination 13 months from the date of surgery. If the Veteran underwent a surgical prosthesis within the past year for a joint, do not schedule an examination, rather, be sure to obtain all medical reports before sending the claim to the Rating Team.

Wrist replacement (prosthesis) – Diagnostic Code 5053. A scheduler 100 percent evaluation is provided for one year following the surgical prosthesis. Request a VA examination 13 months from the date of surgery. If the Veteran underwent a surgical prosthesis within the past year for a joint, do not schedule an examination, rather, be sure to obtain all medical reports before sending the claim to the Rating Team.

Hip replacement (prosthesis) – Diagnostic Code 5054. A scheduler 100 percent evaluation is provided for one year following the surgical prosthesis. Request a VA examination 13 months from the date of surgery. If the Veteran underwent a surgical prosthesis within the past year for a joint, do not schedule an examination, rather, be sure to obtain all medical reports before sending the claim to the Rating Team.

Knee replacement (prosthesis) – Diagnostic Code 5055. A scheduler 100 percent evaluation is provided for one year following the surgical prosthesis. Request a VA examination 13 months from the date of surgery. If the Veteran underwent a surgical prosthesis within the past year for a joint, do not schedule an examination, rather, be sure to obtain all medical reports before sending the claim to the Rating Team.

Ankle replacement (prosthesis) – Diagnostic Code 5056. A scheduler 100 percent evaluation is provided for one year following the surgical prosthesis. Request a VA examination 13 months from the date of surgery. If the Veteran underwent a surgical prosthesis within the past year for a joint, do not schedule an examination, rather, be sure to obtain all medical reports before sending the claim to the Rating Team.

Muscle, neoplasm of, malignant (excluding soft tissue sarcoma) – Diagnostic Code 5327. Six months after discontinuance of radiation treatment, antineoplastic chemotherapy or other

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therapeutic procedures, the appropriate disability rating shall be determined by mandatory VA examination.

Sarcoma, soft tissue (of muscle, fat, or fibrous connective tissue) – Diagnostic Code 5329. Six months after discontinuance of radiation treatment, antineoplastic chemotherapy or other therapeutic procedures, the appropriate disability rating shall be determined by mandatory VA examination.

Malignant neoplasm of the ear (other than skin only) – Diagnostic Code 6208. Six months after is continuance of surgical radiation treatment, antineoplastic chemotherapy or other therapeutic procedure, the appropriate disability rating shall be determined by mandatory VA examination.

Visceral Leishmaniasis – Diagnostic Code 6301. Six months after discontinuance of cessation of treatment for active disease, the appropriate disability rating shall be determined by mandatory VA examination.

Leprosy (Hansen’s Disease) – Diagnostic Code 6302. Six months after the date of inactivity, the appropriate disability rating shall be determined by mandatory VA examination.

Tuberculosis, pulmonary, chronic, inactive – Diagnostic Code 6731: A mandatory examination will be requested immediately following notification that active tuberculosis evaluated has become inactive.

Neoplasms, malignant, any specified part of respiratory system – Diagnostic Code 6819. Six months after discontinuance of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the appropriate disability rating shall be determined by mandatory VA examination.

Ventricular arrhythmias (sustained) – Diagnostic Code 7011. Six months following discharge from the hospital for initial evaluation and medical therapy for a sustained ventricular arrhythmia or for ventricular aneurysmectomy, the appropriate disability rating shall be determined by mandatory VA examination.

Heart valve replacement (prosthesis) – Diagnostic Code 7016. Six months following discharge from the hospital for valve replacement, the appropriate disability rating shall be determined by mandatory VA examination.

Cardiac transplantation – Diagnostic Code 7019. One year following discharge from the hospital for cardiac transplantation, the appropriate disability rating shall be determined by mandatory VA examination.

Aortic aneurysm – Diagnostic Code 7110. Six months following discharge from the hospital for surgical correction, the appropriate disability rating shall be determined by mandatory VA examination.

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Aneurysm, any large artery – Diagnostic Code 7111. Six months following discharge from the hospital for surgical correction, the appropriate disability rating shall be determined by mandatory VA examination.

Soft tissue sarcoma (of vascular origin) – Diagnostic Code 7123. Six months after discontinuance of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the appropriate disability rating shall be determined by mandatory VA examination.

Malignant neoplasms of the digestive system, exclusive of skin growths – Diagnostic Code 7343. Six months after discontinuance of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the appropriate disability rating shall be determined by mandatory VA examination.

Liver transplant – Diagnostic Code 7351. One year following discharge from the hospital for transplant surgery, the appropriate disability rating shall be determined by mandatory VA examination.

Malignant neoplasms of the genitourinary system – Diagnostic Code 7528. Following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the appropriate disability rating shall be determined by a mandatory VA examination at the expiration of six months.

Kidney transplant – Diagnostic Code 7531. A mandatory VA examination will be made one year following hospital discharge.

Malignant neoplasms of gynecological system or breast – Diagnostic Code 7627. Six months after discontinuance of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the appropriate disability rating shall be determined by mandatory VA examination.

Agranulocytosis, acute – Diagnostic Code 7702. A mandatory VA examination is required six months following hospital discharge for bone marrow transplant.

Leukemia – Diagnostic Code 7703. Six months after discontinuance of any surgical, radiation, antineoplastic chemotherapy or other therapeutic procedures, the appropriate disability rating shall be determined by mandatory VA examination.

Hodgkin’s disease – Diagnostic Code 7709. Six months after discontinuance of any surgical, radiation, antineoplastic chemotherapy or other therapeutic procedures, the appropriate disability rating shall be determined by mandatory VA examination.

Non-Hodgkin’s lymphoma – Diagnostic Code 7715. Six months after discontinuance of any surgical, radiation, antineoplastic chemotherapy or other therapeutic procedures, the appropriate disability rating shall be determined by mandatory VA examination.

Aplastic anemia – Diagnostic Code 7716. A mandatory VA examination is required six months following hospital discharge for bone marrow.

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Malignant skin neoplasms (other than malignant melanoma) – Diagnostic Code 7818. A mandatory VA examination is required six months following the completion of antineoplastic treatment.

Malignant melanoma – Diagnostic Code 7833. A mandatory VA examination is required six months following the completion of antineoplastic treatment.

Neoplasm, malignant, any specified part of the endocrine system – Diagnostic Code 7914. Six months after discontinuance of Note: A rating of 100 percent shall continue beyond the cessation of., the appropriate disability rating shall be determined by mandatory VA examination.

C-cell hyperplasia of the thyroid – Diagnostic Code 7919. Six months after discontinuance of Note: A rating of 100 percent shall continue beyond the cessation of., the appropriate disability rating shall be determined by mandatory VA examination.

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Section 48

Routine Future ExaminationEP 310_______

SCHEDULE FOR ROUTINE FUTURE EXAMINATIONS

On July 29, 2010, C&P Service released a revised Fast Letter 10-14, Procedural Change Regarding Routine Future Examinations. This fast letter instructs the field to schedule routine future examinations five years from the date of the rating decision, instead of two years, unless a different reexamination interval is specified in 38 C.F.R. Part 3 or 4.

The revision specifically changed the information on handling the results of a routine future examination (see page 2) so that the second examination should be scheduled for 18, 24, or 30 months from the date of the new rating decision (see 38 Code of Federal Regulations §3.344). The remainder of the letter remains unchanged.

Note: M21-1MR.III.IV.3.B, will be revised in accordance with Fast Letter 10-14.

SCHEDULING ROUTINE FUTURE EXAMINATIONS

The CFR citation for reexamination is 38 CFR 3.327.

For reexamination guidance for disability ratings in effect for five years or more, see 38 CFR 3.344.

For guidance regarding determining the need for review examinations, see M21-1MR III.iv.3.B.15.

Fast Letter (FL) 10-14, Procedural Change Regarding Routine Future Examinations (Revised) , dated July 29, 2010 , provides a procedural change to reexaminations under 38 CFR 3.327. The procedural change is to schedule routine future examinations at five-year intervals instead of two-year intervals. This FL implemented the procedural change to aid in the reduction of the rating related claims inventory.

To further aid in the reduction of the rating related claims inventory, we are providing this additional guidance for field use in determining when to request a routine future exam.

RO employees should request reexaminations, including periods of hospital observation, whenever they determine there is a need to verify the continued existence or the current severity of a disability. Generally, reexamination is required if it is likely that a disability has improved, or if evidence indicates there has been a material change in a disability or that the current rating may be incorrect. For ratings in effect for five years or more for diseases subject to temporary or episodic improvement (as referenced in 38 CFR 3.344), do not

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reduce on any one examination unless it is as full and complete as the exam granting or authorizing payment and sustained improvement is shown by the evidence of record.

Guidelines for Reexamination

Per FL 10-14 , schedule any future review examination at five-year intervals. Schedule the examination five years from the date of the rating decision, with the following exceptions:1. Prestabilization rating decisions under 38 CFR 3.327(b)(1).2. Discharge from military service due to a mental disorder caused by traumatic stress

under 38 CFR 4.129.3. Malignancies that require reevaluation six months following cessation of treatment

for active disease.

Any other future examination required under other sections of 38 CFR Part 3 and 38 CFR Part 4 .

Do not request reexamination per 38 CFR 3.327 , when 1. There is adequate medical evidence for rating purposes and the disability is static,

without material improvement over five years, and not likely to improve.2. The disability is permanent in character and of such nature that there is no likelihood

of improvement.3. The Veteran is over 55 years of age.

The evaluation is the prescribed scheduler minimum or the combined evaluation would not change even if the reexamination resulted in a reduced evaluation for one or more disabilities.

Reference: Compensation Service Bulletin, April 2014

NOTIFICATION REQUIREMENTS

When requesting a VA examination, the following outlines minimum notification requirements:

Create a tracked item.

Send a notice letter to the claimant.

CANCELLATION OF ROUTINE FUTURE EXAMS

Diary code 01 should be cleared and not cancelled

Annotate the file to show why the exam was cancelled; sign and date the annotation

Reference: Quality Conference Call, August 27, 2009

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ROUTINE FUTURE EXAMS FOLLOWING MEDICAL EVENTS OR PROCEDURES

The rating schedule describes when schedular temporary total evaluations are to be assigned for an open-ended period, and when others are for a specified, closed-end period.

An example of an open-ended period is found under diagnostic code 7528, Malignant neoplasms of the genitourinary system. A 100 percent evaluation is assigned, and six months after the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, a mandatory VA exam is conducted. Subsequent evaluations will be based on the residual disability found on exam. Any change in the evaluation based on that exam or subsequent exams shall be subject to the due process requirements of 38 CFR §3.105(e).

In contrast, a schedular temporary total evaluation with a closed-end period is found under diagnostic code 5055, Knee replacement (prosthesis). The rating schedule directs that, following hospital discharge, a one month total rating be assigned based on 38 CFR §4.30. This is followed by assignment of a temporary total evaluation for a period of one year following implantation of the prosthetic joint. After the expiration of the one year, generally, the minimum schedular evaluation is assigned.

In the first example of prostate cancer, there is no question that the plain language of the rating schedule requires a future examination. Therefore, the future examination will be scheduled by the rating decision. In the second example of a knee replacement, there is no such direction or guidance. In keeping with VA’s current emphasis on simplifying the claims process and reducing the number of unnecessary examinations, new guidance is being issued.

In cases where the rating schedule provides for a closed-end temporary total evaluation, the rating establishing the total evaluation will prospectively assign the minimum schedular evaluation effective the day following expiration of the prescribed total period. No future examination will be scheduled prior to the expiration of the temporary total period. The decision notice letter will inform the Veteran of the duration of the temporary total period and the effective date of reduced schedular minimum evaluation.

The exception to this guidance is when the evaluation prior to the temporary total period exceeds the minimum schedular evaluation, and that evaluation is protected under 38 CFR 3.951(b). In such cases, no future examination will be scheduled, and the higher protected evaluation will be assigned the day following expiration of the temporary total period.

Reference: C&P Service Bulletin, May 2010

CHANGES

Change 1, August 27, 2009, added guidance regarding cancellation of routine future exams.

Change 2, July 29, 2010, added guidance from FL 10-14 regarding scheduling routine future exams.

Change 3, August 28, 2011, added guidance from C&P Service Bulletin, May 2010 regarding routine future exams following medical events or procedures.

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Change 4April 17, 2014

Change 4, April 17, 2014, added guidance from the April 2014 Compensation Service Bulletin regarding scheduling routine future examinations.

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January 1, 2011

Section 49

Examination of Specific Disabilities & Issues_______

AID & ATTENDANCE CASES

When requesting an aid and attendance examination, list the problems, such as blindness, dementia, etc. in the remarks section since this will assist in scheduling specialty examinations.

BRAIN AND SPINAL CORD VERSUS NEUROLOGICAL DISORDERS WORKSHEET

In general the five neurological worksheets correspond to the groupings of diagnostic codes in the rating schedule numbered from 8000 through 8914. The correct worksheet for residuals of cerebral vascular accident and for multiple sclerosis is Brain and Spinal Cord. The correct worksheet for migraine headaches is Neurological Disorders, Miscellaneous. Excerpt from Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

CARPAL TUNNEL SYNDROME

Be sure to select a “peripheral nerves” exam rather than a “joints” exam.

CEREBROVASCULAR ACCIDENT (CVA)

If a Veteran had a cerebrovascular accident (CVA), do not order a traumatic brain injury (TBI) examination. The correct examination worksheet for a CVA is the brain/spinal cord examination.

CHRONIC LYMPHOCYTIC LEUKEMIA

If the Veterans has been diagnosed with CLL, a 100 percent evaluation is warranted and a VA examination is not required unless there are specific complications or residuals. Refer the claim to an RVSR for further guidance.

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January 1, 2011

CHLORACNE OR OTHER ACNEFORM DISEASE OR PORPHYRIA CUTANEA TARDA

38 CFR 3.307 provides for service connection of chloracne or other acneform disease or porphyria cutanea tarda on a presumptive basis only if these skin conditions become manifest to a degree of 10 percent or more within a year after the last date on which the Veteran was exposed to an herbicide agent during active military, naval or air service.

Therefore, if the medical evidence does not show the Veteran developed any of these skin conditions during the presumptive period or during military service, there is no need to request an examination. If service connection cannot be considered on a presumptive or direct basis, there is no need to examine these skin conditions.

DEGENERATIVE JOINT DISEASE/OSTEOARTHRITIS OF MULTIPLE JOINTS

Special instructions to the VA examiner are required when a Veteran is service-connected for “degenerative joint disease, multiple joints” or “degenerative joint disease of the right knee, right shoulder and lumbosacral spine.” The examination request must specify the specific joints the Veteran is claiming have worsened. The specific joints to be examined can be taken from the actual disability which is service-connected (e.g. degenerative joint disease of the neck, right shoulder and right knee) or the information may have to be taken from the reasons and bases section of the prior decision.

CIRCULATORY SYSTEM VERSUS NERVOUS SYSTEM DISABILITIES

Scenario: A Veteran claims problems with circulation in his legs and is already service-connected for atherosclerotic heart disease, diabetes mellitus type II and peripheral neuropathy of the lower extremities.

The above cited scenario would not constitute a claim for an increased evaluation of the service-connected peripheral neuropathy. Peripheral neuropathy is a numbness and tingling due to a nerve disability. The circulation problem is a vascular disease, disease of the blood vessels, which requires an ankle/brachial index. Therefore, a VA examination request for the cardiovascular condition would be appropriate versus a neurological examination.

INTESTINES (LARGE & SMALL) VERSUS DIGESTIVE CONDITIONS VERSUS STOMACH , DUODENUM AND PERITONEAL ADHESIONS VERSUS RECTUM AND ANUS

For hemorrhoids, request the Rectum and Anus worksheet.

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January 1, 2011

For inguinal, femoral, and ventral hernias request the Digestive Conditions, Miscellaneous worksheet.

For hiatal hernia and gastroesophageal reflux (GERD), request the Esophagus and Hiatal Hernia worksheet.

For colon irritable bowel syndrome (IBS), resection of the intestine, and diverticulitis, request the Intestines (large and small) worksheet.

For vagotomy and gastroenterostomy, request Stomach, Duodenum and Peritoneal Adhesions worksheet.

Excerpt from Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

MENTAL DISORDERS

The Mental Disorders worksheet is used for all mental conditions except PTSD and eating disorders. See Exam Requests, Star Reporter, Volume 2, Issue 6, dated April 2, 2002.

For guidance regarding qualifications of examiners performing C&P mental disorders examinations, refer to Fast Letter 06-03, Subj: Qualifications for Examiners Performing Compensation and Pension (C&P) Mental Disorder Examinations, dated March 15, 2006.

CO-EXISTING MENTAL DISORDERS. When an examination includes multiple mental disorder diagnoses and at least one is service related, the examiner must delineate, to the extent possible, the symptoms associated with each and discuss any relationship between the disorders. The examiner must disassociate impairment from nonservice-connected disorders to the extent possible and if not possible, the examiner must provide an explanation. If the examiner does not provide the required analysis/explanation, the examination report must be clarified. Reference: VSCM Conference Call, October 20, 2005.

MULTIPLE SCLEROSIS

In cases involving multiple sclerosis, obtain pertinent treatment reports before requesting an examination. In addition, determine whether the Veteran has been treated for any eye condition or psychiatric condition related to multiple sclerosis (make a telephone call if necessary). If the Veteran has received treatment for an eye or psychiatric condition, request the appropriate disability-specialty worksheets.

Be sure to include a request for other affected systems such as digestive, GU, neurological, etc.

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January 1, 2011

MUSCULOSKELETAL SYSTEM

SPINE: For spine exams specify lumbar, thoracic or cervical.

EXTREMITIES: For extremities, include right, left or bilateral.

JOINTS: For joint exams, limit the exam to specific joints or ask that all joints be examined.

TRAUMATIC ARTHRITIS/OSTEOARTHRITIS: For traumatic arthritis, identify the joint and whether or not it is confirmed by x-ray. For osteoarthritis ask that all joints be examined, identify the joints already diagnosed with benefit of x-rays, and ask for x-rays to confirm other affected joints.

See Exam Requests, Star Reporter, Volume 2, Issue 6, dated April 2, 2002.

BONES worksheet versus JOINTS worksheet versus SPINE worksheet: Disabilities of the cervical, dorsal, lumbar and sacral spine are addressed by the Spine worksheet. Degenerative joint disease of the spine is addressed by the Spine worksheet.

The Bones worksheet is for fractures and bone disease that involve functional impairments affecting more than just joints. Osteomyelitis, active rheumatoid arthritis, and bone cancers are the most common examples of such disabilities. There is no need to request both a Bones and Joints worksheet for the same condition. The Joints worksheet is not appropriate for osteomyelitis or bone cancer.

Tell the examiner whether to examine all joints or only specific joints and whether or not x-rays are of record confirming arthritis. If x-rays are already positive for arthritis, there is no requirement to obtain repeat x-rays.

Excerpt from Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

NOTE: Please remind the examiner to base all DeLuca findings on at least three repetitions of range of motion (Reference: Fast Letter 06-25, Subj: Clarification of DeLuca Guidelines for Compensation and Pension Examiners, dated November 29, 2006). The DeLuca statement regarding additional limitations due to repetitive use is no longer required (Reference: C&P Manager’s Conference Call, September 16, 2004).

PERIPHERAL NERVES WORKSHEET VERSUS SPINE WORKSHEET

Do not request both a Spine worksheet and Peripheral Nerves worksheet for spinal disabilities even when separate evaluations have been or may be assigned. The spine worksheet instructs examiners to conduct a neurological examination. Excerpt from Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

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January 1, 2011

PTSD - INITIAL EVALUATION FOR PTSD VERSUS REVIEW EXAMINATION FOR PTSD

There are four mental health worksheets. Sometimes it may be appropriate to request multiple worksheets in this category; however, do so only if necessary.

There are two separate worksheets for post traumatic stress disorder (PTSD): Initial Evaluation for PTSD and Review Examination for PTSD. If service connection is not yet established, request the Initial Evaluation worksheet. If PTSD is already established, request the Review Examination worksheet even if the issue is claim for increase and not routine future examination.

When the issue includes both PTSD and non PTSD mental issues, follow these guides:

If PTSD and eating disorder are at issue, request both worksheets.

If eating disorder and another mental condition are at issue, request both worksheets.

If PTSD and other mental disorder (not eating disorder) are at issue, request only the Initial PTSD or the Review PTSD worksheet and explain claim in remarks.

If PTSD is already service connected and claim is for another mental condition (not eating disorder), request the Review PTSD worksheet and explain claim in remarks.

If mental disorder other than PTSD or eating disorder is already service connected and claim is for PTSD, request only Initial PTSD and explain claim in remarks.

Excerpt from Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

Refer to Addendum C in this development guide for a Sample VA Exam Opinion for PTSD.

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August 28, 2012

Section 50

Signature & Qualification Requirements for Examiners Performing Examinations

_______

WHO MUST SIGN EXAMINATION REPORTS

For guidance regarding who must sign examination reports, refer to M21-1MR.III.iv.3.D.18a.

QUALIFICATIONS FOR EXAMINERS PERFORMING MENTAL DISORDER EXAMINATIONS

For guidance regarding qualifications of examiners performing C&P mental disorders examinations, refer to M21-1MR.III.iv.3.D.18d and Fast Letter 06-03, Subj: Qualifications for Examiners Performing Compensation and Pension (C&P) Mental Disorder Examinations, dated March 15, 2006.

CHANGES

Change 1, August 28, 2012, added guidance regarding “Who Must Sign Examination Reports.”

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January 1, 2011

Section 51

Entering New Patients in CAPRI_______

When entering patients into CAPRI, caution must be taken when entering patient information so as not to create an erroneous record. If a Veteran’s SSN is mistyped on the CAPRI Enter New Patient record screen, CAPRI will create a new patient record if no exact SSN match is found.

When entering a patient record with the wrong SSN, the integrity of the VHA VistA patient record system is compromised, and this could negatively impact patient health care and safety. Furthermore, VHA spends considerable time purging/merging erroneous records with existing patient records. VBA CAPRI users need to exercise due diligence when entering new patient records in CAPRI.

1. The only reason a user should establish a new patient record in CAPRI is to request a C&P examination for a Veteran that is not a current patient within the VHA medical facility’s database.

2. Before adding any new patient record, the VBA user must perform a through patient name and SSN search. If the patient NAME and SSN searches using CAPRI’s Patient Selector function yield no result, then you will have to establish the Veteran as a new patient.

3. Consider the example below for BEETLE BAILEY, SSN 000-00-0002.

Step 1 - From the Patient Selector screen (fig. 1), the user performs a name search (LastName,FirstName): BAILEY,BEETLE.

Figure 1

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January 1, 2011

Step 2 - If “Match not found” is displayed, then enter a SSN search (with no hyphens): 000000002, as shown in fig. 2.

Figure. 2

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January 1, 2011

Step 3 - If the SSN search shows “Match not found,” then the user can proceed to the Enter New Patient record screen (fig. 3) and enter the SSN. Please verify that the SSN is typed correctly. Suggestion: The SSN from the Patient Selector screen (fig. 2) can be copied and pasted into the Enter New Patient record screen, eliminating the potential re-keying error.

Figure. 3

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January 1, 2011

Step 4 – From fig. 3, verify that the SSN is not in use. If a duplicate SSN is not found, the user will be prompted to enter patient identifying data (fig. 4), and a new record will be established.

Figure. 4

For further guidance on entering exam requests into CAPRI, refer to the CAPRI User's Guide.

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Change 34April 17, 2014

Section 52

Specific Disability Considerations_______

1 – AL Amyloidosis...........................................................................52.2

2 – Amyotrophic Lateral Sclerosis..................................................52.3

3 – Cardiovascular Claims...............................................................52.4

4 – Chronic Lymphocytic Leukemia...............................................52.8

5 – Diabetes Mellitus.......................................................................52.10

6 – HIV & AIDS Claims.................................................................52.13

7 – Hypertension.............................................................................52.14

8 – Ischemic Heart Disease............................................................52.16

9 – Insomnia....................................................................................52.17

10 – Malaria Claims.......................................................................52.18

11 – Medical Consequences of Diving...........................................52.19

12 – Meniere’s Syndrome...............................................................52.20

13 – Mental Disorders That Led to Release from Service .........52.21

14 – Multiple Myeloma - Plasmacytoma......................................52.22

15 – Muscle Injuries.......................................................................52.23

16 – Non-Hodgkin’s Lymphoma & Subcategories......................52.24

17 – Positive Tuberculin Claims....................................................52.26

18 – Radical Prostatectomy...........................................................52.27

19 – Respiratory Cancers Due to Agent Orange.........................52.28

20 – Scars.........................................................................................52.29

21 – Traumatic Brain Injury.........................................................52.30

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Change 34April 17, 2014

Section 52.1Specific Disabilities

AL Amyloidosis

GENERAL GUIDANCE

VA’s proposed rule to recognize AL amyloidosis as a disease presumed related to herbicide exposure in Vietnam has been referred to the Office of Management and Budget (OMB) for publishing. 

All claims received for service connection for AL amyloidosis on the basis of herbicide exposure in Vietnam should be established as future diaries with a “NEHMER-AL AMYLOIDOSIS” flash.  This flash has been installed in SHARE and will be available for use beginning Tuesday, October 14, 2008. 

VA has already identified approximately 360 records indicating that a Vietnam Veteran, who served in-country, was either rated for AL amyloidosis or received treatment for it in VA medical facilities.  Efforts are underway to find other in-country Vietnam Veterans who may be potentially entitled to compensation for this disease.   Additional information related to the processing of AL amyloidosis claims on a presumptive basis will be provided as it becomes available.

READUDICATION OF CLAIMS FOR AL AMYLOIDOSIS & OTHER DISEASE UNDER NEHMER

It is critical that Nehmer claims be handled expeditiously and correctly. The processing of Nehmer claims requires VA to operate under court-imposed deadlines. Failure to comply with instructions could result in court-ordered sanctions against VA and/or VA officials.

Reference to Fast Letter 10-41, Processing of Claims for Ischemic Heart Disease (IHD), Parkinson’s Disease (PD), Hairy Cell Leukemia and Other Chronic B-cell Leukemias (HCL/BCL), and Other Diseases Under Nehmer.

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Change 34April 17, 2014

Section 52.2Specific Disabilities

Amyotrophic Lateral Sclerosis (ALS) CasesThe new regulation, 38 CFR 3.318, provides:

The development of ALS at any time after discharge or release from active military, naval, or air service is sufficient to establish service connection for that disease if the Veteran had active, continuous service of 90 days or more.

The presumption of service connection for ALS does not apply if there is affirmative evidence that ALS was not incurred during or aggravated by such service or affirmative evidence that ALS was caused by the Veteran’s own willful misconduct.

VA published the new regulation in interim final rulemaking to implement immediately the Secretary’s decision to establish a presumption of service connection for ALS for Veterans with that diagnosis. There will be an opportunity for comment on the interim final rule, and a final rule will be published that will respond to any comments.

Refer to Fast Letter 08-46, SUBJ: Outreach for Presumption of Service Connection for Amyotrophic Lateral Sclerosis, dated December 8, 2008.

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Change 34April 17, 2014

Section 52.3Specific Disabilities

Cardiovascular Claims

GENERAL GUIDELINES

When developing claims for a cardiovascular condition, the cardiovascular questionnaire will assist the VA examiner in providing a METs estimate:

Send the claimant a cardiovascular questionnaire (located at the end of this section)

HYPERTENSION & RENAL INSUFFICIENCY

In the event a Veteran is service-connected for hypertension and develops renal insufficiency (other than glomerulonephritis, polycystic kidney condition, pyelonephritis or nephrolithiasis), no opinion is required as to the relationship between the hypertension and the renal insufficiency. Request an examination for the kidneys if an exam is needed for evaluation purposes.

However, if the Veteran has both hypertension and diabetes mellitus but is service-connected for only one of these disabilities, request an opinion as to which is the cause of the Veterans renal insufficiency.

HYPERTENSION & ARTERIOSCLEROTIC MANIFESTATIONS

If a Veteran is service-connected for hypertension and subsequently develops and of the following, we do not have to ask for a medical opinion.

Coronary artery disease

Arteriosclerotic heart disease

Stroke

Arteriosclerotic peripheral vascular disease

For further guidance, refer to M21-1, Part VI, 11.18(c), Rating Specific Disabilities, The Cardiovascular System.

HYPERTENSION & DIABETES

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Change 34April 17, 2014

If a Veteran claims hypertension secondary to diabetes, send a request for medical evidence. The issue of hypertension is inferred ONLY when there is medical evidence of diabetes and diabetic nephropathy.

If the Veteran did not claim service connection for hypertension secondary to diabetes mellitus and there is no medical evidence in the file of diabetic nephropathy, we no longer have to infer the issue of service connection for hypertension secondary to diabetes.

If the medical evidence shows that hypertension was diagnosed before diabetic nephropathy was diagnosed, but that there was a change in the treatment of hypertension and/or an increase in blood pressure readings since diabetic nephropathy was diagnosed, obtain a medical opinion to determine if hypertension was aggravated by the service-connected diabetic nephropathy.

CIRCULATORY SYSTEM VERSUS NERVOUS SYSTEM DISABILITIES

Scenario: A Veteran claims problems with circulation in his legs and is already service-connected for atherosclerotic heart disease, diabetes mellitus type II and peripheral neuropathy of the lower extremities.

The above cited scenario would not constitute a claim for an increased evaluation of the service-connected peripheral neuropathy. Peripheral neuropathy is a numbness and tingling due to a nerve disability. The circulation problem is a vascular disease, disease of the blood vessels, which requires an ankle/brachial index. Therefore, a VA examination request for the cardiovascular condition would be appropriate versus a neurological examination.

HEART VERSUS ARRHYTHMIAS VERSUS HYPERTENSION VERSUS ARTERIES AND VEINS WORKSHEET

In general the four cardiovascular worksheets correspond to the rating schedule diagnostic code categories in 38 CFR 4.104. Sometimes it may be appropriate to request multiple worksheets in this category; however, do so only if necessary.

Do not request the Heart worksheet if the Veteran is service connected for varicose veins. The Arteries, Veins and Miscellaneous worksheet should be requested for varicose veins.

If Veteran claims hypertension or is already service connected for hypertension, do not routinely request the Heart worksheet. The Hypertension worksheet instructs the examiners to address arteriosclerotic complications of hypertension and use worksheets for the specific conditions found.

If Veteran is already service connected for both hypertension and heart disease or if a hypertension diagnosis is already established, do not request both Hypertension and Heart worksheets. Only request the Heart worksheet because it includes findings needed to evaluate hypertension already diagnosed per 38 CFR 4.104 diagnostic code 7101, Note 1.

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Change 34April 17, 2014

Excerpt from Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

HYPERTENSION & METS

METs estimates should only be provided for cardiac issues. If a diagnosis of hypertension is provided along with a METs estimate, remember that a METs is a measure of exercise tolerance and not a diagnosis of a heart condition. METS can be affected by many factors, including pulmonary or joint problems. Don't confuse a METs assessment with a diagnosis of a heart condition. Simply because the examiner has included a METs estimate with the diagnosis of hypertension does not mean that the Veteran has a cardiac condition

AUTOMATIC INTERNAL CARDIAC DEFIBRILLATOR

If the Veteran is service-connected for a heart condition and medical evidence shows the Veteran has an implantable Automatic Internal Cardiac Defibrillator (AICD) in place due to the s/c heart condition, do not request an examination. Refer the claim/evidence to an RVSR for review; the Veteran may be automatically entitled to a 100 percent evaluation and therefore, an exam is not needed for the heart condition.

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Change 34April 17, 2014

Cardiovascular Questionnaire

Please complete, sign, and return the following Cardiovascular Questionnaire. This information will help us avoid repeating medical tests when they are available from other sources.

Name of Veteran: _______________________________________________________________ Last Name First Name MI

VA File Number: ________________________ Social Security No: ___________________________

1) In the last 24 months, have you had any test, such as a treadmill test, an EKG, echocardiogram, coronary angiography, heart scan, Multigated Angiogram (MUGA), etc. for your cardiovascular condition? Yes____ or No____

2) If you answered Yes, please specify the date(s) of the test(s): __________________________________________________________________________________________

3) What is the name and address of the health care provider who administered the test? NAME ADDRESS__________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ _________________________________________

4) In addition to tests, have you received any treatment for this condition? Yes____ or No____

5) If so, what is the date of treatment and the name and address of the health care provider who provided treatment? DATE NAME ADDRESS_______________ ______________________ _______________________________________________ ______________________ _______________________________________________ ______________________ _______________________________________________ ______________________ ________________________________

6) Do you need our assistance in getting the test or treatment records? Yes____ or No____

7) If you answered Yes to question #6, we can assist you in obtaining your private medical treatment reports. We have enclosed a VA Form 21-4142 to complete and return to us so that we can request the records directly from the health care provider. Ultimately, it is your responsibility to furnish private medical evidence. We will, however, make every effort to assist you.

8) If you answered No to question #6, please send the records of tests or treatment within 30 days of receipt of this document.

Signature_________________________ Date_____________

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Change 34April 17, 2014

Section 52.4Specific Disabilities

Chronic Lymphocytic Leukemia

GENERAL GUIDELINES

The Secretary has determined there is a positive association between the exposure of humans to an herbicide agent and the occurrence of Chronic Lymphocytic Leukemia (CLL) in humans. Reference: 38 CFR, 3.309(e), Disease associated with exposure to certain herbicide agents.

Refer to the section entitled Claims Related to Exposure to Herbicide Agents, for further guidance and Training Letter 06-05, Lymphoid Malignancies, with emphasis on Chronic Lymphocytic Leukemia, dated October 3, 2006

EXAMINATION GUIDELINES

If the Veterans has been diagnosed with CLL, a 100 percent evaluation is warranted and a VA examination is not required unless there are specific complications or residuals. Refer the claim to an RVSR for further guidance.

READJUDICATION OF CLAIMS FOR AL AMYLOIDOSIS (ALA) AND OTHER DISEASES UNDER NEHMER

Refer to Fast Lett 09-09 for guidance regarding readjudication of claims for AL Amyloidosis (ALA) and other diseases under Nehmer.

On July 19, 2007, the U.S. Court of Appeals for the Ninth Circuit denied the Government's appeal of a district court order holding that the 1991 final stipulation and order in this case, which provided that VA would make certain retroactive benefit payments within the scope of then existing law, will apply through "September 30, 2015, or until such other time as Congress shall establish, should it enact another extension" of the Agent Orange Act.

On July 23, 2007, representatives from Department of Justice, Office of the General Counsel, and Veterans Benefits Administration appeared before Judge Henderson, to show cause why it should not be held in contempt for violating his orders. At issue are two items concerning VA’s adjudication of chronic lymphocytic leukemia claims: (1) Judge Henderson alleges that VA, in its periodic status report, has misrepresented the number of cases reviewed by the Philadelphia Resource Center by counting more than once rating decisions that had to be corrected and reviewed more than once; and (2) he does not find credible VA's explanation

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Change 34April 17, 2014

that a production slowdown during the holiday period can be attributed to vacation and excess leave during that time. A decision is currently pending.

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Change 34April 17, 2014

Section 52.5Specific Disabilities

Diabetes Mellitus

VCAA NOTIFICATION

If the Veteran claims specific complications related to diabetes, these conditions must be considered as new claims.

Send a VCAA notification letter on the claimed diabetes and the issues claimed as secondary. Include both the VCAA SC and Secondary Law attachments in the VCAA notification letter.

If the Veteran is claiming hypertension, coronary artery disease, kidney disease, or peripheral vascular disease secondary to diabetes, send both the VCAA SC and Secondary Law Attachments.

VA EXAMINATION GUIDELINES

DIABETES DIAGNOSIS. A diagnosis of diabetes mellitus will be required prior to requesting a VA examination.

CARDIAC CONDITION & DIABETES. Be sure to include a request for a heart exam if the evidence shows the Veteran is being treated for a cardiac condition. In the remarks section of the request, specify whether or not medical evidence has been received for diabetes mellitus since this will help the C&P unit schedule the exam.

PREVIOUSLY DENIED CONDITIONS: Unless instructed otherwise, VA examiners are required by the C&P Examination Worksheet to address all possible diabetes-related conditions. It may be necessary to inform the VA examiner of conditions that have been determined not to be secondary to the service-connected diabetes. For example, "CAD and HBP have been previously evaluated and determined not to be related to SC diabetes.”

WHEN OPINIONS ARE NOT REQUIRED. If a Veteran claims peripheral neuropathy, diabetic neuropathy, etc. (or the medical evidence shows conditions known to be related to diabetes), an opinion is not required.

COMPLICATIONS RELATED TO DIABETES. If a review of the medical evidence shows the Veteran has a condition(s) known to be related to a service-connected disability, and an examination is being requested for another disability, request an examination for the condition(s) noted in the treatment reports. For example, if the medical evidence shows treatment for neuropathy and the Veteran is service-connected for diabetes, request an examination of the diabetic peripheral neuropathy.

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Change 34April 17, 2014

KNOWN COMPLICATIONS OF DIABETES MELLITUS

EYES1. Diabetic retinopathy

a. Nonproliferative (background)b. Proliferative

2. Cataractsa. Subcapsular (snowflake)b. Nuclear (senile)

KIDNEYS1. Intercapillary glomerulosclerosis

a. Diffuseb. Nodular

2. Infectiona. Pyelonephritisb. Perinephric abscessc. Renal papillary necrosis

3. Renal tubular necrosisa. Following dye studies (urograms, arteriograms)

NERVOUS SYSTEM1. Peripheral neuropathy

a. Distal, symmetric sensory lossb. Motor neuropathy

i. Foot drop, wrist dropii. Mononeuropathy multiplex (diabetic amyotrophy)

iii. Cranial nerves III, IV, VI, VIIc. Autonomic neuropathy

i. Postural hypotensionii. Resting tachycardia

iii. Loss of sweatingiv. Gastrointestinal neuropathy

a) Gastroparesisb) Diabetic diarrhea

v. Urinary bladder atonyvi. Erectile dysfunction (may also be secondary to pelvic vascular disease)

SKIN1. Diabetic dermopathy (shin spots)2. Necrobiosis lipoidica diabeticorum3. Candidiasis4. Foot and leg ulcers

a. Neurotropicb. Ischemic

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Change 34April 17, 2014

CARDIOVASCULAR SYSTEM1. Heart disease

a. Myocardial Infarctionb. Cardiomyopathy

2. Gangrene of the feeta. Ischemic ulcersb. Osteomyelitis

BONES AND JOINTS1. Diabetic cheirarthropathy2. Dupuytren’s contracture3. Charcot joint

UNUSUAL INFECTIONS1. Necrotizing fasciitis2. Necrotizing myositis3. Mucormycosis4. Emphysematous cholecystitis5. Malignant otitis externa

Reference: Basic and Clinical Endocrinology, 6th Edition, Francis S. Greenspan and David G. Garnder, Table 18-19, page 687

HYPERTENSION & DIABETES

Reference: M21-1MR.III.iv.4.F.22.e. Consideration of Hypertension as Secondary to Diabetes Mellitus

If a Veteran claims hypertension secondary to diabetes, send a request for medical evidence. The issue of hypertension is inferred ONLY when there is medical evidence of diabetes and diabetic nephropathy.

If the Veteran did not claim service connection for hypertension secondary to diabetes mellitus and there is no medical evidence in the file of diabetic nephropathy, we no longer have to infer the issue of service connection for hypertension secondary to diabetes.

If the medical evidence shows that hypertension was diagnosed before diabetic nephropathy was diagnosed, but that there was a change in the treatment of hypertension and/or an increase in blood pressure readings since diabetic nephropathy was diagnosed, obtain a medical opinion to determine if hypertension was aggravated by the service-connected diabetic nephropathy.

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Change 34April 17, 2014

Section 52.6Specific Disabilities

HIV & AIDS Claims

DEVELOPMENT GUIDELINES

Refer to M21-1MR, Part IV, Subpart ii, Chapter 1, Section H, Topic 30, Claims for Service Connection for Other Diseases and Disabilities, for further guidance.

If indicated, obtain pre-induction HIV screening

HANDLING RECORDS

Refer to M21-1MR, Part III, Subpart ii, Chapter 4, Section A, Topic 5a for further guidance regarding Records Pertaining to Human Immunodeficiency Virus or Syndrome, Alcohol Abuse, Drug Abuse, or Sickle Cell Anemia

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Change 34April 17, 2014

Section 52.7Specific Disabilities

Hypertension

CLAIMS FOR SECONDARY CONDITIONS DUE TO SERVICE-CONNECTED HYPERTENSION

In cases where a Veteran is service-connected for hypertension and claims secondary conditions of

Coronary artery disease

Arteriosclerotic heart disease

Stroke

Arteriosclerotic peripheral vascular disease

DO NOT ask for a medical opinion as to the relationship between the service-connected hypertension and one of the above listed conditions. 

ADJUDICATING CLAIMS FOR HYPERTENSION DUE TO HERBICIDE EXPOSURE

The following guidance was provide regarding claims or appeals involving service connection for dependency and indemnity compensation and hypertension based on herbicide exposure. If a rating EP does not exist, establish a rating EP using the date of the announcement as the effective date (June 10, 2008), or if a subsequent claim is received thereafter, use the date of receipt as the date of claim.

Send VCAA notice, develop, and adjudicate as necessary. Take the appropriate regular end product (EP, 010, 110, 020, etc.) when promulgating the decision. Also, PCLR EP 695 if the EP has matured (i.e., it is no longer a future EP). If the EP 695 has not matured, PCAN it, but remember to PCLR a corresponding EP 695 the next day. It is important that VACO track these cases.

Reference: C&P Conference Bulletin, June 2008

CONSIDERATION FOR “HISTORY OF DIASTOLIC PRESSURE PREDOMINANTLY 100 OR MORE” UNDER DIAGNOSTIC CODE 7101

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38 Code of Federal Regulations (C.F.R.) § 4.104, Diagnostic Code (DC) 7101, directs assignment of a 10 percent evaluation for a Veteran who has a “history of diastolic pressure predominantly 100 or more” who also requires continuous medication for control.

Blood pressure is routinely checked during most clinical examinations, even if the question of hypertension has not been placed at issue by the patient or physician. For example, a Veteran who served 20 years was diagnosed with hypertension in the last year of service. The service treatment records (STRs) show many normal blood pressure readings throughout service prior to the diagnosis of hypertension. They also show a history of diastolic pressure predominantly 100 or more during the period of diagnostic evaluation immediately preceding the Veteran being diagnosed with hypertension. Interpreting the code to allow consideration of the normal blood pressure readings outside of the period of diagnostic evaluation would likely preclude granting a compensable evaluation under DC 7101.

Therefore, when determining whether there is a “history of diastolic pressure predominantly 100 or more”, only consider blood pressure readings taken when the Veteran is undergoing a diagnostic evaluation for hypertension. The Veteran’s other clinical records, including STRs, documenting treatment prior to the diagnostic evaluation for hypertension, are not considered applicable to determining the “history of diastolic pressure predominantly 100 or more” under DC 7101.

Reference: Compensation Service Bulletin, April 2012

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Section 52.8Specific Disabilities

Ischemic Heart Disease

ISCHEMIC HEART DISEASE AND ASSOCIATED CARDIAC CONDITIONS

Central Office has advised that we should develop and control the following cardiac conditions as claims for ischemic heart disease:

a. Coronary artery disease

b. Coronary artery bypass surgery

c. Myocardial infarction

d. Cardiomegaly

e. Arrythmias

Claims for essential hypertension are NOT considered claims for ischemic heart disease.

Refer to Fast Letter 09-50, Procedures for handling disability claims based on herbicide exposure for hairy cell and other B-cell leukemias, Parkinson’s disease, and ischemic heart disease, dated November 19, 2009 for further guidance.

Atherosclerotic heart disease and ischemic heart disease are pretty much the same conditions. Ischemic heart disease is caused by atherosclerotic heart disease. Therefore, if you have a claim for service connection for ischemic heart disease and the Veteran is already service connected for atherosclerotic heart disease or coronary artery disease, take the Veteran's claim for ischemic heart disease as a claim for increase in the atherosclerotic heart disease/coronary artery disease (claimed as ischemic heart disease). This would not be an EP 681 claim. There are other situations where the Veteran may be service-connected for a heart condition that will not necessarily be the same as ischemic heart disease. For example, the Veteran has hypertensive heart disease or valvular heart disease. In such case, VCAA notification must be sent for the ischemic heart disease and control it with an EP 681. (E-mail Developing EP 681s, dated 05-19-10, A. Dorry, VSC DRO)

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Section 52.9Specific Disabilities

Insomnia

ISSUE: INSOMNIA

Question:We started to see insomnia diagnosed on mental VAEs. Insomnia is normally a symptom of an underlying disorder. Is insomnia a ratable disability in the absence of an underlying diagnosed condition? If so, how should it be rated? Analogous to anxiety or some other mental condition?

Response:We agree that in most cases, insomnia is simply a symptom of some other underlying physical or mental condition. In such cases, insomnia is not a separately ratable disability and should be considered a part of the underlying condition. There is however a condition found in DSM-IV, 307.42, primary insomnia, with the five diagnostic criteria specified, and including ruling out of all other potential causes, such as a co-existing mental condition, associated with another sleep disorder, or caused by a physiological effect of a substance or general medical condition. In cases of primary insomnia, properly diagnosed under DSM criteria, a separate disability may be warranted and evaluated under the most appropriate mental disorder diagnostic code.

Question:We have also seen insomnia (as well as anxiety and depression) diagnosed as secondary to combat stressors in cases where the Veteran does not meet DSM-IV criteria for PTSD. We are unaware of any provisions which permit S/C for a mental disorder secondary to combat stressors other than PTSD. Is this correct?

Response:It is not within the competence of an RVSR to determine secondary etiology. And, PTSD is not the only mental condition that can result from combat stressors. If a claim for a mental disorder other than PTSD is received as due to combat stress, or if an examination report shows another mental disorder is due to combat stress, service connection may be granted on a direct basis if all other requirements for service connection are met.

Source: Star Rating Call, Q&As for the February 2010 Quality Call

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Section 52.10Specific Disabilities

Malaria Claims

DEVELOPMENT GUIDELINES

Claims for an increase in 0% malaria - Ask claimant to submit new evidence, preferably medical evidence, showing recurrent attacks or other disabling effects of malaria.

VA EXAMINATION GUIDELINES

Do not request a VA exam, until the Veteran submits medical evidence showing recurrent attacks or other disabling effects of malaria.

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Section 52.11Specific Disabilities

Medical Consequences of Diving

GENERAL GUIDELINES

Medical consequences of diving will be reported in the service treatment records, but some, such as bone infarcts and arthritis, do not appear immediately and may not be reported in service. In other cases, symptoms may have been mild or subtle and went unreported or unnoticed. With a history of diving in service, and evidence of a bone infarct or arthritis, especially of the hip or shoulder, a diving etiology should be considered. The same is true of many other residuals, such as hearing loss, other ear or labyrinthine abnormalities, neurologic abnormalities, and skin abnormalities.

Many of the Veterans who did saturation diving in the early days (at least from the 1960’s, 70’s, and possibly 80’s) worked under different circumstances from those doing diving today, as new techniques and safety measures have been progressively developed. Therefore, it is possible that early divers experienced more complications than more recent divers. For further guidance, refer to Training Letter 07-04, Medical Consequences of Diving, dated July 5, 2007.

VA EXAMINATION GUIDELINES

In claims from Veterans who were divers, most issues necessitating a medical opinion will be similar to medical opinions needed in any case. The procedures in M21-1MR, III.iv.3.A.9 should be followed. However, when questions arise about the relationship of a claimed condition to diving, particularly when the claimed condition is not addressed in this paper, or when especially complex or unusual questions arise, consultation with medical diving experts may be needed. These questions should be submitted to the Director of Compensation and Pension Service (211) for an opinion.

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Section 52.12Specific Disabilities

Meniere’s Syndrome

GENERAL GUIDELINES

Meniere’s syndrome is evaluated under diagnostic code 6205 or by separately evaluating vertigo (as a peripheral vestibular disorder), hearing impairment, and tinnitus, whichever results in a higher overall evaluation.

EXAMINATION GUIDELINES

An audio and ear disease examination will be required. Refer the claim to an RVSR for further guidance.

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Section 52.13Specific Disabilities

Mental Disorders That Led to Release from ServiceRegional Offices should pay special attention to 38 CFR 4.129, Mental Disorders due to Traumatic Stress, because of the exposure of many servicepersons to highly stressful events while serving in Iraq and Afghanistan. 38 CFR 4.129 states that an immediate evaluation of not less than 50 percent shall be assigned to a Veteran who, because of a highly stressful event in service, develops a mental disorder that results in release from service. In addition, it states that VA will schedule a medical examination within six months of discharge to determine whether a change in this evaluation is warranted.

The initial evaluation should be maintained until evidence from the examination provides the basis for reconsideration. If evidence from the medical examination warrants an increase in evaluation, the effective date will be the date of the examination that supports this increase. An earlier effective date may be assigned based on additional evidence that factually establishes an increase in disability, per 38 CFR 3.400(o)(2). If a reduction in evaluation is warranted based on the results of a medical examination, follow the due process procedures as stated in 38 CFR 3.105(e).

Reference: C&P Service Bulletin, November 2007

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Section 52.14Specific Disabilities

Multiple Myeloma - Plasmacytoma

GENERAL GUIDELINES

After reviewing a case submitted to Central Office, the Chief, Public Health and Environmental Hazards Officer, concluded that plasmacytoma can be classified as a form of multiple myeloma for the purpose of presumptive service connection due to herbicide exposure.

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Section 52.15Specific Disabilities

Muscle Injuries

GENERAL GUIDELINES

Request a VA examination if the evidence of record is insufficient to rate. In claims for gunshot wounds, 99.9 percent of the time, a muscle examination should be requested. For the proper rating of gunshot wound residuals, it is especially important to order the proper examinations.

For further guidance regarding muscle injuries, refer to Training Letter 00-05, Subj: Training letter on muscle injuries and related problems, dated July 3, 2000.

EXAMINATION GUIDELINES

The examination should identify the muscles injured, and any other possible residuals such as nerve damage, scar damage, or other damage. Be specific in the General Remarks section of the exam request. A brief history of the gunshot wound and specific conditions claimed by Veteran is very helpful to the examiners.

Reference: Adjudication Update: Rating Gunshot Wounds and Residuals, March 20 2003 VBN Broadcast.

1.  When ordering a VAMC examination in muscle injury cases, ask the examiner to specify the muscles involved.

2.  If the Veteran is rated under a joint diagnostic code or peripheral nerve code, request a joint and/or peripheral nerve exam in addition to the muscle exam.  In addition, tell the examiner to use additional AMIE worksheets if indicated based on results of the exam.  Examples of additional exams that may need to be scheduled include, but are not limited to Skin, Peripheral Nerves, and Joints.   

3.  If a Veteran is only rated for a scar from a muscle injury and the Veteran claims an increase, order a muscle exam in addition to the skin exam.  Advise the examiner to use additional AMIE worksheets if indicated based on results of the exam.  Examples of additional exams that may need to be scheduled  in this scenario include, but are not limited to, Peripheral Nerves, and Joints.

Reference: E-mail dated 03-15-07, Audrey Dorry (March 2003 C&P Training Broadcast)

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Section 52.16Specific Disabilities

Non-Hodgkin’s Lymphoma & Subcategories

NON-HODGKIN’S LYMPHOMA

The Agent Orange Act of 1991 (Public Law 102-4) establishes a presumption of service connection for Veterans with service in Vietnam during the Vietnam era who subsequently develop, to a degree of 10% or more, non-Hodgkin's lymphoma (NHL), soft-tissue sarcoma or chloracne or other acne-form disease consistent with chloracne. Qualifying skin conditions must have become manifest to a degree of 10% or more within 1 year of the last date of service within the Republic of Vietnam.

Evidence must show the Veteran physically served in-country between January 9, 1962 to May 9, 1975.

Refer to the section entitled Claims Related to Exposure to Herbicide Agents for further guidance.

CLAIMS FOR NON-HODGKIN’S LYMPHOMA UNDER 38 CFR 3.313

VA regulations, 38 CFR § 3.313 , specify that service in Vietnam, including the offshore waters of Vietnam during the Vietnam Era, together with the development of non-Hodgkin’s lymphoma manifested subsequent to such service, is sufficient to establish service connection for that disease.

This regulation does not require herbicide exposure as the basis for a presumptive grant of service connection, as is the case with the presumptive diseases listed at 38 CFR § 3.309(e) . A Veteran’s service in Vietnam, including service in the offshore waters of Vietnam, is the sole basis for presumptive service connection when non-Hodgkin’s lymphoma is diagnosed following service.

VA Regional Offices (ROs) must be aware that any claim for service connection of non-Hodgkin’s lymphoma from a Veteran who served in the offshore blue waters of Vietnam is not to be placed under the Haas stay. These claims fall under 38 CFR § 3.313, not § 3.309, and the Veteran is not required to provide evidence of herbicide exposure. These claims must be adjudicated as soon as possible when they are received.

Reference: C&P Service Bulletin, Addendum, September 2008

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SUBCATEGORIES OF NON-HODGKIN’S LYMPHOMA

If a Vietnam Veteran claims service connection for non-Hodgkin’s lymphoma and the medical evidence shows a diagnosis of any of the following subcategories, the presumption of service connection should be extended to the Veteran.

Several subcategories of non-Hodgkin’s lymphoma have been identified by the United States Centers for Disease Control. The subcategories are:

Low Grade Lymphomas Small lymphocytic with plasmacytoid features Small lymphocytic Intermediate cell Follicular, mixed small and large Mantle zone Follicular, small cleaved

Intermediate Grade Lymphomas Diffuse, small and large Diffuse, small cleaved Diffuse, large cleaved Diffuse, large non-cleaved Diffuse, large Follicular, large

High Grade Lymphomas Small, non-cleaved Lymphoblastic Immunoblastic Burkitt’s

Reference: Addendum C&P Service Bulletin April 2009

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Section 52.17Specific Disabilities

Positive Tuberculin ClaimsPositive Tuberculin Reaction is Sole Condition Claimed. If VA Form 21-526 is received claiming only a positive tuberculin reaction, refer the claim to the rating activity for a determination as to whether or not a disability is present.

Positive Tuberculin Reaction With Other Disabilities Claimed. If a VA Form 21-526 indicates that a positive tuberculin reaction is claimed together with other disabilities, complete any appropriate development required for the other disabilities. Refer the file to the Rating Team for rating of all claimed disabilities.

Reference: Claims Based On Positive Tuberculin Reaction, M21-1MR.IV.ii.1.H26

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Section 52.18Specific Disabilities

Radical Prostatectomy

GENERAL GUIDELINES

An SMC “k” should be assigned for loss of use of a creative organ in all cases of radical prostatectomy.

SURGERY REPORT

Obtain the surgical report to confirm that surgery was completed for a radical prostatectomy and send the claim to the Rating Activity.

EXAMINATION GUIDELINES

There is no need to examine for impotence, retrograde ejaculation, or other cause of loss of use of a creative organ to determine that a qualifying condition is present. Ejaculation, including retrograde ejaculation, can never occur in radical prostatectomy because of the structures transected or removed.

References:

Training Letter 00-02, Subj: Training letter on rating prostate disease, dated May 1, 2000.

Training Letter 00-04, Subj: Correction of Training Letter 00-02, dated June 22, 2000.

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Section 52.19Specific Disabilities

Respiratory Cancers Due to Agent Orange

GENERAL GUIDELINES

Print any available VAMC treatment records from the last 12 months. Print ALL treatment reports related to PCT, Chloracne and Acute and Subacute peripheral neuropathy.

If the Veteran was reportedly treated at the VAMC, but the treatment reports are not available through CAPRI, request treatment records for the last 12 months. Request ALL treatment reports related to PCT, Chloracne and Acute and Subacute peripheral neuropathy.

When treatment records are received, send the claim to the Rating Team.

If no treatment records received after 60 days, send the claim to the Rating Team.

If the Rating Team determines the claim cannot be rated on the evidence of record, the claim will be returned for further development.

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Section 52.20Specific Disabilities

Scars

EXAMINATION GUIDELINES

When ordering an initial exam for "residuals of gunshot wounds" or "residuals of shrapnel wounds" you will need to order BOTH a Muscle examination AND a Scar examination.

If a Veteran is already service-connected for "scars" and claims an increase, you will still need to order both a Scar and a Muscle examination.

If a Veteran is already service-connected for "muscles" and claims an increase, you will still need to order both a Scar and a Muscle examination.

DBQ EXAMINATION FOR IHD

If a DBQ examination for a Veteran's IHD shows the Veteran had a coronary artery bypass graft (CABG) but the Veteran does not expressly claim service connection for the residual scars and there is no evidence in the file that the scars would be compensable, the DBQ for IHD does not need to address the Veteran's residual scars. However, if a VA examination (that does not use a DBQ) examiner fails to address the residual scars from a CABG, that would render the VA examination inadequate. Reference FAQ.

COLOR PHOTOGRAPHS AND EVALUATING SCARS OF THE HEAD, FACE , OR NECK UNDER DC 7800 (AD DE ND U M CO MP EN SAT IO N SERV ICE BU LL E TI N , JU NE 2013 )

Note (3) under DC 7800 directs the following: “Take into consideration unretouched color photographs when evaluating under these criteria.”

If color photos accompany the examination, then rating specialists must consider this evidence when evaluating a scar condition. However, if color photographs are unavailable, the scar condition should be rated based on the findings reported by the examiner. Please do not return the exam as insufficient and request color photographs. This supersedes all previous guidance concerning color photographs for evaluating scars.

Reference: Compensation Service Bulletin, July 2013

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Section 52.21Specific Disabilities

Traumatic Brain Injury

GENERAL GUIDELINES

The residuals of TBI fall into 3 main categories of impairment: cognitive, emotional/behavioral, and physical. A group of subjective symptoms may sometimes also be the main residual of TBI.

The most common, but not all possible, physical (neurological) problems that may be seen after TBI are motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions.

Special monthly compensation should be considered for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc.

Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are speed of information processing, goal setting, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive.

For further information, refer to Fast Letter 08-36, Final Rule: Schedule for Rating Disabilities; Evaluation of Residuals of Traumatic Brain Injury (TBI), dated 10-24-08.

EXAMINATION GUIDELINES

When developing medical evidence in support of a claim for the residual effects of TBI, request the appropriate Compensation and Pension (C&P) examination(s). The Brain and Spinal Cord Examination Worksheet is appropriate for requesting an evaluation of the residual effects from TBI. The specialty examination must be requested separately for any claim which involves a closed-head injury, such as concussion.

A general medical examination will be required for Veterans discharged within one year.

The effective date of new evaluation criteria under diagnostic code 8045 is October 23, 2008. If a Veteran requests review under the new criteria, VA will conduct new examinations that

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conform to the new criteria. For further guidance, refer to Fast Letter 08-36, Final Rule: Schedule for Rating Disabilities; Evaluation of Residuals of Traumatic Brain Injury (TBI), dated 10-24-08.

As of October 10, 2008, a revised TBI disability examination worksheet is available for national use. If an examination for TBI is required prior to release in VistA, a copy of the revised worksheet must accompany the exam request. Reference: Fast Letter 08-34, Revised Traumatic Brain Injury (TBI) Worksheet, dated October 10, 2008.

The examination report should provide information on neurological deficits, bladder and bowel impairment, direct examination of the senses (vision, smell, taste), and psychiatric examination when required. Refer to additional C&P examination worksheets where indicated to capture a complete picture of disability(ies) resulting from TBI.

REFERENCES

Training Letter 07-05, Evaluating Residuals of Traumatic Brain Injury, dated, August 31, 2007

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Section 52.22Specific Disabilities

Sleep Apnea

SLEEP APNEA AND SLEEP STUDIES

Do not accept a diagnosis of sleep apnea, for rating purposes, unless the diagnosis is confirmed by a sleep study. In the absence of sleep study confirmation, service connection for sleep study is precluded, as a current disability of sleep apnea is not demonstrated. A home sleep study is only accepted if it has been clinically determined that the Veteran can be appropriately evaluated by a home sleep study. The study’s results must be evaluated by a competent medical provider.

Receipt of medical evidence disclosing a diagnosis of sleep apnea without confirmation by a sleep study is sufficient to trigger the duty to assist for scheduling an examination if the other provisions of 38 C.F.R. § 3.159(c)(4) have been satisfied. However, such evidence is not sufficient to establish a grant of service connection for sleep apnea.

If service connection for sleep apnea has already been established without confirmation by a sleep study, an examination with sleep study should be conducted to clinically confirm the diagnosis of sleep apnea. Such development is not necessary if the grant of service connection has been in effect for 10 years or more. See 38 U.S.C. § 1159. If the sleep study fails to verify the sleep apnea diagnosis, consider a proposal to sever service connection for sleep apnea with application of 38 C.F.R. § 3.105(d).

Reference: Addendum Compensation Service Bulletin, May 2013

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Section 52.23Specific Disabilities

Carpal Tunnel SyndromeIn a frequently asked question (FAQ) dated October 4, 2000, Compensation Service provided guidance that carpal tunnel syndrome should be considered as an organic disease of the nervous system; thereby, establishing eligibility for the condition as a presumptive condition under 38 C.F.R. § 3.309(a) if manifested to a compensable level within a year after the date of separation from service. Because that FAQ was rescinded, Compensationj Service has clarified the issue.

Carpal tunnel syndrome is an entrapment of the median nerve at the wrist that is most commonly associated with repetitive motion. However, carpal tunnel syndrome may be idiopathic or caused by such diseases as diabetes, hypothyroidism, autoimmune diseases, or tumors. Carpal tunnel syndrome, whatever the etiology, is considered to be a type of mononeuropathy called a pressure neuropathy that results in neurologic signs and symptoms that, if untreated, or treated too late, may lead to permanent weakness and sensory loss in the hand. As such, it is clearly an organic disease of the nervous system, since peripheral nerves are part of the nervous system, and there is objective evidence of nerve damage. Therefore, carpal tunnel syndrome is considered a presumptive condition under § 3.309(a) subject to the rebuttable presumption provisions of § 3.307(d).

Reference: Compensation Service Bulletin, December 2012.

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Section 52.24Specific Disabilities

Female Sexual Arousal Disorder (FSAD)FSAD is defined as the lack of, or significantly reduced, sexual interest/arousal. There are both psychological and biological causes of FSAD, and the two often overlap.

In all claims from a female Veteran for FSAD or other sexual dysfunction where the examination threshold is met, request a Gynecological (GYN) Disability Benefits Questionnaire (DBQ). The DBQ request will include a statement directing the examiner to address whether the Veteran has a diagnosis of FSAD.

If a female Veteran claims FSAD or sexual dysfunction as secondary to a mental health disability and the examination threshold is met, order the appropriate mental health DBQ, as well as the GYN DBQ. Include the language below, as well as instructions to the examiner to provide an opinion about any possible relationship to the service-connected mental disability.

In order to achieve gender parity, ask examiners about FSAD whenever requesting a gynecological exam, just as examiners are prompted to discuss erectile function on all genitourinary examinations of male Veterans. Until we update the GYN DBQ to include questions about FSAD, include the following language in all gynecological examination requests, even if FSAD is not specifically claimed:

“Examiner: Please state whether the Veteran has a diagnosis of Female Sexual Arousal Disorder (FSAD). If additional examination(s) are required, please request and/or perform as necessary.”

As with other disabilities, if FSAD is not expressly claimed, it will not be inferred, unless a claim for sexual dysfunction or other gynecological disability can be reasonably interpreted as a claim for FSAD.

When the requirements for service connection are met, FSAD will be granted as a standalone disability using DC 7699-7611 with a zero percent evaluation. This is the maximum evaluation available for FSAD. When granting service connection, RVSRs must use the legacy evaluation builder in the Veterans Benefits Management System (VBMS) and manually edit the text provided by the evaluation builder. Use the following language to explain the evaluation assigned when granting service connection for FSAD:

“A noncompensable evaluation is assigned for Female Sexual Arousal Disorder (FSAD). This is the maximum evaluation for this disability.”

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Once service connection for FSAD has been granted, the criteria for Special Monthly Compensation (SMC) under 38 CFR 3.350 for loss of use of a creative organ is established and RVSRs should also grant this benefit.

If service connection was previously established for FSAD, RVSRs must review the file for entitlement to SMC(K). If SMC(K) was not previously established with the grant of service connection, the RVSR must place it at issue in the rating decision, establish entitlement to SMC(K), and assign the effective date based on the date service connection for FSAD was established.

The effective date provisions under 38 CFR 3.400 apply to claims for service connection for FSAD. Please note that the provisions of 38 CFR 3.114 do not apply, as there is no regulation change at this time.

Reference: Compensation Service Bulletin, April 2014

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CHANGES

Change 1, March 14, 2005, added clarification regarding when to request worksheets for heart, arrhythmias, hypertension, and arteries and veins.

Change 2, March 28, 2005, added guidance regarding the cardiovascular questionnaire.

Change 3, April 18, 2005, added guidance regarding the chronic lymphocytic leukemia.

Change 4, June 27, 2005, added guidance regarding the radical prostatectomy.

Change 5, July 19, 2005, added section 47.7, Multiple Myeloma - Plasmacytoma; provided guidance regarding plasmacytoma .

Change 6, January 1, 2006, added section 47.8, amyotrophic lateral sclerosis; added topic entitled, “Diabetes Mellitus Claims.”

Change 7, August 26, 2006, added M21-1MR reference; deleted M21-1 reference.

Change 8, January 11, 2007, added 38 CFR reference regarding chronic lymphocytic leukemia.

Change 9, February 13, 2007, added 38 revised DM Questionnaire.

Change 10, May 16, 2007, added guidance regarding muscle injuries.

Change 11, June 27, 2007, added guidance regarding Meniere’s Syndrome.

Change 12, July 17, 2007, added guidance regarding conditions claimed as secondary to diabetes.

Change 13, August 29, 2007, added guidance regarding Hypertension issues and METS results; added guidance regarding CLL Nehmer Review Process; added guidance regarding the medical consequences of diving.

Change 14, August 31, 2007, added guidance regarding traumatic brain injury.

Change 15, November 1, 2007, added guidance regarding hypertension secondary to diabetes mellitus.

Change 16, January 22, 2008, deleted guidance regarding the diabetes and cardiovascular questionnaire (reference Quality Review Committee minutes dated January 9, 2008).

Change 17, October 18, 2008, guidance added regarding secondary conditions due to service-connected hypertension; added new guidance regarding Amyotrophic Lateral Sclerosis; updated guidance regarding the revised TBI exam worksheet; guidance regarding AL amyloidosis; added guidance regarding mental disorders that led to released from service.

Change 18, October 31, 2008, added guidance regarding TBI, from FL 08-36; added guidance regarding the revised rating schedule regarding scars.

Change 19, December 9, 2008, updated references regarding Amyotrophic Lateral Sclerosis.

Change 20, March 8, 2009, added guidance regarding AL Amyloidosis as provided for in FL 09-09.

Change 21, October 7, 2009, updated references.

Change 22, October 30, 2009, added guidance regarding the evaluation of heart conditions if the Veteran has an implantable Automatic Internal Cardiac Defibrillator.

Change 23, April 30, 2010, added guidance insomnia; moved sub-section regarding Claims Based on Contaminated Drinking Water to Section 63.

Change 24, May 20, 2010, added non-Hodgkins lymphoma.

Change 25, July 6, 2010, added exam guidance regarding scars.

Change 26, January 1, 2011, added “Ischemic Heart Diease” and “Respiratory Cancers Due to Agent Orange” from Herbicide section of the guide.

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Change 27, October 19, 2011, deleted procedural guidance required by the Vazquez-Flores v Peake court decision.

Change 28, May 20, 2012, added guidance regarding considerations for "History of Diastolic Pressure Predominantly 100 or More" under diagnostic code 7101. Added guidance regarding the requirement for color photographs for scars of the Head, Face, and Neck.

Change 29, June 12, 2012, removed guidance regarding hypertension based on herbicide exposure that was discussed in Compensation Service Bulletin, Addendum, Volume 1, Issue 9, dated Octboer 2007.

Change 30, January 27, 2013, added guidance regarding carpal tunnel syndrome from the December 2012 Compensation Service Bulletin; added guidance regarding sleep apnea from the January 2013 Compensation Service Bulletin.

Change 31, May 29, 2013, added guidance sleep apnea from the May 2013 Compensation Service Bulletin Addendum.

Change 32, June 20, 2013, deleted reference to FL 09-09 which was replaced by FL 10-41.

Change 33, July 22, 2013, added guidance from the July 2013 Compensation Service Bulletin, regarding color photographs and evaluating scars.

Change 34, April 17, 2014, added guidance from the April 2014 Compensation Service Bulletin, regarding Female Sexual Arousal Disorder.

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Change 23January 20, 2014

Section 53

Gulf War Claims (GWOT)_______

The period during which the VA may determine that presumption service connection may be established for a disability occurring in Gulf War Veterans, has been extended to December 31, 2016. Effective October 16, 2012, a final rule was issued which extended the presumptive period under 38 CFR 3.317 to December 31, 2016.

The provisions of this final rule shall apply to all applications for benefits that are or have been received by VA on or after December 29, 2011, or that were pending before VA, the United States Court of Appeals for Veterans Claims, or the United States Court of Appeals for the Federal Circuit on December 29, 2011.

Reference: 38 CFR 3.317.

GWOT - PRIORITY PROCESSING FOR OPERATIONS IRAQI FREEDOM AND ENDURING FREEDOM (OIF/OEF) VETERANS

Note: The OEF-OIF Program has been changed to GWOT. Any further reference to this program should be addressed accordingly. Reference: From: VAVBAPHO/WAREA, Sent: Monday, December 10, 2012 10:25 AM, Subject: FYI - OEF-OIF Program name change.

VBA Letter 20-07-19 Revised (2nd) revises VBA policy and procedures for priority processing of disability claims filed by Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans.

Priority Processing for Seriously Injured GWOT Veterans

We will continue to expedite all claims of very seriously injured (VSI) and seriously injured (SI) GWOT Veterans. There is no higher priority for any VA employee, whether serving in the field or in headquarters, than ensuring that we are timely meeting the needs of seriously injured GWOT Veterans. Our success requires the full attention of every VBA employee and vigilant oversight by our leaders and GWOT coordinators throughout the organization.

Revised GWOT Priorities

In addition to claims from VSI and SI GWOT Veterans, the following compensation and pension claims and appeals will be processed on a priority basis effective February 9, 2009:

An original or re-opened claim from a GWOT Veteran received within six months of separation from service.

A supplemental claim from a GWOT Veteran for post-traumatic stress disorder (PTSD) if PTSD is not already service connected.

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An appeal from a GWOT Veteran of his/her initial claim decision following GWOT service.

Any claims and appeals from GWOT Veterans currently being processed on a priority basis based on previous prioritization guidance will continue to be expedited until the current claim/appeal is completed. However, prioritization of any future claims from these Veterans will be determined based on the new criteria.

REFERENCE: VBA Letter 20-07-19 Revised (2nd), Subject: Priority Processing for Global War On Terrorism (GWOT) Veterans, dated February 6, 2009

Note: For claimed disabilities, select Priority Processing GWOT special issue flash on the MAPD Contentions screen.

Note: Examination requests need to be expedited; the "remarks" section must noted as “Expedited request – Priority Processing GWOT.”

Those Veterans who are seriously injured as a result of service during Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF), will receive special handling. The goal is to award benefits within 30 days from the date of receipt of claims for compensation (if the service member has been discharged from the military).

Therefore, applications and claims folders will be carried by hand from one element to another within the Veterans Service Center (VSC) as well as between the other divisions of the regional office.

“Serious disability” is injury to or illness of a service member that definitely or possibly will result in discharge from military service. The Department of Defense (DoD) currently classifies injuries and illnesses as “VSI” for very serious, “SI” for serious, “SPC” for special category person where there has been a loss of a body part, and “NSI” for not serious. At a minimum, all service members in VSI, SI and SPC status should be considered seriously disabled for VA purposes. Service members identified as NSI should be contacted and assisted but will not require case management unless their condition warrants.

REFERENCE. For further guidance regarding development, refer to VBA Letter 20-05-14, dated March 8, 2005, Subj: Operation Enduring Freedom & Operation Iraqi Freedom.

DISABILITY CLAIMS BASED ON EXPOSURE TO ENVIRONMENTAL HAZARDS DURING SERVICE IN SOUTHWEST ASIA

The Department of Defense (DoD) has recently provided Compensation and Pension (C&P) Service with information on environmental hazards associated with military service in Southwest Asia. Among the hazards are toxic contaminants produced by burn pits that were located at most military bases throughout Iraq and Afghanistan. The burn pits were large disposal trenches dug into the ground where military waste products were dumped and set on fire. The burned waste products included plastics, metals, rubber, chemical solvents,

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petroleum products, and medical waste. Jet fuel was used to accelerate the burning process. The resulting smoke fumes and particulate matter, which contained the toxic contaminants, spread over the military bases and was inhaled by service members. In addition to burn pit contaminants, some service members were exposed to other environmental hazards. One example is the highly toxic chromium compounds used at the Qarmat Ali Water Treatment Plant in Basrah, Iraq, during 2003. Another example is the 2003 sulfur fire at the Mishraq State Sulfur Mine Plant in Iraq, which burned for three weeks and contaminated the surrounding area with sulfur dioxide and hydrogen sulfide fumes. The firefighters involved with suppressing this fire were found to have long-term respiratory conditions diagnosed as “bronchiolitis.”

C&P Service is currently evaluating the DoD evidence related to Southwest Asia environmental hazards and any harmful health effects that may have resulted from exposure to such environmental hazards. A C&P Training Letter will be released in the near future explaining the situation in more detail and describing steps to be followed when a claim for disability compensation based on environmental hazards is received from a Veteran with Southwest Asia service.

In the meantime, any related claims should be evaluated by regional office personnel on a case-by-case basis with the benefit of doubt provided to the Veteran. When evaluating the evidence, the Veteran’s lay statement of burn pit or other hazardous exposure is sufficient to establish the occurrence of such exposure, if the Veteran served in Southwest Asia and the statement is consistent with the circumstances, conditions, or hardships of the Veteran’s service. When requesting medical examinations, inform the examiner of the Veteran’s service in Southwest Asia and statement of exposure and request an opinion as to whether it is at least as likely as not that the in-service exposure is related to the claimed current disability. If the claim is for a respiratory condition and the exposure site is identified as the Mishraq sulfur fire, request that testing for “bronchiolitis” be conducted in addition to other respiratory testing.

Reference: C&P Service Bulletin, November 2009

DEFINITIONS

For guidance regarding the definition of a claim for compensation for certain disabilities due to undiagnosed illnesses,  refer to the following references:

38 CFR 3.317 , Compensation for certain disabilities due to undiagnosed illnesses

M21-1MR, Part IV, Subpart ii, Chapter 2, Section D , Compensation for Undiagnosed Illness of Persian Gulf Veterans

CHRONIC DISABILITY: According to 38 CFR 3.317, a qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following):

An undiagnosed illness;

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The following medically unexplained chronic multisymptom illnesses that are defined by a cluster of signs or symptoms:

1. Chronic fatigue syndrome; 2. Fibromyalgia; 3. Irritable bowel syndrome; or4. Any other illness that the Secretary determines meets the criteria in paragraph (a)

(2)(ii) of this section for a medically unexplained chronic multisymptom illness; or

Any diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. 1117(d) warrants a presumption of service-connection.

The 6-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest.

Effective March 1, 2002, medically unexplained chronic multi-symptom illnesses such as fibromyalgia, irritable bowel syndrome and chronic fatigue are now considered presumptive conditions for Gulf War Veterans.

The term medically unexplained chronic multisymptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained.

“Objective indications of chronic disability” include both “signs,” in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification.

Disabilities that have existed for 6 months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. The 6-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest.

DEVELOPMENT GUIDELINES

For guidance regarding development of Claims Based on Undiagnosed Illnesses of Gulf War Veterans, refer to M21-1MR, Part IV, Subpart ii, Chapter 1, Section E.

Send Initial Development VCAA Notification letter to Veteran. Send MAPD Special Issues Claimant Letter, 1) GW - Notice - Information Center (toll-free helpline); and 2) GW - Registry exam?

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Send MAPD Special Issues Claimant Letter, GW - Earliest manifestations/evid of illness

Enter a development note in MAPD indicating the Veteran was seriously injured as a result of OEF or OIF.

SPECIFIC DISABILITY CLAIMED

For guidance regarding development of Claims Based on Undiagnosed Illnesses of Gulf War Veterans, refer to M21-1MR, Part IV, Subpart ii, Chapter 1, Section E.

Send Initial Development VCAA Notification letter to Veteran. Send MAPD Special Issues Claimant Letter, 1) GW - Notice - Information Center (toll-free helpline); and 2) GW - Registry exam?

Send MAPD Special Issues Claimant Letter, GW - Earliest manifestations/evid of illness

NO SPECIFIC DISABILITY CLAIMED

If the Veteran alleges exposure to environmental hazards but claims no disability, inform the Veteran that exposure is not a disability.

Send a notice letter to the claimant requesting disabilities claimed.

If no response in 30 days, refer to Administrative Denials Section of this guide for further details.

Note: If “exposure” is the only allegation, the claims is not substantially complete and should not be controlled. (See M21-1MR, Part I, Chapter 1, Section B, Topic 3b, for information on handling incomplete claims.)

EVIDENCE OF SOUTHWEST ASIA SERVICE

Participation in the Southwest Asia Theater of Operations will be verified by the following:

Service in the Southwest Asia Theater of Operations shown on the original or certified copy of the DD Form 214

Verification a the service records center (via PIES O30 request)

Verification through the official military personnel file

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SOUTHWEST ASIA SERVICE VERIFICATION

If the dates of service and active duty dates in Southwest Asia theater of operations are not already established by the evidence of record, complete the following actions:

Submit PIES Request Code O30. Print a copy of the PIES request to be flip-filed in the center section of the C-file.

Send a notice letter to the claimant.

Create a tracked item.

SOUTHWEST ASIA SERVICE MEDAL

The Southwest Asia Service Medal (at right in photo) was established 12 March 1991 by Executive Order 12754.

The medal is awarded to any member of the armed forces for service in prescribed geographical parts of the Middle East during Operations Desert Shield and Desert Storm.

The wearing of as many as three service stars on the suspension ribbon and ribbon bar currently is authorized, one for the period from 02 Aug 1990 to 16 Jan 1991, a second one for the period 17 Jan.-11 April 1992 and a third one for the period beginning 12 April 1992 and closing 30 Nov 1995.

Members of the Armed Forces of the United States serving in Israel, Egypt, Turkey, Syria and Jordan (including the airspace and territorial waters) between 17 January 1991 and 11 April 1991, will also be eligible for this award. Members serving in these countries must have been under the command and control of U.S. Central Command or directly supporting military operations in the combat theater.

It was awarded to those who served or flew into the war zone between Jan. 1, 1991, -- the start of the air war -- and Feb. 28, 1991, when offensive operations concluded.

The war zone included Iraq, Kuwait, Saudi Arabia, Oman, Bahrain, Qatar and the United Arab Emirates.

At sea, the war zone is defined as the Persian Gulf, Red Sea, Gulf of Oman, Gulf of Aden and portions of the Arabian Sea.

Basically, service members qualified if they were attached to units participating in ground or shore operations, aboard ships directly supporting military operations, or participating as crew members in aerial missions directly supporting military operations within the war zone.

Reference: http://www.history.navy.mil/medals/swasia.htm

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PREVIOUSLY DENIED CLAIMS

In the event one or more undiagnosed illnesses have been previously denied, and a claim is received more than one year from the date of the notification letter informing the Veteran of the denial, DO NOT request new and material evidence. These claims need to be re-developed as a new issue. Additionally, if the decision was made within a year from the date of claim, develop the claim as a new issue.

In Suttman v. Brown, the Court determined that even though service connection for a POW presumptive disease has been previously denied, a POW does not have to submit new and material evidence to reopen a claim for service connection for a POW presumptive condition. This is because each claim for a presumptive condition filed within the presumptive period is treated as a new claim rather than a claim to reopen and, hence, does not require "new and material" evidence.

This same principle would apply to all lifelong presumptive disabilities and to the disabilities with shorter presumptive periods. As long as the second or succeeding claims are filed within the presumptive periods, they are to be treated as new claims and not claims to reopen prior denials. Therefore, since the Gulf War presumptive period has been extended to December 31, 2011 for undiagnosed illnesses, new and material evidence would not be required to reopen the claim. This guidance would not apply to a previously denied condition that was diagnosed to have a known etiology unrelated to Gulf War service.

Service connection may be warranted for those Veterans who exhibit objective indications of a qualifying chronic disability, provided such disability becomes manifest either during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2011; and by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. Reference: 38 CFR 3.317, Compensation for certain disabilities due to undiagnosed illnesses.

VA EXAMINATION & OPINION GUIDELINES

When requesting the VA medical examination and Opinions in Claims Under 38 CFR 3.317 be sure to ask the examiner to conduct a Gulf War General Medical Examination Disability Benefits Questionnaire (DBQ), and any required specialist DBQs.

Send the claims folder to the examiner to review. M21-1 MR III.iv.3.A.1.e

The “Notice to Examiners” directs the examiner to provide a medical opinion if the examiner characterizes the disability pattern as a diagnosable chronic multi-symptom illness with a partially explained etiology, or a disease with a clear and specific etiology and diagnosis. Preparation of a separate medical opinion DBQ is not required.

Reference: M21-1MR.IV.ii.1.E

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GULF WAR OPINION FORMAT

Be sure to include the “Notice to Examiners” shown in M21-1MR.IV.ii.1.E.19g

See Addendum K for the Gulf War Opinion Format. Reference: Compensation Service Bulletin, Addendum, December 2013

THRESHOLD FOR ORDERING A VA EXAMINATION

The threshold for ordering Veterans Affairs (VA) examinations for Gulf War Veterans claiming an undiagnosed illness or medically unexplained chronic multi-symptom illness is very low. The Veteran must have served in the Southwest Asia theater of operations, covered in 38 CFR 3.317 (e) (2), and provide a statement of the disability and benefit sought. Medical evidence could show that the Veteran has sought treatment for the disability claimed, or the Veteran’s lay testimony alone could be used to describe the disability pattern.

The Veteran does not have to explicitly state that the claim is “due to Gulf War.”

VSRs/RVSRs should verify Gulf War service when reviewing the claim. If the Veteran does not indicate that a claim is due to Gulf War service, but the claim fits the description of conditions listed under 38 CFR 3.317(a) (2) (B) or 3.317(b), and the Veteran’s service in the Southwest Asia theater of operations is confirmed, then consider the claim for service-connection on the basis of Gulf War service.

VSRs/RVSRs are not expected to determine what is, or is not, an undiagnosed illness or medically unexplained chronic multi-symptom illness. They are expected to determine whether a Veteran had Gulf War service and whether sufficient medical or lay evidence has been submitted showing a chronic disability pattern, lasting at least six months, that fits the symptoms described in 38 CFR 3.317.   Please see Training Letter 10-01, Adjudicating Claims Based on Service in the Gulf War and Southwest Asia, for additional guidance.

Reference: Compensation Service Bulletin, June 2013

Refer the claim to an RVSR who will make the determination as to whether or not the condition is chronic (see definition/explanation above).  If an examination is warranted, the VSR should request a GW exam with the specific opinion (is it due to a known clinical diagnosis, etc.....) IN EVERY CASE where the Veteran alleges a condition is due to GW exposure.

GUIDANCE FROM TRAINING LETTER 10-01

When an undiagnosed illness is claimed, a thorough medical examination report is essential to rule out known diagnoses and provide, where possible, an accurate picture of the disability for rating purposes. Specialist examinations will be ordered as appropriate (e.g. pulmonary

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function studies when breathing problems are claimed; neurological evaluation for headaches; psychiatric/neuropsychiatric examinations for memory loss or fatigue). If multiple joint or muscle pain is alleged, ask the Veteran to identify specific areas affected. When nonspecific complaints are presented, the examiner must address these issues.

It should also be kept in mind that when medical evidence shows a definite diagnosed condition for a Veteran with Southwest Asia service, that diagnosed condition could have been incurred or aggravated during service and would therefore be subject to service connection on a direct basis outside the provisions of § 3.317. If the examiner has determined the Veteran’s disability pattern to be either a diagnosable chronic multi-symptom illness with a partially explained etiology, or a disease with a clear and specific etiology and diagnosis, then service connection cannot be granted under § 3.317 and may only be granted if the medical evidence is sufficient to establish service connection on a direct basis.

If there is no medical evidence that the Veteran has previously been treated for the disability pattern and the only significant evidence is the Veteran’s lay statement describing the disability pattern, a VA examination is still warranted. Case law from the Court of Appeals for Veterans Claims (CAVC), interpreting 38 CFR § 3.159(c)(4), establishes a relatively low threshold for requesting VA medical examinations. In McLendon v. Nicholson, 20 Vet.App. 79 (2006), the Court identified four criteria that, when met, require VA to provide a medical examination. In summary, they are: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence that a qualifying in-service event occurred, (3) an indication that the disability may be associated with the Veteran’s service, and (4) insufficient competent medical evidence on file for a decision on the claim.

Obtain all post-service treatment records before requesting an examination; if medical treatment reports are not available or do not exist, make a note in the remarks section to let the examiner know that records are not available.

Note: A general medical examination will be required. Be sure to select the appropriate DBQ General Medical Exam. 1) If a Veteran files a claim within one year of discharge and does not claim any disabilities related to exposure to Gulf War environmental hazards, select only the “DBQ General Medical Exam – Compensation” worksheet. 2) If a Veteran files a claim within one year of discharge and does claim disabilities related to exposure to Gulf War environmental hazards, select only the “DBQ Gulf War General Medical Examination? Worksheet. DO NOT SELECT BOTH TYPES OF GENERAL MEDICAL EXAMS.

A diagnosis for tension-type headaches is insufficient. If the headaches are attributable to a known clinical diagnosis, ask the examiner to please specify a diagnosis. A neurological examination will be required.

A psychiatric examination (mental health) will be required if the Veteran claims fatigue.

Reference: Training Letter 10-01, Adjudicating Claims Based on Service in the Gulf War and Southwest Asia, dated February 4, 2010

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COMPENSATION SERVICE FAQS REGARDING GULF WAR EXAMS (http://vbacodmoint1.vba.va.gov/bl/21/faq/FAQ_Answer.asp?ref=395)Issue: Gulf War VA Examinations Question #1: The Compensation Service June 2013 Bulletin instructs that "(i)If the Veteran does not indicate that a claim is due to Gulf War service, but the claim fits the description of conditions listed under 38 CFR 3.317(a) (2) (B) or 3.317(b) , and the Veteran's service in the Southwest Asia theater of operations is confirmed, then consider the claim for service-connection on the basis of Gulf War service and order a Gulf War VA Examination."

Per TL 10-01, it is a medical determination whether or not a veteran has a medically unexplained chronic multisymptom illness (see the opinion in TL 10-01). If that is still true, how can we ask the VSR/RVSRs to make this determination? It is unclear to us when a claim falls under 3.317(a)(2)(B) without us making this medical determination on our own.

Question #2 What if the veteran claims a symptom of joint pain, the STRs are silent with respect to any joint problems but the outpatient treatment records show a diagnosis of right knee tendonitis or arthritis? Even though the veteran claimed a sign/symptom, we now have a diagnosis. Can we conclude that this is a medically explained chronic multi-symptom illness, thereby relieving us of the requirement for getting a Gulf War examination with opinion?

Question #3 What if a veteran claims shortness of breath (or even asthma) and the outpatient treatment records show asthma or COPD. STRs are silent for any respiratory problems. Can we conclude that these are medically explained chronic multi-symptom illnesses and therefore not get a Gulf War exam?

Answer Answer #1: The VSR/RVSR cannot make this "medical determination" and should not attempt to. As previously stated, the threshold for ordering C&P exams for disabilities claimed by Veterans with Gulf War service is very low and it is up to the C&P examiner to determine the nature of the Veteran's claimed disability. It must be kept in mind that such claims can fall under TL-10-01, which describes undiagnosed illnesses (UI) and medically unexplained chronic multisymptom illnesses (MUCMI) or under TL-10-03, which describes environmental hazards associated Gulf War service in Iraq and Afghanistan. Service

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connection under TL-10-03 is for diagnosable illnesses and exposure to potential health hazards is acknowledged for exam purposes. Additionally, TL-10-01 makes it clear that an actual UI or MUCMI may show up in post-service treatment records as a "diagnosed" condition:

"If a Veteran has previously sought treatment for a multi-symptom illness from a private physician, it is not likely that a resulting medical report will describe the Veteran's disability pattern as an "undiagnosed illness." Medical personnel in general and physicians in particular are trained to produce a diagnosis as the basis for treatment. Therefore, a "diagnosis" may appear in the Veteran's private medical report."

TL 10-01 also provides a guide for C&P examiners, to be included with the exam request, which outlines four possible medical determinations: (1) UI, (2) MUCMI, (3) partially explained CMI, or (4) diagnosable illness. Therefore this determination is for C&P examiners and not VSR/RVSRs. In sum, if the Veteran served in the Gulf War Theater and there is medical or lay evidence of a current 6-month old relevant disability, a C&P exam should be ordered.

Answer #2 No, a C&P exam should still be ordered, unless service connection is granted. The general rule applies and the veteran should not be denied service connection without a Gulf War exam.

Answer #3 No. As stated above, a private medical "diagnosis" does not rule out the possibility of a MUCMI. Additionally, if the C&P exam shows a diagnosis of asthma or COPD, the examiner will provide an opinion as to whether it is at least as likely as not related to environmental hazards experienced during Gulf War service.

BRAIN CANCER IN GW VETERANS

Currently, there is no basis for granting benefits on a presumptive basis for brain cancer based on sarin exposure in Khamisiyah in 1991. Claims received are to be considered in accordance with the provisions of 38 CFR 3.303 with regard to direct service connection. For further guidance, refer to VSCM Conference Call, October 20, 2005.

PRESUMPTIONS OF SERVICE CONNECTION FOR PERSIAN GULF SERVICE

Revisions to 38 CFR 3.317, effective September 29, 2010

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The amendment to 38 CFR 3.317 establishes 9 new presumptive conditions for Veterans with the following qualifying periods of service:

Service on active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War. The Southwest Asia theater of operations includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. This definition of a “Gulf War” Veteran has not been changed by the newest amendment to 38 CFR 3.317.

Service in Afghanistan on or after September 19, 2001. This was added by the newest amendment effective September 29, 2010.

The amendment to 38 CFR 3.317 reflects a determination of a positive association between service in Southwest Asia or Afghanistan and nine diseases. These diseases are as follows:

a. Brucellosis

b. Campylobacter jejuni

c. Coxiella burnetii (Q fever)

d. Malaria

e. Mycobacterium tuberculosis

f. Nontyphoid Salmonella

g. Shigella

h. Visceral leishmaniasis

i. West Nile virus

Under the final rule, a Veteran will only have to show service in Southwest Asia or Afghanistan, that he or she had one of the nine diseases within a certain time period and now has a current disability as a result of that disease. These diseases will be considered to have been incurred in or aggravated by service if the disease manifests during a presumptive period. The presumptive periods are as follows:

For visceral leishmaniasis or tuberculosis, the disease only needs to become manifest to 10 percent or more at any time. There is no time limit for these conditions.

For malaria, the condition must become manifest to a degree of 10 percent or more within one year from the date of separation from a qualifying period of service (this means separation from service in Southwest Asia or Afghanistan) or at a time when standard or accepted treatises indicate that the incubation period commenced during a qualifying period of service.

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For the remaining other six conditions, the disease must become manifest to 10 percent or more within one year from the date of separation from a qualifying period of service (this means separation from service in Southwest Asia or Afghanistan).

These nine diseases will not be subject to presumptive service connection if:

There is affirmative evidence that the disease was not incurred during a qualifying period of service; or

If there is affirmative evidence that the disease was caused by a supervening condition or event that occurred between the Veteran’s most recent departure from a qualifying period of service and the onset of the disease; or

If there is affirmative evidence that the disease is the result of the Veteran’s own willful misconduct or the abuse of alcohol or drugs.

The new rule identifies the long term health effects potentially associated with these nine infectious diseases. This list does not preclude a finding that other manifestations were caused by one of these nine infectious diseases. Furthermore, if the Veteran is diagnosed with one of the nine presumptive conditions (listed in Column A) and also has a condition listed in Column B (one of the long term health effects), VA must determine, based on the evidence of record in each case, whether the column B condition was caused by the infectious disease. If a Veteran, presumed service connected for one of the nine conditions, is diagnosed with one of the diseases listed in Column B, VA will require a medical opinion as to whether it is at least as likely as not a condition caused by the Veteran having had the associated disease listed in Column A.

TABLE TO § 3.317—LONG-TERM HEALTH EFFECTS POTENTIALLY ASSOCIATED WITH INFECTIOUS DISEASES

A BBrucellosis ....................................... • Arthritis.

• Cardiovascular, nervous, and respiratory system infections.• Chronic meningitis and meningoencephalitis.• Deafness.• Demyelinating meningovascular syndromes.• Episcleritis.• Fatigue, inattention, amnesia, and depression.• Guillain-Barre´ syndrome.• Hepatic abnormalities, including granulomatous hepatitis.• Multifocal choroiditis.• Myelitis-radiculoneuritis.• Nummular keratitis.• Papilledema.• Optic neuritis.• Orchioepididymitis and infections of the genitourinary

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system.• Sensorineural hearing loss.• Spondylitis.• Uveitis.

Campylobacter jejuni ...................... • Guillain-Barre´ syndrome if manifest within 2 months of the infection.• Reactive Arthritis if manifest within 3 months of the infection.• Uveitis if manifest within 1 month of the infection.

Coxiella burnetii (Q fever) ...............

• Chronic hepatitis.• Endocarditis.• Osteomyelitis.• Post-Q-fever chronic fatigue syndrome.• Vascular infection.

Malaria ............................................ • Demyelinating polyneuropathy.• Guillain-Barre´ syndrome.• Hematologic manifestations (particularly anemia after falciparum malaria and splenic rupture after vivax malaria).• Immune-complex glomerulonephritis.• Neurologic disease, neuropsychiatric disease, or both.• Ophthalmologic manifestations, particularly retinal hemorrhage and scarring.• Plasmodium falciparum.• Plasmodium malariae.• Plasmodium ovale.• Plasmodium vivax.• Renal disease, especially nephrotic syndrome.

Mycobacterium tuberculosis ........... • Active tuberculosis.• Long-term adverse health outcomes due to irreversible tissue damage from severe forms of pulmonary and extrapulmonary tuberculosis and active tuberculosis.

Nontyphoid Salmonella ...................

• Reactive Arthritis if manifest within 3 months of the infection.

Shigella ........................................... • Hemolytic-uremic syndrome if manifest within 1 month of the infection.• Reactive Arthritis if manifest within 3 months of the infection.

Visceral leishmaniasis ..................... • Delayed presentation of the acute clinical syndrome.• Post-kala-azar dermal leishmaniasis if manifest within 2 years of the infection.• Reactivation of visceral leishmaniasis in the context of future immunosuppression.

West Nile virus ................................

• Variable physical, functional, or cognitive disability.

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GULF WAR REGULATIONS AND DISCONTINUANCE OF EP 698

Training Letter 10-01, Adjudicating Claims Based on Service in the Gulf War and Southwest Asia, instructed RO personnel to assign a temporary end product (EP) 698 to claims from Gulf War Veterans that involved potential medically unexplained chronic multisymptom illnesses (MUCMIs) other than chronic fatigue syndrome, irritable bowl syndrome, and fibromyalgia. These claims were to be held until a regulatory technical amendment to 38 C.F.R. § 3.317 was finalized, which would clarify that the three named MUCMIs were only examples and not an exclusive list. This regulatory clarification was finalized and became effective on October 7, 2010. Therefore, ROs that have not already done so, can remove the EP 698 and process the claim under a regular EP. The effective date will generally be the date of claim, not the date the amendment was finalized, because this is a clarifying technical amendment rather than creation of a new benefit.

Under current sections 3.317(a) and (b) regulations, Veterans with service in Afghanistan do not qualify for consideration of service connection based on disability patterns of undiagnosed illnesses and MUCMIs [although they do qualify for presumptive service connection of the nine diseases under 3.317(c)]. Therefore, any EP 698 established for a Veteran with Afghanistan service can also be removed from the hold and adjudicated under a regular EP based on the available evidence. Any questions can be forwarded to: VAVBAWAS/CO/211/ENVIRO.

CHANGES

Change 3, January 1, 2005, changed “condition” to read “undiagnosed illnesses” when addressing issues which have been previously denied.

Change 4, March 14, 2005, added the requirement to obtain post-service treatment records before requesting an examination or making a note in the remarks section if the records are not available. Incorporated reference within the appropriate topics.

Change 5, June 13, 2005, modified topic entitled, Previously Denied Claims, to clarify development of undiagnosed illnesses that have been previously denied.

Change 6, January 1, 2006, references incorporated within each topic; add topic entitled, “Brain Cancer in GW Veterans.”

Change 7, November 25, 2006, added guidance regarding exam requests involving symptoms that are attributable to a clinical diagnosis or unknown etiology.

Change 8, December 1, 2006, updated references; updated the presumptive date to December 31, 2011.

Change 9, November 19, 2007, added explanation for chronic disabilities and updated guidance regarding the referral of claims to the RVSR for determination of chronic issues.

Change 10, May 18, 2008, added guidance regarding evidence of SWA service.

Change 11, October 18, 2008, added information regarding the SWA Service Medal.

Change 12, December 15, 2009, added guidance from C&P Service Bulletin, November 2009.

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Change 13, March 5, 2010, added guidance from TL 10-01 regarding medical opinions.

Change 14, September 23, 2010, added guidance/information from Section 45.

Change 15, September 30, 2010, added guidance regarding revisions to 38 CFR 3.317

Change 16, February 1, 2011, added guidance regarding Gulf War Regulations and EP 698

Change 17, August 28, 2011, added guidance regarding new and material evidence based on Suttman v. Brown.

Change 18, May 20, 2012, added guidance regarding requests for General Medical Exams.

Change 19, October 23, 2012, updated guidance from a final rule that extended the presumptive period under 38 CFR 3.317 to December 31, 2016.

Change 20, December 10, 2012, added guidance regarding designation of OEF/OIF to GWOT.

Change 21, June 19, 2013, added guidance from the June 2013 Compensation Service Bulletin regarding Gulf War VA Examinations.

Change 22, September 25, 2013, added guidance from the Compensation Service FAQ site regarding Gulf War Examinations.

Change 23, January 20, 2014, added guidance from M21-1MR regarding VA examination guidelines.

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Section 54

Environmental Hazards in Iraq, Afghanistan, and Other Military Installations

_______

Numerous environmental hazards in Iraq, Afghanistan, and other military installations that could potentially present health risks to service members and Veterans have been identified.

The hazards include the following:

1. Large burn pits throughout Iraq, Afghanistan, and Djibouti on the Horn of Africa;

2. ”Particulate matter” in Iraq and Afghanistan;

3. A large sulfur fire at Mishraq State Sulfur Mine near Mosul, Iraq;

4. Hexavalent chromium exposure at the Qarmat Ali Water Treatment Plant in Basrah, Iraq;

5. Contaminated drinking water at Camp LeJeune, North Carolina; and

6. Pollutants from a waste incinerator near the Naval Air Facility (NAF) at Atsugi, Japan.

This Training Letter describes specific environmental hazards which have been recognized by the VA. The letter contains "fact sheets" that should be provided to VA examiners when requesting a VA examination with opinion requests regarding the environmental exposures. These "fact sheets" need to be sent whenever the Veteran claims exposure to burn pits or particulate matter or any other exposures listed in Training Letter 10-03 and such exposure is confirmed. Please note, that with respect to claims for exposure to burn pits and/or particulate matter, the Veteran's statement about such exposure is sufficient to concede the exposure if confirmation is made that the the Veteran had service in the appropriate theater of operation (Iraq, Afghanistan or Djibouti). When exposure is conceded/confirmed, then the appropriate opinions must also be requested from the VA examiner.

Claims processing policies and procedures are contained in Training Letter 10-03, dated April 26, 2010.

CONSOLIDATION AND PROCESSING OF DISABILITY CLAIMS BASED ON EXPOSURE TO CONTAMINATED DRINKING WATER AT CAMP LEJEUNE , NORTH CAROLINA

Per Fast Letter 11-03, all disability claims and appeals based on exposure to contaminated water at Marine Corps Base Camp Lejeune, North Carolina, will be processed at the Louisville Regional Office (RO). Fast Letter 11-03, SUBJ: Consolidation and Processing

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of Disability Claims Based on Exposure to Contaminated Drinking Water at Camp Lejeune, North Carolina

Pending claims are to be identified by the MAP-D special issue, “Environmental Hazard – Camp Lejeune.” Do not transfer claims where no disability is specifically alleged, e.g. a claim stating “Camp Lejeune” or “exposure at Camp Lejeune.” Follow the procedures in M21-1MR Part I, Chapter 1, Section B.3. If a disability is subsequently identified, then the claims folder is to be PTO'd to Louisville RO. Additionally, do not transfer claims alleging disability of dependents, including birth defects, as VA has no statutory authority to compensate dependents of Veterans exposed to the water contamination. These claims are to be processed under the procedures at M21-1MR. III.ii.7.2.b).

Claims received prior to installation of the special issue identifier in MAP-D in October 2010 cannot be identified through VETSNET Operations Reports (VOR). Therefore, please be on the alert for these cases including appeals from previous denials based on Camp Lejeune water contamination.

The Department of Navy and the Marine Corps have identified contamination of well fields supplying drinking water to multiple housing areas at Camp LeJeune, NC. The chemicals trichloroethylene (TCE) and tetrachloroethylene (PCE, also known as perchloroethylene or "PERC") were first found in the drinking water in the early 1980s during a routine, base-wide sampling. All polluted wells were shut down in 1985. The contaminated water treatment facilities were Tarawa Terrace and Hadnot Point.

The Department of Navy has not been able to identify or estimate the total number of individuals potentially exposed to this contaminated water. The estimates run from 100,000 to as high as 500,000 based on service populations at Camp LeJeune over the period concerned. The Navy has sent out approximately 200,000 direct notifications based on service records covering periods back to 1975.

Information on contaminated water at Camp LeJeune can be found at the Centers for Disease Control, Agency Agency for Toxic Substances and Disease Registry (ATSDR) website.

Reference: C&P Service Bulletin, February 2009.

Reference: Training Letter 11-03, Processing Disability Claims Based on Exposure to Contaminated Drinking Water at Camp Lejeune, dated 04-27-11

CAMP LEJEUNE VETERANS AND HEALTHCARE

On August 6, 2012, the President signed Public Law (PL) 112-154, the Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012. This law brings immediate VA healthcare to Camp Lejeune Veterans and their families diagnosed with certain diseases related to the water contamination that occurred at the base between 1957 and 1987. In addition, the PL contains several compensation-related matters that will be addressed more thoroughly in a future Fast Letter. As certain provisions went into effect on the date of

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enactment, August 6, 2012, Compensation Service is providing guidance for immediate implementation for the following sections:

Section 210--This provision allows Rating Veterans Service Representatives (RVSRs) to prepare memorandum ratings for separating Servicemembers for purposes of waiving the VA home loan funding fee. The previous law only permitted completion of such memo ratings when the ratings were based on a review of a pre-discharge VA examination. This allows disabled Servicemembers to utilize their home loan benefits more quickly and efficiently. Compensation Service will update M21-1Manual Rewrite Part III, Subpart i, Chapter 2, Section C, Topic 9, Block a (M21-1MR III.i.2.C.9.a) to reflect this change.

Section 502--Effective immediately, VA has the authority to allow the following individuals to sign claims filed with VA on behalf of claimants who are under age 18, are mentally incompetent, or are physically unable to sign a form:

a. a court appointed representative, b. a person who is responsible for the care of the claimant, including a spouse or

other relative,c. an attorney in fact or agent authorized to act on behalf of the individual under a

durable power of attorney, or d. the manager or principal officer of an institution caring for the claimant.

We will make the appropriate manual and regulation changes in the future.

Section 507--This provision clarifies that a surviving spouse is entitled to a benefit for the month of a Veteran’s death if, at the time of his or her death, the Veteran was receiving compensation or pension benefits. Regional Offices (ROs) and Pension Management Centers (PMCs) should continue following month-of-death procedures contained in Fast Letter 10-50, Processing Payment of the Veteran’s Rate for the Month of Death Utilizing the New Month of Death (MOD) Screen in Share.

Reference: Compensation Service Bulletin, August 2012.

CHANGES

Change 1, January 31, 2011, added guidance from FL 11-03 regarding the transfer the consolidation and processing of disability claims based on exposure to contaminated drinking water at Camp Lejeuen, NC.

Change 2, April 28, 2011, added TL 11-03 as a reference regarding disability claims based on exposure to contaminated drinking water at Camp Lejeune.

Change 3, August 21, 2012, added August 2012 Compensation Servoice Bulletin as a reference regarding Camp Lejeune Veterans and Healthcare.

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Section 55

Homeless Veterans_______

USE OF MEANS TESTS FOR HOMELESS VETERAN

Veterans’ disability compensation is not based upon a claimant’s income, therefore do not use “means testing” to determine a claim’s eligibility for homeless claims processing. The federal definition of a homeless person was established by Public Law (PL) 100-77, modified as recently as 2009, and codified under 42 U.S.C. 11302. The statute outlines several scenarios for classifying a person or family as homeless or at-risk of becoming homeless. For purposes of establishing eligibility to VA benefits, a person must also be defined as a Veteran pursuant to criteria found at 38 U.S.C. 101(2). This notwithstanding, income should not be the sole factor when determining claims processing priority.

Reference: Compensation Service Bulletin, April 2014

DEFINITION

A Veteran receiving benefits is NOT considered a homeless Vet. PL 100-77, dated July 22, 1987, known as the McKinney Act, provided a definition of homelessness that is commonly used because it controls federal funding. The United States Code Title 42, Chapter 119, Subchapter I contains the official federal definition of homeless. The following is an excerpt from PL 100-77: Sec. 11302. General definition of homeless individual:

§11302. General definition of homeless individual (a) In general For purposes of this chapter, the term ‘homeless’ or homeless individual or homeless person’ includes

1 – an individual who lacks a fixed, regular, and adequate nighttime residence; and2 – an individual who has a primary nighttime residence that is

A – a supervised publicly or privately operated shelter designed to provide temporary living accommodations (including welfare hotels, congregate shelters, and transitional housing for the mentally ill;B – an institution that provides a temporary residence for individuals intended to be institutionalized; orC – a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings.

(c) Exclusion For purposes of this chapter, the term "homeless" or "homeless individual" does not include any individual imprisoned or otherwise detained pursuant to an Act of the Congress or a State law.

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Although the definition does not state this, individuals living with family members, friends, etc. can be considered homeless. Living with relatives is sometimes on a temporary basis until the individual is able to obtain his/her own place to live.

PROCEDURES FOR PROCESSING CLAIMS FOR HOMELESS VETERANS

Refer to Circular 20-91-9, Procedures for Processing Claims for Homeless Veterans, dated June 6, 1991.

All homeless Veteran cases should be worked as a priority. Ensure that all claims initiated by homeless Veterans are processed within a maximum of 75 days from receipt on station.

FLASH

Set the Homeless Veteran flash in SHARE and attached a flash to the C-file.

The Office of Field Operations reminds offices that if a regional office is informed of a homeless Veteran participating in a VHA homeless program (i.e. HUD-VASH, Health Care for Homeless Veterans, etc.), the homeless flash should not be removed. The Veteran is maintaining housing based on VHA assistance and therefore, is not able to maintain permanent housing on his/her own. If a Veteran is being supported by VA services, VBA will still consider the Veteran "homeless " for claim processing purposes. If VBA can further assist the Veteran who is in permanent or transitional housing due to enrollment in a VHA homeless program, then we should continue to process his/her claim expeditiously by not removing the homeless flash. (Reference E-mail From: VAVBAPHO/WAREA , Sent: Tuesday, October 12, 2010 2:04 PM, Subject: Homeless Flash Clarification)

SUBMISSION OF PIES REQUESTS

The MRS must, for requests to NPRC involving a homeless Veteran case, send a “high-priority” e-mail with the Veteran’s identifying information to the VALO at VAVBASTL/RMC/PIESHOMELESS. All PIES requests will continue to be entered for tracking purposes. However, the MRS or Veterans Service Representative will enter the PIES request following receipt of a confirmation email response from the VALO.

For further guidance, refer to Fast Letter 12-02, Procedural Change to Expedite PIES Responses On Homeless Veterans Claims.

EXAMINATION GUIDELINES

When inputting an examination request for a homeless Veteran with DENVER VAMC JURISDICTION, insert the following language at the beginning of your request:

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HOMELESS VETERAN -- PLEASE EXPEDITE. If you are unable to reach the Veteran to schedule appointment on first attempt, please call Barb Martinez, Homeless Outreach Coordinator at the Denver RO, 303-907-3930. Do not share this phone number, this is for assistance with scheduling examinations with homeless Veterans only.

E-mail Barb Martinez the same day you input the examination. While the above language is only for Denver VAMC jurisdiction, please also e-mail Barb for Grand Junction and any other VAMC homeless examination requests. If the Veteran is not scheduled in a timely manner Barb is going to contact the VAMC.

REFERENCES

38 CFR 1.710, Homeless claimants: Delivery of benefit payments and correspondence

CHANGES

Change 1, October 18, 2008, added definition for homeless Veteran and added local reference.

Change 2, April 28, 2010, updated the maximum number of days to complete homeless claims.

Change 3, July 6, 2010, added additional references regarding the definition for homeless Veterans

Change 4, October 12, 2010, added guidance regarding Homeless Flash per E-mail From: VAVBAPHO/WAREA , Sent: Tuesday, October 12, 2010 2:04 PM, Subject: Homeless Flash Clarification

Change 5, March 11, 2011, added guidance regarding examination requests.

Change 6, November 28, 2011, added guidance regarding submission of PIES requests.

Change 7, February 18, 2012, added guidance regarding submission of PIES requests for Homeless Veterans.

Change 8, April 17, 2014, added guidance from the April 2014 Compensation Service Bulletin regarding Use of Means Tests for Homeless Veteran.

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Section 56

Claims Related to Exposure to Herbicide Agents_______

Refer to M21-1MR IV.ii.2.C.10 regarding Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN).

DEVELOPMENT GUIDELINES

If the Veteran submits a claim for a tropical disease that may be subject to presumptive service connection, complete the following actions:

Send the Veteran VCAA notification.

Send MAPD Claimant Letter, Compensation Letter, AO - Current disability, nexus, Vietnam svc

Send MAPD Claimant Letter, Compensation Letter, AO - Med evid of disab fm herbicide needed

PERIPHERAL NEUROPATHY

Note: Insert the following text from 38 CFR 3.309(e), Note 2, at the end of the paragraph noted above for claims of peripheral neuropathy due to AO exposure. The following text will follow the paragraph that addresses skin conditions.

For purposes of this section, the term acute and subacute peripheral neuropathy means transient peripheral neuropathy that appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset.

Note: For the purposes of pheripheral neuropathy due to AO, no VA examination will be required.

Request a VA examination, if applicable – refer to the VA Examination Section in this development guide for further details.

Refer to M21-1MR, Part IV, Subpart ii, Chapter 1, Section H for further guidance regarding claims based on exposure to herbicides.

NO SPECIFIC DISABILITY CLAIMED

If the Veteran alleges herbicide exposure but claims no disability, inform the Veteran that exposure is not a disability.

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Send a notice letter to the claimsnt requesting a specific disability from herbicides and how the claimant was exposed to herbicides. If the claimant can provide evidence showing treatment since discharge from the military, service connection may be warranted on a direct basis.

If no response in 30 days, refer to Administrative Denials Section in this development guide for further details. Process as a denial without a rating decision and take the end product at that point.

Note: If “exposure” is the only allegation, the claims is not substantially complete and should not be controlled. (See M21-1MR, Part I, Chapter 1, Section B, Topic 3b, for information on handling incomplete claims.)

CLAIMED CONDITION IS NOT A QUALIFYING DISABILITY

If the claimed disability is not a qualifying disability recognized as a presumptive residual of exposure to herbicide agents (38 CFR 3.309(e)), the claim should be considered for direct service connection and developed appropriately (see topic “When an Examination Should be Requested”).

Send a notice letter to the claimant that the disability claims is not a recognized condition.

Send a notice letter to the claimant requesting continuity. If the claimant can provide evidence showing treatment since discharge from the military, service connection may be warranted on a direct basis.

If the exposure has not been explained, or exposure is not apparent, send a notice letter and ask the claimant to explain how he/she was exposed to herbicides

If necessary, submit PIES Request Code O36 (Used only for exposure outside of Vietnam). Print a copy of the PIES request to be flip-filed in the center section of the C-file.

Create a tracked item.

NOTE: Under 38 CFR 3.313 (Claims based on service in Vietnam), service in Vietnam together with the development of NHL after service is sufficient to establish service connection for that disease. It does not have to be at least 10% disabling.

VERIFICATION OF SERVICE IN VIETNAM

For general guidance regarding verification of service in Vietnam, refer to the section entitled Verification of Service in Vietnam in this development guide.

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DEVELOPMENT OF HERBICIDE CLAIMS FOR NAVY & COAST GUARD VETERANS

For guidance regarding verification of Vietnam Service for Navy and Coast Guard Veterans, refer to the section entitled Verification of Service in Vietnam for Navy and Coast Guard Veterans in this development guide.

MAPD DEVELOPMENT LETTERS FOR VETERANS WHO SERVED IN VIETNAM

If the Veteran claims a disease associated with exposure to herbicide agents per 38 CFR 3.309(e), complete the following actions when the evidence shows the Veteran physically served in Vietnam:

Note: A diagnosis of diabetes mellitus will be required prior to requesting a VA examination.

Send MAPD Special Issues Claimant Letter, AO - Med evid of disab fm herbicide needed, if applicable (Development for medical treatment).

Send MAPD Special Issues Claimant Letter, AO – Tell us if VA treatment provided, if applicable (Development for medical treatment).

Send MAPD Special Issues Claimant Letter, AO - Notice - free protocol exam for AO exposure. The Veteran should be informed of the availability of hospital examination (Agent Orange Protocol exam) and treatment at any VA Medical Center.

MAPD DEVELOPMENT LETTERS FOR VETERANS WHO SERVED OUTSIDE VIETNAM

If the Veteran claims a disease associated with exposure to herbicide agents per 38 CFR 3.309(e), complete the following actions when the Veterans claim disabilities resulting from exposure to herbicides in locations other than Vietnam.

Note: a diagnosis of diabetes mellitus will be required prior to requesting a VA examination.

Send MAPD Special Issues Claimant Letter, AO- Explain how exposed to herbicides, if applicable.

Send MAPD Special Issues Claimant Letter, AO - Med evid of disab fm herbicide needed, if applicable (Development for medical treatment).

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Note: Delete the sentence, “If you are claiming a skin condition, we need medical evidence that shows your skin condition was present during the first year after your last service in Vietnam.”

Send MAPD Special Issues Claimant Letter, AO – Tell us if VA treatment provided, if applicable (Development for medical treatment).

Send MAPD Special Issues Claimant Letter, AO - Notice - free protocol exam for AO exposure. The Veteran should be informed of the availability of hospital examination (Agent Orange Protocol exam) and treatment at any VA Medical Center.

Note: In the first sentence, delete the words, “while in Vietnam.”

Note: Under the final regulation published January 25, 2011 in the Federal Register, VA will presume herbicide exposure for any Veteran who served between April 1, 1968, and Aug. 31, 1971, in a unit determined by VA and the Department of Defense (DoD) to have operated in an area in or near the Korean DMZ in which herbicides were applied.

Submit PIES Request Code O36 (Used only for exposure outside of Vietnam). Print a copy of the PIES request to be flip-filed in the center section of the C-file.

Note: For Veterans who served in Vietnam, and further development action is required by the JSRRC Coordinator (see the section below entitled, HERBICIDE RELATED CLAIMS FROM VETERANS WHO SERVED IN GUAM), consideration should be given to requesting the military personnel file by submitting a PIES O19 request.

Select MAPD Third Party Development pick, Exposure to herbicides, to create a tracked item.

HERBICIDE RELATED CLAIMS FROM VETERANS WHO SERVED IN THAILAND OR KOREA DURING THE VIETNAM ERA

Effective May 2010, when regional offices receive disability claims based on exposure to tactical herbicides, such as Agent Orange, from Veterans who served in Thailand or Korea during the Vietnam era, there is no longer a requirement to send an inquiry to the C&P Service Agent Orange Mailbox. Development inquiries can be sent directly to the Army and Joint Services Records Research Center (JSRRC) when the available evidence does not indicate tactical herbicide exposure. This will reduce processing time and provide better service to Veterans.

Reference: C&P Service Bulletin, May 2010

HERBICIDE RELATED CLAIMS FROM VETERANS WITH KOREAN SERVICE

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Under the final regulation published January 25, 2011 in the Federal Register, VA will presume herbicide exposure for any Veteran who served between April 1, 1968, and Aug. 31, 1971, in a unit determined by VA and the Department of Defense (DoD) to have operated in an area in or near the Korean DMZ in which herbicides were applied.

These units were identified by DoD documents and are listed in M21-1MR IV.ii.2.C.10.o. When service treatment or personnel records show that a Veteran was assigned to one of these units during the time frame of tactical herbicide use, the Veteran qualifies for the presumption of exposure. When a Veteran with Korean service alleges herbicide exposure but was not in one of the specified units or was in one of the specified units outside the time frame of tactical herbicide use, ROs were previously instructed to send an inquiry to the Agent Orange Mailbox for any additional evidence that might indicate tactical herbicide exposure.

C&P Service has now determined that ROs are no longer required to submit herbicide exposure inquiries received from Korean service Veterans to the Agent Orange Mailbox. Inquires related to potential herbicide exposure outside the specific units and time frame listed in M21-1MR should now be sent directly to JSRRC.

These policy changes are intended to reduce the time required to process these claims.

Reference: C&P Service Bulletin, May 2010

The Secretary of Defense has identified specific units that were assigned or rotated to areas near the DMZ where herbicides were used between April 1968 and July 1969. If the Veteran was exposed, the presumptions found in 38 CFR 3.309(e) apply.

Field Artillery, Signal and Engineer troops were supplied as support personnel as required.

Operational control of a unit of the 2nd Infantry Division was transferred to the 7th Infantry Division in early 1969. That unit was the 3rd Battalion of the 32nd Infantry (3/32nd). A Veteran’s service records may show assignment either to the 3/32nd of the 7th Infantry Division, or to the 3/32nd of the 2nd Infantry Division, depending on when the entry was made in the service record. Both unit designations were rotated to the DMZ during the time that Agent Orange was used, and exposure should be conceded if the Veteran alleges service at the DMZ.

The 2/31st of the 7th Infantry Division, was a DMZ rotational battalion. The 2/31st was under the operation control of the 2nd Infantry Division between January and April 1968, when they, too, rotated to the DMZ. Service records may show the 2/31st as assigned to either the 7th or the 2nd Infantry Division, depending on when the entry was made. If a Veteran was assigned to the 2/31st between January and April 1968, and alleges service at the DMZ, exposure should be conceded.

United Nations Command Security Battalion-Joint Security Area (UNCSB-JSA): The United Nations Command Security Battalion-Joint Security Area (UNCSB-JSA) was stationed at Camp Kitty Hawk in Korea. The soldiers belonged to the 8 th Army, but were part of the United Nations Command Military Assistance Commission structure. The unit

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was permanently stationed near the DMZ and the unit’s mission would have taken them into the DMZ. If a Veteran was assigned to the UNCSB-JSA during the period April 1968 through July 1969, exposure to Agent Orange should be conceded. Reference: VSCM Conference Call, March 17, 2005.

APPLYING PRESUMPTION OF DISEASE TO HERBICIDE EXPOSURE OUTSIDE OF VIETNAM

38 U.S.C. 1116 establishes that if a Veteran served in the Republic of Vietnam between January 9, 1962, and May 7, 1975, VA will presume exposure to herbicides unless there is affirmative evidence to the contrary. If the Veteran also has one of the diseases associated with herbicide exposure (see 38 CFR 3.309(e)), VA may grant service connection for that disease. However, if a Veteran did not serve in the Republic of Vietnam, but alleges exposure to an herbicide agent (as defined in 38 CFR 3.307(a)(6)) during active military service, VA must confirm the exposure. If VA confirms exposure and the Veteran has a disease associated with herbicide exposure, VA will presume that the disease is due to the exposure to herbicides and grant service connection, unless the presumption of service incurrence is rebutted by evidence to the contrary (38 CFR 3.307(d)).

Reference: C&P Service Bulletin, October 2008

HERBICIDE RELATED CLAIMS FROM VETERANS WHO SERVED IN GUAM

Forward the case to the JSRRC Coordinator for further development.

A request may be sent using JSRRC DPRIS WEB - the Veteran must provides dates of exposure, location of exposure, unit of assignment and a detailed description of how he was exposed to Agent Orange.

There are no DoD documents supporting the use, testing, or storage of tactical herbicides on Guam during the Vietnam era. JSRRC has confirmed there is no DoD evidence associating tactical herbicides with Guam during the Vietnam era. Documents from DoD do show that an early herbicide type, and equipment for its application, was stored on Guam during 1951-52, in anticipation of use during the Korean War. However, it was never used and was shipped back to Fort Detrick, Maryland, after the Korean armistice.

One BVA decision that granted service connection based on tactical herbicide exposure on Guam is widely disseminated on the Internet and regularly referred to by Veterans who served on Guam. BVA decisions do not establish legal precedents that regional offices must follow, but this one has apparently influenced some regional office determinations regarding Guam.

This BVA case does not contain evidence that tactical herbicides were present on Guam during the Vietnam era or that military personnel there at that time handled them.

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In the interest of further pursuing the issue of tactical herbicide use on Guam, Compensation Service contacted the Environmental Protection Agency (EPA). A response received from Mr. John McCarroll, EPA Manager of the Pacific Islands Office, stated: “I am not aware of a history of tactical herbicide use on Guam.” Also contacted was Mr. Michael K. Wolfram, EPA Guam Program Manager and Project Manager for military cleanup sites on Guam since 1997. He stated, “I am not familiar with any tactical use of pesticides on Guam, nor have I ever seen any reports identifying the presence of Agent Orange anywhere on Guam.”

The available evidence does not support the conclusion that tactical herbicides such as Agent Orange were used, tested, or stored at Andersen AFB or elsewhere on Guam during the Vietnam era. The BVA decision that reached the opposite conclusion was based on faulty information from a Dow Chemical report, which itself reached unsubstantiated conclusions from the 2002 ATSDR report. There is no evidence from DoD, JSRRC, or EPA corroborating the presence of tactical herbicides on Guam during the Vietnam era. Therefore, C&P Service cannot acknowledge that Veterans stationed on Guam were exposed to tactical herbicides during service there.

Although presumptive service connection is not available, service connection on a direct basis may be available if competent medical evidence, such as an opinion with supporting rational from a qualified medical examiner, provides a link or nexus between a Veteran’s current disabilities and prolonged contact with commercial herbicides during his vegetation control duties on Guam.

Reference: E-mail from Sampsel, James, VBAVACO, Subject: Agent Orange in Guam, dated November 8, 2011

PRESUMPTION OF AGENT ORANGE EXPOSURE FOR KOREAN SERVICE VETERANS

VA published a final rule in the Federal Register on January 25, 2011, that amended 38 CFR § 3.307 by adding a new section (a)(6)(iv). The new section establishes presumptive herbicide exposure for certain Veterans who served in, or near, the Korean demilitarized zone (DMZ) between April 1, 1968 and August 31, 1971. The Department of Defense (DoD) provided VA with the identity of certain military units operating along the DMZ during that time frame. A listing of those units can be found in M21-1MR.IV.ii.2.C.10 p. A Veteran with confirmed service in one of these units during the designated time frame qualifies for the presumption of herbicide exposure. This regulation is a change from previous VA policy, which acknowledged herbicide exposure on a facts-found basis for Veterans of designated units who served from April 1968 to July 1969. The manual will be updated to reflect this change.

Because the new regulation represents a liberalization, the provisions of 38 CFR § 3.114 regarding effective dates of service connection does apply. Veterans who were denied service connection based on the previous policy may now receive a grant, with an effective date “no earlier” than January 25, 2011.

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Reference: Compensation Service Bulletin, August 2011

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TEMPORARY DUTY (TDY) IN VIETNAM DURING THE EARLY YEARS

It should be noted that the expeditionary medal issued by all branches of the service, (which may indicate duty or visitation in Vietnam during the years before 1965) is the Armed Forces Expeditionary Medal (AFEM) rather than the Armed Services Expeditionary Medal as referred to in the July Compensation Service Bulletin.

The Department of Defense website below lists the locations of military service for which the AFEM was awarded.http://prhome.defense.gov/MPP/OEPM/docs/AFEM%20Approved%20Operations.pdf

Reference: C&P Service Bulletin, Addendum, July 2011

NEW PERSONNEL INFORMATION EXCHANGE SYSTEM (PIES) O39 REQUEST FOR CLAIMS INVOLVING TEMPORARY DUTY (TDY) TO VIETNAM

The PIES O39 code should be used when a Veteran claims temporary duty (TDY) to Vietnam and TDY records are needed to confirm service. Submit the O34 and O39 requests at the same time, as this will reduce the time needed to receive a response. The O39 request code provides TDY orders, performance evaluations, and other TDY documents found in the Veteran’s personnel file. By using the O39 code, do not submit an O18 requests; as noted in the August 2011 VSCM Conference Call, “Regardless of whether the PIES O39 produces any evidence of TDY, assume that the entire (personnel) file was reviewed and VA’s duty to assist has been fulfilled.” Reference: PIES Conference Call Agenda-Quarter 4 (minutes), dated October 25, 2011.

The Compensation Service Bulletin dated July 2011 provided evidence development procedures for Agent Orange exposure related claims when the Veteran alleges temporary duty (TDY) to Vietnam during the early war years. In such cases, when an initial O34 PIES request does not provide the required evidence of TDY, our duty to assist obligation requires we obtain the Veteran’s complete military personnel file with an O18 PIES request. This often results in a lengthy review of military documents in an attempt to find specific evidence of TDY.

To streamline the process, Compensation Service has created a new PIES O39 request code. When this code is received by the Records Management Center (RMC) at the National Personnel Records Center (NPRC), they will copy all TDY orders, performance evaluations, and other documents indicating TDY from a Veteran’s personnel file and send them to the requesting regional office (RO). This will save the expense of copying and shipping the entire personnel file and will significantly reduce review time for RO personnel.

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Regardless of whether the PIES O39 request produces any evidence of TDY, assume that the entire file was reviewed and VA’s duty to assist has been fulfilled. Although this new PIES code is a response to issues involving Vietnam service and the presumption of Agent Orange exposure, it has application to any claim where TDY is an issue related to service connection.

Reference: Compensation Service Bulletin, August 2011

From PIES Create:

O39 TEMPORARY VIETNAM DUTY/VISITATION - TO INCLUDE TDY ORDERS, PERFORMANCE EVALUATIONS, AND ANY OTHER EVIDENCE OF TEMPORARY DUTY/VISITATION TO VIETNAM

The new PIES O39 code is up and running and should be used when a vet claims temporary duty (TDY) to Vietnam and TDY records are needed to confirm service. Please submit the O34 and O39 requests at the same time, as this will reduce the time needed to receive a response in regards to your inquiry. The O39 request code provides TDY orders, performance evaluations, and other TDY documents found in the vet’s personnel file. By using the O39 code, you should not have to submit as many O18 requests. As the August 2011 VSCM Conference Call notes states, “Regardless of whether the PIES O39 produces any evidence of TDY, assume that the entire (personnel) file was reviewed and VA’s duty to assist has been fulfilled.” Reference: PIES Conference Call MINUTES, October 25, 2011

ADJUDICATING CERTAIN AGENT ORANGE EXPOSURE-RELATED CLAIMS (RANCH HAND OPERATIONS IN SEA)

Compensation Service recently reviewed a declassified 1971 Department of Defense (DoD) document titled: Project CHECO, Southeast Asia Report, Ranch Hand Operations in SEA. It contains information related to Agent Orange aerial spray missions conducted over Vietnam between 1962 and 1971 by the US Air Force during “Operation Ranch Hand.” This information will assist the Department of Veterans Affairs (VA) regional offices (ROs) when developing for evidence and adjudicating disability claims based on Agent Orange exposure during the Vietnam era. Veterans with service that falls into one of the categories listed below may not be eligible for the statutory presumption of Agent Orange exposure, but may qualify for an acknowledgement of exposure on a direct facts-found basis. This acknowledgement would allow for service connection of any disease that VA associates with Agent Orange exposure. In all cases, give the benefit of doubt to the Veteran. The CHECO Report shows the following:

Testing of Agent Orange Occurred in Vietnam During August 1961

This was before January 9, 1962, date specified in 38 U.S.C. § 1116 as beginning the period of presumptive Agent Orange exposure for Veterans with service in Vietnam. If evidence indicates that a Veteran was involved with this testing, exposure can be acknowledged on a direct facts-found basis.

Operation Ranch Hand

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o Crewmembers who flew on UC-123 aircraft for Agent Orange aerial spray missions prior to May 1964 were not officially assigned to Vietnam as a duty station.

o Began in January 1962, meaning Veterans associated with it fall under the statutory presumptive period of Agent Orange exposure. However, because this was an early period of Vietnam involvement, personnel records may not directly reflect Vietnam service. Therefore, it is important to obtain the complete personnel file for indications of temporary duty assignments to Southeast Asia or award of the Armed Forces Expeditionary Medal, which was issued for Vietnam service prior to creation of the Vietnam Service Medal. Additional indicators would include evidence of flight status and type of aircraft assignments. Operation Ranch Hand UC-123 aircraft conducted aerial spray missions over areas of Laos bordering Vietnam beginning in 1965 and over areas of North Vietnam beginning in 1966.

o If evidence indicates that a Veteran was assigned to a military unit operating in Laos or North Vietnam during a period of aerial spraying, exposure can be acknowledged on a direct facts-found basis.

o Extensive testing of the Agent Orange aerial spray equipment used during Operation Ranch Hand occurred at Eglin AFB, Florida beginning in 1964.

Compensation Service has already informed VA ROs of this testing based on information from DoD. Any evidence indicating that a Veteran was involved with this testing, or performed duties in the area of testing, is sufficient to establish exposure on a direct facts-found basis.

In order to ensure that Veterans who fall into any of the above Agent Orange exposure categories receive complete, accurate, and fair claims processing, Compensation Service will provide RO personnel with a fast letter describing the categories and explaining proper development and adjudication procedures in more detail. For any questions related to these categories of potential exposure or a particular Veteran’s case, please contact the Compensation Service Agent Orange Mailbox.

Reference: Compensation Service Bulletin, December 2012.

CHANGES

Change 4, August 5, 2004, made some typographical corrections and clarified the abbreviation, RVN.

Change 5, February 22, 2005, clarified the reason for requesting continuity when no disability is claimed. Clarified guidance when exposure to herbicides is not as a result of service in Vietnam. Updated the list of units rotated to the DMZ.

Change 6, March 1, 2005, reformatted the section; clarified the parameters for the protocol exam; clarified guidance regarding verification of a Veteran’s presence in the Republic of Vietnam; added guidance for disability claims due to exposure outside Vietnam.

Change 7, March 17, 2005, added United Nations Command Security Battalion-Joint Security Area (UNCSB-JSA) as a recognized unit station near the Korean DMZ.

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Change 38June 20, 2013

Change 8, March 21, 2005, corrected guidance regarding development of claims where the evidence shows the Veterans physically served in Vietnam.

Change 9, March 28, 2005, added further guidance regarding development of claims when the claimed conditions is not a qualifying disability or there is no specific disability claimed.

Change 10, April 5, 2005, guidance regarding verification of Vietnam service moved to Section 71, Verification of Service in Vietnam; added the guidance with regard to sending the Type II Diabetes Questionnaire or the Cardiovascular Questionnaire.

Change 11, April 25, 2005, added guidance regarding development of claims based on direct service connection when there is no evidence of Vietnam service.

Change 12, May 17, 2005, added VSCM Conference Call references to the topic,Claims from Veterans Who Served in Korea.

Change 13, August 4, 2005, removed Addrienne Foster as the POC; added Dorilyn Martz as the POC for Agent Orange related issues regarding Veterans who served in Korea.

Change 14, October 12, 2006, additional Korean DMZ units were added per VSCM Conference Call, September 21, 2006.

Change 15, November 25, 2006, added guidance regarding claims filed under Haas v. Nicholson.

Change 16, April 16, 2007, added reference to FL 06-26 regarding claims filed under Haas v. Nicholson.

Change 17, August 29, 2007, added guidance regarding the herbicide exposure presumption extended to USS Ingersoll crewmembers.

Change 18, January 22, 2008, deleted requirement to send the Type II Diabetes Questionnaire or the Cardiovascular Questionnaire (reference Quality Review Committee minutes dated January 9, 2008).

Change 19, June 30, 2008, added guidance from the June 2008 C&P Service Bulletin regarding presumption of service connection based on service in the Republic of Vietnam for primary AL Amyloidosis

Change 20, October 18, 2008, added guidance regarding application of presumption of disease to herbicide exposure outside of Vietnam; claims for non-Hodgkin’s lymphoma under 38 CFR 3.313 and the Haas Stay; guidance regarding Navy deck logs.

Change 21, August 25, 2009, added guidance regarding claims from Veterans with Thailand service.

Change 22, October 30, 2009, added guidance regarding development for Navy Deck Logs.

Change 23, May 20, 2010, added guidance regarding New Procedures for Claims Based on Herbicide Exposure in Thailand and Korea provided by C&P Service Bulletin, May 2010.

Change 24, June 23, 2010, added guidance regarding Naval vessels that operated in Vietnam Waterways provided by C&P Service Bulletin, June 2010.

Change 25, August 19, 2010, added guidance from the August 2010 C&P Service Bulletin regarding the New Website and Development Procedure for Herbicide Exposure Related Claims from Vietnam Era Navy Veterans.

Change 26, September 10, 2010, added guidance from FL 10-38 regarding end product guidance for new Agent Orange presumptive conditions - Hairy Cell and Other B-Cell Leukemias, Parkinson's Disease, and Ischemic Heart Disease; added guidance from TL 10-06 regarding claims based on herbicide exposure from Veterans with service in the U.S. Navy and Coast Guard during the Vietnam Era; inserted development guidelines and information regarding Ischemic Heart Disease from Section 4.

Change 27, October 21, 2010, added guidance from the October 2010 C&P Service Bulletin regarding additional development procedures for claims from Vietnam Era Navy Veterans.

Change 28, January 31, 2011, added reference for presumption of herbicide exposure for any Veteran who served between April 1, 1968, and Aug. 31, 1971, in a unit determined by VA and the Department of Defense (DoD) to have operated in an area in or near the Korean DMZ in which herbicides were applied.

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Change 38June 20, 2013

Change 29, February 11, 2011, added guidance regarding suppression of the acknowledgment letter when establishing EP 405 or 409.

Change 30, April 25, 2011, added guidance entitled Clarification on Evidence Requirement in Haas Blue Water Navy Claims - When Evidence Shows "Mouth of a River"

Change 31, August 9, 2011, added guidance from C&P Bulletin, Addendum, July 2011, regarding TDY in Vietnam in the early years.

Change 32, August 18, 2011, added guidance from Compensation Service Bulletin, August 2011, regarding Presumption of Agent Orange Exposure for Korean Service Veterans and the New PIES O39 Request for Claims Invovling Temporary Duty to Vietnam.

Change 33, November 25, 2011, added guidance regarding claims for Veterans who served in Guam; deleted guidance regarding End Product Guidance for New Agent Orange Presumptive Conditions from FL 10-38 – the FL was rescinded and replace by FL 11-02. Added guidance regarding PIES request code O39.

Change 34, May 9, 2012, added guidance regarding potential need to submit a PIES O19 request for claims from Veterans who served in Guam.

Change 35, August 29, 2012, added guidance regarding Agent Orange exposure evidence for Veterans of USS Stormes (DD-780) and USS Henderson (DD-785) by VACO Compensation Service.

Change 36, January 27, 2013, added guidance regarding Ranch Hand Operations inj SEA.

Change 37, April 18, 2013, moved development actions that pertain to Navy and Coast Guard Veterans to the section entitled, Developing Herbicide Claims for Navy and Coast Guard Veterans.

Change 38, June 20, 2013, removed reference to FL 09-20, Developing for Evidence of Herbicide Exposure in Haas-Related Claims from Veterans with Thailand Service during the Vietnam Era.

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Change 6November 1, 2010

Section 57

Haas Claims_______

VIETNAM ERA HERBICIDE EXPOSURE CLAIMS ADMINISTRATIVE REVIEW

On September 10, 2010, C&P Service announced the need for an administrative review to determine if the denial of service connection for Vietnam Era Veterans claiming exposure to herbicides was correct based on adjudication of those cases pending at the time of the reversal of the U.S. Court of Appeals for Veterans Claims (CAVC) decision in Haas v. Nicholson. On May 8, 2008, the Federal Circuit reversed the CAVC decision in Haas v. Peake. The Federal Circuit held that the interpretation by the Department of Veterans Affairs (VA) of the phrase “served in the Republic of Vietnam,” which required the physical presence of a Veteran within the land borders of Vietnam during service, was a permissible interpretation of 38 U.S.C. § 1116(a)(1)(A) and 38 C.F.R. § 3.307(a)(6)(iii).

References: Fast Letter 10-37, Vietnam Era Herbicide Exposure Claims Administrative Review, dated September 10, 2010 and Fast Letter 10-37 attachment VCAA letter

Purpose

Fast Letter: 10-37 containing example – VCAA notice (Attachment C) made changes to the paragraphs in the section titled, “What Do We Still Need from you?”

The new paragraphs will provide the Veteran with a concise summary of what the evidence must show for verifying exposure to herbicides while serving aboard ships.

Fast Letter 10-37 has been updated with the new paragraphs.

Instructions

Effective October 12, 2010 the following paragraphs will be used in the VCAA letter for any disability claimed on the basis of exposure to herbicides while serving aboard a ship in the Republic of Vietnam between January 9, 1962 and May 7, 1975.

There will be an emergency update to the PCGL letters in the near future. However, in the mean time the new paragraphs will have to be manually pasted in the VCAA letter and the old paragraphs deleted.

The Old Paragraph(s) to be deleted are as follows:

Send evidence showing you served in-country in the Republic of Vietnam. In-country means that between January 9, 1962, and May 7, 1975, you physically served in or visited the Republic of Vietnam. If you were stationed aboard a ship, you must have disembarked in Vietnam.

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Change 6November 1, 2010

If you were stationed aboard a ship, we need evidence that the ship you served aboard docked on the shores of Vietnam and evidence that places you aboard the ship at that time. Evidence must show that the ship actually docked on the shore and was not anchored in an open deep-water harbor such as Da Nang, Vung Tau, or Cam Ranh Bay. Evidence for shore docking is required. Navy Veterans who served on smaller, shallow draft vessels operating on the brown-colored inland waterways of Vietnam’s rivers, canals, estuaries, and delta areas are defined as “brown water” Veterans.

We need to know how your military duties exposed you to herbicides. There are these possibilities:

You served in the Republic of Vietnam during the Vietnam Era (January 9, 1962, and ending on May 7, 1975). Service in the Republic of Vietnam includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam.

Your job in service (other than in Vietnam) exposed you to herbicides.

If you were stationed aboard a ship, provide us with the name of the ship, a date (within 60 days so that we can verify with the ship’s deck logs) that the ship docked or moored in the Republic of Vietnam and a statement indicating whether you disembarked to shore.

If you were stationed aboard a ship that traveled the inland waterways of the Republic of Vietnam, provide dates (within a 60-day time period of the date that the ship traveled the inland waterways), the name of the ship, and the waterway(s) traveled.

If you served in Vietnam, please send us evidence of this service. If you did not serve in Vietnam, we need to know when, where, and how you were exposed. You may include statements of persons who know of your exposure. Any person making a statement should provide as much description of the exposure as possible, and include his or her name, service number, unit assignment, and dates of service.

The New Paragraphs to be inserted are as follows:

You will receive the presumption of Agent Orange herbicide exposure if you served within or visited the country of Vietnam, or its inland waterways, between January 9, 1962 and May 7, 1975. If you were stationed aboard a Navy or Coast Guard ship that operated on the offshore “blue waters” of Vietnam, we need evidence that the ship you served on docked to the shore of Vietnam or traveled on the inland waterways of Vietnam and evidence that places you aboard the ship at that time. If your ship docked, you must state whether or not you went ashore. If you went ashore, evidence must show that the ship actually docked to the shore or a pier for the presumption of exposure to apply. Please provide us with the name of your ship and the approximate dates, to the best of your recollection, when your ship docked or travelled on the inland waterways. Herbicide exposure will not be presumed if your ship only anchored temporarily in an open deep-water harbor such as Da Nang, Vung Tau, or Cam Ranh Bay and you remained on the ship.

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Change 6November 1, 2010

Some Navy Veterans served on smaller, shallow draft vessels operating primarily on the inland waterways or “brown waters” of Vietnam’s rivers, canals, estuaries, and delta areas, where herbicide exposure is presumed to have occurred. Please tell us if you are one of these Veterans and provide the name of your ship and dates of service in Vietnam.

References: Fast Letter 10-37, Vietnam Era Herbicide Exposure Claims Administrative Review, dated September 10, 2010 and Fast Letter 10-37 attachment VCAA letter

Reference: E-mail from: VAVBAWAS/CO/OFO, Sent: Tuesday, October 12, 2010 9:02 AM, Subject: Herbicide exposure VCAA development paragraph changes

Reference: E-mail from: VAVBAWAS/CO/OFO, Sent: Thursday, October 28, 2010 4:09 PM, Subject: UPDATE! VCAA Paragraphs - Herbicide Exposure

EVIDENCE FOR SHIP DOCKING ON SHORE

In the December 2008 C&P Service Bulletin, information was provided on the difference between Haas related “blue water” offshore naval service and “brown water” inland waterway naval service.

It was explained that service aboard a blue water naval ship that entered a deep-water harbor along the coast of Vietnam, such as the harbors at Da Nang, Cam Ranh Bay, and Vung Tau, did not constitute brown water service for the purpose of presumptive herbicide exposure. These deep-water harbors are considered to be part of the offshore blue waters, not part of the inland brown waters. However, if the blue water Veteran’s claimed herbicide exposure is based on leaving the ship and going ashore, then the issue shifts from a determination of brown water status to a determination of whether the Veteran set foot on the ground in Vietnam.

In order to facilitate timely resolution of these blue water Haas claims, C&P Service now has the following policy. The presumption of herbicide exposure will be extended to any Veteran when:

(1) evidence shows that the Veteran’s ship docked on the shore of Vietnam,

(2) evidence shows that the Veteran was a crewmember aboard ship at that time,

(3) the Veteran provides a statement of leaving the ship and going ashore, and

(4) there is no substantial evidence contradicting the Veteran’s statement.

A PIES O34 request to the National Personnel Records Center can provide evidence of the Veteran’s crewmember status aboard ship. Evidence for the ship’s docking can come from the ship’s deck logs. However, the method for acquiring this evidence has been modified for Haas related claims. Regional offices should not send a request for deck logs directly to the National Archives and Records Administration. Instead, a request for information related to ship histories and/or deck logs should be faxed to JSRRC using a new form letter developed

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Change 6November 1, 2010

for this purpose. This letter will replace the PIES O43 request for Haas cases and will provide JSRRC with the details necessary to conduct meaningful research on the Veteran’s claim. The letter is intended for Haas cases only and will be provided to regional offices in the near future.

IMPROPER TERMINATION OF BENEFITS ALREADY GRANTED FOR HAAS RELATED CLAIMS

C&P Service has become aware that some regional offices are proposing to sever presumptive service-connected disabilities that have already been granted to Haas related Veterans. The justification for this appears to be either that the original award was a clear and unmistakable error (CUE) based on subsequent policy or that the Federal Circuit final decision in the Haas case has retroactive effect. However, neither of these reasons can serve to justify severing an award that was made under the policies and procedures in effect at the time the award was granted.

Before the Haas case entered the court system, there was a period of time when a Veteran’s receipt of the Vietnam Service Medal or service in the offshore waters of Vietnam was sufficient to establish a presumption of herbicide exposure. This broad policy was subsequently narrowed so that service on the ground in Vietnam or on its inland waterways was required to receive a presumption of exposure. The Haas case was initiated as a challenge to this revised policy. Although the final judicial decision in Haas supported VA’s revised policy, that decision cannot be applied retroactively to Veterans who were evaluated under the original broad policy. In the Court of Appeals for Veterans Claims case of Berger v. Brown (1997), the court stated that its holdings, which formulate new interpretations of the law subsequent to regional office decisions, cannot be used as the basis for a CUE action. Additionally, the Federal Circuit, in Jordan v. Nicholson (2005), held that if VA correctly applied a regulation in a prior final decision, the fact that the regulation was later found to be invalid does not establish that the prior final decision contained clear and unmistakable error warranting retroactive correction. Therefore, if a Veteran with a Haas related claim was awarded presumptive service connection based on herbicide exposure when the broad standard was in effect, that service connection cannot now be severed.

Reference: C&P Service Bulletin Addendum, December 2008

USE OF APO NUMBERS AS EVIDENCE

In Haas related claims, or any other claim where the Veteran seeks to establish setting foot on the ground in Vietnam, regional offices should use all available resources to assist the Veteran. One valuable resource is the listing of Army Post Office (APO) address numbers for the Asian Pacific Theater during the Vietnam era. This list contains APO numbers for all major Army and Air Force bases in Asia, including Vietnam, Korea, Thailand, Japan, Taiwan, Okinawa, Guam, and the Philippines. If an APO number is written or stamped in personnel or medical records, this is official evidence of the Veteran’s presence at that

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Change 6November 1, 2010

location. This evidence is valuable in claims based on Agent Orange exposure because it can show Vietnam in-country service or medical treatment. It can also assist with stressor corroboration in PTSD claims by providing verification that a Veteran was at a particular location.

The APO listing is available on the C&P Service Intranet website under the Stressor Verification Site. To access the listing, open the General Information folder and click on “General 1942-2002 APO-FPO Files.” This is a large PDF file and will take several minutes to download. The Asian Pacific Theater APO section is located on pages 4999 through 5005. It is advisable to print the listing and save it for further reference. Each APO number is shown along with the location it identifies and the previous number that it replaced. When successive locations were identified with the same APO number, the dates of use at each location are specified. The close out date (CO) is also specified.

CHANGES

Change 5, October 13, 2010, added guidance regarding the administrative review of Haas claims (FL 10-37).

Change 6, November 1, 2010, added guidance regarding new text for the VCAA Herbicide Exposure paragraphs per E-mail from: VAVBAWAS/CO/OFO, Sent: Thursday, October 28, 2010 4:09 PM, Subject: UPDATE! VCAA Paragraphs - Herbicide Exposure.

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May 29, 2013

Section 58

Nehmer Cases & Fast Track Processing System_______

DISCONTINUANCE OF THE FAST TRACK PROCESSING SYSTEM

Released October 24, 2011, Fast Letter 11-27, Fast Track Processing System (Version 2.0), provides guidance for the Fast Track Processing System (FT), a web-based, automated claims-processing system, specifically developed to process live Veterans’ service connection claims for the three new herbicide-related presumptive conditions: ischemic heart disease, Parkinson’s disease, and hairy cell and other chronic B cell leukemias. VA is working to discontinue FT.

All claims that are already filed in FT will be returned to the RO for final completion. The Veteran does not have to resubmit a claim and may continue to submit evidence in support of their claim directly to the RO of jurisdiction. We will provide further instructions as these claims are returned to ROs.

Effective immediately, Do not forward any claims documentation to the NISC/IBM office for FT scanning and

data capture, as described in Fast Letter 11-27, Upon receipt of any new herbicide-related claim, process it under standard processing

procedures.

The projected schedule for discontinuing FT is as follows: Effective June 1, 2013, VA will:

o No longer accept any new claims in FT, o Notify any claimants who have initiated, but not yet submitted, a claim in FT

to submit it by June 30, 2013. Effective July 1, 2013, VA will terminate the FT website. At a date yet to be determined, VA will:

o Rescind Fast Letter 11-27,o Provide additional guidance to regional offices regarding claims initiated in

FT and not submitted by June 30, 2013.

Reference: Addendum Compensation Service Bulletin, May 2013

NEHMER ADJUDICATION AND READJUDICATION

For additional information, refer to the following:

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May 29, 2013

Fast Letter 10-41, Processing of Claims for Ischemic Heart Disease (IHD), Parkinson’s Disease (PD), Hairy Cell Leukemia and Other Chronic B-cell Leukemias (HCL/BCL), and Other Diseases Under Nehmer

Training Letter 10-04 Training Guide for the Readjudication of Claims for Ischemic Heart Disease (IHD), Parkinson’s Disease (PD), Hairy Cell Leukemia (HCL) and Other Chronic B-cell Leukemias, and Other Diseases Under Nehmer.

CLARIFICATION ON USE OF APO NUMBERS AS EVIDENCE OF VIETNAM SERVICE IN NEHMER CASES

C&P Service is aware that RO personnel working Nehmer claims need clarification regarding use of Army Post Office (APO) mail delivery numbers. Eligibility for benefits under the Nehmer court order requires establishing that the Veteran had duty or visitation within the Republic of Vietnam, or on its inland waterways, between January 9, 1962, and May 7, 1975. Training Letter 10-04, outlines adjudication procedures for Nehmer cases. On page 17, the section Service in the Republic of Vietnam, provides a guide to determining whether the required duty or visitation occurred. That section also includes a listing of sources to assist with the determination.

Possible sources include APO numbers which are listed on page 51 in Appendix 4, List of APOs for Verification of RVN Service. This appendix provides a copy of the historical record of all major Vietnam era Western Pacific Theater (WESTPAC) Army and Air Force Base APO numbers, as published by the Department of Defense (DoD) Military Postal Service Agency.

These WESTPAC APO numbers include military installations located all over the Western Pacific Rim area, not just in Vietnam. APO numbers for bases in Thailand, Japan, the Philippines, Taiwan, Guam, and Okinawa are also included.

When:

an APO number can be found in the Veteran’s military personnel records, service treatment records, or elsewhere, and

that number can be identified as corresponding to one of the APO numbers for a specific base in Vietnam, then

service in Vietnam can be verified.

When the only APO numbers in a Veteran’s file are from Thailand, Guam, or any other WESTPAC location outside Vietnam, then service in Vietnam is not verified.

Appendix 4 contains the statement below:

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May 29, 2013

“The following APOs have been verified by the Military Postal Service Agency (MPSA) as having been used for delivery to Vietnam.”

It appears this statement has caused some confusion and misinterpretation. This statement is meant to convey that all APO numbers on the list that are identified with a specific military base in Vietnam have been verified as accurate by DoD. It is not accurate to interpret the statement to mean that all APO numbers on the entire list have been verified as being associated with a military base in Vietnam. As a result of this confusion, we will modify the statement to improve clarity. In the meantime, please be advised that unless the word “Viet Nam” appears in the location description of an APO mail delivery number, it cannot serve to verify Vietnam service.

Reference: C&P Service Bulletin, December 2010

CHANGES

Change 1, May 29, 2013, added guidance regarding the discontinuance of the Fast Track Processing System.

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Change 5March 7, 2009

Section 59

Verification of Service in Vietnam_______

GENERAL GUIDELINES

SERVICE IN VIETNAM DEFINED: "Service in Vietnam" includes service in the waters offshore, or service in other locations if the conditions of service involved duty or visitation in Vietnam (38 CFR 3.313).

A Veteran must have actually served on land within the Republic of Vietnam (RVN) to qualify for the presumption of exposure to herbicides under 38 CFR 3.307(a)(6). Reference: M21-1MR, Part III, Subpart iii, Chapter 2, Section E, Topic 33(a).

There is no requirement for a specified length of service, duty or visitation in Vietnam under 38 CFR 3.313 (Claims based on service in Vietnam). Even a few hours of service in Vietnam, to include service in the waters offshore, during the Vietnam era may be sufficient to service connect subsequently developed non-Hodgkin's lymphoma (M21-1, Part III, 5.10c, Note).

REVIEW SERVICE RECORDS AND SERVICE TREATMENT RECORDS

Review the service records and service treatment records for evidence of Vietnam service. There may be an indication in the service treatment records showing treatment at a location in the Republic of Vietnam.

Some notations may only show an APO address for location of treatment. A listing of APO and FPO addresses for locations in Vietnam is included in this development guide (Vietnam APO & FPO Listings). Similarly, there may be a service document indicting assignment to a unit with a Vietnam APO address. Unless there is conflicting evidence to the contrary, these are good indications of VN service.

Reference: Verifying Vietnam Service for Claims Involving Exposure to Herbicide Agents, M21-1MR, Part IV, Subpart ii, Chapter 1, Section H, Topic 28d.

REVIEW DD FORM 214 FOR EVIDENCE OF RVN SERVICE

A photocopy of DD Form 214 is acceptable (if not modified or falsified) to verify service in Vietnam, even if DD Form 214 is not certified.

If item 12 (Last Duty Assignment and Major Command) on DD Form 214 shows USARV, the Veteran served in Vietnam

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Change 5March 7, 2009

Notations such as USARVN, USAPACRVN, or USAPACVN, followed by dates may indicate the Veteran served in Vietnam

Remarks section of the DD Form 214 may note specific dates of Vietnam service (e.g. Vietnam Service 04April69-08May70)

Older versions of DD Form 214 (mid-1960’s) for Army Veterans, contains a specific box entitled “Indochina Service” with Yes and No boxes, to be checked as appropriate. Caution must be exercised since service in Laos, Cambodia, or Thailand would also be considered Indochina.

DEVELOPMENT TO SERVICE RECORDS CENTERS

If a review of the service treatment records, service records, or DD Form 214 does not provide verification of in-country Vietnam service:

Submit PIES Request Code O34 for verification of Vietnam service. Select MAPD Third Party Development pick, Service in Vietnam, to create a tracked item.

RESPONSES FROM NPRC – PIES REQUEST CODE O34

In response to a request for verification of dates of service in Vietnam (PIES request code O34), the VA Liaison office will provide one of the following three responses consistently:

1. Positive Response: "The Veteran served in the Republic of Vietnam from MM/DD/YYYY to MM/DD/ YYYY" {if there were multiple periods, add more rows of dates as needed}.

2. Negative Response: "There is no evidence in this Veteran's file to substantiate any service in the Republic of Vietnam." or

3. Maybe Response: "We are unable to determine whether or not this Veteran had in-country service in the Republic of Vietnam."

If the response is Maybe, and the service was Army or Air Force, the VA Liaison Office will send any documents from the Veteran's military personnel file which raise the possibility that in-country service may be involved to help the regional office make a determination.

If the response is Maybe, and the service was Navy or involves a Marine serving on a Navy ship, the VA Liaison Office will search Navy Unit Books, and Navy Ships books, to determine when the ships were in the official waters of the Republic of Vietnam, or if the Veteran was attached to a Navy unit that could have been assigned to shore and provide statements to that effect.

Reference: C&P Compensation and Pension, VSCM Conference Call, July 18, 2002.

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Change 5March 7, 2009

CHANGES

Change 1, April 5, 2005, added guidance regarding verification of Vietnam Service based on responses from NPRC; incorporated guidance regarding verification of Vietnam service from Section 29, Herbicide Exposure Claims.

Change 2, June 27, 2005, added guidance regarding verification of Vietnam Service from the Veteran and from USASCURR for Navy Veterans.

Change 3, September 16, 2005, corrected topic “PIES 034 “Maybe” Response Received; the exception note should have read “Do not send a PIES request O43 . . . “; added guidance to the “General Guidelines” topic, which clarifies the issue of Service in Vietnam Defined.

Change 4, April 3, 2006, added clarification that combat stressors provide verification of Vietnam service.

Change 5, March 7, 2009, changed guidance regarding a “maybe” response for Navy personnel; JSRRC Coordinator will submit PIES request O43.

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Change 4April 18, 2013

Section 60

Developing Herbicide Claims for Navy and Coast Guard Veterans

_______

Refer to M21-1MR IV.ii.2.C.10.k regarding Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Considering Claims Based on Service Aboard Ships Offshore the RVN.

Department of Veterans Affairs (VA) regulations provide Veterans who served in the Republic of Vietnam with the presumption of herbicide exposure due to widespread use of Agent Orange and other herbicides during U.S. military operations within the country. This allows for service connection on a presumptive basis for certain diseases that are associated with such exposure. VA limits the presumption of exposure to Veterans who served on the ground or on the inland waterways of Vietnam and excludes Veterans who served aboard ships operating on Vietnam’s offshore waters. This limitation has been legally upheld by the court system. However, VA has become increasingly aware of evidence showing that some offshore U.S. Navy and Coast Guard ships also operated temporarily on Vietnam’s inland waterways or docked to the shore. Additionally, VA has recently acquired evidence showing that certain ships operated primarily on the inland waterways rather than offshore. Veterans who served aboard these ships qualify for the presumption of herbicide exposure. Assisting Veterans who served aboard these ships requires special claims processing steps that are explained in this training letter.

For further guidance, refer to Training Letter 10-06, Adjudicating Disability Claims Based on Herbicide Exposure from U.S. Navy and Coast Guard Veterans of the Vietnam Era, dated September 9, 2010

DEVELOPMENT PROCEDURES FOR CLAIMS FROM VIETNAM ERA NAVY VETERANS

On September 9, 2010, Compensation and Pension (C&P) Service released Training Letter 10-06, Adjudicating Disability Claims Based on Herbicide Exposure from U.S. Navy and Coast Guard Veterans of the Vietnam Era. Among the topics presented were development procedures for gathering evidence that could confirm exposure to herbicide agents based on the documented activities of the Veteran’s ship. The exposure related ship activities included:

a “brown water” ship operating primarily on Vietnam’s inland waterways,

an offshore “blue water” ship operating temporarily on Vietnam’s inland waterways, and

an offshore “blue water” ship temporarily docking on the shore.

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Change 4April 18, 2013

In all cases where such ship operations occurred, evidence must place the Veteran on the ship at the time of the relevant operations and, in the case of docking, the Veteran must provide a statement of personally going ashore.

Based on obtaining additional information describing Vietnam Era Navy operations, C&P Service has determined that a fourth category of ship activities will be added to the three listed above. This new category is related to the fact that a number of “blue water” offshore ships did not dock, or operate temporarily on Vietnam’s inland waterways, but sent crewmembers ashore. There are two common examples of this situation. One involves ships that anchored in close coastal waters for extended periods of time. This would include:

repair ships, which anchored for months in a harbor for maintenance on other ships, and

hospital ships that were constantly in close coastal waters, moving only to be closer to battlegrounds where casualties were heavy.

It is highly likely that many crewmembers who served on these types of ships went ashore on liberty at some point.

A second example include ships that routinely delivered materials and troops to the shore or into the inland waterways with smaller vessels, but did not dock or enter the rivers themselves because of their large size. This includes:

amphibious ships,

transport ships, and

supply ships.

The smaller vessels were carried in the main ship and were manned by crewmembers who transported and unloaded their cargos ashore. In the situations of long term close coastal anchorage and shore delivery of supplies by smaller vessels, there was a likelihood that some crewmembers went ashore, thus qualifying them for the presumption of herbicide exposure.

The ship list located on the C&P Service Intranet site under Rating Job Aids at the Vietnam Era Navy Ship Agent Orange Exposure Development Site will be modified to add ships that fall into this fourth category. Additionally, Training Letter 10-06 will be updated to identify and explain this category. If a ship is listed in this category, no further research on the ship’s operations is necessary. However, it is important to keep in mind that all crewmembers serving on ships in this category may not have gone ashore and there is no practical way to determine which ones actually did go ashore. Therefore, in order for the presumption of exposure to apply, the Veteran must provide a statement of personally going ashore. Additional contact with the Veteran may be necessary to obtain this statement.

As with the other categories, no claim should be denied solely because the Veteran’s ship does not appear on the C&P Service ship list. This list is evolving and is not complete. Therefore, if evidence is received from:

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Change 4April 18, 2013

a Veteran, such as a ship’s cruise book photos of a beach party,

the Army and Joint Services Records Research Center (JSRRC), such as a ship history or deck log reference to crew shore liberty, or

any other reliable source, such as a Navy website referencing shore based amphibious or supply operations with small vessels, and shows that some crew members of a ship in this category went ashore, and the Veteran provides a statement of personally going ashore, the presumption of herbicide exposure can be established.

Please remember that when such evidence is obtained for a specific ship, it should be forwarded to the C&P Service Agent Orange Mailbox, at VAVBAWAS/CO/211/AGENTORANGE so that the ship can be added to the evolving ship list.

Reference: C&P Service Bulletin, October 2010

ADDITIONAL DEVELOPMENT GUIDELINES REGARDING VIETNAM ERA NAVY VETERANS

The basics for development of claims based on herbicide exposure from US Navy Veterans who served aboard ships in the offshore waters of Vietnam are contained in Training Letter 10-06, Adjudicating Disability Claims Based on Herbicide Exposure from U.S. Navy and Coast Guard Veterans of the Vietnam Era.

The following guidelines must be followed for development of all claims from Vietnam era “blue water” Navy Veterans.

Evidence in the claims file may not contain specific information regarding when, where, and how the Veteran was exposed to herbicides. If the claims file does not contain evidence that the Veteran had duty on the ground, herbicide exposure cannot be presumed unless VA obtains evidence that the Veteran’s ship:

operated temporarily on Vietnam’s inland “brown water” waterways,

docked to the shore, or

otherwise provided an opportunity for the Veteran to go ashore

We must develop to the Veteran, including by telephone contact, to obtain specific details of the herbicide exposure. However, the failure of our efforts to provide these specifics is not grounds for terminating further development. VA has an obligation to pursue reasonable development efforts.

In general, the Personnel Information Exchange System (PIES) 019 or 034 request to the National Personnel Records Center (NPRC) will produce dates that the blue water Navy Veteran’s ship was operating in the offshore waters of Vietnam. Most ships spent intervals

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of a few days or a few weeks in the offshore waters before returning to the Philippines, Japan, Taiwan, or elsewhere for replenishment of supplies. We presume that herbicide exposure could have occurred during those time intervals to include:

any temporary inland waterway travel,

docking and going ashore, or

otherwise going ashore.

Therefore, even if the Veteran cannot provide specifics, the dates of those intervals found in the 019 or 034 can be used to send a DPRIS 043 request to the Army and Joint Services Records Research Center (JSRRC). Normally, one 60-day request would be sufficient for JSRRC to find any evidence that would lead to an acknowledgement of herbicide exposure. However, if one 60-day request does not cover all the intervals of the Veteran’s service in Vietnam’s offshore waters, JSRRC has agreed to research a cumulative 60-day time frame, adding the interval dates together to make up a total 60-day request.

Additionally, if additional evidence is received after the initial 60-day request has been sent, JSRRC has agreed to conduct additional 60-day research requests. The purpose of the additional 60-day requests is to assist Veterans when there is a reasonable expectation that some evidence of herbicide exposure may be discovered through ship histories or deck logs. It is not intended to be an endless “fishing expedition.”

There are some cases where additional 60-day requests are not warranted; for example, Veterans who were stationed aboard aircraft carriers conducting aircraft assaults on the enemy from far offshore. These carriers maintained their positions in the offshore waters for extended periods of time much longer than multiple 60-day requests could cover. However, it is common knowledge that these vessels were too large to travel on the inland waterways or dock on the shore of Vietnam. Therefore, the possibility of herbicide exposure for a crewmember would only occur under the special circumstance of going ashore. If such a special circumstance is claimed, the Veteran needs to be specific about the event and dates, so that a request to JSRRC can be focused. It would not be reasonable to request a “fishing expedition” from JSRRC in this type of case.

The use of the additional 60-day requests is not a clear-cut matter. Therefore, if RO personnel have questions regarding this issue, they can be directed to the C&P Service Agent Orange Mailbox [VAVBAWAS/CO/211/AGENTORANGE].

Reference: C&P Service Bulletin, December 2010

CLARIFICATION ON EVIDENCE REQUIREMENT IN HAAS BLUE WATER NAVY CLAIMS – WHEN EVIDENCE SHOWS “MOUTH OF A RIVER”

Training Letter 10-06, Adjudicating Disability Claims Based on Herbicide Exposure from U.S. Navy and Coast Guard Veterans of the Vietnam Era, discusses development procedures and evidence requirements for establishing that an offshore “blue water” ship entered the

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“brown water” of Vietnam’s inland waterways, thus qualifying crewmembers for the presumption of Agent Orange exposure.

The Policy Staff recently received questions regarding the evidence necessary to establish a ship’s inland waterway service when the phrase “mouth of the river” appears in deck logs. In part, the training letter indicates that when deck logs refer to entering or anchoring in the “mouth of a river,” Compensation Service deems this sufficient to establish service on the inland waterways. The benefit-of-the-doubt doctrine applies and evidence of the vessel’s presence in a river’s mouth is sufficient to establish the presumption of exposure for Veterans on the ship.

When deck logs, an official ship history, a cruise book, or any other reliable document states that a ship “entered” or “anchored” “in the mouth of the river,” inland waterway service can be acknowledged and the presumption of Agent Orange exposure extended to the crewmembers.

However, if the reference is to being “near,” “close” or “in the vicinity of” “the mouth of the river,” inland waterway service cannot be acknowledged. For US Navy ships, being near the mouth of a river can mean being several thousand yards offshore, with reference to the river serving as a topographical bearing marker, in conjunction with other bearing markers, to pinpoint the exact location of the ship for the deck log record. It is important for RO personnel to recognize and apply this distinction in order to promote consistency and fairness in the adjudication of Haas related claims.

Reference: C&P Bulletin, April 2011

VIETNAM ERA NAVY SHIP LIST

The ship list on the C&P Service Intranet site provides assistance for RO development of claims based on Agent Orange herbicide exposure from Vietnam era Navy Veterans. The site is located under “Rating Job Aids” within the link “Vietnam Era Ship Agent Orange Exposure Development Site.” It can be accessed at: http://vbaw.vba.va.gov/bl/21/rating/VENavyShip.htm. For a complete explanation of its use, see Training Letter 10-06, Adjudicating Disability Claims Based on Herbicide Exposure from U.S. Navy and Coast Guard Veterans of the Vietnam Era. (Reference: C&P Bulletin, January 2011)

An expanded and updated Vietnam Era Navy Ship Agent Orange Exposure Development Site has been posted on the Compensation Service Intranet under Rating Job Aids (Nov 2012). The updated site includes additional ship categories that are explained in the site’s introduction. Ships that are listed in more than one category now have a “(see other category)” designation, and new and re-classified ships on the list are italicized. (See Navy and Coast Guard Ships Associated with Service in Vietnam and Exposure to Herbicide Agents - List Updated 11-08-12) (Reference: Compensation Service Bulletin, November 2012)

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The Qui Nhon Bay Harbor is considered part of the inland waterways of Vietnam. The harbor was located within an enclosed bay fed by the Song Kon River and entry into the bay required a ship to navigate through a narrow “S” curve entry point. Once in the harbor, a ship was surrounded on all sides by land. Ships on the list that were formerly categorized as docking at Qui Nhon are now categorized as temporarily entering the inland waterways and the presumption of Agent Orange exposure should be extended to all Veterans aboard at the time of entry. (Reference: Compensation Service Bulletin, November 2012)

The list includes ships operating on Vietnam’s close coastal waters for extended periods, with evidence that crew members went ashore or that smaller vessels from the ship went ashore regularly with supplies or personnel. (Reference: C&P Bulletin, January 2011)

As with the docking category, a statement from the Veteran of personally going ashore is required to qualify for the presumption of herbicide exposure under the new category. (Reference: C&P Bulletin, January 2011)

The C&P Service Intranet site continues to be updated with many new ships based on deck log and ship history information obtained by C&P Service. RO personnel should continue to send any documentation received from the Veteran or from the Army and Joint Services Records Research Center (JSRRC), which would justify including a ship on the list, to the Agent Orange Mailbox: VAVBAWAS/CO/211/AGENTORANGE. (Reference: C&P Bulletin, January 2011)

NAVAL VESSELS THAT OPERATED IN VIETNAM WATERWAYS

This following list of Naval vessels may be used to assist with development of herbicide exposure related disability claims from Navy Veterans. The list includes vessels that operated on the inland “brown water ” waterways of Vietnam as well as large “blue water” vessels that operated temporarily on the inland waterways or docked to the shore. If evidence places a Veteran on one of these vessels at the time of inland waterway operations, the Veteran is eligible for the presumption of herbicide exposure. In the case of a ship with confirmed docking to the shore, the Veteran must also provide a statement that he went ashore to be eligible for the presumption.

Vessels that operated primarily or exclusively on the inland waterways

All U.S. Coast Guard Cutters with hull designation WPB [patrol boat] and WHEC [high endurance cutters]

USS Colleton (APB-36)

USS Asheville (PG-84) [patrol gunboat] USS Mercer (APB-39)

USS Gallop (PG-85) USS Nueces (APB-40)

USS Antelope (PG-86) USS Benewah (APB-35)

USS Ready (PG-87) USS Tutuila (ARG-4) [repair ship]

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USS Crockett (PG-88) USS Satyr (ARL-23) [repair ship]

USS Marathon (PG-89) USS Sphinx (ARL-24)

USS Canon (PG-90) USS Askari (ARL-30)

USS Patapsco (AOG-1) [gasoline tanker] USS Indra (ARL-37)

USS Elkhorn (AOG-7) USS Krishna (ARL-38)

USS Genesee (AOG-8) Barracks Barge (APL-26) [sleeping quarters]

USS Kishwaukee (AOG-9) Barracks Barge (APL-30)

USS Tombigbee (AOG-11) USS Belle Grove (LSD-2) [landing ship dock]

USS Noxubee (AOG-56) USS Comstock (LSD-19)

USS Mark (AKL-12) [light cargo ship] USS Tortuga (LSD-26)

USS Brule (AKL-28) Winnemucca (YTB-785) [harbor tug]USS Montrose (APA-212) [attack transport]

Floating Base Platform (YRBM-17) [repair, berthing, and messing barge]

USS Okanogan (APA-210) Floating Base Platform (YRBM-18)

USS Bexar (APA-237) Floating Base Platform (YRBM-20)USS Benewah (APB-35) [self-propelled barracks ship]

Vessels that operated temporarily on Vietnam’s inland waterways or docked to the shore

USS Card (ACV-11) [escort carrier] mined, sunk, and salvaged in Saigon River Harbor during May 1964USS Maury (AGS-16) [mapping survey ship] conducted surveys of Mekong Delta and other coastal areas and rivers beginning November 1965 through 1969USS Henrico (APA-45) [amphibious attack transport] operated on Hue River during March 1965 and conducted numerous troop landing through March 1967USS Montrose (APA-212) operated on Song Hue River during December 1965, operated on Long Tau River during March 1967, and operated on Cua Viet River and at Dong Ha during May 1967USS Talladega (APA-208) operated on Saigon River during October 1967USS Bolster (ARS-38) [salvage ship] crew operated on land to extract USS Clark County (LST-601) from beach after grounding at Duc Pho from November 18 to December 1, 1967USS Canberra (CAG-2) [guided missile cruiser] operated on Saigon River from March 31 through April 1, 1966, on Cua Viet River during December 15, 1966, and on Mekong Delta Ham Luong River during January 15, 1967USS Sproston (DD-577) [destroyer] operated on Mekong Delta and Ganh Rai Bay during

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January 1966USS Picking (DD-685) operated on Saigon River during November 16, 1965

USS Epperson (DD-719) docked to Da Nang Pier on October 4, 1970

USS Southerland (DD-743) operated on Song Nga Bay and Saigon River during July 1966

USS John W. Thomason (DD-760) operated on Nga Be River during 1969USS Buck (DD-761) operated on Mekong River Delta and Saigon River during October 1966USS Preston (DD-795) operated on Mekong River Delta, Ganh Rai Bay, and Saigon River during September 28 – 29 and December 27 – 29, 1965USS Warrington (DD-843) operated on Mekong River Delta Rung Sat Special Zone, North of Vung Gahn Rai Bay during March 1967USS Dyess (DD-880) operated on Saigon River and Rung Sat Special Zone from June 19–July 1, 1966USS Perkins (DD-877) operated on Saigon River during June 1969

USS Orleck (DD-886) operated on Mekong River Delta during July 1969USS Joseph Strauss (DDG-16) [guided missile destroyer] operated on Mekong River Delta and Ganh Rai Bay during November 7 and December 7, 1968USS Waddell (DDG-24) operated on Cua Viet River during March 1967USS Newell (DER-322) [radar destroyer escort] docked at port of Nha Trang during December 22-24, 1965USS Duluth (LPD-6) [amphibious transport dock] docked to pier at Da Nang during March and October 1971USS Cleveland (LPD-7) operated on Cua Viet River and at Dong Ha, as well as Hue River, from November 1967 through 1968 and Saigon River during September 1969USS Dubuque (LPD-8) docked at Da Nang on March 15, 1970USS Boxer (LPH-4) [amphibious assault ship] docked to pier at Cam Rahn Bay on September 9, 1965USS Carter Hall (LSD-3) [landing ship dock] operated on Cua Viet River and at Dong Ha during December 1967

Reference: C&P Service Bulletin, June 2010

NEW WEBSITE AND DEVELOPMENT PROCEDURE FOR HERBICIDE EXPOSURE RELATED CLAIMS FROM VIETNAM ERA NAVY VETERANS

New Website

Compensation and Pension (C&P) Service has developed a new website on its Intranet home page designed to assist regional office (RO) personnel with developing claims from Vietnam era Navy Veterans based on herbicide exposure. The site is located under Rating Job Aids

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and is named Vietnam Era Navy Ship Agent Orange Exposure Development Site. It contains links to several sites including:

Ships operating on the inland waterways or docking in Vietnam . This site lists individual Brown Water Navy vessels, and types of vessels, that operated primarily or exclusively on the inland waterways of Vietnam. It also lists individual Blue Water Navy vessels that temporarily operated on Vietnam’s inland waterways or docked to the shore, along with dates of operation. The activity of all these ships has been verified through official documents or websites and will be updated periodically. If the Veteran served aboard one of the listed Brown Water Navy vessels at any time during its Vietnam tour, the presumption of exposure applies. If the Veteran served aboard one of the listed Blue Water Navy vessels, the presumption will apply only if he or she was aboard during the specified dates. The ships are arranged by vessel type and hull number but can be searched by name through use of the “Find” tool under the “Edit” function on your personal computer tool bar. Because this list is not complete, the presumption of herbicide exposure should not be denied solely because the Veteran’s ship is not on this list.

Dictionary of American Naval Fighting Ships (DANFS). This site provides official ship histories for most Navy vessels. The histories vary in completeness but some provide detailed descriptions of service on Vietnam’s inland waterways, whether operating as part of the permanent Mobile Riverine Force or operating temporarily on gunfire support or supply missions. Ships are listed alphabetically by name. Since DANFS is an official US Navy site, evidence from it supporting the claim will generally be sufficient to establish the presumption of herbicide exposure.

US Naval Bases and Support Activities Vietnam . This site provides a description of all land-based locations that supported US Navy operations in Vietnam. It is not an official government site but can serve as a valuable starting point for research if the name of one of these bases, or a unit located there, appears in the claims file or is identified by the Veteran.

New Procedure

When developing claims from Vietnam era Navy Veterans based on herbicide exposure, RO personnel were instructed to send requests for deck logs to the National Archives and Records Administration. This procedure will no longer be necessary. The staff of the Army and Joint Services Records Research Center (JSRRC) has agreed to expand their research on Navy ships to include deck log research, when necessary. This means that when JSRRC receives a DPRIS O43 request, they will review the ship’s official history for a record of inland water operations or docking. If this does not provide supporting evidence, JSRRC will then review deck logs for the time frame identified by the Veteran. The time frame submitted must be limited to 60 days but can include different date ranges, as long as the cumulative time frame does not exceed 60 days. The DPRIS request screen will accept two date ranges for a single ship under Dates Ship was in RVN Territorial Waters. If additional date ranges are required for the same ship, type them into the space for Circumstances Surrounding Exposure to Agent Orange. In that same space, also describe the Veteran’s statement as to

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how exposure occurred. JSRRC will provide a summary of its findings for the time frames requested.

Reference: C&P Service Bulletin, August 2010

HERBICIDE EXPOSURE PRESUMPTION EXTENDED TO USS INGERSOLL CREWMEMBERS

The USS Ingersoll (DD 652) operated as a Navy destroyer gunship providing fire support for military ground operations along the Vietnam coast during 1965. In addition to coastal duty, the USS Ingersoll traveled up the Saigon River on October 24th and 25th of 1965 to fire on enemy bases. C&P Service has reviewed the ship’s deck logs, located at the National Archives and Records Administration, and confirmed this service in the “inland waterways” of Vietnam. As a result, the presumption of herbicide exposure, as described in 38 CFR 3.307(a)(6)(i), should be extended to any crewmember who served aboard ship during October of 1965. This presumption is authorized by M21-1MR.IV.ii.2.C.10b. Regional offices should reevaluate any disability claim based on herbicide exposure from one of these Veterans that has been denied.

Reference: Addendum C&P Service Bulletin, Volume 1, Issue 7, dated July 31, 2007.

REVIEW OF AGENT ORANGE EXPOSURE EVIDENCE FOR VETERANS OF USS STORMES (DD-780) AND USS HENDERSON (DD-785) BY VACO COMPENSATION SERVICE

In response to a request from the Chicago VA Regional Office for an evaluation of evidence submitted to that office for Agent Orange exposure among Veterans who served aboard the USS Stormes (DD-780) and USS Henderson (DD-785), VACO Compensation Service is providing the following assessment.

Background

According to 38 CFR § 3.307(a)(6)(iii), eligibility for the presumption of Agent Orange exposure requires that a Veteran’s military service involved “duty or visitation in the Republic of Vietnam” between January 9, 1962 and May 7, 1975. This includes service within the country of Vietnam itself or aboard a ship that operated on the inland waterways of Vietnam. However, this does not include service aboard a large ocean-going ship that operated only on the offshore waters of Vietnam, unless evidence shows that a Veteran went ashore. Inland waterways include the rivers, canals, estuaries, delta areas, and enclosed bays of Vietnam. They do not include open deep-water harbors such as those at Da Nang, Nha Trang, Cam Ranh, or Vung Tau. These are considered to be part of the offshore waters of Vietnam because of their deep-water anchorage capabilities and open access to the South China Sea. Aerial spraying of Agent Orange over Vietnam was used to destroy enemy food crops and remove jungle foliage cover to reveal enemy positions. No such use occurred over

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Vietnam’s offshore open waters that would justify extending the presumption of exposure to Veterans whose only service was aboard ships operating on those offshore waters and who never went ashore.

The Department of Veterans Affairs (VA) has developed a list ships intended to provide VA regional offices with a resource for determining whether a particular US Navy or Coast Guard Veteran of the Vietnam era is eligible for the presumption of Agent Orange exposure based on operations of the Veteran’s ship. The ships list contains two categories based on documentary evidence (deck logs, cruise books, etc.): (1) ships that entered Vietnam’s inland waterways, and (2) ships that docked in Vietnam or otherwise sent crewmembers ashore. Under the first category, all crewmembers aboard at the time of inland waterway service are eligible for the presumption of exposure because they were within the country of Vietnam. Under the second category, the Veteran must provide a statement of personally going ashore to be eligible for the presumption of exposure because there is no record of which crewmembers actually went ashore.

Evidence Submitted

Evidence submitted to the Chicago Regional Office includes individual medical reports showing that Veterans who served aboard the designated ships have developed diseases associated by VA with Agent Orange exposure. Since these diseases occur to a great extend in the non-Veteran public at large, especially during the later years of life, these medical reports are not evidence that Agent Orange exposure occurred or caused these diseases.

The evidence also included deck logs from the USS Stormes for September 13-17, 1966. These deck logs do not show inland waterway travel or docking and do not mention that crewmembers went ashore. They show that the ship was conducting gunfire support missions from 1000 –6000 yards off the coast of Vietnam during this period.

Additional documents submitted include a declassified 1969 US Army Technical Report on herbicide spray droplet size drift and a report on the Australian Navy study related to dioxin content in seawater brought aboard ships for desalinization. The issues of potential Agent Orange exposure from spray drift and seawater intake for potable water processing were addressed in the Institute of Medicine’s Blue Water Navy Vietnam Veterans and Agent Orange Exposure (2011). The report noted that Agent Orange spray missions were only conducted along coastal territory when prevailing winds were blowing inland. Therefore, spray drift over open water was minimal. The report also addressed the Australian Navy study, which concluded that any dioxin present in seawater undergoing shipboard desalinization was not eliminated. The Institute of Medicine found that any dioxin runoff from land spraying present in seawater would have been highly diluted. Additionally, US Navy regulations required that seawater for potable processing was to be drawn 10 miles offshore. Available evidence does not show significant dioxin levels this far out to sea. As a result, these documents do not provide evidence of Agent Orange exposure.

A final category of evidence submitted was lay statements from crewmembers of the USS Stormes. They stated that, while providing support for the 2nd ARVN (Army of the Republic

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of Vietnam) and 2nd US Advisory Group, the ship sent its small whaleboat ashore with supplies and to evacuate troops. They provided a list of names of the crew members going ashore and a photo of a patch issued to the 1966 “landing party.” The USS Stormes deck logs support this contention by stating that on September 17, 1966, the ship provided support to the 2nd ARVN and 2nd US Advisory Group. This evidence is sufficient to show the likelihood that some crewmembers went ashore. As a result, the USS Stormes is added to the Agent Orange related ship list as indicated below. The presumption of Agent Orange exposure will only apply to those Veterans who state that they went ashore with the whaleboat on this date.

Conclusion

There is insufficient evidence to add the USS Henderson to the ships list. The USS Stormes is added as follows and will appear on the next update of the ships list.

USS Stormes (DD-780) sent motorized whaleboat ashore to assist 2nd ARVN and 2nd US Advisory Group on September 17, 1966

Reference: E-Mail From: VAVBAPHO/WAREA, Sent: Wednesday, June 27, 2012 2:34 PM, Subject: Agent Orange Info

PIES “MAYBE” RESPONSE RECEIVED – NAVY VETERANS

If the PIES response states the service records center was unable to verify in-country service, the VA Liaison will send extracts from the personnel file for review; if in-country Vietnam service cannot be verified.

If the Navy Veteran’s presence in the Republic of Vietnam cannot be verified:

Forward the claim to the JSRRC Coordinator; the coordinator will submit PIES Request Code O43 for verification of Vietnam service for Navy only. This request code has sufficient fields to allow for the entry of the names of up to five ships and the dates each were reportedly in the territorial waters of the Republic of Vietnam. Print a copy of the PIES request to be flip-filed in the center section of the C-file.

EXCEPTION: Do not send a PIES request O43 if the Veteran was in the Army, Air Force, or Marine Corps; send the claim to the Rating Board.

Although FL04-11 instructs us to send a request to CURR, we have consistently received letters from USASCURR stating, "We do not maintain military personnel files, unit histories, or files related to a Veteran's duty assignments.  We do not determine a Veteran's specific duty location.  Therefore, we are unable to document or verify that [Veteran] "flew into", "stepped foot", or served in the Republic of Vietnam." Send the claim to the Rating Board.

PIES REQUEST O43 SCREEN PROMPT

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AGENT ORANGE EXPOSURE AMONG NAVAL AVIATION VETERANS OF THE VIETNAM ERA

During the Vietnam era, most naval aviation units were either carrier based or operated out of Western Pacific locations other than Vietnam, such as Guam or Okinawa. However, some squadrons were based in Vietnam itself or aircraft elements of the squadron rotated in and out of Vietnam for temporary duty. If a Veteran with naval aviation service files an Agent Orange exposure related disability claim based on service in Vietnam, and initial development does not provide evidence to support the required in-country duty or visitation, further development is required to comply with VA’s duty to assist. Further development should include a Personnel Information Exchange System (PIES) O18 request to the National Personnel Records Center (NPRC) for the Veteran’s complete military records and/or a Defense Personnel Records Information Retrieval System (DPRIS) O43 request for unit research to the Army and Joint Services Records Research Center (JSRRC).

An additional resource, which may support the claim and reduce processing time, is the official Navy website: Dictionary of American Naval Aviation Squadrons. This website contains the history of all attack squadrons, designated by the prefix “VA” and all strike fighter squadrons, designated by the prefix “VFA.” The “V” designation is a holdover from the early days of flight and refers to a “heavier than air vehicle.” The histories of other aircraft types are included but most Vietnam era Navy aircraft types are VA or VFA. These histories describe unit locations, including Vietnam in-country rotations. If the Veteran’s unit history shows Vietnam in-country rotation and the Veteran provides a lay statement of

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personal in-country service, then the presumption of exposure can be acknowledged. This website will be added to the C&P Service Intranet Rating Job Aids link: Vietnam Era Navy Ship Agent Orange Exposure Development Site. In the meantime, the site can be accessed at: http://www.history.navy.mil/branches/dictvol1.htm.

Reference: C&P Bulletin, February 2011

CHANGES

Change 1, January 31, 2011, added guidance regarding Revised and Updated Vietnam Era Navy Ship List.

Change 2, February 28, 2011, added guidance regarding Agent Orange Exposure Among Naval Aviation Veterans of the Vietnam Era.

Change 3, December 9, 2012, added guidance regarding Vietnam Era Navy Ship Agent Orange Exposure Development Site.

Change 4, April 18, 2013, reformatted the section to consolidate development guidance as it pertains to Navy and Coast Guard Veterans.

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Section 61

Vietnam APO & FPO Listings_______

VIETNAM APO LISTING

APO LocationDate

OpenedDate

Closed15 Can Tho, Vietnam 12-May-62 1-Sep-7327 Bien Hoa, Vietnam 25-Apr-62 14-Feb-7338 Quin Nhon, Vietnam 12-May-62 25-Apr-7240 Nha Trang, Vietnam 25-Apr-62 1-Sep-7391 Vung Tau, Vietnam 22-Oct-62 25-Mar-7395 Cheju & Pleiku, Vietnam 12-May-62 8-Apr-7296 Soc Trang, Vietnam 12-Oct-62 1-Oct-7297 Ban Me Thuot, Vietnam 22-Oct-62 15-Mar-73137 Danang & Danang Aprt, Vietnam 9-Nov-71 9-Mar-73143 Saigon, Vietnam 1-Jun-59

Tan Son Nhut AB, Vietnam 4-Sep-73Saigon, Vietnam 2-May-75

157 Vinh Long, Vietnam 3-May-63 1-Oct-72158 Hue, Vietnam 6-May-63 10-Feb-73299 Kontum, Vietnam 9-Sep-63 10-Oct-72300 Bac Lieu, Vietnam 18-Sep-63 1-Oct-7296201 Gia Dinh, Vietnam 15-Nov-66

Tan Son Nhut, Vietnam 13-Mar-7396203 Monkey Mountain, Quang Nam, RVN 10-Nov-66 6-Mar-7396204 Delat, Tuyen Duc, Vietnam 10-Nov-66 1-Oct-7296205 Nha Trang, Vietnam 1-Dec-66 28-Mar-7396214 Nha Be, Vietnam 1-Nov-66 11-May-68

Puenene, Maui, Hawaii 20-Jun-7296215 Can Tho, Vietnam 12-May-62 1-Sep-7396216 Tay Ninh, Vietnam 11-Apr-67 28-Feb-7196217 Duc Pho, Vietnam 28-Dec-67 28-Dec-7196219 Chu Lai, Vietnam 17-Oct-67 7-Apr-7196221 Phuoc Vinh, Vietnam 31-Dec-67

Phan Thiet, Vietnam 1-Oct-7296222 Cholon, Saigon, Vietnam 1-Nov-66

Tan Son Nhut, Vietnam 13-Feb-68 28-Mar-7396223 Phu Bai, Vietnam 26-Jan-68

Long Binh, Vietnam 19-Nov-6996225 Cu Chi, Vietnam Mar-66 20-Apr-7196226 Phu Tai Valley, Vietnam 1-Oct-68 25-Apr-7296227 Bien Hoa, Vietnam 25-Apr-62 14-Feb-7396228 Chu Lai, Vietnam 17-Feb-68

Phu Bai, Vietnam 12-Mar-68Bien Hoa, Vietnam 25-Sep-68

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Tan Son Nhut AB, Vietnam 28-Oct-68 10-Dec-6996230 DaNang AB, Vietnam 1-Nov-71 30-Nov-7196234 Bien Hoa, Vietnam 10-Dec-71

Tan Son Nhut AB Vietnam 1-Mar-72Saigon, Vietnam 2-May-75

96236 Duong Dong, Vietnam 13-Jul-67 6-Jan-6996238 Quin Nhon, Vietnam 12-May-62 25-Apr-7296240 Nha Trang, Vietnam 25-Apr-62 1-Sep-7396243 Saigon, Vietnam 1-Jun-59

Tan Son Nhut AB, Vietnam 4-Sep-73Saigon, Vietnam 2-May-75

96250 An Khe, Vietnam 18-Oct-67Bong Son, Vietnam 8-Oct-69 17-Aug-71Bien Hoa, Vietnam 5-May-65

96256 Tuy Hoa, Vietnam 1-Aug-66Tay Ninh, VietnamChu Lai, Vietnam 23-Apr-67Moc Bai, Vietnam 1-May-69DaNang, Vietnam 7-Jun-71 22-Jun-72

96257 Xuan Loc, Vietnam 8-Jul-66Bien Hoa, Vietnam 26-Sep-69Di An, Vietnam 5-Apr-70Long Binh, VietnamPhu Loi, Vietnam 28-Dec-72

96258 Hue, Vietnam 6-May-63 10-Feb-7396260 Quang Ngai, Vietnam 25-Jul-63 10-Feb-7396262 Saigon, Vietnam

Pleiku, Vietnam 6-Aug-66An Khe, Vietnam 1-Mar-70 15-Dec-70

96265 Tuy Hoa, Vietnam 10-Sep-66Pleiku, Vietnam 10-Apr-67 15-Dec-70

96266 Long Binh, Vietnam 1-Jun-66 28-Mar-7396268 Bear Cat, Vietnam 10-Oct-66

Dan Tieng Vietnam 14-Jul-67 1-Oct-7296269 Dong Ha, Vietnam 5-Nov-66 16-Apr-7296278 Pleiku, Vietnam 16-Jul-66 15-Dec-7096279 Song Be, Vietnam 1-Dec-66

Long Binh, Vietnam 15-Feb-7196289 Saigon, Vietnam 3-Apr-66 15-Apr-7296291 Vung Tau, Vietnam 22-Oct-62 25-Mar-7396294 An Khe, Vietnam 3-Apr-66 25-Jul-72

Cheo Reo, Vietnam 25-Jul-72 1-Oct-7296295 Pleiku, Vietnam 12-May-62 8-Apr-7296296 Soc Trang, Vietnam 12-Oct-62 1-Oct-7296297 Ban Me Thuot, Vietnam 22-Oct-62 15-Mar-7396307 Tan Son Nhut Airfield, Vietnam 25-Sep-64 13-Mar-7396308 Phu Bai Airport, Vietnam 25-Mar-65 10-Feb-7396309 Cholon, Oia Dinh, Vietnam 1-May-65 28-Mar-73

Tan Son Nhut, Vietnam96312 Cam Ranh Bay, Vietnam 1-May-65 21-Jun-72

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96314 Tan Son Nhut Airfield, Vietnam 25-Sep-64 20-Apr-7296316 Tuy Hoa, Vietnam 1-May-65 22-Feb-7296317 Phan Thiet, Vietnam 1-May-65

Da Nang, Vietnam 27-Dec-70 27-Apr-7296318 Camp Holloway, Vietnam 1-May-65

Camp Schmidt, Vietnam 28-May-73Pleiku, Vietnam

96320 Bin Thuy AB, Vietnam 9-Aug-65 16-Apr-7296321 Phan Rang, Vietnam 20-Aug-65 25-Mar-7296322 Tan Son Nhut Airfield, Vietnam 1-Oct-65 15-Jun-6996325 Chu Lai, Vietnam 1-Oct-65 28-Dec-7296326 Cam Ranh Bay, Vietnam 29-Oct-65 17-May-7296327 Phu Quoc Island, Vietnam 5-Nov-65 1-Mar-6796332 Camp Davies, Saigon Vietnam 15-Oct-67

Long Binh, Vietnam 10-Oct-69 25-Oct-7296337 Danang, Vietnam 25-Apr-62

Danang Aprt, Vietnam 9-Nov-71 9-Mar-7396345 Quin Nhon, Vietnam 1-Jul-65

Bien Hoa, Vietnam 27-Jul-65Saigon, Vietnam 12-Nov-65 2-Nov-70

96347 Bien Hoa, Vietnam 8-Jul-65An Khe, Vietnam 1-Aug-65Phan Rang, Vietnam 14-Nov-65Long Binh, Vietnam 15-Sep-69 28-Mar-73

96348 Tan Son Nhut AB, Vietnam 20-Sep-67Long Binh, Vietnam 1-Mar-72 20-Feb-73

96349 Da Nang, Vietnam 1-May-68 28-Mar-7396350 Nha Trang, Vietnam 25-Oct-66 5-Apr-7296353 Cu Chi, Vietnam 15-Jan-66 23-Dec-7096355 Pleiku, Vietnam 1-Jan-66

Duc Pho, Vietnam 1-Aug-67LZ Baldy, Vietnam 28-Jan-68LZ English-Bong Son, Vietnam 2-Mar-68Pleiku, Vietnam 30-Mar-68 15-Dec-70

96357 Vinh Long, Vietnam 3-May-63 1-Oct-7296359 My Tho, Vietnam 5-Jan-66 10-Oct-7296361 Tan Son Nhut AB, Vietnam 25-Oct-67 29-Oct-7096362 Dong Ha, Quang Tri Prov, Vietnam 15-Feb-66 31-Oct-6996363 Ca Mau, Xuyan Prov, South Vietnam 4-Jan-66 1-Oct-7296368 Phu Cat Binh Dinh, Vietnam 11-Jul-66 15-Mar-7296370 Bear Cat, Vietnam 1-Oct-66

Dong Tam, Vietnam96371 Phu My, Vietnam 20-Dec-66

Bear Cat, Vietnam 15-Jan-67Dong Tam, VietnamTan An, Vietnam 1-Aug-69 5-Oct-70

96372 Phu My, Vietnam 15-Jan-67Bear Cat, Vietnam 19-Apr-67Dong Tam, Vietnam 18-Aug-69

96373 Bear Cat, Vietnam 8-Dec-66

3

January 1, 2004

Dong Tam, Vietnam96374 Chu Lai, Vietnam 23-Apr-67 26-Jan-7296375 Long Binh, Vietnam 1-Jul-67 28-Mar-7396376 Xuan Loc, Vietnam 20-Feb-67 15-Feb-7296377 Cam Ranh, Vietnam 1-Dec-66 30-Apr-7296379 Cam Ranh Bay, Vietnam 23-May-67 30-Apr-7296381 Saigon, Vietnam 21-Dec-66

Long Binh, Vietnam 26-Sep-68 28-Mar-7396383 Bien Hoa, AFB , Vietnam 18-Dec-67

Phu Bai, Vietnam 25-Sep-68 9-Mar-7296384 Long Binh, Vietnam 7-Jan-67 21-Oct-72

Tan Son Nhut AB, Vietnam 21-Oct-72 13-Mar-7396385 Tay Ninh, Vietnam 15-Nov-67 31-Dec-7096388 Saigon, Vietnam 25-Mar-67 21-Oct-72

Tan Son Nhut AB, Vietnam 21-Oct-72 28-Mar-7396393 Saigon VN, Vietnam 1-Mar-73 2-May-7596395 Quang Tri, Vietnam 9-Aug-71 30-Mar-7296398 Di An, Vietnam 15-Nov-70 31-Oct-72

Phu Loi, Vietnam 26-Feb-71 31-Oct-7296399 Saigon, Vietnam 26-Oct-70 28-Mar-7396402 Bac Lieu, Vietnam 18-Sep-63 1-Oct-7296477 Quang Tri, Vietnam 15-Jul-68 15-Aug-7196485 Phu Cat, Vietnam 1-Jan-71

Qui Nhon, Vietnam 20-Mar-7396490 An Khe, Vietnam 30-Sep-65

Phu Bai, Vietnam 1-Feb-68Camp Evans, Vietnam 1-Oct-68Bien Hoa, Vietnam 12-Jul-69 16-Aug-72

96491 Qui Non, Vietnam 1-Oct-65Tan Son Nhut AB, Vietnam 28-Mar-66 23-Feb-73Long Binh, Vietnam 15-May-66 23-Feb-73

96492 Charang Valley, Vietnam 5-Oct-68 25-Apr-7296493 Bad Loc, Vietnam 18-Nov-68 15-Apr-7296494 Camp Holloway, Pleiku, Vietnam 18-Jun-69 1-May-7296495 Quang Tri, Vietnam 1-May-6896496 Long Binh, Vietnam 20-Mar-68 25-Mar-7396499 Kontum, Vietnam 9-Sep-63 10-Oct-7296530 Bear Cat, Vietnam 28-Mar-68 2-Dec-7296599 Long Binh, Vietnam 1-Jul-66

An He, Vietnam 1-Feb-68 4-Jul-69

Source:Craig G. Erlanger Captain      USMC Plans Officer, MPSA 2461 Eisenhower AV Ste 818 Alexandria, VA 22331-0006 DSN 221-7851, COMM (703)-325-7851,  Fax: x 9534 Email: craig.erlanger@hqda.army.mil

4

January 1, 2004

VIETNAM FPO LISTING

The following Navy addresses have been identified by the Military Postal History Society, a private organization, as being located in Vietnam. These addresses cannot be verified by MPSA, however MPSA cannot state they were not in Vietnam. These will most likely appear as FPO (Fleet Post Office) or “Navy Br.”, rather than APO.

150 955 17041 17090 17095 17115 9622096621 96622 96623 96624 96625 96626 9662796628 96629 96638 96639 96641 96647 9664896694 96695 96696

Official source unknown. Taken from Verification of Vietnam Service: A Primer, by Vince Hancock, VA Regional Winston-Salem, dated September 24, 2002

5

Change 1March 13, 2006

Section 62

Vietnam Era Dates_______

Section 505 of Public Law 104-275 (signed into law effective 10-9-96), moves the beginning of the Vietnam Era….

to February 28, 1961, for Veterans who actually served in the Republic of Vietnam between February 28, 1961 to May 7, 1975,

from January 9, 1962 to May 7, 1975, the beginning date of service in Vietnam for purposes of the presumption of exposure to herbicides.

For further information refer to 38 CFR 3.2 and 38 CFR 3.307

CHANGES

Change 1, March 13, 2006, corrected the dates of service regarding the presumption of exposure to herbicides as a result of serving in Vietnam.

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Change 7March 30, 2009

Section 63

Exposure to Asbestos_______

1 – Development Guidelines..................................................62.3

2 – Asbestos Claims Memorandum......................................62.5

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Change 7March 30, 2009

Section 63.1Exposure to Asbestos

Development GuidelinesRefer to M21-1MR, Part IV, Subpart ii, Chapter 1, Section H for guidance regarding claims for asbestos-related diseases.

NO SPECIFIC DISABILITY CLAIMED

If the Veteran alleges exposure to asbestos but claims no disability, inform the Veteran that exposure is not a disability.

Send MAPD Special Issues Claimant Letter, ASB - tell us specific disability fm asbestos exposure.

If the Veteran fails to respond in 30 days, refer to Administrative Denials Section in this development guide for further details.

Note: If “exposure” is the only allegation, the claims is not substantially complete and should not be controlled. (See M21-1MR.I.1.B.3, Block b, for information on handling incomplete claims.)

SPECIFIC DISABILITY CLAIMED

Send MAPD Special Issues Claimant Letter, ASB - tell us where, when, how exposed.

Send MAPD Compensation Claimant Letter, Continuity – med evid since service needed. If the claimant can provide evidence showing treatment since discharge from the military, service connection may be warranted on a direct basis.

MEDICAL EVIDENCE REQUIRED

Send MAPD Special Issues Claimant Letter, ASB - medical evid of disease (biopsy) needed.

Submit PIES Request Code O16. Print a copy of the PIES request to be flip-filed in the center section of the C-file.

Select MAPD Third Party Development pick, Exposure to asbestos.

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Change 7March 30, 2009

RATING ACTIVITY RESPONSIBILITY

After completing the initial development and all evidence is of record, route the claim to the Rating Team.

The rating activity is responsible for determining whether or not military records demonstrate evidence of asbestos exposure in service and ensuring that development is accomplished to determine if there is pre-service and post-service evidence of occupational or other asbestos exposure. See M21-1MR, Part IV, Subpart ii, Chapter 1, Section H, Asbestos-Related Diseases.

The RVSR must determine whether or not military records demonstrate evidence of asbestos exposure in service. RVSRs must assure that development is accomplished to determine whether or not there is preservice and/or post-service evidence of asbestos exposure. See M21-1MR, Part IV, Subpart ii, Chapter 2, Section C, Asbestos-Related Diseases.

If the initial development and the 30 day VCAA period has expired, but the service records center has not provided verification of asbestos exposure, do not delay in routing the claim to the Rating Team.

CHANGES

Change 3, March 14, 2005, added guidance regarding the rating activity’s responsibility for determining evidence of asbestos exposure.

Change 4, November 8, 2005, corrected typographical error that routing of the claim to the Rating Team should “not” be delayed if the initial development and 60 day VCAA period has expired.

Change 5, February 24, 2006, added the requirement to request continuity when the Veteran claims a specific disability.

Change 6, March 10, 2006, added M21-1MR reference.

Change 7, March 30, 2009, added M21-1MR references; changed 60 day period to 30 day.

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Change 7March 30, 2009

Section 63.2Exposure to Asbestos

Asbestos Claims Memorandum

Department ofVeterans Affairs Memorandum

Date: May 13, 2002

From: Mary M. Parker

Subj: Asbestos claims

To: PIES Coordinators, Military Records SpecialistsThru: Veterans Service Center ManagersCC: Gloria Hamly, Naval Sea Systems Command

1. This memo is intended to spell out, as clearly as possible, what VA PIES users at all field stations need to do when they receive a response to request code O16 [ASBESTOS - FURNISH RECORDS OF EXPOSURE IN SERVICE OR JOBS VETERAN PERFORMED] from the VA PIES Unit at NPRC.

2. First, some background. Cases involving asbestos exposure generally relate to Navy Veterans who were exposed to asbestos while working on Navy ships. The service record does not usually contain documents stating specifically whether or not the Veteran was exposed to asbestos. So, VA PIES Unit personnel used to make copies of pages from the service record showing assignments, and transfers and receipts, which they sent to the Navy liaison office at code 13 (NPRC), where one of the Navy liaison staff would review some charts and provide a statement regarding probability of exposure to asbestos, based on ratings the service person held while in service. The Navy Liaison Office is no longer staffed to perform this duty in response to VARO (PIES) requests. Consequently, we have developed new procedures for handling asbestos cases.

3. In response to an O16 request, VA PIES Unit personnel at NPRC will continue to either make copies of records stating the Veteran was exposed to asbestos, or if no such documents can be found, make copies of pages from the service record showing assignments, and transfers and receipts. They will then post response code # 1 (requested documents mailed/faxed) in PIES and send the photocopies directly to the appropriate VA Regional Office.

4. Regional Offices should refer to the attached chart which shows Navy Job Titles (Ratings) and Probability of Exposure to make determinations regarding the likelihood of exposure. If, for

4

Change 7March 30, 2009

any reason, more details regarding rate descriptions or more rates are needed, you may also go to the following web site: http://buperscd.technology.navy.mil/bup_updt/new_occstd/Occstd.pdf

5. For assistance in unusual cases, such as a negative determination which leads to a Board of Veterans Appeals remand or congressional follow-up, the Military Records Specialists at each station may contact Gloria Hamly at the following address: Commander, Naval Sea Systems Command, Attn: OTP (G Hamly), 1333 Isaac Hull Ave. S.E. Stop 1210, Washington Navy Yard, D.C. 20376-1210, or via or e-mail: Hamlygp@navsea.navy.mil for assistance. Please be sure to furnish as much information as possible : name, service number, social security number, assignments, transfers, receipts, ratings, etc. to assist her in her search.

6. If you have any questions or concerns, please contact Mary Parker via Exchange or telephone 314-538-4296.

/s/MARY M. PARKER

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Change 7March 30, 2009

ENCLOSURE

JOB TITLES PROBABILITY(AA) Airman Apprentice Minimal(ABE) Aviation Boatswain’s Mate (Launch&RecEquip) Probable(ABF) Aviation Boatswain’s Mate Probable(ABH) Aviation Boatswain’s Mate, Aircraft Handler) Probable(AC) Air Traffic Controller Minimal(ACM) Aviation Chief Metalsmith Probable(ADJ) Aviation Machinist’s Mate (Jet Engine Mechanic) ProbableADR) Aviation Machinist’s Mate Probable(AE) Aviation Electrician’s Mate Probable(AFCM) Aircraft Maintenanceman (Master Chief) Minimal(AG) Aerographer’s Mate Minimal(AK) Aviation Storekeeper Minimal(AM) Aviation Structural Mechanic Probable(AME) Aviation Structural Mechanic (Safety Equipment ) Probable(AMH) Aviation Structural Mechanic-Hydraulics Probable(AMS) Aviation Structural Mechanic (Structural) Probable(AN) Airman Minimal(AO) Aviation Ordnanceman Minimal(AQ) Aviation Fire Control Technician Highly Probable(AR) Airman Recruit Minimal(ARM) Aviation Radioman Probable(AS) Aviation Support Equipment Technician Probable(AT) Aviation Electronic Technician Probable(AW) Aviation Antisubmarine Warfare Operator Probable(AX) Aviation Antisub Warfare Technician Probable(AZ) Aviation Maintenance Administrationman Minimal(B) Boilermaker (WWII) Highly Probable(BU) Builder Probable.(BM) Boatswain’s Mate Minimal(BR) Boilermaker Highly Probable(BT) Boiler Technician Highly Probable(CD) Construction Driver Probable(CE) Construction Electrician Probable(CM) Construction Mechanic Minimal(CN) Construction man Probable(Cox) Coxswain Minimal(CS) Commissary man Minimal(CT) Communication Technician Minimal(CTR) Cryptologic Technician (Collections) Minimal(DC) Damage Controlman Minimal(DK) Disbursing Clerk Minimal(DP) Data Processing Technician Minimal(DS) Data System Technician Minimal(DT) Dental Technician Minimal

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Change 7March 30, 2009

(EM) Electrician’s Mate Probable(EN) Engineman Probable(EO) Equipment Operator Minimal(ET) Electronics Technician Probable(FC) Fire Controlman Highly Probable(FN) Fireman Highly Probable(FP) Pipefitter Highly Probable(FT) Fire Control Technician Highly Probable(FTG) Fire Control Technician (Guns) Highly Probable(GM) Gunner’s Mate Minimal(GSM) Gas Turbine System Technician (Mechanical) Probable(HC) Hospital Corpsman Minimal(HN) Hospital man Minimal(HT) Hull Maintenance Technician Highly Probable(IC) Interior Communication Technician Probable(IM) Instrument man Highly Probable(LI) Lithographer Minimal(M)(ME) Metalsmith Minimal(MA) Master-At-Arms Minimal(MLC) Molder Probable(MM) Machinist Mate Probable(MN) Mineman Minimal(MOMM)

Motor Machinist Mate Probable

(MR) Machinery Repairman Minimal(MS) Mess Management Specialist Minimal(MT) Missile Technician Probable(MU) Musician Minimal(NC) Navy Counselor Minimal(OM) Optical man Minimal(OS) Operations Specialist Minimal(PC) Postal Clerk Minimal(PH) Photographer’s Mate Minimal(PHM) Pharmacist Minimal(PN) Personnel man Minimal(Prtr) Printer Minimal(PT) Photographic Intelligence man Minimal(PTR) Painter Probable(QM) Quartermaster Minimal(RD) Radarman Minimal(RM) Radioman Minimal(RN) Radarman Minimal(SC) Ship’s Cook Minimal(SD) Stewart Minimal(SF) Shipfitter Minimal(SFM) Shipfitter (Metal Smith) Minimal

7

Change 7March 30, 2009

(SFP) Shipfitter (Pipefitter) Minimal(SH) Ship’s Serviceman Minimal(SK) Storekeeper Minimal(SM) Signalman. Minimal(SN) Seaman Minimal(SO) Sonar man Highly Probable(SoM) Soundman Highly Probable(ST) Sonor Technician Highly Probable(STG) Sonar Technician (Surface) Highly Probable

(SOG) in 60’s(STS) Sonar Technician (Submarine) Highly Probable(StM) Steward’s Mate Minimal(SW) Steelworker Probable(TA) Stewart Apprentice Minimal(TD) Trademan Minimal(TE) Teletype Minimal(TM) Torpedo man’s Mate Probable(TN) Stewards man Minimal(UT) Utilities man Highly Probable(WT) Water Tender. Highly Probable(Y) Yeoman Minimal

8

Change 7October 30, 2009

Section 64

POW Claims_______

Refer all POW claims to the POW Rating Board; the board is responsible for directing all development actions.

FORMER PRISONER OF WAR VERIFICATION

There is a Former Prisoner of War (FPOW) link on the Rating Job Aids website http://vbaw.vba.va.gov/bl/21/rating/rat00.htm under the “Other Resources” section. The FPOWs on this site are verified and the Veteran’s listed on this site can be granted FPOW status. However, if you cannot find the Veteran you are looking for, that does not mean he or she is not a FPOW. Do not deny any FPOW claim based on the name not being listed on this site. Additional development will be required. To access the website, click on the link. The link will take you to the Defense Prisoner of War/Missing Personnel Office’s (DPMO’s) website. Select the war period (i.e. Korea, Vietnam, or the Cold War) and search for the Veteran’s name and identifying information.

Reference: C&P Service Bulletin, October 2009

Accept a Veteran's statement regarding disabilities incurred as a POW unless inconsistent with other evidence. Supporting statements from other comrades constitute medical evidence. Discrepancies or deficiencies in the evidence require development. Reference: M21-1MR, Part IV, Subpart ii, Chapter 1, Section G.

Check the DD Form 214 for any internment dates, otherwise, obtain POW internment dates and place.

Submit PIES Request Code O25. Print a copy of the PIES request to be flip-filed in the center section of the C-file.

If necessary, send MAPD Third Party Development Letter, POW - verify POW Status fm National Archives. If necessary, select MAPD Third Party Development pick, POW information, to create a tracked item.

If the evidence of record does not show the Veteran was interned as a prisoner of war, send MAPD Special Issues Claimant Letter, POW statement from Veteran and others needed.

INTERNMENT IN NEUTRAL OR ALLIED COUNTRY

If the location of internment was in a neutral or allied country, develop information concerning conditions of the internment.

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Change 7October 30, 2009

PRESUMPTIVE DISABILITY CLAIMED

If the claimed disability is a presumptive condition for former POWs, no development is required to establish continuity.

Send MAPD Special Issues Claimant Letter, POW - witness of disab in service needed.

Ref: Presumptive service connection for chronic, tropical or prisoner-of-war related disease, or disease associated with exposure to certain herbicide agents; wartime and service on or after January 1, 1947, 38 CFR 3.307

CLAIMED DISABILITY NOT PRESUMPTIVE

If the claimed disability is not presumptive, develop for any treatment mentioned in the Veteran's claim. If none is provided, request Treatment Since Discharge.

POW PROTOCOL EXAMINATION

The Veteran is entitled to POW Protocol exam. All claims where POW status is verified and no protocol exam is of record, request a POW Protocol must be requested.

POW PRESUMPTIVE CONDITIONS

Avitaminosis Beriberi (including Beriberi heart disease) Chronic dysentery Helminthiasis Malnutrition (including optic atrophy associated with malnutrition) Pellagra Any other nutritional deficiency Psychosis Any of the anxiety states Dysthymic disorder (or depressive neurosis) Organic residuals of frostbite (provided Veteran was in such a climate) Post-traumatic osteoarthritis Irritable bowel syndrome Peptic ulcer disease Peripheral neuropathy (except where related to infectious causes)

2

Change 7October 30, 2009

Cirrhosis of the liver (added 07-18-03) Osteoporosis (added October 10, 2008; osteoporosis was made a POW

presumption for those Former-POWs who were detained or interned for any period of time, whose osteoporosis is at least 10 percent disabling and who have a diagnosis of post-traumatic stress disorder.) Reference Fast Letter 09-15, dated March 3, 2009.

Osteoporosis (added September 28, 2009; an Former-POW can get service connection for osteoporosis on a presumptive basis if he was detained or interned for at least 30 days and the osteoporosis is at least 10 percent disabling. There is no requirement that the Former-POW be diagnosed with PTSD. However, unlike the presumption implemented in 2008, the Former-POW must have been detained or interned for at least 30 days.)

ISCHEMIC HEART DISEASE

The issue at hand is service connection for this condition on a presumptive basis for former POWs such as VA now does for irritable bowel syndrome and other conditions.

Develop for any medical treatment the Veteran mentions on his/her claim.

Treatment Since Discharge (continuity) is not required.

REQUESTS FOR PRISONER OF WAR RECORDS

Reference: M21-1MR, Part III, Subpart iii, Chapter 2, Section G.

WORLD WAR II RECORD GROUPS

Reference: M21-1MR, Part III, Subpart iii, Chapter 2, Section G.

KOREAN CONFLICT RECORD GROUPS

Reference: M21-1MR, Part III, Subpart iii, Chapter 2, Section G.

POW RECORDS FOR PERIODS OTHER THAN WORLD WAR II AND KOREAN CONFLICT

Reference: M21-1MR, Part III, Subpart iii, Chapter 2, Section G.

FORMER PRISONER OF WAR - DEFINITION

3

Change 7October 30, 2009

Reference: 38 CFR 3.1(y)(2)

CHANGES

Change 2, May 1, 2005, incorporated references within each topic; added guidance for processing Cheyenne Satellite office POW claims; added guidance regarding verification of POW status.

Change 3, August 8, 2005, added guidance regarding the responsibility of the POW Rating Board to initiate all required development actions.

Change 4, November 25, 2006, added guidance regarding POW Protocol exams for Cheyenne Veterans being conducted at the Denver VAMC.

Change 5, June 19, 2008, added guidance regarding retrival information for POW verification data.

Change 6, April 16, 2009, added M21-1MR references.

Change 7, October 30, 2009, added guidance regarding verification of former prisoner of war Veterans; added guidance regarding osteoporosis as a presumptive disability.

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Change 32July 3, 2013

Section 65

Post-Traumatic Stress Disorder (PTSD) - Combat

_______

1 – General Guidelines........................................................................63.2

2 – Confirmed Combat-Related Stressors........................................63.6

3 – Decorations Which May Confirm Combat-Related Stressors..63.8

4 – Unconfirmed Stressor Events....................................................63.10

5 – Requests for VA Examinations..................................................63.17

6 – Marine Corps Records................................................................63.19

7 - Relaxation of Evidentiary Standard for Establishing In-Service Stressors in Claims for Posttraumatic Stress Disorder..........63-21

8 – PTSD Not Diagnosed at VA Examination................................63-24

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Change 32July 3, 2013

Section 65.1Post-Traumatic Stress Disorder - Combat

General Guidelines_______

IN-SERVICE INITIAL DIAGNOSIS OF PTSD

When there is a prima facie diagnosis of PTSD by a mental health professional in service, verification of the stressor, whether in-service or pre-service, is not required. Reference: Fast Letter 08-08, Additional Guidance on Post-Traumatic Stress Disorder (PTSD), dated April 7, 2008.

If the Veteran was diagnosed with PTSD in service and the claimed stressor is related to service, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in service stressor.  In other words, under regulatory provision, even though the Veteran was diagnosed with PTSD in service, the Veteran's stressor must still be related to military service, it must be consistent with the circumstances, conditions or hardships of the Veteran's military service and there can be no clear and convincing evidence to the contrary that the claimed stressor occurred.  Then, in such case, the Veteran's lay testimony can be accepted regarding the claimed in-service stressor. Reference: 38 CFR 3.304(f)

ISSUE: PTSD STRESSOR

Question:When a Veteran claims that his in-service stressor is that he witnessed the death of another (whether it be friendly, enemy, or civilian) and we corroborate that his unit was in a hostile area which was exposed to probable combat, can we concede the Veteran's claimed stressor if his post deployment questionnaire in the STRs shows that he witnessed the death of another? We are spending an additional 6 months to a year waiting for "evidence" and usually end up denying the claim because of the lack of a "verified" stressor.

Answer:In the scenario provided above it can clearly be shown by in-service records (the post-deployment questionnaire) that the Veteran witnessed the death of another. The Veteran’s reports remained consistent and the diagnosis is associated with this reported and supported stressful event. The existence of the stressor should be considered adequately supported by the records. However, based on this fact pattern, no concession should be made that the Veteran engaged in combat.

Source: Star Rating Call, Q&As for the March 2010 Quality Call

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Change 32July 3, 2013

CORROBORATION OF IN-SERVICE STRESSORS NOT BASED ON COMBAT

When combat participation cannot be confirmed, or when the claimed stressor is not related to combat, request credible supporting evidence. For further guidance, refer to Fast Letter 08-08, Additional Guidance on Post-Traumatic Stress Disorder (PTSD), dated April 7, 2008.

REQUIREMENTS FOR ESTABLISHING SERVICE CONNECTION FOR PTSD

Service connection for post-traumatic stress disorder (PTSD) requires 1) credible evidence that the claimed in-service stressor occurred; 2) medical evidence diagnosing the condition; and 3) a link, established by medical evidence, between current symptoms and an in-service stressor. Refer to M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 13a, and 38 CFR 3.304(f) for further guidance.

Note: For Veteran's diagnosed with PTSD in service, the issue of verifying the stressor is moot.  We simply have to advise the examiner that the Veteran was diagnosed with PTSD in service and therefore, the issue of a verified stressor is moot.

SIGNIFICANCE OF POW AND COMBAT EXPERIENCE

The Veteran’s testimony alone establishes the occurrence of the claimed in-service stressor. Refer to M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 13b for further guidance.

In the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran’s service, the Veteran’s testimony alone may establish the occurrence of the claimed in-service stressor (38 CFR 3.304(f)(2)).

A Veteran’s lay testimony of a stressor which is not refuted is not sufficient to establish a stressor since the law requires that a stressor be verified (See Zarycki v. Brown). However, lay evidence of a stressor is sufficient to establish the Veteran’s claim. In addition, the evidence which verifies the stressor need not be service treatment records.

POW status which satisfies the requirements of 38 CFR 3.1(y) (Former prisoner of war) will be considered conclusive evidence of an in-service stressor.

DEFINITION OF ENGAGING IN COMBAT

Engaging in combat with the enemy means personal participation in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. Refer to M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 13c for further guidance.

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Change 32July 3, 2013

COMBAT STATUS , LAY EVIDENCE , AND BUDDY STATEMENTS

When a Veteran, who engaged in combat with the enemy, files a claim for benefits based on an in-service incident, injury, or disease which resulted from that combat, the Veteran’s own lay testimony is sufficient to establish the occurrence of that incident, injury, or disease. If combat status is not shown by receipt of a combat related award, then other evidence must be evaluated to establish the status. In this situation, a “buddy statement” may contribute to the evidence for combat status. C&P Service is currently reviewing the parameters for use of the buddy statement as lay evidence that may serve to establish the combat status of a claimant Veteran. C&P guidance on this matter for ROs will be released soon.

Reference: Compensation & Pension Service Bulletin, Addendum, Volume 1, Issue 9, dated October 2007.

See M21-1MR, Part III, Subpart iii, Chapter 1, Section C, 14e for guidance regarding development for buddy statements.

Note: Refer to M21-1MR, Part III, Subpart iii, Chapter 2, Section E, 35d for guidance regarding verification of affiant (buddy) statements.

COMBAT STATUS AND THE USE OF LAY TESTIMONY AS EVIDENCE

VA regulations provide for the use of a claimant Veteran’s lay testimony as probative evidence sufficient to establish the occurrence of an incident, injury, or disease during active military service if the Veteran was engaged in combat with the enemy. The issue of combat status is most often addressed in claims for PTSD when the Veteran is providing a statement describing an in-service stressor that produced current symptoms. If the Veteran engaged in combat, lay testimony alone will establish the occurrence of the stressor. In such cases, combat status is presumed when the Veteran has received a combat related award. When combat is claimed but military records do not show a combat award, development is undertaken as a means to establish the Veteran’s participation in combat activity. Lay testimony associated with combat status in PTSD claims is governed by 38 CFR 3.304(f)(1).

Regional Offices should also be aware that 38 CFR 3.304(d) extends the relaxed evidentiary standards associated with combat status to any claimed injury or disease. This regulation allows for the use of satisfactory lay or other evidence as sufficient proof to establish the in-service incurrence or aggravation of an injury or disease if it is the result of a Veteran’s involvement in combat. Such lay evidence is acceptable as long as it is consistent with the circumstances, conditions, or hardships of the Veteran’s service, despite the lack of any corroborating evidence in official records. While this regulation allows for the use of lay evidence to establish in-service incurrence or aggravation, it does not authorize lay evidence as a replacement for the additional medical evidence of a nexus and a currently diagnosed disability that is required to establish service connection. Regional Offices are advised to pay special attention to this regulation in cases where any injury or disease is claimed to have resulted from combat involvement. It has added significance now because of the influx of claims from Veterans who have participated in the Global War on Terrorism.

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Change 32July 3, 2013

Reference: C&P Service Bulletin, November 2007.

CONTINUITY

Although PTSD may be recognized as having its onset at any time, continuity must be requested for all claims for service connection. Reference M21-1MR, Part IV, Subpart ii, Chapter 1, Section A, 2d.

Send a notice letter to the claimant requesting continuity.

For further information regarding Continuity, refer to the Terms & Definitions Section in this development guide.

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Change 32July 3, 2013

Section 65.2Post-Traumatic Stress Disorder - Combat

Confirmed Combat-Related Stressors_______

DECORATION AS EVIDENCE OF ENGAGEMENT IN COMBAT

If a Veteran received one of the decorations cited in M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 13d, but does not expressly state the nature of the stressor, assume that the stressor is combat related (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 13d, Notes).

If the Veteran contends receipt of a decoration cited in M21-1MR, IV.ii.1.D.13d , but the DD Form 214 (or other evidence) does not show receipt of the decoration, send a request for the military personnel file (PIES request code O19).

If the Veteran contends receipt of the Purple Heart, send an e-mail to HECPurpleHeartTeam@med.va.gov; the HEC Purple Heart Team may be able to verify the Veteran’s receipt of the Purple Heart. Although this guidance was provided in Fast Letter 02-25, which has been rescinded, the HEC Purple Heart Team has confirmed they will answer inquiries regarding Veterans who are in receipt of the Purple Heart.

CLOSE COMBAT BADGE

The Army announced on February 11, 2005, that it has created a new decoration called the Close Combat Badge (CCB). The badge is intended to provide special recognition to ground combat arms soldiers who are trained and employed in direct combat missions similar to Infantry and Special Forces. For further guidance, refer to VSCM Conference Call, February 17, 2005.

DEVELOPMENT ACTIONS

If the Veteran received one of the decorations noted above, complete the following actions:

Send the Veteran a VCAA notification letter. Do NOT ask the Veteran for specific details in any case in which there is credible supporting evidence that the claimed in-service stressor occurred (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 14c).

Request any medical records the Veteran indicates. Refer to Medical Evidence Development Section in this development guide for further details regarding development for medical evidence.

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If the Veteran reports having received treatment from a Vet Center, Send MAPD Third Party Development Letter, PTSD – request copy of Vet Center records.

Request a VA examination, if necessary to decide the claim. Refer to the section entitled Post-Traumatic Stress Disorder (Combat, Requests for Examinations for further guidance.

Note: For Veteran's diagnosed with PTSD in service, the issue of verifying the stressor is moot.  We simply have to advise the examiner that the Veteran was diagnosed with PTSD in service and therefore, the issue of a verified stressor is moot.

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Section 65.3Post-Traumatic Stress Disorder - Combat

Decorations Which May Confirm Combat-Related Stressors

_______

GLOBAL WAR ON TERRORISM EXPEDITIONARY MEDAL, GLOBAL WAR ON TERRORISM SERVICE MEDAL , AFGHANISTAN CAMPAIGN MEDAL , OR IRAQ CAMPAIGN MEDAL

If a Veteran received Global War on Terrorism Expeditionary Medal, Global War on Terrorism Service Medal, Afghanistan Campaign Medal, or Iraq Campaign Medal, refer to M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 14 for further guidance.

COMBAT ACTION RIBBON

If a USMC Veteran claims having received a Combat Action Ribbon, but the award is not shown on the DD Form 214, the USMC has posted the names (and last four numbers of the SSN) for Marines awarded the Combat Action Ribbon for the past 15 years. The site includes names of Veterans from Operation Iraqi Freedom and Operation Enduring Freedom. The website is at:

https://lnweb1.manpower.usmc.mil/manpower/mm/mmma/AwardsVerification.nsf/search

On that page, go to “Award Search” in the lower left corner and click on the drop down box, then on “CAR” then on “search.” It takes some time for the database to begin to provide names (each page contains 5000 names).

If the personnel file or USMC website confirms that the decorations cited above were awarded for engagement in combat complete the following development actions:

Send the Veteran a VCAA notification letter. Do NOT ask the Veteran for specific details in any case in which there is credible supporting evidence that the claimed in-service stressor occurred (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 14c).

Request any medical records the Veteran indicates. Refer to Medical Evidence Development Section in this development guide for further details regarding development for medical evidence.

If the Veteran reports having received treatment from a Vet Center, Send MAPD Third Party Development Letter, PTSD – request copy of Vet Center records.

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Request a VA examination, if necessary to decide the claim, and specify in the examination request which decoration(s) the Veteran received and ask the examiner to elicit the stressor event (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 13d, Notes).

Note: If the Veteran reported receiving treatment, obtain all medical evidence prior to requesting an examination.

Refer to the section entitled Examination of Specific Disabilities & Issues , Topic: PTSD - Initial Evaluation for PTSD versus Review Examination for PTSD, in this development guide for further guidance.

ARMY AIRCRAFT CREW MEMBER BADGE (BASIC AVIATION BADGE RENAMED)

Under certain circumstances receipt of the Army Aircraft Crew Member Badge may indicate participation in combat with the enemy as specified in 38 USC 1154(b) or 38 CFR 3.304 (d) and (f)(2).

This badge was awarded for any of the following situations:

Temporary badge for any crew member engaged in flight while on flight status

Permanent badge for Army soldiers during the Vietnam Era who were on qualified fight status with crew member and aircraft related MOSs (military occupational specialties), including door gunner and medic, and who performed their duties for at least 12 months.

Permanent badge if they were wounded by the enemy or injured in an aircraft accident while performing their flight duties, or participated in at least 15 combat missions under probable exposure to enemy fire while serving in their principal MOS.

Award of the badge in and of itself does not generally confirm combat participation. ROs should investigate all evidence of record including other badges, decorations, and military records, to make determinations.

Reference: C&P Service Bulletin, October 2009

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Section 65.4Post-Traumatic Stress Disorder - Combat

Unconfirmed Stressor Events_______

RELAXATION OF EVIDENTIARY STANDARD FOR ESTABLISHING IN-SERVICE STRESSORS IN CLAIMS FOR POSTTRAUMATIC STRESS DISORDER – 38 CFR § 3.304(F)(3)

PTSD Questionnaire. VCAA notice letters need to include VA Form 21-0781, Statement in Support of Claim for Service Connection for Post Traumatic Stress Disorder; Veterans must provide us with an account of their in-service stressors.

Examination. Review the application and available service records to determine if a VA examination should be scheduled. If the Veteran’s DD-Form 214 verifies service in a location that would involve “hostile military or terrorist activity” as evidenced by such awards as an Iraq Campaign Medal, Afghanistan Campaign Medal, or Vietnam Service Medal, this evidence would be sufficient to schedule the Veteran for a VA psychiatric examination.

For purposes of the new rule change, an examination report from a private psychiatrist, psychologist, or other mental health specialist will not be adequate for establishing service connection for PTSD. However, such examination may be sufficient to trigger VA’s duty to assist, which includes providing the Veteran with a VA examination. The initial PTSD examination must be conducted by a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted (such as QTC or MES).

JSRRC Review. Utilization of JSRRC and other outside entities for stressor verification purposes will be primarily limited to PTSD cases involving noncombat and personal assault stressors.

Training Letter 10-05, dated July 16, 2010, addresses the amended 38 CFR 3.304(f) which eliminates the requirement for corroborating evidence of in-service stressors if the claimed stressor is related to a Veteran's "fear of hostile military or terrorist activity."

PTSD PREVIOUSLY DENIED

If the previous denial was for the lack a diagnosis, new and material evidence is NOT required to reopen the claim.

For claims to reopen a previously denied service connection PTSD claim, new and material evidence will be required as the regulatory amendment is not considered a liberalizing rule under 38 C.F.R. § 3.114. To reopen a claim under new § 3.304(f)(3), VA will accept a

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Veteran’s lay statement regarding an in-service stressor – “fear of hostile military or terrorist activity” – as sufficient to constitute new and material evidence for the purpose of reopening a previously denied claim, if the Veteran’s record otherwise shows service in a location involving exposure to “hostile military or terrorist activity.” If review of the record discloses a previously submitted lay statement demonstrating “fear of hostile military or terrorist activity,” such statement will be sufficient for reopening a claim if the Veterans’ record otherwise demonstrates service in a location involving exposure to “hostile military or terrorist activity.”

A new VA examination may not be necessary in cases where a Veteran is filing a claim to reopen a previously denied service connection PTSD claim, current VA treatment records show a PTSD diagnosis, and there was a PTSD diagnosis in the evidentiary record in conjunction with a previous claim. If the previous denial was based upon inability to establish the occurrence of the claimed stressor, a new VA examination may not be required if the diagnosis was based on, or included a reference to, the Veteran’s fear of hostile military or terrorist activities and there are current treatment records, including private treatment records, that are sufficient to assign a disability evaluation.

Training Letter 10-05, dated July 16, 2010, addresses the amended 38 CFR 3.304(f) which eliminates the requirement for corroborating evidence of in-service stressors if the claimed stressor is related to a Veteran's "fear of hostile military or terrorist activity."

WHAT CONSTITUTES CREDIBLE SUPPORTING EVIDENCE

Refer to M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 13e for further guidance.

THE DEGREE OF STRESSOR CORROBORATION REQUIRED

Refer to M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 13f for further guidance.

USING PRIMARY EVIDENCE TO CORROBORATE A CLAIMED IN-SERVICE STRESSOR

Primary evidence is generally considered the most reliable source for verifying in-service stressors It is typically obtained from the U.S. Army and Joint Services Records Research Center (JSRRC) (formerly the U.S. Armed Services Center for Unit Records Research (CURR)), the National Archives and Records Administration (NARA), or the Marine Corps University Archives (MCUA) and should be carefully reviewed for information corroborating participation in combat or to otherwise corroborate a claimed in-service stressor. Refer to M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 13h for further guidance.

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REQUESTING EVIDENCE THAT A STRESSOR OCCURRED

If the evidence (e.g. DD Form 214, military personnel file, etc.) does not establish the Veteran was engaged in combat with the enemy, or the evidence does establish this but the claimed stressor is not related to that combat, then credible supporting evidence is required to establish that a stressor occurred (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 14b).

SECONDARY SOURCES OF EVIDENCE WHICH MAY CORROBORATE A CLAIMED IN-SERVICE STRESSOR

Refer to M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 13i for further guidance.

INITIAL DEVELOPMENT

If the Veteran has not provided sufficient evidence (questionnaire/statement) to corroborate a claims in-service stressor, send MAPD Special Issues Claimant Letter, PTSD - Need stressor details/med evid combat-related incdnt. (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 14c).

In accordance with M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 14d, the Veteran must be informed that the information is necessary to obtain supportive evidence of each of the stressful events and that failure to respond or an incomplete response may result in denial of the claim. Add the following sentence to the bullet entitled, “Complete the enclosed questionnaire:”

This information is necessary to obtain supportive evidence of each of the stressful events. An incomplete response or failure to respond may result in denial of your claim.

Note: Allow 30 days for receipt of PTSD Questionnaire (VA Form 21-0781).

Note: At a minimum, the Veteran must provide 1) a stressor that can be documented, 2) the location where the incident took place, 3) the approximate date (within a two-month period of time) of the incident, and 4) the unit of assignment at the time the stressful event occurred. However, specific details of claimed stressful events may also be gathered from such sources as VA or private medical treatment reports and examination reports (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 14d).

Send MAPD Compensation Claimant Letter, Combat not verified.

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Note: The list of decorations in the MAPD letter must be modified to include the Combat Aircrew Insignia and the Close Combat Badge. (reference VSCM Conference Call, February 17, 2005)

Submit PIES Request Code O19 (Request for service personnel records that documents awards, medals, decorations, military occupational specialty, campaigns, assignments, etc.) (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 14e).

Print a copy of the PIES request to be flip-filed in the center section of the C-file.

Select MAPD Third Party Development pick, Svc rcd pages for PTSD, to create a tracked item.

Request any medical records the Veteran indicates (i.e. private medical evidence, military outpatient treatment reports, etc.). Request hospital reports and clinical records if the Veteran indicates pertinent treatment in a Department of Veterans Affairs (VA) facility, Vet Center, or elsewhere (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 14a).

If the Veteran reports having received treatment from a Vet Center, Send MAPD Third Party Development Letter, PTSD – request copy of Vet Center records.

Refer to Medical Evidence Development Section in this development guide for further details regarding development for federal and non-federal medical evidence.

If the Veteran provides the name of a person who has knowledge of the condition/event but did not provide a complete address, send MAPD Compensation Claimant Letter, Buddy mentioned – No complete address. See M21-1MR, Part III, Subpart iii, Chapter 1, Section C, 14e for guidance regarding development for buddy statements.

A stressor may be verified by non-medical records, buddy statements, witness statements, etc. If relying on buddy statements, verify the buddy’s presence in the combat situation. See M21-1MR, Part III, Subpart iii, Chapter 2, Section E, Topic 35d (Verifying Service of Affiants for procedures to verify buddy statements.

SHIPS’ MUSTER ROLLS OR DECK LOGS

When considering Ships’ Deck Logs as a possible means for corroborating a stressor event, refer to the CURR Stressor Verification Guide for guidance regarding 1) the purpose and content of deck logs, 2) information that is not contained in a Deck Log, and 3) where to send requests for Deck Logs. Deck Logs from commissioned ships are the only logs sent to the Naval Historical Center for archiving.

Do NOT request a VA examination until the stressor event is corroborated/verified (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 15a).

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To obtain information from historical muster rolls or deck logs, write to the appropriate repository. Addresses can be located at the following Navy internet site:

http://www.navy.mil/navydata/navy_legacy_hr.asp?id=214

SUBSEQUENT DEVELOPMENT

If the Veteran completely fails to respond to the initial request for information (e.g. VAF 0781) about the claimed stressful event, a follow-up request is not necessary. Reference: Fast Letter 08-08, Additional Guidance on Post-Traumatic Stress Disorder (PTSD), dated April 7, 2008, and M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 15n.

If the Veteran submits insufficient information in response to the initial request for information, send a 10-day follow-up letter explaining 1) what information is missing, and 2) why the information is needed (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 15n).

Do NOT request a VA examination until the stressor event is corroborated/verified (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 15a).

DEVELOPMENT FOR IN-SERVICE MENTAL HEALTH TREATMENT RECORDS

Refer to Fast Letter 08-08, Additional Guidance on Post-Traumatic Stress Disorder (PTSD), dated April 7, 2008, for guidance regarding development for in-service mental health treatment records.

PTSD QUESTIONNAIRE/STRESSOR STATEMENT NOT RECEIVED

If the Veteran fails to provide a questionnaire/stressor statement after the initial request and has not responded within 30 days to the follow-up letter, or submits information that is still insufficient, refer the case to the JSRRC coordinator to make a formal finding that sufficient information required to corroborate the claimed stressor(s) does not exist (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 15n).

PTSD QUESTIONNAIRE/STRESSOR STATEMENT RECEIVED

Upon receipt of the PTSD questionnaire/stressor statement and the military personnel file, refer the claim to the JSRRC Coordinator. The JSRRC coordinator will corroborate only what the Veteran discusses. Other “facts” are irrelevant if they are not claimed by the Veteran

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CORROBORATION OF STRESSOR EVENT

The JSRRC coordinator is the primary point of contact for all JSRRC-related related issues within each regional office and

1) determines whether or not submission of a request for stressor verification is appropriate

2) serves as the MCUA and NARA point of contact for issues related to records requests

3) personally submits all of the RO’s requests for stressor corroboration

4) notifies JSRRC, MCUA, or NARA when further action on a pending research request is no longer necessary, (i.e., evidence is received that verifies the claimed stressor or the claim is withdrawn altogether)

5) determines the status of research requests pending at JSRRC by checking the stressor corroboration database, and

6) forwards inquiries from the regional office regarding JSRRC-related issues to the VACO JSRRC e-mailbox at VAVBAWAS/CO/CURR.

For further guidance refer to M21-1MR, IV.ii.1.D.15j.

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Section 65.5Post-Traumatic Stress Disorder - Combat

Requests for VA Examinations_______

EXAMS FOR CONFIRMED COMBAT-RELATED STRESSORS

Request a VA examination, if necessary to decide the claim, and specify in the examination request that VA has verified the Veteran’s combat service, and specify any details regarding the combat stressor contained in the record. (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 13e).

Citing the combat decoration received by the Veteran should suffice for this requirement. Ask the examiner to elicit the stressor event.

Note: If the Veteran reported receiving treatment, obtain all medical evidence prior to requesting an examination.

Refer to the section entitled Examination of Specific Disabilities & Issues , Topic: PTSD - Initial Evaluation for PTSD versus Review Examination for PTSD, in this development guide for further guidance.

Note: For Veteran's diagnosed with PTSD in service, the issue of verifying the stressor is moot.  We simply have to advise the examiner that the Veteran was diagnosed with PTSD in service and therefore, the issue of a verified stressor is moot.

EXAMS FOR CORROBORATED EVENTS

Once the stressor event is corroborated (JSRRC review completed), request a VA examination, if necessary to decide the claim, and ask the examiner to discuss the stressor the Veteran has identified (do not ask the examiner to elicit a stressor).

Refer to Addendum C in this development guide for a Sample VA Exam Opinion for PTSD.

Note: If the Veteran reported receiving treatment, obtain all medical evidence prior to requesting an examination.

Refer to the section entitled Examination of Specific Disabilities & Issues , Topic: PTSD - Initial Evaluation for PTSD versus Review Examination for PTSD, in this development guide for further guidance.

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Note: For Veteran's diagnosed with PTSD in service, the issue of verifying the stressor is moot.  We simply have to advise the examiner that the Veteran was diagnosed with PTSD in service and therefore, the issue of a verified stressor is moot.

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Section 65.6

Post-Traumatic Stress Disorder - Combat

Marine Corps Records_______

REQUESTING VERIFICATION OF STRESSOR EVENTS FROM THE MARINE CORPS HISTORICAL CENTER

Send requests for verification of stressors to the Marine Corps Historical Center (MCHC), if the records required for stressor verification cannot be found in the Virtual VA Marine Corp Unit Records database. Refer to the Marine Corps Records System section in this development guide for further details regarding access to the Marine Corps Unit Records database.

Note: MAPD Third Party Development Letter, PTSD – diagnosed, confirm stressor, to MC Historical Ctr could be used to send a request to MCHC, however, a) the MCHC address element will need to be corrected, b) information listed on page 2 of the fast letter noted above will need to be added, and c) the text of the letter which states, “Also enclosed is a copy of a report of contact or a copy of the Veteran’s statement . . .” must be deleted per the fast letter noted above.

CHANGE FOR REQUESTING VIETNAM ERA MARINE CORPS RECORDS

Previously, the Marine Corps Archives and Special Collections (MCASC) in Quantico, Virginia, processed the VA Regional Offices’ (VAROs) requests for records to corroborate claimed stressors for Vietnam Era Veterans if the VARO could not corroborate the stressor(s) through review of Marine Corps unit records in Virtual VA. Since then, unit records covering the Vietnam Era (1965-1975) have been permanently transferred to the National Archives in College Park, Maryland. Requests for records during this period should now be requested from the following address: National Archives and Records Administration (NARA), Attention: Modern Military Records, 8601 Adelphi Road, College Park, Maryland 20740-6001. Please note that MCASC still maintains records covering 1976 to present.

Reference: C&P Service Bulletin, October 2008

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Section 65.7Post-Traumatic Stress Disorder - Combat

Relaxation of Evidentiary Standard for Establishing In-Service Stressors in Claims for Posttraumatic Stress

Disorder_______

The primary result of the amendment of 38 CFR § 3.304(f) is the elimination of the requirement for corroborating evidence of the claimed in-service stressor if it is related to the Veteran’s “fear of hostile military or terrorist activity.” The new regulatory provision requires that:

(1) A VA psychiatrist or psychologist, or contract equivalent, must confirm that the claimed stressor is adequate to support a diagnosis of PTSD;

(2) the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service; and

(3) the Veteran’s symptoms are related to the claimed stressor.

The regulation amendment has no impact on PTSD claims that arise out of in-service diagnoses of PTSD, or PTSD stressors experienced during combat, internment as a prisoner-of-war, or as the result of personal assault.

Reference: Training Letter 10-05, Relaxation of Evidentiary Standard for Establishing In-Service Stressors in Claims for Posttraumatic Stress Disorder – 38 CFR § 3.304(f)(3), dated July 16, 2010

ESTABLISHING THE OCCURRENCE OF A STRESSOR EVENT

VA will now rely on a Veteran’s lay testimony alone to establish occurrence of a stressor related to hostile military or terrorist activity, provided that the claimed stressor is consistent with the places, types, and circumstances of service, and a VA psychiatrist or psychologist, or contract equivalent, determines that the claimed stressor is adequate to support a PTSD diagnosis and that the Veteran’s symptoms are related to the claimed stressor.

The new § 3.304(f)(3) defines “fear of hostile military or terrorist activity” to mean that a Veteran experienced, witnessed, or was confronted with an event or circumstances that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others and the Veteran’s response to the event or circumstances involved a psychological or psycho-physiological state of fear, helplessness, or horror. The event or circumstances include (but are not limited to) the following:

Actual or potential improvised explosive device (IED);

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Vehicle-imbedded explosive device; Incoming artillery, rocket, or mortar fire; Small arms fire, including suspected sniper fire; or Attack upon friendly aircraft

Utilization of JSRRC and other outside entities for stressor verification purposes will be primarily limited to PTSD cases involving noncombat and personal assault stressors.

In PTSD claims under new § 3.304(f)(3), stressor development may only need to be conducted if a review of the available records, such as the Veteran’s DD Form-214 or other service records, is inadequate to determine that the Veteran served in a location involving “hostile military or terrorist activity.”

Reference: Training Letter 10-05, Relaxation of Evidentiary Standard for Establishing In-Service Stressors in Claims for Posttraumatic Stress Disorder – 38 CFR § 3.304(f)(3), dated July 16, 2010

VCAA NOTICE LETTERS AND VAF FM 21-0781

The Veterans Claims Assistance Act (VCAA) notice letters used for PTSD claims include VA Form 21-0781, Statement in Support of Claim for Service Connection for Post Traumatic Stress Disorder. We will continue to require that this form be attached to VCAA notice letters, as Veterans must provide us with an account of their in-service stressors.

Reference: Training Letter 10-05, Relaxation of Evidentiary Standard for Establishing In-Service Stressors in Claims for Posttraumatic Stress Disorder – 38 CFR § 3.304(f)(3), dated July 16, 2010

REOPENING PREVIOUSLY DENIED SERVICE CONNECTION CLAIMS

For claims to reopen a previously denied service connection PTSD claim, new and material evidence will be required as the regulatory amendment is not considered a liberalizing rule under 38 C.F.R. § 3.114. To reopen a claim under new § 3.304(f)(3), VA will accept a Veteran’s lay statement regarding an in-service stressor – “fear of hostile military or terrorist activity” – as sufficient to constitute new and material evidence for the purpose of reopening a previously denied claim, if the Veteran’s record otherwise shows service in a location involving exposure to “hostile military or terrorist activity.” If review of the record discloses a previously submitted lay statement demonstrating “fear of hostile military or terrorist activity,” such statement will be sufficient for reopening a claim if the Veterans’ record otherwise demonstrates service in a location involving exposure to “hostile military or terrorist activity.”

A new VA examination may not be necessary in cases where a Veteran is filing a claim to reopen a previously denied service connection PTSD claim, current VA treatment records show a PTSD diagnosis, and there was a PTSD diagnosis in the evidentiary record in

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conjunction with a previous claim. If the previous denial was based upon inability to establish the occurrence of the claimed stressor, a new VA examination may not be required if the diagnosis was based on, or included a reference to, the Veteran’s fear of hostile military or terrorist activities and there are current treatment records, including private treatment records, that are sufficient to assign a disability evaluation.

Reference: Training Letter 10-05, Relaxation of Evidentiary Standard for Establishing In-Service Stressors in Claims for Posttraumatic Stress Disorder – 38 CFR § 3.304(f)(3), dated July 16, 2010

VA EXAMINATION GUIDELINES

Regional office personnel requesting PTSD examinations must temporarily add the following language to examination requests in order to ensure that examiners are aware that if a diagnosis of PTSD is made, the examiner must now also determine if the Veteran’s claimed stressor is related to the Veteran’s fear of in-service hostile military or terrorist activity.

Examiner,In addition to the other information provided in the examination report, please specifically state whether or not the claimed stressor is related to the Veteran’s fear of hostile military or terrorist activity.

Reference: Training Letter 10-05, Relaxation of Evidentiary Standard for Establishing In-Service Stressors in Claims for Posttraumatic Stress Disorder – 38 CFR § 3.304(f)(3), dated July 16, 2010

PTSD EXAMINATIONS AND THE NEW “FEAR-BASED” STRESSOR REGULATION

The new posttraumatic stress disorder (PTSD) regulation at 38 CFR 3.304(f)(3) allows a Veteran’s lay statement alone to establish the occurrence of a claimed in-service stressor when:

it is related to fear of hostile military or terrorist activity, and

a VA psychiatrist or psychologist, or contract equivalent, confirms that the claimed stressor is adequate to support a diagnosis of PTSD, and

the Veteran’s symptoms are related to the claimed stressor.

This regulation shifts much of the stressor verification process from RO personnel to the VA medical examiner, resulting in the examination report taking on increased significance for resolving the claim. Issues related to the examination process are covered in Training Letter 10-05, Relaxation of Evidentiary Standard for Establishing In-Service Stressors in Claims for

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Posttraumatic Stress Disorder. However, we have received a number of specific questions regarding when an examination should be scheduled and how it should be evaluated.

Scheduling PTSD Examinations

The threshold for scheduling a VA examination in “fear-based” PTSD claims is relatively low, but ROs are obligated to first verify that the places, types, and circumstances of the Veteran’s service are consistent with an environment where a fear stressor associated with hostile military or terrorist activity may have occurred. This is a case-by-case determination based on duty locations and service or campaign medals received, among other factors. A specific question was whether receipt of the Vietnam Service Medal or Vietnam Campaign Medal, as evidence of service in a hostile military environment, is sufficient to schedule a PTSD examination. Compensation Service has determined that receipt of either of these medals would constitute service in a potentially hostile military environment and therefore would qualify the Veteran for a PTSD examination. This includes receipt of these medals for service aboard a ship in the offshore “blue waters” of Vietnam or for service in Thailand. This is justified because the “fear-based” PTSD regulation is intended to encompass military service not involving direct combat but where there was always a potential for hostile military or terrorist activity, as was the case in the Southeast Asia Theater of operations during the Vietnam War.

Reference: C&P Bulletin, April 2011

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Section 65.8Post-Traumatic Stress Disorder - Combat

PTSD Not Diagnosed at VA Exam_______

What if the “fear-based” PTSD examination report involves a scenario where a mental disorder other than PTSD is diagnosed? Is the fear-based stressor, which is accepted by the examiner as having occurred during service, sufficient to service connect the examiner’s diagnosis of a non-PTSD psychiatric condition, such as depression or generalized anxiety disorder?

The answer is “no” because section 3.304(f)(3) was written specifically for, and applies only to, PTSD. If the diagnosis is something other than PTSD, then the general requirements for service connection apply. In such cases, a current disability has been diagnosed and a medical nexus provided by the examiner, but no in-service disease, injury, or event has been established. And, neither the Veteran’s lay statement nor the examiners subjective acceptance is sufficient to establish occurrence of the in-service disease, injury, or event. However, since this was initially a PTSD claim, RO personnel can proceed with the usual development/research to corroborate the event in the same manner as a claimed stressor. If credible supporting evidence can be obtained for the event, its occurrence would be established. Service connection would then be possible for depression or generalized anxiety disorder because the examiner has already provided a diagnosis and medical nexus.

Reference: Compensation Service Bulletin, April 2011

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Section 65.9Post-Traumatic Stress Disorder - Combat

Service Connection for In-service Posttraumatic Stress Disorder (PTSD) as Related to a Pre-service Stressor

_______

What if the “fear-based” PTSD examination report involves a scenario where a mental disorder other than PTSD is diagnosed? Is the fear-based stressor, which is accepted by the examiner as having occurred during service, sufficient to service connect the examiner’s diagnosis of a non-PTSD psychiatric condition, such as depression or generalized anxiety disorder?

The Veterans Benefits Administration (VBA) will amend 38 C.F.R. § 3.304(f) to clarify that service connection may be granted for PTSD when first manifesting in service and is related to a pre-service stressor.

Until that revision is finalized, regional offices (ROs) may grant service connection for PTSD when first manifesting in service and related to a pre-service stressor under the 38 U.S.C. § 1110, which is the statute containing the general criteria for establishing service connection for a chronic disability.

When PTSD first manifests in service as the result of a pre-service stressor, do not cite 38 C.F.R. § 3.304(f) , as the current language of the regulation clearly limits establishing service connection for PTSD to an in-service stressor. See Arzio v. Shinseki, 602 F.3d 1343 (Fed. Cir. 2010). Also, reference to 38 C.F.R. § 3.303(a) should not be made in pre-service stressor PTSD claims. Accordingly, Compensation Service is rescinding Fast Letter 99-85, Service Connection for Posttraumatic Stress Disorder (PTSD) diagnosed In-Service, which contains such instructions.

The existence of a pre-service stressor does not rebut the presumption of soundness under 38 U.S.C. § 1111 for a claim involving an in-service diagnosis of PTSD. The mere existence of a pre-service stressor is insufficient to clearly and unmistakably establish that PTSD existed prior to service and was not aggravated by such service.

Reference: Compensation Service Bulletin, April 2013

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CHANGES

Change 4, February 4, 2005, added guidance regarding the failure to provide a PTSD questionnaire may result in the denial of the claim; added Close Combat Badge to the list of decorations considered to be evidence of participation in a stressful event; provided guidance regarding development for Marine Corps stressor events; provided guidance regarding development to USASCURR.

Change 5, March 14, 2005, references incorporated within each topic; added guidance as to selecting Initial Review examination worksheet versus Review examination worksheet.

Change 6, April 25, 2005, added guidance regarding development for medical evidence and VA examinations.

Change 7, May 26, 2005, added guidance regarding development for verification of stressor event for Marine Corp Veterans; topic entitled “Requesting Verification of Stressor Events from the Marine Corps Historical Center.”

Change 8, June 13, 2005, added sample letter to MCHC for a Determination as to the Availability of Records Required to Verify a Claims Stressor.

Change 9, July 5, 2005, reformatted the section and added guidance from the CURR Stressor Verification Guide.

Change 10, September 12, 2005, added guidance regarding the use of VA Form 21-0781, Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD) in lieu of the MAPD PTSD questionnaire.

Change 11, January 1, 2006, references incorporated with each topic.

Change 12, March 10, 2006, added M21-1MR references.

Change 13, August 14, 2006, added guidance regarding development for verification of the new Gulf War medals.

Change 14, August 16, 2006, deleted reference to MAPD Third Party letter, PTSD – diagnosed,confirm stressor, to USASCURR; added guidance regarding MAPD Third Party letters, PTSD – request copy of Vet Center records, and PTSD – diagnosed, confirm stressor, to USMC Quantico.

Change 15, November 23, 2006, updated procedures and references.

Change 16, May 24, 2007, clarification provided regarding when to request the personnel file in the event the Veteran contends receipt of a decoration, but the DD Form 214 (or other evidence) does not show receipt of the decoration.

Change 17, June 25, 2007, added guidance for creating a tracked item when the claim is pending review by the JSRRC Coordinator.

Change 18, August 29, 2007, updated references.

Change 19, September 19, 2007, updated references and added guidance regarding exam requests for conceded stressor events.

Change 20, November 1, 2007, added guidance regarding Combat Status, Lay Evidence and Buddy Statements (General Guidance section).

Change 21, January 26, 2008, added guidance regarding diagnosis of PTSD during military service.

Change 22, April 16, 2008, added M21-1MR reference regarding development for buddy statements; added guidance regarding development for in-service mental health treatment records.

25

Change 32July 3, 2013

Change 23, October 1, 2008, added guidance regarding development for in-service mental health treatment records, in-service initial diagnosis of PTSD, corroboration of in-serice stressors not based on combat.

Change 24, October 30, 2009, added guidance regarding the Army Aircraft Member Badge which may indicate participation in combat with the enemy.

Change 25, April 30, 2010, added guidance from the STAR Rating Call Q&As regarding verification of a stressor when the Veteran claims having witnessed the death of another.

Change 26, July 18, 2010, added guidance from TL 10-05, which addresses the amended 38 CFR 3.304(f) which eliminates the requirement for corroborating evidence of in-service stressors if the claimed stressor is related to a Veteran's "fear of hostile military or terrorist activity.”

Change 27, October 15, 2010, added guidance Global War on Terrorism Expeditionary Medal, Global War on Terrorism Service Medal, Afghanistan Campaign Medal, or Iraq Campaign Medal outlined in M21-1MR.

Change 28, February 14, 2011, added guidance regarding exams requested per TL 10-05, Relaxation of Evidentiary Standard for Establishing In-Service Stressors in Claims for Posttraumatic Stress Disorder.

Change 29, April 25, 2011, updated examination guidelines.

Change 30, April 4, 2013, updated guidance regarding claims for PTSD but the VA examiner provides a diagnosis for some other mental disorder.

Change 31, April 26, 2013, added guidance regarding Service Connection for In-service Posttraumatic Stress Disorder (PTSD) as Related to a Pre-service Stressor from the April 2013 Compensation Service Bulletin.

Change 32, July 3, 2013, updated guidance to reflect 10-days for the follow-up development letter for stressor event if the Veteran provides insufficient information.

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Change 17January 20, 2014

Section 66

Post-Traumatic Stress Disorder (PTSD) – Personal Assault

_______

To establish service connection for PTSD, there must be credible evidence to support the Veteran’s assertion that the stressful event occurred (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 16d).

Service connection for post-traumatic stress disorder (PTSD) requires medical evidence diagnosing the condition; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible evidence that the claimed in-service stressor occurred. (38 CFR 3.304(f)).

MILITARY SEXUAL TRAUMA REFERENCE

On July 15, 2010, C&P Service released Fast Letter 10-25, Corroborating Military Sexual Trauma (MST) Using DD Form 2910, Victim Reporting Preference Statement, or Similar Forms. This letter provides additional guidance on MST and authorizes ROs and Pension Management Centers (PMC) to accept DD Form 2910, Victim Reporting Preference Statement; DD Form 2911, Forensic Medical Report: Sexual Assault Examination; and other similar DoD forms as corroborating evidence of a report of MST. The fast letter also provides instructions on development to Veterans and DoD. Decision makers must weigh the evidence of DD Forms 2910 or 2911 in determining whether a sexual assault occurred.

Guidance regarding telephone development and letter development are contained in Fast Letter 10-25, dated July 15, 2010, Subj: Corroborating Military Sexual Trauma (MST) Using DD Form 2910, Victim Reporting Preference Statement, or Similar Forms.

Development of a claim for service connection for PTSD based upon Military Sexual Trauma (MST) is contained in Training Letter 05-04, dated November 10, 2005, Subj: Military Sexual Trauma Training Material.

IMPROPER DEVELOPMENT OF MILITARY SEXUAL TRAUMA (MST) CLAIMS

An element of review for Compensation Service and the Office of Inspector General (OIG) has been the processing of MST claims. Noted errors in processing include a lack of documented phone call reports to the Veteran by the Women Veterans Coordinator (WVC). Per FL 10-25, Corroborating MST Using DD Form 2910, Victim Reporting Preference Statement, or Similar Forms, the WVC should contact the Veteran via telephone and ask if s/he completed DD Form 2910, DD Form 2911, or other similar form after the alleged

1

Change 17January 20, 2014

incident. Proceed to document the contact on VA Form 21-0820, Report of General Information.

Following telephone contact, the 5103 notice will be sent to the claimant to include normal personal trauma development AND the additional paragraphs in the FL specific to MST, dependent on whether or not the incident report filed was ‘restricted’ or ‘unrestricted.’ If the WVC is unable to contact the Veteran, development of evidence should be continued by using the ‘restricted’ report paragraphs in the FL.

ROs should ensure that documented VA Form 21-0820s are of record if contact has been made with the Veteran and that all appropriate elements of MST development are included in the 5103 notice.

Reference: Compensation Service Bulletin, December 2013

INITIAL DEVELOPMENT ACTIONS

If the Veteran submits a stressor statement that is related to personal trauma, forward the claim to the Rating Team RVSR for review. If there is evidence to support the claimed stressor, the RVSR will prepare a memorandum outlining the stressor and the evidence identified that corroborates the claimed stressor.

Note: JSRRC coordinators are not required to review personal trauma/noncombat PTSD stressor events.

If the Veteran has not provided sufficient evidence (questionnaire/statement) to corroborate a claims in-service stressor, send MAPD Special Issues Claimant Letter, 1) PTSD - Need stressor details/med evid personal trauma incdnt; 2) PTSD - Notice - free treatment for PTSD personal assault; and 3) PTSD - Notice - info re PTSD Women Vet Coord. Be sure to include the VA Form 21-0781(a).

In accordance with M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 14d, we are required to “Inform the Veteran that the information is necessary to obtain supportive evidence of each of the stressful events and failure to respond or an incomplete response may result in denial of the claim.” Add the following sentence to the bullet entitled, “Complete the enclosed questionnaire:”

This information is necessary to obtain supportive evidence of each of the stressful events. An incomplete response or failure to respond may result in denial of your claim.

Note: PTSD claims cannot be denied if it is based on in-service personal trauma without first advising the claimant that evidence from sources other than service treatment records (STRs), such as evidence of behavioral changes, which may constitute credible supporting evidence of the stressor. VA Form 21-0781(a) contains this language.

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Change 17January 20, 2014

Submit PIES Request Code O18 (Request the Veteran’s entire official military personnel file (OMPF). Print a copy of the PIES request to be flip-filed in the center section of the C-file.

Select MAPD Third Party Development pick, “Personnel rcds-personal trauma” to create a tracked item.

Request any medical records the Veteran indicates (i.e. private medical evidence, military outpatient treatment reports, etc.). Request hospital reports and clinical records if the Veteran indicates pertinent treatment in a Department of Veterans Affairs (VA) facility, Vet Center, or elsewhere (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 14a).

If the Veteran reports having received treatment from a Vet Center, Send MAPD Third Party Development Letter, PTSD – request copy of Vet Center records.

Refer to Medical Evidence Development Section in this development guide for further details regarding development for federal and non-federal medical evidence.

If the Veteran provides the name of a person who has knowledge of the condition/event but did not provide a complete address, send MAPD Compensation Claimant Letter, Buddy mentioned – No complete address. See M21-1MR, Part III, Subpart iii, Chapter 1, Section C, 14e for guidance regarding development for buddy statements.

A stressor may be verified by non-medical records, buddy statements, witness statements, etc. If relying on buddy statements, verify the buddy’s presence in the combat situation. See M21-1MR, Part III, Subpart iii, Chapter 2, Section E, Topic 35d (Verifying Service of Affiants for procedures to verify buddy statements.

Do NOT request a VA examination until the stressor event is corroborated/verified (M21-1MR, IV.ii.1.D.15a).

CONTINUITY

Although PTSD may be recognized as having its onset at any time, continuity must be requested for all claims for service connection. Reference M21-1MR, Part IV, Subpart ii, Chapter 1, Section A, 2d.

Send a notice letter to the claimant requesting continuity.

For further information regarding Continuity, refer to the Terms & Definitions Section in this development guide.

ALTERNATIVE SOURCES OF INFORMATION

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Change 17January 20, 2014

Service records not normally requested may be needed to develop this type of claim. Responses to the development letter requesting details concerning the personal assault may identify additional information sources; see M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 13k for further guidance.

Other types of evidence may include mental health counseling center reports, pregnancy tests, tests for sexually transmitted diseases, statements from family members, roommates, fellow service members, or clergy (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 17g).

OBTAINING POLICE REPORTS

Obtain any reports from the military police, shore patrol, provost marshal's office, or other military law enforcement. Development may include phone, fax, e-mail, or correspondence as long as documented in the file (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 17h).

SUBSEQUENT DEVELOPMENT

If the Veteran fails to respond within 60 days to the initial request for information (e.g. VAF 0781-1) about the claimed stressful event, send a 30-day follow-up letter requesting information as described in M21-1MR Part IV, Subpart ii, 1.D.15.c. (M21-1MR.IV.ii.1.D).

If the Veteran submits insufficient information in response to the initial request for information, send a 10-day follow-up letter explaining 1) what information is missing, and 2) why the information is needed (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 15n).

Do NOT request a VA examination until the stressor event is corroborated/verified (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 15a).

PTSD QUESTIONNAIRE/STRESSOR STATEMENT NOT RECEIVED

If the Veteran fails to provide a questionnaire/stressor statement after the initial request and has not responded within 30 days to the follow-up letter, or submits information that is still insufficient, refer the case to the JSRRC coordinator to make a formal finding that sufficient information required to corroborate the claimed stressor(s) does not exist (M21-1MR, Part IV, Subpart ii, Chapter 1, Section D, Topic 15n).

CREATING A TRACKED ITEM FOR MST COORDINATOR REVIEWS

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Change 17January 20, 2014

Following receipt of all evidence (to include a stressor statement from the Veteran), create a tracked item in MAPD (see bulleted items below) and forward the claims folder to the JSRRC Coordinator for review. In the event the Veteran has not provided a questionnaire/stressor statement following the initial and subsequent request, create a tracked item in MAPD and forward the claims folder to the JSRRC Coordinator.

Create a MAPD 3rd Party tracked item by clicking on the “Add” button (middle of the screen, last button below the arrows)

On the Add View Paragraph screen, suspense the action for 30 days, and select letter heading “Claimant Letter - No Introduction.” In the Development Action line, enter “MST Coordinator Review Pending.” In the Paragraph Text box, enter “Created for tracking purposes only.” Click “OK” button.

On the 3rd Party Development Screen in the Addressee area, click the “Add/Edit” button (otherwise an error message will be received if an address is not added); on the Organization line, enter Team Designation (e.g. 27D1, 27D2, etc.) and click the “OK” button; then click the “To Continue” button.

On the Print Letter screen, click on the “Word” button; delete the contents of the letter and add the following statement: “This letter was created for tracking purposes only.” Click “Done with Development” button.

REQUESTS FOR VA EXAMINATION

Once all the evidence is received, refer the claim to the Rating Team RVSR for review of the evidence and determination as to whether a VA examination is warranted.

Complete the following actions if an RVSR has determined there is credible supporting evidence of the personal assault to warrant a VA examination:

Send MAPD Compensation Letter, Notice – VA exam is being scheduled for you. See VA Examination section for further details.

Select MAPD Third Party Development pick, Request Examination, to created a tracked item.

Note: If the Veteran reported receiving treatment, obtain all medical evidence prior to requesting an examination.

Refer to the section entitled Examination of Specific Disabilities & Issues , Topic: PTSD - Initial Evaluation for PTSD versus Review Examination for PTSD, in this development guide for further guidance.

Reference: M21-1MR.IV.ii.1.D.15a

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Change 17January 20, 2014

IN-SERVICE DIAGNOSIS OF PTSD

C&P Service is currently working on revising the pertinent regulations regarding claims where a Veteran was diagnosed with Post Traumatic Stress Disorder (PTSD) while on active duty. In the interim, stations are requested to use the guidance provided under 38 CFR 3.303, rather than 3.304(f), to adjudicate claims involving an in-service diagnosis of PTSD.

C&P Service is preparing a Fast Letter that will provide additional, detailed guidance. Until the Fast Letter is released, please rely on the policy statement and procedural guidance below.

C&P Service Policy Statement: If a Veteran was diagnosed with PTSD while on active duty, that diagnosis is sufficient to warrant an examination for the condition without additional preliminary development.

Interim Procedures: If Service Treatment Records (STR) indicate a diagnosis of, or treatment for, PTSD, schedule an original PTSD examination. If the STR do not contain the mental health records to show who diagnosed the condition and the reason for the diagnosis, use the remarks section of the examination request to ask the examiner to confirm the diagnosis and attempt to elicit information about the stressful event(s).

Reference: DUSB Conference Call Summary, January 23, 2008

CHANGES

Change 2, July 16, 2004, reformatted the development actions regarding the MAPD letter with a reminder to include the appropriate questionnaire.

Change 3, March 14, 2004, added guidance as to selecting Initial Review examination worksheet versus Review examination worksheet.

Change 4, April 25, 2005, added guidance regarding development for evidence and parameters for requesting a VA examination.

Change 5, April 28, 2005, added guidance from M21-1, Part III, 5.14c(2)(a) which requires a notice to the Veteran that failure to provide a complete questionnaire may result in denial of the claim.

Change 6, September 12, 2005, added guidance regarding the use of VA Form 21-0781a, Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD) Secondary to Personal Trauma in lieu of the MAPD PTSD questionnaire.

Change 7, January 1, 2006, references incorporated within each topic; added topic entitled, “Military Sexual Trauma.”

Change 8, March 10, 2006, added M21-1MR references.

Change 9, November 26, 2006, updated procedures and references.

Change 10, June 25, 2007, added guidance for creating a tracked item when the claim is pending review by the MST Coordinator (RVSR).

Change 11, August 29, 2007, added additional guidance regarding the referral of MST claims to the Pre-Determination Team RVSR.

6

Change 17January 20, 2014

Change 12, January 26, 2008, added guidance regarding diagnosis of PTSD during military service.

Change 13, April 16, 2008, added M21-1MR reference regarding development for buddy statements.

Change 14, September 17, 2009, added guidance regarding development for evidence from sources other than STRs.

Change 15, July 18, 2010, added guidance regarding telephone development and letter development contained in FL 10-25.

Change 16, July 3, 2013, updated guidance to reflect 10-days for the follow-up development letter for stressor event if the Veteran provides insufficient information.

Change 17, January 20, 2014, added guidance from the December 2013 Compensation Service Bulletin regarding improper development of Military Sexual Trauma (MST) Claims.

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Change 11May 5, 2011

Section 67

1151 ClaimsClaims for Compensation Due to Treatment

at a VA Facility (38 USC 1151)_______

Benefits are payable for additional disability or death caused by VA hospital care, medical or surgical treatment, or examination only if VA fault or "an event not reasonably foreseeable" proximately caused the disability or death. Benefits are also payable for disability or death caused by VA's training and rehabilitation services or compensated work therapy.

Reference: 38 CFR 3.361, Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical or surgical treatment, examination, training and rehabilitation services, or compensated work therapy program for claims received on or after October 1, 1997.

Reference: 38 CFR 3.358, Compensation for disability or death from hospitalization, medical or surgical treatment, examinations or vocational rehabilitation training (§3.800) for claims received before October 1, 1997.

Reference: 38 CFR 3.800, Disability or death due to hospitalization, etc., for claims received before October 1, 1997.

Determine if the claim is a claim under 38 U.S.C. 1151 or if it is secondary claim. The claim is secondary if the claimed disability is the result of treatment for a service connected condition.

MAP-D ENTRIES (VCAA NOTIFICATION , CLAIMS REQUIREMENTS & DEVELOPMENT OF CLAIMS)

Enter “1151 Claim” on the MAPD Contentions Screen

Update the Medical column to “No” (do not request continuity)

Select the WTEMS law – “Compensation due to 1151” or “DIC 1151”

The Veteran must provide date and location of treatment.

For further guidance, refer to M21-1MR, Part IV, Subpart ii, Chapter 1, Section A, Topic 3g and M21-1MR, Part IV, Subpart ii, Chapter 2, Section G

VA RECORDS

Request information from the VA medical facility involved:

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Change 11May 5, 2011

Select a locally prepared letter or utilize CAPRI (see reference below) – PCGL Local letter ROGDV-12 is available.

Although M21-1MRIV.ii.1.A.3.g directs the development for evidence from the VA medical facility be accomplished with a locally generated letter, the MAPD letter cited above could be utilized.

For General Information on Entitlement to Benefits Under 38 U.S.C. 1151, Determining Entitlement to Benefits Under 38 U.S.C. 1151, and Preparing a Rating Decision Involving a Claim for Benefits Under 38 U.S.C. 1151, refer to M21-1MR, Part IV, Subpart ii, Chapter 2, Section G.

REQUESTS FOR SERVICE RECORDS

If service treatment records and verification of service are not of record, submit a request for the records.

Submit PIES Request Code M01 or DPRIS request for the service treatment records.

Submit PIES Request Code S01 or DPRIS request for the verification of service.

Print a copy of the PIES request to be flip-filed in the center section of the C-file.

VA EXAMINATION GUIDELINES

Refer a claim under 38 U.S.C. 1151 to a Rating RVSR for review and determination as to whether or not a VA examination and/or opinion should be requested. (M21-1MRIII.iv.3.A.9.a; M21-1MRIII.ii.7.3.b and M21-1MRIII.ii.7.5.c)

Before requesting a VA examination, obtain all treatment reports.

The VA examination request must include the following statement:

This is an 1151 claim…

Send the C-file to the VAMC when scheduling the examination.

Send MAPD Compensation Letter, Notice – VA exam is being scheduled for you. See VA Examination section for further details.

Select MAPD Third Party Development pick, Request Examination, to create a tracked item.

Reference: Instructions for Providing Medical Opinions - Claims Under 38 U.S.C. 1151, M21-1MRIII.iv.3.A.9.e

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Change 11May 5, 2011

NOTE: Do not request an examiner under VA's contract examination program to provide an examination or medical opinion on a claim involving benefits under 38 U.S.C. 1151. (M21-1MRIII.iv.3.A.9.e)

NO SPECIFIC DISABILITY CLAIMED

If the Veteran does not provide a specific disability,

Send development letter requesting the name of the disability.

If no response in 30 days, refer to Failure to Prosecute Section of this guide for further details.

Note: If “exposure” is the only allegation, the claims is not substantially complete and should not be controlled. (See M21-1MR, Part I, Chapter 1, Section B, Topic 3b, for information on handling incomplete claims.)

CHANGESChange 2, January 31, 2004, incorporated changes from FL 04-26.Change 3, January 1, 2006, references incorporated with each topic; added guidance regarding claims requirements and development of claims.Change 4, February 24, 2006, modified topic entitled “Certified VA Records”; changed the text “Send the claimant. . .” to read “Send a request to the VA Medical Center . . . “Change 5, April 3, 2006, added additional 38 CFR references.Change 6, July 5, 2006, added M21-1MR references; added guidance regarding requests to the Veteran for the date location and description of the incident by using the MAPD Add function rather than the MAPD Claimant letter, 1151-need date, location, description of incident, which has been deleted; added guidance regarding the use of MAPD third party development pick, 1151 development to VAMC, and deleted the requirement to send a PCGL letter for treatment reports.Change 7, October 12, 2006, deleted the requirement to send the MAPD letter when requesting VA treatment records; added the requirement to send a local PCGL letter when requesting VA treatment records in accordance with the M21-1MR reference.Change 8, March 8, 2007, deleted the reference to FL 04-26 which has been rescinded; the regulatory changes have been incorporated into the Code of Federal Regulations.Change 9, April 16, 2009, added guidance regarding MAPD paragraphs to be used to obtain the date, location, and description of the incident and to request treatment reports from VA medical facilities.Change 10, December 2, 2010, added additional guidance regarding MAPD selections; VA records; and service records.Change 11, May 5, 2011, deleted references to MAPD development letters.

3

Change 3October 30, 2009

Section 68

Chemical, Biological, Radiological, Nuclear and Explosives Claims

_______

VA has notified potential beneficiaries about the exposure of certain service members to chemical and biological warfare agents (i.e., Project 112/SHAD and mustard gas) during service. The Department of Defense has released a Chemical, Biological, Radiological, Nuclear, and Explosives (CBRNE) database which contains the names of several thousand service members who were exposed to one or more of at least 140 chemical or biological agents during tests conducted at Edgewood Arsenal in Maryland.

NO SPECIFIC DISABILITY CLAIMED

If the Veteran alleges exposure but claims no specific disability, inform the Veteran that exposure is not a disability. Tell the Veteran to specify the disabilities resulting from exposure and to submit medical evidence of the earliest manifestations of symptoms together with evidence of continuity of treatment.

Send development letter requesting the name of the disability.

Claims that allege exposure to a chemical or biological agent, but do not attribute the development of a specific disability or disease to said exposure, are not substantially complete and should not be controlled. Reference: Training Letter 06-04, dated September 12, 2006, Subj: Department of Defense (DoD) Identifies Additional Service Members Who Participated in the Testing of Chemical and Biological Warfare Agents During Service.

If no response in 30 days, refer to Administrative Denials Section of this guide for further details.

Note: If “exposure” is the only allegation, the claims is not substantially complete and should not be controlled. (See M21-1MR.I.1.B.3,.b, for information on handling incomplete claims.)

SPECIFIC DISABILITY CLAIMED

Establish EP 683 in addition to the standard EP (e.g., 010, 110, 020) (see Training Letter 06-04 for further guidance).

Send the Veteran a VCAA notification letter regarding the claimed disability (VBA Notification Letter to Test Participants) and attach a copy of the DOD Fact Sheet (Fact Sheet - Edgewood Arsenal Chemical Agent Exposure Studies: 1955-1975)

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Change 3October 30, 2009

Refer to Medical Evidence Development Section for specific details regarding development for medical records.

E-Mail C&P Service to Verify Participation in CBRNE Testing (see Training Letter 06-04 for further guidance).

If C&P Service responds that the claimant’s name is not in the current CBRNE database, develop for a copy of the Veteran’s personnel file (see Training Letter 06-04 for further guidance).

Upon verification of a Veteran’s participation in CBRNE testing, make a determination as to whether a physical examination is required (see Training Letter 06-04 for further guidance). If an examination is warranted . . .

1. Send MAPD Compensation Letter, Notice – VA exam is being scheduled for you. See VA Examination section for further details.

2. Select MAPD Third Party Development pick, Request Examination, to created a tracked item.

REFERENCE. Training Letter 06-04, dated September 12, 2006, Subj: Department of Defense (DoD) Identifies Additional Service Members Who Participated in the Testing of Chemical and Biological Warfare Agents During Service.

TOXIC CHEMICAL CLAIMS

These types of claims are considered for direct service connection and are usually related to exposure to occupational hazards.

For additional guidance, refer to Training Letter 03-03, Dated April 10, 2003, Subj: Training letter on Iraq conflict claims.

Request VA exam if required

1. Send MAPD Compensation Letter, Notice – VA exam is being scheduled for you. See VA Examination section for further details.

2. Select MAPD Third Party Development pick, Request Examination, to created a tracked item.

CLAIMS BASED ON SERVICE AT NAVAL AIR FACILITY , ATSUGI , JAPAN

Regional office personnel should be aware of the following information in preparation for any disability claims received from Veterans based on service at the Naval Air Facility (NAF) Atsugi, Japan. Official documents show that during the years between 1985 and 2001, personnel at NAF Atsugi were exposed to environmental contaminants. The source

2

Change 3October 30, 2009

was an off-base waste incinerator business owned and operated by a private Japanese company. Known as the Jinkanpo or Shinkampo Incinerator Complex, the operation consisted of a combustion waste disposal complex equipped with four incinerators burning up to 90 tons of industrial and medical waste daily. The complex was located approximately 100 yards south of the NAF Atsugi perimeter and during the spring and summer months the prevailing winds would blow the incinerators’ emissions over the NAF. Environmental assessment reports conducted during the years of incinerator operations stated that there was significant degradation of air quality at the sites sampled and identified the sources as incomplete burning of wastes in uncontrolled incinerators and evaporation of solvents poured onto outdoor waste piles prior to incineration. The identified chemicals of potential concern included: chloroform; 1,2-dichloroethane; methylene chloride; trichloroethylene; chromium; dioxins and furans; and other particulate matter.

Compensation and Pension (C&P) Service has only recently acquired knowledge of NAF Atsugi and its potential health effects on Veterans, as well as Department of the Navy efforts to inform personnel who were stationed there of possible long term health risks. C&P Service will keep regional offices informed of any additional information obtained on the NAF Atsugi situation. In the meantime, all related claims should be evaluated on a case-by-case basis with evidentiary weight given to medical examinations and opinions from both private and VA physicians. In all cases, the benefit of doubt should be provided to the Veteran.

Reference: C&P Service Bulletin, October 2009

CHANGESChange 1, January 1, 2006, references incorporated within each topic.Change 2, October 12, 2006, retitled section and added reference regarding Chemical, Biological, Radiological, Nuclear, and Explosives claims.Change 3, October 30, 2009, added guidance regarding environment contaminants at the Naval Air Facility, Atsugi, Japan.

3

Change 4August 10, 2009

Section 69

Project 112/SHAD Claims_______

The Department of Veteran Affairs, in cooperation with the Department of Defense, has provided guidance regarding claims for compensation for disabilities which are claimed to be the residuals of exposure to hazardous materials during Project Shipboard Hazard and Defense (SHAD).

NO SPECIFIC DISABILITY CLAIMED

If the Veteran alleges exposure but claims no specific disability, inform the Veteran that exposure is not a disability. Tell the Veteran to specify the disabilities resulting from exposure and to submit medical evidence of the earliest manifestations of symptoms together with evidence of continuity of treatment.

Send development letter requesting the name of the disability.

Claims that allege exposure, but do not attribute the development of a specific disability or disease to said exposure, are not substantially complete and should not be controlled. (See M21-1MR, Part I, Chapter 1, Section B, Topic 3b, for information on handling incomplete claims.)

If no response in 30 days, refer to Administrative Denials Section of this guide for further details.

Note: If “exposure” is the only allegation, the claims is not substantially complete and should not be controlled. (See M21-1MR.I.1.B.3,.b, for information on handling incomplete claims.)

SPECIFIC DISABILITY CLAIMED

Establish EP 683 in addition to the standard EP (e.g., 010, 110, 020) (see Fast Letter 02-24 for further guidance).

Send the Veteran a VCAA notification letter regarding the claimed disability.

Refer to Medical Evidence Development Section for specific details regarding development for medical records.

E-Mail C&P Service for Verification of SHAD Participation (see Fast Letter 02-24 for further guidance).

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Change 4August 10, 2009

If C&P Service responds that the claimant is not on the current “SHAD list,” develop for a copy of the military personnel file and DD Form 214 (see Fast Letter 02-24 for further guidance).

Upon verification of a Veteran’s participation in SHAD testing, make a determination as to whether a physical examination is required (see Fast Letter 02-24 for further guidance). If an examination is warranted . . .

1. Send MAPD Compensation Letter, Notice – VA exam is being scheduled for you. See VA Examination section for further details.

2. Select MAPD Third Party Development pick, Request Examination, to created a tracked item.

For further guidance regarding the development of SHAD claims, refer to the Fast Letter 02-24, dated September 26, 2002, Subj: Information and Procedures about SHAD.

CHANGES

Change 1, January 1, 2005, incorporated guidance from Training Letter 04-03.

Change 2, January 1, 2006, references incorporated within each topic.

Change 3, November 22, 2006, updated procedures and references.

Change 4, August 10, 2009, references updated.

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Change 27March 25, 2014

Section 70

Total Disability Individual Unemployability (TDIU) Claims

_______

GENERAL GUIDELINES

As a result of Rice v. Shinseki (2009), TDIU claims are no longer adjudicated as freestanding claims. A TDIU claim may be expressly claimed in conjunction with an original service-connection claim, or with a claim for increased evaluation. If, in connection with a claim for increased compensation, the evidence of record shows evidence of unemployability, and the Veteran meets the schedular criteria for TDIU, then the evidence reasonably raises a TDIU claim.

The following is an overview of changes as the result of Fast Letter 13-13.

• VA will no longer presume a claim for TDIU is a claim for increase in all service-connected disabilities. As part of a substantially complete application for TDIU, VA will require that the claimant with multiple service-connected disabilities specify at least one disability that he or she believes causes the unemployability.

• VA will consider the Veteran’s specification of the disabilities that he or she believes cause unemployability to be claims for increased evaluation for those conditions.

• VA will require the claimant complete and submit VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability, to substantiate the claim of TDIU.

• VA will administratively deny TDIU claims if VA requests, but the Veteran does not submit, required forms or evidence.

• VA has the flexibility to request either condition-specific Disability Benefits Questionnaires (DBQs) or a general medical DBQ when VA determines that examinations are needed to decide the claim.

• VA will interpret the schedular requirements in 38 C.F.R. 4.16(a) to mean that a combined 70 percent rating is only required if no single disability is rated at 60 percent disabling.

Reference: Fast Letter 13-13, Claims for Total Disability Based on Individual Unemployability (TDIU), dated June 17, 2013

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SCHEDULER REQUIREMENTS

38 C.F.R. 4.16(a) provides the schedular requirements for TDIU as follows: “if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more.” However, in some cases, a Veteran will have one disability ratable at 60 percent with an additional disability rated at 0 or 10 percent, and the combined rating will still equal 60 percent. In these cases, consider the schedular requirements to be met. The reference in 4.16(a) to two or more disabilities should be interpreted as applying to cases where no single disability is sufficient to meet the 60 percent criterion.

Reference: Fast Letter 13-13, Claims for Total Disability Based on Individual Unemployability (TDIU), dated June 17, 2013

A grant of individual unemployability requires one service-connected disability at 60% or a combined degree of 70%, with at least one service-connected disability rated at 40% (38CFR 4.16) or have an extra-schedular evaluation approved by the Compensation and Pension Service (211B); and be unemployable in fact by reason of service-connected disability. (M21-1MR, Part IV, Subpart ii, Chapter 2, Section F)

SECTION 5103 NOTICE REQUIREMENTS

Send the Veteran a TDIU-specific Section 5103 notice for all TDIU claims. Include any disability(ies) the Veteran specifies causes the unemployability in the notice as a claim for increase.

Reference: Fast Letter 13-13, Claims for Total Disability Based on Individual Unemployability (TDIU), dated June 17, 2013

For additional guidance, refer to M21-1MR, Part IV, Subpart ii, Chapter 2, Section F.

HANDLING RECEIPT/NON-RECEIPT OF THE VA FORM 21-8940

With regard to receipt of non receipt of a VA Form 21-8940, refer to the tables in Fast Letter 13-13, Claims for Total Disability Based on Individual Unemployability (TDIU), dated June 17, 2013.

Note: Request VA Form(s) 21-4192 for the Veteran’s last year of employment even if the Veteran has not worked for five years or more. Fast Letter 13-13

Note: If the information on VA Form 21-4192 only states that the Veteran retired, then request additional information as to whether the Veteran's retirement was by reason of

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disability. If so, ask the employer to identify the nature of the disability for which the Veteran was retired. Reference: M21-1MR, Part IV, Subpart ii, Chapter 2, Section F, 25.

ADMINISTRATIVE DENIALS

VA will administratively deny TDIU claims if VA requests, but the Veteran does not submit, required forms or evidence. Refer to the tables in Fast Letter 13-13, Claims for Total Disability Based on Individual Unemployability (TDIU), for further guidance.

DEVELOPMENT FOR MEDICAL EVIDENCE

Develop for medical evidence reported on the application form.

The evidence should reflect the Veteran's condition within the past 12 months and include, but need not be limited to, results from a VA examination, hospital reports, or outpatient treatment records.

If the medical evidence of record is incomplete or inconsistent, schedule a medical examination. Request special tests only when required for proper evaluation of the degree of severity of the relevant disabilities.

For additional guidance, refer to M21-1MR.IV.ii.2.F.

SOCIAL SECURITY EVIDENCE REQUESTS FOR INDIVIDUAL UNEMPLOYABILITY CLAIMS

Per M21-1MR IV.ii.2.F.25.f, VBA will consider obtaining Social Security Disability (SSD) records when:

evidence of record is insufficient to award increased compensation based on IU, and

the Veteran’s claims folder shows that the Veteran has been examined or awarded disability benefits by SSA.

FL 13-13, Claims for Total Disability Based on Individual Unemployability (TDIU) , states that VA Form 21-8940, Veteran's Application for Increased CompensationBased on Unemployability, is needed to substantiate the claim of TDIU.

When the Veteran’s record shows that he/she has been awarded disability benefits by SSA, and a VA Form 21-8940 is of record, ROs should obtain the SSD records. However, ROs are not required to request SSD request when a Veteran fails to return VA Form 21-8940. In those cases, the claim is not substantially complete and no further development action is needed.

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Email questions to the VAVBAWAS/CO/212A mailbox. (Reference: Compensation Service Bulletin, March 2014)

VA FORM 21-4192, REQUEST FOR EMPLOYMENT INFORMATION IN CONNECTION WITH CLAIM FOR DISABILITY

VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, is used by VA to request information from a Veteran’s employers as to whether the Veteran’s disability affected his or her employment to include resulting in termination of employment. VA primarily uses the form in developing evidence in determining whether or not a Veteran may be entitled to a total disability evaluation on the basis of TDIU.

Some employers, rather than completing the VA Form 21-4192, have responded to VA’s request for employment information with a statement that the Veteran’s employment can be verified through www.theworknumber.com/socialservices or another related website. These websites require that the user create an account, which is free; however, the information provided is limited to only the dates of employment. No information regarding disability is provided.

Such response is the equivalent of returning the VA Form 21-4192 with necessary information omitted. Aside from the dates of employment, VA also needs to know why the Veteran was terminated and if any concessions were made for disability.

If an employer responds to the VA Form 21-4192 by providing a website, we must follow-up with the employer and again request that the form be completed, allowing an additional 10 days for response. At the same time, notify the Veteran that the employer has failed to provide the complete information contained in VA Form 21-4192 and that a second request to the employer is being made for the information. The Veteran must also be informed that it is his or her ultimate responsibility to provide the information. If no response is forthcoming from the Veteran or employer, the claim should be rated on the evidence of record.

Reference: Compensation Service Bulletin, December 2013

USING WEBSITES TO VERIFY EMPLOYMENT

The Department of Veterans Affairs (VA) uses VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, to request information from a Veteran’s employer as to whether a Veteran’s disability affected his or her employment, including indicating if the disability resulted in termination of employment. VA primarily uses the form when developing for evidence to determining if a Veteran is entitled to a total disability evaluation on the basis of individual unemployability (TDIU).

Rather than completing the VA Form 21-4192, some employers have responded to VA’s request with a statement that the Veteran’s employment can be verified through

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www.theworknumber.com/socialservices or other related websites. These websites have limited value, as they only provide information about the dates of employment. Aside from the dates of employment, VA also needs to know why the Veteran was terminated and if any concessions were made for disability.

In these circumstances, follow-up with the employer requesting that the form be completed and allow an additional 10 days for response. At the same time, notify the Veteran that:

the employer has failed to respond to VA’s request to provide the information contained in VA Form 21-4192,

VA is making a second request to the employer for the information, and

it is his or her ultimate responsibility to provide the information.

If we do not receive a response from the Veteran or employer in the allotted time frame, rate the claim based on the evidence of record.

Reference: Compensation Service Bulletin, September 2010

FOLLOW-UP DEVELOPMENT FOR EMPLOYMENT INFORMATION

If VA Form 21-4192 is not received from the Veteran's employer(s) within 30 days, send a follow-up request to the employer(s) for VA Form 21-4192, allowing an additional 10 days for response, and notify the Veteran that the employer has failed to respond to VA's request, and it is ultimately his/her responsibility to obtain this information.

Reference: M21-1MRIV.ii.2.F.25.e

VOCATIONAL REHABILITATION RECORDS OR SOCIAL SECURITY ADMINISTRATION RECORDS

If the evidence indicates that the Veteran has been seen by the Vocational Rehabilitation and Employment Service (VR&E) or has applied for disability benefits from the Social Security Administration (SSA), these records, to include any decisions and supporting documentation, must be obtained. Reference: Training Letter 10-07, Adjudication of Claims for Total Disability Based on Individual Unemployability (TDIU), dated September 14, 2010.

If available evidence is insufficient to award individual unemployability benefits and the record shows that the Veteran is receiving Social Security benefits because of disability, complete copies of the SSA records must be obtained and considered. For additional guidance, refer to M21-1MR.IV.ii.2.F.

EXAMINATIONS FOR INDIVIDUAL UNEMPLOYABILITY

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VA is not required to provide a general medical examination in connection with every TDIU claim. The decision to request a medical examination or opinion is contingent upon VA’s duty to assist as part of an original disability compensation claim (38 CFR §3.159(c)(4)), or as part of a claim for increased evaluation (38 CFR §3.326). These regulations require VA to provide an examination to a claimant “if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim.”

When developing a claim involving a request for TDIU, normally request condition-specific DBQs for the issue(s) alleged to cause unemployability (e.g., joints, mental, peripheral nerves, etc.). These DBQs should generally be sufficient to fairly and fully adjudicate TDIU claims. Do not order examinations for disabilities not alleged to cause or contribute to unemployability.

Schedule a general medical examination only if the rating activity determines that it is needed to fairly and fully adjudicate the TDIU claim, such as original claims for disability compensation or TDIU claims involving the impact of multiple service-connected and/or nonservice-connected disabilities upon employability.

If the facts of the case require VA to examine the Veteran, do not ask the examiner to opine as to whether or not the Veteran is unemployable due to his or her service-connected disabilities. See M21-1MR, III.iv.3.A.9.f. The responsibility for this decision rests solely with the rating activity (see 38 CFR § 4.16(a)). VA should request that the examiner comment instead on the functional impairment caused solely by the service-connected disabilities.

Reference: Fast Letter 13-13, Claims for Total Disability Based on Individual Unemployability (TDIU), dated June 17, 2013

FUNCTIONAL IMPAIRMENT STATEMENTS. The VA examination request must include one or a combination of the following statements in the remarks section. This request does not have to be prepared in the medical opinion format.

Discuss the Veteran's functional impairment and the types of employment activity that would be limited because of the service connected physical disabilities. Please provide a complete rationale.

OR

Discuss the Veteran's functional impairment and the types of employment activity that would be limited because of the service connected psychiatric disorder. Please provide a complete rationale.

UNEMPLOYABILITY DUE TO PSYCHIATRIC DISABILITY. If the Veteran claims his/her unemployability is due solely to a service-connected psychiatric condition, request only a psychiatric examination and provide the psychiatric I.U. statement (shown below). Otherwise, if the Veteran is service-connected for both physical and psychiatric disabilities,

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make sure the exam request contains both and/or a combination of the I.U. statements (shown below).

Central Office guidance dictates that if the Veteran is only service connected for a psychiatric condition and claims IU based on this condition, it would be appropriate to order only a psychiatric exam without a general medical exam. (e-mail From: VAVBAWAS/CO/21Q&A, Sent: Friday, January 21, 2011 12:42 PM)

LISTING SERVICE-CONNECTED DISABILITIES. If an examination is required, list the disabilities the Veteran claims results in causing the unemployability Any service-connected disabilities which have recently been examined do not need to be re-examined. If in doubt, refer the case to an RVSR.

Nonservice-connected conditions should only be examined when: the claim is also for VA pension benefits, or if there are un-adjudicated presumptive disabilities.

DO NOT ASK FOR LEGAL OPINIONS

Do not request a medical authority to assume any responsibility inherent to the rating activity. Reference: M21-1MR.III.iv.3.A.9.f.

Do not ask, “. . . is the Veteran unemployable?” Do not state the opinions as, "Veteran is claiming individual unemployability, please provide opinion." Instead ask the examiner to comment on the Veteran’s ability to function in his normal occupational environment and to describe functional limitations. NOTE - Asking the examiner to discuss the Veteran's functional impairment and effect on normal occupation is basically an examination question and not a formal medical opinion request. Accordingly, this question may properly be asked in the remarks section without using the formal medical opinion request form. See Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

The examiner could be asked to “describe the extent of functional impairment due to the service-connected disability and how that impairment impacts on physical and sedentary employment.” See Exam Requests, Star Reporter, Volume 2, Issue 6, dated April 2, 2002.

SELF-EMPLOYMENT OR TIGHTLY HELD CORPORATION

Development to produce evidence necessary to establish the degree to which service-connected conditions have impaired the Veteran's ability to engage in self-employment must generally be more extensive than development where the Veteran worked for others. For guidance, refer to M21-1MR, Part IV, Subpart ii, Chapter 2, Section F, Topic 26, Evaluating Evidence of Self-Employment or Employment With a Tightly Held Corporation.

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In the letter to the Veteran, insert the text found in Addendum B, Statement for Self-Employment Cases.

UNEMPLOYABILITY AS AN INFERRED ISSUE

For guidance regarding the development of individual unemployability (IU) as an inferred claim, refer to M21-1MR, Part IV, Subpart ii, Chapter 2, Section F, Topic 25i for guidance.

In situations where IU is inferred and additional evidence is needed, VBA decision makers must now follow these procedures:

Do not establish a new end product (EP) 021 Rate all other claimed issues that can be decided Show the issue of potential IU entitlement as deferred in the rating decision Develop the inferred IU issue under the existing end product, which will remain

pending Send the Veteran VA Form 21-8940 for completion

Every inferred IU claim that is deferred for additional evidence must be resolved by a formal rating decision after either the evidence is received or the notification period expires. If the regional office does not receive a response within 60 days, it still must prepare a formal rating decision. Although there is a failure to reply to our development, a merits determination is still warranted based on the evidence of record and must explain why the benefit is not being granted. Once the rating decision is made and the Veteran is notified, the regional office may take credit for the initial EP established for the claim if all other issues have been decided.

Reference: Fast Letter 08-06, Subj: Revised Procedures for End Product Credit for Select Individual Unemployability Claims, dated February 27, 2008

APPEALS INVOLVING TDIU

If the Veteran has filed a Notice of Disagreement (NOD) regarding an increased evaluation for a service-connected disability while the appeal is pending, the Veteran claims TDIU due, at least in part, to the disability on appeal AND the rating decision denies the TDIU claim the TDIU claim is now part of the pending appeal. VA should send the Veteran a Statement of the Case (SOC) or Supplemental Statement of the Case (SSOC) regarding the TDIU.

If the Veteran filed a NOD on a TDIU evaluation the Veteran subsequently claims that a service-connected disability not on appeal causes unemployability AND the rating decision fails to increase the evaluation to the schedular maximum that disability will also be considered in appellate status. VA should send the Veteran a SOC or SSOC regarding the evaluation of that disability.

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Reference: Fast Letter 13-13, Claims for Total Disability Based on Individual Unemployability (TDIU), dated June 17, 2013

TOTAL DISABILITY DUE TO INDIVIDUAL UNEMPLOYABILITY (TDIU) AND VOLUNTEERING

VA, under the regulatory authority of 38 C.F.R. 4.16 , may grant TDIU to a Veteran in receipt of a less than total scheduler evaluation if the Veteran is unable to secure or follow substantially gainful employment. Substantially gainful employment is defined as employment at which non-disabled individuals earn their livelihood with earnings comparable to the particular occupation in the community where the Veteran resides. See M21-Manual Rewrite (MR) Part IV, Subpart ii, Chapter 2, Section F, Topic24, Block c (M21-1MR IV.ii.2.F.24c).

Some Veterans who are in receipt of compensation on the basis of TDIU participate in volunteer work or activities. Volunteer work alone is not sufficient basis to warrant reduction of a TDIU evaluation. However, the TDIU evaluation may be reduced if the volunteer work and/or other evidence demonstrates that the Veteran is actually capable of employability. (See 38 C.F.R. 3.343(c)(1).)

The Veterans Court, in Faust v. West, 13 Vet.App. 342 (2000), provided guidance in defining employability in holding that employment in a substantially gainful occupation that showed actual employability is as follows: “One that provides annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that the veteran actually works and without regard to the veteran’s earned annual income prior to his having been awarded a 100 percent rating based on individual unemployability.”

The Veteran’s participation in volunteer work must clearly demonstrate that the Veteran can participate in substantially gainful employment. For example, a Veteran that inserts flyers into envelopes for a local charitable organization once or twice a month would not generally be indicative of the capability to secure or follow substantially gainful employment.

However, a Veteran who performs volunteer work that requires marketable abilities or skills that can be utilized over a sustained period to earn a livelihood, may demonstrate ability to secure or follow gainful employment to warrant reduction of a TDIU evaluation under 38 C.F.R. § 3.343(c)(1).

Reduction of a TDIU evaluation must be carefully considered on the basis of all probative evidence of record and in accordance with applicable regulatory authority such as 38 C.F.R.3.105(e) and 3.343(c)(1) regarding reduction of a TDIU evaluation. Please note that 3.343(c)(1) provides special considerations for activities related to vocational rehabilitation, education, training, and VA work therapy programs. To the extent that volunteer work may be involved in any of those programs, the decision to reduce would need to take account of those special considerations.

Reference: Compensation Service Bulletin, September 2013

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CHANGES

Change 3, July 12, 2004, VA examination statements were modified.

Change 4, August 10, 2004, moved the explanation for requesting VA examinations to Section 28 of this guide; provided formatting changes regarding development and follow-up development actions.

Change 5, February 18, 2005, provided guidance regarding the requirement to include all service-connected disabilities in the notification letter along with the VCAA law attachment for increased evaluations. VA examination requirements were added.

Change 6, March 7, 2005, incorporated references into appropriate topics; added guidance with regard to avoiding request for legal opinions.

Change 7, March 14, 2005, guidance added for sending VCAA notification only if the Veteran claims an increase evaluation; guidance added to check with an RVSR before requesting a VA examination if the scheduler requirements are met and the evidence shows the Veteran is unemployable; added guidance regarding IU as an inferred issue.

Change 8, January 1, 2006, references incorporated within each topic.

Change 9, February 6, 2006,added further guidance on processing IU as an inferred issue.

Change 10, June 20, 2006, modified VCAA notification requirements for receipt of a claim for individual unemployability.

Change 11, January 13, 2007, updated manual reference regarding the requirement for VA Form 21-8940.

Change 12, June 12, 2007, added Training Letter 07-01 reference regarding the requirement for a rating decision when the VA Form 21-8940 is not returned by the Veteran.

Change 13, September 27, 2007, updated IU opinion statement used for psychiatric exam requests.

Change 14, October 5, 2007, updated IU opinion statement used for physical exam requests.

Change 15, October 13, 2007, updated reference regarding Evaluating Evidence of Self-Employment or Employment With a Tightly Held Corporation.

Change 16, February 29, 2008, deleted guidance regarding establishment of EP 021 for inferred IU issues and added guidance from FL 08-06.

Change 17, April 13, 2009, added reference regarding RVSR review of Vocational Rehabilitation record.

Change 18, September 14, 2010, added guidance from Training Letter 10-07, Adjudication of Claims for Total Disability Based on Individual Unemployability (TDIU), dated September 14, 2010.

Change 19, January 23, 2011, added additional guidance regarding exams for claims from Veterans for which the only service connected disability is a psychiatric condition.

Change 20, March 28, 2012, removed guidance regarding the transfer of the C-file to the VAMC for TDIU claims.

Change 21, May 7, 2012, added guidance regarding follow-up requests to the employer for VAF 21-4192.

Change 22, October 28, 2012, added guidance regarding “Using Websites to Verify Employment.”

Change 23, May 17, 2013, added guidance regarding phrasing of exam requests as noted in the May 2013 Compensation Service Bulletin.

Change 24, June 19, 2013, added guidance from FL 13-13.

Change 25, September 19, 2013, added guidance from the September 2013 Compensation Service Bulletin regarding TDIU and volunteering.

Change 26, January 20, 2014, added guidance from the December 2013 Compensation Service Bulletin regarding requests for VAF 21-4192.

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Change 27, March 25, 2014, added guidance from the March 2014 Compensation Service Bulletin regarding Social Security evidence requests.

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Section 71

Hearing Loss & Tinnitus Claims_______

When adjudicating claims for service connection for hearing loss and tinnitus, employees should request a VA audiology examination if:

the record contains a current diagnosis of hearing loss or tinnitus or persistent or recurrent symptoms of the disability (which may be satisfied by the Veteran’s lay statement), AND

establishes that the Veteran suffered an injury, disease, or event in service, AND and indicates the current diagnosis of, or recurrent/persistent symptoms of, hearing loss

or tinnitus may be associated with the in-service injury, disease or event.

(See 38 CFR § 3.159(c)(4)).

The courts have recognized that the evidentiary threshold for scheduling a VA examination is very low. (See McLendon v. Nicholson, 20 Vet. App. 79 (2006)).

If the evidentiary threshold under § 3.159(c)(4) has otherwise been met, a Veteran’s military occupational specialty (MOS) does not preclude scheduling a VA examination.

Example: The Veteran had an MOS that was not conducive to noise exposure, but has provided competent lay evidence of in-service noise exposure and a current medical diagnosis of hearing loss (or competent lay statements of persistent symptoms related to hearing loss). Since the provisions of § 3.159(c)(4) have been met, it is appropriate to schedule an audiology examination.

Reference: Compensation Service Bulletin, May 2012

Service connection for hearing loss can be granted if it is incurred in, aggravated by, or, for sensorineural hearing loss, presumptive to military service. Ideally, in establishing service connection, an entrance and discharge audiogram will be in the service treatment records. However, many Veterans do not have both, and the Department of Defense has not always used audiometry. In these claims, an opinion from an audiologist is required before a determination about service connection can be made. Reference: Training Letter 10-02, Adjudicating Claims for Hearing Loss and/or Tinnitus, dated March 18, 2010

AUDIO MEDICAL OPINION REQUEST (VERIS VERSION)

See Addendum Q for a sample format for requesting audio medical opinion requests through VERIS (contract exams).

HEARING LOSS CRITERIA

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In order to be considered a disability for VA purposes, hearing loss must meet the criteria established in 38 CFR 3.385:

“…[I]mpaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent.”

HEARING LOSS DURING SERVICE. If the separation/retirement examination shows hearing loss that meets the VA criteria for hearing loss (38 CFR 3.385), request an examination whether or not the Veteran claimed hearing loss.

If the Veteran claims hearing loss which does not meet the criteria set forth by 38 CFR 3.385, acoustic trauma will be conceded for the purposes of requesting a VA examination and opinion if the Veteran performed duty as a aircraft mechanic, artilleryman, infantryman, boiler mechanic, machinist, etc.

MEDICAL EXAMINATIONS & OPINIONS - DISABILITY BENEFIT QUESTIONNAIRE

DBQ website indicates the following information about the Hearing Loss/Tinnitus DBQ:

Hearing Loss /Tinnitus DBQ worksheet (6/9/11).  When there is a request for an audiology exam and opinion, the Hearing Loss/Tinnitus DBQ should be used. It includes medical opinion in the Etiology section (Section 1, Question 4 and Section 2, Question 3). These opinions are limited to direct service connection nexus issues, i.e. the relationship between diagnosed hearing loss and/or tinnitus and noise exposure during military service.

In cases in which we are only dealing with service connection for hearing loss and/or tinnitus and require a nexus opinion, we should only select the DBQ Hearing Loss/Tinnitus worksheet. We should not also select the DBQ Medical Opinion worksheet.

The Remarks section of the exam request should still include information about military noise exposure, e.g., Veteran's MOS and probability of noise exposure from the DOD spreadsheet (Duty MOS Noise Exposure Listing, Fast Letter 10-35), evidence Veteran was in combat, etc.

DENVER VARO SAMPLE OPINION TEXT

When requesting an Audiological DBQ exam for Hearing Loss and Tinnitus and a medical opinion is required for hearing loss and/or tinnitus, insert the following statement in the remarks section:

"Medical Opinion Required."

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Following this statement, insert information regarding the Veteran’s military specialty and probability of noise exposure as noted on Duty MOS Noise Exposure Listing from Fast Letter 10-35.

Based on discussions with VHA staff, including this statement will greatly assist them in reviewing exam requests and routing the examination request.

SAMPLE:Examine NSC: Hearing LossTinnitus

Medical Opinion RequiredMOS is________, which has a _____ probability of noise exposure.

C-file to follow B3964 (first letter of Veteran's last name, last four of SSN) POA: XXX Input by _____________, ext XXXEnd

DENVER VARO LOCAL PROCEDURES

Attach a routing slip to send the C-file to the appropriate VA medical center. The C-file must accompany the examination when requesting an opinion.

MEDICAL EXAMINATIONS & OPINIONS - GENERAL

These guidelines are standard and are unchanged from existing regulations and procedures.

HEARING LOSS

When is an audiology examination needed? Common needs will be when the record is unclear regarding the presence, severity, type, or etiology of hearing loss, the relationship of two conditions to one another, or the presence of tinnitus. This will often be the case when there is no evidence of calibrated audiometry in the record. Older records (before 1980) frequently contain whispered voice tests which cannot be considered as reliable evidence that hearing loss did or did not occur. Whispered voice tests are notoriously subjective, inaccurate, and insensitive to the types of hearing loss most commonly associated with noise exposure. Also see M21-1MR at III.iv.4.B.12b.

Example #1: A 79 year-old Veteran served as a Marine during the Korean War. He filed a claim for hearing loss based on noise exposure during combat in service. He had a recent VA audiogram showing a moderate to severe bilateral sensorineural hearing loss. He is unsure when his hearing loss began but it has become increasingly noticeable to him in recent years. His participation in combat in Korea is confirmed. There are no service

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treatment records except for normal entrance and discharge exams, and neither included an audiogram, but he had no complaints of hearing loss. An audiologic opinion is needed to determine the likely etiology of his hearing loss, that is, to determine if it is related to his service experiences.

Example #2: A 24 year-old Veteran returned from Iraq in 2007 with some complaints of tinnitus developing a few months after discharge. Her audiogram on separation showed some worsening of hearing at the 3000 and 4000 Hz levels compared to her entrance audiogram, but her hearing impairment did not reach the level required to be considered a disability under § 3.385. An audiology examination and opinion are required to determine 1) if hearing impairment is present that now meets the criteria to be considered a disability under § 3.385, 2) if so, if it is related to service, and 3) if the complaint of tinnitus is related to any hearing loss found. (See below re Hensley v. Brown, 5 Vet.App. 155, 159 (1993).)

Example #3: A 66 year-old Veteran was in service from 1961 to 1965, served in Vietnam as a clerk, and did not experience any combat. He has complained of hearing loss since service, during which time he had multiple middle ear infections of both left and right sides. No discharge audiometry examination is available, but his service treatment records show treatment for otitis media on 3 occasions during 1964-65. He has complained of hearing loss for the past 10 years and filed a claim for hearing loss due to ear infections in service. He has medical records showing treatment for otitis media post-service during 1968 and 1970 but none since. A private audiometry test showed a mixed type of hearing loss in the right ear only and mild sensorineural hearing loss in the left ear. An audiology examination and opinion would be needed to determine if he has hearing loss, the type of hearing loss, and if it is consistent with his ear infections either in service or after service, or both, or is more likely due to another cause.

Example #4: A 69 year-old Veteran served 18 months in Vietnam in 1964 in non-combat duty. He filed a claim in 2009 for sudden onset in 2008 of severe right-sided sensorineural hearing loss that he believes is related to his service-connected diabetes mellitus. One private physician stated that the hearing loss is due to diabetes while another attributed the hearing loss to labyrinthitis. A VA audiologic and ENT examination are needed to clarify the etiology of the hearing loss and any possible relationship to in-service injury, event, or illness, or to his service-connected diabetes.

Reference: Training Letter 10-02, Adjudicating Claims for Hearing Loss and/or Tinnitus, dated March 18, 2010

WHAT NEEDS TO BE INCLUDED IN AN OPINION REQUEST?

When an opinion is requested, identify the evidence to be reviewed, the issue(s) to be addressed, and the claimant’s contentions, and provide a summary of the evidence in the case.

Identify the evidence to be reviewed by stating on the medical opinion request form the source of the evidence, subject matter involved, and approximate dates covered by the evidence, and by tabbing the evidence in the claims folder. Inform the examiner that his or

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her review is not limited to the evidence identified on the request form or tabbed in the claims folder.

Reference: Training Letter 10-02, Adjudicating Claims for Hearing Loss and/or Tinnitus, dated March 18, 2010

IS A C-FILE REVIEW NEEDED?

The C-file must accompany a request for an opinion. A review by regional office (RO) personnel does not substitute for a thorough review of the C-file and other pertinent evidence by the subject matter expert asked to provide an opinion.

Reference: Training Letter 10-02, Adjudicating Claims for Hearing Loss and/or Tinnitus, dated March 18, 2010

WHAT SHOULD THE MEDICAL OPINION REQUEST?

The medical opinion request should not ask the provider to determine if hearing loss or tinnitus is service connected, as this is not the function of the provider. Instead, for example, for direct service connection, the in-service injury, event, or illness, should be identified, as well as the current disability (hearing loss, tinnitus, or both) and the examiner asked to provide an opinion as to whether or not the current disability was caused by or the result of the identified in-service injury, event, or illness, if it is not otherwise clear from the records.

Reference: Training Letter 10-02, Adjudicating Claims for Hearing Loss and/or Tinnitus, dated March 18, 2010

TINNITUS OPINIONS

If service treatment records mention a complaint of tinnitus and the Veteran claims tinnitus and has current complaints of tinnitus, a medical opinion regarding possible causation is not required. Service connection can be established without an opinion about the specific cause of the tinnitus because it began in service.

If there is no record in the service treatment records of tinnitus, but there is a claim or complaint of tinnitus, the audiologist is asked on the examination protocol to offer an opinion about an association to hearing loss, or an event, injury, or illness in service, if it is within the scope of his or her practice.

1) If the examiner states that tinnitus is a symptom that is associated with hearing loss, the tinnitus should be service connected and separately evaluated under diagnostic code 6260 if the hearing loss is determined to be service connected. No additional opinion about the relationship of tinnitus to service is needed.

2) If the examiner states that the tinnitus is not related to hearing loss, it will be up to the regional office to make a determination, based on all the evidence of record, as to whether or not the etiology of tinnitus requires further assessment by one or more additional examinations.

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3) If there is no hearing loss, it will be up to the regional office to make a determination, based on all the evidence of record, as to whether or not the etiology of tinnitus requires further assessment by one or more additional examinations.

4) If the audiologist is unable to determine the etiology with reasonable certainty, it will be up to the regional office to make a determination, based on all the evidence of record, as to whether or not the etiology of tinnitus requires further assessment by one or more additional examinations.

The type of and need for any additional examination(s) will depend on the Veteran’s claim as to the cause of tinnitus. If the Veteran claims tinnitus due to hearing loss, and the examiner says they are not related, no further action is needed. If the Veteran claims tinnitus due to another condition, an appropriate general medical or ENT or other examination and request for an opinion may be warranted. For example, an ENT examination might be needed if tinnitus is due to labyrinthitis, cholesteatoma, etc., is at issue, while a general medical examination would be needed if tinnitus due to an ototoxic drug, hypertension, renal disease, etc., is at issue.

Example #1: The Veteran claims that he has had tinnitus for the past 6 months, and he has been told by his doctor that it is due to chemotherapy for a service-connected malignancy. He was treated with surgery and chemotherapy for malignant sarcoma of a muscle of the left arm in service 4 years ago. This determination is not within the scope of an audiologist's practice, and therefore the regional office should request an opinion about the association from another appropriate non-audiologic provider.

Example #2: The Veteran claims tinnitus due to kidney disease and hypertension. He was discharged in 1997, and neither service nor post-service treatment records indicate evidence of kidney disease or hypertension until 2005. There is no record of hearing loss in or after service. No further examination or opinion would be needed to determine the relationship of tinnitus to service, and service connection would be denied.

Example #3: The Veteran claims tinnitus and first complained of it in 2002. He was discharged in 2001. He also has a mixed hearing loss that was diagnosed during service, and the audiologist offers an opinion that the tinnitus is associated with (or due to, or a symptom of, or related to) the hearing loss. No further examination or opinion is needed, and the tinnitus should be service-connected. Note that this would not represent presumptive service connection, but service connection based on the tinnitus being a symptom of the hearing loss that was incurred in service.

Example #4: The Veteran claims tinnitus due to a head injury in service in 1983. He was discharged in 1988. He also claims hearing loss due to noise exposure in service. Service records do indicate a fall aboard a ship with a mild concussion and lacerations to the scalp but there were no complaints of tinnitus at or after the time of injury until 1997. The Veteran’s personal doctor (a non-audiologist) provided an opinion that the Veteran’s tinnitus is due to the in-service head injury. The Veteran is 63 years old and now has a diagnosis of neurosensory hearing loss, with date of onset unknown. His service records do not include a discharge audiology examination. In this case, an audiology examination for hearing loss

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and tinnitus would be in order. The audiologist could offer an opinion about the relationship of hearing loss, if present, to service and about the relationship of the tinnitus to hearing loss. However, since the issue of tinnitus due to a head injury is beyond the scope of an audiologist to determine, if the audiologist states any of the following: tinnitus is not likely due to hearing loss, tinnitus is due to hearing loss but hearing loss likely did not begin in service, or there is no hearing loss, the regional office should order an examination for tinnitus claimed as the residual of a head injury. This examination should be conducted by an appropriate non-audiologic examiner, in order to determine the relationship of the tinnitus to the head injury in service.

Reference: Training Letter 10-02, Adjudicating Claims for Hearing Loss and/or Tinnitus, dated March 18, 2010

SERVICE CONNECTION BASED ON NOISE EXPOSURE DUE TO MILITARY SPECIALTY (I.E. MOS, AFSC)

Fast Letter 10-35 introduces the Duty MOS Noise Exposure Listing, a rating job aid for determinations regarding service connection of hearing loss and/or tinnitus. The Duty MOS Noise Exposure Listing is a compilation of Department of Defense-verified lists of military occupational specialties (MOSs) and the corresponding probability of hazardous noise exposure. Use of a single listing of duty position and probability of exposure to hazardous noise will help to standardize processing of these claims.

Each branch of the Armed Services has reviewed and endorsed lists of military occupational specialties and the corresponding probability of hazardous noise exposure related to an individual’s occupational specialty. The Duty MOS Noise Exposure Listing is available at http://vbaw.vba.va.gov/bl/21/rating/docs/dutymosnoise.xls.

Direct service connection may not be granted without medical evidence of a current disability; medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

A Veteran is competent to report symptoms of hearing loss and/or tinnitus as a disability because symptoms of hearing loss and tinnitus are capable of lay observation. See Charles v. Principi, 16 Vet. App. 370 (2002); Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Consequently, a Veteran’s testimony regarding hearing loss and/or tinnitus is sufficient to serve as evidence that the disability(ies) currently exists.

Effective September 2, 2010 (date of Fast Letter 10-35), when a claim for hearing loss and/or tinnitus is received, the decision maker must review the claim for:

Sufficient evidence of a current disability (including lay evidence); and

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Evidence of hearing loss and/or tinnitus in service; or records documenting an event, injury, disease, or symptoms of a disease potentially related to an audiological disability.

If there is no documented evidence of an in-service illness, injury, or event with which the claimed conditions could be associated, the Duty MOS Noise Exposure Listing will be considered. Based on the Veteran’s records, each duty MOS, Air Force Specialty Code, rating, or duty assignment documented will be reviewed for a determination as to the probability of exposure to hazardous noise on the Duty MOS Noise Exposure Listing. If the duty position is shown to have a “Highly Probable” or “Moderate” probability of exposure to hazardous noise, exposure to such noise will be conceded for purposes of establishing the in-service event.

In such cases, where there is sufficient evidence of a current disability and the in-service exposure to hazardous noise is conceded based on the Duty MOS Noise Exposure Listing, we would be obligated to request a VA examination and opinion to determine if there is a medical nexus. The level of probability of exposure conceded, such as “Highly Probable” or “Moderate,” should be included in the information provided to the examiner in the body of the examination request.

Additionally, in other cases where an examination and opinion request are otherwise warranted, the probable level of exposure to hazardous noise associated with the Veteran’s documented duty position will be provided in the examination request remarks.

Finally, the Duty MOS Noise Exposure Listing is not an exclusive means of establishing a Veteran’s in-service noise exposure. Claims for service connection of hearing loss must be evaluated in light of all evidence of record in each case, including treatment records and examination results.

Fast Letter 10-35, Modifying the Development Process in Claims for Hearing Loss and/or Tinnitus, dated September 2, 2010.

For further guidance regarding requests for audiometric examinations and medical opinions, refer to M21-1MR.III.iv.4.B.12.d.

PRESUMPTION OF SERVICE CONNECTION

1. Sensorineural hearing loss may be service-connected as a presumptive condition under 38 CFR 3.309(a) because it is an organic disease of the nervous system.

2. Unlike hearing loss, tinnitus may not be service-connected as a presumptive condition under 38 CFR 3.309(a) because it is a subjective symptom rather than an organic disease of the nervous system.

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3. An opinion for the purposes of presumptive service connection for hearing loss should follow the same format as described above under opinions and be based on all pertinent evidence of record.

Example: A Veteran claims and has neurosensory hearing loss that was diagnosed 9 months after service. He had normal hearing at discharge examination. He suffered injuries, including head trauma, in a motorcycle accident 6 months after discharge. Since he did not have hearing loss diagnosed in service but had it in the presumptive period and also had a possible intervening cause during the presumptive period, a medical opinion would be needed to determine whether the sensorineural hearing loss is related to an event, injury, or disease in service or if it is due to the post-service trauma. In this case, opinions might be required from both an audiologist and a general medical examiner.

Reference: Training Letter 10-02, Adjudicating Claims for Hearing Loss and/or Tinnitus, dated March 18, 2010

HENSLEY DECISION

Service connection for hearing loss may be established in some cases even if hearing loss first met the requirements of 3.385 after service (Hensley v. Brown, 5 Vet.App. 155, 159 (1993)).

In Hensley, the Court stated that when audiometric test results at a Veteran’s separation from service do not meet the regulatory requirements for establishing a “disability” at that time, he or she may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service.

Therefore, a claim for current hearing loss may require an examination, even if there was a change in the level of hearing at the time of discharge compared to entrance to service, but it did not reach the level of a disability per 38 CFR 3.385. An audiologist’s opinion may be required to determine if a significant change in hearing thresholds occurred during military service.

Example #1: A Veteran had the following audiometric examinations on entrance and separation.

Right ear 500 1000 2000 3000 4000 (Hz) Date10 20 15 25 20 (dB) 07/71 (entrance)10 20 15 35 35 (dB) 06/75 (separation)

Left ear 500 1000 2000 3000 4000 (Hz) Date10 20 20 25 30 (dB) 07/71 (entrance)10 25 20 35 35 (dB) 06/75 (separation)

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The Veteran did not claim hearing loss and did not meet the criteria for hearing loss as a disability per 38 CFR 3.385 at the time of separation. Audiometry does, however, show a decrease in hearing at the 3000 and 4000 Hz levels in both ears at separation compared to entrance. In 1985, the Veteran had a private audiologic examination and received a diagnosis of bilateral sensorineural hearing loss manifested by levels of 60 dB on audiometry at the 3000 Hz level and 70 dB at the 4000 Hz level in both ears. All other threshold levels were less than 30 dB. The audiologist stated that the hearing loss was most likely due to noise exposure. The Veteran was in combat in Vietnam, where he served for 2 years. He said that his hearing had progressively worsened after 1980, and he claimed service connection for hearing loss in 1995.

An examination and opinion by a VA audiologist is needed in this case to establish the current level of hearing loss, to assess the significance of the changes in level of audiometric testing in service in both ears (for example, the 10 dB drop at 3000 Hz and the 15 dB drop at 4000 Hz in the right ear and the 10 dB drop at 3000 Hz and the 5 dB drop at 4000 Hz in the left ear) and to provide an opinion about the relationship of current bilateral hearing impairment to service noise exposure or to other causes, such as post-service occupational or recreational noise exposure.

Pertinent points from the Hensley decision: When audiometric test results at a Veteran's separation from service do not meet the regulatory requirements for establishing a "disability" at that time, he or she may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service. The absence of a “ratable increase” during active duty may not determine service connection.

Example #2: The Veteran entered service in 2004, served in Iraq from 2005 to 2007 as a cook, and was discharged in 2008. He had the following audiometry results:

Right ear 500 1000 2000 3000 4000 (Hz) Date10 20 20 50 50 (dB) 04/04 (entrance)15 20 20 60 65 (dB) 09/08 (separation)

Left ear 500 1000 2000 3000 4000 (Hz) Date10 20 20 25 30 (dB) 04/04 (entrance)15 20 20 35 35 (dB) 09/08 (separation)

The Veteran was diagnosed with mild sensorineural hearing loss in his right ear at entrance to service. The threshold in the right ear was worse by 10 dB at 3000 and by 15 dB at 4000 at separation. The issue then becomes, was the hearing loss aggravated in service or should the increase in hearing loss be attributed to normal progress of the condition? A second issue may arise regarding the left ear if, in the future, a sensorineural hearing loss is diagnosed, since there was some worsening at the 3000 and 4000 Hz levels at separation, but the decrease in hearing did not reach the level of a disability under § 3.385. See Pertinent points from the

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Hensley decision, above.

In Hensley, the Court noted that clear and unmistakable evidence is required to rebut a finding of service aggravation when there is an increase in disability during service (38 CFR 3.306(b)) and stated that independent medical evidence or a quote from recognized medical treatises is needed to provide adequate support for a medical conclusion that worsening is attributed to natural progress.

Since there is no regulation that defines when a change in hearing is significant or constitutes an increase in disability, if there is a change in pre-existing hearing loss between entrance and separation, an audiologic opinion will be required. The audiologist should be asked to assess the significance of any changes in level of hearing in service, and to provide an opinion as to whether they represent normal variability in audiometric measurement, normal progression of hearing loss, or are indicative of worsening due to the circumstances of service.

Reference: Training Letter 10-02, Adjudicating Claims for Hearing Loss and/or Tinnitus, dated March 18, 2010

DO NOT ASK FOR LEGAL OPINIONS

Do not request a medical authority to assume any responsibility inherent to the rating activity. Reference: M21-1MR.III.iv.3.A.9.f.

It is not appropriate to ask the examiner, “Veteran is claiming service connection for hearing loss (tinnitus). Is it at least as likely as not that the Veteran’s hearing loss (tinnitus) is related to military service?” Rather the request should identify the in-service event(s) that is claimed to be the basis of the current hearing loss (tinnitus); such as having served two years as a jet engine mechanic. In this particular instance, it would be more appropriate to phrase the opinion as, "Is it at least as likely as not that the Veteran’s current hearing loss (tinnitus) is due to or caused by the acoustic trauma of having worked for two years as a jet engine mechanic during military service?” See Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

TINNITUS, RATED AT 10 PERCENT DISABLING

DO NOT order an examination for tinnitus when the Veteran is at the scheduler maximum of 10 percent. Since 10 percent is the maximum scheduler evaluation for tinnitus, there is no need to order a VAMC audiology exam. If in the case of an Individual Unemployability Claim, the Veteran is service-connected for hearing loss, then requesting an audiology exam for hearing loss is appropriate; but not for tinnitus since the Veteran is at the scheduler maximum of 10 percent.

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HEARING LOSS PREVIOUSLY DENIED

Although the service treatment records may show hearing loss that meets the criteria set forth by the Hensley decision,” 38 CFR 3.159(c)(4)(iii) is quite specific in that requests for medical examinations and medical opinions applies to a claim to reopen a finally adjudicated claim only if new and material evidence is presented or secured.

Before a VA examination and opinion can be requested, the Veteran must submit new and material evidence with the following exceptions:

Hearing Loss Greater than 20 Decibels and Claim Denied More than 1 Year Ago. In the following scenarios, the Veteran’s service treatment records show hearing loss greater than 20 decibels and the “original” claim for hearing loss was denied more than 1 year ago.

Scenario 1 – The reason for denial was that hearing loss at the time of the decision did not meet the VA criteria outlined in 38 CFR 3.385.Since the Veteran did not have hearing loss which met the VA criteria, the Veteran should definitely be asked to submit new and material evidence; if the Veteran provides evidence which clearly shows current hearing loss that meets VA criteria for hearing loss, request a VA examination and a medical opinion; if the Veteran provides evidence that does NOT clearly show hearing loss that meets VA criteria, the claim should be referred to an RVSR for a determination as to whether the evidence is new and material. Technically (legally), the claim is NOT reopened unless new and material evidence is received.

Scenario 2 – The reason for denial was no link to military service and the evidence at the time of the decision showed hearing loss which met the VA criteria outline in 38 CFR 3.385.Although the evidence at the time of the decision showed hearing loss which met the VA criteria for hearing loss, the Veteran should be asked to submit new and material evidence. If the Veteran’s military duty obviously exposed them to hazardous noise (aircraft mechanic, pilot, machinist, artillery gunner, etc.), consider the overall merits of the case and decide whether or not to request a VA examination and opinion, which might (depending on the outcome) amount to new and material evidence. In this particular instance, new and material evidence is being “secured” rather than “presented” by the Veteran. If the merits of the case do not suggest a relationship of the current hearing loss to the Veteran’s military service, wait for the Veteran to submit new and material evidence and then refer the claim to an RVS for a determination as to whether the evidence is new and material, thereby possibly warranting a request for a VA examination and opinion.

NEW AND MATERIAL EVIDENCE. See M21-1MR, Part III, Subpart iii, Chapter 1, Section B for further details; an RVSR makes the determination as to whether the evidence received is new and material.

SELECTING THE APPROPRIATE WORKSHEET

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AUDIO worksheet versus EAR DISEASE worksheet. If tinnitus and hearing loss are the only audio issues, i.e. such conditions as vertigo or otitis media are not at issue, request only the Audio worksheet. The Ear Disease worksheet is not necessary. The Audio worksheet includes instructions for opinions for etiology of tinnitus. An opinion for etiology of hearing loss can be given by the audiologist.

If an audio disability other than hearing loss and tinnitus is at issue, request both the Audio and Ear Disease worksheets. The ear disease examiner will need audio test results to address most audio diseases.

Excerpt from Fast Letter 04-15, Subj: Compensation and Pension Examination Improvement Initiative, dated July 21, 2004, enclosure entitled, Examination Request Ready Reference Guide.

CHANGES

Change 2, January 1, 2005, added guidelines regarding requests for examinations when the Veteran’s military duties involved acoustic trauma. The requirement to send VCAA notification on tinnitus claims was added.

Change 3, March 14, 2005, added guidelines with regard to avoiding requests for legal opinions; incorporated references within each topic; added guidance with regard to selecting an audio exam worksheet versus and ear disease worksheet; added guidance regarding requests an exam for Hensley hearing loss.

Change 4, April 5, 2005, added guidelines when hearing loss at the time of entry and separation from service meets the criteria under 38 CFR 3.385 and the difference is 10 decibels or more (topic entitled Hearing Loss & VA Examination Guidelines, Scenario’s 5 & 6).

Change 5, August 14,2006, deleted guidance that directed opinions for tinnitus should ask the examiner whether it is at least as likely as not that tinnitus is related to military service. The guidance should be the same as it is for hearing loss; “whether it is at least as likely as not that tinnitus is due to or caused by acoustic trauma . . . “

Change 6, June 6, 2007, deleted the guidance regarding tinnitus claims wherein a VA examination without opinion is requested if the Veteran was discharged within one year (change was precipitated by a STAR review comment).

Change 7, December 7, 2007, updated guidance regarding claims for tinnitus.

Change 8, January 21, 2008, added sample VA exam text for hearing loss and tinnitus opinions.

Change 9, March 12, 2008, added guidance regarding exams for hearing loss that are 10 decibles or greater during military service.

Change 10, July 12, 2008, pursuant to the STAR Conference Call on 07-31-08, hearing loss claims adjudicated based on the findings set forth in the Hensley v Brown court decision, a medical opinion is required as to whether the hearing loss is due to acoustic trauma during military service.

Change 11, November 10, 2008, added guidance regarding requesting exams for tinnitus, even if diagnosed during military service.

Change 12, January 20, 2010, added guidance regarding completing audio medical opinion requests through VERIS.

Change 13, March 23, 2010, added guidance provided in Training Letter 10-02, Adjudicating Claims for Hearing Loss and/or Tinnitus.

Change 14, September 2, 2010, added guidance provided in Training Letter 10-35, Modifying the Development Process in Claims for Hearing Loss and/or Tinnitus (Service Connection Based on Noise Exposure Due to Military Specialty).

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Change 15, October 27, 2011, added guidance regarding DBQs and medical opinions for hearing loss & tinnitus.

Change 16, January 13, 2012, updated exam guidance.

Change 17, March 28, 2012, updated exam guidance regarding medical opinions.

Change 18, May 20, 2012, added guidance regarding the scheduling of hearing loss and tinnitus exams.

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Section 72

Hepatitis Claims_______

1 – Development Guidelines..................................................72.2

2 – Sample Request for Medical Opinion............................72.4

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Change 8July 6, 2012

Section 72.1Hepatitis Claims

Development Guidelines

NOTIFICATION GUIDELINES

Compensation Service implemented both the “Hepatitis C Risk Factors Questionnaire” and a Hepatitis C WTEMS page as a selection item for insertion into MAP-D. This selection is located under Special Issues Development Type and is called, ‘Hepatitis C Questionnaire’. With this change, RO employees developing Hepatitis C claims no longer need to copy and paste this information into development letters.

Compensation Service realizes that WTEMS items are normally separate selections. However, in order to implement this into MAP-D in a timely manner, it was necessary to combine both elements. This combination will be separated in a future VETSNET release.

Send MAPD Special Issues Claimant Letter, Hepatitis C Questionnaire (questionnaire on Which Risk Factors Apply to You).

Reference Compensation Service Conference Call, June 2012

CLAIMS RECEIVED 25 YEARS AFTER DISCHARGE

If treatment for hepatitis is noted during military service as acute & transitory, and the claim is received 25 years after discharge, the Veteran must provide evidence showing chronicity.

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TREATMENT REPORTS

Before requesting an examination for hepatitis C, obtain all treatment records since discharge, including mental health records. Before providing a VA examination and opinion, the examiner will need to know the cause of the Veteran’s hepatitis C, and if the Veteran has a history of drug abuse. The Veteran may deny a history of drug abuse when in fact the medical evidence may show otherwise.

INCARCERATION AS A RISK FACTOR

Periods of incarceration in excess of 3 days could be considered a viable risk factor for contracting hepatitis C.  This information comes from Murphy EL, Et al: “Risk Factors for Hepatitis C Virus Infection in U.S. Blood Donors” Hepatology vol 31 pp 756-762 (2000).  Although this is not a risk factor listed in the VCAA language, when reviewing a file, if there is evidence the Veteran was incarcerated for more than 3 days, this is a risk factor that should be included in the VA examination request and considered by the VA examiner.

CLAIMS FOR HEPATITIS C DUE TO AIR INJECTION GUNS

Fast Letter 04-13 states that despite the lack of scientific evidence to document transmission with air gun injectors, it is biologically plausible. Therefore, if a Veteran claims Hepatitis C due to jet injected inoculations, the Veteran is entitled to an examination with a medical opinion. The opinion should include a discussion of all modes of transmission applicable to the particular Veteran and a rationale as to why the examiner believes the air gun was or was not the source of Veteran's Hepatitis C.

VA EXAMINATION GUIDELINES

If the Veteran identifies the risk factors and treatment reports show a diagnosis of Hepatitis C, request a VA examination and send the claims folder for review. The examination request should include the following:

A request for confirmatory testing of HCV infection if not already of record.

List any risk factors identified by the Veteran.

Point out all risk factors confirmed by the evidence in the claims folder, whether identified by the Veteran or not. While the Veteran may claim additional risk factors, the examiner should be asked to consider only those risk factors that are confirmed or supported by the evidence of record.

Ask for an opinion about relationship between the current HCV infection and confirmed or supported risk factor(s).

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Request liver function testing and detailed description of clinical findings and reported symptoms.

Reference: Hepatitis C Review, dated April 17, 2001, Training Letter 01-02

Refer to the section entitled Hepatitis Claims for Sample Request for Medical Opinions.

MEDICAL OPINIONS. Do not ask the examiner if the Veteran’s hepatitis C is at least as likely as not related to military service.” Rather the request should ask the examiner to opine as to the most likely etiology of the Veteran’s hepatitis C.

The examination must be specific and identify the specific incident or disability/disease that occurred during military service.  Asking the examiner if the hepatitis C is related to service can lead to misleading medical opinions.  For example, a Veteran may have engaged in IV drug use during military service.  If the examiner is asked if it is at least as likely as not that the Veteran's hepatitis C is related to service and the examiner believes the IV drug use caused the hepatitis C, the examiner would likely offer an opinion that the hepatitis C is related to service.  However, service connection would not be warranted because drug use is considered willful misconduct.

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Section 72.2Hepatitis Claims

Sample Request for Medical Opinions

REQUEST FOR MEDICAL OPINION

ISSUE: Whether hepatitis C is related to confirmed or supported risk factors.

CONTENTION: Veteran contends that hepatitis C is related to confirmed or supported risk factors.

AVAILABLE PERTINENT EVIDENCE:

MILITARY SERVICE: 09-02-1966 to 06-01-1968

PRIVATE MEDICAL RECORDS: Treatment reports from Dr. Reveille, tagged in C-file

VA RECORDS: Outpatient treatment reports from the Denver VAMC, tagged in C-file.

OTHER: Statement from the Veteran on VA Form 21-4138, tagged in C-file.

REQUESTED OPINION:Please review private medical evidence from Dr. Reveille, the outpatient treatment reports from the Denver VAMC, and the Veteran’s statement. Service treatment records are negative for treatment of hepatitis C.

a. Please do confirmatory testing of HCV infectionb. Risk factors identified by Veteran – none.c. Risk factors confirmed by the evidence in the claims folder – substance abuse, tattoo

during military serviced. Please provide an opinion about the relationship between the current HCV infection and

confirmed or supported risk factor(s). Provide a complete rational for these opinions.e. Please do liver function testing and give detailed description of clinical findings and

reported symptoms

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CHANGES

Change 1, July 26, 2004, clarified the tests required for confirmatory testing of HCV infection.

Change 2, August 5, 2004, renamed the section “Hepatitis Claims;” explained process of obtaining the Hepatitis questionnaire; VA examination guidelines modified in that we do not have to tell the examiner the types of confirmatory testing that are accepted as evidence of HCV infection.

Change 3, February 16, 2005, added instruction provided by the November 2004 VSCM Conference Call regarding modifications that must be made to the VCAA letter and deletion of the risk factors enclosure. Added a sample medical opinion.

Change 4, March 14, 2005, added guidance regarding procurement of treatment reports.

Change 5, September 21, 2005, modified Section 44.2, Sample Request for Medical Opinion, to eliminate request as to whether the hepatitis is related to military service; removed Section 44.4, VCAA Law Attachment, which is located in Section 77.

Change 6, March 24, 2009, added guidance regarding incarceration of more than 3 days may be considered a risk factor.

Change 7, June 20, 2012, added guidance regarding new Map-D development paragraph and WTEMS paragraph.

Change 8, July 6, 2012, added guidance regarding claims due to air injection guns.

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Change 2November 15, 2011

Section 73

Cold Weather Injury Claims_______

Thousands of military service personnel have suffered from frostbite and trench foot including but not limited to Veterans of the Battle of the Bulge during World War II and the Battle of the Chosin Reservoir in Korea.

Once the acute cold injury has resolved, there may be no symptoms until many years later. It should also be noted that although the Veteran may have another disease, such as hypertension or diabetes, that can result in findings similar to cold injury residuals. This should not preclude an examiner from identifying such findings as residuals of cold injury, if it is at least as likely as not that they are.

Consider the reevaluation of Veterans with earlier service-connected cold injuries when reviewing their files for other reasons. Large numbers of Veterans rated at 0% for cold injury after WWII have significant residuals now.

CHRONIC EFFECTS OF EXPOSURE

For guidance regarding the chronic effects of exposure, refer to M21-1MR,III.iv.4.E.21.

BATTLE OF THE BULGE

The Battle of the Bulge which lasted from December 16, 1944 to January 28, 1945 was the largest land battle of World War II in which the United States participated. Veterans who were in the Battle of the Bulge during World War II were exposed to extreme cold. This may be shown on the DD Form 214 as participation in Ardennes Offensive.

CHOSIN RESERVOIR CAMPAIGN

For guidance regarding the Chosin Reservoir Campaign, refer to M21-1MR,III.iv.4.E.21.e.

SERVICE RECORDS DEVELOPMENT

Consider the circumstances of service, even if the service treatment records are not positive for a claimed cold injury.

Submit PIES Request Code O19, for service records that document awards, medals, decorations, military occupations specialty, campaigns, and assignments.

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Print a copy of the PIES request to be flip-filed in the center section of the C-file.

VA EXAMINATION GUIDELINES

Request a VA examination if the circumstances of service are consistent with exposure to extreme cold. If the Veteran has not completed the protocol examination, select Cold Injury Protocol Examination.

The Cold Injury Protocol exam should be requested for all cold injury claims. (Star Reporter, Volume 2, Issue 6, dated April 2, 2002)

See the VA Examinations Section for further details regarding requests for examinations.

CHANGES

Change 1, January 1, 2006, references incorporated within each topic.

Change 2, November 15, 2011, references updated.

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Change 13August 21, 2012

Section 74

Dental Claims_______

NO SPECIFIC DISABILITY CLAIMED

Send MAPD Compensation Claimant Letter, Name of dental disability needed.

If no response in 30 days, refer to Administrative Denials Section of this guide for further details.

ELIGIBILITY REQUESTS FOR DENTAL TREATMENT RECEIVED FROM THE VETERAN

If a Veteran submits a claim for dental treatment to the Veterans Service Center (VSC), refer the application to the VA medical center (VAMC) eligibility clerk for review and determination of dental treatment eligibility.

Reference: M21-1MR, Part III, Subpart v, Chapter 7, Section C

If a claim for dental treatment is submitted directly to a VBA regional office, VBA will not prepare a dental treatment rating, but will refer the claim to the VHA outpatient clinic. Reference: Fast Letter 12-18, Final Rule: Dental Conditions, dated July 10, 2012.

PROCESSING OF VA FORM 10-7131 FOR DENTAL OUTPATIENT TREATMENT - 38 U.S.C. 1712(A)(1)

The treating VA facility initiates VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action, if it cannot determine eligibility and the dental treatment claim. Refer to M21-1MR, Part III, Subpart v, Chapter 7, Section B for guidance regarding the processing of VA Form 10-7131 for dental outpatient treatment.

CLAIMS FOR SERVICE CONNECTION - COMPENSATION

Treat a claim for dental disability submitted on VA Form 21-526, Veteran’s Application for Compensation or Pension, as a claim for compensation except when the Veteran makes it clear that he/she is seeking dental treatment only. Refer copies of dental claims for compensation, as well as for treatment, to the outpatient or dental clinic responsible for the Veteran’s residence. Reference: M21-1MR, Part IX, Subpart ii, Chapter 2, Rating for Dental Treatment.

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Change 13August 21, 2012

Make a copy of the VA Form 21-526 and the DD Form 214 and send it to the appropriate clinic/department noted below:

Denver VA Eastern Colorado Health Care System Eligibility Department or FAX the application to (303) 393-4638, Attention: Kathleen Rockney

Grand Junction VA Medical Center, Dental Clinic

Cheyenne VA Medical Center, Eligibility Department

Sheridan VA Medical Center, Dental Clinic

VA Salt Lake City Health Care System, Eligibility Department

New Mexico VA Health Care System, Eligibility Department

Annotate the VA Form 21-526 "Copy sent to VAMC outpatient clinic."

Do not place the claim under end product control.

However, if the claimant is requesting service connection for a specific disability as a result of trauma during military service and the evidence shows the incurrence of an injury during service, send the VCAA notice and complete all other development for federal and non-federal records. Upon completion of all development actions, forward the claim to the Rating Team.

Do not request an examination for treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease (pyorrhea). If the Veteran submits a claim for service connection for these issues, the RVSR will prepare a formal rating and deny the conditions if

a Veteran claims compensation for one of these conditions on VA Form 21-526 or elsewhere, and

the record shows no complicating condition subject to service connection.

Reference: Service connection of dental conditions for treatment purposes, 38 CFR 3.381a and Rating for Dental Treatment, M21-1MR, Part IX, Subpart ii, Chapter 2

If a claim for disability compensation is submitted that includes a compensable dental condition as an issue, VBA will prepare a rating for compensation purposes and notify VHA. Reference: Fast Letter 12-18, Final Rule: Dental Conditions, dated July 10, 2012.

CLAIMS FOR DENTAL TREATMENT

Claims for dental treatment under 38 CFR 17.161 are normally handled by the outpatient clinic, without referral to the Veterans Service Center (VSC) or the rating activity.

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Change 13August 21, 2012

If a regional office receives a claim that includes a request for dental treatment, the request should be referred to the Business Office at the VHA facility that is nearest to the Veteran's home. VHA can frequently determine eligibility for dental treatment without referral to the Veterans Benefits Administration (VBA). If the VHA facility cannot definitively determine dental eligibility based on the available information, the claim may be referred to the VHA Health Eligibility Center (HEC) for review.

Upon receipt of the request for dental treatment, VHA will determine whether a claim for dental treatment requires referral to VBA for adjudicative action or additional information. When necessary, the VHA Business Office or HEC will refer requests for adjudicative action or additional information through Automated Medical Information Exchange (AMIE), Compensation and Pension Record Interchange (CAPRI), VA Form 10-7131 (Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action), or VA Form 10-564-D (Dental Trauma Rating). (VA Form 10-564-D is no longer available, but may still be in use.)

Upon receipt of the request, a Rating Veterans Service Representative will prepare a dental rating making the requested determination. The dental rating should be attached to the VA Form 10-7131 or VA Form 10-564D and returned to the VHA Business Office. VHA is responsible for notifying the Veteran of the determination of eligibility for dental treatment. Should VHA deny eligibility for dental treatment, VHA is responsible for notifying the Veteran. See VHA Directive 2008-039.

Unless it has been requested by VHA, do not prepare a dental rating or establish “service connection for dental treatment purposes” in a regular rating decision.

Reference: Fast Letter 10-42, SUBJ: Guidance on Rating Dental Conditions, dated October 12, 2010.

A dental rating will only be prepared at the request of the VHA pursuant to a claim for dental treatment. Reference: M21-1MR, Part IX, Subpart ii, Chapter 2, Rating for Dental Treatment.

If the Veteran submits a VA Form 21-526 for dental treatment only, refer the claim to the outpatient clinic for proper disposition.

Make a copy of the VA Form 21-526 and the DD Form 214 and send it to the appropriate clinic/department noted below:

Denver VA Eastern Colorado Health Care System Eligibility Department or FAX the application to (303) 393-4638, Attention: Rose Armijo

Grand Junction VA Medical Center, Dental Clinic

Cheyenne VA Medical Center, Eligibility Department

Sheridan VA Medical Center, Dental Clinic

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Change 13August 21, 2012

VA Salt Lake City Health Care System, Eligibility Department

New Mexico VA Health Care System, Eligibility Department

Annotated the VA Form 21-526 "Copy sent to VAMC outpatient clinic."

Do not place the claim under end product control.

NOTIFICATION TO THE CLAIMANT

The following paragraph will be sent to the Veteran who claims a dental condition:

We have referred your request for dental treatment to the <Facility Name>. Further inquiries concerning dental treatment should be directed to the <Facility Name, Address, & Dept>. You may contact them directly at < Telephone Number>.

VA Eastern Colorado Health Care System 1055 Clermont St.Denver, CO 80220Eligibility Dept (303) 393-5137

Grand Junction VA Medical Center2121 North Ave.Grand Junction, CO 81501Dental Clinic (970) 242-0731 ext 2272

Cheyenne VA Medical Center2360 E. Pershing BlvdCheyenne, WY 82001Eligibility Dept (307) 778-7579

Sheridan VA Medical Center1898 Fort RoadSheridan , WY 82801Dental Clinic (307) 672-3094

VA Salt Lake City Health Care System500 Foothill DriveSalt Lake City , UT 84148Eligibility Dept (801) 582-2585

New Mexico VA Health Care System1501 San Pedro Dr SEAlbuquerque, NM 87108-5153Eligibility Dept (505) 256-2741

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Change 13August 21, 2012

TEMPOROMANDIBULAR JOINT DISORDERS (TMJ)

In the August 2009 C&P Service Bulletin, Central Office advised that the provisions of DeLuca apply to the evaluation of temporomandibular joint disorders (TMJ) since TMJ clearly involves musculoskeletal joints and the evaluation of TMJ is based on loss of motion.

Reference: C&P Service Bulletin, August 2009

CHANGES

Change 2, July 26, 2004, provided formatting changes.

Change 3, November 3, 2004, provided guidance on completing claims for disabilities due to dental trauma during military service.

Change 4, April 30, 2005, provided guidance regarding end product control on claims for dental treatment only; incorporated references within each topic.

Change 5, June 3, 2005, modified the topic entitled, Claims for Dental Treatment; added a requirement to include a copy of the DD Form 214 when sending applications for dental treatment to the VA medical center and send the FAX attention: Josephine.

Change 6, July 22, 2005, added additional guidance regarding the responsibility for processing eligibility requests and processing of VA Form 10-7131; updated manual references; added VA medical facility names, addresses and telephone numbers.

Change 7, April 26, 2006, modified the topic entitled, Claims for Service Connection – Compensation; changed the FAX number and point of contact at the Eligibility Department.

Change 8, August 29, 2007, added M21-1MR reference regarding “Eligibility for Department of Veterans Affairs (VA) Medical and Dental Treatment.”

Change 9, August 25, 2009, added guidance regarding TMJ.

Change 10, January 21, 2010, updated POC information for Denver VA Eastern Colorado Health Care System Eligibility Department.

Change 11, October 15, 2010, add guidance regarding requests from VHA for a dental rating.

Change 12, June 8, 2011, deleted the requirement to insert additional language in examination requests for TMJ since the exam worksheet has been updated to include findings based on DeLuca.

Change 13, August 21, 2012, added guidance/reference regarding the Final Rule for Dental Conditions (FL 12-18).

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Change 5March 25, 2014

Section 75

Paragraph 29/30 ClaimsEP 320_______

EP 320 PROPER USE

An EP 320 is established whenever a hospital report is received for a service-connected condition which is evaluated at less than 100 percent.

PARAGRAPH 29 ENTITLEMENT: If the Veteran is hospitalized for more than 21 days for a service-connected condition, entitlement to Paragraph 29 benefits may be warranted. If, however, the Veteran is hospitalized for 21 days or less and the Veteran did not claim entitlement to Paragraph 29 benefits, the issue will not be raised by rating decision merely to deny the benefit.

PARAGRAPH 30 ENTITLEMENT: The hospital report will be reviewed for entitlement to Paragraph 30 benefits. If there is entitlement, a grant of benefits may be warranted. If there is no such entitlement and the Veteran did not claim it, the issue will not be raised by rating decision simply to deny the benefit.

INFORMAL CLAIMS FOR INCREASED EVALUATION: Per the FAQ cited below, hospital reports are considered informal claims for increased evaluation (assuming the Veteran is not already at 100 percent). Therefore, whenever hospital reports are received and an EP 320 is established, the issue must be evaluated, whether or not an increase in the service-connected disability is warranted.

Reference: C&P FAQ, EP 320: Proper Use

PARAGRAPH 29 ENTITLEMENT

Entitlement to Para 29 benefits may be warranted if the Veteran was hospitalized for a service connected disability in excess of 21 days. The Veteran will receive temporary 100% until first of the month following date of discharge.

Example: Admitted 2-4-00Discharged 3-1-00Veteran will receive 100% rate from 2-4-00 to 4-1-00

For further information, refer to 38 CFR §4.29 Ratings for service-connected disabilities requiring hospital treatment or observation.

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Change 5March 25, 2014

PARAGRAPH 30 ENTITLEMENT

Entitlement to Para 30 benefits may be warranted if the Veteran requires convalescent care following surgery of a service connected disability. The temporary 100% rate may be awarded for a period of at least one month. For further information, refer to 38 CFR 4.30.

38 Code of Federal Regulations (CFR) 4.30 provides that a temporary 100 percent evaluation may be granted on the basis of convalescence following surgery or immobilization by cast of at least one major joint for a service-connected disability. Convalescent ratings may be granted or extended based solely on consideration of a work excuse from a medical provider, provided there’s a clear connection between the claimant’s inability to return to previous employment and the surgery or cast immobilization, and there is no contrary evidence of record. However, in determining whether or not to grant or extend Paragraph 30 benefits, the work excuse will be weighed as one piece of evidence for consideration if there is any contrary medical evidence in the record. (Reference: Compensation Service Bulletin, March 2014)

CLAIM INITIATED BY THE VETERAN

Establish the end product – EP 020

Send the Veteran the VCAA notification letter; suspense for 30 days.

Note: In accordance with M21-1MR.I.1.B.3.k, cases where the evidence is sufficient to substantiate the claim and grant the benefit sought, it is unnecessary to send the "notice statement" of what it takes to substantiate a claim. However, in those cases where the claim for Para 29/30 is accompanied by a claim for increase, reopened claim, or previously denied claim, send the VCAA notice for all issues.

If Veteran reports being hospitalized at a VAMC and is seeking Paragraph 29 benefits, download the hospital summary. If Veteran is still hospitalized, develop to Veteran. Suspense for 30 days.

If the Veteran reports having had surgery at a VAMC and is seeking Paragraph 30 benefits, download the surgical report and any subsequent progress notes.

If no medical evidence is received with the claim or you are unable to download the hospital summary or surgical report, develop as an increase. Do not schedule an exam at this time. Suspense for 30 days.

At the end of the VCAA 30 day period (see Note above) and if medical evidence is of record, send the claim to the Rating Team.

HOSPITAL REPORTS PROCESSING

Step 1 (Optional) – Rack and Stack:

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Change 5March 25, 2014

When you receive a stack of hospital reports, it’s a good idea to put the reports in terminal digit order (or alphabetical order) because there may be duplicate reports. This step will eliminate having to process a report twice.

Step 2 - Triage:

You will need the following applications: SHARE (to check current address, Awards/Ratings, Claims/Denials, and Folder

Location) MAPD (to check for pending claims, and check current address) CAPRI (to review and print discharge summaries)

1. In SHARE: Go to “Corporate Inquiries” and enter the Veteran’s claim number.

2. Go to the “Awards/Ratings” tab. Then go to the “Rating Information” tab.

3. Compare what the Veteran is service connected for with the “Admitting Diagnosis” on the hospital report. If it’s not clear, you may have to check CAPRI to see if they were admitted/treated for a S/C condition. If the Veteran is not service connected for the reason they were admitted: Write, “NAN (no action necessary), not a SC condition. PIF Clear EP330.” Go to the BIRLS Inquiry screen and check the Folder Location tab. Write “Drop Mail” and location of the claims file in the upper right hand corner of the hospital report (i.e. 339, 376, etc). When you are done with all of the reports, you can quickly sort them for distribution.

4. If the Veteran is 100% SC for the condition they were admitted: Write, “NAN, already 100% SC for condition. PIF Clear 330.” Again, go to the BIRLS Inquiry screen and check the Folder Location tab. Write “Drop Mail” and the location of the claims file in the upper right hand corner of the hospital report (i.e. 339, 376, etc).

5. If the hospital report shows the Veteran was admitted for an SC condition which is evaluated at less than 100 percent, Write, “Veteran is XX% SC for XXXX.” These reports will need further evaluation (may require Rater advice too). You can process these when you are finished eliminating the NAN files.

6. If you cannot determine what the Veteran is SC for (blank, or old rating not in SHARE), you can sometimes find the SC and NSC disabilities using a Master Record Inquiry. If there is no information in SHARE, have the file pulled (if at 339). If the C-file is not at 339 (i.e. 376), write “please call in file” and give to Triage (If the Veteran lives in our jurisdiction). Don’t call in files that are not in our jurisdiction. You will send these to their respective jurisdictions. When you are finished with the list of reports, sort them into two stacks – 1 for PIF Clear, and 2 for further processing.

Step 3: NAN files - PIF Clear and Distribute:

1. Go back into SHARE. Select the PIF Clear option.

2. On the next screen, put in the date of claim (date of admission on the hospital report) and the Unit (21, 27, etc.).

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Change 5March 25, 2014

3. When you have completed clearing the EP 330’s, you will need to send the hospital reports to the appropriate DROP location. If the location is 339, just write DROP in the upper right hand corner and put them in the DROP bin.

4. If the location is another RO, staple a white Routing Slip to the hospital report, noting the station number (example: RO 442) and check the box “Vets Records Located Your Office.” Then place in Outgoing mail bin in Triage area. If Veteran is deceased, make applicable annotations and drop file in appropriate drop file bin.

Step 4: Action Files -Establishing an EP 320:

1. Before establishing an EP320, go to Corporate Inquiries in SHARE. Click on Claims/Denials tab and see if there is a pending claim or if an EP 330 has been PCLRed with the admission date listed on the hospital report you have. If you see a pending claim, go into MAPD to determine if it is for an issue or one of the issues for which the Veteran was hospitalized. If so, NAN. Make applicable annotations and drop file. Note: If the file has not yet been developed by a VSR (MSTAT - no contentions listed yet), you may have to get the file to determine if the new claim is associated with the hospital report.

2. If an EP 320 should be CESTed, CEST using date the Veteran was admitted to hospital as date of claim.

3. Print discharge summary. If a discharge summary is not in CAPRI, there may be discharge notes listed under Clinical Documents. Do not print all inpatient records. The RVSR can electronically review all records if necessary.

4. In MAPD enter contention as “EP 320 hospital report received” medical “yes” (so it shows up on the letter), and “miscellaneous”. Then go to Third Party Development and choose Request for Admission Report. Then proceed to Claimant Letter and choose Subsequent Contact. Go into that letter and delete all text except for “EP 320 hospital report received.” Save and print.

5. Close the tracked item in MAPD. Make sure Claim Level Suspense is Ready for Decision.

6. Make sure you put an EP tag on the C-file.

7. COVER case to RFD (or appropriate FIT).

CHANGES

Change 2, January 1, 2006, references incorporated within each topic.

Change 3, December 18, 2009, added guidance regarding proper use of EP320 (C&P FAQ).

Change 4, January 20, 2012, added processing guidance for hospital reports.

Change 5, March 25, 2014, added guidance from the March 2014 Compensation Service Bulletin regarding entitlement to Para 30 benefits.

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Change 5March 25, 2014

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Change 2November 20, 2006

Section 76

Merchant Marine Claims_______

Merchant Marine seamen who served under the Coast Guard, Naval Transportation Service or Army Transportation Service in active oceangoing service during the period from December 7, 1941, to August 15, 1945, are eligible to receive discharge certificates. See M21-1MR, Part III, Subpart iii, Chapter 2, Section F for further details.

Merchant Marine service after August 15, 1945, does not establish entitlement to compensation and pension.

VERIFICATION OF SERVICE

For guidance regarding verification of service, refer to M21-1MR, Part III, Subpart iii, Chapter 2, Section F, Topic 36.

SERVICE RECORDS DEVELOPMENT

For guidance regarding development for service treatment records, refer to M21-1MR, Part III, Subpart iii, Chapter 2, Section F, Topic 38-39.

CONTINUITY OF TREATMENT

If a disability compensation claim is received more than one year following discharge, ask the claimant to provide evidence of continuity of treatment for the alleged conditions from date of separation to present.

The disabilities claimed must have occurred during actual voyages, not merely while attached to a vessel.

Advise claimants that difficulty may be encountered in obtaining medical records and that they should provide as much detailed information as possible.

CHANGES

Change 1, January 1, 2006, references incorporated within each topic.

Change 2, November 20, 2006, references updated

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Change 8August 19, 2010

Section 77

Ionizing Radiation Claims_______

GENERAL GUIDELINES

When regional offices receive new claims involving exposure to radiation, the existence of a radiogenic disease will be confirmed prior to transfer to the Jackson RO. Exposure to radiation alone is not a disability. Such claims must be supported by the existence of a radiogenic disease.

Obtain information on the diagnosis of the Veteran's disease and, if known, the specific cell type and stage.

Example: If the disease is skin cancer, ask the claimant to provide the: type of cancer diagnosed, specific site of each lesion , date that the disease was first diagnosed or treated, and name and address of the physician or facility who

o made the diagnosis, or o first treated the claimed disease

Reference: C&P Service Bulletin, June 2008

If a radiogenic disease is confirmed, the claims folder will be transferred to the Jackson RO. Reference: Fast Letter 06-20, Centralization of Radiation Claims Processing

RADIATION CLAIMS PROCESSING

Secretary Eric K. Shinseki announced a goal of completing VA claims in 125 days or less. Based on data from the Jackson RO, for FY 2010 to date, the average number of days to complete claims based on exposure to ionizing radiation, is approximately 398 days. Days to complete occupational radiation exposure claims is 411 days and days to complete atmospheric radiation exposure cases is 387 days. C&P believes a significant portion of this time is due to developing cases at the local RO prior to shipping the files to Jackson.

As stated in Fast Letter 06-20, Consolidation of Adjudication - Radiation Claims, dated October 16, 2006, and revised January 23, 2007, processing of all claims for service connection based on radiation exposure is centralized to the Jackson RO. When ROs receive new claims identified as involving radiation exposure, the existence of a radiogenic disease must be confirmed prior to transfer to the Jackson RO. Confirmation of the existence of a presumptive disease under 38 CFR 3.309(d) in a “radiation-exposed Veteran” or of a “radiogenic disease” as defined in 38 CFR 3.311 is, generally, a medical diagnosis from a

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Change 8August 19, 2010

health care provider. A death certificate listing cause of death as a presumptive [38 CFR 3.309(d)] or “radiogenic disease” [38 CFR 3.311], if signed by a physician, is sufficient confirmation of diagnosis.

In order to approach Secretary Shinseki’s goal of completing all claims in 125 days or less, it is essential ROs continue to permanently transfer the claims folder to the Jackson RO as soon as they have confirmation of a diagnosis. Jackson RO will process and complete any additional development for the radiation issue as well as any other pending claims.

C&P is updating the Fast Letter with current information, to include contact numbers, and will reissue the Fast Letter in the near future.

Reference: C&P Service Bulletin, August 2010

CHANGES

Change 3, January 1, 2005, clarified development procedures and incorporated the guidance provided by FL 04-20.

Change 4, May 1, 2005, added guidance regarding additional presumptive conditions as provided by FL 05-02.

Change 5, January 1, 2006, added requirement for additional service records development.

Change 6, November 25, 2006, jurisdiction of radiation claims transferred to the Jackson VARO.

Change 7, June 30, 2008, added guidance from June 2008 C&P Service Bulletin regarding confirmation of claimed radiation disabilities.

Change 8, August 19, 2010, added guidance from August 2010 C&P Service Bulletin regarding Radiation Claims Processing.

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Change 4August 26, 2006

Section 78

Mustard Gas Claims_______

GENERAL GUIDELINES

All claims relating to mustard agent or Lewisite exposure are being centrally processed at the Muskogee VA Regional Office (VARO). Any file transferred because of a mustard gas claim will be a permanent transfer.

Reference: M21-1MR, Part IV, Subpart ii, Chapter 1, Section F, Claims for Service Connection for Disabilities Resulting From Exposure to Mustard Gas or Lewisite

PENDING CLAIMS

CLAIMS PENDING PRIOR TO JANUARY 19, 2005. All VAROs will expeditiously complete existing pending mustard agent and Lewisite claims. These should not be transferred to Muskogee.

CLAIM PENDING ON OR AFTER JANUARY 19, 2005. Claims received on or after January 19, 2005, must be mailed to the Muskogee VARO for processing.

Reference: M21-1MR, Part IV, Subpart ii, Chapter 1, Section F, Claims for Service Connection for Disabilities Resulting From Exposure to Mustard Gas or Lewisite

CHANGES

Change 2, June 24, 2004, provides a completely updated section for mustard gas development claims.

Change 3, April 5, 2005, development guidelines changed by Training Letter 05-01, dated March 28, 2005.

Change 4, August 26, 2006, added M21-1MR reference; deleted reference to Training Letter 05-01.

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Change 3January 1, 2006

Section 79

Smoking Claims_______

A disability or death shall not be considered to have resulted from personal injury suffered from or disease contracted in line of duty on the basis that it resulted from injury or disease attributable to the use of tobacco products in service. Service connection cannot be granted for a condition that is attributable to tobacco use during military service. For further guidance, refer to General Counsel Opinion Assessment Document, VAOPGCPREC 6-2003 and M21-1, Part VI, 7.29, Disability or Death From Use of Tobacco Products.

CLAIMS BASED ON THE EFFECTS OF TOBACCO PRODUCTS

The provisions of 38 CFR 3.300 do not prohibit service connection if:

1) The disability or death resulted from a disease or injury that is otherwise shown to have been incurred or aggravated during service. For purposes of this section, "otherwise shown" means that the disability or death can be service-connected on some basis other than the Veteran's use of tobacco products during service, or that the disability became manifest or death occurred during service; or

2) The disability or death resulted from a disease or injury that appeared to the required degree of disability within any applicable presumptive period under38 CFR §§3.307, 3.309, 3.313, or 3.316; or

3) Secondary service connection is established for ischemic heart disease or other cardiovascular disease under 38 CFR §3.310(b).

MOST COMMONLY EXPECTED CLAIMS

Lung Cancer Emphysema or other COPD Chronic bronchitis Heart disease Stokes/peripheral vascular disease Other types of cancer

DEVELOPMENT GUIDELINES

The claimant must submit the following within specified time limits:

a) Medical evidence of claimed disability;

b) Evidence of disease or injury during service (nexus).

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Change 3January 1, 2006

Obtain STRs and relevant post-service treatment reports. Simultaneously develop for any medical treatment mentioned on the claim.

Request a VA examination and medical opinion as appropriate. Refer to the VA Examination Section for further details.

CHANGES

Change 2, September 29, 2004, added M21-1 reference.

Change 3, January 1, 2006, references incorporated within each topic.

2

April 16, 2009

Section 80

Guidance on Intertwined Issues (Appeals)Below are some examples of new claims that ARE intertwined with pending appeals. This list is not all-inclusive and is intended to be a guide. When in doubt, common sense should be used.

Appeal issue(s): New Claims

Evaluation of psychiatric disability SC for any other psychiatric disabilitySC for alcohol 2nd PTSD IU – when based solely on the psychiatric disability

Evaluation of DC 7301 to 7329, etc. SC for any of the digestive codes that can’t be combined with each other (needto be rated together and elevation considered).

Evaluation of DC 6600 to 6817, etc. SC for any other respiratory codes thatcan’t be combined with each (need to berated together and elevation considered).

Below are some examples of new claims that are NOT intertwined with pending appeals. This list is not all-inclusive and is intended to be a guide. When in doubt, common sense should be used.

Appeal issue(s): New Claims

Evaluation of back disabilities SC for lower extremity neurological impairment (radiculopathy or neuropathy). The issue of orthopedic impairment is the jurisdiction of the appeals team.

Evaluation of neck disabilities SC for upper extremity neurologicalimpairment (radiculopathy or neuropathy). The issue of orthopedic impairment is the jurisdiction of the appeals team.

Evaluation of diabetes SC or increased evaluation for complications of diabetes (peripheral neuropathy, diabetic retinopathy, etc.).

Evaluation of any SC disability Paragraph 29/30 claims for the appeal issue. In the rating decision it should be noted the

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April 16, 2009

evaluation of the condition is on appeal and is not addressed in the rating decision, only the entitlement to paragraph 29/30 is addressed.

Evaluation of any SC disability SC for new disability 2nd to the SC disability Rating Board can rate the 2nd claim. However, if an exam of the SC disability was required, appeals will need to rate the results of the exam of the primary SC disability.

Individual Unemployability Claims

Whether an IU claim is intertwined with the appeal is a case by case decision.

If the appeal issue is SC for a disability, The Rating Board can evaluate all SC disabilities and issue the decision on IU.

If the appeal issue is an increased evaluation, that issue should be rated separately by Appeals. The Rating Board can then rate the remaining issues and issue the decision on IU.

If the appeal issue is an increased evaluation for a psychiatric disability, and if the IU claim is that the psychiatric disability results in unemployability, the IU claim should be rated by the Appeals Team.

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Change 1February 4, 2011

Section 81

Helpless Child Claims_______

For general information on proof of permanent incapacity for self-support, refer to M21-1MR, Part III, Subpart iii, Chapter 7. This reference includes guidance on the following:

considering claims under 38 CFR 3.315(a) the information necessary to establish the extent of the disability reporting facts based on personal observation when not to refer a claim to the rating activity handling evidence received more than three months prior to child’s 18th birthday, and determining when a Department of Veterans Affairs (VA) examination is required

DEVELOPMENT ACTIONS

The following MAPD letters/paragraphs are available:

Dependency/Children Letter, Helpless – med evid and age disabled needed

Dependency/Children Letter, Helpless - child mbr household before 18 needed

What the Evidence Must Show - Helpless Child

CHANGES

Change 1, February 4, 2011, updated references and development actions.

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Change 9January 31, 2011

Section 82

Spina Bifida & Other Birth Defects Claims_______

JURISDICTION OF CHAPTER 18 CLAIMS

All Chapter 18 benefits are to be handled by the Denver Regional Office.

All other regional offices must forward the following information to the Denver Regional Office for development and processing:

o New claims with any supporting evidence from the claimant

o Any service data/verification available from the Veteran’s claim folder (if located at the regional office), and

o Any development evidence or additional documentation evidence received from the claimant or any other source.

Note: The spina bifida/birth defects coordinators at each regional office will coordinate forwarding of all evidence with the Denver Regional Office.

Refer to M21-1MR, Part VI, Chapter 1, Topic 1a, for further details.

INITIAL ELIGIBILITY VERIFICATION

VSR will not develop for additional evidence from the claimant if it can be determined immediately that the claimant cannot meet all the qualifying requirements for

Vietnam or specific Korean service

nature of disability, and

relationship

For specific details regarding initial review of eligibility requirements, see M21-1MR, Part VI, Chapter 2, Section B, Topic 3.

DEVELOPMENT PROCESS OVERVIEW

For specific details regarding the development process for Chapter 18 benefits, see M21-1MR, Part VI, Chapter 2, Section B, Topic 4

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Change 9January 31, 2011

VIETNAM SERVICE AND DATE OF CONCEPTION REQUIREMENTS AND DEVELOPMENT

For specific details regarding Vietnam service eligibility requirements and date of conception requirements for Chapter 18 benefits, see M21-1MR, Part VI, Chapter 2, Section B, Topic 5.

KOREAN SERVICE AND DATE OF CONCEPTION REQUIREMENTS AND DEVELOPMENT

Under the final regulation published January 25, 2011 in the Federal Register, VA will presume herbicide exposure for any Veteran who served between April 1, 1968, and Aug. 31, 1971, in a unit determined by VA and the Department of Defense (DoD) to have operated in an area in or near the Korean DMZ in which herbicides were applied.

These units, including any Field Artillery, Signal, and Engineer support personnel attached, are listed M21-1MR, Part VI, Chapter 2, Section B, Topic 6b.

United Nations Command Security Battalion-Joint Security Area (UNCSB-JSA): The United Nations Command Security Battalion-Joint Security Area (UNCSB-JSA) was stationed at Camp Kitty Hawk in Korea. The soldiers belonged to the 8th Army, but were part of the United Nations Command Military Assistance Commission structure. The unit was permanently stationed near the DMZ and the unit’s mission would have taken them into the DMZ. If a Veteran was assigned to the UNCSB-JSA during the period April 1968 through July 1969, exposure to Agent Orange should be conceded. Reference: VSCM Conference Call, March 17, 2005 and Reference: VSCM Conference Call, September 21, 2006.

RELATIONSHIP REQUIREMENTS

For specific details regarding general relationship requirements that must be met to qualify for Chapter 18 benefits, see M21-1MR, Part VI, Chapter 2, Section B, Topic 7.

DISABILITY REQUIREMENTS FOR SPINA BIFIDA BENEFITS

Benefits for children with spina bifida of Veterans who served in Vietnam. Benefits are payable to the biological child of an individual who performed active service in the Republic of Vietnam regardless of character of service, and including service in waters offshore or other if service involved visitation or duty in country during January 9, 1962 to May 7, 1975 regardless of the child’s age or marital status who was conceived after the date on which the Veteran first entered the Republic of Vietnam.

Reference: Children, 38 CFR 3.403

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Change 9January 31, 2011

QUALIFYING TYPES OF SPINA BIFIDA

For specific details regarding qualifying types of spina bifida for eligibility under Chapter 18, see M21-1MR, Part VI, Chapter 2, Section B, Topic 8.

DISABILITY REQUIREMENTS FOR OTHER COVERED BIRTH DEFECTS

For specific details regarding information on the eligibility requirements regarding the type of disability that must exist for other covered birth defect benefits to be awarded, see M21-1MR, Part VI, Chapter 2, Section B, Topic 9.

DEVELOPING FOR MEDICAL AND LAY EVIDENCE

VA considers the following documents acceptable without further examination for rating purposes, as long as they are adequate for assessing the appropriate level of disability:

statements from private physicians, or

examination reports from government or private institutions.

Note: VA will schedule an examination if the claimant does not have documents that are acceptable for rating purposes.

For specific details regarding the development of Chapter 18 claims, see M21-1MR, Part VI, Chapter 2, Section B, Topic 10.

BENEFITS FOR CHILDREN WITH SPINA BIFIDA OF VETERANS OF CERTAIN SERVICE IN KOREA

Chapter 18 of 38 U.S.C. title 38 was amended to provide benefits and services to children born with spina bifida of certain Veterans who served in or near the DMZ in Korea. The Act entitles such children to benefits in the same way that Chapter 18 currently provides benefits for children of Vietnam Veterans.

DoD defoliated the fields of fire between the front line defensive positions and the south barrier fence. The size of the treated area was a strip of lane 151 miles long and up to 350 yards wide from the fence to north of the "civilian control line." There is no indication that herbicide was sprayed in the DMZ itself.

Submit PIES Request Code O36 (Used only for exposure outside of Vietnam). Print a copy of the PIES request to be flip-filed in the center section of the C-file.

Select MAPD Third Party Development pick, Exposure to herbicides, to create a tracked item.

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Change 9January 31, 2011

Update the Claim Level Suspense Reason and set the suspense date accordingly.

OTHER BIRTH DEFECTS ELIGIBILITY & DEVELOPMENT

Benefits for children with other birth defects of Veterans who served in Vietnam. VA will only cover birth defects that are potentially linked to a female Veteran’s service in Vietnam and have resulted in a permanent mental or physical disability. A Vietnam Veteran must have performed active military, naval, or air service in the Republic of Vietnam during the Vietnam era. Qualify service means service in the RVN, and waters off-shore and service in other locations, if such service involved duty or visitation in the RVN. The Vietnam era is defined as beginning on February 28, 1961 to May 7, 1975, for the purpose of other covered birth defect benefits eligibility.

Development Process. For specific details regarding the development of spina bifida claims, see M21-1MR, Part VI, Chapter 2, Section B.

ACCRUED BENEFITS

Accrued benefits are payable for spina bifida claims.  However, accrued benefits are based on evidence in file (or deemed in file) at the time of death.  Therefore, development action (e.g. medical evidence, etc.) is not required and VCAA notification is not required.

Upon receipt of a completed application, forward the claim to the Rating Team.

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Change 9January 31, 2011

VA Form 21-0304 received

No

Deny

Properly signed?• Return form for signature.• Develop for medical evidence concurrently, if not a potential denial.• If a potential denial, explain options to claimant.

Yes

No

Establish EP. Make a Red File.

Child’s DOBafter 1-9-1962?

Yes

NoDid veteran serve in

Vietnam between1-9-1962 & 5-7-1975?

Yes

NoChild’s DOB after the

veteran served inVietnam?

Yes

Spina Bifida Processing

No

Yes

Child’s DOB 8-10mos. after veteranwas in Vietnam? *

* Only applies if veteran is male.

Yes

NoChild diagnosed with

spina bifida?(not spina bifida occulta)

Request the second part of thechild’s birth certificate showing

gestation period.

Yes

• Develop for dependency and service verification.• Use 60 day suspense.

Veteran have a claimfolder?

Request completed VA Form 21-4142.

Yes

Dependency andservice verified?

Pull file.Review all evidence of record.

Yes

Primary Health CareProvider listed?

Review VA Form 21-0304.

Review all evidence of

record.

Request spina bifida

medical records via 203 screen

or other means.

Deny

Deny

Deny

Case is readyto be rated.

No

No

No

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Change 9January 31, 2011

FACT SHEET

What is spina bifida?

Spina bifida, which literally means “cleft spine,” is characterized by the incomplete development of the brain, spinal cord, and/or meninges (the protective covering around the brain and spinal cord). It is the most common neural tube defect in the United States—affecting 1,500 to 2,000 of the more than 4 million babies born in the country each year.

What are the different types of spina bifida?

There are four types of spina bifida: occulta, closed neural tube defects, meningocele, and myelomeningocele.

Occulta is the mildest and most common form in which one or more vertebrae are malformed. The name “occulta,” which means “hidden,” indicates that the malformation, or opening in the spine, is covered by a layer of skin. This form of spina bifida rarely causes disability or symptoms.

Closed neural tube defects make up the second type of spina bifida. This form consists of a diverse group of spinal defects in which the spinal cord is marked by a malformation of fat, bone, or membranes. In some patients there are few or no symptoms; in others the malformation causes incomplete paralysis with urinary and bowel dysfunction.

In the third type, meningocele, the meninges protrude from the spinal opening, and the malformation may or may not be covered by a layer of skin. Some patients with meningocele may have few or no symptoms while others may experience symptoms similar to closed neural tube defects.

Myelomeningocele, the fourth form, is the most severe and occurs when the spinal cord is exposed through the opening in the spine, resulting in partial or complete paralysis of the parts of the body below the spinal opening. The paralysis may be so severe that the affected individual is unable to walk and may have urinary and bowel dysfunction.

What causes spina bifida?

The exact cause of spina bifida remains a mystery. No one knows what disrupts complete closure of the neural tube, causing a malformation to develop. Scientists suspect genetic, nutritional, and environmental factors play a role. Research studies indicate that insufficient intake of folic acid—a common B vitamin—in the mother’s diet is a key factor in causing spina bifida and other neural tube defects. Prenatal vitamins that are prescribed for the pregnant mother typically contain folic acid as well as other vitamins. (See “Can the disorder be prevented?” below for more information on folic acid.)

What are the signs and symptoms of spina bifida?

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Change 9January 31, 2011

The symptoms of spina bifida vary from person to person, depending on the type. Often, individuals with occulta have no outward signs of the disorder. Closed neural tube defects are often recognized early in life due to an abnormal tuft or clump of hair or a small dimple or birthmark on the skin at the site of the spinal malformation.

Meningocele and myelomeningocele generally involve a fluid-filled sac—visible on the back—protruding from the spinal cord. In meningocele, the sac may be covered by a thin layer of skin, whereas in most cases of myelomeningocele, there is no layer of skin covering the sac and a section of spinal cord tissue usually is exposed.

What are the complications of spina bifida?

Complications of spina bifida can range from minor physical problems to severe physical and mental disabilities. It is important to note, however, that most people with spina bifida are of normal intelligence. Severity is determined by the size and location of the malformation, whether or not skin covers it, whether or not spinal nerves protrude from it, and which spinal nerves are involved. Generally all nerves located below the malformation are affected. Therefore, the higher the malformation occurs on the back, the greater the amount of nerve damage and loss of muscle function and sensation.

In addition to loss of sensation and paralysis, another neurological complication associated with spina bifida is Chiari II malformation—a rare condition (but common in children with myelomeningocele) in which the brainstem and the cerebellum, or rear portion of the brain, protrude downward into the spinal canal or neck area. This condition can lead to compression of the spinal cord and cause a variety of symptoms including difficulties with feeding, swallowing, and breathing; choking; and arm stiffness.

Chiari II malformation may also result in a blockage of cerebrospinal fluid, causing a condition called hydrocephalus, which is an abnormal buildup of cerebrospinal fluid in the brain. Cerebrospinal fluid is a clear liquid that surrounds the brain and spinal cord. The buildup of fluid puts damaging pressure on the brain. Hydrocephalus is commonly treated by surgically implanting a shunt—a hollow tube—in the brain to drain the excess fluid into the abdomen.

Some newborns with myelomeningocele may develop meningitis, an infection in the meninges. Meningitis may cause brain injury and can be life-threatening.

Children with both myelomeningocele and hydrocephalus may have learning disabilities, including difficulty paying attention, problems with language and reading comprehension, and trouble learning math.

Additional problems such as latex allergies, skin problems, gastrointestinal conditions, and depression may occur as children with spina bifida get older.

How is it diagnosed?

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Change 9January 31, 2011

In most cases, spina bifida is diagnosed prenatally, or before birth. However, some mild cases may go unnoticed until after birth, or postnatally. Very mild cases, in which there are no symptoms, may never be detected.

Prenatal Diagnosis

The most common screening methods used to look for spina bifida during pregnancy are second trimester maternal serum alpha fetoprotein (MSAFP) screening and fetal ultrasound. The MSAFP screen measures the level of a protein called alpha-fetoprotein (AFP), which is made naturally by the fetus and placenta. During pregnancy, a small amount of AFP normally crosses the placenta and enters the mother’s bloodstream. But if abnormally high levels of this protein appear in the mother’s bloodstream it may indicate that the fetus has a neural tube defect. The MSAFP test, however, is not specific for spina bifida, and the test cannot definitively determine that there is a problem with the fetus. If a high level of AFP is detected, the doctor may request additional testing, such as an ultrasound or amniocentesis to help determine the cause.

The second trimester MSAFP screen described above may be performed alone or as part of a larger, multiple-marker screen. Multiple-marker screens look not only for neural tube defects, but also for other birth defects, including Down syndrome and other chromosomal abnormalities. First trimester screens for chromosomal abnormalities also exist but signs of spina bifida are not evident until the second trimester when the MSAFP screening is performed.

Amniocentesis—an exam in which the doctor removes samples of fluid from the amniotic sac that surrounds the fetus—may also be used to diagnose spina bifida. Although amniocentesis cannot reveal the severity of spina bifida, finding high levels of AFP may indicate that the disorder is present.

Postnatal Diagnosis

Mild cases of spina bifida not diagnosed during prenatal testing may be detected postnatally by X-ray during a routine examination. Doctors may use magnetic resonance imaging (MRI) or a computed tomography (CT) scan to get a clearer view of the spine and vertebrae. Individuals with the more severe forms of spina bifida often have muscle weakness in their feet, hips, and legs. If hydrocephalus is suspected, the doctor may request a CT scan and/or X-ray of the skull to look for extra fluid inside the brain.

How is spina bifida treated?

There is no cure for spina bifida. The nerve tissue that is damaged or lost cannot be repaired or replaced, nor can function be restored to the damaged nerves. Treatment depends on the type and severity of the disorder. Generally, children with the mild form need no treatment, although some may require surgery as they grow.

The key priorities for treating myelomeningocele are to prevent infection from developing through the exposed nerves and tissue of the defect on the spine, and to protect the exposed nerves and structures from additional trauma. Typically, a child born with spina bifida will

8

Change 9January 31, 2011

have surgery to close the defect and prevent infection or further trauma within the first few days of life.

Doctors have recently begun performing fetal surgery for treatment of myelomeningocele. Fetal surgery—which is performed in utero (within the uterus)—involves opening the mother’s abdomen and uterus and sewing shut the opening over the developing baby’s spinal cord. Some doctors believe the earlier the defect is corrected, the better the outcome is for the baby. Although the procedure cannot restore lost neurological function, it may prevent additional loss from occurring. However, the surgery is considered experimental and there are risks to the fetus as well as to the mother.

The major risks to the fetus are those that might occur if the surgery stimulates premature delivery such as organ immaturity, brain hemorrhage, and death. Risks to the mother include infection, blood loss leading to the need for transfusion, gestational diabetes, and weight gain due to bed rest.

Still, the benefits of fetal surgery are promising, and include less exposure of the vulnerable spinal nerve tissue and bones to the intrauterine environment, in particular the amniotic fluid, which is considered toxic. As an added benefit, doctors have discovered that the procedure affects the way the brain develops in the uterus, allowing certain complications—such as Chiari II with associated hydrocephalus—to correct themselves, thus, reducing or, in some cases, eliminating the need for surgery to implant a shunt.

Many children with myelomeningocele develop a condition called progressive tethering, or tethered cord syndrome, in which their spinal cords become fastened to an immovable structure—such as overlying membranes and vertebrae—causing the spinal cord to become abnormally stretched and the vertebrae elongated with growth and movement. This condition can cause loss of muscle function to the legs, bowel, and bladder. Early surgery on the spinal cord may allow the child to regain a normal level of functioning and prevent further neurological deterioration.

Some children will need subsequent surgeries to manage problems with the feet, hips, or spine. Individuals with hydrocephalus generally will require additional surgeries to replace the shunt, which can be outgrown or become clogged.

Some individuals with spina bifida require assistive devices such as braces, crutches, or wheelchairs. The location of the malformation on the spine often indicates the type of assistive devices needed. Children with a defect high on the spine and more extensive paralysis will often require a wheelchair, while those with a defect lower on the spine may be able to use crutches, bladder catherizations, leg braces, or walkers.

Treatment for paralysis and bladder and bowel problems typically begins soon after birth, and may include special exercises for the legs and feet to help prepare the child for walking with braces or crutches when he or she is older.

CHANGES

9

Change 9January 31, 2011

Change 1, February 22, 2005, updated the list of units rotated to the DMZ.

Change 2, March 10, 2005, change relevant period of time for Veterans who served in or near the Korean DMZ; incorporated references into appropriate topics.

Change 3, March 17, 2005, added United Nations Command Security Battalion-Joint Security Area (UNCSB-JSA) as a recognized unit station near the Korean DMZ.

Change 4, August 4, 2005, removed Addrienne Foster as the POC; added Dorilyn Martz as the POC for Agent Orange related issues regarding Veterans who served in Korea.

Change 5, October 12, 2006, additional Korean DMZ units were added per VSCM Conference Call, September 21, 2006.

Change 6, April 30, 2008, added guidance regarding accrued benefits.

Change 7, February 3, 2010, added spina bifida fact sheet information.

Change 8, February 12, 2010, added additional manual guidance for Chapter 18 claims.

Change 9, January 31, 2011, added reference for presumption of herbicide exposure for any Veteran who served between April 1, 1968, and Aug. 31, 1971, in a unit determined by VA and the Department of Defense (DoD) to have operated in an area in or near the Korean DMZ in which herbicides were applied.

10

Change 10January 20, 2014

Section 83

Special Monthly Compensation_______

If there is a reasonable probability of entitlement to special monthly compensation (SMC), undertake any development necessary including a request for VA examination if necessary.

SPECIALLY ADAPTED HOUSING (SAH) UPDATES

M21-1MR, Part IX, Subpart i, Chapter 3 (M21-1MR IX.i.3), provides guidance on the criteria for establishing entitlement to Specially Adapted Housing (SAH).

Extension of SAH Provisions

On September 30, 2013, H.R. 1412 was signed into law as Public Law (PL) 113-37.  Section 2(g) of the law extends the temporary specially adapted housing (SAH) expansion in 38 U.S.C. § 2101(a) originally created by section 202 of PL 112-154 for an additional year (through September 30, 2014), The law specifies that permanent loss or loss of use of one or more lower extremity that precludes locomotion absent the use of certain devices will constitute a qualifying disability for the purpose of SAH for Veterans and service members who served and became permanently disabled on or after September 11, 2001.

Please note that although PL 113-37 provides that the Secretary may not approve more than 30 applications for assistance under the temporary provisions during fiscal year 2014, this does not affect regional office (RO) processing of SAH issues. 

Addition of Amyotrophic Lateral Sclerosis (ALS)

On December 3, 2013, an interim final rule was published (78 FR 72573) adding a new subsection  38 C.F.R. § 3.809 (d)  to specify that service-connected ALS is a qualifying condition for the purpose of determining entitlement to SAH assistance for Veterans and service members. Claims from service members with ALS incurred or aggravated in the line of duty also qualify under the rule change.

The interim final rule is effective December 3, 2013 and applies to all applications for SAH pending before VA on, or received after, December 3, 2013. 

In view of these changes:

Continue to analyze SAH issues in accordance with existing guidance.  (See M21-1 Manual Rewrite (MR) Part IX, Subpart I, Chapter 3 (M21-1MR IX.i.3)). Information about rating claims for SAH due to ALS is forthcoming in a fast letter.

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Change 10January 20, 2014

Until Veterans Benefits Management System-Rating (VBMS-R) is updated, RVSRs, and DROs should modify generated rating text to reflect the current law using the following as appropriate:

o Temporary provisions of 38 U.S.C. §2101(a) provide that Veterans who served on or after September 11, 2001, and incurred a permanent disability that is “due to the loss or loss of use of one or more lower extremities which so affects the functions of balance or propulsion as to preclude ambulation without the aid of braces, crutches, canes, or a wheelchair” may be awarded SAH. The temporary provisions apply to claims pending on or after October 1, 2012 and approved by the Secretary on or before September 30, 2014.

o ALS is a qualifying permanent and total disability for the purpose of specially adapted housing.

Until Modern Awards Processing-Development (MAP-D) and the Veterans Benefits Management System (VBMS) are updated with the appropriate Section 5103 notice, replace the current language for the Housing Benefit development action with the What the Evidence Must Show (WTEMS)- Housing language provided below.  

In VBMS:1.   Under Associated Development Actions, click on Add.2.   Under Choose Category, select What the Evidence Must Show.3.   Select Custom Development Action.4.   Under Select a Section, select Important Information.5.   In Enter Custom Title field, type in WTEMS – Housing.6.   In Enter Custom Text field, copy and paste in the entire set of WTEMS updated language. 7.   Update Days Suspended to 0.

In MAP-D:1.   Under the claimant letter format, generate letter by clicking on word.2.   Under What the Evidence Must Show for Specially Adapted Housing or Special

Home Adaptation, copy and paste correct language into document. 3.   Save changes.

Please note that we are making every effort to include the Housing WTEMS attached below as patch to VBMS the weekend of December 21, 2013.  At this time, the earliest that MAP-D could be updated is late fiscal year 2014.

Housing Benefit WETMS

To support your claim for specially adapted housing (SAH) the evidence must show you are a Veteran entitled to compensation under 38 U.S.C. Chapter 11 for a permanent and totally

disabling qualifying condition, OR service member on active duty who has a permanent and totally disabling qualifying

condition incurred or aggravated in the line of duty

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Change 10January 20, 2014

To support that you have a qualifying condition for SAH the evidence must show: amyotrophic lateral sclerosis (ALS), OR loss (amputation) or loss of use of

o both lower extremities ORo one lower extremity and one upper extremity affecting balance or propulsion, ORo one lower extremity plus residuals of organic disease or injury affecting balance or

propulsion creating a need for regular, constant use of a wheelchair , braces, crutches or canes as a normal mode of getting around (although getting around by other methods may be occasionally possible); OR

o loss or loss or use of both upper extremities precluding use of the arms at or above the elbow; OR

o blindness in both eyes, with light perception only and the loss or loss of use of one lower extremity; OR

o a severe burn injury, meaning full thickness or subdermal burns that have resulted in contractures with limitation of motion of two or more extremities, or at least one extremity and the trunk.

To support your claim for SAH the evidence may alternatively show you are a Veteran who served and became permanently disabled from a qualifying condition on or

after September 11, 2001 OR service member on active duty who was permanently disabled in the line of duty from a

qualifying condition on or after the same date.

To support that you have a qualifying condition under the alternative service criteria the evidence must show:

loss (amputation) or loss of use ofo one or more lower extremities, severely affecting the functions of balance or

propulsion and creating a need for regular, constant use of a wheelchair, braces, crutches or canes as a normal mode of getting around (although getting around by other methods may be occasionally possible).

To support your claim for a special home adaptation (SHA) grant the evidence must show you are a

Veteran entitled to compensation under 38 U.S.C. Chapter 11 for a qualifying condition, OR

service member on active duty who has a qualif residuals of inhalation injury (including, but not limited to, pulmonary fibrosis, asthma,

and chronic obstructive pulmonary disease)ying condition incurred or aggravated in the line of duty.

To support that you have a qualifying condition for SHA the evidence must show: blindness with central visual acuity of 20/200 or worse in each eye using a standard

correcting lens, OR blindness such that the visual field in each eye subtends and angle no greater than 20

degrees, OR

3

Change 10January 20, 2014

permanent and total disability from loss, or loss of use, of both hands, OR permanent and total disability from a severe burn injury meaning

o deep partial thickness burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk, OR

o full thickness or subdermal burns that have resulted in contracture(s) with limitation of motion of one or more extremities or the trunk, OR

o residuals of inhalation injury (including, but not limited to, pulmonary fibrosis, asthma, and chronic obstructive pulmonary disease).

Reference: Addendum Compensation Service Bulletin, December 2013

DEVELOPMENT AND EVIDENCE REQUIREMENTS

If the claim for SMC was received with evidence, did the evidence show at least one of the following due to a service-connected condition(s)?

Need for aid and attendance of another person in performing activities of daily living

Severe visual impairment

Permanently housebound

Loss (or loss of use) of certain body parts.

If the claim for SMC was received without evidence . . .

Send MAPD Compensation Claimant Letter, Special Monthly Compensation.

Ref: Special monthly compensation ratings, 38 CFR 3.350.

If in doubt, refer the claim to a Rating Specialist before undertaking development.

AID AND ATTENDANCE (A&A)

CRITERIA FOR REGULAR A&A. The criteria for determining need for A&A is contained in 38 CFR 3.352(a).

A single service-connected disability rated 100 percent under a schedular evaluation is generally a prerequisite to a determination of need for regular A&A. For definition of "single disability," see 38 CFR 4.16. Any lesser disability would be incompatible with the requirements of 38 CFR 3.352(a).

If a current examination is of record and the disability evaluation is less than 100 percent after a current examination, but it is considered that the disability is so severe as to

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Change 10January 20, 2014

demonstrate a need for regular A&A, submit the claim to Compensation and Pension Service (211B) for an advisory opinion.

EVIDENCE REQUIREMENTS FOR A&A. If the initial claim for A&A did not include a statement from a licensed health care professional, ask the Veteran to furnish a statement from the licensed health care professional who provides or supervises the daily skilled health care on a continuing basis in the Veteran's home.

Send the Medical Statement for Housebound or A&A. Refer to Addendum D for a sample statement.

VA FORM 21-2680, EXAMINATION FOR HOUSEBOUND STATUS OR PERMANENT NEED FOR REGULAR AID AND ATTENDANCE. The VA Form 21-2680 may be used by any physician to provide evidence that a claimant or beneficiary is in need of aid and attendance and/or housebound benefits.  Claimants applying for A&A/Housebound benefits may use such standard forms as VAF  21-4138, VAF 21-526 or VAF 21-527.

Reference: C&P Service Bulletin, February 2009

EVIDENCE DOES NOT SHOW NEED FOR A&A. If the evidence does not show the need for A&A, refer the claim to an RVSR. No further development is required.

VA EXAMINATION FOR REGULAR A&A. Be sure to select the DBQ exam for A&A and Housebound. When the issue is Special Monthly Compensation based on A&A/housebound, list the service-connected disabilities in the exam request.

If there is sufficient medical records in the file but the RVSR cannot make a determination as to the need for aid and attendance or being housebound, ask the VA examiner to render an opinion based on a review of the evidence rather than scheduling the Veteran for an examination.

Only order individual exams if the Veteran is also requesting an increase for the disability or disabilities.

CRITERIA FOR HIGHER LEVEL OF A&A. A Veteran entitled to the regular A&A allowance under 38 U.S.C. 1114(r) is entitled to receive, in lieu of that allowance, a higher A&A allowance if the Veteran is found to be in need of and receiving a higher level of care. Refer to 38 CFR 3.352(h) for further details.

The higher allowance is only awarded when the need is clearly established and the amount of skilled service required by the Veteran is substantial. This allowance is payable even if such skilled service is being furnished by VA or another entity at no expense to the Veteran. Refer 38 CFR 3.352(b) for further details.

VA EXAMINATION FOR HIGHER LEVEL OF A&A. If the statement from a licensed health care professional shows that qualifying skilled services are provided on a continuing basis, request an immediate examination to include a certification of the need for the level of

5

Change 10January 20, 2014

care required for entitlement to the higher rate under 38 U.S.C. 1114(r)(2) authorized by Public Law 95-479. Provide a copy of the statement submitted by the licensed provider to the examiner. Tell the examiner the certification can be based on a review of the records in the file and that examination of the Veteran is at the examiner’s discretion.

In response to the request for examination, the examining physician should complete item 32 of VA Form 21-2680, "Examination for Housebound Status or Permanent Need for Regular Aid and Attendance."

For further details, refer to M21-1MR, Part IV, Subpart ii, Chapter 2, Section H, Special Monthly Compensation.

QUALIFIED NURSING HOMES

For details on identifying qualified nursing homes, refer to M21-1MR, Part V, Subpart iii, Chapter 2, Section B, A&A Status for Beneficiaries Who Are Patients in a Qualified Nursing Home.

LOSS OF USE

VA EXAMINATION. The responsibility for determining whether there is loss of use of an extremity rests with the rating activity and cannot be delegated to the examining physician.

Do not ask the examiner “to determine loss of use,” or

Do not ask the examiner to express an opinion as to “whether there is or is not loss of use” of an extremity or extremities.

The VA examination should request a detailed objective description of remaining function and a quantitative assessment of strength for each extremity involved, and describe any pain that affects use. If an examination report is not determinative for loss of use, request appropriate specialized examination.

PRECAUTIONS. Exercise considerable care when issuing requests for examinations. For example, if a prior examination clearly established loss of use of both lower extremities at a level preventing natural knee action, do not request a complete medical examination if the only issue in question is the extent of involvement of one or both of the upper extremities. Instead, request an examination with a notation that the examination is to be restricted to the degree of functional impairment of the upper extremities.

For further details, refer to M21-1MR, Part IV, Subpart ii, Chapter 2, Section H, Special Monthly Compensation.

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Change 10January 20, 2014

SPECIAL MONTHLY COMPENSATION (SMC) UNDER 38 U.S.C. § 1114(S) (STATUTORY HOUSEBOUND) AND A TOTAL RATING BASED UPON INDIVIDUAL UNEMPLOYABILITY (TDIU)

The United States Court of Appeals for Veterans Claims (Court) held in Bradley v. Peake, 22 Vet. App. 280 (2008), that for purposes of SMC at the (s) rate, the statute does not limit a service-connected disability rated as total to only a schedular 100-percent rating. The regulation permits a TDIU rating based on a single disability to satisfy the statutory requirements of a total rating.

For example, a Veteran who is in receipt of a TDIU rating based on a single disability, but is also service connected for other disabilities totaling 60 percent or more, is entitled to SMC housebound at the (s) rate – or “statutory housebound” – under the Bradley decision. If, subsequently, the Veteran files a claim for an increased evaluation and is increased to a schedular 100 percent evaluation, there is a question whether the Veteran continues to meet the entitlement criteria under Bradley for entitlement to SMC at the (s) rate.

The Court was clear that VA is obligated to maximize the benefits granted. In Bradley, the Court explained that in a case where an increase to a 100-percent schedular rating would subsume the TDIU rating and the Veteran would no longer be entitled to SMC at the (s) rate, VA decision makers are to assess whether the Veteran still meets the criteria for TDIU based on a single disability before substituting a combined total schedular rating for the TDIU. As a result, in cases where a single service-connected condition supports a TDIU rating and the Veteran has other service-connected conditions entitling him or her to statutory housebound, the TDIU evaluation should be retained if the Veteran would otherwise lose the SMC rate.

Reference: C&P Bulletin, January 2011

SPECIAL ADAPTIVE HOUSING AND SPECIAL HOME ADAPTATION GRANTS (PUBLIC LAW 112-154, SECTIONS 202/203)

Section 202 of Public Law 112-154 provides that in addition to those Veterans currently eligible for SAH under 38 U.S.C. § 2101(a) (see 38 C.F.R. § 3.809), Veterans who served on or after September 11, 2001, and incurred a permanent, but not necessarily total, disability that is “due to the loss or loss of use of one or more lower extremities which so affects the functions of balance or propulsion as to preclude ambulating without the aid of braces, crutches, canes, or a wheelchair” are eligible for the SAH benefit. The amendment is temporary, and provides that the SAH benefit may be awarded for claims pending on or after October 1, 2012, as long as the application is approved on or before September 30, 2013. Unless Congress extends or makes this benefit permanent, we will not amend the regulation, 38 C.F.R. § 3.809.

Decision makers should be aware that this new provision is only available to Global War on Terror (GWOT) Veterans and, in addition, differs from prior SAH benefits.

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Change 10January 20, 2014

For further guidance, refer to the December 2012 Compensation Service Bulletin.

CHANGES

Change 1, July 10, 2004, added guidance regarding exam requirements for a higher level of aid and attendance (R2).

Change 2, March 14, 2005, added guidance regarding exam requirements for aid and attendance or being housebound.

Change 3, May 1, 2005, reformatted the section; added guidance regarding evidence requirements; added Medical Statement for Housebound or A&A.

Change 4, July 30, 2008, deleted A&A statement from within the section; Medical Statement for Housebound or A&A was added as Addendum D

Change 5, October 18, 2008, added guidance regarding the use of VA Form 21-2680 by other than VA physicians.

Change 6, March 7, 2009, added guidance regarding the use of VA Form 21-2680 by any physician.

Change 7, July 27, 2009, added guidance regarding the identification of qualified nursing homes; updated M21-1MR references.

Change 8, February 1, 2011, added guidance regarding Special Monthly Compensation (SMC) under 38 U.S.C. § 1114(s) (Statutory Housebound) and a Total Rating Based Upon Individual Unemployability (TDIU).

Change 9, January 27, 2013, added guidance Special Adaptive Housing and Special Home Adaptation Grants under Public Law 112-154, Sections 202/203 for GWOT Veterans.

Change 10, January 20, 2014, added guidance regarding Special Adaptive Housing from the December 2013 Addendum Compensation Service Bulletin.

8

Change 1November 25, 2011

Section 84

Original Pension Claim_______

PENSION CONSOLIDATION AT THE PMC

Original live and death pension claims are being consolidated at the three Pension Maintenance Centers (PMCs) located in Philadelphia, St. Paul, and Milwaukee. For further guidance, see Fast Letter 08-23, Pension Consolidation Procedures, dated July 22, 2008.

ADMINISTRATIVE GRANT OF PENSION

All RO and PMC staff should remember that it is the policy of the Compensation and Pension Service to pay all benefits as expeditiously as possible. Therefore, field stations are to promptly pay pension when no disability decision is required, such as when the claimant is:

age 65 or older,

in receipt of Social Security disability benefits, or

a patient in a nursing home (see 38 CFR 3.3(a)(3)(vi)).

Payment of pension should not be deferred pending development of any compensation issue when there is sufficient evidence (including income/net worth information) to grant pension.  Likewise, the rating activity should make a partial decision if the record contains sufficient evidence to grant any benefit at issue.  For more information on providing benefits at the earliest possible point in the claims process, see:

M21-1MR, Part III, Subpart iv, Chapter 6, Section A, Topic 1 (M21-1MR, III.iv.6.A.1),

M21-1MR, IV.ii.1.A.1 , and

M21-1 Part V, Chapter 4, Paragraph 4.09.

Reference: E-mail from VAVBAWAS/CO/OFO , SUBJ: Pension Guidance-Important, dated 09-24-10

CHANGES

Change 1, November 25, 2011, added guidance regarding administrative award of pension.

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Change 1November 25, 2011

Section 85

Reopened Pension Claim_______

PENSION CONSOLIDATION AT THE PMC

The Veterans Benefits Administration (VBA) has consolidated original live and death pension claims from 57 Home Regional Offices (HROs) to three Pension Maintenance Centers (PMCs) located in Philadelphia, St. Paul, and Milwaukee. For further guidance, see Fast Letter 08-23, Pension Consolidation Procedures, dated July 22, 2008.

ADMINISTRATIVE GRANT OF PENSION

All RO and PMC staff should remember that it is the policy of the Compensation and Pension Service to pay all benefits as expeditiously as possible. Therefore, field stations are to promptly pay pension when no disability decision is required, such as when the claimant is:

age 65 or older,

in receipt of Social Security disability benefits, or

a patient in a nursing home (see 38 CFR 3.3(a)(3)(vi)).

Payment of pension should not be deferred pending development of any compensation issue when there is sufficient evidence (including income/net worth information) to grant pension.  Likewise, the rating activity should make a partial decision if the record contains sufficient evidence to grant any benefit at issue.  For more information on providing benefits at the earliest possible point in the claims process, see:

M21-1MR, Part III, Subpart iv, Chapter 6, Section A, Topic 1 (M21-1MR, III.iv.6.A.1),

M21-1MR, IV.ii.1.A.1 , and

M21-1 Part V, Chapter 4, Paragraph 4.09.

Reference: E-mail from VAVBAWAS/CO/OFO , SUBJ: Pension Guidance-Important, dated 09-24-10

CHANGES

Change 1, November 25, 2011, added guidance regarding administrative award of pension.

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June 16, 2010

Section 86

Death Benefits_______

DEATH PENSION CONSOLIDATION AT THE PMC

Original live and death pension claims are being consolidated at the three Pension Maintenance Centers (PMCs) located in Philadelphia, St. Paul, and Milwaukee. Reference: Fast Letter 08-23, SUBJ: Pension Consolidation Procedures.

APPLICATION FORMS

Original live and death pension claims from the 57 Home Regional Offices (HROs) to three Pension Maintenance Centers (PMCs) located in Philadelphia, St. Paul, and Milwaukee. Reference: Fast Letter 08-23, SUBJ: Pension Consolidation Procedures.

There are three primary applications you will encounter for death benefits -

VA Form 21-534 - Application for Dependency and Indemnity Compensation, Death Pension, and Accrued Benefits by a Surviving Spouse or Child (Including Death Compensation if Applicable)

VA Form 21-535 - Application for Dependency and Indemnity Compensation by Parent(s) (Including Accrued Benefits and Death Compensation when Applicable)

VA Form 21-601 - Application for Accrued Amounts Due a Deceased Beneficiary

You may also encounter as an associated claim VA Form 21-530, Application for Burial Benefits.

VA Form 21-534: This is the most common application you will receive. On original claims, it serves as a claim for all three benefits - DIC, death pension, and accrued. It is also to be considered as a claim for month of death payment for the surviving spouse. Both surviving spouse and surviving child use this application. An abbreviated version, VA Form 21-534a is used for in-service deaths and is currently handled by the Philadelphia RO.

VA Form 21-535: This application is used for claims of DIC and accrued benefits by a parent or parents. There is no death pension benefit for a parent, although income is a determining factor for their eligibility for DIC.

VA Form 21-601: This application is used for claims of accrued benefits. Although a surviving spouse, child, or parent may submit this form; they should submit their claim on the VA Form 21-534 or 535. Individuals who have paid the Veterans just debts and last expenses and are seeking reimbursement should use VA Form 21-601.

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June 16, 2010

BASIC DIC EVIDENTIARY REQUIREMENTS CHECKLIST

VA Form 21-534: (“Application for Dependency and Indemnity Compensation, Death Pension and Accrued Benefits by a Surviving Spouse or Child (Including Death Compensation if Applicable)”)

Evidence showing:

the cause of death, and

that the cause of death was

o related to, or hastened by, a service-connected (SC) condition, or

o related to a disease or injury that existed during active military service.

OR

Entitlement to DIC under U.S.C. 1318:

o Veteran was in receipt of, or entitled to receive, compensation for a totally disabling SC disability (to include IU):

for ten or more years immediately preceding death or

continuously for a period of not less than five years from the date of separation from service until death, or

for a period of not less than one year immediately preceding death for a former prisoner of war who died after September 30, 1999.

OR

Entitlement to DIC under U.S.C 1151

Proof of the Veteran’s death as explained in 38 CFR 3.211

Verification of marital relationship and/or child relationship to the deceased Veteran

Service Treatment Records and all other relevant records

REMEMBER: VA Form 21-534 is required for a claim for DIC. The form is also a claim for death pension, accrued benefits, and month of death payment. All of these issues must be addressed in our notification letter(s) regarding the claim (M21-1MR Part IV.iii.1.1a).

DETERMINING DIC ENTITLEMENT

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June 16, 2010

Dependency and Indemnity Compensation (DIC) is defined as a monthly payment made to a surviving spouse, child, or parent because the cause of death was service connected on or after January 1, 1957, or before January 1, 1957, if the survivor elects to receive DIC in lieu of death compensation.

DIC under U.S.C. 1310(a)

Generally, to determine entitlement to DIC, VA needs evidence showing:

the cause of death, and that the cause of death was related to, or hastened by:

o a service-connected (SC) condition, or

o related to a disease or injury that existed during active military service.

DIC under 38 USC 1318

DIC can be paid if a Veteran was in receipt of, or entitled to receive, compensation for a totally disabling SC disability (to include IU)

for ten or more years immediately preceding death

continuously for a period of not less than five years from the date of separation from service until death, or

for a period of not less than one year immediately preceding death for a former prisoner of war who died after September 30, 1999.

The file should be routed to rating activity if any of the above situations apply.

DIC under U.S.C. 1151

DIC can be awarded if the Veteran’s death was attributable to:

o hospital care, medical or surgical treatment, or examination furnished the Veteran under any law administered by the Secretary,

o participation in vocational rehabilitation training under 38 U.S.C. Chapter 31, or

o participation in compensated work therapy (CWT).

ESTABLISHING ENTITLEMENT AS THE SURVIVING SPOUSE

Verification of a claimant’s marital relationship to a deceased Veteran is required in order to establish entitlement to DIC. M21-1MR III.iii.5.E provides information for establishing a valid marriage in death cases.

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If the claimant fails to submit, or does not submit all the requested dependency information in a DIC claim, after VCAA has expired, we will deny as "failure to

respond/failure to prosecute” (FTR or FTP).

DO NOT send these files to the rating activity.

June 16, 2010

Surviving Spouse

See 38 CFR 3.50(b) for the definition of a “surviving spouse”.

A claimant filing for death benefits, as the surviving spouse of a Veteran, must establish that he/she and the Veteran had a valid marriage. The fact that benefits were paid for a person as the spouse of the Veteran during the Veteran's lifetime does not automatically establish that person's status as the surviving spouse after the Veteran's death.

Before a marriage may be established for VA purposes, it is always necessary to have the claimant's statement of marital history. In order to verify the Veteran and claimant were free to marry we need to know the following information about both the Veteran’s and the claimant’s previous marriages:

Date (month and year) and Place (city, state or state, country) of current spouse Name (first and last) of all, including current spouse How marriage was terminated for all previous marriages (death, divorce, etc.) Date (month and year) and Place (city, state or state, country) marriage was

terminated for all previous marriages

We also must have the current spouse’s Social Security number.

Documentary proof of dissolution of all prior marriages of both parties is required if dissolution of prior marriages cannot be established based on the claimant's certified statement.

See 38 CFR 3.50(b)

ACCRUED BENEFITS

Accrued benefits are benefits to which a Veteran was entitled on the date of death, but were not paid. Often, the benefits were not paid as the result of a claim that was pending but never finally adjudicated due to the death of the Veteran.

An accrued benefit decision is based on

existing ratings or decisions, or

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June 16, 2010

evidence on in VA’s possession on or before the date of the beneficiaries death in support of a claim for VA benefits pending on the date of death

For beneficiaries who died on or after December 16, 2003, a claim for accrued benefits must be filed within a year of the beneficiary’s death.

A VSR can deny the claim for accrued benefits without development because no accrued amount exists, and explain the reason for the denial in the notification letter.

Do not request rating action for accrued purposes unless evidence was in the file at the date of death to establish relationship and other factors affecting entitlement.

If it is determined that accrued benefits are payable upon the death of a Veteran, they are payable to the living person first listed below:

To his or her spouse

His or her children (in equal shares)

His of her dependent parents (in equal shares) or the surviving parent

Note: The fact that a preferred beneficiary fails to file or prosecute a claim does not permit payment of his/her share of accrued benefits to a person or persons having an equal or lower preference. A waiver of right also does not permit such payment.

DEATH PENSION ELIGIBILITY

Remember: The earlier the claimant is recognized as ineligible the better. It is no service to the claimant to develop when the record does not support basic eligibility.

Veteran’s Minimum Active Duty Service ( M21-1MR.V.i.1.2.a , and M21- 1MR. III.ii.6.4 )

entered service prior to September 7, 1980 and completed a period of active duty of at least 90 days, or

entered service after September 7, 1980 and completed a continuous period of active duty of at least 24 months or for the full period called to active duty, or

In receipt of or entitled to receive compensation or retired pay due to s/c wartime disability at time of death, or

Discharged due to disability (Rating required).

Wartime Service ( M21-1MR V.i.1.2.b )

At least one day of service during a wartime period. (based on chart)

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Period of War Beginning and Ending DatesMexican Border Period

May 9, 1916 through April 5, 1917 for Veterans who served in Mexico, on its borders, or adjacent waters

World War I April 6, 1917 through November 11, 1918; for Veterans who served in Russia, April 6, 1917 through April 1, 1920

World War II December 7, 1941 through December 31, 1946Korean Conflict June 27, 1950 through January 31, 1955Vietnam Era August 5, 1964 through May 7, 1975; for Veterans who served "in

country" before August 5, 1964, February 28, 1961 through May 7, 1975

Gulf War August 2, 1990 through a date to be set by law or Presidential Proclamation

Dependency (see “Death Pension Dependency” handout for more information and references)

No conflicting information/need to develop for proof

All needed information provided

Spouse:

statement of prior marriages un-remarried/terminated marriage prior to 11/01/90

marriage date requirement met continuous cohabitation requirement met

Income (M21-1MR.V.i.3, and M21-1MR.V.iii.1)

MAPR > IVAP

Net Worth (M21-1MR.V.i.3, and M21-1MR.V.iii.1)

Less than $80,000 if granting, VA Form 21-8049/determination needed if over $80,000

REVIEWING THE APPLICATION

This is where the hard work begins for the VSR. The latest edition of VA Form 21-534 has instructed the claimant to skip various portions if certain conditions are met.

Date of claim: Review the date of receipt with the date of the Veteran’s death. If the date of receipt is within one year of the Veteran’s death, then all benefits granted are payable from the first of the month of the Veteran’s death.

If over one year, then the effective date is the date of claim for DIC or death pension. Accrued benefits should be denied as not claimed within the time limit.

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June 16, 2010

Note: Although the time limit has passed, it is not improper to deny accrued for no benefits owed in the notification letter if applicable.

Veteran data: Identify the Veteran’s record through his name, SSN, service number, and C-file #. If a C-file # is assigned, correct identification is usually correct. Older Veterans who are assigned NOD folders with SSN as the file number should be carefully reviewed for the existence of a C-file #. This is particularly important on death pension claims several years after the Veteran’s death.

Claimed benefit: Determine the intention of the claimant of benefits being sought. If ‘yes’ was checked for service-connected death, then the claim is for DIC. If the income sections are completed, then consider the claim for both death pension and DIC.

If ‘no’ is selected, the intent is most likely for death pension only. However, watch for inferred DIC conditions such as 100% rating at time of death. Also, the submission of medical evidence or VA Form 21-4142 for a Veteran’s records should be considered intent for a claim of service connected death.

If either box is not selected, or “unknown” is indicated, presume the claim is for DIC. This occurs often when the Veteran was 100% for an unrelated condition.

Occasionally an application will be for death pension Medicaid nursing home rate only. The manual states that DIC (if entitled) should be paid as the greater benefit and to inform the claimant to elect the $90 rate. However, recent national STAR reviews have indicated that DIC should not be paid as it may do irreparable harm to the claimants Medicaid benefits. Clarification with the claimant may be in order for these claims.

Claimant data: Determine whether the claimant is a surviving spouse, child, or spouse with child. A parent must always claim benefits on VA Form 21-535. Address and date of birth is required. A social security number is required except for non-resident aliens and children under age 2. Resident aliens must provide a letter from Social Security explaining why they don’t have a number assigned.

Military service: This is a section that the claimant is told to skip if the Veteran was receiving benefits. It is common to see ‘in file’ or ‘of record,’ especially if a service officer assisted the claimant in completing the claim. This is usually acceptable. However, in cases where a C-file # isn’t identified and the Veteran’s SSN was not in BIRLS, this poses a problem and delays processing.

For entitlement to benefits, the service must be other than dishonorable. If the information is missing on the application, but BIRLS shows verified service, accept the BIRLS record. If the Veteran was receiving benefits, consider the service verified as honorable.

If there is no record, a copy of the Veteran’s discharge document must be submitted or sufficient information submitted to get verification from the military.

Marital history: Unless there is evidence or an indication of a conflict, accept the statement of marital history as is.

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June 16, 2010

The manual specifically states that being established on the Veteran’s award does NOT establish entitlement as the surviving spouse. The reasoning for this is continuous cohabitation. A Veteran needs not to be living with the spouse to claim them as a dependent on live compensation. However, continuous cohabitation is required for a surviving spouse to be eligible for death benefits. Due to the number of cases that would be unduly developed, current station policy is to assume continuous cohabitation was not broken if the claimant was on the Veteran’s award.

A second problem that frequently arises from this section is establishing a valid marriage. The claimant often states ‘in file,’ ‘of record’ or ‘unknown’ for the Veteran’s prior marriages. When the file is reviewed, the information isn’t of record. Also, incomplete information is often provided, missing the city or month of the divorce or death for terminating the marriage. This information is required for a deemed valid marriage.

Dependent children: Be careful not to miss this section. Also, review the Veteran’s file and clarify the status of any child on the Veteran’s award that isn’t being claimed. Requirements to establish a surviving child are covered below.

Additional benefits: Review the application for requests of aid and attendance. Even if not claimed on the application, consider medical evidence or physician statements for the claimant as a claim for aid and attendance. If the claimant is in a nursing home, aid and attendance is an authorization grant and neither medical evidence nor a rating decision are needed. This applies to both DIC and death pension. Housebound is for death pension only and requires a rating decision.

Also, this section is usually when the $90 Medicaid nursing home rate claim is indicated. If Medicaid has been applied for, consider it as granted per regulations.

Income and Net Worth: This section must be completed for any claim for death pension. There can be no empty boxes. If there is none, there must be an indication by the claimant. The application states this is done by entering either 0 or none. However, the manual rewrite and national STAR has indicated that intent is sufficient.

Any unambiguous entry on the EVR such as “none,” “O,” or “n/a,” is acceptable. Accept lining through the block as an acceptable way of indicating “none.” Treat any indefinite entry such as “?” or “unknown” as no response.

If the boxes are inconsistently marked and omitted, then clarification must be made. Telephone development is acceptable and encouraged.

If interest assets are reported (any amount), then development for the amount of interest is required. If interest or dividends are reported, but does not report the source of the interest/dividends income as net worth, you will need to develop for this net worth.

Always review SHARE for SSA benefits, regardless of what is reported by the claimant.

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June 16, 2010

Note: If DIC is granted, it is unnecessary to have completed income information. It is also common for a claimant to leave the section totally blank or say “DIC only.” Do not develop for income in these cases.

Signature: Make sure the claimant signed the application. It must contain at least an X with two witnesses. Court ordered guardianship and VA ‘friend of the claimant’ are the only exceptions. Family member signatures that have general power of attorney forms are not acceptable for VA purposes.

REVIEW THE EVIDENCE - DEVELOP , READY TO RATE, OR FINALIZE?

After reviewing the evidence for the benefits sought, many cases can be resolved quickly. Don’t automatically assume a VCAA notice is required. If the benefit sought can be granted, no notice is required. Sometimes only a piece of information or clarification by telephone can eliminate the need of further development.

Immediate denial: All benefits - the evidence shows the claimant was not the surviving spouse, such as divorced. Be sure to check for children on the application before denying. You may also deny a child if the evidence demonstrates that they are over age 23.

Death pension - no wartime service or excessive income. You must deny for no wartime service before denying for excessive income. Deny DIC if no indication of entitlement and it was not claimed and deny accrued if there was no claim pending at death. Use care and determine that aid and attendance was not claimed. If it was, income must exceed the higher rate.

Immediate grant: DIC - In service death and DD 1300 of record or a previous rating decision granting service-connected burial or DIC to another class claimant.

Death pension - if surviving dependent, net worth, income, and service requirements are met. Deny DIC if no indication and deny accrued if no claim pending at death.

Accrued - Occasionally a rating decision before the Veteran’s death is of record that wasn’t promulgated. This accrued benefit may be paid without a new rating decision. Also, any monies previously withheld may be paid as an accrued benefit.

Ready to rate: DIC - cause of death shows a condition the Veteran was previously rated service connected for; Veteran was 100% for previous 10 years or other 1318 requirements; Veteran was rated 100% for a vital organ; or the cause of death was a presumptive condition.

Aid and attendance - Physician statement clearly demonstrates requirements met. Consult your assigned RVSR if likely but you’re unsure.

Accrued - If a rating decision after the date of death grants the Veteran’s claim. (New rating required.)

There is no rating required for death pension.

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Develop: If the above situations don’t apply, then VCAA is required. In addition to specific evidence being requested, attach the corresponding WEMS for each benefit that you do not grant up front. Normally this would be DIC, death pension, and accrued, with aid and attendance if claimed. If you pay pension and defer DIC, do not include the pension WEMS.

Remember, you are writing to surviving dependents. Watch the wording in your letters and use terms they understand as this is probably the first time they have dealt directly with the VA.

A recent STAR review and later a court decision have contradicted manual requirements saying VCAA is not necessary for accrued benefits since all evidence must be in file at time of death and there is nothing the claimant may add. The accrued WEMS currently only applies to reimbursement type claims since claims by relationship are either eligible or not. However, due to the recent decisions, unless the RVSR makes a favorable decision, current station policy is to send VCAA for accrued whenever an appeal or claim was pending at death, regardless if DIC and death pension are adjudicated without VCAA. Additional court rulings have also indicated that a Veteran’s claim that was finalized but the appeal period not expired can be appealed as an accrued claim. This subject has been under constant evolution due to court decisions so it is incumbent upon the VSR to stay abreast of changing regulations and policies.

MANUAL REFERENCES FOR DEVELOPMENT, M21-1MR, PART IV, SUBPART III , CHAPTER 1

Use the information below to determine when to develop for income and net worth information.

If … Then … only partial income and net worth

information was provided on the application, and

basic entitlement to pension otherwise exists

develop for the missing information.

the claimant has alleged that death of the Veteran was SC, and

all income and net worth information was completely omitted

do not develop for income and net worth information.

Notes: Inform the claimant, in the notification letter,

that death pension was not considered because evidence of income and net worth was not provided.

If basic entitlement to pension does not exist, deny the claim without regard to income or net worth.

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June 16, 2010

Example: In a case in which there is no qualifying service, deny the claim for no qualifying service rather than for excessive income.

basic entitlement to pension does not otherwise exist, as in cases in which there is no qualifying service

do not develop income and net worth information.

d. Evidence Required to Determine Entitlement to DIC

Generally, to determine entitlement to DIC, VA needs evidence showing

the cause of death, and that the cause of death was- related to, or hastened by, a service-connected

(SC) condition, orrelated to a disease or injury that existed during active military service.

e. Obtaining Evidence Relating the Cause of Death to a Service- Connected Condition

Evidence to support a claim for DIC may be obtained from

the claims folder, if service connection for a disease or injury was previously established,

VA medical center treatment reports or VA outpatient clinic records,

service medical records, orprivate doctor or hospital treatment records.

f. Referring Cases to the Rating Activity

Once development is complete, refer the claim to the rating activity for a decision on the issue of service connection for the cause of death.

Note: Some death claims may be referred to the rating activity as soon as they are received. This is particularly true if service connection for a disease or injury was established during the Veteran’s lifetime.

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g. Developing for Proof of Death Develop for evidence listed in 38 CFR 3.211 that constitutes proof of death.

When acceptable evidence cannot be obtained, the fact that death occurred may still be conceded under the provisions of 38 CFR 3.211(f). These cases must be

fully developed for facts and circumstances that support a presumption of death, and

submitted to the rating activity for determining- service connection for the cause of death- the existence of a disability related to service

at the time of death, or- discharge from service for a service-connected

(SC) disability.

Reference: For more information on proof of death, see M21-1MR.III.v.1.H.

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WHAT THE EVIDENCE MUST SHOW FOR DEATH BENEFITS

To support a claim for Dependency and Indemnity Compensation (DIC) benefits based on a service-connected disability established during the Veteran’s lifetime, the evidence must show:

The Veteran died while on active military service; OR

The Veteran had a service-connected disability(ies) that was either the principal or contributory cause of the Veteran’s death; OR

The Veteran died from a nonservice-connected injury or disease AND was receiving, or entitled to receive, VA compensation for a service-connected disability rated totally disabling

For at least 10 years immediately before death; OR

For at least 5 years after the Veteran’s release from active duty preceding death; OR

For at least 1 year before death, if the Veteran was a former prisoner of war who died after September 30, 1999.

To support a claim for DIC benefits based on a disability that was not service connected or for which the Veteran did not file a claim during his or her lifetime, the evidence must show:

An injury or disease that was incurred or aggravated during active military service, or an event in service that caused an injury or disease; AND

A physical or mental disability that was either the principle or contributory cause of death. This may be shown by medical evidence or by lay evidence of persistent and recurrent symptoms of disability that were visible or observable; AND

A relationship between the disability associated with the cause of death and an injury, disease, or event in military service. Medical records or medical opinions are generally required to establish this relationship.

To support your claim for death pension benefits, the evidence must show:

1. The Veteran met certain minimum requirements regarding active military service during a period of war. Generally, those requirements involve:

90 days of consecutive service, at least one day of which was during a period of war; OR

90 days of combined service during at least one period of war;

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(Note: If the Veteran’s service began after September 7, 1980, additional length-of-service requirements may apply, typically requiring two years of continuous service or completion of active-duty obligations.)

OR, any length of active military service during a period of war when:

At the time of death, the Veteran was receiving (or entitled to receive) VA disability compensation, or retirement pay for a service-connected disability; OR

The Veteran was discharged from active military service due to a service-connected disability.

2. Your net worth and income do not exceed certain requirements

To support your claim for accrued benefits, the evidence must show:

Benefits were due the Veteran based on existing ratings, decisions, or evidence in VA's possession at the time of death, but the benefits were not paid before the Veteran's death; AND

You are the surviving spouse, child, or dependent parent of the deceased Veteran.

VA pays accrued benefits in the following order of priority:

1. Spouse

2. Children of the Veteran (in equal shares)

3. Dependent parents (in equal shares)

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January 1, 2004

Section 87

Institutionalized Veteran_______

PENSION

VA Hospital or VA Nursing Home

SMP Code 19B

COMPENSATION

Admission in any government facility

SMC basic and hospital codes must be different (i.e. Basic 03, Hospital 48)

ADJUSTMENT OF ALLOWANCES

Adjustment of allowance for aid and attendance, 38 CFR 3.552.

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Change 3January 27, 2013

Section 88

Power of Attorney (POA) Appointments_______

POWER OF ATTORNEY DESIGNATIONS & REVOCATIONS

POA Codes: For a complete list of representative, see M21-1MR, Part I, Chapter 3, Section B, Exhibit 1, Power of Attorney designations.

SYSTEM UPDATES: For every new POA, you must update all of the following screens using the program listed.

BIRL's Update - SHARE

Pending Issue Change - SHARE

VACOLS - VACOLS Exemptions: No need to look for VACOLS if you are CESTing a brand new claim (EP's 010, 110, 140, 180) with POA attached

RELEASE OF CONFIDENTIAL INFORMATION: A statement on an attorney's letterhead, signed by the attorney, is NOT sufficient to release a claimant's confidential information to that attorney. Under the Privacy Act, an attorney may not access a claimant's confidential information without the claimant's written permission. Therefore, VA may release information to an attorney only if it receives VA Form 21-22a, Appointment of Individual as Claimant's Representative, signed by both the claimant and the attorney. Refer to M21-1MR, Part I, Chapter 3, Section A for further guidance.

POWER OF ATTORNEY REVOCATIONS

If the Veteran revokes the designated representative, annotate the revoked or terminated declaration of representation and return it to the prior representative. Keep a copy of the revoked declaration of representation on the right hand side of the claims folder. See M21-1MR, Part I, Chapter 3, Section A, Topic 7 for further details.

GUIDANCE REGARDING VA FORM 21-22

Refer to Fast Letter 12-16 regarding guidance the “Revision of VA Form 21-22, Appointment of Veterans Service Organization as Claimant’s Representative,” dated June 20, 2012.

The following is an “Update Regarding Fast Letter 12-16, Revision of VA Form 21-22, Appointment of Veterans Service Organization as Claimant’s Representative.” Fast Letter

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Change 3January 27, 2013

12-16, Revision of VA Form 21-22, Appointment of Veterans Service Organization as Claimant’s Representative, released on June 20, 2012, details the recent revisions to the Department of Veterans Affairs (VA) Form 21-22, and provides procedures for utilizing the new features of the form. Though Fast Letter 12-16 states prior versions of the VA Form 21-22 will no longer be accepted, we have implemented a grace period for transitioning to the new form. Offices should continue to accept the June 2009 version of the VA Form 21-22 until September 1, 2012. During this grace period, accept the June 2009 version of the form, but also develop to the claimant for a completed copy of the revised form.

After September 1, 2012, VA will no longer accept any prior versions of the VA Form 21-22. Prior versions of the form that were processed and placed in claims folders before September 1, 2012, will remain valid.

Refrence: Addendum Compensation Service Bulletin, June 2012.

Reminder Regarding Fast Letter 12-16, Revision of VA Form 21-22, Appointment of Veterans Service Organization as Claimant’s Representative

As indicated in the June 2012 Veterans Service Center Manager (VSCM) Bulletin Addendum, Compensation Service implemented a grace period allowing ROs and PMCs to accept the June 2009 version of the VA Form 21-22, until September 1, 2012.

In the fall of 2012, VA plans to release a new functionality in eBenefits called the Stakeholder Enterprise Portal (SEP) that will allow Veterans Service Organizations (VSOs) to electronically immediately indicate acceptance of a claimant’s appointment. Until the release of SEP, ROs and PMCs are required to accept the new VA Form 21-22 with or without the VSO’s signature.

Reference: Compensation Service Bulletin, August 2012.

SEARCHABLE INTERNET-BASED LISTING OF ACCREDITIED ATTORNEYS , AGENTS, AND VETERANS SERVICE ORGANIZATIONS REPRESENTATIVES

VA’s Office of the General Counsel (OGC), Professional Staff Group II, has posted an internet-based listing of accredited attorneys, agents, and Veterans service organizations representatives. This system is available for access by VA personnel and members of the public to verify accreditation status. 

Accreditation means the authority granted by VA to representatives, agents and attorneys to assist claimants in claims for VA benefits before VA. The listing may be accessed through the VA website at http://www.va.gov/ogc/apps/accreditation/index.html.

You can obtain a list of all recognized Veterans service organizations by clicking the search button without entering anything in the search fields. You can also access a listing of all organizations through which an individual is accredited by clicking on the name of a service organization representative. 

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Change 3January 27, 2013

Please share this information with your Agent and Attorney Fee Coordinators and anyone in your VA Regional Office who may be interested in using this listing.

Reference: C&P Service Bulletin, August 2008

CLAIMANT REPRESENTATIVE ROLES

What a Recognized POA Can Do What a Recognized POA Cannot DoSubmit an informal claim. For example: A claimant's service organization of record files a document stating the Veteran wishes to apply for VA Pension.

Sign an original, formal claim for benefits, such as that which is filed on a 21-526 or 21-534

Submit a Noice of Disagreement or an appealPresent evidence on behalf of a claimant.  For example:  We send a Veteran a letter requesting a marriage certificate.  The service organization of record submits and signs a cover sheet indicating that it is attached and attachs the certificate.  This is acceptable.

Submit a VCAA Notice Response advising whether or not the claimant has additional evidence to submit

Sign the form(s) requested in a development letter, such as if we ask a surviving spouse to complete a VA Form 21-8049 in order to make a net worth determination.

Request, on behalf of the claimant, additional time to submit evidence.

What a Recognized POA Can Do What a Recognized POA Cannot Do

Submit a claim which does not require claimant certification, such as a claim for Special Monthly Pension once an original claim is of record .

Sign a claim or other form which does require claimant certification, such as an Eligibility Verification Report or Medical Expense Report or a Declaration of Status of Dependents (21-686c).

Change a claimant's address or direct deposit information by phone, as long as the verification requirements have been met.

Sign a VA Form 21-572 or VA Form 24-0296 or other document to change claimant's address or direct deposit information.

Claimant Certification Requirement explanation. Claims that require claimant certification are generally claims where the evidence that will be used to decide the claim is the form submitted. A Medical Expense Report is enough to adjust a claimant's benefit, as the form itself is the evidence. Therefore, it must be signed by the Veteran or surviving spouse. On the other hand, in a claim for special monthly pension, we will not use the document that is asking for SMP to decide the claim. We will use medical evidence obtained or a VA exam. As a result, it can be signed by the claimant's recognized POA. A 21-4138 is a good example of a form that may or may not require a claimant signature. If the 21-4138 is a claim for additional benefits or

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if it is acting as a cover, it can be signed by the claimant's representative. However, if the 21-4138 includes information that will affect benefits (a report of the death of a Veteran's spouse, a report that the Veteran left an assisted living facility) it must be signed by the claimant. Treat information received from a service organization, that requires a claimant signature, as third party information. Sumissions noted in the left column do not require a claimant signature.

Remember, for purposes of this handout, the term "POA" refers to a claimant's duly appointed service organization, agent, individual or attorney. A private power-of-attorney appointment has no effect on a claim, as a private power of attorney is not recognized for VA purposes.

Refer to M21-1MR, Part I, Chapter 3, Section A for further guidance.

USE OF VA FORM 21-0845, AUTHORIZATION TO DISCLOSE PERSONAL BENEFICIARY/CLAIMANT INFORMATION TO A THIRD PARTY

The Office of Management and Budget (OMB) has approved the use of VA Form 21-0845, Authorization to Disclose Personal Beneficiary/Claimant Information to a Third Party. This form allows National Call Centers (NCCs) and Regional Offices (ROs) to release specified information normally protected under privacy provisions to family members or other designated persons who are not powers of attorney, agents, or fiduciaries. This information can be unlimited or limited (e.g., the status of claim, benefit, payment history, payment rate, debt owed VA, or any other information specified by the authorizer). The form also allows such designated individuals to provide certain information to VA (e.g., such as changes in address or direct deposit accounts). Designated persons must correctly answer a security question chosen by the claimant or beneficiary to confirm their authorization.

Upon receipt of VA Form 21-0845, an entry is required in MAP-D notes that states, VA Form 21-0845 of record. If beneficiary or claimant selected a limited time frame for the authorization, include in MAP-D notes, VA Form 21-0845 expires on MM/DD/YYYY. In addition, please fax the completed form to the St. Paul Capture Unit at 612-970-5488, which will upload the authorization form into Virtual VA (VVA). In VVA, the form is located under Representation – Other, and named Authorization for Third Party Release.

Reference: C&P Service Bulletin, October 2009

ATTORNEY REPRESENTATION LANGUAGE IN PCGL AND SOC LETTERS

On December 22, 2006, the President signed Public Law 109-461.  Section 101 of the law amends chapter 59 of title 38, United States Code, governing the recognition of individuals for the preparation, presentation, and prosecution of claims for benefits before the Department of Veterans Affairs (VA).  The amended regulations establish the procedures and rules necessary to facilitate the paid representation of claimants by agents and attorneys after a Notice of Disagreement (NOD) has been filed rather than, as title 38 previously stated, after the Board of Veterans’ Appeals first makes a final decision with respect to the case.   Fast

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Change 3January 27, 2013

Letter 09-21 provides information concerning the VA final rule that amends the regulations governing the representation of claimants for Veterans benefits.  The final rule was effective June 23, 2008. 

A review of some recent letters indicates Regional Offices continue to use the old language found in M21-MR, Part I, Chapter 5.B.8.b.  Similar erroneous language is also in the PCGL paragraph titled “033 Representation”, and in the VETSNET Statement of Case (SOC) program.

The manual is scheduled to be updated.  Programming changes are scheduled for PCGL to remove paragraph 033.  The VETSNET SOC program is also scheduled to be updated.  The programming changes are scheduled for August 2010.

Effective immediately do not use the language that contains the erroneous statement that indicates attorney fees can be charged after the Board of Veterans’ Appeals first makes a final decision.  This should be replaced with the language that indicates that attorney fees are payable after the NOD is filed.  The proper PCGL paragraph is “033a Representation – RFW.”

Any paragraphs in any letters that contain the old language should be replaced with the representation paragraph below:

Representation If you do not have a representative, it is not too late to choose one. An accredited representative of a recognized service organization may represent you in your claim for VA benefits without charge. An accredited attorney or an accredited agent may also represent you before VA, and may charge you a fee for services performed after the filing of a notice of disagreement.  In certain cases, VA will pay your accredited agent or attorney directly from your past due benefits.  For more information on the accreditation process and fee agreements (including filing requirements), you and/or your representative should review 38 U.S.C. § 5904 and 38 C.F.R. § 14.636 and VA's website at http://www.va.gov/ogc/accreditation.asp.   You can also find the names of accredited attorneys, agents and service organization representatives on this website.

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Change 3January 27, 2013

UPDATING SHARE AND VBMS TO REFLECT POWER OF ATTORNEY (POA) AUTHORIZED ACCESS TO SENSITIVE INFORMATION

A claimant must give specific consent in order to release information in the claims folder that is protected under the provisions of 38 U.S.C. 7332. This information relates to drug abuse, alcoholism or alcohol abuse, infection with HIV, or sickle cell anemia.

When reviewing a Veteran’s claims file, or when a claimant submits a VA Form 21-22, Appointment of Veterans Service Organization as Claimant's Representative, or VA Form 21-22a, Appointment of Individual As Claimant's Representative, claims personnel must update Share to reflect whether or not the claimant has authorized disclosure of his or her records protected by Section 7332 to an appointed representative. The claimant indicates this authorization in items 12 and 13 of the VA Form 21-22 and in items 9 and 10 of the VA Form 21-22a. An appointed representative’s access to the claimant’s records in the Stakeholders Enterprise Portal (SEP) is dictated by how the claimant’s record is completed in Share; therefore, it is important to ensure the record is updated appropriately.

Update the POA access by checking the box in VBMS.

When a claimant authorizes a representative’s access with no limitations to records protected by Section 7332, claims personnel establishing a claim in Share must select the name of the representative and select “Y” in the “Auth’d POA Access” box.

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Change 3January 27, 2013

If a claimant indicates any limitation to or does not authorize a representative’s access to records protected by Section 7332, claims personnel establishing a claim in Share must select the name of the representative and select “N” in the “Auth’d POA Access” box.

When there is a pending claim and claims personnel must change an existing representative to another via BIRLS, they must remember to execute a pending issue change (PCHG) to update Share to reflect whether or not the claimant authorized disclosure of records.

Details regarding POA access are viewable on the “All Relationships” tab of Corporate Inquiry and also on the General Information screen under Awards/Ratings. We will provide an updated Online Help within the SHARE application, to include detailed guidance on this issue.

Please Note: These procedures supersede any previous procedures regarding updating Share for POA access.

Reference: Compensation Service Bulletin, December 2012

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Change 3January 27, 2013

CHANGES

Change 1, June 29, 2012, added guidance regarding revisions to VA Form 21-22.

Change 2, August 21, 2012, added guidance (reminder) from the August 2012 Compensation Service Bulletin.Change 3, January 27, 2013, added guidance regarding POA authorized access to sensitive information from the November 2012 Compensation Service Bulletin.

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Change 3March 23, 2011

Section 89

Writeouts – Pending Message Work Items(EP 810 series)

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GUIDELINES FOR 631 DIARY DUE NOTIFICATIONS

Incorrect processing of VETSNET 800 Series Work Items has been identified as a common error trend in many Regional Offices. Since February 2008, VETSNET 800 Series Work Items have been generated in lieu of BDN writeouts for running awards. The 800 Series Work Items assist the Veterans Ser-vice Center in identifying cases that require follow-up action. An 800 Series Work Item is basically a combination of a writeout and a control End Product (EP). Work Items appear only in the VETSNET Corporate Database and are not available via PIF Inquiry.

In order to view individual Work Items in Share, use the Corporate Inquiries function and select the “Claims/Denials” tab. If multiple EPs/Work Items exist, a grid will be displayed contain-ing all active and historical EPs/Work Items. To display data specific to the Work Item in question, click on the 800 Series Work Item from the grid view. To view a Work Item in MAP-D, search for the claim number in question (click on “File” then on “Search”). Then, click on the pending 800 Series Work Item from the tree view. Details and notes will display just as they would for other EPs.

It is important to keep in mind that 800 Series Work Items are system-generated and are for tracking purposes only. Do not complete any development, rating, or award actions under an 800 Series Work Item. One-time Clears in the 800 Series, as well as manually establishing items in the 800 Series, is neither appropriate nor authorized. If you are ready to dispose of an 800 Series Work Item that served as a tracking item, use the PIF Cancel or PIF Clear functions in Share as follows:

Work Items where no action is necessary: PIF Cancel using the reason “VETSNET Msg Rvwd, no action necessary”

Work Items where additional processing is necessary: PIF Clear using the reason “VETSNET Msg Rvwd, work under proper EP”

The correct date of claim for establishment of the proper EP when action is necessary is the date of the 800 Series Work Item. One of the most common errors found is use of the date of review of the 800 Series Work Item as the date of claim. Additionally, to track the completion of action on potential under-payments or overpayments as a result of an 800 Series Work Item, it is important to establish and maintain an EP 693 in addi-tion to any other EP required. The correct date of claim for EP 693 is also the date of the 800 Series Work Item. The EP 693 must remain pending with any other controlling EP until all ac-tions

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are complete. If EP 600 is established to provide due proc-ess, the EP 693 should remain pending along with EP 600. When all actions are complete, clear the pending EP 693.

These procedures may not strike readers as crucial in the broad scheme of things, but consider their effect on workload manage-ment information. Errors that degrade data integrity undermine VA’s ability to focus claims processing effort where it’s most needed. And in today’s environment, appropriate focus of effort truly is a crucial activity.

Reference: QA Times, Volume 1, Issue 1, January 2011

VETSNET 800 Series Work Items Desk Reference

Fast Letter 08-09, Prioritization and Processing of System-Generated Messages (Writeouts)

Training Letter 09-04, Guidance on Date of Claim Issues

ISSUE: VA FORM 21-4140

Question:

If a 21-4140 is not returned can we call the Veteran to see if he/she has been employed and document the response on VAF 21-0820? Or must the vet complete and return the 21-4140?

Answer:

The Veteran must sign the 21-4140. The signature on the form is the Veteran's certification that he/she has or has not worked. The requirement to obtain the certification concerning employment status is not "development" but a stipulation for the continuation of payment of Individual Unemployability. Documentation of a phone call stating the Veteran said he/she had not worked would not suffice in court if we later found the Veteran had been working and VA was trying to prosecute for fraud. On quality review we would currently call a STAR error if the requirement for a signed 21-4140 was bypassed by a telephone call. The Veteran's actual signature and certification of employment history for the preceding 12 months is required for continuation of TDIU.

Source: Star Rating Call, Q&As for the March 2010 Quality Call

REVIEW FOR RETURN OF VA FORM 21-4140

VA Form 21-4140 is sent to all Veterans who have been granted individual unemployability benefits, and a diary is established for timely return of this form. The form asks the Veterans if they’ve worked in the last year. The Veteran is required to return the completed form within 60 days from the date of notice.

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If the Veteran returns a completed VA Form 21-4140 timely and reports having not worked in the past year, the claims assistant will clear an EP 692, annotate the form, clear the diary and return the claims folder to files.

If the VAF Form 21-4140 is not received, a writeout is generated. The following describes the procedures to follow:

1. If a hardcopy writeout is received, the claims folder must be reviewed for receipt of a completed VA Form 21-4140.

If a VA Form 21-4140 has been received, check the top of the VA Form 21-4140 to ensure it is the copy sent to the Veteran and not the RO copy.

If the VA Form 21-4140 is the RO copy, the form should be filed down in the center of the claims folder; clear the EP 810.

If the VA Form 21-4140 was received from the Veteran, the EP 810 must be cleared; check CORPORATE Claims/Denials tab in SHARE. Check for a previously cleared EP 692.

2. Check MAPD notes for a diary regarding the VA Form 21-4140. If you find a Diary for that form, print it out, and pull the claims folder.

3. If a VA Form 21-4140 has not been received, clear the EP 810 and establish an EP 310, update MAPD Status to Ready for Decision, and forward the claims folder to the Rating Team. The Rating Team will complete a rating decision proposing to reduce the Veteran’s benefits. Be sure to choose “Unemployability” as the contention in MAPD and under Classifications, choose “Unemployability.”

4. When clearing the EP 810, use the “Diary due date/reason/legend” selection.

TELEPHONE DEVELOPMENT FOR VA FORM 21-4140

In the February 2010 edition of the Compensation and Pension (C&P) Service Bulletin, it was explained that Veterans in receipt of total disability based on individual unemployability (TDIU) must complete and sign a yearly VA Form 21-4140, Employment Questionnaire, and return it to the regional office (RO) as a means to certify continued unemployment. This may be done by regular mail, fax, or a scanned document attached to an email.

C&P Service has received questions as to whether RO personnel may telephone the Veteran when the deadline for submission has past and request that the Veteran send the 21-4140 by one of these means. The answer is “yes.” If the Veteran has neglected to return the form, it is faster and easier to call the Veteran and request it, than to initiate proceedings to terminate TDIU only to reinstate TDIU after the Veteran complies.

This phone communication is an excellent means to expedite receipt of the 21-4140 by one of the methods described above. Please remember that the call itself, even with a statement of

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Change 3March 23, 2011

unemployment from the Veteran, is not a substitute for receipt of the actual form with the Veteran’s signature.

Reference: C&P Bulletin, March 2011

FUTURE PHYSICAL EXAMINATION

1. CEST EP 310, DOC for messages generated as a result of matching programs and BDN write-outs, the date shown on the message, or if no date is shown, the date of the review. (M21-1MR.III.ii.1.B.7.d).

2. Set-up a review exam with the appropriate VAMC in CAPRI

3. Track in MAPD and send Veteran notification letter

4. Send folder to appropriate VAMC of jurisdiction

5. Set the suspense date for 30 days

6. After exam is released, review the exam for completeness and forward the claims folder to the Rating Team for a rating decision

7. Change the status in MAPD to RFD and update the suspense reason

REFERENCES

800 Series Work Items (WI) Handout

VETSNET 800 Series Work Items Desk Reference

Guidance regarding “Determining the Need for Review Examinations,” refer to M21-1MR.III.iv.3.B.15

Guidance regarding VAF 21-4140, Employment Questionnaire, refer to M21-1MR.IV.ii.2.F.28 (Special Considerations in IU Claims)

CHANGES

Change 1, July 27, 2009, added guidance regarding future examinations; change title of section.

Change 2, April 30, 2010, added guidance regarding return of the VA Fm 21-4140.

Change 3, March 23, 2011, added guidance regarding telephone development for VAF 21-4140.

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Change 1April 26, 2013

Section 90

Veterans Living at a Foreign Residence_______

JURISDICTION OF PRE-DISCHARGE CLAIMS PROCESSING FOR SERVICE MEMBERS REQUIRING EXAMINATIONS IN FOREIGN COUNTRIES

As a follow up to the June and November 2012 DUSB calls: The jurisdiction of pre-discharge claims processing for Service Members requiring examinations in foreign countries (excluding those scheduled for examinations at Landstuhl Regional Medical Center and Yongsan Army Installation) prior to their discharge, will be assumed by the regional office of jurisdiction.  Specific details are provided below.

Compensation & Pension examinations conducted in foreign countries must generally be coordinated with the U.S. Consulate or embassy.  This process can take several months and constitutes “prolonged development,” under M21-1MR III.i.2.A.1.e. 

Therefore, claims filed by overseas Service Members who will reside overseas after separation, including claims filed at the Manila (Philippines) Regional Office, should be forwarded to the regional office of jurisdiction (Pittsburgh, Houston, or White River Junction), per M21-1MR III.ii.5.A.1.b, rather than the Quick Start consolidated processing or BDD rating activity sites.  Claims filed under these circumstances should be established with the EP modifier “6,” indicating foreign jurisdiction, rather than the “1” or “7” modifiers currently in use for BDD/QS.

Claims filed by Service members who are returning to the States after separation but cannot get an examination completed overseas, should be forwarded to the Consolidated Processing Site (CPS), as a Quick Start claim.

A foreign permanent residence does not preclude a service member from participation in BDD or Quick Start.  If a service member separates from a location within the continental United States, and the examination can be accomplished before he or she relocates to a foreign country, the claim remains eligible for the BDD and Quick Start programs.

Procedures for previously adjudicated BDD/QS claims processed by the Rating Activity Site (RAS) and maintained at those locations as part of the “paperless” claims processing protocol:

The RASs retain jurisdiction of claims until such time as a subsequent claim is filed.  If the Veteran resides in a foreign jurisdiction, the RAS should immediately transfer the claims file to the ROJ (Pittsburgh, Houston or White River Junction).  The ROJ should maintain the integrity of the eFolder in Virtual VA, and process the claim accordingly.  The PLCP flash should be retained for claims processed exclusively in Virtual VA.  As of March 25, 2013, claimants with foreign addresses remain excluded from VBMS processing.

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Change 1April 26, 2013

Procedures for BDD/QS claims currently pending at a RAS/CPS, where the Service Member resides in a foreign jurisdiction:

Effective immediately, any claim pending at a RAS or CPS where the SM permanently resides in a foreign jurisdiction, including Manila, should be immediately transferred to the ROJ (Pittsburgh, Houston, WRJ).  Upon receipt at the ROJ, the end product should be changed to show the “6” modifier.  The PLCP flash should be retained, and the ROJ should maintain the integrity of the eFolder in Virtual VA, and process the claim accordingly.  As of March 25, 2013, claimants with foreign addresses remain excluded from VBMS processing.

Reference: Email message, From: VAVBAPHO/WAREA, Sent: Tuesday, April 09, 2013 9:15 AM

FOREIGN RESIDENCE CHANGE OF ADDRESS

Do not transfer cases to the Pittsburg RO because a claimant moves to an APO or an FPO address.

If the folder is currently located at the Pittsburgh RO, jurisdiction remains at the Pittsburgh RO when a claimant changes his/her address to an APO or a FPO address.

Reference: M21-1MR, Part III, Subpart ii, Chapter 5, Section A, 1d

MEDICAL EXAMINATIONS FOR FOREIGN BENEFICIEARES

Pittsburgh RO handles requests for medical examinations to be performed by the Department of State for foreign beneficiaries with two exceptions: Mexican, South and Central American and Caribbean cases, which are handled by the Houston RO, and Canadian cases, which are handled by the White River Junction VAM&ROC.

Send a request for a medical examination to the appropriate RO above. Submit the request on VA Form 21-2507, "Request for Physical Examination," and annotate it to show the appropriate references from the VA Physician's Guide for Disability Evaluation Examinations.

Reference: Field and Medical Examination Requests for Foreign Beneficiaries, M21-1MR, Part III, Subpart iv, Chapter 3, Section A.

CHANGES

Change 1, April 26, 2013, added guidance regarding jurisdiction of pre-discharge claims processing for Service Members requiring examinations in foreign countries.

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February 4, 2008

Section 91

Routing Claims to Central OfficeClaims involving the following reasons/conditions, must be routed to Central Office for review; be sure to to route the cases to 211B

Administrative Review Advisory Opinions Equitable Relief Extraschedular Approval (3.321 and 4.16(b)) Forfeiture POW Determinations Radiation Retro 250K/8 Year Cases Visual Efficiency Questionable Remands

Reference: C&P Service Bulletin, January 2008

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Change 3December 14, 2009

Section 92

Whereabouts Unknown & Returned Mail_______

GENERAL GUIDELINES

ADDRESS UNKNOWN. The claimant's address does not constitute evidence. Refer to M21-1MR, Part III, Subpart iii, Chapter 1, Section B, Topic 11 for further guidance.

CLAIMANT UNABLE/UNWILLING TO FURNISH ADDRESS. If a claimant is unwilling or unable to furnish a current mailing address, refer to M21-1MR, Part III, Subpart iii, Chapter 1, Section B, Topic 11 for further guidance.

ABANDONED CLAIMS. When evidence is not furnished within 1 year after the date of request, the claim will be considered abandoned. Refer to 38 CFR 3.158 and M21-1MR, Part III, Subpart iii, Chapter 1, Section B, Topic 3g, 11a & 11e for further guidance.

NEW ADDRESS PROVIDED

1. CADD the PIF. If there is a running award, CADD the master record.

2. Re-date the letter and resend.

3. Annotate the file

PROCEDURES FOR DESTRUCTION OF RETURNED MAIL WITH NO EVIDENTIARY VALUE

According to RCS VB-1, Part I, Section XIII, 13-052.200 and M21-1MR.III.ii.3.C.9a, certain documents may be removed from a claims folder if they have served their purpose and have no legal, administrative, or historical value. These include envelopes and returned original VA letters with no evidentiary value.

Refer to Fast Letter 09-46, Procedures for Destruction of Returned Mail with No Evidentiary Value, dated November 2, 2009 for further guidance.

CHANGES

Change 1, January 1, 2006, references incorporated within topic.

Change 2, December 6, 2006, references updated.

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Change 3December 14, 2009

Change 3, December 14, 2009, guidance added regard procedures for destruction of returned mail with no evidentiary value.

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Change 7August 22, 2011

Section 93

Withdrawn Claims_______

ACCEPTABLE NOTICE

There is no regulatory requirement that a claimant's request to withdraw a claim be in writing. As a result, a claimant can withdraw his or her claim via a telephone or written request (follow the requirements of 38 CFR 3.217(b) for telephone communication). Once the service center receives a request to withdraw the claim from the claimant or his/her representative, it should immediately write the claimant a letter in which the claimant is told that per his or her request, the claim for [itemize the specific claim here] has been withdrawn. Although there is no regulation on point, the provisions of 38 CFR 3.158, which most closely resemble a claim withdrawal request, provide that the claimant should be informed that if he/she files the same claim within one year of the date of the letter, the effective date for any grant of benefits for the same claim will be awarded as if the claim were not withdrawn.

Absent communication directly from the claimant or the representative, however, the service center should not assume that the claim is withdrawn or invite the claimant to withdraw the claim.

Regarding appeal rights, 38 CFR 3.103(f) provides that "The claimant or beneficiary and his or her representative will be notified in writing of decisions affecting the payment of benefits or granting relief. All notifications will advise the claimant of the reason for the decision; the right to initiate an appeal." When a claimant withdraws a claim, there is no VA decision involved. As a result, there is no authority or requirement to provide appeal rights. More to the point, there is no decision to appeal.

Do not accept a phone call or a message from a third party (e.g. VA medical center, vet center, etc.). For instance, if an examination is cancelled because a Veteran wants to withdraw the claim, call the Veteran or send a letter asking the Veteran to confirm whether or not the claim is to be withdrawn. If the Veteran has a designated a Power of Attorney, ask the designated representative for clarification.

Source: C&P Service Home Page, FAQ link, Withdrawal of claim by the claimant

ISSUE: WITHDRAWAL OF CLAIM BY THE CLAIMANT

Question:

In the FAQ "Issue: Withdrawal of claim by the claimant" clarification is being requested as to what "letter" should be used to determine the 1 year time frame for the Veteran to come back in with a claim for the same claimed issues that are being withdrawn. The following sentence is taken from the "Answer" section, 1st paragraph, of this FAQ. “Although there is

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Change 7August 22, 2011

no regulation on point, the provisions of 38 CFR 3.158, which most closely resemble a claim withdrawal request, provide that the claimant should be informed that if he/she files the same claim within one year of the date of the letter, the effective date for any grant of benefits for the same claim will be awarded as if the claim were not withdrawn."

Our Authorization Quality people say the 1 year time frame that is provided in our letter to the Veteran acknowledging the withdrawal of a claim would be based on the date of the VCAA letter (based on 3.158), not the date of our "notification letter" to the Veteran acknowledging the withdrawn claim. For example: The VCAA letter is dated 02-01-09; the Veteran withdraws the claim on 04-15-09; our letter to the Veteran is dated 04-20-09 --- does the Veteran have 1 year from the date of VCAA letter (02-01-2010) or one year from the date of our notification letter (04-20-2010) to reopen a claim for the same conditions?

Can you discuss what is the proper date and why? And, in the case of a withdrawal of a claim prior to VCAA being sent - any suggestions of what date to be used to determine the 1-year time frame?

Answer:

The proper answer is the one-year time frame begins with the date of the notification letter, not the VCAA letter. This is the date the Veteran was properly notified of the actions that will transpire as the result of his/her actions when dealing with their withdrawal of their claim.

Source: Star Rating Call, Q&As for the February 2010 Quality Call

DISPOSING OF END PRODUCT

Do not cancel the end product unless the withdrawal statement is received from the Veteran or the designated Power of Attorney.

If a signed statement is received from the Veteran, or the designated POA, requesting the claim be withdrawn, complete the following actions:

If it’s an original claim (e.g. EP110, 010, 140, 180, 190), process the denial in VETSNET under the basic eligibility tab. Select “Claim Withdrawn by Claimant” from the drop-down menu; annotate EP, date, and initials on the withdrawal statement.

If it’s an non-original claim (e.g. EP020), PCAN the end product; annotate EP, date, and initials on the withdrawal statement.

CHANGESChange 1, July 10, 2004, provided additional clarification.Change 2, January 7, 2005, provided additional information regarding cancellation of the end product.

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Change 7August 22, 2011

Change 3, May 18, 2005, formatting changes.Change 4, Nopvember 14, 2008, formatting changes.Change 5, April 3, 2009, updated guidance regarding withdrawal of claims per C&P Service FAQ.Change 6, April 30, 2010, updated guidance regarding withdrawal of claims per Star Rating Call Q&As.Change 7, August 22, 2011, updated guidance regarding processing original claims.

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Change 1August 24, 2006

Section 94

VETSNET Participant Profile Flashes_______

The following are possible flashes that can be set in Participant Profile:

38 USC 1151 Attorney Fee Automobile Adaptive Equipment Paid Automobile Allowance Paid BIRLS shows incompetent, use proper procedures Blind BVA Decision Call C&P Svc for approval to write DNA Call for current mailing address CAVC Temp File CH 31 R&E Folder Retired CHAMPUS Entitlement Exists Claim Must be Processed with Folder Combined Evaluation Created by Conversion Not RBA Committee on Waiver Case Compensation Under 1925 Rating Schedule Congressional Converted Retired Pay Involved Copy VAF 21-526 before return to vet for sign Counsel Folder Location Disappearance of Veteran Dual Benefits FBI Case Finance Flash (VA Form 27-8886) Folder Stored at RMC Forfeiture Case General Law Case Gulf War Registry GW Undiagnosed Illness Hardship Homeless In Receipt of Chapter 31 In Receipt of RSFPP Insurance Award Insurance Flash (VA Form 20-6879) IVM Job Training Folder Exists Marker/Engraving Paid Prior to Conversion More Than 9 Children Existed on a Converted Record

1

Change 1August 24, 2006

Naval Pension Case NSC Burial Paid Prior to Conversion NSC Burial/Plot Paid Prior to Conversion NSC Burial/Trans Pain Prior to Conversion NSC Burial/Trans/Plot Paid Prior to Conversion Office of Investigation, Central Office OIG Case Operation Enduring Freedom/Operation Iraqi Freedom Opt Trmt Rcds Recvd for Dth Comp/Pen Claim Date OWCP referral after rating, disallow, notify Vet Plot Paid Prior to Conversion Possible CHAMPVA Entitlement May Exist Potential Attorney Fee POW Provider Proof of Medical Expense Case Railroad Retirement Rebuilt Fldr, Ntfy NPRC when consolid w/lost File Review SSN - Adjustments Made By Conversion SC Burial Paid Prior to Conversion SC Burial/Plot Paid Prior to Conversion SC Burial/Trans Paid Prior to Conversion Secret Service Case Special Adaptive Housing Paid Special Condition Existed Prior to Conversion SSN Existed In Another Record Supervised Direct Pay Temporary Folder Exists Term 346 R&E Folder Retired Transportation Paid Prior to Conversion Under IVM Review VA Employee VR Trainee

CHANGES

Change 1, August 24, 2006, added Combined Evaluation Created by Conversion Not RBA, Folder Stored at RMC, More Than 9 Children Existed on a Converted Record, NSC Burial/Plot Paid Prior to Conversion, Operation Enduring Freedom/Operation Iraqi Freedom, Possible CHAMPVA Entitlement May Exist, SSN Existed In Another Record; deleted Inactive SC Folder Exists.

2

April 28, 2005

Section 95

Understanding Combined Evaluations_______

Many Veterans ask the question, “Why is my combined evaluation 80 percent when I have one disability rated at 60 percent and another at 50 percent which equals 110 percent?”

Combined Rating Table. When a Veteran receives a compensable evaluation for multiple compensable disabilities, the Combined Rating Table must be used to compute the percentage. To understand why the Combined Rating Table is used, it must first be understood that disability ratings are combined and not added.

The Combined Rating Table is constructed so that a total evaluation will not exceed 100 percent. This is based on the basic premise that before becoming disabled, an individual is considered to 100 percent able-bodied. Combining disabilities is the process of weighing the overall efficiency of the individual. For example, let’s consider a Veteran with one disability rated at 50 percent. As such, the Veteran is 50 percent disabled and has 50 percent remaining capability.

Now let’s assume this Veteran has an additional compensable disability rated at 30 percent. Since the Veteran is already 50 percent disabled, the second condition is not 30 percent of 100 percent but 30 percent of the remaining 50 percent capability which would equate to 15 percent. This 15 percent now is added to the 50 percent disability rating, and the Veteran is now considered 65 percent disabled, with 35 percent remaining capability.

Should this Veteran have still another 20 percent disability, this would be combined by taking 20 percent of the remaining 35 percent capability, which would represent a disability of 7 percent. This percentage when added to the 65 percent disability rating would now represent 72 percent disability, with 28 percent remaining capability.

Another principle to keep in mind is that compensation ratings are rounded off to the nearest 10 percent evaluation. In our illustration the Veteran’s combined 72 percent disability rating would then be rounded off to 70 percent. This Veteran would receive compensation based on a combined rating of 70 percent even though his disabilities (50, 30, and 20), if added together, would equal 100 percent.

Bilateral Factor. Another rating feature quite frequently misunderstood is the application of the bilateral factor in compensation ratings. The bilateral factor is the only other factor that will cause a different computation from that described above.

The VA’s rating schedule provides that when a partial disability results in an injury or disease involving both arms or both legs or paired muscles such as the buttocks, a special combined rating principle know as the bilateral factor is applied.

For example, should the compensation disabilities involve both arms, the ratings are combined as previously explained, and then 10 percent of the resulting figure (the bilateral factor) is added to the total evaluation to arrive at the final compensation rating allowed.

1

April 28, 2005

Accordingly, as with our previous illustration, provided the three disabilities of 50, 30, and 20 percent involve disabilities of the arms, 10 percent of the 72 percent, or 7.2 percent, would be added to the 72 percent for a total of 79.2 percent. When rounded off to the nearest 10 percent evaluation this would result in a combined evaluation of 80 percent.

Should there be compensable disabilities of both arms and legs, the evaluations for all of the arms and legs are combined first with applying the bilateral factor, and then all other disabilities if any are combined as in the initial illustration.

2

Change 10January 13, 2012

Section 96

Ready to Rate Review ChecklistVAF 21-526 Signed? For VONAPP guidelines refer to the section entitled VONAPP

Applications for further guidance.

All claimed disabilities identified? Check entire VAF 21-526, 4138s, letters, VA exams, STRs, and other medical reports.

VCAA notification sent for each issue? VCAA law attachments provided for each issue?

Has the VCAA notification period (30 days) expired?

Service verified and honorable for all periods? SHARE updated?

Any evidence of willful and persistent misconduct necessitating administrative decision?

Service treatment records obtained for all periods? Do the STRs appear to be complete? Make sure the STR envelope is right-side up and the transmittal sheet (if any) is stapled to the front without stapling the document inside the envelope.

Fire-related procedures followed?

OMPF (201 file) been obtained, if necessary (i.e. PTSD claims)?

Vietnam or Gulf War service verified, if necessary?

All medical evidence obtained? If additional issues (implied claims) were noted in the service records, has the 5103 notification been sent?

Note: Check the contents of the Charge Card Folder - If all the evidence shown in MAPD is not in the claims file, the Charge Card Folder should be checked.

All federal records obtained (VA, SSA, military service records, etc.)? If federal records could not be obtained, has a formal finding and 10-day notice been completed?

VAMC outpatient treatment records up-loaded to Virtual VA? Reference: Fast Letter 11-28,

VA examination complete? All disabilities addressed and opinion offered if requested? If additional issues were raised on examination, has the VCAA notification been sent?

Note 1: If during a VA examination, the Veteran reports having been injured during military service and has current complaints, this is an informal claim. Send the Veteran a VCAA notification letter regarding the claimed disability.

Note 2: If during a VA examination, the Veteran reports having a disability related to military service or to a service-connected disability, send the Veteran a VCAA notification letter.

Note 3: Please read the VA examination carefully; if the Veteran is just reporting various illnesses or injuries but makes no reference to their relationship to military service or to a service-connected disability, DO NOT raise these issues or invite a claim.

1

Change 10January 13, 2012

Note 4: If the VA examination shows a diagnoses for impairment of both central vision and field of vision, take the case to an RVSR for review.

C&P examination for mental disorders completed by a qualified examiner? See VA Examinations for further guidance.

Stressor verification evidence sufficient and appropriately developed?

Claims folder appropriately tagged/flagged? EP Tag, Over 70, POW, Gulf War, and Appeal flag.

Attorney Fee case? Has the claims folder been reviewed by the attorney-fee coordinator?

Claim for service-connected death/DIC? Send the claim as ready to rate if the cause of death shown on the death certificate is a service connected disability OR the Veteran was rated at 100% (or was in receipt of IU) for 10 years of more.

Claim for convalescence (a.k.a. paragraph 30, temporary 100% evaluation)? Send the claim as ready to rate if private or VA treatment reports show surgical treatment for a service-connected disability OR VCAA suspense has expired and no medical evidence has been received (check CAPRI for treatment records)

Claim for special monthly pension? Send the claim as ready to rate if 1) VCAA suspense has expired and 2) an aid and attendance statement has been received.

Claim for service connection for diabetes? Send the claim as ready to rate if 1) Vietnam service is verified and 2) private or VA treatment reports show a diagnosis for diabetes and recent treatment, preferably by one of the following medications: metformin, glucophage, glipzide, glucotrol, glyburide, diabeta, micronase, pioglitazone, actos, rosaglitazone, or avendia.

Claim for lung cancer or prostate cancer? Send the claim as ready to rate if 1) Vietnam service is verified and 2) private or VA treatment reports show a current diagnosis of cancer and/or active cancer (within the past 6 months) OR on-going treatment for cancer through radiation, chemotherapy, prostatectomy, lobectomy, or hormonal injections.

Claim for disabilities due to exposure to herbicides? Send the claim as ready to rate if 1) VCAA notice has expired and 2) the disability is not listed under 38 CFR 3.309(e).

Claim for individual unemployability? Send the claim as ready to rate if 1) VCAA Notice has expired and 2) no VA Form 21-8940 has been received.

Claim for special monthly compensation for aid and attendance/housebound? Send the claim as ready to rate if 1) VCAA Notice has expired and 2) the Veteran does not have a service-connected disability.

MAPD Claim Level Suspense reason updated to “Ready to Rate” and suspense date updated?

MAPD Claim Status updated to “Ready for Decision?”

2

Change 10January 13, 2012

CHANGES

Change 2, October 21, 2004, directs the use of PCGL for sending the RTR notification to the claimant.Change 3, January 1, 2005, added additional guidance regarding new issues raised during a VA examination; deleted the requirement to send the Veteran a notice letter advising the Veteran the claim is ready to rate. Guidance was provided when the VA examination shows a finding of impairment of both central vision and field of vision. Added requirement to annotate the development checklist with the ready to rate date and initials.

Change 4, March 14, 2005, added items regarding verification of stressor event, attorney fee case, SSA records, admin decisions, fire-related case.

Change 5, April 25, 2005, added items regarding completion of mental examinations by qualified examiners.

Change 6, May 16, 2005, added item regarding evidence that may be found in the Charge Card Folder; change RTR suspense date to read 60-90 days.

Change 7, October 5, 2005, added a reminder to check for verification of all periods of service; check for receipt of STRs for all periods of service; check for OMPF (201 file); check for verification of Vietnam or Gulf War service; check for appropriate tags/flags.

Change 8, December 14, 2006, miscellaneous edits compelted and cross-references added.

Change 9, February 9, 2009, added claim specific items.

Change 10, January 13, 2012, added VAMC OPTs being up-loaded to Virtual VA.

3

Change 10July 22, 2013

Section 97

VCAA Law Attachments_______

1 – SC Death...........................................................................77.3

2 – Spina Bifida......................................................................77.4

3 – Dependency.......................................................................77.5

4 – Hepatitis C........................................................................77.6

5 – Burial.................................................................................77.7

6 – Permanent & Total..........................................................77.8

7 – Incompetency & Competency.........................................77.9

8 – Extraschedular...............................................................77.10

9 – Loss of Use......................................................................77.11

10 – 10-Percent Rating for Multiple SC Disabilities.........77.12

11 – SAH and SHA Claims..................................................95.12

1

Change 10July 22, 2013

MAPD VCAA Law Index

Accrued

Auto Allowance

Claim for Increase

Compensation due to 1151

Death Pension

DIC

DIC 1151

Effective Date

Housing benefit

IU

NSC Live Pension

Paragraph 29

Paragraph 30

Parents’ DIC/SMP

Secondary S/C

Service connected comp

Service connected comp AA or HB

SMP

Spouse/DIC NSC AA or HB

2

Change 10July 22, 2013

Section 98.1VCAA Law Attachments

SC DeathWhat The Evidence Must Show

To establish entitlement for service connected death benefits, the evidence must show three things:

The cause of death.

This is usually shown by the Veteran's death certificate or other evidence showing cause of death. If you have not already done so, please send us this evidence.

An injury, disease or other event in service.

We will get service treatment records and will review them to see if they show the Veteran had an injury or disease in service, or suffered an event in service causing injury or disease. We will also get other military service records if they are necessary. We will review the evidence contained in the deceased Veteran's claims file.

A relationship between the cause of death and the injury, disease, or event in service.

This is usually shown by the death certificate, or in other medical records or medical opinions. You should send us a copy of the Veteran's death certificate. We will request other medical evidence from the Veteran's doctors if you tell us about it. You can give us a medical opinion regarding a relationship from your own doctor.

3

Change 10July 22, 2013

Section 98.2VCAA Law Attachments

Spina BifidaWhat The Evidence Must Show

To establish entitlement for spina bifida benefits, the evidence must show the following:

38 CFR 3.814 defines "spina bifida" as any form and manifestation of spina bifida except spina bifida occulta.

38 CFR 3.814 states that VA shall pay a monthly allowance based upon the level of disability to, or for, an individual who it has determined is suffering from spina bifida and whose biological father or mother is or was a Vietnam Veteran and who was conceived after the date on which the Veteran first served in the Republic of Vietnam (without regard to the characterization of the individual's service) during the Vietnam era.

The term "Vietnam Veteran" means an individual who performed active military, naval, or air service in the Republic of Vietnam during the period beginning on February 28, 1961, and ending on May 7, 1975. Service in the Republic of Vietnam includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam.

The VA shall required evidence that is sufficient to establish the individual claiming benefits has spina bifida and that the individual's biological father or mother is or was a Vietnam Veteran. In the absence of this evidence, benefits cannot be established.

4

Change 10July 22, 2013

Section 98.3VCAA Law Attachments

DependencyWhat The Evidence Must Show

To establish entitlement to an additional amount of compensation for a spouse, child, and/or dependent parent, there must be a combined service-connected disability evaluated at 30 percent or more.

5

Change 10July 22, 2013

Section 98.4VCAA Law Attachments

Hepatitis CWhat The Evidence Must Show

To establish entitlement for service-connected compensation benefits for hepatitis C, the evidence must show three things:

You were diagnosed with hepatitis C in service, OR, you had symptoms of hepatitis C in service, OR you were exposed to certain hepatitis C risk factors in service. If we do not yet have them, we will get your service treatment records and will review them to see if they contain this evidence. We will also get other military service records, if necessary.

A current diagnosis of hepatitis C. This can be shown by medical evidence indicating a confirmed diagnosis of hepatitis C. We will get any VA medical records or other medical treatment records you tell us about. You can also give us other evidence showing you have persistent or recurrent symptoms of hepatitis C. This evidence could be your own statement or statements from other people describing your physical or mental symptoms. The confirmed diagnosis means a positive EIA (enzyme immunoassay) or ELISA (enzyme-linked immunosorbent assay) along with a positive RIBA (recombinant immunoblot assay, also called "Western blot" test); or a positive test for HCV RNA (hepatitis C viral ribonucleic acid).

A relationship between your current hepatitis C and the infection, symptoms, or risk factor exposure you had in service. This evidence is usually contained in medical records or medical opinions. We will request this medical evidence for you if you tell us about it. You can give us a medical opinion regarding this relationship from your own doctor.

6

Change 10July 22, 2013

Section 98.5VCAA Law Attachments

BurialWhat The Evidence Must Show

To support the claim for burial benefits, the evidence must show the following:

1. The cause of death was the result of a service-connected disability or disabilities; OR

2. The cause of death was not the result of a service-connected disability, however, at the time of death the Veteran was in receipt of pension or compensation, or would have been in receipt of compensation had it not been for payment of military retirement pay; OR

3. The cause of death was not the result of a service-connected disability, however, the Veteran had a claim pending at the time of the death, and

there was sufficient evidence of record on the date of the Veteran's death to have supported an award of compensation or pension effective prior to the date of the death; OR

there was sufficient prima facie evidence of record on the date of death to indicate the Veteran would have been entitled to compensation or pension prior to date of death; OR

the deceased was a Veteran of any war or was discharged or released from active military service for a disability incurred or aggravated in the line of duty.

OR

4. The cause of death was the result of nonservice-connected causes while properly hospitalized by the VA.

7

Change 10July 22, 2013

Section 98.6VCAA Law Attachments

Permanent & TotalWhat The Evidence Must Show

To support your claim for a permanent and total evaluation, the evidence must show the following:

To receive a Total Disability evaluation, your disability must cause impairment sufficient to render it impossible for the average person to follow a substantially gainful occupation.

To receive a Permanent Total Disability evaluation, your disability must cause impairment which is certain to continue throughout your life. Diseases and injuries of long standing which are actually totally incapacitating will be regarded as permanently and totally disabling when the probability of permanent improvement under treatment is remote.

8

Change 10July 22, 2013

Section 98.7VCAA Law Attachments

Incompetency & CompetencyWhat The Evidence Must Show

To make a determination of incompetency and competency, the evidence must show the following:

A mentally incompetent person is one who because of injury or disease lacks the mental capacity to contract or to manage his or her own affairs, including disbursement of funds without limitation. (38 CFR 3.353)

Unless the medical evidence is clear, convincing and leaves no doubt as to the person’s incompetency, the rating agency will make no determination of incompetency without a definite expression regarding the question by the responsible medical authorities. Determinations relative to incompetency will be based upon all evidence of record and there should be a consistent relationship between the percentage of disability, facts relating to commitment or hospitalization and the holding of incompetency.

9

Change 10July 22, 2013

Section 98.8VCAA Law Attachments

ExtraschedularWhat The Evidence Must Show

To establish entitlement to an extraschedular evaluation for your service connected disabilities, the evidence must show that your service connected conditions present such an exception or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. The Under Secretary for Benefits or the Director, Compensation and Pension Service, must approve a grant of extraschedular evaluation commensurate with the average earning capacity impairment due exclusively to the service connected disabilities.

10

Change 10July 22, 2013

Section 98.9VCAA Law Attachments

Loss of UseWhat The Evidence Must Show

In order to support your claim for increased disability compensation benefits based on the loss of use, the evidence must show:

the use of your hand is no better than if it were amputated and replaced by a prosthesis; it is not capable of grasping or manipulation.

OR

the use of your foot is no better than if it were amputated and replaced by a prosthesis; it is unable to perform normal functions such as balancing, propulsion, or ambulation.

OR

you have severe damage by disease or injury to both buttocks bilaterally, inability to rise without assistance from a seated or stopped position, or inability to maintain postural stability.

OR

you have the loss of one or both testicles, ovaries, or other creative organs; have a condition of the reproductive tract, such as a male Veteran who is undergoing removal of the epididymis or prostate gland, or a female Veteran who is having her uterus or a fallopian tube removed; have retrograde ejaculation, or spermatozoa dumping into the bladder; have the loss of erectile power secondary to diabetes or multiple sclerosis.

OR

you have lost the use or blindness of one eye, having only light perception, and there is inability to recognize test letters at 1 foot and when further examination of the eye reveals that perception of objects, hand movements, or counting fingers cannot be accomplished at 3 feet.

OR

you have the absence of air and bone conduction or hearing loss is permanent.

OR

you have a disability of the organs of speech which constantly precludes communication by speech.

11

Change 10July 22, 2013

Section 98.10VCAA Law Attachments

10-Percent Rating for Multiple Noncompensable SC Disabilities

What The Evidence Must Show

In order to support your claim for a 10-percent rating for multiple noncompensable service-connected disabilities, the evidence must shown that two or more separate permanent service-connected disabilites clearly interfere with normal employability.

12

Change 10July 22, 2013

Section 98.11VCAA Law Attachments

Specially Adapted Housing or Special Home Adaptation

Fast Letter 11-05 has been amended to update the “What the Evidence Must Show” attachment to reflect the inclusion of residuals of inhalation injury.

HOUSING BENEFIT WHAT THE EVIDENCE MUST SHOW (WTEMS) CHANGES (CO MP EN SAT IO N SERV ICE BU LL E TI N , JU LY 2013 )

In the September 2012 Compensation Service Bulletin, the Compensation Service provided an updated interim Housing Benefit WTEMS to be used pending a future Modern Awards Processing-Development (MAP-D) release.

Upon further review of the wording of that WTEMS, the Compensation Service has determined that the updated language in that letter contained omissions and other inaccuracies.

It omitted the Public Law (P.L). 112-154 Section 202 changes, providing expanded bases in 38 USC 2101(a) for grants of specially adapted housing (SAH) for a one-year period.

It incorrectly stated that special home adaptation (SHA) grant vision criteria must be permanently and totally disabling. Under the P.L. 112-154, Section 203 amendments to 38 USC 2101(b), vision criteria are no longer required to be permanently and totally disabling.

It provided that for SAH and SHA the evidence must show a service connected disability. Neither SAH nor SHA eligibility is limited to service connected disability. Both benefits are available based on disabilities compensated under 38 USC 1151, and for active duty service members based on qualifying disabilities in the line of duty.

It did not state the visual field equivalent for visual acuity of 20/200 or less provided under the P.L. 112-154, Section 203 changes.

It did not specify the regulatory criteria established for severe burn injury and implied that residuals of inhalational injury constitute an independent basis for SHA when in fact they are a sub-category of severe burn injuries. This was discussed in the Supplementary Information of the rulemaking adding the severe burn injury criteria to 38 CFR 3.809a.

For the remainder of the Fiscal Year (FY) replace the current language for the “Housing Benefit” development action with the language provided on the next two pages of this development guide.

13

Change 10July 22, 2013

If the temporary 38 USC 2101(a) SHA criteria expire on September 30, 2013 as expected, further alteration of the text will be necessary, and the Compensation Service will provide additional instructions at that time.

Reference: Compensation Service Bulletin, July 2013

14

Change 10July 22, 2013

What The Evidence Must Show

To support your claim for specially adapted housing (SAH) the evidence must show you are a Veteran entitled to compensation under 38 U.S.C. Chapter 11 for a permanent and totally

disabling qualifying condition, OR service member on active duty who has a permanent and totally disabling qualifying

condition incurred or aggravated in the line of duty.

To support that you have a qualifying condition for SAH the evidence must show: loss (amputation) or loss of use of

- both lower extremities OR- one lower extremity and one upper extremity affecting balance or propulsion, OR- one lower extremity plus residuals of organic disease or injury affecting balance or

propulsion creating a need for regular, constant use of a wheelchair, braces, crutches or canes as a normal mode of getting around (although getting around by other methods may be occasionally possible); OR

loss or loss or use of both upper extremities precluding use of the arms at or above the elbow; OR

blindness in both eyes, with light perception only and the loss or loss of use of one lower extremity; OR

a severe burn injury, meaning full thickness or subdermal burns that have resulted in contractures with limitation of motion of- two or more extremities, or- at least one extremity and the trunk.

To support your claim for SAH the evidence may alternatively show you are a Veteran who served and became permanently disabled from a qualifying condition on or

after September 11, 2001 OR service member on active duty who was permanently disabled in the line of duty from a

qualifying condition on or after the same date.

To support that you have a qualifying condition under the alternative service criteria the evidence must show:

loss (amputation) or loss of use of - one or more lower extremities, severely affecting the functions of balance or

propulsion and creating a need for regular, constant use of a wheelchair, braces, crutches or canes as a normal mode of getting around (although getting around by other methods may be occasionally possible). 

To support your claim for a special home adaptation (SHA) grant the evidence must show you are a

Veteran entitled to compensation under 38 U.S.C. Chapter 11 for a qualifying condition, OR

service member on active duty who has a qualifying condition incurred or aggravated in the line of duty.

To support that you have a qualifying condition for SHA the evidence must show:

15

Change 10July 22, 2013

blindness with central visual acuity of 20/200 or worse in each eye using a standard correcting lens, OR

blindness such that the visual field in each eye subtends and angle no greater than 20 degrees, OR

permanent and total disability from loss, or loss of use, of both hands, OR permanent and total disability from a severe burn injury meaning

- deep partial thickness burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk, OR

- full thickness or subdermal burns that have resulted in contracture(s) with limitation of motion of one or more extremities or the trunk, OR

- residuals of inhalation injury (including, but not limited to, pulmonary fibrosis, asthma, and chronic obstructive pulmonary disease).

16

Change 10July 22, 2013

CHANGES

Change 1, May 3, 2005, so as to be consistent with the current format for VCAA law attachments, the heading and paragraph entitled, “How Will VA Help You Obtain Evidence for Your Claim” was removed from each of the sub-sections.

Change 2, June 27, 2005, added VCAA law attachment regarding making determinations for incompetency and competency.

Change 3, March 27, 2006, replaced VCAA Law attachment, “Effective Dates,” with the text provided by Central Office (VSCM Conference Call Agenda, Addendum, March 16, 2006.

Change 4, November 25, 2006, added VCAA law attachment for Automotive Allowance.

Change 5, May 15, 2007, deleted attachment regarding VCAA notice on effective date (the VCAA Law attachment on Effective Date has been incorporated in MAPD).

Change 6, June 1, 2007, added VCAA law attachments for Extraschedular evaluations

Change 7, September 19, 2007, added VCAA law attachment regarding loss of use.

Change 8, December 11, 2007, deleted Automotive Allowance law attachment; added VCAA law attachment regarding entitlement to 10 percent evaluation for multiple noncompensable service connected disabilities (38CFR 3.324).

Change 9, November 29, 2011, added FL 11-05 (rescinded) reference regarding WTEMS attachment for Specially Adapted Housing and Special Home Adaptation Claims.

Change 10, July 22, 2013, added guidance from the July 2013 Compensation Service Bulletin regarding SHA WETMS.

17

September 15, 1999

Section 98

Abbreviations and AcronymsA&A Aid and AttendanceAAO Assistant Adjudication OfficerACDUTRA Active Duty for TrainingADM Administrative Decision Made (BIRLS)AGG AggravationAIQ Annual Income Questionnaire (Prior to EVR)AL American Legion (POA)AMA Against Medical AdviceAMIE Automated Medical Information ExchangeAO Adjudication OfficerAR Accounts ReceivableATS Appeals Tracking SystemAWOL Absent Without LeaveBDN Benefit Delivery Network (BDN)BIRLS Beneficiary Identification & Records Locator SubsystemBPI Benefits Payment Inquiry (See VAI)BVA Board of Veterans AppealsBVA Blind Veterans Association (POA)C&C Confirmed and Continued (Rating)C&D Constitutional & DevelopmentalC-File Veterans Claims FolderCBD Chief Benefits Director, Veterans Benefits AdministrationCDA Constitutional or Developmental AbnormalityCFR Code of Federal RegulationsCH30 Montgomery GI BillCH31 Vocational Rehabilitation, Education, & TrainingCH34 GI BillCH35 Dependents Education Assistance (DEA)CHAMPUS Civ Health & Med Pgm of Uniformed Svs (Active & Retired)CHAMPVA Civ Health & Med Pgm of Veterans Affairs (SC/P&T)Chapter 30 Montgomery GI BillChapter 31 Vocational Rehabilitation, Education, & TrainingChapter 34 GI BillChapter 35 Dependents' Educational Assistance (DEA)CME Continuing Medical ExpenseCOBRA Congressional Omnibus Budget Reconciliation Act of 1990COD Character of DischargeCOD Certificate of Delivery (Education)COLA Cost of Living AllowanceCOVA Court of Veterans Appeals (The Court)COWC Committee on Waivers and CompromisesCPD Compensation/Pension - Death

1

September 15, 1999

CPL Compensation/Pension - LiveCSA Civil Service AnnuityCTA/CTU Central Transcription Activity/Central Transcription UnitCUST (OF) Legal Custodian of...DAV Disabled American Veteran (POA)DC District CounselDD214 DOD Discharge FormDEA Dependents' Educational Assistance (Chapter 35)DEV Development (or BIRLS development required)DIC Dependency and Indemnity Compensation (SC Death)DLP Date Last PaidDOB Date of BirthDOC Date of ClaimDOD Department of DefenseDOD Date of DeathDOD Date of DivorceDVA Dishonorable for VA Purposes (BIRLS code)DVB Department of Veterans Benefits (prior to VBA)EAI Educational Assistance Inquiry (See VAI)EOD Entered on DutyEOM End of MonthEOY End of YearEP End ProductETS Expiration Term of ServiceEVR Eligibility Verification RecordFARC Federal Archives Records CenterFECA Federal Employees Compensation ActFERS Federal Employees Retirements SystemFTP Failure to ProsecuteGC General CounselGDN GuardianGSW Gunshot WoundHB HouseboundHO Hearing OfficerHON Honorable Military ServiceHR Hospital ReportHS Hospital SummaryHVA Honorable for VA Purposes (BIRLS code)INC IncurrenceIHL Institution of Higher LearningIU Individual UnemployabilityIVAP Income for VA purposesIVM Income Verification MatchKC Korean ConflictKIA Killed In ActionLG Loan Guaranty

2

September 15, 1999

LOD Line of DutyM/R Master Record of Active Account(s)MAPR Maximum Annual Pension RateMBP Mexican Border PeriodMOPH Military Order of the Purple Heart (POA)MRS Military Record SpecialistNARS National Association of Radiation SurvivorsNCD Non-College DegreeNDT Notice of Disagreement Tracking System (replaced VARMS);

renamed ATS, June 92NOAA National Oceanic and Atmospheric AdministrationNOD Notice of DeathNOD Notice of DisagreementNOK Next of KinNPRC National Personnel Records CenterNSC Non-Service ConnectedNSLI National Service Life InsuranceNW Net WorthO&E Observation and ExaminationO-Rating Found on the S99 Disposition ScreenOBRA Omnibus Budget Reconciliation Act of 1982 (aka OMNIBUS)OJT On-the-Job TrainingOPC Outpatient ClinicOPT Outpatient TreatmentOTH Other Than Honorable DischargeP&T Permanent and TotalPEB Physical Evaluation Board (Military)PFOP Personal Funds of PatientPGF Principle Guardianship FilePGW Persian Gulf WarPHS Public Health ServicePIF Pending Issue FilePL Public LawPMR's Private Medical RecordsPOA Power of Attorney (usually Service Organizations)POW Prisoner of WarPRES PresumptionPTE Peacetime EnlistmentPTI Permanently Transferred InPTO Permanently Transferred OutPTSD Post-Traumatic Stress DisorderPVA Paralyzed Veterans of America (POA)Para 29 Receipt of compensation when hospitalization exceeds 21 days (temp

100% during Para 30 Convalescence Rating after surgery (temp100% compensation)QCRE (Concerns SQC)

3

September 15, 1999

R&E CH31 FolderRAD Release from Active DutyRDPC Regional Data Processing CenterREPS Restored Entitlement Program for Survivors(Quayle Amendment)RPC Records Processing CenterRPO Regional Processing OfficeRR Railroad RetirementSAO Systematic Analysis of OperationsSAT Satisfactory Service (BIRLS code)SAW Spanish American WarSBP Survivors Benefit Plan (Retired Military)SC Service ConnectedSFW Shell Fragment WoundSIRS Special Issue Rating SystemSLC/SL Special Law CodeSMC Special Monthly CompensationSMIB Supplemental Medical Insurance BenefitSMP Special Monthly PensionSTR's Service treatment recordsSOC Statement of the CaseS/P Status PostSQC Statistical Quality ControlSSA Social Security AdministrationSSAN Social Security NumberSSI Supplemental Security IncomeSSN Social Security NumberSSOC Supplemental Statement of the CaseBDN VA's Computer System (Now called VETSNET)TDRL Temporary Disability Retired ListTTI Temporary Transfer InTTO Temporary Transfer OutUHC Under Honorable ConditionsUME Unreimbursed Medical ExpensesUOTHC Under Other Than Honorable ConditionsUSC United States CodeUSPH U.S. Public HealthVA Department of Veterans AffairsVAC Department of Veterans Affairs CenterVADATS Department of Veterans Affairs Data Transmission SystemVADS Veterans Assistance Discharge SystemVAE V.A. ExaminationVAH Department of Veterans Affairs HospitalVAI Veterans Assistance InquiryVAMC Department of Veterans Affairs Medical CenterVAOPC Department of Veterans Affairs Out-Patient ClinicVARMS Veterans Appeals Records Management System (now NDT)

4

September 15, 1999

VARO Department of Veterans Affairs Regional OfficeVARO&IC Dept of Veterans Affairs Regional Office & Insurance CenterVBA Vocational Rehabilitation & Counseling (CH31)VBC Veterans Benefits CounselorVCE Veterans Claims ExaminerVE Vietnam EraVESTNET Newest term for VA Computer NetworkVFW Veterans of Foreign Wars (POA)VHA Veterans Health AdministrationVR&C Vocational Rehabilitation & CounselingVRC Vocational Rehabilitation CounselorVRS Vocational Rehabilitation SpecialistVSD Veterans Services DivisionVSO Veterans Service OrganizationVSO Veterans Service OfficerVVA Vietnam Veterans of America (POA)WOE War Orphans Educational Assistance (Prior to DEA)WWI World War IWWII World War IIXC Deceased Veterans Claims FolderY-CAUT Claim Authorized

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Section 99

Terms & Definitions_______

CONTINUITY

You may need evidence of continuity of treatment (treatment since discharge.). The request for continuity will depend on whether the disability is chronic in nature. Chronicity may be established in one of three ways:

1) By definition (regulation): 38 CFR 3.309 defines those conditions that are chronic by definition. If these conditions are shown to exist in service or manifested to a compensable degree within the presumptive period (generally one year) following service, service connection is generally warranted. In this situation continuity of treatment for the claimed condition after service is not required. However, you may need to request evidence of treatment within the first year following military service.

2) By traumatic injury or surgical treatment in service with probable residuals. The residual can be as simple as a surgical scar. Examples include a shell fragment wound, a fractured bone, or a hernia repair. In this situation, continuity of treatment for the claimed condition after service is not required.

3) By repeated occurrences or episodes: 38 CFR 3.303(b) provides: for the showing of a chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings, or a diagnosis including the word chronic. When the disease entity is established (See Disease subject to presumptive service connection, 38 CFR 3.309), there is no requirement of evidentiary showing of continuity.

4) Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic as stated in 1, 2 and 3 above. Examples of non-chronic conditions include pneumonia, acute low back strain or acute bronchitis.

DIRECT SERVICE CONNECTION

A disability determined to be service-connected due to service or aggravated by service. It is either shown in the STR treatment record, or on discharge exam. VA exam may be requested to establish current level of disability or residual of an acute disease or injury.

Direct service connection may also be established for a condition which existed prior to entry into service (EPTE) and was aggravated beyond its natural progression during the Veteran's

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period of service. See Direct service connection; wartime and peacetime,  38 CFR 3.304; and Direct service connection; peacetime service before January 1, 1947,  38 CFR 3.305.

DUTY TO ASSIST

Pub. L. 106-475 and 38 CFR 3.159 defines VBA’s duty to assist claimants who file substantially complete claims for VA benefits.

Section 3.159(c)(4) states the threshold of when it is necessary to get a medical examination or opinion to decide the claim. It is necessary if the information and evidence in the claims file contains:

1. competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability;

2. evidence that establishes the Veteran suffered an event, injury, or disease during military service, or has a presumptive disease or symptoms of a presumptive disease as long as the claimant has the required service to qualify for that presumption;

3. evidence that indicates the disability or symptoms may be associated with the established event, injury, or disease in service or with another service-connected disability, but the case does not contain sufficient medical evidence for the Secretary to decide the claim.

The VA’s duty to assist requires:

Developing for all relevant evidence in the custody of a Federal department or agency, including VA medical records, service treatment records, Social Security Administration records, or evidence from other Federal agencies;

Developing for private records and lay or other evidence;

A duty to examine Veterans or obtain a medical opinion if the examination or opinion is necessary to make a decision on a claim for compensation.

For further guidance, see Duty to Assist, M21-1, Part III, 1.02.

FIRST TREATMENT

Evidence to show first treatment following service will be used to identify the first manifestations and medical treatment for the claimed conditions.

HEARING LOSS

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Sensori-neural - high frequency hearing loss

Conductive – mechanical hearing loss

INFERRED ISSUE

An inferred issue is not a claim (M21-1MR.III.ii.7.2a)

INFORMAL CLAIM

Any communication or action, indicating an intent to apply for one or more benefits under the laws administered by the Department of Veterans Affairs (38 CFR 3.155)

Do not establish a pending issue for the following informal claims:

1. Any communication to apply for benefits but a VA Form 21-526 is not been received. Send VA Form 21-526 to claimant providing 60 days and a one year time limit. Complete no further development at this time (reference: M21-1MR, Part III, Subpart ii, Chapter 2, Section D, Topic 15c).

2. Unsigned application. Return the application immediately for signature. Photocopy application, send the original back to claimant for signature and develop for evidence, providing 60 days and a one year time limit. Complete no further development. Be sure a date stamp exists on the document and encourage the claimant to resubmit the same document as it may affect the effective date.

3. Signed application missing critical elements of the information or which requires clarification of a benefit sought. Develop to claimant for missing evidence providing 60 days and a one year time limit. Complete no further development at this time.

Has a disability been claimed?

NO SPECIFIC ISSUE = NO CLAIM = NO END PRODUCT

INCOMPLETE CLAIM = INFORMAL CLAIM

If no specific disability has been claimed, or the disability is unclear, the Veteran should be sent a letter or contacted by telephone (see Use of Telephone and FAX for Claims Development Section) (M21-1, Part III, Subchapter III, 11.18).

4. Any communication from a third-party representative who is not an accredited representative. Ask the claimant to formalize the claim and develop for evidence needed from the claimant, providing 60 days and a one year time limit. Complete no further development at this time.

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5. Any communication from an accredited representative, but the communication does not show the signature of the appointed representative.

6. Any communication received from an accredited representative prior to execution of VA Form 21-22. Ask claimant to formalize the claim and develop for evidence needed to claimant only, providing 60 days and a one year time limit. Complete no further development at this time.

7. Congressional inquiries without a VA Form 21-526 on file. Ask the claimant to formalize the claim by submitted a VA Form 21-526 application, providing 60 days and a one year time limit. No third party development. If applicable, contact the POA for assistance in formalizing claim.

8. Documented phone calls from a claimant or a claimant’s representative indicating an intent to apply for benefits. It need not specifically identify benefits sought. Develop to claimant for specific evidence providing 60 days and a one year time limit. Complete no further development at this time.

9. Applications with a Guardian’s signature where we do not have VA or court approval of the guardianship. Photocopy application, send original back to claimant for signature providing 60 days and a one year time limit. Develop for any other necessary evidence needed to include Letters of Guardianship.

10. An application for VA burial benefits is an informal claim for DIC if the widow(er) indicates Veteran’s death is due to service. Send a VA Form 21-534 to the widow(er) providing 60 days and a one year time limit. Complete no further development at this time.

MULTIAXIAL SYSTEM

Axis Description

Axis I Clinical Syndromes

Axis II Developmental Disorders Personality Disorders

Axis III Physical Disorders and Conditions

Axis IV Severity of Psychosocial Stressors

Axis V Global Assessment of Functioning

DSM-III-R, Classification

PRESUMPTIVE SERVICE CONNECTION

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A disability may be service-connected if it falls into certain categories and was incurred during time frames established by legislation.

1) Chronic diseases may be service-connected if they are manifest to a percent of 10% or more within 1 year of discharge. Tuberculosis and Hansen's Disease may be service connected if it is manifest to a percent of 10% or more within 3 years of discharge and Multiple Sclerosis if manifest to a percent of 10% or more within 7 years. See Chronic diseases, 38 CFR 3.309(a).

2) Tropical diseases may be service-connected if manifest within 1 year of discharge or due to the administration of therapy or preventive therapy. See Presumptive service connection for chronic, tropical or prisoner-of-war related disease, or disease associated with exposure to certain herbicide agents; wartime and service on or after January 1, 1947.   38 CFR 3.307; and Tropical diseases. 38 CFR 3.309(b); and 38 USC 1112; and M21-1, Part IV, 5.05.

3) Diseases specific to POWs may be service-connected if manifest to a percent of 10% or more anytime after discharge from service. See Presumptive service connection for chronic, tropical or prisoner-of-war related disease, or disease associated with exposure to certain herbicide agents; wartime and service on or after January 1, 1947.   38 CFR 3.307; and Diseases specific as to former prisoners of war. 38 CFR 3.309(c).

4) Diseases associated with Exposure to Certain Herbicides may be service-connected if a qualifying disability exists. Different time frames and percentage requirements exist for each new piece of legislation covering this area. See Diseases associated with exposure to certain herbicide agents. 38 CFR 3.307(a)(6); and Disease associated with exposure to certain herbicide agents. 38 CFR 3.309(e)

5) Diseases associated with Exposure to Ionizing Radiation may be service-connected if a qualifying disability exists under one of two laws. See Diseases specific to radiation-exposed Veterans. 38 CFR 3.309(d); and Claims based on exposure to ionizing radiation.  38 CFR 3.311; and M21-1, III, 5.12.

RECENT TREATMENT

You may need recent treatment depending on how long after service the claim for service connection is made. In those cases where the claim is filed shortly (within 1 year) after discharge, there is no need to request evidence of recent treatment. If the appropriate information and release forms are provided on the application, action should be taken to ensure all available evidence is of record when the decision is made. This ensures we have met our duty to assist as defined by VCAA of 2000.

SERVICE CONNECTION

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Service connection may be established if the facts, shown by the evidence, establish that a particular injury or disease was incurred during service in the Armed Forces. Service connection may also be established if an injury or disease preexisted military service and was aggravated while in service.

The development of evidence to support a determination of service connection may include four elements:

1) Service treatment records; In the case of preexisting conditions, request treatment prior to service

2) Continuity - evidence of ongoing treatment from military service to present.

3) First treatment - evidence to show the first treatment for the claimed disability following service.

4) Recent treatment - evidence to show recent treatment and current severity for the claimed condition. In many cases this will be a VA examination.

VCAA ACT OF 2000 ATTACHMENTS

The VCAA Act of 2000 requires the VA to notify the claimant of the status of the claim and what the evidence must show to establish entitlement.

With regard to the “status of the claim” attachment, neither the law (38CFR) or the court decision (NICHOLAS P. QUARTUCCIO, APPELLANT, v. ANTHONY J. PRINCIPI, SECRETARY OF VETERANS AFFAIRS, APPELLEE) addresses the requirements for informing the Veteran “what we have received.” The law and court decision is very clear with regard to having to “notify the claimant of any information and medical or lay evidence that is necessary to substantiate the claim” and to “inform the claimant which information and evidence, if any, that the claimant is to provide to VA and which information and evidence, if any, that VA will attempt to obtain on behalf of the claimant.” (38 CFR 3.159(b)).

Essentially, the only direction provided as direction of VA Central Office that requires the use of the “Quartuccio attachment (What’s The Status of Your Claim and How You Can Help). The attachment requires the VA to notify the claimant of three areas: 1) what we have received; 2) what the VA is responsible for obtaining; and 3) what the VA will make reasonable efforts to obtain.

The “evidence received section” should list as much information as necessary so as to keep the Veteran informed of the evidence we have obtained. The Veteran should know (for example) that we have the 1989, 1992, and 1996 outpatient treatment reports. The “evidence received section” should include all evidence pertaining to the disability claimed. A majority of the information/evidence could be taken from prior rating decisions, however, older rating decisions may not list all the evidence consider at the time of the decision.

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WARTIME SERVICE PERIODS – 38 CFR 3.2

Period Dates

Indian Wars 01-01-17 thru 12-31-98 (See CFRs)

Spanish-American War 05-21-98 thru 07-04-02 (See CFRs)

Mexican Border Wars 05-09-16 thru 04-05-17

World War I 04-06-17 thru 11-11-18

Russian Service thru 04-01-20

World War II 12-07-41 thru 12-31-46

Merchant Marine 12-07-41 thru 08-15-45

Korean Conflict 06-27-50 thru 01-31-55

Vietnam Era 08-05-64 thru 05-07-75

Desert Shield/Storm 08-02-90 thru

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Section 100

AddendumA. REQUEST FOR REPORT OF INVESTIGATION

B. STATEMENT FOR SELF-EMPLOYMENT CASE (Unemployability Cases)

C. SAMPLE PTSD MEDICAL OPINION – NO MEDAL, NO DIAGNOSIS IN SERVICE

D. SAMPLE PTSD MEDICAL OPINION - PTSD DIAGNOSED IN SERVICE

E. SAMPLE NON-COMBAT PTSD MEDICAL OPINION

F. MEDICAL STATEMENT FOR HOUSEBOUND OR A&A

G. CHARACTER OF DISCHARGE ADMINISTRATIVE DECISION

H. SAMPLE LETTER FOR DEPENDENTS RECORDS

I. SAMPLE LETTER – SOLICIT CLAIM-ADD’L EVID RCV’D

J. Reserved

K. GULF WAR OPINION FORMAT

L. Reserved

M. FAILURE TO PROSECUTE – VA EXAM

N. INCOMPETENCY NOTIFICATION

O. SAMPLE FINAL ATTEMPT LETTER

P. SAMPLE LETTER FOR ROUTINE FUTURE EXAMINATIONS

Q. SAMPLE AUDIO MEDICAL OPINION REQUEST (VERIS Version)

R. DBQ EXAM WORKSHEET

S. PENSION CHECKLIST

CHANGES

Change 9, January 1, 2006, added Addendum D, Medical Statement for Housebound or A&A

Change 10, February 24, 2006, added text for VA exam notifications to Cheyenne, Sheridan and Salt Lake City VA Medical Centers

Change 11, November 25, 2006, deleted Request for Central Office Medical Opinion (Radiation Cases); added Sample VA Exam Request for PTSD.

Change 12, December 6, 2006, added Sample Letter for Dependent Records.

Change 13, June 23, 2007, added Sample Letter for soliciting a claim due to receipt of additional medical evidence (SOLICIT CLAIM-ADD’L EVID RCVD)

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Change 14, May 18, 2008, added sample text for VA exam notification to Albuquerque, Colorado Springs, and Grand Junction VA Medical Centers

Change 15, June 9, 2008, added sample letter for routine future examinations

Change 16, July 30, 2008, added updated sample Medical Statement for Housebound or A&A

Change 17, October 18, 2008, deleted Sample Formal Finding; added sample Incompetency Notification.

Change 18, November 7, 2008, added additional statement to the VA Exam Opinion for PTSD sample regarding in-service diagnosis for PTSD.

Change 19, November 21, 2008, added text to the Sample 10-day Notice regarding alternative sources for service verification and service treatment records.

Change 20, March 8, 2009, removed sample VAMC notification paragraaphs.

Change 21, January 20, 2010, added sample audio medical opinion request (VERIS version).

Change 22, January 6, 2012, removed addendum E, sample PTSD medical opinion.

Change 23, January 26, 2012, updated addendum C, sample PTSD medical opinion.

Change 24, April 5, 2012, updated examination/opinion samples.

Change 25, April 28, 2012, added Pension Checklist.

Change 26, May 8, 2012, added DBQ Exam Worksheet.

Change 27, August 28, 2012, added Sample Non-Combat PTSD Exam.

Change 28, May 30, 2014, added Sample Final Attempt Letter.

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Addendum AREQUEST FOR REPORT OF INVESTIGATION

[Enter First and Last Name of Veteran] has filed a claim for U.S. Department of Veterans Affairs (VA) benefits for disabilities incurred in an incident on [Enter Month, Day and Year of Incident]. We need a report of your investigation in order to process the claim.

The following information may be of assistance to you in locating your investigation report.

1. Type of incident: [Enter Type of Incident]

2. Place where incident occurred: [Enter Place Where Incident Occurred]

3. Time of incident: [Enter Time of Incident]

4. Veteran's home address: [Enter Veteran's Home Address]

5. Veteran's Social Security Number: [Enter Veteran's SSN]

Please send us a copy of the report of the investigation. The enclosed postage paid envelope may be used for your response.

Your assistance in providing your investigation report will be greatly appreciated.

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Addendum BSTATEMENT FOR SELF-EMPLOYMENT CASES

This letter concerns your claim for Department of Veterans Affairs individual unemployability benefits due to your service-connected disabilities.

On the enclosed VA Form 21-4138, Statement in Support of Claim, please submit the following information for the period __________ to __________.

Types of work performed

Amount of time lost in the previous 12 months due to service-connected disabilities

Number of hours worked per week

Gross earnings and net earnings

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Addendum CSAMPLE PTSD MEDICAL OPINION – NO MEDAL, NO DIAGNOSIS IN SERVICE

NAME: C-NUMBER:

EXAMINE NSCPTSD

MEDICAL OPINION

Type of medical opinion requested: Whether the Veterans confirmed in-service stressor(s) is the basis of a current diagnosis of post traumatic stress disorder.

Contention: (1) The Veteran contends that (describe stressor A). We have/have not corroborated this stressor.(2) The Veteran contends that (describe stressor B). We have/have not corroborated this stressor.(3) The Veteran contends that (describe stressor C). We have/have not corroborated this stressor.

Opinion Requested: VA has confirmed the following in-service stressor(s). Please examine the Veteran and ask the Veteran to describe these in-service stressors to you (listed below). Please determine if there is a current diagnosis of PTSD which is linked to these confirmed stressors only. If a diagnosis of PTSD cannot be linked to these confirmed stressors, please tell us and provide complete reasons and basis.(1) stressor A(2) stressor B(3) stressor C

Potentially Relevant Evidence: Note: the examiners review of the record is NOT restricted to the evidence listed below. This list is provided in an effort to assist the examiner in location potentially relevant evidence:Tab A: Sick Call notes dated July 1, 2006Tab B: Chronological Records of Medical Care dated July 3, 2006Tab C: Chronological Records of Medical Care dated July 10, 2006Tab D: Medical Evaluation Board dated August 5, 2008

Additional Instructions: Insert additional instruction to clinician as necessary (i.e. hierarch of contingent opinions) when deemed necessary by the rater, as well as an opinion regarding conflicting evidence.

C-file to follow (or not to follow) BXXXX (first letter of Veteran's last name, last four of SSN) POA: XXX Input by: ______________, Ext XXXXWxxxxEND

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Addendum DSAMPLE PTSD MEDICAL OPINION - PTSD DIAGNOSED IN SERVICE

NAME: C-NUMBER:

Examine NSCPTSD

MEDICAL OPINION

Type of medical opinion requested: Direct service connection – PTSD

Contention:. The Veteran is claiming that his PTSD was incurred in or caused by [claimed in-service event] that occurred [estimated date or time frame]

3. Opinion request

Direct service connection[VA has corroborated the in-service stressor.]

Please examine the Veteran and ask the Veteran to describe the in-service stressor to you.

Is the Veteran’s PTSD at least as likely as not (50 percent or greater probability) incurred in or caused by military service in Iraq that occurred Jan 2009 to Dec 2009. Rationale must be provided in the appropriate section below. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion.

Please determine if there is a current diagnosis of PTSD which is linked to this corroborated stressor only. If a diagnosis of PTSD cannot be linked to this corroborated stressor, please tell us. Please provide complete reasons and basis.

5. Potentially relevant evidence

NOTE: The examiner’s review of the record is NOT restricted to the evidence listed below. This list is provided in an effort to assist the examiner in locating potentially relevant evidence.

Tab A: _________________________

Tab B: _________________________Tab C: _________________________Tab D: _________________________

C-file to follow (or not to follow) BXXXX (first letter of Veteran's last name, last four of SSN) POA: XXX Input by: ______________, Ext XXXXWxxxxEND:

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Addendum ESAMPLE COMBAT INJURY MEDICAL OPINION

NAME: C-NUMBER:

Please examine the following SC: N/A

Please examine the following NSC: Bilateral shoulders

MEDICAL OPINION

Type of medical opinion requested: Direct service connection

Contention: The Veteran is claiming that his right shoulder condition was incurred in or caused by being knocked down by artillery and mortars during combat in Korean war.

The Veteran is claiming that his left shoulder condition was incurred in or caused by being knocked down by artillery and mortars during combat in Korean war.

3. Opinion request

Direct service connection

Is the Veteran’s right shoulder condition at least as likely as not (50 percent or greater probability) incurred in or caused by being knocked down by artillery and mortars that occurred while in combat in Korea. Rationale must be provided in the appropriate section below. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion.

Is the Veteran’s left shoulder condition at least as likely as not (50 percent or greater probability) incurred in or caused by being knocked down by artillery and mortars that occurred while in combat in Korea. Rationale must be provided in the appropriate section below. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion.

5. Potentially relevant evidence

NOTE: The examiner’s review of the record is NOT restricted to the evidence listed below. This list is provided in an effort to assist the examiner in locating potentially relevant evidence.

Tab A: DD-214

Tab B: _________________________Tab C: _________________________Tab D: _________________________Tab E: _________________________Tab F: _________________________

6. Insert additional instructions to clinician as necessary (e.g. hierarchy of contingent opinions)

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[Note: Please tell the examiner that there are no service treatment records. However, the Veteran’s DD-214 shows receipt of a CIB with service in Korea and that he was in a gun battalion. Per 3.304(d), satisfactory lay or other evidence that an injury or disease was incurred or aggravated in combat will be accepted as sufficient proof of service connection if the evidence is consistent with the circumstances, conditions or hardships of such service even though there is no official record of such incurrence or aggravation. Therefore, we may accept the fact that the Veteran was knocked down by mortars and artillery during service.]

Prepared and input by XXXC file to follow POA: XXXWxxxx

End

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Addendum FMEDICAL STATEMENT FOR HOUSEBOUND OR A&A

(to be completed by the examining physician)

VETERAN’S NAME: ______________________________________

CLAIMANT’S NAME: ____________________________________

VA FILE NUMBER: ______________________________________

Indicate if the claimant is competent to handle his/her own legal and financial affairs. If the claimant is not competent, please state the specific diagnosis affecting competency.

1. GENERAL: (Describe posture and general appearance)

Diagnosis:

2. UPPER EXTREMITIES: (Describe restrictions of each upper extremity)

3. LOWER EXTREMITIES: (Describe restriction of each lower extremity, with reference to extent of limitation of motion, atrophy, contractures or other interference, also if affected, please comment on weight bearing, balance, and propulsion of each lower extremity)

4. SPINE: (Describe restriction of the spine, trunk and neck)

5. OTHER: (Set forth all other pathology including the effects of advancing age, such as dizziness, loss of memory, poor balance, which affects the claimant’s ability to perform self-care, ambulate, or travel.)

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Indicate which of the below functions the claimant is unable or requires assistance in performing:

Dress and undress Keep clean and presentable

Eat Meals Attend to the needs of nature

6. AMBULATION: Indicate if the claimant can walk without ambulatory aids or the assistance of another person, and if so, indicate distance:

If ambulatory aids are required for locomotion, what aids are utilized (cane, braces, crutches, walker, etc.)? Also indicate the distance the claimant can walk with the aid.

State if the claimant is restricted to his/her immediate premises, and if bedridden, indicate the number of hours per day spent in bed.

Describe how often per day or week and under what circumstances the claimant is able to leave home or immediate premises.

7. OTHER INFORMATION: (Is the claimant blind? If so, indicate best corrected visual acuity)I certify that the foregoing statements are true and correct to the best of my knowledge and belief.

_____________________________ _________________________________________Date Signature of Examining Physician

Address:_______________________________________

________________________________________

(If additional space is needed, please indicate item number on a separate sheet.)

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Addendum GCHARACTER OF DISCHARGE ADMINISTRATIVE DECISION

DEPARTMENT OF VETERANS AFFAIRS CSS XXX XX XXXXREGIONAL OFFICE155 VAN GORDON STREET, BOX 25126 LAST NAME, First, MIDENVER, COLORADO 80225

ADMINISTRATIVE DECISION

ISSUE: Character of Discharge Determination

EVIDENCE: Claimant’s service records (Court Memorandum, dated Nov 19, 194, Sep 14, 1984, Sep 16, 1984, Jan 23, 1985, and Jan 26, 1985; USS Fulton message R 280013Z Oct 84

DECISION: It is held that the period of service from December 31, 1980, to January 29, 1985, is considered dishonorable for VA purposes. The claimant is not entitled to health care under Chapter 17, Title 38 U.S.C. for any disability determined to be service-connected.

REASONS AND BASES: The claimant entered active duty in the U.S. Navy on December 31, 1980, and received a bad conduct discharge on Jan 29, 1985. The Veteran was discharged by conviction of a special court-martial.

Due process notification was sent to the claimant on January 28, 1997. The claimant has not responded to the correspondence, therefore, this decision is made on the evidence of record.

The DD Form 214, Certificate of Release or Discharge From Active Duty, indicates three period of time lost: May 22, 1984, to June 26, 1984; September 25, 1984, to November 3, 1984; December 13, 1984, to January 19, 1985.

The claimant was charged with violation of the Uniform Code of Military Justice for larceny, unauthorized absence, and missed movement. On September 27, 1984, the claimant was determined to be absent without leave since September 25, 1984 from the USS Fulton, located at New London, Connecticut. The claimant was charged with larceny of government property in the amount of $1,292.55 during the period April 1, 1983, to September 30, 1983. On October 28, 1984, the claimant was classified as a deserter.

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The issue of the claimant’s sanity is not involved. The claimant’s period of service from October 31, 1977, to October 30, 1980, is honorable.

38 C.F.R. 3.12(d)(4) states that a discharge or release because of willful and persistent misconduct will be considered dishonorable service for VA purposes. Without some contention on the part of the claimant, a determination as to whether the offense was minor cannot be made. In light of repeated unauthorized absences, and larceny, the offense is considered willful and persistent misconduct.

Servicepersons discharged under other than honorable conditions may be eligible for health care and other related benefits under Title 38, Chapter 17 for any disabilities incurred in or aggravated in the line of duty during active service provided he or she was not discharged under one of the statutory bars of 38 CFR 3.12(c). (38 CFR 3.360)

SUBMITTED BY: _______________________________ DATE: _________________

CONCURRED BY: _______________________________ DATE: _________________

APPROVED BY: _______________________________ DATE: _________________

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Addendum HSAMPLE LETTER FOR DEPENDENT RECORDS

Dear Sir or Madam:

A claim for benefits has been received by our office from [Insert Veteran’s Name] who received treatment as a dependent of a military service member. Please send us the medical treatment records identified below.

Type of RecordsRequested: _____________

Years of Treatment: _____________

Treatment Location: _____________

Name ofDependent: _____________

SSAN ofDependent: _____________

Name ofServiceperson: _____________

SSAN ofServiceperson: _____________

If you do not have the Veteran's records, please furnish the name and complete mailing address of the organization which may have these records.

Your cooperation is appreciated and a prompt response will assist us in providing a timely decision on the pending claim.

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Addendum ISAMPLE LETTER – SOLICIT CLAIM-ADD’L EVID RCVD

May 18, 2023

THOMAS S. GREEN111 CONE STDENVER, CO 80000

Dear Mr. Green:

We have received records from University Hospital related to medical treatment you received in the past. In order to proceed further, we first need a claim from you or your representative specifying the medical conditions that you would like us to evaluate or consider as a result of these records.

Please give us this information on the enclosed Statement in Support of Claim (VA Form 21-4138) and return the form to the address at the top of this letter. We recommend you return the form as soon as you can, in order to ensure the earliest possible payment date, if an award is authorized. Put your full name and VA file number on all documents so they will be easily associated with your records.

Where Should You Send What We Need?

Please send what we need to this address:

Department of Veterans AffairsRegional OfficeP.O. Box 25126Denver CO 80225-0126

How Can You Contact Us?

If you are looking for general information about benefits and eligibility, you should visit our web site at http://www.va.gov. Otherwise, you can contact us in several ways. Please give us your VA file number, 26 264 837, when you do contact us.

Call us at 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the number is 1-800-829-4833.

On the Internet at https://iris.va.gov. Write to us at the address at the top of this letter.

We are trying to decide claims as quickly as possible. We appreciate your help.

In Reply Refer To: 339/21D1/mrbCSS

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Sincerely yours,

[NAME]Veterans Service Center Manager

Email us at: https://iris.va.gov

Enclosure(s): VA Form 21-4138

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Addendum JRESERVED

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Addendum KGULF WAR OPINION FORMAT

Please examine this Veteran, who has service in Southwest Asia, for any chronic disability pattern. Please review the claims folder as part of your evaluation and state, with your findings, that it was reviewed. The Veteran has claimed a disability pattern related to [insert symptoms described by Veteran].

Please provide a medical statement explaining whether the Veteran’s disability pattern is:

(1) an undiagnosed illness (2) a diagnosable but medically unexplained chronic multi-symptom illness of unknown

etiology (3) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (4) a disease with a clear and specific etiology and diagnosis.

If, after examining the Veteran and reviewing the claims file, you determine that the Veteran’s disability pattern is either (3) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (4) a disease with a clear and specific etiology and diagnosis, then please provide a medical opinion, with supporting rational, as to whether it is “at least as likely as not” that the disability pattern or diagnosed disease is related to a specific exposure event experienced by the Veteran during service in Southwest Asia.

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Addendum LRESERVED

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Addendum MFAILURE TO PROSECUTE - VA EXAM

On {Date of Development Letter}, we wrote and asked you to appear for a VA examination. Because you failed to appear for the VA examination, we must deny your claim.

What Do We Need From You?

Please tell us when you are willing to report for a VA examination. If you are having difficulty making your appointment, call us, we may be able to help.

When And Where Do You Send The Information Or Evidence?

If we receive notice of your willingness to report for the VA examination by {Date of Development Letter plus one year}, we can continue processing your claim. A notification received from you after {Date of Development Letter plus one year}, must be considered a new claim. That means any benefits you may be eligible for can't start before the date we receive your notification.

IMPORTANT

It is to your advantage to send this notification as soon as you can.

What You Should Do If You Disagree With Our Decision.

If you do not agree with our decision, you should write and tell us why. You have one year from the date of this letter to appeal the decision. The enclosed VA Form 4107, "Your Rights to Appeal Our Decision," explains your right to appeal.

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Addendum NINCOMPETENCY NOTIFICATION

On November 7, 2008, we will replace the current “Brady Bill,” paragraph in PCGL (What Could Be Affected, paragraph M09b) with the following paragraphs. Users of MAP-D must auto-text the notice of proposed adverse action (in lieu of Incompetency Brady Bill Notice), and ensure that VA Form 21-4138, Statement in Support of Claim, is enclosed.

Notice of proposed adverse action:

 A determination of incompetency will prohibit you from purchasing, possessing, receiving, or transporting a firearm or ammunition.  If you knowingly violate any prohibition, pursuant to section 924(a)(2) of title 18, United States Code, as implemented by Public Law 103-159 of the Brady Handgun Violence Prevention Act, you may be fined, imprisoned, or both.

If we decide that you are unable to handle your VA funds, you may apply to this regional office for the relief of prohibitions imposed by the Brady Act with regards to the possession, purchase, receipt, or transportation of a firearm.  Submit your request to the address at the top of this letter on the enclosed VA Form 21-4138, Statement in Support of Claim.  VA will determine whether such relief is warranted.

Notice of adverse action:

As we advised you previously, the Brady Handgun Violence Prevention Act prohibits you from purchasing, possessing, receiving, or transporting a firearm or ammunition based upon our determination that you are incompetent to handle your VA funds.  You may be fined and/or imprisoned if you knowingly violate this law.

You may apply to VA for the relief of firearms prohibitions imposed by the law by submitting your request to the address at the top of this letter on the enclosed VA Form 21-4138, Statement in Support of Claim.  VA will determine whether such relief is warranted.

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Addendum OSAMPLE FINAL ATTEMPT LETTER

IMPORTANT—Reply Needed Within 10 DaysDear <Veteran name>:

We are continuing to work on your claim.

What is The Current Status Of Your Claim?

As previously advised in letter(s) of <letter date> and <letter date>, we requested your <enter the specific type of Federal records: separation documents, STRs, etc.>.  

We have determined that <enter the specific type of Federal records: separation documents, STRs, etc.> cannot be located and therefore are unavailable for review. All efforts to obtain the needed information have been exhausted, and based on these facts, we have determined that further attempts to obtain the records would be unsuccessful.

We have taken the following actions in an effort to obtain these records:

<List in detail each action taken to obtain records. List actions in chronological order from oldest to newest.>

<This should include identification of each source contacted, the dates of contact, and the source’s response.>

What Do We Still Need from You?

Please submit any relevant documents in your possession including:

Any available copies of <enter the specific type of Federal records: separation documents, STRs, etc.> as listed above.

Any other relevant evidence or information that you think will support your claim, to include such things as buddy statements.

If you are unable to submit records, you may also advise us of possible locations(s) of these records.

How Soon Should You Send What We Need?We encourage you to send any information or evidence as soon as you can. However, if we do not hear from you within 10 days, we will make a determination on the evidence of record.

Where Should You Send What We Need?

Please send what we need to this address:

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Department of Veterans AffairsRegional OfficeXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

How Can You Contact Us?If you are looking for general information about benefits and eligibility, you should visit our web site at http://www.va.gov. Otherwise, you can contact us in several ways. Please give us your VA file number, <file #>, when you do contact us.

Call us at 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the Federal number is 711 (international number is 1-800-829-4833).

Send us an inquiry using the Internet at https://iris.va.gov. Write to us at the address at the top of this letter.

What is eBenefits?eBenefits provides electronic resources in a self-service environment to service members, Veterans, and their families. Through the eBenefits website you can:

Track the status of your claim or appeal View your payment history Obtain verification of military service, civil service preference, or VA benefits Receive a copy of your military discharge documents, and Manage your VA life insurance policy

Enrolling in eBenefits is easy. Just visit www.eBenefits.va.gov for more information.

We look forward to resolving your claim in a fair and timely manner.

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Addendum PSAMPLE LETTER FOR ROUTINE FUTURE EXAMINATIONS

Dear :

We are requesting the Denver VA Medical Center schedule you for an examination. The examination will be limited to your (add contention). This examination is needed to evaluate the current condition of your disability since it may have improved or worsened since your last evaluation. The VA Medical Center will notify you of the specific date, time, and place for your examination.

What Do We Need From You?We need additional things from you. Please put your VA file number on the first page of every document you send us.

It is very important that you report for the examination at the scheduled time. If you will be out of town; have moved out of the area; or simply cannot keep an appointment, please contact the Compensation & Pension Exam Unit as soon as possible to discuss scheduling options. The local number is (303) 393-2807; the toll-free number is 1-888-336-8262, extension 2807 (Monday - Friday, 8:00 am - 4:00 pm). You may leave a voicemail message which will be returned as soon as possible. Please call only if you will not be available for an examination in the next six weeks.

If you do not report for the examination, we will not have all the evidence we need to properly evaluate your claim. This could result in additional delays in processing your claim, denial of your claim, a reduction in benefits, or discontinuance of your monthly VA disability benefits. Therefore, it is very important that you make every effort to keep your scheduled appointment.

How Can You Contact Us?You can contact us in several ways. Please let us know your VA file number, CSS 123 12 1234, when you contact us.

Call us at 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the number is 1-800-829-4833.

For your convenience, you may reach us by FAX at (303) 914-5903. For specific information about your claim, you can visit us at https://iris.va.gov. For

general information about benefits, visit our web site at www.va.gov. Write to us at the address at the top of this letter.

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Addendum QSAMPLE AUDIO MEDICAL OPINION REQUEST (VERIS VERSION)

NAME: C-NUMBER:

Examine NSC: Hearing LossTinnitus

Medical Opinion RequiredMOS is________, which has a _____ probability of noise exposure.

C-file to follow B3964 (first letter of Veteran's last name, last four of SSN) POA: XXX Input by _____________, ext XXXEnd

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Addendum RDBQ EXAM WORKSHEET

Veteran’s Name: VAMC:

C-Number: SSN:

Date Ordered: By:

Priority of Exam: Inadequate Exam Dated:Approved by:

Send File? Expedite?:

DBQ General Medical DBQ Prisoner of War ProtocolDBQ Gulf War General Medical DBQ Cold Injury ResidualsDBQ General Pension Exam Aid & Attendance or Housebound Exam

Body System: Musculoskeletal (DC 5000-5329)DBQ Ankle Conditions DBQ FibromyalgiaDBQ Amputations DBQ Flatfoot (Pes Planus)DBQ Back Conditions (Thoracolumbar Spine) DBQ Foot Miscellaneous (Other Than Flatfoot)DBQ Knee & Lower Leg Conditions DBQ Hand and Finger ConditionsDBQ Hip and Thigh Conditions DBQ Muscle InjuriesDBQ Neck Conditions (Cervical Spine) DBQ Non-Degenerative Arthritis, inc. GoutDBQ Shoulder & Arm Conditions DBQ OsteomyelitisDBQ Elbow and Forearm ConditionsDBQ Wrist Conditions

Body System: Organs of Sense (DC 6000-6276)DBQ Eye Conditions DBQ Loss Of Sense of Smell and TasteDBQ Hearing Loss & Tinnitus DBQ Ear Conditions

Body System: Infectious Diseases, Immune Disorders, and Nutritional Deficiencies (CD 6300-6354)

DBQ Persian Gulf & Afghanistan Infectious Diseases

DBQ Chronic Fatigue SyndromeDBQ Nutritional Deficiencies

DBQ Infectious Diseases DBQ Systematic Lupus Erythematous and Other Immune DisorderDBQ HIV-Related Illness

Body System: Respiratory (DC 6502-6847)DBQ Sinusitis, Rhinitis, and Other Disease of the Nose and Throat

DBQ Sleep ApneaDBQ Tuberculosis

DBQ Respiratory Conditions

Body System: Cardiovascular (DC7000-7123)DBQ Ischemic Heart Disease DBQ Arteries and VeinsDBQ Heart ConditionsDBQ Hypertension

Body System: Genitourinary (DC 7500-7542)DBQ Male Reproductive System Conditions DBQ Kidney Conditions (Nephrology)

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DBQ Urinary Tract and Bladder DBQ Prostate Cancer

Body System: Gynecological and Breast (DC 7610-7629)DBQ Gynecological ConditionsDBQ Breast Conditions and Disorders

Body System: Hematologic (DC 7700-7716)DBQ Hemic and Lymphatic Conditions Including Leukemia

DBQ Hairy Cell And Other B-Cell Leukemias

Body System: Endocrine (DC 7900-7919)DBQ Diabetes Mellitus DBQ Thyroid & ParathyroidDBQ Endocrine Diseases Other Than Diabetes

Body System: Neurologic (DC 8000-8914)DBQ Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) (ALS)

Brain & Spinal Cord

DBQ Parkinson’s DBQ Peripheral Nerves (Excluding Diabetic Neuropathy)DBQ Diabetic Sensory-Motor Peripheral

Neuropathy

DBQ Headaches (Including Migraine)DBQ Cranial NervesDBQ NarcolepsyDBQ Central Nervous System Diseases

DBQ Multiple Sclerosis DBQ Seizure Disorder (Epilepsy)DBQ Initial Evaluation of Residuals of TBI DBQ Review Evaluation of Residuals of TBI

Body System: Mental Disorders (DC 9201-9521)DBQ Initial PTSD DBQ Mental Disorders (except PTSD and

Eating Disorders)DBQ Review PTSD DBQ Eating Disorders

Body System: Dental and Oral (DC 9900-9916)DBQ Oral and Dental DBQ Temporomandibular Joint (TMJ)

Conditions

Body System: Digestive (DC 7200-7348)DBQ Intestinal (Other Than Surgical or Infectious)

DBQ Gall Bladder and Pancreas

DBQ Intestinal Surgery (Resection, Colostomy, Ileostomy)

DBQ Hepatitis, Cirrhosis, Other Liver ConditionsDBQ Peritoneal Adhesions

DBQ Abdominal, Inguinal, and Femoral Hernia

DBQ Rectum and Anus ConditionsDBQ Stomach and Duodenal Conditions

DBQ Esophageal Conditions

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Body System: Skin (DC 7800-7819)DBQ Scars Disfigurement DBQ Skin Diseases

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Addendum SPENSION CHECKLIST

March 2012

If the claimant does not meet one of the following criteria, deny the claim without ANY development:

1) < 90 days of service prior to September 7, 1980 (If only 85-89 days of service that would otherwise count, do a PIES request for travel time to see if you can get them 90 days total.)

or < 24 month of continuous service after September 7, 1980 (please see M21-1MR III.ii.6.4.a for what is acceptable if less than 2 months after 9/7/1980.)

Reference: M21-1MR.V.i.1.2

2) At least 1 day during a period of war Note, this is in addition to #1. If you have 2 separate periods, and one meets the time requirement but was not during wartime, and the other was during wartime but does not meet the time requirements, deny pension.Reference: M21-1MR.V.i.1.2

3) Excessive income - Pull a Share print. Even if you do not have complete income information, and this info alone makes the vet over income effective the date of claim, deny.Reference: M21-1MR.V.i.3.A.1.a

If the claimant meets the above requirements, check the following. If you have answered NO to any of these, VCAA development is needed:

Verified Service? Yes No If no, initiate just like you would for compensation

Reference: M21-1MR.III.6

65 or older, in receipt of SSD/SSI, or a patient in a N/H? Yes No If no, initiate development for medical evidence

(Note – early retirement does not count! Double check vet is actually getting SSDI if started getting Social Security between the ages of 62 and 65. Can grant effective the disability onset date – which in SSDI cases is typically 6 months prior to their first SSDI payment.)Reference: M21-1MR.V.i.2.1.d (also section e and f)

Complete dependent information? Yes No If no, initiate development and send VA Form 21-686c or 21-4138

(MUST be done before a decision regarding pension can be made!)Reference: M21-1MR III.iii.5.A.1.g

Complete income information for vet AND dependents? Yes No

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If no, make copy and return incomplete portion of application(Note, the “other” box on the new 21-526 does not indicate if the amount is monthly or annual. If claimant does not clarify, develop for this clarification.)Reference: M21-1MR V.i.3.B.5.b

Complete net worth information for vet AND dependents? Yes No If no, make copy and return incomplete portion of application

Reference: M21-1MR V.i.3.A.1.h

If IRA net worth reported, and they are over the age of 70, do they report IRA distribution income? Yes No

If not, you should develop for this. (Note, for pension we do not count IRA interest, we only count IRA distribution income. If they are over this age, most banks require you to take out a certain percentage each year. If they report interest and list IRA, ask for clarification as they typically assume we want their IRA interest income.)

Reference: M21-1MR V.iii.1.I.56.c and PMC Station Policy to avoid IVM

If the claimant meets the above requirements, check the following. If you have answered YES to any of these, VCAA development is needed:

Claiming income from a property or business? Yes No If yes, develop for 21-4185

Reference: M21-1MR V.i.3.B.7.a

Claiming farm income? Yes No If yes, develop for 21-4165

Reference: M21-1MR V.i.3.B.7.a

Net worth greater than $80,000? Yes No If yes, send VA Form 21-8049 to claimant

Reference: M21-1MR V.i.3.A.4.d and M21-1MR V.iii.1.J.70.c

If interest-bearing net worth greater than $5,000, is $0.00 interest reported? Yes No If yes, develop for interest income

(Note, 3% interest rule no longer applies. If claimant reports ANY interest amount take their word for it and do NOT develop.)

Reference: Fast Letter 11-16

Claiming A/A or HB and not in N/H? Yes No If yes send 21-2680 (under pension tab in Map-D)

Reference: M21-1MR V.iii.2.A.1Note: If A/A form is submitted with application and is sufficient to grant benefits, a development letter is not needed. If you think we may have sufficient information to grant, check with a rater before developing. Thirty days for additional development for someone who meets the very low income bar for pension cannot afford to wait unnecessarily.

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Note – Follow M21-1MRV.ii.3.1.d for when to infer for this benefit. You only rate for this if the vet requests it, or if they claim medical expenses that require this rating (assisted living expenses claimed). Do not infer merely to deny!

Does vet claim medical expenses for a spouse who is in a care facility? Yes No If yes, develop for medical evidence from a licensed physician indicating what the

spouse’s disability is, and whether or not they need to live in a protected environment. (If spouse is in a N/H, development is not needed.)Reference: M21-1MR V.iii.1.G.43 (sections e, h, and m)

(Note: There is no such thing as spousal aid and attendance in pension. This is only for compensation. Do not rate for this if you are only granting pension!)

VETS MARRIED TO VETS:If it is a Veteran married to a Veteran, consult a pension subject matter expert. There are special rules regarding these claims, and in most cases it becomes more complicated.

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WHAT TO DENY FIRST

If you can deny something without additional action – do it. We do not develop to deny, and we do not waste the Veteran’s time and resources to obtain information when we’ll just deny it anyways.

o Example 1: Right off the bat you can tell the vet is excess income, but they also have over $80k in NW – deny excess income since you would still need to develop for a 21-8049 before could deny for NW.

o Example 2: If you need to get the vet rated, but you have the 21-8049 and you can deny for NW – deny for NW instead of sending it to the RB.

If you can deny for more than one thing without additional action, deny by whichever is most permanent.

o Example 1: If the vet tells you dates of service and they are not a wartime vet, but you also have enough info to deny for excess income – deny for no wartime service.

o Example 2: If you have enough info to deny for NW, but income is also a bar – deny for NW.

o Example 3: You asked for complete income and you didn’t get it, but you pull a share print and their SSA alone makes them excess income – deny excess income instead of FTP. Note – you should not develop for medical expenses if the info you can deny the claim right away. The award letter provides the Veteran the opportunity to submit this information and gives them well over a year in many cases. You should not be developing for this information unless you need to clarify expenses the vet already told us about.

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