Overview
In This Section |
This section contains the following topics:
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1. Applications for Compensation and/or Pension, and Applications for Survivors Benefits
Introduction |
This topic contains information about applications for disability compensation and/or pension, including
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Change Date |
February 27, 2019
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III.ii.2.B.1.a. Requirements for a Formal Application Received Prior to March 24, 2015 |
Prior to March 24, 2015, the historical 38 CFR 3.151 required claimants to complete and submit a form prescribed by the Secretary of the Department of Veterans Affairs (VA) when filing an original claim for disability compensation and/or pension. The prescribed forms were
As the names of the forms imply, claimants may have used
References: For more information on
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III.ii.2.B.1.b. Requirements for a Complete Claim Received on or After March 24, 2015 |
Effective March 24, 2015, VA will only recognize compensation, pension, survivors, and related claims if they are submitted on the required standard forms. The table below provides guidance on the correct VA form to use based on the type of benefit sought by the claimant.
Note: The VA Form 21-526c is for pre-discharge compensation claims under the Benefits Delivery at Discharge (BDD) program.
References: For more information on
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III.ii.2.B.1.c. Benefit Requests Not Requiring a Prescribed Form |
A prescribed claim form is not required for requests for
References: For more information on
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III.ii.2.B.1.d. Using a Claimant’s Entries on VA Form 21-526 to Determine Which Benefit He/She Is Seeking |
VA Form 21-526 was discontinued effective February 19, 2019. Use the table below to determine whether a claimant’s entries on VA Form 21-526 constitute a claim for disability compensation, Veterans Pension, or both, for forms accepted
Note: If any doubt exists as to which benefit a claimant is seeking, ask the claimant for clarification.
Reference: For more information on handling outdated forms, see M21-1, Part III, Subpart ii, 1.C.8.a.
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III.ii.2.B.1.e.Discretionary Application of 38 CFR 3.151(a) |
38 CFR 3.151(a) instructs that a claim for compensation may be accepted as a claim for Veterans Pension and vice versa. Application of this provision of 38 CFR 3.151(a) is discretionary. Not all claims for Veterans Pension are necessarily claims for compensation and vice versa.
Consider the following three criteria when deciding whether VA will make the discretionary decision to apply 38 CFR 3.151(a) in the context of the Standard Claims and Appeals Forms rule.
Important: If all of the above criteria are not met, then the discretionary application of 38 CFR 3.151(a) is not warranted. In situations where the
Note: For DIC and Survivors Pension, the claims provisions are not discretionary.
References: For more information on
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III.ii.2.B.1.f. Processing Additional Correspondence Received With a Prescribed Form |
A claimant may submit correspondence in conjunction with a prescribed form that identifies additional benefits being sought. VA may accept these statements as part of the claim under specific circumstances.
Use the table below to determine if VA can accept the correspondence as part of the claim for benefits or a request for application.
Example 1: A Veteran submits a claim for an increase for his/her SC posttraumatic stress disorder, right and left knee patellofemoral pain syndrome, and lumbosacral strain on a VA Form 21-526EZ. The Veteran also submits a VA Form 21-4138, Statement in Support of Claim, at the same time as the VA Form 21-526EZ that describes the worsening of the disabilities as well as a new right hip problem caused by an altered gait related to the knee conditions. The right hip condition can be accepted as a claim because the VA Form 21-526EZ is the prescribed form for SC disabilities and the VA Form 21-4138 was submitted at the same time as the prescribed VA Form 21-526EZ.
Example 2: A Veteran submits a claim for pension on VA Form 21P-527EZ. At the same time, the Veteran submits a VA Form 21-4138 requesting A&A. The statement on the VA Form 21-4138 can be accepted as a claim for SMP with A&A or housebound benefits because the VA Form 21P-527EZ is a prescribed form for SMP A&A and the VA Form 21-4138 was submitted at the same time as the prescribed VA Form 21P-527EZ.
Example 3: A Veteran submits an original claim for SC for cervical spine strain on a VA Form 21-526EZ. One day later, the Veteran submits a VA Form 21-4138 for a claim for SC for anxiety disorder. VA Form 21-4138 is not the proper prescribed form for a claim for SC. Additionally, the VA Form 21-4138 was received at a different time than the prescribed VA Form 21-526EZ. Since the statement pertaining to anxiety was not submitted on the proper prescribed form and did not accompany a prescribed form submitted at the same time, no claim for SC for anxiety disorder exists. The VA Form 21-4138 regarding anxiety disorder is accepted as a request for application that will be reviewed in accordance with M21-1, Part III, Subpart ii. 2.C.6.
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III.ii.2.B.1.g. Reviewing VA Form 21-2680 to Identify Claims for SMC or SMP |
VA Form 21-2680 can be used as a standalone form if the claimant and/or the supporting documentation identifies whether the benefit sought is SMC or SMP. Revisions to the form (effective September 2018) allow the claimant to identify the benefit sought.
The identification of the benefit sought can be
When VA Form 21-2680 is submitted but the claimant does not identify the benefit sought, determine the benefit sought by applying the principles in the table below when the Veteran is identified as the claimant on the form.
Notes:
Reminder: When accepting VA Form 21-2680 as a claim for SMC or SMP, the form is a potential claim for both A&A and housebound benefits.
References: For more information on
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III.ii.2.B.1.h.Reviewing VA Form 21-2680 for Claims for Spousal or Survivors’ A&A or Housebound Benefits |
VA Form 21-2680 can be used as a standalone form to claim spousal or survivors’ A&A or housebound benefits if the benefit sought is adequately identified. Revisions to the form (effective September 2018) allow the claimant to identify the benefit sought.
The identification of the benefit sought can be
Use the table below when a Veteran’s spouse, surviving spouse, or parent is identified as the claimant or the individual being examined on VA Form 21-2680.
Reference: For more information on handling claims for spousal A&A when the combined evaluation of the Veteran’s SC conditions is less than 30 percent, see M21-1, Part III, Subpart iii, 5.L.1.f.
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III.ii.2.B.1.i.Issues That Arise From Consideration of VA Forms 21-2680, 21-4502, or 26-4555 |
VA Forms 21-2680, 21-4502, and 26-4555 are not specific claims for increased evaluation of an SC disability. However, the issue of increased evaluation can be considered within the scope of the claim for SMC, auto, or adapted housing benefits and should be addressed in the rating decision when
Important: If the medical evidence is insufficient to evaluate the disability, request examination of the condition as a part of the claim for SMC, auto, or adapted housing benefits. Do not routinely request examinations without first assessing the medical evidence for sufficiency. Only address the condition in the rating decision when examination or other medical evidence confirms a change in the disability evaluation of the SC issue is warranted or confirms the presence of the condition that is within the scope of another SC condition.
References: For more information on
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III.ii.2.B.1.j. Handling Requests for P&T Status for Compensation |
Veterans may submit a specific request for P&T status related to receipt of compensation benefits.
Note: Requests for P&T status may be routinely addressed as entitlement to Dependents Educational Assistance (DEA) in the rating decision.
References: For more information on
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III.ii.2.B.1.k. Non- Discretionary Application of 38 CFR 3.152(b) |
38 CFR 3.152(b) provides that a survivor’s claim for
VA has no discretion in this matter.
The following table shows which benefits VA must address depending on which forms the claimant submits.
Note: Although VA must take issue with all three survivor benefits, the proper end product (EP) is 190 when DIC is not claimed on an initial application. Change the EP to 140 if it later becomes clear that
References: For more information on
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III.ii.2.B.1.l. Receipt of EZ Form Requesting a Different Benefit Application |
The VA Form 21-526EZ and VA Form 21P-527EZ contain instructions for the claimant to request a different benefit application.
Use the table to determine what action must be taken upon receipt of such notice.
Reference: For more information about requests for applications, see
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III.ii.2.B.1.m. Considering Unclaimed Theories of SC |
Although there may be multiple theories or means of establishing entitlement to a benefit for a disability, if the theories all pertain to the same benefit for the same disability, they constitute the same claim. A claim for SC encompasses all potential theories of SC, whether claimed or unclaimed.
When a claimant has claimed SC for an issue, the evidence of record must be reviewed to determine the scope of that claim. All claims must be liberally read to consider other potential theories of SC.
Although VA is obligated to determine all potential claims raised by the evidence, theories of SC which have no support in the record need not be further developed or specifically addressed in a rating decision. However, a denial of SC is a denial for all potential theories, whether specifically addressed in the rating or not.
To determine whether an unclaimed theory of SC is reasonably raised by the record, consider factors or evidence such as
Example: A Veteran claims SC for multiple myeloma on a direct basis. The evidence of record does not support the direct theory. However, the evidence does show that the Veteran served in Vietnam. As multiple myeloma is defined in 38 CFR 3.309(e) as a condition presumptively associated with exposure to herbicide, the theory of presumptive SC is reasonably raised by the evidence and considered within the scope of the claim.
Exception: The requirement to liberally read claims based on multiple theories does not extend to claims of CUE, as the burden is on the claimant to specifically raise each issue. Each new CUE theory is independent.
References: For more information on considering
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2. Claims Filed at or Prior to Separation From Service
Change Date |
September 19, 2017
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III.ii.2.B.2.a. Claims Filed at or Prior to Separation From Service |
In an effort to begin compensating Veterans for their service-related disabilities as soon as they separate from service, VA has developed several programs that allow Veterans to begin the claims process at or prior to separation.
Examples:
References: For more information about
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3. Reviewing Application Completeness and Handling Variances
Introduction |
This topic contains miscellaneous information about claims for VA benefits, including
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Change Date |
February 27, 2019
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III.ii.2.B.3.a. What Constitutes a Substantially Complete Application |
VA has a duty to assist claimants who file a substantially complete application for benefits. The criteria for a substantially complete application are found in 38 CFR 3.160(a) and M21-1, Part I, 1.A.4.f.
References: For more information about
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III.ii.2.B.3.b.
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Do not establish EP control for an application for benefits unless it is substantially complete.
References: For more information on
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III.ii.2.B.3.c. Determining the Proper DOC for Claims Establishment Purposes |
The date of claim (DOC) for claims establishment purposes is the earliest date anyVA facility received the claim.
Important: Pension and burial claims electronically submitted via www.Vets.gov (Vets.gov) use the actual date of VA receipt of the application and not the Centralized Mail (CM) time stamp. Applications submitted via Vets.gov will haveVets.gov Submission in the upper right corner of every page and an electronic date stamp at the bottom left corner of every page.
Example Scenario:
Result: When the RO places the claim under EP control, it must use October 14, 2006, as the DOC.
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III.ii.2.B.3.d. Identifying an Incomplete Application |
Consider an application incomplete if it is signed but the claimant has not provided all the information described in M21-1, Part I, 1.B.1.b.
Reference: For more information about the criteria for a substantially complete application, see 38 CFR 3.160(a) and 38 CFR 3.159(a)(3).
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III.ii.2.B.3.e.
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A lack of signature from the claimant or other legally authorized individual renders an application incomplete for
Upon receipt of an unsigned application for benefits, follow the procedures for handling incomplete applications included at M21-1, Part I, 1.B.1.g.
Exception: When VA Form 21-2680 is accepted as a prescribed form for a claim for SMC or SMP, no claimant signature is required on the form.
Important: The application must be signed by the claimant or other legally authorized individual somewhere on the application itself. The submission of an unsigned application with other signed forms is not sufficient to satisfy the requirement for a signed application.
References: For more information on
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III.ii.2.B.3.f. Requests for Benefits That Are Not Filed on a Prescribed Form |
Use the table below to determine whether a request for benefits that is not filed on one of the prescribed forms in M21-1, Part III, Subpart ii, 2.B.1.a or M21-1, Part III, Subpart ii, 2.B.1.b is considered an informal claim or a request for application.
References: For more information about
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III.ii.2.B.3.g. Furnishing Applications to Claimants |
VA has an obligation under 38 CFR 3.150 to provide an application for benefits to anyone who requests one.
Before furnishing an application to a claimant in person, enter the Veteran’s name and file number in the appropriate spaces on the form.
Rationale: When the claimant eventually returns the application to VA, it will be easier and faster to
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4. Claims Based on Reports of Examination or Hospitalization
Introduction |
This topic contains information on reviewing reports of examination or hospitalization at VA facilities, military treatment facilities (MTF) or private healthcare facilities to determine whether claims action is warranted, including
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Change Date |
August 1, 2018
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III.ii.2.B.4.a. Notification of a Veteran’s Admission to an MTF |
Veterans who are admitted to a military treatment facility (MTF) are asked if they have ever filed a claim for compensation or pension with VA.
If the Veteran has ever filed a claim for compensation or pension, the MTF notifies VA of the Veteran’s admission.
Note: MTFs will not send notification of outpatient treatment and admissions that are solely for the purpose of examination.
References: For more information on actions to take
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III.ii.2.B.4.c.Handling Notice of a Report of VA or MTF Examination or Hospitalization Occurring on or After March 24, 2015 |
Notice of examination in a VA or uniformed services health care facility occurring on or after March 24, 2015, is not a claim. The date of examination will be considered for effective date purposes if a complete claim or intent to file (ITF) is received within one year from the date of examination or hospitalization for the following:
Important: Notice of hospitalization in a VA or uniformed services health care facility occurring on or after March 24, 2015, will be accepted as a prescribed form for benefits claimed under 38 CFR 4.29 or 38 CFR 4.30 or other temporary total evaluations for convalescence as discussed in M21-1, Part IV, Subpart ii, 2.J.5.aand M21-1, Part IV, Subpart ii, 2.J.6.a. However, a report of hospitalization will only be accepted as a claim applicable to disabilities which are currently SC when entitlement to a temporary total evaluation can be granted.
Notes:
References: For more information on
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III.ii.2.B.4.d. Action to Take Upon Receipt of Medical Evidence From an MTF |
Follow the instructions in M21-1, Part III, Subpart iii, 1.C.4 upon receipt of medical evidence from an MTF.
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III.ii.2.B.4.e. Actions to Take Upon Receipt of VA or MTF Reports of Hospitalization |
As noted in M21-1, Part III, Subpart ii, 2 B.4.c, a report of hospitalization in a VA or MTF occurring on or after March 24, 2015, will be accepted as a prescribed form for benefits claimed under 38 CFR 4.29 or 38 CFR 4.30 or other temporary total schedular evaluation assigned for convalescence purposes.
Follow the steps in the table below upon receipt of such notice of hospitalization.
Note: The proper EP to clear for action based on receipt of a hospital report is contingent on the ending action. When
References: For more information on
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III.ii.2.B.4.f. Establishing a Claim Based on VA Medical Treatment Prior to March 24, 2015 |
Follow the steps in the table below if the VA medical evidence shows treatment prior to March 24, 2015, for
Important: If VA medical evidence shows treatment on or after March 24, 2015,do not establish an EP to control receipt of this evidence. No further action is needed other than ensuring that the evidence is associated with the beneficiary’s claim folder, as this evidence may be utilized for effective date purposes, if a formal claim is received within one year of the date of treatment.
References: For more information on
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III.ii.2.B.4.g. Accepting Evidence of Private Examination or Hospitalization Occurring Prior to March 24, 2015 |
Private medical evidence may be accepted as a claim if
Note: Once a claim is established, refer it for development or rating activity as necessary.
References: For more information on
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5. Incorrectly Established Claims
Introduction |
This topic contains information about incorrectly established claims, including
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Change Date |
February 19, 2019
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III.ii.2.B.5.a. How to Identify an Incorrectly Established Claim |
As stated in M21-1, Part III, Subpart ii, 2.B.1.b effective March 24, 2015, VA will only recognize compensation, pension, survivors, and related claims if they are submitted on the required standard forms.
The term “incorrectly established claim” refers to a request for benefits not submitted on a prescribed form that was received and
In situations where a claim was incorrectly established based on receipt of a request for benefits not submitted on a prescribed form, corrective action is needed as described in this topic.
Note: These instructions do not apply to a request for application that was misidentified as a claim but has not had development initiated. For these situations, follow the guidance in M21-1, Part III, Subpart ii, 2.C.6.a.
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III.ii.2.B.5.d.Instructions for Addressing Issues or Conditions Incorrectly Established as an EP and a Decision Has Not Been Made |
Follow the steps in the table below to address requests for benefits that were incorrectly established as an EP and a decision has not been made.
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III.ii.2.B.5.e.Instructions for Addressing Issues or Conditions Incorrectly Established as an EP and a Decision Has Been Made |
Follow the steps in the table below to address requests for benefits that were incorrectly established as an EP, when a decision has been made.
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III.ii.2.B.5.f. Instructions for Addressing Issues or Conditions Incorrectly Added to a Valid EP and a Decision Has Not Been Made |
Follow the steps in the table below to address requests for benefits that were incorrectly added to a valid EP and a decision has not been made.
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III.ii.2.B.5.g.Instructions for Addressing Issues or Conditions Incorrectly Added to a Valid EP and a Decision Was Made |
Follow the steps in the table below to address requests for benefits that were incorrectly added to a valid EP and a decision was made.
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III.ii.2.B.5.h. Receipt of a Prescribed Form in Response to Incorrect Claims Guidance After the EP 930 Has Been Cleared |
When an RO receives a prescribed form in response to the incorrect claims guidance provided by M21-1, Part III, Subpart ii, 2.B.5 and the corrective EP 930 has already been cleared, the claims processor must determine if the EP established upon receipt of the form is still required.
Important: Claims processors may be able to identify these forms by the phraseRO Request – Signature Needed written at the top of each page, however, not every form will state this.
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III.ii.2.B.5.i. Disagreements Received on Incorrectly Added and Decided Claims |
When a claimant has been notified of a decision, even when the decision was made without the claim having been submitted on a required prescribed form, accept any timely and otherwise appropriately submitted legacy appeal or decision review request on the decision.
References: For more information on
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Change-March-24-2015-Transmittal-Sheet-M21-1MRIII_ii_2_SecB_TS.docx | May 10, 2019 | 40 KB |
in Chapter 2 Benefit Programs and Types of Claims, Part III General Claims Process, Subpart ii Initial Screening and Determining Veteran Status
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