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M21-1, Part III, Subpart ii, Chapter 2, Section B – Claims for Disability Compensation and-or Pension, and Claims for Survivors Benefits

Overview


In This Section

This section contains the following topics:
Topic
Topic Name
1
2
3
4
5

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

Change Date

February 27, 2019

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

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.
If the benefit sought is …
Then the prescribed form is VA Form 
  • service connection (SC) (initial)
  • increased evaluation, or
  • a claim for a permanent and total (P&T) rating
associated with a supplemental claim received within one year of the prior decision
associated with a supplemental claim received one year or more after the prior decision
associated with a request for higher-level review of a prior decision
temporary total disability rating (paragraph 29 and 30 benefits)
Note:  Hospitalization reports from VA or military treatment facilities will be accepted as a prescribed form for paragraph 29 and 30 benefits.
References:  For more information on
total disability rating based on individual unemployability (TDIU)
TDIU can also be claimed on any of the following VA Forms:
Notes:
  • VA Form 21-8940 is not required to claim individual unemployability (IU).  However, submission of VA Form 21-8940 by the Veteran is required in the course of development of the IU claim and for the award of TDIU benefits.
  • VA Form 21-8940 is not an acceptable standard form for a claim for increase.  However, as a part of adjudication of the TDIU issue, the evaluation of the service-connected (SC) disabilities claimed to cause unemployability must be considered.  For more information on considering entitlement to an increased evaluation of SC disabilities when considering claims for TDIU, seeM21-1, Part IV, Subpart ii, 2.F.2.h.
References:  For more information on
child incapable of self-support benefits
Note:  Information about a child incapable of self-support submitted by a Veteran on VA Form 21-0538Status of Dependents Questionnaire, will be accepted as a claim to add the dependent(s) to the Veteran’s award.
Veterans Pension (initial)
dependency and indemnity compensation (DIC), Survivors Pension and accrued benefits (initial)
income adjustments for running pension awards or to supplement initial applications (income/asset/net worth, liberalized legislation)
Exception:  VA does not require beneficiaries to use a specific form to report a change in income that will result in a decrease in benefits.  A beneficiary may report such changes
  • in writing
  • by telephone, e-mail, or fax, or
  • through eBenefits.
burial benefits (initial)
specially adapted housing (SAH) or special housing adaptation (SHA)
SAH/SHA can also be claimed on VA Form 21-526EZ.
Important:
  • SAH/SHA claims require
  • VA Form 26-4555 or 26-4555c is a claim for both SAH and SHA.
    • A grant of SAH renders the issue of SHA moot since SAH is the greater benefit.  SHA need not be addressed when SAH is granted.
    • If SAH is denied, the rating decision must address both SAH and SHA.
Note:  When eligibility is being determined in response to a request from a regional loan center referral or 890 work item, VA Form 26-4555 or 26-4555c is not required in the claims folder.
Reference:  For more information on issues that may arise from consideration of VA Form 26-4555, see M21-1, Part III, Subpart ii, 2.B.1.i.
auto allowance
Auto allowance can also be claimed on VA Form 21-526EZ.
Important:  VA Form 21-4502 is required for the award of benefits and can be used as a standalone form for initial auto allowance claims.
Reference:  For more information on issues that may arise from consideration of VA Form 21-4502, see M21-1, Part III, Subpart ii, 2.B.1.i.
special monthly compensation (SMC) for housebound/aid and attendance (A&A) including spousal A&A
Reference:  For more information on reviewing VA Form 21-2680 to identify the benefit sought, see M21-1, Part III, Subpart ii, 2.B.1.gi.
SMC for housebound/A&A for DIC benefits
Reference:  For more information on reviewing VA Form 21-2680 to identify the benefit sought, see M21-1, Part III, Subpart ii, 2.B.1.gi.
special monthly pension (SMP) for housebound and/or A&A
Reference:  For more information on reviewing VA Form 21-2680 to identify the benefit sought, see M21-1, Part III, Subpart ii, 2.B.1.gi.
spina bifida
apportionment
dependents
Important:  A Veteran may use VA Form 21-0538, to initiate the process of adding a spouse to his/her award. However, this form contains no sections wherein the Veteran may provide his/her marital history or the marital history of his/her spouse. Without this information, VA cannot determine whether the Veteran and his/her spouse are free to marry. Accordingly, a Veteran in this case must ultimately provide the information contained inVA Form 21-686c in addition to the VA Form 21-0538. In accordance with M21-1, Part III, Subpart iii, 5.A.4.h, this information may be obtained through a phone call to the Veteran.
Note:  A VA Form 21-674 can be accepted as a standard form for a school child claiming DIC in his or her own right if the child was previously on a surviving spouse’s DIC award.
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

III.ii.2.B.1.c.  Benefit Requests Not Requiring a Prescribed Form 

A prescribed claim form is not required for requests for
  • review based on clear and unmistakable error (CUE)
  • substitution
  • a finding of incompetency received from a first or third party, and
  • removal of a dependent.
References:  For more information on

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
  • prior to February 19, 2019, or
  • on or after February 19, 2019, under the circumstances described in M21-1, Part III, Subpart ii, 1.C.8.a allowing for acceptance of the form after its discontinuation.
If the claimant …
Then consider the application a claim for …
asserts a relationship between his/her service in the armed forces and an
  • illness
  • disease, or
  • injury
Example:  The claimant provides dates of treatment that fall within his/her period of service.
compensation only.
  • claims to be totally disabled without indicating that this is due to service in the armed forces, and
  • furnishes information about
    • employment, and/or
    • income, or
  • has attained age 65, claims no disability, and furnishes information about
    • employment, and/or
    • income
pension only.
  • asserts a relationship between his/her service in the armed forces and an
    • illness
    • disease, or
    • injury
  • claims to be totally disabled, and
  • furnishes information about
    • employment, and/or
    • income
compensation and pension.
completes all or a portion of
  • Part II of the application, which deals with service-related disabilities, and
  • Parts VII through X of the application, which deal with
    • income
    • net worth, and
    • deductible expenses
compensation and pension.
requests dental treatment only
dental treatment only and follow the procedures at M21-1, Part III, Subpart v, 7.C.1.a.
Reference:  For more information on claims involving dental conditions only, see
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.

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.
  • Regardless of which claims form is submitted, the information on the claim must constitute a substantially complete claim for the unclaimed benefit being considered under 38 CFR 3.151(a).
    • If VA Form 21P-527EZ is accepted as a claim for compensation, the claim form must include information that would otherwise be included on a claim for compensation.
    • If VA Form 21-526EZ is accepted as a claim for Veterans Pension, the claim form must include information that would otherwise be included on a claim for Veterans Pension including income information.
  • The evidence of record must establish a likelihood that the benefit will be granted.
  • The claim must be reasonably interpreted to reflect an intent to claim benefits for the issue at hand.  Generally, this is reflected via the claimant listing the issue on the claim form.
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

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.
  • There must be intent to claim the issues recorded on the additional correspondence.
    • The intent may be specifically expressed or assumed based on context of the submission.
    • The prescribed form accompanying the evidence must be appropriate to the benefit sought as discussed in M21-1, Part III, Subpart ii, 2.B.1.b.
    • Non-service-connected (NSC) issues listed on VA Form 21-8940are not accepted as claimed issues unless the claimant specifically expresses intent to claim those issues.  Handle NSC issues listed on VA Form 21-8940 as directed at M21-1 Part IV, Subpart ii, 2.F.2.h.
  • Medical evidence submitted with the claim, such as private or VA treatment records or Disability Benefits Questionnaires, is not considered a claim or additional correspondence sufficient to accept as a claim.
  • When a claimant’s signature is included on a prescribed form but a POA’s signature is on the additional correspondence, do not presume that the additional issues were intended to be submitted as part of the application package.  In this situation, additional issues submitted and signed by a POA that are not on a prescribed form should be treated as a request for application.
  • When the source of additional correspondence submitted with a prescribed form cannot be ascertained, assume it is from same source as the prescribed form unless there is evidence to the contrary.
  • When a form requires a signature, the form must be signed without regard to other accompanying submitted forms bearing a signature.
Use the table below to determine if VA can accept the correspondence as part of the claim for benefits or a request for application.
If the additional correspondence is submitted …
Then consider the additional issues …
at the same time as the appropriate prescribed form
as part of the pending claim.
  • at a different time than the appropriate prescribed form, or
  • with a form not prescribed for the specific benefit requested in the additional correspondence
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.

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
  • specific, with the Veteran identifying on the form whether the claim is for SMC or SMP, or
  • based on sympathetic reading of the claim via reviewing the issues raised on VA Form 21-2680 in the context of the benefits the Veteran is receiving.
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:
  • In any situation, if VA Form 21-2680 or the evidence submitted with it specifically identifies the benefit sought as either SMC or SMP, that identification of the benefit sought supersedes the guidance below.
  • Although VA Form 21-2680 may be accepted as a prescribed claim form for SMC or SMP, it is not required to grant entitlement to either benefit.  Do not undertake routine development for completion of this form when deciding a claim for SMC or SMP.  For more information on use of VA Form 21-2680, see M21-1, Part IV, Subpart ii, 2.H.1.j.
If …
Then accept the VA Form 21-2680 as …
the Veteran is
  • receiving compensation
  • entitled to receive compensation but has elected to receive military retired pay, or
  • submitting any initial claim for compensation
a claim for SMC regardless of the conditions listed on the VA Form 21-2680.
Exception:  If the evidence of record suggests that pension with SMP may be payable as a greater benefit if claimed, then also accept the VA Form 21-2680as a request for application for pension with SMP.
if the Veteran is
  • receiving pension, or
  • submitting any initial claim for pension
a claim for SMP regardless of the conditions listed on VA Form 21-2680.
dual entitlement exists
a claim for
  • SMC if the Veteran is in receipt of compensation, or
  • SMP if in receipt of pension.
Important:  In addition to accepting theVA Form 21-2680 as a claim for SMC or SMP based on the benefit currently being received (as directed above), also accept the VA Form 21-2680
  • as a claim for the opposite benefit (the benefit the Veteran is not currently in receipt of)only if the opposite benefit can be granted and the grant results in a greater benefit to the Veteran, or
  • as a request for application if the Veteran is currently receiving compensation andthe evidence suggests that pension may be the greater benefit but no income information is of record.
has not submitted a prior or current original claim for compensation or pension
a request for application.
Reference:  For more information on handling a request for application, seeM21-1, Part III, Subpart ii, 2.C.6.a.
  • the Veteran is not in receipt of, entitled to receive, or currently claiming VA compensation or pension benefits, and
  • has previously submitted an original claim for either pension or compensation which has been denied
a request for application.
Note:  When a Veteran is SC with a zero-percent combined disability evaluation, accept the VA Form 21-2680 as a request for application since the Veteran is not in receipt of monetary compensation.
Reference:  For more information on handling a request for application, seeM21-1, Part III, Subpart ii, 2.C.6.a.
a supplemental claim.
Notes:
  • Submission of VA Form 21-2680 is not required for the supplemental claim.
  • When a prior claim for SMC or SMP has been denied but VA Form 21-2680 is not accompanied by VA Form 21-0995, then accept the submission of VA Form 21-2680 as an initial claim and follow the applicable procedure based on corresponding claim status or benefit entitlement as directed in the remaining guidance in this table.
the Veteran is already in receipt of A&A for compensation
a request for application.
Reference:  For more information on handling a request for application, seeM21-1, Part III, Subpart ii, 2.C.6.a.
the Veteran is already in receipt of A&A for pension
a duplicate request for SMP, unless following the above procedures within this table allows for acceptance of theVA Form 21-2680 as a claim for SMC.
Note:  If the claim is accepted as a duplicate request for SMP, provide notice that the claimed benefit has previously been awarded.
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.
  • A grant of A&A renders the issue of housebound moot for the same type of benefit (either SMC or SMP) since A&A is the greater benefit.  The issue of entitlement to SMC or SMP based on housebound status need not be addressed when A&A is granted for the same type of benefit (SMC or SMP).
  • If A&A is denied, the rating decision must address the issue of housebound status since VA Form 21-2680 is a claim for both benefits.
References:  For more information on

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
  • specific, with the claimant identifying which benefit is being claimed, or
  • based on sympathetic reading of the claim such as
    • identifying the dependent as the claimant or the individual being examined on the VA Form 21-2680, and
    • considering the information on the form in the context of the VA benefits being paid based on the Veteran’s service.
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.
When …
Then accept the VA Form 21-2680 as a claim for …
  • a Veteran is in receipt of, entitled to receive, or claiming compensation, and
  • the spouse is identified as the individual being examined on the form
spousal A&A.
  • a surviving spouse is receiving DIC or survivors pension, and
  • the spouse is identified as the individual being examined on the form
surviving spouse’s A&A and housebound benefits.
  • a Veteran’s parent is receiving parent’s DIC, and
  • the parent is identified as the individual being examined on the form
A&A for the parent.
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.

III.ii.2.B.1.i.Issues That Arise From Consideration of VA Forms 21-2680, 21-4502, or 26-4555

VA Forms 21-268021-4502, 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
  • evidence on the form or in the evidence associated with the claim indicates the presence of a disability that is within the scope of an SC disability (such as a complication of diabetes), or
  • evidence on the form or other lay or medical evidence associated with the claim indicates the SC disability may have worsened.
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

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.
  • A request for P&T status must
    • be received on a prescribed form for SC or increased evaluation, and
    • specify the SC issue or issues that are associated with the claimed P&T status.
  • Handle requests for P&T status that do not identify the associated issue(s) as incomplete applications except when only one SC disability exists.  When a single SC disability exists, presume that the claim for P&T status is associated with the single SC disability.
  • A request for P&T status for compensation purposes is inherently tied to an underlying claim for SC or increased evaluation.  Thus, development of the underlying claim satisfies any development need associated with the request for P&T status.
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

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
  • DIC will also be considered a claim for Survivors Pension and accrued benefits, and
  • Survivors Pension will also be considered a claim for DIC and accrued benefits.
VA has no discretion in this matter.
The following table shows which benefits VA must address depending on which forms the claimant submits.
When …
Then VA is obligated to address the claimant’s entitlement to …
a surviving parent submits VA Form 21P-535
  • DIC, and
  • accrued benefits.
a surviving spouse or child submits
  • DIC
  • Survivors Pension, and
  • accrued benefits.
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
  • the survivor is claiming DIC, or
  • there is a reasonable possibility that the Veteran’s death is SC and a rating decision is required.
References:  For more information on

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.
If the VA Form …
Then send the claimant a request for application letter and attach …
21-526EZ has “Pension” written
  • at the top of the form, or
  • in the claimed disabilities section
21P-527EZ has “Will claim compensation – send VA Form 21-526EZ” written
  • at the top of the form, or
  • in the claimed disabilities that prevent you from working section
Reference:  For more information about requests for applications, see

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
  • circumstances of service
  • type of disability for which the claimant seeks benefits, and
  • any evidence of record.
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

2.  Claims Filed at or Prior to Separation From Service


Change Date

September 19, 2017

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:
  • BDD, and
  • Integrated Disability Evaluation System (IDES).
References:  For more information about

 3.  Reviewing Application Completeness and Handling Variances


Introduction

This topic contains miscellaneous information about claims for VA benefits, including

Change Date

February 27, 2019

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

III.ii.2.B.3.b.
When to Place an Application for Benefits Under EP Control

Do not establish EP control for an application for benefits unless it is substantially complete.
References:  For more information on

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:
  • A VA medical center (VAMC) receives the application on October 14, 2006.
  • The VAMC forwards the application to the regional office (RO) on November 1, 2006.
  • The RO does not receive the application in its mailroom until November 5, 2006.
Result:  When the RO places the claim under EP control, it must use October 14, 2006, as the DOC.

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).

III.ii.2.B.3.e.
Handling an Unsigned Application for Benefits

 
A lack of signature from the claimant or other legally authorized individual renders an application incomplete for
  • original claims received prior to March 24, 2015, and
  • all claims received on or after March 24, 2015.
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

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.
If received …
And …
Then process the submission as …
prior to March 24, 2015
the submission represents the original claim for benefits
an informal claim.
VA previously processed an original claim for benefits
a claim and
  • establish EP control, and
  • initiate development of the claim.
on or after March 24, 2015
N/A
a request for application.
References:  For more information about

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
  • identify the Veteran on whom the claim is based, and
  • associate the application with the proper claims folder.

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

Change Date

August 1, 2018

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

III.ii.2.B.4.b.  Accepting a Report of VA or MTF Examination or Hospitalization Dated Prior to March 24, 2015 as a Claim

Evidence of examination or hospitalization in a VA or uniformed services health care facility occurring before March 24, 2015, is an informal claim for
  • an increased disability rating for an SC disability, or
  • pension, when entitlement to pension was previously denied based on the absence of evidence of permanent and total disability.
Note:  A notice of hospitalization may not suffice as an informal claim if a Veteran with an SC disability(ies) is hospitalized for a disability for which SC has not been established.

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:
  • a claim for an increased disability evaluation received for one or more conditions treated as part of the examination or hospitalization, or
  • pension, when entitlement to pension was previously denied based on the absence of evidence of permanent and total disability.
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:
  • A report of VA or MTF examination or hospitalization occurring on or after March 24, 2015, showing a nursing home stay is not sufficient to grant aid and attendance (A&A) without a formal application.
  • Prior procedures required establishment of a tracking diary when entitlement to benefits under 38 CFR 4.29 or 38 CFR 4.30 could not be established but an increase in severity of the disability was shown that met the criteria for a higher evaluation.  However, the establishment of a tracking diary in this situation is no longer necessary.
References:  For more information on

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.

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.
Step
Action
1
  • If the report of hospitalization is for hospitalization at a VA facility, review the report to determine whether a SC disability was treated during the hospitalization.
    • If yes, proceed to Step 3.
    • If no,
      • annotate No Action Necessary – Paragraph 29 and/or 30 entitlement not shown due to treatment for NSC disabilityon the report of hospitalization and take no further action, and
      • clear EP 330.
  • If the report of hospitalization is for hospitalization at an MTF, proceed to Step 2.
2
For reports of hospitalization at an MTF
  • establish EP 320
  • follow the procedures at M21-1, Part III, Subpart iii, 1.C.3, and
  • upon receipt of the report of hospitalization, review the report to determine whether a SC disability was treated during the hospitalization.
    • If yes, proceed to Step 3.
    • If no,
      • annotate No Action Necessary – Paragraph 29 and/or 30 entitlement not shown due to treatment for NSC disabilityon the report of hospitalization and take no further action
      • change EP 320 to EP 330, and
      • clear EP 330.
3
Review the hospitalization report to determine if additional review by the rating activity is required.  Does the evidence suggests that hospitalization
  • was in excess of 21 days for an SC disability, as described in38 CFR 4.29, or
  • included surgical treatment for an SC disability?
If yes, proceed to Step 4.
If no,
  • annotate No Action Necessary – Paragraph 29 and/or 30 entitlement not shown on the report of hospitalization and take no further action
  • change EP 320 to EP 330 (if EP 320 is pending), and
  • clear EP 330.
4
Establish EP 320, if not already established.
5
Obtain all relevant records associated with the report of hospitalization.  For
6
Forward to the rating activity for review and action.
7
The rating activity reviews the report of hospitalization to determine whether entitlement to benefits is warranted under
8
If entitlement to benefits under 38 CFR 4.29 or 38 CFR 4.30 or convalescence based on a temporary total schedular evaluation is
  • warranted, then proceed with rating and authorization action under EP 320, or
  • not warranted, then
    • change the controlling EP 320 to an EP 330
    • clear the EP 330, and
    • annotate No Action Necessary – Paragraph 29 and/or 30 entitlement not shown on the report of hospitalization in the claims folder.
Note:  The proper EP to clear for action based on receipt of a hospital report is contingent on the ending action.  When
  • benefit entitlement is warranted, clear EP 320.
  • benefit entitlement is not warranted, clear EP 330.
References:  For more information on

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
  • an SC disability, or
  • manifestations of an SC disability.
Step
Action
1
Accept the date of admission for treatment, date of outpatient treatment, or date of examination for an SC disability as the DOC for increased evaluation.
2
Establish and maintain control of the claim.
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

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
  • it shows treatment for an SC disability or manifestations of an SC disability prior to March 24, 2015
  • it shows a reasonable probability of entitlement to a benefit, and
  • it was received by VA prior to March 24, 2015.
Note:  Once a claim is established, refer it for development or rating activity as necessary.
References:  For more information on

III.ii.2.B.4.h.Considering Evidence of Examination or Hospitalization Occurring on or After March 24, 2015

If VA or MTF medical evidence shows treatment, but not hospitalization over 21 days on or after March 24, 2015, do not establish an EP to control receipt of this evidence.
Ensure the evidence is associated with the beneficiary’s claim folder, as this evidence may be utilized for effective date purposes if a formal claim or ITF is received within one year of the date of treatment.
Example 1:  Veteran is SC for diabetes mellitus type 2 at 10 percent due to a restricted diet.  VA medical center (VAMC) treatment report dated June 10, 2015, shows physician prescribed oral medication as part of the diabetic treatment plan.  On May 1, 2016, the Veteran submits a claim for an increase in diabetes mellitus type 2.  The Veteran’s
  • DOC is May 1, 2016, and
  • effective date of increase is June 10, 2015.
Example 2:  Veteran is SC for diabetes mellitus type 2 at 10 percent due to a restricted diet.  VAMC treatment report dated June 10, 2015, shows physician prescribed oral medication as part of the diabetic treatment plan.  On March 1, 2016, the Veteran submits an ITF for compensation benefits.  On September 20, 2016, the Veteran submits a claim for an increase in diabetes mellitus type 2.  The Veteran’s
  • DOC is September 20, 2016
  • active ITF date is March 1, 2016, and
  • effective date of increase is June 10, 2015.
Reason:  An ITF for compensation benefits was received within one year of the treatment warranting an increased evaluation.  The Veteran submitted a complete compensation claim within a year of the VA receiving the active ITF.

5.  Incorrectly Established Claims


Introduction

This topic contains information about incorrectly established claims, including

Change Date

February 19, 2019

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
  • established and processed under a new EP, or
  • added to an existing EP and processed.
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.

III.ii.2.B.5.b.Information to Provide the Claimant or Authorized Representative

Upon identification of a claim that has been established improperly due to non-receipt of a prescribed form, take action to resolve the issue. The claims processor must inform the claimant and/or authorized representative
  • that the request for benefits was incorrectly accepted as a claim, and VA regulations require that all claims must be submitted on a prescribed form effective March 24, 2015
  • which issues or conditions cannot be considered a valid claim
  • that VA will not continue to process a pending request for benefits until a complete claim is received on a prescribed form
  • of the timeframe the claimant has to submit a prescribed form, if an active ITF is pending, and
  • of expedited claims submission options such as
    • filing the claim using eBenefits,
    • faxing the form directly to the CM scanning vendor, or
    • submitting a claim through their Veterans service organization (VSO).

III.ii.2.B.5.c.Determining What Steps to Take to Address the Incorrectly Established Claim

Refer to the table below to determine the steps for addressing an incorrectly established claim.
If the request for benefits was …
Then refer to …
established as a new EP and a decisionhas not been made
established as a new EP and a decision has been made
added to a valid, pending EP and a decision has not been made
added to a valid, pending EP and a decision has been made

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.
Step
Action
1
Review the claimant’s record to determine whether an active ITF (for the same general benefit as the incorrectly established claim) was pending prior to the incorrect establishment of the EP.
If an active ITF …
Then …
was not pending
proceed to Step 2.
was pending
  • ensure that the ITF status is correctly reflected in the claimant corporate record
  • submit requests to correct an ITF status to the Enterprise Service Desk (ESD), and
  • proceed to Step 3.
References:  For more information about
2
Determine how VA received the request for benefits.
If the request for benefits was received through …
Then …
CM
proceed to Step 3.
telephone or in-person contact with a VA representative
  • establish an ITF effective the date of the contact, and
  • proceed to Step 3.
3
Make two attempts in a 24-hour period to contact the claimant and/or authorized representative and provide him/her the information in M21-1, Part III, Subpart ii, 2.B.5.b.  Use the table below as a guide for methods of contact.
If the claimant …
Then …
has an authorized representative
call, e-mail, or, if co-located at the regional office (RO), meet the authorized representative in person.
does not have an authorized representative
call the claimant.
If attempts to contact are
  • successful, wait two business days for receipt of the complete claim on a prescribed form, then proceed to the next step, or
  • unsuccessful, proceed to the next step.
Important:  All successful telephone or in-person contact must be documented on VA Form 27-0820, Report of General Information, and included in the claims folder.  All e-mail correspondence must beincluded in the claims folder.
4
Review the claimant’s record to determine if a complete claim has been received while the invalid EP is pending.
If a complete claim …
Then …
has been received since the establishment of the invalid EP
  • change the invalid EP to EP 400 – Request for Application
  • clear the EP 400
  • establish a new EP (ex. EP 020) with a DOC based on receipt of the complete claim, and
  • finish development of the complete claim under the new EP.
has not been received
  • change the invalid EP to EP 400 – Request for Application
  • utilize the Letter Creatortool to send the Incorrectly Established Claim letter or equivalent letter in Personal Computer Generated Letters (PCGL), and
  • clear the EP 400.
Reference:  For more information on using the Letter Creator tool, see the Letter Creator User Guide.

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.
Step
Action
1
Review the claimant’s record to determine whether an active ITF (for the same general benefit as the incorrectly established claim) was pending prior to the incorrect establishment of the EP.
If an active ITF …
Then …
was not pending
proceed to Step 2.
was pending
  • ensure that the ITF status is correctly reflected in the claimant corporate record
  • submit requests to correct an ITF status to the ESD, and
  • proceed to Step 3.
References:  For more information about
2
Determine how VA received the request for benefits.
If the request for benefits was received through …
Then …
CM
proceed to Step 3.
telephone or in-person contact with a VA representative
  • establish an ITF effective the date of the contact, and
  • proceed to Step 3.
3
Review the claimant’s record and determine if the award was authorized.
If the award …
Then …
has been authorized
proceed to Step 4.
has not been authorized
return the case to the rating activity with instructions to
  • pull the rating back into VBMS-Rating (VBMS-R) for corrections,
  • delete the issues that were invalid to ensure the conditions are removed from the master record
  • return the rating with update
  • follow the instructions in M21-1, Part III, Subpart ii, 4.G.2.d-f to request deletion of the rating decision narrative and codesheet, and
  • route the case to the development activity to complete the actions in M21-1, Part III, Subpart ii, 2.B.5.d beginning with Step 3.
4
Review the claimant’s record to determine if a complete claim has been received and a valid EP is pending.
If a complete claim …
and the invalid EP …
Then …
has been received since the establishment of the invalid EP
is still pending
  • change the invalid EP to EP 930 – Correction of a National Quality Error
  • establish a new EP with a DOC based on receipt of the complete claim, and
  • finish development of the complete claim under the new EP.
has been cleared and the current EP is controlling a valid claim
  • establish an EP 930 – Correction of a National Quality Error, and
  • leave a permanent VBMS note explaining why the EP 930 is being established and associate the note with the EP 930.
has not been received
is still pending
change the invalid EP to EP 930 – Correction of a National Quality Error.
has been cleared
  • establish an EP 930 – Correction of a National Quality Error, and
  • leave a permanent VBMS note explaining why the EP 930 is being established and associate the note with the EP 930.
Note:  For corrections identified at the RO level, use EP 930 – Correction of Local Quality Error.
Reference:  For more information on associating a permanent note to an EP, see M21-1, Part III, Subpart ii, 4.G.2.m.
5
Make two attempts in a 24-hour period to contact the claimant and/or authorized representative and provide him/her the information in M21-1, Part III, Subpart ii, 2.B.5.b.  Use the table below as a guide for methods of contact.
If the claimant …
Then …
has an authorized representative
call, email, or, if co-located at the RO, meet the authorized representative in person.
does not have an authorized representative
call the claimant.
If attempts to contact are
  • successful, wait two business days for receipt of the complete claim on a prescribed form, then proceed to the next step, or
  • unsuccessful, proceed to Step 7.
Important:  All successful telephone or in-person contact must be documented on VA Form 27-0820 and included in the claims folder.  All e-mail correspondence must be included in the claims folder.
6
Review the claimant’s record to determine if a complete claim has been received in response to the actions taken in Step 5.
If a complete claim …
Then …
has been received for the issues or conditions previously submitted on correspondence other than a prescribed form
  • update the EP 930 contention list with the issues/conditions
  • edit the DOCUMENT PROPERTIES and change the SUBJECT of the claim document to response to Incorrect Claim Establishment, and
  • clear the EP 930.  No further action is required for addressing the incorrect claims.
has been received for the issues or conditions previously submitted on correspondence other than a prescribed form and includes
new issues or contentions
  • update the EP 930 contention list with the issues/conditions
  • edit the DOCUMENT PROPERTIES and change the SUBJECT of the claim document to response to Incorrect Claim Establishment with new issues
  • process the new issues or conditions under the appropriate EP, establishing one if necessary, and
  • clear the EP 930.  No further action is required for addressing the incorrect claims.
has not been received
Proceed to Step 7.
7
Identify the prescribed form(s) required to validate the request for benefits and print.
On the printed form(s)
  • fill out the Veteran’s (and claimant, if different) identifying information
  • fill out the issues or conditions that were not considered valid claims, and
  • write in the top left corner of each page, “RO Request – Signature Needed.”
8
Utilize the Letter Creator tool or equivalent letter in PCGL to create theIncorrectly Adjudicated Claim letter, and
  • attach the form(s) prepared in Step 7
  • send the letter to the claimant, and
  • clear the EP 930.
Reference:  For more information on using the Letter Creator tool, see the Letter Creator User Guide.

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.
Step
Action
1
Review the claimant’s record to determine whether an active ITF (for the same general benefit as the incorrectly established claim) was pending prior to the incorrect establishment of the EP.
If an active ITF …
Then …
was not pending
proceed to Step 2.
was pending
  • ensure that the ITF status is correctly reflected in the claimant corporate record,
  • submit requests to correct an ITF status to the ESD, and
  • proceed to Step 3.
References:  For more information about
2
Determine how VA received the request for benefits.
If the request for benefits was received through …
Then …
CM
proceed to Step 3.
telephone or in-person contact with a VA representative
  • establish an ITF effective the date of the contact, and
  • proceed to Step 3.
3
Remove the issues or conditions from the pending EP and establishEP 400 – Request for Application to track the actions taken in Steps 4 and 5.
4
Make two attempts in a 24-hour period to contact the claimant and/or authorized representative and provide him/her the information in M21-1, Part III, Subpart ii, 2.B.5.b.  Use the table below as a guide for methods of contact.
If the claimant …
Then …
has an authorized representative
call, email, or if co-located at the RO, meet the authorized representative in person.
does not have an authorized representative
call the claimant.
If attempts to contact are
  • successful, wait two business days for receipt of the complete claim, then proceed to the next step, or
  • unsuccessful, proceed to the next step.
Important:  All successful telephone or in-person contact must be documented on VA Form 27-0820 and included in the claims folder.  All e-mail correspondence must be included in the claims folder.
5
Review the claimant’s record to determine if the complete claim for the previously identified issues or conditions has been received.
If a complete claim …
Then …
has been received
  • add the issues or conditions to the pending rating EP, and
  • continue processing the claim.
has not been received
  • utilize the Letter Creatortool or equivalent letter in PCGL to send theIncorrectly Established Claim letter, and
  • clear the EP 400.
Reference:  For more information on using the Letter Creator tool, see the Letter Creator User Guide.

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.
Step
Action
1
Review the claimant’s record to determine whether an active ITF (for the same general benefit as the incorrectly established claim) was pending prior to the incorrect establishment of the EP.
If an active ITF …
Then …
was not pending
proceed to Step 2.
was pending
  • ensure that the ITF status is correctly reflected in the claimant corporate record
  • submit requests to correct an ITF status to the ESD, and
  • proceed to Step 3.
References:  For more information about
2
Determine how VA received the request for benefits.
If the request for benefits was received through …
Then …
CM
proceed to Step 3.
telephone or in-person contact with a VA representative
  • establish an ITF effective the date of the contact, and
  • proceed to Step 3.
3
Review the claimant’s record and determine if the award was authorized.
If the award …
Then …
has been authorized
proceed to Step 4.
has not been authorized
return the case to the rating activity with instructions to
  • pull the rating back into VBMS-R for corrections
  • delete the issues that were invalid to ensure the conditions are removed from the master record
  • return the rating with update
  • follow the instructions in M21-1, Part III, Subpart ii, 4.G.2.d-f to request deletion of the rating decision narrative and codesheet, and
  • route the case to the development activity to complete the actions in M21-1, Part III, Subpart ii, 2.B.5.dbeginning with Step 3.
4
Make two attempts in a 24-hour period to contact the claimant and/or authorized representative and provide him/her the information in M21-1, Part III, Subpart ii, 2.B.5.b.  Use the table below as a guide for methods of contact.
If the claimant …
Then …
has an authorized representative
call, email, or if co-located at the RO, meet the authorized representative in person.
does not have an authorized representative
call the claimant.
If attempts to contact are
  • successful, wait two business days for receipt of the complete claim on a prescribed form, then proceed to the next step, or
  • unsuccessful, proceed to Step 7.
Important:  All successful telephone or in-person contact must be documented on VA Form 27-0820 and included in the claims folder.  All e-mail correspondence must be included in the claims folder.
5
Review the claimant’s record to determine if a complete claim on a prescribed form has been received and the valid EP the issues or conditions were erroneously adjudicated under is still pending.
If a complete claim …
and the valid EP …
Then …
has been received
is still pending
  • add the issues or conditions back onto the EP,
  • finish development of the complete claim as needed, and
  • proceed to Step 6.
has been cleared and the current EP has been established to control the receipt of the complete claim resulting from the actions in Step 4
  • change the EP to EP 930 – Correction of a National Quality Error, and
  • leave a permanent VBMS note explaining why the EP is being changed to EP 930 and associate the note with the EP 930.
has not been received
is still pending
proceed to Step 6.
has been cleared
  • establish an EP 930 – Correction of a National Quality Error, and
  • leave a permanent VBMS note explaining why the EP 930 is being established and associate the note with the EP 930.
Note:  For corrections identified at the RO level, use EP 930 – Correction of Local Quality Error.
Reference:  For more information on associating a permanent note to an EP, see M21-1, Part III, Subpart ii, 4.G.2.m.
6
Review the claimant’s record to determine if a complete claim has been received in response to the actions taken in Step 4.
If a complete claim …
Then …
has been received for the issues or conditions previously submitted on correspondence other than a prescribed form
  • update the EP 930 contention list with the issues/conditions,
  • edit the DOCUMENT PROPERTIES and change the SUBJECT of the claim document to response to Incorrect Claim Establishment, and
  • clear the EP 930.  No further action is required for addressing the incorrect claims.
has been received for the issues or conditions previously submitted on correspondence other than a prescribed form and includes
new issues or contentions
  • update the EP 930 contention list with the issues/conditions,
  • edit the DOCUMENT PROPERTIES and change the SUBJECT of the claim document to response to Incorrect Claim Establishment with new issues
  • process the new issues or conditions under the appropriate EP, establishing one if necessary, and
  • clear the EP 930.  No further action is required for addressing the incorrect claims.
has not been received
proceed to Step 7.
7
Identify the prescribed form(s) required to validate the request for benefits and print.
On the printed form(s)
  • fill out the Veteran’s (and claimant, if different) identifying information
  • fill out the issues or conditions that were not considered valid claims, and
  • write in the top left corner of each page, RO Request – Signature Needed.
8
Utilize the Letter Creator tool or equivalent letter in PCGL to create the Incorrectly Adjudicated Claim letter, and
  • attach the form(s) prepared in Step 7
  • send the letter to the claimant, and
  • clear the EP 930.
Reference:  For more information on using the Letter Creator tool, see the Letter Creator User Guide.
9
If a claim is
Note:  When a claimant fails to submit the prescribed form solicited in Step 8, do not take further action to revise any claim or issue that was decided without the proper submission of a prescribed claim form.  Specifically, no further action is necessary to sever SC or otherwise revise the prior decision unless the decision was otherwise erroneous.

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.
If the prescribed form lists …
Then …
only the issues or conditions previously submitted on correspondence other than a prescribed form
  • edit the DOCUMENT PROPERTIES and change the SUBJECT of the claim document to response to Incorrect Claim Establishment
  • leave a permanent note in VBMS indicating that the form was received in response to incorrect claim establishment guidance and no adjudication action is required, and
  • cancel the tracking EP.
new issues or contentions
  • edit the DOCUMENT PROPERTIES and change the SUBJECT of the claim document to response to Incorrect Claim Establishment with new issues
  • leave a permanent note in VBMS indicating that the form was received in response to incorrect claim establishment guidance but contains new issues or conditions for adjudication, and
  • process the new issues or conditions under the appropriate EP.
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.

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
Historical_M21-1III_ii_2_SecB_3-29-17.doc May 10, 2019 525 KB
Historical_M21-1III_ii_2_SecB_8-12-16.doc May 10, 2019 248 KB
Historical_M21-1III_ii_2_SecB_3-23-16.doc May 10, 2019 209 KB
Historical_M21-1III_ii_2_SecB_5-5-16.doc May 10, 2019 222 KB
Historical_M21-1III_ii_2_SecB_02-08-16.doc May 10, 2019 200 KB
Historical_M21-1III_ii_2_SecB_9-24-15.doc May 10, 2019 143 KB
Historical_M21-1III_ii_2_SecB_10-29-15.doc May 10, 2019 145 KB
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