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M21-1, Part III, Subpart ii, Chapter 2, Section D – Supplemental Claims

Overview


In This Section

This section contains the topic “Supplemental Claims.”

1.  Supplemental Claims


Introduction

This topic includes information on supplemental claims, including

Change Date

February 19, 2019

III.ii.2.D.1.a.  Definition:  Supplemental Claim

supplemental claim is any complete claim for a Department of Veterans Affairs (VA) benefit on a prescribed application form where the claimant or his/her authorized representative disagrees with the decision VA made on an initial or supplemental claim for the same or similar benefit on the same or similar basis.
The request for review can be submitted within one year of the prior decision or outside the year.
Reference:  For more information on effective dates when a supplemental claim is granted, see

III.ii.2.D.1.b.  Definition:  Same or Similar Benefit on Same or Similar Basis

Generally, the same or similar benefit on the same or similar basis means VA has previously decided a claim for the same benefit type.
Examples of types of benefits:
  • service connection (SC) for right knee arthritis
  • entitlement to individual unemployability
  • SC for cause of death, and
  • entitlement to non-service-connected pension
Important:  In claims for compensation, a claim based on a new theory of SC is a supplemental claim.  A new theory of SC (for example, when direct SC was previously denied, and secondary SC is now claimed) is sufficient new and relevant evidence to satisfy the evidentiary threshold discussed in M21-1, Part III, Subpart ii, 2.D.1.e.
References:  For more information on

III.ii.2.D.1.c.  Prescribed Supplemental Claim Form

Supplemental claims must be submitted on the prescribed supplemental claim form, VA Form 20-0995, Decision Review Request: Supplemental Claim.
Reference:  For more information on the definition of a complete supplemental claim, see 38 CFR 3.160(a).

III.ii.2.D.1.d.  Supplemental Claims Establishment

All supplemental claims must be established in Caseflow using the appropriate end product (EP), claim label, and any applicable special issues.
References:  For more information on

III.ii.2.D.1.e.  Requirement for New Evidence

To be considered a complete claim, a supplemental claim must identify or include potentially new evidence.
Carefully screen all newly received evidence per the steps in the table below to determine the appropriate action.
Step
Action
1
Does the claim include or identify potentially new evidence?
  • If yes, proceed to the next step.
  • If no, follow the incomplete claim procedures detailed in M21-1, Part I, 1.B.1.g.
2
Does the new evidence warrant additional development action(s)?
  • If yes,
    • complete required development actions, and, when complete,
    • refer the claim to the rating activity for a decision.
  • If no, refer the claim to the rating activity for a decision once any applicable 30-day response period required underSection 5103 has expired.
References:  For more information on

III.ii.2.D.1.f.  Duty to Provide Section 5103 Notice

Do not provide Section 5103 notice for a supplemental claim that is filed within a year of the date VA issues notice of a prior decision on the same issue.
For supplemental claims filed more than a year after the prior decision on the same issue, review the claimant’s selection for the 5103 Notice Acknowledgement, Item 16 on VA Form 20-0995, to determine if the claimant received electronic Section 5103 notice.  If the claimant checked the box in Item 16, there is no need to provide a Section 5103 notice.
References:  For more information on

III.ii.2.D.1.g.  ITF and Supplemental Claims

Do not associate an intent to file (ITF) with a supplemental claim.
Reference:  For more information on date of filing for supplemental claims, see 38 CFR 3.2501(d).

III.ii.2.D.1.h.  Handling Incomplete Supplemental Claims

If the claimant submits a supplemental claim that is not substantially complete, follow the procedures in M21-1, Part I, 1.B.1.g to notify the claimant.
References:  For more information on
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Change-July-15-2015-Transmittal-Sheet-M21-1III_ii_2_SecE_TS.docx May 10, 2019 41 KB
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