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M21-1, Part III, Subpart ii, Chapter 2, Section E – Claims for Increase

Overview


In This Section

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

1.  Identification of Claims for Increase


Introduction

This topic contains information about claims for increase, including

Change Date

February 19, 2019

III.ii.2.E.1.a.  Definition: Claim for Increase

Per 38 CFR 3.1(p)(1), a claim for increase is a type of initial claim that requests an increase in a disability evaluation or rate of a benefit being paid based on a change or worsening in condition or circumstance since the last decision issued by the Department of Veterans Affairs (VA) for the benefit.
Important:  Under 38 CFR 3.2500, a claimant may also submit a request for review of a prior evaluation or rate being paid within one year of the prior decision.  Any request filed on the appropriate form under these review options should be handled under the specific lane of review selected by the claimant, and not under the claim for increase provisions.
Reference:  For more information on handling submissions for increased compensation during the one-year decision review period, see M21-1, Part III, Subpart ii, 1.E.3.

III.ii.2.E.1.b.  Types of Claims for Increase

Claims for increase may include, but are not limited to, claims for
  • increased service-connected (SC) compensation including
    • increased disability evaluation, and/or
    • entitlement to special monthly compensation (SMC)
  • an increased rate of benefits due to the addition of a dependent, or
  • increased non-service-connected (NSC) pension including a claim
    • showing either a reduction of, or a deduction from, income, or
    • for entitlement to special monthly pension (SMP).

III.ii.2.E.1.c.  Prescribed Form for a Claim for Increased Compensation

A claim for an increased evaluation in an SC disability must be filed on VA Form 21-526EZApplication for Disability Compensation and Related Compensation Benefits, or other prescribed form appropriate to the specific type of increased compensation sought.
Reference:  For more information on prescribed forms, see M21-1, Part III, Subpart ii, 2.B.1.b.

2.  Policies for Claims for Increase


Introduction

This topic contains policies for claims for increase, including

Change Date

January 28, 2016

III.ii.2.E.2.a.  Responsibilities of the Rating Activity

The rating activity is responsible for evaluating disabilities under the applicable laws and rating schedule, including statutory benefits such as
  • loss or loss of use of various body organs or parts
  • SMP, other than aid and attendance (A&A) awarded to patients in nursing homes, and
  • SMC.

III.ii.2.E.2.b.  Claims for Increase in the Level of Disability

Refer any claim for increase in the level of disability to the rating activity for action after completing any necessary development actions.
Reference:  For information on requesting records and when to order an examination, see M21-1, Part I, 1.C.

III.ii.2.E.2.c.  Claims for SMP, Including A&A and Housebound Benefits

Prior to March 24, 2015, consider any communication from a claimant or his/her representative a “claim for SMP” (A&A or the housebound benefit) if it indicates a desire for increased benefits because of
  • an NSC disability, or
  • nursing home patient status.
Effective March 24, 2015, all claims must be received on the prescribed form.
Refer the claim to the rating activity unless the evidence establishes that the claimant is a patient in a nursing home.
Note:  If the evidence establishes that the claimant is a patient in a nursing home, refer the claim for development, if development is necessary.  Otherwise, refer the claim to the post-determination team to grant A&A without a rating.
Reference:  For information regarding prescribed forms for SMC and SMP claims, see M21-1, Part III, Subpart ii, 2.B.1.b.

3.  Submissions for Increased Compensation Received During the Decision Review Period


Introduction

This topic contains procedures for handling submissions for increased compensation received during the decision review period, including


Change Date

February 19, 2019

III.ii.2.E.3.a. Submissions During the Decision Review Period

Under 38 CFR 3.2500, claimants can request a review of a decision issued on a claim for increased compensation during the one-year period following a decision.
Any submissions during this decision review period must be screened to determine the intent of the claimant.  The form used by the claimant will determine whether the submission should be handled as a
  • claim for increase, or
  • continuously pursued issue under 38 CFR 3.2500.

III.ii.2.E.3.b. Screening Submissions During the Decision Review Period

Use the table below to determine how to handle a submission involving an increase in compensation benefits that is filed within one year of the prior decision addressing the evaluation of the same condition.
If the claimant submits …
Then handle the submission as a …
claim for increase.
continuously pursued claim under 38 CFR 3.2500(c).
evidence without a claim form
request for application per M21-1, Part III, Subpart ii, 2.C.6.
Reference:  For more information on prescribed forms, see M21-1, Part III, Subpart ii, 2.B.1.b.
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9-26-16_Key-Changes_M21-1III_ii_2_SecE.docx May 10, 2019 55 KB
Change-July-15-2015-Transmittal-Sheet-M21-1III_ii_2_SecEoldF_TS.docx May 10, 2019 40 KB
9-22-17_Key-Changes_M21-1III_ii_2_SecE.docx May 10, 2019 57 KB
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Historical_M21-1III_ii_2_SecE_03-24-2015.docx May 10, 2019 58 KB
Change-July-15-2015-Transmittal-Sheet-M21-1III_ii_2_SecE_TS.docx May 10, 2019 41 KB
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