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M21-1, Part III, Subpart ii, Chapter 7 – Referrals to the Rating Activity

Overview


In This Section

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

1.  Referring Claims to the Rating Activity After Development Is Complete


Change Date

April 24, 2015

III.ii.7.1.a.  Referring Claims to the Rating Activity After Development Is Complete

If the issue requires a rating decision and a claimant is
  • otherwise eligible for benefits from the Department of Veterans Affairs (VA), and
  • VA has received new, competent medical or lay evidence in support of the claim,
refer the claim to the rating activity after all development actions, to include VA examinations as necessary, are complete.
Note:  Although evidence to decide all contentions associated with the Veteran’s claim may not be of record, the rating activity should decide any contention for which sufficient evidence exists to award the benefit sought.
Exception:  If a claimant is seeking service connection (SC) for the cause of death or for a disability, VA may not deny a claim until it has obtained the Veteran’s service treatment records (STRs) or formally determined the STRs are unavailable.  If VA formally determines the STRs are unavailable, refer the claim to the rating activity after all other development actions are complete, even if VA received no medical or lay evidence in support of the claim.
References:  For more information on

2.  Referring Claims Involving Death After Service


Introduction

This topic contains information on referring claims to the rating activity that involve death after service, including

Change Date

December 20, 2018

III.ii.7.2.a.  General Responsibilities of a Claims Processor

A claims processor must review the evidence of record to determine if a claim for survivors benefits
  • should be submitted to the rating activity, or
  • can be decided without a rating decision.

III.ii.7.2.b.  General Policy Regarding the Referral of Survivors Benefits Claims to the Rating Activity

Refer each claim for survivors benefits to the rating activity if death occurred within five years of separation from military service.
Exception:  A claims processor may deny a claim for survivors benefits without referral to the rating activity if the death was due to
  • homicide
  • execution for a crime, or
  • accident or disaster.

III.ii.7.2.c.  Specific Situations in Which Survivors Benefits Claims Should Be Referred to the Rating Activity

If one or more of the following situations arise, forward the claim for survivors benefits to the rating activity for consideration of SC for the cause of death:
  • the claimant has specifically raised the issue of SC for the cause of death on the application or otherwise, including Dependency and Indemnity Compensation (DIC) under 38 U.S.C. 1151
  • a rating decision was made during the Veteran’s lifetime, awarding SC for one or more of the following:
    • cardiovascular condition
    • genitourinary condition
    • any chronic disease listed under 38 CFR 3.309, or
    • condition affecting any vital organ
  • the Veteran had at least one service-connected (SC) disability independently evaluated at 50 percent or more disabling
  • the Veteran had one or more SC conditions with a combined 100-percent evaluation
  • the Veteran was in receipt of individual unemployability benefits
  • a claims processor that is not a member of the rating activity determines there is reasonable probability that the death may be related to service, whether from
    • disease
    • injury, or
    • self-infliction
  • the claimant has filed for Survivors Pension, and the Veteran met the wartime service requirement but did not meet the 90-day length of service requirement, unless one of the following situations exists:
    • there is no indication or claim that the discharge from service was for an SC disability
    • discharge was for reasons other than a disability
    • service records show no disability, or
    • the Veteran, at the time of death, was receiving or entitled to receive compensation for an SC disability based on service during a period of war
  • a claim for accrued benefits is received, or
  • a claim for SC burial benefits is received.
Exception:  If a claim for SC for cause of death is filed by a parent or parents, and the income is excessive for the receipt of DIC,
  • deny the claim because of excessive income, and
  • notify the claimant that no other aspect of the claim has been considered.
Notes:
  • If the rating activity determines the facts do not warrant a formal determination of SC, the claim may be
    • annotated that there is no evidence of SC death, and
    • returned to the authorization activity for resolution of the formally claimed issues.
  • If a claim for survivors benefits cannot be referred to the rating activity for a formal determination of SC, the authorization activity must deny the issue administratively.
References:  For more information on

III.ii.7.2.d.  Award of Survivors Pension Prior to Rating Decision Regarding SC Death

To avoid any delays due to necessary development, award Survivors Pension benefits prior to referring the claim to the rating activity for a decision on SC for cause of death.
Annotate the award with “Decision on SC deferred.”  Continue end product control.
If, after evidence is received, the claim is denied, the authorization activity must enter the notation, “Cause of death not due to service, M21-1, Part III, Subpart ii, 7.3,” on the last award, followed by the
  • authorizer’s initials, and
  • date when the decision notice was released to the claimant.

3.  Special Purpose Rating Determinations in Survivors Benefits Claims


Introduction

This topic contains information on the various special purpose rating determinations in survivors benefits claims, including special purpose determinations that

Change Date

April 24, 2015

III.ii.7.3.a.  Special Purpose Determinations That Do Not Require a Claim for Survivors Benefits

The table below describes special purpose determinations which may be made whether or not a claim for survivors benefits has been received.
Special Purpose Determination
Reference
Burial Allowance
Accrued Benefits
Death Gratuity
Dependents’ Educational Assistance
Loan Guaranty
Service Academy Appointments
Special Allowance Under 38 U.S.C. 1312(a)
Testamentary Capacity for Insurance Purposes
Special Allowance–Public Law 97-377, Section 156, Restored Entitlement Program For Survivors (REPS)

III.ii.7.3.b.  Special Purpose Determinations That Require a Claim for DIC

The table below describes special purpose determinations in which a claim for DIC is required before the special purpose determination may be made.
Note:  If a claim for DIC has not been filed
Special Purpose Determination
Reference
Public Housing Preference
State Bonus and Tax Exemption
Retired Serviceman’s Family Protection Plan
Survivor Benefit Plan
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