M21-1, Part III, Subpart iv, Chapter 7, Section B – Reviewing the Rating Decision

In This Section

Change Date

III.iv.7.B.1.a.  Review of Rating Decisions

• a second signer including the Veterans Service Center Manager (VSCM) or Pension Management Center Manager (PMCM)
• a supervisor
• local quality review team members
• Veteran service organization (VSO) representatives, and/or
• the authorization activity.

• the Compensation Service staff, to include Quality Assurance
• a decision maker in connection with a legacy appeal or request for decision review under 38 CFR 3.2500, and/or
• Veterans Service Center (VSC) and Pension Management Center (PMC) management and/or quality review personnel.

References:  For more information on

• correction of errors found in rating decisions, see M21-1, Part III, Subpart iv, 7.B.3
• VSO review of rating decisions, see M21-1, Part I, 3.B.3
• processing rating decisions, see M21-1, Part III, Subpart v, 2.A.2
• quality reviews, see M21-4, Chapter 3, and
• the legacy appellate process, see M21-1, Part I, 5.

Introduction

• dissenting opinion versus difference of opinion
• who is responsible for resolving dissenting opinions, and
• handling dissenting opinions.

Change Date

III.iv.7.B.2.a.  Dissenting Opinion vs. Difference of Opinion

• a dissenting opinion scenario occurs when multiple decision makers whose signatures are required on a rating decision do not concur on some aspect of an unpromulgated decision, and
• a difference of opinion scenario occurs when a decision maker is of the opinion that revision or amendment is needed (for reasons that do not qualify as clear and unmistakable error (CUE)) of a promulgated rating decision completed by another decision maker.

• handling differences of opinion under 38 CFR 3.105(b), see M21-1, Part III, Subpart vi, 1.A.1 and 4
• handling differences of opinion on supervisory review, see M21-1, Part III, Subpart vi, 1.A.1 and 4, and
• revision of decisions, see M21-1, Part III, Subpart iv, 2.B.

III.iv.7.B.2.b.  Who Is Responsible for Resolving Dissenting Opinions

III.iv.7.B.2.c.  Handling Dissenting Opinions

Introduction

• correcting narrative deficiencies before or after authorization
• correcting the codesheet before or after authorization
• procedure for correction of rating decisions, and
• revising erroneous anatomical qualifiers.

Change Date

III.iv.7.B.3.a.  Correcting Narrative Deficiencies Before or After Authorization

III.iv.7.B.3.b.  Correcting the Codesheet Before or After Authorization

• affect payment or eligibility to a benefit, or
• could affect payment in the future.

Such errors include, but are not limited to

• determinations on entitlement (service connection (SC), special monthly compensation (SMC), etc.)
• disability evaluations
• effective dates
• combined evaluations
• diagnostic codes (DCs)
• SMC codes, and
• bilateral factors.

Important:  In addition to the above, as provided in M21-1, Part III, Subpart ii, 3.C.7.a, periods of active military service must be updated and verified in the system prior to rating.  Such errors may not affect payment but if the Codesheetdoes not reflect the correct service dates, return the rating decision for correction.

III.iv.7.B.3.c.  Procedure for Correction of Rating Decisions

• When a correction of an entitlement outcome is required for an issued decision that is binding, there must be
  • CUE under the provisions of 38 CFR 3.105(a) and M21-1, Part III, Subpart iv, 2.B.4, or
  • approval of difference of opinion under 38 CFR 3.105(b) andM21-1, Part III, Subpart vi, 1.A.1 and 4.
• Due process procedures under 38 CFR 3.103 may apply where correction of an error in a rating decision would constitute an adverse action.

III.iv.7.B.3.d.Revising Erroneous Anatomical Qualifiers

• A notice of proposed adverse action is not required simply due to a change in anatomical site, unless it results in a reduction in compensation.
• This change will not violate the protection of SC under 38 CFR 3.957, or protection of a service-connected evaluation under 38 CFR 3.951.
• A CUE decision, under 38 CFR 3.105(a), is for application when previous determinations are binding.

• Read v. Shinseki, 651 F. 3d 1296 (2011), and
• Gifford v. Brown, 6 Vet. App. 269 (1994).