M21-1, Part III, Subpart v, Chapter 1, Section E - Determinations of Insanity

Overview

In This Section

This section contains the topic, “Effect of Insanity on Administrative Decisions.”

1. Effect of Insanity on Administrative Decisions

Introduction

This topic contains information on the effect of insanity on administrative decisions, including

Change Date

August 18, 2017

III.v.1.E.1.a. Effect of Insanity on VA Benefits

If a Veteran was determined to be insane at the time of the commission of the act or acts that would otherwise result in an adverse character of discharge (COD), line-of-duty (LOD), or willful misconduct determination, hold that he/she

was without fault, and
is not precluded from any Department of Veterans Affairs (VA) benefits.

Reference: For more information involving insanity and homicide in death claims, see M21-1, Part III, Subpart v, 1.F.3.e.

III.v.1.E.1.b. Placing Insanity at Issue

Insanity is placed at issue in the following ways:

by specific allegation by the Veteran or an authorized representative
by the VA employee if the evidence indicates the possibility of insanity, or
if suicidal death occurs in service.

Reference: For more information on the regulation regarding

insanity see 38 CFR 3.354, and
suicide see 38 CFR 3.302.

III.v.1.E.1.c. Developing Cases in Which Insanity Is an Issue

If insanity is at issue, develop the case completely before making a determination.

Obtain the following information when developing:

all service and post-service treatment records that are in any way relevant, and
complete transcripts of any court martial or board proceedings that may be relevant.

Note: State specifically in a PIES request that the reason for the request is that “insanity is at issue.”

References: For more information on obtaining

service records, see M21-1, Part III, Subpart iii, 2.B, and
post-service treatment records, see M21-1, Part III, Subpart iii, 1.C.

III.v.1.E.1.d. Referring a Case for Rating Action

After completing development, refer the case to the rating activity to resolve the issue of insanity, and use the table below to determine how to process the resulting decision.

If the insanity determination is relevant to the issue of …	Then the rating activity …
COD LOD, or willful misconduct	prepares a rating decision in which the issue of insanity is the sole issue, and routes its rating decision to the development activity to support preparation of an administrative decision.
in-service suicide	prepares a formal rating decision granting or denying service-connected death, and routes its rating decision to the authorization activity for final award or denial action.

Reference: For more information on rating the question of insanity, see M21-1, Part IX, Subpart ii, 2.6.

III.v.1.E.1.e. Forgoing a Separate Notice of a Rating Decision Addressing Insanity Only

Rating determinations regarding insanity are rendered solely to influence and inform the preparation of subsequent administrative decisions. As such, do notprepare or release a decision notice to communicate the outcome of a rating decision that addresses, as a solitary issue, the question of a Veteran’s (or former service member’s) insanity.

If the rating activity resolves the question of insanity unfavorably (i.e. deeming the Veteran or former service member sane at the time of commission), briefly discuss this factor in preparing the administrative decision notice required in

III.v.1.E.1.f. Preparing an Administrative Decision

When a rating decision is received, whether or not insanity is established, the development activity must prepare an administrative decision concerning COD, LOD, or willful misconduct for approval, as required.

Important: All subsequent action must be based on this determination or on a formal rating decision that may have been made.

References: For more information on administrative decisions for

COD, see M21-1, Part III, Subpart v,1.B.1
LOD, see M21-1, Part III, Subpart v,1.D.6, and
willful misconduct, see M21-1, Part III, Subpart v, 1.D.1-3.

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Last Updated: 1 year ago in Chapter 1 Administrative Decisions, Part III General Claims Process, Subpart v General Authorization Issues and Claimant Notification

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M21-1, Part III, Subpart v, Chapter 1, Section E – Determinations of Insanity