Overview
In This Section |
This section contains the following topics:
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1. General Claim Considerations
Introduction |
This topic contains general information about awards and denials of claims, including
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Change Date |
February 19, 2019 |
III.v.2.A.1.a. Final Stage in Adjudicating a Claim |
The final stage in adjudicating a claim, after all relevant evidence (to include Federal tax information (FTI)) has been collected and reviewed, and a rating decision prepared (if necessary), is to
Reference: For more information about FTI, see M21-1, Part X, 9. |
III.v.2.A.1.c. Requirement to Reduce or Withhold Payments |
Even if VA determines a claimant is eligible for monetary benefits, to include disability compensation for one or more service-connected (SC) disability(ies), VA may have to reduce or withhold payments if
References: For more information about reducing or withholding payments based on
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III.v.2.A.1.d. Reviewing a Supplemental Claim |
For a supplemental claim, the process for requesting information from a claimant and other sources is the same as it is for an initial claim.
If basic eligibility criteria (such as Veteran status, or wartime and minimum active duty service requirements for pension claims) are met, the rating activity must review the following types of supplemental claims:
Important: The rating activity does not need to review pension claims to make a disability determination when income or net worth bar pension entitlement.
Reference: For more information about supplemental claims, see M21-1, Part III, Subpart ii, 2.D.
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2. General Information on Processing Decisions
Introduction |
This topic contains general information on processing decisions, including
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Change Date |
July 13, 2018
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III.v.2.A.2.a. Responsibility for Processing Rating Decisions |
Once Veterans service organizations (VSOs) have been given an opportunity to review completed rating decisions for which they hold valid power of attorney, the rating activity must route the rating decisions directly to the authorization activity.
The authorization activity is responsible for processing rating decisions.
Reference: For more information about VSO review of completed rating decisions, see M21-1, Part I, 3.B.3.
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III.v.2.A.2.b. Effective Date of Payment Under 38 CFR 3.31 |
It is important to understand the difference between the effective date of paymentand the effective date of entitlement.
Under 38 CFR 3.31, VA may not pay monetary benefits based on an original, supplemental, or increased award of compensation, pension, or Dependency and Indemnity Compensation (DIC) for any period prior to the first day of the calendar month following the month in which the beneficiary became entitled to the benefit.
Example:
Scenario: The rating activity assigns an increased disability rating to a Veteran’s SC back disorder effective April 21, 2012. (This represents the effective date of entitlement.)
Result: The effective date of the corresponding increase in the Veteran’s compensation is May 1, 2012. (This represents the effective date of payment.)
Exception: Effective October 1, 2011, Section 605 of Public Law 111-275amended 38 U.S.C. 5111 to allow VA to pay disability compensation from the date of entitlement to said benefit to any Veteran who retires or separates from active duty due to a catastrophic disability. For VA purposes, “catastrophic disability” means a permanent, severely disabling injury, disorder, or disease that compromises the ability of the Veteran to carry out the activities of daily living to such a degree that he/she requires
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III.v.2.A.2.c. Award Processing Responsibilities |
The table below describes who is responsible for specific actions during the award process.
Important:
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III.v.2.A.2.d. Awards That Require VSCM or PMCM Concurrence |
Some awards require concurrence by a Veterans Service Center Manager (VSCM) or Pension Management Center Manager (PMCM) (or a designee of one of these managers) in addition to authorization by an SVSR. They include
The table below describes the process for obtaining concurrence from a VSCM or PMCM.
Reference: For more information about the process described in the above table, see the NWQ Playbook.
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3. General Information on Denials
Change Date |
February 19, 2019
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III.v.2.A.3.a. Definition: Denial |
A decision is considered a denial if, after review of a claim or issue and all evidence associated with it, VA makes a formal decision to
Note: The initial establishment of a noncompensable disability rating for a SC disability is not considered a denial. Although compensation is not payable for the disability (except, potentially, under 38 CFR 3.324), the noncompensable rating may entitle the Veteran to other VA benefits, such as medical care under 38 CFR 17.37(b) and 17.38. |
III.v.2.A.3.b. Authority of the Authorization Activity to Make Decisions That Affect an Individual’s Entitlement to VA Benefits |
The authorization activity has the authority to make basic eligibility determinations. It also has the authority to decide
Restrictions: The authorization activity does not have the authority to
Note: If basic eligibility is established and the claim requires consideration of medical evidence of record, refer it to the rating activity for review. Claims of this nature require a formal, coded rating decision.
Exception: M21-1, Part III, Subpart v, 2.A.3.c describes conditions under whichthe authorization activity may deny a claim without a rating decision.
References: For more information on
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III.v.2.A.3.c. Conditions Under Which the Authorization Activity May Deny a Claim |
The authorization activity may deny a claim for disability compensation or survivors benefits without a rating decision under any of the following conditions:
Notes:
References: For more information on
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III.v.2.A.3.d. Requirement to Receive and Review All Required Evidence Before Denying a Claim |
Unless there is a statutory bar to entitlement to benefits, the authorization activity must not deny any claim until VA has
Note:
References: For more information on
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III.v.2.A.3.e. Incomplete Applications and Benefit Requests That Are Not Filed on a Prescribed Form |
Do not process a denial if a claimant has failed to submit a
References: For more information on handling
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4. Denials Based on a Claimant’s Failure to Furnish Requested Evidence
Introduction |
This topic contains information on denials that are based on a claimant’s failure to furnish requested evidence, including
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Change Date |
March 21, 2018
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III.v.2.A.4.a. Handling a Claimant’s Failure to Submit Evidence VA Requested |
If a claimant fails to submit evidence within a time period VA specified,
Important:
References: For more information on
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III.v.2.A.4.b. Handling a Claimant’s Failure to Report for a VA Examination |
The table below describes the process for handling cases in which a claimant fails to report for a VA examination without good cause.
References: For more information about
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5. Special Denial Procedures
Introduction |
This topic contains information on special denial procedures, including |
Change Date |
February 19, 2019 |
III.v.2.A.5.a. Changing the Basis of a Previous Denial |
If VA reviews or reconsiders a claim it previously denied and decides to change the basis of the denial, it must
References: For more information on
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Historical_M21-1III_v_2_SecA_5-31-17.docx | May 16, 2019 | 75 KB |
Historical_M21-1III_v_2_SecA_4-29-16.docx | May 16, 2019 | 68 KB |
1-11-18_Key-Changes_M21-1III_v_2_SecA.docx | May 16, 2019 | 69 KB |
2-19-19_Key-Changes_M21-1III_v_2_SecA.docx | May 16, 2019 | 59 KB |
Historical_M21-1III_v_2_SecA_4-6-15.docx | May 16, 2019 | 74 KB |
5-31-17_Key-Changes_M21-1III_v_2_SecA.docx | May 16, 2019 | 65 KB |
3-21-18_Key-Changes_M21-1III_v_2_SecA.docx | May 16, 2019 | 68 KB |
3-24-17_Key-Changes_M21-1III_v_2_SecA.docx | May 16, 2019 | 66 KB |
7-13-18_Key-Changes_M21-1III_v_2_SecA.docx | May 16, 2019 | 53 KB |
4-29-16_Key-Changes_M21-1III_v_2_SecA.docx | May 16, 2019 | 63 KB |
Change-April-6-2015-Transmittal-Sheet-M21-1MRIII_v_2_SecA_TS.docx | May 16, 2019 | 40 KB |
in Chapter 2 Decision Authorization and Notification, Part III General Claims Process, Subpart v General Authorization Issues and Claimant Notification
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