M21-1, Part III, Subpart v, Chapter 6, Section D – Adjusting Compensation When a Veteran Is Hospitalized in Excess of 21 Days

• If yes,
  • establish a pending EP 320 with the date of claim from the date of hospital admission, and
  • forward to the rating activity for an award ofParagraph 29 benefits.
• If no,
  • establish an EP 320 control as described in M21-1, Part III, Subpart v, 6.D.2.b
  • wait for the hospital summary, then
  • forward the summary to the rating activity.

• starts in one calendar month, and
• continues into the next calendar month

• commence payment of the total rate effective the first day of the month following the date of admission, per 38 CFR 3.31(a) and 38 CFR 3.401(h)(1), and
• reduce the award to the prehospital rate effective the earlier of the first day of the month following the month
  • hospitalization ended, or
  • treatment for the SC condition ended, per 38 CFR 3.501(m).

• is entirely within one calendar month, and
• a convalescent period is not required

• commence payment effective the first day of the month of admission per 38 CFR 3.31(c)(5), and
• reduce the award to the prehospital rate effective the first day of the following month, per 38 CFR 3.501(m).

• continue the 100-percent award pending receipt of the hospital summary
• continue the future EP 320 control for receipt and review of the hospital summary by the rating activity
• allow the award to continue subject to reduction effective the first day of the month following the month in which the period of convalescence ends, per 38 CFR 4.30, and
• if a hospital summary is not received within 30 days from the date of discharge, follow up with the medical facility.

• reduce the award to the prehospital rate effective the first day of the month following the date of discharge without referral to the rating activity
• reinstate the prehospital evaluations
• continue the future EP 320 control for receipt of the hospital summary, and
• upon receipt of the hospital summary, refer the summary to the rating activity for review.

• with a regular discharge
• with an irregular discharge, or
• to outpatient treatment

• reduce the award effective the first day of the month following the month in which the third 14-day period begins, per 38 CFR 4.29(a)(2)
• request a hospital special report covering treatment for the SC disability that was the basis for the Paragraph 29rating, and
• upon receipt of the report, refer the report to the rating activity.

• If the Veteran is competent or has a fiduciary,
  • reduce the award to the prehospital rate effective the first day of the month following the month in which hospitalization or treatment for the SC condition terminated, and
  • process as outlined in M21-1, Part III, Subpart v, 6.D.3.a.
• If the Veteran is not competent and does not have a fiduciary,
  • suspend the institutional award, and
  • inform the fiduciary activity of all of the facts.

• the prehospital evaluation should be increased, reduced, or restored, and
• the competency status should be changed.

• A Veteran was hospitalized on March 3 for an SC disability previously evaluated at 30 percent. The period of hospitalization continued until discharge on April 14. A claim for increase was received following discharge. The rating activity reviewed the hospital summary and reevaluated the disability at 50 percent effective May 1.

Result:

• Compensation for a temporary 100-percent evaluation was assigned from March 3, with an effective pay date of April 1, under38 CFR 3.31(a).
• Compensation for a new evaluation of 50 percent was paid effective May 1, following reduction of the temporary 100-percent evaluation.

• restored
• a convalescent rating is notassigned, and
• the award was previously reduced to the prehospital evaluation

• restored
• a convalescent rating is notassigned, and
• the 100-percent evaluation was allowed to continue

• restored, and
• a convalescent rating isassigned after the temporary 100-percent evaluation was discontinued and the pre-hospitalization rate was resumed, as outlined in M21-1, Part III, Subpart v, 6.D.3.a

• restore the 100-percent evaluation to avoid interruption in payment at the increased amount, and
• pay the rate for the prehospital evaluation assigned in the rating, effective the day following the last day the convalescent rate is paid.

• restored, and
• the 100-percent hospital rate has been continued as outlined in M21-1, Part III, Subpart v, 6.D.3.a

• process the award with the convalescent rating, and
• take award action to effect the future change to the prehospital evaluations assigned.

• reduced
• a convalescent rating is notassigned
• the 100-percent evaluation was continued, and
• a rating proposing to reduce the prehospital evaluation per 38 CFR 3.105(e) was prepared

• reduce payments to the prehospital rate effective the first day of the month following the month in which the period of convalescence ended
• send the Veteran a notice of proposed adverse action, and
• after the 60-day due process period ends, if reduction is still warranted,
  • the rating activity prepares a rating reducing the evaluation effective the last day of the month after 60 days from the date of the rating decision, and
  • the authorization activity
    • prepares the award, and
    • sends notification to the Veteran.

• preparation of the rating decision, see M21-1, Part IV, Subpart ii, 2.J.4
• notice of proposed adverse action requirements, see M21-1, Part I, 2.B.2, and
• effective dates of reduced evaluations, see 38 CFR 3.501.

• reduced, and
• a convalescent rating isassigned

• apply the provisions of 38 CFR 3.105(e), if the prehospital rate is to be reduced following a convalescent rating, and
• follow the procedures shown in the row directly above in this table.