M21-1, Part IV, Subpart ii, Chapter 2, Section E – Service Connection for Disabilities Incurred as a Prisoner of War (POW)

In This Section

Introduction

• designating members of the rating activity to handle FPOW claims
• the purpose of FPOW rating activities
• Veterans Service Center Manager (VSCM) and Pension Management Center Manager (PMCM) responsibility for selecting the FPOW rating activity
• the members of the FPOW rating activity, and
• the responsibilities of the FPOW rating activities.

Change Date

IV.ii.2.E.1.a.  Designating Members of the Rating Activity to Handle FPOW Claims

IV.ii.2.E.1.b.  Purpose of FPOW Rating Activities

• knowledgeable on issues affecting FPOWs, and
• sensitive to the FPOW experience.

IV.ii.2.E.1.c.  VSCM and PMCM Responsibility for Selecting the FPOW Rating Activity

IV.ii.2.E.1.d.  Members of the FPOW Rating Activity

• must consist of two regular members and one alternate, and
• should include a medical member, if available.

IV.ii.2.E.1.e.  Responsibilities of the FPOW Rating Activity

Introduction

• considering all relevant laws, regulations, and directives for FPOW claims
• the liberal application of directives per 38 CFR 3.304(e) in FPOW claims
• Department of Veterans Affairs (VA) responsibilities when adjudicating claims involving FPOWs
• considering the adequacy of medical evidence in FPOW claims
• statements from FPOWs as evidence of disability
• ensuring complete development of FPOW claims
• finding a reasonable basis for establishing SC in FPOW claims, and
• requesting an advisory opinion in FPOW claims.

Change Date

IV.ii.2.E.2.a.  Considering All Relevant Laws, Regulations, and Directives for FPOW Claims

• presumptive service connection, see
  • 38 U.S.C. 1112(b)
  • 38 CFR 1.18
  • 38 CFR 3.307(a)(5), and
  • 38 CFR 3.309(c)
• evidentiary thresholds in FPOW ratings, see 38 CFR 3.304(e)
• development procedures for claims based on FPOW status, see M21-1, Part IV, Subpart ii, 1.G, and
• administrative decisions for FPOW status, see M21-1, Part III, Subpart v, 1.C.

IV.ii.2.E.2.b.  Liberal Application of Directives Per 38 CFR 3.304(e) in FPOW Claims

• deficient or completely absent service treatment records (STRs), causing difficulty in providing evidence of disease or injuries suffered during or immediately prior to confinement, and
• the physical and mental disabilities caused by internment as a prisoner of war (POW) may not manifest until many years after active duty service.

IV.ii.2.E.2.c.  VA Responsibilities When Adjudicating Claims From FPOWs

• the POW experience, or
• diseases subject to presumptive service connection.

IV.ii.2.E.2.d.  Considering the Adequacy of Medical Evidence in FPOW Claims

• FPOW protocol examinations, see M21-1, Part III, Subpart iv, 3.A.11
• FPOW social surveys, see M21-1, Part III, Subpart iv, 3.A.12, and
• adequate and current examinations, see
  • M21-1, Part III, Subpart iv, 3.D, and
  • VAOPGCPREC 11-1995.

IV.ii.2.E.2.e.  Statements from FPOWs as Evidence of Disability

IV.ii.2.E.2.f.  Ensuring Complete Development of FPOW Claims

• ensure that examinations are complete and comprehensive, and
• afford the Veteran every opportunity to present a complete and accurate picture of his/her POW-related disabilities.

IV.ii.2.E.2.g.  Finding a Reasonable Basis for Establishing SC in FPOW Claims

• Intercurrent diseases or injuries, shown to be the cause of the disabilities under consideration, may preclude the establishment of SC.
• Evidence of treatment or observation of the claimed disability during service is not required.
• A lack of a history showing continuity or chronicity of the claimed disabilities since separation from service, although an important factor generally, is not by itself sufficient to justify denying SC.

IV.ii.2.E.2.h.  Requesting an Advisory Opinion in FPOW Claims

Introduction

• establishing presumptive SC under 38 CFR 3.309(c)
• disabilities presumed to be SC for FPOWs under 38 CFR 3.309(c)
• absence of evidence in service records or presumptive disabilities in FPOW claims
• assigning noncompensable evaluations in FPOW claims, and
• denying presumptive SC for an FPOW claim.

Change Date

IV.ii.2.E.3.a.  Establishing Presumptive SC Under 38 CFR 3.309(c)

• establishing presumptive SC for disabilities that are 10 percent or more disabling, see 38 CFR 3.307(a)(5), and
• the history of the length of confinement requirement, see M21-1, Part IV, Subpart ii, 2.E.6.a.

IV.ii.2.E.3.b.  Disabilities Presumed to be SC for  FPOWs Under 38 CFR 3.309(c)

• The disabilities in 38 CFR 3.309(c)(1) apply to all FPOWs, regardless of the length of detainment.
• The disabilities in 38 CFR 3.309(c)(2) apply only to FPOWs who were detained for 30 days or longer.

• The presumption of SC for organic residuals of frostbite applies if it is determined that the Veteran was interned in climactic conditions consistent with the occurrence of frostbite.
• The presumption of SC for osteoporosis if the Veteran has posttraumatic stress disorder (PTSD) applies to claims received on or after October 10, 2008.
• The presumption of SC for osteoporosis if the Veteran was detained for more than 30 days and does not have PTSD applies to claims received on or after September 28, 2009.

IV.ii.2.E.3.c.  Absence of Evidence in Service Records of Presumptive Disabilities in FPOW Claims

IV.ii.2.E.3.d.  Assigning Noncompensable Evaluations in FPOW Claims

IV.ii.2.E.3.e.  Denying Presumptive SC for an FPOW Claim

• the disability in question cannot be associated with the Veteran’s POW experiences (for example, the claimed condition was the result of an intercurrent disease or injury per 38 CFR 3.307(d)), or
• the Veteran was never diagnosed with the disability in question.

Introduction

• considering SC for
  • residuals of frostbite
  • peptic ulcer disease, and
  • peripheral neuropathy
• distinguishing between post-traumatic arthritis and degenerative arthritis in an FPOW claim
• final responsibility for determining SC for post-traumatic osteoarthritis in an FPOW claim
• considering SC for osteoporosis when
  • PTSD is diagnosed, and
  • PTSD is not diagnosed, and
• FPOW claims with diagnoses of both osteoporosis and arthritis.

Change Date

IV.ii.2.E.4.a.  Considering SC for Residuals of Frostbite

• Frostbite injury may occur at different temperatures and after different lengths of exposure, depending on the individual.
• If a Veteran was a POW during seasons other than winter, the possibility of exposure to climatic conditions consistent with permanent frostbite injury must not be eliminated without careful consideration.

IV.ii.2.E.4.b.  Considering SC for  Peptic Ulcer Disease

IV.ii.2.E.4.c.  Considering SC for Peripheral Neuropathy

• Review the circumstances of the Veteran’s internment as it may have included exposure to infectious agents.
• The possibility of nutritional deficiency during internment and resultant lowering of the body’s resistance to infection must be considered.
• Medical evidence must establish a current diagnosis of peripheral neuropathy.

IV.ii.2.E.4.d.  Distinguishing Between Post-Traumatic Arthritis and Degenerative Arthritis in an FPOW Claim

• the nature of the trauma
• a statement of the type and severity of the injuries received, and
• the frequency of traumatic injury, such as how often an FPOW might have been beaten by his captors.

• the appearance of arthritis at an earlier age than would be expected normally, or
• confinement of arthritis to the location of the alleged trauma, regardless of the age at which it appears.

IV.ii.2.E.4.e.  Final Responsibility for Determining SC for Post-Traumatic Osteoarthritis in an FPOW Claim

IV.ii.2.E.4.f.  Considering SC for Osteoporosis – PTSD Diagnosed

• were detained or interned for any period of time, and
• have a diagnosis of PTSD.

IV.ii.2.E.4.g.  Considering SC for Osteoporosis – PTSD Not Diagnosed

IV.ii.2.E.4.h.  FPOW Claims With Diagnoses of Both Osteoporosis and Arthritis

• Arthritis is described as inflammation of a joint or joints.
• Osteoporosis is described as inadequate bone formation resulting in low bone mass, microscopic deterioration of bone tissue, and increased bone fragility, which results in an increased incidence of fracture.

Introduction

• information required in the POW rating decision
• citing disabilities in an FPOW claim
• considering the results of the POW protocol examination
• coding specific FPOW disabilities, and
• VSCM review of POW rating decisions prior to promulgation.

Change Date

IV.ii.2.E.5.a.  Information Required in the POW Rating Decision

• dates of confinement, and
• name(s) of specific camp(s) or sector(s) in which the Veteran was confined.

IV.ii.2.E.5.b.  Citing Disabilities in an FPOW Claim

IV.ii.2.E.5.c.  Considering the Results of the POW Protocol Examination

• all disabilities identified by the medical examiner, and
• all complaints mentioned by the Veteran that are indicative of a specific, ratable disorder.

IV.ii.2.E.5.d.  Coding Specific FPOW Disabilities

IV.ii.2.E.5.e.  VSCM Review of FPOW Rating Decisions Prior to Promulgation

Introduction

• history behind the length of confinement requirement for POWs, and
• history of Public Laws (PLs) and Federal Register citations for FPOW diseases.

Change Date

IV.ii.2.E.6.a.  History Behind the Length of Confinement Requirement for FPOWs

• psychosis
• any of the anxiety states
• dysthymic disorder (or depressive neurosis)
• organic residuals of frostbite, and
• post-traumatic arthritis.

• M21-1, Part IV, Subpart ii, 2.E.3.b, and
• M21-1, Part IV, Subpart ii, 2.E.3.c.

IV.ii.2.E.6.b.  History of PLs and Federal Register Citations for FPOW Diseases