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M21-1, Part V, Subpart ii, Chapter 1, Section A – Requirements for Live Pension Ratings

Overview


In This Section

This section contains the following topics:
Topic
Topic Name
1
2
3
4

 

1.  Evidence of Disability for Veterans Pension Purposes


Introduction

This topic contains information on the evidence of disability for pension purposes, including

Change Date

March 18, 2014

V.ii.1.A.1.a.  When a Rating Determination of Permanent and Total Disability Is Not Required

A rating determination of permanent and total disability is not required to establish eligibility for Veterans Pension when a Veteran is
  • age 65 or older, or
  • presumed to be totally and permanently disabled for pension purposes because he/she is
    • a patient in a nursing home for long-term care because of disability, or
    • disabled, as determined by the Commissioner of Social Security for purposes of any benefits administered by the Commissioner, such as Social Security Disability (SSD) benefits or Supplemental Security Income (SSI).
Notes:
  • For pension purposes, a medical foster home that VA has recognized and approved under 38 CFR 17.73 is equivalent to a nursing home.
  • Veterans who are age 62, 63, or 64 must be rated unless they
    • provide a copy of the letter awarding SSI or SSD benefits
    • are receiving SSI, or
    • are receiving Social Security benefits and the date in the DATE OF INITIAL ENT field in Share is exactly six full months after the date in the DISABILITY ONSET DATE field in Share.
References:  For more information on

V.ii.1.A.1.b.  When a Rating Determination of Permanent and Total Disability Is Required

If the Veteran does not meet the requirements of M21-1, Part V, Subpart ii, 1.A.1.a, he/she must be shown by a rating to
  • meet the disability percentage requirements set forth in 38 CFR 4.16 and4.17 or have an extra-schedular evaluation approved under 38 CFR 3.321(b)(2), and
  • be unable to secure and follow a substantially gainful occupation by reason of disabilities which are likely to be permanent
Notes:
  • A Veteran must be unemployed or marginally employed to receive pension based on disability.  “Unemployed” is not synonymous with and does not necessarily mean “unemployable.”  However, the greater the disability, the less the need of other evidence of unemployability.
  • For purposes of establishing disability for Veterans Pension, VA interprets38 CFR 4.16(a) to mean that a combined 70 percent disability rating is only required if no single disability is rated at 60 percent disabling.

V.ii.1.A.1.c.  Inclusion of SC Disabilities in an NSC Rating

Service-connected (SC) disabilities may be included along with non-service-connected (NSC) disabilities in Veterans Pension ratings.  Additionally, SC disabilities may be included in special monthly pension aid and attendance and housebound ratings.
Note:  If the evaluation of a particular SC disability is protected under 38 CFR 3.951 or 38 CFR 3.952, evaluate the disability at its protected level.

2.  Veterans Pension Rating Percentage Requirements


Introduction

This topic contains information on the rating percentage requirements, including the

Change Date
March 18, 2014

V.ii.1.A.2.a.  History of Pension Eligibility Based on Age-65 Status

Before October 31, 1990, there was a statutory presumption that Veterans who had attained age 65 were permanently and totally disabled for pension purposes.

The Omnibus Budget Reconciliation Act of 1990, Public Law (PL) 101-508, Section 8002, eliminated the statutory presumption for all claims filed after October 31, 1990.

Effective September 17, 2001, PL 107-103 eliminated the requirement for a rating determination of eligibility for Veterans 65 years of age or older.  However, such Veterans are not presumed to be disabled.  Instead, Veterans who have attained age 65 do not need to be disabled to qualify for pension at the basic rate.


V.ii.1.A.2.b. Current Disability Rating Requirement When Necessary

In 1990, VA revised 38 CFR 4.17 to require for all Veterans, regardless of age, a single disability rated 60 percent or a combined evaluation of 70 percent, with one disability ratable at 40 percent or higher.

Note:  Effective September 17, 2001, this requirement became moot for certain Veterans who had either attained age 65 or who were presumed disabled based on nursing home status or being found disabled by Social Security Administration.

Reference:  For more information on a single disability rated 60 percent, see M21-1, Part V, Subpart ii, 1.A.1.b


V.ii.1.A.2.c. Effective Dates for the Rating Requirements

Use the table below to determine the effective dates for the rating requirements.

If VA received the claim …

Then …

on or after September 17, 2001 the rating percentages described in M21-1, Part V, Subpart ii, 1.A.2.b apply only to Veterans under age 65.
on or after December 15, 1991, but before September 17, 2001 the rating requirements described in M21-1, Part V, Subpart ii, 1.A.2.b apply to all claims.
on or after October 31, 1990 but before December 16, 1991 the percentage disability requirements are

  • 60 percent for one or more disabilities for Veterans age 55 through 59, and
  • 50 percent for Veterans who were at least age 60.

3.  Veterans Pension Eligibility Under 38 CFR 3.321(b)(2)


Introduction

This topic contains information on eligibility under 38 CFR 3.321(b)(2), including

Change Date

February 19, 2019

V.ii.1.A.3.a.  When to Consider Eligibility Under 38 CFR 3.321(b)(2)

Consider extra-schedular eligibility under 38 CFR 3.321(b)(2) in all cases in which the Veteran does not meet the schedular requirements for pension.
Reference:  For more information on extra-schedular pension rating decisions, see

V.ii.1.A.3.b. Approval of Extra-Schedular Evaluation in Veterans Pension Claims

The table below shows the approval process for claims being considered for Veterans Pension on an extra-schedular basis under 38 CFR 3.321(b)(2).
Important:  Discuss in the Reasons for Decision part of the rating decision why disability for pension can or cannot be granted under this regulation.  The rating decision should contain sufficient information to clearly show the basis for the disability grant or denial.
If …
Then …
a rating decision proposes an extra-schedular grant of disability for pension
refer the rating decision to the Pension Management Center Manager (PMCM) or Veterans Service Center Manager (VSCM) recommending approval.
Notes:
  • The PMCM or VSCM may approve disability for pension without submitting the rating decision to Central Office.
  • If disability for pension is being granted, it is not necessary to refer to extra-schedular consideration in the Issuesection of the rating decision.
the PMCM or VSCM does not approve the extra-schedular grant of disability for pension
  • prepare another rating decision to deny pension
  • identify the extra-schedular issue in theIssue section of the rating decision, and
  • inform the Veteran of the reason for the denial.
Notes:
  • The letter informing the Veteran of the pension denial must also inform him/her of the reason pension was not granted under the provisions of 38 CFR 3.321(b)(2).
  • The rating should include a reference to38 CFR 3.321(b)(2) as an applicable law to this decision.
Reference:  For more information on the requirement to include applicable laws and regulations in a decision notice, see M21-1, Part III, Subpart v, 2.B.1.b.

V.ii.1.A.3.c.  Considering Retroactive Eligibility

If eligibility for pension is established from a date subsequent to the date of the claim, consider whether retroactive eligibility may be established under 38 CFR 3.321(b)(2).
If retroactive eligibility under 38 CFR 3.321(b)(2) is not in order, provide an explanation in the Reasons for Decision section of the rating decision.

 

4.  Rating Previously Discontinued Veterans Pension Claims


Change Date
February 19, 2019

V.ii.1.A.4.a. When to Rate Reopened Pension Claims

If pension was previously discontinued because the Veteran’s income from wages exceeded the income threshold for marginal employment and the Veteran is under age 65, then disability for pension must be re-evaluated using the rating criteria in effect at the time the Veteran submits a new pension claim.

In all other reopened pension cases, no new rating decision is required.

Reference:  For more information on the poverty threshold, see the United States Census Bureau Poverty web site.

Historical_M21-1V_ii_1_SecA_5-10-15.docx May 20, 2019 51 KB
2-19-19_Key-Changes_M21-1V_ii_1_SecA.docx May 20, 2019 44 KB
Change-May-20-2015-Transmittal-Sheet-M21-1MRV_ii_1_SecA_TS.doc May 20, 2019 65 KB
Transmittal-M21-1MR_V_ii_TS.doc May 20, 2019 70 KB
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