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M21-1, Part VIII, Chapter 4 – Rating Accrued Claims

Overview


In This Chapter

This chapter contains the following topics:
Topic
Topic Name
1
2

1.  General Information on Accrued Rating Decisions


Introduction

This topic contains general information on accrued rating decisions, including

Change Date

February 19, 2019

VIII.4.1.a.  When to Make Accrued Rating Decisions

Address accrued in a rating decision when, after the original claimant’s death, there is
  • an accrued claim, and
  • an issue within the jurisdiction of the rating activity for claims pending at death, including
    • informal claims received before March 24, 2015
    • initial and supplemental claims
    • higher-level reviews (HLR)
    • previously denied claims that had new and material evidence to support the claim in or deemed in the claims folder at the date of death, and
    • claims of clear and unmistakable error (CUE) pending at death, and
  • any substantive appeals or administrative appeals pending at the time of death.
Notes:
  • The evidence requirements for an accrued decision based on new and relevant evidence are the same as the evidence requirements imposed on the original claimant to support a supplemental claim.
  • Benefits are not payable when a claim for accrued benefits raises a CUE in a previously denied finally adjudicated claim.
References:  For more information on

VIII.4.1.b.  Procedures Governing Accrued Rating Decisions

Accrued rating decisions are governed by the same procedures applicable to other ratings.
Reference:  For more information on general rating decision procedures, see M21-1, Part III, Subpart iv.

VIII.4.1.c.  Determining the Retroactive Period Based on the Date of Death

The table below shows the limitations in the retroactive period covered by the rating decision based on the date of the original claimant’s death.
If death occurred …
Then the retroactive period covered by the rating decision is …
  • on or after January 1, 1958, but
  • before October 9, 1996
limited to any one-year period before death.
  • on or after October 9, 1996, but
  • before December 16, 2003
limited to any two-year period before death.
on or after December 16, 2003
not limited.
Exception: When accrued benefits are payable to the survivors or estate of aNehmer class member under 38 CFR 3.816(f), there is no limitation in the retroactive period, regardless of the date of death.
References: For more information on
  • the time limits to
  • payment of accrued benefits when death occurs
    • on or after January 1, 1958, but before October 9, 1996, seePublic Law (PL) 85-857, and
    • on or after October 9, 1996, but before December 16, 2003, seePL 104-275, and
    • on or after December 16, 2003, see PL 108-183
  • limitation of payment, see Terry v. Principi, 367 F.3d 1291 (Fed. Cir. 2004), and
  • accrued benefits under Nehmer, see M21-1, Part IV, Subpart ii, 2.C.4.

VIII.4.1.d.  Considering a Rating Decision Dated Prior to Death

A rating dated prior to the claimant’s death is valid and may be processed by authorization for accrued purposes.
Notes:
  • A rating decision prepared after the original claimant’s death cannot be promulgated.
  • If a rating decision cannot be promulgated, reverse file it in the claims folder to serve as a flash for potential benefits under PL 110-389, theVeterans’ Benefits Improvement Act of 2008.

VIII.4.1.e.  Consideration of Evidence for Requests for Substitution

Review the table below to determine what evidence to consider in the rating decision.
If a request for substitution has …
Then base the rating decision …

been granted and the claim pending at death was

  • a formal claim,
  • an initial claim,
  • supplemental claim, or
  • legacy appeal
  • on evidence contained within the file on the date of death,and
  • additional evidence submitted by the substitute claimant who has the same rights as that of the deceased claimant.
Reference:  For information on the rights of a substitute claimant, see M21-1, Part VIII, 2.3.
been granted and the claim pending at death was a request for HLR
on evidence contained within the file on the date of the notification letter addressing the issue that the request is based on
not been granted
on the evidence contained within the file on the date of death.
Reference:  For information on evidence in the file at the date of death, see M21-1, Part VIII, 1.4.
Note:  The monetary benefit sought in both situations is called an accrued benefit.

VIII.4.1.f.  Obtaining All Evidence for Accrued Claims

The following evidence must be in the claims folder even if the reports are not reduced to writing or are not physically placed in the claims folder until after death:
  • service department records at the Records Management Center (RMC)
  • reports of Department of Veterans Affairs (VA) hospitalization
  • reports of hospitalization, treatment, or examinations authorized by VA, and
  • reports of autopsy made by VA on the date of death.
References:  For more information on

VIII.4.1.g.  Payment of Accrued Benefits for the Month of Death

The Veteran’s rate for the month of death is generally not payable as an accrued benefit.  It is available only to the surviving spouse under 38 U.S.C. 5110(d) and 38 U.S.C. 5310.
A rating decision is required, however, if it is needed to establish the Veteran’s rate of benefits for the month of death for payment purposes for the surviving spouse under 38 U.S.C. 5310.
References:  For more information on

2.  Preparing the Rating Decision


Introduction

This topic contains information on accrued rating decisions, including

Change Date

February 19, 2019

VIII.4.2.a.  Format for an Accrued Rating Decision

Prepare an accrued rating decision in the same format as a rating decision for disability or survivor benefits.
Reference:  For more information on completing the rating decision narrative, seeM21-1, Part III, Subpart iv,6.C.

VIII.4.2.b.  Addressing the Issue of Accrued or Substitution in the Rating Decision

The issue statement for an accrued claim should be worded as Entitlement to Accrued Benefits, even if the accrued is a result of a request for substitution.

VIII.4.2.c.  Handling the Accrued Rating Decision

Use the information in the table below to handle the accrued rating decision.
If an accrued rating decision is …
Then …
favorable
use the template language generated by selecting the accrued grant radio button in Veterans Benefits Management System – Rating (VBMS-R).
Note:  The accrued template is only available for selection if the Veteran is deceased. When generated, the accrued grant template will appear at the top of the first page of theCodesheet below the data tables.
Reference:  For more information, see the VBMS-R User Guide.
Unfavorable, because necessary evidence was not received to support the claim
include that discussion in the reasons for decision.

VIII.4.2.d.  Preparing the Coded Conclusion for Accrued Claims

Prepare the coded conclusion in the same manner as for live or survivor cases.
Reference:  For more information about preparing the coded conclusion, see M21-1, Part III, Subpart iv, 6.E.
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