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

In This Chapter

Introduction

• when to make accrued rating decisions
• procedures governing accrued rating decisions
• determining the retroactive period based on the date of death
• considering a rating decision dated prior to death
• consideration of evidence for requests for substitution
• obtaining all evidence for accrued claims, and
• payment of accrued benefits for the month of death.

Change Date

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

• 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.

• 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.

• appeals pending at death, see M21-1, Part I, 5.J.3
• pending claims and appeals, see M21-1, Part VIII, 1.2, and
• issues within the jurisdiction of the rating activity, see M21-1, Part III, Subpart iv, 2.A.1.

VIII.4.1.b.  Procedures Governing Accrued Rating Decisions

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

• the time limits to
  • submit an accrued, see M21-1, Part VIII, 3.1.e
  • submit a request for substitution, see M21-1, Part VIII, 3.1.f, and
  • responding to a notice for additional information in an accrued claim or a request for substitution, see M21-1, Part VIII, 3.3
• 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 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

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

• 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.

• evidence in the file at the date of death, see M21-1, Part VIII, 1.4
• the rights of a substitute claimant, see M21-1, Part VIII, 2.3, and
• required development for requests for substitution and requests for substitution after the request has been granted for accrued claims, seeM21-1, Part VIII, 3.

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

• determining the amount of accrued benefits, see M21-1, Part VIII, 5.3, and
• determining benefit rates for the surviving spouse, see M21-1, Part IV, Subpart iii, 3.A.5.

Introduction

• format for an accrued rating decision
• addressing the issue of accrued or substitution in the rating decision
• handling the accrued rating decision, and
• preparing the coded conclusion for accrued claims.

Change Date

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

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

VIII.4.2.c.  Handling the Accrued Rating Decision

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