Development
Guide for Compensation & Pension Benefits
March
1995
Department of Veterans Affairs
Compensation and Pension Service
Washington, DC
Introduction
The need for this guide developed
from the increasing complexity of the development process. Numerous decisions
from the Board of Veterans’ Appeals and Court of Veterans Appeals along with
more medically complex issues and a continually changing body of medical
information have resulted in the cumbersome, fragmented, and confusing material
currently available. While the information needed to successfully develop
claims is present, its use is far too complicated.
The purpose of this guide is
to provide a convenient, easy to use reference for the vast majority of
development actions for claims under Rating Activity jurisdiction. It is not
designed to be all-encompassing. Nor does it replace or supersede information
provided in M21-1 or 38 CFR. Rather, it is to be used in conjunction with other
reference material.
The goal of the guide is
simple; to help ensure that every claim is developed completely, consistently
and in a timely manner the first time. Of course, this will not happen every
time. Many times new potential evidence becomes available late in the
development process. Nothing can be done about those situations. However, this
guide will assist in ensuring that all evidence of record is developed
fully.
The guide is written with
the understanding that the user already has a working knowledge of the
development process and basic development requirements. The focus of the guide
is on requirements which are more issue oriented and seem to cause confusion in
the development process. For instance, development of a radiation claim.
The development process is
in constant change. Likewise, the guide is meant to change. Any recommendations
for improvement are always appreciated. Please forward any corrections,
additions or suggestions to VACO, Compensation & Pension Training (212C).
Organization
The guide has been organized
into sections on basic development common to all claims and, more specifically,
by types of claim. In addition, sections are provided for issue specific
development; for instance exposure to herbicide agents, PTSD or asbestos
claims. Within each issue specific section are instructions on how to follow
development steps specific to that type of claim. Examples of all development
screens and suggested letters are also provided which relate to that type of
claim.
The information is presented
in a brief, outline format. In this manner, the guide can be left in a
convenient location and easily followed while doing actual development. Again,
the idea is to avoid as much fumbling with manuals and regulations as possible.
Citations are provided for more detail and literal interpretation when needed.
This guide is designed to be
used in conjunction with the included check sheets for live and death claims.
Table of Contents
I. General Development
Process Section I
A. Four Stages of Claims
Processing I-1
B. Basic Development Process
I-2
C. Check Lists I-6
D. Review of
Application/Claim I-7
E. Service Department
Development I-8
F. Dependency Development
I-17
G. Income Development I-23
II. Compensation Section
II
A. Background II-1
B. Original (EP 010 or 110
series) II-6
C. Re-opened (EP 020 series)
II-8
1. Condition previously
denied service connection II-8
2. Condition not previously
denied (i.e. new condition) II-9
3. Condition already service
connected II-9
D. Issue specific claims
II-10
1. Exposure to Herbicide
Agents (Agent Orange) II-11
2. Asbestos II-14
3. POW II-15
4. Mustard Gas claims II-17
5. Post-Traumatic Stress
Disorder II-19
6. Radiation exposure II-24
7. Conditions secondary to
drug/alcohol use II-28
8. Smoking II-29
9. 1151 claims II-30
10. Toxic Chemical Exposure
Claims II-32
11. HIV/AIDS II-33
12. PGW/Environmental Agents
II-34
III. Live Pension Section
III
A. Original (EP180) III-1
B. Reopened live pensions
claims (EP 020) III-2
IV. Death Claims Section
IV
A. Dependency and Indemnity
Compensation (DIC) IV-1
B. Death Pension IV-3
C. Burial Development IV-4
D. Accrued Claims IV-5
Table
of Contents
V. AMIE Quick Reference
Guide Section V
Appendix A - Sample
Development Letters Appendix A
Logical
Adjudicative Process
The
application of FACTS to LAW
Where do we find the law?
-- * Title 38, United
States Code (38 USC)
* Title 38, Code
of Federal Regulations (38 CFR)
* Precedent
Decisions
THE
CLAIMS PROCESS: QUESTIONS FOR EVERY CASE
1. What is the issue?
2. Under which laws/regulations can we establish
entitlement?
3. What do the facts have to demonstrate to establish
entitlement?
4. What evidence do I need to establish the facts?
REMINDERS
NO SPECIFIC ISSUE = NO CLAIM
= NO END PRODUCT
INCOMPLETE CLAIM =
INFORMAL CLAIM
Section I
General Development Process
A. Four Stages of Claims
Processing I-1
B. Basic Development
Process I-2
C. Checklists I-6
D. Review of
Application/Claim I-7
E. Service Department
Development I-8
F. Dependency Development
I-17
G. Income Development
I-23
A.
The Four Stages of the Claims Process
1. Issue(s) to be Decided
Well-grounded,
plausible claim?
If so, we have a duty to
assist.
2. Development of Facts
What evidence is necessary to
resolve the issue(s)?
What evidence is of record?
Develop for all additional
evidence necessary to resolve the issue(s).
3. Decision - The
Application of Facts & Law
a. Facts - Derived from Step
2 and development.
b. Law
(1) Title 38 USC
(2) Regulations - 38 CFR
(3) Precedent Decisions
(4) COVA
(5) GC Opinions
4. Notification (38 USC
5104)
B. Basic Development
Process
Review application for
completeness, information identifying the veteran, and claimant's signature.
List all claimed conditions
and identify type of claim (original, reopened, increase, pension, etc.).
Verify correctness of End
Product.
Determine if potential
eligibility based on service exists for benefit claimed.
If pension is
claimed, review income and dependency first and determine
eligibility.
If service, income, and
dependency appear to be complete, continue development.
Service Development
Develop for anything needed
from military service department (service verification, SMRs, personnel file).
Medical
Development
CLAIM FOR COMPENSATION ONLY:
Less than 1 year since
discharge:
Identify and develop any
special issues.
Request any medical evidence
if indicated.
Request VA exam, if
indicated.
More than 1 year since
discharge:
Request continuity and/or
chronicity evidence
Request treatment records
from VA or military facilities
Identify and develop any
special issues
Request private medical
treatment records if indicated
Request VA exam, if
indicated
CLAIM FOR PENSION
ONLY:
Request any records of
treatment for the past year:
Private
VA or Military
VR&C
SSA
Request VA exam if indicated
DUAL CLAIM: PENSION AND COMPENSATION:
Request any of the evidence
indicated as noted above
Some items need not be
duplicated
CLAIM FOR INCREASE:
Request medical evidence to
support claim for increase in severity
Request VAF 21-4142 from
veteran
Request private medical
evidence, if appropriate
Request VA medical records
Request VA exam, if
indicated
PREVIOUSLY DENIED
CLAIM:
Request specific evidence
for consideration
Evidence must be new and
material, not duplicate and must bear directly on issue for consideration.
SPECIAL MONTHLY
COMPENSATION:
Request medical evidence, if
indicated
Recent treatment
Aid and Attendance, if
indicated
Request VA exam, if
indicated
SPECIAL MONTHLY
PENSION
Request medical evidence
Recent
treatment
Housebound
Aid and
Attendance
-- or --
Request supporting
statement, if nursing home establishes reason for claim
Develop Medicaid information
Request Expense information
Verify that Nursing home is
approved and licensed
COMPETENCY
ISSUES:
Request medical evidence and
submit for initial rating
Request certified court
certificates regarding this issue, if indicated
INDIVIDUAL
UNEMPLOYABILITY:
Obtain VA Form 21-8940, Request
for Individual Unemployability
Develop for any medical
evidence, if needed
Develop employment
statements from employers during last year of employment
DEATH CLAIMS:
Obtain Death Certificate
Obtain Autopsy Report, when
directed
Obtain Terminal Hospital
Report, when directed
Obtain treatment records
with initial diagnosis, when directed
COMBINATION
CLAIMS:
List all conditions and type
of evidence needed to establish a valid claim for consideration of each issue.
Develop each type of
evidence needed.
Dependency
and Income Development
For all
types of claims, we recommend Dependency or Income be developed simultaneously
with service and medical evidence, if indicated.
C.
Checklists
Four
development checklists are currently available for use with this Development
Guide. There are checklists for burials (VAF 21-0280), compensation (VAF
21-0281), pension (VAF 21-0282), and DIC/death pension/accrued (VAF 21-0283).
The checklists are not all-inclusive; however, there is space provided for
items not listed.
The items listed are the
ones where development is normally required. All items are self explanatory. If
there is a question or development of a specific issue, see the development
guide for further clarification or necessary manual or CFR citations.
The first column identifies
"Issue/Evidence/Action". Preprinted are the most common needs with
the last block under each major section shown as "other". The second
column, "Of Record", provides a space for the reviewer to insert his
or her initials when the evidence is of record. The third set of columns is
identified as "Evidence Required". The three sub-columns require
entry of what document was requested, when (date), and by whom (initials). The
fourth set of columns is to be utilized when the evidence has not been received
and "Follow Up" action is due. The date of follow up plus initials
are for entry. The final set of columns is titled "Evidence
Received". It provides for entry of the date plus initials of the person
who has noted the evidence has been received.
The upper portion of the
checklist is self-explanatory as to the information for input.
The bottom of the second
page of each checklist requires insertion of the suspense period for action,
notation of referral to the Rating Activity as well as spacing for additional
pertinent notes.
D. Review of Application/Claim
Completeness: Review the application for completeness. Be sure the
application or claim request is signed by the claimant.
For original claims,
the application must contain at a minimum the following:
-claimant's name
-veteran's name
-veteran's social security
number or service number
-branch of service
-approximate dates of
service
-signature of claimant
This is enough to establish
a claim, file, and control. If the application is incomplete, it must be copied
and the original returned for completion by the claimant.
For reopened claims,
any statement indicating the claimant's desire to file a claim may be accepted.
Usually these requests are filed by the claimant or her or his representative.
An informal claim also establishes a reopened claim if it is based on VA or
military hospital medical evidence or congressional inquiries.
Unsigned claims must be returned immediately for signature and
no control or end product established. Be sure a date stamp exists on the
document and encourage the claimant to resubmit the same document as it may
affect the effective date.
References:
M21-1, Part III, 2.01c,d,e,f
M21-1, Part IV, 6.07
38 CFR 3.113
38 CFR 3.155
E. Service Department Development
Service Verification
Acceptable:
Documents: 38 CFR 3.203; M21-1, Part IV, 10.04b
Original copy of DD 214
Carbon copy of DD 214
Copy of DD 214 received from
Service Department at time of Discharge (M21-1, Part III, 4.02a(2)
Copy of DD 214 authenticated
by Adjudication or Veterans Services Division (not Service Organizations)
VADS: M21-1, Part II, 6.05d(19) and (26), 6.05e and 5.20a;
Part IV, l0.04c
Character of service is HON
or UHC
Branch of service code is
not ARNG or ANG
Separation reason is SAT
There is a "Y" in
the VADS field or VERIFIED field and veteran's RAD is 6-1-68 or later (all
persons entering active duty after
11-5-93 will have a
"D" in the VADS field until discharged and VADS updated)
If veteran retired for
length of service (20 years or more) and other evidence is complete, send
to Rating Board for action. Request verification of all unverified service via
Target 201 and 202 screens and continue to control (M21-1, 10.04d).
Fire Related (M21-1, Part III, 4.23) -- On July 12, 1973, a fire at
the NPRC in St. Louis destroyed 85 percent of the stored records for Army
veterans serving between 1941 and 1960, and 85 percent of Air Force personnel
with surnames beginning with the letters I through Z who were discharged prior
to 1964 and had no retired or Reserve Status.
Every request submitted
suspected to be a fire-related case should be on a manually
prepared VA Form 21-3101 accompanied by a discharge document.
If DD 214 is not of
record
If DD 214 is not of
record, request veteran to complete DA-13075 or DARP Form 2580 for possible
alternate sources (M21-1, Part III, 4.25b). A VA Form 21-3101 to appropriate
Service Code should be sent hard copy with either DD 214 or DA-13075 attached.
You should make every effort to anticipate possible alternate sources that may
be of record on the application. Possible sources of alternate records are:
Private Records Physicians,
Hospitals, etc.
Veteran Centers VA exams
VA hospital and outpatient clinics
Military hospitals
Social Security
Administration Veteran/Claimant statements
Buddy statements Field exams
Social and Industrial Survey
Photographs while in the service
Insurance physical
Employment physical
VR&C files Pharmacy
prescriptions while in Letters to/from the veteran while in the service
Burial Claims:
The evidence which VA relied
on to pay compensation or pension during the veteran’s lifetime may be used to
verify qualifying service for entitlement to non-service connected burial benefits.
(M21-1, Part III, 13.05; 38 CFR 3.203(c))
Travel Time:
M21-1, Part III, 2.08c
Minimum Active Duty
Requirement: (After 9-7-80)
M21-1, Part III, 2.08d
Uncharacterized
Separations:
38 CFR 3.12(k)
Upgraded
Discharges:
38 CFR 3.12 (e)(f)(g)(h); M21-1, Part IV, 11.01
POW Dates:
38 CFR 3.1(y)(2); M21-1, Part III, Chapter 4,
Subchapter 8;
M21-1, Part III, 5.16;
M21-1, Part II, 6.05(h)(18)
Character of Discharge:
38 CFR 3.12; M21-1, Part IV, 11.01 and 11.02
If discharge is OTH
or otherwise questionable:
1. Request facts and
circumstances using VAF 21-3101 to Service Department
2. Request obligated service
on same 3101 if service is continuous and more than one period of service is
shown. CONDITIONAL DISCHARGE
(38 CFR 3.13; M21-1, Part
IV, 11.01i and 11.02g)
3. Send veteran Due Process
letter allowing 60 days for reply.
(M21-1, Part IV, 11.02).
4. Develop for SMR and all
available medical evidence simultaneously. Order a VA exam (if applicable) only
if a conditional discharge is indicated (as there is probable entitlement).
5. BUPD should be done after
Character of Discharge Decision has been finalized. (M21-1, Part IV, 11.02g(3))
Military Benefits
Retired Pay
Carefully examine the
veteran's claim, DD 214 and other available separation documents, or BIRLS MSC
Screen (which comes from the VADS interface) for any evidence of retired pay.
Service retired pay may be verified via 3101 from the appropriate address code
per Addendum A of M21-1, Part III, Chapter 4.
The veteran may also be
requested to furnish verification of the receipt or amount of retired pay;
however; the service department MUST verify any conflicting information. (38
CFR 3.750; M21-1, Part IV, 21.01; M21-1, Part III, 2.09; M21-1, Part II,
6.05h).
Severance or Readjustment
Pay
Carefully examine the
veteran's claim, DD 214 and other available separation documents, or BIRLS MSC
Screen for any evidence of severance pay. Severance pay may be verified via
3101 from the appropriate address code in Addendum A of M21-1, Part III,
Chapter 4. (38 CFR 3.700a(3); M21-1, Part IV, 20.31; M21-1 Part II, 6.05h;
M21-1, Part III, 2.09)
Voluntary Separation
Incentive (VSI) and Special Separation Benefit (SSB)
To facilitate the downsizing
of the armed forces, service members have the option to receive payment under
one of two incentive programs (VSI or SSB). To qualify for either of these exit
bonuses, the service person must have served on active duty for more than six
(6) years but fewer than twenty (20) years as of December 5, 1991; served at
least five (5) years of continuous active duty immediately before separation;
and agree to serve in the Ready Reserve. Service persons approved for
separation under SSB or VSI must separate on or before September 30, 1995. SSB
provides a lump sum payment while VSI is paid in annual installments.
Identification of veterans
receiving SSB or VSI can be found in blocks (18) and (26) of their DD 214s. A
VADS record will indicate any SSB payment as LUMP SUM READJUSTMENT PAY on the
MSC screen. If a pending issue file is subsequently established, the 401 screen
will display 100 percent of that amount in the SEPARATION PAY field. VSI
information will not be entered into the VADS record since any offset will be
accomplished by DOD.
Questionable receipt of
amounts of SSB or VSI may be made to the appropriate service department code
via 3101. (38 CFR 3.700; M21-1, Part III, 2.10.1; M21-1, Part IV, 20.31).
Requesting Service Medical Records
1. Review VA Form 21-526 and
DD Form 214 to check veteran's reserve status (i.e., inactive reserve, active
reserve, National Guard, retired, or none).
2. Request service medical
records using Target 201, 202 screens. Target requests on VA Form 21-3101-4 for
all address codes are printed at the National Personnel Records Center (NPRC)
in St. Louis. NPRC uses its indexing system to determine if it has the
requested record. If NPRC has the record, it responds to the VA Form 21-3101.
If it does not, NPRC forwards the VA Form 21-3101 by mail to the address code entered
by the operator at the regional office.
3. The following is a list
of frequently used Address Codes. For more detail, consult M21-1, Part III,
Chapter 4, Addendum A (Address Codes) and Addendum C (Addresses and phone
numbers).
4. Control and follow-up
procedures for SMR requests (and the involvement of station service records
specialists) are contained in M21-1, Part III, Chapter 4, Subchapter V.
Follow-ups should be promptly made based on circumstances in individual cases,
i.e., ever-changing time frames furnished by the various service departments.
SMRC - Address Code 375 (M21-1, Part III, 4.01h; M21-1,
Part III, Subchapter II
SGO - Surgeon General Office records are automatically
furnished for 3101 requests after 5-18-90. (M21-1, Part III, 4.22)
State Adjutants General (National Guard Headquarters) (M21-1, Part III,
Chapter 4, Addendum F)
F. Dependency Development
Acceptable Verification of Dependency
MARITAL RELATIONSHIP
Marriage
The original Marriage Certificate,
a copy of the marriage certifcate that has been certified to be a true copy of
the original by the custodian of public records, or an uncertified photocopy
that is deemed to be genuine and free from alteration by VA, is acceptable
evidence.
Alternate evidence may be
submitted to document Marriage. (See M21-1, Part III, 6.06).
References:
M21-1, Part III, 6.06
M21-1, Part IV, 12.01
38 CFR 3.204, 3.205
C&P Fast Letter 4-92
(9/14/94)
Common-law Marriage
Some states recognize
informal or common law marriages. Once established, it is valid anywhere in all
respects and no different from a ceremonial marriage. Requirements vary from
state to state but the following three elements must be met in all cases:
1. An agreement between the
parties to be married.
2. Cohabitation.
3. Holding out to the public
as married.
References:
M21-1, Part III, 6.08
M21-1, Part IV, 12.03c
38 CFR 3.1 (j)
Void and Annulled
Marriages
Annulment of marriage can be
established by a copy or abstract of the annulment decree. The copy or abstract
must bear the original stamp, seal or signature of the custodian of the
records, or qualify as an acceptable photocopy under M21-1, Part III, paragraph
1.07a, or is an uncertified photocopy that is deemed to be genuine and free
from alteration by VA.
Certain marriages have no
legal effect although a marriage ceremony has taken place and the marriage has
been registered. If the marriage is determined to be void, fully develop the
facts. After development, submit the case to District Counsel for a legal
opinion as to whether or not the marriage is void.
References:
M21-1, Part III, 6.07g &
h
M21-1, Part IV, 12.03
38 CFR 3.207, 3.204
C&P Fast Letter 4-92
(9/14/94)
Veteran and Spouse -
Separated or Estranged
Old Law/Section 306 (See
M21-1, Part IV, 16.10)
Improved Pension (See M21-1,
Part IV, 16.28)
Divorce
Documentary proof of
dissolution of prior marriages is not routinely required. A certified statement
from the claimant must include:
1. The first and last names
of prior marriage partners.
2. How prior marriages
terminated (death, divorce, annulment).
3. The date prior marriages
terminated (month and year at a minimum).
4. The place prior marriages
terminated (city and state).
If there is a conflict in
the marital evidence submitted and the evidence of record, request a certified
copy or certified abstract of a final divorce decree, or an uncertified
photocopy that is deemed to be genuine and free from alteration by VA.
References:
M21-1, Part III, 6.07d &
i
M21-l, Part III, 1.07a
M21-1, Part IV, 12.03 f
38 CFR 3.204, 3.206
C&P Fast Letter 4-92
(9/14/94)
PARENTAL RELATIONSHIP
If claiming parent(s) as dependents,
we need an original birth certificate, a certified copy of the veteran's birth
certificate which has been certified by the custodian of the records, or an
uncertified photocopy that is deemed to be genuine and free from alteration by
VA. A copy may also be certified by a VA employee, an accredited representative
of a Veterans Service Organization, or a military or civilian personnel
appointed on orders for this purpose by the commander of a military
installation.
References:
M21-1, Part III, 6.01
M21-1, Part III, 6.23-6.31
M21-1, Part IV, Chapter 13
38 CFR 2.50
38 CFR 3.59
C&P Fast Letter 4-92
(9/14/94)
CHILD RELATIONSHIP
Birth
Primary evidence is the
original birth certificate, a certified copy from the custodian of the record,
or an uncertified photocopy that is deemed to be genuine and free from
alteration by VA. The custodian of birth records is generally the State
Department of Records or Vital Statistics in the state where the child was
born.
An alternate form of
evidence to document the birth of a child may be submitted as secondary
evidence. (See Reference).
References:
M21-l, Part III, 6.17
38 CFR 3.209
38 CFR 3.204
C&P Fast Letter 4-92
(9/14/94)
Legitimate Child
Evidence will be required to
establish the legality of the marriage of the mother of the child to the
veteran or to show that the child is otherwise legitimate by state laws
together with evidence of birth as described in the section on Birth.
(M21-1, Part III, 6.18,
6.19)
Illegitimate Child
As to the mother of an
illegitimate child, proof of birth of the child is all that is required. As to
the father, the evidence will be determined in accordance with the facts in the
individual case.
(M21-1, Part III, 6.18,
6.19b)
Adopted Child
A certified copy of the
decree of adoption or the adoptive placement agreement, or an uncertified
photocopy of either which is deemed by VA to be genuine and free from
alteration. A certified copy of the child's revised birth certificate (or an
uncertified photocopy deemed to be genuine and free from alteration by VA) may
be accepted to establish the child from the date of receipt of the birth
certificate.
(M21-1, Part III, 6.20)
Stepchild
A birth certificate showing
names of natural parents, evidence of the marriage of the veteran to the
natural parent of the child and evidence the child is a member of the veteran's
household.
(M21-1, Part III, 6.21)
Helpless Child
Any communication or
evidence indicating or claiming permanent incapacity for self-support of a
child of a veteran. Request claimant submit medical evidence of physical and/or
mental condition which shows the disability existed at the age of 18. Claimant
should also submit statements from teachers, tutors or social workers, who have
observed the child.
(M21-1, Part IV, 15.02,
15.03)
Basic Dependency
References:
M21-1, Part III, 6.17, 6.18,
6.19, 6.20, 6.21
38 CFR 3.204, 3.209, 3.10
38 CFR 3.57, 3.58
38 CFR 3.403 (e)
C&P Fast Letter 4-92
(9/14/94)
G. Income
Development
Eligibility for VA non-service-connected pension
benefits and parents' Dependency and Indemnity Compensation (DIC) is contingent
on, among other things, the claimant's income. The claimants’ net worth is a
factor in determining eligibility for Section 306 and Improved Pension. Net
worth is not a factor in Old Law pension and parents DIC cases.
If gross income from all
sources exceeds the applicable limit (See M21-1, Part I, Appendix B), deny
claim because of excess income. If special monthly pension is a factor, use the
A&A or housebound income limit. Unreimbursed medical expenses and
educational expenses paid after date of claim may be used to reduce income.
If gross income from all
sources is less than the applicable limit established by law in M21-1, Part I,
Appendix B, develop claim as shown in Sections III and IV of this training
guide.
The general rule set out in
38 CFR 3.271 is that all income is countable unless specifically excluded by 38
CFR 3.272. (M21-1, Part IV, 16.41a(1))
Income Development: M21-1, Part III, 7.02, 7.05
Income Counting
Procedures: M21-1, Part IV, 16.23
Countable Income M21-1, Part IV, 16.41c
Countable monthly income includes (but is not limited
to):
Income from retirement or
survivors programs, interest, dividends, Social Security (Not SSI), Civil
Service, military retirement, black lung, and other recurring monthly income.
Countable annual income includes (but is not limited
to):
Wages/salary,
business/rental income, farm income, Indian income (M21-1, Part IV, 16.43 a-h),
interest/dividend income, Worker's Compensation, Unemployment Compensation,
insurance payments or dividends.
What Income is
Excludable?
(What does not count as
income?) M21-1, Part IV, 16.41a-b; 38 CFR 3.271-2
Exclusions include
(but are not limited to):
SSI (Supplemental Social
Security), maintenance (room and board), proceeds of casualty insurance, profit
from occasional sale of property, agent orange settlement payments, royalties
for extracting minerals from the ground, income tax refunds, withheld Social
Security, interest on IRA's (Individual Retirement Accounts), and scholarships
and grants for school attendance (if not in excess of actual expenses), redress
payments to WWII Japanese internees, and interest on irrevocable burial trusts.
Income Classifications: one time, recurring, non-recurring
M21-1, Part IV, 16.22
Income Reporting
Periods:
M21-1, Part III, 7.01e
Income of Parents:
Dependency and Indemnity Compensation (DIC)
38 CFR 3.251
Income Verification Match
(IVM):
VBA Circulars 20-91-11R (2-22-93), 21-92-7, paragraph
2e,
Fast Letter 3-54
Deductible Expenses:
M21-1, Part IV, 16.30
Development of Medical
Expenses:
38 CFR 3.262 and 3.272
M21-1, Part III, 7.06
Prospective Medical
expenses: M21-1, Part IV, 16.31(10)(d)
M21-1, Part III, 7.06
List of possible Medical
expenses:
M21-1, Part IV, Chapter 16,
Addendum A)
Development of Final
Expenses:
M21-1, Part III, 7.07
M21-1, Part IV, 16.32
Development of
Educational Expenses:
M21-1, Part III, 7.08
M21-1, Part IV, 16.34b
Development of Child
Hardship Exclusion:
M21-1, Part III, 7.09
M21-1, Part IV, 16.34c
Net Worth Development:
M21-1, Part III, 7.10
The basic issue in
evaluating net worth is whether or not the claimant's financial resources are
sufficient to meet the claimant's basic needs without assistance from VA.
No specific dollar amount
can be designated as excessive net worth. What constitutes excessive net worth
is a question of fact for resolution after consideration of the facts and
circumstances in each case.
Net worth includes the value
of real estate (except the claimant's single family dwelling), value of
personal property, cash, stocks, bonds, bank accounts, CD's, IRA's, Mutual
funds, Keoghs, business assets and any other property.
If net
worth is over $50,000, send claimant VA Form 21-8049. (For $50,000 limit, see
change 52 dated 5-19-94, M21-1, Part IV).
Section II
Compensation
A. Background II-1
B. Developing Original
(EP 010 or 110) II-6
C. Developing Reopened
Claims (EP 020) II-8
1. Condition previously
denied II-8
2. Condition not
previously denied (new) II-9
3. Claim for increase
II-9
D. Specific Claims Issues
II-10
1. Exposure to Herbicide
Agents II-11
2. Asbestos II-14
3. POW claims II-15
4. Mustard Gas II-17
5. Post Traumatic Stress
Disorder II-19
6. Radiation Exposure
II-24
7. Conditions Secondary
to Drug/Alcohol II-28
8. Smoking II-29
9. 1151 Claims II-30
10. Toxic Chemical
Exposure Claims II-32
11. HIV/AIDS II-33
12. PGW/Environmental
Agents II-34
A. Background
A decision to establish service connection is in order
if the facts, shown by the evidence, establish that a particular injury or
disease resulting in disability was incurred coincident with service in the
Armed Forces, or, if preexisting such service, was aggravated while in service.
The development of evidence
to support a determination of service connection may include four elements:
1. Service Medical Records
2. Continuity - evidence of
ongoing treatment from military service to present.
3. First treatment -
evidence to show the first treatment for the claimed disability following
service.
4. Recent treatment -
evidence to show recent treatment and current severity for the claimed
condition. In many cases this will be a VA examination.
5. In the case of
preexisting conditions, request treatment prior to service.
Service Medical Records (SMR)
In all cases you will need SMRs.
Continuity
You may need evidence of
continuity of treatment (treatment since discharge.). The request for continuity
will depend on whether the disability is chronic in nature.
Chronicity may be established in one of three ways:
1. By definition
(regulation): 38 CFR 3.309 defines those conditions that are chronic by
definition. If these conditions are shown to exist in service or manifested to
a compensable degree within the presumptive period (generally one year)
following service, service connection is generally warranted. In this situation
continuity of treatment for the claimed condition after service is not
required. However, you may need to request evidence of treatment within the
first year following military service.
2. By traumatic injury or
surgical treatment in service with probable residuals. The residual can be
as simple as a surgical scar. Examples include a shell fragment wound, a
fractured bone, or a hernia repair. In this situation, continuity of treatment
for the claimed condition after service is not required.
3. By repeated
occurrences or episodes: 38 CFR 3.303(b) provides: for the showing of a
chronic disease in service there is required a combination of manifestations
sufficient to identify the disease entity, and sufficient observation to
establish chronicity at the time, as distinguished from merely isolated
findings, or a diagnosis including the word chronic. When the
disease entity is established (See 38 CFR 3.309), there is no requirement of
evidentiary showing of continuity.
Continuity of
symptomatology is required only where
the condition noted during service (or in the presumptive period) is not, in
fact, shown to be chronic as stated in 1, 2 and 3 above. Examples of non
chronic conditions include pneumonia, acute low back strain or acute
bronchitis.
Requests for Continuity
of Treatment: In those cases where
the claimed disability is shown to be chronic in nature, you do not
need to request continuity of treatment.
First Treatment
Evidence to show first
treatment following service will be used to identify the first manifestations
and medical treatment for the claimed conditions.
Recent Treatment
You may need recent treatment depending on how long
after service the claim for service connection is made. In those cases where
the claim is filed shortly (within 6 months) after discharge, there is no need
to request evidence of recent treatment. If the appropriate information and
release forms are provided on the application, action should be taken to ensure
all available evidence is of record when the decision is made. This ensures we
have met our duty to assist as defined by the Court of Veterans Appeals.
Direct Service Connection
A disability determined to
be service-connected due to service or aggravated by service. It is either
shown in the SMR treatment record, or on discharge exam. VA exam may be requested
to establish current level of disability or residual of an acute disease or
injury.
Direct service connection
may also be established for a condition which existed prior to entry into
service (EPTE) and was aggravated beyond its natural progression during the
veteran's period of service. (38 CFR 3.304 and 3.305)
Presumptive Service Connection:
A disability may be
service-connected if it falls into certain categories and was incurred during
time frames established by legislation.
Chronic diseases may be service-connected if they are manifest to a percent of 10% or more within 1 year of discharge. Tuberculosis and Hansen's Disease may be service connected if it is manifest to a percent of 10% or more within 3 years of discharge and Multiple Sclerosis if mani