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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 manifest to a percent of 10% or more within 7 years.
38 CFR 3.309(a)
Tropical diseases may be service-connected if manifest within 1 year of discharge or due to the administration of therapy or preventive therapy.
M21-1, Part IV, 5.05
38 CFR 3.307
38 CFR 3.309(b)
38 USC 1112
Diseases specific to POWs may be service-connected if manifest to a percent of 10% or more anytime after discharge from service
38 CFR 3.307
38 CFR 3.309(c)
Diseases associated with Exposure to Certain Herbicides may be service-connected if a qualifying disability exists. Different time frames and percentage requirements exist for each new piece of legislation covering this area.
38 CFR 3.307(a)(6)
38 CFR 3.309(e)
Diseases associated with Exposure to Ionizing Radiation may be service-connected if a qualifying disability exists under one of two laws.
M21-1, III, 5.12
Fast Letter 3-126
38 CFR 3.309(d)
38 CFR 3.311
B. Developing Original (EP 010 or 110 series)
(38 CFR 3.170d(b))
The application should be reviewed to ensure veteran has claimed a disability. If no specific disability has been claimed, or the disability is unclear, the veteran should be asked for clarification. All other development should be requested at the same time.
Request SMRs (if not already in) in accordance with M21-1, Part V, Chapters 17.04 and 17.05 (Target 201 & 202 screens) and M21-1, Part III, Chapter 4 (address codes). A quick reference guide for address codes is provided at the end of this section. Veteran should be asked for any service medical records in his possession.
Develop for any necessary private medical treatment mentioned in the veteran's claim as follows:
1. If the veteran does not provide release forms for any claimed private treatment, send the necessary number of VA Form 21-4142 to the veteran via the Target 203 screen.
2. If release forms are provided for private treatment records, send the forms along with VA Form Letters 21-104 or 21-107 or local letter, as appropriate to the hospital or doctor that provided the treatment. As a local option, a letter may be sent to the veteran at the same time, requesting assistance from the veteran in obtaining the medical evidence.
3. If the doctor or hospital does not respond within 60 days, request the veteran to assist in obtaining the records by using the Hospital/Doctor field on the Target 203 screen. Enter the appropriate hospital or doctor in the required field.
Request any necessary reports from any claimed VA treatment via a hard copy 7131 or AMIE request as appropriate.
If any condition is one listed under Specific Claims Issues follow the steps listed for that type of claim in addition to development needed for any other claimed disabilities.
If veteran is more than one year from discharge or the condition is not presumptive for the type of claim filed and supporting private medical information is not provided, request Treatment Since Discharge on the Target 203 screen.
If veteran's SMRs do not show treatment for the claimed condition or the veteran specifically states that no treatment was received in service, request Treatment For on the Target 203 screen.
If veteran's service falls within a possible fire related period, send a NA Form 13055 to the veteran and develop for alternate sources. Any alternate sources that may have been identified on the application should be developed at the same time.
If veteran indicates treatment at a military hospital subsequent to service, request the records using VA Form 21-8359 if appropriate.
If claim involves injuries from a vehicle accident, request Line of Duty (LOD) determination from the service department if it appears line of duty is an issue and request Accident from veteran on Target 203 screen.
If civilian authorities may have been involved, send a request for the police report.
If reserve or national guard duty is involved, request verification of active duty dates and ask veteran to provide proof of duty status when disability was incurred.
After development is complete, claim should be forwarded to the Rating Activity for review of development and consideration for exam.
C. Developing Re-opened Service Connected Claims (EP 020 series)
1. Condition previously denied service connection :
With the exception of reopened PTSD claims, if the veteran does not submit new and material evidence to reopen claim, inform veteran that claim was previously disallowed, the date of the disallowance and the reasons for disallowance. Veteran should be informed he must submit new and material evidence to reopen claim. He should be given 60 days to submit the new and material evidence. The claim should be kept under end product control.
If the veteran submits medical evidence, the case should be referred to the rating board to determine if evidence is new and material.
If veteran indicates where to obtain new and material evidence to reopen claim, develop for any relevant private medical treatment mentioned in the veteran's claim if it is not already of record as follows:
If the veteran does not provide release forms for any claimed private treatment, send the necessary number of VA Form 21-4142 to the veteran via the Target 203 screen.
If release forms are provided for private treatment records, send the forms along with VA Form Letters 21-104 or 21-121 or local letters as appropriate to the hospital or doctor that provided the treatment. As a local option, a letter may be sent to the veteran at the same time, requesting assistance from the veteran in obtaining the medical evidence.
If the doctor or hospital does not respond within 60 days, request the veteran to assist in obtaining the records by using the Hospital/Doctor field on the Target 203 screen. Enter the appropriate hospital or doctor in the required field.
Request reports of any claimed VA treatment which is not already of record via AMIE or VA Form 10-7131 if necessary.
2. Condition not previously denied service connection (i.e. a new condition):
Develop as if for an original service connection claim (See B in this section)
3. Condition already service connected (Claim for increase):
If veteran does not indicate any treatment for a service connected disability, use the Target 208 screen Request for evidence SC increase claimed field.
Develop for any recent (treatment in preceding year) private medical treatment mentioned in the veteran's claim if it is not already of record as follows:
If the veteran does not provide release forms for any claimed private treatment, send the necessary number of VA Form 21-4142 to the veteran via the Target 203 screen.
If release forms are provided for private treatment records, send the forms along with VA Form letters 21-104 or 21-107 or local letter, as appropriate to the hospital or doctor that provided the treatment. As a local option, a letter may be sent to the veteran at the same time, requesting assistance from the veteran in obtaining the medical evidence.
If the doctor or hospital does not respond within 60 days, request the veteran to assist in obtaining the records by using the "Hospital/Doctor" field on the Target 203 screen. Enter the appropriate hospital or doctor in the required field.
Request reports of any claimed VA treatment which is not already of record by using a hard copy 7131 or AMIE request as appropriate.
Do not request Treatment Since Discharge. Continuity is not an issue for a condition which is already service connected.
D. SPECIFIC CLAIMS ISSUES
Issues in which specialized development are needed and the issues are of special interest to the Department or Congress.
Some issues are monitored using the Special Issue Rating System (SIRS).
Terminal digits on end products are used to designate some issues.
2 - Ionizing Radiation
3 - POW
4 - PTSD
5 - Exposure to Herbicide Agents
9 - Persian Gulf War (PGW)
The SIRS system allows entries for asbestos, HIV/AIDS, Exposure to Herbicide Agents, POW, PTSD, and Ionizing Radiation claims.
Other Specific Claims Issues addressed in this section include:
Toxic Chemical Exposure Claims
Smoking/Tobacco claims
Mustard Gas Claims
Persian Gulf War claims to include Environmental Agent Exposure
M21-1, Part V, Chapter 14
1. Exposure to Herbicide Agents:
If a specific disability is not claimed, request Nature of Disability via the Target 203 screen.
If the claimed disability is not a qualifying disability recognized as a presumptive residual of exposure to herbicide agents, consider the claim for direct service connection and develop as necessary.
Those conditions which are associated with exposure to herbicide agents are as follows:
* Chloracne or other acne form disease consistent with chloracne
* Hodgkin's disease
* Non-Hodgkin's Lymphoma
* Porphyria cutanea tarda (a skin condition)
* Multiple Myeloma
* Respiratory cancers (cancer of the lung, bronchus, larynx or trachea)
* Soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma,
Kaposi's sarcoma, or mesothelioma)
NOTE: The term soft-tissue sarcoma includes the following:
Rhabdomysarcoma
Ectomesenchymoma
Malignant glomus tumor
Malignant hemangiopericytoma
Synovial sarcoma (malignant synovioma)
Malignant giant cell tumor of tendon sheath
Malignant Schwannoma
Malignant mesenchymoma
Congenital and infantile fibrosarcoma
Epithelioid sarcoma
Adult fibrosarcoma
Dermatofibrosarcoma protuberans
Malignant fibrous histiocytoma
Liposarcoma
Leiomyosarcoma
Malignant granular cell tumor
Alveolar soft part sarcoma
Extraskeletal Ewing's sarcoma
Malignant ganglioneuroma
Epithelioid Leiomysarcoma (malignant meiomyblastoma)
Angiosarcoma (hemangiosarcoma and lymphangiosarcoma)
Proliferating (systemic) angioendotheliomatosis
Clear cell sarcoma of tendons and aponeuroses
Develop for:
Proof of exposure
Service in the Republic of Vietnam
Includes the waters offshore
Service in other countries if the conditions of service involved duty or visitation in the Republic of Vietnam
If no evidence of Vietnam service is present, request personnel file/201 file from appropriate address code.
Exposure is conceded if proof of service in the Republic of Vietnam is shown. No special development letter is required. If a veteran served in Vietnam or the adjacent waters, it is presumed he/she was exposed to herbicide agents.
Disability claimed as a residual to the exposure.
Develop any medical evidence if need to do so is indicated.
Notify veteran he may have an Exposure to Herbicide Agents Protocol exam at any VA Medical Center. If veteran has had one they should notify VARO.
Obtain copy of Exposure to Herbicide Agents Protocol exam if indicated.
References:
38 USC 1116
38 CFR 3.307(a)(6)
38 CFR 3.309(e)
38 CFR 3.313
M21-1, Part III, 5.10
VBA Circular 21-94-1
3. POW Claims:
Verify the veteran's POW status through the service department. Obtain POW internment dates and place.
If the location of internment was in a neutral or allied country, develop information concerning conditions of the internment.
If the claimed disability is a presumptive condition for former POWs, no development is required to establish continuity. POW presumptive conditions are as follows:
Avitaminosis
Beriberi (including Beriberi heart disease)
Chronic dysentery
Helminthiasis
Malnutrition (including optic atrophy associated with malnutrition)
Pellagra
Any other nutritional deficiency
Psychosis
Any of the anxiety states
Dysthymic disorder (or depressive neurosis)
Organic residuals of frostbite (provided veteran was in such a climate)