M21-1MR, Part III, Subpart II, Chapter 2, Section B




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M21-1MR, Part III, Subpart ii, Chapter 2, Section B

Section B. Original Disability Claims

Overview




In this Section

This section contains the following topics:




Topic

Topic Name

See Page

6

Identification of Original Disability Claims

2-B-2

7

Policies Regarding Original Disability Claims

2-B-6

8

Claims Filed Prior to, or at the Time of, Separation From Active Duty

2-B-10



6. Identification of Original Disability Claims




Introduction

This topic contains general policies for handling original disability claims, including


  • what constitutes an original claim by a Veteran

  • identifying an original disability claim

  • determining the type of claim

  • letters, memorandums, and other communications from claimants, and

  • injury due to hospital treatment.



Change Date

September 30, 2010



a. What Constitutes an Original Claim by a Veteran?

Per 38 CFR § 3.160, an original claim is an initial formal application on a form prescribed by the Secretary of the Department of Veterans Affairs (VA). For Veterans, the prescribed form is VA Form 21-526, Veteran’s Application for Compensation or Pension.



b. Identifying an Original Disability Claim

Depending on the claimant’s manner of preparation and the interpretation by the Veterans Service Representative (VSR) of the claimant’s intent, VA Form 21-526, constitutes an original claim for


  • disability compensation

  • disability pension, or

  • both.


Note: If any doubt exists as to which benefit the claimant seeks, ask the claimant for clarification.

Continued on next page

6. Identification of Original Disability Claims, Continued


c. Determining the Type of Claim

Use the table below to determine the type of disability claim filed on VA Form 21-526.



If the applicant …

Then consider the application a claim for …

  • provides information claiming in-service treatment for

  • sickness

  • disease, or

  • injury, or

  • claims to be totally disabled and furnishes information about

  • employment, and

  • income

compensation and pension.

provides information claiming in service treatment for


  • sickness

  • disease, or

  • injury

compensation only.

  • claims to be totally disabled without indicating that this was due to military service, and

  • furnishes information about

  • employment, and

  • income

pension only.

Continued on next page

6. Identification of Original Disability Claims, Continued



c. Determining the Type of Claim (continued)




If the applicant …

Then consider the application a claim for …

provides information about dental treatment only

dental treatment only.
Note: Unless the Veteran specifically claims service-connected compensation due to dental trauma, refer the VA Form 21-526, or any other form of communication indicating a dental claim, to the eligibility clerk of the VA medical center (VAMC) of jurisdiction for a determination of eligibility for dental treatment.
Reference: For more information on claims for a dental condition only, see

  • M21-1MR, Part III, Subpart v, 7.C.17

  • 38 CFR § 17.161, and

  • 38 U.S.C. § 1712(a)(1).


d. Letters, Memorandums, and Other Communications From Claimants

Letters, memorandums, or other communications from claimants or their representatives may be considered formal claims if they



Note: If the claimant has already completed a prior formal application, he/she does not need to complete another.
Reference: For more information on reopened claims, see

  • 38 CFR § 3.155

  • 38 CFR § 3.160, and

  • M21-1MR, Part III, Subpart ii, 2.E.

Continued on next page

6. Identification of Original Disability Claims, Continued


e. Injury Due to Hospital Treatment

Consider, as an informal claim for benefits under 38 U.S.C. § 1151, any statement showing an intent to file a claim for benefits resulting from


  • hospital, medical or surgical treatment by VA

  • examination by VA, or

  • pursuit of a course of vocational rehabilitation.

Such a claim may also be filed as a formal claim on




  • VA Form 21-526, Veteran’s Application for Compensation or Pension.

  • VA Form 21-534, Application for Dependency and Indemnity Compensation or Death Pension and Accrued Benefits by a Surviving Spouse or Child, or

  • VA Form 21-535, Application for Dependency and Indemnity Compensation by Parent(s).


Note: If an individual or his/her representative files an informal claim, send him/her the appropriate application form.
Reference: For more information, see 38 CFR § 3.154.



7. Policies Regarding Original Disability Claims




Introduction

This topic contains policy information regarding original disability claims, including


  • general policy on providing and completing the appropriate VA form

  • providing an application for benefits upon receipt of a Notice of Death (NOD)

  • circumstances under which an application is not routinely sent

  • information to include on a form before furnishing the form to a claimant

  • information required on VA Form 21-526 for a substantially complete claim

  • signatures by mark or thumbprint

  • facsimile signatures with claims

  • photocopies of signatures

  • obsolete application forms

  • dependency issues, and

  • claims establishment.



Change Date

September 30, 2010



a. General Policies on Providing and Completing the Appropriate VA Form

If requested, provide the appropriate application to any person applying for benefits, per 38 CFR § 3.150.
Per 38 U.S.C. § 5101, an individual must file a specific claim on the form prescribed by the Secretary in order to receive benefits from VA.
Reference: For a list of formal application forms, see M21-1MR, Part III, Subpart ii, 2.B.6.e.

Continued on next page

7. Policies Regarding Original Disability Claims, Continued


b. Providing an Application for Benefits Upon Receipt of a Notice of Death (NOD)

Upon receipt of a Notice of Death (NOD) of a Veteran, send the appropriate application to prospective claimants whose names and addresses are of record, for completion by, or on behalf, of any dependent who has apparent entitlement to


  • burial benefits

  • death pension

  • dependency and indemnity compensation (DIC), or

  • educational benefits under 38 U.S.C. Chapter 35.


Note: If an accrued benefit is payable, but there is no indication that anyone is entitled to any other benefit, forward the appropriate application form to the preferred dependent and indicate the time limit for receipt of the application.



c. Circumstances Under Which an Application Is Not Routinely Sent

If disability or death is due to VA hospital treatment, medical or surgical treatment, examination, or training, do not routinely send an application for benefits.
If, however, an informal claim for benefits has been filed and additional evidence is required in order to make a decision, send the appropriate application form to the claimant.



d. Information to Include on a Form Before Furnishing the Form to a Claimant

Before furnishing an application to a claimant in person, enter the following information in the spaces provided on the form:


  • the Veteran’s name, and

  • the Veteran’s file number.


Rationale: This action helps to ensure ready identification and later association with the claims folder.

Continued on next page

7. Policies Regarding Original Disability Claims, Continued


e. Information Required on VA Form 21-526 for a Substantially Complete Claim

VA Form 21-526 constitutes a substantially complete application for disability benefits if it contains:


  • the claimant’s name

  • sufficient service information for VA to verify the claimed service

  • identification of the benefit sought

  • identification of medical condition(s) on which the claim is based

  • signature of the Veteran (or the Veteran’s mark or thumb print), and

  • a statement of income (if claim is for nonservice-connected pension).



f. Signatures by Mark or Thumbprint

VA accepts signatures by mark or thumbprint if they are


  • witnessed by two people who sign their names and give their addresses

  • witnessed by an accredited agent, attorney, or service organization representative

  • certified by a notary public or any other person having authority to administer oaths for general purposes, or

  • certified by a VA employee who has been given authority by the Secretary under 38 CFR § 2.3.



g. Facsimile Signatures With Claims

VA may accept a claim and signature received via facsimile (fax). Unless there is some question as to the validity of the document or signature, a faxed signature may be considered to meet the definition of a signature for a substantially complete application under 38 CFR § 3.159(a)(3).



h. Photocopies of Signatures

Generally, photocopies of signatures may be accepted in lieu of original signatures. However, under 38 CFR § 3.217(a) Note, an original signature should still be required for situations in which


  • regulation expressly requires signature or certification on documents, or

  • the document is of questionable origin or authenticity.






Continued on next page

7. Policies Regarding Original Disability Claims, Continued



h. Photocopies of Signatures (continued)

References: For examples of regulations pertaining to the need for original signatures or certification of statements, see

  • 38 CFR § 3.203(a)(1), and

  • 38 CFR § 3.204(c).



i. Obsolete Application Forms

Upon receipt of a claim for disability compensation or pension filed on an obsolete application form


  • consider the claim valid, and

  • determine if it is necessary to request completion of VA Form 21-526 or another form in order to obtain additional evidence necessary for completion of the claim.



j. Dependency Issues

The table below indicates whether dependency is a factor in determining entitlement to


  • compensation only, and

  • pension only.




Type of Claim

Dependency Policy

Compensation only

Dependency is not an entitling factor.

Pension only

Dependency is an entitling factor.



k. Claims Establishment

The date of claim for claims establishment is the earliest date any VA facility actually received the claim.
Example: If a VA medical center or another regional office (RO) received the claim on October 14, 2006, and then forwarded the claim to the RO establishing the pending issue, the date of claim for claims establishment is October 14, 2006.


8. Claims Filed Prior to, or at the Time of, Separation From Active Duty




Introduction

This topic contains information on original disability claims filed prior to, or at the time of, discharge from active duty, including


  • where to find information on Benefits Delivery at Discharge (BDD) and other pre-discharge programs

  • handling VA Form 21-526

  • VA Form 21-526 not of record

  • serviceperson on active duty whose separation is imminent

  • serviceperson on active duty whose separation is not imminent

  • serviceperson on active duty whose separation date is unknown

  • hospitalized by VA awaiting separation

  • priority handling of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) serviceperson or seriously ill serviceperson

  • claims establishment, and

  • date of claim.



Change Date

September 30, 2010



a. Where to Find Information on BDD and Other Pre-Discharge Programs

Detailed information about Benefits Delivery at Discharge (BDD), Quick Start, or Disability Evaluation System (DES) programs, uniquely designed to handle pre-discharge disability claims, is not included in this topic. This topic provides general information on handling a VA Form 21-526 if received at an RO prior to the date of discharge of the serviceperson. See the following references for more information on pre-discharge disability claim programs:


  • M21-1MR, Part III, Subpart i, 2.A, includes a description of

  • BDD claims

  • non-BDD pre-discharge (Quick Start) claims

  • hospitalized serviceperson claims

  • unsolicited pre-discharge claims, and

  • Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) claims.



Continued on next page

8. Claims Filed Prior to, or at the Time of, Separation From Active Duty, Continued


b. Handling VA Form 21-526

Generally, if the regular serviceperson, reserve member, or guard member submits a VA Form 21-526 with the service department prior to or at the time of separation, the application would be handled as a BDD or non-BDD pre-discharge claim. The RO and BDD Intake Site responsibilities for handling pre-discharge claims are discussed in M21-1MR, Part III, Subpart i, 2.B.
Reference: For more information on RO responsibility for handling pre-discharge claims, see M21-1MR, Part III, Subpart i, 2.B.6.



c. VA Form 21-526 Not of Record

If there is an indication that a claimant filed VA Form 21-526 at the RO, but the form is not of record, follow the lost claim procedures described in M21-1MR, Part III, Subpart ii, 2.D.17.c.



d. Serviceperson on Active Duty Whose Separation is Imminent

Generally, follow the steps in the table below upon receipt of VA Form 21-526 for a serviceperson still on active duty, whose separation is imminent. For detailed instructions on handling a claim for a serviceperson whose discharge is imminent, see M21-1MR, Part III, Subpart i, 2.B.4.
Definition: “Imminent” means ready to take place. For the purposes of this topic, separation occurring within 60 days is considered imminent.




Step

Action

1

  • Establish a corporate record in Share,

  • using end product (EP) 017, 117, or 027, and

  • selecting the “Pre-discharge” indicator.

  • Establish a pending diary due date for the day after the anticipated date of release from active duty.

2

Build a claims folder.

3

  • Write to the claimant to

  • provide the Veterans Claims Assistance Act (VCAA) notification and VCAA Notice Response

  • request verification of service, specifically a DD Form 214, Certificate of Release or Discharge from Active Duty, and

  • explain that VA cannot pay compensation to a person still on active duty.

Continued on next page

8. Claims Filed Prior to, or at the Time of, Separation From Active Duty, Continued



d. Serviceperson on Active Duty Whose Separation is Imminent (continued)




Step

Action

4

Deny the claim 60 days following the anticipated date of separation, if

  • the claimant does not submit evidence to verify separation from service, or

  • service data is unavailable in the Veterans Information Solution (VIS) system.




Note: VIS is a web-based application that provides VA with access to data from the Defense Enrollment Eligibility Registration System (DEERS). Verification of service may be obtained through VIS.
References: For more information on

  • VIS, see the VIS User Guide, and

  • Share, see the Share User Guide and updated information via the application help menu.


e. Serviceperson on Active Duty Whose Separation is Not Imminent

Upon receipt of VA Form 21-526 for a serviceperson still on active duty, whose separation is not imminent (60 days or more) and he or she is not participating in the BDD program or hospitalized awaiting separation,


  • establish EP 110 or 010

  • deny claim under reason code 19, ON ACTIVE DUTY/RETIRED PAY, and

  • properly notify claimant of reason for denial.



f. Serviceperson on Active Duty Whose Separation Date is Unknown

Upon receipt of VA Form 21-526 for a serviceperson still on active duty, whose separation date is unknown, write to the claimant to


  • explain that VA cannot pay compensation for a person still on active duty, and

  • request that a DD Form 214 be submitted upon discharge from active duty.

Continued on next page

8. Claims Filed Prior to, or at the Time of, Separation From Active Duty, Continued



f. Serviceperson on Active Duty Whose Separation Date is Unknown (continued)

Note: Do not establish EP control for receipt of service information. Since complete service information was not provided, the application is not substantially complete under 38 CFR § 3.159(a)(3).


g. Hospitalized by VA Awaiting Separation

Upon receipt of VA Form 21-526 for a serviceperson who is on active duty awaiting separation while hospitalized at a VA medical facility


  • place the application for benefits under EP 010 or 110 control, and

  • establish a diary for review at 45-day intervals until the separation from active duty is confirmed.


Note: The diary’s purpose is to determine the date of separation from service.



h. Priority Handling of OEF/OIF Veteran or Seriously Ill Serviceperson

Claims from regular serviceperson, reserve member, or guard members returning from deployment Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) and claims involving serious injuries or illness will receive priority handling. These claims may require case management.
Reference: For more information on handling priority claims, see M21-1MR, Part III, Subpart i, 2.A.1.f.


i. Claims Establishment

For establishment purposes, use the earliest date a VA facility received the claim.
Example: If a VA medical center (VAMC) or another RO received the claim first and forwarded it to the RO establishing the pending issue, use the date the VAMC or other RO received the claim.



j. Date of Claim

    The date of claim for determining the effective date for benefits will be the first day following separation from active military service.



2-B-


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