PartIII,Subpartii,Chapter,SectionBOriginal

1、M21-1MR, Part III, Subpart ii, Chapter 2, Section BSection B. Original Disability ClaimsOverviewIn this SectionThis section contains the following topics:TopicTopic NameSee Page6Identification of Original Disability Claims2-B-27Policies Regarding Original Disability Claims2-B-68Claims Filed Prior to

2、, or at the Time of, Separati on From Active Duty2-B-102-B-1M21-1MR, Part III, Subpart ii, Chapter 2, Section B6. Identification of Original Disability Claims,Con ti nued6. Identification of Original Disability ClaimsIntroductionThis topic contains general policies for handling original disability c

3、laims, in cludi ng* what constitutes an original claim by a Veteran* identifying an original disability claim* determining the type of claim* letters, memora ndums, and other com muni cati ons from claima nts, and* injury due to hospital treatment.Change DateSeptember 30, 2010a. What Constitutes an

4、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 Departme nt of Vetera ns Affairs (VA). For Vetera ns, the prescribed form isVA Form 21-526, Vetera n s Applicati on for Compe nsati on or Pen sionb. Identifyi

5、ng an Original Disability ClaimDepending on the claimant s manner of prepardtibei interpretation bythe Vetera ns Service Represe ntative (VSR) of the claima ntVA Forms intent,21-526, constitutes an original claim for* disability compensation* disability pension, or* both.Note If any doubt exists as

6、to which ben efit the claima nt seeks, ask the claimant for clarification.Contin ued on n ext pagec. Determining the Type of ClaimUse the table below to determine the type of disability claim filed onVA Form 21-526.If the applicantThen consider the application a claim for provides information claimi

7、ng inservice treatme nt for-sick ness-disease, or-injury, or claims to be totally disabled and fur ni shes in formatio n about-employme nt, and-in comecompe nsati onand vides information claiming in service treatme nt for sick ness disease, or in jurycompe nsati ononly. claims to be total

8、ly disabled without in dicat ing that this was due to military service, and fur ni shes in formatio n about-employme nt, and-in comepensiononly.Contin ued on n ext pagec. Determining the Type of Claim (continued)If the applicantThen consider the application a claim for provides in formati on about d

9、en tal treatme ntonlyden tal treatme nton ly.Note Un less the Vetera n specifically claims serviceconn ected compe nsati on due to den tal trauma, refer theVA Form 21-526, or any other form of com muni catio n in dicati ng a den tal claim, to the eligibility clerk of the VA medical cen ter (VAMC) of

10、 jurisdiction for a determ in atio n of eligibility for den tal treatme nt.Reference For more in formati on on claims for a den tal con diti on only, see M21-1MR, Part III, Subpart v, 7.C.17 38 CFR 7.161, and *38 U.S.C. 1712(a)(1).d. Letters, Memorandums, and Other Communicatio ns From ClaimantsLett

11、ers, memora ndums, or other com muni cati ons from claima nts or their represe ntatives may be con siderefbrmal claims if they* request in creased ben efits* reopen previously denied claims, or* open a new claim.Note If the claima nt has already completed a prior formal applicati on, he/she does not

12、 n eed to complete ano ther.Reference For more in formati on on reope ned claims, see *38 CFR .155* 38 CFR .160, and* M21-1MR, Part III, Subpart ii, 2.E .e. Injury Due to Hospital TreatmentCon sider, as an in formal claim for ben efits un der38 U.S.C. 1 51, any stateme nt show ing an intent to file

13、a claim for ben efits result ing from* hospital, medical or surgical treatment by VA* exam in ati on 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, Ap

14、plicatio n for Depe ndency and In dem nityCompe nsati on or Death Pension and Accrued Ben efits by a Surviving Spouse or Child, or* VA Form 21-535, Applicatio n for Depe ndency and In dem nity Compe nsati on by Pare nt(s).Note If an in dividual or his/her represe ntative files an in formal claim, se

15、nd him/her the appropriate application form.Reference For more information, see38 CFR 3.154.2-B-5M21-1MR, Part III, Subpart ii, Chapter 2, Section B7. Policies Regarding Original Disability Claims,Co nti nued7. Policies Regarding Original Disability ClaimsIntroductionThis topic contains policy infor

16、mation regarding original disability claims, in cludi ng* general policy on providing and completing the appropriate VA form* provid ing an applicati on for ben efits upon receipt of a Notice of Death (NOD)* circumstances under which an application is not routinely sentinformation to include on a fo

17、rm before furnishing the form to a claimant* information required on VA Form 21-526 for a substantially complete claim* sig natures by mark or thumbpri nt* facsimile sig natures with claims* photocopies of sig natures* obsolete application forms* dependency issues, and* claims establishment.Change D

18、ateSeptember 30, 2010a. General Policies on Providing and Completing the Appropriate VA FormIf requested, provide the appropriate applicati on to any pers on appl ying for ben efits, per38 CFR 3.150.Per 38 U.S.C. 5101, an in dividual must file a specific claim on the form prescribed by the Secretary

19、 in order to receive ben efits from VA.Reference For a list of formal application forms, seeM21-1MR, Part III, Subpart ii, 2.B.6.eContin ued on n ext pageb. 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 app

20、ropriate applicati on to prospective claima nts whose n ames and addresses are of record, for completi on by, or on behalf, of any depe ndent who has appare nt en titleme nt to* burial ben efits* death pension* dependency and indemnity compensation (DIC), or* educatio nal ben efits un der38 U.S.C. C

21、hapter 35Note If an accrued ben efit is payable, but there is no in dicati on that anyone is en titled to any other ben efit, forward the appropriate applicati on form to the preferred depe ndent and in dicate the time limit for receipt of the applicatio n.c. Circumstances Under Which an Application

22、 Is Not Routinely SentIf disability or death is due to VA hospital treatment, medical or surgical treatme nt, exam in atio n, or training, donot routi nely send an applicati on for ben efits.If, however, an in formal claim for ben efits has bee n filed and additi onal evide nee is required in order

23、to make a decisi on, send the appropriate application form to the claimant.d. Information to Include on a Form Before Furnishing the Form to a ClaimantBefore furnishing an application to a claimant in person, enter the following information in the spaces provided on the form:* the Veteran s name, an

24、d* the Veteran s file number.Rationale: This action helps to ensure ready identification and later associati on with the claims folder.Contin ued on n ext page2-B-9e. Information Required on VA Form 21526 for a Substantially Complete ClaimVA Form 21-526 constitutes a substantially complete applicati

25、on for disability ben efits if it contains:* the claimant s name* sufficient service information for VA to verify the claimed service* ide ntificati on of the ben efit sought* identification of medical condition(s) on which the claim is based* sig nature of the Vetera n (or the Vetera n s mark or th

26、umb prin t), and* a stateme nt of in come (if claim is for non service-c onn ected pension).f. Signatures by Mark or ThumbprintVA accepts sig natures by mark or thumbpri nt if they are* witnessed by two people who sign their names and give their addresses* wit nessed by an accredited age nt, attor n

27、ey, or service orga ni zati on represe ntative* certified by a notary public or any other person having authority to adm ini ster oaths for gen eral purposes, or* certified by a VA employee who has been given authority by the Secretary under 38 CFR .3.g. Facsimile Signatures With ClaimsVA may accept

28、 a claim and sig nature received via facsimile (fax). Un less there is some questi on as to the validity of the docume nt or sig nature, a faxed sig nature may be con sidered to meet the defi niti on of a sig nature for a substantially complete 即plication under38 CFR 3.159(a)(3).h. Photocopies of Si

29、gnaturesGen erally, photocopies of sig natures may be accepted in lieu of origi nal sig natures. However, un der38 CFR 3.217(a) Note, an origi nal sig nature should still be required for situati ons in which* regulati on expressly requires sig nature or certificati on on docume nts, or* the document

30、 is of questionable origin or authenticity.h. Photocopies of Signatures (continued)References For examples of regulati ons perta ining to the n eed for orig inal sig natures or certificatio n of stateme nts, see 38 CFR .203(a)(1), and 38 CFR .204(c).i. Obsolete Application FormsUpon receipt of a cla

31、im for disability compensation or pension filed on an obsolete applicatio n form* consider the claim valid, and* determine if it is necessary to request completion of VA Form 21-526 or ano ther form in order to obta in additi onal evide nee n ecessary for completi on of the claim.j. Dependency Issue

32、sThe table below in dicates whether depe ndency is a factor in determ ining en titleme nt to* compensation only, andk. Claims Establishment* pension only.Type of ClaimDependency PolicyCompe nsati ononlyDependency isnot an entitling factor.PensiononlyDependencyis an entitling factor.The date of claim

33、 for claims establishment is theearliest date any VA facility actually received the claim.Example If a VA medical cen ter or ano ther regi onal 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 esta

34、blishment is October 14, 2006.M21-1MR, Part III, Subpart ii, Chapter 2, Section B8. Claims Filed Prior to, or at the Time of, Separation FromActive Duty, Contin uedIntroductionThis topic contains information on original disability claims filed prior to, or at the time of, discharge from active duty,

35、 in cludi ng* where to find in formatio n on Ben efits 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* servic

36、eperson on active duty whose separation date is unknown* hospitalized by VA awaiting separation* priority handling of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) servicepers on or seriously ill servicepers on* claims establishment, and* date of claim.Change DateSeptember 30, 2010a.

37、Where to Find Information on BDD and Other Pre-Discharge ProgramsDetailed in formatio n about Ben efits Delivery at Discharge (BDD), Quick Start, or Disability Evaluation System (DES) programs, uniquely designed to han dle pre-discharge disability claims, is not in cluded in this topic. This topic p

38、rovides gen eral in formati on on han dli ng aVA Form 21-526 if received at an RO prior to the date of discharge of the serviceperson. See the following refere nces for more in formatio n on pre-discharge disability claim programs:* M21-1MR, Part III, Subpart i, 2.A , includes a description of-BDD c

39、laims-non-BDD pre-discharge (Quick Start) claims-hospitalized serviceperson claims-unsolicited pre-discharge claims, and-Operati on Iraqi Freedom/Operati on En duri ng Freedom (OIF/OEF) claims.* M21-1MR, Part III, Subpart iv, 3.A.4 , includes a description of the BDD exam in ati on programb. Handlin

40、g VA Form 21526c. VA Form 21526 Not ofRecordd.Serviceperson on Active Duty Whose Separation is ImminentGen erally, if the regular servicepers on, reserve member, or guard member submits aVA Form 21-526 with the service department prior to or at the time of separatio n, the applicati on would be han

41、dled as a BDD or non-BDD predischarge claim. The RO and BDD In take Site resp on sibilities for han dli ng pre-discharge claims are discussed iM21-1MR, Part III, Subpart i, 2.B.Reference For more in formatio n on RO resp on sibility for han dli ng predischarge claims, seeM21-1MR, Part III, Subpart i

42、, 2.B.6.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 inM21- 1MR, Part III, Subpart ii, 2.D.17.C.Gen erally, follow the steps in the table below upon receipt oVA Form 21526 for a servicepers on stil

43、l on active duty, whose separati on is imminent. For detailed instructions on handling a claim for a serviceperson whose discharge is immi nent, seeM21-1MR, Part III, Subpart i, 2.B.4.Definition:“Imminent ” means reaayet place. For the purposes of thistopic, separati on occurri ng with in 60 days is

44、 con sidered imminent.StepAction1* Establish a corporate record in Share,-using end product (EP) 017,117, or 027, and-selecting the-disPharge ” indicator.* Establish a pending diary due date for the day after the an ticipated date of release from active duty.2Build a claims folder.3* Write to the cl

45、aimant to- provide the Vetera ns Claims Assista nee Act (VCAA) no tificati on and VCAA Notice Resp onse- request verificatio n of service, specifically a DD Form 214, Certificate of Release or Discharge from Active Duty and- expla in that VA cannot pay compe nsatio n to a pers on still on active dut

46、y.Contin ued on n ext page2-B-11M21-1MR, Part III, Subpart ii, Chapter 2, Section B8. Claims Filed Prior to, or at the Time of, Separation FromActive Duty, Contin uedd. Serviceperson on Active Duty Whose Separation is Imminent (con ti nued)StepAction4Deny the claim 60 days following the anticipated

47、date of separati on, if* the claima nt does not submit evide nce to verify separati on from service, or* service data is un available in the Vetera ns In formatio n Soluti on (VIS) system.Note VIS is a web-based application that provides VA with access to data from the Defense En rollme nt Eligibili

48、ty Registrati on System (DEERS). Verificati on of service may be obta ined through VIS.References For more in formati on on* VIS, see theVIS User Guide, and* Share, see thdBhare User Guideand updated information via the applicati on help menu.e.Serviceperson on Active Duty Whose Separation is Not Im

49、minentUpon receipt of VA Form 21-526 for a servicepers on still on active duty, whose separatio n 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/RET

50、IRED PAY, and* properly no tify claima nt of reas on for deni al.f.Serviceperson on Active Duty Whose Separation Date is UnknownUpon receipt of VA Form 21-526 for a servicepers on still on active duty, whose separatio n date is unknown, write to the claima nt to* explain that VA cannot pay compensation for a person still on active duty, and* request that aDD Form 214 be submitted upon discharge from active duty.Contin ued on n ext page2-B-#M21-1MR, Part III, Subpart ii, Chapter 2, Section B8. Claims F