In This Section

Introduction

• description of PL 106-475, and
• amendment to
  • 38 U.S.C. 5102
  • 38 U.S.C. 5103, and
  • 38 U.S.C. 5103A.

Change Date

I.i.1.A.1.a.  Description of PL 106-475

• redefined the Department of Veterans Affairs’ (VA’s) duty to assist claimants in obtaining evidence necessary to substantiate a claim
• eliminated the requirement from Morton v. West, 12 Vet.App. 477 (1999), that a claimant must submit a well-grounded claim before VA can assist in developing the claim, and
• mandated specific notice requirements regarding information that is necessary to substantiate a claim.

• duty to notify under 38 U.S.C. 5103, see M21-1, Part III, Subpart i, 2.B
• duty to assist with obtaining records, see M21-1, Part III, Subpart i, 2.C, and
• duty to assist with providing a medical examination or opinion, see M21-1, Part IV, Subpart i, 1.A and B, and
• regulation on the duty to notify and duty to assist, see 38 CFR 3.159.

I.i.1.A.1.b.  Amendment to 38 U.S.C. 5102

• notify the claimant of the information necessary to complete the application, and
• to defer assistance until the claimant submits the information.

• screening applications for substantial completeness, see M21-1, Part II, Subpart iii, 1.C.1
• notification requirements for an incomplete application, see M21-1, Part II, Subpart iii, 1.C.2.b and c
• notification requirements for a request for application or an intent to file a claim, see M21-1, Part II, Subpart iii, 1.C.2.e, and
• prescribed forms to furnish claimants, see M21-1, Part II, Subpart iii, 1.A.1.a.

I.i.1.A.1.c.  Amendment to 38 U.S.C. 5103

• M21-1, Part III, Subpart i, 2.B, and
• 38 CFR 3.159(b)(1).

I.i.1.A.1.d.  Amendment to 38 U.S.C. 5103A

• M21-1, Part III, Subpart i, 2.C, and
• M21-1, Part IV, Subpart i, 1.A and B, and
• 38 CFR 3.159(c).

Introduction

• PL 112-154, Section 504, authorization of use of electronic communication to provide notice to claimants for benefits, and
• PL 112-154, Section 505, duty to assist claimants in obtaining private records.

Change Date

I.i.1.A.2.a.  PL 112-154, Section 504, Authorization of Use of Electronic Communication to Provide Notice to Claimants for Benefits

• provide Section 5103 notices by the most effective means available, including electronic communications
• provide Section 5103 notices before, rather than after, the submission of a claim such as attaching the notice to an application
• eliminate the need to provide additional Section 5103 notices on subsequent claims if the same type of Section 5103 notice has already been provided on a current pending claim within the previous year, and
• utilize e-mails as a way to transmit Section 5103 notices; however, this is currently not a viable option due to privacy and security concerns.

• M21-1, Part III, Subpart i, 2.B, and
• 38 CFR 3.159(b).

I.i.1.A.2.b.  PL 112-154, Section 505, Duty to Assist Claimants in Obtaining Private Records

• make no less than two requests to a custodian of a private record (which was consistent with VA procedures prior to enactment of PL 112-154), and
• encourage claimants under VA regulations to submit relevant private medical records if such submission does not burden the claimant.

• M21-1, Part III, Subpart i, 2.C.2, and
• 38 CFR 3.159(c)(1).

Introduction

Change Date

I.i.1.A.3.a.  Impact of PL 115-55

I.i.1.A.3.b.  PL 115-55 and Duty to Notify

I.i.1.A.3.c.  PL 115-55 and Applicability of Duty to Assist

I.i.1.A.3.d.  PL 115-55 and Duty to Assist Errors

I.i.1.A.3.e.  PL 115-55 and Duty to Provide Decision Notice

• identification of the issues adjudicated
• a summary of the evidence considered
• a summary of the applicable laws and regulations
• identification of findings favorable to the claimant
• in the case of a denial, identification of elements not satisfied leading to the denial
• an explanation of how to obtain or access evidence used in making the decision
• if applicable, identification of the criteria that must be satisfied to grant service connection (SC) or the next higher level of compensation, and
• a summary of the applicable review options under 38 CFR 3.2500 available for the claimant to seek further review of the decision.

• required notice elements in
  • rating decisions, see M21-1, Part V, Subpart iv, 1.A
  • notification letters, see M21-1, Part VI, Subpart i, 1.B, and
  • administrative decisions, see M21-1, Part X, Subpart v, 1.C, and
• favorable findings, see M21-1, Part V, Subpart iv, 1.A.5.

Introduction

• definition of relevant records
• refraining from or discontinuing assistance
• claims that are inherently incredible or lack merit, and
• definition of
  • competent medical evidence
  • competent lay evidence
  • substantially complete application
  • event
  • information
  • an initial claim
  • a supplemental claim, and
  • reopened claim.

Change Date

I.i.1.A.4.a.  Definition:  Relevant Records

• relate to the disability or injury, or pension or Dependency and Indemnity Compensation (DIC) claim for which the claimant is seeking benefits, and
• have a reasonable possibility of helping to substantiate the claim.

• M21-1, Part III, Subpart i, 2.E, and
• Golz v. Shinseki,  590 F.3d 1317, 1320-21 (Fed. Cir. 2010).

I.i.1.A.4.b.  Refraining From or Discontinuing Assistance

• the claimant’s ineligibility for the benefit sought because of lack of qualifying service, lack of Veteran status, or other lack of legal eligibility
• claims that are inherently incredible or clearly lack merit, and
• an application requesting a benefit to which the claimant is not entitled as a matter of law.

• circumstances where VA will refrain from or discontinue providing assistance, see 38 CFR 3.159(d)
• determining Veteran status and eligibility for benefits, see M21-1, Part III, i.1, and
• inherently incredible claims, see M21-1, Part I, Subpart i,1.A.4.c.

I.i.1.A.4.c.  Claims That Are Inherently Incredible or Lack Merit

• A claimant alleges her service-connected tinnitus caused her hammertoes, but she furnishes no medical evidence to support this allegation.
• A Veteran claims he developed posttraumatic stress disorder as a result of combat service in the Republic of Vietnam, but military records clearly show he had no foreign or combat service.

• claims that are inherently incredible or lack merit, see 38 CFR 3.159(d), and
• notification requirements for claims that are inherently incredible or lack merit, see M21-1, Part II, Subpart iii, 1.C.2.f.

I.i.1.A.4.d.  Definition:  Competent Medical Evidence

I.i.1.A.4.e.  Definition:  Competent Lay Evidence

• accept it at face value unless there is reason to question it, and
• when conflicting evidence exists, weigh all the evidence as appropriate.

I.i.1.A.4.f.  Definition:  Substantially Complete Application

• the claimant’s name
• the claimant’s relationship to the Veteran, if applicable
• sufficient service information for VA to verify the claimed service, if applicable
• the benefit sought and any medical condition(s) on which it is based
• the claimant’s signature
• a statement of income in claims for Veterans Pension or Survivors Pension and Parents’ DIC
• identification or inclusion of potentially new evidence in supplemental claims, and
• for HLRs, identification of the date of the decision for which review is sought.

• the criteria for substantially complete applications, see
  • 38 CFR 3.159(a)(3), and
  • M21-1, Part II, Subpart iii, 1.C.1, and
• signature requirements, see M21-1, Part II, Subpart i, 2.B.2.

I.i.1.A.4.g.  Definition:  Event

I.i.1.A.4.h.  Definition:  Information

I.i.1.A.4.i.  Definition:  Initial Claim

• the first filing by a claimant (original claim), and
• a subsequent claim filed by a claimant for
  • an increase in a disability evaluation
  • a new benefit, or
  • a new disability.

• substantially complete claims, see
  • 38 CFR 3.159(a)(3), and
  • M21-1 Part I, Subpart i, 1.A.4.f
• initial claims, see 38 CFR 3.1(p)(1), and
• claims for increase, see M21-1, Part II, Subpart iii, 2.C.

I.i.1.A.4.j.  Definition:  Supplemental Claim

• substantially complete claims, see
  • 38 CFR 3.159(a)(3), and
  • M21-1 Part I, Subpart i, 1.A.4.f, and
• supplemental claims, see
  • 38 CFR 3.2501, and
  • M21-1, Part II, Subpart iii, 2.B.

I.i.1.A.4.k.  Definition:  Reopened Claim

• Final means the claim is no longer active, and the appeal period has expired.
• Reopened claims do not include claims for increased evaluations or ancillary benefits.

• revisions based on a supplemental claim, see M21-1, Part X, Subpart ii, 2.A, and
• claims reopened under a different theory of entitlement, see Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009).