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Updated Dec 05, 2024

In This Section
 
This section contains the topic “Notification Requirements for Complete Claims.”
 
 

1.  Notification Requirements for Complete Claims

 
 
 

Introduction

  
This topic contains information on providing notice under 38 U.S.C. 5103, including

Change Date
 
December 5, 2024

III.i.2.B.1.a. VA’s Duty to Notify Claimants of Necessary Information or Evidence
 
The Department of Veterans Affairs (VA) shall provide to the claimant, by the most effective means available, a notice (hereafter referred to as ‘Section 5103 notice’) of any information and medical or lay evidence not previously provided that is necessary to substantiate the claim.
 
Important:  VA has historically provided claimants the required Section 5103 notice in a paper-based letter after receipt of a substantially complete application for benefits.  However, Public Law 112-154, Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012, enacted on August 6, 2012, amended 38 U.S.C. 5103 to afford VA more flexibility in how and when VA delivers the notice.
 
References:  For more information on

III.i.2.B.1.b.  Means Through Which Section 5103 Notice Is Provided Prior to and During Claim Development
 
The claimant will have already received the Section 5103 notice
  • on a standard EZ application form when filing
    • a claim through the Fully Developed Claim (FDC) Program, or
    • a claim through the standard claims process,
  • through online claims submission via VA claims submission service websites
  • when an automated Section 5103 notice is generated during the establishment of the end product, or
  • when, on VA Form 20-0995, Decision Review Request:  Supplemental Claim, the claimant certifies receipt of notice under Section 5103 via electronic review.
In rare instances, such as those described in M21-1, Part III, Subpart i, 2.B.1.d and e, a Section 5103 notice letter must be sent to the claimant, but only when required, and only when one of the above methods was not utilized in the filing of the claim.
 
Important:
  • If the Section 5103 notice has been provided to the claimant but there is a special issue or circumstance that requires additional information to support their claim (such as those described in M21-1, Part III, Subpart i, 2.B.1.f), then the claims processor is obligated to notify claimants of this required information.  In such cases, do not include redundant Section 5103 notice information in the letter to claimants.
  • Provide an automated Section 5103 notice to the claimant when their power of attorney is providing the sole signature on a non-original claim and both the
    • claim submission is via means other than the Stakeholder Enterprise portal (SEP), and
    • 38 U.S.C. 5103 notification requirement has not already been met.
  • Pension and burial applications electronically submitted on-line via www.va.gov (va.gov) will not include FDC information, What The Evidence Must Show or application instructions in the electronic claims folder.  However, claimants are already provided this information when submitting the application within va.gov.
Notes:
  • Do not include the claimed conditions (contentions) in the Section 5103 notice letter.
  • VA is not required to include the diagnostic criteria for a specific disability in the Section 5103 notice even if the claimant asserts entitlement to a specific evaluation level because the law permits a generic Section 5103 notice.  See Wilson v. Mansfield, 506 F.3d 1055, 1062 (Fed. Cir. 2007).
  • To document VA’s compliance with 38 U.S.C. 5103, ensure a copy of any Section 5103 notice, along with enclosures, is included in the claims folder.  Do not include copies of any forms requested to be returned.
References:  For more information on

III.i.2.B.1.c.  Exceptions to the Notification Requirement
 
It is unnecessary to provide a claimant Section 5103 notice
  • upon receipt of a supplemental claim within one year of the date VA issues notice of a prior decision
  • upon receipt of a request for higher-level review under 38 CFR 3.2601, or
  • where the evidence of record (to include VA medical center records available electronically) is sufficient to substantiate a claim and award the maximum benefit sought without undertaking development for additional evidence.
Note:  Consider the factors below when determining whether the need to send Section 5103 notice has been eliminated based on the ability to grant the maximum benefit sought.
  • Provide a Section 5103 notice if any development is necessary (including a request for an examination).
  • Per 38 U.S.C. 5103A(b)(3)(B), the term “maximum benefit” means the highest evaluation assignable in accordance with the evidence of record, as long as such evidence is
    • adequate for rating purposes, and
    • sufficient to grant the earliest possible effective date.

III.i.2.B.1.d.  Section 5103 Notice Requirements for Subsequent Claims

  
In accordance with 38 U.S.C. 5103(b)(4), regional  offices (ROs) are not required in certain cases to send a Section 5103 notice for a subsequent claim that is filed while a previous claim is pending.
 
The table below contains notification requirements when the claimant submits a subsequent claim while a previous claim is still pending.
 
If the previous notice …
Then …
sufficiently identified the information and evidence necessary to substantiate such subsequent claim(s)
a new Section 5103 notice is not required.
 
Exception:  Send a Section 5103 notice if over one year has passed since the notice was sent and a subsequent claim(s) is received.
did not include the information and evidence necessary to substantiate the current claim type
  • send a Section 5103 notice that specifically addresses the new claim type, and
  • provide the following statement in the notice:
We are continuing to work on your previous claim(s) and have received your additional claim(s). Our previous letter(s) provided you with sufficient information regarding the evidence needed to support your claim, as well as what VA will do.
 
Important:
  • In the context of 38 U.S.C. 5103(b)(4), ‘pending’ claims also include claims that are not finally adjudicated under 38 CFR 3.160(d).
  • When notice is provided concurrent with a claim, such as on VA Form 21-526EZ, consider the notice received by the claimant on the date the claim is received by VA.

III.i.2.B.1.e.  Cases That Require Issuance of a Standard Section 5103 Notice Letter

  
In rare instances when Section 5103 notice is required and the claimant has not been provided the required Section 5103 notice through the methods illustrated in M21-1, Part III, Subpart i, 2.B.1.b, it may be necessary to send the claimant a standard Section 5103 notice letter.
 
Example:  When rating a claim pending for 15 months, the decision maker discovers a claimed issue that was received on a non-EZ form over one year after the initial Section 5103 notice was provided.  No action has been taken on this issue.
 
Analysis:  In this case, since the claimed issue was not previously covered by a prior Section 5103 notice, a standard Section 5103 notice letter must be provided to the claimant.
 
The table below describes the required elements and actions to take when issuing a claimant a standard Section 5103 notice letter.
 
Required Element
Action
What the evidence must show (WTEMS) to substantiate the claim
Provide the following WTEMS, when a claim for direct or increased service connection (SC) is sought
  • original service connection (also referred to as the continuity WTEMS),
  • secondary service connection (which includes information regarding aggravation), and
  • the increased rating attachments.
Information the claimant is responsible for submitting to VA
Request the claimant to
Time limit for submission of evidence
Inform the claimant that
  • if they do not respond to the request for information within 30 days of the date of the request, VA may decide the claim based on all the information and evidence of record, and
  • they have one year from the date of the request to submit any evidence or information to substantiate the claim.
Evidence VA will attempt to obtain on the claimant’s behalf
Inform the claimant of the evidence VA is requesting, such as
  • service treatment records (STRs),
  • private records (when VA Forms 21-4142 and 21-4142a are received and complete), and
  • medical examination requests.
Section 5103 notice response form
Inform the claimant that they may
  • notify VA that there is no further information or evidence to submit, and
  • request that VA decide the claim based on all the information and evidence of record.
 

III.i.2.B.1.f.  Notification Requirements for Special Issues

  
In some special issue or special circumstance claims, the standard 5103 notice letter does not inform the claimant that additional information or evidence is necessary to develop and adjudicate the claim.  In these situations, send a subsequent development letter to the claimant soliciting the information needed.  Do not send the development letter if the evidence of record
  • provides the information the subsequent development letter solicits, or
  • is otherwise sufficient to decide the claim.
Example:  A Veteran claiming SC for hepatitis C submits medical records that address risk factors for the disease.  Do not send a letter soliciting hepatitis C risk factors as this information is addressed in the evidence of record.
 
Use the table below to determine whether a special issue or special circumstance claim requires additional notice under Section 5103.
If the claimed issue is associated with or involves … Then …
asbestos exposure send additional notice as directed at  M21-1, Part VIII, Subpart iii, 7.B.1.b.
Chemical Biological Radiological Nuclear and Explosives claims send additional notice as directed at M21-1, Part VIII, Subpart iii, 5.A.
entitlement to compensation under 38 U.S.C. 1151
no additional notice is necessary.
 
Reference:  For more information on development of claims for compensation under 38 U.S.C. 1151, see M21-1, Part VIII, Subpart iv, 6.A.
environmental hazards (not covered under 38 CFR 3.317) send additional notice to request general information about the exposure event, as directed at M21-1, Part VIII, Subpart iii, 9.B.1.c.
fire-related STRs send additional notice as directed at  M21-1, Part III, Subpart ii, 2.F.1.b.
hepatitis requiring risk factor development send additional notice as directed at M21-1, Part V, Subpart iii, 6.2.f.
herbicide exposure send additional notice as directed at M21-1, Part VIII, Subpart i, 1.A.
military sexual trauma send additional notice as directed at  M21-1, Part VIII, Subpart iv, 1.A and B.
mustard gas or Lewisite exposure send additional notice as directed at  M21-1, Part VIII, Subpart iii, 3.A.3.b.
former prisoner of war (FPOW) status
send additional notice to develop for
  • evidence surrounding internment, and/or
  • witness information for the claimed in-service injury or disease.
Reference:  For more information on development of claims based on FPOW status, see M21-1, Part VIII, Subpart iv, 2.C.1.a.
radiation exposure under 38 CFR 3.309(d)
no additional notice is necessary.
 
Reference:  For more information on development of claims based on radiation exposure under 38 CFR 3.309(d), see M21-1, Part VIII, Subpart iii, 4.A.
radiation exposure (ionizing) under 38 CFR 3.311
send additional notice developing for evidence of
  • radiation exposure with the radiation risk activity questionnaire, and
  • a radiogenic disease.
Reference:  For more information on development of claims based on ionizing radiation exposure under 38 CFR 3.311, see M21-1, Part VIII, Subpart iii, 4.B.2.
  • legacy reopened claims, or
  • supplemental claims received more than one year after the prior decision
no additional notice is required.
 
Note:  Supplemental claims received within one year of the last decision do not require notice under Section 5103, as discussed in M21-1, Part III, Subpart i, 2.B.1.c.
 
References:  For more information on supplemental claims, see M21-1, Part II, Subpart iii, 2.B.
Shipboard Hazards and Defense (SHAD) project exposure
no additional notice is necessary.
 
Reference:  For more information on development of claims based on SHAD project exposure, see M21-1, Part VIII, Subpart iii, 6.A.
special operations participation send additional notice as directed at M21-1, Part VIII, Subpart iv, 9.A.1.b.
Southwest Asia service (qualifying disability under 38 CFR 3.317)
no additional notice is necessary.
 
Reference:  For more information on development of claims for qualifying disabilities associated with service in Southwest Asia, see M21-1, Part VIII, Subpart ii, 1.B.
Vet Center records send additional notice as directed at M21-1, Part III, Subpart ii, 1.A.2.n.
 
Note:  Homeless Veterans’ claims do not require additional Section 5103 notice but do require special handling as directed at M21-1, Part X, Subpart i, 1.2.
 
Reference:  For more information on the impact of special issue and/or special circumstance development on FDCs, see M21-1, Part X, Subpart i, 2.B.3.b.