Section C – Pre-Rating Review of Claims by the Rating Activity

Updated Jan 08, 2024

In This Section

This section contains the following topics:

Topic	Topic Name
1	Confirming Rating Activity Jurisdiction
2	Reviewing for Compliance With the Department of Veterans Affairs’ (VA’s) Duty to Notify and Assist
3	Considering Matters of Law

1. Confirming Rating Activity Jurisdiction

Change Date

May 15, 2017

V.i.1.C.1.a. Pre-rating Review to Confirm Rating Activity Jurisdiction

The rating activity must review cases routed for a rating decision, to confirm that the claimed issues require a rating decision in accordance with M21-1, Part V, Subpart i, 1.A.

Before issuing a rating decision, the rating activity must also ensure that any needed administrative decisions, such as a line of duty determination, have been completed and authorized.

References: For more information on

the rating activity generally, see M21-1, Part V, Subpart i, 1.A
referrals to the rating activity, see M21-1, Part V, Subpart i, 1.B
determining the issues, see M21-1, Part V, Subpart ii, 3.A
partial rating decisions and deferred issues, see M21-1, Part V, Subpart ii, 3.B
administrative decisions, see M21-1, Part X, Subpart v, 1.C, and
establishing Veteran status, see M21-1, Part III, Subpart i, 1.A.

2. Reviewing for Compliance With VA’s Duty to Notify and Assist

Introduction

The following topic contains information about considering VA’s duty to notify and assist, including

Change Date

July 10, 2019

V.i.1.C.2.a. Duty to Notify Review by the Rating Activity

The decision maker is responsible for ensuring that the Department of Veterans Affairs’ (VA’s) duty to notify has been satisfied before proceeding to a decision. Use the table below to review the evidence of record and ensure VA’s duty to notify requirements have been met.

If …	Then review …
VA receives a claim on the prescribed form	the form to ensure it is substantially complete, and the claim to ensure it is not inherently incredible or lacking merit. *References*: For more information on substantially complete application, see M21-1, Part II, Subpart iii, 1.C, and 38 CFR 3.159(a)(3), and action required on claims that are inherently incredible or lack merit, see M21-1, Part I, Subpart i, 1.A.4.c, and M21-1, Part II, Subpart iii, 1.C.2.e.
the form is substantially complete	the Section 5103 notice to ensure it meets the legal requirements for the claim. *Exception: If all benefits sought can be granted, Section 5103 notice is not required. Notes: EZ forms provide the Section 5103 notice for most types of claims. A notification letter providing the Section 5103 notice must be sent to the claimant if the claim was not filed on an EZ form the EZ form did not provide the Section 5103 notice for the specific type of claim, or the claim was filed by a power of attorney. References*: For more information on notification requirements for a complete application, see M21-1, Part II, Subpart iii, 1.C.1.a cases that require issuances of a standard Section 5103 notice, see M21-1, Part III, Subpart i, 2.B.1.d, and exception to the notification requirement, see M21-1, Part III, Subpart i, 2.B.1.b.
VA becomes aware of the existence of relevant records before the claim is decided	the claims folder to ensure that VA has notified the claimant of the relevant records of the need for a release of records (if applicable), and to obtain the records and provide them to VA if the claimant does not provide the necessary release.
evidence requested by VA from a third party does not exist or cannot be obtained	the claims folder to ensure that VA has identified the records that could not be obtained explained the efforts VA made to obtain the records described any further action VA will take regarding the claim, including, but not limited to notice that VA will decide the claim based on the evidence of record unless the claimant submits the records VA was unable to obtain, and indicated that the claimant is ultimately responsible for providing the evidence. *Note*: For non-Federal records requests, VA may provide the notice at the same time it makes a follow-up attempt to obtain the relevant records.
a proposed adverse action is referred for final decision	the notice of proposed adverse action to ensure all the elements of due process have been met. *References*: For more information about due process, see M21-1, Part I, Subpart i, 1.B, and the notice of proposed adverse action, see M21-1, Part X, Subpart ii, 3.A.

References: For more information on

notifying the claimant of necessary information or evidence, see 38 CFR 3.159(b)
notifying the claimant when records cannot be obtained, see
- 38 CFR 3.159(e), and
- M21-1, Part III, Subpart i, 2.C.3, and
ensuring that notification has been sent through the Centralized Benefits Communications Management (CBCM) program, see
- M21-1, Part II, Subpart i, 2.C.4.c, and
- the Talent Management System (TMS) course titled Centralized Benefits Communications Management (VA 4562424).

V.i.1.C.2.b. Duty to Assist Review by the Rating Activity

The decision maker is responsible for ensuring that the duty to assist has been satisfied before proceeding to a decision. Use the table below to review the evidence of record and ensure VA’s duty to assist requirements have been met.

If the information or evidence is …	Then ensure VA …
needed in support of a benefit-specific or special-issue claim type (for example, individual unemployability or service connection for hepatitis)	notified the claimant of any additional forms or special-issue evidence needed to support the claim how the forms/evidence can be obtained/presented, and when the forms/evidence must be received. Reference: For more information on notification requirements for special issues, see M21-1, Part III, Subpart i, 2.B.1.f.
requested from Federal agencies	received complete records, or if the records were not obtained, determined that they do not exist or additional efforts would be futile. *Reference*: For more information on duty to assist with Federal records, see M21-1, Part III, Subpart ii, 1.A.1.a, and 38 CFR 3.159(c)(2).
requested from the claimant and/or private providers	received complete records, or if the records are not received, made reasonable efforts to obtain them. *References*: For more information on reasonable efforts to obtain non-Federal records, see M21-1, Part III, Subpart i, 2.C.2, and 38 CFR 3.159(c)(1), and claimants’ cooperation with the duty to assist in obtaining non-Federal records, see M21-1, Part III, Subpart i, 2.C.2.c, and 38 CFR 3.159(c)(1)(i).
VA medical records	obtained all VA medical records pertinent to the issues, and associated them with the electronic claims folder. *Note: Vet Center records require the Veteran’s authority to release records and are not stored in the Compensation and Pension Record Interchange (CAPRI). References: For more information on obtaining VA medical records, see M21-1, Part III, Subpart ii, 1.A.2, and storing records from CAPRI, see the CAPRI User Manual*.
an examination request	requested all examinations and medical opinions, when required, and included the correct information to the examiner in the request(s). *Reference*: For more information on VA’s duty to provide medical examinations or medical opinions, see M21-1, Part IV, Subpart i, 1.A, and 38 CFR 3.159(c)(4).
an examination report	received a complete examination report that is sufficient for rating purposes, or received notice that the claimant failed to report. *References*: For more information on reviewing examination reports for sufficiency, see M21-1, Part IV, Subpart i, 3.A, and failure to report to scheduled examinations, see 38 CFR 3.655, and M21-1, Part IV, Subpart ii, 2.B.

References: For more information on

circumstances where VA will refrain from or discontinue providing assistance, see 38 CFR 3.159(d), and
ensuring that notification has been sent through the CBCM program, see
- M21-1, Part II, Subpart i, 2.C.4.c, and
- the TMS course titled Centralized Benefits Communications Management (VA 4562424).

3. Considering Matters of Law

Introduction

This topic contains information about considering matters of law, including

Change Date

April 9, 2018

V.i.1.C.3.a. Referring to the Authorization Activity Claims That Are Unsupported by Law

Refer a claim to the authorization activity for an administrative denial of benefits when the claimed entitlement is unsupported by law.

Example: Such claims include pension claims from Veterans with only peacetime service.

Reference: For more information on conditions under which the authorization activity may deny a claim, see M21-1, Part VI, Subpart i, 1.A.3.b and c.

V.i.1.C.3.b. Dismissing Claims Unsupported by Law

When a claim is unsupported by law, the claim

should be dismissed as a result of the lack of legal merit
does not require any development action, and
does not require a rating decision.

Note: The claim must clearly be unsupported by law to be dismissed.

38 CFR Part 3 (Click to Open)

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M21-1 Table of Contents

M21-5 Table of Contents

In This Section

1. Confirming Rating Activity Jurisdiction

Change Date

V.i.1.C.1.a. Pre-rating Review to Confirm Rating Activity Jurisdiction

2. Reviewing for Compliance With VA’s Duty to Notify and Assist

Introduction

Change Date

V.i.1.C.2.a. Duty to Notify Review by the Rating Activity

V.i.1.C.2.b. Duty to Assist Review by the Rating Activity

3. Considering Matters of Law

Introduction

Change Date

V.i.1.C.3.a. Referring to the Authorization Activity Claims That Are Unsupported by Law

V.i.1.C.3.b. Dismissing Claims Unsupported by Law

Related M21 References

M21-1 Table of Contents

M21-5 Table of Contents