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Updated Jan 13, 2025

In This Section

This section contains the following topics:
Topic
Topic Name
1
2
3
4
5
6
7 Effective Dates Based on Judicial Precedents or General Counsel Opinions
8

1.  General Guidance on Assignment of Effective Dates


Introduction


Change Date

January 13, 2025

V.ii.4.A.1.a.  Gathering Evidence for Effective Date Determinations

The assignment of an effective date is an integral part of the decision-making process as it establishes the date from which entitlement to benefits begins.
  • Assignment of effective date for the purposes of payment of benefits is directed in statute at 38 U.S.C. 5110 and regulated by 38 CFR 3.400.
  • Assignment of effective date for general purposes associated with reductions and discontinuances is directed in statute at 38 U.S.C. 5112 and regulated by 38 CFR 3.500.
Effective date determinations are made based on facts gathered during review of the evidence.  Particularly, answers to the questions below drive the effective date determination.
  • What is the issue?  Some examples of types of issues include but are not limited to
    • claim for
      • service connection (SC)
      • pension entitlement, or
      • increased evaluation, or
    • a request
      • to review a prior decision
      • to add a dependent, or
      • for burial benefits.
  • What is the date of receipt of claim?
  • Did the claimant submit an intent to file (ITF)?
  • What is the date basic entitlement arose?
  • Do any liberalizing laws or other Department of Veterans Affairs (VA) issues apply?  Some examples of liberalizing laws or other VA issues include but are not limited to
    • 38 CFR 3.114 for changes in law or issue, or
    • the Nehmer v. United States Department of Veterans Affairs, No. CV-86-6160 TEH (N.D. Cal.), court order.
  • Is this a continuously pursued claim or issue under 38 CFR 3.2500?
Reference:  For more information on the impact of the Nehmer court order on assignment of effective dates, see M21-1, Part VIII, Subpart i, 2.B.2.

V.ii.4.A.1.b.  General Effective Date Rule

The general rule is that the effective date is assigned based on the date of receipt of claim or the date entitlement arose, whichever is later.  Before applying the general rule, however, all information gathered during evidence review must be considered to determine whether a more specific effective date rule applies.
Note:  Date of claim and effective date are not synonymous.  Although the effective date is often the date of receipt of the claim, the effective date is determined by a variety of factors and is frequently not the same date as the date on which the claim is received.
References:  For more information on

V.ii.4.A.1.c.  Definition:  Date Entitlement Arose

There is no regulatory definition of the phrase date entitlement arose. However, in Wright v. Gober, 10 Vet.App. 343 (1997), the phrase “date entitlement arose” was found to be similar to the phrase “facts found.”  This case, along with the regulatory context, strongly suggest that the date entitlement arose is the date on which the facts in the case demonstrate that the entitling criteria are first met.

V.ii.4.A.1.d.  Determining the Applicable Date of Claim for Effective Date Purposes

When determining the date of claim and its relationship to the proper effective date for assignment, consider the date of receipt of a complete claim, as well as a related ITF or incomplete claim filed within a year prior to the date of receipt of the complete claim.
Notes:
  • If a claimant files both an ITF and an incomplete claim before the complete claim is filed, the complete claim will be considered filed as of the date of receipt of whichever was filed first, provided it is perfected within the necessary timeframe.
  • Occasionally, mail processing delays, public health emergencies, natural disasters, or other extenuating events may impact claim submission timeliness and downstream date of claim considerations.  In those cases, wherever applicable, follow any relevant temporary or interim guidance for date of claim processing, to include resources available on the Compensation Service Interim Guidance Page.
Example 1:  A Veteran submits an ITF for compensation on August 6, 2020, and an incomplete claim for compensation on July 30, 2021.  Following notification of the incomplete claim, the Veteran then submits a complete claim for the same issues on September 27, 2021.
Result:  The Veteran did not perfect the ITF within the required timeframe.  Therefore, VA cannot apply the ITF to the effective date as the complete claim was received more than a year after the date on which the ITF was filed.  However, the incomplete claim can be used for effective date purposes on any awarded issues filed on the complete claim since the incomplete claim was perfected within the required timeframe.
Example 2:  A Veteran submits an ITF for compensation on June 20, 2021, and an incomplete claim on July 30, 2021.  Following notification of the incomplete claim, the Veteran then submits a complete claim for the same issues on September 27, 2021.
Result:  The Veteran perfected the ITF by filing the complete claim within the necessary one-year timeframe.  Therefore, VA can apply the ITF to the effective date of any awarded issues filed on the complete claim.
References:  For more information on

V.ii.4.A.1.e. Determining Whether Date of Claim or Date Entitlement Arose Is Later

The determination as to whether the date of claim or date entitlement arose is later, as specified in the general rule, is dependent on the date when the entitling criteria for the benefit sought are met.
  • The entitling criteria for a claim are frequently met on or before the date of claim based on the lay, medical, and other information presented during the entire process of claim development.
  • When applying the general rule, the assignment of an effective date based on date entitlement arose being later than the date of receipt of the claim is only appropriate when the evidence clearly establishes that the entitling criteria were not met as of the date of receipt of the claim.
Example 1:  A Veteran claims SC for a knee condition with pain on March 21, 2015.  There are no post-service treatment records submitted with the claim.  Service treatment records (STRs) do show treatment for chronic knee pain and complaints of instability during service.  The VA examination dated July 14, 2015, confirms a diagnosis of patellofemoral pain syndrome.
Analysis:  The entitling criteria are met on or before the date of the claim because the Veteran reported the presence of a chronic disability which was later confirmed on examination and linked to military service.  There is no affirmative evidence indicating that the knee disability was not present on the date of receipt of the claim.  In fact, the evidence indicates the presence of a chronic knee disability due to the in-service knee problems that predated the claim.  Thus, the effective date may be assigned based on the date of receipt of the claim unless a different, specific effective date provision otherwise applies.
Example 2:  A Veteran claims SC for elevated blood sugar due to possible diabetes on October 8, 2014, associated with confirmed Vietnam service.  Private treatment records are requested and received showing that the Veteran’s blood sugars were first slightly elevated in June 2013, and the records document continued monitoring thereafter.  A VA examination dated January 3, 2015, indicates a diagnosis of type 2 diabetes mellitus, and the physician notes that the diagnostic criteria for diabetes were first met as shown in the private treatment records on November 13, 2014, when blood sugars and other testing met the American Diabetes Association criteria for a diabetes diagnosis, as the documented symptoms prior to that time were not sufficient for a diagnosis.
Analysis:  The entitling criteria were not met as of the date of the receipt of the claim because the symptoms were not sufficient for a diagnosis of the disability at that time.  There is affirmative evidence showing that the entitling criteria (which require the presence of a chronic disability) were first met on November 13, 2014, which is later than the date of receipt of the claim.  Thus, the effective date is assigned based on the date entitlement arose since it is later than the date of claim, unless a different, specific effective date provision otherwise applies.

V.ii.4.A.1.f.  Effective Date of Entitlement Versus Effective Date of Payment

Under 38 CFR 3.31, VA may not pay monetary benefits based on an initial or supplemental award of compensation, pension, or Dependency and Indemnity Compensation (DIC) for any period prior to the first day of the calendar month following the month in which the beneficiary became entitled to the benefit.
Reference:  For more information on effective date of payment and exceptions to payment under 38 CFR 3.31, see M21-1, Part VI, Subpart i, 1.A.2.b.

V.ii.4.A.1.g.  Effective Date Associated With Sympathetic Reading or a Within Scope Determination

The effective date of a grant of SC for any disabilities arising from the sympathetic reading of a claim, or finding a disability within the scope of a different claimed disability, is governed by the date of receipt of the expressly claimed issue which resulted in sympathetic reading and/or finding a disability within scope.
Sympathetic reading and/or finding one disability within scope of another claimed disability may occur in any type of claim for compensation (initial, supplemental, etc.) or pension, and potentially in other claim situations.
Examples:
  • A Veteran claims SC for hearing loss.  The examination report disclosed that the Veteran reported ringing of the ears during service.  The examiner diagnosed tinnitus and related it to the Veteran’s service.  In such a situation, the tinnitus claim is considered within the scope of the hearing loss claim.  If SC is otherwise warranted for tinnitus, the assignment of effective date of the grant should be guided by the date that the claim for SC for hearing loss was received.
  • A Veteran claims SC for arthritis of the knees.  The examination showed no arthritis, but chondromalacia patellae and lateral instability were diagnosed.  If SC is in order, both conditions should be considered within the scope of the same claim for the knee and the same effective date assigned.
References:  For more information on

V.ii.4.A.1.h.  Impact of PL 112-154, Section 506, on FDC Effective Dates

In certain situations, retroactive effective dates were warranted under Public Law (PL) 112-154, Section 506, for certain fully developed claims (FDCs), as is discussed in
Otherwise, a claim’s inclusion in the FDC Program does not uniquely impact effective date assignment, and the usual effective date rules relevant to the underlying claim type and/or individual adjudicated issue(s) are for application.

V.ii.4.A.1.i.  Maximizing Benefits With Effective Date Determinations

In some situations, different theories of entitlement allow for assignment of different effective dates.  In such cases, consider each effective date rule when assigning an effective date and assign the most advantageous effective date that applies for the facts of the case.
Note:  38 CFR 3.303(d) is not intended to limit the theory under which SC may be established, especially when one theory is more favorable than another.  This provision clarifies that SC for disabilities identified as presumptive may also be awarded on a direct basis, but it does not restrict the ability to award SC on a presumptive basis when both direct and presumptive SC may be supported.
Example:  A Veteran claims SC for coronary artery disease.  The evidence supports entitlement to SC on a presumptive basis for coronary artery disease associated with herbicide exposure, and 38 CFR 3.114 can be applied to grant an effective date one year prior to the date of receipt of the claim.  The criteria to grant an earlier effective date under 38 CFR 3.816 in accordance with the holding in Nehmer v. United States Veterans Administration, No. CV86-6160 TEH (N.D. Cal.), have not been met.  The evidence also supports a grant of SC as secondary to the Veteran’s SC diabetes mellitus.  For the secondary theory of entitlement, the effective date would be the date of receipt of the claim.  As the presumptive theory allows for assignment of an earlier effective date, SC should be granted on the presumptive basis to allow for maximized benefits.

2.  Impact of ITF on Effective Date


Introduction

This topic includes information describing the impact of an ITF on assignment of effective dates, including

Change Date

March 31, 2023

V.ii.4.A.2.a.  Applicability of ITF on Effective Date Assignment

On March 24, 2015, 38 CFR 3.155 was revised to include procedures for a claimant to indicate a desire to file a claim via submission of an ITF.  When an ITF is properly submitted, and a complete initial claim is received within one year of the ITF, the complete initial claim is considered filed as of the date the ITF was received.
Notes:
  • The regulations governing ITF acceptance and impact, including 38 CFR 3.155, are not effective date rules.  The provisions for ITF apply to the date a claim is considered received, which in turn may impact determinations about effective dates.
  • When an application includes an application initiation date, decision makers should consider the application initiation date as the date of claim for the purposes of assigning an effective date.
    • The application initiation date should not be recorded as the actual date of claim in other VA systems, however.
    • Applications created through the Veterans Online Application (VONAPP) Direct Connect (VDC) on or after March 24, 2015, will not contain an application initiation date, as the application initiation date will be captured as an ITF in accordance with the Standard Claims and Appeals Forms Rule.
References:  For more information on

V.ii.4.A.2.b.  Effective Date of Entitlement Following Receipt of an ITF

When an ITF is active and an applicable claim is subsequently received within one year of the date of receipt of the ITF, consider the claim received as of the date of receipt of the ITF as discussed in 38 CFR 3.155 and M21-1, Part II, Subpart iii, 2.A.1.
Note:  A Veteran may secure a benefit effective date as early as the day following separation from service if
  • an ITF is communicated within one year of separation from such service, and
  • a substantially complete application is subsequently submitted within one year of that ITF communication’s receipt.

V.ii.4.A.2.c.  Examples of Selecting an Effective Date Following Receipt of an ITF

The table below contains examples of the proper assignment of effective dates following receipt of an ITF.
Scenario
Conclusions
The potential effective date of entitlement to increased compensation is June 1, 2015, because VA received the VA Form 21-526EZ, within one year of the date it received the Veteran’s communication of an ITF.
Note:  The ITF helps identify the potential effective date but is not necessarily determinative of the outcome of effective date assignment.  All other applicable effective date regulations must be considered.  For example, application of 38 CFR 3.400(o)(2) may allow for assignment of an effective date earlier than the ITF based on treatment records showing worsening of the disability in the one year prior to receipt of the claim.
  • VA receives VA Form 21-0966 from a Veteran on June 1, 2015.
  • On November 1, 2015, the Veteran begins a non-original, initial, online application for benefits through a VA claims submission service website.
  • On January 1, 2016, the Veteran completes and submits the online application.
  • Commencement of the online application process on November 1, 2015, constitutes a duplicate communication of an ITF.
  • The potential effective date of entitlement to benefits is June 1, 2015, because the Veteran completed and submitted the online application within one year of the date VA received the first communication of an ITF.
  • VA receives VA Form 21-0966 from a Veteran on March 26, 2015.  The Veteran checked the Compensation box on the form.
  • VA receives another VA Form 21-0966 from a Veteran on May 20, 2015.  The Veteran checked the Compensation box on the form.
  • VA receives a completed and signed VA Form 21-526EZ on April 8, 2016, for an increase in the evaluation of a SC back condition.
The potential effective date of entitlement to benefits is April 8, 2016, because
  • the application was not received within one year of the March 26, 2015, ITF, and
  • the VA Form 21-0966 received May 20, 2015, is a duplicate communication of an ITF since it is received within the active period of the already-received ITF and is for the same benefit.
The duplicate ITF has no effect on benefit entitlement.
  • A Veteran communicates an ITF for compensation to a National Call Center (NCC) on June 1, 2015.
  • On November 1, 2015, the Veteran begins an online application for SC for a back disorder through a VA claims submission service website.
  • On January 1, 2016, VA receives a VA Form 21-526EZ from the Veteran with a non-original, initial claim for SC for a knee disorder.
  • On February 1, 2016, the Veteran completes and submits the online application for SC for a back disorder.
  • Commencement of the online application process on November 1, 2015, constitutes a duplicate (not a new and separate) communication of an ITF.
  • The potential effective date of entitlement to SC for the knee disorder is June 1, 2015, because VA received the VA Form 21-526EZ within one year of the date the Veteran contacted the NCC.
  • The potential effective date of entitlement to SC for the back disorder is February 1, 2016. (The receipt of VA Form 21-526EZ on January 1, 2016, prevents VA from considering the Veteran’s communication of an ITF when choosing an effective date for SC for the back disorder.)
  • A Veteran is honorably discharged from active duty on September 1, 2015.
  • On December 1, 2015, VA receives the Veteran’s communication of an ITF.
  • On November 1, 2016, VA receives VA Form 21-526EZ from the Veteran with a claim for SC for a knee disorder.
The potential effective date of entitlement to SC for the knee disorder is September 2, 2015, the day following the date of discharge.
Rationale:
  • VA received the communication of an ITF within one year of the date of discharge.
  • VA received the VA Form 21-526EZ within one year of the date VA received the communication of an ITF.
  • On October 8, 2015, VA receives an ITF for compensation.
  • The in-country Vietnam Veteran subsequently mails VA an original FDC for SC for type 2 diabetes mellitus associated with exposure to Agent Orange.  Evidence shows a diagnosis of diabetes in 1999.
  • VA receives the Veteran’s claim on April 11, 2016.
The potential effective date of entitlement to SC for diabetes is October 8, 2014, because
  • VA received communication of an ITF on October 8, 2015, and
  • 38 CFR 3.114 applies to the effective date determination.
  • On December 18, 2021, the Veteran files an initial claim for SC of right lower extremity peripheral neuropathy.
  • On March 2, 2022, the Veteran was notified that the claim was denied.  Evidence available at the time of the claim’s adjudication failed to confirm the existence of a clinical diagnosis.
  • On September 13, 2022, VA receives an ITF for compensation from the Veteran.
  • On February 27, 2023, VA receives a supplemental claim for SC for peripheral neuropathy of the right lower extremity from the Veteran.
  • The supplemental claim is accompanied by private medical evidence documenting a clinical diagnosis as early as December 15, 2021.
The potential effective date of entitlement to SC for peripheral neuropathy of the right lower extremity is December 18, 2021, the date of the initial claim.
Rationale:
  • The ITF received on September 13, 2022, establishes continuous pursuit of the December 2021 claim as the Veteran filed a(n)
    • ITF within one year of the March 2022 decision, and
    • complete supplemental claim within one year of the ITF.
  • The supplemental claim was not finally adjudicated prior to July 30, 2021.  On this date, the U.S. Court of Appeals for the Federal Circuit, in Military-Veterans Advocacy v. Secretary of Veterans Affairs, No. 19-1600 (Fed. Cir. 2021), invalidated the portion of 38 CFR 3.155 which precluded the application of ITFs to supplemental claims.
  • The appropriate effective date rule is 38 CFR 3.2500(h)(1), which directs that the effective date will be fixed in accordance with the date of receipt of the initial claim or date entitlement arose, whichever is later.
Reference:  For more information on ITFs and supplemental claims, see
  • A new claim for lumbar arthritis is received on June 21, 2022, on VA Form 21-526EZ.
  • Rating decision dated August 10, 2022, denies entitlement to SC for lumbar arthritis due to no diagnosis.  The Veteran is notified the same day.
  • On December 22, 2022, an ITF for compensation on VA Form 21-0966 is received.
  • On July 21, 2023, a new claim for eczema is received on VA Form 21-526EZ, which changes the ITF status to Claim Received.
  • On August 30, 2023, VA Form 20-0995, Decision Review Request: Supplemental Claim, for lumbar arthritis is received with new and relevant evidence.
The potential effective date of entitlement to SC for lumbar arthritis is August 30, 2023, the date the supplemental claim was received.
Rationale:
  • The VA Form 21-526EZ submitted on July 21, 2023, is the next received compensation claim; therefore, the December 22, 2022, ITF applies to the claim for eczema, not the subsequently filed supplemental claim for lumbar arthritis.
  • The ITF in this scenario does not represent continuous pursuit, because the ITF was not in Active status when the Veteran filed the supplemental claim.
  • The Veteran filed the supplemental claim more than one year after the notice of decision.
  • The appropriate effective date rule is 38 CFR 3.2500(h)(2), which directs that the effective date will be fixed in accordance with the date entitlement arose, but will not be earlier than the date of receipt of the supplemental claim.

3.  Effective Dates for Direct and Secondary SC


Introduction


Change Date

January 13, 2025

V.ii.4.A.3.a.  Procedures for Handling Claims for Direct SC

Claims for compensation based on direct SC are governed by 38 CFR 3.400(b)(2)(i).
There are two main provisions of this effective date rule.
  • For claims received more than one year following discharge from active duty, the general rule applies.  Thus, the effective date will be date of receipt of claim or date entitlement arose, whichever is later.
  • For claims within one year of discharge from a period of active duty, the effective date may be as early as the day following discharge.  Refer to the table below for more information on the application of this provision of 38 CFR 3.400(b)(2)(i).
Step
Action
1
Is the date of receipt of the claim within one year of discharge?
  • If yes, go to Step 2.
  • If no, then apply the general rule, unless another effective date rule applies.
2
Review the character of discharge (COD) for the most recent period of service.  Refer to the table below to determine appropriate action to take based on the COD.
If the separation from service was …
Then …
under conditions other than dishonorable
go to Step 3.
dishonorable and only a single period of service was performed
dishonorable but
  • there were multiple periods of continuous service, and
  • the prior period of service was under conditions other than dishonorable
References:  For more information on
3
Determine when the disability was incurred or aggravated during the Veteran’s military service.
Did active duty service continue without a break in service from the date the claimed disability was incurred or aggravated?
  • If yes, go to Step 4.
  • If no, then apply the general rule unless another effective date rule applies.
4
Were the entitling criteria for a grant of SC met as of the day following discharge?
  • If yes, then grant SC effective the day following discharge.
  • If no, then grant SC effective the date entitlement arose.
Exception:  If a claim is received to reinstate compensation following a return to active duty, apply 38 CFR 3.654(b) and follow the procedures in M21-1, Part X, Subpart v, 2.B.1.g.
Note:  A Veteran may seek entitlement to SC for new disabilities concurrently with a request to reinstate compensation following discharge from a period of active service.  The effective date of SC for the newly-claimed disabilities is assigned in accordance with the steps in the table above.
Reference:  For more information on effective dates for the resumption of compensation following release from active duty, see M21-1, Part X, Subpart i, 6.D.3.c.

V.ii.4.A.3.b.  Example 1: Effective Date for Direct SC

A Veteran claims SC for a knee disability.
Facts:
  • The claim is received on August 11, 2011.
  • The Veteran was honorably discharged on July 15, 2010.
  • Evidence supports a grant of SC for the knee disability on the basis that a chronic knee disability was incurred during the Veteran’s period of honorable active duty service.
Analysis:  Since the claim was not received within one year of the Veteran’s release from active service, the general rule applies.  The effective date is the date of receipt of the claim or the date entitlement arose, whichever is later.  As the entitling criteria were met as of the date of receipt of the claim by virtue of the existence of a chronic disability present since its incurrence in service, the effective date is the date of receipt of the claim.

V.ii.4.A.3.c.  Example 2: Effective Date for Direct SC

A Veteran claims SC for a back disability.
Facts:
  • The claim is received on October 11, 2015.
  • The Veteran has two periods of honorable active service that are non-continuous.
    • The first period of service was from December 19, 2000, to December 18, 2008.
    • The Veteran was in the Army National Guard from 2008 until present.
    • The second period of active service was a period of Title 10 service when the Veteran was deployed with an Army National Guard unit from July 22, 2014, to August 2, 2015.
  • The Veteran was diagnosed with degenerative disc disease of the thoracolumbar spine during the first period of service.  The Veteran’s back disability required no additional treatment and is not mentioned in the STRs for the second period of active service.
  • The evidence of record supports a grant of SC for degenerative disc disease on the basis that it was incurred during the first period of active service.
Analysis:  Although the claim was received within one year of the Veteran’s release from the recent period of honorable active service, since the back disability was not incurred or aggravated in the recent period of service and there was not continuous active service from the time the back disability was incurred, the effective date must be the date of receipt of the claim, October 11, 2015.

V.ii.4.A.3.d.  Claims for Compensation Received Within One Year of Dishonorable Service

The provision of 38 CFR 3.400(b)(2)(i) allowing assignment of an effective date of the day following discharge is not applicable to dishonorable periods of service.  Thus, when multiple periods of continuous service are present but the character of service for the last period constitutes a bar to benefits as discussed in 38 CFR 3.12, the effective date will be date of receipt of claim or date entitlement arose, whichever is later.
Example 1:  The Veteran had two periods of service which were continuous.  The Veteran filed a claim three months after discharge.  The last period of service was characterized by a dishonorable discharge, so the character of service is a bar to VA benefits.  COD and conditional discharge determinations have been completed per M21-1, Part X, Subpart iv, 1.A.  SC benefits are warranted based on disabilities incurred during the first period of honorable service.
Analysis:  Although the Veteran submitted the claim within one year of the release from active duty, the provision of 38 CFR 3.400(b)(2)(i) allowing assignment of an effective date the day following discharge is not for application because the last period of service is dishonorable.  The claim was not submitted within one year of the honorable period of service; the proper effective date is the date of receipt of the claim.
Example 2:  The Veteran had two periods of service which were continuous.  The Veteran filed a claim prior to discharge from the last period of service. The last period of service was characterized by a dishonorable discharge, so the character of service is a bar to VA benefits.  COD and conditional discharge determinations have been completed per M21-1, Part X, Subpart iv, 1.A.  SC benefits are warranted based on disabilities incurred during the first period of honorable service.
Analysis:  The Veteran is not entitled to VA compensation while receiving active service pay, per 38 CFR 3.654(b).  Under 38 CFR 3.400(b)(2)(i), the effective date is the date of claim or the date entitlement arose, whichever is later.  In this situation, the date entitlement arose is later than the date of claim.  The effective date is the day following separation date for the period of dishonorable service, which is the date entitlement arose.

V.ii.4.A.3.e.  Effective Date for a Claim Received During a Period of Hospitalization

When, during the course of a hospitalization in a VA or approved hospital for a period in excess of 21 days, SC for the disability under treatment is granted, establish entitlement to a temporary 100-percent rating from the first day of the hospitalization, if otherwise in order.
Example:  The Veteran was hospitalized at a VA facility for posttraumatic stress disorder (PTSD) on June 27, 2011.  On July 14, 2011, the Veteran submitted an original claim for SC for PTSD.  On July 29, 2011, the Veteran was discharged from the VA facility.  Award SC with a temporary 100-percent evaluation under 38 CFR 4.29 from the date of admission to the VA facility, June 27, 2011.
References:  For more information on effective dates for hospital ratings

V.ii.4.A.3.f.  Effective Dates for Secondary SC

Although 38 CFR 3.310 directs that a secondary disability shall be considered a part of the original condition, this regulation covers entitlement to secondary SC but does not direct assignment of an effective date.
  • The effective date for secondary SC is governed by the general rule for assignment of effective dates described in the opening paragraph of 38 CFR 3.400.
  • A claim for secondary SC is an allegation of additional disability that is proximately due to or the result of a SC disease or injury.  As an additional disability, a secondarily SC disability cannot be treated as an increased evaluation under 38 CFR 3.400(o) for effective date purposes.  An award of increased compensation does not encompass an award of secondary SC because, by definition, secondary SC requires the incurrence of an additional disability which is separately rated under the VA Schedule for Rating Disabilities.
  • For effective date purposes, a secondary disability is distinguished from and treated differently than a complication of a disease process or other issue that is considered within scope of a separately claimed disability, as discussed at M21-1, Part V, Subpart ii, 4.A.1.g and M21-1, Part V, Subpart ii, 4.A.5.e.
  • The effective date of an award of SC is not based on the date of the earliest medical evidence demonstrating a causal connection between a primary condition and another disability secondarily related to it.  The effective date of secondary SC must be based on the date that the application upon which SC was eventually awarded was filed.
References:  For more information on

V.ii.4.A.3.g.  Correlation Between Effective Date for Primary and Secondary SC Disabilities

The effective date assigned for a secondary SC disability cannot be earlier than the effective date assigned for the causal or primary SC disability.
When a claim for SC for a disability is pending and subsequent development of the claim reveals that the disability is caused by a disability that may be associated with service, the decision maker must investigate the possibility of SC for the unclaimed causal disability as well as SC on a secondary basis for the claimed disability.
  • The duty to investigate SC for the causal disability as within scope of the claimed issue is prompted when
    • the claimed disability is shown to be secondary to the unclaimed causal disability, and
    • when the criteria under 38 CFR 3.159(c)(4) have been satisfied.
  • If the causal or primary disability is, in fact, related to service, the pending claim reasonably encompasses a claim for benefits for the causal disability.
  • The effective date of benefits for the causal disability is guided by the date of receipt of the claim for the secondary disability.
Example:  A Veteran files a claim for SC for right shoulder pain as the result of a fall caused by instability of the right knee which is not SC and has not otherwise been expressly claimed.  Development of the claim confirms a diagnosis of right shoulder impingement that is secondary to the unclaimed knee condition.  The knee injury (resulting in recurrent instability of the right knee) was sustained in service and current medical evidence shows treatment for continued symptoms since the Veteran’s discharge.  Sufficient evidence to establish SC for the knee disability is of record and the medical evidence shows the right shoulder disability was directly caused by the fall that occurred when the Veteran’s knee buckled unexpectedly.  Consider the unclaimed knee disability within scope of the claimed shoulder disability and establish SC for both issues with an effective date assigned based on the date of receipt of the claim for SC for the right shoulder condition.
References:  For more information on

4.  Effective Dates for Presumptive SC


Introduction

This topic includes information clarifying the principles for assigning effective dates for claims for presumptive SC, including

Change Date

January 13, 2025

V.ii.4.A.4.a.  Effective Dates for Presumptive SC

The assignment of effective dates for presumptive SC is regulated by 38 CFR 3.400(b)(2)(ii).
The effective date will be the day following separation from service when all of the following criteria are met:
  • the claim is received within one year of separation from active duty, and
  • the requirements for SC are met during service, including evidence showing that the disability
    • became manifest, and
    • was incurred or aggravated during active service, and
  • there was continuous active service following the period of service on which the presumption is based.
The effective date will be the date entitlement arose when all of the following criteria are met:
  • the claim is received within one year of separation from active duty, and
  • the requirements for SC are not met during service.
When the claim is not received within one year of separation from active service, the general rule applies and the effective date will be date of receipt of claim or date entitlement arose, whichever is later, unless another effective date rule applies.  For example, 38 CFR 3.114 may apply to the assignment of an effective date for presumptive SC.
References:  For more information on

V.ii.4.A.4.b.  Example 1: Assigning Effective Dates for Presumptive SC

Facts:  The Veteran served on active duty from June 21, 2012 to June 22, 2016, and submitted a claim for SC for hypertension on May 12, 2017.  STRs show no evidence of treatment for or diagnosis of hypertension during service.  Private treatment records show that the hypertension first manifested to a compensable degree on March 19, 2017.
Analysis:  The claim for SC was received within one year of release from active duty, but the requirements for SC were not met during service.  Thus, the effective date is the date entitlement arose, which is the date hypertension was first diagnosed, March 19, 2017.

V.ii.4.A.4.c.  Example 2: Assigning Effective Dates for Presumptive SC

Facts:  The Veteran was discharged March 3, 1972.  Evidence showed the Veteran had confirmed service in Vietnam.  On February 22, 2017, the Veteran submitted a claim for SC for type 2 diabetes mellitus associated with herbicide exposure.  Private treatment records confirmed that the Veteran was diagnosed with and treated for type 2 diabetes mellitus with an oral hypoglycemic medication since 2015.
Analysis:  The claim for SC was received more than one year following discharge from active service.  As the entitling criteria were all met as of the date of receipt of the claim, the proper effective date is the date of receipt of the claim.  38 CFR 3.114 is not applicable because the Veteran’s diabetes was first diagnosed in 2015, and no other effective date provision is appropriate based on the facts of this scenario.

5.  Effective Dates for Claims for Increased Compensation


Introduction


Change Date
January 13, 2025

V.ii.4.A.5.a.  Regulatory Provisions Applicable to Claims for Increase

Claims for increase are regulated by 38 CFR 3.400(o).  The effective date for a claim for increase will be the general rule, which is date of receipt of the claim or date entitlement arose, whichever is later, unless one of the following three exceptions apply:
  • After basic entitlement has been terminated, such as by severance of SC, a retroactive increase or additional benefit will not be awarded.
  • A grant of aid and attendance (A&A) or housebound benefits associated with an initial or supplemental claim for pension or compensation is regulated by 38 CFR 3.401(a).
  • Per 38 CFR 3.400(o)(2), increased compensation may be awarded on the earliest date as of which it is factually ascertainable that an increase in disability had occurred if a complete claim or ITF is received within one year from such date.
Important:  If an increased evaluation is awarded as part of a continuously pursued issue, the effective date is assigned based on 38 CFR 3.2500(h)(1).
References:  For more information on assigning effective dates for increased evaluations

V.ii.4.A.5.b. Application of 38 CFR 3.400(o)(2)

Receipt of medical reports may be used to establish effective date(s) for retroactive benefits based on facts found on an increase in disability.  The effective date will be the earliest date it is factually ascertainable that the increase in disability occurred if all the following criteria are satisfied:
  • A complete claim or ITF must be received within one year of the date the medical records show the initial increase in disability occurred.
  • When applying 38 CFR 3.400(o)(2), an increase in a Veteran’s SC disability must have occurred during the one-year prior to the date of the Veteran’s claim in order to receive an effective date of up to one year prior to the date of the claim. When the increased disability occurred more than one year prior to the date of receipt of the claim for increase, then the effective date will be the date of receipt of the claim.
  • The medical reports must relate to examination, hospitalization, or medical treatment of a disability for which SC has been previously established.
References:  For more information on assigning effective dates

V.ii.4.A.5.c. Effective Dates for IU Under 38 CFR 3.400(o)(2)

In Norris v. West, 12 Vet.App. 413, 420 (1999), the Court of Appeals for Veterans Claims (CAVC) held that evidence of a Veteran’s unemployability arising from an already SC disability is evidence of an increase in the severity of that disability.
When considering a claim for individual unemployability (IU) based on an already SC disability(ies), review the evidence to determine whether it is factually ascertainable that the criteria for entitlement to IU were first met during the one-year period prior to the date of receipt of the claim.
To determine whether an earlier effective date for IU under 38 CFR 3.400(o)(2) may be assigned, one of the two criteria for entitlement for IU under 38 CFR 4.16(a) must be demonstrated during the one year prior to date of receipt of the IU claim.
When the evidence shows that one or both criteria below are satisfied in the one-year period prior to the date of receipt of the IU claim, an earlier effective date for IU under 38 CFR 3.400(o)(2) is warranted based on the date one or both criteria are satisfied.  Those criteria are
  • the evaluation of the SC disabilities is increased such as to satisfy the criteria for IU, including
    • a single SC disability rated at 60 percent or more, or
    • multiple SC disabilities yielding a combine rating of 70 percent or more with at least one of those disabilities rated 40 percent or more, and/or
  • an inability to secure or follow a substantially gainful occupation.
Important:
  • Entitlement to IU requires that all criteria as described under 38 CFR 4.16(a) or (b) be met.  When one of the criteria has been met for an extended period of time (potentially years before the claim) and the remaining criteria arises during the one-year period prior to the date of receipt of the IU claim, consideration of an earlier effective date for IU is warranted.  Both criteria need not initially arise during the one year prior to receipt of the IU claim so long as both are met sometime prior to the effective date of the grant of entitlement to IU.
  • Entitlement to IU is a potential consideration any time an SC disability is evaluated.
    • Consequently, 38 CFR 3.400(o)(2) may be applied to the IU effective date
      • anytime an SC disability is evaluated and the outcome of the claim either grants or confirms and continues an evaluation causing the Veteran’s SC disabilities to satisfy the schedular criteria described in 38 CFR 4.16(a) for potential IU entitlement, and
      • the claim for IU is received within one year of the decision evaluating the SC disabilities such as to meet the schedular criteria.
    • This is true whether the prior evaluation decision resulted in the schedular criteria having been met
      • for the first time
      • based on a confirmed and continued evaluation, or
      • based on an increased evaluation, even when the criteria were previously first met at the time of a prior determination.
References:  For more information on
  • the effective date of a grant of increased compensation based on unemployability, see Dalton v. Nicholson, 21 Vet.App. 23 (2007)
  • the prohibition on assigning an effective date for IU that precedes the effective date of SC for the underlying disabilities, see Delrio v. Wilkie, 32 Vet.App. 232 (2019), and
  • a grant of entitlement to IU following reduction of a schedular 100-percent evaluation, see M21-1, Part X, Subpart ii, 4.A.4.b.

V.ii.4.A.5.d. Example of IU Effective Date Impacted by 38 CFR 3.400(o)(2)

Facts:  On June 12, 2016, a Veteran submitted a claim for an increase in the 30-percent evaluation of PTSD.  The combined evaluation of the Veteran’s SC disabilities was 70 percent, with a single disability evaluated as 40-percent disabling, since 2010.  Development of the claim confirmed that the evaluation of the PTSD warranted an increase to 50 percent.  A rating decision dated December 5, 2016, granted the increased evaluation, and the combined evaluation of the Veteran’s SC disabilities increased to 80 percent effective June 12, 2016.  The Veteran was notified of the decision on December 5, 2016.
The Veteran subsequently submitted VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability, on February 17, 2017, reporting that the Veteran had stopped working in 2012 due to SC PTSD and other disabilities.  Development of the claim confirmed that entitlement to IU was warranted due to the combined effects of the Veteran’s SC disabilities.
Analysis:  Since the Veteran last worked in 2012, which is more than one year prior to the claim, 38 CFR 3.400(o)(2) may not be applied to grant an effective date coinciding with the cessation of employment.  However, since the claim for increase, received on June 12, 2016, resulted in a combined evaluation that satisfied the schedular criteria for potential IU entitlement and the claim for IU was received within one year of the December 5, 2016, decision granting that combined evaluation, 38 CFR 3.400(o)(2) applies to the effective date.  Consequently, the proper effective date for the grant of IU is June 12, 2016, the date of receipt of the claim for increased evaluation since IU was an issue eventually associated with that claim for increase and it is factually ascertainable that the increase occurred within one year of the date of receipt of the IU claim.

V.ii.4.A.5.e. Handling Effective Dates for Complications or Residuals of an SC Disability

When the evaluation criteria in 38 CFR Part 4 or other policy or procedural guidance directs that a given disability is to be rated based on residuals or that complications for a given disability are to be rated separately, the complications or residuals are considered increased manifestations of the primary disability.  Consequently, the applicable effective date rule is 38 CFR 3.400(o).
Example 1:  The evaluation criteria for diabetes under 38 CFR 4.119, Diagnostic Code (DC) 7913, include the presence of complications of diabetes as a determinant of the proper evaluation.  Note (2) under the evaluation criteria instructs the rating activity to evaluate complications of diabetes separately if doing so would result in a greater evaluation.  Because of the language in 38 CFR 4.119, DC 7913, the diagnosed complications of diabetes establish a worsening of the disability, and the provisions of 38 CFR 3.400(o) are applicable in determining the effective date of increased compensation, whether the evaluation of diabetes is increased or the complications of diabetes are separately established as SC.
Example 2:  The evaluation criteria for diseases and injuries of the spine under 38 CFR 4.71a, DC 5235-5242, Note 1, directs that associated objective neurological abnormalities be evaluated separately under an appropriate DC.  Based on this note, objective neurological abnormalities establish a worsening of the spinal disability, and the provisions of 38 CFR 3.400(o) are applicable in determining the effective date of increased compensation based on the presence of the neurological impairment without regard to whether the evaluation for the spinal disability is increased.
Note:  Although the disabilities are considered worsening of the primarily-diagnosed disability, procedural conventions within Veterans Benefits Management System – Rating (VBMS-R) require that the disabilities be coded as secondary to establish the connection between the primary disability and the associated complications or residuals.  However, the VBMS-R convention of identifying the disability as secondary does not impact assignment of an effective date.
References:  For more information on

V.ii.4.A.5.f.  Claims for Increase Received With Requests for Reinstatement

Veterans often file a claim for an increased disability rating concurrently with their request for reinstatement of disability compensation following discharge from a period of active service.  Follow the procedures at M21-1, Part X, Subpart v, 2.B.1.g for control of the claim and reinstatement of compensation.
The effective date for the increased evaluation, if warranted, is regulated by 38 CFR 3.400.  The effective date is the earlier of the following dates:
  • the date on which the increased disability was first shown (up to one year prior to the date VA received the claim) per 38 CFR 3.400(o)(2), or
  • the date of receipt of the claim or the date entitlement arose, whichever is later.
Note:  The effective date may never fall within a period of active duty.

V.ii.4.A.5.g.  Entitlement to A&A or Housebound Benefits for Retroactive Awards

The effective date of entitlement to special monthly compensation (SMC) or special monthly pension (SMP) is generally guided by date of receipt of claim, or date entitlement arose, except as provided in 38 CFR 3.400(o)(2).
However, a special provision exists to allow an earlier effective date for entitlement to SMC or SMP when an award of compensation or pension benefits is effective for a period prior to the date of receipt of the claim.  This special provision, contained in 38 CFR 3.401(a), applies to
  • additional compensation or pension for a Veteran’s need for A&A or housebound status, or
  • additional compensation due to the spouse’s need for A&A.
Example:  A Veteran submitted an original claim for compensation for ischemic heart disease (IHD) as due to herbicide exposure on June 22, 2019.  The Veteran’s personnel records confirmed herbicide exposure during service.  The evidence submitted with the Veteran’s claim shows that the Veteran was diagnosed with coronary artery disease prior to August 31, 2010 (the date IHD was added to the list of presumptive condition associated with herbicide exposure).  The claim included a request for entitlement to additional compensation based on A&A benefits for the Veteran’s spouse.
  • The effective date of the grant of SC for the heart disability (which is evaluated as 100-percent disabling) is impacted by 38 CFR 3.114(a)(3).  SC is warranted effective June 22, 2018, one year prior to the date of receipt of the claim.
  • Evidence shows that the Veteran’s spouse suffered a severe stroke on October 14, 2018, which caused the requirement for A&A.
  • Entitlement to additional compensation, payable to the Veteran, due to the spouse’s need for A&A is warranted effective October 14, 2018, the date the criteria for entitlement to A&A arose during the retroactive period of the award of SC compensation benefits.
Reference:  For more information on entitlement to additional compensation or pension during the retroactive period of an award, see 38 CFR 3.401(a).

 6.  Effective Dates Based on a Change of Law or Regulation


Introduction

This topic includes information clarifying the principles for determining effective dates when a decision is impacted by new guidance, including

Change Date

June 27, 2022

V.ii.4.A.6.a.  Impact of Guidance Changes

Changes to laws, regulations, or policy or procedural guidance may impact the assignment of effective dates.  The outcome of an effective date determination in such situations is dependent upon the
  • nature of the change, and
  • the status of the claim.

V.ii.4.A.6.b.  Definition: Liberalizing Law

liberalizing law is one which brings about a substantive change in the law creating a new and different entitlement to a benefit.
Reference:  For more information on the definition of liberalizing law, as identified by the U.S. Court of Appeals for the Federal Circuit, see Spencer v. Brown, 17 F.3d 368 (Fed. Cir. 1994).

V.ii.4.A.6.c.  Significance of Changes of Law

Appropriately analyzing changes of law is critical to adjudication.  For the purpose of the guidance contained in this block, law means statutory changes, regulatory changes, or precedential case law.  Changes of law may alter the standard of entitlement, the burden of proof, the extent of the duty to assist, substantive due process requirements, the existing understanding of medical or legal concepts, or agency procedures.
For new claims received after a change of law has become effective that affects the standard of entitlement to a benefit, the main consideration for decision makers is effective date.  It is important to analyze whether the newly applicable law has a liberalizing effect or potentially an adverse effect requiring the reduction or discontinuance of benefits.
Note:  Some changes of law may necessitate a general review of potentially-impacted past claimants and current beneficiaries who do not have claims pending.  This may consist of outreach or even re-adjudication of claims.  However general reviews are not routinely mandated and should never be initiated by field decision makers in the absence of a specific agency directive permitting authorized review jurisdiction.
With respect to claims pending when a change of law on the standard of entitlement becomes effective, the change creates a question of choice of law (applicability) and, potentially, effective date issues.  Failure to properly analyze the new law (and apply the new law as applicable) may result in an error or other need for correction of the rating decision.
References:  For more information on

V.ii.4.A.6.d.  Awarding Retroactive Benefits Based on a Law Change

Under 38 CFR 3.114(a), VA may award retroactive benefits if the claimant had potential entitlement at the time the liberalizing law, VA issue, such as certain precedent opinions of VA General Counsel, or regulation became effective.
This regulation applies to
  • cases involving pending or previously denied claims, and
  • original claims filed after the change in law or administrative issue.
Note:  A liberalizing law is one which brings about a substantive change in the law creating a new and different entitlement to a benefit.
References:  For more information on

V.ii.4.A.6.e.  Origin of Liberalizing Issue

A liberalizing issue originates from
  • regulation by VA, or
  • statutes (38 U.S.C.) by Congress.

V.ii.4.A.6.f.  Origin of VA Issue

A VA issue originates from an existing regulation or a new regulation issued by VA.

V.ii.4.A.6.g.  Statutory Eligibility Requirements for Retroactive Awards Under 38 CFR 3.114

The plain language of 38 U.S.C. 5110(g) governing the effective date for a claim granted based on a favorable change in law and its implementing regulation requires two specific findings:
  • a liberalizing law or administrative issue was implemented, and
  • the ultimate grant of benefits was pursuant to such a favorable change in law.
The use of the words pursuant to indicates that the benefits of this provision apply only where the law or administrative issue is one which provides a substantive basis for establishing entitlement to benefits.
Note:  The regulatory criteria, as discussed in M21-1, Part V, Subpart ii, 4.A.6.h, adds an additional requirement for eligibility.
Reference:  For more information on the threshold for eligibility pursuant to a liberalizing law or issue, see Brown v. Nicholson, 21 Vet.App. 290 (2007).

V.ii.4.A.6.h.  Regulatory Eligibility Requirements for Retroactive Awards Under 38 CFR 3.114

The provisions of 38 CFR 3.114(a) for retroactive benefits apply to claimants who become eligible for initial or increased benefits solely because of liberalizing changes in law or administrative issues.
In addition to the statutory eligibility standard provided in 38 U.S.C. 5110(g)38 CFR 3.114 provides that the claimant must meet the eligibility requirements of the liberalizing law or regulations
  • on the effective date of the
    • liberalizing law or regulation, and
    • award, and
  • during the entire retroactive period.
Important:  The requirements expressed in this block apply
  • equally to pending and previously denied claims, and
  • to any type of VA issue impacted by a law change, including but not limited to
    • rating issues
    • authorization issues, or
    • other benefit determinations, such as vocational rehabilitation/employment.
References:  For more information on

V.ii.4.A.6.i.  Entitlement Factors Inapplicable for Consideration Under 38 CFR 3.114 for Pension and Parents’ DIC

For pension and Parents’ DIC, the entitlement factors of income (and net worth for pension) are not considered to be eligibility factors for the purposes of qualifying for an effective date under 38 CFR 3.114.
Eligibility factors for pension include factors such as wartime service, age 65 or disability for Veterans, and relationship to the Veteran for survivors.  Therefore, it is not necessary for a claimant’s income or net worth to have been within acceptable limits continuously from the effective date of a liberalizing law or regulation.  VA may pay pension or Parents’ DIC for all or any portion of the applicable retroactive period for which the claimant is entitled.
Partial retroactive payments during the liberalized period can be paid i
  • net worth changes during the liberalized period that allows a partial payment, or
  • the maximum annual pension rate (MAPR) changes during the liberalized period, which results in the income for VA purposes (IVAP) being less than the MAPR.
Note:  The MAPR can change if a dependent is added to the award or SMP is granted.  It does not include a change in medical expenses without a change in MAPR.
Reference:  For more information on application of 38 CFR 3.114 for pension and Parents’ DIC effective dates, see M21-1, Part IX, Subpart iii, 1.A.4.

V.ii.4.A.6.j.  Example 1:  Age-65 Liberalizing Legislation in a Pension Claim

Situation:  A Veteran, age 85, is granted Veterans Pension based on the date of claim of October 17, 2014.  The grant is based on monthly retirement income of $1,200.00 and annual medical expenses of $4,858.00 (consisting of monthly Medicare Part B premiums of $104.90 and monthly supplemental health insurance of $300.00).
The Veteran submits a claim for an earlier effective date under liberalizing legislation within one year of VA’s decision notice, showing that income and net worth have not changed from the previous year.  However, medical expenses are slightly different in that the health insurance of $300.00 did not start until October 1, 2014.  Additionally, the claimant submitted $600.00 in eye care expenses paid in December 2014.
Result:  The Veteran is eligible for consideration of an earlier pension effective date because the Veteran was age 70 on September 17, 2001, the effective date of section 207 of PL 107-103.  However, when entitlement is considered from October 17, 2013, based on the reported income and the corrected medical expense information, the Veteran’s IVAP exceeds the MAPR.  A retroactive benefit for the liberalized period cannot be granted because there was not a change in MAPR that allowed for a partial grant of benefits within the liberalized period.

V.ii.4.A.6.k.  Example 2:  Age 65 Liberalizing Legislation in a Pension Claim

Situation:  A Veteran, age 85, is granted Veterans Pension based on the date of claim of October 17, 2014.  The grant is based on monthly retirement income of $1,200.00 and annual medical expenses of $4,858.00 (consisting of monthly Medicare Part B premiums of $104.90 and monthly supplemental health insurance of $300.00).
The Veteran submits a claim for an earlier effective date under liberalizing legislation within one year of VA’s decision notice, showing that net worth and medical expenses have not changed for the prior year.  However, income is slightly different because a one-time inheritance of $5,000.00 was received on March 15, 2014.
Result:  The Veteran is eligible for consideration of an earlier date because the Veteran was age 70 on September 17, 2001, the effective date of section 207 of PL 107-103.  When entitlement is considered from October 17, 2013, based on the reported income and medical expense information, the Veteran’s IVAP is below the applicable MAPR.  Therefore, the Veteran is entitled to an earlier pension effective date.  VA grants pension from October 17, 2013, payable November 1, 2013.  VA must readjudicate the award and count the inheritance of $5,000 from April 1, 2014, to April 1, 2015.  Pension payments are stopped from April 1, 2014, to April 1, 2015, as the Veteran’s IVAP exceeds the MAPR.  VA can re-start the award effective April 1, 2015, payable May 1, 2015, if evidence is available or submitted to show that the Veteran meets the income and net worth criteria for benefits from April 1, 2015.  If not, the Veteran may reapply for benefits at a later date.
Note:  Because the Veteran claimed an earlier effective date for pension under liberalizing legislation, VA must readjudicate the claim based on the facts found.  VA has no authority to pick and choose the award effective date.  The Veteran has the choice to claim an earlier effective date under liberalizing legislation.  Therefore, if a claim is submitted, VA must readjudicate the claim using all of the facts and information submitted by the Veteran.  This would include counting all reported income and considering all allowable medical expenses applicable during the liberalized period.
References:  For more information on

V.ii.4.A.6.l.   Awarding or Increasing Benefits Under 38 CFR 3.114

If a liberalizing law or approval of a liberalizing VA issue, such as a change in rating or dependency criteria, establishes liberalized standards of entitlement, then award or increase benefits retroactively, as outlined in the table below.
Exception:  This does not apply for any period prior to December 1, 1962.
If the claim is
reviewed …
And …
Then benefits may be awarded …
on the initiative of VA
within one year from the effective date of the law or VA issue
from the effective date of the law or VA issue.
more than one year after the effective date of the law or VA issue
for a period of one year prior to the date of administrative determination of entitlement.
at the request of the claimant
received within one year from the effective date of the law or VA issue
from the effective date of the law or VA issue.
received more than one year after the effective date of the law or VA issue
for a period of one year prior to the date of receipt of the request.
Note:  If an ITF was received within one year from the effective date of the law and the claimant submits a complete claim within a year of VA receiving the ITF for the same benefit, the benefits may be awarded from the effective date of the law or VA issue.
Reference:  For more information on ITF, see M21-1, Part II, Subpart iii, 2.A.

V.ii.4.A.6.m.  Determining Which Statutory or Regulatory Version Is More Favorable

When a statute or regulation changes during the pendency of a claim to which the law is applicable, a determination must be made as to whether the new law or prior law is more favorable to the disposition of the pending claim.
The new law is more favorable if
  • it would support an allowance that the prior standard would not (such as SC, or an increased evaluation), or
  • both standards would support an allowance but the new standard would support an allowance of a greater degree (such as an increased evaluation or special monthly compensation).
The prior standard is more favorable when it would support
  • a greater allowance than the new law, or
  • the same allowance, making it more favorable in that the allowance could typically be assigned from an earlier effective date.

V.ii.4.A.6.n.  Provision of Due Process for Reducing or Discontinuing Awards Under 38 CFR 3.114(b)

Under 38 CFR 3.114(b), VA must provide due process if a new law, regulation, change in the interpretation of a law, or issue requires VA to reduce or discontinue benefits that were properly authorized under instructions in effect at the time the award was processed.  VA must
  • send the claimant a written notice of proposed adverse action, and
  • allow 60 days for the claimant to submit evidence showing why the change should not be made.
Make the proposed change effective the first of the month following the date on which the 60-day due process period ends, unless VA receives evidence within 65 days of the date of the notice of proposed adverse action that shows VA should not take the proposed action.
Reference:  For more information on due process procedures and requirements, see M21-1, Part I, Subpart i, 1.B.

V.ii.4.A.6.o.  Example of Staged Rating Impacted by 38 CFR 3.114

Facts:  A Veteran with verified in-country service in Vietnam submits an original claim for SC for type 2 diabetes mellitus on January 1, 2014, along with evidence dated January 1, 1999, showing confirmed diagnosis of diet-controlled diabetes.  A VA examination conducted on February 3, 2014, shows the Veteran uses insulin.
Analysis:  As all of the entitling criteria for a grant of SC were met as of the date of the law change to recognize type 2 diabetes mellitus as a presumptive disability associated with herbicide exposure, per 38 CFR 3.114(a)(3), a one-year retroactive effective date is warranted for the grant of SC.  Thus, SC is granted January 1, 2013.  A 10-percent evaluation is warranted from January 1, 2013, since the evidence shows only diet-controlled diabetes.  Effective February 3, 2014, the first time the evidence showed the requirement for insulin, a 20-percent evaluation is warranted.

V.ii.4.A.6.p.  Applicability of Revised Rating Schedule Criteria

When VA issues a regulatory amendment to the rating schedule while an initial or increased rating claim is pending, and that amendment is more favorable to the claimant than the prior regulation, VA should apply the
  • more favorable regulation to rate the disability for periods from and after the effective date of the change, and
  • prior regulation to rate the disability for earlier periods.
Refer to the table below for the three-step analysis involved in deciding the claim for increased rating in situations in which the rating criteria is revised during the pendency of the claim.
Step
Action
1
Determine whether the intervening change is more favorable to the Veteran.  This may require application of each version of the regulation to the facts of the case unless it is clear from the face of both versions of the regulation that the change is more favorable.
If the revised criteria are
  • more favorable, go to Step 2, or
  • not more favorable, then evaluate the claim for increased rating under the prior version of the regulation.
2
Apply the more favorable amended regulation to rate the disability for periods from and after the effective date of the regulatory change.
3
Apply the prior regulation to rate the disability for periods preceding the effective date of the regulatory change.
References:  For more information on
  • the analysis required to determine whether revised rating schedule criteria allows for retroactive applicability, see VAOPCGCPREC 3-2000
  • evaluating disabilities following rating schedule readjustment, see M21-1, Part V, Subpart ii, 3.D.2, and
  • potential liberalization associated with the revision of the criteria for rating psychiatric disorders which became effective February 3, 1988, see VAOPGCPREC 9-1992.

7.  Effective Dates Based on Judicial Precedents or General Counsel Opinions


Introduction

This topic includes information clarifying the principles for determining effective dates when a decision is impacted by a precedential judicial decision or a decision of the Office of General Counsel, including

Change Date

June 27, 2022

V.ii.4.A.7.a.  Effective Dates Based on Judicial Precedents

A precedential decision by CAVC, U.S. Court of Appeals for the Federal Circuit, or the U.S. Supreme Court that affects a statute, regulation, or other VA rule is legally binding upon VA effective the date of the issuance of the decision.  The effect of such a decision may result in different effective dates for different classes of claimants with regard to the issue decided.
A court’s decision is not a liberalizing issue for purposes of application of 38 CFR 3.114.  However, if CAVC’s decision results in an amendment to a regulation or statute, then the claimant or appellant may be entitled to retroactive disability or death benefits under the provision of 38 CFR 3.114(a).  When regulatory revision results, the claimant may receive retroactive benefits for a period of up to one year prior to the date of receipt of the claim, but no earlier than the effective date of the amended regulation or statue.
Refer to the table below to determine the impact of a judicial precedent on an effective date.
If the claim …
Then …
is pending at a regional office (RO), Board of Veterans’ Appeals, or before a court on the date a precedent decision is issued
the ruling of the court must be considered in deciding the pending claim.
If the decision is favorable, the effective date may go as far back as the date the pending claim was received unless a specific provision, law, or regulation provides for an earlier date.
is received on or after the date of issuance of the court decision which has a bearing on that claim
the claim must be decided under the provisions of the court’s ruling.
If a favorable decision is made, the effective date will be the date of receipt of the claim unless a specific provision of law or regulation provides for an earlier date.
became final prior to the date of issuance of the court decision
the prior decision is not subject to review under the provisions of the court’s ruling.
  • Decisions may not be challenged on the basis of clear and unmistakable error (CUE) based solely on the provisions of the court’s ruling.
  • A new claim must be filed on or after the date of the court’s decision to allow for consideration under the provisions of the court’s ruling.  If a favorable decision is made, the effective date will be the date of receipt of the claim unless a specific provision, law, or regulation provides for an earlier effective date.
Notes:
  • Court decisions invalidating VA regulations or statutory interpretations do not have retroactive effect in relation to prior claim decisions that are now finally adjudicated under 38 CFR 3.160(d).  However, court decisions relating to pending claims may be applied retroactive to the date of the court holding.
  • VA may only stay the binding effect of a precedential decision of CAVC if it files a motion for stay with the court that rendered the decision.
  • When there is an interim period between the issuance of a precedential holding and the publication of associated procedural guidance, any decision made during the interim period that fails to implement the precedential holding, such that a manifestly different decision would result based on the holding, should be corrected with a finding of CUE.
References:  For more information on

V.ii.4.A.7.b.  Example:  Effective Date Based on Judicial Precedent:  Pending Claim

Facts:  In Esteban v. Brown, 6 Vet.App. 259 (1994), CAVC liberally interpreted VA’s rule against pyramiding in a manner favorable to the claimant.
On September 1, 1993, a Veteran submitted a claim for an increased evaluation for an SC facial injury.  The claim was still pending on the date of CAVC’s decision for Esteban v. Brown.
Analysis:  An increased evaluation was granted based solely upon the Esteban decision for the residuals of the facial injury because the Veteran’s condition met the criteria for the increased evaluation.
The effective date in this case is September 1, 1993, the date of claim since the claim was pending on the date of the precedential decision.  The assignment of the effective date is not limited to the date of the CAVC decision since it did not result in a liberalizing regulation.

V.ii.4.A.7.c.  Example:  Effective Date Based on Judicial Precedent:  Prior Decision Not Final

Facts:  In Petitti v. McDonald, 27 Vet.App. 415 (2015), CAVC liberally interpreted VA’s regulation at 38 CFR 4.59 concerning assignment of a compensable evaluation based on painful motion for a joint.
On January 22, 2015, the Veteran claimed SC for a right knee condition.  SC was granted for chronic right knee strain with a 0-percent evaluation.  The VA examination revealed no objective evidence of painful motion on examination.  No other objective evidence of painful motion was of record.  The Veteran was notified on June 13, 2015, of a grant of SC with a 0-percent evaluation assigned.
On February 11, 2016, the Veteran’s authorized representative submitted a request to reconsider the 0-percent evaluation in connection with the CAVC holding in Petitti.  The evidence of record at the time of the non-final decision to assign a 0-percent evaluation did include credible lay evidence of painful motion.
Analysis:  As the June 13, 2015, decision was not final at the time of the October 28, 2015, CAVC Petitti holding, the ruling of CAVC must be considered in deciding the pending request for reconsideration.  Accordingly, as the holding allows for assignment of the higher 10-percent evaluation based on credible lay evidence of painful motion, the prior decision must be reconsidered and a 10-percent evaluation assigned effective January 22, 2015, the date of receipt of the prior, non-final claim.  The assignment of the effective date is not limited to the date of the CAVC decision since it did not result in a liberalizing regulation.

V.ii.4.A.7.d.  Example:  Effective Date Based on Judicial Precedent:  Liberalizing Regulation

Facts:  In Gregory v. Brown, 5 Vet.App. 108 (1993), CAVC invalidated portions of 38 CFR 3.53(a).  VA subsequently published an amendment to that regulation that implemented CAVC’s holding with an effective date of the regulation retroactive to May 13, 1993, the date of CAVC’s decision.  On June 1, 1994, the surviving spouse, who had a final decision denying benefits in 1985 due to reliance on the now invalidated regulation, filed a claim.
Analysis:  Because VA issued liberalizing regulations to implement the decision, the
  • provisions of 38 CFR 3.114(a) must be applied, and
  • appropriate effective date is June 1, 1993, one year prior to date of claim.

V.ii.4.A.7.e.  Example:  Effective Date Based on Judicial Precedent: No Regulatory Change

Facts:  Although CAVC’s decision in Esteban v. Brown, 6 Vet.App. 259 (1994), liberally interpreted VA’s rule against pyramiding in a manner favorable to the claimant, VA determined that no regulatory changes were required as a result of that decision.
On June 10, 1994, a Veteran submitted a claim for an increased evaluation for residuals of an SC facial injury.  The claim was received after the date of the Esteban decision.
Analysis:  Based solely on CAVC’s decision, the evaluation of the facial injury was increased effective June 10, 1994, the date of receipt of claim.
The provisions of 38 CFR 3.114(a) do not apply.  No retroactive award is warranted because CAVC decisions are not liberalizing issues for purposes of a retroactive effective date.

V.ii.4.A.7.f.  Effective Dates Based on General Counsel Opinions

In most instances, General Counsel opinions interpret statutes and regulations and thus generally clarify existing law rather than change law.  Consequently, they usually do not represent changes in law or VA issue for the purposes of application of 38 CFR 3.114.
However, on occasion a General Counsel opinion may conclude that a prior VA interpretation of the law was erroneous and announce a new interpretation for future use.  Such an opinion would constitute a change in law or VA issue for purposes of application of 38 CFR 3.114.
Reference:  For more information on applicability of 38 CFR 3.114 associated with General Counsel opinions, see VAOPGCPREC 88-1990.

8.  Claims for Earlier Effective Dates


Introduction

This topic includes information clarifying the principles for determining effective dates when a decision is impacted by new guidance, including

Change Date

February 19, 2019

V.ii.4.A.8.a.  Requests for an Earlier Effective Date

In Rudd v. Nicholson, 20 Vet.App. 296 (2006), CAVC held that VA has no authority to adjudicate a “freestanding” request for an earlier effective date associated with an RO decision that has become finally adjudicated under 38 CFR 3.160(d).
Although VA cannot consider a request for an earlier effective date on a finally adjudicated RO decision, the claimant may allege CUE with respect to the assignment of the effective date in that prior decision.  For the CUE claim to be considered valid, the claimant must specify the factual or legal errors at issue.
Example:  A claimant’s statement that “my effective date is wrong, or “I want an earlier effective date” does not sufficiently specify the factual or legal error at issue.
References:  For more information on

V.ii.4.A.8.b.  Processing Freestanding Requests for an Earlier Effective Date

Use the table below to determine how to process a freestanding request for an earlier effective date.
If the request for an earlier effective date…
Then …
  • alleges a CUE, and
  • specifies the factual or legal error(s) at issue
process the request in accordance with M21-1, Part X, Subpart ii, 5.A.2.a.
  • does not allege a CUE, or
  • alleges a CUE but does not specify the factual or legal error(s) at issue
respond to the request in accordance with M21-1, Part X, Subpart ii, 5.A.2.b.
References:  For more information on