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Updated Jan 03, 2024

In This Section

  
This section contains the topic “Developing Claims Filed Under 38 U.S.C. 1151.”

 
 

1.  Developing Claims Filed Under 38 U.S.C. 1151

 

 

Introduction

 
This topic contains information on developing claims filed under 38 U.S.C. 1151, including

Change Date

 

August 3, 2022

VIII.iv.6.A.1.a.  General Information About Claims Filed Under 38 U.S.C. 1151

  
38 U.S.C. 1151 provides for the payment of compensation for additional disability or death proximately caused by
  • Department of Veterans Affairs (VA)
    • hospital care
    • medical or surgical treatment, or
    • examination
  • participation in vocational rehabilitation training, or
  • participation in compensated work therapy.
Disabilities and/or causes of death recognized under this provision of law are compensated “as if” service-connected (SC), but are not actually SC.

VIII.iv.6.A.1.b.  Possible Sources of Information About the Incident

 

Documentary evidence pertinent to the incident upon which the claim is based may assume many possible forms, including

  • medical records
  • surgical records
  • hospital clinical records, and/or
  • nurses’ notes.

VIII.iv.6.A.1.c.  Requesting Information From the Medical Facility

  
Follow the steps in the table below to obtain evidence and information from the medical facility identified as the site of the incident upon which the claim is based.
 
Step
Action
1
Retrieve any and all clinical reports, progress notes, and hospital summaries associated with the incident in question using the
2
Follow the instructions in M21-1, Part III, Subpart ii, 1.A.2.h to upload all pertinent records to the Veteran’s electronic claims folder.
3
For all claims under 38 U.S.C. 1151, request comprehensive evidence of the claimed incident using CAPRI’s electronic VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action, request functionality. Include the mandatory request elements described in the second column of the fifth row of the table at M21-1, Part III, Subpart ii, 1.A.2.d.
 
Select the 7131 REQUEST tab in the patient’s CAPRI record, and cut and paste the following text into the COMMENTS field, populating necessary details about the claimant where appropriate:
 
We have received a claim from the person identified below for benefits under 38 U.S.C. 1151 based on alleged injury while at your facility.
 
Name:
File Number:
SSN:
Date of Birth:
 
The claimant alleges sustaining an injury to the [condition].  This injury occurred on [MM-DD-YYYY].
 
To assist us in making a determination, please furnish all of the following evidence, if available, for this patient for the period of medical care from [MM-DD-YYYY] to [MM-DD-YYYY]:
  • medical records
  • surgical records
  • hospital clinical records
  • nurses’ notes, and
  • any other documentation of patient injury.
Note:  The electronic VA Form 10-7131 in CAPRI
  • supports text entry of up to four pages, and
  • maintains tracking information regarding the status of requests.
 
References:   For more information on

VIII.iv.6.A.1.d.  Quality Assurance Investigative Reports

 
Request quality assurance investigative reports only if the claimant
  • identifies these records as evidence necessary to substantiate the claim
  • identifies quality assurance records consistent with 38 U.S.C. 5103A(b)(1), and
  • furnishes sufficient information to locate the records consistent with 38 U.S.C. 5103A(c)(2).
Notes:
  • If the Veterans Health Administration (VHA) denies access to these records, request an Office of General Counsel (OGC) review.
  • An OGC review is not appropriate when VHA denies access to these records because they are no longer available.
Reference:  For more information on the documents that qualify as quality assurance reports, see