In This Chapter

This chapter contains the following topics:

Introduction

This topic contains general information on eligibility and development for original pension claims, including

• elements of pension entitlement
• pension development guidelines for claims processors, and
• effective dates and payment dates for
  • Veterans Pension, and
  • Survivors Pension.

Change Date

March 7, 2022

IX.i.2.1.a.  Elements of Pension Entitlement

In order to establish entitlement to Veterans Pension, the following elements must be shown:

• qualifying service
• a permanent and total (P&T) disability, or age 65 or older
• countable income is below the maximum annual pension rate (MAPR), and
• net worth limitations are met.

In order to establish entitlement to Survivors Pension, the following elements must be shown:

• qualifying service
• relationship to the Veteran
• for a surviving spouse, the spouse is not remarried
• for a surviving child, the child is unmarried and
  • under age 18
  • became permanently helpless before age 18, or
  • is between age 18 and 23 and is in school
• countable income is below the MAPR, and
• net worth limitations are met.

References:  For more information on

• Veterans Pension, see 38 U.S.C. 1521
• Survivors Pension for surviving spouses, see 38 U.S.C. 1541, and
• Survivors Pension for surviving children, see 38 U.S.C. 1542.

IX.i.2.1.b. 
Pension Development Guidelines for Claims Processors

It is the responsibility of the claims processor to develop the evidence needed to establish entitlement to pension.  If a claim does not meet one or more of the eligibility requirements, deny the claim.  Do not develop or rate the claim.

Use the table below to find information on developing for each pension entitlement element.

Notes:

• If a fully developed claim (FDC) that is accepted as substantially complete as noted in M21-1, Part II, Subpart iii, 1.C.1.a requires additional development to the claimant, exclude the claim from the FDC Program and develop as necessary.  A claims processor cannot deny an FDC from a claimant that meets basic eligibility criteria without first developing for any information or evidence needed to support the claim.
• If pension benefits cannot be granted or denied upon initial review of a claim, and a Section 5103 notice was not provided on the application, a Section 5103 notice must be included in any development letter. 
• A Veteran may need to report for any Department of Veterans Affairs (VA) medical examinations VA determines are necessary to decide the claim.

Reference:  For more information regarding FDC processing, see M21-1, Part X, Subpart i, 2.A and B.

IX.i.2.1.c.  Effective Dates and Payment Dates for Veterans Pension

In general, the effective date for an original Veterans Pension claim is the date the claim was received, per 38 CFR 3.400.  The payment date is the first day of the month following the date the claim was received, per 38 CFR 3.31.

References:  For more information on

• retroactive Veterans Pension effective dates
  • under 38 CFR 3.400 or Public Law 107-103, see M21-1, Part IX, Subpart ii, 2.B.7.b and c, and 
  • due to a Veteran’s P&T disability or liberalizing law, see M21-1, Part IX, Subpart iii, 1.A.4.c and d, and
• effective dates associated with a receipt of an intent to file, see M21-1, Part II, Subpart iii, 2.A.1.

IX.i.2.1.d.  Effective Dates and Payment Dates for Survivors Pension

Use the table below to determine the effective date and payment date of an original Survivors Pension claim.

Notes:

• When the Survivors Pension award effective date is the first day of the month of the Veteran’s death, the first day of the initial year is the date of the Veteran’s death. VA does not count income that a surviving spouse or child received before the Veteran’s death.
• In an original surviving spouse award, claims processors should also pay the month of death payment if it was not paid automatically. See 38 CFR 3.20 and M21-1, Part XI, Subpart ii, 2.1.

References:  For more information on

• the effective date based on the non-service-connected death of a Veteran after separation from service, see 38 CFR 3.400(c)(3), and
• the definition of initial year, see M21-1, Part IX, Subpart iii, 1.A.3.g.

Introduction

This topic contains information on developing for P&T disability and age, including

• when a rating determination of P&T disability is not required
• acceptable evidence of age
• Social Security disability evidence and Share verification
• determining disability effective date based on Social Security information
• when a rating determination of P&T disability is required
• acceptable medical evidence and definition of adequate medical evidence for pension rating purposes
• VA examination authorization
• obtaining evidence before referring a claim to the rating activity
• action to take when medical evidence is not received, and
• developing for unemployability.

Change Date

March 7, 2022

IX.i.2.2.a.  When a Rating Determination of P&T Disability Is Not Required

A rating determination of P&T disability is not required to establish eligibility for Veterans Pension when a Veteran is

• age 65 or older, or
• presumed to be P&T disabled for pension purposes due to being
  • a patient in a nursing home for long-term care because of a disability, or
  • disabled, as determined by the Commissioner of Social Security.

Note:  A medical foster home that VA has recognized and approved under 38 CFR 17.73 is equivalent to a nursing home.

IX.i.2.2.b.  Acceptable Evidence of Age

Age is a factor in Veterans Pension claims.  If the Veteran is age 65 or older, a rating determination of P&T disability is not required.

If the date of birth as given by the Veteran agrees with other dates of birth shown in the records, no further development is necessary.  Otherwise, per 38 CFR 3.208, accept the youngest age shown in the records, pending receipt of acceptable evidence of birth as listed in 38 CFR 3.209.

IX.i.2.2.c.  Social Security Disability Evidence and Share Verification

If a Veteran is younger than age 65, but the Social Security Administration (SSA) has determined that the Veteran is disabled, the Veteran may be presumed P&T disabled for pension purposes from the date of disability onset.

The information provided in the Share SSA data screens may be used to determine eligibility for VA pension.  Use the table below to determine the nature of the Social Security benefit obtained from Share.

Reference:  For more information on using Share, see the Share User Guide.

IX.i.2.2.d.  Determining Disability Effective Date Based on Social Security Information

Unless VA pension eligibility is based on age, a Veteran must be disabled to be eligible. VA pension eligibility based on an SSA finding of disability should be effective from the later of

• the date of receipt of the pension application, or
• the date of disability.

The Social Security information available through Share may be used to determine eligibility for VA pension.  Use the table below to determine the effective date of a disability for pension purposes.

Reference:  For more information on when the evidence indicates payment of SSI, see M21-1, Part IX, Subpart i, 2.2.c. 

IX.i.2.2.e.  When a Rating Determination of P&T Disability Is Required

If the Veteran is not age 65 or older, or presumed to be P&T disabled because of being a patient in a nursing home or VA approved medical foster home, or disabled as determined by the Commissioner of Social Security, then the Veteran must be shown by a rating to

• meet the disability percentage requirements set forth in 38 CFR 4.16 and 4.17 or have an extra-schedular evaluation approved under 38 CFR 3.321(b)(2), and
• be unable to secure and follow a substantially gainful occupation (unemployable) by reason of disabilities which are likely to be permanent.

Note:  For pension claims that require a P&T disability determination, a general medical examination is necessary for all claims when there is insufficient medical evidence available to decide the claim.

References:  For more information on

• acceptable medical evidence for rating purposes, see M21-1, Part IX, Subpart i, 2.2.f, and
• when a VA examination is authorized, see M21-1, Part IX, Subpart i, 2.2.g. 

IX.i.2.2.f.  Acceptable Medical Evidence and Definition of Adequate Medical Evidence for Pension Rating Purposes 

Adequate medical evidence for pension rating purposes must address all medical or mental conditions provided by the Veteran and can be used to evaluate the impact of each condition on the Veteran’s employability.

The following types of medical evidence may be accepted for rating purposes if they are adequate:

• a statement from a licensed health care professional as described in M21-1, Part IX, Subpart ii, 2.C.1.b, or
• a hospital or examination report from any government or private institution.

Evidence of current disability may be contained in reports from a VA or a non-VA medical facility, or in evidence already of record showing the existence of a chronic condition likely to interfere with employability.  If such evidence is obtained, or is already of record, submit the claim to the rating activity.  If this evidence does not support a grant of P&T, and adequate medical evidence is not available, has not been provided, or is not of record, then a medical examination must be scheduled.

References:  For more information on licensed health care professionals to include advanced practice registered nurses for

• evidence on which to base aid and attendance (A&A) and housebound determinations, see M21-1, Part XII, Subpart i, 2.B.1.b, and
• medical evidence used for A&A ratings, see M21-1, Part IX, Subpart ii, 2.C.1.b.

IX.i.2.2.g.  VA Examination Authorization

Per 38 CFR 3.326(a), if the submitted medical evidence or medical evidence of record is not adequate for rating purposes, a VA examination will be authorized.

Use the table below to determine the actions to take based on whether the medical evidence is adequate.

Note:  Claims processors have the authority to request an examination for any claim for which special circumstances may warrant it even if an examination is not required based on this topic.

Reference:  For the definition of adequate medical evidence for pension rating purposes, see M21-1, Part IX, Subpart i, 2.2.f.

IX.i.2.2.h.  Obtaining Evidence Before Referring a Claim to the Rating Activity

If no medical evidence of the claimed disability is of record, request medical evidence from the claimant.

If medical evidence is of record, but is not adequate for rating purposes, schedule the claimant for a VA examination.

Once adequate medical evidence is of record, refer the claim to the rating activity.

Note:  When questions of doubt arise in determining if medical evidence is adequate for rating purpose, refer the claim to the rating activity.

References:  For more information on

• VA’s duty to notify, see M21-1, Part III, Subpart i, 2.B.1.a
• the definition of competent medical evidence, see 38 CFR 3.159(a)(1)
• when to schedule a VA examination, see 38 CFR 3.326, and
• the definition of adequate medical evidence for pension rating purposes, see M21-1, Part IX, Subpart i, 2.2.f. 

IX.i.2.2.i.  Action to Take When Medical Evidence Is Not Received

If no medical evidence of the claimed disability has been received and 30 days have passed from the date of request

• deny the claim, and
• notify the Veteran that
  • the evidence must be provided, and
  • in order for VA to review the evidence, the Veteran must file a supplemental claim.

No additional development is needed and no rating decision is completed.

Notes: 

• An examination may be needed, depending on the information provided on a lay statement.  Follow the guidance outlined in 38 CFR 3.326(a) when ordering examinations and the medical evidence accompanying the claim is not adequate for rating purposes, if appropriate.
• When questions of doubt arise involving adequate medical evidence, refer the claim to the rating activity.
• Do not immediately deny the claim if medical evidence necessary to decide the claim is located at a Federal facility.

References:  For more information on

• VA’s duty to assist in obtaining
  • Federal records and VA’s responsibility to obtain them, see M21-1, Part III, Subpart i, 2.C.1, and
  • non-Federal or private records, see M21-1, Part III, Subpart i, 2.C.2, and
• the requirement for a supplemental claim in order for VA to review new evidence after a denial, see M21-1, Part II, Subpart iii, 2.B.1.e.

IX.i.2.2.j.  Developing for Unemployability

In order for VA to make an unemployability decision, a Veteran must provide their work history for the one year period before becoming disabled.

Use the table below to determine which form to send the Veteran when additional information is needed.

References:  For more information on development in

• MAP-D, see the MAP-D User’s Guide, and
• Veterans Benefits Management System (VBMS), see the VBMS Core User Guide.

Change Date

September 1, 2021

IX.i.2.3.a.  Requesting Necessary Evidence for Income and Net Worth

Do not develop in a piecemeal manner.  Develop for income information at the same time as for other evidence needed to determine entitlement.

References:  For more information on

• developing for evidence of income and net worth, see M21-1, Part IX, Subpart i, 3.A
• requesting information from
  • other Federal agencies, see M21-1, Part III, Subpart ii, 1.C
  • Railroad Retirement Board, see M21-1, Part IX, Subpart i, 3.C.4
  • Office of Personnel Management, see M21-1, Part XIII, Subpart ii, 2.D
  • public assistance agencies, see M21-1, Part XIII, Subpart ii, 3.B, and
  • public benefit eligibility for legal aliens, see M21-1, Part XIII, Subpart ii, 3.C
• requests to VA concerning a State bonus or tax exemption, see M21-1, Part XIII, Subpart ii, 4.B, and
• requests for research purposes, see M21-1, Part XIII, Subpart ii, 5.C.

Introduction

This topic contains information on developing for the willful misconduct aspect of an injury, including

• when to develop for willful misconduct, and
• where to find information on administrative determinations of insanity.

Change Date

April 21, 2015

IX.i.2.4.a.  When to Develop for Willful Misconduct

Pension is not payable for any condition due to the Veteran’s own willful misconduct.

Develop the willful misconduct aspect of an injury in a pension case only when the residual disability from that injury would be a material factor in the grant or denial of a claim.  If there is doubt on this point, obtain advice from the rating activity.

Generally, if the facts of record are relatively clear as to the innocent incurrence of an injury, suggesting no element of willful misconduct, do not develop for this aspect of the claim.

Example:  Unless there is a reasonable probability of willful misconduct, the mere fact that the injury was incurred in an automobile accident is not sufficient reason to initiate development.

Reference:  For more information on willful misconduct, see

• M21-1, Part X, Subpart iv, 1.C, and
• 38 CFR 3.301.

IX.i.2.4.b.  Where to Find Information On Administrative Determinations of Insanity

If there is a question as to whether a Veteran was insane at the time the act was committed that would otherwise be considered misconduct, see M21-1, Part X, Subpart iv, 2.A.

Introduction

This topic contains information on referring pension claims to the rating activity, including

• general information on referring pension claims to the rating activity, and
• action to take in cases in which the Veteran does not meet the minimum service requirement.

Change Date

December 9, 2016

IX.i.2.5.a.  General Information on Referring Pension Claims to the Rating Activity

Refer a claim to the rating activity, provided that

• medical evidence adequate for rating has been received, or
• evidence or allegations of record are sufficient to create a rating issue, and
• the claimant meets all the criteria (service, income and net worth, and, for survivor claims, relationship). 

References:  For information on

• when Survivors Pension claims would need a rating determination, see M21-1, Part IX, Subpart ii, 2.C, and
• the definition of adequate medical evidence for pension rating purposes, see M21-1, Part IX, Subpart i, 2.2.f.

IX.i.2.5.b.  Action to Take in Cases in Which the Veteran Does Not Meet the Minimum Service Requirement

If the Veteran does not meet the minimum service requirement, refer the claim to the rating activity for a determination of basic eligibility only if military service department records indicate that the Veteran was discharged because of a disability.

References:  For information on

• the minimum service requirements for Veterans pension, see M21-1, Part IX, Subpart i, 1.2.a
• exceptions to the minimum service requirements, see M21-1, Part III, Subpart i, 1.B.1.c, and
• considering travel time, see M21-1, Part III, Subpart i, 1.B.2.c.