In This Chapter

Introduction

Change Date

VIII.iii.10.1.a.  Presumption of SC for COVID-19

VIII.iii.10.1.b.  Nomenclature for COVID-19 

• novel coronavirus
• Coronavirus
• severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2
• coronavirus disease, and
• COVID-19.

VIII.iii.10.1.c.  Applicable Theories of SC

• direct SC under 38 CFR 3.303
• on the basis of aggravation under 38 CFR 3.306, or
• on a secondary basis under 38 CFR 3.310. 

VIII.iii.10.1.d.  Definition:  Symptoms of COVID-19

VIII.iii.10.1.e.  Manifestation Period

• during a qualifying period of duty, if that period was more than 48 continuous hours in duration, or
• within 14 days following the date of separation from a qualifying period of duty.

• 38 U.S.C. 1164(b) and (c), and
• M21-1, Part VIII, Subpart iii, 10.A.2.a.

Introduction

Change Date

VIII.iii.10.2.a.  Qualifying Period of  Service Requirements

• active duty from March 1, 2020, until January 5, 2024
• active duty for training (ADT) under Title 10 or full-time National Guard duty (as defined in Section 101 of Title 10) under orders issued on or after March 13, 2020, until January 5, 2024, or
• certain periods of inactive duty for training (IADT) during which COVID-19 is presumed to have been incurred occurring between March 13, 2020, and January 5, 2024.

• considering certain periods of IADT as qualifying service, see M21-1, Part VIII, Subpart iii, 10.2.c, and
• verifying periods of ADT and IADT, see M21-1, Part III, Subpart i, 1.A.2.e.

VIII.iii.10.2.b.  Required Duration of Service

VIII.iii.10.2.c.  IADT as Qualifying Service

• during a period of IADT, if the period of service was more than 48 continuous hours, or
• in the 14-day manifestation period following a period of IADT of any duration.

Introduction

Change Date

VIII.iii.10.3.a.  Use of the COVID-19 Special Issue Indicator

VIII.iii.10.3.b.  Handling Allegations of COVID-19 Exposure 

Introduction

Change Date

VIII.iii.10.4.a.  COVID-19 Claims Development

VIII.iii.10.4.b.  Referral to the Rating Activity

• referring claims to the rating activity after development is complete, see M21-1, Part V, Subpart i, 1.B.1.a, and
• requesting examinations for claims for SC for COVID-19 and residuals, see M21-1, Part VIII, Subpart iii, 10.5.

Introduction

Change Date

VIII.iii.10.5.a.  Evidence Needed to Request an Examination

• qualifying period of duty
• competent lay or medical evidence of a current disability or persistent or recurrent symptoms of a disability, and
• allegation of the onset of those symptoms during the manifestation period that is credible and consistent with all other facts of record.

• A positive COVID-19 test is not required before requesting an examination.
• For claims based on ADT and IADT, treat the qualifying period of duty as active service for the purpose of scheduling an examination or medical opinion under 38 CFR 3.159.

• M21-1, Part IV, Subpart i, 1.B.1.a and b, and
• Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

VIII.iii.10.5.b.  Requesting Medical Opinions to Confirm a COVID-19 Diagnosis

• a claimant has qualifying service, and
• symptoms arose during the applicable manifestation period, regardless of whether the condition was formally diagnosed, but there is question as to whether the symptoms experienced by the claimant are attributable to COVID-19.

VIII.iii.10.5.c.  Guidelines for Examinations

• Request the Infectious Diseases Disability Benefits Questionnaire for all COVID-19-related claims, even if the record indicates that COVID-19 has resolved.
• Request separate DBQs appropriate for the claimed residual conditions.
• Note on the examination request the date of any COVID-19 test(s) and the results.
• Ensure any specifically claimed COVID-19 residual condition is identified in the examination request so the examiner is fully aware of any residual condition(s) that must be addressed.
• If the evidence indicates the claimed disability or symptoms may be associated with COVID-19, request a medical opinion as needed. 

Introduction

Change Date

VIII.iii.10.6.a.  Presumptive SC Applicability

• the defined manifestation period, see
  • 38 U.S.C. 1164(a)(2)(A), and
  • M21-1, Part VIII, Subpart iii, 10.A.1.e, and
• rating considerations for evaluating COVID-19, see M21-1, Part V, Subpart iii, 3.6.

VIII.iii.10.6.b.  Presumptive vs. Direct SC for COVID-19

• An in-service diagnosis of COVID-19 is sufficient to concede an in-service event for the purposes of establishing direct SC.  This applies even when the service records do not explicitly include the results of a COVID-19 test.
• If evidence shows that chronic residuals of COVID-19 are related to service through a medical nexus, direct SC is warranted.

VIII.iii.10.6.c.  Prohibition of Direct SC for COVID-19 Based on IADT

• SC for a disability that results from administration of a COVID-19 vaccination during IADT, see M21-1, Part V, Subpart iii, 3.6.e, and
• adjudicating claims based on ADT and IADT, see M21-1, Part III, Subpart i, 1.A.2.k.

VIII.iii.10.6.d.  Considering Presumptive vs. Direct SC for COVID-19

VIII.iii.10.6.e.  Rebuttal of Presumptive SC for COVID-19

• 38 U.S.C. 1113, and
• M21-1, Part V, Subpart ii, 2.B.1.d.

VIII.iii.10.6.f.  Effective Date Considerations for Presumptive SC for COVID-19

• The establishment of the presumptive provision is a liberalizing rule that warrants consideration of 38 CFR 3.114.
• The availability of direct SC for chronic residuals of COVID-19 incurred in or caused by a period of active duty or ADT is not based on a liberalizing provision. 
• Statutory provisions for presumptive SC were added effective January 5, 2021.  Presumptive SC cannot be established prior to that date.