In This Chapter

Introduction

• general responsibilities of a claims processor
• general policy regarding the referral of survivors benefits claims to the rating activity
• award of Survivors Pension prior to rating decision regarding service-connected (SC) death
• specific situations in which survivors benefits claims must be referred to the rating activity
• determining when a review for implicit service connection (SC) for the cause of death is needed and referring the claim to the rating activity, and
• rating activity’s responsibilities upon review of an implicit claim for SC death.

Change Date

XI.ii.1.1.a.  General Responsibilities of a Claims Processor

• should be submitted to the rating activity, or
• can be decided without a rating decision.

XI.ii.1.1.b.  General Policy Regarding the Referral of Survivors Benefits Claims to the Rating Activity

• homicide
• execution for a crime, or
• accident or disaster.

c.  Award of Survivors Pension Prior to Rating Decision Regarding SC Death

• authorizer’s initials, and
• date when the decision notice was released to the claimant.

XI.ii.1.1.d.  Specific Situations in Which Survivors Benefits Claims Must Be Referred to the Rating Activity

• the claimant has specifically raised the issue of SC for the cause of death on the application or otherwise, including Dependency and Indemnity Compensation (DIC) under 38 U.S.C. 1151
• a rating decision was made during the Veteran’s lifetime, awarding SC for a condition affecting a vital organ such as but not limited to the following:
  • brain
  • heart
  • lungs
  • liver, or
  • kidneys
• the Veteran had one or more SC conditions with a combined 100-percent evaluation
• the Veteran was in receipt of individual unemployability benefits
• a claims processor determines there is reasonable probability that the death may be related to service, whether from
  • disease
  • injury, or
  • self-infliction
• the claimant has filed for Survivors Pension, and the Veteran met the wartime service requirement but did not meet the 90-day length of service requirement, unless one of the following situations exists:
  • there is no indication or claim that the discharge from service was for an SC disability
  • discharge was for reasons other than a disability
  • service records show no disability, or
  • the Veteran, at the time of death, was receiving or entitled to receive compensation for an SC disability based on service during a period of war
• a claim for accrued benefits that involves a rating issue is received, or
• a claim for SC burial benefits is received.

• If a claim for SC for cause of death is filed by a parent or parents, and the income is excessive for the receipt of DIC,
  • deny the claim because of excessive income, and
  • notify the claimant that no other aspect of the claim has been considered.
• Do not send a non-SC burial claim to the rating activity if the Veteran’s death certificate (or proof of death equivalent to a death certificate per 38 CFR 3.211) is not of record.

• If the rating activity determines the facts do not warrant a formal determination of SC, the claim may be
  • annotated that there is no evidence of SC death, and
  • returned to the authorization activity for resolution of the formally claimed issues.
• If a claim for survivors benefits cannot be referred to the rating activity for a formal determination of SC, the authorization activity must deny the issue administratively.

• the non-discretionary application of 38 CFR 3.152(b) regarding survivors benefits, see M21-1, Part II, Subpart iii, 1.A.3.e
• the rating activity’s responsibility for reviewing potential SC for cause of death, see M21-1, Part XII, Subpart i, 1.B
• determining if a review for implicit SC death is needed and referring the claim to the rating activity, see M21-1, Part XI, Subpart ii, 1.1.e
• proof of death equivalent to a death certificate, see 38 CFR 3.211
• cause of death, see 38 CFR 3.312
• when to send an accrued claim to the rating activity, see M21-1, Part XI, Subpart ii, 3.D.1.a, and
• SC burial benefits, see M21-1, Part XI, Subpart iii, 1.B.2.

XI.ii.1.1.e.  Determining When a Review for Implicit SC for the Cause of Death Is Needed and Referring the Claim to the Rating Activity

f.  Rating Activity’s Responsibilities Upon Review of an Implicit Claim for SC Death

Introduction

• do not require a claim for survivors benefits, and
• require a claim for DIC.

Change Date

XI.ii.1.2.a.  Special Purpose Determinations That Do Not Require a Claim for Survivors Benefits

XI.ii.1.2.b.  Special Purpose Determinations That Require a Claim for DIC

• inform the requester that the Department of Veterans Affairs is without authority to make a determination unless a claim is filed, and
• furnish the requestor with a VA Form 21P-534 EZ, Application for DIC, Survivors Pension, and/or Accrued Benefits, or VA Form 21P-535, Application for Dependency and Indemnity Compensation by Parent(s) (Including Accrued Benefits and Death Compensation When Applicable), as appropriate.