--- title: "Part VIII, Subpart i, Chapter 3, Section C Eligibility and Development for Chapter 18 Benefits" document: "M-21-1" section: "Part VIII, Subpart i, Chapter 3, Section C" canonical: "https://veteranai.co/va-regulations/m21-1/viii.i.3.c-eligibility-and-development-for-chapter-18-benefits" source: "https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000177430/M21-1-Part-VIII-Subpart-i-Chapter-3-Section-C-Eligibility-and-Development-for-Chapter-18-Benefits" updated: "2026-09-07T14:37:31.571386Z" --- March 2, 2020 ### VIII.i.3.C.1.a. Application Requirement for Chapter 18 Benefits A claimant seeking benefits associated with spina bifida and other covered birth defects may use _[VA Form 21-0304, Application for Benefits for a Qualifying Veteran’s Child Born With Disabilities]()._ Whether another filing satisfies Department of Veterans Affairs (VA) claim criteria is determined by [38 CFR 3.151]() and [38 CFR 3.155]().**Reference:** For more information about Denver Regional Office (RO) jurisdiction in Chapter 18 claims and determinations see [M21-1, Part VIII, Subpart i, 3.A.1](). ### VIII.i.3.C.1.b. Initial Review of Eligibility Requirements Before Undertaking Development Do not develop for additional evidence from the claimant if it can be determined immediately that the claimant cannot meet all the qualifying requirements for * service of the Veteran parent in * Vietnam * Korea, or * Thailand, and * relationship to the Veteran. When confirmation cannot be obtained that the above elements of basic eligibility have been met, prepare an administrative denial and notify the claimant. **Important:** When evidence received demonstrates that the disability in question is not a qualifying disability, do not develop for additional medical evidence. Refer to the rating activity any claim found to require * a determination as to the existence of a qualifying disability, or * denial due to immediate recognition that the claimant has only spina bifida occulta. **References:** For more information on * Denver RO jurisdiction in Chapter 18 claims and determinations see [M21-1, Part VIII, Subpart i, 3.A.1]() * development for medical evidence of a disability following rating activity review, see M21-1, Part VIII, Subpart i, 3.C.2.a, and * decision-making by the authorization activity, see * [M21-1, Part VIII, Subpart i, 3.D.1.a](), and * [M21-1, Part VIII, Subpart i, 3.E](). ### VIII.i.3.C.1.c. Example 1: When Additional Development Is Not Necessary for a Spina Bifida Claim ** _Situation_** :**_ _**A child of a Veteran who served only during the Gulf War applies for spina bifida benefits. **Action:** Send a denial letter _without_ developing for the nature of the disability or relationship evidence. **Rationale:** It is immediately apparent that the parent of the claimant cannot meet Vietnam, Korea, or Thailand service requirements for Chapter 18 benefits. ### VIII.i.3.C.1.d. Example 2: When Additional Development Is Not Necessary for a Chapter 18 Claim **Situation:** A child with spina bifida occulta applies for Chapter 18 benefits. **Action:** Refer the case to the rating activity for a rating decision denying the claim _without_ developing for Vietnam, Korea, or Thailand service requirements and relationship evidence. **Rationale:** The claimant does not have a qualifying spina bifida disability that meets the requirements for Chapter 18 benefits. A rating decision is required to implement a denial of benefits when the child has spina bifida occulta or no spina bifida condition exists. **Note:** In addition to denying the claim for spina bifida benefits, the rating activity will address entitlement to benefits for other covered birth defects under [38 CFR 3.815]() via annotation of the _Codesheet_ for subsequent administrative denial. ### VIII.i.3.C.1.e. Example 3: When Additional Development Is Not Necessary for a Chapter 18 Claim **Situation:** A child submits a claim for multiple myeloma. Medical evidence confirms a diagnosis of multiple myeloma. Only the father has qualifying service. **Action:** The development activity refers the claim to the rating activity for a determination regarding VA’s duty to develop for medical evidence in accordance with [38 CFR 3.159(d)](). The rating activity will complete a formal rating decision denying the claim. **Rationale:** The claimant does not have a qualifying spina bifida disability that meets the requirements for Chapter 18 benefits. A rating decision is required to implement a denial of benefits when the child does not have a qualifying disability. **Note:** In addition to denying the claim for spina bifida benefits, the rating activity must also include an annotation on the _Codesheet_ to address entitlement to benefits for other covered birth defects under [38 CFR 3.815]() for subsequent denial by the authorization activity. ### VIII.i.3.C.1.f. Character of Discharge Exception for Chapter 18 Eligibility Eligibility for Chapter 18 benefits is not dependent on character of discharge. That is, regardless of the characterization of service of the Veteran parent, individuals may receive Chapter 18 benefits if the specific service and relationship requirements are met. **Reference:** For more information on character of service criteria for entitlement to Chapter 18 benefits, see * [38 USC 1831(4)]() for Vietnam Veterans * [38 USC 1821(c)]() for Korea Veterans, and * [38 USC 1822(c)]() for Thailand Veterans. ## 2. Development Process Overview March 2, 2020 ### VIII.i.3.C.2.a. Development Process for Chapter 18 Benefits The table below describes the responsibilities of the development activity during the stages of the development process for Chapter 18 benefits.| **Stage**| **Description** 1| The development activity develops for and reviews * service records to prove that the biological Veteran parent has qualifying Vietnam, Korea, or Thailand service dates and duty assignments * birth certificates to determine date of conception, and * evidence of a biological relationship between the individual and the parent with qualifying Vietnam, Korea, or Thailand service. **Notes:** * The Denver RO is responsible for all adjudication activities including the concession of qualifying service for all Chapter 18 claims. * The development activity updates claims-processing systems with the Veteran’s verified Vietnam, Korea, or Thailand theater service that is qualifying for Chapter 18 entitlement. 2| If the claimant is seeking benefits under * [38 CFR 3.814](), the development activity reviews the claim and submitted evidence to determine if the claimant alleges to have a diagnosis of spina bifida (including myelomeningocele and meningocele). If the claimant * alleges a diagnosis of spina bifida, go to Step 5, or * does not allege to have a diagnosis of spina bifida, go to Step 3, or * [38 CFR 3.815](), go to Step 5. 3| The development activity refers the claim to the rating activity for a determination regarding VA’s duty to develop for medical evidence in accordance with [38 CFR 3.159(d)](). 4| The rating activity * reviews the evidence submitted and determines if the claim for benefits under [38 CFR 3.814]() is inherently incredible or lacks merit as discussed in [38 CFR 3.159(d)](), and * follows the steps in the table below based on the findings of the review. | **If additional development is ...**| **Then** the rating activity **...** necessary| * prepares [_VA Form 21-6789, Deferred Rating Decision_](), to * document the determination, and * provide directed development * uploads [_VA Form 21-6789_]() to the claims folder, and * refers the claim to the development activity to follow the procedures in Step 5. not necessary _and_ the claimant submitted medical evidence with the claim| * adds a permanent note in the claims folder documenting the reasons no additional development was warranted under [38 CFR 3.159(d)](), and * goes to Step 6 to formally deny the claim based on a lack of evidence of a spina bifida condition. not necessary _and_ the claimant _did not_ submit medical evidence| * prepares [_VA Form 21-6789_](), to document the determination that no additional development is required under [38 CFR 3.159(d)]() * uploads [_VA Form 21-6789_]() to the claims folder, and * refers the claims folder to the authorization activity for a decision, as directed in Step 6. 5| The development activity develops for * medical evidence verifying that the individual has a qualifying medical condition for Chapter 18 benefits, and * any other medical and lay evidence regarding treatment and symptoms. When development is complete, the development activity refers the claim to either the authorization or rating activity for a decision. 6| The authorization or rating activity proceeds with a decision on the claim. **Important:** Refer to the rating activity for a decision only as provided by M21-1, Part VIII, Subpart i, 3.C.1.b and [M21-1, Part VIII, Subpart i, 3.D.1.a](). **Reference:** For more information on Denver RO jurisdiction in Chapter 18 claims and determinations, see [M21-1, Part VIII, Subpart i, 3.A](). ## 3. Vietnam Service Requirements and Development December 31, 2019 ### VIII.i.3.C.3.a. Vietnam Service Requirement A **_Vietnam Veteran_** is a person who performed active military, naval, or air service in the Republic of Vietnam (RVN) during the period * beginning on January 9, 1962, and ending on May 7, 1975, for the purpose of spina bifida benefits eligibility under [38 CFR 3.814(c)(1)](), and * beginning on February 28, 1961, and ending on May 7, 1975, for the purpose of other covered birth defect benefits eligibility under [38 CFR 3.815(c)(1)](). **Notes:** * Service in RVN generally requires service on land within the country borders, on inland waterways, or in the eligible offshore waters of RVN, including specific bays and harbors. * The dates of covered RVN service for spina bifida benefits eligibility in [38 CFR 3.814(c)(1)]() correspond with the dates to which the presumption of exposure to herbicide agents in RVN applies, as discussed in [38 CFR 3.307(a)(6)(iii)](). * The dates of covered RVN service for eligibility for benefits for other covered birth defects benefits in [38 CFR 3.815(c)(1)]() correspond with the dates in the definition of the Vietnam era in [38 CFR 3.2(f)](). **References:** For more information on * Vietnam service requirements for * spina bifida benefits eligibility, see [38 CFR 3.814(c)(1)](), and * other covered birth defects benefits eligibility, see [38 CFR 3.815(c)(1)](), and * developing for RVN service, see * [M21-1, Part VIII, Subpart i, 1.A.1](), and * [M21-1, Part VIII, Subpart i, 1.B.2](). ## 4. Korea Service Requirements and Development This topic contains information on Korea service requirements and development, including * specific Korea service requirements * presumption of herbicide exposure for Veterans with covered service in Korea, and * establishing herbicide exposure. March 2, 2020 ### VIII.i.3.C.4.a. Specific Korea Service Requirements Effective December 16, 2003, the Veterans Benefits Act of 2003, as codified at [38 U.S.C. 1821](), provides benefits and services to children born with spina bifida who are the natural children of Veterans with covered service in Korea.**_Covered service in Korea_** requires * active military, naval, or air service in or near the Korean demilitarized zone (DMZ) during the period beginning on September 1, 1967, and ending on August 31, 1971, and * exposure to an herbicide agent during such service as determined by VA in consultation with the Department of War (DOW). ### VIII.i.3.C.4.b. Presumption of Herbicide Exposure for Veterans With Covered Service in Korea Under [38 U.S.C. 1821(c)]() and [38 CFR 3.814(c)(2)](), presume exposure to an herbicide agent for Veterans who served * between September 1, 1967, and August 31, 1971, and * in a unit that VA or DOW has determined to have operated in an area in or near the Korean DMZ. **Exception:** The presumption of exposure that arises from the showing above will be rebutted where there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service.**Notes:** * For a list of units or other military entities that DOW has identified as operating in or near the Korean DMZ during the qualifying time period, see [M21-1, Part VIII, Subpart i, 1.B.4.c](). * The provisions of [38 CFR 3.814(c)(2)]() have been amended twice to revise the applicable dates for the concession of exposure to herbicides on a factual basis for Veterans who served in specific designated units operating in or near the Korean DMZ. * Before February 24, 2011, the applicable dates were April 1968 to July 1969. * Before amendment by _Public Law_ _(PL) 116-23, Blue Water Navy Vietnam Veterans Act_ , on January 1, 2020, the applicable dates were April 1, 1968, to August 31, 1971. ### VIII.i.3.C.4.c. Establishing Herbicide Exposure Use the table below to establish exposure to herbicides in claims based on Korea service.| **If the Veteran served in Korea …**| **Then …** in a unit or other military entity listed in [M21-1, Part VIII, Subpart i, 1.B.4.c]() between September 1, 1967, and August 31, 1971| concede that the Veteran * served at or near the DMZ, and * was exposed to herbicides containing Agent Orange. * in a unit other than one listed in [M21-1, Part VIII, Subpart i, 1.B.4.c](), or * during a period that was _not_ between September 1, 1967, and August 31, 1971. | send a request to the VA's Records Acquisition and Research Center (RAR) for verification of exposure to herbicides on a factual, case-by-case basis. **Reference:** For more information on requesting records from RAR in support of a Korean DMZ herbicide claim, see [M21-1, Part VIII, Subpart i, 1.B.4.d](). ## 5. Thailand Service Requirements and Development This topic contains information on Thailand service requirements and development, including * specific Thailand service requirements, and * establishing herbicide exposure for Veterans with covered service in Thailand. September 15, 2025 ### VIII.i.3.C.5.a. Specific Thailand Service Requirements Effective January 1, 2020, _PL 116-23_ , as codified at [38 U.S.C. 1822](), provides benefits and services to children born with spina bifida who are the natural children of Veterans with covered service in Thailand. **_Covered service in Thailand_** requires * active military, naval, or air service in Thailand during the period beginning on January 9, 1962, and ending on May 7, 1975, and * exposure to an herbicide agent during such service as determined by VA in consultation with DOW. **Reference:** For more information on developing claims based on herbicide exposure in Thailand, see [M21-1, Part VIII, Subpart i, 1.B.2](). ### VIII.i.3.C.5.b. Establishing Herbicide Exposure for Veterans With Covered Service in Thailand For the purpose of establishing herbicide exposure for entitlement to spina bifida benefits, _covered service in Thailand_ means service in Thailand at any United States or Royal Thai base during the period beginning on January 9, 1962, and ending on May 7, 1975, without regard to where on the base the Veteran was located or what military job specialty the Veteran performed. _**Reference**_ : For more information on historical policies for concession of herbicide exposure in Thailand, see [M21-1, Part VIII, Subpart i, 1.A.2.b](). ## 6. Date of Conception Considerations This topic contains information on date of conception considerations in claims involving Vietnam, Korea, or Thailand service, including * requirement for conception during or after qualifying service, and * estimating date of conception and taking next action. December 31, 2019 ### VIII.i.3.C.6.a. Requirement for Conception During or After Qualifying Service To be eligible for Chapter 18 benefits, the individual must have been conceived after the date on which the Veteran parent first had qualifying service in RVN, Korea, or Thailand. ### VIII.i.3.C.6.b. Estimating Date of Conception and Taking Next Action Follow the steps in the table below to estimate the date of conception and determine the next action to take. | **Step**| **Action** 1| Review the date of birth on the birth certificate. 2| Use the following to determine the likely date of conception: * The second page of a birth certificate (Part 2) contains health and statistical data, such as an estimate of the length of pregnancy. Although Part 2 of a birth certificate is not mandatory to establish eligibility, this evidence may help to establish the date of conception. * According to _Danforth's Obstetrics and Gynecology_ , a “normal,” full-term birth may occur as many as 10 months or as few as 8 months after conception. 3| Use the table below to determine the appropriate next action to take. | **If the date of conception (at least as likely as not) was …**| **Then …** during or after the Veteran’s qualifying RVN, Korea, or Thailand service| move on to consideration of evidence of relationship under M21-1, Part VIII, Subpart i, 3.C.7. before the Veteran’s qualifying RVN, Korea, or Thailand service| go to [M21-1, Part VIII, Subpart i, 3.E.2](). **Note:** Questions about the child’s date of conception will be resolved by an administrative decision. ## 7. Relationship Requirements and Developing for Relationship Evidence This topic contains information on relationship requirements and developing for relationship evidence, including * general relationship eligibility requirements of an individual * definition of natural child * effect of parent sex * development for relationship evidence for * spina bifida, and * other covered birth defects. December 31, 2019 ### VIII.i.3.C.7.a. General Relationship Eligibility Requirements of an Individual To be eligible for Chapter 18 benefits, the individual must be the natural child of a Veteran with qualifying service.**Important:** VA requires more than a written statement to establish parentage. A birth certificate will _always_ be required.**Note:** Specific relationship requirements exist, separately, for spina bifida benefits and other covered birth defects benefits.**References:** For more information on the * specific relational requirements for benefits for * spina bifida, see M21-1, Part VIII, Subpart i, 3.C.7.d, and * other covered birth defects, see M21-1, Part VIII, Subpart i, 3.C.7.e * Vietnam service requirement for benefits for spina bifida or other covered birth defects, see M21-1, Part VIII, Subpart i, 3.C.3, and * the service requirements for spina bifida benefits in * Korea, see M21-1, Part VIII, Subpart i, 3.C.4, and * Thailand, see M21-1, Part VIII, Subpart i, 3.C.5. ### VIII.i.3.C.7.b. Definition: Natural Child A parent’s **_natural child_** is the parent’s biological child, regardless of the child’s * age * marital status, or * dependency status. An individual cannot become eligible for Chapter 18 benefits through an adoptive parent. Only a biological parent of an adopted individual can make that individual eligible. ### VIII.i.3.C.7.c. Effect of Parent Sex Use the table below to determine the effect of the Veteran parent’s sex on a child’s entitlement to benefits. | **If the Veteran’s child suffers from ...**| **And the Veteran parent rendered qualifying service in …**| **Then VA may award benefits ...** spina bifida| * RVN * Korea, or * Thailand | regardless of the sex of the Veteran parent. **Note:** Even if both of an individual’s parents are eligible Veterans meeting the service requirements, the eligible child is entitled to only one award of spina bifida benefits. a covered birth defect| \--| only if the child’s biological _**mother**_ is a Vietnam Veteran. ### VIII.i.3.C.7.d. Development for Relationship Evidence for Spina Bifida Review the parents’ names on the birth certificate in the Veteran’s claims folder. Ensure the birth certificate lists the Veteran(s) as the parent of the claimant.**Notes:** * A birth certificate with the parents’ names on it or a photocopy of the birth certificate is considered sufficient evidence to verify the claim. * If the child lives with adoptive parents, evidence is still required to show that one of the biological parents is a Vietnam Veteran or a Veteran meeting the specific Korea or Thailand service requirements. * In circumstances where paternity is an issue (for example, the birth certificate shows no father or shows someone other than the Veteran father as the informant), * request the types of evidence specified in [38 CFR 3.209]() and [38 CFR 3.210]() to establish parentage, and * note that the provisions of [38 CFR 3.204(a)(1)]() for accepting only a written statement are _not_ applicable to these cases per [38 CFR 3.814(c)(3)](). ### VIII.i.3.C.7.e. Development for Relationship Evidence for Other Covered Birth Defects Review the mother’s name on the birth certificate in the Veteran’s claims folder. Ensure that the birth certificate lists the Veteran as the mother of the claimant.**Note:** A birth certificate with the mother’s name on it or a photocopy of the birth certificate is considered sufficient evidence to verify the claim. ## 8. Disability Requirement for Spina Bifida Benefits December 12, 2018 ### VIII.i.3.C.8.a. Qualifying Types of Spina Bifida for Eligibility Under Chapter 18 Spina bifida benefits are payable for all types of spina bifida except spina bifida occulta.The term **_spina bifida_** refers to a defective closure of the bony encasement of the spinal cord but does not include other neural tube defects, such as encephalocele and anencephaly ([VAOPGCPREC 5-1999]()).**Note:** The rating activity is responsible for assessing disability level for spina bifida. ## 9. Disability Requirement for Other Covered Birth Defects This topic contains information on the disability requirement for other covered birth defects, including * definition of birth defect * limitation on birth defects and conditions covered * covered birth defects for benefits under Chapter 18 * birth defects not covered due to * familial disorders * birth-related disorders, chromosomal disorders, or congenital malignancies, and * lack of permanent physical or mental disability, and * conditions not covered due to * birth-related injury or fetal/neonatal infirmity, and * developmental etiology. October 20, 2016 ### VIII.i.3.C.9.a. Definition: Birth Defect A **_birth defect_** is an abnormality of * structure * function, or * metabolism. The abnormality may be * genetically determined, or * a result of environmental influence during embryonic or fetal life. ### VIII.i.3.C.9.b. Limitation on Birth Defects and Conditions Covered Not all birth defects and conditions qualify an individual for Chapter 18 benefits. VA will only cover birth defects that are potentially linked to a female Veteran’s Vietnam service and have resulted in a permanent mental or physical disability.Birth defects and conditions that have been excluded fall under one of the categories listed below. The condition * has been determined by VA not to be associated with Vietnam service by reason of its classification as a * chromosomal abnormality, or * congenital malignancy * is related to a familial or hereditary condition of the parent * is likely to have occurred due to actions during the prenatal or postnatal period, including a * birth-related injury, or * fetal or neonatal infirmity with well-established causes * is a developmental disorder rather than a birth defect, or * does not result in a permanent mental or physical disability. ### VIII.i.3.C.9.c. Covered Birth Defects for Benefits Under Chapter 18 Covered birth defects include, but are not limited to * achondroplasia * cleft lip and cleft palate * congenital heart disease * congenital talipes equinovarus (clubfoot) * esophageal and intestinal atresia * Hallerman-Streiff syndrome * hip dysplasia * Hirschprung’s disease (congenital megacolon) * hydrocephalus due to aqueductal stenosis * hypospadias * imperforate anus * neural tube defects (including spina bifida, encephalocele, and anencephaly) * Poland syndrome * pyloric stenosis * syndactyly (fused digits) * tracheoesophageal fistula * undescended testicle, and * Williams syndrome. **Note:** If any of the birth defects listed above are determined to be familial in a particular family, they are not covered birth defects. ### VIII.i.3.C.9.d. Birth Defects Not Covered Due to Familial Disorders Birth defects that are familial disorders are not covered birth defects. These include, but are not limited to * albinism * alpha-antitrypsin deficiency * Crouzon syndrome * cystic fibrosis * Duchenne’s muscular dystrophy * galactosemia * hemophilia * Huntington’s disease * Hurler syndrome * Kartagener’s syndrome (primary ciliary dyskinesia) * Marfan syndrome * neurofibromatosis * osteogenesis imperfecta * pectus excavatum * phenylketonuria * sickle cell disease * Tay-Sachs disease * thalassemia, and * Wilson’s disease. **Note:** If any of the birth defects listed above are determined not to be familial in a particular family, then they are covered birth defects. ### VIII.i.3.C.9.e. Birth Defects Not Covered Due to Birth-Related Disorders, Chromosomal Disorders, or Congenital Malignancies Conditions identified in the table below are _not_ considered covered birth defects by reason of their respective classifications as * birth-related injuries * chromosomal disorders, or * congenital malignancies. **Note:** These listings are not necessarily exhaustive. | **Birth-Related Injuries**| **Chromosomal Disorders**| **Congenital Malignancies** brain damage due to anoxia during or around time of birth| Down syndrome and other trisomies| medulloblastoma cerebral palsy due to birth trauma| Fragile X syndrome| neuroblastoma facial nerve palsy or other peripheral nerve injury| Klinefelter’s syndrome| retinoblastoma fractured clavicle| Turner’s syndrome| teratoma Horner's syndrome due to forceful manipulation during birth| Wilm’s tumor ### VIII.i.3.C.9.f. Birth Defects Not Covered Due to Lack of Permanent Physical or Mental Disability Birth defects that are not covered because they lack permanent physical or mental disability include, but are not limited to * conditions rendered non-disabling through treatment * congenital heart problems surgically corrected or resolved without disabling residuals * heart murmurs unassociated with a diagnosed cardiac abnormality * hemangiomas that have resolved with or without treatment, and * scars (other than of the head, face, or neck) as the only residual of corrective surgery for birth defects. ### VIII.i.3.C.9.g. Conditions Not Covered Due To Birth-Related Injury or Fetal/Neonatal Infirmity Conditions that are due to a fetal or neonatal infirmity with well-established causes or that are miscellaneous pediatric conditions are not covered birth defects. These include, but are not limited to * asthma and other allergies * effects of maternal rubella, toxoplasmosis, syphilis, or other maternal infection during pregnancy * fetal alcohol syndrome or fetal effects of maternal drug abuse * hyaline membrane disease * maternal-infant blood incompatibility * neonatal infections * neonatal jaundice * post-infancy deafness/hearing impairment (onset after the age of one year) * prematurity, and * refractive disorders of the eye. ### VIII.i.3.C.9.h. Conditions Not Covered Due to Developmental Etiology Conditions that are developmental disorders are not covered birth defects. These include, but are not limited to * attention deficit disorder * autism * epilepsy diagnosed after infancy (after the age of one year) * learning disorders, and * mental retardation (unless part of a syndrome that is a covered birth defect). ## 10. Developing for Medical and Lay Evidence This topic contains information on developing for medical and lay evidence, including * VA examinations under * 38 CFR 3.814, and * 38 CFR 3.815, and * developing for medical evidence of * spina bifida under 38 CFR 3.814, and * a covered birth defect under 38 CFR 3.815. December 12, 2018 ### VIII.i.3.C.10.a. VA Examinations Under 38 CFR 3.814 For the purpose of claims seeking monetary allowance under [38 CFR 3.814]() for spina bifida, VA will schedule an examination only under limited circumstances.**Important:** * Only request an examination under [38 CFR 3.814]() when * necessary to determine the degree of disability from spina bifida, and * the medical evidence is not sufficient for that purpose. * VA may accept statements from private physicians or examination reports from government or private institutions in lieu of a VA examination. * It is inappropriate to schedule an examination when the evidence of record does not show that spina bifida exists. * Do not request magnetic resonance imaging. ### VIII.i.3.C.10.b. VA Examinations Under 38 CFR 3.815 For claims seeking monetary allowance under [38 CFR 3.815]() for other covered birth defects, VA will schedule an examination * when necessary to determine whether an individual has a covered birth defect, and * for rating claims for covered birth defects. **Note:** VA may accept statements from private physicians or examination reports from government or private institutions in lieu of a VA examination. ### VIII.i.3.C.10.c. Developing for Medical Evidence of Spina Bifida Under 38 CFR 3.814 Follow the steps in the table below to develop for medical evidence of spina bifida under [38 CFR 3.814]().| **Step**| **Action** 1| Does the Chapter 18 claims folder contain medical evidence showing that the claimant has a form of spina bifida other than spina bifida occulta? * If _yes_ , go to Step 3. * If _no_ , * send the claimant a letter requesting supporting medical evidence * attach * [ _VA Form 21-4142, Authorization to Disclose Information to the Department of Veteran Affairs (VA)_](), and * [ _VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA)_]() * allow 30 days for a reply, and * go to Step 2. 2| Did the claimant reply to the request and submit the requested supporting medical evidence? * If _yes_ , go to Step 3. * If _no_ , go to Step 4. 3| Is the medical evidence adequate for purposes of assigning an evaluation? * If _yes_ , go to Step 4. * If _no_ , schedule a VA examination and follow up to obtain the report before going to Step 4. 4| Send the claim to the rating activity to review the claim for rating. ### VIII.i.3.C.10.d. Developing for Medical Evidence of a Covered Birth Defect Under 38 CFR 3.815 Follow the steps in the table below to develop for evidence of a covered birth defect under [38 CFR 3.815]().| **Step**| **Action** 1| Does the Chapter 18 claims folder contain medical evidence showing that the claimant has a covered birth defect as defined in [38 CFR 3.815(c)(3)]()? * If _yes_ , go to Step 3. * If _no_ , * send the claimant a letter requesting supporting medical evidence * attach * _[VA Form 21-4142]()_ , and * _[VA Form 21-4142a]() _ * allow 30 days for a reply, and * go to Step 2. 2| Did the claimant reply to the request and submit supporting medical evidence of a covered birth defect? * If _yes_ , go to Step 3. * If _no_ , go to Step 4. 3| Is the medical evidence adequate to find a covered birth defect **_and_** assign an evaluation? * If _yes_ , go to Step 4. __ * If _no_ , schedule a VA examination and follow up to obtain the report before going to Step 4. 4| Send the claim to the rating activity to review the claim for rating.