--- title: "Part VIII, Subpart i, Chapter 3, Section D Rating" document: "M-21-1" section: "Part VIII, Subpart i, Chapter 3, Section D" canonical: "https://veteranai.co/va-regulations/m21-1/viii.i.3.d-rating" source: "https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000177431/M21-1-Part-VIII-Subpart-i-Chapter-3-Section-D-Rating" updated: "2026-09-06T14:37:10.237956Z" --- December 12, 2018 ### VIII.i.3.D.1.a. Decision-Making Roles and Responsibilities The roles and responsibilities for making a decision in Chapter 18 benefit claims are shown in the following table.| **If all elements of basic eligibility ...**| **Then the ...** are not met| authorization activity decides the claim.**Note:** No referral to the rating activity is needed.**References:** For more information on * authorization issues in Chapter 18 claims, see [M21-1, Part VIII, Subpart i, 3.E](), and * determining basic eligibility and referring for further action during development, see [M21-1, Part VIII, Subpart i, 3.C](). are met| rating activity * considers the medical and lay evidence, and * determines whether to award or deny entitlement to a monthly monetary allowance. **Note:** All Chapter 18 claims fall under the jurisdiction of the Denver Regional Office, per [M21-1, Part VIII, Subpart i, 3.A.1](). ### VIII.i.3.D.1.b. Rating a Claim Based on Spina Bifida The table below provides guidance for the rating activity to follow when making a decision on a spina bifida claim. | **If the claimed disability is ...**| **Then ...** * diagnosed as spina bifida occulta, or * diagnosed as other than spina bifida | prepare a rating decision denying the claim. spina bifida| * prepare a rating decision establishing entitlement, as * Level I * Level II, or * Level III, and * determine a beginning date of entitlement as provided in [38 CFR 3.814(e)](). ### VIII.i.3.D.1.c. Rating a Claim Based on Other Covered Birth Defects The table below provides guidance for the rating activity to follow when making a decision on other covered birth defect claims. | **If the claimed disability is ...**| **Then ...** not a covered birth defect, per [38 CFR 3.815 (c)(3) and (d)]()| prepare a rating decision denying the claim. a covered birth defect per [38 CFR 3.815 (c)(3) and (d)]()| * prepare a rating decision establishing entitlement, as * Level I * Level II * Level III, * Level IV, _or_ * Level 0, if the individual has no current disability resulting from a covered birth defect, _and_ * determine a beginning date of entitlement as provided in [38 CFR 3.815(i)](). ### VIII.i.3.D.1.d. Assigning Effective Dates Under 38 CFR 3.814(e) and (f) The effective date for a grant of a monetary allowance based on _spina bifida_ (whether based on an initial or supplemental claim) will generally be the _later_ of the following dates: * the date the Department of Veterans Affairs (VA) received the claim * the date of birth if the claim is received within one year of that date, or * the date entitlement arose. **Exceptions:** * An increase will be effective the earliest date the evidence establishes that the level of severity increased, but only if the beneficiary applies for an increase within one year of that date. * If granting a supplemental claim based on corrected military records, VA will award the benefit from the latest of the following dates: * the date the Veteran or beneficiary applied for a correction of the military records * the date the previously disallowed claim was filed, or * the date one year before the date of receipt of the supplemental claim. **Important:** The effective date cannot be earlier than October 1, 1997.**Reference:** For more information about the effective date of awards and commencement of payments of monetary allowances for spina bifida, see [VAOPGCPREC 3-1999](). ### VIII.i.3.D.1.e. Assigning Effective Dates Under 38 CFR 3.815(i) and (j) The effective date for a grant of a monetary allowance based on _other covered birth defects_ (whether an initial or supplemental claim) will generally be the _latest_ of the following dates: * the date VA received the claim * the date of birth if the claim is received within one year of that date, or * the date entitlement arose ** _Exceptions_** : * Apply [38 CFR 3.114(a)]() as applicable. * An increase will be effective the earliest date the evidence establishes that the level of severity increased, but only if the beneficiary applies for an increase within one year of that date. * If granting a supplemental claim based on corrected military records, VA will award the benefit from the latest of the following dates: * the date the Veteran or beneficiary applied for a correction of the military records * the date the previously disallowed claim was filed, or * the date one year before the date of receipt of the supplemental claim. **Important:** No benefits may be paid for any period prior to December 1, 2001. ### VIII.i.3.D.1.f. Reductions and Discontinuances Reductions and discontinuances must be made as provided in [38 CFR 3.814(f)]() or [38 CFR 3.815(j)](). VA will generally reduce or discontinue awards according to the facts found except as provided in [38 CFR 3.105]() and [38 CFR 3.114(b)](). * If benefits were paid erroneously because of beneficiary error, VA will reduce or discontinue benefits as of the effective date of the erroneous award. * If benefits were paid erroneously because of administrative error, VA will reduce or discontinue benefits effective the date in the LAST PAID DATE field on the AWARD INFORMATION tab in Share. ## 2. Disability Rating Levels Assigned to Spina Bifida Claims This topic contains information on disability rating levels assigned to spina bifida claims, including * spina bifida disability levels * categories of neurological impairment * minimum disability level assignable * disability level for children under the age of one year * exceptional cases, and * scheduling periodic reassessment of disability levels. December 12, 2018 ### VIII.i.3.D.2.a. Spina Bifida Disability Levels Once the rating activity determines that the individual is entitled to benefits based on spina bifida disability, it assigns the highest disability level based on severity of symptoms and degree of any permanent physical or mental disability.The table below describes the disability levels for spina bifida ratings.| **Level**| **Description** I| The individual * walks without braces or other external support as the primary means of mobility in the community * has no sensory or motor impairment of upper extremities * has an intelligence quotient (IQ) of 90 or higher, **_and_** * is continent of urine and feces without the use of medication _or_ other means to control incontinence. II| The individual meets **_any_** of the criteria listed below: * walks with braces or other external support as the primary means of mobility in the community * has sensory or motor impairment of upper extremities, but is able to * grasp a pen * feed self, and * perform self-care * has an IQ of at least 70 but less than 90 * requires medication or other means to control the effects of urinary bladder impairment and no more than two times per week is unable to remain dry for at least three hours at a time during waking hours * requires bowel management techniques or other treatment to control the effects of bowel impairment but does not have fecal leakage severe or frequent enough to require wearing absorbent materials at least four days a week, **_or_** * has colostomy that does not require wearing a bag. **Note:** The rating activity assigns a disability at Level II provided that none of the disabilities is severe enough to warrant payment at Level III. III| The individual meets **_any_** of the criteria listed below: * uses a wheelchair as the primary means of mobility in the community * has sensory or motor impairment of the upper extremities severe enough to prevent * grasping a pen * feeding self, and * performing self-care * has an IQ of 69 or less * is unable to remain dry for three hours at a time during waking hours, at least three times a week, despite the use of medication or other means to control the effects of urinary bladder impairment * has fecal leakage severe or frequent enough to require wearing of absorbent materials at least four days a week, despite bowel management techniques or other treatment to control the effects of impairment * regularly requires manual evacuation or digital stimulation to empty the bowel, **_or_** * has a colostomy that requires wearing a bag. ### VIII.i.3.D.2.b. Categories of Neurological Impairment In determining the appropriate disability level to assign, the rating activity assesses the severity of each category of neurological impairment (extremities functioning, mental functioning, and bowel-bladder functioning) as * least severe (1) * intermediate severity (2), _or_ * most severe (3). The rating activity records these category values on the _Codesheet_. **Important:** The highest level assigned for any of the categories determines the overall level of disability.**Example:** If extremities and bowel-bladder functions are not impaired (each scored 1) but IQ is 80 (scored as 2), then disability Level II is assigned. ### VIII.i.3.D.2.c. Minimum Disability Level Assignable The rating activity assigns the highest evaluation warranted by the evidence of record. The minimum disability level assignable is Level I.Assign a Level I * if basic entitlement is granted, but there is no or insufficient evidence to determine the disability level, _and_ * until one of the following is received supporting a higher level: * additional medical evidence, _or_ * VA examination report. The rating activity prepares a deferred rating under code 38 while the required evidence is pending. The minimum disability Level I remains in effect even if the individual fails to report for a VA examination. ### VIII.i.3.D.2.d. Disability Level for Children Under the Age of One Year The rating activity assigns disability Level I for children under the age of one year unless a pediatric neurologist or pediatric neurosurgeon certifies that, in his or her medical judgment, there is neurological deficit that will prevent the child from * ambulating * grasping a pen * self-feeding * performing self-care, _or_ * achieving urinary or fecal continence. If such a deficit is present, the rating activity assigns disability Level III. ### VIII.i.3.D.2.e. Exceptional Cases The Director of Compensation Service may increase the monthly allowance in order to best represent the extent that the disabilities resulting from spina bifida, or from treatment procedures for spina bifida, limit the individual’s ability to engage in ordinary, day-to-day activities. The Director of Compensation Service may increase the monthly payment for an individual who would otherwise be paid at Level I or II, if there are one or more disabilities resulting from spina bifida, or treatment for spina bifida, such as * blindness * uncontrolled seizures, _or_ * renal failure. In this case, the individual may receive a Level II or Level III payment, depending on whether the effects of a disability are equal in severity to the effects specified under Level II or III. ### VIII.i.3.D.2.f. Scheduling Periodic Reassessments of Disability Level VA will periodically reassess the disability level of a beneficiary.Use the table below to determine the course of action for scheduling the periodic reassessments of the disability level. | **When the individual is …**| **Schedule a reassessment …** under the age of one| when the individual is one year old. between the age of one and twenty-one| when medical evidence is received indicating a change is warranted, but at a minimum every five years. over the age of twenty-one| _only_ if evidence indicates * a material change in disability, or * the current rating may be incorrect. ## 3. Disability Rating Levels Assigned to Other Covered Birth Defect Claims This topic contains information on disability rating levels assigned to other covered birth defect claims, including * other covered birth defects disability levels * exceptional cases, and * scheduling periodic reassessments of disability level. December 12, 2018 ### VIII.i.3.D.3.a. Other Covered Birth Defects Disability Levels In the process of examining medical evidence, the rating activity determines a disability level for each case qualifying for other covered birth defect benefits.The table below describes the disability levels for other covered birth defect ratings.| **Level**| **Description** 0| The individual has no current disability resulting from covered birth defects. I| The individual * has residual physical or mental effects that only _occasionally_ or _intermittently_ limit or prevent some daily activities, **_or_** * has disfigurement or scarring of the head, face, or neck with gross distortion or gross asymmetry of any facial feature (nose, chin, forehead, eyes (eyelids), ears (auricles), cheeks, or lips). II| The individual has residual physical or mental effects that frequently or constantly limit or prevent some daily activities, but the individual * is able to work or attend school * can carry out most household chores * can travel * provides age-appropriate self-care, **_and_** * displays communication, behavior, social interaction, and intellectual functioning appropriate for age, **_or_** * has disfigurement or scarring of the head, face, or neck with either gross distortion or gross asymmetry of one facial feature or one paired set of facial features (nose, chin, forehead, eyes (eyelids), ears (auricles), cheeks, or lips). III| The individual * has residual physical or mental effects that limit or hinder most daily activities, but the individual is able to provide age-appropriate self-care, such as * eating * dressing * grooming, _and_ * carrying out personal hygiene * may be unable, or does so intermittently and with difficulty, to * attend school * travel, _or_ * carry out household chores * displays communication, behavior, social interaction, and intellectual functioning that are not entirely appropriate for age, **_or_** * has disfigurement or scarring of the head, face, or neck with either gross distortion or gross asymmetry of two facial features or two paired sets of facial features (nose, chin, forehead, eyes (eyelids), ears (auricles), cheeks, or lips). IV| The individual * has residual physical or mental effects that prevent age-appropriate self-care, such as * eating * dressing * grooming, _and_ * carrying out personal hygiene * displays communication, behavior, social interaction, and intellectual functioning that are grossly inappropriate for age, **_or_ ** * has disfigurement or scarring of the head, face, or neck with either gross distortion or gross asymmetry of three facial features or three paired sets of facial features (nose, chin, forehead, eyes (eyelids), ears (auricles), cheeks, or lips). **Reference:** For more information on other covered birth defects, see * [38 CFR 3.815](), and * [M21-1, Part VIII, Subpart i, 3.C.9](). ### VIII.i.3.D.3.b. Exceptional Cases The Director of Compensation Service may increase the monthly allowance in order to best represent the extent that the disabilities resulting from other covered birth defects, or from treatment procedures for covered birth defects, limit the individual’s ability to engage in ordinary, day-to-day activities. The Director of Compensation Service may increase the monthly payment for an individual who would otherwise be paid at Level I, II, or III, if there are one or more disabilities resulting from other birth defects, or treatment for other birth defects, such as * blindness * uncontrolled seizures, _or_ * renal failure. In this case, the individual may receive a Level II, III, or IV payment, depending on whether the effects of a disability are equal in severity to the effects specified under Level II, III, or IV. ### VIII.i.3.D.3.c. Scheduling Periodic Reassessments of Disability Level VA will reassess a determination whenever it receives evidence indicating that a change is warranted. ## 4. Preparation of a Chapter 18 Benefits Rating Decision This topic contains information on preparing a rating decision, specifically the rating _Codesheet_ , including entries on the _Codesheet_ for * spina bifida claims, and * other birth defect claims. December 31, 2019 ### VIII.i.3.D.4.a. Entries on the Codesheet for Spina Bifida Claims Whether granted or denied, all rating decisions require certain entries on the _Codesheet_.Use the table below to determine how to annotate the _Codesheet_.| **If benefits are …**| **Then state the coded conclusion as …**| **Example** granted| _Spina bifida benefits_ followed by * disability level (I, II, or III) * a parenthetical evaluation for each of the three categories of neurological impairment (1, 2, or 3), and * the effective date. **Notes:** * When a minimum evaluation is assigned because of insufficient medical evidence, indicate _minimum_ as the parenthetical evaluation as follows: _Level I (minimum) from 10-01-01_. * If additional development is conducted for medical evidence, reflect the deferred rating as a code 38 on the _Codesheet_. | _Spina bifida benefits Level II (extrm 1, control 1, intel 2) from 10-01-01_ denied| _Spina bifida benefits denied_ followed on the next line by * _02-Diagnosis of spina bifida occulta_ , or * _03-No spina bifida condition_. | _Spina bifida benefits denied_ _02-Diagnosis of spina bifida occulta_ ** _Note_** : A rating decision is not prepared for claims that have been denied for the following reasons: * the child was conceived before the Vietnam or specific Korean or Thailand service * the claimant failed to furnish requested evidence * the parent(s) were not Vietnam Veteran(s) or Veterans with specific Korean or Thailand service, _or_ * the individual is not a natural child of the Veteran. **References:** For more information on * Vietnam service requirements, see [M21-1, Part VIII, Subpart i, 3.C.3]() * the specific * Korean service requirements, see [M21-1, Part VIII, Subpart i, 3.C.4](), and * Thailand service requirements, see [M21-1, Part VIII, Subpart i, 3.C.5](), and * administrative decisions see [M21-1, Part X, Subpart v, 1.C](). ### VIII.i.3.D.4.b. Entries on Codesheet for Other Covered Birth Defect Claims Whether granted or denied, all rating decisions require certain entries on the _Codesheet_. Follow the instructions below to determine how to annotate the _Codesheet_.| **Granted**| State: _Chapter 18 benefits are granted for_ **[insert name of defect]** _at Level_ **[insert Level 0, I, II, III or IV]** _effective_ **[insert date]**. If benefits are granted at Level 0, state: _No current disability exists, entitlement for treatment purposes and vocational training only_. **Example 1:** _Chapter 18 benefits are granted for cleft lip at Level I effective 12-01-2001._ **Example 2:** _Chapter 18 benefits are granted for Poland syndrome at Level II effective 01-01-2002._ **Denials**| State: _Chapter 18 benefits are denied for_ **[insert name of claimed condition]**. Then, list the reason: * _no qualifying birth defect exists_ * _disability due to familial disorder_ * _disability resulted from birth-related injury_ * _disability is the result of a fetal or neo-natal infirmity with well-established causes_ * _disability not a permanent physical or mental disability_ * _disability due to congenital malignant neoplasm_ * _disability due to chromosomal disorder_ , or * _disability due to developmental disorder_. **Note:** A rating decision is not prepared for claims that have been denied for the following reasons: * the individual was conceived before the Veteran-parent first served in the Republic of Vietnam during the Vietnam era, per [M21-1, Part VIII, Subpart i, 3.C.3 ]() * the individual failed to furnish requested evidence * the biological mother was not a Vietnam Veteran * Veteran-parent is not female * child deceased prior to 12-01-2001, or * the individual is not a natural child of the Veteran.