Search VA regulations and diagnostic codes

Evidence Requested From the Claimant

III.i.2.D.1.c. Clarifying Issues and Claims Whenever the disability claimed is not clearly identified, ask the claimant and authorized representative to clarify the issues to ensure appropriate development and accurate decision-making. Example: A Veteran files a claim for compensation for a…

Rating Action on Review Examination Results and Cancellations

| solicit a claim for benefits in accordance with [M21-1, Part V, Subpart ii, 3.A.3.a](</system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000180486/M21-1-Part-V-Subpart-ii-Chapter-3-Section-A-Determining-the-Issues>). Example: A Veteran SC…

Arthritis

V.iii.1.C.5.c. Example of Noncompensable Degenerative Arthritis of a Single Joint _Situation_ : The Veteran has x-ray evidence of degenerative arthritis of the right knee without limited or painful motion. | _Coded Conclusion_ :| 1\. SC (PTE INC)| 5003| Degenerative arthritis, right…

Convalescent Ratings Under 38 CFR 4.30

Example 1: A Veteran enters the hospital on March 10 for a total knee replacement and is discharged on March 13. The convalescent rating will commence on March 10. The convalescent rating is continued for one month beginning April 1, the first day of the month after the date of discharge, and…

Special monthly compensation ratings.

(iv) Blindness in both eyes having only light perception; (v) Blindness in both eyes leaving the veteran so helpless as to be in need of regular aid and attendance. (2) Natural elbow or knee action. In determining whether there is natural elbow or knee action with prosthesis in place, consideration…

Record Maintenance During the Development Process

III.i.2.F.2.a. Identifying Contentions Enter issues as contentions when they are · expressly claimed by the claimant/Veteran/authorized representative, and/or · put at issue and require development. Important: · This information will be made available via Department of Veterans Affairs (VA)…

VI.ii.2.2.k. Recouping Separation Benefits (Other Than Disability Severance Pay) From a Veteran With Multiple Periods of Service _Important_ : The information in this block applies to the recoupment of all types of separation benefits _except_ disability severance pay. Separation…

Debt Collection

VI.iii.2.C.3.e. Example: Withholding Benefits From a Retroactive Award Is Not in Order Situation: · In September 2018, VA created a debt when it retroactively removed the Veteran’s son from the Veteran’s award effective July 1, 2016, because the Veteran failed to return [_VA Form 21-0538…

V.iii.11.4.c. Example 3: Rating Decision Involving Complications of Diabetes Mellitus Situation: The Veteran underwent a below-the-knee amputation due to complications of diabetes mellitus. In addition · his diabetes mellitus requires · more than one daily injection of insulin · restricted…

Schedule of ratings—muscle injuries.

The Pelvic Girdle and Thigh | | Rating | | --- | --- | | 5313 Group XIII. Function: Extension of hip and flexion of knee; outward and inward rotation of flexed knee; acting with rectus femoris and sartorius (see XIV, 1, 2) synchronizing simultaneous flexion of hip and knee and extension of hip…

Muscle Injuries

3| For the injury to MG XIII with an associated ankylosed knee, are there other MG injuries in the same anatomical region affecting the pelvic girdle and/or thigh? · If _no_ , then no additional change to the evaluation for the muscle injury is warranted. · If _yes_ , do the affected MG injuries…

General Criteria for Sufficiency of Examination Reports

IV.i.3.A.1.n. Evaluating Disability Diagnoses The precise cause of a disability is often difficult to determine. It is important that · the same disability is not covered by more than one diagnosis, and · a definite and unambiguous diagnosis is made for each complaint or symptom having a…

V.iii.5.1.f. Considering Cardiovascular Conditions Subsequent to Amputation Grant SC on a secondary basis for the following conditions that develop subsequent to the service-connected (SC) amputation of one lower extremity at or above the knee, or SC amputations of both lower extremities at or…

V.iii.10.2.c. Evaluating Tissue Loss of the Auricle, Anatomical Loss of the Eye, and Other Disabling Effects Evaluate tissue loss of the auricle under [38 CFR 4.87, DC 6207](<http://www.ecfr.gov/cgi-bin/text-idx?SID=3448d4d006e9807a14305759baa1ccc8&node=se38.1.4_187&rgn=div8>) and anatomical…

Amputation rule.

§ 4.68. Amputation rule. The combined rating for disabilities of an extremity shall not exceed the rating for the amputation at the elective level, were amputation to be performed. For example, the combined evaluations for disabilities below the knee shall not exceed the 40 percent evaluation…

Examination Sufficiency for Specific Disabilities

IV.i.3.B.1.g. Musculoskeletal Examination Report Review for Functional Loss The clinician conducting a musculoskeletal examination must address additional functional limitation or LOM during flare-ups or following repeated use over time, based on the Veteran’s history and the examiner’s…

Establishing Veteran Status

Note: There is no requirement to complete an administrative decision in these cases.Reference: For more information on when administrative decisions are necessary based on lack of qualifying service, see M21-1, Part III, Subpart i, 1.A.1.f. _Important_ : To ensure the rating _Narrative_…

Accrued Authorization and Notification

XI.ii.3.E.16.b. Jurisdiction of Accrued Claims With an Associated Claim for DIC Use the table below to determine which office has jurisdiction over an accrued claim or request for substitution based on a deceased Veteran’s claim, request for decision review, or appeal when there is an…

Examples of Award Adjustments Necessitated by a Veteran's Election of Drill Pay

VI.ii.3.C.1.i. VA Is Withholding Part of the Veteran’s Compensation to Recoup Separation Benefits _Scenario_ : · In January 2010, VA grants a Veteran’s original claim for disability compensation, assigning the Veteran a disability rating of · 30 percent for depression, and · 10 percent for…

Protected Ratings

X.ii.1.B.1.c. Protection at Lower Than the Current Evaluation In some cases, the current evaluation may not have been in effect for 20 years, but the evaluation has been at a lower level for the requisite 20-year period. In such cases, the current evaluation is not the protected evaluation, but…