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Part VI, Subpart i, Chapter 1, Section ADecision Authorization

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Revised September 29, 2025

VI.i.1.A.1.aFinal Stage in Adjudicating a Claim

The final stage in adjudicating a claim, after all relevant evidence (to include Federal tax information (FTI)) has been collected and reviewed, and a rating decision prepared (if necessary), is to

  • award benefits when entitlement exists, and/or
  • deny benefits when entitlement does not exist.

Reference: For more information on FTI, see M21-1, Part XIV, 4.A-D.

VI.i.1.A.1.bResponsibility for Awarding or Denying Benefits

A single claim typically involves multiple issues the Department of Veterans Affairs (VA) must resolve. The authorization activity is responsible for ensuring VA makes a decision to award or deny entitlement to benefits for each issue a claimant raises. The authorization activity must

  • address all issues based on
    • eligibility criteria, and
    • any rating decision, and
  • inform the claimant of the decision on each issue.

Notes:

  • Many adjudication actions will be a combination of awarding and denying entitlement.
  • The end product controlling the claim must remain pending until VA resolves each of the issues the claimant raised in that claim.

VI.i.1.A.1.cRequirement to Reduce or Withhold Payments

If VA determines a claimant is eligible for monetary benefits, to include disability compensation for one or more service-connected (SC) disability(ies), VA may have to reduce or withhold payments if

  • the claimant
    • received separation benefits
    • is receiving military retired pay (MRP) or Survivor Benefit Plan (SBP), or
    • is receiving benefits based on another Veteran’s service, or
  • VA has proposed to rate the claimant incompetent.

Note : If a beneficiary is receiving benefits based on the beneficiary's own service and separate benefits based on another Veteran’s service, a change in one benefit may affect the other benefit. Example : A Veteran is granted disability compensation at the 20-percent rate. The same Veteran is receiving Parents’ Dependency and Indemnity Compensation (DIC). Disability compensation is countable income and will potentially cause a reduction to the Parents’ DIC award.References: For more information on

VI.i.1.A.1.dRequirements for Veteran-Married-to-Veteran Claims

In some cases, VA grants or increases compensation benefits to a Veteran that is married to another Veteran. In these situations, claims processors should review the spouse’s record to determine if the compensation benefit affects the spouse’s VA benefits. If the spouse is receiving pension or Parents’ DIC, the claims processor should

  • establish an EP 150 with claim label PMC-Income Adjustment on the spouse’s award
  • use the date of authorization of the compensation claim as the date of claim for the EP 150, and
  • ensure the Veteran Married to Veteran corporate flash is applied to both Veteran’s records.

Note : In Veteran-married-to-Veteran cases, the Veteran Married to Veteran corporate flash should be applied even if the spouse is not receiving VA benefits. References : For more information on

VI.i.1.A.1.eReviewing a Supplemental Claim

For a supplemental claim, the process for requesting information from a claimant and other sources is the same as it is for an initial claim. If basic eligibility criteria (such as Veteran status, or wartime and minimum active duty service requirements for pension claims) are met, the rating activity must review the following types of supplemental claims:

  • claims for benefits involving (a) specific disability(ies), and/or
  • claims in which benefits were previously discontinued due to a change in special eligibility, such as no longer being
    • permanently and totally disabled, or
    • in need of aid and attendance (A&A).

Important: The rating activity does not need to review pension claims to make a disability determination when income or net worth bar pension entitlement. Reference: For more information on supplemental claims, see

2General Information on Processing Decisions

This topic contains general information on processing decisions, including

  • responsibility for processing rating decisions
  • effective date of payment under 38 CFR 3.31
  • award-processing responsibilities
  • awards eligible for self-authorization, and
  • awards that require Veterans Service Center Manager (VSCM) or Pension Management Center Manager (PMCM) concurrence.

Revised June 5, 2026

VI.i.1.A.2.aResponsibility for Processing Rating Decisions

After rating decisions are completed they are routed directly to the authorization activity, which is responsible for processing rating decisions.

VI.i.1.A.2.bEffective Date of Payment Under 38 CFR 3.31

It is important to understand the difference between the effective date of payment and the effective date of entitlement. Under 38 CFR 3.31, VA may not pay monetary benefits based on an original, supplemental, or increased award of compensation, pension, or DIC for any period prior to the first day of the calendar month following the month in which the beneficiary became entitled to the benefit. Example:Scenario: The rating activity assigns an increased disability rating to a Veteran’s SC back disorder effective April 21, 2022. (This represents the effective date of entitlement.) Result: The effective date of the corresponding increase in the Veteran’s compensation is May 1, 2022. (This represents the effective date of payment.) Exception: Effective October 1, 2011, Section 605 of Public Law 111-275 amended 38 U.S.C. 5111 to allow VA to pay disability compensation from the date of entitlement to said benefit to any Veteran who retires or separates from active duty due to a catastrophic disability. For VA purposes, "catastrophic disability" means a permanent, severely disabling injury, disorder, or disease that compromises the ability of the Veteran to carry out the activities of daily living to such a degree that the Veteran requires

  • personal or mechanical assistance to leave home or bed, or
  • constant supervision to avoid physical harm to self or others.

VI.i.1.A.2.cAward-Processing Responsibilities

The table below describes who is responsible for specific actions during the award process.

Who Is ResponsibleActions

Veterans Service Representative (VSR)

  • Conduct a cursory review of the rating decision, to include the code sheet, in an attempt to identify any obvious errors, such as failure to consider entitlement to Chapter 35 benefits when a total disability rating is granted and no future examination is required.
    • Access the RATING screen in the Veterans Benefits Management System – Awards (VBMS-A) to validate data contained in the rating decision and notify the rating activity if any inconsistencies exist.
    • Enter additional data pertaining to the decision into the claims-processing system, as applicable.
    • Generate an award.
    • Ensure, as applicable, that the award document fully reflects all new and/or increased entitlements implemented by the associated rating decision and/or authorization determination(s).
    • Prepare a decision notice for the claimant.
    • For pension and Parents' DIC cases only: Ensure documentation of calculations made to determine the rate of benefits (such as calculations of medical expenses, net worth, and waived overpayments) are included in the electronic claims folder.
    • Route the award to a Senior VSR (SVSR).

Notes:

  • The only entry or update VSRs may make on the RATING screen is to select one of the override buttons along the bottom of the screen to ensure the appropriate effective date is generated when implementing award actions such as
    • reducing a disability rating, or
    • switching a Veteran’s disability rating from a total rating based on individual unemployability to a 100-percent schedular rating (or vice versa).
  • If the decision notice contains FTI, follow the instructions in M21-1, Part VI, Subpart i, 1.B.2.
  • The successful generation of adjusted payment rates from the earliest implicated effective date – for awards converted from the Benefits Delivery Network – may require the entry of an appropriate control date in the ONLY GENERATE NEW AWARD LINES FROM field on the claims-processing system’s RECORD DECISIONS screen.
  • The processing of a decision is commonly referred to as an “award” action, regardless of whether the decision
    • constitutes a grant or denial of benefits, or
    • results in an adjustment of benefits.

References: For more information on

SVSR

  • Review the award and decision notice for accuracy. (Return the award and decision notice to the VSR for correction if errors exist.)
  • Authorize the award.
  • Date the decision notice with the expected date of mailing (if applicable).
  • Release the following for mailing to the claimant:
    • decision notice
    • copy of the rating decision (if applicable), and
    • any pertinent enclosures.

Notes:

  • If a decision notice contains FTI, see M21-1, Part VI, Subpart i, 1.B.2.
  • M21-1, Part VI, Subpart i, 1.A.2.d, describes circumstances under which a VSR may take the actions described in this cell.

Important:

  • In the VBMS awards-processing environment, the returning of an award or decision notice to a VSR for correction is known as a deferral. The National Work Queue (NWQ) Playbook contains instructions (under the heading VBMS Deferrals) that claims processors must follow to properly manage such deferrals.

  • The Veterans Benefits Administration’s mission is to serve Veterans and eligible dependents and survivors in the most timely and accurate manner possible.

    • It is only appropriate to extend suspense or diary dates if it is necessary for a specific adjudicative action. Suspense dates must always correspond with specific actions and should not be arbitrarily extended under any circumstance.
    • When employees handle a claim, employees are expected to take the most full and complete action possible on a claim every time – including development, rating, and promulgation actions – to move a claim forward to accurate completion in the claims process. Every effort should be made to move the claim to the next processing cycle each time it is handled.

VI.i.1.A.2.dAwards Eligible for Self-Authorization

A VSR may generate and authorize the corresponding award action (taking the actions described in both rows of the table in M21-1, Part VI, Subpart i, 1.A.2.c) when the award action does not result in a change of monetary benefits under the following circumstances:

  • denying additional compensation for a dependent(s), or
  • promulgating a rating decision that
    • constitutes a denial, as defined in M21-1, Part VI, Subpart i, 1.A.3.a, or
    • does not change the combined evaluation when
      • granting service connection (SC), and/or
      • increasing an evaluation(s).

Exceptions:

  • VSRs may not self-authorize the award action if promulgation of the rating or dependency decision will result in an increase, reduction, or discontinuation of benefits.
  • The policy described in this block does not apply to award actions
    • taken by pension management centers, or
    • involving
      • the Nehmer stipulation
      • original claims, and/or
      • an administrative decision.

Note : A VSR must have “self-authorization” authority to generate and authorize the same award.References: For more information on

VI.i.1.A.2.eAwards That Require VSCM or PMCM Concurrence

Some awards require concurrence by a Veterans Service Center Manager (VSCM) or Pension Management Center Manager (PMCM) (or a designee of one of these managers) in addition to authorization by an SVSR. These circumstances include

  • awards having a net effect of a payment of at least $40,000, and
  • awards that were generated using the GENERATE AWARD OVERRIDE function.

References: For more information on the

3General Information on Denials

This topic contains general information on denials, including

  • definition of a denial
  • authority of the authorization activity to make decisions that affect an individual's entitlement to VA benefits
  • conditions under which the authorization activity may deny a claim
  • requirement to receive and review all required evidence before denying a claim, and
  • incomplete applications and benefit requests that are not filed on a prescribed form.

Revised April 16, 2021

VI.i.1.A.3.aDefinition: Denial

A decision is considered a denial if, after review of a claim or issue and all evidence associated with it, VA makes a formal decision to

  • not award a benefit the claimant is seeking
  • confirm and continue a prior decision (this includes rating decisions that confirm and continue a disability rating following a routine future examination or hospitalization of a Veteran), or
  • reduce or discontinue benefits.

Note: The initial establishment of a noncompensable disability rating for an SC disability is not considered a denial. Although compensation is not payable for the disability (except, potentially, under 38 CFR 3.324), the noncompensable rating may entitle the Veteran to other VA benefits, such as medical care under 38 CFR 17.37(b) and 17.38.

VI.i.1.A.3.bAuthority of the Authorization Activity to Make Decisions That Affect an Individual's Entitlement to VA Benefits

The authorization activity has the authority to make basic eligibility determinations. It also has the authority to decide

  • the effect an individual's income and/or net worth has on the entitlement to income-based benefits
  • whether entitlement to additional benefits for a dependent or dependents exists, and
  • whether entitlement to A&A under 38 CFR 3.351(c)(2) exists, based on the status of the following individuals as a patient in a nursing home:
    • Veteran in receipt of Veterans Pension
    • surviving spouse or parent in receipt of DIC
    • surviving spouse in receipt of Survivors Pension, or
    • spouse of a Veteran when the Veteran is in receipt of disability compensation.

Restrictions: The authorization activity does not have the authority to

  • determine whether service treatment records support a claim for disability compensation, or
  • deny without a rating decision a claim for survivors’ benefits that involves the issue of SC for the cause of death.

Note: If basic eligibility is established and the claim requires consideration of medical evidence of record, refer it to the rating activity for review. Claims of this nature require a formal, coded rating decision. Exception: M21-1, Part VI, Subpart i, 1.A.3.c describes conditions under which the authorization activity may deny a claim without a rating decision. References: For more information on

VI.i.1.A.3.cConditions Under Which the Authorization Activity May Deny a Claim

The authorization activity may deny a claim for disability compensation or survivors benefits without a rating decision under any of the following conditions:

  • a legal bar to entitlement exists
  • the claimant does not respond within 30 days to a request for evidence needed to determine whether or not there is a legal bar to entitlement, such as in cases involving continuous cohabitation, or
  • in survivors benefit cases, the claim is one in which
    • SC for the cause of death was not specifically claimed, and
    • there is no reasonable probability that the cause or contributory cause of death was related to service (including, but not limited to, death due to accident or natural disaster, homicide, or execution for a crime).

Notes:

  • Resolve any issues regarding basic eligibility or bars to benefits before considering SC. In accordance with 38 CFR 3.159(d), VA should not continue providing assistance with a claim if there is no reasonable possibility that assistance will substantiate the claim.
  • If VA concurrently denies SC for the cause of death and awards pension, enter the following as a remark on the corresponding award document:_ SC death benefits denied – M21-1, Part VI, Subpart i, 1.A.3.c._
  • When notifying a claimant of a decision that authorization activity made (without referral to the rating activity) to deny entitlement to a claimed benefit, authorization activity must include the following in the decision notice, just as the rating activity does in rating decisions:
    • reasons and bases for the decision
    • laws and regulations relevant to the claim
    • a summary of the evidence authorization activity considered
    • element(s) necessary to grant the claim that were not met, and
    • findings that are favorable to the claimant under 38 CFR 3.104(c).

References: For more information on

VI.i.1.A.3.dRequirement to Receive and Review All Required Evidence Before Denying a Claim

Unless there is a statutory bar to entitlement to benefits, the authorization activity must not deny any claim until VA has

  • received and reviewed all evidence required to make a decision, or
  • exhausted all reasonable means of obtaining the evidence and, for records from Federal sources, determined that either
    • the record does not exist, or
    • further efforts to obtain the record would be futile.

Note: A formal claim requires a formal decision and notification. However, VA’s consideration of subordinate and within-scope issues associated with a claim (as explained in M21-1, Part V, Subpart ii, 3.A) does not necessarily require a formal decision and notification if such consideration would result in a denial.References: For more information on

VI.i.1.A.3.eIncomplete Applications and Benefit Requests That Are Not Filed on a Prescribed Form

Do not process a denial if a claimant has failed to submit a

References: For more information on

4Denials Based on a Claimant’s Failure to Furnish Requested Evidence

This topic contains information on denials that are based on a claimant’s failure to furnish requested evidence, including handling

  • a claimant’s failure to
    • submit evidence VA requested, and
    • report for a VA examination, and
  • an abandoned claim.

Revised April 24, 2020

VI.i.1.A.4.aHandling a Claimant’s Failure to Submit Evidence VA Requested

If a claimant fails to submit evidence within a time period VA specified,

  • refer the claim to the rating activity (if a rating decision is required)
  • process a denial (or award benefits, if other evidence of record supports a grant of entitlement to all or some of the benefits the claimant is seeking), and
  • prepare a decision notice.

Important:

  • If VA denies any portion of a claim because the claimant failed to submit evidence VA requested, the decision notice must
    • state this fact
    • explain that other evidence of record does not support the claim, and
    • inform the claimant the evidence VA requested must be furnished, along with VA Form 20-0995, Decision Review Request: Supplemental Claim, within one year of the date of the decision notice in order to remain entitled to benefits from the original date of claim, if VA later establishes entitlement.
  • Prepare a new decision notice if VA previously denied a claim based on a claimant’s failure to submit evidence, then VA subsequently
    • makes another determination of non-entitlement based on additional evidence the claimant furnished within one year of the date of the previous notice of denial, or
    • denies the claim solely on legal grounds.

References: For more information on

VI.i.1.A.4.bHandling a Claimant’s Failure to Report for a VA Examination

The table below describes the process for handling cases in which a claimant fails to report for a VA examination without good cause.

StageWho Is ResponsibleAction
1

development activity

Refers the claim to the rating activity for consideration.

2

rating activity

Decides the claim in accordance with principles set forth in M21-1, Part IV, Subpart i, 2.F.1.a.

3

rating activity

Routes the rating decision to the authorization activity.

4

authorization activity

Processes an award and/or denial and issues notification to the claimant. Important: If a denial is based on the claimant’s failure to report for an examination, either the rating decision or the decision notice must

  • inform the claimant that VA cannot favorably decide the claim without an examination, and
  • advise the claimant to
    • notify VA when ready to report for an examination, or
    • submit a properly executed disability benefits questionnaire.

References: For more information on

VI.i.1.A.4.cHandling an Abandoned Claim

If a claimant fails to provide evidence within one year of VA’s request and VA has not decided the claim as of the expiration of the one-year period, consider the claim abandoned. Important: It is not necessary to advise a claimant of review rights when the claimant has abandoned the claim. Reference: For more information on abandoned claims, see

5Special Denial Procedures

This topic contains information on special denial procedures, including

  • changing the basis of a previous denial, and
  • references to other special denial procedures.

Revised August 10, 2020

VI.i.1.A.5.aChanging the Basis of a Previous Denial

If VA reviews or reconsiders a claim it previously denied and decides to change the basis of the denial, it must

  • reprocess the denial according to the instructions in M21-1, Part VI, Subpart i, 1.A.2.c, and
  • if necessary, make appropriate system selections to
    • add any new favorable findings related to the basis of the new denial, and/or
    • overturn any and all findings that
      • were formerly found favorable to the claimant under 38 CFR 3.104(c), but
      • are no longer applicable.

References: For more information on

VI.i.1.A.5.bReferences to Other Special Denial Procedures

The table below contains references to other special denial procedures.

For more information on …See …

notifying a claimant that election of pension is not in the claimant's best interest

M21-1, Part IX, Subpart iii, 2.C.2.b.

notifying a claimant of a denial that is based on income

M21-1, Part IX, Subpart iii, 1.A.3.

eligibility determinations regarding the Department of Defense’s death gratuity

M21-1, Part XI, Subpart ii, 4.

denying a request for release of information or amendment of records

VA Handbook 6300.4, paragraphs 3.d and 3.e.

denying claims from certain foreign residents

M21-1, Part X, Subpart i, 3.B.3.

End of Part VI, Subpart i, Chapter 1, Section A

This text is a rendering of Part VI, Subpart i, Chapter 1, Section A. The official version is the one that governs your claim.

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