Part X, Subpart iv, Chapter 2, Section AInsanity Determinations

Revised August 26, 2024

X.iv.2.A.1.a#Effect of Insanity on VA Benefits

If a Veteran was determined to be insane at the time of commission of the act or acts that would otherwise result in an adverse character of discharge (COD), line-of-duty (LOD), or willful misconduct determination, hold that the Veteran

• was without fault, and
• is not precluded from any Department of Veterans Affairs (VA) benefits.

References: For more information on

• definition of insanity for VA purposes, see 38 CFR 3.354(a), and
• insanity and homicide in death claims, see M21-1, Part X, Subpart iv, 2.B.

X.iv.2.A.1.b#Placing Insanity at Issue

Insanity is placed at issue in the following ways:

• by specific allegation by the Veteran or an authorized representative
• by the VA employee if the evidence indicates the possibility of insanity, or
• if suicidal death occurs in service.

Note: The possibility of insanity is raised by the record if there is evidence showing that

• the individual had a qualifying disease (excluding personality disorder or mental deficiency), and
• such qualifying disease caused one or more of the following at the time the offense(s) in question took place:
  • a more or less prolonged deviation from the individual’s normal method of behavior
  • interference with the peace of society (disruptions of legal order), or
  • antisocial departure from, and inadaptability to, the accepted standards of the community to which the individual belongs by birth and education.

Important: The mere diagnosis of a mental condition is not sufficient on its own to place insanity at issue. The development activity should not refer a case to the rating activity for an insanity determination without evidence showing the individual potentially met the definition of insanity under 38 CFR 3.354(a), as described above, or without having fully developed for facts and circumstances. Reference:_ _For more information on the

• regulation regarding
  • insanity see 38 CFR 3.354, and
  • suicide see 38 CFR 3.302, and
• criteria for a determination of insanity, see VAOPGCPREC 20-97.

X.iv.2.A.1.c#Developing Cases in Which Insanity Is an Issue

If insanity is at issue, develop the case completely before making a determination.Obtain the following information when developing:

• all service and post-service treatment records that are in any way relevant, and
• complete transcripts of any court martial or board proceedings that may be relevant.

References: For more information on obtaining

• service records, see M21-1, Part III, Subpart ii, 2.B, and
• post-service treatment records, see
  • M21-1, Part III, Subpart ii, 1.A, and
  • M21-1, Part III, Subpart ii, 3.

X.iv.2.A.1.d#Referring a Case for Rating Action

After completing development, refer the case to the rating activity if the issue of insanity is raised as described in M21-1, Part X, Subpart iv, 2.A.1.b, and use the table below to determine how to process the resulting decision.

Important : The rating activity is not required to make a formal decision on the issue of insanity when the matter is neither claimed nor appropriately raised by the record, as described in M21-1, Part X, Subpart iv, 2.A.1.b. If the rating activity does not believe the facts of the case raise the possibility of insanity, then the rating activity should

• return the claim for continuation of the administrative decision process, and
• document the finding that referral for an insanity determination was inappropriate by entering a note in the Veterans Benefits Management System.

Notes :

• When resolving the issue of insanity,

  • apply the

    • definition of insanity found in 38 CFR 3.354, and

    • discussion of insanity found in VAOPGCPREC 20-1997, and

  • state in the Narrative of the rating decision, The Veteran[was] [was not]insane at the time of commission of the offense.

• A rating decision finding the Veteran to have been sane at the time in question, supported by the necessary explanation, is sufficient as to the particular period of service or offense at issue.

• Determinations of insanity are adjudicative decisions that must be premised on existing regulatory provisions and agency policies. Do not routinely rely on medical assessments and opinions to resolve the legal question of insanity for VA purposes.

X.iv.2.A.1.e#Forgoing a Separate Notice of a Rating Decision Addressing Insanity Only

Rating determinations regarding insanity are rendered solely to influence and inform the preparation of subsequent administrative decisions. As such, do not prepare or release a decision notice to communicate the outcome of a rating decision that addresses, as a solitary issue, the question of a Veteran’s (or former service member’s) insanity. If the rating activity resolves the question of insanity unfavorably (that is, deeming the Veteran or former service member sane at the time of commission), briefly discuss this factor in preparing the administrative decision notice required in

• M21-1, Part X, Subpart v, 1.C.2.j, or
• M21-1, Part X, Subpart iv, 1.A.1.n.

X.iv.2.A.1.f#Preparing an Administrative Decision

When a rating decision is received, whether or not insanity is established, the development activity must prepare an administrative decision concerning COD, LOD, or willful misconduct for approval, as required.Important: All subsequent action must be based on this determination or on a formal rating decision that may have been made.References: For more information on administrative decisions for

• COD, see M21-1, Part X, Subpart iv, 1.A and B, and
• willful misconduct and LOD, see M21-1, Part X, Subpart iv, 1.C.