Part XI, Subpart ii, Chapter 1

Revised June 25, 2024

XI.ii.1.1.a#General Responsibilities of a Claims Processor

A claims processor must review the evidence of record to determine if a claim for survivors benefits

• should be submitted to the rating activity, or
• can be decided without a rating decision.

XI.ii.1.1.b#General Policy Regarding the Referral of Survivors Benefits Claims to the Rating Activity

Refer each claim for survivors benefits to the rating activity if death occurred within five years of separation from military service. Exception: A claims processor may deny a claim for survivors benefits without referral to the rating activity if the death was due to

• homicide
• execution for a crime, or
• accident or disaster.

XI.ii.1.1.c#Award of Survivors Pension Prior to Rating Decision Regarding SC Death

To avoid any delays due to necessary development for service-connected (SC) death, award Survivors Pension benefits, if applicable, prior to referring the claim to the rating activity for a decision on service connection (SC) for the cause of death.Annotate the award with “ Decision on SC deferred.” Continue end product (EP) control.If, after evidence is received, the claim is denied, the authorization activity must enter the notation, “ Cause of death not due to service, M21-1, Part XI, Subpart ii, 1.1.c ,” on the last award, followed by the

• authorizer’s initials, and
• date when the decision notice was released to the claimant.

If development is needed to determine eligibility for Survivor Pension, develop at the same time as the SC cause of death, if all other eligibility factors are met.

XI.ii.1.1.d#Specific Situations in Which Survivors Benefits Claims Must Be Referred to the Rating Activity

If one or more of the following situations arise, forward the claim for survivors benefits to the rating activity for consideration of SC for the cause of death:

• the claimant has specifically raised the issue of SC for the cause of death on the application or otherwise, including Dependency and Indemnity Compensation (DIC) under 38 U.S.C. 1151
• a rating decision was made during the Veteran’s lifetime, awarding SC for a condition affecting a vital organ such as but not limited to the following:
  • brain
  • heart
  • lungs
  • liver, or
  • kidneys
• the Veteran had one or more SC conditions with a combined 100-percent evaluation
• the Veteran was in receipt of individual unemployability benefits
• a claims processor determines there is reasonable probability that the death may be related to service, whether from
  • disease
  • injury, or
  • self-infliction
• the claimant has filed for Survivors Pension, and the Veteran met the wartime service requirement but did not meet the 90-day length of service requirement, unless one of the following situations exists:
  • there is no indication or claim that the discharge from service was for an SC disability
  • discharge was for reasons other than a disability
  • service records show no disability, or
  • the Veteran, at the time of death, was receiving or entitled to receive compensation for an SC disability based on service during a period of war
• a claim for accrued benefits that involves a rating issue is received, or
• a claim for SC burial benefits is received.

Exceptions:

• If a claim for SC for cause of death is filed by a parent or parents, and the income is excessive for the receipt of DIC,
  • deny the claim because of excessive income, and
  • notify the claimant that no other aspect of the claim has been considered.
• Do not send a non-SC burial claim to the rating activity if the Veteran’s death certificate (or proof of death equivalent to a death certificate per 38 CFR 3.211) is not of record.

Notes:

• If the rating activity determines the facts do not warrant a formal determination of SC, the claim may be
  • annotated that there is no evidence of SC death, and
  • returned to the authorization activity for resolution of the formally claimed issues.
• If a claim for survivors benefits cannot be referred to the rating activity for a formal determination of SC, the authorization activity must deny the issue administratively.

References: For more information on

• the non-discretionary application of 38 CFR 3.152(b) regarding survivors benefits, see M21-1, Part II, Subpart iii, 1.A.3.e
• the rating activity’s responsibility for reviewing potential SC for cause of death, see M21-1, Part XII, Subpart i, 1.B
• determining if a review for implicit SC death is needed and referring the claim to the rating activity, see M21-1, Part XI, Subpart ii, 1.1.e
• proof of death equivalent to a death certificate, see 38 CFR 3.211
• cause of death, see 38 CFR 3.312
• when to send an accrued claim to the rating activity, see M21-1, Part XI, Subpart ii, 3.D.1.a, and
• SC burial benefits, see M21-1, Part XI, Subpart iii, 1.B.2.

XI.ii.1.1.e#Determining When a Review for Implicit SC for the Cause of Death Is Needed and Referring the Claim to the Rating Activity

The development activity must ensure all necessary evidence relating to SC death, as outlined in M21-1, Part XII, Subpart i, 1.B.1.g, is obtained and if applicable, award any Survivors Pension benefits prior to referring the claim to the rating activity in accordance with M21-1, Part XI, Subpart ii, 1.1.c.Upon expiration of the development timeframe and/or receipt of the requested evidence, review the evidence of record to determine if the claim must be referred to the rating activity. If the development activity is unsure if a grant of SC death is warranted, refer the claim for an implicit SC death review by the rating activity.The table below describes the additional responsibilities of the development activity and of the rating activity in ensuring that a claim for an implicit SC death under a non-SC death EP or claim label is properly reviewed.

XI.ii.1.1.f#Rating Activity’s Responsibilities Upon Review of an Implicit Claim for SC Death

Upon review of an implicit claim for SC death, the rating activity must use the table below to take the actions outlined for the applicable situation.

2Special Purpose Rating Determinations in Survivors Benefits Claims

This topic contains information on the various special purpose rating determinations in survivors benefits claims, including special purpose determinations that

• do not require a claim for survivors benefits, and
• require a claim for DIC.

Revised April 24, 2015

XI.ii.1.2.a#Special Purpose Determinations That Do Not Require a Claim for Survivors Benefits

The table below describes special purpose determinations which may be made whether or not a claim for survivors benefits has been received.

XI.ii.1.2.b#Special Purpose Determinations That Require a Claim for DIC

The table below describes special purpose determinations in which a claim for DIC is required before the special purpose determination may be made. Note: If a claim for DIC has not been filed

• inform the requester that the Department of Veterans Affairs is without authority to make a determination unless a claim is filed, and
• furnish the requestor with a VA Form 21P-534 EZ, Application for DIC, Survivors Pension, and/or Accrued Benefits, or VA Form 21P-535, Application for Dependency and Indemnity Compensation by Parent(s) (Including Accrued Benefits and Death Compensation When Applicable), as appropriate.