Standard Claims and Appeals Forms, 57659-57698 [2014-22633]
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Vol. 79
Thursday,
No. 186
September 25, 2014
Part II
Department of Veteran Affairs
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38 CFR Parts 3, 19, and 20
Standard Claims and Appeals Forms; Final Rule
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Federal Register / Vol. 79, No. 186 / Thursday, September 25, 2014 / Rules and Regulations
Department of Veterans Affairs, 810
Vermont Avenue NW., Washington, DC
20420, (202) 461–9700. (This is not a
toll-free number.)
SUPPLEMENTARY INFORMATION:
DEPARTMENT OF VETERANS
AFFAIRS
38 CFR Parts 3, 19, and 20
RIN 2900–AO81
Executive Summary
Standard Claims and Appeals Forms
Department of Veterans Affairs.
ACTION: Final rule.
AGENCY:
The Department of Veterans
Affairs (VA) amends its adjudication
regulations and the appeals regulations
and rules of practice of the Board of
Veterans’ Appeals (Board) to require
that all claims governed by VA’s
adjudication regulations be filed on
standard forms prescribed by the
Secretary, regardless of the type of claim
or posture in which the claim arises.
This rulemaking also eliminates the
constructive receipt of VA reports of
hospitalization or examination and
other medical records as informal
claims for increase or to reopen while
retaining the retroactive effective date
assignment for awards for claims for
increase which are filed on a standard
form within 1 year of such
hospitalization, examination, or
treatment. This final rule also
implements the concept of an intent to
file a claim for benefits, which operates
similarly to the current informal claim
process, but requires that the
submission establishing a claimant’s
effective date of benefits must be
received in one of three specified
formats. Finally, these amendments will
provide that VA will accept an
expression of dissatisfaction or
disagreement with an adjudicative
determination by the agency of original
jurisdiction(AOJ) as a Notice of
Disagreement (NOD) only if it is
submitted on a standardized form
provided by VA for the purpose of
appealing the decision, in cases where
such a form is provided. Although a
standardized NOD form will only
initially be provided in connection with
decisions on compensation claims, VA
may require a standard NOD form for
any type of claim for VA benefits if, in
the future, it develops and provides a
standardized NOD form for a particular
benefit. The purpose of these
amendments is to improve the quality
and timeliness of the processing of
veterans’ claims for benefits by
standardizing the claims and appeals
processes through the use of forms.
DATES: Effective Date: This final rule is
effective March 24, 2015.
FOR FURTHER INFORMATION CONTACT:
Stephanie Li, Chief, Regulations Staff
(211D), Compensation Service,
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SUMMARY:
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I. Purpose of the Final Rule
The Department of Veterans Affairs
(VA) amends its adjudication
regulations and its appeals regulations
and rules of practice of the Board of
Veterans’ Appeals (Board) for the
purpose of improving the quality and
timeliness of the processing of veterans’
claims for benefits and appeals. Under
38 U.S.C. 501(a), VA is authorized to
make these regulatory changes as it is
granted broad authority to ‘‘prescribe all
rules and regulations which are
necessary or appropriate to carry out the
laws administered by [VA] and are
consistent with those laws,’’ including
specifically authority to prescribe ‘‘the
forms of application by claimants under
such laws.’’ Congress has characterized
a request for Board review as an
‘‘[a]pplication for review on appeal.’’ 38
U.S.C. 7106, 7107, 7108. Additionally,
38 U.S.C. 5101 explicitly provides that
claimants must file ‘‘a specific claim in
the form prescribed by the Secretary’’ in
order for VA to pay benefits.
II. Summary of Major Provisions
The major provisions of this final rule
include the following: VA will
standardize the claims and appeals
processes through the use of specific
mandatory forms prescribed by the
Secretary, regardless of the type of claim
or posture in which the claim arises.
These amendments will apply to all
benefits within the scope of 38 CFR part
3, namely pension, compensation,
dependency and indemnity
compensation, and monetary burial
benefits. These changes to VA’s
adjudication regulations not only will
drive modernization of the claims and
appeals processes, but will also provide
veterans, claimants, and authorized
representatives with a clearer and easier
way to initiate and file claims.
These final regulations also eliminate
the provisions of 38 CFR 3.157 which
allowed various documents other than
claims forms to constitute claims,
specifically, VA reports of
hospitalization or examination and
other medical records which could be
regarded as informal claims for increase
or to reopen a previously denied claim.
Nonetheless, this rule retains the
current retroactive effective date
assigned for awards for claims for
increased evaluation as long as they are
filed on a standard form within 1 year
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of such hospitalization, examination, or
treatment.
This final rule further implements a
procedure to replace the non-standard
informal claim process in 38 CFR 3.155
by employing a standard form on which
a claimant or his or her representative
can file an ‘‘intent to file’’ a claim for
benefits.
Finally, this final rule provides that
VA will accept an expression of
dissatisfaction or disagreement with an
adjudicative determination by the
agency of original jurisdiction (AOJ) as
a Notice of Disagreement (NOD) only if
it is submitted on a standardized form
provided by VA for the purpose of
appealing the decision. This
requirement only applies in cases where
VA provides such a form with the
Notice of Appeal Rights sent with the
notice of a decision on a claim. In these
cases, this rule replaces the current
provision in 38 CFR 20.201 which
permitted an appellant to begin the
appeal process by filing in any format a
statement that can be ‘‘reasonably
construed’’ as seeking appellate review.
This procedure made the identification
of an appeal a time-intensive and
inefficient interpretive exercise,
complicated by the fact that an NOD
could be embedded within
correspondence addressing a variety of
other matters, often contributing to
delay in VA recognizing that an
appellant sought to initiate an appeal.
VA also adds two new sections to part
19 in this final rule. For NODs filed on
a form provided by the AOJ, new 38
CFR 19.24 will govern. This provision
sets forth the procedures governing the
treatment of incomplete forms, the
criteria of a complete form, the
timeframe to cure an incomplete form,
the failure to respond to request to cure,
action when a complete form is filed,
and clarification of issues which are not
enumerated on the form for appellate
review. For NODs filed where no form
is provided by the AOJ, new 38 CFR
19.23 which clarifies whether the
requirements of current 38 CFR 19.26,
19.27, and 19.28, or newly adopted
§ 19.24 would apply to a particular case,
will govern. Although a standardized
NOD form will only initially be
provided in connection with decisions
on compensation claims, VA may
require a standard NOD form for any
type of claim for VA benefits if, in the
future, it develops and provides a
standardized NOD form for a particular
benefit.
III. Costs and Benefits
This rulemaking will not affect
veterans’ eligibility for benefits, but
rather prescribe that they must use a
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standard application form to formally
apply for benefits. It also specifies that
medical records themselves no longer
constitute claims in the absence of a
claim submitted formally. However, the
retroactive effective date treatment for
hospitalization, treatment, or
examination under current regulation
will apply if a claimant files an intent
to file a claim or a complete claim
within one year of such medical care.
Likewise, this rulemaking amends VA’s
appeals regulations and rules of practice
of the Board of Veterans’ Appeals
(Board) to provide that VA will only
accept an expression of dissatisfaction
or disagreement with an adjudicative
determination by the AOJ as a Notice of
Disagreement (NOD) if it is submitted
on a standardized form provided by VA
for the purpose of appealing the
decision, in cases where such a form is
provided. This rulemaking seeks to
change the format in which claimants
initiate a claim, file a claim, and initiate
an appeal through the use of VAprescribed forms but does not alter
claimants’ entitlement to benefits or the
amounts of awards granted.
While there are no substantial
monetary burdens on the claimant, the
cost to claimants in submitting complete
claims or initiating an appeal on a
prescribed form or submitting
expressions of intent to file in a
specified format can be calculated in
terms of a claimant’s time to fill out VA
forms. Claimants and/or authorized
representatives may need to learn and
acclimate themselves to the new intent
to file a claim process, which functions
similarly to the current informal claim
process. However, those claimants who
are familiar with VA’s claims process
may recognize the operation of the
intent to file process as functioning
similar to the current informal claim
process. The difference is that the intent
to file a claim form serves as the
effective date placeholder like the
informal claim itself but must be
submitted in specified standard formats
and will only trigger VA’s duty to
furnish the claimant the appropriate
form.
While VA recognizes this time cost to
claimants in completing a prescribed
claim or appeal form, it concludes that
this up-front time burden to claimants is
equivalent to (or even lesser than the
unquantifiable time it takes for
approximately half of claimants to
compose non-standard submissions and
the time VA spends identifying and
clarifying the communication received
in non-standard submissions, all of
which add to delays in processing and
adjudicating claims and appeals and the
overall timeliness of delivering benefits
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to claimants. Therefore, we have
determined that the time required by
claimants to fill out forms is less than
or equal to the current time burdens on
claimants submitting non-standard
submissions along with the time it takes
for VA to identify, clarify, and develop
these non-submissions. This also
applies to claimants opting to submit an
intent to file a claim and a complete
claim.
By requiring data to be formatted in
a standard way through the use of
forms, VA will be able to cut processing
time in identifying and developing
claims, which will result in faster
delivery of benefits to all veterans.
While approximately half of the
claimant population files non-standard
submissions, the other half continues to
file claims on a prescribed form. For the
claimant population filing on prescribed
forms, there is no additional burden as
a result of this rulemaking.
As previously stated, this rulemaking
does not affect the amount of monies
paid to a claimant or entitlement to
benefits except in the case where a
claimant who is not familiar with the
intent to file a claim process submits an
informal claim which VA will deem as
a request for an application for benefits,
resulting in the claimant submitting an
intent to file a claim form or complete
claim at a later date. VA intends to
mitigate this situation by delaying the
effective date of this rule by 180 days
from publication in order to perform
robust outreach to inform and educate
claimants and authorized
representatives of this new standardized
procedure of the claims and appeals
processes.
This rulemaking will allow VA to
decrease the processing time in
identifying, clarifying, and processing
non-standard submissions as claims or
appeals since VA will be able to easily
target and identify these claims or
initiations of appeals based on the
submitted form. This means increased
quality in processing claims as VA
would be able to more accurately
identify claims and to correctly assign
effective dates of awards for claims
submitted on prescribed forms. Thus,
standardizing the claims and appeals
processes through the use of forms
translates to faster delivery of benefits to
claimants. In addition, standardizing
submissions on prescribed forms is an
essential component to VA’s current
and developing electronic business
programs which are designed to
facilitate the efficient and accurate
processing and adjudication of claims
and appeals. In order to utilize the
efficiency of such programs, data inputs
require a standard format which would
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be achieved through the use of
prescribed forms.
In sum, we are only making
procedural changes to the claims
process by mandating the submission of
standard forms to initiate a claim or to
file a claim and to the appellate process
by mandating the submission of
standard forms where such a form is
provided. We have determined that the
costs associated with this rulemaking
are mostly in terms of the burden of
time required by claimants and/or their
authorized representatives but such
time burdens are equivalent to the
current time burdens in our current
claims and appeals processing.
Moreover, the use of standardized forms
will result in realtime savings to VA in
identifying, clarifying, and processing
claims and appeals. Thus, there is an
overall benefit to the public as a result
of this rulemaking. On October 31, 2013,
VA published in the Federal Register
(78 FR 65490) a proposed rule to amend
its adjudication regulations and the
appeals regulations and rules of practice
of the Board of Veterans’ Appeals
(Board). There were several major
components of these proposed changes.
The first was to require that all claims
be filed on standard forms prescribed by
the Secretary, regardless of the type of
claim or posture in which the claim
arises. The second component proposed
was to eliminate the constructive receipt
of VA reports of hospitalization or
examination and other medical records
as informal claims for increase or to
reopen (see current 38 CFR 3.157) while
retaining the beneficial retroactive
effective date that may be assigned for
grants for increase filed on a standard
form within 1 year of such
hospitalization, examination, or
treatment. The third component
proposed that VA would accept an
expression of dissatisfaction or
disagreement with an adjudicative
determination by the agency of original
jurisdiction (AOJ) as a Notice of
Disagreement (NOD) only if it is
submitted on a standard form provided
by VA for the purpose of appealing the
decision. VA proposed that this
requirement would apply only in cases
where VA provides the standard form
with the Notice of Appeal Rights sent to
the claimant with the notice of a
decision on a claim.
VA provided a 60-day public
comment period, which ended on
December 30, 2013, and received 53
public comments, 4 of which were
received after the comment period
expired. Although VA is not legally
required to consider late-filed
comments, it has reviewed, considered,
and addressed all comments received in
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the interest of maximizing public
dialogue to further serve veterans,
claimants, and authorized
representatives. VA received comments
from various organizations and
individuals, including The Center for
Elder Veterans Rights; the County
Veteran Service Officer Association of
Wisconsin; Veteran Warriors; New York
State Division of Veterans’ Affairs;
Wounded Warrior Project; Disabled
American Veterans; National Veterans
Legal Services Program and the Military
Order of the Purple Heart (jointly
submitted); American Legion; Veterans
for Common Sense; Veterans Justice
Group, LLC; Veterans of Foreign Wars of
the United States; Military Officers
Association of America; Vietnam
Veterans of America; VetsFirst; National
Organization of Veterans Advocates;
Paralyzed Veterans of America; State of
Illinois Department of Veterans’ Affairs;
the law firms of Bergmann and Moore;
and Chisholm Chisholm and Kilpatrick;
and other interested persons. We
responded to all commenters as follows.
All of the issues raised by the
commenters that concerned at least one
portion of the rule can be grouped
together by similar topic, and we have
organized our discussion of the
comments accordingly. For the reasons
set forth in the proposed rule and
below, we are adopting the proposed
rule as final, with changes, explained
below, to proposed 38 CFR 3.1, 3.154,
3.155, 3.160, 3.400, 3.812, 19.24, and
20.201. To ensure consistency with
these changes, we have also
implemented changes to 38 CFR 3.108,
3.109, 3.403, 3.660, 3.665, 3.666, and
3.701.
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I. Changes to Initial Claims Process
Based on Public Comments
A. Definition of ‘‘Claim’’
In proposed § 3.1(p), VA defined
‘‘Claim’’ to mean ‘‘a written
communication requesting a
determination of entitlement or
evidencing a belief in entitlement, to a
specific benefit under the laws
administered by the Department of
Veterans Affairs.’’ VA proposed to
replace the current term, ‘‘Claim—
Application’’ which is defined as ‘‘a
formal or informal communication in
writing requesting a determination of
entitlement or evidencing a belief in
entitlement, to a benefit’’ in current
paragraph (p). This definition was
confusing and did not make clear the
difference between a ‘‘claim’’ and an
‘‘application.’’ Therefore, VA proposed
to clarify the current definition by
eliminating the words ‘‘Application,’’
‘‘formal,’’ and ‘‘informal’’ in the
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proposed definition in order to conform
with the amendments to the
adjudication regulations.
One commenter stated that the
proposed definition of a ‘‘claim’’ was
inconsistent with proposed § 3.155,
which provides that a standard form
which VA determines does not contain
all requested information would not be
considered a claim if that document is
not submitted via electronic means. We
agree with this comment. In order to
clarify the regulatory definition as
proposed, VA has revised this definition
to add that the written communication
must be ‘‘submitted on an application
form prescribed by the Secretary.’’ This
change requires that the communication
be on a VA form in order to be
considered a claim and maintains the
essence of the ‘‘formal communication’’
in the current definition of a ‘‘claim’’ in
§ 3.1(p). Therefore, any written
communication requesting a
determination of entitlement to a
specific benefit received on or after the
effective date of this rulemaking will be
defined as one that has been submitted
on a VA-prescribed form.
B. Claims for Benefits Under 38 U.S.C.
1151
Currently, VA does not require that
claims for entitlement to compensation
under 38 U.S.C. 1151, which provides
disability compensation and death
benefits for a qualifying disability or
death of a veteran from VA treatment,
examination, or vocational
rehabilitation, be submitted or filed on
a standard form or application. 38
U.S.C. 1151; 38 CFR 3.150(c), 3.154,
3.361. Because VA is adopting as a final
rule the amendment to its adjudication
regulations to require that all claims be
filed on standard forms prescribed by
the Secretary, VA is revising current
§ 3.150 by removing paragraph (c),
which provides that when disability or
death is due to VA hospital treatment,
training, medical or surgical treatment,
or examination, a specific application
for benefits will not be initiated.
VA also revises § 3.154, which
currently provides that ‘‘VA may accept
as a claim for benefits under 38 U.S.C.
1151 . . . any communication in
writing indicating an intent to file a
claim for disability compensation or
dependency and indemnity
compensation,’’ to require claimants to
file or submit a complete paper or
electronic claim in order to apply for
benefits under 38 U.S.C. 1151 and
§ 3.361, the regulation governing the
criteria of entitlement to 38 U.S.C. 1151
benefits. 38 U.S.C. 1151; 38 CFR 3.150
and 3.154.
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Commenters stated that requiring
claimants to file a complete claim for
this benefit is an unreasonable burden
to place on veterans who allegedly
became disabled by VA. One commenter
stated that requiring an application for
this benefit would delay an effective
date of any award to the detriment of
the claimant.
VA makes no change based on this
comment. VA’s intent is to modernize
the claims processing system by
standardizing the format in which all
disability claims are received. In order
for AOJ personnel to readily identify
claims and process them efficiently, it is
imperative that all claims appear in
easily identifiable formats using a
standardized form. Similar to VA’s
current informal claims, VA does not
require that claims for benefits under 38
U.S.C. 1151 be filed on any particular
form. See 38 CFR 3.154. Since these
claims are received in a non-standard
format, VA has to determine whether
any statements can be construed as a
claim for benefits under 38 U.S.C. 1151.
Reviewing and clarifying these nonstandard submissions is extremely time
consuming and can also result in claims
being overlooked. VA believes that
using a standard form is a minimal
burden to place on claimants, even
those who may be due compensation as
a result of VA’s own errors in providing
medical treatment. Additionally, as
discussed at length in section I.E. below,
the requirements of a complete claim
are minimal and simple. Accordingly,
VA will require that even claims based
on disability or death due to VA
hospital care, medical or surgical
treatment, examination, training and
rehabilitation services or compensated
work therapy program be initiated by
completing and filing a standard form.
Moreover, the effective date of any
award granted for this benefit is
governed by current § 3.400(i) which
provides that an effective date for an
award granted would be ‘‘date injury or
aggravation was suffered if claim is
received within 1 year after that date;
otherwise, date of receipt of claim.’’
Therefore, this final rule will not have
any detrimental effect on the effective
date of any payment that may be
awarded for this type of claim.
However, VA makes minor revisions
to § 3.154 as proposed, in order to
ensure consistency with the intent to
file process, discussed more fully in
section I. C. Specifically, we have
removed any reference to ‘‘paper or
electronic’’ forms and instead made
clear that claimants must file a complete
claim on the appropriate ‘‘application
form prescribed by the Secretary’’ to
apply for section 1151 benefits. We have
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also added a reference to § 3.155(b),
which establishes the ‘‘intent to file’’
process in order to make clear that the
liberalizing features of this process are
available for section 1151 benefits. This
process essentially provides that a claim
will be deemed received on the date a
claimant submitted an intent to file a
claim, provided the application form is
received within 1 year from the date the
intent to file is submitted. Therefore,
claimants will have up to 1 year from
the date injury or aggravation was
suffered due to hospitalization,
treatment, or examination, pursuant to
operation of § 3.400(i), to submit their
intent to file, and up to 1 additional year
to perfect the intent to file with an
application form prescribed by the
Secretary by operation of § 3.155(b).
C. Standardizing the Informal Claim
Process With Intent To File a Claim
Form
VA’s procedures for informal claims,
currently governed by § 3.155, provide
that an informal claim is any
communication or action, i.e., in a nonstandard format, indicating a claimant’s
intent to apply for benefits from a
claimant, an authorized representative,
a Member of Congress, or a person
acting as next friend of a claimant who
is not of full capacity or age, which
identifies the benefit sought. If an
application has not been previously
filed, VA would forward one to the
claimant and if filed within 1 year of
submission of the informal claim, the
application would be considered filed
as of the date of receipt of the informal
claim. 38 CFR 3.155(a). Generally, when
a compensation claim is granted, VA
pays a monthly benefit according to the
severity of the veteran’s disability
beginning from the claim’s effective
date, which is usually the date the claim
was filed. 38 U.S.C. 5110. Therefore,
§ 3.155 allowed claimants to secure a
potential earlier effective date for an
award by submitting an informal claim
that was subsequently ratified by a
formal application or for which an
application was already of record.
Although current § 3.155 provided
claimants with a favorable effective date
in the filing of informal claims, it
allowed informal claims to be submitted
in a non-standard format that not only
could be difficult to distinguish from
other routine correspondence but could
also be incomplete for adjudication. In
particular, as we explained in the
proposed rule, § 3.155(c) allowed
informal requests for increase or
reopening to constitute claims without
any need for formal ratification or filing
on a standard form of any kind. See 78
FR at 65491–92. While the informal
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claims process was meant to make the
process of initiating a claim as informal
as possible, it also unintentionally
incentivized the submission of claims in
non-standard formats that frustrate
timely, accurate, and orderly claims
processing.
Therefore, VA proposed to eliminate
the concept of an ‘‘informal’’ claim in
§ 3.155 by replacing ‘‘informal claim’’
with ‘‘incomplete’’ and ‘‘complete’’
claims, and by differentiating between
non-electronic and electronic claims in
order to incentivize the submission of
claims in a format, whether filed in
paper or electronically, that would be
more amenable to efficient processing.
VA proposed that claims filed through
an online claims submission tool within
a VA Web-based electronic claims
application system would be considered
filed as of the date of the ‘‘incomplete
claim’’—i.e., the date the claim was
electronically saved in VA’s electronic
claims application system but not
electronically submitted to VA—if the
claim is ultimately completed and
submitted within 1 year. As stated in
the proposed rule, filing a claim through
this electronic process would allow
claimants to preserve an effective date
while affording the claimant the
opportunity to gather the necessary
evidence to substantiate the claim. In
other words, VA maintained the
favorable effective date treatment of the
informal claim process for incomplete
electronic claims whereas incomplete
non-electronic claims did not receive
such treatment. VA proposed that nonelectronic claims be considered filed as
of the date VA received a complete
claim.
The purpose of the distinction
between electronic and non-electronic
claim submission with regard to
effective date treatment was to
incentivize claimants to file electronic
claims, which are processed by VA
more efficiently and result in more
expeditious delivery of benefits to
claimants. VA believed that the
advantages of its Web-based paperless
claims systems offered claimants and/or
their authorized representatives, as well
as VA personnel, a faster, more
convenient way of processing and
adjudicating claims. VA’s Web-based
paperless claims systems, such as
eBenefits and the Stakeholder
Enterprise Portal, guide claimants and/
or their authorized representatives in an
interview-style process where responses
are auto-populated into a VA form and
can be submitted electronically with a
press of a button. VA will receive the
electronic claim within 1 hour as
opposed to the receipt of paper claims
which can take several days. Claimants
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and/or their authorized representatives
are also able to upload evidence
electronically for consideration with
their electronic claim. This electronic
process ensures more accurate
responses from the claimant or
representative as well as a more
consistently completed form. The nature
and format of the interview in eBenefits
prompts claimants to answer all
pertinent questions in order to obtain
information necessary to substantiate
the claim, checks for errors and missing
information, and readdresses any
unanswered questions, all of which
ensure more accurate claims processing
and adjudication. However, claimants
who file on paper do not have these
types of checks to ensure accuracy or
sufficiency of responses provided on a
form. Thus, there is an increased
likelihood that these applications or
forms on paper may be incomplete,
incorrect, or insufficient for processing.
Moreover, the advantages of VA’s Webbased paperless claims system offer VA
personnel a way to process and
adjudicate electronic claims more
efficiently and more accurately through
the Veterans Benefits Management
System (VBMS), an internal VA
business application that facilitates the
evidence-gathering phase of the claims
process and employs evaluation and
rules-based decision-support tools to
increase the speed and accuracy of
rating decisions. For electronic claims
files in VBMS, robust optical character
recognition capabilities make it possible
to search thousands of pages of evidence
in a fraction of the time required to
search paper files. Paper submissions
must be manually scanned into VBMS,
adding an extra time-intensive step for
paper submissions. A piece of mail must
be identified, sorted, sent to a scanning
facility, and meta-data must be entered.
This delay does not exist for
submissions that are initially received
in an electronic format.
VA received many comments
regarding the elimination of the
informal claim under current § 3.155.
The majority of the commenters
expressed concern that eliminating the
current informal claim process would be
burdensome to claimants since the
favorable effective date treatment of the
current informal claim process would
not exist for claimants who file paper
claims. One commenter stated that
‘‘eliminating informal claims with a
process of incentivizing submissions of
claims in a format more amenable to
efficient processing makes the claims
process more formalized to the
detriment of claimants.’’ Commenters
further stated that the informal claim
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was a way for veterans to establish a
date of claim while they are being
assisted in filing the proper forms and
in gathering evidence in support of their
claims by veterans service organizations
and other authorized representatives.
Another commenter expressed that the
informal claim process provided
claimants of different educational
backgrounds a way of filing for benefits
because VA’s current claims process is
difficult to understand. The major
concern regarding the elimination of
informal claims was the loss of potential
benefits due to a claimant’s inability to
preserve an earlier effective date for an
award granted.
Numerous commenters advanced the
position that the current informal claim
process, with its attendant effective date
rules, is required by statute, specifically
by 38 U.S.C. 5102(c). That subsection
reads in pertinent part: ‘‘Time limitation
. . . If information that a claimant and
the claimant’s representative, if any, are
notified under subsection (b) is
necessary to complete an application is
not received by the Secretary within one
year from the date such notice is sent,
no benefit may be paid or furnished by
reason of the claimant’s application.’’
Subsection (b), in turn, requires the
Secretary to notify claimants of the
information necessary to complete an
incomplete application for benefits.
VA does not agree with these
comments to the extent they view the
informal claim process as
unambiguously required by statute. VA
does not interpret 38 U.S.C. 5102(c) to
require the informal claims process, or
to require effective date consequences of
any kind for incomplete applications.
There are several reasons for this
conclusion.
First and foremost, the informal
claims process and the effective date
rules that it entails did not originate in
38 U.S.C. 5102(c). Rather, the current
informal claim process is a longstanding
feature of VA’s regulations, grounded in
VA’s authority to administer the
veterans benefits claim system in a proclaimant way. The concept behind
informal claims originated in the
internal memoranda of one of VA’s
predecessor entities, the Bureau of War
Risk Insurance, in the course of
implementing the War Risk Insurance
Act, Public Law 63–193, 38 Stat. 712
(1914), as amended by Act of June 12,
1917, ch. 26, § 5, 40 Stat. 102, 103–104.
The Office of General Counsel of the
Bureau of War Risk Insurance held that
a veteran who was so disabled as to be
precluded from filling out a form 526
prior to his death, but expressed an
intent to file a compensation claim
while being treated by the U.S. Public
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Health Service, was considered to have
filed a valid claim during his lifetime.
The informal claims rule in
substantially its current form was
ultimately included in the publication
of part 3 of Title 38, CFR 26 FR 1561,
1570 (Feb. 24, 1961). By contrast, 38
U.S.C. 5102(c) was added in 2003.
Veterans Benefits Act of 2003, Sec.
701(a), Public Law 108–183, 117 Stat.
2651, 2670 (Dec. 16, 2003).
The plain language of section 5102(c),
similarly suggests that section 5102 does
not require the informal claim process,
or for incomplete applications to hold a
claimant’s effective date. The statutory
language creates a ‘‘limitation’’ on what
benefits ‘‘may’’ be paid by reason of an
incomplete application in the event it is
not perfected within one year. By
specifying that ‘‘no benefit may be paid’’
for incomplete applications that are not
properly completed and formalized
within one year, the statute allows VA
to maintain a rule treating the
incomplete application as a basis for an
effective date in the event benefits are
ultimately granted, but does not require
VA to do so. The statute affirmatively
prevents any effective date
consequences for an incomplete
application not formalized within one
year.
The statutory structure strongly favors
the same conclusion. Section 5102
appears in Chapter 51 of Title 38,
United States Code. The Chapter is
entitled ‘‘Claims, Effective Dates,
Payments.’’ Section 5102 appears in
Subchapter I, dealing with ‘‘Claims.’’
‘‘Effective Dates’’ are the subject of an
entirely separate Subchapter II. 38
U.S.C. 5110. Further, Congress
explicitly created numerous statutory
bases for effective date retroactivity,
using the construction ‘‘the effective
date of an award . . . shall be’’ each
time. 38 U.S.C. 5110(b)(1)–(4), (c), (d).
No such language appears in section
5102(c). Consistent with this reasoning,
the legislative history of section 5102(c)
does not suggest that Congress
understood itself to be providing a rule
of effective date retroactivity when it
added this subsection to the United
States Code.
Finally, we note section 5102(c)
applies only to responses to
notifications from the Secretary,
required by section 5102(b), that a
claimant has submitted an incomplete
application. Therefore, even to the
extent section 5102(c) is construed to
require that a claimant’s submissions
establish an effective date, it applies
only to incomplete applications under
section 5102(b), not to all informal
claimant submissions.
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Because the informal claims rule is a
liberalizing feature of VA’s regulations
and is not clearly required by statute, it
may be adjusted by regulation in order
to meet contemporaneous needs in
administering the claims workload. This
is a reasonable exercise of the authority
granted to VA by statute. VA will
continue to pursue and implement
technological solutions as a major part
of its drive to eliminate the backlog of
claims. VA will strive for a claims
process that is paperless to the extent
feasible both as relates to VA’s own
work, and claimant inputs.
Nevertheless, VA recognizes that a
transition of such magnitude takes time.
Numerous commenters objected
strenuously to two features of the
proposed rule: that non-standard
submissions would no longer preserve a
claimant’s effective date for paper
original claims, and that electronic
claims would be treated more favorably,
continuing to receive the effect of this
liberalizing feature of VA’s regulations.
VA has carefully considered the input it
has received from commenters and
determined that changes to the rule as
originally proposed are appropriate.
Modernization and standardization
must accommodate the interests and
preferences of the veterans and other
stakeholders for whose benefit we seek
to modernize the process, and the
comments make clear that many
veterans and stakeholders continue to
prefer more informal processes than VA
originally proposed. Accordingly,
necessity may dictate more continued
reliance on non-electronic submissions
than was originally proposed.
Therefore, in order to strike a balance
between standardizing, modernizing,
and streamlining the claims process and
providing veterans, claimants, and their
survivors with a process that remains
veteran-friendly and informal, VA has
revised proposed § 3.155 to replace the
concept of an ‘‘informal’’ claim with the
concept of an ‘‘intent to file a claim for
benefits.’’ The ‘‘intent to file’’ process
will share similarities with the current
informal claim process. However, one
major difference is that it requires the
submission holding a claimant’s
effective date to be in a standard format
in order for claimants to preserve the
date of a claim for a complete claim that
is filed within 1 year of receipt of such
intent to file a claim. To implement this
provision, VA introduces a new form to
be used in conjunction with revised
§ 3.155, VA Form 21–0966, Intent to File
a Claim for Compensation and/or
Pension Benefits, (hereinafter ‘‘VAF 21–
0966’’) which is described in more
detail in the Paperwork Reduction Act
section of this rulemaking. The intent to
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file a claim process is a standardized
method of filing an informal claim
which would be submitted in a format
more amenable to efficient processing,
while still allowing veterans to receive
favorable effective date treatment
similar to that available under the
current ‘‘informal claim’’ rule. It also
achieves the standardization of the
claims process by requiring that all
claims or initiation of claims be filed on
a VA-prescribed form.
VA considers the process put in place
by this rule a logical outgrowth of the
original proposal, particularly in light of
the comments received. The original
proposal would have required all claims
to originate on standard forms
regardless of format or posture in which
the claim arose, but with effective date
placeholder treatment similar to the
current informal claims rule available in
order to incentivize electronic
submissions. VA considers this change
responsive to comments urging VA to
maintain a way for all veterans to secure
an effective date placeholder while the
formal application form is completed,
and responsive to comments urging that
paper and electronic claims receive
identical treatment for effective date
purposes. Additionally, one commenter
explicitly suggested that VA adopt a
‘‘standardized Informal Claim form.’’
Another commenter suggested
‘‘maintaining informal claims in the
context of standardized forms.’’
While VA requires submission of the
intent to file a claim in a designated
form, the substantive information
required to preserve an effective date
through the intent to file a claim process
is less than the requirements for
claimants to preserve an effective date
for a claim through the informal claim
process under current § 3.155.
Currently, an informal claim is defined
as any communication or action,
indicating an intent to apply for one or
more benefits from certain persons that
must identify the benefit sought. See 38
CFR 3.155(a).
In this final rule, VA revises § 3.155(b)
to provide that a claimant, his or her
duly authorized representative, a
Member of Congress, or some person
acting as next friend of claimant who is
not of full age or capacity, may indicate
a claimant’s desire to file a claim for
benefits by submitting an intent to file
a claim to VA. The intent to file a claim
must be submitted on a VA-prescribed
form or other specified format
designated for the purpose of indicating
the claimant’s intent to file a claim. An
intent to file a claim must provide
sufficient identifiable or biographical
information to identify the claimant.
This requirement is necessary because if
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VA cannot identify the claimant to
whom an intent to file pertains, the
intent to file cannot serve its intended
function as an effective date placeholder
for that claimant. VA has chosen the
flexible, functional standard of a
claimant being identifiable based on the
information provided, rather than
enumerating specific pieces of necessary
information in order to establish an
intent to file. This is because different
claimants will have different pieces of
identifying information close at hand,
and VA wants the placeholder to be
easy for claimants to establish. The
prescribed paper intent to file form
accordingly solicits several pieces of
information to identify the claimant,
such as name, Social Security Number,
address, telephone number(s), email
address(es), and VA file number, if
applicable. Claimants and authorized
representatives will no longer be
required to identify the specific benefit
sought in order to preserve a potential
earlier effective date as required by
current § 3.155, but the designated form
or other specified format must be used.
An intent to file a claim therefore
differs in two crucial respects from the
current informal claim process. It must
be submitted in a designated format
rather than in a non-standard
communication, and the claimant must
be identifiable, but it requires less
substantive specificity than would be
required to establish an informal claim
under current regulations. In particular,
an intent to file a claim need not
identify the particular medical issues,
symptoms, or conditions on which the
claim will ultimately be based in order
to establish an effective date. The
current regulation requires the claimant
to ‘‘identify the benefit sought.’’ 38 CFR
3.155(a). Case law is clear that this
means the claimant must describe the
nature of the disability for which he is
seeking benefits, such as by describing
a body part or symptom of the
disability. Brokowski v. Shinseki, 23
Vet. App. 79, 86–87 (2009). An intent to
file a claim need not contain this level
of specificity.
This substantive liberalization of the
information necessary to establish an
effective date will align claimant
incentives with the interests of efficient
and accurate claims processing. Under
the current process, veterans filing an
initial claim are incentivized to file
multiple informal claims in piecemeal
fashion as soon as they become aware of
potential entitlement to benefits for each
condition. This leads to confusion and
potentially duplicative administrative
action by VA. Under the intent to file a
claim process, claimants will have up to
a year to gather evidence, potentially
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facilitating the process of establishing
entitlement for any additional
conditions without fear that they will
lose benefits by not claiming each
individual condition with specificity as
quickly as possible, before presenting a
comprehensive package to VA for
processing.
We accomplish this substantive
liberalization of the information
necessary to establish an effective date
by providing in § 3.155(b)(2) that an
intent to file a claim ‘‘need not identify
the specific benefit claimed or any
medical condition(s) on which the claim
is based.’’ In the rest of § 3.155(b)(2),
however, we make clear that if a
claimant provides extraneous
information beyond what is needed to
establish an intent to file a claim, such
as information that VAF 21–0966 does
not solicit, this extraneous information
does not alter the status of the intent to
file a claim, and in particular does not
convert it into a complete claim or a
substantially complete application. For
example, if a claimant provides, in
white space on a paper VAF 21–0966,
information suggesting the particular
disability on which the claim will be
based, this extraneous information is of
no force and effect other than that it is
added to the file as evidence for
adjudicative purposes. Such extraneous
statements or information may be used
as evidence in support of a claim that
is filed to perfect VAF 21–0966. If a
veteran or claimant submits information
such as a description of symptoms or
complaints of a medical condition on
VAF 21–0966 and identifies the same
description of symptoms or complaints
of a medical condition in a complete
claim filed within 1 year, VA may
consider such information as evidence
to substantiate the claim. Similarly, we
also make clear at the end of
§ 3.155(b)(2) that extraneous
information provided in an oral
communication meant to establish an
intent to file under § 3.155(b)(1)(iii) is of
no effect and generally will not be
recorded in the record of the claimant’s
intent to file. This limitation is
necessary to ensure that the intent to file
process does not degenerate into caseby-case determinations as to whether a
claimant has unintentionally provided
sufficient information to elevate an
intent to file to a complete claim, which
would displace the statutory
requirement to ultimately file an
application form prescribed by the
Secretary. Because the purpose of an
intent to file is to establish a
placeholder for any and all issues
ultimately raised in the complete claim,
this limitation does not limit the
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substantive scope of the claimant’s
intent to file, and only operates to
prevent an intent to file a claim from
constituting a substantially complete
application.
In response to comments received,
this final rule provides that there are
three ways to submit an intent to file a
claim for benefits, which we enumerate
in this final rule at § 3.155(b)(1). First,
in § 3.155(b)(1)(i), we provide that a
claimant or authorized representative
may submit an intent to file a claim
electronically by saving an application
in a claims-submission tool within a VA
Web-based electronic claims application
system prior to submitting the electronic
claim for processing. Currently, the
claim submission tool within VA’s Webbased electronic claims application
system prompts the claimant and/or
authorized representative to enter
biographical or identifiable information
upon entering the electronic claims
application process and records the date
a claimant or authorized representative
saves the online application prior to
submission for processing. The
electronic claims application system
also notifies the claimant and/or
authorized representative that the date
the electronic application was saved
will serve as an effective date for an
award granted if a complete application
is submitted within 1 year; otherwise,
the date VA electronically receives the
complete electronic claim will serve as
the date of claim. The claimant and/or
authorized representative must
acknowledge this notice by checking a
box.
VA considers the following actions in
VA’s current electronic claims process
together to constitute an electronic
intent to file a claim: (1) The act of a
claimant or authorized representative
entering into and commencing the
online application process indicates an
intent to apply for benefits, i.e.,
disability compensation benefits; (2)
entering in biographical or identifiable
information in electronic application for
benefits in the claims submission tool
within a VA Web-based electronic
claims application system; (3) without
providing the specific benefit sought or
the symptoms or medical condition(s)
for which the benefit is sought.
Therefore, an electronic version of VAF
21–0966 for the purpose of submitting
an electronic intent to file a claim for
benefits is not necessary as the claims
submission tool within VA’s Web-based
electronic claims application system
achieves the intent to file a claim
requirements through the act of entering
and saving an electronic application in
the claims submission tool within VA’s
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Web-based electronic claims application
system.
As we explained in the proposed rule,
the limitation that the communication
must take place within an online
benefits account is necessary to prevent
open-ended narrative format
submissions, such as unsolicited emails,
from constituting an intent to file a
claim. The further limitation that the
intent to file must be submitted through
a claims submission tool within VA’s
Web-based electronic application
system is to ensure that non-standard
communications, such as emails within
the current eBenefits system, do not
constitute an intent to file a claim
merely because they took place within
eBenefits. VA must be careful to define
an intent to file a claim in a way that
channels claimant submissions through
a predictable, standardized process.
Second, § 3.155(b)(1)(ii) provides that
claimants and/or authorized
representatives may submit an intent to
file a claim using the new proposed
form, VAF 21–0966. Specifically, the
submission to an agency of original
jurisdiction, such as a VA regional
office, of a signed and dated intent to
file, on the form prescribed by the
Secretary for that purpose, will be
accepted as an intent to file. This form
has three components: (1) a checkbox
for a claimant to indicate his or her
intent to file for compensation, pension,
survivors’ benefits, and/or other benefits
governed by 38 CFR part 3 (this
information is used to furnish the
appropriate application form(s) to the
claimant); (2) claimant identification
such as name, Social Security Number,
date of birth, gender, VA file number, if
applicable, mailing and/or forwarding
address, telephone number(s), and email
address(es); and (3) signature and date
block for claimant’s declaration of intent
to apply for one or more benefits and
acknowledgement that a complete
application for each type of benefit
selected must be received by VA within
1 year of receipt of VAF 21–0966 to be
considered filed as of the date of receipt
of such form. VA intends to make this
form available online as well as in the
paper format to claimants who request
one.
Third, § 3.155(b)(1)(iii) provides that a
claimant or authorized representative
may submit an oral intent to file a claim
by contacting certain designated VA
personnel, typically in one of VA’s call
centers. However, claimants may
express an intent to apply for benefits to
VA personnel either in person or by
telephone. The oral intent to file will be
captured on a paper VAF 21–0966
generated from transaction in person or
over the phone call which will then be
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uploaded into claimant’s electronic file.
In order for VA to take action based on
oral statements, the VA employee must
adhere to the requirements under 38
CFR 3.217(b) which provides that the
VA employee must: identify himself or
herself as a VA employee who is
authorized to receive the information or
statement; verify the identity of the
provider as either the beneficiary or his
or her fiduciary by obtaining specific
information about the beneficiary that
can be verified from the beneficiary’s
VA records, such as Social Security
Number, date of birth, branch of
military service, dates of military
service, or other information; inform the
provider that the information or
statement will be used for the purpose
of calculating benefit amounts; and
must document in the beneficiary’s VA
record the specific information or
statement provided, the date such
information or statement was provided,
the identity of the provider, and the
steps taken to verify the identity of the
provider. This contact provides VA with
an opportunity to educate veterans,
claimants, and their families on the
process of filing a complete claim in
conjunction with the intent to file a
claim, the benefits of VA’s Fully
Developed Claim program, obtaining
electronic access to our Web-based
electronic claims submission tool such
as eBenefits, and the benefits of
receiving assistance from accredited
veterans service organizations.
In the event a dispute arises over
whether an oral intent to file was
received on a particular date, the
presence or absence of a record of the
intent to file in VA’s records will
govern, absent a specific basis to
conclude that designated VA personnel
received an oral intent to file but did not
contemporaneously document the
communication as required. This is
consistent with the general principle,
often referred to as the ‘‘presumption of
regularity,’’ that government officials are
presumed to ‘‘have properly discharged
their official duties’’ unless there is
clear evidence otherwise. Miley v.
Principi, 366 F.3d 1343, 1347 (Fed. Cir.
2004); see also Butler v. Principi, 244
F.3d 1337, 1339–41 (Fed. Cir. 2001)
(presumption of regularity applies to the
administration of veterans benefits).
This limitation is necessary to ensure
that the possibility of establishing an
effective date of benefits payments
through oral communications with VA
personnel does not become a way to
claim entitlement to an earlier effective
date with no basis other than the bare
assertion that a particular
undocumented conversation took place.
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We emphasize that allowing oral
communications with certain
designated personnel to constitute
intents to file a claim is an extremely
liberal approach to allowing claimants
and their representatives to establish an
effective date. We also note that the
presumption of regularity, like all
presumptions, is rebuttable. Finally, to
the extent a claimant or representative
wishes to guard against the possibility
that the designated VA personnel who
receive the communication will
erroneously fail to contemporaneously
document it, he or she can submit an
intent to file in one of the other two
formats.
When VA receives VAF 21–0966 or an
oral intent to file a claim, VA will notify
the claimant and/or the authorized
representative of any information
necessary to complete the formal
application form, such as a VAF 21–
526EZ and, as statutorily required
pursuant to 38 U.S.C. 5102, VA will
furnish the claimant with the
appropriate application form(s) as
claimant indicates on the 21–0966 or
orally to VA personnel.
Non-standard narrative
communications not falling within these
three enumerated scenarios will not be
considered an intent to file a claim
received on the designated form, and
accordingly will not establish an
effective date placeholder.
Finally, notwithstanding our
conclusion that 38 U.S.C. 5102(c) does
not require that an incomplete
application hold a claimant’s effective
date, we have provided via regulation,
in § 3.155(c), that an incomplete
application form will hold the
claimant’s date of application for up to
1 year.
As discussed in more detail below,
revised § 3.155 of the final rule also
provides that only one complete claim
for a given benefit (e.g., compensation,
pension) may be associated with each
intent to file a claim for the same benefit
for purposes of the effective date
placeholder mechanism. In other words,
if a claimant submits a VAF 21–0966 for
compensation, and then files two or
more successive complete compensation
claims within 1 year, only the issues
contained in the first complete
compensation claim would relate back
to the VAF 21–0966 for effective date
purposes.
Similarly, we address the possibility a
claimant may file both an intent to file
and an incomplete application relating
to the same claim in § 3.155(d). We
make clear that, in the event the
application is ultimately perfected, VA
will consider it filed as of the date of
receipt of whichever was filed first, the
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incomplete application or the intent to
file. However, we also make clear the
complete claim will not be considered
filed more than one year prior to the
date of receipt of the complete claim,
absent a separate basis for additional
retroactivity. See e.g., 38 U.S.C.
5110(b)(3).
VA believes that the revisions to
proposed § 3.155 serve as an optimal
solution to the concerns expressed by
the commenters by providing veterans,
claimants, and their families a way to
preserve a potential favorable effective
date while giving them 1 year from the
date of submission to file a complete
claim as currently provided in the
informal claim process as well as help
VA streamline the claims process
through the standardization of inputs.
The intent to file a claim process also
serves to modernize VA’s claims process
by keeping non-standard submissions
from constituting claims. By requiring
an intent to file a claim be submitted on
a designated standard form, VA
personnel will spend less time
determining whether a claimant wishes
to file a claim, when a claim has been
filed, and what type of benefit the
claimant is seeking. VA believes the
intent to file a claim process ensures
more efficient processing that does not
unduly erode the longstanding informal,
non-adversarial, pro-claimant nature of
the VA system. See Walters v. Nat’l
Ass’n of Radiation Survivors, 473 U.S.
305, 323–24 (1985). In order to
implement the standardization of the
informal claim process with the intent
to file a claim process, VA has
reorganized proposed § 3.155 by
eliminating the distinction between
non-electronic and electronic claims as
published in the proposed rule and
designated this section of the final rule
as a description of how claimants can
file a claim. VA has consolidated the
types of requests for application for
benefits as published in proposed
subparagraphs (c)(1) and (c)(3) of § 3.155
of the proposed rule in paragraph (a) of
this final rule.
One commenter noted that the person
acting as next friend of claimant must be
of full age and capacity and that the
term ‘‘full age’’ is not defined and that
the term ‘‘capacity’’ is broad and
susceptible to challenge in the future.
VA has mirrored the language in current
§ 3.155 to describe persons submitting
the informal claim and replaced the
term ‘‘sui juris’’ with its definition, ‘‘of
full age or capacity.’’ See Black’s Law
Dictionary, 1662 (10th ed. 2014). While
use of the word-for-word legal
definition ‘‘of full age and capacity’’ in
this context would not imply that the
claimant in question must be both under
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18 and not of full capacity, given the
resulting sentence as a whole, we have
opted to use the disjunctive ‘‘or’’ in
order to make clear that claimants who
are not of full capacity need not also be
under 18 in order to be within the ‘‘next
friend’’ provision of this paragraph.
Accordingly, there is no substantive
change in the definition. Rather, VA is
merely continuing to provide a way for
claimants who cannot engage in a legal
contract due to age or disability to be
represented by someone (or next friend)
who can do so on their behalf.
Therefore, VA makes no change to the
proposed rule based on this comment.
One commenter stated that email
requests for benefits should trigger the
duty to provide claimants with the
information necessary to complete the
application. VA agrees with this
comment and has provided in § 3.155(a)
of this final rule that upon receipt of any
request for an application, to include
email transmissions, VA will provide
the appropriate form or application
pursuant to current § 3.150 and will
provide claimants with the information
necessary to complete it. We note,
however, that an email requesting
benefits, without more, is a nonstandard narrative submission. While
such a submission clearly triggers VA’s
obligation to send the correct form, it
does not on its own serve as an effective
date placeholder.
Further, VA has redesignated
proposed subparagraph (c)(2) of § 3.155
of the proposed rule which provides
that an application form prescribed by
the Secretary that does not meet the
standard of a complete claim is a
request for an application for benefits.
VA believes that an incomplete
application form prescribed by the
Secretary is not equivalent to a nonstandard submission. Therefore, VA has
redesignated this as paragraph (c) in the
final rule to distinguish an incomplete
application form from a non-standard
submission request, which is an
application for benefits and governed by
paragraph (a) of the final rule. Regarding
incomplete application forms, VA has
added the statement that it will notify
the claimant and his or her
representative, if any, of the information
necessary to complete the application
form prescribed by the Secretary and
that if a complete claim is received
within one year of submission of the
incomplete application or form, VA will
calculate an effective date of any award
granted as of the date the incomplete
application form was received.
VA received comments noting that the
proposed rule did not provide for when
VA would notify claimants and/or
authorized representatives of the
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information necessary to complete a
claim for benefits if VA receives an
application form that is not complete
pursuant to the proposed § 3.160(a). In
response, VA has provided the 1-year
timeframe as described above in revised
§ 3.155(c) of this final rule. In current
§ 3.109, VA provides a 1-year filing
period for claimants to submit evidence
necessary to complete an application.
VA believes that a 1-year timeframe to
cure an incomplete application provides
claimants with sufficient time and
remains consistent with other current
existing adjudication regulations.
VA has also eliminated the
categorization of ‘‘non-electronic
claims’’ and ‘‘electronic claims’’ in
proposed paragraphs (a) and (b) of the
proposed rule and replaced these
distinctions with the concept of the
‘‘intent to file a claim’’ to standardize
the current informal claim process in
paragraph (b) of § 3.155 of this final
rule. VA clarifies that this process
would apply to all claims governed by
part 3 of title 38 in the Code of Federal
Regulations.
One commenter requested an
explanation of the effects of the changes
implemented by this final rule on
authorized representatives and inquired
about the type of interaction VA
envisions for authorized representatives
if electronic mail communication
through eBenefits is delivered directly
to the claimant. In the proposed rule,
filing an electronic claim was the only
way to secure an effective date
placeholder. As we explain above, the
structure of this final rule no longer
attaches unique effective date
consequences to a claim being
submitted in electronic versus nonelectronic format. In § 3.155(b)(5), we
make clear that the only requirement
specifically directed toward
representatives is that a power of
attorney must have been executed at the
time the intent to file is written. This is
substantively identical to requirements
pertaining to representatives for the
informal claim process. 38 CFR 3.155(b)
(2013). To the extent this comment asks
a broader question, separate from the
structure governing what inputs may
and may not constitute a claim, it is
beyond the scope of the rule as now
revised. VA will take this comment and
all other stakeholder input under
advisement in continuing to address the
scope of representative access to
electronic communications between VA
personnel and claimants.
In new subparagraphs (b)(1) through
(b)(2) of § 3.155 of this final rule, VA
outlines the criteria for an intent to file
a claim, namely, that it must be in a
prescribed form (whether on paper,
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electronic, or oral), must identify the
general benefit to be claimed, but it
need not identify the specific benefit
sought or symptom(s) or medical
condition(s) on which the claim is
based. In new subparagraph (b)(3), VA
provides the action it will take upon
receipt of an intent to file a claim. In
addition to furnishing the appropriate
application form prescribed by the
Secretary in association with the intent
to file a claim, VA will notify the
claimant and claimant’s representative,
if any, of the information necessary to
complete the appropriate application
form prescribed by the Secretary. We
note that in the context of intents to file
submitted as incomplete eBenefits
applications pursuant to § 3.155(b)(1)(i),
this requirement is satisfied by
automated system prompts.
In new subparagraph (b)(4) of § 3.155
of the final rule, VA provides that if an
intent to file a claim is not submitted in
the appropriate form as outlined in
subparagraph (b)(1) and (b)(2) or is not
ratified by a complete claim within 1
year of submission of the intent to file
a claim, VA will not take further action
unless a new claim or a new intent to
file a claim is received. In new
subparagraph (b)(5), VA provides that
any service organization, attorney or
agent indicating a represented
claimant’s intent to file a claim must
have executed a power of attorney at the
time the communication was written.
This mirrors what is currently provided
in the informal claim regulation in
§ 3.155(b).
The ‘‘intent to file a claim’’ process
does not interfere with VA’s other
initiatives to eliminate the backlog of
claims. In particular, the Fully
Developed Claim (FDC) program allows
VA to provide faster decisions and
delivery of benefits to claimants through
the use of the standard forms created
specifically for FDCs that contain the
notice to claimants of the information
and evidence necessary to substantiate
the claim (hereinafter ‘‘section 5103
notice’’) and claimant’s certification that
all evidence has been submitted with
the FDC. Claimants receive the section
5103 notice at the time they file a claim
and not after they submit the claim to
VA. While VA continues to be
responsible for obtaining relevant
Federal records and provides a medical
examination when necessary to decide
the claim pursuant to 38 U.S.C. 5103A,
VA is able to adjudicate the claim more
expeditiously because additional time is
not taken to request and obtain other
evidence that a claimant identifies but
does not have in his or her possession.
We note that one commenter suggested
that delays in the claims processing
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system are because VA spends ‘‘too
much time and paper on a ‘duty to
assist’ letter.’’ Much of the value in
standard forms is they allow VA to
discharge the very legal and procedural
obligations to which this commenter
refers more efficiently, so that a greater
share of VA personnel’s time may be
devoted to engaging the substance of the
claim.
The intent to file a claim process
complements and does not conflict with
the FDC process. The effective date
placeholder provided by the intent to
file a claim process allows claimants to
‘‘protect’’ their effective date while they
gather all information and evidence they
have to submit with their complete
claim. If a claimant is able to gather and
submit all evidence he or she wishes to
submit within this one year period,
there will often be no reason why the
claimant cannot file the claim as an
FDC. This, in turn, may lead to an even
more favorable effective date if the
claim is an original FDC, because
Congress has provided for up to one
year of special effective date
retroactivity for ‘‘an original claim that
is fully-developed’’ if filed before
August 6, 2015. 38 U.S.C. 5110(b)(2)(A).
In the event the claim is not amenable
to filing as an FDC, the claimant
nevertheless will receive the benefit of
the effective date placeholder
established by the intent to file a claim.
We note that, similar to the effective
date treatment given to original FDCs, it
is possible for specific statutory
effective date provisions in 38 U.S.C.
5110 to apply in cases where an intent
to file a claim has also been filed. For
example, section 5110(b)(1) allows the
effective date for an award of disability
compensation to be the day following
the date of the veteran’s discharge from
service if an application is received
within a year of such date. Similarly, up
to a year of retroactivity is available for
claims for increased disability
compensation. See 38 U.S.C. 5110(b)(3)
(‘‘[t]he effective date of an award of
increased compensation shall be the
earliest date as of which it is
ascertainable that an increase in
disability had occurred, if application is
received within one year from such
date.’’). This rule does not, and indeed
could not, operate to displace these
special statutory effective dates
enumerated in section 5110. These
statutory effective dates are generally
tied to the date of receipt of the
application. This rule provides that VA
will deem the ‘‘application’’ to have
been received as of the date of the intent
to file a claim, which is the mechanism
by which a claimant puts VA on notice
that he or she intends to ultimately
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submit an application for benefits.
Accordingly, the special statutory
retroactive effective dates operate
independently of, and in addition to,
VA’s decision to provide claimants up
to a year to perfect and complete their
application from the date they initially
put VA on notice that they intend to file
a claim.
We further note that, to the extent the
intent to file process and these special
statutory effective dates intersect, the
amount of retroactive benefits is always
limited by the facts found—a claimant
can never receive disability benefits for
a period in which he or she was not, as
a factual matter, disabled, or at a degree
of disability higher than supported by
the contemporaneous facts. This caveat
is current, established law, unaltered by
this rule. Basic entitlement to
compensation is always dependent on
the existence of a current or
contemporaneous ‘‘disability,’’ and its
accompanying severity as determined
by the rating for that disability. 38
U.S.C. 1110, 1114, 1131; 38 CFR part 4.
Additionally, all effective dates are
generally ‘‘fixed in accordance with the
facts found.’’ 38 U.S.C. 5110(a). The
special retroactive effective date
provisions in section 5110 generally
contain similar restrictions. In
particular, the statutory provision that
increased disability compensation may
be effective for up to a year prior to the
date of application is limited by ‘‘the
earliest date as of which it is
ascertainable that an increase in
disability had occurred.’’ 38 U.S.C.
5110(b)(3).
The following examples illustrate this
implementing principle.
If a hypothetical claimant files an
intent to file a claim on April 1, 2019,
and files a complete claim for increase
on September 1, 2019, and evidence of
record establishes the disability
worsened on January 1, 2019, the
effective date will be January 1, 2019.
This is the ‘‘earliest date as of which it
is ascertainable an increase in disability
occurred’’ and it is within one year of
the date the application was deemed
received (April 1, 2019). Section
5110(b)(3), as applied to the claim
process defined in this rule, permits an
effective date corresponding to the date
the disability worsened in this factual
scenario.
Similarly, if a hypothetical claimant
files an intent to file a claim on April
1, 2019, and files a complete claim on
March 1, 2020, and evidence of record
establishes that the disability worsened
on January 1, 2019, the effective date
will be January 1, 2019. The application
was received within 1 year of the
‘‘earliest date as of which it is
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ascertainable an increase in disability
occurred’’ and was itself perfected
within 1 year.
In the event the intent to file is
received more than a year following the
increase in disability, section 5110(b)(3)
is inapplicable. See Gaston v. Shinseki,
605 F.3d 979, 983–84 (Fed. Cir. 2010)
(special effective dates in section 5110
apply to claims filed within one year of
the triggering event specified in statute).
Therefore, if a hypothetical claimant
files an intent to file a claim on April
1, 2029, and files a complete claim on
September 1, 2029, and evidence of
record establishes that the disability
worsened on January 1, 2019, the
effective date will be April 1, 2029.
In new § 3.155(b)(6), we provide that
VA will not recognize more than one
intent to file concurrently for the same
benefit (e.g., compensation, pension). If
an intent to file has not been followed
by a complete claim, a subsequent
intent to file regarding the same benefit
received within one year of the prior
intent to file will have no effect. There
are two alternatives to this rule, neither
of which VA believes are sound policy.
The first would be simply to allow
claimants to file an unlimited number of
intents to file for the same benefit, and
relate back to the earliest filed that is
within one year of the complete claim.
This rule would allow, and even
encourage, multiple unnecessary filings,
with attendant wasted administrative
action and confusion. The second
alternative would be to allow claimants
to file multiple intents to file, but make
clear that each intent to file ‘‘updates’’
or ‘‘cancels’’ any other pending intents
to file for the same benefit. While this
structure would allow a claimant to
protect an interim effective date in the
event it becomes clear he or she will be
unable to complete a claim within the
year provided, this structure would also
imply that the claimant has abandoned
the earlier, more favorable date. Since it
should be extremely rare for claimants
to be unable to file a complete claim
within the full year provided, VA is
concerned that allowing claimants to
‘‘update’’ pending intents to file in order
to accommodate this scenario could
lead to many claimants inadvertently
harming their interests by canceling
earlier and more favorable dates through
unnecessary filings. Accordingly, only
one intent to file may be recognized at
a time for a given benefit.
D. Treatment of Complete Claims
In new paragraph (d) of § 3.155 of the
final rule, VA provides that all claims,
regardless of type, must be complete
claims, and the effective date for
benefits is generally the date VA
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receives a complete claim (subject to the
intent to file process). This requirement
in the first sentence of § 3.155(d) is to
make clear that complete claims are not
a distinguishable entity from the other
types of claims enumerated in § 3.160—
in other words, the standards of a
complete claim must be met for all types
of claims, including claims to reopen
and claims for increase. Furthermore,
VA has reiterated the effective date
treatment of the intent to file a claim
process by stating that an intent to file
a claim that meets the requirements as
provided in new paragraph (b) of § 3.155
of this final rule will serve to establish
an effective date if a complete claim is
received within 1 year. This reiteration
makes clear that the intent to file
process applies to all claims governed
by 38 CFR part 3. VA also makes clear
that only one complete claim for a
particular benefit may be associated
with each intent to file a claim for that
same benefit for purposes of this special
effective date rule. In other words, if a
claimant files one intent to file a claim
for compensation, and then files two or
more successive complete claims for
compensation within 1 year, only issues
contained within the first complete
claim would relate back to the intent to
file a claim for effective date purposes.
There is no limit on the number of
issues or conditions in each complete
claim. Accordingly, it is in claimants’
best interests to claim all potential
issues under a particular benefit in one
comprehensive package.
VA believes this final rule is less apt
to cause confusion than the alternative,
which would allow claimants to submit
several claims under the same benefit
over the course of a year while still
relating back to the earliest effective
date. This would encourage fragmented
presentation of claims which further
complicates and delays the
development and disposition of already
pending claims by causing duplicative
VA processing actions or creating
confusion regarding the development
actions that must be taken for each
claim. Although claimants may submit
new claims at any time, it is far more
efficient to submit all issues under the
same benefit in a single unified claim.
As discussed above, VA will
recognize multiple intents to file at a
time provided each intent to file
identifies a different benefit sought (e.g.,
compensation, pension). VA does not
intend to limit a claimant to identifying
only one benefit sought in an intent to
file. For example, an intent to file may
indicate that a claimant intends to file
complete claims for both compensation
and pension. However, if a claimant
submits an intent to file for only one
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benefit (e.g., compensation), VA will not
recognize another intent to file for
compensation benefits until a complete
claim for compensation has been
submitted or 1 year has expired,
whichever occurs first.
VA’s decision to recognize multiple
intents to file stems directly from the
fact that § 3.155(d) of the final rule
provides that only one complete claim
for a particular benefit may be
associated with each intent to file a
claim for that benefit. VA seeks to
encourage claimants to utilize its
electronic claims submission tools to
promote accuracy and efficiency of
claims processing. Currently, however,
claimants are able to submit an
electronic application only for
compensation benefits. Thus, if VA
were to require a claimant to submit
only one complete claim for all benefits
(e.g., compensation and pension) at the
same time, it would be impossible to
utilize VA’s electronic claims
submission tools to apply for
compensation benefits. Allowing
claimants to submit multiple intents to
file, provided that each is for a different
benefit, enables veterans to submit a
claim for compensation electronically
while still preserving an effective date
for other benefits through the paper or
oral intent to file process.
For example, if a veteran submits a
VAF 21–0966 for pension on January 1,
2018, saves an online application for
compensation on February 28, 2018,
and VA receives a complete claim for
pension on August 1, 2018 and a
complete claim for compensation on
September 1, 2018, VA will treat the
pension claim as having been received
on January 1, 2018, and the
compensation claim as having been
received on February 28, 2018, for
effective date purposes. In addition, if a
veteran submits a VAF 21–0966 for
compensation and pension on March 1,
2020, and VA receives a complete claim
for compensation via VA’s electronic
claims submission tool on November 1,
2020, and a complete claim for pension
on paper on January 1, 2021, VA will
treat both the compensation and
pension claims as having been received
on March 1, 2020.
One commenter noted that in the
proposed rule VA allowed only one
complete claim to be associated with an
incomplete claim and inquired whether
disabilities that are service connected as
secondary to a claimed or named issue
would be afforded the effective date of
the claimed or named issue being
adjudicated. If a benefit is granted for
the primary claim or issue for which an
intent to file a claim has been submitted
and a benefit is granted on a secondary
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basis to the primary claim or issue
associated with an intent to file a claim,
the effective date would be the same as
for the primary claim because it was an
entitlement established by the evidence
of record and within the scope of the
issue or condition enumerated in the
complete claim giving rise to the
primary claim. For example, if VA
awards compensation benefits for the
primary condition of diabetes and
evidence of record shows other
conditions are caused by or related to
the diabetes, VA would assign an
effective date for the secondary
conditions as of the date VA awarded
the primary condition. The result would
be different if the claim for secondary
service connection arose in the course of
a later, separate claim from the one in
which the primary condition was
determined to be service connected,
either because of changed facts (such as
changed status of disability), or because
entitlement was not granted in the
original claim and VA’s decision
became final. For example, suppose a
hypothetical claimant in receipt of
compensation benefits for a lower back
disability and diabetes files a claim for
increase only for the diabetes and the
evidence of record shows that claimant
has a right knee disability secondary to
the service-connected lower back
disability. In this case, VA would
adjudicate the claim for increase for the
diabetes and solicit a claim for an
increase in the lower back disability and
secondary condition of the right knee.
The result in both cases flows from the
plain terms of §§ 3.155(b) and 3.400,
and from VA’s obligation to consider
entitlements reasonably within the
scope of complete claims filed on a
standard form (see Section I. E. below).
E. Types of Claims
In response to comments, VA has
revised proposed § 3.160 to define
certain types of claims in a way that is
meant to complement the structure
created in revised § 3.155. In proposed
§ 3.160, VA defined a complete claim as
‘‘[a] submission on a paper or electronic
form prescribed by the Secretary that is
fully filled out and provides all the
requested information. This includes,
but is not limited to, meeting the
following requirements: (1) . . . must be
signed by the claimant or a person
legally authorized to sign for the
claimant[;] (2) . . . identify the benefit
sought[;] and (3) . . . [provide] a
description of any symptom(s) or
medical condition(s) on which the
benefit is based . . . [; and] (4) [for
pension or survivor benefits, provide] a
statement of income . . .’’.
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Some commenters stated that a
‘‘[v]eteran who submits a paper claim
and inadvertently fails to check a single
box on the VA form may lose thousands
of dollars in disability benefits,
particularly in the case where VA
renders the application ‘incomplete’.’’
The proposed rule made clear that it
was not VA’s intent to reject forms for
minor ministerial or formalistic
deficiencies. See 78 FR at 65496.
Nevertheless, we agree that a less
amorphous standard for completeness is
appropriate. In response to the concerns
expressed in the public comments
regarding the term ‘‘fully filled out’’ to
describe a complete claim and the
proposed language that the
requirements for a complete claim
would ‘‘not [be] limited to’’ those
proposed requirements listed in
proposed § 3.160, VA has deleted the
open-ended requirement that a form be
‘‘fully filled out,’’ and the qualifier that
the requirements of a complete claim
are not limited to those specifically
enumerated in the rule. To address the
concern that forms would be rejected for
minor ministerial deficiencies, such as
failure to check a box, this final rule
provides a clear and consistent standard
for what constitutes a complete claim.
Accordingly, VA has defined a complete
claim as a submission of an application
form prescribed by the Secretary,
whether paper or electronic, that
contains the following express
information requirements: (1) The name
of the claimant; the relationship to the
veteran, if applicable; and sufficient
service information for VA to verify the
claimed service, if applicable; (2) a
complete claim must be signed by the
claimant or a person legally authorized
to sign for the claimant; (3) A complete
claim must identify the benefit sought;
(4) A description of any symptom(s) or
medical conditions on which the benefit
is based must be provided to the extent
the form prescribed by the Secretary so
requires; and (5) for a nonserviceconnected disability or death pension
and parents dependency and indemnity
compensation claims, a statement of
income must be provided to the extent
the form prescribed by the Secretary so
requires.
These revised requirements of a
complete claim are similar to the criteria
for which VA considers an application
to be ‘‘substantially complete’’ under
current 38 CFR 3.159 in order to trigger
VA’s duty to assist under 38 U.S.C.
5103A. Current § 3.159, the regulation
governing VA’s assistance in developing
claims, provides that a ‘‘substantially
complete application’’ means ‘‘an
application containing the claimant’s
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name; his or her relationship to the
veteran, if applicable; sufficient service
information for VA to verify the claimed
service, if applicable; the benefit
claimed and any medical condition(s)
on which it is based; the claimant’s
signature; and in claims for non-service
connected disability or death pension
and parents’ dependency and indemnity
compensation, a statement of income.’’
Therefore, claimants who submit an
intent to file a claim will have 1 year
from the date of such submission to file
a complete claim that is similar to the
current standards of a substantially
complete application.
One commenter inquired whether the
‘‘paper’’ on which a claimant is seeking
benefits must be ‘‘prescribed by the
Secretary’’ as described in proposed
§ 3.160(a), or if an advocate’s letterhead
used to file a claim on a claimant’s
behalf constitutes a submission on
paper for the purpose of a complete
claim. One commenter stated that
requiring a form prescribed by the
Secretary for submission of claims
would interfere with an advocate’s
ability to provide representation to the
fullest extent possible since such a
requirement would curtail the
advocate’s ability to provide rationale to
support a claimant’s entitlement to a
particular benefit. The proposed rule
made clear that a complete claim must
be submitted on a ‘‘paper or electronic
form prescribed by the Secretary.’’ In
response to this comment, VA has
revised the relevant portion of the final
rule in § 3.160(a), to clarify that a
complete claim must be submitted in
the form prescribed by the Secretary,
whether paper or electronic. In order to
achieve standardization of the claims
and appeals processes, it is necessary
that submissions to initiate a claim or to
file a claim be in a standard format that
is easily digitalized and processed in
conjunction with VA’s transition to the
technological solutions implemented
such as several Web-based paperless
claims systems.
However, we make no changes in
response to the concern in these
comments that requiring claims to be
filed on standard forms would somehow
impair claimants’ ability to submit
evidence in support of their claims, or
would impair representatives’ ability to
represent their clients. Similarly, some
commenters expressed the view that the
proposed rule attempted to require
claimants to file an FDC, which requires
claimants to certify that they have
submitted all evidence they intend to
submit, in order to file a claim at all.
This rule does not alter the scope of
evidence submission in the VA system.
The fact that a claim must be initiated
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on a standard form does not in any way
imply that a claimant cannot submit
evidence in favor of that claim while the
claim is pending. We note that neither
the proposed rule, nor this final rule,
alter 38 CFR 3.103(d), which governs
submission of evidence and provides
that ‘‘[a]ny evidence . . . offered by the
claimant in support of a claim . . . [is]
to be included in the records.’’ The
proposed rule did not contain any
provision requiring that all evidence in
favor of a claim accompany its initial
submission. We do note, however, that
claimants who protect their effective
date by filing an intent to file a claim,
gather all possible evidence, and submit
all evidence along with their claims will
frequently be able to participate in the
FDC program. VA disagrees that
mandating the use of VA-prescribed
forms interferes with an advocate’s
ability to provide claimants with
representation to the fullest extent
possible. Mandating the use of standard
forms does not preclude advocates from
filing claims on behalf of a claimant or
from submitting statements of rationale
in support of a represented claimant’s
entitlement to a particular benefit.
Additionally, some commenters noted
that while submitting a complete claim
may seem easy, some claimants or
representatives filing on a claimant’s
behalf may not have the necessary
information readily available, resulting
in delays in submitting a complete
claim which would result in
establishing a later date of claim. VA
believes the intent to file a claim
process addresses this concern.
In paragraph (a)(4), VA further
clarifies that for compensation claims, a
description of symptoms and specific
medical conditions on which the benefit
is to be based must be provided to
whatever extent the form prescribed by
the Secretary so requires, or else the
form may not be considered complete.
Similarly, in paragraph (a)(5), VA
clarifies that a statement of income must
be provided for nonservice-connected
disability or death pension and parents’
dependency and indemnity
compensation claims to the extent the
form prescribed by the Secretary so
requires in order for the claim to be
considered complete.
VA received several comments stating
that its requirement that claimants
identify the benefit sought, particularly,
to specifically identify the medical
condition(s) on which the benefit is
based in order to be considered a
complete claim is onerous, especially
for the elderly, homeless, and those
with limited education or mental and/
or physical disabilities, because it forces
the claimant to diagnose a specific
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medical condition for which they are
not competent to do and subjects
claimants to a strict pleading standard.
The commenters expressed concern that
requiring claimants to identify a
diagnosis as part of meeting the criteria
for a ‘‘complete claim’’ would undo the
process of VA reasonably raising claims
through a sympathetic reading of the
evidence. The commenters stated that
requiring claimants to provide the
benefit sought and, particularly, the
requirement of a description of the
symptom(s) or medical condition(s) on
which the benefit is based contradicted
existing caselaw. Many of the
commenters quoted case law providing
that ‘‘[a]lthough an appellant who has
no special medical expertise may testify
as to the symptoms he can observe, he
generally is not competent to provide a
diagnosis that requires the application
of medical expertise to the facts
presented.’’ See Clemons v. Shinseki, 23
Vet. App. 1, 4–5 (2009). Furthermore,
commenters also referenced Ingram v.
Nicholson, 21 Vet. App. 232, 255–56
(2007), which holds that
unsophisticated claimants cannot be
presumed to know the law and plead
claims based on legal elements and that
the Secretary must look at the
conditions stated and the causes averred
in a pro se pleading to determine
whether they reasonably suggest the
possibility of a claim for a benefit under
title 38, regardless of whether the
appellant demonstrates an
understanding that such a benefit exists
or of the technical elements of such a
claim.
VA understands the concerns raised
in the public comments regarding the
specificity required in order for a claim
to be considered complete. However,
the regulatory language of § 3.160(a)(4)
clearly states that for compensation
claims, VA requires ‘‘a description of
any symptom(s) or medical condition(s)
on which the benefit is based’’ as one of
the criteria for a claim to be considered
complete. VA is aware that claimants
are generally not competent to diagnose
a medical disability and are generally
only competent to identify and explain
the symptoms observed and
experienced. The regulatory
requirement in § 3.160(a)(4) is
consistent with this caselaw because it
only requests a description of
‘‘symptom(s) or medical condition(s) on
which the benefit is based’’ which
claimants are competent to describe to
VA. The regulatory language, both as
proposed and as here revised, is clear
that VA is not requiring claimants to
provide a medical diagnosis. Rather, VA
intends to continue its current
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longstanding practice of accepting
claimants’ description of observable
symptom(s) or experiences or reference
to a part of the anatomy such as ‘‘right
knee’’ in order to meet the criteria of
identifying the benefit sought for a
‘‘complete claim.’’ For example, a claim
for the ‘‘right knee’’ can be
sympathetically read, based on the
evidence of record, to encompass claims
for arthritis, ankylosis of the knee, knee
‘‘locking,’’ etc. We note also that
claimants whose conditions have been
diagnosed by a treating physician are
competent to report those diagnoses.
See Jandreau v. Nicholson, 492 F.3d
1372, 1377 (Fed. Cir. 2007). However, in
order to accommodate different
circumstances, the regulation is drafted
broadly to require only a description of
the condition or its symptoms.
One commenter asked that we clarify
how VA would proceed when a
claimant specifies a particular disability
on the claim form, but the disability is
ultimately determined to be a different
disability from the one listed, such as
when development of a claim for posttraumatic stress disorder (PTSD) leads
to a diagnosis of depression or another
psychiatric disorder other than PTSD.
Consistent with our reasoning above
and the fact that the rule requires only
that claimants identify ‘‘symptom(s) or
medical condition(s) on which the
benefit is based,’’ VA would continue to
develop and ultimately adjudicate this
claim as appropriate without requiring
the claimant to ‘‘re-file’’ a new form
specifically identifying the new
diagnosis. The result would be different
if the claim were not reasonably within
the scope of the same ‘‘symptom(s) or
medical condition(s)’’ on which the
original claim was based.
Similarly, the requirements of § 3.160
clearly do not equate to a legal pleading
or require specific medical knowledge
and are not overly technical. It is VA’s
intent to maintain the current practice
of accepting the claimant’s account of
symptoms and lay statements of
experiences in identifying a medical
condition for which he or she is seeking
benefits. While VA has revised one of
the requirements of a ‘‘complete claim’’
to request claimants provide identifiable
information, it has made no change to
the regulatory language in the
requirement of identifying the benefit
sought in compensation claims to mean
‘‘symptom(s) or medical condition(s)’’
based on these comments. The
regulation language requires only that
the claimant identify the ‘‘symptoms or
medical conditions’’ on which the claim
of entitlement to compensation is based,
in order to facilitate the orderly
development of the claim.
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In addition, VA received several
comments expressing concern that it
would no longer grant benefits based on
inferred claims or claims reasonably
raised by the evidence of record due to
the requirements of a ‘‘complete claim’’
which specifies that a claimant must
identify the benefit sought, to include
symptom(s) or medical condition(s) on
which the benefit is based. Many
commenters stated that the proposed
regulation assumes that the veteran
possesses a complete understanding of
the entire spectrum of benefits available
to them which they do not. Commenters
were concerned that, in order to qualify
as a complete claim, the claimant must
list particular benefits with specificity
on their application forms, or else risk
having the claim denied.
We agree that it is necessary to
provide a more detailed explanation of
how we will reconcile the pro-claimant
practice of VA identifying and
adjudicating claims raised by the
evidence of record but not specifically
raised by the claimant with the
requirement that all claims be submitted
on a standard form. It has been VA’s
longstanding practice to infer or identify
and award certain benefits that a
claimant has not expressly requested
but that are related to a claimed
condition and there is evidence of
record indicating entitlement. The
practice of identifying these ‘‘reasonably
raised claims’’ is not mandated or
defined by any statute or regulation. We
note, however, that the ‘‘[s]tatement of
policy’’ in 38 CFR 3.103(a) provides
that, in developing and deciding the
‘‘claim’’ filed by a claimant, ‘‘it is the
obligation of VA . . . to render a
decision which grants every benefit that
can be supported in law while
protecting the interests of the
Government.’’ Relatedly, a number of
court decisions have noted that, in the
legislative history of the Veterans
Judicial Review Act, Public Law 100–
687, the House Committee on Veterans’
Affairs stated that VA should ‘‘fully and
sympathetically develop the veteran’s
claim to its optimum before deciding it
on the merits.’’ H.R. Rep. No. 100–963
at 13 (1988); reprinted in 1988
U.S.C.C.A.N. 5782, 5794–95; see
Roberson v. Principi, 251 F.3d 1378,
1384 (Fed. Cir. 2001); Norris v. West, 12
Vet. App. 413, 420 (1999). Consistent
with these policies, VA employs the
practice of identifying and adjudicating
reasonably raised claims as an
administrative tool to provide for
consideration of issues and benefits that
have not been expressly claimed but
that logically are placed at issue upon
a sympathetic reading of the claim(s)
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presented to VA and the record
developed with respect to such claim(s).
This rule does not alter VA’s general
practice of identifying and adjudicating
issues and claims that logically relate to
and arise in connection with a claim
pending before VA. Although the rule
requires claimants to specify the
symptoms or conditions on which their
claims are based and the benefits they
seek, it generally would not preclude
VA from identifying, addressing, and
adjudicating related matters that are
reasonably raised by the evidence of
record which the claimant may not have
anticipated or claimed, but which
logically should be addressed in relation
to the claim filed. Rather, such matters
generally may be viewed as being
within the scope of the claim filed, as
sympathetically interpreted in light of
the record. This rulemaking does not
alter or delete the requirement in 38
CFR 3.103(a) for VA to ‘‘render a
decision which grants every benefit that
can be supported in law while
protecting the interests of the
Government.’’ This policy recognizes
that many ancillary benefits that many
veterans are not aware of may continue
to be adjudicated and awarded as part
of VA’s disposition of the issues a
claimant has specifically raised.
However, entirely separate conditions
never identified on a standard claim
form generally will not be the subject of
claims that are reasonably raised by the
evidence of record. As an initial matter,
we do not construe 38 CFR 3.103(a) or
other governing authorities to establish
a legal duty to identify and adjudicate
claims that are unrelated to the
particular claims raised by the claimant.
Section 3.103(a) specifies that claimants
are entitled to written notice of the
decision made ‘‘on his or her claim’’
and that VA will assist in developing
‘‘the facts pertinent to the claim’’ and
will render a decision which grants
every benefit that can be supported in
law while protecting the interests of the
Government. Those provisions thus
relate to matters that are reasonably
within the scope of the claim filed by
the claimant. They do not, however,
create a duty to adjudicate matters
unrelated to the claim filed. In this way,
§ 3.103(a) reflects the principle of
sympathetic construction of claims,
while adhering to the general statutory
framework that requires a specific claim
in order to support a benefit award, 38
U.S.C. 5101(a), and to establish the date
on which entitlement to an award may
be effective, 38 U.S.C. 5110(a).
Similarly, insofar as judicial decisions
have referenced a duty of sympathetic
development deriving from
congressional intent expressed in H.R.
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Rep. No. 100–963, that report similarly
refers to a duty to fully and
sympathetically develop the claimant’s
‘‘claim’’ to its optimum before deciding
such claim. We do not construe that
statement as requiring VA to identify
and adjudicate issues and claims that
are unrelated to the claim(s) presented
to VA.
Further, establishing a duty on VA’s
part to identify claims reasonably raised
by the evidence of record which are
unrelated to the claim(s) presented
would be incompatible with the
requirement in § 3.160(a)(4), as
prescribed in this final rule, that a
complete claim enumerate the
conditions or symptoms on which the
claim is to be based. If claims that are
reasonably raised by the evidence of
record for totally new conditions were
permissible, it would be possible to
identify only one condition on the
standard application form, but submit
evidence relating to multiple conditions
on the expectation VA will identify and
adjudicate those unidentified claims.
This would inevitably lead to exactly
the time-intensive clarifications and
interpretations we seek to avoid
remaining necessary in a large volume
of cases.
The permissible scope of claims that
are reasonably raised by the evidence of
record in light of the requirement in
§ 3.160(a)(4) overlaps somewhat with
the scope of the implicit denial rule.
The basic idea of that rule is that claims
pending but not explicitly denied in a
decision addressing other claims can be
deemed ‘‘implicitly denied’’ in certain
circumstances. In Ingram v. Nicholson,
23 Vet. App. 232, 248 (2007), the Court
of Appeals for Veterans Claims
(hereinafter ‘‘Veterans Court’’) said the
implicit denial rule cannot cover claims
that are very different from one another
in content. For instance, the denial of
nonservice-connected pension claims
did not put Mr. Ingram on notice that
his claims under 38 U.S.C. 1151 had
been denied. Ingram, 23 Vet. App. at
243. However, the United States Court
of Appeals for the Federal Circuit
(hereinafter ‘‘Federal Circuit’’) later held
that a claim for endocarditis was
implicitly denied when the AOJ denied
a claim for rheumatic heart disease.
Adams v. Shinseki, 568 F.3d 956, 963
(Fed. Cir. 2009).
Applying a similar scope to these
claims that are reasonably raised by the
evidence of record but not specifically
claimed by the claimant will allow VA
to continue this pro-claimant practice
largely undisturbed while still requiring
claims to originate on standard forms.
VA’s grant or denial of a pending claim
necessarily implies that VA has
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considered all potential theories of
entitlement reasonably inferable from
the evidence of record and reasonably
within the scope of that claim. This is
consistent with the requirement in
§ 3.160(a)(4) that the completed
application form enumerate
‘‘symptom(s) or condition(s)’’ but not
‘‘diagnoses’’ or some other more discrete
requirement. For example, if a claimant
lists ‘‘heart condition’’ on a standard
form, VA would consider entitlement
theories based on both endocarditis and
rheumatic heart disease, to the extent
justified by the evidence of record. This
means VA would continue to award
benefits reasonably raised by the
evidence of record based on secondary
service connection or service
connection based on aggravation due to
an already service-connected disability,
entitlement to total disability based on
individual unemployability, benefits
such as housing or automobile
allowance, or special monthly
compensation benefits if the evidence is
clear that the claimant meets the
eligibility or requirements for such
benefits and VA can adjudicate these
claims. This provision has been
outlined in new paragraph (d) of
§ 3.155. In new § 3.155(d)(2), we have
provided that VA will continue to
identify and adjudicate claims
reasonably raised by the evidence of
record that are related to or are
reasonably within the scope of the
claimed issues in the complete claim.
As explained above, § 3.103(a) currently
provides the predicate for full and
sympathetic development of claims, to
include consideration of matters
reasonably related to and raised in
connection with a claim before VA,
whether or not raised expressly by the
claimant. We have provided that VA
will put at issue for adjudication any
ancillary benefit(s) or other claims not
expressly raised by the claimant that are
related and arise as a result of the
adjudication of a claimed issue. Such
issues, other than ancillary benefits,
which have not been claimed by the
claimant but have resulted as
complications of claimed serviceconnected conditions will continue to
be identified and adjudicated as also
indicated by part 4 of the CFR, VA
Schedule for Rating Disabilities.
We note that the existence of the
discretionary, pro-claimant practice of
identifying claims reasonably raised by
the evidence of record does not imply
that claims potentially remain pending
indefinitely, awaiting the suggestion
that contemporaneous evidence may
have supported inferring a claim that
was not actually filed. As the implicit
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57673
denial rule itself suggests, VA’s grant or
denial of a pending claim necessarily
implies that VA has determined that no
other claims are reasonably raised by
the claims specifically identified by the
claimant and the accompanying
evidence of record. The correct way to
contest this determination is on direct
appeal, or in a claim for clear and
unmistakable error. See Deshotel v.
Nicholson, 457 F.3d 1258, 1261–62
(Fed. Cir. 2006). VA also notes that
‘‘where there can be found no intent to
apply for VA benefits, a claim for
entitlement to such benefits has not
been reasonably raised.’’ Criswell v.
Nicholson, 20 Vet.App. 501, 504 (2006).
Accordingly, in the next to last sentence
of § 3.155(d)(2), we clarify that VA’s
decision addressing some, but not all, of
the issues raised in a complete claim
does not imply that the reminder of the
enumerated issues (and issues
reasonably within their scope in light of
the evidence of record) have been
denied, since VA must still decide the
remaining enumerated issues. However,
in the final sentence of § 3.155(d)(2) we
make clear that VA’s decision on a
claim necessarily implies that VA has
determined the evidence of record does
not support a grant of benefits for any
other issue reasonably within the scope
of the issues enumerated in the
complete claim. This rule text makes
clear that VA’s duty to broadly construe
the evidence of record does not vitiate
the finality of otherwise final VA
decisions.
We further note that identifying and
adjudicating claims reasonably raised by
the evidence of record are a proclaimant practice meant to resolve
claims without the need for unnecessary
administrative action when VA is
already actively developing and
adjudicating a claim. It should not be
construed as creating a rule or practice
that the filing of evidence, without a
claim for increase for a condition
already service connected executed on a
completed application, constitutes a
claim for increase. Such a practice
would form a boundless exception to
the requirement to file a complete claim
for increase made explicit in § 3.155(d),
and would be inconsistent with our
explicit elimination of current § 3.157.
Some commenters specifically
questioned how claims for Total
Disability based on Individual
Unemployability (TDIU) would operate
under a system requiring standard
forms. Generally, TDIU is not a ‘‘claim,’’
but a rating that is provided in light of
the impact of an individual’s
disabilities. Rice v. Shinseki, 22 Vet.
App. 447, 452–54 (2009). This implies
that VA must consider potential
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entitlement to TDIU when the necessary
substantive thresholds are met, and
whenever evidence of record potentially
establishes unemployability, whether in
the context of an original claim or a
claim for increase. As we said in the
proposed rule, ‘‘[i]t is VA’s intent that
a request for an increase accompanied
by evidence of unemployability
continue to constitute a claim for TDIU,
but the claim for increase itself must be
filed on a standard form.’’ 78 FR at
65497. However, it also implies that the
requirements to initiate an original
claim or a claim for increase, such as
initiating an application with an intent
to file a claim and perfecting it with a
completed application form, apply, as
they would to efforts to seek any other
rating.
Other commenters asserted that it has
been VA’s longstanding practice to
assist veterans at the beginning of the
claims process and that requiring
claimants to provide a complete claim is
comparable to the ‘‘well-grounded
claim’’ elements which Congress
ordered abandoned by the Veterans
Claims Assistance Act of 2000. One
commenter stated that ‘‘the idea of not
considering a claim to have been
properly filed, and therefore not eligible
for an effective date until it is ‘complete’
sounds remarkably similar to the
universally rejected requirement of
filing a ‘well-grounded’ claim.’’ Another
commenter stated that electronic
applications that fall short of the
standards of a complete claim would
not constitute a claim of any kind,
complete or otherwise, and that the
proposed rule was incompatible with
the duty to assist as mandated by 38
U.S.C. 5103A. Other commenters
seemed to be under the impression that,
under the proposed rule, a veteran
would be required to complete all
development on a claim before it would
be considered complete and accepted,
and some accused VA of attempting to
shift legal burdens onto the veteran,
though not all commenters
characterized this as requiring a ‘‘wellgrounded’’ claim.
Historically, section 5107 of title 38,
United States Code provided that a
person who submitted a claim for
benefits had the burden of submitting
evidence sufficient to justify a belief by
a fair and impartial individual that the
claim was well grounded. 38 U.S.C.
5107(a) (1994). This seemingly
subjective determination ultimately
came to be defined with some
particularity, and the elements of a
‘‘well grounded claim’’ eventually bore
resemblance to the elements of ultimate
entitlement to disability compensation.
Compare Epps v. Gober, 126 F.3d 1464,
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1468 (Fed. Cir. 1997) with Holton v.
Shinseki, 557 F.3d 1362, 1366 (Fed. Cir.
2009). The Veterans Court even
suggested that VA was legally precluded
from providing assistance to claimants
who had yet to submit evidence
sufficient to establish wellgroundedness. See Grivois v. Brown, 6
Vet. App. 136, 140 (1994). Congress
recognized the illogic of requiring
claimants to all but establish
entitlement to benefits in order to be
eligible for receiving VA assistance in
gathering the evidence needed to
establish entitlement in enacting the
Veterans Claims Assistance Act of 2000.
See H.R. Rep. 106–781 at *6–*9 (July 24,
2000).
We disagree with the assertion that
the proposed rule would have
resurrected the well-grounded claim
requirement, or that this rule as now
revised resurrects that requirement. The
proposed rule would not have required
claimants to submit evidence
establishing ultimate entitlement to
benefits in order for the claim to be
recognized as a complete claim, and
neither does this final rule.
The determination that a ‘‘complete
claim’’ has been submitted is based on
objective standards that are explicitly
outlined in § 3.160(a). The criteria of a
‘‘complete claim’’ correspond directly to
the current standards for a
‘‘substantially complete application’’ in
§ 3.159 which governs VA’s statutory
duty to assist claimants in developing
claims. Therefore, once VA receives a
complete claim, the statutory duty to
assist claimants in obtaining evidence to
substantiate the claim is triggered.
While a form must contain the elements
of information explicitly required by
§ 3.160(a) in order to be considered
complete, there is no requirement to
submit medical or other evidence in
support of the claim in order for the
application form to be considered
complete. In other words, requiring that
a claim be complete in order for VA to
begin adjudicative activity is not at all
the same thing as requiring ultimate
entitlement to be demonstrated before
VA will begin adjudicative activity.
Therefore, VA has made no change to
the proposed rule based on this
comment.
Similarly, another commenter
asserted that claimants should not be
responsible for developing their claims
and that VA has a duty to assist
veterans. The requirement that
claimants submit a complete claim does
not entail shifting the burden on the
claimant to develop his or her claim.
The submission of a complete claim as
set forth in § 3.160(a) of this final rule
allows for efficient, fair, and orderly
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processing and adjudication of a claim
because the information necessary to
develop and adjudicate the claim has
been provided. VA’s statutory duty to
notify claimants of information and
evidence necessary to substantiate the
claim and duty to assist claimants in
obtaining evidence necessary to
substantiate the claim remain
unchanged. VA will continue to develop
claims that are considered complete.
VA eliminates the definition of
‘‘incomplete claim’’ that had appeared
at paragraph (b) as proposed, and
replaces it with the definition of an
‘‘original claim’’ as originally proposed
at paragraph (c), with the minor change
of deleting ‘‘or form’’ from the phrase,
‘‘application form or form prescribed by
the Secretary’’. This change is to make
clear that an application form is the
form prescribed by the Secretary rather
than some distinct administrative tool.
In paragraph (c), VA adopts as final the
definition of a ‘‘pending claim’’ which
was proposed at paragraph (e). This
change updates the existing definition
of ‘‘pending claim,’’ which is currently
defined as ‘‘an application, formal or
informal, which has not been finally
adjudicated’’ by replacing the phrase
‘‘an application, formal or informal’’
with the word ‘‘claim.’’
In paragraph (d), VA adopts as final
the definition of ‘‘finally adjudicated
claim,’’ as originally proposed at
paragraph (f). This action primarily
replaces the phrase ‘‘an application,
formal or informal’’ in the current
definition with the word ‘‘claim.’’ Since
VA is eliminating the term ‘‘informal
claim,’’ it removes references to the
phrase or words, ‘‘informal’’ and
‘‘formal’’ for consistency in the existing
definitions. These changes are not
meant to alter the law of finality in the
VA benefits system. See Cook v.
Principi, 318 F.3d 1334, 1339–41 (Fed.
Cir. 2002) (en banc).
Furthermore, VA has withdrawn the
definitions of ‘‘new or supplemental
claim’’ in proposed paragraph (d) of the
proposed rule and the revised definition
of ‘‘claim for increase’’ in proposed
paragraph (h) of the proposed rule. The
definition of a claim for increase in
current § 3.160(f) accordingly remains
unchanged by this final rule. While the
new proposed definitions were intended
to provide clarification, the statements
of commenters demonstrated a
misunderstanding and confusion about
the usage and application of these
terms. Because no substantive change to
the scope of what constitutes a claim for
increase was intended, and the more
particular definition in the proposed
rule is not necessary to achieve
consistency with the intent to file
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process, VA has withdrawn these
proposed definitions in this final rule.
However, in revised paragraph (e) of
this final rule, VA continues the
definition of ‘‘reopened claim’’ that
appears in current § 3.160(e) with slight
modifications to insert ‘‘new and
material evidence’’ as clarification of
VA’s existing criteria for reopening a
previously denied claim.
F. Elimination of Report of Examination
or Hospitalization as Claim for Increase
or To Reopen
Through this final rule, VA removes
current § 3.157, which had provided
that reports of examination or
hospitalization can constitute informal
claims to increase or reopen. In
implementing one consistent standard
for the claims process, VA has
eliminated informal claims for increase
or to reopen based on receipt of VA
treatment, examination, or
hospitalization reports, private
physician medical reports, or state,
county, municipal, or other government
medical facilities to establish a
retroactive effective date as provided in
current §§ 3.155(c) and 3.157. The idea
that certain records or statements
themselves constitute constructive
claims is inconsistent with the
standardization and efficiency VA
intends to accomplish with this final
rule.
Therefore, in place of current §§ 3.155
(c) and 3.157, VA adopts the
amendments to § 3.400(o)(2) as
proposed, with two changes necessary
to respond to concerns raised by
commenters and to implement the
intent to file process we have adopted
in order to respond to the broadest
concerns in the comments. The first
change is to add the words ‘‘or intent to
file a claim’’ after ‘‘a complete claim’’ in
both the first and second sentences of
the rule as proposed. The rule now
states that a retroactive effective date
may be granted, when warranted by the
facts found, based on date of treatment,
examination, or hospitalization from
any medical facility, if the claimant files
a complete claim for increase or an
intent to file such a claim within 1 year
of such medical care. This amendment
preserves the favorable substantive
features of the current treatment of
reports of examination or
hospitalization under § 3.157, but
requires claimants to file a complete
claim for increase, or an intent to file
that is later perfected by a complete
claim, within 1 year after medical care
was received.
The other change is to insert the
words ‘‘based on all evidence of record’’
in the first sentence of the regulation, so
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the language describing the relevant
effective date now reads, ‘‘[e]arliest date
as of which it is factually ascertainable
based on all evidence of record that an
increase in disability had occurred’’.
This addition is to respond to a
comment expressing concern that
§ 3.400(o)(2) as proposed would
‘‘restrict[] the evidence needed to
establish an earlier effective date to only
medical evidence.’’ The language in the
second sentence of § 3.400(o)(2) as
proposed specific to the treatment of
medical records was intended to
specifically address, in regulatory text,
the situations in which medical records
may establish an effective date. This
language was intended to make clear, in
governing regulation text separate from
the elimination of current § 3.157, that
medical records are evidence used to
establish contemporaneous state of
disability once a claim has been filed,
and do not themselves constitute
claims. By adding ‘‘based on all
evidence of record’’ to the first sentence,
we are making clear that the date as of
which it is factually ascertainable that
an increase in disability occurred may
be based on any kind of evidence to the
extent that evidence is credible and
probative. Placing this clarification in
the first sentence of the regulation
avoids confusing matters by discussing
types of evidence other than medical
records in the second sentence, which is
meant to provide clarification in light of
the elimination of § 3.157.
Some commenters asserted that
eliminating § 3.157 would shift the
burden of filing a claim to the claimant,
who may be more focused on
undergoing treatment than in
considering the existence of a potential
monetary benefit. VA fully appreciates
that while a veteran is hospitalized or
receiving crucial medical treatment, a
veteran may be more focused on his or
her health than on pursuing a claim for
compensation. VA has no desire to
preclude veterans from receiving
benefits for periods of hospitalization or
medical treatment—VA only wishes to
receive inputs in a standard format in
order to serve veterans as efficiently as
possible. Therefore, VA has provided a
1-year window within which a claimant
can submit an intent to file a claim as
outlined in § 3.155(b) of this final rule
or file a complete claim for increase. As
we discuss in section I.C of this final
rule notice, the filing of an intent to file
within this one year period provides up
to a year to perfect the application by
filing a complete claim. Under this final
rule, all a veteran must do to preserve
the earliest possible effective date of
benefits is take the minimal step of
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filing an intent to file within 1 year from
the date as of which it is ascertainable
that an increase in disability has
occurred, in any of the permissible
formats discussed in § 3.155(b). 38
U.S.C. 5110(b)(3). Filing the intent to
file placeholder then provides the
claimant up to another year to perfect
the application by filing a complete
claim. VA believes this process provides
a significant amount of time for veterans
undergoing medical treatment or
hospitalization to perform these
minimal steps without losing any
benefits. VA strongly believes that any
de minimis burden associated with
filling out a form, whether an intent to
file a claim form or a complete claim,
rather than having a medical record
itself constitute a claim for increase is
clearly outweighed by the efficiencies
that will be realized as claims become
easier to identify and process.
Several commenters stated that
revised § 3.400(o)(2), the effective date
provision for claims for increase, limits
retroactive payments to no more than 1
year and that, currently, veterans may
be eligible for many years of retroactive
payments based on facts found in the
medical evidence. Other commenters
stated that the rule eliminates the
present right of a veteran to use the date
of treatment in a VA medical facility for
a non-service-connected disability if a
claim is submitted within 1 year and VA
determines that service connection
should be granted or when a claim
specifying the benefit sought is received
within 1 year from the date of such
examination, treatment, or hospital
admission.
The plain language of the statute
governing effective dates for an award of
increased compensation based on an
increase in disability allows an effective
date based on when it is factually
ascertainable that an increase in
disability had occurred, ‘‘if application
is received within one year from such
date.’’ 38 U.S.C. 5110(b)(3).
Accordingly, it is clear that the effective
date of a claim for increase can never be
more than one year prior to the date of
application. With this rule, VA is
ending the practice that certain records
themselves constitute claims, but is not
disturbing the potential period during
which a veteran may receive an award
of increased compensation, provided
the factual basis for such an award
exists, and provided the veteran files a
complete claim for increased
compensation or an intent to file that is
ultimately perfected by a complete
claim for increased compensation
within one year.
The situation identified by the
commenters does not arise because VA
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grants effective dates more than a year
in advance of when the application is
received—VA is flatly prohibited by
statute from doing so. Rather, it arises
when a veteran files a claim for
increase, and VA becomes aware of a
document, such as record of admission
to a VA or uniform services hospital,
potentially more than one year old, that
itself constitutes a claim pursuant to
current § 3.157, but has not been
recognized as a claim or obtained by
Veterans Benefits Administration (VBA)
adjudicators until the instant claim for
increase has been filed. In this scenario,
benefits are not being paid more than
one year prior to the date of application,
but are being paid pursuant to a ‘‘claim’’
which was only recently found to have
been pending. In other words, in this
scenario the veteran is being paid a
‘‘retroactive’’ award because a claim was
not properly identified and processed,
and remained pending potentially for
years. This is exactly the type of
situation that VA seeks to prevent by
insisting that claims must be on
standard forms amenable to easy
identification and processing. This rule
does not preclude a veteran from
receiving increased compensation for
any period for which he is so entitled,
provided he files a claim on a standard
form or an intent to file within one year
of when the increase in disability
occurs. This rule does not ‘‘take away’’
potential avenues for a veteran to
receive years of retroactive benefits, but
rather prevents the situations that make
retroactive payments necessary in the
first place, provided the veteran takes
the minimal step of filing a claim on a
standard form. VA strongly believes it is
preferable for veterans to be in current
receipt of benefits to which they are
entitled, rather than go without those
benefits due to agency error for years
before receiving retroactive payments.
Additionally, we note that, to the extent
a record that itself constitutes a claim is
in existence as of the date this rule
becomes effective and has not been
identified and acted upon, this rule
cannot extinguish that record’s status as
a claim under the law that was in effect
as of the time that record was created,
to the extent it is ever identified as
claim. This rule cannot and does not
preclude benefits that might be due for
any unidentified and unadjudicated
claims now pending.
Likewise, § 3.400(o)(2) does not alter
the current procedures and laws
governing the assignment of effective
date(s) for an award granted for the first
time based on treatment,
hospitalization, or examination.
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G. Special Allowance Payable Under
Section 156 of Public Law 97–377
Finally, VA adopts minor
amendments to proposed § 3.812 which
govern a special allowance under Public
Law 97–377. VA replaces the
terminology ‘‘formal’’ and ‘‘informal’’
claims with ‘‘complete claim’’ and
‘‘intent to file a claim,’’ as appropriate,
to ensure consistency with the rest of
the final rule.
One commenter stated that mandating
the filing of a complete form for this
particular benefit prior to VA
recognizing it as a claim flew in the face
of a half century or more of veteranfriendly regulations. However, because
VA has replaced the concept of informal
claim with the concept of intent to file
a claim in § 3.155(b) of this final rule,
claimants applying for this benefit in
§ 3.812 can preserve an earlier effective
date by submitting an intent to file a
claim that is later ratified by a complete
claim if filed within one year of receipt
of the intent to file a claim. Therefore,
claimants and/or beneficiaries would
not lose out on possible benefits due to
the requirement of a complete claim
being filed for this particular benefit.
H. Other Comments Regarding Initial
Claims
VA received many comments
asserting that VA’s mandate of the use
of forms in the VA claims process is
burdensome to claimants by making it
more difficult for claimants to file a
claim and by overcomplicating the
claims process, particularly for those
with disability limitations or limited
access to VA forms. The commenters
expressed that such mandate of the use
of forms creates an adversarial
relationship between claimants and VA.
Some commenters stated that VA is
acting only in its own best interest in
reducing the statistics on the claim
backlog and not in veterans’ interests.
VA has responded to these concerns
by adopting the intent to file process,
which is meant to reconcile the need for
standard inputs with the claimant’s
need to preserve an effective date while
complying with the procedural
requirement of filling out an application
form. VA is sensitive to the concern
that, in some cases, the very disability
for which a veteran is seeking
compensation may make it difficult to
fill out a form. This final rule strikes an
appropriate balance between providing
claimants with a more efficient process
that does not erode the longstanding
informal, non-adversarial, pro-claimant
nature of the VA system with the
ongoing workload challenges relative to
VA’s operating resources. VA considers
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increasing the role of standard forms a
key component to streamlining,
standardizing and modernizing the
claims process. The current informal
claim process allows non-standard
submissions to constitute claims, which
involves increased time spent
determining whether a claim has been
filed, identifying the benefit claimed,
sending letters to the claimant and
awaiting a response, and requesting and
awaiting receipt of evidence. These
steps all significantly delay the
adjudication and delivery of benefits to
veterans and their families. Requiring
the use of standard forms imposes
minimal, if any, burden on claimants.
Further, by making it possible for all
claimants to preserve an effective date
by utilizing the ‘‘intent to file’’ process,
VA believes the benefits of these
changes outweigh any such burden.
Even those claimants who, due to their
disabilities, may have trouble filling out
an application form, can utilize one of
the three acceptable formats for an
intent to file, including oral
communications with certain
designated VA personnel, and take up to
a year to perfect the application form
without losing benefits.
Moreover, current standard forms
such as VA Forms 21–526EZ, 21–527EZ,
and 21–534EZ (hereinafter ‘‘EZ forms’’)
contain the statutorily required notice to
claimants of the information and
evidence necessary to substantiate a
claim at the onset of filing a claim. See
38 U.S.C. 5103. This means claimants
do not have to wait for VA to send
notices to claimants of VA’s duty to
assist in developing a claim. Claimants
will be informed of what information
and evidence is necessary in
substantiating their claims prior to or at
the time they file a claim.
In addition, the EZ forms used for
filing disability compensation, pension,
and survivor benefits as well as the
NOD form are shorter in length, making
them less burdensome and timeconsuming for claimants to complete.
Additionally, EZ forms contain preprinted lists of potentially available
benefits to help guide claimants through
the claim process. VA believes that the
standard format of VA’s forms that
provide pre-printed selections from
which claimants can choose poses less
of a burden on claimants because
claimants spend less time describing
their intent to file a claim, identifying
and describing symptoms or medical
conditions, or expressions of
disagreement to a VA decision in a
narrative format of non-standard
submissions.
Some commenters asserted that there
would be a constituency of claimants
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who would not have access to VA’s
standard forms. The forms necessary to
file claims for benefits are widely
available, both online and in VA
regional offices. Additionally, VA will
continue to provide claimants with the
correct forms upon request. 38 U.S.C.
5102. Furthermore, with the regulatory
changes to § 3.155 standardizing the
informal claim process through the
concept of an intent to file a claim,
claimants or their authorized
representatives can contact designated
VA personnel directly to establish an
intent to file a claim and preserve a
potential earlier effective date of their
claim, and VA will furnish claimants
with the appropriate claim application
form(s) necessary for claimants to
submit a complete claim. Many veterans
service organizations also have access to
VA forms.
One commenter objected to our
discussion in the proposed rule pointing
out that electronic claims could more
easily be separated by issue and routed
around the country for consideration by
specialists, often referred to as the
‘‘centers of excellence’’ concept. The
proposed rule would not have
implemented or mandated the ‘‘centers
of excellence’’ concept. It would have
incentivized electronic claim
submission, which removes many of the
manual steps necessary to convert
claims to electronic format. VA will
only move toward electronic issue-byissue brokering of workload when it is
confident that this step adds both
accuracy and efficiency to the claims
process.
One commenter stated that the
proposed rule would have created
multiple definitions of ‘‘receipt’’ which
38 U.S.C. 5110, the statute governing
effective dates of awards, does not
authorize, and that particularly for
electronic claims VA would not receive
the identical form sent to VA via mail
or other means and that the effective
date of an electronic claim is outside the
meaning of the statute. This final rule
no longer attaches effective date
distinctions to whether a claim is
received in paper or electronic format.
VA notes that statutes neither expressly
permit nor prohibit VA’s current
longstanding practice of assigning an
effective date based on receipt of an
informal claim to establish an effective
date when such informal claim is later
ratified by a completed application form
within 1 year. Through this final rule,
VA is simply modifying the traditional
informal claims process to make it more
amenable to timely and efficient
processing, while maintaining
essentially the same longstanding
liberalizing effective date rule that the
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informal claim process has entailed. To
the extent this comment is read as
raising the broader point that recurring
terms in section 5110 such as ‘‘date of
receipt of application’’ and ‘‘date . . .
application is received’’ must be
interpreted and implemented in a
consistent way, VA has done so in this
final rule. See e.g., 38 U.S.C. 5110(a),
(b)(2), (b)(3). As we explain in section
I.C, a claimant must file an application
form. However, for effective date
purposes, VA will deem that application
form to have been received as of the
date VA was put on notice, through the
submission of an intent to file, that a
claimant intended to file a claim. Any
specific statutory effective dates that are
available (if justified by facts found)
prior to the date that the application is
deemed filed will operate
independently.
Some commenters raised practical
complaints with the eBenefits system.
Some asserted that eBenefits is
confusing to claimants, while others
focused on technical barriers to
eBenefits access. Similarly, some
commenters pointed to past information
security breaches, and the fact that the
technology necessary to file an
electronic claim may be expensive, as
reasons why allowing an effective date
placeholder solely for incomplete
electronic claims would be a potential
burden to claimants. Because this final
rule no longer attaches potential
effective date consequences to whether
a claim is initiated electronically prior
to its ultimate filing as a complete
claim, we consider these comments
addressed insofar as the structure of
VA’s claims rules is concerned. We will
continue the operational work of
improving online claim submission
tools and conducting outreach to
veterans on how to submit claims.
Some commenters pointed out that
some veterans are illiterate, or are blind,
or have brain injury, mental health
problems, or other cognitive
impairments, and might therefore have
difficulty using technology or filling out
VA forms. In this final rule, we have
provided that claimants may establish
an effective date placeholder via oral
contact with designated VA personnel.
We also note that 38 U.S.C. 5101(a)(2),
as amended by Section 502 of Public
Law 112–154, allows certain authorized
signers to sign a form required by
section 5101(a)(1) on behalf of an
individual who ‘‘has not attained the
age of 18 years, is mentally
incompetent, or is physically unable to
sign a form’’.
One commenter argued there is
insufficient space on VA claims forms to
identify disabilities with sufficient
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particularity, which will cause problems
for veterans as well as processing
problems at VA. The current form 21–
526 contains space for seven conditions,
as well as additional open space in
which the veteran can indicate
additional conditions if necessary. The
form 21–526EZ already contains space
to specifically list thirty conditions.
More fundamentally, forms are capable
of being revised based on experience
and operational needs, provided VA
complies with the necessary procedural
requirements in doing so. An objection
to the design of one particular form does
not, therefore, imply that VA rules
cannot or should not require claims to
originate on standard forms. Finally, as
we explain in section I.C, the
commenter is mistaken as to the level of
particularity required. The proposed
rule would not have, and this final rule
does not, require the veteran to identify
a specific medical diagnosis in order to
complete a claim. As § 3.160(a)(4) makes
clear, all that is required is a
‘‘description of any symptom(s) or
medical condition(s),’’ and this
requirement can be satisfied by simply
claiming ‘‘right knee’’ or ‘‘shoulder,’’
which will require VA to consider all
possible right knee or shoulder
disabilities established by the evidence
of record.
Some commenters also suggested that
VA’s desire to increase the importance
of standard forms in the claims process
implies that VA cares more about the
speed with which decisions are reached
than the quality of those decisions. VA
disagrees with these comments.
Standard forms increase clarity and
accuracy as well as efficiency, leading to
lower error rates and higher quality in
benefits processing. Additionally, VA
strongly believes that unacceptable
delays in the processing of veterans
benefits claims, colloquially known as
the ‘‘backlog,’’ also hurt veterans
because benefits cannot be paid until a
claim is decided. Many features of VA’s
current claims process also contribute to
the backlog or, at a minimum, hamper
VA’s ability to address the backlog.
Most inputs into the claims process,
such as claimant submissions, are still
received in paper format. Further, many
submissions, including submissions
requiring VA to take action, are not
received in a standard format. This
increases time spent determining
whether a claim or a notice of
disagreement to a decision has been
filed, identifying the benefit or
contention claimed or appealed,
sending letters to the claimant and
awaiting for a response, and requesting
and awaiting receipt of evidence. These
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steps all significantly delay the
adjudication and delivery of benefits. By
requiring the use of standardized forms
for all claims and appeals, VA is able to
more easily identify issues and
contentions associated with claims or
the initiation of an appeal that are filed,
resulting in greater accuracy, efficiency,
and speed in processing and
adjudicating claims and appeals.
Some commenters suggested that VA
should have standard forms, including
for informal claims, but that use of those
forms should be optional. VA has made
no changes based on these comments.
Making standard forms optional will not
achieve the necessary standardization of
the process because VA personnel
would still be required to engage in
time-intensive interpretive review of
narrative submissions in order to
determine whether a claim or appeal
has been filed.
One commenter suggested that if the
rule as proposed were confirmed as
final, staff attorneys should be made
available to all veterans who request
one, free of charge, to navigate the
‘‘adversarial’’ process that would result.
We disagree that requiring forms be
filed at certain critical phases of the
claims and appeals process amounts to
an ‘‘adversarial’’ approach, particularly
in light of the express authority
conferred by Congress. Additionally, in
this final rule, we have provided
multiple avenues for a claimant to
protect an effective date while taking up
to a year to fill out the required form.
One commenter requested that VA
‘‘clearly state and abide by [a] suspense/
deadline for each claim processed.’’
That is exactly what VA is trying to do.
The Secretary has clearly stated that
VA’s operational goal is to process all
claims with 98 percent accuracy within
125 days, has defined a claim pending
longer than 125 days as part of the
‘‘backlog,’’ and pledged to eliminate the
backlog in 2015. Given the volume and
complexity of VA’s workload, the use of
standard forms are indispensable to
reaching and maintaining this level of
accurate production. This comment also
suggested that the ‘‘tens levels set forth
by the VA’’ are redundant. We construe
this comment as an objection to VA’s
Schedule for Rating Disabilities, 38 CFR
part 4, rather than to the rules and
procedures governing the processing,
development, and adjudication of
claims, and as such this comment is
beyond the scope of this rule. We also
note that the 10 percent incremental
evaluation applicable to the rating of
disabilities is explicitly required by
statute. See 38 U.S.C. 1114, 1155. This
commenter also asserts that ‘‘taking one
to two years with no back dating to the
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start of a claim is unacceptable by any
standard.’’ VA agrees, and that is why
our operational goal is 125 days.
However, we note that once a claim is
granted, it is paid as of that claim’s
effective date, which generally
corresponds to the date of the receipt of
application, and is not controlled by the
date of decision.
Multiple commenters objected to the
rule as proposed on constitutional
grounds. These comments generally
advanced two arguments. First,
commenters argued that requiring
veterans to fill out an application form
deprives them of benefits without due
process of law. Second, commenters
advanced the related argument that
attaching different effective date
consequences to whether claims
originate in paper or electronic format
violates the equal protection component
of Fifth Amendment due process.
VA disagrees with these comments,
but believes an extended doctrinal
discussion is unnecessary given the
revisions to our original proposal that
we adopt in this final rule. By adopting
the intent to file process, VA has
provided multiple standardized but
claimant-friendly avenues for veterans
to hold an effective date while they fill
out a formal application form, including
oral communications with designated
VA personnel. The same amount of
effective date protection is available for
both paper and electronic inputs. Since
this final rule provides that claimants
can secure an effective date of benefits
with only the minimal action necessary
to constitute an intent to file, any
constitutional concerns arising out of
the rule as proposed are obviated.
One comment argues that VA is
changing position from historical
practice so suddenly that it renders
VA’s actions arbitrary and capricious.
The argument that the proposed change
was too sudden is belied by its very
status as a proposal. This rule originated
as a proposed rule, and received
numerous comments as well as vigorous
public scrutiny and debate. In response
to the formal comments received, we
have revised the proposal significantly
in order to reconcile the competing
interests as faithfully as possible.
Many comments advanced the
position that VA should not consider
rule changes when other avenues for
improving the accuracy and efficiency
of the claims system are available. The
embedded premise of these comments is
that so long as there is any room for
improvements in training, staffing,
management of AOJ personnel, and
innumerable other areas of
administrative responsibility, rule
change is impermissible. VA disagrees
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for two reasons. First and foremost,
many of the inherent difficulties in
administering a system as large and
complex as the VA benefits system are
exacerbated by the prevalence of nonstandard submissions. Second, as many
commenters acknowledged, VA is
actively engaged in improving all
aspects of its operations. VA is not
relying solely on regulatory change to
achieve its goals, but does believe
regulatory change is necessary and
justified. In any event, these comments
are beyond the scope of the rule.
One comment pointed out there
would be inconsistencies between the
legal structure of the claim system in
this rule as proposed, and as reflected
in the consolidated re-proposal of the
Regulation Rewrite project. 78 FR 71042
(Nov. 27, 2013). The Regulation Rewrite
project was not designed to formulate
and implement changes to the
substantive content of VA’s regulations.
The Regulation Rewrite project is a
comprehensive multi-year effort to
‘‘reorganize and rewrite’’ VA’s
regulations governing claims currently
governed by 38 CFR part 3. 78 FR at
71042. Substantive legal changes have
been incorporated into the rewritten
regulations throughout the project. See
e.g., 78 FR at 71065 (discussing changes
to 38 CFR part 5 as proposed to
accommodate provisions of Section 502
of Public Law 112–154 dealing with
persons authorized to sign a claim on a
veteran’s behalf). Substantive changes at
the regulatory level will be handled in
similar fashion, with the content of any
final publication of 38 CFR part 5 being
revised to incorporate the current state
of the law.
I. Other Regulations
VA has determined that revisions to
current adjudication regulations which
were not published in the proposed rule
are necessary to ensure consistency with
the changes in this final rule. Therefore,
VA revises current 38 CFR 3.108, 3.109,
3.151, 3.403, 3.660, 3.665, and 3.666.
and 3.701, which would not have been
amended in the published proposed
rule, by generally replacing the phrase
‘‘informal claim’’ with the phrase
‘‘claim or intent to file a claim as set
forth in § 3.155(b).’’ Since VA is
eliminating the term ‘‘informal claim,’’
it has removed references to the phrase
‘‘informal claim’’ and replaced it with
the phrase ‘‘claim or intent to file a
claim’’ for consistency in these
adjudication regulations to reflect this
change.
We have also made minor changes in
phrasing to the affected regulations in
order to execute this change. In
particular, we have amended
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§ 3.403(a)(3) by removing the phrase,
‘‘notice of the expected or actual birth
meeting the requirements of an informal
claim’’ and replaced it with ‘‘a claim or
intent to file a claim as set forth in
§ 3.155(b)’’. This change preserves the
generally beneficial nature of paragraph
(a)(3) by providing a date-of-birth
effective date whenever VA receives a
claim or an intent to file a claim within
1 year of the veteran’s death. The
replacement of the term ‘‘informal
claim’’ with ‘‘intent to file a claim’’ does
not change the substance of these
regulations.
In § 3.666(c), we have simply removed
the phrase ‘‘(which constitutes an
informal claim)’’ and have not replaced
it with a reference to an intent to file a
claim. This section governs resumption
of payment of pension for incarcerated
beneficiaries and fugitive felons upon
release from incarceration. An intent to
file a claim is simply inapposite to this
situation, because VA does not require
a claim for resumption of payment in
this context. VA makes the necessary
adjustments upon receipt of satisfactory
notice. Simply replacing the language in
the parenthetical with language
designed for the intent to file process
would have the bizarre effect of
requiring an intent to file a claim, and
therefore ultimately a claim, in a context
where VA has no reason to require a
separate claim. Accordingly, we have
simply removed this parenthetical to
make clear that pension will be resumed
as of the day of release from
incarceration if notice is received within
one year following release.
We have changed the wording of
§ 3.701(b), which provides for elections
between pension and compensation.
Paragraph (b) now reads, ‘‘[a]n election
generally must be in writing and must
specify the benefit the person wishes to
receive.’’ This is necessary because an
intent to file a claim is a placeholder in
VA’s systems, and is not structured to
be a substantive submission, such as
one affecting the election of benefits.
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II. Changes to Appeals Process Based
on Public Comments
A. Commencement and Perfection of an
Appeal
VA revises § 20.201 to incorporate the
standardized NOD requirement
substantially as proposed, with minor
amendments and clarifications. In
newly added paragraph (a), VA outlines
the requirements for appeals relating to
cases in which the AOJ provides a
standard form for the purpose of
initiating an appeal. In paragraph (a)(1),
entitled ‘‘Format,’’ VA has provided
that, for every case in which the AOJ
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provides, in connection with its
decision, a form identified as being for
the purpose of initiating an appeal, an
NOD would consist of a completed and
timely submitted copy of that form. In
these cases, VA will not accept as an
NOD any other submission expressing
disagreement with an adjudicative
determination by the AOJ. As we
discuss in greater detail below, this
means a completed form must be
submitted within one year from the date
of mailing of notice of the AOJ decision,
or, if VA requests clarification of an
incomplete form, within 60 days of the
date the request was sent, or the
remainder of the one year period from
the date of mailing of notice of the AOJ
decision, whichever is later.
One commenter suggested that VA’s
statutory authority in 38 U.S.C. 501(a)(2)
to establish the ‘‘forms of application’’
does not extend to notices of
disagreement. This commenter argued
that the term ‘‘[a]pplication for review
on appeal’’ in 38 U.S.C. 7106 is
confined to the context of
administrative appeals to the Board by
VA officials and does not include
notices of disagreement. We agree that
section 7106, standing alone, potentially
bears the reading that an ‘‘[a]pplication
for review on appeal’’ refers only to an
administrative appeal.
However, we make no changes based
on this comment, for three reasons.
First, while section 7106 permits the
commenter’s reading, it does not require
it. The limitation in the first sentence of
section 7106 that an application for
review on appeal must be received
within the one-year period described in
38 U.S.C. 7105 could be read simply to
impose a time limit on administrative
appeals, and does not imply that
requests for Board review other than
administrative appeals are something
other than an ‘‘[a]pplication for review
on appeal.’’ Second, 38 U.S.C.
7107(a)(1) discusses how ‘‘each case
received pursuant to an application for
review on appeal’’ will be docketed.
This statutory section governs the
docketing of all appeals before the
Board, not just administrative appeals.
Third, section 7108 also refers to an
‘‘application for review on appeal,’’ and
requires that it be in conformity with
the entirety of 38 U.S.C. Ch. 71. Nothing
in the language or context of this statute
implies that the term ‘‘application for
review on appeal’’ is confined to
administrative appeals, and the fact that
all ‘‘application[s] for review on appeal’’
must comply with all requirements in
38 U.S.C. Ch. 71 implies that an
‘‘application for review on appeal’’ is
any request for Board review. Chapter
71 includes 38 U.S.C. 7105, the statute
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governing requirements of, and
treatment of, NODs.
Some commenters pointed out that
the standardized NOD form addresses
only compensation claims. As the
proposed rule explained, this is
necessary due to the legal structure of
VA and the dynamics of VA’s appellate
workload. VA has chosen a flexible
standard rather than identifying a
particular form number or control
number in the rule text in order to
ensure the rule functions for all of VA’s
diverse operations. The standard for
what constitutes an NOD applies to all
VBA benefit lines, as well as the rest of
VA. However, the current standard NOD
form was designed only for
compensation claims. One of the key
features of the form’s design is that it
solicits particular pieces of information
relevant to a compensation claim.
Standard NOD forms for other types of
benefits, such as loan guaranty and
educational benefits, have not yet been
created. Requiring appeals of other
benefits, such as home loan guaranty or
education benefits, to be submitted
using this form in its current state
would likely be confusing to veterans.
At the same time, the overwhelming
majority of the VA appellate workload
concerns appeals of AOJ decisions on
claims for compensation. Board of
Veterans’ Appeals, Department of
Veterans Affairs, Report of the
Chairman: Fiscal Year 2012, at 22
(2013) (96.1 percent of Board
dispositions in FY 2012 were for
compensation claims). Therefore, VA is
concerned that making the NOD form so
generic as to accommodate appeals of
all benefits VA-wide might dilute much
of the efficiency gain VA expects from
mandating the use of standardized
forms. Nevertheless, VA will continue
to seek ways to provide a standardized
format for VA benefits lines to receive
an appeal, whether on one all-purpose
form or individual specialized forms.
To reflect these current realities, the
standard reflected in amended
§ 20.201(a)(1) is designed to produce a
single rule that can function flexibly
VA-wide while allowing for the creation
of forms that are functional for each VA
benefits line. Additionally, § 20.201(b)
provides a ‘‘fallback’’ standard for
benefits where standardized appellate
processing is not as pressing a need as
it is with compensation claims. This
approach allows for standard forms in
VA benefits lines where the volume,
complexity, and frequency of appeal
call for standardization, without
disrupting the administration of other
benefits that are infrequently appealed.
In § 20.201(b), if VA does not provide a
standard appeal form for a particular
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type of claim, the claim is governed by
the current standard for what
constitutes an NOD as provided in
current § 19.26 and regulatory text of
§ 19.23(b) and § 20.201(b). As of the
publication of this final rule, VA only
expects regularly to provide a standard
appeal form for compensation claims
and similar monetary benefits claims.
However, VA may choose to provide
standard forms with AOJ decisions for
other benefits lines as the volume and
dynamics of VA’s workload continue to
evolve. Additionally, if VA fails to
provide a standard appeal form to the
claimant due to a case-specific error, the
claimant would be able to initiate an
appeal under the current standard for an
NOD where a written communication
expressing dissatisfaction or
disagreement and a desire to contest the
result will constitute an NOD. See
§ 20.201(b).
The second sentence makes clear that
if the AOJ provides a standard form
with its decision, triggering the
applicability of § 20.201(a), VA will not
accept a document or communication in
any other format as an NOD. VA
believes this rule is necessary to make
use of the standard form mandatory and
maximize improvement and efficiency
in the appellate process. Additionally,
VA clarifies in this final rule that
submitting a different VA form does not
meet the standard for an NOD in cases
governed by § 20.201(a). Many VA
forms, such as VA Form 21–4138,
Statement in Support of Claim, are so
generic that they would not yield the
clarity and standardization this rule
change is designed to achieve.
In the future, different standard forms
may be developed for different benefit
lines. Under this final rule, the
particular version provided with the
AOJ decision must be used. For
example, if a claimant received an AOJ
decision relating to a compensation
claim and received a compensationfocused form (such as VA Form 21–
0958, Notice of Disagreement) from the
AOJ, the claimant could not initiate an
appeal by returning a different form
developed for the purpose of initiating
appeals of AOJ decisions relating to a
home loan guaranty.
In § 20.201(a)(2) of this final rule, VA
has made clear that it may ‘‘provide’’
the form to the claimant electronically
or in paper format. VA has provided
that if a claimant has an online benefits
account such as eBenefits, notifications
within the system that provide a link to
a standard appeal form would be
considered sufficient for the AOJ to
have ‘‘provided’’ the form to the
claimant and trigger the applicability of
§ 20.201(a). Similarly, if a claimant has
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provided VA with an email address for
the purpose of receiving
communications from VA, emailing
either a copy of the form itself or a
hyperlink where that form may be
accessed is sufficient. The email should
identify that the hyperlink is to a
required VA appeal form. Some
comments could be read to suggest that
VA should provide the form in both
electronic and paper format to all
claimants. To the extent this was the
commenters’ intent, VA rejects this
suggestion. Sending paper forms to
claimants who have established an
online benefits account or otherwise
indicated an intent to receive
communications from VA in electronic
format, such as by providing VA with an
email address for that purpose, would
be duplicative, wasteful, and
inconsistent with VA’s goals to
modernize the claims and appeals
process.
Finally, if a claimant has chosen to
interact with VA using paper, VA will
provide a paper version of the standard
form in connection with its decision.
The specific piece of paper that is sent
to the claimant need not be returned in
order to constitute an NOD, but the
same form must be returned. In other
words, if a claimant is sent a copy of a
particular form, he or she must return a
completed copy of that form, but not
necessarily the same piece of paper that
was mailed to the claimant.
Several commenters expressed
concern about VA’s procedure for
furnishing the standard form to
claimants and inquired as to the
procedure VA would take in order to
obtain the correct VA form from the
claimant if an alternate communication
is received by VA. As we explain above,
the requirement for an NOD to appear
on a standard form is only triggered
when VA provides a form for the
purpose of initiating an appeal in
connection with its benefits decision.
Accordingly, the requirement to use a
standard form necessarily only applies
to claimants who have already received
that form, and an explanation of how to
appeal VA’s decision. See 38 U.S.C.
5104 (notice of Secretary’s decision
‘‘shall include an explanation of the
procedure for obtaining review of the
decision’’). In the event VA receives an
incomplete standard NOD form, it will
follow the procedures set forth in
§ 19.24(b)(1). VA will furnish the
appropriate form or the standard NOD
form to claimants in paper format with
the decision notification letter as well as
providing a hyperlink to the standard
form in the decision notification letter.
One comment suggested that
§ 20.201(a)(2) be revised to state that VA
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‘‘must’’ provide the appeal form in the
applicable format, rather than ‘‘may.’’
This same comment asserts the rule
‘‘assume[s] VA will provide that form in
its decision letter.’’ This comment is
predicated on a misunderstanding of the
rule. Again, the requirement to use the
standard form is not triggered unless VA
provides the form in connection with its
decision. Inserting the term ‘‘must’’ into
§ 20.201(a)(2) would broaden the scope
of claims for which use of a form would
be mandatory.
One comment suggested that
§ 20.201(a)(2) should be revised to
require that the form be provided to the
claimant’s representative, if any, in
addition to the claimant. We have
considered this suggestion and agree. A
claimant’s representative generally must
receive the same decision notice that is
sent to the claimant. 38 U.S.C. 5104(a).
While this statutory principle does not
necessarily imply that any
representative must receive the form in
order to trigger the requirement that the
form be used to initiate an appeal,
ensuring representatives receive the
necessary form adds minimal additional
administrative burden.
However, we do not believe any
revisions are necessary in order to make
this clear. The rule as proposed and as
here confirmed as final provided that
the requirement to use a standard form
arises when the AOJ provides the
standard form, ‘‘in connection with its
decision.’’ Because the same statute
governing content of VA decisions
specifies that representatives are to
receive the same notice that is sent to
the claimant, this implies that any
representative should also receive the
form. We note that this reasoning
implies that the presumption
established in § 20.201(a)(3) will apply
to the question of whether the form was
provided to the representative.
Additionally, this rule does not alter the
scope of evidence or argument
submission within the VA system.
Therefore, if a representative is unsure
whether the form was provided,
particularly in a compensation claim,
we see no readily apparent substantive
reason why the representative would
not simply use the form, which is and
will remain widely available, to keep
the veteran’s claim moving as quickly as
possible. We see no reason why a
trained, accredited representative who
is aware of VA forms would spend an
inordinate amount of time attempting to
protect an option to submit an NOD in
a non-standard narrative format, rather
than simply filling out a form and
submitting argument on a separate
document if necessary. Finally, we note
the fact that the representative must
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receive the form in order to trigger the
requirement that the form be used does
not imply that the representative must
receive the form in the same format as
the claimant. In particular, a
representative with access to VA’s
Stakeholder Enterprise Portal, or who
otherwise interacts with VA
electronically, does not have to receive
the form in paper merely because he or
she represents a claimant that prefers to
interact with VA through paper.
In § 20.201(a)(3), VA has provided
that any indication whatsoever in the
claimant’s claims file or benefits
account of provision of a form would be
sufficient to presume the form was
provided, triggering the applicability of
§ 20.201(a) rather than § 20.201(b).
Under this rule, an indication as
minimal as a statement in a decision
notification letter such as ‘‘Attached:
VA Form 21–0958’’ would be sufficient
to trigger the presumption that the form
was provided and § 20.201(a) governs.
See Butler, 244 F.3d at 1339–41
(presumption of regularity applies to the
administration of veterans benefits).
In § 20.201(a)(4), VA provides that, if
a standard VA form requires some
degree of specificity from the claimant
as to which issues the claimant seeks to
appeal, the claimant must indeed
provide the information the form
requests in order for the submission to
constitute an NOD. For example, the
current form provides claimants with a
selection of separate boxes allowing
claimants to identify broad categories of
disagreement. VA believes it would be
helpful to the process to have this
requirement in the governing regulation.
Several commenters objected to the
requirement that an appeal be initiated
on a standard form. Many commenters
advanced the position that VA does not
have authority to require that NODs be
on standard forms designed for the
purpose of initiating an appeal, and
provided to the claimant with an
explanation that the form must be used
to initiate an appeal. In particular, some
commenters argued that governing
statutes did not allow VA to mandate
the use of a form and that whether a
document is an NOD is a question of
law for the Veterans Court to determine
de novo under 38 U.S.C. 7261(a).
Commenters also stated that requiring
an NOD form violates the Court’s
interpretation and plain language of 38
U.S.C. 7105.
VA has clear authority to require that
a claimant submit an NOD on a
particular form, and accordingly does
not agree with these comments. The
Federal Circuit has explicitly held that
38 U.S.C. 7105 ‘‘does not express a
complete and unambiguous meaning for
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the statutory term ‘notice of
disagreement,’ ’’ and that VA’s
implementation of section 7105
accordingly must receive the significant
deference due an agency’s reasonable
construction of a statute it administers.
Gallegos v. Principi, 283 F.3d 1309,
1313 (Fed. Cir. 2002); see Chevron,
U.S.A., Inc. v. Natural Resources
Defense Council, Inc., 467 U.S. 837,
842–45 (1984). Additionally, Congress
has specifically delegated authority to
VA to issue rules concerning ‘‘the forms
of application,’’ 38 U.S.C. 501(a)(2), and
has characterized a request for Board
review as an ‘‘[a]pplication for review
on appeal.’’ 38 U.S.C. 7106, 7107, 7108.
These explicit delegations of authority,
coupled with the significant benefits
that consistent use of the standard NOD
form will have in improving the
timeliness and accuracy in processing of
veterans’ appeals, make clear that our
construction of section 7105 is
reasonable.
It is irrelevant that the Veterans Court
might analyze whether a particular
document qualifies as an NOD as a
question of law as opposed to a question
of fact. If anything, this highlights the
essentially interpretive nature of the
current standard for an NOD. The
Veterans Court’s authority to review
VA’s determinations regarding whether
a particular veteran filed a timely NOD
under the legal standard applicable to
that veteran’s case does not have any
bearing whatsoever on VA’s authority to
define, by regulation, the legal standard
for an NOD, so long as VA’s definition
is consistent with the governing statute,
and a reasonable interpretation of any
statutory ambiguity.
Part of the rationale for requiring
standard VA forms, particularly for the
appeals of compensation claims, is that
they enable VA to identify the substance
of an appeal as early as possible in the
process. Additionally, inputs from the
claimant in a standardized format are
much more easily turned into data that
can be used in evaluating and
processing a claim or appeal.
VA strives to maintain the veteranfriendly, pro-claimant nature of the
appeals process by providing a format in
the standard form that allows claimants
to choose from pre-printed selections as
well as ample space on the form for
statements or comments in a narrative
format.
Some commenters expressed concern
that mandating the use of a standard
form means VA will not provide its
statutory duty of assisting claimants
with developing their claims or
providing notice to claimants. Some
maintained that the duty to assist
precludes VA from requiring appeals be
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initiated on standard forms. The
statutory duty to assist plainly does not
require VA to accept NODs regardless of
the format in which they are filed;
rather, it governs what efforts VA must
undertake to help a veteran secure
evidence necessary to establish the
elements of entitlement. 38 U.S.C.
5103A. That VA has a duty to gather
evidence does not imply VA cannot
issue reasonable regulations within its
explicitly delegated statutory authority
that are necessary to administer the
claims process. Further, the Federal
Circuit has held that what constitutes an
NOD is ambiguous in 38 U.S.C. 7105,
which, unlike 38 U.S.C. 5103A, applies
specifically to the appellate process.
VA’s regulations implementing this
statutory term accordingly receive
Chevron deference. Gallegos, 283 F.3d
at 1313.
VA disagrees with these comments,
but offers one clarifying change. The
plain language of § 19.24(a), both as
proposed and as here confirmed as final,
requires VA to identify and implement
any necessary development or review
action when a timely notice of
disagreement is filed. As proposed,
§ 19.24(a) provided that the AOJ ‘‘may’’
reexamine the claim and determine
what development or review action is
warranted. The use of the term ‘‘may’’
in the proposed rule was consistent
with the inherently discretionary nature
of VA’s development and review
obligation specific to this phase of the
process, and with the general scope of
the duty to assist. See 38 U.S.C.
7105(d)(1) (AOJ must take ‘‘such
development or review action as it
deems proper’’); see also 38 U.S.C.
5103A(a), (d) (Secretary must make
reasonable efforts to assist in obtaining
evidence ‘‘necessary’’ to substantiate the
claim, and must provide a medical
examination when one is ‘‘necessary to
make a decision’’). However, to make
clear that the AOJ is required to review
the claim in cases where a timely NOD
is filed and make the threshold
determination of whether any further
development or review action is deemed
necessary, we have changed ‘‘may’’ to
‘‘will’’ in this final rule. This rule does
not alter VA’s substantive duties in
regard to the processing of NODs. VA is
only requiring that claimants provide
their expression of dissatisfaction or
disagreement of an AOJ decision in a
specified format, i.e., on a standard
form. This does not alter the scope of
VA’s duty to take appropriate review
and development action upon the filing
of a notice of disagreement, or in any
way affect VA’s duty to assist claimants.
One commenter argued that AOJ
personnel failing to recognize an NOD
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under the current standard indicates a
need for better training, not imposing a
requirement on a veteran to complete a
form. We disagree with the embedded
premise of this comment that the
current standard is the ‘‘correct’’
standard that must be maintained
regardless of evidence and reasoning
indicating that it harms veterans and
VA’s efforts to accurately and efficiently
process appeals of benefits decisions.
Furthermore, VA has rigorous training
programs for AOJ personnel, and these
will continue under the implementation
of this rule. More fundamentally, the
standard for what constitutes an NOD
under the current rule is inherently
subjective, meaning no amount of
training can totally eliminate error in
the identification of NODs. Even
determinations that are not ‘‘erroneous’’
can be overturned by higher
decisionmakers who simply take a
different view of whether the subjective
standard of what constitutes an NOD is
met given the facts of the case.
Several commenters criticized the
layout or content of the current standard
NOD form. Some stated that the content
of the current standard appeals form did
not provide claimants with an option for
claimants to select an AOJ’s de novo
appellate review. Other commenters
expressed concern that the form is
inadequate to appeal certain benefits.
Other commenters suggested the form
contains too many terms of art to be
useful to veterans. Other commenters
questioned the motive behind VA
inquiring whether claimants would like
direct communication with the AOJ
regarding the appeal. Generally, VA is
considering the comments regarding the
content of the current standard appeals
form and will update or revise the form
based on these comments as necessary.
Specifically, VA is considering whether
the form should be revised to include an
election of de novo AOJ review pursuant
to 38 CFR 3.2600, as multiple
commenters urged. One commenter
expressed concern that the NOD form
does not have any language or
endorsement for the veteran to provide
indicating that he or she desires to
contest the result of the agency’s
decision. Similarly, another commenter
even suggested that this omission could
lead to VA determining its own form,
even if completed, does not constitute
an NOD, and disallow appeals due to
deficiencies in a form it had mandated
the use of. While VA can and will
continue to revise forms based on
experience in the administration of its
programs, we note that the filing of the
form itself provides the necessary
indication that the veteran disagrees
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with the original decision and desires to
contest the result.
It is true the form contains terms of art
specific to compensation claims. We
address this issue in section II.D. below.
In particular, however, we note that we
have revised § 19.24(b)(2) to enumerate
the information required to complete a
standard NOD form with greater
particularity. As we explain more fully
in section II.D., the form will continue
to solicit more detailed information
from the veteran because this is useful
in orderly and efficient processing, but
in § 19.24(b)(2)(iii) we clarify that the
form is considered complete if it
enumerates the issues or conditions for
which appellate review is sought.
Although no changes to the standard
NOD form were made, we did amend
the instructions to the NOD form to
provide notice to claimants of what is
minimally necessary to constitute a
complete NOD as well as the action VA
will take when an incomplete NOD is
received.
To the extent commenters object to
the current form’s focus on issues
specific to compensation claims, rather
than other benefit lines, we address this
issue above—the requirement to use a
form is only triggered when VA
provides the claimant a form for the
purpose of initiating an appeal in
connection with its initial decision.
This will enable VA to tailor the content
of standard NOD forms to suit the
substantive needs of VA’s diverse
benefit lines and operations. To the
extent commenters object to the lack of
a dedicated space on the current form to
identify a claimant’s belief that VA
wrongly denied entitlement to an
ancillary benefit related to a
compensation claim, such as special
monthly compensation, aid and
attendance, or total disability by reason
of individual unemployability, there are
at least two spaces on the current form
where it would be appropriate to
identify these issues, to the extent a
claimant is able to provide this degree
of specificity. One, such information
could be included on the section of the
form asking the claimant to identify
disagreement as to the evaluation
assigned. While each of these ancillary
benefits have their own specific criteria,
they are all fundamentally amounts of
increased compensation that are owed
to the claimant based upon the
circumstances, including severity of
disability, like any other rating and as,
discussed above, fall within the scope of
a complete claim when entitlement is
shown by evidence of record and stems
from one or more enumerated issues in
a claim. See 38 CFR 3.350, 4.16. Two,
such information could be included in
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the section on the form specifically
designated for a narrative statement
from the claimant. Additionally, though
we view the election of AOJ de novo
review as beyond the scope of a
rulemaking requiring a standard form to
initiate an appeal, we note that the
claimant can also elect to utilize this
procedure in this space on the current
standard NOD form designed for a
narrative statement. VA will consider
whether the form should be revised to
include a dedicated space for these
types of information based on its
ongoing experiences in administration
of the standard NOD form process. The
form includes a space to elect direct
communication with the AOJ regarding
the appeal because informal
communications between AOJ
personnel and veterans and their
representatives are extremely valuable
in clarifying and sometimes even
resolving the issues in an appeal. Many
claimants appreciate the availability of
this direct and informal engagement
from AOJ personnel. However, other
claimants react negatively, and even feel
that VA is harassing them if multiple
attempts at phone contact are made. The
election allows VA to target its limited
AOJ personnel time to cases where it is
likely to be useful.
In § 20.201(a)(5), VA states that the
filing of an alternate form or other
communication does not extend, toll, or
otherwise delay the time limit for filing
an NOD. In addition, VA clarifies that
returning the incorrect VA form,
including a form designed to appeal a
different benefit, does not extend the
deadline for filing an NOD. This policy
is necessary to bring efficiency to
appeals processing. Imposing a
requirement that AOJ personnel, even in
cases where a form pursuant to
§ 20.201(a)(5) was provided to the
claimant, must scour non-standard
claimant submissions in search of
communications which might be
reasonably construed as an expression
of disagreement in order to make sure
the claimant has not attempted to
initiate an appeal in the incorrect format
would require exactly the same timeintensive interpretive exercise that VA
seeks to end by requiring use of a
standard form. VA believes the one-year
statutory period in which to file an NOD
is ample time to fill out and return the
standard NOD form. Some commenters
requested that an alternate form or other
communication toll the time limit for
filing the correct form. For instance, one
commenter urged the addition of new
text in § 20.201(a)(5) essentially
providing that if a communication that
would qualify as an NOD under current
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rules is received in a case governed by
§ 20.201(a), VA will provide another
copy of the correct form and provide
another 60 days (or the remainder of the
one year statutory period in which to
initiate an appeal, whichever is longer)
for the claimant to return it. Other
commenters suggested that the time
limit not be tolled, but that VA still be
required to identify statements
indicating a claimant’s disagreement not
filed on the standard NOD form, notify
the veteran of the deficiency, and resend the NOD form.
VA makes no change based on these
comments. The point of requiring
appeals to be initiated on standard
forms is to reduce the need for AOJ
personnel to engage in the timeintensive interpretive review of nonstandard narrative submissions.
Requiring VA to identify that a
particular submission can ‘‘be construed
as disagreement’’ in a case otherwise
governed by the requirement to use a
standard form would destroy the
predictability and efficiency that use of
a form makes possible because it would
require the same amount of ‘‘by hand’’
review as is required under the current
system. Given that the requirement to
use the correct form is only triggered
when VA has provided the form to the
claimant, we do not believe it is
justified to create an exception requiring
exactly the kind of interpretive review
of narrative submissions, in such cases,
that this rule seeks to end. However, we
note that the fact we do not create an
exception requiring AOJ personnel to
engage in this type of review does not
imply that this rule would prevent AOJ
personnel from notifying a veteran who
has clearly expressed disagreement in a
narrative format that he or she must use
the form. In many instances, AOJ
personnel may even conclude that doing
so serves the interest of both clarity and
efficiency.
In § 20.201(c), VA clarifies that it does
not require a standardized form for
simultaneously contested claims, which
are claims in which the award of
benefits to one person may result in the
disallowance or reduction of benefits to
another person. 38 CFR 20.3(p). Such
claims arise only rarely and, irrespective
of the nature of the benefit sought, they
commonly present unique issues
involving marital or other relationships
of different individuals claiming
entitlement to the same or similar
benefits based on their relationship to
the same veteran. Further, in 38 U.S.C.
7105A, Congress has prescribed a 60day time limit for filing NODs in
simultaneously contested claims. In
view of these claims’ unique features,
we do not alter those governing
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standards. Moreover, because
simultaneously contested claims
constitute a very small portion of VA’s
appellate caseload, excluding those
claims from the requirement to use
standardized forms will not
significantly affect the objectives of this
rule. VA, therefore, states in paragraph
(c) of § 20.201 that the provisions of
§ 20.201(b) apply to simultaneously
contested claims. However, claimants in
simultaneously contested claims could
use a standard VA form, when feasible,
even though they would not be required
to do so.
B. Procedures for NODs Received on
Standard Form
This final rule creates two new
sections in part 19. New § 19.23
generally clarifies which procedures
apply to appeals governed by
§ 20.201(a), and which apply to appeals
governed by § 20.201(b). New § 19.23(b)
specifies that current procedures in
§§ 19.26 through 19.28 would continue
to apply to appeals of benefits decisions
governed by § 20.201(b), and new
§ 19.23(a) provides that these
procedures would apply only to those
cases. In other words, the provisions of
§§ 19.26 through 19.28 apply only to
appeals of AOJ decisions relating to
cases in which no standard form was
provided by the AOJ for the purpose of
initiating an appeal. New § 19.23(a) also
clarifies that the procedures in new
§ 19.24 apply to appeals of AOJ
decisions for cases in which the AOJ
provides a form for the purpose of
initiating an appeal, which are governed
by § 20.201(a). With this new clarifying
section, VA hopes to eliminate any
confusion potentially caused by the fact
that §§ 19.26 through 19.28 will no
longer provide governing procedures for
the overwhelming majority of VA’s
appellate caseload, but must be retained
for processing NODs relating to other
benefits for which no standardized NOD
form is provided.
One commenter stated that the
standard form for a NOD primarily
addresses compensation claims and not
other types of claims such as pension or
survivor benefits. Currently, the
compensation-focused form is VA’s only
standard NOD form. VA has not yet
designed appeal forms that meet the
specific needs of all other VA benefit
lines.
In paragraph (a) of new § 19.24, VA
provides that its practice of reexamining
a claim whenever an NOD is received
and determining if additional review or
development is warranted are also
applied to NODs submitted on
standardized forms.
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One comment suggested that 38 CFR
19.27 be changed to include reference to
§ 19.24 in addition to its current
reference to § 19.26. Section 19.27
specifies the procedures for situations
when VA does not believe a document
filed by a claimant expresses
disagreement and a desire to appeal
with adequate clarity to constitute an
NOD. VA views § 19.27 and related
§ 19.28 as being necessary primarily due
to the current amorphous standard for
what constitutes an NOD, and believes
that adopting standard forms will
obviate the need for these procedures in
the vast majority of cases. In cases
governed by § 20.201(a) and accordingly
by § 19.24, there should be no need for
appellate consideration of the
‘‘adequacy’’ of the NOD—the correct
form either was, or was not, filed within
the applicable timeframe. VA
accordingly declines to make § 19.27
applicable to the procedures in § 19.24.
However, in considering this
comment, VA has concluded it is
necessary for this final rule to include
some mechanism for claimants to
challenge VA’s determination that the
correct form was not timely filed. Even
if there should be no issue as to whether
an NOD was ‘‘adequate’’ in a case
governed by § 20.201(a) and § 19.24,
there is the possibility for technical
errors or errors by AOJ personnel. We
have therefore revised § 19.24 as
proposed to include a new paragraph
(d), which makes clear that VA’s
determination that no NOD was filed
may be appealed. However, this
paragraph also makes clear that
appellate consideration is limited to the
question of whether the correct form
was timely filed. This limitation is
necessary in order to prevent this
avenue for challenging VA’s
determination that no form was filed
from creating an open-ended exception
to the otherwise valid requirement that
an NOD must be on a standard form in
cases governed by §§ 20.201(a) and
19.24. In the event a competent
appellate review authority determines
that a valid NOD was in fact filed, the
AOJ would be required to process the
appeal, to include providing a statement
of the case relating to the substance of
the appeal. We note that, unlike § 19.27,
new paragraph 19.24(d) does not utilize
the procedures for administrative
appeals in 38 CFR 19.50–19.53. Those
procedures are designed to
accommodate disagreements among
agency personnel that admit of a degree
of subjective difference of opinion, such
as whether an ‘‘adequate’’ notice of
disagreement under the traditional
standard has been filed. Our purpose in
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making VA’s determination that no
NOD governed by §§ 20.201(a) and
19.24 was filed appealable is to provide
claimants a way to appeal any
administrative or technical errors by VA
personnel in the determination of
whether the correct form was timely
filed, not to resolve disagreements
among AOJ personnel in the resolution
of subjective questions such as whether
an ‘‘adequate’’ NOD has been filed.
Related to this issue, another
comment asks whether VA believes it
has authority to limit the Veterans
Court’s jurisdiction by rejecting an NOD
that satisfies the requirements of 38
U.S.C. 7105. We respond to the
embedded premise of this comment,
that requiring an NOD be on a standard
form is inconsistent with section
7105(d), in section II.A. However, we
have provided explicitly for appellate
review of whether a valid NOD has been
filed even in cases where the
requirement to utilize a standard form
attaches, in part to ensure claimants
have a means of obtaining factual
review of VA’s determinations as to
whether the correct form was filed in a
timely way (short of the drastic step of
filing a petition for a writ of
mandamus). VA has clear authority to
define what constitutes an NOD, but
claimants have a right to review of VA
factual and legal determinations under
any standard VA promulgates.
But the further suggestion that VA
cannot establish any requirements
pertaining to what constitutes an NOD
because those requirements form a
‘‘barrier’’ to the Veterans Courts’ review
of the merits of a claim cannot be
correct. This would imply that VA is
prohibited, by virtue of the Veterans
Court’s mere existence, from exercising
authority explicitly delegated by statute.
Further, we note that it is well
established that ‘‘[a] court’s prior
judicial construction of a statute trumps
an agency construction otherwise
entitled to Chevron deference only if the
prior court decision holds that its
construction follows from the
unambiguous terms of the statute and
thus leaves no room for agency
discretion.’’ Nat’l Cable & Telecomm
Ass’n v. Brand X Internet Services, 545
U.S. 967, 982 (2005); see also Eurodif
S.A. v. U.S, 423 F.3d 1275, 1276–77
(Fed. Cir. 2005).
C. Complete and Incomplete Appeals
Forms
In response to comments, in
paragraph (b) of new § 19.24, VA has
revised the proposed rule to reorganize
this section for clarification purposes by
distinguishing between incomplete and
complete appeal forms. VA has
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redesignated proposed paragraph (b) as
‘‘Incomplete and Complete Appeal
Forms’’ and restructured this section to
categorize ‘‘incomplete appeal forms’’ in
subparagraph (b)(1) and ‘‘complete
appeal forms’’ in subparagraph (b)(2).
Section 19.24(b)(1) outlines the
procedures for when a claimant submits
the correct form timely but incomplete.
VA believes that the authority to require
a claimant to use a particular form
necessarily implies the authority to
require that the form be completed, to
include identifying each specific issue
on which review of the AOJ decision is
desired. VA strongly believes that if
veterans provide all information
requested on the standardized VA form,
this will lead to the fastest possible
result for that individual veteran and
the VA appellate system will work more
efficiently for all veterans. Accordingly,
if VA determines a form is incomplete,
VA may require the claimant to timely
file a completed version of the form.
D. Completeness of the NOD Form
In revised § 19.24(b)(2), VA describes
the standard by which it would
determine whether or not a form to
initiate an appeal is complete, both in
general and for compensation claims in
particular. In general, a claimant must
provide the information to identify the
claimant, the claim to which the form
pertains, any information necessary to
identify the broad category of the
disagreement, and the claimant’s
signature in order for that form to be
considered complete. However, we did
not specifically enumerate the type of
information necessary to identify the
claimant in the rule text in order to
provide VA with some flexability to
ascertain the identity of a claimant by
using certain information or a
combination of information which the
claimant may provide. For example,
there are many claimants with identical
names to other claimants and a
claimant’s name alone may not
necessarily identify a specific claimant
with a particular claims file. If there is
other information specific to a claimant
such as a Social Security Number, then
VA would be able to identify a claimant
to his or her claims file even without the
claimant’s name. As opposed to
allowing VA to use the information
provided in a combination of ways to
identify a claimant, we believe that
enumerating the type of information
required to identify a claimant with
specificity would hinder both claimants
and the VA processing NODs. If VA
were to outline the exact requirements
of what is necessary to identify
claimants in its regulations, then a form
which contained information that could
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identify a particular claimant but did
not contain other non-essential
information could render the form
incomplete. This would result in VA
rejecting these forms for minor
ministerial or formalistic deficiencies,
thereby delaying the processing and
adjudication of a claimant’s appeal. By
allowing VA to determine in its
discretion what information is necessary
in identifying a claimant without
specific particularity in the regulations,
the regulation will enable VA to process
these notices of disagreement without
rejecting such forms as incomplete if
certain information was not provided,
thereby eliminating or preventing
prolonged administrative delays and
speeding up completion of an appeal.
For compensation claims being
appealed, a form is considered
incomplete if it does not enumerate the
issues or conditions for which appellate
review is sought. With respect to the
nature of disagreement, the form directs
claimants to indicate, for each appealed
condition, whether they disagree with
the AOJ’s decision on the question of
service connection, disability
evaluation, effective date, and/or any
other question. This information enables
VA to more efficiently process appeals
and avoid expending time and other
resources on matters the claimant does
not contest.
It is not VA’s intention to be overly
technical in determining whether
claimants have completed a form. The
purpose of this final rule is the orderly
and efficient processing of veterans’
claims and appeals, not the exclusion of
legitimate appeals, and VA’s decision to
conclude that a form is incomplete and
request completion will be guided by
this principle. See Robinson v. Shinseki,
557 F.3d 1355, 1361 (Fed. Cir. 2009)
(‘‘[i]n direct appeals, all filings must be
read ‘in a liberal manner’ whether or not
the veteran is represented’’). As with the
consideration of claims meeting the
standard of a complete claim, VA
stresses that it does not intend to
consider a form used to initiate an
appeal to be incomplete and to request
further completion unless that is a
reasonable course of action to facilitate
orderly processing of the appeal.
Several commenters stated that the
requirement of a complete standard
form for an expression of disagreement
‘‘converts a legal notice into a
substantive pleading by installing
requirements in an undefined form’’
that violates 38 U.S.C. 7105(a) and that
the form requires a level of knowledge
beyond the average veteran, especially
one who is not represented by a VAaccredited representative. VA considers
the requirements of a complete NOD
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minimally burdensome to claimants. VA
disagrees that providing basic
information sufficient to identify which
claim or issue the claimant seeks to
appeal, such as identifying that an
appeal pertains to a claim for a knee
disability as opposed to a shoulder
disability, is equivalent to requiring a
substantive pleading sufficient to
initiate a civil action. In order to
provide claimants with clear indication
of what constitutes a complete form as
provided in § 19.24(b)(2), we have
amended the instructions to the NOD
form to provide the criteria for a
complete NOD but we have not changed
or altered the NOD form itself.
As we have explained, VA has
intentionally drafted this rule to make it
possible for VA to respond to evolving
needs in the appellate workload, to
include the possibility that benefit lines
other than compensation may need a
standardized form to facilitate orderly
processing. However, this does not
mean this rule would allow VA to
impose unlimited requirements into an
undefined form. First of all, alteration to
any existing form, and creation of any
new form, is governed by the Paperwork
Reduction Act (see below), which in
many cases requires public notice and
comment before new collections of
information are legally valid. More
fundamentally, however, any
requirement that VA ‘‘inserts’’ into a
standard NOD form must be a
reasonable exercise of VA’s statutory
authority. If VA were to add to a
standard NOD form a requirement
totally unrelated to providing notice
that the claimant disagrees with a VA
decision and obtaining information
necessary to facilitate the orderly
administrative action such a notice
triggers, that requirement would be
beyond the scope of the statutes that
confer authority on VA to require the
form in the first place.
Section 19.24(b)(2) responds to
commenters’ concerns regarding the
level of specificity required for a form
to be considered complete by making
clear that a form ‘‘will,’’ rather than
‘‘may,’’ be considered complete if it
meets the following criteria: Information
to identify the claimant; information to
identify the claim to which the form
pertains, and information necessary to
identify the specific nature of the
disagreement, to include for
compensation claims, the issues or
conditions for which appellate review is
sought; and the claimant’s signature. In
particular, we note that § 19.24(b)(2)(iii)
as revised provides that, for
compensation claims, a form will be
considered complete if it enumerates
the issues or conditions for which
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appellate review is sought, or if it
provides other more granular
information required on the form to
identify the nature of the disagreement
(such as disagreement with disability
rating, effective date or denial of service
connection). This means that, at a
minimum, VA would consider the
identification of an issue, such as a
‘‘shoulder disability,’’ sufficient for
purposes of meeting this criterion for a
complete appeal form, even if the form
on its face requires additional
information. While the current standard
appeals form for compensation claims
instructs claimants to list each specific
issue of disagreement, it also provides
selections for more detailed description
in association with each issue. For each
issue of disagreement, claimants can
select an area of disagreement, e.g.,
service connection, effective date of an
award, evaluation of disability, or other
and claimants can also provide a
percentage of the evaluation sought if
applicable. However, VA would
consider this form complete if the
claimant provides biographical
information, the specific issue(s), and
the claimant’s signature. It would not be
necessary for a claimant to describe the
area of disagreement or percentage of
the evaluation sought for each issue in
order for VA to consider the form
complete. Once VA receives the
complete NOD, it will make the
appropriate readjudication
determinations necessary for those
specific issues listed such as
determining whether the correct
evaluation percentage or effective date
was assigned or if other benefits should
have been granted based on the
evidence. However, we believe it is
valuable for the form to solicit
information pertaining to the specific
nature of the disagreement, even if
claimants can complete the form by
providing less information. We note that
claimants will facilitate the timely
consideration of their appeals if they
provide VA with as much information
as possible regarding the nature of their
disagreement as early in the process as
possible.
One commenter asked if a veteran
indicates a particular effective date on a
standard form, but the correct date is
earlier, which date VA would grant. In
the clean hypothetical situation posited
by the commenter, the answer is that
VA would grant the correct date. Again,
the requirement to use a standard form
to initiate the appeal, even a form that
solicits particular information in order
to facilitate accurate and efficient
consideration of the claim, does not
alter the scope of VA’s ‘‘development
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57685
and review’’ action required by 38
U.S.C. 7105(d).
E. Timeframe To Cure Incomplete NOD
In revised and redesignated
§ 19.24(b)(3), VA states that incomplete
forms must be completed within 60
days from the date of VA’s request for
clarification, or the remainder of the
period in which to initiate an appeal of
the AOJ decision, whichever is later. VA
provides this 60-day grace period in
order to protect the claimant’s rights in
the event the statutory deadline has
passed when VA determines the
claimant has filed an incomplete form.
Given that submission of the correct
form would clearly identify to AOJ
personnel that a claimant wishes to
pursue an appeal, VA would accept the
incomplete form for purposes of
determining whether a claimant has met
the statutory deadline. However, the
claimant must complete the form within
the 60-day timeframe. This time
requirement would correspond to the
current 60-day period provided in 38
CFR 19.26(c) for clarification of an
ambiguous NOD filed under the
traditional process.
In § 19.24(b)(4), VA states that if no
completed form is received within the
timeframe established in paragraph
(b)(3), the decision of the AOJ shall
become final.
Some commenters stated that
incomplete NODs that are not cured
within 60 days would mean the veteran
would forfeit the right to appeal. As
proposed § 19.24(b)(2) clearly stated,
‘‘[i]f VA requests clarification of an
incomplete form, a complete form must
be received within 60 days from the
date of the request, or the remainder of
the period in which to initiate an appeal
of the decision of the [AOJ], whichever
is later.’’ Accordingly, the veteran does
not forfeit the right to appeal so long as
a complete form is submitted within the
statutory one-year period in which to
submit an NOD, or within the 60-day
‘‘grace’’ period, whichever provides the
veteran with more time to cure the
deficiency. The regulatory language
makes clear to provide that the issues or
contentions enumerated in incomplete
forms will become final if they are not
cured within the 60-day period or
within the statutory one-year period for
submitting an NOD. In order to address
commenters’ concerns that VA will
deem a form incomplete without
providing any notice to the veteran, we
have also revised § 19.24(b)(1) to make
clear that the requirement to cure or
correct the filing of an incomplete form
by filing a completed version of the
correct form does not arise unless VA
informs the claimant or his or her
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representative that the form is
incomplete and requests clarification.
VA will not spend its limited resources
by undertaking this cycle of clarifying
activity unless it is necessary to the
orderly processing and adjudication of
the appeal. We also note that § 19.24(b)
as proposed referenced the
‘‘verification’’ of an incomplete form.
We have replaced ‘‘verification’’ with
‘‘clarification’’ in the relevant portion of
§ 19.24(b)(1) as organized in this final
rule.
In § 19.24(b)(5), VA provides that if
the completed form arrives within the
timeframe established in paragraph
(b)(3), VA will treat the completed form
as the NOD and will reexamine the
claim to determine whether additional
review or development is warranted.
Furthermore, if no further review or
development is required, VA will
prepare a Statement of the Case
pursuant to § 19.29 of this part unless
the disagreement is resolved by a grant
of the benefit(s) sought on appeal or the
NOD is withdrawn by the claimant.
VA initially proposed in § 19.24(b)(5)
that if a form is so incomplete that the
claimant to whom it pertains is
unidentifiable, VA would not take
action on the basis of the submission of
that form and the form would be
discarded. Moreover, VA proposed that
it would always attempt to identify the
claimant to whom the form pertains
based on any statements or other
information provided before discarding
the form. However, this proposed
provision has been deleted as such
instances are rare. Even though this
scenario is so rare that VA does not
view it as necessary to include in
regulations, VA will always attempt to
identify the claimant to whom any form
pertains based on all available context
and information.
In paragraph (c) of § 19.24 of this final
rule, VA provides that if a form
enumerates some, but not all, of the
issues or conditions which were the
subject of the AOJ decision, the form
would be considered complete with
respect to the issues on appeal.
Furthermore, VA clarifies that any
issues or medical conditions not
enumerated would not be considered
appealed on the basis of the filing of
that form and that those unnamed issues
would become final 1 year after the date
of the mailing of the notice of the
decision unless the claimant files a
separate form addressing those issues or
conditions within the timeframe set
forth in paragraph (b)(3) of this section.
This does not prevent the claimant from
appealing those issues or contentions
not named in the form or from filing a
subsequent form initiating appeals of
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other issues within the AOJ decision.
VA has added this clarification to the
final rule in this paragraph (c) as the
proposed rule did not specifically state
that a claimant would retain the ability
to appeal other unnamed issues or
contentions within the timeframe
allowed by current § 19.26(c).
F. Other Regulations
To ensure other regulatory sections
that discuss NODs are consistent with
these changes, VA also adopts the minor
revisions in this final rule to a few other
sections. Specifically, VA revises
§ 3.2600, which discusses optional de
novo review procedures at the AOJ after
an NOD is filed, to cross reference the
format and timeliness requirements of
§ 20.201, and either § 20.302(a) or
§ 20.501(a), as applicable, in the first
sentence of paragraph (a). VA also
revises § 20.3(c), which currently
defines an appellant as ‘‘a claimant who
has initiated an appeal to the Board of
Veterans’ Appeals by filing a Notice of
Disagreement pursuant to the provisions
of 38 U.S.C. 7105.’’ Since 38 U.S.C. 7105
only requires that an NOD be submitted
in writing, VA revises 38 CFR 20.3(c) to
cross reference the format requirements
in § 20.201, and the timeliness
requirements of either § 20.302(a) or
§ 20.501(a), as applicable. VA believes
this revision would ensure that there is
no confusion regarding what
requirements a claimant must follow to
submit a valid NOD. Similarly, § 20.200
currently provides, in part, that an
appeal includes ‘‘a timely filed Notice of
Disagreement in writing.’’ VA revises
§ 20.200 to replace ‘‘in writing’’ with
cross references to § 20.201, and either
§ 20.302(a) or § 20.501(a), as applicable.
Effective Date of Final Rule
In order to accommodate the changes
to VA’s claims and appeals processes,
VA estimates that it will need 6 months,
or approximately 180 days, to prepare
for and implement this final rule. This
180-day period provides time for VA to
conduct outreach efforts to inform and
educate veterans, claimants, their family
members, authorized representatives,
and other stakeholders, to train and
educate VA staff on the more
standardized process, and to implement
changes to VA’s internal, operational
business programs. As such, this final
rule will apply only with respect to
claims and appeals filed 180 days after
the date this rule is published in the
Federal Register as a final rule. Claims
and appeals pending under the current
regulations as of that date would
continue to be governed by the current
regulations.
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Paperwork Reduction Act
The Paperwork Reduction Act of 1995
(44 U.S.C. 3507(d)) requires that VA
consider the impact of paperwork and
other information collection burdens
imposed on the public. According to the
1995 amendments to the Paperwork
Reduction Act (5 CFR 1320.8(b)(2)(vi)),
an agency may not collect or sponsor
the collection of information, nor may it
impose an information collection
requirement, unless it displays a
currently valid Office of Management
and Budget (OMB) control number. This
final rule includes provisions
constituting collections of information
under the Paperwork Reduction Act of
1995 (44 U.S.C. 3501 through 3521) that
require approval by OMB.
I. Changes to the Scope of Currently
Approved OMB Information Collections
As part of the proposed rule, RIN
2900–AO81, VA previously solicited
comments on the collections of
information contained in this section.
As noted in the proposed rule, this final
rule will impose amended information
collection requirements in 38 CFR
3.154, 3.155, 3.812, and 20.201 which
are described immediately following
this paragraph, under their respective
titles. As required by the Paperwork
Reduction Act of 1995 (at 44 U.S.C.
3507(d)), VA has submitted these
information collection amendments to
OMB for its review. Notice of OMB
approval for this information collection
will be published in a future Federal
Register document.
Title: Standard Claims and Appeals
Forms.
Summary of collection of information:
The Department of Veterans Affairs
(VA) through its Veterans Benefits
Administration (VBA) administers an
integrated program of benefits and
services, established by law, for
veterans, service personnel, and their
dependents and/or beneficiaries. Title
38 U.S.C. 5101(a) provides that a
specific claim in the form provided by
the Secretary must be filed in order for
benefits to be paid to any individual
under the laws administered by the
Secretary. The amended collection of
information in final 38 CFR 3.154,
3.155, 3.403, 3.660, 3.665, 3.666, 3.701,
3.812, and 20.201 would require
claimants to submit VA prescribed
applications in either paper or
electronic submission of responses,
where applicable, in order to initiate the
claims or appeals process for all VA
benefits, to include but not limited to:
Entitlement under 38 U.S.C. 1151,
which governs disability compensation
and death benefits for a qualifying
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disability or death of a veteran from VA
treatment, examination or vocational
rehabilitation; disability compensation;
non-service connected pension; and
dependency and indemnity
compensation (DIC), death pension, and
accrued benefits. In addition, under this
rulemaking, we would require claimants
to submit a standard form to initiate an
appeal. Information is requested by this
form under the authority of 38 U.S.C.
7105.
Description of need for information
and proposed use of information: There
is no substantive change in the need for
information and proposed use of
information collected for the following
affected OMB-approved Control
Numbers:
• 2900–0791 (VA Form 21–0958)—
This form will be used by claimants to
indicate a disagreement with a decision
issued by a Regional Office to initiate an
appeal.
• 2900–0001 (VA Form 21–526 and
21–526b)—These forms are used to
gather the necessary information to
determine a veteran’s eligibility,
dependency, and income, as applicable,
for the compensation and/or pension
benefit sought without which
information would prevent a
determination of entitlement;
• 2900–0743 (VA Form 21–526c)—
This form is used to gather necessary
information from service members filing
claims under the Benefits Delivery at
Discharge or Quick Start programs
under Title 38 U.S.C. 5101(a) used in a
joint effort between VA and Department
of Defense (DoD) for the expeditious
process of determining entitlement to
compensation disability benefits;
• 2900–0002 (VA Form 21–527)—
This form is used to gather the
necessary information to determine a
veteran’s eligibility and dependency, as
applicable, for disability pension sought
without which information would
prevent a determination of entitlement;
• 2900–0004 (VA Form 21–534)—
This form is used to gather necessary
information to determine the eligibility
of surviving spouses and children for
dependency and indemnity
compensation (DIC), death pension,
accrued benefits and death
compensation;
• 2900–0004 (VA Form 21–534a)—
This form is used to gather necessary
information to determine the eligibility
of surviving spouses and children of
veterans who died while on active duty
service for DIC, death pension, accrued
benefits, and death compensation;
• 2900–0005 (VA Form 21–535)—
This form is used to gather necessary
information to determine a parent’s
eligibility, dependency and income, as
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applicable, for the death benefit sought;
and
• 2900–0747 (VA Forms 21–526EZ,
21–527EZ, and 21–534EZ)—These
forms are used to gather the necessary
information to determine a veteran’s
eligibility, dependency, and income, as
applicable, for the compensation and/or
pension and disability pension and to
determine the eligibility of surviving
spouses, children and parents for
dependency and indemnity
compensation (DIC), death pension,
accrued benefits and death
compensation as well as other benefits.
• 2900–0572 (VA Form 21–0304)—
This form is used to gather the
necessary information to determine
eligibility for the monetary allowance
and the appropriate level of payment for
a child with spina bifida who is the
natural child of a veteran who served in
the Republic of Vietnam during the
Vietnam era and for a child with certain
birth defects who is the natural child of
a female veteran who served in the
Republic of Vietnam during the Vietnam
era.
• 2900–0721 (VA Form 21–2680)—
This form is used to gather the
necessary information to determine
eligibility for the aid and attendance
and/or household benefit.
• 2900–0067 (VA Form 21–4502)—
This form is used to gather the
necessary information to determine if a
veteran or serviceperson is entitled to an
automobile allowance and adaptive
equipment.
• 2900–0390 (VA Form 21–8924)—
This form is used to gather the
necessary information to determine if
the application meets the Restored
Entitlement Program for Survivors
(REPS) program which pays VA benefits
to certain surviving spouses and
children of veterans who died in service
prior to August 13, 1981 or who died as
a result of a service-connected disability
incurred or aggravated prior to August
13, 1981.
• 2900–0404 (VA Form 21–8940)—
This form is used to gather the
necessary information to determine
whether individual unemployability
benefits may be paid to a veteran who
has a service-connected disability(ies)
which result in an inability to secure or
follow substantially gainful occupation.
• 2900–0132 (VA Form 26–4555)—
This form is used to gather the
necessary information to determine the
eligibility for the Specially Adapted
Housing (SAH) or Special Housing
Adaptations (SHA) benefits for disabled
veterans or servicemembers.
Description of likely respondents:
There is no substantive change in the
description of likely respondents for the
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following affected OMB-approved
Control Numbers:
• 2900–0791 (VA Form 21–0958)—
Veterans or claimants who indicate
disagreement with a decision issued by
a Regional Office (RO) will use VA Form
21–0958 in order to initiate the appeals
process. The veteran or claimant may or
may not continue with an appeal to the
Board of Veterans Appeals (BVA). If the
veteran or claimant opts to continue to
BVA for an appeal, this form will be
included in the claim folder as
evidence.
• 2900–0001 (VA Form 21–526 and
21–526b)—Veterans or claimants who
express an intent to file for disability
compensation and/or pension benefit
may continue to use VA Form 21–526.
Veterans or claimants who express an
intent to file for disability compensation
for an increased evaluation, service
connection for a new disability,
reopening of a previously denied
disability, or for a disability secondary
to an existing service connected
disability or for other ancillary benefits
such as aid and attendance, automobile
allowance, spousal aid and attendance,
or other benefit may continue to use VA
Form 21–526b.
• 2900–0743 (VA Form 21–526c)—
Service members filing claims under the
Benefits Delivery at Discharge or Quick
Start programs under Title 38 U.S.C.
5101(a) may continue to use VA Form
21–526c for disability compensation
benefits.
• 2900–0002 (VA Form 21–527)—
Veterans who are reapplying for VA
pension benefits or previously applied
for VA compensation benefits and are
now applying for VA pension benefits
may continue to use VA Form 21–527.
• 2900–0004 (VA Form 21–534 and
21–534a)—Claimants such as surviving
spouses and children filing for
dependency and indemnity
compensation (DIC), death pension,
accrued benefits, and death
compensation claims may continue to
use VA Form 21–534. Military Casualty
Assistance Officers who are assisting
surviving spouses and children in filing
claims for death benefits may continue
to use VA Form 21–534a.
• 2900–0005 (VA Form 21–535)—
Claimants who are filing for benefits
subsequent to the death of the veteran
may continue to use VA Form 21–535.
• 2900–0747 (VA Forms 21–526EZ,
21–527EZ, and 21–534EZ)—Veterans or
claimants who are filing for disability
compensation, pension, dependency
and indemnity compensation, death
pension, accrued benefits and death
compensation claims and other benefits
such an ancillary benefit claims and
entitlement to 38 U.S.C. 1151 benefits
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that filed for processing in both the
traditional claims system or in the
expedited claims processing system
known as the Fully Developed Claims
program may continue to use VA Form
21–526EZ for disability compensation;
VA Form 21–527EZ for non-service
connected pension benefits; and VA
Form 21–534EZ for dependency and
indemnity compensation, death
pension, and/or accrued benefits.
• 2900–0572 (VA Form 21–0304)—
Claimants who are filing for the
monetary allowance and payment for a
child with spina bifida who is the
natural child of a veteran who served in
the Republic of Vietnam during the
Vietnam era and for a child with certain
birth defects who is the natural child of
a female veteran who served in the
Republic of Vietnam during the Vietnam
era may continue to use VA Form 21–
0304.
• 2900–0721 (VA Form 21–2680)—
Claimants who are filing for eligibility
for the aid and attendance and/or
household benefit may continue to use
VA Form 21–2680.
• 2900–0067 (VA Form 21–4502)—
Veterans or servicepersons who are
filing for entitlement to an automobile
allowance and adaptive equipment may
continue to use VA Form 21–4502.
• 2900–0390 (VA Form 21–8924)—
Certain surviving spouses and children
of veterans who died in service prior to
August 13, 1981 or who died as a result
of a service-connected disability
incurred or aggravated prior to August
13, 1981 under the Restored Entitlement
Program for Survivors (REPS) program
may continue to use VA Form 21–8924.
• 2900–0404 (VA Form 21–8940)—
Claimants who file for individual
unemployability benefits for serviceconnected disability(ies) which result in
an inability to secure or follow
substantially gainful occupation may
continue to use VA Form 21–8940.
• 2900–0132 (VA Form 26–4555)—
Disabled veterans or servicemembers
who file for Specially Adapted Housing
(SAH) or Special Housing Adaptations
(SHA) benefits may continue to use VA
Form 26–4555.
Estimated frequency of responses:
• 2900–0791 (VA Form 21–0958)—
One time for most claimants; however,
the frequency of responses is also
dependent on the number of appeals
submitted on this form by the claimant
as VA does not limit the number of
appeals that a claimant can submit.
• 2900–0001 (VA Form 21–526 and
21–526b)—One time for most
beneficiaries; however, the frequency of
responses is also dependent on the
number of claims submitted on this
form by the claimant as VA does not
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limit the number of claims that a
claimant can submit.
• 2900–0743 (VA Form 21–526c)—
One time for most beneficiaries;
however, the frequency of responses is
also dependent on the number of claims
submitted on this form by the claimant
as VA does not limit the number of
claims that a claimant can submit.
• 2900–0002 (VA Form 21–527)—
One time for most beneficiaries;
however, the frequency of responses is
also dependent on the number of claims
submitted on this form by the claimant
as VA does not limit the number of
claims that a claimant can submit.
• 2900–0004 (VA Form 21–534 and
21–534a)—One time for most
beneficiaries.
• 2900–0005 (VA Form 21–535)—
One time for most beneficiaries.
• 2900–0747 (VA Forms 21–526EZ,
21–527EZ, and 21–534EZ)—One time
for most beneficiaries; however, the
frequency of responses is also
dependent on the number of claims
submitted on this form by the claimant
as VA does not limit the number of
claims that a claimant can submit.
• 2900–0572 (VA Form 21–0304)—
One time for most beneficiaries.
• 2900–0721 (VA Form 21–2680)—
One time for most beneficiaries.
• 2900–0067 (VA Form 21–4502)—
One time for most beneficiaries.
• 2900–0390 (VA Form 21–8924)—
One time for most beneficiaries.
• 2900–0404 (VA Form 21–8940)—
One time for most beneficiaries.
• 2900–0132 (VA Form 26–4555)—
One time for most beneficiaries.
Estimated average burden per
response: There is no substantive
change in the estimated average burden
per response for the following affected
OMB-approved Control Numbers:
• 2900–0791 (VA Form 21–0958)—30
minutes.
• 2900–0001 (VA Form 21–526 and
21–526b)—VA Form 21–526—1 hour;
and VA Form 21–526b—15 minutes;
and VA Form 21–4142—5 minutes.
• 2900–0743 (VA Form 21–526c)—15
minutes.
• 2900–0002 (VA Form 21–527)—1
hour.
• 2900–0004 (VA Form 21–534 and
21–534a)—VA Form 21–534—1 hour
and 15 minutes and VA Form 534a—15
minutes.
• 2900–0005 (VA Form 21–535)—1
hour and 12 minutes.
• 2900–0747 (VA Forms 21–526EZ,
21–527EZ, and 21–534EZ)—VA Form
21–526EZ—25 minutes; VA Form 21–
527EZ—25 minutes; and VA Form 21–
534EZ—25 minutes.
• 2900–0572 (VA Form 21–0304)—10
minutes.
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• 2900–0721 (VA Form 21–2680)—30
minutes.
• 2900–0067 (VA Form 21–4502)—15
minutes.
• 2900–0390 (VA Form 21–8924)—20
minutes.
• 2900–0404 (VA Form 21–8940)—45
minutes.
• 2900–0132 (VA Form 26–4555)—10
minutes.
Estimated number of respondents: VA
anticipates the annual estimated
numbers of respondents for each of the
OMB-approved forms as follows:
• 2900–0791 (VA Form 21–0958)—
144,000 per year as previously
estimated in ICR Reference No. 201206–
2900–001 and as published in the
Federal Register, 77 FR 42556 on July
19, 2012 and 77 FR 60027 on October
1, 2012.
• 2900–0001 (VA Form 21–526 and
21–526b)—304,325 per year, based on 5year estimated average of formal and
informal initial compensation and
pension claims received annually at
83,855 and formal and informal new or
reopened compensation claims received
annually at 217,178, in addition to the
historically reported annual estimated
number of responses for VA Form 21–
4142 at 3,292.
• 2900–0743 (VA Form 21–526c)—
161,000 per year as previously
estimated in ICR Reference No. 201209–
2900–010 and as published in the
Federal Register, 77 FR 190, on October
1, 2012 and 77 FR 240 on December 13,
2012.
• 2900–0002 (VA Form 21–527)—
17,111 per year, based on a 5-year
estimated average of 12,253 reopened
pension claims received on VA Form
21–527 in addition to an estimated
number of 4,858 expected to be received
for informal reopened pension claims.
• 2900–0004 (VA Form 21–534 and
21–534a)—33,864 per year, based on a
5-year estimated average of 32,438
formal and informal death benefits
claims filed by surviving spouses/child
in addition to a 5-year estimated
number of 1,426 formal and informal
death benefits claims filed by surviving
spouses/child for in-service death.
• 2900–0005 (VA Form 21–535)—
1,783 per year, based on a 5-year
estimated average of 1,046 formal death
benefits filed by parents in addition to
an expected estimated number of
informal death benefit claims at 737.
• 2900–0747 (VA Forms 21–526EZ,
21–527EZ, and 21–534EZ)—1,048,652
per year, based on: (a) An estimated
number of both formal and informal—
initial, new, reopened compensation
claims at 835,910; plus (b) an estimated
number of both formal and informal
pension claims at 101,086; (c) an
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estimated number of both formal and
informal death benefit claims at
111,656, all of which total 1,048,652.
VA expanded a modified version of a
pilot study, known as the Express Claim
Program, for which VA Forms 21–526EZ
and 21–527EZ were used. Therefore, the
number of claimants expected to
respond was estimated at 104,440.
These EZ forms contain the section 5103
notification for disability, pension, and
now death benefits in paper and
electronic format. The electronic
application uses the EZ form in its
question prompts and generates this
form upon completion of the interview
process.
While this rule does not attach unique
effective date consequences to utilizing
the electronic claim process, as the
proposed rule would have, VA still
expects a substantial increase in the
number of respondents for this
particular Control Number. As one
commenter pointed out, the fact that VA
is able to decide a claim more quickly
when the claimant files an electronic
application form provides claimants an
incentive to utilize the electronic
process. Additionally, the intent to file
a claim process that we establish in this
final rule will greatly increase the role
of standard application forms because
VA will provide claimants with the
required standard application form
upon receiving an intent to file a claim.
VA will typically provide EZ forms in
this purpose. This intent to file a claim
process will apply to types of claims for
which no standard form of any kind is
currently required, such as claims
governed by current § 3.155(c).
• 2900–0572 (VA Form 21–0304)—
430 per year.
• 2900–0721 (VA Form 21–2680)—
14,000 per year.
• 2900–0067 (VA Form 21–4502)—
1,552 per year.
• 2900–0390 (VA Form 21–8924)—
1,800 per year.
• 2900–0404 (VA Form 21–8940)—
24,000 per year.
• 2900–0132 (VA Form 26–4555)—
4,158 per year.
OMB Control Numbers 2900–0572,
2900–0721, 2900–0067, 2900–0390,
2900–0404, and 2900–0132 are
collections of information for particular
benefits such as automobile allowance,
housing adaptation, individual
unemployability, etc., which are
currently required by the VA in order
for these claims to be processed and
adjudicated. Since VA requires these
forms to be submitted for filing of a
particular benefit, VA does not expect
an increase in the annual likely number
of respondents. In addition, VA is not
changing the substance of the collection
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of information on these OMB-approved
collections of information nor is it
increasing the respondent burden. We
are including these collections of
information in this rulemaking because
it is relevant to the rulemaking but is
not directly altered by it.
Estimated total annual reporting and
recordkeeping burden:
• 2900–0791 (VA Form 21–0958)—
Annual burden continues to be 72,000
hours. The total estimated cost to
respondents continues to be $1,080,000
(72,000 hours x $15/hour). This
submission does not involve any
recordkeeping costs.
• 2900–0001 (VA Form 21–526 and
21–526b)—For VA Form 21–526, the
annual burden is 83,855 hours. The total
estimated cost to respondents is
$1,257,825 (83,855 hours × $15/hour).
This submission does not involve any
recordkeeping costs. For VA Form 21–
526b, the annual burden is 54,295
hours. The total estimated cost to
respondents is $81,443 (54,295 hours ×
$15/hour). This submission does not
involve any recordkeeping costs. For VA
Form 21–4142, the annual burden is 263
hours. The total estimated cost to
respondents is $330 (263 hours × $15/
hour). This submission does not involve
any recordkeeping costs.
• 2900–0743 (VA Form 21–526c)—
Annual burden continues to be 40,250
hours. The total estimated cost to
respondents continues to be $603,750
(40,250 hours × $15/hour). This
submission does not involve any
recordkeeping costs.
• 2900–0002 (VA Form 21–527)—
Annual burden is 17,111 hours. The
total estimated cost to respondents is
$256,665 (17,111 hours × $15/hour).
This submission does not involve any
recordkeeping costs.
• 2900–0004 (VA Form 21–534 and
21–534a)—For VA Form 21–534, the
annual burden is 40,548 hours. The total
estimated cost to respondents is
$608,220 (40,548 hours × $15/hour).
This submission does not involve any
recordkeeping costs. For VA Form 21–
534a, the annual burden is 357 hours.
The total estimated cost to respondents
is $5,355 (3,57 hours × $15/hour). This
submission does not involve any
recordkeeping costs.
• 2900–0005 (VA Form 21–535)—
Annual burden is 2,140 hours. The total
estimated cost to respondents is $32,100
(2,140 hours × $15/hour). This
submission does not involve any
recordkeeping costs.
• 2900–0747 (VA Forms 21–526EZ,
21–527EZ, and 21–534EZ)—For VA
Form 21–526EZ, the annual burden is
348,296 hours. The total estimated cost
to respondents is $55,224,440 (348,296
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57689
hours × $15/hour). This submission
does not involve any recordkeeping
costs. For VA Form 21–527EZ, the
annual burden is 42,119 hours. The total
estimated cost to respondents is
$631,785 (42,119 hours × $15/hour).
This submission does not involve any
recordkeeping costs. For VA Form 21–
534EZ, the annual burden is 46,523
hours. The total estimated cost to
respondents is $697,845 (46,523 hours ×
$15/hour). This submission does not
involve any recordkeeping costs.
• 2900–0572 (VA Form 21–0304)—
Annual burden continues to be 72
hours. The total estimated cost to
respondents continues to be $1,080 (72
hours × $15/hour). This submission
does not involve any recordkeeping
costs.
• 2900–0721 (VA Form 21–2680)—
Annual burden continues to be 7,000
hours. The total estimated cost to
respondents continues to be $105,000
(7,000 hours × $15/hour). This
submission does not involve any
recordkeeping costs.
• 2900–0067 (VA Form 21–4502)—
Annual burden continues to be 388
hours. The total estimated cost to
respondents continues to be $5,820 (388
hours × $15/hour). This submission
does not involve any recordkeeping
costs.
• 2900–0390 (VA Form 21–8924)—
Annual burden continues to be 600
hours. The total estimated cost to
respondents to be $9,000 (600 hours ×
$15/hour). This submission does not
involve any recordkeeping costs.
• 2900–0404 (VA Form 21–8940)—
Annual burden continues to be 18,000
hours. The total estimated cost to
respondents continues to be $270,000
(18,000 hours × $15/hour). This
submission does not involve any
recordkeeping costs.
• 2900–0132 (VA Form 26–4555)—
Annual burden continues to be 693
hours. The total estimated cost to
respondents continues to be $10,395
(693 hours × $15/hour). This submission
does not involve any recordkeeping
costs.
This rulemaking is mandating the use
of existing VA forms in the processing
and adjudication of claims and appeals.
These amendments to §§ 3.154, 3.155,
3.403, 3.660, 3.665, 3.666, 3.701, 3.812,
and 20.201 affect the estimated annual
number of respondents and
consequently, the estimated total annual
reporting and recordkeeping burden but
do not otherwise affect the existing
collections of information that have
already been approved by the Office of
Management and Budget (OMB). The
use of information, description of likely
respondents, estimated frequency of
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responses, estimated average burden per
response will remain unchanged for
these forms. While there is no
substantive change in the
aforementioned collection of
information for these amendments, VA
foresees a change in the quantity of
information collected and the total
annual reporting for certain currently
approved OMB control numbers on
account of this rulemaking.
VA’s Collection of Data:
Other than for original claims and
certain ancillary benefits, VA
historically and currently accepts claims
for benefits in any format submitted,
whether on a prescribed form or not. VA
has never standardized the use of forms
for claims or appeals processing 1. VA
maintains a record of the number of
types of benefit claims received
annually based on claim types such as
original claims, claims for increase or to
reopen a previously denied claim,
claims for ancillary benefits, pension,
and death benefits which have been
submitted on the appropriate prescribed
form. However, reliance on claim types
based on the form submitted may not
accurately capture the number of claims
received. For instance, one claim type
can be filed using more than one
prescribed form and a claimant can file
two types of claim such as a claim for
increase and a claim to reopen on one
prescribed VA form which will be
categorized as one claim type received,
i.e., recorded as either a claim for
increase or a claim to reopen. For
informal claims, VA has not quantified
the number of informal claims received,
but it quantifies the particular claim
type filed in the informal claim such as
original, increase, new, reopen, etc. As
a result of this rulemaking requiring the
use of prescribed forms for all claims for
benefits, VA will be able to gather and
collect the data quantifying the number
of prescribed forms in the future which
will provide VA with a more accurate
account of how many respondents will
respond on various VA prescribed
forms.
Electronic Claims:
Due to the fact that there is no current
data enumerating the total number of
1 Currently, VA accepts any claim filed
subsequent to the original, initial compensation/
pension claim that is submitted in any form, i.e.,
informal claim to initiate the claims process. For
example, a claim for increase or reopen, which
currently is not required to be submitted on a
prescribed form, can be established using different
VA forms such as VA Form 21–526 Veteran’s
Application for Compensation and/or Pension; VA
Form 21–526EZ, Application for Disability
Compensation or Related Compensation; VA Form
21–526b, Veteran’s Supplemental Claim for
Compensation; or VA Form 21–4138, Statement in
Support of Claim.
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18:44 Sep 24, 2014
Jkt 232001
different types of VA forms received
annually, we have projected the annual
number of respondents for the forms
based on the estimated number of types
of claims received annually over a 5year period. We have also approximated
the number of electronic claims
received for compensation, pension, and
death claims. Currently, VA’s electronic
claims processing system, i.e., eBenefits
and Veterans Online Applications
(VONAPP), uses VA Form 21–526EZ for
disability compensation claims
submitted electronically. VA is also in
the process of adding other VA forms to
VONAPP such as VA Form 21–527EZ
and 21–534EZ (hereinafter ‘‘EZ forms’’
will be used to refer to VA Forms 21–
526EZ, 21–527EZ, and 21–534EZ,
collectively). VA also provides these EZ
forms to claimants who wish to submit
their claims on paper because these
forms expedite the claims process by: (a)
Offering the claimant a choice for either
the expedited process of ‘‘Fully
Developed Claims’’ or the traditional
claims process; (b) listing more detailed
questions for a variety of benefits sought
in order to capture thoroughly the
specifics of a claim; and (c) providing
claimants with the required notice of
VA’s duty to assist the claimant
pursuant to 38 U.S.C. 5103, which is
issued at the time the claimant files a
claim instead of when the VA receives
the claim. The use of these EZ forms
ultimately speeds up the claims process
and ensures faster delivery of benefits to
claimants; therefore, VA has
encouraged, directed, and provided
these EZ forms to claimants who wish
to file benefit claims.
With the ease and efficiency of
completing and filing electronic claims
through VA’s Web-based electronic
claims application system, VA expects
the number of electronic claims to
increase. Additionally, VA expects the
number of EZ forms to increase even in
cases where the claimant opts not to use
the electronic process, because VA will
typically provide an EZ form in
response to an intent to file a claim.
Because eBenefits and VONAPP uses
(and will continue to use) the EZ forms,
we anticipate that the total number of
annual responses received on the EZ
forms electronically for all benefits will
increase by at least 29 percent while the
total number of annual response
received on VA Forms 21–526, 21–526b,
21–527, 21–534, 21–534a, and 21–535
(‘‘traditional forms’’) will decrease.
Based on data from Fiscal Year (FY)
October 2010 through September 2011,
the number of compensation disability
claims received electronically was
142,899 and the number of total
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compensation disability and
dependency claims received
electronically was 496,851. Thus, the
percentage of compensation disability
electronic claims received was 29
percent. With VA’s outreach and efforts
to promote the electronic claims
processing system and with future
implementation of pension, death, and
appeals electronic claims processing,
VA estimates an increase of the
submission of electronic claims by at
least 29 percent based upon the FY 2010
through 2011 data. Since the trend is to
direct claimants to submit claims on EZ
forms both electronically and on paper,
we approximate that 70 percent of
claims will be submitted on the EZ form
while 30 percent will be submitted on
the traditional forms.
Informal Claims:
The data used in formulating the
estimated number of annual responses
to the various affected prescribed forms
was extrapolated from data recorded for
the number of types of claims received
annually for FY April 2009 through
April 2013. This data is not sufficiently
granular to provide the number of
informal claims received given that the
data only depicts the number of initial,
new or reopened compensation and
pension claims received and the number
of initial death benefit claims received.
Since informal claims may or may not
be submitted on a prescribed form, there
is no method for accurately recording or
quantifying the total number of informal
claims received or inferred annually.
Therefore, we approximate that for
compensation, pension, and death
benefits, 50 percent of each of these
benefits are informal claims. Thus,
based on the data of an average of
claims received over a 5-year period, we
expect that the total number of informal
claims for compensation, pension, and
death benefits that will be submitted on
a prescribed form will increase by at
least 50 percent.
Notices of Disagreement:
Previously, VA estimated that the
annual number of respondents
submitting the currently approved
collection instrument, VA Form 21–
0958, Notice of Disagreement, (OMB
Control Number 2900–0791) would be
144,000, based on VA historically
receiving 12 Notices of Disagreement
per 100 completed VBA decisions, with
more than 1.2 million VBA decisions in
FY 2012. According to data for FY 2009
to FY 2012, the average number of
Notices of Disagreement received
annually was 129,539. For FY 2013, it
is projected that VA will receive
126,735 Notices of Disagreement. The
estimate associated with the currently
approved collection was based upon the
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assumption that all notices of
disagreement would be submitted on
this collection instrument, though that
is not necessarily the case under current
rules. As a result of this rulemaking,
however, the overwhelming majority of
notices of disagreement would in fact be
submitted on this collection instrument,
since this rulemaking is requiring that
all notices of disagreement be submitted
on VA Form 21–0958 in cases where
that form is provided. Accordingly,
while VA does expect to receive many
more completed Forms 21–0958, there
is no expected increase in the annual
number of respondents nor an increased
burden on respondents from that
reflected in currently approved
collections.
In addition, VA is amending the
instructions which accompany VA Form
21–0958 to alter the current language
from ‘‘not mandatory’’ to provide that
VA Form 21–0958 will be required to
initiate an appeal from a decision on
compensation claims. We have also
provided notification to claimants that
only the issues listed on VA Form 21–
0958 will be considered on appeal but
that the claimant retains the right to
appeal unnamed issues or contentions
within 1 year from the date of the
decision notification letter. Moreover,
we have added a separate section in the
instructions to provide claimants with
the criteria for a complete NOD form
which conforms with the final
regulatory language in § 19.24(b)(2)
which enumerates the requirements for
a complete NOD, namely that the form
must contain: information to identify
the claimant; information to identify the
specific nature of the disagreement; and
claimant’s signature. In order to further
assist claimants in submitting a
complete NOD, we have provided
samples for clarification of what is
minimally necessary to identify the
specific nature of the disagreement. We
note that one of the public commenters
questioned VA’s motive behind
inquiring whether claimants would like
direct communication with the AOJ
regarding the appeal. In response, we
have amended the instructions to
provide that claimants would have the
option of being contacted by telephone
in order for VA to request clarification
from claimants if there was any
ambiguous information which may
hinder expeditious processing of the
NOD. While we have amended the
instructions to VA Form 21–0958 to
conform to the final rule and to give
notice to claimants of the requirements
of the amended appeals regulations, we
did not change, amend, or alter VA
Form 21–0958. Therefore, we do not
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foresee any additional burden to the
claimant in completing this form.
Methodology for Estimated Annual
Number of Respondents for Affected
Forms:
We have formulated the estimated
total of annual responses for
compensation, pension, and death
benefit claims by increasing the
expected number of total claims
submitted on paper by 50 percent from
data extrapolated for claims received
annually over a 5-year period. We
project that 30 percent of compensation,
pension, and death benefit claims will
be submitted on traditional forms
whereas 70 percent will be submitted on
EZ forms. Accordingly, VA expects a
decrease in the total estimated number
of annual responses for VA Forms 21–
526, 21–527, 21–534, 21–534a, and 21–
535 whereas the total estimated number
of annual responses for VA Forms 21–
526EZ, 21–527EZ, and 21–534EZ have
increased substantially. The projected
numbers for each affected form are
provided in further detail in the above
section, ‘‘Estimated number of
respondents,’’ according to each OMB
Control Number.
II. New Information Collection
The information collection described
in this section was not previously
discussed in the proposed rule.
Comments on the collection of
information contained in this section
should be submitted to the Office of
Management and Budget, Attention:
Desk Officer for the Department of
Veterans Affairs, Office of Information
and Regulatory Affairs, Washington, DC
20503 or emailed to OIRA_Submission@
omb.eop.gov, with copies sent by mail
or hand delivery to the Director,
Regulations Management (02REG),
Department of Veterans Affairs, 810
Vermont Avenue NW., Room 1068,
Washington, DC 20420; fax to (202)
273–9026; or submitted through
www.Regulations.gov. Comments
should indicate that they are submitted
in response to ‘‘RIN 2900–AO81—
Standard Claims and Appeals Forms.’’
Notice of OMB approval for this
information collection will be published
in a future Federal Register document.
The Department considers comments
by the public on proposed collections of
information in:
• Evaluation whether the proposed
collections of information are necessary
for the proper performance of the
functions of the Department, including
whether the information will have
practical utility;
• Evaluating the accuracy of the
Department’s estimate of the burden of
the proposed collections of information,
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including the validity of the
methodology and assumptions used;
• Enhancing the quality, usefulness,
and clarity of the information to be
collected; and
• Minimizing the burden of the
collections of information on those who
are to respond, including through the
use of appropriate automated,
electronic, mechanical, or other
technological collection techniques or
other forms of information technology,
e.g., permitting electronic submission of
responses.
This final rule will impose the
following new information collection
requirements in standardizing the
current informal claim process in 38
CFR 3.155 by requiring a standard form
to be used to establish a claimant’s
intention to file a claim for VA benefits.
As required by the Paperwork
Reduction Act of 1995 (44 U.S.C.
3507(d)), VA has submitted this
information amendment to OMB for its
review and for approval 180-days after
the date this rule is published in the
Federal Register as a final rule. On
October 31, 2013, VA published in the
Federal Register (78 FR 65490) a
proposed rule to amend its adjudication
regulations and rules of practice of the
Board of Veterans’ Appeals (Board) to
standardize the claims and appeals
process by requiring the use of VA
forms to file a claim and to initiate an
appeal. The proposed rule attempted to
address the issue that current nonstandard submissions from claimants
including submission requiring VA to
take action are not received in a
standard format. Non-standard
submissions from claimants meant
increased time spent determining
whether a claim has been filed,
identifying the benefit claimed, sending
letters to the claimant and awaiting a
response, and requesting and awaiting a
response, and requesting and awaiting
receipt of evidence. These steps all
significantly delay the adjudication and
delivery of benefits to veterans and their
families. By standardizing the claims
process through the use of standard
forms, VA would be able to more easily
identify issues and contentions
associated with claims that are filed,
resulting in greater accuracy, efficiency,
and speed in the processing and
adjudication of claims. Therefore, the
proposed rule proposed to amend VA’s
current adjudication regulations to
standardize the claims process by
eliminating the informal claim, i.e., the
non-standard submission of a claimant’s
claim or intent to file a claim, by
requiring claimants to submit a VAprescribed form or application to apply
for benefits.
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While the current informal claim
establishes a date of claim (in the case
of an original claim, a complete
application that is submitted on a
standard form must be filed within 1
year of the filing of the informal claim),
the proposed rule eliminated the
informal claim process and established
that a complete claim submitted in the
standard paper form would establish the
date of claim. However, for electronic
claims, VA would establish the date of
claim based on the date when the
claimant saved an incomplete electronic
application without submitting it for
processing. Claimants would have 1
year to submit the completed electronic
application in order to preserve the date
claimant saved the application as the
date of claim. The result of the proposed
rule would have allowed a favorable
effective date treatment for electronic
claims only. The purpose of the
distinction between electronic and nonelectronic claim submission with regard
to effective date treatment was to
incentivize claimants to file electronic
claims, which are processed by VA
more efficiently and result in more
expeditious delivery of benefits to
claimants.
Based upon the concerns and issues
raised by the public commenters on the
proposed rule, particularly, regarding
the dissimilar treatment of effective
dates for electronic and non-electronic
claims submissions and its impact on
claimants, VA determined that
modernization and standardization of
the claims process could also be
achieved by formalizing and
standardizing the current informal
claims process while retaining favorable
effective date treatment for claimants
filing in paper form. In response, VA
revised the proposed regulation of
§ 3.155 in this final rule to replace the
concept and term ‘‘informal claim’’ with
the concept and term ‘‘intent to file a
claim for benefits.’’ In revised final
§ 3.155, claimants can submit an intent
to file a claim for benefits on the
prescribed VA form designated for this
purpose to establish a date of claim if
the claimant files a complete claim
within 1 year of submitting the intent to
file a claim. VA considers the concept
of the intent to file a claim for benefits
in revised § 3.155 to be a logical
outgrowth of VA’s goal of standardizing
the claims process through the use of
forms as outlined in the published
proposed rule. Moreover, this concept
provides the most optimal solution to
the concerns regarding the proposed
rule that were raised by the commenters
while still standardizing and
modernizing the VA claims process.
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In order to implement this intent to
file a claim process, VA created a new
form, VA Form 21–0966, Intent to File
a Claim for Compensation and/or
Pension, Survivors Pension, or Other
Benefits, to be used for this purpose.
This process is a reconciliation of VA’s
need for claims to originate on standard
forms and commenters’ desire for ways
to establish an effective date while a
complete claim on an application form
is completed. Accordingly, it did not
exist at the time of the publication of the
proposed rule and as the new intent to
file process is being codified in this
final rule, VA is submitting this new
collection of information specifically
used for the intent to file process for
OMB approval and for public comment
in this final rule.
The new VA Form 21–0966 will be
used to establish a date of claim if a
complete claim is filed within 1 year of
receipt of this form for all claims
whether initial or supplemental. VA
notes that a claimant can also submit an
intent to file a claim for benefits by
contacting VA personnel in field offices
by telephone or in person. VA personnel
will document the intent to file on VA
Form 21–0966. A filled out form will be
uploaded into VA’s internal business
and operational programs so that VA
personnel will be able to refer to this
document in order assign the
appropriate effective date for any award
granted. Therefore, this newly proposed
VA Form 21–0966, will enable VA to
document a claimant’s intent to file a
claim which will greatly enhance VA’s
standardization of the claims process
through the use of VA-prescribed forms.
Claimants can also submit an intent to
file a claim via electronically in VA’s
claims submission tool within its Webbased electronic claims application
system by entering biographical data
and saving the electronic application
without submitting it for processing.
Therefore, there is no separate
electronic ‘‘intent to file a claim’’ form;
the act of entering information and
saving the electronic application will
serve as the intent to file a claim for
benefits.
Title: Intent to File a Claim
Summary of collection of information:
The Department of Veterans Affairs
(VA) through its Veterans Benefits
Administration (VBA) administers an
integrated program of benefits and
services, established by law, for
veterans, service personnel, and their
dependents and/or beneficiaries. Title
38 U.S.C. 5101(a) provides that a
specific claim in the form provided by
the Secretary must be filed in order for
benefits to be paid to any individual
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under the laws administered by the
Secretary. The amended collection of
information in the final rule 38 CFR
3.155 would require claimants and/or
their authorized representatives to
submit a VA-prescribed form in either
paper or electronic submission, where
applicable, to express a claimant’s
intent to file a claim for benefits in order
to establish an effective date
placeholder for any award granted if the
claimant files a complete claim within
1 year of receipt of the intent to file a
claim. VA proposes to create a new
form, VA Form 21–0966, Intent to File
a Claim for Compensation and/or
Pension, Survivors Pension, or Other
Benefits. Claimants and their
representatives can submit their intent
to file a claim in three ways: (1) On
paper using VA’s newly created,
proposed VA Form 21–0966, Intent to
File a Claim for Compensation and/or
Pension, Survivors Pension, or Other
Benefits; (2) electronically through a
claims submission tool within a VA
Web-based electronic claims application
system; or, (3) by telephone contact with
designated VA personnel who will
record the intent to file a claim on the
proposed VA Form 21–0966, Intent to
File a Claim for Compensation and/or
Pension, Survivors Pension, or Other
Benefits.
Description of need for information
and proposed use of information: This
form will be used by claimants and/or
their authorized representatives to
indicate an intent to file a claim for
compensation and/or disability benefits
to establish an effective date for an
award granted in association with a
complete claim filed within 1 year of
such form. This form collects
biographical information of the claimant
such as name; Social Security Number;
service number, if applicable; date of
birth; gender; VA claim number, if
applicable; current mailing address;
forwarding address; telephone
number(s); email address(es); and
signature. The collection of information
also requests claimants to indicate what
type of claim for benefits, i.e.,
compensation and/or pension, the
claimant intends to file. VA will use this
form to identify claimants in its internal
business operational systems to record
the date of receipt of this document for
the purposes of establishing a date of
claim for a complete claim that is filed
within 1 year. VA also uses the
information to furnish the claimant with
the appropriate VA form or application
for compensation and pension benefits.
Description of likely respondents:
Veterans, claimants, and/or authorized
representatives who indicate an intent
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to file a claim for disability
compensation and/or pension benefits.
Estimated frequency of responses:
One time for most beneficiaries;
however, the frequency of responses is
also dependent on the number of intents
to file a claim submitted by the
claimant. VA does not limit the number
of submissions of the intent to file a
claim for benefits, except that VA will
accept only one intent to file a claim per
complete claim filed.
Estimated average burden per
response: VA estimates an average of 15
minutes to gather information and
complete the new, proposed VA Form
21–0966, Intent to File a Claim for
Compensation, and/or Pension,
Survivors Pension, or Other Benefits.
Estimated number of respondents: VA
anticipates the annual estimated
number of respondents to be 724,561
per year, the sum of which is based on
5-year estimated average of: 41,928
formal and informal initial
compensation and pension claims
received annually and 108,589 formal
and informal new or reopened
compensation claims received annually;
6,127 formal reopened pension claims
received annually and 2,429 informal
reopened pension claims expected to be
received annually; 16,219 formal and
informal death benefits claimed filed by
surviving spouses/child received
annually and 713 formal and informal
death benefits claims filed by surviving
spouses/child for in-service death
received annually; 523 formal death
benefits filed by parents received
annually and 737 expected informal
death benefits claims filed by parents
received annually; 417,955 formal and
informal, initial, new, reopened
compensation claims received annually
plus 50,543 formal and informal
pension claims received annually plus
55,828 formal and informal death
benefits claims received annually; 215
claims for monetary allowance and
payment for a child with spina bifida
who is a natural child of a veteran
having served in the Republic of
Vietnam during the Vietnam era; 7,000
claims for aid and attendance and/or
household benefits; 776 claims for
automobile and adaptive equipment
allowance; 900 claims for benefits under
the Restored Entitlement Program for
Survivors program; 12,000 claims for
individual unemployability benefits;
and 2,079 claims for Specially Adapted
Housing or Special Housing Adaptation
benefits.
Estimated total annual reporting and
recordkeeping burden: The annual
burden is 181,140 hours. The total
estimated cost to respondents is
$2,717,100 (181,140 hours × $15/hour).
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This submission does not involve any
recordkeeping costs.
Methodology for Estimated Annual
Number of Respondents for Proposed
Collection of Information on VA Form
21–0966, Intent to File a Claim for
Compensation and/or Pension Benefits:
Using the data as reported in the
proposed rule, we estimate that at least
50 percent of all claims, which would
have been filed informally, will be filed
in conjunction with the intent to file a
claim form. Therefore, we have
multiplied the expected number of total
claims submitted on paper by 50
percent from data extrapolated for
claims received annually over a 5-year
period to calculate the estimated
number of intent to claim form. An
itemization of the projected numbers for
an intent to file a claim form in
association with each approved OMB
form is provided in further detail in the
above section, ‘‘Estimated number of
respondents.’’
VA’s Collection of Data:
Other than for original claims and
certain ancillary benefits, VA
historically and currently accepts claims
for benefits in any format submitted,
whether on a prescribed form or not. VA
has never standardized the use of forms
for claims or appeals processing 2. VA
maintains a record of the number of
types of benefit claims received
annually based on claim types such as
original claims, claims for increase or to
reopen a previously denied claim,
claims for ancillary benefits, pension,
and death benefits which have been
submitted on the appropriate prescribed
form. However, reliance on claim types
based on the form submitted may not
accurately capture the number of claims
received. For instance, one claim type
can be filed using more than one
prescribed form and a claimant can file
two types of claim such as a claim for
increase and a claim to reopen on one
prescribed VA form which will be
categorized as one claim type received,
i.e., recorded as either a claim for
increase or a claim to reopen. For
informal claims, VA has not quantified
the number of informal claims received,
but it quantifies the particular claim
2 Currently, VA accepts any claim filed
subsequent to the original, initial compensation/
pension claim that is submitted in any form, i.e.,
informal claim to initiate the claims process. For
example, a claim for increase or reopen, which
currently is not required to be submitted on a
prescribed form, can be established using different
VA forms such as VA Form 21–526 Veteran’s
Application for Compensation and/or Pension; VA
Form 21–526EZ, Application for Disability
Compensation or Related Compensation; VA Form
21–526b, Veteran’s Supplemental Claim for
Compensation; or VA Form 21–4138, Statement in
Support of Claim.
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57693
type filed in the informal claim such as
original, increase, new, reopen, etc. As
a result of this rulemaking requiring the
use of prescribed forms for all claims for
benefits, VA will be able to gather and
collect the data quantifying the number
of prescribed forms in the future which
will provide VA with a more accurate
account of how many respondents will
respond on various VA prescribed
forms.
VA is replacing ‘‘informal claims’’
with ‘‘intent to file a claim’’ and is
requiring the submission of complete
claim in revised § 3.155 as a placeholder
for a potential earlier effective date.
Since eBenefits and VONAPP uses (and
will continue to use) the EZ forms, we
anticipate that the total number of
annual responses received on the EZ
forms electronically for all benefits will
increase by at least 29 percent while the
total number of annual response
received on VA Forms 21–526, 21–526b,
21–527, 21–534, 21–534a, and 21–535
(‘‘traditional forms’’) will decrease.
Based on data from Fiscal Year (FY)
October 2010 through September 2011,
the number of compensation disability
claims received electronically was
142,899 and the number of total
compensation disability and
dependency claims received
electronically was 496,851. Thus, the
percentage of compensation disability
electronic claims received was 29
percent. With VA’s outreach and efforts
to promote the electronic claims
processing system and with future
implementation of pension, death, and
appeals electronic claims processing,
VA estimates an increase of the
submission of electronic claims by at
least 29 percent based upon the FY 2010
through 2011 data. Since the trend is to
direct claimants to submit claims on EZ
forms both electronically and on paper,
we approximate that 70 percent of
claims will be submitted on the EZ form
while 30 percent will be submitted on
the traditional forms.
The data used in formulating the
estimated number of annual responses
to the various affected prescribed forms
was extrapolated from data recorded for
the number of types of claims received
annually for FY April 2009 through
April 2013. This data is not sufficiently
granular to provide the number of
informal claims received given that the
data only depicts the number of initial,
new or reopened compensation and
pension claims received and the number
of initial death benefit claims received.
Since informal claims may or may not
be submitted on a prescribed form, there
is no method for accurately recording or
quantifying the total number of informal
claims received or inferred annually.
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Therefore, we approximate that for
compensation, pension, and death
benefits, 50 percent of each of these
benefits are informal claims. Thus,
based on the data of an average of
claims received over a 5-year period, we
expect that the total number of informal
claims for compensation, pension, and
death benefits that will be submitted on
a prescribed form will increase by at
least 50 percent. This estimate is used
to calculate the estimated expected
number of intent to file a claim forms.
Regulatory Flexibility Act
The Secretary hereby certifies that
these regulatory amendments would not
have a significant economic impact on
a substantial number of small entities as
they are defined in the Regulatory
Flexibility Act, 5 U.S.C. 601–612. These
amendments would not directly affect
any small entities. Only VA
beneficiaries and their survivors could
be directly affected. Therefore, pursuant
to 5 U.S.C. 605(b), these amendments
are exempt from the initial and final
regulatory flexibility analysis
requirements of sections 603 and 604.
President’s priorities, or the principles
set forth in this Executive Order.’’
The economic, interagency,
budgetary, legal, and policy
implications of this regulatory action
have been examined, and it has been
determined to be a significant regulatory
action under Executive Order 12866.
VA’s impact analysis can be found as
a supporting document at https://
www.regulations.gov, usually within 48
hours after the rulemaking document is
published. Additionally, a copy of the
rulemaking and its impact analysis are
available on VA’s Web site at https://
www1.va.gov/orpm/, by following the
link for ‘‘VA Regulations Published.’’
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Executive Orders 12866 and 13563
Unfunded Mandates
The Unfunded Mandates Reform Act
of 1995 requires, at 2 U.S.C. 1532, that
agencies prepare an assessment of
anticipated costs and benefits before
issuing any rule that may result in an
expenditure by State, local, and tribal
governments, in the aggregate, or by the
private sector of $100 million or more
(adjusted annually for inflation) in any
given year. This rule would have no
such effect on State, local, and tribal
governments, or on the private sector.
Executive Orders 12866 and 13563
direct agencies to assess the costs and
benefits of available regulatory
alternatives and, when regulation is
necessary, to select regulatory
approaches that maximize net benefits
(including potential economic,
environmental, public health and safety
effects, and other advantages;
distributive impacts; and equity).
Executive Order 13563 (Improving
Regulation and Regulatory Review)
emphasizes the importance of
quantifying both costs and benefits,
reducing costs, harmonizing rules, and
promoting flexibility. Executive Order
12866 (Regulatory Planning and
Review) defines a ‘‘significant
regulatory action,’’ which requires
review by OMB, as ‘‘any regulatory
action that is likely to result in a rule
that may: (1) Have an annual effect on
the economy of $100 million or more or
adversely affect in a material way the
economy, a sector of the economy,
productivity, competition, jobs, the
environment, public health or safety, or
State, local, or tribal governments or
communities; (2) Create a serious
inconsistency or otherwise interfere
with an action taken or planned by
another agency; (3) Materially alter the
budgetary impact of entitlements,
grants, user fees, or loan programs or the
rights and obligations of recipients
thereof; or (4) Raise novel legal or policy
issues arising out of legal mandates, the
Catalog of Federal Domestic Assistance
Numbers and Titles
The Catalog of Federal Domestic
Assistance program numbers and titles
for this rule are 64.100, Automobiles
and Adaptive Equipment for Certain
Disabled Veterans and Members of the
Armed Forces; 64.101, Burial Expenses
Allowance for Veterans; 64.102,
Compensation for Service-Connected
Deaths for Veterans’ Dependents;
64.103, Life Insurance for Veterans;
64.104, Pension for Non-ServiceConnected Disability for Veterans;
64.105, Pension to Veterans Surviving
Spouses, and Children; 64.106,
Specially Adapted Housing for Disabled
Veterans; 64.109, Veterans
Compensation for Service-Connected
Disability; 64.110, Veterans Dependency
and Indemnity Compensation for
Service-Connected Death; 64.114,
Veterans Housing—Guaranteed and
Insured Loans; 64.115, Veterans
Information and Assistance;
64.116,Vocational Rehabilitation for
Disabled Veterans; 64.117, Survivors
and Dependents Educational Assistance;
64.118, Veterans Housing—Direct Loans
for Certain Disabled Veterans; 64.119,
Veterans Housing—Manufactured Home
Loans; 64.120, Post-Vietnam Era
Veterans’ Educational Assistance;
64.124, All-Volunteer Force Educational
Assistance; 64.125, Vocational and
Educational Counseling for
Servicemembers and Veterans; 64.126,
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Native American Veteran Direct Loan
Program; 64.127, Monthly Allowance
for Children of Vietnam Veterans Born
with Spina Bifida; and 64.128,
Vocational Training and Rehabilitation
for Vietnam Veterans’ Children with
Spina Bifida or Other Covered Birth
Defects.
Signing Authority
The Acting Secretary of Veterans
Affairs, or designee, approved this
document and authorized the
undersigned to sign and submit the
document to the Office of the Federal
Register for publication electronically as
an official document of the Department
of Veterans Affairs. Sloan D. Gibson,
Acting Secretary, Department of
Veterans Affairs, approved this
document on July 30, 2014, for
publication.
List of Subjects
38 CFR Part 3
Administrative practice and
procedure, Claims, Disability benefits,
Health care, Pensions, Radioactive
materials, Veterans, Vietnam.
38 CFR Parts 19 and 20
Administrative practice and
procedure, Claims, Veterans.
Dated: September 18, 2014.
William F. Russo,
Acting Director, Office of Regulation Policy
& Management, Office of the General Counsel,
Department of Veterans Affairs.
For the reasons set forth in the
preamble, VA amends 38 CFR parts 3,
19, and 20 as follows:
PART 3—ADJUDICATION
Subpart A—Pension, Compensation,
and Dependency and Indemnity
Compensation
1. The authority citation for part 3,
subpart A continues to read as follows:
■
Authority: 38 U.S.C. 501(a), unless
otherwise noted.
■
2. Revise § 3.1(p) to read as follows:
§ 3.1
Definitions.
*
*
*
*
*
(p) Claim means a written
communication requesting a
determination of entitlement or
evidencing a belief in entitlement, to a
specific benefit under the laws
administered by the Department of
Veterans Affairs submitted on an
application form prescribed by the
Secretary.
*
*
*
*
*
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§ 3.108
[Amended]
3. Amend § 3.108 by removing
‘‘formal or informal claim’’ and adding
in its place ‘‘complete claim as set forth
in § 3.160(a) or an intent to file a claim
as set forth in § 3.155(b)’’.
■ 4. Amend § 3.109, paragraph (a)(2) by
revising the first sentence to read as
follows:
■
§ 3.109
Time limit.
*
*
*
*
*
(a) * * *
(2) The provisions of this paragraph
are applicable to original initial
applications, to applications for
increased benefits by reason of
increased disability, age, or the
existence of a dependent, and to
applications for reopening or
resumption of payments. * * *
*
*
*
*
*
§ 3.150
[Amended]
5. Amend § 3.150 by removing
paragraph (c).
■
§ 3.151
[Amended]
6. Amend § 3.151, Cross Reference, by
removing ‘‘Informal claims.’’ and adding
in its place ‘‘Intent to file a claim.’’.
■ 7. Revise § 3.154 to read as follows:
■
§ 3.154
etc.
Injury due to hospital treatment,
Claimants must file a complete claim
on the appropriate application form
prescribed by the Secretary when
applying for benefits under 38 U.S.C.
1151 and 38 CFR 3.361. See §§ 3.151,
3.160(a), and 3.400(i) concerning
effective dates of awards; see § 3.155(b)
regarding intent to file the appropriate
application form.
(Authority: 38 U.S.C. 501 and 1151.)
CROSS REFERENCE: Effective Dates.
See § 3.400(i). Disability or death due to
hospitalization, etc. See §§ 3.358, 3.361
and 3.800.
■ 8. Revise § 3.155 to read as follows:
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§ 3.155
How to file a claim.
The following paragraphs describe the
manner and methods in which a claim
can be initiated and filed. The
provisions of this section are applicable
to all claims governed by part 3.
(a) Request for an application for
benefits. A claimant, his or her duly
authorized representative, a Member of
Congress, or some person acting as next
friend of a claimant who is not of full
age or capacity, who indicates a desire
to file for benefits under the laws
administered by VA, by a
communication or action, to include an
electronic mail that is transmitted
through VA’s electronic portal or
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otherwise, that does not meet the
standards of a complete claim is
considered a request for an application
form for benefits under § 3.150(a). Upon
receipt of such a communication or
action, the Secretary shall notify the
claimant and the claimant’s
representative, if any, of the information
necessary to complete the application
form or form prescribed by the
Secretary.
(b) Intent to file a claim. A claimant,
his or her duly authorized
representative, a Member of Congress, or
some person acting as next friend of
claimant who is not of full age or
capacity may indicate a claimant’s
desire to file a claim for benefits by
submitting an intent to file a claim to
VA. An intent to file a claim must
provide sufficient identifiable or
biographical information to identify the
claimant. Upon receipt of the intent to
file a claim, VA will furnish the
claimant with the appropriate
application form prescribed by the
Secretary. If VA receives a complete
application form prescribed by the
Secretary, as defined in paragraph (a) of
§ 3.160, appropriate to the benefit
sought within 1 year of receipt of the
intent to file a claim, VA will consider
the complete claim filed as of the date
the intent to file a claim was received.
(1) An intent to file a claim can be
submitted in one of the following three
ways:
(i) Saved electronic application. When
an application otherwise meeting the
requirements of this paragraph (b) is
electronically initiated and saved in a
claims-submission tool within a VA
web-based electronic claims application
system prior to filing of a complete
claim, VA will consider that application
to be an intent to file a claim.
(ii) Written intent on prescribed intent
to file a claim form. The submission to
an agency of original jurisdiction of a
signed and dated intent to file a claim,
on the form prescribed by the Secretary
for that purpose, will be accepted as an
intent to file a claim.
(iii) Oral intent communicated to
designated VA personnel and recorded
in writing. An oral statement of intent
to file a claim will be accepted if it is
directed to a VA employee designated to
receive such a communication, the VA
employee receiving this information
follows the provisions set forth in
§ 3.217(b), and the VA employee
documents the date VA received the
claimant’s intent to file a claim in the
claimant’s records.
(2) An intent to file a claim must
identify the general benefit (e.g.,
compensation, pension), but need not
identify the specific benefit claimed or
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any medical condition(s) on which the
claim is based. To the extent a claimant
provides this or other extraneous
information on the designated form
referenced in paragraph (b)(1)(ii) of this
section that the form does not solicit,
the provision of such information is of
no effect other than that it is added to
the file for appropriate consideration as
evidence in support of a complete claim
if filed. In particular, if a claimant
identifies specific medical condition(s)
on which the claim is based in an intent
to file a claim, this extraneous
information does not convert the intent
to file a claim into a complete claim or
a substantially complete application.
Extraneous information provided in an
oral communication under paragraph
(b)(1)(iii) of this section is of no effect
and generally will not be recorded in
the record of the claimant’s intent to
file.
(3) Upon receipt of an intent to file a
claim, the Secretary shall notify the
claimant and the claimant’s
representative, if any, of the information
necessary to complete the appropriate
application form prescribed by the
Secretary.
(4) If an intent to file a claim is not
submitted in the form required by
paragraph (b)(1) of this section or a
complete claim is not filed within 1 year
of the receipt of the intent to file a
claim, VA will not take further action
unless a new claim or a new intent to
file a claim is received.
(5) An intent to file a claim received
from a service organization, an attorney,
or agent indicating a represented
claimant’s intent to file a claim may not
be accepted if a power of attorney was
not executed at the time the
communication was written. VA will
only accept an oral intent to file from a
service organization, an attorney, or
agent if a power of attorney is of record
at the time the oral communication is
received by the designated VA
employee.
(6) VA will not recognize more than
one intent to file concurrently for the
same benefit (e.g., compensation,
pension). If an intent to file has not been
followed by a complete claim, a
subsequent intent to file regarding the
same benefit received within 1 year of
the prior intent to file will have no
effect. If, however, VA receives an intent
to file followed by a complete claim and
later another intent to file for the same
benefit is submitted within 1 year of the
previous intent to file, VA will
recognize the subsequent intent to file to
establish an effective date for any award
granted for the next complete claim,
provided it is received within 1 year of
the subsequent intent to file.
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(c) Incomplete application form.
Upon receipt of a communication
indicating a belief in entitlement to
benefits that is submitted on a paper
application form prescribed by the
Secretary that is not complete as defined
in § 3.160(a) of this section, the
Secretary shall notify the claimant and
the claimant’s representative, if any, of
the information necessary to complete
the application form prescribed by the
Secretary. If a complete claim is
submitted within 1 year of receipt of
such incomplete application form
prescribed by the Secretary, VA will
consider it as filed as of the date VA
received the incomplete application
form prescribed by the Secretary that
did not meet the standards of a
complete claim. See § 3.160(a) for
Complete Claim.
(d) Claims. (1) Requirement for
complete claim and date of claim. A
complete claim is required for all types
of claims, and will generally be
considered filed as of the date it was
received by VA for an evaluation or
award of benefits under the laws
administered by the Department of
Veterans Affairs. If VA receives a
complete claim within 1 year of the
filing of an intent to file a claim that
meets the requirements of paragraph (b)
of this section, it will be considered
filed as of the date of receipt of the
intent to file a claim. Only one complete
claim for a benefit (e.g., compensation,
pension) may be associated with each
intent to file a claim for that benefit,
though multiple issues may be
contained within a complete claim. In
the event multiple complete claims for
a benefit are filed within 1 year of an
intent to file a claim for that benefit,
only the first claim filed will be
associated with the intent to file a claim.
In the event that VA receives both an
intent to file a claim and an incomplete
application form before the complete
claim as defined in § 3.160(a) is filed,
the complete claim will be considered
filed as of the date of receipt of
whichever was filed first provided it is
perfected within the necessary
timeframe, but in no event will the
complete claim be considered filed
more than one year prior to the date of
receipt of the complete claim.
(2) Scope of claim. Once VA receives
a complete claim, VA will adjudicate as
part of the claim entitlement to any
ancillary benefits that arise as a result of
the adjudication decision (e.g.,
entitlement to 38 U.S.C. Chapter 35
Dependents’ Educational Assistance
benefits, entitlement to special monthly
compensation under 38 CFR 3.350,
entitlement to adaptive automobile
allowance, etc.). The claimant may, but
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need not, assert entitlement to ancillary
benefits at the time the complete claim
is filed. VA will also consider all lay
and medical evidence of record in order
to adjudicate entitlement to benefits for
the claimed condition as well as
entitlement to any additional benefits
for complications of the claimed
condition, including those identified by
the rating criteria for that condition in
38 CFR Part 4, VA Schedule for Rating
Disabilities. VA’s decision on an issue
within a claim implies that VA has
determined that evidence of record does
not support entitlement for any other
issues that are reasonably within the
scope of the issues addressed in that
decision. VA’s decision that addresses
all outstanding issues enumerated in the
complete claim implies that VA has
determined evidence of record does not
support entitlement for any other issues
that are reasonably within the scope of
the issues enumerated in the complete
claim.
CROSS REFERENCE: Complete claim.
See § 3.160(a). Effective dates. See
§ 3.400.
§ 3.157
[Removed]
9. Remove § 3.157.
■ 10. Amend § 3.160 by removing the
introductory text and revising
paragraphs (a) through (e) to read as
follows:
■
§ 3.160
Types of claims.
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(Authority: 38 U.S.C. 501)
*
*
*
*
*
11. Amend § 3.400 by:
■ a. Revising paragraph (o)(2); and
■ b. Adding an authority citation at the
end of paragraph (o)(2).
The revision and addition to read as
follows:
■
(a) Complete claim. A submission of
an application form prescribed by the
Secretary, whether paper or electronic,
that meets the following requirements:
(1) A complete claim must provide
the name of the claimant; the
relationship to the veteran, if applicable;
and sufficient service information for
VA to verify the claimed service, if
applicable.
(2) A complete claim must be signed
by the claimant or a person legally
authorized to sign for the claimant.
(3) A complete claim must identify
the benefit sought.
(4) A description of any symptom(s)
or medical condition(s) on which the
benefit is based must be provided to the
extent the form prescribed by the
Secretary so requires; and
(5) For nonservice-connected
disability or death pension and parents’
dependency and indemnity
compensation claims, a statement of
income must be provided to the extent
the form prescribed by the Secretary so
requires.
(b) Original claim. The initial
complete claim for one or more benefits
on an application form prescribed by
the Secretary.
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(c) Pending claim. A claim which has
not been finally adjudicated.
(d) Finally adjudicated claim. A claim
that is adjudicated by the Department of
Veterans Affairs as either allowed or
disallowed is considered finally
adjudicated by whichever of the
following occurs first:
(1) The expiration of the period in
which to file a notice of disagreement,
pursuant to the provisions of § 20.302(a)
or § 20.501(a) of this chapter, as
applicable; or,
(2) Disposition on appellate review.
(e) Reopened claim. An application
for a benefit received after final
disallowance of an earlier claim that is
subject to readjudication on the merits
based on receipt of new and material
evidence related to the finally
adjudicated claim, or any claim based
on additional evidence or a request for
a personal hearing submitted more than
90 days following notification to the
appellant of the certification of an
appeal and transfer of applicable
records to the Board of Veterans’
Appeals which was not considered by
the Board in its decision and was
referred to the agency of original
jurisdiction for consideration as
provided in § 20.1304(b)(1) of this
chapter.
§ 3.400
General.
*
*
*
*
*
(o) * * *
(2) Disability compensation. Earliest
date as of which it is factually
ascertainable based on all evidence of
record that an increase in disability had
occurred if a complete claim or intent to
file a claim is received within 1 year
from such date, otherwise, date of
receipt of claim. When medical records
indicate an increase in a disability,
receipt of such medical records may be
used to establish effective date(s) for
retroactive benefits based on facts found
of an increase in a disability only if a
complete claim or intent to file a claim
for an increase is received within 1 year
of the date of the report of examination,
hospitalization, or medical treatment.
The provisions of this paragraph apply
only when such reports relate to
examination or treatment of a disability
for which service-connection has
previously been established.
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(Authority: 38 U.S.C. 501, 5101)
*
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§ 3.403
*
*
*
[Amended]
12. Amend § 3.403 in paragraph (a)(3)
by removing ‘‘notice of the expected or
actual birth meeting the requirements of
an informal claim,’’ and adding in its
place ‘‘a claim or an intent to file a
claim as set forth in § 3.155(b),’’.
■
§ 3.660
[Amended]
13. Amend § 3.660 in paragraph (c) by
removing ‘‘notice constituting an
informal claim’’ and adding in its place
‘‘a claim or an intent to file a claim as
set forth in § 3.155(b)’’.
■
§ 3.665
[Amended]
14. Amend § 3.665 in paragraph (f) by:
a. Removing ‘‘an informal claim’’ and
adding in its place ‘‘a claim or intent to
file a claim as set forth in § 3.155(b)’’;
and
■ b. Removing ‘‘new informal claim.’’
and adding in its place ‘‘new claim or
intent to file a claim as set forth in
§ 3.155(b).’’.
■
■
§ 3.666
[Amended]
15. Amend § 3.666 by:
a. In paragraph (a)(4), removing ‘‘an
informal claim’’ and adding in its place
‘‘a claim or intent to file a claim as set
forth in § 3.155(b)’’;
■ b. In paragraph (a)(4), removing ‘‘new
informal claim.’’ and adding in its place
‘‘new claim or intent to file a claim as
set forth in § 3.155(b).’’;
■ c. In paragraph (b)(3), removing ‘‘an
informal claim.’’ and adding in its place
‘‘a claim or intent to file a claim as set
forth in § 3.155(b).’’; and
■ d. In paragraph (c), removing ‘‘(which
constitutes an informal claim)’’.
■ 16. Amend § 3.701 by revising
paragraph (b) to read as follows:
■
■
Secretary in order for VA to pay this
special allowance. When VA receives an
intent to file a claim or inquiries as to
eligibility, VA will follow the
procedures outlined in § 3.155.
Otherwise, the date of receipt of the
complete claim will be accepted as the
date of claim for this special allowance.
See §§ 3.150, 3.151, 3.155, 3.400.
*
*
*
*
*
Subpart D—Universal Adjudication
Rules That Apply to Benefit Claims
Governed by Part 3 of This Title
18. The authority citation for part 3,
subpart D continues to read as follows:
■
(Authority: 38 U.S.C. 501(a), unless
otherwise noted.)
19. Amend § 3.2600(a) by revising the
first sentence to read as follows:
■
§ 3.2600 Review of benefit claims
decisions.
(a) A claimant who has filed a Notice
of Disagreement submitted in
accordance with the provisions of
§ 20.201 of this chapter, and either
§ 20.302(a) or § 20.501(a) of this chapter,
as applicable, with a decision of an
agency of original jurisdiction on a
benefit claim has a right to a review of
that decision under this section. * * *
*
*
*
*
*
PART 19—BOARD OF VETERANS’
APPEALS: APPEALS REGULATIONS
Subpart B—Appeals Processing by
Agency of Original Jurisdiction
20. The authority citation for part 19
continues to read as follows:
■
Authority: 38 U.S.C. 501(a), unless
otherwise noted.
21. Add new §§ 19.23 and 19.24 to
subpart B to read as follows:
■
*
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§ 3.701 Elections of pension or
compensation.
§ 19.23 Applicability of provisions
concerning Notice of Disagreement.
(a) Appeals governed by § 20.201(a) of
this chapter shall be processed in
accordance with § 19.24. Sections 19.26,
19.27 and 19.28 shall not apply to
appeals governed by § 20.201(a) of this
chapter.
(b) Appeals governed by § 20.201(b) of
this chapter shall be processed in
accordance with §§ 19.26, 19.27, and
19.28.
*
*
*
*
(b) Form of election. An election must
be in writing and must specify the
benefit the person wishes to receive.
*
*
*
*
*
■ 17. Amend § 3.812 by:
■ a. Revising paragraph (e).
■ b. Amending paragraph (f) in the
second sentence by removing ‘‘claim’’
and adding in its place ‘‘complete
claim’’.
The revision to read as follows:
§ 3.812 Special allowance payable under
section 156 of Pub. L. 97–377.
*
*
*
*
*
(e) Claims. Claimants must file or
submit a complete claim on a paper or
electronic form prescribed by the
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§ 19.24 Action by agency of original
jurisdiction on Notice of Disagreement
required to be filed on a standardized form.
(a) Initial action. When a timely
Notice of Disagreement in accordance
with the requirements of § 20.201(a) of
this chapter is filed, the agency of
original jurisdiction will reexamine the
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claim and determine whether additional
review or development is warranted.
(b) Incomplete and complete appeal
forms—(1) Incomplete appeal forms. In
cases governed by paragraph (a) of
§ 20.201 of this chapter, if VA
determines a form filed by the claimant
is incomplete and requests clarification,
the claimant must timely file a
completed version of the correct form in
order to initiate an appeal. A claimant
is not required to cure or correct the
filing of an incomplete form by filing a
completed version of the correct form
unless VA informs the claimant or his
or her representative that the form is
incomplete and requests clarification.
(2) Complete appeal forms. In general,
a form will be considered complete if
the following information is provided:
(i) Information to identify the
claimant;
(ii) The claim to which the form
pertains;
(iii) Any information necessary to
identify the specific nature of the
disagreement if the form so requires. For
compensation claims, this criterion will
be met if the form enumerates the issues
or conditions for which appellate
review is sought, or if it provides other
information required on the form to
identify the claimant and the nature of
the disagreement (such as disagreement
with disability rating, effective date, or
denial of service connection); and
(iv) The claimant’s signature.
(3) Timeframe to complete correct
form. In general, a claimant who wishes
to initiate an appeal must provide a
complete form within the timeframe
established by § 20.302(a) of this
chapter. When VA requests clarification
of an incomplete form, the claimant
must provide a complete form in
response to VA’s request for
clarification within the later of the
following dates:
(i) 60 days from the date of the
request; or
(ii) 1 year from the date of mailing of
the notice of the decision of the agency
of original jurisdiction.
(4) Failure to respond. If the claimant
fails to provide a completed form within
the timeframe set forth in paragraph
(b)(3) of this section, the decision of the
agency of original jurisdiction will
become final.
(5) Form timely completed. If a
completed form is received within the
timeframe set forth in paragraph (b)(3)
of this section, VA will treat the
completed form as the Notice of
Disagreement and VA will reexamine
the claim and determine whether
additional review or development is
warranted. If no further review or
development is required, or after
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necessary review or development is
completed, VA will prepare a Statement
of the Case pursuant to § 19.29 unless
the disagreement is resolved by a grant
of the benefit(s) sought on appeal or the
NOD is withdrawn by the claimant.
(c) Issues under appellate review. If a
form enumerates some but not all of the
issues or conditions which were the
subject of the decision of the agency of
original jurisdiction, the form will be
considered complete with respect to the
issues for which appellate review is
sought and identified by the claimant.
Any issues or conditions not
enumerated will not be considered
appealed on the basis of the filing of
that form and will become final unless
the claimant timely files a separate form
for those issues or conditions within the
applicable timeframe set forth in
paragraph (b)(3) of this section.
(d) Disagreement concerning whether
Notice of Disagreement has been filed.
Whether or not a claimant has timely
filed a Notice of Disagreement is an
appealable issue, but in such a case,
appellate consideration shall be limited
to the question of whether the correct
form was timely filed.
PART 20—BOARD OF VETERANS’
APPEALS: RULES OF PRACTICE
22. The authority citation for part 20
continues to read as follows:
■
Authority: 38 U.S.C. 501(a) and as noted in
specific sections.
Subpart A—General
■
23. Revise § 20.3(c) to read as follows:
§ 20.3
Rule 3. Definitions.
*
*
*
*
*
(c) Appellant means a claimant who
has initiated an appeal to the Board of
Veterans’ Appeals by filing a timely
Notice of Disagreement pursuant to the
provisions of § 20.201, and either
§ 20.302(a) or § 20.501(a), as applicable.
*
*
*
*
*
Subpart C—Commencement and
Perfection of Appeal
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■
24. Revise § 20.200 to read as follows:
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§ 20.200
appeal.
Rule 200. What constitutes an
An appeal consists of a timely filed
Notice of Disagreement submitted in
accordance with the provisions of
§ 20.201, and either § 20.302(a) or
§ 20.501(a), as applicable and, after a
Statement of the Case has been
furnished, a timely filed Substantive
Appeal.
(Authority: 38 U.S.C. 7105)
■
25. Revise § 20.201 to read as follows:
§ 20.201
Rule 201. Notice of Disagreement.
(a) Cases in which a form is provided
by the agency of original jurisdiction for
the purpose of initiating an appeal.
(1) Format. For every case in which
the agency of original jurisdiction (AOJ)
provides, in connection with its
decision, a form for the purpose of
initiating an appeal, a Notice of
Disagreement consists of a completed
and timely submitted copy of that form.
VA will not accept as a notice of
disagreement an expression of
dissatisfaction or disagreement with an
adjudicative determination by the
agency of original jurisdiction and a
desire to contest the result that is
submitted in any other format,
including on a different VA form.
(2) Provision of form to the claimant.
If a claimant has established an online
benefits account with VA, or has
designated an email address for the
purpose of receiving communications
from VA, VA may provide an appeal
form pursuant to paragraph (a)(1) of this
section electronically, whether by email,
hyperlink, or other direction to the
appropriate form within the claimant’s
online benefits account. VA may also
provide a form pursuant to paragraph
(a)(1) of this section in paper format.
(3) Presumption form was provided.
This paragraph (a) applies if there is any
indication whatsoever in the claimant’s
file or electronic account that a form
was sent pursuant to paragraph (a)(1) of
this section.
(4) Specificity required by form. If the
agency of original jurisdiction gave
notice that adjudicative determinations
were made on several issues at the same
time, the specific determinations with
which the claimant disagrees must be
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identified to the extent a form provided
pursuant to paragraph (a)(1) of this
section so requires. If the claimant
wishes to appeal all of the issues
decided by the agency of original
jurisdiction, the form must clearly
indicate that intent. Issues not identified
on the form will not be considered
appealed.
(5) Alternate form or other
communication. The filing of an
alternate form or other communication
will not extend, toll, or otherwise delay
the time limit for filing a Notice of
Disagreement, as provided in
§ 20.302(a). In particular, returning the
incorrect VA form, including a form
designed to appeal a different benefit
does not extend, toll, or otherwise delay
the time limit for filing the correct form.
(b) Cases in which no form is provided
by the agency of original jurisdiction for
purpose of initiating an appeal. A
written communication from a claimant
or his or her representative expressing
dissatisfaction or disagreement with an
adjudicative determination by the
agency of original jurisdiction and a
desire to contest the result will
constitute a Notice of Disagreement
relating to a claim for benefits in any
case in which the agency of original
jurisdiction does not provide a form
identified as being for the purpose of
initiating an appeal. The Notice of
Disagreement must be in terms which
can be reasonably construed as
disagreement with that determination
and a desire for appellate review. If the
agency of original jurisdiction gave
notice that adjudicative determinations
were made on several issues at the same
time, the specific determinations with
which the claimant disagrees must be
identified.
(c) Simultaneously contested claims.
The provisions of paragraph (b) of this
section shall apply to appeals in
simultaneously contested claims under
§§ 20.500 and 20.501, regardless of
whether a standardized form was
provided with the decision of the
agency of original jurisdiction.
(Authority: 38 U.S.C. 7105)
[FR Doc. 2014–22633 Filed 9–24–14; 8:45 am]
BILLING CODE 8320–01–P
E:\FR\FM\25SER2.SGM
25SER2
Agencies
[Federal Register Volume 79, Number 186 (Thursday, September 25, 2014)]
[Rules and Regulations]
[Pages 57659-57698]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-22633]
[[Page 57659]]
Vol. 79
Thursday,
No. 186
September 25, 2014
Part II
Department of Veteran Affairs
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38 CFR Parts 3, 19, and 20
Standard Claims and Appeals Forms; Final Rule
Federal Register / Vol. 79 , No. 186 / Thursday, September 25, 2014 /
Rules and Regulations
[[Page 57660]]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Parts 3, 19, and 20
RIN 2900-AO81
Standard Claims and Appeals Forms
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: The Department of Veterans Affairs (VA) amends its
adjudication regulations and the appeals regulations and rules of
practice of the Board of Veterans' Appeals (Board) to require that all
claims governed by VA's adjudication regulations be filed on standard
forms prescribed by the Secretary, regardless of the type of claim or
posture in which the claim arises. This rulemaking also eliminates the
constructive receipt of VA reports of hospitalization or examination
and other medical records as informal claims for increase or to reopen
while retaining the retroactive effective date assignment for awards
for claims for increase which are filed on a standard form within 1
year of such hospitalization, examination, or treatment. This final
rule also implements the concept of an intent to file a claim for
benefits, which operates similarly to the current informal claim
process, but requires that the submission establishing a claimant's
effective date of benefits must be received in one of three specified
formats. Finally, these amendments will provide that VA will accept an
expression of dissatisfaction or disagreement with an adjudicative
determination by the agency of original jurisdiction(AOJ) as a Notice
of Disagreement (NOD) only if it is submitted on a standardized form
provided by VA for the purpose of appealing the decision, in cases
where such a form is provided. Although a standardized NOD form will
only initially be provided in connection with decisions on compensation
claims, VA may require a standard NOD form for any type of claim for VA
benefits if, in the future, it develops and provides a standardized NOD
form for a particular benefit. The purpose of these amendments is to
improve the quality and timeliness of the processing of veterans'
claims for benefits by standardizing the claims and appeals processes
through the use of forms.
DATES: Effective Date: This final rule is effective March 24, 2015.
FOR FURTHER INFORMATION CONTACT: Stephanie Li, Chief, Regulations Staff
(211D), Compensation Service, Department of Veterans Affairs, 810
Vermont Avenue NW., Washington, DC 20420, (202) 461-9700. (This is not
a toll-free number.)
SUPPLEMENTARY INFORMATION:
Executive Summary
I. Purpose of the Final Rule
The Department of Veterans Affairs (VA) amends its adjudication
regulations and its appeals regulations and rules of practice of the
Board of Veterans' Appeals (Board) for the purpose of improving the
quality and timeliness of the processing of veterans' claims for
benefits and appeals. Under 38 U.S.C. 501(a), VA is authorized to make
these regulatory changes as it is granted broad authority to
``prescribe all rules and regulations which are necessary or
appropriate to carry out the laws administered by [VA] and are
consistent with those laws,'' including specifically authority to
prescribe ``the forms of application by claimants under such laws.''
Congress has characterized a request for Board review as an
``[a]pplication for review on appeal.'' 38 U.S.C. 7106, 7107, 7108.
Additionally, 38 U.S.C. 5101 explicitly provides that claimants must
file ``a specific claim in the form prescribed by the Secretary'' in
order for VA to pay benefits.
II. Summary of Major Provisions
The major provisions of this final rule include the following: VA
will standardize the claims and appeals processes through the use of
specific mandatory forms prescribed by the Secretary, regardless of the
type of claim or posture in which the claim arises. These amendments
will apply to all benefits within the scope of 38 CFR part 3, namely
pension, compensation, dependency and indemnity compensation, and
monetary burial benefits. These changes to VA's adjudication
regulations not only will drive modernization of the claims and appeals
processes, but will also provide veterans, claimants, and authorized
representatives with a clearer and easier way to initiate and file
claims.
These final regulations also eliminate the provisions of 38 CFR
3.157 which allowed various documents other than claims forms to
constitute claims, specifically, VA reports of hospitalization or
examination and other medical records which could be regarded as
informal claims for increase or to reopen a previously denied claim.
Nonetheless, this rule retains the current retroactive effective date
assigned for awards for claims for increased evaluation as long as they
are filed on a standard form within 1 year of such hospitalization,
examination, or treatment.
This final rule further implements a procedure to replace the non-
standard informal claim process in 38 CFR 3.155 by employing a standard
form on which a claimant or his or her representative can file an
``intent to file'' a claim for benefits.
Finally, this final rule provides that VA will accept an expression
of dissatisfaction or disagreement with an adjudicative determination
by the agency of original jurisdiction (AOJ) as a Notice of
Disagreement (NOD) only if it is submitted on a standardized form
provided by VA for the purpose of appealing the decision. This
requirement only applies in cases where VA provides such a form with
the Notice of Appeal Rights sent with the notice of a decision on a
claim. In these cases, this rule replaces the current provision in 38
CFR 20.201 which permitted an appellant to begin the appeal process by
filing in any format a statement that can be ``reasonably construed''
as seeking appellate review. This procedure made the identification of
an appeal a time-intensive and inefficient interpretive exercise,
complicated by the fact that an NOD could be embedded within
correspondence addressing a variety of other matters, often
contributing to delay in VA recognizing that an appellant sought to
initiate an appeal.
VA also adds two new sections to part 19 in this final rule. For
NODs filed on a form provided by the AOJ, new 38 CFR 19.24 will govern.
This provision sets forth the procedures governing the treatment of
incomplete forms, the criteria of a complete form, the timeframe to
cure an incomplete form, the failure to respond to request to cure,
action when a complete form is filed, and clarification of issues which
are not enumerated on the form for appellate review. For NODs filed
where no form is provided by the AOJ, new 38 CFR 19.23 which clarifies
whether the requirements of current 38 CFR 19.26, 19.27, and 19.28, or
newly adopted Sec. 19.24 would apply to a particular case, will
govern. Although a standardized NOD form will only initially be
provided in connection with decisions on compensation claims, VA may
require a standard NOD form for any type of claim for VA benefits if,
in the future, it develops and provides a standardized NOD form for a
particular benefit.
III. Costs and Benefits
This rulemaking will not affect veterans' eligibility for benefits,
but rather prescribe that they must use a
[[Page 57661]]
standard application form to formally apply for benefits. It also
specifies that medical records themselves no longer constitute claims
in the absence of a claim submitted formally. However, the retroactive
effective date treatment for hospitalization, treatment, or examination
under current regulation will apply if a claimant files an intent to
file a claim or a complete claim within one year of such medical care.
Likewise, this rulemaking amends VA's appeals regulations and rules of
practice of the Board of Veterans' Appeals (Board) to provide that VA
will only accept an expression of dissatisfaction or disagreement with
an adjudicative determination by the AOJ as a Notice of Disagreement
(NOD) if it is submitted on a standardized form provided by VA for the
purpose of appealing the decision, in cases where such a form is
provided. This rulemaking seeks to change the format in which claimants
initiate a claim, file a claim, and initiate an appeal through the use
of VA-prescribed forms but does not alter claimants' entitlement to
benefits or the amounts of awards granted.
While there are no substantial monetary burdens on the claimant,
the cost to claimants in submitting complete claims or initiating an
appeal on a prescribed form or submitting expressions of intent to file
in a specified format can be calculated in terms of a claimant's time
to fill out VA forms. Claimants and/or authorized representatives may
need to learn and acclimate themselves to the new intent to file a
claim process, which functions similarly to the current informal claim
process. However, those claimants who are familiar with VA's claims
process may recognize the operation of the intent to file process as
functioning similar to the current informal claim process. The
difference is that the intent to file a claim form serves as the
effective date placeholder like the informal claim itself but must be
submitted in specified standard formats and will only trigger VA's duty
to furnish the claimant the appropriate form.
While VA recognizes this time cost to claimants in completing a
prescribed claim or appeal form, it concludes that this up-front time
burden to claimants is equivalent to (or even lesser than the
unquantifiable time it takes for approximately half of claimants to
compose non-standard submissions and the time VA spends identifying and
clarifying the communication received in non-standard submissions, all
of which add to delays in processing and adjudicating claims and
appeals and the overall timeliness of delivering benefits to claimants.
Therefore, we have determined that the time required by claimants to
fill out forms is less than or equal to the current time burdens on
claimants submitting non-standard submissions along with the time it
takes for VA to identify, clarify, and develop these non-submissions.
This also applies to claimants opting to submit an intent to file a
claim and a complete claim.
By requiring data to be formatted in a standard way through the use
of forms, VA will be able to cut processing time in identifying and
developing claims, which will result in faster delivery of benefits to
all veterans. While approximately half of the claimant population files
non-standard submissions, the other half continues to file claims on a
prescribed form. For the claimant population filing on prescribed
forms, there is no additional burden as a result of this rulemaking.
As previously stated, this rulemaking does not affect the amount of
monies paid to a claimant or entitlement to benefits except in the case
where a claimant who is not familiar with the intent to file a claim
process submits an informal claim which VA will deem as a request for
an application for benefits, resulting in the claimant submitting an
intent to file a claim form or complete claim at a later date. VA
intends to mitigate this situation by delaying the effective date of
this rule by 180 days from publication in order to perform robust
outreach to inform and educate claimants and authorized representatives
of this new standardized procedure of the claims and appeals processes.
This rulemaking will allow VA to decrease the processing time in
identifying, clarifying, and processing non-standard submissions as
claims or appeals since VA will be able to easily target and identify
these claims or initiations of appeals based on the submitted form.
This means increased quality in processing claims as VA would be able
to more accurately identify claims and to correctly assign effective
dates of awards for claims submitted on prescribed forms. Thus,
standardizing the claims and appeals processes through the use of forms
translates to faster delivery of benefits to claimants. In addition,
standardizing submissions on prescribed forms is an essential component
to VA's current and developing electronic business programs which are
designed to facilitate the efficient and accurate processing and
adjudication of claims and appeals. In order to utilize the efficiency
of such programs, data inputs require a standard format which would be
achieved through the use of prescribed forms.
In sum, we are only making procedural changes to the claims process
by mandating the submission of standard forms to initiate a claim or to
file a claim and to the appellate process by mandating the submission
of standard forms where such a form is provided. We have determined
that the costs associated with this rulemaking are mostly in terms of
the burden of time required by claimants and/or their authorized
representatives but such time burdens are equivalent to the current
time burdens in our current claims and appeals processing. Moreover,
the use of standardized forms will result in realtime savings to VA in
identifying, clarifying, and processing claims and appeals. Thus, there
is an overall benefit to the public as a result of this rulemaking. On
October 31, 2013, VA published in the Federal Register (78 FR 65490) a
proposed rule to amend its adjudication regulations and the appeals
regulations and rules of practice of the Board of Veterans' Appeals
(Board). There were several major components of these proposed changes.
The first was to require that all claims be filed on standard forms
prescribed by the Secretary, regardless of the type of claim or posture
in which the claim arises. The second component proposed was to
eliminate the constructive receipt of VA reports of hospitalization or
examination and other medical records as informal claims for increase
or to reopen (see current 38 CFR 3.157) while retaining the beneficial
retroactive effective date that may be assigned for grants for increase
filed on a standard form within 1 year of such hospitalization,
examination, or treatment. The third component proposed that VA would
accept an expression of dissatisfaction or disagreement with an
adjudicative determination by the agency of original jurisdiction (AOJ)
as a Notice of Disagreement (NOD) only if it is submitted on a standard
form provided by VA for the purpose of appealing the decision. VA
proposed that this requirement would apply only in cases where VA
provides the standard form with the Notice of Appeal Rights sent to the
claimant with the notice of a decision on a claim.
VA provided a 60-day public comment period, which ended on December
30, 2013, and received 53 public comments, 4 of which were received
after the comment period expired. Although VA is not legally required
to consider late-filed comments, it has reviewed, considered, and
addressed all comments received in
[[Page 57662]]
the interest of maximizing public dialogue to further serve veterans,
claimants, and authorized representatives. VA received comments from
various organizations and individuals, including The Center for Elder
Veterans Rights; the County Veteran Service Officer Association of
Wisconsin; Veteran Warriors; New York State Division of Veterans'
Affairs; Wounded Warrior Project; Disabled American Veterans; National
Veterans Legal Services Program and the Military Order of the Purple
Heart (jointly submitted); American Legion; Veterans for Common Sense;
Veterans Justice Group, LLC; Veterans of Foreign Wars of the United
States; Military Officers Association of America; Vietnam Veterans of
America; VetsFirst; National Organization of Veterans Advocates;
Paralyzed Veterans of America; State of Illinois Department of
Veterans' Affairs; the law firms of Bergmann and Moore; and Chisholm
Chisholm and Kilpatrick; and other interested persons. We responded to
all commenters as follows.
All of the issues raised by the commenters that concerned at least
one portion of the rule can be grouped together by similar topic, and
we have organized our discussion of the comments accordingly. For the
reasons set forth in the proposed rule and below, we are adopting the
proposed rule as final, with changes, explained below, to proposed 38
CFR 3.1, 3.154, 3.155, 3.160, 3.400, 3.812, 19.24, and 20.201. To
ensure consistency with these changes, we have also implemented changes
to 38 CFR 3.108, 3.109, 3.403, 3.660, 3.665, 3.666, and 3.701.
I. Changes to Initial Claims Process Based on Public Comments
A. Definition of ``Claim''
In proposed Sec. 3.1(p), VA defined ``Claim'' to mean ``a written
communication requesting a determination of entitlement or evidencing a
belief in entitlement, to a specific benefit under the laws
administered by the Department of Veterans Affairs.'' VA proposed to
replace the current term, ``Claim--Application'' which is defined as
``a formal or informal communication in writing requesting a
determination of entitlement or evidencing a belief in entitlement, to
a benefit'' in current paragraph (p). This definition was confusing and
did not make clear the difference between a ``claim'' and an
``application.'' Therefore, VA proposed to clarify the current
definition by eliminating the words ``Application,'' ``formal,'' and
``informal'' in the proposed definition in order to conform with the
amendments to the adjudication regulations.
One commenter stated that the proposed definition of a ``claim''
was inconsistent with proposed Sec. 3.155, which provides that a
standard form which VA determines does not contain all requested
information would not be considered a claim if that document is not
submitted via electronic means. We agree with this comment. In order to
clarify the regulatory definition as proposed, VA has revised this
definition to add that the written communication must be ``submitted on
an application form prescribed by the Secretary.'' This change requires
that the communication be on a VA form in order to be considered a
claim and maintains the essence of the ``formal communication'' in the
current definition of a ``claim'' in Sec. 3.1(p). Therefore, any
written communication requesting a determination of entitlement to a
specific benefit received on or after the effective date of this
rulemaking will be defined as one that has been submitted on a VA-
prescribed form.
B. Claims for Benefits Under 38 U.S.C. 1151
Currently, VA does not require that claims for entitlement to
compensation under 38 U.S.C. 1151, which provides disability
compensation and death benefits for a qualifying disability or death of
a veteran from VA treatment, examination, or vocational rehabilitation,
be submitted or filed on a standard form or application. 38 U.S.C.
1151; 38 CFR 3.150(c), 3.154, 3.361. Because VA is adopting as a final
rule the amendment to its adjudication regulations to require that all
claims be filed on standard forms prescribed by the Secretary, VA is
revising current Sec. 3.150 by removing paragraph (c), which provides
that when disability or death is due to VA hospital treatment,
training, medical or surgical treatment, or examination, a specific
application for benefits will not be initiated.
VA also revises Sec. 3.154, which currently provides that ``VA may
accept as a claim for benefits under 38 U.S.C. 1151 . . . any
communication in writing indicating an intent to file a claim for
disability compensation or dependency and indemnity compensation,'' to
require claimants to file or submit a complete paper or electronic
claim in order to apply for benefits under 38 U.S.C. 1151 and Sec.
3.361, the regulation governing the criteria of entitlement to 38
U.S.C. 1151 benefits. 38 U.S.C. 1151; 38 CFR 3.150 and 3.154.
Commenters stated that requiring claimants to file a complete claim
for this benefit is an unreasonable burden to place on veterans who
allegedly became disabled by VA. One commenter stated that requiring an
application for this benefit would delay an effective date of any award
to the detriment of the claimant.
VA makes no change based on this comment. VA's intent is to
modernize the claims processing system by standardizing the format in
which all disability claims are received. In order for AOJ personnel to
readily identify claims and process them efficiently, it is imperative
that all claims appear in easily identifiable formats using a
standardized form. Similar to VA's current informal claims, VA does not
require that claims for benefits under 38 U.S.C. 1151 be filed on any
particular form. See 38 CFR 3.154. Since these claims are received in a
non-standard format, VA has to determine whether any statements can be
construed as a claim for benefits under 38 U.S.C. 1151. Reviewing and
clarifying these non-standard submissions is extremely time consuming
and can also result in claims being overlooked. VA believes that using
a standard form is a minimal burden to place on claimants, even those
who may be due compensation as a result of VA's own errors in providing
medical treatment. Additionally, as discussed at length in section I.E.
below, the requirements of a complete claim are minimal and simple.
Accordingly, VA will require that even claims based on disability or
death due to VA hospital care, medical or surgical treatment,
examination, training and rehabilitation services or compensated work
therapy program be initiated by completing and filing a standard form.
Moreover, the effective date of any award granted for this benefit is
governed by current Sec. 3.400(i) which provides that an effective
date for an award granted would be ``date injury or aggravation was
suffered if claim is received within 1 year after that date; otherwise,
date of receipt of claim.'' Therefore, this final rule will not have
any detrimental effect on the effective date of any payment that may be
awarded for this type of claim.
However, VA makes minor revisions to Sec. 3.154 as proposed, in
order to ensure consistency with the intent to file process, discussed
more fully in section I. C. Specifically, we have removed any reference
to ``paper or electronic'' forms and instead made clear that claimants
must file a complete claim on the appropriate ``application form
prescribed by the Secretary'' to apply for section 1151 benefits. We
have
[[Page 57663]]
also added a reference to Sec. 3.155(b), which establishes the
``intent to file'' process in order to make clear that the liberalizing
features of this process are available for section 1151 benefits. This
process essentially provides that a claim will be deemed received on
the date a claimant submitted an intent to file a claim, provided the
application form is received within 1 year from the date the intent to
file is submitted. Therefore, claimants will have up to 1 year from the
date injury or aggravation was suffered due to hospitalization,
treatment, or examination, pursuant to operation of Sec. 3.400(i), to
submit their intent to file, and up to 1 additional year to perfect the
intent to file with an application form prescribed by the Secretary by
operation of Sec. 3.155(b).
C. Standardizing the Informal Claim Process With Intent To File a Claim
Form
VA's procedures for informal claims, currently governed by Sec.
3.155, provide that an informal claim is any communication or action,
i.e., in a non-standard format, indicating a claimant's intent to apply
for benefits from a claimant, an authorized representative, a Member of
Congress, or a person acting as next friend of a claimant who is not of
full capacity or age, which identifies the benefit sought. If an
application has not been previously filed, VA would forward one to the
claimant and if filed within 1 year of submission of the informal
claim, the application would be considered filed as of the date of
receipt of the informal claim. 38 CFR 3.155(a). Generally, when a
compensation claim is granted, VA pays a monthly benefit according to
the severity of the veteran's disability beginning from the claim's
effective date, which is usually the date the claim was filed. 38
U.S.C. 5110. Therefore, Sec. 3.155 allowed claimants to secure a
potential earlier effective date for an award by submitting an informal
claim that was subsequently ratified by a formal application or for
which an application was already of record.
Although current Sec. 3.155 provided claimants with a favorable
effective date in the filing of informal claims, it allowed informal
claims to be submitted in a non-standard format that not only could be
difficult to distinguish from other routine correspondence but could
also be incomplete for adjudication. In particular, as we explained in
the proposed rule, Sec. 3.155(c) allowed informal requests for
increase or reopening to constitute claims without any need for formal
ratification or filing on a standard form of any kind. See 78 FR at
65491-92. While the informal claims process was meant to make the
process of initiating a claim as informal as possible, it also
unintentionally incentivized the submission of claims in non-standard
formats that frustrate timely, accurate, and orderly claims processing.
Therefore, VA proposed to eliminate the concept of an ``informal''
claim in Sec. 3.155 by replacing ``informal claim'' with
``incomplete'' and ``complete'' claims, and by differentiating between
non-electronic and electronic claims in order to incentivize the
submission of claims in a format, whether filed in paper or
electronically, that would be more amenable to efficient processing. VA
proposed that claims filed through an online claims submission tool
within a VA Web-based electronic claims application system would be
considered filed as of the date of the ``incomplete claim''--i.e., the
date the claim was electronically saved in VA's electronic claims
application system but not electronically submitted to VA--if the claim
is ultimately completed and submitted within 1 year. As stated in the
proposed rule, filing a claim through this electronic process would
allow claimants to preserve an effective date while affording the
claimant the opportunity to gather the necessary evidence to
substantiate the claim. In other words, VA maintained the favorable
effective date treatment of the informal claim process for incomplete
electronic claims whereas incomplete non-electronic claims did not
receive such treatment. VA proposed that non-electronic claims be
considered filed as of the date VA received a complete claim.
The purpose of the distinction between electronic and non-
electronic claim submission with regard to effective date treatment was
to incentivize claimants to file electronic claims, which are processed
by VA more efficiently and result in more expeditious delivery of
benefits to claimants. VA believed that the advantages of its Web-based
paperless claims systems offered claimants and/or their authorized
representatives, as well as VA personnel, a faster, more convenient way
of processing and adjudicating claims. VA's Web-based paperless claims
systems, such as eBenefits and the Stakeholder Enterprise Portal, guide
claimants and/or their authorized representatives in an interview-style
process where responses are auto-populated into a VA form and can be
submitted electronically with a press of a button. VA will receive the
electronic claim within 1 hour as opposed to the receipt of paper
claims which can take several days. Claimants and/or their authorized
representatives are also able to upload evidence electronically for
consideration with their electronic claim. This electronic process
ensures more accurate responses from the claimant or representative as
well as a more consistently completed form. The nature and format of
the interview in eBenefits prompts claimants to answer all pertinent
questions in order to obtain information necessary to substantiate the
claim, checks for errors and missing information, and readdresses any
unanswered questions, all of which ensure more accurate claims
processing and adjudication. However, claimants who file on paper do
not have these types of checks to ensure accuracy or sufficiency of
responses provided on a form. Thus, there is an increased likelihood
that these applications or forms on paper may be incomplete, incorrect,
or insufficient for processing. Moreover, the advantages of VA's Web-
based paperless claims system offer VA personnel a way to process and
adjudicate electronic claims more efficiently and more accurately
through the Veterans Benefits Management System (VBMS), an internal VA
business application that facilitates the evidence-gathering phase of
the claims process and employs evaluation and rules-based decision-
support tools to increase the speed and accuracy of rating decisions.
For electronic claims files in VBMS, robust optical character
recognition capabilities make it possible to search thousands of pages
of evidence in a fraction of the time required to search paper files.
Paper submissions must be manually scanned into VBMS, adding an extra
time-intensive step for paper submissions. A piece of mail must be
identified, sorted, sent to a scanning facility, and meta-data must be
entered. This delay does not exist for submissions that are initially
received in an electronic format.
VA received many comments regarding the elimination of the informal
claim under current Sec. 3.155. The majority of the commenters
expressed concern that eliminating the current informal claim process
would be burdensome to claimants since the favorable effective date
treatment of the current informal claim process would not exist for
claimants who file paper claims. One commenter stated that
``eliminating informal claims with a process of incentivizing
submissions of claims in a format more amenable to efficient processing
makes the claims process more formalized to the detriment of
claimants.'' Commenters further stated that the informal claim
[[Page 57664]]
was a way for veterans to establish a date of claim while they are
being assisted in filing the proper forms and in gathering evidence in
support of their claims by veterans service organizations and other
authorized representatives. Another commenter expressed that the
informal claim process provided claimants of different educational
backgrounds a way of filing for benefits because VA's current claims
process is difficult to understand. The major concern regarding the
elimination of informal claims was the loss of potential benefits due
to a claimant's inability to preserve an earlier effective date for an
award granted.
Numerous commenters advanced the position that the current informal
claim process, with its attendant effective date rules, is required by
statute, specifically by 38 U.S.C. 5102(c). That subsection reads in
pertinent part: ``Time limitation . . . If information that a claimant
and the claimant's representative, if any, are notified under
subsection (b) is necessary to complete an application is not received
by the Secretary within one year from the date such notice is sent, no
benefit may be paid or furnished by reason of the claimant's
application.'' Subsection (b), in turn, requires the Secretary to
notify claimants of the information necessary to complete an incomplete
application for benefits.
VA does not agree with these comments to the extent they view the
informal claim process as unambiguously required by statute. VA does
not interpret 38 U.S.C. 5102(c) to require the informal claims process,
or to require effective date consequences of any kind for incomplete
applications. There are several reasons for this conclusion.
First and foremost, the informal claims process and the effective
date rules that it entails did not originate in 38 U.S.C. 5102(c).
Rather, the current informal claim process is a longstanding feature of
VA's regulations, grounded in VA's authority to administer the veterans
benefits claim system in a pro-claimant way. The concept behind
informal claims originated in the internal memoranda of one of VA's
predecessor entities, the Bureau of War Risk Insurance, in the course
of implementing the War Risk Insurance Act, Public Law 63-193, 38 Stat.
712 (1914), as amended by Act of June 12, 1917, ch. 26, Sec. 5, 40
Stat. 102, 103-104. The Office of General Counsel of the Bureau of War
Risk Insurance held that a veteran who was so disabled as to be
precluded from filling out a form 526 prior to his death, but expressed
an intent to file a compensation claim while being treated by the U.S.
Public Health Service, was considered to have filed a valid claim
during his lifetime. The informal claims rule in substantially its
current form was ultimately included in the publication of part 3 of
Title 38, CFR 26 FR 1561, 1570 (Feb. 24, 1961). By contrast, 38 U.S.C.
5102(c) was added in 2003. Veterans Benefits Act of 2003, Sec. 701(a),
Public Law 108-183, 117 Stat. 2651, 2670 (Dec. 16, 2003).
The plain language of section 5102(c), similarly suggests that
section 5102 does not require the informal claim process, or for
incomplete applications to hold a claimant's effective date. The
statutory language creates a ``limitation'' on what benefits ``may'' be
paid by reason of an incomplete application in the event it is not
perfected within one year. By specifying that ``no benefit may be
paid'' for incomplete applications that are not properly completed and
formalized within one year, the statute allows VA to maintain a rule
treating the incomplete application as a basis for an effective date in
the event benefits are ultimately granted, but does not require VA to
do so. The statute affirmatively prevents any effective date
consequences for an incomplete application not formalized within one
year.
The statutory structure strongly favors the same conclusion.
Section 5102 appears in Chapter 51 of Title 38, United States Code. The
Chapter is entitled ``Claims, Effective Dates, Payments.'' Section 5102
appears in Subchapter I, dealing with ``Claims.'' ``Effective Dates''
are the subject of an entirely separate Subchapter II. 38 U.S.C. 5110.
Further, Congress explicitly created numerous statutory bases for
effective date retroactivity, using the construction ``the effective
date of an award . . . shall be'' each time. 38 U.S.C. 5110(b)(1)-(4),
(c), (d). No such language appears in section 5102(c). Consistent with
this reasoning, the legislative history of section 5102(c) does not
suggest that Congress understood itself to be providing a rule of
effective date retroactivity when it added this subsection to the
United States Code.
Finally, we note section 5102(c) applies only to responses to
notifications from the Secretary, required by section 5102(b), that a
claimant has submitted an incomplete application. Therefore, even to
the extent section 5102(c) is construed to require that a claimant's
submissions establish an effective date, it applies only to incomplete
applications under section 5102(b), not to all informal claimant
submissions.
Because the informal claims rule is a liberalizing feature of VA's
regulations and is not clearly required by statute, it may be adjusted
by regulation in order to meet contemporaneous needs in administering
the claims workload. This is a reasonable exercise of the authority
granted to VA by statute. VA will continue to pursue and implement
technological solutions as a major part of its drive to eliminate the
backlog of claims. VA will strive for a claims process that is
paperless to the extent feasible both as relates to VA's own work, and
claimant inputs.
Nevertheless, VA recognizes that a transition of such magnitude
takes time. Numerous commenters objected strenuously to two features of
the proposed rule: that non-standard submissions would no longer
preserve a claimant's effective date for paper original claims, and
that electronic claims would be treated more favorably, continuing to
receive the effect of this liberalizing feature of VA's regulations. VA
has carefully considered the input it has received from commenters and
determined that changes to the rule as originally proposed are
appropriate. Modernization and standardization must accommodate the
interests and preferences of the veterans and other stakeholders for
whose benefit we seek to modernize the process, and the comments make
clear that many veterans and stakeholders continue to prefer more
informal processes than VA originally proposed. Accordingly, necessity
may dictate more continued reliance on non-electronic submissions than
was originally proposed.
Therefore, in order to strike a balance between standardizing,
modernizing, and streamlining the claims process and providing
veterans, claimants, and their survivors with a process that remains
veteran-friendly and informal, VA has revised proposed Sec. 3.155 to
replace the concept of an ``informal'' claim with the concept of an
``intent to file a claim for benefits.'' The ``intent to file'' process
will share similarities with the current informal claim process.
However, one major difference is that it requires the submission
holding a claimant's effective date to be in a standard format in order
for claimants to preserve the date of a claim for a complete claim that
is filed within 1 year of receipt of such intent to file a claim. To
implement this provision, VA introduces a new form to be used in
conjunction with revised Sec. 3.155, VA Form 21-0966, Intent to File a
Claim for Compensation and/or Pension Benefits, (hereinafter ``VAF 21-
0966'') which is described in more detail in the Paperwork Reduction
Act section of this rulemaking. The intent to
[[Page 57665]]
file a claim process is a standardized method of filing an informal
claim which would be submitted in a format more amenable to efficient
processing, while still allowing veterans to receive favorable
effective date treatment similar to that available under the current
``informal claim'' rule. It also achieves the standardization of the
claims process by requiring that all claims or initiation of claims be
filed on a VA-prescribed form.
VA considers the process put in place by this rule a logical
outgrowth of the original proposal, particularly in light of the
comments received. The original proposal would have required all claims
to originate on standard forms regardless of format or posture in which
the claim arose, but with effective date placeholder treatment similar
to the current informal claims rule available in order to incentivize
electronic submissions. VA considers this change responsive to comments
urging VA to maintain a way for all veterans to secure an effective
date placeholder while the formal application form is completed, and
responsive to comments urging that paper and electronic claims receive
identical treatment for effective date purposes. Additionally, one
commenter explicitly suggested that VA adopt a ``standardized Informal
Claim form.'' Another commenter suggested ``maintaining informal claims
in the context of standardized forms.''
While VA requires submission of the intent to file a claim in a
designated form, the substantive information required to preserve an
effective date through the intent to file a claim process is less than
the requirements for claimants to preserve an effective date for a
claim through the informal claim process under current Sec. 3.155.
Currently, an informal claim is defined as any communication or action,
indicating an intent to apply for one or more benefits from certain
persons that must identify the benefit sought. See 38 CFR 3.155(a).
In this final rule, VA revises Sec. 3.155(b) to provide that a
claimant, his or her duly authorized representative, a Member of
Congress, or some person acting as next friend of claimant who is not
of full age or capacity, may indicate a claimant's desire to file a
claim for benefits by submitting an intent to file a claim to VA. The
intent to file a claim must be submitted on a VA-prescribed form or
other specified format designated for the purpose of indicating the
claimant's intent to file a claim. An intent to file a claim must
provide sufficient identifiable or biographical information to identify
the claimant. This requirement is necessary because if VA cannot
identify the claimant to whom an intent to file pertains, the intent to
file cannot serve its intended function as an effective date
placeholder for that claimant. VA has chosen the flexible, functional
standard of a claimant being identifiable based on the information
provided, rather than enumerating specific pieces of necessary
information in order to establish an intent to file. This is because
different claimants will have different pieces of identifying
information close at hand, and VA wants the placeholder to be easy for
claimants to establish. The prescribed paper intent to file form
accordingly solicits several pieces of information to identify the
claimant, such as name, Social Security Number, address, telephone
number(s), email address(es), and VA file number, if applicable.
Claimants and authorized representatives will no longer be required to
identify the specific benefit sought in order to preserve a potential
earlier effective date as required by current Sec. 3.155, but the
designated form or other specified format must be used.
An intent to file a claim therefore differs in two crucial respects
from the current informal claim process. It must be submitted in a
designated format rather than in a non-standard communication, and the
claimant must be identifiable, but it requires less substantive
specificity than would be required to establish an informal claim under
current regulations. In particular, an intent to file a claim need not
identify the particular medical issues, symptoms, or conditions on
which the claim will ultimately be based in order to establish an
effective date. The current regulation requires the claimant to
``identify the benefit sought.'' 38 CFR 3.155(a). Case law is clear
that this means the claimant must describe the nature of the disability
for which he is seeking benefits, such as by describing a body part or
symptom of the disability. Brokowski v. Shinseki, 23 Vet. App. 79, 86-
87 (2009). An intent to file a claim need not contain this level of
specificity.
This substantive liberalization of the information necessary to
establish an effective date will align claimant incentives with the
interests of efficient and accurate claims processing. Under the
current process, veterans filing an initial claim are incentivized to
file multiple informal claims in piecemeal fashion as soon as they
become aware of potential entitlement to benefits for each condition.
This leads to confusion and potentially duplicative administrative
action by VA. Under the intent to file a claim process, claimants will
have up to a year to gather evidence, potentially facilitating the
process of establishing entitlement for any additional conditions
without fear that they will lose benefits by not claiming each
individual condition with specificity as quickly as possible, before
presenting a comprehensive package to VA for processing.
We accomplish this substantive liberalization of the information
necessary to establish an effective date by providing in Sec.
3.155(b)(2) that an intent to file a claim ``need not identify the
specific benefit claimed or any medical condition(s) on which the claim
is based.'' In the rest of Sec. 3.155(b)(2), however, we make clear
that if a claimant provides extraneous information beyond what is
needed to establish an intent to file a claim, such as information that
VAF 21-0966 does not solicit, this extraneous information does not
alter the status of the intent to file a claim, and in particular does
not convert it into a complete claim or a substantially complete
application. For example, if a claimant provides, in white space on a
paper VAF 21-0966, information suggesting the particular disability on
which the claim will be based, this extraneous information is of no
force and effect other than that it is added to the file as evidence
for adjudicative purposes. Such extraneous statements or information
may be used as evidence in support of a claim that is filed to perfect
VAF 21-0966. If a veteran or claimant submits information such as a
description of symptoms or complaints of a medical condition on VAF 21-
0966 and identifies the same description of symptoms or complaints of a
medical condition in a complete claim filed within 1 year, VA may
consider such information as evidence to substantiate the claim.
Similarly, we also make clear at the end of Sec. 3.155(b)(2) that
extraneous information provided in an oral communication meant to
establish an intent to file under Sec. 3.155(b)(1)(iii) is of no
effect and generally will not be recorded in the record of the
claimant's intent to file. This limitation is necessary to ensure that
the intent to file process does not degenerate into case-by-case
determinations as to whether a claimant has unintentionally provided
sufficient information to elevate an intent to file to a complete
claim, which would displace the statutory requirement to ultimately
file an application form prescribed by the Secretary. Because the
purpose of an intent to file is to establish a placeholder for any and
all issues ultimately raised in the complete claim, this limitation
does not limit the
[[Page 57666]]
substantive scope of the claimant's intent to file, and only operates
to prevent an intent to file a claim from constituting a substantially
complete application.
In response to comments received, this final rule provides that
there are three ways to submit an intent to file a claim for benefits,
which we enumerate in this final rule at Sec. 3.155(b)(1). First, in
Sec. 3.155(b)(1)(i), we provide that a claimant or authorized
representative may submit an intent to file a claim electronically by
saving an application in a claims-submission tool within a VA Web-based
electronic claims application system prior to submitting the electronic
claim for processing. Currently, the claim submission tool within VA's
Web-based electronic claims application system prompts the claimant
and/or authorized representative to enter biographical or identifiable
information upon entering the electronic claims application process and
records the date a claimant or authorized representative saves the
online application prior to submission for processing. The electronic
claims application system also notifies the claimant and/or authorized
representative that the date the electronic application was saved will
serve as an effective date for an award granted if a complete
application is submitted within 1 year; otherwise, the date VA
electronically receives the complete electronic claim will serve as the
date of claim. The claimant and/or authorized representative must
acknowledge this notice by checking a box.
VA considers the following actions in VA's current electronic
claims process together to constitute an electronic intent to file a
claim: (1) The act of a claimant or authorized representative entering
into and commencing the online application process indicates an intent
to apply for benefits, i.e., disability compensation benefits; (2)
entering in biographical or identifiable information in electronic
application for benefits in the claims submission tool within a VA Web-
based electronic claims application system; (3) without providing the
specific benefit sought or the symptoms or medical condition(s) for
which the benefit is sought. Therefore, an electronic version of VAF
21-0966 for the purpose of submitting an electronic intent to file a
claim for benefits is not necessary as the claims submission tool
within VA's Web-based electronic claims application system achieves the
intent to file a claim requirements through the act of entering and
saving an electronic application in the claims submission tool within
VA's Web-based electronic claims application system.
As we explained in the proposed rule, the limitation that the
communication must take place within an online benefits account is
necessary to prevent open-ended narrative format submissions, such as
unsolicited emails, from constituting an intent to file a claim. The
further limitation that the intent to file must be submitted through a
claims submission tool within VA's Web-based electronic application
system is to ensure that non-standard communications, such as emails
within the current eBenefits system, do not constitute an intent to
file a claim merely because they took place within eBenefits. VA must
be careful to define an intent to file a claim in a way that channels
claimant submissions through a predictable, standardized process.
Second, Sec. 3.155(b)(1)(ii) provides that claimants and/or
authorized representatives may submit an intent to file a claim using
the new proposed form, VAF 21-0966. Specifically, the submission to an
agency of original jurisdiction, such as a VA regional office, of a
signed and dated intent to file, on the form prescribed by the
Secretary for that purpose, will be accepted as an intent to file. This
form has three components: (1) a checkbox for a claimant to indicate
his or her intent to file for compensation, pension, survivors'
benefits, and/or other benefits governed by 38 CFR part 3 (this
information is used to furnish the appropriate application form(s) to
the claimant); (2) claimant identification such as name, Social
Security Number, date of birth, gender, VA file number, if applicable,
mailing and/or forwarding address, telephone number(s), and email
address(es); and (3) signature and date block for claimant's
declaration of intent to apply for one or more benefits and
acknowledgement that a complete application for each type of benefit
selected must be received by VA within 1 year of receipt of VAF 21-0966
to be considered filed as of the date of receipt of such form. VA
intends to make this form available online as well as in the paper
format to claimants who request one.
Third, Sec. 3.155(b)(1)(iii) provides that a claimant or
authorized representative may submit an oral intent to file a claim by
contacting certain designated VA personnel, typically in one of VA's
call centers. However, claimants may express an intent to apply for
benefits to VA personnel either in person or by telephone. The oral
intent to file will be captured on a paper VAF 21-0966 generated from
transaction in person or over the phone call which will then be
uploaded into claimant's electronic file. In order for VA to take
action based on oral statements, the VA employee must adhere to the
requirements under 38 CFR 3.217(b) which provides that the VA employee
must: identify himself or herself as a VA employee who is authorized to
receive the information or statement; verify the identity of the
provider as either the beneficiary or his or her fiduciary by obtaining
specific information about the beneficiary that can be verified from
the beneficiary's VA records, such as Social Security Number, date of
birth, branch of military service, dates of military service, or other
information; inform the provider that the information or statement will
be used for the purpose of calculating benefit amounts; and must
document in the beneficiary's VA record the specific information or
statement provided, the date such information or statement was
provided, the identity of the provider, and the steps taken to verify
the identity of the provider. This contact provides VA with an
opportunity to educate veterans, claimants, and their families on the
process of filing a complete claim in conjunction with the intent to
file a claim, the benefits of VA's Fully Developed Claim program,
obtaining electronic access to our Web-based electronic claims
submission tool such as eBenefits, and the benefits of receiving
assistance from accredited veterans service organizations.
In the event a dispute arises over whether an oral intent to file
was received on a particular date, the presence or absence of a record
of the intent to file in VA's records will govern, absent a specific
basis to conclude that designated VA personnel received an oral intent
to file but did not contemporaneously document the communication as
required. This is consistent with the general principle, often referred
to as the ``presumption of regularity,'' that government officials are
presumed to ``have properly discharged their official duties'' unless
there is clear evidence otherwise. Miley v. Principi, 366 F.3d 1343,
1347 (Fed. Cir. 2004); see also Butler v. Principi, 244 F.3d 1337,
1339-41 (Fed. Cir. 2001) (presumption of regularity applies to the
administration of veterans benefits). This limitation is necessary to
ensure that the possibility of establishing an effective date of
benefits payments through oral communications with VA personnel does
not become a way to claim entitlement to an earlier effective date with
no basis other than the bare assertion that a particular undocumented
conversation took place.
[[Page 57667]]
We emphasize that allowing oral communications with certain designated
personnel to constitute intents to file a claim is an extremely liberal
approach to allowing claimants and their representatives to establish
an effective date. We also note that the presumption of regularity,
like all presumptions, is rebuttable. Finally, to the extent a claimant
or representative wishes to guard against the possibility that the
designated VA personnel who receive the communication will erroneously
fail to contemporaneously document it, he or she can submit an intent
to file in one of the other two formats.
When VA receives VAF 21-0966 or an oral intent to file a claim, VA
will notify the claimant and/or the authorized representative of any
information necessary to complete the formal application form, such as
a VAF 21-526EZ and, as statutorily required pursuant to 38 U.S.C. 5102,
VA will furnish the claimant with the appropriate application form(s)
as claimant indicates on the 21-0966 or orally to VA personnel.
Non-standard narrative communications not falling within these
three enumerated scenarios will not be considered an intent to file a
claim received on the designated form, and accordingly will not
establish an effective date placeholder.
Finally, notwithstanding our conclusion that 38 U.S.C. 5102(c) does
not require that an incomplete application hold a claimant's effective
date, we have provided via regulation, in Sec. 3.155(c), that an
incomplete application form will hold the claimant's date of
application for up to 1 year.
As discussed in more detail below, revised Sec. 3.155 of the final
rule also provides that only one complete claim for a given benefit
(e.g., compensation, pension) may be associated with each intent to
file a claim for the same benefit for purposes of the effective date
placeholder mechanism. In other words, if a claimant submits a VAF 21-
0966 for compensation, and then files two or more successive complete
compensation claims within 1 year, only the issues contained in the
first complete compensation claim would relate back to the VAF 21-0966
for effective date purposes.
Similarly, we address the possibility a claimant may file both an
intent to file and an incomplete application relating to the same claim
in Sec. 3.155(d). We make clear that, in the event the application is
ultimately perfected, VA will consider it filed as of the date of
receipt of whichever was filed first, the incomplete application or the
intent to file. However, we also make clear the complete claim will not
be considered filed more than one year prior to the date of receipt of
the complete claim, absent a separate basis for additional
retroactivity. See e.g., 38 U.S.C. 5110(b)(3).
VA believes that the revisions to proposed Sec. 3.155 serve as an
optimal solution to the concerns expressed by the commenters by
providing veterans, claimants, and their families a way to preserve a
potential favorable effective date while giving them 1 year from the
date of submission to file a complete claim as currently provided in
the informal claim process as well as help VA streamline the claims
process through the standardization of inputs.
The intent to file a claim process also serves to modernize VA's
claims process by keeping non-standard submissions from constituting
claims. By requiring an intent to file a claim be submitted on a
designated standard form, VA personnel will spend less time determining
whether a claimant wishes to file a claim, when a claim has been filed,
and what type of benefit the claimant is seeking. VA believes the
intent to file a claim process ensures more efficient processing that
does not unduly erode the longstanding informal, non-adversarial, pro-
claimant nature of the VA system. See Walters v. Nat'l Ass'n of
Radiation Survivors, 473 U.S. 305, 323-24 (1985). In order to implement
the standardization of the informal claim process with the intent to
file a claim process, VA has reorganized proposed Sec. 3.155 by
eliminating the distinction between non-electronic and electronic
claims as published in the proposed rule and designated this section of
the final rule as a description of how claimants can file a claim. VA
has consolidated the types of requests for application for benefits as
published in proposed subparagraphs (c)(1) and (c)(3) of Sec. 3.155 of
the proposed rule in paragraph (a) of this final rule.
One commenter noted that the person acting as next friend of
claimant must be of full age and capacity and that the term ``full
age'' is not defined and that the term ``capacity'' is broad and
susceptible to challenge in the future. VA has mirrored the language in
current Sec. 3.155 to describe persons submitting the informal claim
and replaced the term ``sui juris'' with its definition, ``of full age
or capacity.'' See Black's Law Dictionary, 1662 (10th ed. 2014). While
use of the word-for-word legal definition ``of full age and capacity''
in this context would not imply that the claimant in question must be
both under 18 and not of full capacity, given the resulting sentence as
a whole, we have opted to use the disjunctive ``or'' in order to make
clear that claimants who are not of full capacity need not also be
under 18 in order to be within the ``next friend'' provision of this
paragraph. Accordingly, there is no substantive change in the
definition. Rather, VA is merely continuing to provide a way for
claimants who cannot engage in a legal contract due to age or
disability to be represented by someone (or next friend) who can do so
on their behalf. Therefore, VA makes no change to the proposed rule
based on this comment.
One commenter stated that email requests for benefits should
trigger the duty to provide claimants with the information necessary to
complete the application. VA agrees with this comment and has provided
in Sec. 3.155(a) of this final rule that upon receipt of any request
for an application, to include email transmissions, VA will provide the
appropriate form or application pursuant to current Sec. 3.150 and
will provide claimants with the information necessary to complete it.
We note, however, that an email requesting benefits, without more, is a
non-standard narrative submission. While such a submission clearly
triggers VA's obligation to send the correct form, it does not on its
own serve as an effective date placeholder.
Further, VA has redesignated proposed subparagraph (c)(2) of Sec.
3.155 of the proposed rule which provides that an application form
prescribed by the Secretary that does not meet the standard of a
complete claim is a request for an application for benefits. VA
believes that an incomplete application form prescribed by the
Secretary is not equivalent to a non-standard submission. Therefore, VA
has redesignated this as paragraph (c) in the final rule to distinguish
an incomplete application form from a non-standard submission request,
which is an application for benefits and governed by paragraph (a) of
the final rule. Regarding incomplete application forms, VA has added
the statement that it will notify the claimant and his or her
representative, if any, of the information necessary to complete the
application form prescribed by the Secretary and that if a complete
claim is received within one year of submission of the incomplete
application or form, VA will calculate an effective date of any award
granted as of the date the incomplete application form was received.
VA received comments noting that the proposed rule did not provide
for when VA would notify claimants and/or authorized representatives of
the
[[Page 57668]]
information necessary to complete a claim for benefits if VA receives
an application form that is not complete pursuant to the proposed Sec.
3.160(a). In response, VA has provided the 1-year timeframe as
described above in revised Sec. 3.155(c) of this final rule. In
current Sec. 3.109, VA provides a 1-year filing period for claimants
to submit evidence necessary to complete an application. VA believes
that a 1-year timeframe to cure an incomplete application provides
claimants with sufficient time and remains consistent with other
current existing adjudication regulations.
VA has also eliminated the categorization of ``non-electronic
claims'' and ``electronic claims'' in proposed paragraphs (a) and (b)
of the proposed rule and replaced these distinctions with the concept
of the ``intent to file a claim'' to standardize the current informal
claim process in paragraph (b) of Sec. 3.155 of this final rule. VA
clarifies that this process would apply to all claims governed by part
3 of title 38 in the Code of Federal Regulations.
One commenter requested an explanation of the effects of the
changes implemented by this final rule on authorized representatives
and inquired about the type of interaction VA envisions for authorized
representatives if electronic mail communication through eBenefits is
delivered directly to the claimant. In the proposed rule, filing an
electronic claim was the only way to secure an effective date
placeholder. As we explain above, the structure of this final rule no
longer attaches unique effective date consequences to a claim being
submitted in electronic versus non-electronic format. In Sec.
3.155(b)(5), we make clear that the only requirement specifically
directed toward representatives is that a power of attorney must have
been executed at the time the intent to file is written. This is
substantively identical to requirements pertaining to representatives
for the informal claim process. 38 CFR 3.155(b) (2013). To the extent
this comment asks a broader question, separate from the structure
governing what inputs may and may not constitute a claim, it is beyond
the scope of the rule as now revised. VA will take this comment and all
other stakeholder input under advisement in continuing to address the
scope of representative access to electronic communications between VA
personnel and claimants.
In new subparagraphs (b)(1) through (b)(2) of Sec. 3.155 of this
final rule, VA outlines the criteria for an intent to file a claim,
namely, that it must be in a prescribed form (whether on paper,
electronic, or oral), must identify the general benefit to be claimed,
but it need not identify the specific benefit sought or symptom(s) or
medical condition(s) on which the claim is based. In new subparagraph
(b)(3), VA provides the action it will take upon receipt of an intent
to file a claim. In addition to furnishing the appropriate application
form prescribed by the Secretary in association with the intent to file
a claim, VA will notify the claimant and claimant's representative, if
any, of the information necessary to complete the appropriate
application form prescribed by the Secretary. We note that in the
context of intents to file submitted as incomplete eBenefits
applications pursuant to Sec. 3.155(b)(1)(i), this requirement is
satisfied by automated system prompts.
In new subparagraph (b)(4) of Sec. 3.155 of the final rule, VA
provides that if an intent to file a claim is not submitted in the
appropriate form as outlined in subparagraph (b)(1) and (b)(2) or is
not ratified by a complete claim within 1 year of submission of the
intent to file a claim, VA will not take further action unless a new
claim or a new intent to file a claim is received. In new subparagraph
(b)(5), VA provides that any service organization, attorney or agent
indicating a represented claimant's intent to file a claim must have
executed a power of attorney at the time the communication was written.
This mirrors what is currently provided in the informal claim
regulation in Sec. 3.155(b).
The ``intent to file a claim'' process does not interfere with VA's
other initiatives to eliminate the backlog of claims. In particular,
the Fully Developed Claim (FDC) program allows VA to provide faster
decisions and delivery of benefits to claimants through the use of the
standard forms created specifically for FDCs that contain the notice to
claimants of the information and evidence necessary to substantiate the
claim (hereinafter ``section 5103 notice'') and claimant's
certification that all evidence has been submitted with the FDC.
Claimants receive the section 5103 notice at the time they file a claim
and not after they submit the claim to VA. While VA continues to be
responsible for obtaining relevant Federal records and provides a
medical examination when necessary to decide the claim pursuant to 38
U.S.C. 5103A, VA is able to adjudicate the claim more expeditiously
because additional time is not taken to request and obtain other
evidence that a claimant identifies but does not have in his or her
possession. We note that one commenter suggested that delays in the
claims processing system are because VA spends ``too much time and
paper on a `duty to assist' letter.'' Much of the value in standard
forms is they allow VA to discharge the very legal and procedural
obligations to which this commenter refers more efficiently, so that a
greater share of VA personnel's time may be devoted to engaging the
substance of the claim.
The intent to file a claim process complements and does not
conflict with the FDC process. The effective date placeholder provided
by the intent to file a claim process allows claimants to ``protect''
their effective date while they gather all information and evidence
they have to submit with their complete claim. If a claimant is able to
gather and submit all evidence he or she wishes to submit within this
one year period, there will often be no reason why the claimant cannot
file the claim as an FDC. This, in turn, may lead to an even more
favorable effective date if the claim is an original FDC, because
Congress has provided for up to one year of special effective date
retroactivity for ``an original claim that is fully-developed'' if
filed before August 6, 2015. 38 U.S.C. 5110(b)(2)(A). In the event the
claim is not amenable to filing as an FDC, the claimant nevertheless
will receive the benefit of the effective date placeholder established
by the intent to file a claim.
We note that, similar to the effective date treatment given to
original FDCs, it is possible for specific statutory effective date
provisions in 38 U.S.C. 5110 to apply in cases where an intent to file
a claim has also been filed. For example, section 5110(b)(1) allows the
effective date for an award of disability compensation to be the day
following the date of the veteran's discharge from service if an
application is received within a year of such date. Similarly, up to a
year of retroactivity is available for claims for increased disability
compensation. See 38 U.S.C. 5110(b)(3) (``[t]he effective date of an
award of increased compensation shall be the earliest date as of which
it is ascertainable that an increase in disability had occurred, if
application is received within one year from such date.''). This rule
does not, and indeed could not, operate to displace these special
statutory effective dates enumerated in section 5110. These statutory
effective dates are generally tied to the date of receipt of the
application. This rule provides that VA will deem the ``application''
to have been received as of the date of the intent to file a claim,
which is the mechanism by which a claimant puts VA on notice that he or
she intends to ultimately
[[Page 57669]]
submit an application for benefits. Accordingly, the special statutory
retroactive effective dates operate independently of, and in addition
to, VA's decision to provide claimants up to a year to perfect and
complete their application from the date they initially put VA on
notice that they intend to file a claim.
We further note that, to the extent the intent to file process and
these special statutory effective dates intersect, the amount of
retroactive benefits is always limited by the facts found--a claimant
can never receive disability benefits for a period in which he or she
was not, as a factual matter, disabled, or at a degree of disability
higher than supported by the contemporaneous facts. This caveat is
current, established law, unaltered by this rule. Basic entitlement to
compensation is always dependent on the existence of a current or
contemporaneous ``disability,'' and its accompanying severity as
determined by the rating for that disability. 38 U.S.C. 1110, 1114,
1131; 38 CFR part 4. Additionally, all effective dates are generally
``fixed in accordance with the facts found.'' 38 U.S.C. 5110(a). The
special retroactive effective date provisions in section 5110 generally
contain similar restrictions. In particular, the statutory provision
that increased disability compensation may be effective for up to a
year prior to the date of application is limited by ``the earliest date
as of which it is ascertainable that an increase in disability had
occurred.'' 38 U.S.C. 5110(b)(3).
The following examples illustrate this implementing principle.
If a hypothetical claimant files an intent to file a claim on April
1, 2019, and files a complete claim for increase on September 1, 2019,
and evidence of record establishes the disability worsened on January
1, 2019, the effective date will be January 1, 2019. This is the
``earliest date as of which it is ascertainable an increase in
disability occurred'' and it is within one year of the date the
application was deemed received (April 1, 2019). Section 5110(b)(3), as
applied to the claim process defined in this rule, permits an effective
date corresponding to the date the disability worsened in this factual
scenario.
Similarly, if a hypothetical claimant files an intent to file a
claim on April 1, 2019, and files a complete claim on March 1, 2020,
and evidence of record establishes that the disability worsened on
January 1, 2019, the effective date will be January 1, 2019. The
application was received within 1 year of the ``earliest date as of
which it is ascertainable an increase in disability occurred'' and was
itself perfected within 1 year.
In the event the intent to file is received more than a year
following the increase in disability, section 5110(b)(3) is
inapplicable. See Gaston v. Shinseki, 605 F.3d 979, 983-84 (Fed. Cir.
2010) (special effective dates in section 5110 apply to claims filed
within one year of the triggering event specified in statute).
Therefore, if a hypothetical claimant files an intent to file a claim
on April 1, 2029, and files a complete claim on September 1, 2029, and
evidence of record establishes that the disability worsened on January
1, 2019, the effective date will be April 1, 2029.
In new Sec. 3.155(b)(6), we provide that VA will not recognize
more than one intent to file concurrently for the same benefit (e.g.,
compensation, pension). If an intent to file has not been followed by a
complete claim, a subsequent intent to file regarding the same benefit
received within one year of the prior intent to file will have no
effect. There are two alternatives to this rule, neither of which VA
believes are sound policy. The first would be simply to allow claimants
to file an unlimited number of intents to file for the same benefit,
and relate back to the earliest filed that is within one year of the
complete claim. This rule would allow, and even encourage, multiple
unnecessary filings, with attendant wasted administrative action and
confusion. The second alternative would be to allow claimants to file
multiple intents to file, but make clear that each intent to file
``updates'' or ``cancels'' any other pending intents to file for the
same benefit. While this structure would allow a claimant to protect an
interim effective date in the event it becomes clear he or she will be
unable to complete a claim within the year provided, this structure
would also imply that the claimant has abandoned the earlier, more
favorable date. Since it should be extremely rare for claimants to be
unable to file a complete claim within the full year provided, VA is
concerned that allowing claimants to ``update'' pending intents to file
in order to accommodate this scenario could lead to many claimants
inadvertently harming their interests by canceling earlier and more
favorable dates through unnecessary filings. Accordingly, only one
intent to file may be recognized at a time for a given benefit.
D. Treatment of Complete Claims
In new paragraph (d) of Sec. 3.155 of the final rule, VA provides
that all claims, regardless of type, must be complete claims, and the
effective date for benefits is generally the date VA receives a
complete claim (subject to the intent to file process). This
requirement in the first sentence of Sec. 3.155(d) is to make clear
that complete claims are not a distinguishable entity from the other
types of claims enumerated in Sec. 3.160--in other words, the
standards of a complete claim must be met for all types of claims,
including claims to reopen and claims for increase. Furthermore, VA has
reiterated the effective date treatment of the intent to file a claim
process by stating that an intent to file a claim that meets the
requirements as provided in new paragraph (b) of Sec. 3.155 of this
final rule will serve to establish an effective date if a complete
claim is received within 1 year. This reiteration makes clear that the
intent to file process applies to all claims governed by 38 CFR part 3.
VA also makes clear that only one complete claim for a particular
benefit may be associated with each intent to file a claim for that
same benefit for purposes of this special effective date rule. In other
words, if a claimant files one intent to file a claim for compensation,
and then files two or more successive complete claims for compensation
within 1 year, only issues contained within the first complete claim
would relate back to the intent to file a claim for effective date
purposes. There is no limit on the number of issues or conditions in
each complete claim. Accordingly, it is in claimants' best interests to
claim all potential issues under a particular benefit in one
comprehensive package.
VA believes this final rule is less apt to cause confusion than the
alternative, which would allow claimants to submit several claims under
the same benefit over the course of a year while still relating back to
the earliest effective date. This would encourage fragmented
presentation of claims which further complicates and delays the
development and disposition of already pending claims by causing
duplicative VA processing actions or creating confusion regarding the
development actions that must be taken for each claim. Although
claimants may submit new claims at any time, it is far more efficient
to submit all issues under the same benefit in a single unified claim.
As discussed above, VA will recognize multiple intents to file at a
time provided each intent to file identifies a different benefit sought
(e.g., compensation, pension). VA does not intend to limit a claimant
to identifying only one benefit sought in an intent to file. For
example, an intent to file may indicate that a claimant intends to file
complete claims for both compensation and pension. However, if a
claimant submits an intent to file for only one
[[Page 57670]]
benefit (e.g., compensation), VA will not recognize another intent to
file for compensation benefits until a complete claim for compensation
has been submitted or 1 year has expired, whichever occurs first.
VA's decision to recognize multiple intents to file stems directly
from the fact that Sec. 3.155(d) of the final rule provides that only
one complete claim for a particular benefit may be associated with each
intent to file a claim for that benefit. VA seeks to encourage
claimants to utilize its electronic claims submission tools to promote
accuracy and efficiency of claims processing. Currently, however,
claimants are able to submit an electronic application only for
compensation benefits. Thus, if VA were to require a claimant to submit
only one complete claim for all benefits (e.g., compensation and
pension) at the same time, it would be impossible to utilize VA's
electronic claims submission tools to apply for compensation benefits.
Allowing claimants to submit multiple intents to file, provided that
each is for a different benefit, enables veterans to submit a claim for
compensation electronically while still preserving an effective date
for other benefits through the paper or oral intent to file process.
For example, if a veteran submits a VAF 21-0966 for pension on
January 1, 2018, saves an online application for compensation on
February 28, 2018, and VA receives a complete claim for pension on
August 1, 2018 and a complete claim for compensation on September 1,
2018, VA will treat the pension claim as having been received on
January 1, 2018, and the compensation claim as having been received on
February 28, 2018, for effective date purposes. In addition, if a
veteran submits a VAF 21-0966 for compensation and pension on March 1,
2020, and VA receives a complete claim for compensation via VA's
electronic claims submission tool on November 1, 2020, and a complete
claim for pension on paper on January 1, 2021, VA will treat both the
compensation and pension claims as having been received on March 1,
2020.
One commenter noted that in the proposed rule VA allowed only one
complete claim to be associated with an incomplete claim and inquired
whether disabilities that are service connected as secondary to a
claimed or named issue would be afforded the effective date of the
claimed or named issue being adjudicated. If a benefit is granted for
the primary claim or issue for which an intent to file a claim has been
submitted and a benefit is granted on a secondary basis to the primary
claim or issue associated with an intent to file a claim, the effective
date would be the same as for the primary claim because it was an
entitlement established by the evidence of record and within the scope
of the issue or condition enumerated in the complete claim giving rise
to the primary claim. For example, if VA awards compensation benefits
for the primary condition of diabetes and evidence of record shows
other conditions are caused by or related to the diabetes, VA would
assign an effective date for the secondary conditions as of the date VA
awarded the primary condition. The result would be different if the
claim for secondary service connection arose in the course of a later,
separate claim from the one in which the primary condition was
determined to be service connected, either because of changed facts
(such as changed status of disability), or because entitlement was not
granted in the original claim and VA's decision became final. For
example, suppose a hypothetical claimant in receipt of compensation
benefits for a lower back disability and diabetes files a claim for
increase only for the diabetes and the evidence of record shows that
claimant has a right knee disability secondary to the service-connected
lower back disability. In this case, VA would adjudicate the claim for
increase for the diabetes and solicit a claim for an increase in the
lower back disability and secondary condition of the right knee. The
result in both cases flows from the plain terms of Sec. Sec. 3.155(b)
and 3.400, and from VA's obligation to consider entitlements reasonably
within the scope of complete claims filed on a standard form (see
Section I. E. below).
E. Types of Claims
In response to comments, VA has revised proposed Sec. 3.160 to
define certain types of claims in a way that is meant to complement the
structure created in revised Sec. 3.155. In proposed Sec. 3.160, VA
defined a complete claim as ``[a] submission on a paper or electronic
form prescribed by the Secretary that is fully filled out and provides
all the requested information. This includes, but is not limited to,
meeting the following requirements: (1) . . . must be signed by the
claimant or a person legally authorized to sign for the claimant[;] (2)
. . . identify the benefit sought[;] and (3) . . . [provide] a
description of any symptom(s) or medical condition(s) on which the
benefit is based . . . [; and] (4) [for pension or survivor benefits,
provide] a statement of income . . .''.
Some commenters stated that a ``[v]eteran who submits a paper claim
and inadvertently fails to check a single box on the VA form may lose
thousands of dollars in disability benefits, particularly in the case
where VA renders the application `incomplete'.'' The proposed rule made
clear that it was not VA's intent to reject forms for minor ministerial
or formalistic deficiencies. See 78 FR at 65496. Nevertheless, we agree
that a less amorphous standard for completeness is appropriate. In
response to the concerns expressed in the public comments regarding the
term ``fully filled out'' to describe a complete claim and the proposed
language that the requirements for a complete claim would ``not [be]
limited to'' those proposed requirements listed in proposed Sec.
3.160, VA has deleted the open-ended requirement that a form be ``fully
filled out,'' and the qualifier that the requirements of a complete
claim are not limited to those specifically enumerated in the rule. To
address the concern that forms would be rejected for minor ministerial
deficiencies, such as failure to check a box, this final rule provides
a clear and consistent standard for what constitutes a complete claim.
Accordingly, VA has defined a complete claim as a submission of an
application form prescribed by the Secretary, whether paper or
electronic, that contains the following express information
requirements: (1) The name of the claimant; the relationship to the
veteran, if applicable; and sufficient service information for VA to
verify the claimed service, if applicable; (2) a complete claim must be
signed by the claimant or a person legally authorized to sign for the
claimant; (3) A complete claim must identify the benefit sought; (4) A
description of any symptom(s) or medical conditions on which the
benefit is based must be provided to the extent the form prescribed by
the Secretary so requires; and (5) for a nonservice-connected
disability or death pension and parents dependency and indemnity
compensation claims, a statement of income must be provided to the
extent the form prescribed by the Secretary so requires.
These revised requirements of a complete claim are similar to the
criteria for which VA considers an application to be ``substantially
complete'' under current 38 CFR 3.159 in order to trigger VA's duty to
assist under 38 U.S.C. 5103A. Current Sec. 3.159, the regulation
governing VA's assistance in developing claims, provides that a
``substantially complete application'' means ``an application
containing the claimant's
[[Page 57671]]
name; his or her relationship to the veteran, if applicable; sufficient
service information for VA to verify the claimed service, if
applicable; the benefit claimed and any medical condition(s) on which
it is based; the claimant's signature; and in claims for non-service
connected disability or death pension and parents' dependency and
indemnity compensation, a statement of income.'' Therefore, claimants
who submit an intent to file a claim will have 1 year from the date of
such submission to file a complete claim that is similar to the current
standards of a substantially complete application.
One commenter inquired whether the ``paper'' on which a claimant is
seeking benefits must be ``prescribed by the Secretary'' as described
in proposed Sec. 3.160(a), or if an advocate's letterhead used to file
a claim on a claimant's behalf constitutes a submission on paper for
the purpose of a complete claim. One commenter stated that requiring a
form prescribed by the Secretary for submission of claims would
interfere with an advocate's ability to provide representation to the
fullest extent possible since such a requirement would curtail the
advocate's ability to provide rationale to support a claimant's
entitlement to a particular benefit. The proposed rule made clear that
a complete claim must be submitted on a ``paper or electronic form
prescribed by the Secretary.'' In response to this comment, VA has
revised the relevant portion of the final rule in Sec. 3.160(a), to
clarify that a complete claim must be submitted in the form prescribed
by the Secretary, whether paper or electronic. In order to achieve
standardization of the claims and appeals processes, it is necessary
that submissions to initiate a claim or to file a claim be in a
standard format that is easily digitalized and processed in conjunction
with VA's transition to the technological solutions implemented such as
several Web-based paperless claims systems.
However, we make no changes in response to the concern in these
comments that requiring claims to be filed on standard forms would
somehow impair claimants' ability to submit evidence in support of
their claims, or would impair representatives' ability to represent
their clients. Similarly, some commenters expressed the view that the
proposed rule attempted to require claimants to file an FDC, which
requires claimants to certify that they have submitted all evidence
they intend to submit, in order to file a claim at all. This rule does
not alter the scope of evidence submission in the VA system. The fact
that a claim must be initiated on a standard form does not in any way
imply that a claimant cannot submit evidence in favor of that claim
while the claim is pending. We note that neither the proposed rule, nor
this final rule, alter 38 CFR 3.103(d), which governs submission of
evidence and provides that ``[a]ny evidence . . . offered by the
claimant in support of a claim . . . [is] to be included in the
records.'' The proposed rule did not contain any provision requiring
that all evidence in favor of a claim accompany its initial submission.
We do note, however, that claimants who protect their effective date by
filing an intent to file a claim, gather all possible evidence, and
submit all evidence along with their claims will frequently be able to
participate in the FDC program. VA disagrees that mandating the use of
VA-prescribed forms interferes with an advocate's ability to provide
claimants with representation to the fullest extent possible. Mandating
the use of standard forms does not preclude advocates from filing
claims on behalf of a claimant or from submitting statements of
rationale in support of a represented claimant's entitlement to a
particular benefit.
Additionally, some commenters noted that while submitting a
complete claim may seem easy, some claimants or representatives filing
on a claimant's behalf may not have the necessary information readily
available, resulting in delays in submitting a complete claim which
would result in establishing a later date of claim. VA believes the
intent to file a claim process addresses this concern.
In paragraph (a)(4), VA further clarifies that for compensation
claims, a description of symptoms and specific medical conditions on
which the benefit is to be based must be provided to whatever extent
the form prescribed by the Secretary so requires, or else the form may
not be considered complete. Similarly, in paragraph (a)(5), VA
clarifies that a statement of income must be provided for nonservice-
connected disability or death pension and parents' dependency and
indemnity compensation claims to the extent the form prescribed by the
Secretary so requires in order for the claim to be considered complete.
VA received several comments stating that its requirement that
claimants identify the benefit sought, particularly, to specifically
identify the medical condition(s) on which the benefit is based in
order to be considered a complete claim is onerous, especially for the
elderly, homeless, and those with limited education or mental and/or
physical disabilities, because it forces the claimant to diagnose a
specific medical condition for which they are not competent to do and
subjects claimants to a strict pleading standard. The commenters
expressed concern that requiring claimants to identify a diagnosis as
part of meeting the criteria for a ``complete claim'' would undo the
process of VA reasonably raising claims through a sympathetic reading
of the evidence. The commenters stated that requiring claimants to
provide the benefit sought and, particularly, the requirement of a
description of the symptom(s) or medical condition(s) on which the
benefit is based contradicted existing caselaw. Many of the commenters
quoted case law providing that ``[a]lthough an appellant who has no
special medical expertise may testify as to the symptoms he can
observe, he generally is not competent to provide a diagnosis that
requires the application of medical expertise to the facts presented.''
See Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009). Furthermore,
commenters also referenced Ingram v. Nicholson, 21 Vet. App. 232, 255-
56 (2007), which holds that unsophisticated claimants cannot be
presumed to know the law and plead claims based on legal elements and
that the Secretary must look at the conditions stated and the causes
averred in a pro se pleading to determine whether they reasonably
suggest the possibility of a claim for a benefit under title 38,
regardless of whether the appellant demonstrates an understanding that
such a benefit exists or of the technical elements of such a claim.
VA understands the concerns raised in the public comments regarding
the specificity required in order for a claim to be considered
complete. However, the regulatory language of Sec. 3.160(a)(4) clearly
states that for compensation claims, VA requires ``a description of any
symptom(s) or medical condition(s) on which the benefit is based'' as
one of the criteria for a claim to be considered complete. VA is aware
that claimants are generally not competent to diagnose a medical
disability and are generally only competent to identify and explain the
symptoms observed and experienced. The regulatory requirement in Sec.
3.160(a)(4) is consistent with this caselaw because it only requests a
description of ``symptom(s) or medical condition(s) on which the
benefit is based'' which claimants are competent to describe to VA. The
regulatory language, both as proposed and as here revised, is clear
that VA is not requiring claimants to provide a medical diagnosis.
Rather, VA intends to continue its current
[[Page 57672]]
longstanding practice of accepting claimants' description of observable
symptom(s) or experiences or reference to a part of the anatomy such as
``right knee'' in order to meet the criteria of identifying the benefit
sought for a ``complete claim.'' For example, a claim for the ``right
knee'' can be sympathetically read, based on the evidence of record, to
encompass claims for arthritis, ankylosis of the knee, knee
``locking,'' etc. We note also that claimants whose conditions have
been diagnosed by a treating physician are competent to report those
diagnoses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir.
2007). However, in order to accommodate different circumstances, the
regulation is drafted broadly to require only a description of the
condition or its symptoms.
One commenter asked that we clarify how VA would proceed when a
claimant specifies a particular disability on the claim form, but the
disability is ultimately determined to be a different disability from
the one listed, such as when development of a claim for post-traumatic
stress disorder (PTSD) leads to a diagnosis of depression or another
psychiatric disorder other than PTSD. Consistent with our reasoning
above and the fact that the rule requires only that claimants identify
``symptom(s) or medical condition(s) on which the benefit is based,''
VA would continue to develop and ultimately adjudicate this claim as
appropriate without requiring the claimant to ``re-file'' a new form
specifically identifying the new diagnosis. The result would be
different if the claim were not reasonably within the scope of the same
``symptom(s) or medical condition(s)'' on which the original claim was
based.
Similarly, the requirements of Sec. 3.160 clearly do not equate to
a legal pleading or require specific medical knowledge and are not
overly technical. It is VA's intent to maintain the current practice of
accepting the claimant's account of symptoms and lay statements of
experiences in identifying a medical condition for which he or she is
seeking benefits. While VA has revised one of the requirements of a
``complete claim'' to request claimants provide identifiable
information, it has made no change to the regulatory language in the
requirement of identifying the benefit sought in compensation claims to
mean ``symptom(s) or medical condition(s)'' based on these comments.
The regulation language requires only that the claimant identify the
``symptoms or medical conditions'' on which the claim of entitlement to
compensation is based, in order to facilitate the orderly development
of the claim.
In addition, VA received several comments expressing concern that
it would no longer grant benefits based on inferred claims or claims
reasonably raised by the evidence of record due to the requirements of
a ``complete claim'' which specifies that a claimant must identify the
benefit sought, to include symptom(s) or medical condition(s) on which
the benefit is based. Many commenters stated that the proposed
regulation assumes that the veteran possesses a complete understanding
of the entire spectrum of benefits available to them which they do not.
Commenters were concerned that, in order to qualify as a complete
claim, the claimant must list particular benefits with specificity on
their application forms, or else risk having the claim denied.
We agree that it is necessary to provide a more detailed
explanation of how we will reconcile the pro-claimant practice of VA
identifying and adjudicating claims raised by the evidence of record
but not specifically raised by the claimant with the requirement that
all claims be submitted on a standard form. It has been VA's
longstanding practice to infer or identify and award certain benefits
that a claimant has not expressly requested but that are related to a
claimed condition and there is evidence of record indicating
entitlement. The practice of identifying these ``reasonably raised
claims'' is not mandated or defined by any statute or regulation. We
note, however, that the ``[s]tatement of policy'' in 38 CFR 3.103(a)
provides that, in developing and deciding the ``claim'' filed by a
claimant, ``it is the obligation of VA . . . to render a decision which
grants every benefit that can be supported in law while protecting the
interests of the Government.'' Relatedly, a number of court decisions
have noted that, in the legislative history of the Veterans Judicial
Review Act, Public Law 100-687, the House Committee on Veterans'
Affairs stated that VA should ``fully and sympathetically develop the
veteran's claim to its optimum before deciding it on the merits.'' H.R.
Rep. No. 100-963 at 13 (1988); reprinted in 1988 U.S.C.C.A.N. 5782,
5794-95; see Roberson v. Principi, 251 F.3d 1378, 1384 (Fed. Cir.
2001); Norris v. West, 12 Vet. App. 413, 420 (1999). Consistent with
these policies, VA employs the practice of identifying and adjudicating
reasonably raised claims as an administrative tool to provide for
consideration of issues and benefits that have not been expressly
claimed but that logically are placed at issue upon a sympathetic
reading of the claim(s) presented to VA and the record developed with
respect to such claim(s).
This rule does not alter VA's general practice of identifying and
adjudicating issues and claims that logically relate to and arise in
connection with a claim pending before VA. Although the rule requires
claimants to specify the symptoms or conditions on which their claims
are based and the benefits they seek, it generally would not preclude
VA from identifying, addressing, and adjudicating related matters that
are reasonably raised by the evidence of record which the claimant may
not have anticipated or claimed, but which logically should be
addressed in relation to the claim filed. Rather, such matters
generally may be viewed as being within the scope of the claim filed,
as sympathetically interpreted in light of the record. This rulemaking
does not alter or delete the requirement in 38 CFR 3.103(a) for VA to
``render a decision which grants every benefit that can be supported in
law while protecting the interests of the Government.'' This policy
recognizes that many ancillary benefits that many veterans are not
aware of may continue to be adjudicated and awarded as part of VA's
disposition of the issues a claimant has specifically raised.
However, entirely separate conditions never identified on a
standard claim form generally will not be the subject of claims that
are reasonably raised by the evidence of record. As an initial matter,
we do not construe 38 CFR 3.103(a) or other governing authorities to
establish a legal duty to identify and adjudicate claims that are
unrelated to the particular claims raised by the claimant. Section
3.103(a) specifies that claimants are entitled to written notice of the
decision made ``on his or her claim'' and that VA will assist in
developing ``the facts pertinent to the claim'' and will render a
decision which grants every benefit that can be supported in law while
protecting the interests of the Government. Those provisions thus
relate to matters that are reasonably within the scope of the claim
filed by the claimant. They do not, however, create a duty to
adjudicate matters unrelated to the claim filed. In this way, Sec.
3.103(a) reflects the principle of sympathetic construction of claims,
while adhering to the general statutory framework that requires a
specific claim in order to support a benefit award, 38 U.S.C. 5101(a),
and to establish the date on which entitlement to an award may be
effective, 38 U.S.C. 5110(a). Similarly, insofar as judicial decisions
have referenced a duty of sympathetic development deriving from
congressional intent expressed in H.R.
[[Page 57673]]
Rep. No. 100-963, that report similarly refers to a duty to fully and
sympathetically develop the claimant's ``claim'' to its optimum before
deciding such claim. We do not construe that statement as requiring VA
to identify and adjudicate issues and claims that are unrelated to the
claim(s) presented to VA.
Further, establishing a duty on VA's part to identify claims
reasonably raised by the evidence of record which are unrelated to the
claim(s) presented would be incompatible with the requirement in Sec.
3.160(a)(4), as prescribed in this final rule, that a complete claim
enumerate the conditions or symptoms on which the claim is to be based.
If claims that are reasonably raised by the evidence of record for
totally new conditions were permissible, it would be possible to
identify only one condition on the standard application form, but
submit evidence relating to multiple conditions on the expectation VA
will identify and adjudicate those unidentified claims. This would
inevitably lead to exactly the time-intensive clarifications and
interpretations we seek to avoid remaining necessary in a large volume
of cases.
The permissible scope of claims that are reasonably raised by the
evidence of record in light of the requirement in Sec. 3.160(a)(4)
overlaps somewhat with the scope of the implicit denial rule. The basic
idea of that rule is that claims pending but not explicitly denied in a
decision addressing other claims can be deemed ``implicitly denied'' in
certain circumstances. In Ingram v. Nicholson, 23 Vet. App. 232, 248
(2007), the Court of Appeals for Veterans Claims (hereinafter
``Veterans Court'') said the implicit denial rule cannot cover claims
that are very different from one another in content. For instance, the
denial of nonservice-connected pension claims did not put Mr. Ingram on
notice that his claims under 38 U.S.C. 1151 had been denied. Ingram, 23
Vet. App. at 243. However, the United States Court of Appeals for the
Federal Circuit (hereinafter ``Federal Circuit'') later held that a
claim for endocarditis was implicitly denied when the AOJ denied a
claim for rheumatic heart disease. Adams v. Shinseki, 568 F.3d 956, 963
(Fed. Cir. 2009).
Applying a similar scope to these claims that are reasonably raised
by the evidence of record but not specifically claimed by the claimant
will allow VA to continue this pro-claimant practice largely
undisturbed while still requiring claims to originate on standard
forms. VA's grant or denial of a pending claim necessarily implies that
VA has considered all potential theories of entitlement reasonably
inferable from the evidence of record and reasonably within the scope
of that claim. This is consistent with the requirement in Sec.
3.160(a)(4) that the completed application form enumerate ``symptom(s)
or condition(s)'' but not ``diagnoses'' or some other more discrete
requirement. For example, if a claimant lists ``heart condition'' on a
standard form, VA would consider entitlement theories based on both
endocarditis and rheumatic heart disease, to the extent justified by
the evidence of record. This means VA would continue to award benefits
reasonably raised by the evidence of record based on secondary service
connection or service connection based on aggravation due to an already
service-connected disability, entitlement to total disability based on
individual unemployability, benefits such as housing or automobile
allowance, or special monthly compensation benefits if the evidence is
clear that the claimant meets the eligibility or requirements for such
benefits and VA can adjudicate these claims. This provision has been
outlined in new paragraph (d) of Sec. 3.155. In new Sec. 3.155(d)(2),
we have provided that VA will continue to identify and adjudicate
claims reasonably raised by the evidence of record that are related to
or are reasonably within the scope of the claimed issues in the
complete claim. As explained above, Sec. 3.103(a) currently provides
the predicate for full and sympathetic development of claims, to
include consideration of matters reasonably related to and raised in
connection with a claim before VA, whether or not raised expressly by
the claimant. We have provided that VA will put at issue for
adjudication any ancillary benefit(s) or other claims not expressly
raised by the claimant that are related and arise as a result of the
adjudication of a claimed issue. Such issues, other than ancillary
benefits, which have not been claimed by the claimant but have resulted
as complications of claimed service-connected conditions will continue
to be identified and adjudicated as also indicated by part 4 of the
CFR, VA Schedule for Rating Disabilities.
We note that the existence of the discretionary, pro-claimant
practice of identifying claims reasonably raised by the evidence of
record does not imply that claims potentially remain pending
indefinitely, awaiting the suggestion that contemporaneous evidence may
have supported inferring a claim that was not actually filed. As the
implicit denial rule itself suggests, VA's grant or denial of a pending
claim necessarily implies that VA has determined that no other claims
are reasonably raised by the claims specifically identified by the
claimant and the accompanying evidence of record. The correct way to
contest this determination is on direct appeal, or in a claim for clear
and unmistakable error. See Deshotel v. Nicholson, 457 F.3d 1258, 1261-
62 (Fed. Cir. 2006). VA also notes that ``where there can be found no
intent to apply for VA benefits, a claim for entitlement to such
benefits has not been reasonably raised.'' Criswell v. Nicholson, 20
Vet.App. 501, 504 (2006). Accordingly, in the next to last sentence of
Sec. 3.155(d)(2), we clarify that VA's decision addressing some, but
not all, of the issues raised in a complete claim does not imply that
the reminder of the enumerated issues (and issues reasonably within
their scope in light of the evidence of record) have been denied, since
VA must still decide the remaining enumerated issues. However, in the
final sentence of Sec. 3.155(d)(2) we make clear that VA's decision on
a claim necessarily implies that VA has determined the evidence of
record does not support a grant of benefits for any other issue
reasonably within the scope of the issues enumerated in the complete
claim. This rule text makes clear that VA's duty to broadly construe
the evidence of record does not vitiate the finality of otherwise final
VA decisions.
We further note that identifying and adjudicating claims reasonably
raised by the evidence of record are a pro-claimant practice meant to
resolve claims without the need for unnecessary administrative action
when VA is already actively developing and adjudicating a claim. It
should not be construed as creating a rule or practice that the filing
of evidence, without a claim for increase for a condition already
service connected executed on a completed application, constitutes a
claim for increase. Such a practice would form a boundless exception to
the requirement to file a complete claim for increase made explicit in
Sec. 3.155(d), and would be inconsistent with our explicit elimination
of current Sec. 3.157.
Some commenters specifically questioned how claims for Total
Disability based on Individual Unemployability (TDIU) would operate
under a system requiring standard forms. Generally, TDIU is not a
``claim,'' but a rating that is provided in light of the impact of an
individual's disabilities. Rice v. Shinseki, 22 Vet. App. 447, 452-54
(2009). This implies that VA must consider potential
[[Page 57674]]
entitlement to TDIU when the necessary substantive thresholds are met,
and whenever evidence of record potentially establishes
unemployability, whether in the context of an original claim or a claim
for increase. As we said in the proposed rule, ``[i]t is VA's intent
that a request for an increase accompanied by evidence of
unemployability continue to constitute a claim for TDIU, but the claim
for increase itself must be filed on a standard form.'' 78 FR at 65497.
However, it also implies that the requirements to initiate an original
claim or a claim for increase, such as initiating an application with
an intent to file a claim and perfecting it with a completed
application form, apply, as they would to efforts to seek any other
rating.
Other commenters asserted that it has been VA's longstanding
practice to assist veterans at the beginning of the claims process and
that requiring claimants to provide a complete claim is comparable to
the ``well-grounded claim'' elements which Congress ordered abandoned
by the Veterans Claims Assistance Act of 2000. One commenter stated
that ``the idea of not considering a claim to have been properly filed,
and therefore not eligible for an effective date until it is `complete'
sounds remarkably similar to the universally rejected requirement of
filing a `well-grounded' claim.'' Another commenter stated that
electronic applications that fall short of the standards of a complete
claim would not constitute a claim of any kind, complete or otherwise,
and that the proposed rule was incompatible with the duty to assist as
mandated by 38 U.S.C. 5103A. Other commenters seemed to be under the
impression that, under the proposed rule, a veteran would be required
to complete all development on a claim before it would be considered
complete and accepted, and some accused VA of attempting to shift legal
burdens onto the veteran, though not all commenters characterized this
as requiring a ``well-grounded'' claim.
Historically, section 5107 of title 38, United States Code provided
that a person who submitted a claim for benefits had the burden of
submitting evidence sufficient to justify a belief by a fair and
impartial individual that the claim was well grounded. 38 U.S.C.
5107(a) (1994). This seemingly subjective determination ultimately came
to be defined with some particularity, and the elements of a ``well
grounded claim'' eventually bore resemblance to the elements of
ultimate entitlement to disability compensation. Compare Epps v. Gober,
126 F.3d 1464, 1468 (Fed. Cir. 1997) with Holton v. Shinseki, 557 F.3d
1362, 1366 (Fed. Cir. 2009). The Veterans Court even suggested that VA
was legally precluded from providing assistance to claimants who had
yet to submit evidence sufficient to establish well-groundedness. See
Grivois v. Brown, 6 Vet. App. 136, 140 (1994). Congress recognized the
illogic of requiring claimants to all but establish entitlement to
benefits in order to be eligible for receiving VA assistance in
gathering the evidence needed to establish entitlement in enacting the
Veterans Claims Assistance Act of 2000. See H.R. Rep. 106-781 at *6-*9
(July 24, 2000).
We disagree with the assertion that the proposed rule would have
resurrected the well-grounded claim requirement, or that this rule as
now revised resurrects that requirement. The proposed rule would not
have required claimants to submit evidence establishing ultimate
entitlement to benefits in order for the claim to be recognized as a
complete claim, and neither does this final rule.
The determination that a ``complete claim'' has been submitted is
based on objective standards that are explicitly outlined in Sec.
3.160(a). The criteria of a ``complete claim'' correspond directly to
the current standards for a ``substantially complete application'' in
Sec. 3.159 which governs VA's statutory duty to assist claimants in
developing claims. Therefore, once VA receives a complete claim, the
statutory duty to assist claimants in obtaining evidence to
substantiate the claim is triggered. While a form must contain the
elements of information explicitly required by Sec. 3.160(a) in order
to be considered complete, there is no requirement to submit medical or
other evidence in support of the claim in order for the application
form to be considered complete. In other words, requiring that a claim
be complete in order for VA to begin adjudicative activity is not at
all the same thing as requiring ultimate entitlement to be demonstrated
before VA will begin adjudicative activity. Therefore, VA has made no
change to the proposed rule based on this comment.
Similarly, another commenter asserted that claimants should not be
responsible for developing their claims and that VA has a duty to
assist veterans. The requirement that claimants submit a complete claim
does not entail shifting the burden on the claimant to develop his or
her claim. The submission of a complete claim as set forth in Sec.
3.160(a) of this final rule allows for efficient, fair, and orderly
processing and adjudication of a claim because the information
necessary to develop and adjudicate the claim has been provided. VA's
statutory duty to notify claimants of information and evidence
necessary to substantiate the claim and duty to assist claimants in
obtaining evidence necessary to substantiate the claim remain
unchanged. VA will continue to develop claims that are considered
complete.
VA eliminates the definition of ``incomplete claim'' that had
appeared at paragraph (b) as proposed, and replaces it with the
definition of an ``original claim'' as originally proposed at paragraph
(c), with the minor change of deleting ``or form'' from the phrase,
``application form or form prescribed by the Secretary''. This change
is to make clear that an application form is the form prescribed by the
Secretary rather than some distinct administrative tool. In paragraph
(c), VA adopts as final the definition of a ``pending claim'' which was
proposed at paragraph (e). This change updates the existing definition
of ``pending claim,'' which is currently defined as ``an application,
formal or informal, which has not been finally adjudicated'' by
replacing the phrase ``an application, formal or informal'' with the
word ``claim.''
In paragraph (d), VA adopts as final the definition of ``finally
adjudicated claim,'' as originally proposed at paragraph (f). This
action primarily replaces the phrase ``an application, formal or
informal'' in the current definition with the word ``claim.'' Since VA
is eliminating the term ``informal claim,'' it removes references to
the phrase or words, ``informal'' and ``formal'' for consistency in the
existing definitions. These changes are not meant to alter the law of
finality in the VA benefits system. See Cook v. Principi, 318 F.3d
1334, 1339-41 (Fed. Cir. 2002) (en banc).
Furthermore, VA has withdrawn the definitions of ``new or
supplemental claim'' in proposed paragraph (d) of the proposed rule and
the revised definition of ``claim for increase'' in proposed paragraph
(h) of the proposed rule. The definition of a claim for increase in
current Sec. 3.160(f) accordingly remains unchanged by this final
rule. While the new proposed definitions were intended to provide
clarification, the statements of commenters demonstrated a
misunderstanding and confusion about the usage and application of these
terms. Because no substantive change to the scope of what constitutes a
claim for increase was intended, and the more particular definition in
the proposed rule is not necessary to achieve consistency with the
intent to file
[[Page 57675]]
process, VA has withdrawn these proposed definitions in this final
rule. However, in revised paragraph (e) of this final rule, VA
continues the definition of ``reopened claim'' that appears in current
Sec. 3.160(e) with slight modifications to insert ``new and material
evidence'' as clarification of VA's existing criteria for reopening a
previously denied claim.
F. Elimination of Report of Examination or Hospitalization as Claim for
Increase or To Reopen
Through this final rule, VA removes current Sec. 3.157, which had
provided that reports of examination or hospitalization can constitute
informal claims to increase or reopen. In implementing one consistent
standard for the claims process, VA has eliminated informal claims for
increase or to reopen based on receipt of VA treatment, examination, or
hospitalization reports, private physician medical reports, or state,
county, municipal, or other government medical facilities to establish
a retroactive effective date as provided in current Sec. Sec. 3.155(c)
and 3.157. The idea that certain records or statements themselves
constitute constructive claims is inconsistent with the standardization
and efficiency VA intends to accomplish with this final rule.
Therefore, in place of current Sec. Sec. 3.155 (c) and 3.157, VA
adopts the amendments to Sec. 3.400(o)(2) as proposed, with two
changes necessary to respond to concerns raised by commenters and to
implement the intent to file process we have adopted in order to
respond to the broadest concerns in the comments. The first change is
to add the words ``or intent to file a claim'' after ``a complete
claim'' in both the first and second sentences of the rule as proposed.
The rule now states that a retroactive effective date may be granted,
when warranted by the facts found, based on date of treatment,
examination, or hospitalization from any medical facility, if the
claimant files a complete claim for increase or an intent to file such
a claim within 1 year of such medical care. This amendment preserves
the favorable substantive features of the current treatment of reports
of examination or hospitalization under Sec. 3.157, but requires
claimants to file a complete claim for increase, or an intent to file
that is later perfected by a complete claim, within 1 year after
medical care was received.
The other change is to insert the words ``based on all evidence of
record'' in the first sentence of the regulation, so the language
describing the relevant effective date now reads, ``[e]arliest date as
of which it is factually ascertainable based on all evidence of record
that an increase in disability had occurred''. This addition is to
respond to a comment expressing concern that Sec. 3.400(o)(2) as
proposed would ``restrict[] the evidence needed to establish an earlier
effective date to only medical evidence.'' The language in the second
sentence of Sec. 3.400(o)(2) as proposed specific to the treatment of
medical records was intended to specifically address, in regulatory
text, the situations in which medical records may establish an
effective date. This language was intended to make clear, in governing
regulation text separate from the elimination of current Sec. 3.157,
that medical records are evidence used to establish contemporaneous
state of disability once a claim has been filed, and do not themselves
constitute claims. By adding ``based on all evidence of record'' to the
first sentence, we are making clear that the date as of which it is
factually ascertainable that an increase in disability occurred may be
based on any kind of evidence to the extent that evidence is credible
and probative. Placing this clarification in the first sentence of the
regulation avoids confusing matters by discussing types of evidence
other than medical records in the second sentence, which is meant to
provide clarification in light of the elimination of Sec. 3.157.
Some commenters asserted that eliminating Sec. 3.157 would shift
the burden of filing a claim to the claimant, who may be more focused
on undergoing treatment than in considering the existence of a
potential monetary benefit. VA fully appreciates that while a veteran
is hospitalized or receiving crucial medical treatment, a veteran may
be more focused on his or her health than on pursuing a claim for
compensation. VA has no desire to preclude veterans from receiving
benefits for periods of hospitalization or medical treatment--VA only
wishes to receive inputs in a standard format in order to serve
veterans as efficiently as possible. Therefore, VA has provided a 1-
year window within which a claimant can submit an intent to file a
claim as outlined in Sec. 3.155(b) of this final rule or file a
complete claim for increase. As we discuss in section I.C of this final
rule notice, the filing of an intent to file within this one year
period provides up to a year to perfect the application by filing a
complete claim. Under this final rule, all a veteran must do to
preserve the earliest possible effective date of benefits is take the
minimal step of filing an intent to file within 1 year from the date as
of which it is ascertainable that an increase in disability has
occurred, in any of the permissible formats discussed in Sec.
3.155(b). 38 U.S.C. 5110(b)(3). Filing the intent to file placeholder
then provides the claimant up to another year to perfect the
application by filing a complete claim. VA believes this process
provides a significant amount of time for veterans undergoing medical
treatment or hospitalization to perform these minimal steps without
losing any benefits. VA strongly believes that any de minimis burden
associated with filling out a form, whether an intent to file a claim
form or a complete claim, rather than having a medical record itself
constitute a claim for increase is clearly outweighed by the
efficiencies that will be realized as claims become easier to identify
and process.
Several commenters stated that revised Sec. 3.400(o)(2), the
effective date provision for claims for increase, limits retroactive
payments to no more than 1 year and that, currently, veterans may be
eligible for many years of retroactive payments based on facts found in
the medical evidence. Other commenters stated that the rule eliminates
the present right of a veteran to use the date of treatment in a VA
medical facility for a non-service-connected disability if a claim is
submitted within 1 year and VA determines that service connection
should be granted or when a claim specifying the benefit sought is
received within 1 year from the date of such examination, treatment, or
hospital admission.
The plain language of the statute governing effective dates for an
award of increased compensation based on an increase in disability
allows an effective date based on when it is factually ascertainable
that an increase in disability had occurred, ``if application is
received within one year from such date.'' 38 U.S.C. 5110(b)(3).
Accordingly, it is clear that the effective date of a claim for
increase can never be more than one year prior to the date of
application. With this rule, VA is ending the practice that certain
records themselves constitute claims, but is not disturbing the
potential period during which a veteran may receive an award of
increased compensation, provided the factual basis for such an award
exists, and provided the veteran files a complete claim for increased
compensation or an intent to file that is ultimately perfected by a
complete claim for increased compensation within one year.
The situation identified by the commenters does not arise because
VA
[[Page 57676]]
grants effective dates more than a year in advance of when the
application is received--VA is flatly prohibited by statute from doing
so. Rather, it arises when a veteran files a claim for increase, and VA
becomes aware of a document, such as record of admission to a VA or
uniform services hospital, potentially more than one year old, that
itself constitutes a claim pursuant to current Sec. 3.157, but has not
been recognized as a claim or obtained by Veterans Benefits
Administration (VBA) adjudicators until the instant claim for increase
has been filed. In this scenario, benefits are not being paid more than
one year prior to the date of application, but are being paid pursuant
to a ``claim'' which was only recently found to have been pending. In
other words, in this scenario the veteran is being paid a
``retroactive'' award because a claim was not properly identified and
processed, and remained pending potentially for years. This is exactly
the type of situation that VA seeks to prevent by insisting that claims
must be on standard forms amenable to easy identification and
processing. This rule does not preclude a veteran from receiving
increased compensation for any period for which he is so entitled,
provided he files a claim on a standard form or an intent to file
within one year of when the increase in disability occurs. This rule
does not ``take away'' potential avenues for a veteran to receive years
of retroactive benefits, but rather prevents the situations that make
retroactive payments necessary in the first place, provided the veteran
takes the minimal step of filing a claim on a standard form. VA
strongly believes it is preferable for veterans to be in current
receipt of benefits to which they are entitled, rather than go without
those benefits due to agency error for years before receiving
retroactive payments. Additionally, we note that, to the extent a
record that itself constitutes a claim is in existence as of the date
this rule becomes effective and has not been identified and acted upon,
this rule cannot extinguish that record's status as a claim under the
law that was in effect as of the time that record was created, to the
extent it is ever identified as claim. This rule cannot and does not
preclude benefits that might be due for any unidentified and
unadjudicated claims now pending.
Likewise, Sec. 3.400(o)(2) does not alter the current procedures
and laws governing the assignment of effective date(s) for an award
granted for the first time based on treatment, hospitalization, or
examination.
G. Special Allowance Payable Under Section 156 of Public Law 97-377
Finally, VA adopts minor amendments to proposed Sec. 3.812 which
govern a special allowance under Public Law 97-377. VA replaces the
terminology ``formal'' and ``informal'' claims with ``complete claim''
and ``intent to file a claim,'' as appropriate, to ensure consistency
with the rest of the final rule.
One commenter stated that mandating the filing of a complete form
for this particular benefit prior to VA recognizing it as a claim flew
in the face of a half century or more of veteran-friendly regulations.
However, because VA has replaced the concept of informal claim with the
concept of intent to file a claim in Sec. 3.155(b) of this final rule,
claimants applying for this benefit in Sec. 3.812 can preserve an
earlier effective date by submitting an intent to file a claim that is
later ratified by a complete claim if filed within one year of receipt
of the intent to file a claim. Therefore, claimants and/or
beneficiaries would not lose out on possible benefits due to the
requirement of a complete claim being filed for this particular
benefit.
H. Other Comments Regarding Initial Claims
VA received many comments asserting that VA's mandate of the use of
forms in the VA claims process is burdensome to claimants by making it
more difficult for claimants to file a claim and by overcomplicating
the claims process, particularly for those with disability limitations
or limited access to VA forms. The commenters expressed that such
mandate of the use of forms creates an adversarial relationship between
claimants and VA. Some commenters stated that VA is acting only in its
own best interest in reducing the statistics on the claim backlog and
not in veterans' interests.
VA has responded to these concerns by adopting the intent to file
process, which is meant to reconcile the need for standard inputs with
the claimant's need to preserve an effective date while complying with
the procedural requirement of filling out an application form. VA is
sensitive to the concern that, in some cases, the very disability for
which a veteran is seeking compensation may make it difficult to fill
out a form. This final rule strikes an appropriate balance between
providing claimants with a more efficient process that does not erode
the longstanding informal, non-adversarial, pro-claimant nature of the
VA system with the ongoing workload challenges relative to VA's
operating resources. VA considers increasing the role of standard forms
a key component to streamlining, standardizing and modernizing the
claims process. The current informal claim process allows non-standard
submissions to constitute claims, which involves increased time spent
determining whether a claim has been filed, identifying the benefit
claimed, sending letters to the claimant and awaiting a response, and
requesting and awaiting receipt of evidence. These steps all
significantly delay the adjudication and delivery of benefits to
veterans and their families. Requiring the use of standard forms
imposes minimal, if any, burden on claimants. Further, by making it
possible for all claimants to preserve an effective date by utilizing
the ``intent to file'' process, VA believes the benefits of these
changes outweigh any such burden. Even those claimants who, due to
their disabilities, may have trouble filling out an application form,
can utilize one of the three acceptable formats for an intent to file,
including oral communications with certain designated VA personnel, and
take up to a year to perfect the application form without losing
benefits.
Moreover, current standard forms such as VA Forms 21-526EZ, 21-
527EZ, and 21-534EZ (hereinafter ``EZ forms'') contain the statutorily
required notice to claimants of the information and evidence necessary
to substantiate a claim at the onset of filing a claim. See 38 U.S.C.
5103. This means claimants do not have to wait for VA to send notices
to claimants of VA's duty to assist in developing a claim. Claimants
will be informed of what information and evidence is necessary in
substantiating their claims prior to or at the time they file a claim.
In addition, the EZ forms used for filing disability compensation,
pension, and survivor benefits as well as the NOD form are shorter in
length, making them less burdensome and time-consuming for claimants to
complete. Additionally, EZ forms contain pre-printed lists of
potentially available benefits to help guide claimants through the
claim process. VA believes that the standard format of VA's forms that
provide pre-printed selections from which claimants can choose poses
less of a burden on claimants because claimants spend less time
describing their intent to file a claim, identifying and describing
symptoms or medical conditions, or expressions of disagreement to a VA
decision in a narrative format of non-standard submissions.
Some commenters asserted that there would be a constituency of
claimants
[[Page 57677]]
who would not have access to VA's standard forms. The forms necessary
to file claims for benefits are widely available, both online and in VA
regional offices. Additionally, VA will continue to provide claimants
with the correct forms upon request. 38 U.S.C. 5102. Furthermore, with
the regulatory changes to Sec. 3.155 standardizing the informal claim
process through the concept of an intent to file a claim, claimants or
their authorized representatives can contact designated VA personnel
directly to establish an intent to file a claim and preserve a
potential earlier effective date of their claim, and VA will furnish
claimants with the appropriate claim application form(s) necessary for
claimants to submit a complete claim. Many veterans service
organizations also have access to VA forms.
One commenter objected to our discussion in the proposed rule
pointing out that electronic claims could more easily be separated by
issue and routed around the country for consideration by specialists,
often referred to as the ``centers of excellence'' concept. The
proposed rule would not have implemented or mandated the ``centers of
excellence'' concept. It would have incentivized electronic claim
submission, which removes many of the manual steps necessary to convert
claims to electronic format. VA will only move toward electronic issue-
by-issue brokering of workload when it is confident that this step adds
both accuracy and efficiency to the claims process.
One commenter stated that the proposed rule would have created
multiple definitions of ``receipt'' which 38 U.S.C. 5110, the statute
governing effective dates of awards, does not authorize, and that
particularly for electronic claims VA would not receive the identical
form sent to VA via mail or other means and that the effective date of
an electronic claim is outside the meaning of the statute. This final
rule no longer attaches effective date distinctions to whether a claim
is received in paper or electronic format. VA notes that statutes
neither expressly permit nor prohibit VA's current longstanding
practice of assigning an effective date based on receipt of an informal
claim to establish an effective date when such informal claim is later
ratified by a completed application form within 1 year. Through this
final rule, VA is simply modifying the traditional informal claims
process to make it more amenable to timely and efficient processing,
while maintaining essentially the same longstanding liberalizing
effective date rule that the informal claim process has entailed. To
the extent this comment is read as raising the broader point that
recurring terms in section 5110 such as ``date of receipt of
application'' and ``date . . . application is received'' must be
interpreted and implemented in a consistent way, VA has done so in this
final rule. See e.g., 38 U.S.C. 5110(a), (b)(2), (b)(3). As we explain
in section I.C, a claimant must file an application form. However, for
effective date purposes, VA will deem that application form to have
been received as of the date VA was put on notice, through the
submission of an intent to file, that a claimant intended to file a
claim. Any specific statutory effective dates that are available (if
justified by facts found) prior to the date that the application is
deemed filed will operate independently.
Some commenters raised practical complaints with the eBenefits
system. Some asserted that eBenefits is confusing to claimants, while
others focused on technical barriers to eBenefits access. Similarly,
some commenters pointed to past information security breaches, and the
fact that the technology necessary to file an electronic claim may be
expensive, as reasons why allowing an effective date placeholder solely
for incomplete electronic claims would be a potential burden to
claimants. Because this final rule no longer attaches potential
effective date consequences to whether a claim is initiated
electronically prior to its ultimate filing as a complete claim, we
consider these comments addressed insofar as the structure of VA's
claims rules is concerned. We will continue the operational work of
improving online claim submission tools and conducting outreach to
veterans on how to submit claims.
Some commenters pointed out that some veterans are illiterate, or
are blind, or have brain injury, mental health problems, or other
cognitive impairments, and might therefore have difficulty using
technology or filling out VA forms. In this final rule, we have
provided that claimants may establish an effective date placeholder via
oral contact with designated VA personnel. We also note that 38 U.S.C.
5101(a)(2), as amended by Section 502 of Public Law 112-154, allows
certain authorized signers to sign a form required by section
5101(a)(1) on behalf of an individual who ``has not attained the age of
18 years, is mentally incompetent, or is physically unable to sign a
form''.
One commenter argued there is insufficient space on VA claims forms
to identify disabilities with sufficient particularity, which will
cause problems for veterans as well as processing problems at VA. The
current form 21-526 contains space for seven conditions, as well as
additional open space in which the veteran can indicate additional
conditions if necessary. The form 21-526EZ already contains space to
specifically list thirty conditions. More fundamentally, forms are
capable of being revised based on experience and operational needs,
provided VA complies with the necessary procedural requirements in
doing so. An objection to the design of one particular form does not,
therefore, imply that VA rules cannot or should not require claims to
originate on standard forms. Finally, as we explain in section I.C, the
commenter is mistaken as to the level of particularity required. The
proposed rule would not have, and this final rule does not, require the
veteran to identify a specific medical diagnosis in order to complete a
claim. As Sec. 3.160(a)(4) makes clear, all that is required is a
``description of any symptom(s) or medical condition(s),'' and this
requirement can be satisfied by simply claiming ``right knee'' or
``shoulder,'' which will require VA to consider all possible right knee
or shoulder disabilities established by the evidence of record.
Some commenters also suggested that VA's desire to increase the
importance of standard forms in the claims process implies that VA
cares more about the speed with which decisions are reached than the
quality of those decisions. VA disagrees with these comments. Standard
forms increase clarity and accuracy as well as efficiency, leading to
lower error rates and higher quality in benefits processing.
Additionally, VA strongly believes that unacceptable delays in the
processing of veterans benefits claims, colloquially known as the
``backlog,'' also hurt veterans because benefits cannot be paid until a
claim is decided. Many features of VA's current claims process also
contribute to the backlog or, at a minimum, hamper VA's ability to
address the backlog. Most inputs into the claims process, such as
claimant submissions, are still received in paper format. Further, many
submissions, including submissions requiring VA to take action, are not
received in a standard format. This increases time spent determining
whether a claim or a notice of disagreement to a decision has been
filed, identifying the benefit or contention claimed or appealed,
sending letters to the claimant and awaiting for a response, and
requesting and awaiting receipt of evidence. These
[[Page 57678]]
steps all significantly delay the adjudication and delivery of
benefits. By requiring the use of standardized forms for all claims and
appeals, VA is able to more easily identify issues and contentions
associated with claims or the initiation of an appeal that are filed,
resulting in greater accuracy, efficiency, and speed in processing and
adjudicating claims and appeals.
Some commenters suggested that VA should have standard forms,
including for informal claims, but that use of those forms should be
optional. VA has made no changes based on these comments. Making
standard forms optional will not achieve the necessary standardization
of the process because VA personnel would still be required to engage
in time-intensive interpretive review of narrative submissions in order
to determine whether a claim or appeal has been filed.
One commenter suggested that if the rule as proposed were confirmed
as final, staff attorneys should be made available to all veterans who
request one, free of charge, to navigate the ``adversarial'' process
that would result. We disagree that requiring forms be filed at certain
critical phases of the claims and appeals process amounts to an
``adversarial'' approach, particularly in light of the express
authority conferred by Congress. Additionally, in this final rule, we
have provided multiple avenues for a claimant to protect an effective
date while taking up to a year to fill out the required form.
One commenter requested that VA ``clearly state and abide by [a]
suspense/deadline for each claim processed.'' That is exactly what VA
is trying to do. The Secretary has clearly stated that VA's operational
goal is to process all claims with 98 percent accuracy within 125 days,
has defined a claim pending longer than 125 days as part of the
``backlog,'' and pledged to eliminate the backlog in 2015. Given the
volume and complexity of VA's workload, the use of standard forms are
indispensable to reaching and maintaining this level of accurate
production. This comment also suggested that the ``tens levels set
forth by the VA'' are redundant. We construe this comment as an
objection to VA's Schedule for Rating Disabilities, 38 CFR part 4,
rather than to the rules and procedures governing the processing,
development, and adjudication of claims, and as such this comment is
beyond the scope of this rule. We also note that the 10 percent
incremental evaluation applicable to the rating of disabilities is
explicitly required by statute. See 38 U.S.C. 1114, 1155. This
commenter also asserts that ``taking one to two years with no back
dating to the start of a claim is unacceptable by any standard.'' VA
agrees, and that is why our operational goal is 125 days. However, we
note that once a claim is granted, it is paid as of that claim's
effective date, which generally corresponds to the date of the receipt
of application, and is not controlled by the date of decision.
Multiple commenters objected to the rule as proposed on
constitutional grounds. These comments generally advanced two
arguments. First, commenters argued that requiring veterans to fill out
an application form deprives them of benefits without due process of
law. Second, commenters advanced the related argument that attaching
different effective date consequences to whether claims originate in
paper or electronic format violates the equal protection component of
Fifth Amendment due process.
VA disagrees with these comments, but believes an extended
doctrinal discussion is unnecessary given the revisions to our original
proposal that we adopt in this final rule. By adopting the intent to
file process, VA has provided multiple standardized but claimant-
friendly avenues for veterans to hold an effective date while they fill
out a formal application form, including oral communications with
designated VA personnel. The same amount of effective date protection
is available for both paper and electronic inputs. Since this final
rule provides that claimants can secure an effective date of benefits
with only the minimal action necessary to constitute an intent to file,
any constitutional concerns arising out of the rule as proposed are
obviated.
One comment argues that VA is changing position from historical
practice so suddenly that it renders VA's actions arbitrary and
capricious. The argument that the proposed change was too sudden is
belied by its very status as a proposal. This rule originated as a
proposed rule, and received numerous comments as well as vigorous
public scrutiny and debate. In response to the formal comments
received, we have revised the proposal significantly in order to
reconcile the competing interests as faithfully as possible.
Many comments advanced the position that VA should not consider
rule changes when other avenues for improving the accuracy and
efficiency of the claims system are available. The embedded premise of
these comments is that so long as there is any room for improvements in
training, staffing, management of AOJ personnel, and innumerable other
areas of administrative responsibility, rule change is impermissible.
VA disagrees for two reasons. First and foremost, many of the inherent
difficulties in administering a system as large and complex as the VA
benefits system are exacerbated by the prevalence of non-standard
submissions. Second, as many commenters acknowledged, VA is actively
engaged in improving all aspects of its operations. VA is not relying
solely on regulatory change to achieve its goals, but does believe
regulatory change is necessary and justified. In any event, these
comments are beyond the scope of the rule.
One comment pointed out there would be inconsistencies between the
legal structure of the claim system in this rule as proposed, and as
reflected in the consolidated re-proposal of the Regulation Rewrite
project. 78 FR 71042 (Nov. 27, 2013). The Regulation Rewrite project
was not designed to formulate and implement changes to the substantive
content of VA's regulations. The Regulation Rewrite project is a
comprehensive multi-year effort to ``reorganize and rewrite'' VA's
regulations governing claims currently governed by 38 CFR part 3. 78 FR
at 71042. Substantive legal changes have been incorporated into the
rewritten regulations throughout the project. See e.g., 78 FR at 71065
(discussing changes to 38 CFR part 5 as proposed to accommodate
provisions of Section 502 of Public Law 112-154 dealing with persons
authorized to sign a claim on a veteran's behalf). Substantive changes
at the regulatory level will be handled in similar fashion, with the
content of any final publication of 38 CFR part 5 being revised to
incorporate the current state of the law.
I. Other Regulations
VA has determined that revisions to current adjudication
regulations which were not published in the proposed rule are necessary
to ensure consistency with the changes in this final rule. Therefore,
VA revises current 38 CFR 3.108, 3.109, 3.151, 3.403, 3.660, 3.665, and
3.666. and 3.701, which would not have been amended in the published
proposed rule, by generally replacing the phrase ``informal claim''
with the phrase ``claim or intent to file a claim as set forth in Sec.
3.155(b).'' Since VA is eliminating the term ``informal claim,'' it has
removed references to the phrase ``informal claim'' and replaced it
with the phrase ``claim or intent to file a claim'' for consistency in
these adjudication regulations to reflect this change.
We have also made minor changes in phrasing to the affected
regulations in order to execute this change. In particular, we have
amended
[[Page 57679]]
Sec. 3.403(a)(3) by removing the phrase, ``notice of the expected or
actual birth meeting the requirements of an informal claim'' and
replaced it with ``a claim or intent to file a claim as set forth in
Sec. 3.155(b)''. This change preserves the generally beneficial nature
of paragraph (a)(3) by providing a date-of-birth effective date
whenever VA receives a claim or an intent to file a claim within 1 year
of the veteran's death. The replacement of the term ``informal claim''
with ``intent to file a claim'' does not change the substance of these
regulations.
In Sec. 3.666(c), we have simply removed the phrase ``(which
constitutes an informal claim)'' and have not replaced it with a
reference to an intent to file a claim. This section governs resumption
of payment of pension for incarcerated beneficiaries and fugitive
felons upon release from incarceration. An intent to file a claim is
simply inapposite to this situation, because VA does not require a
claim for resumption of payment in this context. VA makes the necessary
adjustments upon receipt of satisfactory notice. Simply replacing the
language in the parenthetical with language designed for the intent to
file process would have the bizarre effect of requiring an intent to
file a claim, and therefore ultimately a claim, in a context where VA
has no reason to require a separate claim. Accordingly, we have simply
removed this parenthetical to make clear that pension will be resumed
as of the day of release from incarceration if notice is received
within one year following release.
We have changed the wording of Sec. 3.701(b), which provides for
elections between pension and compensation. Paragraph (b) now reads,
``[a]n election generally must be in writing and must specify the
benefit the person wishes to receive.'' This is necessary because an
intent to file a claim is a placeholder in VA's systems, and is not
structured to be a substantive submission, such as one affecting the
election of benefits.
II. Changes to Appeals Process Based on Public Comments
A. Commencement and Perfection of an Appeal
VA revises Sec. 20.201 to incorporate the standardized NOD
requirement substantially as proposed, with minor amendments and
clarifications. In newly added paragraph (a), VA outlines the
requirements for appeals relating to cases in which the AOJ provides a
standard form for the purpose of initiating an appeal. In paragraph
(a)(1), entitled ``Format,'' VA has provided that, for every case in
which the AOJ provides, in connection with its decision, a form
identified as being for the purpose of initiating an appeal, an NOD
would consist of a completed and timely submitted copy of that form. In
these cases, VA will not accept as an NOD any other submission
expressing disagreement with an adjudicative determination by the AOJ.
As we discuss in greater detail below, this means a completed form must
be submitted within one year from the date of mailing of notice of the
AOJ decision, or, if VA requests clarification of an incomplete form,
within 60 days of the date the request was sent, or the remainder of
the one year period from the date of mailing of notice of the AOJ
decision, whichever is later.
One commenter suggested that VA's statutory authority in 38 U.S.C.
501(a)(2) to establish the ``forms of application'' does not extend to
notices of disagreement. This commenter argued that the term
``[a]pplication for review on appeal'' in 38 U.S.C. 7106 is confined to
the context of administrative appeals to the Board by VA officials and
does not include notices of disagreement. We agree that section 7106,
standing alone, potentially bears the reading that an ``[a]pplication
for review on appeal'' refers only to an administrative appeal.
However, we make no changes based on this comment, for three
reasons. First, while section 7106 permits the commenter's reading, it
does not require it. The limitation in the first sentence of section
7106 that an application for review on appeal must be received within
the one-year period described in 38 U.S.C. 7105 could be read simply to
impose a time limit on administrative appeals, and does not imply that
requests for Board review other than administrative appeals are
something other than an ``[a]pplication for review on appeal.'' Second,
38 U.S.C. 7107(a)(1) discusses how ``each case received pursuant to an
application for review on appeal'' will be docketed. This statutory
section governs the docketing of all appeals before the Board, not just
administrative appeals. Third, section 7108 also refers to an
``application for review on appeal,'' and requires that it be in
conformity with the entirety of 38 U.S.C. Ch. 71. Nothing in the
language or context of this statute implies that the term ``application
for review on appeal'' is confined to administrative appeals, and the
fact that all ``application[s] for review on appeal'' must comply with
all requirements in 38 U.S.C. Ch. 71 implies that an ``application for
review on appeal'' is any request for Board review. Chapter 71 includes
38 U.S.C. 7105, the statute governing requirements of, and treatment
of, NODs.
Some commenters pointed out that the standardized NOD form
addresses only compensation claims. As the proposed rule explained,
this is necessary due to the legal structure of VA and the dynamics of
VA's appellate workload. VA has chosen a flexible standard rather than
identifying a particular form number or control number in the rule text
in order to ensure the rule functions for all of VA's diverse
operations. The standard for what constitutes an NOD applies to all VBA
benefit lines, as well as the rest of VA. However, the current standard
NOD form was designed only for compensation claims. One of the key
features of the form's design is that it solicits particular pieces of
information relevant to a compensation claim. Standard NOD forms for
other types of benefits, such as loan guaranty and educational
benefits, have not yet been created. Requiring appeals of other
benefits, such as home loan guaranty or education benefits, to be
submitted using this form in its current state would likely be
confusing to veterans.
At the same time, the overwhelming majority of the VA appellate
workload concerns appeals of AOJ decisions on claims for compensation.
Board of Veterans' Appeals, Department of Veterans Affairs, Report of
the Chairman: Fiscal Year 2012, at 22 (2013) (96.1 percent of Board
dispositions in FY 2012 were for compensation claims). Therefore, VA is
concerned that making the NOD form so generic as to accommodate appeals
of all benefits VA-wide might dilute much of the efficiency gain VA
expects from mandating the use of standardized forms. Nevertheless, VA
will continue to seek ways to provide a standardized format for VA
benefits lines to receive an appeal, whether on one all-purpose form or
individual specialized forms.
To reflect these current realities, the standard reflected in
amended Sec. 20.201(a)(1) is designed to produce a single rule that
can function flexibly VA-wide while allowing for the creation of forms
that are functional for each VA benefits line. Additionally, Sec.
20.201(b) provides a ``fallback'' standard for benefits where
standardized appellate processing is not as pressing a need as it is
with compensation claims. This approach allows for standard forms in VA
benefits lines where the volume, complexity, and frequency of appeal
call for standardization, without disrupting the administration of
other benefits that are infrequently appealed. In Sec. 20.201(b), if
VA does not provide a standard appeal form for a particular
[[Page 57680]]
type of claim, the claim is governed by the current standard for what
constitutes an NOD as provided in current Sec. 19.26 and regulatory
text of Sec. 19.23(b) and Sec. 20.201(b). As of the publication of
this final rule, VA only expects regularly to provide a standard appeal
form for compensation claims and similar monetary benefits claims.
However, VA may choose to provide standard forms with AOJ decisions for
other benefits lines as the volume and dynamics of VA's workload
continue to evolve. Additionally, if VA fails to provide a standard
appeal form to the claimant due to a case-specific error, the claimant
would be able to initiate an appeal under the current standard for an
NOD where a written communication expressing dissatisfaction or
disagreement and a desire to contest the result will constitute an NOD.
See Sec. 20.201(b).
The second sentence makes clear that if the AOJ provides a standard
form with its decision, triggering the applicability of Sec.
20.201(a), VA will not accept a document or communication in any other
format as an NOD. VA believes this rule is necessary to make use of the
standard form mandatory and maximize improvement and efficiency in the
appellate process. Additionally, VA clarifies in this final rule that
submitting a different VA form does not meet the standard for an NOD in
cases governed by Sec. 20.201(a). Many VA forms, such as VA Form 21-
4138, Statement in Support of Claim, are so generic that they would not
yield the clarity and standardization this rule change is designed to
achieve.
In the future, different standard forms may be developed for
different benefit lines. Under this final rule, the particular version
provided with the AOJ decision must be used. For example, if a claimant
received an AOJ decision relating to a compensation claim and received
a compensation-focused form (such as VA Form 21-0958, Notice of
Disagreement) from the AOJ, the claimant could not initiate an appeal
by returning a different form developed for the purpose of initiating
appeals of AOJ decisions relating to a home loan guaranty.
In Sec. 20.201(a)(2) of this final rule, VA has made clear that it
may ``provide'' the form to the claimant electronically or in paper
format. VA has provided that if a claimant has an online benefits
account such as eBenefits, notifications within the system that provide
a link to a standard appeal form would be considered sufficient for the
AOJ to have ``provided'' the form to the claimant and trigger the
applicability of Sec. 20.201(a). Similarly, if a claimant has provided
VA with an email address for the purpose of receiving communications
from VA, emailing either a copy of the form itself or a hyperlink where
that form may be accessed is sufficient. The email should identify that
the hyperlink is to a required VA appeal form. Some comments could be
read to suggest that VA should provide the form in both electronic and
paper format to all claimants. To the extent this was the commenters'
intent, VA rejects this suggestion. Sending paper forms to claimants
who have established an online benefits account or otherwise indicated
an intent to receive communications from VA in electronic format, such
as by providing VA with an email address for that purpose, would be
duplicative, wasteful, and inconsistent with VA's goals to modernize
the claims and appeals process.
Finally, if a claimant has chosen to interact with VA using paper,
VA will provide a paper version of the standard form in connection with
its decision. The specific piece of paper that is sent to the claimant
need not be returned in order to constitute an NOD, but the same form
must be returned. In other words, if a claimant is sent a copy of a
particular form, he or she must return a completed copy of that form,
but not necessarily the same piece of paper that was mailed to the
claimant.
Several commenters expressed concern about VA's procedure for
furnishing the standard form to claimants and inquired as to the
procedure VA would take in order to obtain the correct VA form from the
claimant if an alternate communication is received by VA. As we explain
above, the requirement for an NOD to appear on a standard form is only
triggered when VA provides a form for the purpose of initiating an
appeal in connection with its benefits decision. Accordingly, the
requirement to use a standard form necessarily only applies to
claimants who have already received that form, and an explanation of
how to appeal VA's decision. See 38 U.S.C. 5104 (notice of Secretary's
decision ``shall include an explanation of the procedure for obtaining
review of the decision''). In the event VA receives an incomplete
standard NOD form, it will follow the procedures set forth in Sec.
19.24(b)(1). VA will furnish the appropriate form or the standard NOD
form to claimants in paper format with the decision notification letter
as well as providing a hyperlink to the standard form in the decision
notification letter.
One comment suggested that Sec. 20.201(a)(2) be revised to state
that VA ``must'' provide the appeal form in the applicable format,
rather than ``may.'' This same comment asserts the rule ``assume[s] VA
will provide that form in its decision letter.'' This comment is
predicated on a misunderstanding of the rule. Again, the requirement to
use the standard form is not triggered unless VA provides the form in
connection with its decision. Inserting the term ``must'' into Sec.
20.201(a)(2) would broaden the scope of claims for which use of a form
would be mandatory.
One comment suggested that Sec. 20.201(a)(2) should be revised to
require that the form be provided to the claimant's representative, if
any, in addition to the claimant. We have considered this suggestion
and agree. A claimant's representative generally must receive the same
decision notice that is sent to the claimant. 38 U.S.C. 5104(a). While
this statutory principle does not necessarily imply that any
representative must receive the form in order to trigger the
requirement that the form be used to initiate an appeal, ensuring
representatives receive the necessary form adds minimal additional
administrative burden.
However, we do not believe any revisions are necessary in order to
make this clear. The rule as proposed and as here confirmed as final
provided that the requirement to use a standard form arises when the
AOJ provides the standard form, ``in connection with its decision.''
Because the same statute governing content of VA decisions specifies
that representatives are to receive the same notice that is sent to the
claimant, this implies that any representative should also receive the
form. We note that this reasoning implies that the presumption
established in Sec. 20.201(a)(3) will apply to the question of whether
the form was provided to the representative. Additionally, this rule
does not alter the scope of evidence or argument submission within the
VA system. Therefore, if a representative is unsure whether the form
was provided, particularly in a compensation claim, we see no readily
apparent substantive reason why the representative would not simply use
the form, which is and will remain widely available, to keep the
veteran's claim moving as quickly as possible. We see no reason why a
trained, accredited representative who is aware of VA forms would spend
an inordinate amount of time attempting to protect an option to submit
an NOD in a non-standard narrative format, rather than simply filling
out a form and submitting argument on a separate document if necessary.
Finally, we note the fact that the representative must
[[Page 57681]]
receive the form in order to trigger the requirement that the form be
used does not imply that the representative must receive the form in
the same format as the claimant. In particular, a representative with
access to VA's Stakeholder Enterprise Portal, or who otherwise
interacts with VA electronically, does not have to receive the form in
paper merely because he or she represents a claimant that prefers to
interact with VA through paper.
In Sec. 20.201(a)(3), VA has provided that any indication
whatsoever in the claimant's claims file or benefits account of
provision of a form would be sufficient to presume the form was
provided, triggering the applicability of Sec. 20.201(a) rather than
Sec. 20.201(b). Under this rule, an indication as minimal as a
statement in a decision notification letter such as ``Attached: VA Form
21-0958'' would be sufficient to trigger the presumption that the form
was provided and Sec. 20.201(a) governs. See Butler, 244 F.3d at 1339-
41 (presumption of regularity applies to the administration of veterans
benefits).
In Sec. 20.201(a)(4), VA provides that, if a standard VA form
requires some degree of specificity from the claimant as to which
issues the claimant seeks to appeal, the claimant must indeed provide
the information the form requests in order for the submission to
constitute an NOD. For example, the current form provides claimants
with a selection of separate boxes allowing claimants to identify broad
categories of disagreement. VA believes it would be helpful to the
process to have this requirement in the governing regulation.
Several commenters objected to the requirement that an appeal be
initiated on a standard form. Many commenters advanced the position
that VA does not have authority to require that NODs be on standard
forms designed for the purpose of initiating an appeal, and provided to
the claimant with an explanation that the form must be used to initiate
an appeal. In particular, some commenters argued that governing
statutes did not allow VA to mandate the use of a form and that whether
a document is an NOD is a question of law for the Veterans Court to
determine de novo under 38 U.S.C. 7261(a). Commenters also stated that
requiring an NOD form violates the Court's interpretation and plain
language of 38 U.S.C. 7105.
VA has clear authority to require that a claimant submit an NOD on
a particular form, and accordingly does not agree with these comments.
The Federal Circuit has explicitly held that 38 U.S.C. 7105 ``does not
express a complete and unambiguous meaning for the statutory term
`notice of disagreement,' '' and that VA's implementation of section
7105 accordingly must receive the significant deference due an agency's
reasonable construction of a statute it administers. Gallegos v.
Principi, 283 F.3d 1309, 1313 (Fed. Cir. 2002); see Chevron, U.S.A.,
Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 842-45
(1984). Additionally, Congress has specifically delegated authority to
VA to issue rules concerning ``the forms of application,'' 38 U.S.C.
501(a)(2), and has characterized a request for Board review as an
``[a]pplication for review on appeal.'' 38 U.S.C. 7106, 7107, 7108.
These explicit delegations of authority, coupled with the significant
benefits that consistent use of the standard NOD form will have in
improving the timeliness and accuracy in processing of veterans'
appeals, make clear that our construction of section 7105 is
reasonable.
It is irrelevant that the Veterans Court might analyze whether a
particular document qualifies as an NOD as a question of law as opposed
to a question of fact. If anything, this highlights the essentially
interpretive nature of the current standard for an NOD. The Veterans
Court's authority to review VA's determinations regarding whether a
particular veteran filed a timely NOD under the legal standard
applicable to that veteran's case does not have any bearing whatsoever
on VA's authority to define, by regulation, the legal standard for an
NOD, so long as VA's definition is consistent with the governing
statute, and a reasonable interpretation of any statutory ambiguity.
Part of the rationale for requiring standard VA forms, particularly
for the appeals of compensation claims, is that they enable VA to
identify the substance of an appeal as early as possible in the
process. Additionally, inputs from the claimant in a standardized
format are much more easily turned into data that can be used in
evaluating and processing a claim or appeal.
VA strives to maintain the veteran-friendly, pro-claimant nature of
the appeals process by providing a format in the standard form that
allows claimants to choose from pre-printed selections as well as ample
space on the form for statements or comments in a narrative format.
Some commenters expressed concern that mandating the use of a
standard form means VA will not provide its statutory duty of assisting
claimants with developing their claims or providing notice to
claimants. Some maintained that the duty to assist precludes VA from
requiring appeals be initiated on standard forms. The statutory duty to
assist plainly does not require VA to accept NODs regardless of the
format in which they are filed; rather, it governs what efforts VA must
undertake to help a veteran secure evidence necessary to establish the
elements of entitlement. 38 U.S.C. 5103A. That VA has a duty to gather
evidence does not imply VA cannot issue reasonable regulations within
its explicitly delegated statutory authority that are necessary to
administer the claims process. Further, the Federal Circuit has held
that what constitutes an NOD is ambiguous in 38 U.S.C. 7105, which,
unlike 38 U.S.C. 5103A, applies specifically to the appellate process.
VA's regulations implementing this statutory term accordingly receive
Chevron deference. Gallegos, 283 F.3d at 1313.
VA disagrees with these comments, but offers one clarifying change.
The plain language of Sec. 19.24(a), both as proposed and as here
confirmed as final, requires VA to identify and implement any necessary
development or review action when a timely notice of disagreement is
filed. As proposed, Sec. 19.24(a) provided that the AOJ ``may''
reexamine the claim and determine what development or review action is
warranted. The use of the term ``may'' in the proposed rule was
consistent with the inherently discretionary nature of VA's development
and review obligation specific to this phase of the process, and with
the general scope of the duty to assist. See 38 U.S.C. 7105(d)(1) (AOJ
must take ``such development or review action as it deems proper'');
see also 38 U.S.C. 5103A(a), (d) (Secretary must make reasonable
efforts to assist in obtaining evidence ``necessary'' to substantiate
the claim, and must provide a medical examination when one is
``necessary to make a decision''). However, to make clear that the AOJ
is required to review the claim in cases where a timely NOD is filed
and make the threshold determination of whether any further development
or review action is deemed necessary, we have changed ``may'' to
``will'' in this final rule. This rule does not alter VA's substantive
duties in regard to the processing of NODs. VA is only requiring that
claimants provide their expression of dissatisfaction or disagreement
of an AOJ decision in a specified format, i.e., on a standard form.
This does not alter the scope of VA's duty to take appropriate review
and development action upon the filing of a notice of disagreement, or
in any way affect VA's duty to assist claimants.
One commenter argued that AOJ personnel failing to recognize an NOD
[[Page 57682]]
under the current standard indicates a need for better training, not
imposing a requirement on a veteran to complete a form. We disagree
with the embedded premise of this comment that the current standard is
the ``correct'' standard that must be maintained regardless of evidence
and reasoning indicating that it harms veterans and VA's efforts to
accurately and efficiently process appeals of benefits decisions.
Furthermore, VA has rigorous training programs for AOJ personnel, and
these will continue under the implementation of this rule. More
fundamentally, the standard for what constitutes an NOD under the
current rule is inherently subjective, meaning no amount of training
can totally eliminate error in the identification of NODs. Even
determinations that are not ``erroneous'' can be overturned by higher
decisionmakers who simply take a different view of whether the
subjective standard of what constitutes an NOD is met given the facts
of the case.
Several commenters criticized the layout or content of the current
standard NOD form. Some stated that the content of the current standard
appeals form did not provide claimants with an option for claimants to
select an AOJ's de novo appellate review. Other commenters expressed
concern that the form is inadequate to appeal certain benefits. Other
commenters suggested the form contains too many terms of art to be
useful to veterans. Other commenters questioned the motive behind VA
inquiring whether claimants would like direct communication with the
AOJ regarding the appeal. Generally, VA is considering the comments
regarding the content of the current standard appeals form and will
update or revise the form based on these comments as necessary.
Specifically, VA is considering whether the form should be revised to
include an election of de novo AOJ review pursuant to 38 CFR 3.2600, as
multiple commenters urged. One commenter expressed concern that the NOD
form does not have any language or endorsement for the veteran to
provide indicating that he or she desires to contest the result of the
agency's decision. Similarly, another commenter even suggested that
this omission could lead to VA determining its own form, even if
completed, does not constitute an NOD, and disallow appeals due to
deficiencies in a form it had mandated the use of. While VA can and
will continue to revise forms based on experience in the administration
of its programs, we note that the filing of the form itself provides
the necessary indication that the veteran disagrees with the original
decision and desires to contest the result.
It is true the form contains terms of art specific to compensation
claims. We address this issue in section II.D. below. In particular,
however, we note that we have revised Sec. 19.24(b)(2) to enumerate
the information required to complete a standard NOD form with greater
particularity. As we explain more fully in section II.D., the form will
continue to solicit more detailed information from the veteran because
this is useful in orderly and efficient processing, but in Sec.
19.24(b)(2)(iii) we clarify that the form is considered complete if it
enumerates the issues or conditions for which appellate review is
sought. Although no changes to the standard NOD form were made, we did
amend the instructions to the NOD form to provide notice to claimants
of what is minimally necessary to constitute a complete NOD as well as
the action VA will take when an incomplete NOD is received.
To the extent commenters object to the current form's focus on
issues specific to compensation claims, rather than other benefit
lines, we address this issue above--the requirement to use a form is
only triggered when VA provides the claimant a form for the purpose of
initiating an appeal in connection with its initial decision. This will
enable VA to tailor the content of standard NOD forms to suit the
substantive needs of VA's diverse benefit lines and operations. To the
extent commenters object to the lack of a dedicated space on the
current form to identify a claimant's belief that VA wrongly denied
entitlement to an ancillary benefit related to a compensation claim,
such as special monthly compensation, aid and attendance, or total
disability by reason of individual unemployability, there are at least
two spaces on the current form where it would be appropriate to
identify these issues, to the extent a claimant is able to provide this
degree of specificity. One, such information could be included on the
section of the form asking the claimant to identify disagreement as to
the evaluation assigned. While each of these ancillary benefits have
their own specific criteria, they are all fundamentally amounts of
increased compensation that are owed to the claimant based upon the
circumstances, including severity of disability, like any other rating
and as, discussed above, fall within the scope of a complete claim when
entitlement is shown by evidence of record and stems from one or more
enumerated issues in a claim. See 38 CFR 3.350, 4.16. Two, such
information could be included in the section on the form specifically
designated for a narrative statement from the claimant. Additionally,
though we view the election of AOJ de novo review as beyond the scope
of a rulemaking requiring a standard form to initiate an appeal, we
note that the claimant can also elect to utilize this procedure in this
space on the current standard NOD form designed for a narrative
statement. VA will consider whether the form should be revised to
include a dedicated space for these types of information based on its
ongoing experiences in administration of the standard NOD form process.
The form includes a space to elect direct communication with the AOJ
regarding the appeal because informal communications between AOJ
personnel and veterans and their representatives are extremely valuable
in clarifying and sometimes even resolving the issues in an appeal.
Many claimants appreciate the availability of this direct and informal
engagement from AOJ personnel. However, other claimants react
negatively, and even feel that VA is harassing them if multiple
attempts at phone contact are made. The election allows VA to target
its limited AOJ personnel time to cases where it is likely to be
useful.
In Sec. 20.201(a)(5), VA states that the filing of an alternate
form or other communication does not extend, toll, or otherwise delay
the time limit for filing an NOD. In addition, VA clarifies that
returning the incorrect VA form, including a form designed to appeal a
different benefit, does not extend the deadline for filing an NOD. This
policy is necessary to bring efficiency to appeals processing. Imposing
a requirement that AOJ personnel, even in cases where a form pursuant
to Sec. 20.201(a)(5) was provided to the claimant, must scour non-
standard claimant submissions in search of communications which might
be reasonably construed as an expression of disagreement in order to
make sure the claimant has not attempted to initiate an appeal in the
incorrect format would require exactly the same time-intensive
interpretive exercise that VA seeks to end by requiring use of a
standard form. VA believes the one-year statutory period in which to
file an NOD is ample time to fill out and return the standard NOD form.
Some commenters requested that an alternate form or other communication
toll the time limit for filing the correct form. For instance, one
commenter urged the addition of new text in Sec. 20.201(a)(5)
essentially providing that if a communication that would qualify as an
NOD under current
[[Page 57683]]
rules is received in a case governed by Sec. 20.201(a), VA will
provide another copy of the correct form and provide another 60 days
(or the remainder of the one year statutory period in which to initiate
an appeal, whichever is longer) for the claimant to return it. Other
commenters suggested that the time limit not be tolled, but that VA
still be required to identify statements indicating a claimant's
disagreement not filed on the standard NOD form, notify the veteran of
the deficiency, and re-send the NOD form.
VA makes no change based on these comments. The point of requiring
appeals to be initiated on standard forms is to reduce the need for AOJ
personnel to engage in the time-intensive interpretive review of non-
standard narrative submissions. Requiring VA to identify that a
particular submission can ``be construed as disagreement'' in a case
otherwise governed by the requirement to use a standard form would
destroy the predictability and efficiency that use of a form makes
possible because it would require the same amount of ``by hand'' review
as is required under the current system. Given that the requirement to
use the correct form is only triggered when VA has provided the form to
the claimant, we do not believe it is justified to create an exception
requiring exactly the kind of interpretive review of narrative
submissions, in such cases, that this rule seeks to end. However, we
note that the fact we do not create an exception requiring AOJ
personnel to engage in this type of review does not imply that this
rule would prevent AOJ personnel from notifying a veteran who has
clearly expressed disagreement in a narrative format that he or she
must use the form. In many instances, AOJ personnel may even conclude
that doing so serves the interest of both clarity and efficiency.
In Sec. 20.201(c), VA clarifies that it does not require a
standardized form for simultaneously contested claims, which are claims
in which the award of benefits to one person may result in the
disallowance or reduction of benefits to another person. 38 CFR
20.3(p). Such claims arise only rarely and, irrespective of the nature
of the benefit sought, they commonly present unique issues involving
marital or other relationships of different individuals claiming
entitlement to the same or similar benefits based on their relationship
to the same veteran. Further, in 38 U.S.C. 7105A, Congress has
prescribed a 60-day time limit for filing NODs in simultaneously
contested claims. In view of these claims' unique features, we do not
alter those governing standards. Moreover, because simultaneously
contested claims constitute a very small portion of VA's appellate
caseload, excluding those claims from the requirement to use
standardized forms will not significantly affect the objectives of this
rule. VA, therefore, states in paragraph (c) of Sec. 20.201 that the
provisions of Sec. 20.201(b) apply to simultaneously contested claims.
However, claimants in simultaneously contested claims could use a
standard VA form, when feasible, even though they would not be required
to do so.
B. Procedures for NODs Received on Standard Form
This final rule creates two new sections in part 19. New Sec.
19.23 generally clarifies which procedures apply to appeals governed by
Sec. 20.201(a), and which apply to appeals governed by Sec.
20.201(b). New Sec. 19.23(b) specifies that current procedures in
Sec. Sec. 19.26 through 19.28 would continue to apply to appeals of
benefits decisions governed by Sec. 20.201(b), and new Sec. 19.23(a)
provides that these procedures would apply only to those cases. In
other words, the provisions of Sec. Sec. 19.26 through 19.28 apply
only to appeals of AOJ decisions relating to cases in which no standard
form was provided by the AOJ for the purpose of initiating an appeal.
New Sec. 19.23(a) also clarifies that the procedures in new Sec.
19.24 apply to appeals of AOJ decisions for cases in which the AOJ
provides a form for the purpose of initiating an appeal, which are
governed by Sec. 20.201(a). With this new clarifying section, VA hopes
to eliminate any confusion potentially caused by the fact that
Sec. Sec. 19.26 through 19.28 will no longer provide governing
procedures for the overwhelming majority of VA's appellate caseload,
but must be retained for processing NODs relating to other benefits for
which no standardized NOD form is provided.
One commenter stated that the standard form for a NOD primarily
addresses compensation claims and not other types of claims such as
pension or survivor benefits. Currently, the compensation-focused form
is VA's only standard NOD form. VA has not yet designed appeal forms
that meet the specific needs of all other VA benefit lines.
In paragraph (a) of new Sec. 19.24, VA provides that its practice
of reexamining a claim whenever an NOD is received and determining if
additional review or development is warranted are also applied to NODs
submitted on standardized forms.
One comment suggested that 38 CFR 19.27 be changed to include
reference to Sec. 19.24 in addition to its current reference to Sec.
19.26. Section 19.27 specifies the procedures for situations when VA
does not believe a document filed by a claimant expresses disagreement
and a desire to appeal with adequate clarity to constitute an NOD. VA
views Sec. 19.27 and related Sec. 19.28 as being necessary primarily
due to the current amorphous standard for what constitutes an NOD, and
believes that adopting standard forms will obviate the need for these
procedures in the vast majority of cases. In cases governed by Sec.
20.201(a) and accordingly by Sec. 19.24, there should be no need for
appellate consideration of the ``adequacy'' of the NOD--the correct
form either was, or was not, filed within the applicable timeframe. VA
accordingly declines to make Sec. 19.27 applicable to the procedures
in Sec. 19.24.
However, in considering this comment, VA has concluded it is
necessary for this final rule to include some mechanism for claimants
to challenge VA's determination that the correct form was not timely
filed. Even if there should be no issue as to whether an NOD was
``adequate'' in a case governed by Sec. 20.201(a) and Sec. 19.24,
there is the possibility for technical errors or errors by AOJ
personnel. We have therefore revised Sec. 19.24 as proposed to include
a new paragraph (d), which makes clear that VA's determination that no
NOD was filed may be appealed. However, this paragraph also makes clear
that appellate consideration is limited to the question of whether the
correct form was timely filed. This limitation is necessary in order to
prevent this avenue for challenging VA's determination that no form was
filed from creating an open-ended exception to the otherwise valid
requirement that an NOD must be on a standard form in cases governed by
Sec. Sec. 20.201(a) and 19.24. In the event a competent appellate
review authority determines that a valid NOD was in fact filed, the AOJ
would be required to process the appeal, to include providing a
statement of the case relating to the substance of the appeal. We note
that, unlike Sec. 19.27, new paragraph 19.24(d) does not utilize the
procedures for administrative appeals in 38 CFR 19.50-19.53. Those
procedures are designed to accommodate disagreements among agency
personnel that admit of a degree of subjective difference of opinion,
such as whether an ``adequate'' notice of disagreement under the
traditional standard has been filed. Our purpose in
[[Page 57684]]
making VA's determination that no NOD governed by Sec. Sec. 20.201(a)
and 19.24 was filed appealable is to provide claimants a way to appeal
any administrative or technical errors by VA personnel in the
determination of whether the correct form was timely filed, not to
resolve disagreements among AOJ personnel in the resolution of
subjective questions such as whether an ``adequate'' NOD has been
filed.
Related to this issue, another comment asks whether VA believes it
has authority to limit the Veterans Court's jurisdiction by rejecting
an NOD that satisfies the requirements of 38 U.S.C. 7105. We respond to
the embedded premise of this comment, that requiring an NOD be on a
standard form is inconsistent with section 7105(d), in section II.A.
However, we have provided explicitly for appellate review of whether a
valid NOD has been filed even in cases where the requirement to utilize
a standard form attaches, in part to ensure claimants have a means of
obtaining factual review of VA's determinations as to whether the
correct form was filed in a timely way (short of the drastic step of
filing a petition for a writ of mandamus). VA has clear authority to
define what constitutes an NOD, but claimants have a right to review of
VA factual and legal determinations under any standard VA promulgates.
But the further suggestion that VA cannot establish any
requirements pertaining to what constitutes an NOD because those
requirements form a ``barrier'' to the Veterans Courts' review of the
merits of a claim cannot be correct. This would imply that VA is
prohibited, by virtue of the Veterans Court's mere existence, from
exercising authority explicitly delegated by statute. Further, we note
that it is well established that ``[a] court's prior judicial
construction of a statute trumps an agency construction otherwise
entitled to Chevron deference only if the prior court decision holds
that its construction follows from the unambiguous terms of the statute
and thus leaves no room for agency discretion.'' Nat'l Cable & Telecomm
Ass'n v. Brand X Internet Services, 545 U.S. 967, 982 (2005); see also
Eurodif S.A. v. U.S, 423 F.3d 1275, 1276-77 (Fed. Cir. 2005).
C. Complete and Incomplete Appeals Forms
In response to comments, in paragraph (b) of new Sec. 19.24, VA
has revised the proposed rule to reorganize this section for
clarification purposes by distinguishing between incomplete and
complete appeal forms. VA has redesignated proposed paragraph (b) as
``Incomplete and Complete Appeal Forms'' and restructured this section
to categorize ``incomplete appeal forms'' in subparagraph (b)(1) and
``complete appeal forms'' in subparagraph (b)(2). Section 19.24(b)(1)
outlines the procedures for when a claimant submits the correct form
timely but incomplete. VA believes that the authority to require a
claimant to use a particular form necessarily implies the authority to
require that the form be completed, to include identifying each
specific issue on which review of the AOJ decision is desired. VA
strongly believes that if veterans provide all information requested on
the standardized VA form, this will lead to the fastest possible result
for that individual veteran and the VA appellate system will work more
efficiently for all veterans. Accordingly, if VA determines a form is
incomplete, VA may require the claimant to timely file a completed
version of the form.
D. Completeness of the NOD Form
In revised Sec. 19.24(b)(2), VA describes the standard by which it
would determine whether or not a form to initiate an appeal is
complete, both in general and for compensation claims in particular. In
general, a claimant must provide the information to identify the
claimant, the claim to which the form pertains, any information
necessary to identify the broad category of the disagreement, and the
claimant's signature in order for that form to be considered complete.
However, we did not specifically enumerate the type of information
necessary to identify the claimant in the rule text in order to provide
VA with some flexability to ascertain the identity of a claimant by
using certain information or a combination of information which the
claimant may provide. For example, there are many claimants with
identical names to other claimants and a claimant's name alone may not
necessarily identify a specific claimant with a particular claims file.
If there is other information specific to a claimant such as a Social
Security Number, then VA would be able to identify a claimant to his or
her claims file even without the claimant's name. As opposed to
allowing VA to use the information provided in a combination of ways to
identify a claimant, we believe that enumerating the type of
information required to identify a claimant with specificity would
hinder both claimants and the VA processing NODs. If VA were to outline
the exact requirements of what is necessary to identify claimants in
its regulations, then a form which contained information that could
identify a particular claimant but did not contain other non-essential
information could render the form incomplete. This would result in VA
rejecting these forms for minor ministerial or formalistic
deficiencies, thereby delaying the processing and adjudication of a
claimant's appeal. By allowing VA to determine in its discretion what
information is necessary in identifying a claimant without specific
particularity in the regulations, the regulation will enable VA to
process these notices of disagreement without rejecting such forms as
incomplete if certain information was not provided, thereby eliminating
or preventing prolonged administrative delays and speeding up
completion of an appeal. For compensation claims being appealed, a form
is considered incomplete if it does not enumerate the issues or
conditions for which appellate review is sought. With respect to the
nature of disagreement, the form directs claimants to indicate, for
each appealed condition, whether they disagree with the AOJ's decision
on the question of service connection, disability evaluation, effective
date, and/or any other question. This information enables VA to more
efficiently process appeals and avoid expending time and other
resources on matters the claimant does not contest.
It is not VA's intention to be overly technical in determining
whether claimants have completed a form. The purpose of this final rule
is the orderly and efficient processing of veterans' claims and
appeals, not the exclusion of legitimate appeals, and VA's decision to
conclude that a form is incomplete and request completion will be
guided by this principle. See Robinson v. Shinseki, 557 F.3d 1355, 1361
(Fed. Cir. 2009) (``[i]n direct appeals, all filings must be read `in a
liberal manner' whether or not the veteran is represented''). As with
the consideration of claims meeting the standard of a complete claim,
VA stresses that it does not intend to consider a form used to initiate
an appeal to be incomplete and to request further completion unless
that is a reasonable course of action to facilitate orderly processing
of the appeal.
Several commenters stated that the requirement of a complete
standard form for an expression of disagreement ``converts a legal
notice into a substantive pleading by installing requirements in an
undefined form'' that violates 38 U.S.C. 7105(a) and that the form
requires a level of knowledge beyond the average veteran, especially
one who is not represented by a VA-accredited representative. VA
considers the requirements of a complete NOD
[[Page 57685]]
minimally burdensome to claimants. VA disagrees that providing basic
information sufficient to identify which claim or issue the claimant
seeks to appeal, such as identifying that an appeal pertains to a claim
for a knee disability as opposed to a shoulder disability, is
equivalent to requiring a substantive pleading sufficient to initiate a
civil action. In order to provide claimants with clear indication of
what constitutes a complete form as provided in Sec. 19.24(b)(2), we
have amended the instructions to the NOD form to provide the criteria
for a complete NOD but we have not changed or altered the NOD form
itself.
As we have explained, VA has intentionally drafted this rule to
make it possible for VA to respond to evolving needs in the appellate
workload, to include the possibility that benefit lines other than
compensation may need a standardized form to facilitate orderly
processing. However, this does not mean this rule would allow VA to
impose unlimited requirements into an undefined form. First of all,
alteration to any existing form, and creation of any new form, is
governed by the Paperwork Reduction Act (see below), which in many
cases requires public notice and comment before new collections of
information are legally valid. More fundamentally, however, any
requirement that VA ``inserts'' into a standard NOD form must be a
reasonable exercise of VA's statutory authority. If VA were to add to a
standard NOD form a requirement totally unrelated to providing notice
that the claimant disagrees with a VA decision and obtaining
information necessary to facilitate the orderly administrative action
such a notice triggers, that requirement would be beyond the scope of
the statutes that confer authority on VA to require the form in the
first place.
Section 19.24(b)(2) responds to commenters' concerns regarding the
level of specificity required for a form to be considered complete by
making clear that a form ``will,'' rather than ``may,'' be considered
complete if it meets the following criteria: Information to identify
the claimant; information to identify the claim to which the form
pertains, and information necessary to identify the specific nature of
the disagreement, to include for compensation claims, the issues or
conditions for which appellate review is sought; and the claimant's
signature. In particular, we note that Sec. 19.24(b)(2)(iii) as
revised provides that, for compensation claims, a form will be
considered complete if it enumerates the issues or conditions for which
appellate review is sought, or if it provides other more granular
information required on the form to identify the nature of the
disagreement (such as disagreement with disability rating, effective
date or denial of service connection). This means that, at a minimum,
VA would consider the identification of an issue, such as a ``shoulder
disability,'' sufficient for purposes of meeting this criterion for a
complete appeal form, even if the form on its face requires additional
information. While the current standard appeals form for compensation
claims instructs claimants to list each specific issue of disagreement,
it also provides selections for more detailed description in
association with each issue. For each issue of disagreement, claimants
can select an area of disagreement, e.g., service connection, effective
date of an award, evaluation of disability, or other and claimants can
also provide a percentage of the evaluation sought if applicable.
However, VA would consider this form complete if the claimant provides
biographical information, the specific issue(s), and the claimant's
signature. It would not be necessary for a claimant to describe the
area of disagreement or percentage of the evaluation sought for each
issue in order for VA to consider the form complete. Once VA receives
the complete NOD, it will make the appropriate readjudication
determinations necessary for those specific issues listed such as
determining whether the correct evaluation percentage or effective date
was assigned or if other benefits should have been granted based on the
evidence. However, we believe it is valuable for the form to solicit
information pertaining to the specific nature of the disagreement, even
if claimants can complete the form by providing less information. We
note that claimants will facilitate the timely consideration of their
appeals if they provide VA with as much information as possible
regarding the nature of their disagreement as early in the process as
possible.
One commenter asked if a veteran indicates a particular effective
date on a standard form, but the correct date is earlier, which date VA
would grant. In the clean hypothetical situation posited by the
commenter, the answer is that VA would grant the correct date. Again,
the requirement to use a standard form to initiate the appeal, even a
form that solicits particular information in order to facilitate
accurate and efficient consideration of the claim, does not alter the
scope of VA's ``development and review'' action required by 38 U.S.C.
7105(d).
E. Timeframe To Cure Incomplete NOD
In revised and redesignated Sec. 19.24(b)(3), VA states that
incomplete forms must be completed within 60 days from the date of VA's
request for clarification, or the remainder of the period in which to
initiate an appeal of the AOJ decision, whichever is later. VA provides
this 60-day grace period in order to protect the claimant's rights in
the event the statutory deadline has passed when VA determines the
claimant has filed an incomplete form. Given that submission of the
correct form would clearly identify to AOJ personnel that a claimant
wishes to pursue an appeal, VA would accept the incomplete form for
purposes of determining whether a claimant has met the statutory
deadline. However, the claimant must complete the form within the 60-
day timeframe. This time requirement would correspond to the current
60-day period provided in 38 CFR 19.26(c) for clarification of an
ambiguous NOD filed under the traditional process.
In Sec. 19.24(b)(4), VA states that if no completed form is
received within the timeframe established in paragraph (b)(3), the
decision of the AOJ shall become final.
Some commenters stated that incomplete NODs that are not cured
within 60 days would mean the veteran would forfeit the right to
appeal. As proposed Sec. 19.24(b)(2) clearly stated, ``[i]f VA
requests clarification of an incomplete form, a complete form must be
received within 60 days from the date of the request, or the remainder
of the period in which to initiate an appeal of the decision of the
[AOJ], whichever is later.'' Accordingly, the veteran does not forfeit
the right to appeal so long as a complete form is submitted within the
statutory one-year period in which to submit an NOD, or within the 60-
day ``grace'' period, whichever provides the veteran with more time to
cure the deficiency. The regulatory language makes clear to provide
that the issues or contentions enumerated in incomplete forms will
become final if they are not cured within the 60-day period or within
the statutory one-year period for submitting an NOD. In order to
address commenters' concerns that VA will deem a form incomplete
without providing any notice to the veteran, we have also revised Sec.
19.24(b)(1) to make clear that the requirement to cure or correct the
filing of an incomplete form by filing a completed version of the
correct form does not arise unless VA informs the claimant or his or
her
[[Page 57686]]
representative that the form is incomplete and requests clarification.
VA will not spend its limited resources by undertaking this cycle of
clarifying activity unless it is necessary to the orderly processing
and adjudication of the appeal. We also note that Sec. 19.24(b) as
proposed referenced the ``verification'' of an incomplete form. We have
replaced ``verification'' with ``clarification'' in the relevant
portion of Sec. 19.24(b)(1) as organized in this final rule.
In Sec. 19.24(b)(5), VA provides that if the completed form
arrives within the timeframe established in paragraph (b)(3), VA will
treat the completed form as the NOD and will reexamine the claim to
determine whether additional review or development is warranted.
Furthermore, if no further review or development is required, VA will
prepare a Statement of the Case pursuant to Sec. 19.29 of this part
unless the disagreement is resolved by a grant of the benefit(s) sought
on appeal or the NOD is withdrawn by the claimant.
VA initially proposed in Sec. 19.24(b)(5) that if a form is so
incomplete that the claimant to whom it pertains is unidentifiable, VA
would not take action on the basis of the submission of that form and
the form would be discarded. Moreover, VA proposed that it would always
attempt to identify the claimant to whom the form pertains based on any
statements or other information provided before discarding the form.
However, this proposed provision has been deleted as such instances are
rare. Even though this scenario is so rare that VA does not view it as
necessary to include in regulations, VA will always attempt to identify
the claimant to whom any form pertains based on all available context
and information.
In paragraph (c) of Sec. 19.24 of this final rule, VA provides
that if a form enumerates some, but not all, of the issues or
conditions which were the subject of the AOJ decision, the form would
be considered complete with respect to the issues on appeal.
Furthermore, VA clarifies that any issues or medical conditions not
enumerated would not be considered appealed on the basis of the filing
of that form and that those unnamed issues would become final 1 year
after the date of the mailing of the notice of the decision unless the
claimant files a separate form addressing those issues or conditions
within the timeframe set forth in paragraph (b)(3) of this section.
This does not prevent the claimant from appealing those issues or
contentions not named in the form or from filing a subsequent form
initiating appeals of other issues within the AOJ decision. VA has
added this clarification to the final rule in this paragraph (c) as the
proposed rule did not specifically state that a claimant would retain
the ability to appeal other unnamed issues or contentions within the
timeframe allowed by current Sec. 19.26(c).
F. Other Regulations
To ensure other regulatory sections that discuss NODs are
consistent with these changes, VA also adopts the minor revisions in
this final rule to a few other sections. Specifically, VA revises Sec.
3.2600, which discusses optional de novo review procedures at the AOJ
after an NOD is filed, to cross reference the format and timeliness
requirements of Sec. 20.201, and either Sec. 20.302(a) or Sec.
20.501(a), as applicable, in the first sentence of paragraph (a). VA
also revises Sec. 20.3(c), which currently defines an appellant as ``a
claimant who has initiated an appeal to the Board of Veterans' Appeals
by filing a Notice of Disagreement pursuant to the provisions of 38
U.S.C. 7105.'' Since 38 U.S.C. 7105 only requires that an NOD be
submitted in writing, VA revises 38 CFR 20.3(c) to cross reference the
format requirements in Sec. 20.201, and the timeliness requirements of
either Sec. 20.302(a) or Sec. 20.501(a), as applicable. VA believes
this revision would ensure that there is no confusion regarding what
requirements a claimant must follow to submit a valid NOD. Similarly,
Sec. 20.200 currently provides, in part, that an appeal includes ``a
timely filed Notice of Disagreement in writing.'' VA revises Sec.
20.200 to replace ``in writing'' with cross references to Sec. 20.201,
and either Sec. 20.302(a) or Sec. 20.501(a), as applicable.
Effective Date of Final Rule
In order to accommodate the changes to VA's claims and appeals
processes, VA estimates that it will need 6 months, or approximately
180 days, to prepare for and implement this final rule. This 180-day
period provides time for VA to conduct outreach efforts to inform and
educate veterans, claimants, their family members, authorized
representatives, and other stakeholders, to train and educate VA staff
on the more standardized process, and to implement changes to VA's
internal, operational business programs. As such, this final rule will
apply only with respect to claims and appeals filed 180 days after the
date this rule is published in the Federal Register as a final rule.
Claims and appeals pending under the current regulations as of that
date would continue to be governed by the current regulations.
Paperwork Reduction Act
The Paperwork Reduction Act of 1995 (44 U.S.C. 3507(d)) requires
that VA consider the impact of paperwork and other information
collection burdens imposed on the public. According to the 1995
amendments to the Paperwork Reduction Act (5 CFR 1320.8(b)(2)(vi)), an
agency may not collect or sponsor the collection of information, nor
may it impose an information collection requirement, unless it displays
a currently valid Office of Management and Budget (OMB) control number.
This final rule includes provisions constituting collections of
information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501
through 3521) that require approval by OMB.
I. Changes to the Scope of Currently Approved OMB Information
Collections
As part of the proposed rule, RIN 2900-AO81, VA previously
solicited comments on the collections of information contained in this
section. As noted in the proposed rule, this final rule will impose
amended information collection requirements in 38 CFR 3.154, 3.155,
3.812, and 20.201 which are described immediately following this
paragraph, under their respective titles. As required by the Paperwork
Reduction Act of 1995 (at 44 U.S.C. 3507(d)), VA has submitted these
information collection amendments to OMB for its review. Notice of OMB
approval for this information collection will be published in a future
Federal Register document.
Title: Standard Claims and Appeals Forms.
Summary of collection of information: The Department of Veterans
Affairs (VA) through its Veterans Benefits Administration (VBA)
administers an integrated program of benefits and services, established
by law, for veterans, service personnel, and their dependents and/or
beneficiaries. Title 38 U.S.C. 5101(a) provides that a specific claim
in the form provided by the Secretary must be filed in order for
benefits to be paid to any individual under the laws administered by
the Secretary. The amended collection of information in final 38 CFR
3.154, 3.155, 3.403, 3.660, 3.665, 3.666, 3.701, 3.812, and 20.201
would require claimants to submit VA prescribed applications in either
paper or electronic submission of responses, where applicable, in order
to initiate the claims or appeals process for all VA benefits, to
include but not limited to: Entitlement under 38 U.S.C. 1151, which
governs disability compensation and death benefits for a qualifying
[[Page 57687]]
disability or death of a veteran from VA treatment, examination or
vocational rehabilitation; disability compensation; non-service
connected pension; and dependency and indemnity compensation (DIC),
death pension, and accrued benefits. In addition, under this
rulemaking, we would require claimants to submit a standard form to
initiate an appeal. Information is requested by this form under the
authority of 38 U.S.C. 7105.
Description of need for information and proposed use of
information: There is no substantive change in the need for information
and proposed use of information collected for the following affected
OMB-approved Control Numbers:
2900-0791 (VA Form 21-0958)--This form will be used by
claimants to indicate a disagreement with a decision issued by a
Regional Office to initiate an appeal.
2900-0001 (VA Form 21-526 and 21-526b)--These forms are
used to gather the necessary information to determine a veteran's
eligibility, dependency, and income, as applicable, for the
compensation and/or pension benefit sought without which information
would prevent a determination of entitlement;
2900-0743 (VA Form 21-526c)--This form is used to gather
necessary information from service members filing claims under the
Benefits Delivery at Discharge or Quick Start programs under Title 38
U.S.C. 5101(a) used in a joint effort between VA and Department of
Defense (DoD) for the expeditious process of determining entitlement to
compensation disability benefits;
2900-0002 (VA Form 21-527)--This form is used to gather
the necessary information to determine a veteran's eligibility and
dependency, as applicable, for disability pension sought without which
information would prevent a determination of entitlement;
2900-0004 (VA Form 21-534)--This form is used to gather
necessary information to determine the eligibility of surviving spouses
and children for dependency and indemnity compensation (DIC), death
pension, accrued benefits and death compensation;
2900-0004 (VA Form 21-534a)--This form is used to gather
necessary information to determine the eligibility of surviving spouses
and children of veterans who died while on active duty service for DIC,
death pension, accrued benefits, and death compensation;
2900-0005 (VA Form 21-535)--This form is used to gather
necessary information to determine a parent's eligibility, dependency
and income, as applicable, for the death benefit sought; and
2900-0747 (VA Forms 21-526EZ, 21-527EZ, and 21-534EZ)--
These forms are used to gather the necessary information to determine a
veteran's eligibility, dependency, and income, as applicable, for the
compensation and/or pension and disability pension and to determine the
eligibility of surviving spouses, children and parents for dependency
and indemnity compensation (DIC), death pension, accrued benefits and
death compensation as well as other benefits.
2900-0572 (VA Form 21-0304)--This form is used to gather
the necessary information to determine eligibility for the monetary
allowance and the appropriate level of payment for a child with spina
bifida who is the natural child of a veteran who served in the Republic
of Vietnam during the Vietnam era and for a child with certain birth
defects who is the natural child of a female veteran who served in the
Republic of Vietnam during the Vietnam era.
2900-0721 (VA Form 21-2680)--This form is used to gather
the necessary information to determine eligibility for the aid and
attendance and/or household benefit.
2900-0067 (VA Form 21-4502)--This form is used to gather
the necessary information to determine if a veteran or serviceperson is
entitled to an automobile allowance and adaptive equipment.
2900-0390 (VA Form 21-8924)--This form is used to gather
the necessary information to determine if the application meets the
Restored Entitlement Program for Survivors (REPS) program which pays VA
benefits to certain surviving spouses and children of veterans who died
in service prior to August 13, 1981 or who died as a result of a
service-connected disability incurred or aggravated prior to August 13,
1981.
2900-0404 (VA Form 21-8940)--This form is used to gather
the necessary information to determine whether individual
unemployability benefits may be paid to a veteran who has a service-
connected disability(ies) which result in an inability to secure or
follow substantially gainful occupation.
2900-0132 (VA Form 26-4555)--This form is used to gather
the necessary information to determine the eligibility for the
Specially Adapted Housing (SAH) or Special Housing Adaptations (SHA)
benefits for disabled veterans or servicemembers.
Description of likely respondents: There is no substantive change
in the description of likely respondents for the following affected
OMB-approved Control Numbers:
2900-0791 (VA Form 21-0958)--Veterans or claimants who
indicate disagreement with a decision issued by a Regional Office (RO)
will use VA Form 21-0958 in order to initiate the appeals process. The
veteran or claimant may or may not continue with an appeal to the Board
of Veterans Appeals (BVA). If the veteran or claimant opts to continue
to BVA for an appeal, this form will be included in the claim folder as
evidence.
2900-0001 (VA Form 21-526 and 21-526b)--Veterans or
claimants who express an intent to file for disability compensation
and/or pension benefit may continue to use VA Form 21-526. Veterans or
claimants who express an intent to file for disability compensation for
an increased evaluation, service connection for a new disability,
reopening of a previously denied disability, or for a disability
secondary to an existing service connected disability or for other
ancillary benefits such as aid and attendance, automobile allowance,
spousal aid and attendance, or other benefit may continue to use VA
Form 21-526b.
2900-0743 (VA Form 21-526c)--Service members filing claims
under the Benefits Delivery at Discharge or Quick Start programs under
Title 38 U.S.C. 5101(a) may continue to use VA Form 21-526c for
disability compensation benefits.
2900-0002 (VA Form 21-527)--Veterans who are reapplying
for VA pension benefits or previously applied for VA compensation
benefits and are now applying for VA pension benefits may continue to
use VA Form 21-527.
2900-0004 (VA Form 21-534 and 21-534a)--Claimants such as
surviving spouses and children filing for dependency and indemnity
compensation (DIC), death pension, accrued benefits, and death
compensation claims may continue to use VA Form 21-534. Military
Casualty Assistance Officers who are assisting surviving spouses and
children in filing claims for death benefits may continue to use VA
Form 21-534a.
2900-0005 (VA Form 21-535)--Claimants who are filing for
benefits subsequent to the death of the veteran may continue to use VA
Form 21-535.
2900-0747 (VA Forms 21-526EZ, 21-527EZ, and 21-534EZ)--
Veterans or claimants who are filing for disability compensation,
pension, dependency and indemnity compensation, death pension, accrued
benefits and death compensation claims and other benefits such an
ancillary benefit claims and entitlement to 38 U.S.C. 1151 benefits
[[Page 57688]]
that filed for processing in both the traditional claims system or in
the expedited claims processing system known as the Fully Developed
Claims program may continue to use VA Form 21-526EZ for disability
compensation; VA Form 21-527EZ for non-service connected pension
benefits; and VA Form 21-534EZ for dependency and indemnity
compensation, death pension, and/or accrued benefits.
2900-0572 (VA Form 21-0304)--Claimants who are filing for
the monetary allowance and payment for a child with spina bifida who is
the natural child of a veteran who served in the Republic of Vietnam
during the Vietnam era and for a child with certain birth defects who
is the natural child of a female veteran who served in the Republic of
Vietnam during the Vietnam era may continue to use VA Form 21-0304.
2900-0721 (VA Form 21-2680)--Claimants who are filing for
eligibility for the aid and attendance and/or household benefit may
continue to use VA Form 21-2680.
2900-0067 (VA Form 21-4502)--Veterans or servicepersons
who are filing for entitlement to an automobile allowance and adaptive
equipment may continue to use VA Form 21-4502.
2900-0390 (VA Form 21-8924)--Certain surviving spouses and
children of veterans who died in service prior to August 13, 1981 or
who died as a result of a service-connected disability incurred or
aggravated prior to August 13, 1981 under the Restored Entitlement
Program for Survivors (REPS) program may continue to use VA Form 21-
8924.
2900-0404 (VA Form 21-8940)--Claimants who file for
individual unemployability benefits for service-connected
disability(ies) which result in an inability to secure or follow
substantially gainful occupation may continue to use VA Form 21-8940.
2900-0132 (VA Form 26-4555)--Disabled veterans or
servicemembers who file for Specially Adapted Housing (SAH) or Special
Housing Adaptations (SHA) benefits may continue to use VA Form 26-4555.
Estimated frequency of responses:
2900-0791 (VA Form 21-0958)--One time for most claimants;
however, the frequency of responses is also dependent on the number of
appeals submitted on this form by the claimant as VA does not limit the
number of appeals that a claimant can submit.
2900-0001 (VA Form 21-526 and 21-526b)--One time for most
beneficiaries; however, the frequency of responses is also dependent on
the number of claims submitted on this form by the claimant as VA does
not limit the number of claims that a claimant can submit.
2900-0743 (VA Form 21-526c)--One time for most
beneficiaries; however, the frequency of responses is also dependent on
the number of claims submitted on this form by the claimant as VA does
not limit the number of claims that a claimant can submit.
2900-0002 (VA Form 21-527)--One time for most
beneficiaries; however, the frequency of responses is also dependent on
the number of claims submitted on this form by the claimant as VA does
not limit the number of claims that a claimant can submit.
2900-0004 (VA Form 21-534 and 21-534a)--One time for most
beneficiaries.
2900-0005 (VA Form 21-535)--One time for most
beneficiaries.
2900-0747 (VA Forms 21-526EZ, 21-527EZ, and 21-534EZ)--One
time for most beneficiaries; however, the frequency of responses is
also dependent on the number of claims submitted on this form by the
claimant as VA does not limit the number of claims that a claimant can
submit.
2900-0572 (VA Form 21-0304)--One time for most
beneficiaries.
2900-0721 (VA Form 21-2680)--One time for most
beneficiaries.
2900-0067 (VA Form 21-4502)--One time for most
beneficiaries.
2900-0390 (VA Form 21-8924)--One time for most
beneficiaries.
2900-0404 (VA Form 21-8940)--One time for most
beneficiaries.
2900-0132 (VA Form 26-4555)--One time for most
beneficiaries.
Estimated average burden per response: There is no substantive
change in the estimated average burden per response for the following
affected OMB-approved Control Numbers:
2900-0791 (VA Form 21-0958)--30 minutes.
2900-0001 (VA Form 21-526 and 21-526b)--VA Form 21-526--1
hour; and VA Form 21-526b--15 minutes; and VA Form 21-4142--5 minutes.
2900-0743 (VA Form 21-526c)--15 minutes.
2900-0002 (VA Form 21-527)--1 hour.
2900-0004 (VA Form 21-534 and 21-534a)--VA Form 21-534--1
hour and 15 minutes and VA Form 534a--15 minutes.
2900-0005 (VA Form 21-535)--1 hour and 12 minutes.
2900-0747 (VA Forms 21-526EZ, 21-527EZ, and 21-534EZ)--VA
Form 21-526EZ--25 minutes; VA Form 21-527EZ--25 minutes; and VA Form
21-534EZ--25 minutes.
2900-0572 (VA Form 21-0304)--10 minutes.
2900-0721 (VA Form 21-2680)--30 minutes.
2900-0067 (VA Form 21-4502)--15 minutes.
2900-0390 (VA Form 21-8924)--20 minutes.
2900-0404 (VA Form 21-8940)--45 minutes.
2900-0132 (VA Form 26-4555)--10 minutes.
Estimated number of respondents: VA anticipates the annual
estimated numbers of respondents for each of the OMB-approved forms as
follows:
2900-0791 (VA Form 21-0958)--144,000 per year as
previously estimated in ICR Reference No. 201206-2900-001 and as
published in the Federal Register, 77 FR 42556 on July 19, 2012 and 77
FR 60027 on October 1, 2012.
2900-0001 (VA Form 21-526 and 21-526b)--304,325 per year,
based on 5-year estimated average of formal and informal initial
compensation and pension claims received annually at 83,855 and formal
and informal new or reopened compensation claims received annually at
217,178, in addition to the historically reported annual estimated
number of responses for VA Form 21-4142 at 3,292.
2900-0743 (VA Form 21-526c)--161,000 per year as
previously estimated in ICR Reference No. 201209-2900-010 and as
published in the Federal Register, 77 FR 190, on October 1, 2012 and 77
FR 240 on December 13, 2012.
2900-0002 (VA Form 21-527)--17,111 per year, based on a 5-
year estimated average of 12,253 reopened pension claims received on VA
Form 21-527 in addition to an estimated number of 4,858 expected to be
received for informal reopened pension claims.
2900-0004 (VA Form 21-534 and 21-534a)--33,864 per year,
based on a 5-year estimated average of 32,438 formal and informal death
benefits claims filed by surviving spouses/child in addition to a 5-
year estimated number of 1,426 formal and informal death benefits
claims filed by surviving spouses/child for in-service death.
2900-0005 (VA Form 21-535)--1,783 per year, based on a 5-
year estimated average of 1,046 formal death benefits filed by parents
in addition to an expected estimated number of informal death benefit
claims at 737.
2900-0747 (VA Forms 21-526EZ, 21-527EZ, and 21-534EZ)--
1,048,652 per year, based on: (a) An estimated number of both formal
and informal--initial, new, reopened compensation claims at 835,910;
plus (b) an estimated number of both formal and informal pension claims
at 101,086; (c) an
[[Page 57689]]
estimated number of both formal and informal death benefit claims at
111,656, all of which total 1,048,652.
VA expanded a modified version of a pilot study, known as the
Express Claim Program, for which VA Forms 21-526EZ and 21-527EZ were
used. Therefore, the number of claimants expected to respond was
estimated at 104,440. These EZ forms contain the section 5103
notification for disability, pension, and now death benefits in paper
and electronic format. The electronic application uses the EZ form in
its question prompts and generates this form upon completion of the
interview process.
While this rule does not attach unique effective date consequences
to utilizing the electronic claim process, as the proposed rule would
have, VA still expects a substantial increase in the number of
respondents for this particular Control Number. As one commenter
pointed out, the fact that VA is able to decide a claim more quickly
when the claimant files an electronic application form provides
claimants an incentive to utilize the electronic process. Additionally,
the intent to file a claim process that we establish in this final rule
will greatly increase the role of standard application forms because VA
will provide claimants with the required standard application form upon
receiving an intent to file a claim. VA will typically provide EZ forms
in this purpose. This intent to file a claim process will apply to
types of claims for which no standard form of any kind is currently
required, such as claims governed by current Sec. 3.155(c).
2900-0572 (VA Form 21-0304)--430 per year.
2900-0721 (VA Form 21-2680)--14,000 per year.
2900-0067 (VA Form 21-4502)--1,552 per year.
2900-0390 (VA Form 21-8924)--1,800 per year.
2900-0404 (VA Form 21-8940)--24,000 per year.
2900-0132 (VA Form 26-4555)--4,158 per year.
OMB Control Numbers 2900-0572, 2900-0721, 2900-0067, 2900-0390,
2900-0404, and 2900-0132 are collections of information for particular
benefits such as automobile allowance, housing adaptation, individual
unemployability, etc., which are currently required by the VA in order
for these claims to be processed and adjudicated. Since VA requires
these forms to be submitted for filing of a particular benefit, VA does
not expect an increase in the annual likely number of respondents. In
addition, VA is not changing the substance of the collection of
information on these OMB-approved collections of information nor is it
increasing the respondent burden. We are including these collections of
information in this rulemaking because it is relevant to the rulemaking
but is not directly altered by it.
Estimated total annual reporting and recordkeeping burden:
2900-0791 (VA Form 21-0958)--Annual burden continues to be
72,000 hours. The total estimated cost to respondents continues to be
$1,080,000 (72,000 hours x $15/hour). This submission does not involve
any recordkeeping costs.
2900-0001 (VA Form 21-526 and 21-526b)--For VA Form 21-
526, the annual burden is 83,855 hours. The total estimated cost to
respondents is $1,257,825 (83,855 hours x $15/hour). This submission
does not involve any recordkeeping costs. For VA Form 21-526b, the
annual burden is 54,295 hours. The total estimated cost to respondents
is $81,443 (54,295 hours x $15/hour). This submission does not involve
any recordkeeping costs. For VA Form 21-4142, the annual burden is 263
hours. The total estimated cost to respondents is $330 (263 hours x
$15/hour). This submission does not involve any recordkeeping costs.
2900-0743 (VA Form 21-526c)--Annual burden continues to be
40,250 hours. The total estimated cost to respondents continues to be
$603,750 (40,250 hours x $15/hour). This submission does not involve
any recordkeeping costs.
2900-0002 (VA Form 21-527)--Annual burden is 17,111 hours.
The total estimated cost to respondents is $256,665 (17,111 hours x
$15/hour). This submission does not involve any recordkeeping costs.
2900-0004 (VA Form 21-534 and 21-534a)--For VA Form 21-
534, the annual burden is 40,548 hours. The total estimated cost to
respondents is $608,220 (40,548 hours x $15/hour). This submission does
not involve any recordkeeping costs. For VA Form 21-534a, the annual
burden is 357 hours. The total estimated cost to respondents is $5,355
(3,57 hours x $15/hour). This submission does not involve any
recordkeeping costs.
2900-0005 (VA Form 21-535)--Annual burden is 2,140 hours.
The total estimated cost to respondents is $32,100 (2,140 hours x $15/
hour). This submission does not involve any recordkeeping costs.
2900-0747 (VA Forms 21-526EZ, 21-527EZ, and 21-534EZ)--For
VA Form 21-526EZ, the annual burden is 348,296 hours. The total
estimated cost to respondents is $55,224,440 (348,296 hours x $15/
hour). This submission does not involve any recordkeeping costs. For VA
Form 21-527EZ, the annual burden is 42,119 hours. The total estimated
cost to respondents is $631,785 (42,119 hours x $15/hour). This
submission does not involve any recordkeeping costs. For VA Form 21-
534EZ, the annual burden is 46,523 hours. The total estimated cost to
respondents is $697,845 (46,523 hours x $15/hour). This submission does
not involve any recordkeeping costs.
2900-0572 (VA Form 21-0304)--Annual burden continues to be
72 hours. The total estimated cost to respondents continues to be
$1,080 (72 hours x $15/hour). This submission does not involve any
recordkeeping costs.
2900-0721 (VA Form 21-2680)--Annual burden continues to be
7,000 hours. The total estimated cost to respondents continues to be
$105,000 (7,000 hours x $15/hour). This submission does not involve any
recordkeeping costs.
2900-0067 (VA Form 21-4502)--Annual burden continues to be
388 hours. The total estimated cost to respondents continues to be
$5,820 (388 hours x $15/hour). This submission does not involve any
recordkeeping costs.
2900-0390 (VA Form 21-8924)--Annual burden continues to be
600 hours. The total estimated cost to respondents to be $9,000 (600
hours x $15/hour). This submission does not involve any recordkeeping
costs.
2900-0404 (VA Form 21-8940)--Annual burden continues to be
18,000 hours. The total estimated cost to respondents continues to be
$270,000 (18,000 hours x $15/hour). This submission does not involve
any recordkeeping costs.
2900-0132 (VA Form 26-4555)--Annual burden continues to be
693 hours. The total estimated cost to respondents continues to be
$10,395 (693 hours x $15/hour). This submission does not involve any
recordkeeping costs.
This rulemaking is mandating the use of existing VA forms in the
processing and adjudication of claims and appeals. These amendments to
Sec. Sec. 3.154, 3.155, 3.403, 3.660, 3.665, 3.666, 3.701, 3.812, and
20.201 affect the estimated annual number of respondents and
consequently, the estimated total annual reporting and recordkeeping
burden but do not otherwise affect the existing collections of
information that have already been approved by the Office of Management
and Budget (OMB). The use of information, description of likely
respondents, estimated frequency of
[[Page 57690]]
responses, estimated average burden per response will remain unchanged
for these forms. While there is no substantive change in the
aforementioned collection of information for these amendments, VA
foresees a change in the quantity of information collected and the
total annual reporting for certain currently approved OMB control
numbers on account of this rulemaking.
VA's Collection of Data:
Other than for original claims and certain ancillary benefits, VA
historically and currently accepts claims for benefits in any format
submitted, whether on a prescribed form or not. VA has never
standardized the use of forms for claims or appeals processing \1\. VA
maintains a record of the number of types of benefit claims received
annually based on claim types such as original claims, claims for
increase or to reopen a previously denied claim, claims for ancillary
benefits, pension, and death benefits which have been submitted on the
appropriate prescribed form. However, reliance on claim types based on
the form submitted may not accurately capture the number of claims
received. For instance, one claim type can be filed using more than one
prescribed form and a claimant can file two types of claim such as a
claim for increase and a claim to reopen on one prescribed VA form
which will be categorized as one claim type received, i.e., recorded as
either a claim for increase or a claim to reopen. For informal claims,
VA has not quantified the number of informal claims received, but it
quantifies the particular claim type filed in the informal claim such
as original, increase, new, reopen, etc. As a result of this rulemaking
requiring the use of prescribed forms for all claims for benefits, VA
will be able to gather and collect the data quantifying the number of
prescribed forms in the future which will provide VA with a more
accurate account of how many respondents will respond on various VA
prescribed forms.
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\1\ Currently, VA accepts any claim filed subsequent to the
original, initial compensation/pension claim that is submitted in
any form, i.e., informal claim to initiate the claims process. For
example, a claim for increase or reopen, which currently is not
required to be submitted on a prescribed form, can be established
using different VA forms such as VA Form 21-526 Veteran's
Application for Compensation and/or Pension; VA Form 21-526EZ,
Application for Disability Compensation or Related Compensation; VA
Form 21-526b, Veteran's Supplemental Claim for Compensation; or VA
Form 21-4138, Statement in Support of Claim.
---------------------------------------------------------------------------
Electronic Claims:
Due to the fact that there is no current data enumerating the total
number of different types of VA forms received annually, we have
projected the annual number of respondents for the forms based on the
estimated number of types of claims received annually over a 5-year
period. We have also approximated the number of electronic claims
received for compensation, pension, and death claims. Currently, VA's
electronic claims processing system, i.e., eBenefits and Veterans
Online Applications (VONAPP), uses VA Form 21-526EZ for disability
compensation claims submitted electronically. VA is also in the process
of adding other VA forms to VONAPP such as VA Form 21-527EZ and 21-
534EZ (hereinafter ``EZ forms'' will be used to refer to VA Forms 21-
526EZ, 21-527EZ, and 21-534EZ, collectively). VA also provides these EZ
forms to claimants who wish to submit their claims on paper because
these forms expedite the claims process by: (a) Offering the claimant a
choice for either the expedited process of ``Fully Developed Claims''
or the traditional claims process; (b) listing more detailed questions
for a variety of benefits sought in order to capture thoroughly the
specifics of a claim; and (c) providing claimants with the required
notice of VA's duty to assist the claimant pursuant to 38 U.S.C. 5103,
which is issued at the time the claimant files a claim instead of when
the VA receives the claim. The use of these EZ forms ultimately speeds
up the claims process and ensures faster delivery of benefits to
claimants; therefore, VA has encouraged, directed, and provided these
EZ forms to claimants who wish to file benefit claims.
With the ease and efficiency of completing and filing electronic
claims through VA's Web-based electronic claims application system, VA
expects the number of electronic claims to increase. Additionally, VA
expects the number of EZ forms to increase even in cases where the
claimant opts not to use the electronic process, because VA will
typically provide an EZ form in response to an intent to file a claim.
Because eBenefits and VONAPP uses (and will continue to use) the EZ
forms, we anticipate that the total number of annual responses received
on the EZ forms electronically for all benefits will increase by at
least 29 percent while the total number of annual response received on
VA Forms 21-526, 21-526b, 21-527, 21-534, 21-534a, and 21-535
(``traditional forms'') will decrease. Based on data from Fiscal Year
(FY) October 2010 through September 2011, the number of compensation
disability claims received electronically was 142,899 and the number of
total compensation disability and dependency claims received
electronically was 496,851. Thus, the percentage of compensation
disability electronic claims received was 29 percent. With VA's
outreach and efforts to promote the electronic claims processing system
and with future implementation of pension, death, and appeals
electronic claims processing, VA estimates an increase of the
submission of electronic claims by at least 29 percent based upon the
FY 2010 through 2011 data. Since the trend is to direct claimants to
submit claims on EZ forms both electronically and on paper, we
approximate that 70 percent of claims will be submitted on the EZ form
while 30 percent will be submitted on the traditional forms.
Informal Claims:
The data used in formulating the estimated number of annual
responses to the various affected prescribed forms was extrapolated
from data recorded for the number of types of claims received annually
for FY April 2009 through April 2013. This data is not sufficiently
granular to provide the number of informal claims received given that
the data only depicts the number of initial, new or reopened
compensation and pension claims received and the number of initial
death benefit claims received. Since informal claims may or may not be
submitted on a prescribed form, there is no method for accurately
recording or quantifying the total number of informal claims received
or inferred annually. Therefore, we approximate that for compensation,
pension, and death benefits, 50 percent of each of these benefits are
informal claims. Thus, based on the data of an average of claims
received over a 5-year period, we expect that the total number of
informal claims for compensation, pension, and death benefits that will
be submitted on a prescribed form will increase by at least 50 percent.
Notices of Disagreement:
Previously, VA estimated that the annual number of respondents
submitting the currently approved collection instrument, VA Form 21-
0958, Notice of Disagreement, (OMB Control Number 2900-0791) would be
144,000, based on VA historically receiving 12 Notices of Disagreement
per 100 completed VBA decisions, with more than 1.2 million VBA
decisions in FY 2012. According to data for FY 2009 to FY 2012, the
average number of Notices of Disagreement received annually was
129,539. For FY 2013, it is projected that VA will receive 126,735
Notices of Disagreement. The estimate associated with the currently
approved collection was based upon the
[[Page 57691]]
assumption that all notices of disagreement would be submitted on this
collection instrument, though that is not necessarily the case under
current rules. As a result of this rulemaking, however, the
overwhelming majority of notices of disagreement would in fact be
submitted on this collection instrument, since this rulemaking is
requiring that all notices of disagreement be submitted on VA Form 21-
0958 in cases where that form is provided. Accordingly, while VA does
expect to receive many more completed Forms 21-0958, there is no
expected increase in the annual number of respondents nor an increased
burden on respondents from that reflected in currently approved
collections.
In addition, VA is amending the instructions which accompany VA
Form 21-0958 to alter the current language from ``not mandatory'' to
provide that VA Form 21-0958 will be required to initiate an appeal
from a decision on compensation claims. We have also provided
notification to claimants that only the issues listed on VA Form 21-
0958 will be considered on appeal but that the claimant retains the
right to appeal unnamed issues or contentions within 1 year from the
date of the decision notification letter. Moreover, we have added a
separate section in the instructions to provide claimants with the
criteria for a complete NOD form which conforms with the final
regulatory language in Sec. 19.24(b)(2) which enumerates the
requirements for a complete NOD, namely that the form must contain:
information to identify the claimant; information to identify the
specific nature of the disagreement; and claimant's signature. In order
to further assist claimants in submitting a complete NOD, we have
provided samples for clarification of what is minimally necessary to
identify the specific nature of the disagreement. We note that one of
the public commenters questioned VA's motive behind inquiring whether
claimants would like direct communication with the AOJ regarding the
appeal. In response, we have amended the instructions to provide that
claimants would have the option of being contacted by telephone in
order for VA to request clarification from claimants if there was any
ambiguous information which may hinder expeditious processing of the
NOD. While we have amended the instructions to VA Form 21-0958 to
conform to the final rule and to give notice to claimants of the
requirements of the amended appeals regulations, we did not change,
amend, or alter VA Form 21-0958. Therefore, we do not foresee any
additional burden to the claimant in completing this form.
Methodology for Estimated Annual Number of Respondents for Affected
Forms:
We have formulated the estimated total of annual responses for
compensation, pension, and death benefit claims by increasing the
expected number of total claims submitted on paper by 50 percent from
data extrapolated for claims received annually over a 5-year period. We
project that 30 percent of compensation, pension, and death benefit
claims will be submitted on traditional forms whereas 70 percent will
be submitted on EZ forms. Accordingly, VA expects a decrease in the
total estimated number of annual responses for VA Forms 21-526, 21-527,
21-534, 21-534a, and 21-535 whereas the total estimated number of
annual responses for VA Forms 21-526EZ, 21-527EZ, and 21-534EZ have
increased substantially. The projected numbers for each affected form
are provided in further detail in the above section, ``Estimated number
of respondents,'' according to each OMB Control Number.
II. New Information Collection
The information collection described in this section was not
previously discussed in the proposed rule. Comments on the collection
of information contained in this section should be submitted to the
Office of Management and Budget, Attention: Desk Officer for the
Department of Veterans Affairs, Office of Information and Regulatory
Affairs, Washington, DC 20503 or emailed to
OIRASubmission@omb.eop.gov, with copies sent by mail or hand
delivery to the Director, Regulations Management (02REG), Department of
Veterans Affairs, 810 Vermont Avenue NW., Room 1068, Washington, DC
20420; fax to (202) 273-9026; or submitted through www.Regulations.gov.
Comments should indicate that they are submitted in response to ``RIN
2900-AO81-- Standard Claims and Appeals Forms.'' Notice of OMB approval
for this information collection will be published in a future Federal
Register document.
The Department considers comments by the public on proposed
collections of information in:
Evaluation whether the proposed collections of information
are necessary for the proper performance of the functions of the
Department, including whether the information will have practical
utility;
Evaluating the accuracy of the Department's estimate of
the burden of the proposed collections of information, including the
validity of the methodology and assumptions used;
Enhancing the quality, usefulness, and clarity of the
information to be collected; and
Minimizing the burden of the collections of information on
those who are to respond, including through the use of appropriate
automated, electronic, mechanical, or other technological collection
techniques or other forms of information technology, e.g., permitting
electronic submission of responses.
This final rule will impose the following new information
collection requirements in standardizing the current informal claim
process in 38 CFR 3.155 by requiring a standard form to be used to
establish a claimant's intention to file a claim for VA benefits. As
required by the Paperwork Reduction Act of 1995 (44 U.S.C. 3507(d)), VA
has submitted this information amendment to OMB for its review and for
approval 180-days after the date this rule is published in the Federal
Register as a final rule. On October 31, 2013, VA published in the
Federal Register (78 FR 65490) a proposed rule to amend its
adjudication regulations and rules of practice of the Board of
Veterans' Appeals (Board) to standardize the claims and appeals process
by requiring the use of VA forms to file a claim and to initiate an
appeal. The proposed rule attempted to address the issue that current
non-standard submissions from claimants including submission requiring
VA to take action are not received in a standard format. Non-standard
submissions from claimants meant increased time spent determining
whether a claim has been filed, identifying the benefit claimed,
sending letters to the claimant and awaiting a response, and requesting
and awaiting a response, and requesting and awaiting receipt of
evidence. These steps all significantly delay the adjudication and
delivery of benefits to veterans and their families. By standardizing
the claims process through the use of standard forms, VA would be able
to more easily identify issues and contentions associated with claims
that are filed, resulting in greater accuracy, efficiency, and speed in
the processing and adjudication of claims. Therefore, the proposed rule
proposed to amend VA's current adjudication regulations to standardize
the claims process by eliminating the informal claim, i.e., the non-
standard submission of a claimant's claim or intent to file a claim, by
requiring claimants to submit a VA-prescribed form or application to
apply for benefits.
[[Page 57692]]
While the current informal claim establishes a date of claim (in
the case of an original claim, a complete application that is submitted
on a standard form must be filed within 1 year of the filing of the
informal claim), the proposed rule eliminated the informal claim
process and established that a complete claim submitted in the standard
paper form would establish the date of claim. However, for electronic
claims, VA would establish the date of claim based on the date when the
claimant saved an incomplete electronic application without submitting
it for processing. Claimants would have 1 year to submit the completed
electronic application in order to preserve the date claimant saved the
application as the date of claim. The result of the proposed rule would
have allowed a favorable effective date treatment for electronic claims
only. The purpose of the distinction between electronic and non-
electronic claim submission with regard to effective date treatment was
to incentivize claimants to file electronic claims, which are processed
by VA more efficiently and result in more expeditious delivery of
benefits to claimants.
Based upon the concerns and issues raised by the public commenters
on the proposed rule, particularly, regarding the dissimilar treatment
of effective dates for electronic and non-electronic claims submissions
and its impact on claimants, VA determined that modernization and
standardization of the claims process could also be achieved by
formalizing and standardizing the current informal claims process while
retaining favorable effective date treatment for claimants filing in
paper form. In response, VA revised the proposed regulation of Sec.
3.155 in this final rule to replace the concept and term ``informal
claim'' with the concept and term ``intent to file a claim for
benefits.'' In revised final Sec. 3.155, claimants can submit an
intent to file a claim for benefits on the prescribed VA form
designated for this purpose to establish a date of claim if the
claimant files a complete claim within 1 year of submitting the intent
to file a claim. VA considers the concept of the intent to file a claim
for benefits in revised Sec. 3.155 to be a logical outgrowth of VA's
goal of standardizing the claims process through the use of forms as
outlined in the published proposed rule. Moreover, this concept
provides the most optimal solution to the concerns regarding the
proposed rule that were raised by the commenters while still
standardizing and modernizing the VA claims process.
In order to implement this intent to file a claim process, VA
created a new form, VA Form 21-0966, Intent to File a Claim for
Compensation and/or Pension, Survivors Pension, or Other Benefits, to
be used for this purpose. This process is a reconciliation of VA's need
for claims to originate on standard forms and commenters' desire for
ways to establish an effective date while a complete claim on an
application form is completed. Accordingly, it did not exist at the
time of the publication of the proposed rule and as the new intent to
file process is being codified in this final rule, VA is submitting
this new collection of information specifically used for the intent to
file process for OMB approval and for public comment in this final
rule.
The new VA Form 21-0966 will be used to establish a date of claim
if a complete claim is filed within 1 year of receipt of this form for
all claims whether initial or supplemental. VA notes that a claimant
can also submit an intent to file a claim for benefits by contacting VA
personnel in field offices by telephone or in person. VA personnel will
document the intent to file on VA Form 21-0966. A filled out form will
be uploaded into VA's internal business and operational programs so
that VA personnel will be able to refer to this document in order
assign the appropriate effective date for any award granted. Therefore,
this newly proposed VA Form 21-0966, will enable VA to document a
claimant's intent to file a claim which will greatly enhance VA's
standardization of the claims process through the use of VA-prescribed
forms.
Claimants can also submit an intent to file a claim via
electronically in VA's claims submission tool within its Web-based
electronic claims application system by entering biographical data and
saving the electronic application without submitting it for processing.
Therefore, there is no separate electronic ``intent to file a claim''
form; the act of entering information and saving the electronic
application will serve as the intent to file a claim for benefits.
Title: Intent to File a Claim
Summary of collection of information: The Department of Veterans
Affairs (VA) through its Veterans Benefits Administration (VBA)
administers an integrated program of benefits and services, established
by law, for veterans, service personnel, and their dependents and/or
beneficiaries. Title 38 U.S.C. 5101(a) provides that a specific claim
in the form provided by the Secretary must be filed in order for
benefits to be paid to any individual under the laws administered by
the Secretary. The amended collection of information in the final rule
38 CFR 3.155 would require claimants and/or their authorized
representatives to submit a VA-prescribed form in either paper or
electronic submission, where applicable, to express a claimant's intent
to file a claim for benefits in order to establish an effective date
placeholder for any award granted if the claimant files a complete
claim within 1 year of receipt of the intent to file a claim. VA
proposes to create a new form, VA Form 21-0966, Intent to File a Claim
for Compensation and/or Pension, Survivors Pension, or Other Benefits.
Claimants and their representatives can submit their intent to file a
claim in three ways: (1) On paper using VA's newly created, proposed VA
Form 21-0966, Intent to File a Claim for Compensation and/or Pension,
Survivors Pension, or Other Benefits; (2) electronically through a
claims submission tool within a VA Web-based electronic claims
application system; or, (3) by telephone contact with designated VA
personnel who will record the intent to file a claim on the proposed VA
Form 21-0966, Intent to File a Claim for Compensation and/or Pension,
Survivors Pension, or Other Benefits.
Description of need for information and proposed use of
information: This form will be used by claimants and/or their
authorized representatives to indicate an intent to file a claim for
compensation and/or disability benefits to establish an effective date
for an award granted in association with a complete claim filed within
1 year of such form. This form collects biographical information of the
claimant such as name; Social Security Number; service number, if
applicable; date of birth; gender; VA claim number, if applicable;
current mailing address; forwarding address; telephone number(s); email
address(es); and signature. The collection of information also requests
claimants to indicate what type of claim for benefits, i.e.,
compensation and/or pension, the claimant intends to file. VA will use
this form to identify claimants in its internal business operational
systems to record the date of receipt of this document for the purposes
of establishing a date of claim for a complete claim that is filed
within 1 year. VA also uses the information to furnish the claimant
with the appropriate VA form or application for compensation and
pension benefits.
Description of likely respondents: Veterans, claimants, and/or
authorized representatives who indicate an intent
[[Page 57693]]
to file a claim for disability compensation and/or pension benefits.
Estimated frequency of responses: One time for most beneficiaries;
however, the frequency of responses is also dependent on the number of
intents to file a claim submitted by the claimant. VA does not limit
the number of submissions of the intent to file a claim for benefits,
except that VA will accept only one intent to file a claim per complete
claim filed.
Estimated average burden per response: VA estimates an average of
15 minutes to gather information and complete the new, proposed VA Form
21-0966, Intent to File a Claim for Compensation, and/or Pension,
Survivors Pension, or Other Benefits.
Estimated number of respondents: VA anticipates the annual
estimated number of respondents to be 724,561 per year, the sum of
which is based on 5-year estimated average of: 41,928 formal and
informal initial compensation and pension claims received annually and
108,589 formal and informal new or reopened compensation claims
received annually; 6,127 formal reopened pension claims received
annually and 2,429 informal reopened pension claims expected to be
received annually; 16,219 formal and informal death benefits claimed
filed by surviving spouses/child received annually and 713 formal and
informal death benefits claims filed by surviving spouses/child for in-
service death received annually; 523 formal death benefits filed by
parents received annually and 737 expected informal death benefits
claims filed by parents received annually; 417,955 formal and informal,
initial, new, reopened compensation claims received annually plus
50,543 formal and informal pension claims received annually plus 55,828
formal and informal death benefits claims received annually; 215 claims
for monetary allowance and payment for a child with spina bifida who is
a natural child of a veteran having served in the Republic of Vietnam
during the Vietnam era; 7,000 claims for aid and attendance and/or
household benefits; 776 claims for automobile and adaptive equipment
allowance; 900 claims for benefits under the Restored Entitlement
Program for Survivors program; 12,000 claims for individual
unemployability benefits; and 2,079 claims for Specially Adapted
Housing or Special Housing Adaptation benefits.
Estimated total annual reporting and recordkeeping burden: The
annual burden is 181,140 hours. The total estimated cost to respondents
is $2,717,100 (181,140 hours x $15/hour). This submission does not
involve any recordkeeping costs.
Methodology for Estimated Annual Number of Respondents for Proposed
Collection of Information on VA Form 21-0966, Intent to File a Claim
for Compensation and/or Pension Benefits:
Using the data as reported in the proposed rule, we estimate that
at least 50 percent of all claims, which would have been filed
informally, will be filed in conjunction with the intent to file a
claim form. Therefore, we have multiplied the expected number of total
claims submitted on paper by 50 percent from data extrapolated for
claims received annually over a 5-year period to calculate the
estimated number of intent to claim form. An itemization of the
projected numbers for an intent to file a claim form in association
with each approved OMB form is provided in further detail in the above
section, ``Estimated number of respondents.''
VA's Collection of Data:
Other than for original claims and certain ancillary benefits, VA
historically and currently accepts claims for benefits in any format
submitted, whether on a prescribed form or not. VA has never
standardized the use of forms for claims or appeals processing \2\. VA
maintains a record of the number of types of benefit claims received
annually based on claim types such as original claims, claims for
increase or to reopen a previously denied claim, claims for ancillary
benefits, pension, and death benefits which have been submitted on the
appropriate prescribed form. However, reliance on claim types based on
the form submitted may not accurately capture the number of claims
received. For instance, one claim type can be filed using more than one
prescribed form and a claimant can file two types of claim such as a
claim for increase and a claim to reopen on one prescribed VA form
which will be categorized as one claim type received, i.e., recorded as
either a claim for increase or a claim to reopen. For informal claims,
VA has not quantified the number of informal claims received, but it
quantifies the particular claim type filed in the informal claim such
as original, increase, new, reopen, etc. As a result of this rulemaking
requiring the use of prescribed forms for all claims for benefits, VA
will be able to gather and collect the data quantifying the number of
prescribed forms in the future which will provide VA with a more
accurate account of how many respondents will respond on various VA
prescribed forms.
---------------------------------------------------------------------------
\2\ Currently, VA accepts any claim filed subsequent to the
original, initial compensation/pension claim that is submitted in
any form, i.e., informal claim to initiate the claims process. For
example, a claim for increase or reopen, which currently is not
required to be submitted on a prescribed form, can be established
using different VA forms such as VA Form 21-526 Veteran's
Application for Compensation and/or Pension; VA Form 21-526EZ,
Application for Disability Compensation or Related Compensation; VA
Form 21-526b, Veteran's Supplemental Claim for Compensation; or VA
Form 21-4138, Statement in Support of Claim.
---------------------------------------------------------------------------
VA is replacing ``informal claims'' with ``intent to file a claim''
and is requiring the submission of complete claim in revised Sec.
3.155 as a placeholder for a potential earlier effective date. Since
eBenefits and VONAPP uses (and will continue to use) the EZ forms, we
anticipate that the total number of annual responses received on the EZ
forms electronically for all benefits will increase by at least 29
percent while the total number of annual response received on VA Forms
21-526, 21-526b, 21-527, 21-534, 21-534a, and 21-535 (``traditional
forms'') will decrease. Based on data from Fiscal Year (FY) October
2010 through September 2011, the number of compensation disability
claims received electronically was 142,899 and the number of total
compensation disability and dependency claims received electronically
was 496,851. Thus, the percentage of compensation disability electronic
claims received was 29 percent. With VA's outreach and efforts to
promote the electronic claims processing system and with future
implementation of pension, death, and appeals electronic claims
processing, VA estimates an increase of the submission of electronic
claims by at least 29 percent based upon the FY 2010 through 2011 data.
Since the trend is to direct claimants to submit claims on EZ forms
both electronically and on paper, we approximate that 70 percent of
claims will be submitted on the EZ form while 30 percent will be
submitted on the traditional forms.
The data used in formulating the estimated number of annual
responses to the various affected prescribed forms was extrapolated
from data recorded for the number of types of claims received annually
for FY April 2009 through April 2013. This data is not sufficiently
granular to provide the number of informal claims received given that
the data only depicts the number of initial, new or reopened
compensation and pension claims received and the number of initial
death benefit claims received. Since informal claims may or may not be
submitted on a prescribed form, there is no method for accurately
recording or quantifying the total number of informal claims received
or inferred annually.
[[Page 57694]]
Therefore, we approximate that for compensation, pension, and death
benefits, 50 percent of each of these benefits are informal claims.
Thus, based on the data of an average of claims received over a 5-year
period, we expect that the total number of informal claims for
compensation, pension, and death benefits that will be submitted on a
prescribed form will increase by at least 50 percent. This estimate is
used to calculate the estimated expected number of intent to file a
claim forms.
Regulatory Flexibility Act
The Secretary hereby certifies that these regulatory amendments
would not have a significant economic impact on a substantial number of
small entities as they are defined in the Regulatory Flexibility Act, 5
U.S.C. 601-612. These amendments would not directly affect any small
entities. Only VA beneficiaries and their survivors could be directly
affected. Therefore, pursuant to 5 U.S.C. 605(b), these amendments are
exempt from the initial and final regulatory flexibility analysis
requirements of sections 603 and 604.
Executive Orders 12866 and 13563
Executive Orders 12866 and 13563 direct agencies to assess the
costs and benefits of available regulatory alternatives and, when
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public
health and safety effects, and other advantages; distributive impacts;
and equity). Executive Order 13563 (Improving Regulation and Regulatory
Review) emphasizes the importance of quantifying both costs and
benefits, reducing costs, harmonizing rules, and promoting flexibility.
Executive Order 12866 (Regulatory Planning and Review) defines a
``significant regulatory action,'' which requires review by OMB, as
``any regulatory action that is likely to result in a rule that may:
(1) Have an annual effect on the economy of $100 million or more or
adversely affect in a material way the economy, a sector of the
economy, productivity, competition, jobs, the environment, public
health or safety, or State, local, or tribal governments or
communities; (2) Create a serious inconsistency or otherwise interfere
with an action taken or planned by another agency; (3) Materially alter
the budgetary impact of entitlements, grants, user fees, or loan
programs or the rights and obligations of recipients thereof; or (4)
Raise novel legal or policy issues arising out of legal mandates, the
President's priorities, or the principles set forth in this Executive
Order.''
The economic, interagency, budgetary, legal, and policy
implications of this regulatory action have been examined, and it has
been determined to be a significant regulatory action under Executive
Order 12866.
VA's impact analysis can be found as a supporting document at
https://www.regulations.gov, usually within 48 hours after the
rulemaking document is published. Additionally, a copy of the
rulemaking and its impact analysis are available on VA's Web site at
https://www1.va.gov/orpm/, by following the link for ``VA Regulations
Published.''
Unfunded Mandates
The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C.
1532, that agencies prepare an assessment of anticipated costs and
benefits before issuing any rule that may result in an expenditure by
State, local, and tribal governments, in the aggregate, or by the
private sector of $100 million or more (adjusted annually for
inflation) in any given year. This rule would have no such effect on
State, local, and tribal governments, or on the private sector.
Catalog of Federal Domestic Assistance Numbers and Titles
The Catalog of Federal Domestic Assistance program numbers and
titles for this rule are 64.100, Automobiles and Adaptive Equipment for
Certain Disabled Veterans and Members of the Armed Forces; 64.101,
Burial Expenses Allowance for Veterans; 64.102, Compensation for
Service-Connected Deaths for Veterans' Dependents; 64.103, Life
Insurance for Veterans; 64.104, Pension for Non-Service-Connected
Disability for Veterans; 64.105, Pension to Veterans Surviving Spouses,
and Children; 64.106, Specially Adapted Housing for Disabled Veterans;
64.109, Veterans Compensation for Service-Connected Disability; 64.110,
Veterans Dependency and Indemnity Compensation for Service-Connected
Death; 64.114, Veterans Housing--Guaranteed and Insured Loans; 64.115,
Veterans Information and Assistance; 64.116,Vocational Rehabilitation
for Disabled Veterans; 64.117, Survivors and Dependents Educational
Assistance; 64.118, Veterans Housing--Direct Loans for Certain Disabled
Veterans; 64.119, Veterans Housing--Manufactured Home Loans; 64.120,
Post-Vietnam Era Veterans' Educational Assistance; 64.124, All-
Volunteer Force Educational Assistance; 64.125, Vocational and
Educational Counseling for Servicemembers and Veterans; 64.126, Native
American Veteran Direct Loan Program; 64.127, Monthly Allowance for
Children of Vietnam Veterans Born with Spina Bifida; and 64.128,
Vocational Training and Rehabilitation for Vietnam Veterans' Children
with Spina Bifida or Other Covered Birth Defects.
Signing Authority
The Acting Secretary of Veterans Affairs, or designee, approved
this document and authorized the undersigned to sign and submit the
document to the Office of the Federal Register for publication
electronically as an official document of the Department of Veterans
Affairs. Sloan D. Gibson, Acting Secretary, Department of Veterans
Affairs, approved this document on July 30, 2014, for publication.
List of Subjects
38 CFR Part 3
Administrative practice and procedure, Claims, Disability benefits,
Health care, Pensions, Radioactive materials, Veterans, Vietnam.
38 CFR Parts 19 and 20
Administrative practice and procedure, Claims, Veterans.
Dated: September 18, 2014.
William F. Russo,
Acting Director, Office of Regulation Policy & Management, Office of
the General Counsel, Department of Veterans Affairs.
For the reasons set forth in the preamble, VA amends 38 CFR parts
3, 19, and 20 as follows:
PART 3--ADJUDICATION
Subpart A--Pension, Compensation, and Dependency and Indemnity
Compensation
0
1. The authority citation for part 3, subpart A continues to read as
follows:
Authority: 38 U.S.C. 501(a), unless otherwise noted.
0
2. Revise Sec. 3.1(p) to read as follows:
Sec. 3.1 Definitions.
* * * * *
(p) Claim means a written communication requesting a determination
of entitlement or evidencing a belief in entitlement, to a specific
benefit under the laws administered by the Department of Veterans
Affairs submitted on an application form prescribed by the Secretary.
* * * * *
[[Page 57695]]
Sec. 3.108 [Amended]
0
3. Amend Sec. 3.108 by removing ``formal or informal claim'' and
adding in its place ``complete claim as set forth in Sec. 3.160(a) or
an intent to file a claim as set forth in Sec. 3.155(b)''.
0
4. Amend Sec. 3.109, paragraph (a)(2) by revising the first sentence
to read as follows:
Sec. 3.109 Time limit.
* * * * *
(a) * * *
(2) The provisions of this paragraph are applicable to original
initial applications, to applications for increased benefits by reason
of increased disability, age, or the existence of a dependent, and to
applications for reopening or resumption of payments. * * *
* * * * *
Sec. 3.150 [Amended]
0
5. Amend Sec. 3.150 by removing paragraph (c).
Sec. 3.151 [Amended]
0
6. Amend Sec. 3.151, Cross Reference, by removing ``Informal claims.''
and adding in its place ``Intent to file a claim.''.
0
7. Revise Sec. 3.154 to read as follows:
Sec. 3.154 Injury due to hospital treatment, etc.
Claimants must file a complete claim on the appropriate application
form prescribed by the Secretary when applying for benefits under 38
U.S.C. 1151 and 38 CFR 3.361. See Sec. Sec. 3.151, 3.160(a), and
3.400(i) concerning effective dates of awards; see Sec. 3.155(b)
regarding intent to file the appropriate application form.
(Authority: 38 U.S.C. 501 and 1151.)
CROSS REFERENCE: Effective Dates. See Sec. 3.400(i). Disability or
death due to hospitalization, etc. See Sec. Sec. 3.358, 3.361 and
3.800.
0
8. Revise Sec. 3.155 to read as follows:
Sec. 3.155 How to file a claim.
The following paragraphs describe the manner and methods in which a
claim can be initiated and filed. The provisions of this section are
applicable to all claims governed by part 3.
(a) Request for an application for benefits. A claimant, his or her
duly authorized representative, a Member of Congress, or some person
acting as next friend of a claimant who is not of full age or capacity,
who indicates a desire to file for benefits under the laws administered
by VA, by a communication or action, to include an electronic mail that
is transmitted through VA's electronic portal or otherwise, that does
not meet the standards of a complete claim is considered a request for
an application form for benefits under Sec. 3.150(a). Upon receipt of
such a communication or action, the Secretary shall notify the claimant
and the claimant's representative, if any, of the information necessary
to complete the application form or form prescribed by the Secretary.
(b) Intent to file a claim. A claimant, his or her duly authorized
representative, a Member of Congress, or some person acting as next
friend of claimant who is not of full age or capacity may indicate a
claimant's desire to file a claim for benefits by submitting an intent
to file a claim to VA. An intent to file a claim must provide
sufficient identifiable or biographical information to identify the
claimant. Upon receipt of the intent to file a claim, VA will furnish
the claimant with the appropriate application form prescribed by the
Secretary. If VA receives a complete application form prescribed by the
Secretary, as defined in paragraph (a) of Sec. 3.160, appropriate to
the benefit sought within 1 year of receipt of the intent to file a
claim, VA will consider the complete claim filed as of the date the
intent to file a claim was received.
(1) An intent to file a claim can be submitted in one of the
following three ways:
(i) Saved electronic application. When an application otherwise
meeting the requirements of this paragraph (b) is electronically
initiated and saved in a claims-submission tool within a VA web-based
electronic claims application system prior to filing of a complete
claim, VA will consider that application to be an intent to file a
claim.
(ii) Written intent on prescribed intent to file a claim form. The
submission to an agency of original jurisdiction of a signed and dated
intent to file a claim, on the form prescribed by the Secretary for
that purpose, will be accepted as an intent to file a claim.
(iii) Oral intent communicated to designated VA personnel and
recorded in writing. An oral statement of intent to file a claim will
be accepted if it is directed to a VA employee designated to receive
such a communication, the VA employee receiving this information
follows the provisions set forth in Sec. 3.217(b), and the VA employee
documents the date VA received the claimant's intent to file a claim in
the claimant's records.
(2) An intent to file a claim must identify the general benefit
(e.g., compensation, pension), but need not identify the specific
benefit claimed or any medical condition(s) on which the claim is
based. To the extent a claimant provides this or other extraneous
information on the designated form referenced in paragraph (b)(1)(ii)
of this section that the form does not solicit, the provision of such
information is of no effect other than that it is added to the file for
appropriate consideration as evidence in support of a complete claim if
filed. In particular, if a claimant identifies specific medical
condition(s) on which the claim is based in an intent to file a claim,
this extraneous information does not convert the intent to file a claim
into a complete claim or a substantially complete application.
Extraneous information provided in an oral communication under
paragraph (b)(1)(iii) of this section is of no effect and generally
will not be recorded in the record of the claimant's intent to file.
(3) Upon receipt of an intent to file a claim, the Secretary shall
notify the claimant and the claimant's representative, if any, of the
information necessary to complete the appropriate application form
prescribed by the Secretary.
(4) If an intent to file a claim is not submitted in the form
required by paragraph (b)(1) of this section or a complete claim is not
filed within 1 year of the receipt of the intent to file a claim, VA
will not take further action unless a new claim or a new intent to file
a claim is received.
(5) An intent to file a claim received from a service organization,
an attorney, or agent indicating a represented claimant's intent to
file a claim may not be accepted if a power of attorney was not
executed at the time the communication was written. VA will only accept
an oral intent to file from a service organization, an attorney, or
agent if a power of attorney is of record at the time the oral
communication is received by the designated VA employee.
(6) VA will not recognize more than one intent to file concurrently
for the same benefit (e.g., compensation, pension). If an intent to
file has not been followed by a complete claim, a subsequent intent to
file regarding the same benefit received within 1 year of the prior
intent to file will have no effect. If, however, VA receives an intent
to file followed by a complete claim and later another intent to file
for the same benefit is submitted within 1 year of the previous intent
to file, VA will recognize the subsequent intent to file to establish
an effective date for any award granted for the next complete claim,
provided it is received within 1 year of the subsequent intent to file.
[[Page 57696]]
(c) Incomplete application form. Upon receipt of a communication
indicating a belief in entitlement to benefits that is submitted on a
paper application form prescribed by the Secretary that is not complete
as defined in Sec. 3.160(a) of this section, the Secretary shall
notify the claimant and the claimant's representative, if any, of the
information necessary to complete the application form prescribed by
the Secretary. If a complete claim is submitted within 1 year of
receipt of such incomplete application form prescribed by the
Secretary, VA will consider it as filed as of the date VA received the
incomplete application form prescribed by the Secretary that did not
meet the standards of a complete claim. See Sec. 3.160(a) for Complete
Claim.
(d) Claims. (1) Requirement for complete claim and date of claim. A
complete claim is required for all types of claims, and will generally
be considered filed as of the date it was received by VA for an
evaluation or award of benefits under the laws administered by the
Department of Veterans Affairs. If VA receives a complete claim within
1 year of the filing of an intent to file a claim that meets the
requirements of paragraph (b) of this section, it will be considered
filed as of the date of receipt of the intent to file a claim. Only one
complete claim for a benefit (e.g., compensation, pension) may be
associated with each intent to file a claim for that benefit, though
multiple issues may be contained within a complete claim. In the event
multiple complete claims for a benefit are filed within 1 year of an
intent to file a claim for that benefit, only the first claim filed
will be associated with the intent to file a claim. In the event that
VA receives both an intent to file a claim and an incomplete
application form before the complete claim as defined in Sec. 3.160(a)
is filed, the complete claim will be considered filed as of the date of
receipt of whichever was filed first provided it is perfected within
the necessary timeframe, but in no event will the complete claim be
considered filed more than one year prior to the date of receipt of the
complete claim.
(2) Scope of claim. Once VA receives a complete claim, VA will
adjudicate as part of the claim entitlement to any ancillary benefits
that arise as a result of the adjudication decision (e.g., entitlement
to 38 U.S.C. Chapter 35 Dependents' Educational Assistance benefits,
entitlement to special monthly compensation under 38 CFR 3.350,
entitlement to adaptive automobile allowance, etc.). The claimant may,
but need not, assert entitlement to ancillary benefits at the time the
complete claim is filed. VA will also consider all lay and medical
evidence of record in order to adjudicate entitlement to benefits for
the claimed condition as well as entitlement to any additional benefits
for complications of the claimed condition, including those identified
by the rating criteria for that condition in 38 CFR Part 4, VA Schedule
for Rating Disabilities. VA's decision on an issue within a claim
implies that VA has determined that evidence of record does not support
entitlement for any other issues that are reasonably within the scope
of the issues addressed in that decision. VA's decision that addresses
all outstanding issues enumerated in the complete claim implies that VA
has determined evidence of record does not support entitlement for any
other issues that are reasonably within the scope of the issues
enumerated in the complete claim.
CROSS REFERENCE: Complete claim. See Sec. 3.160(a). Effective
dates. See Sec. 3.400.
Sec. 3.157 [Removed]
0
9. Remove Sec. 3.157.
0
10. Amend Sec. 3.160 by removing the introductory text and revising
paragraphs (a) through (e) to read as follows:
Sec. 3.160 Types of claims.
(a) Complete claim. A submission of an application form prescribed
by the Secretary, whether paper or electronic, that meets the following
requirements:
(1) A complete claim must provide the name of the claimant; the
relationship to the veteran, if applicable; and sufficient service
information for VA to verify the claimed service, if applicable.
(2) A complete claim must be signed by the claimant or a person
legally authorized to sign for the claimant.
(3) A complete claim must identify the benefit sought.
(4) A description of any symptom(s) or medical condition(s) on
which the benefit is based must be provided to the extent the form
prescribed by the Secretary so requires; and
(5) For nonservice-connected disability or death pension and
parents' dependency and indemnity compensation claims, a statement of
income must be provided to the extent the form prescribed by the
Secretary so requires.
(b) Original claim. The initial complete claim for one or more
benefits on an application form prescribed by the Secretary.
(c) Pending claim. A claim which has not been finally adjudicated.
(d) Finally adjudicated claim. A claim that is adjudicated by the
Department of Veterans Affairs as either allowed or disallowed is
considered finally adjudicated by whichever of the following occurs
first:
(1) The expiration of the period in which to file a notice of
disagreement, pursuant to the provisions of Sec. 20.302(a) or Sec.
20.501(a) of this chapter, as applicable; or,
(2) Disposition on appellate review.
(e) Reopened claim. An application for a benefit received after
final disallowance of an earlier claim that is subject to
readjudication on the merits based on receipt of new and material
evidence related to the finally adjudicated claim, or any claim based
on additional evidence or a request for a personal hearing submitted
more than 90 days following notification to the appellant of the
certification of an appeal and transfer of applicable records to the
Board of Veterans' Appeals which was not considered by the Board in its
decision and was referred to the agency of original jurisdiction for
consideration as provided in Sec. 20.1304(b)(1) of this chapter.
(Authority: 38 U.S.C. 501)
* * * * *
0
11. Amend Sec. 3.400 by:
0
a. Revising paragraph (o)(2); and
0
b. Adding an authority citation at the end of paragraph (o)(2).
The revision and addition to read as follows:
Sec. 3.400 General.
* * * * *
(o) * * *
(2) Disability compensation. Earliest date as of which it is
factually ascertainable based on all evidence of record that an
increase in disability had occurred if a complete claim or intent to
file a claim is received within 1 year from such date, otherwise, date
of receipt of claim. When medical records indicate an increase in a
disability, receipt of such medical records may be used to establish
effective date(s) for retroactive benefits based on facts found of an
increase in a disability only if a complete claim or intent to file a
claim for an increase is received within 1 year of the date of the
report of examination, hospitalization, or medical treatment. The
provisions of this paragraph apply only when such reports relate to
examination or treatment of a disability for which service-connection
has previously been established.
[[Page 57697]]
(Authority: 38 U.S.C. 501, 5101)
* * * * *
Sec. 3.403 [Amended]
0
12. Amend Sec. 3.403 in paragraph (a)(3) by removing ``notice of the
expected or actual birth meeting the requirements of an informal
claim,'' and adding in its place ``a claim or an intent to file a claim
as set forth in Sec. 3.155(b),''.
Sec. 3.660 [Amended]
0
13. Amend Sec. 3.660 in paragraph (c) by removing ``notice
constituting an informal claim'' and adding in its place ``a claim or
an intent to file a claim as set forth in Sec. 3.155(b)''.
Sec. 3.665 [Amended]
0
14. Amend Sec. 3.665 in paragraph (f) by:
0
a. Removing ``an informal claim'' and adding in its place ``a claim or
intent to file a claim as set forth in Sec. 3.155(b)''; and
0
b. Removing ``new informal claim.'' and adding in its place ``new claim
or intent to file a claim as set forth in Sec. 3.155(b).''.
Sec. 3.666 [Amended]
0
15. Amend Sec. 3.666 by:
0
a. In paragraph (a)(4), removing ``an informal claim'' and adding in
its place ``a claim or intent to file a claim as set forth in Sec.
3.155(b)'';
0
b. In paragraph (a)(4), removing ``new informal claim.'' and adding in
its place ``new claim or intent to file a claim as set forth in Sec.
3.155(b).'';
0
c. In paragraph (b)(3), removing ``an informal claim.'' and adding in
its place ``a claim or intent to file a claim as set forth in Sec.
3.155(b).''; and
0
d. In paragraph (c), removing ``(which constitutes an informal
claim)''.
0
16. Amend Sec. 3.701 by revising paragraph (b) to read as follows:
Sec. 3.701 Elections of pension or compensation.
* * * * *
(b) Form of election. An election must be in writing and must
specify the benefit the person wishes to receive.
* * * * *
0
17. Amend Sec. 3.812 by:
0
a. Revising paragraph (e).
0
b. Amending paragraph (f) in the second sentence by removing ``claim''
and adding in its place ``complete claim''.
The revision to read as follows:
Sec. 3.812 Special allowance payable under section 156 of Pub. L. 97-
377.
* * * * *
(e) Claims. Claimants must file or submit a complete claim on a
paper or electronic form prescribed by the Secretary in order for VA to
pay this special allowance. When VA receives an intent to file a claim
or inquiries as to eligibility, VA will follow the procedures outlined
in Sec. 3.155. Otherwise, the date of receipt of the complete claim
will be accepted as the date of claim for this special allowance. See
Sec. Sec. 3.150, 3.151, 3.155, 3.400.
* * * * *
Subpart D--Universal Adjudication Rules That Apply to Benefit
Claims Governed by Part 3 of This Title
0
18. The authority citation for part 3, subpart D continues to read as
follows:
(Authority: 38 U.S.C. 501(a), unless otherwise noted.)
0
19. Amend Sec. 3.2600(a) by revising the first sentence to read as
follows:
Sec. 3.2600 Review of benefit claims decisions.
(a) A claimant who has filed a Notice of Disagreement submitted in
accordance with the provisions of Sec. 20.201 of this chapter, and
either Sec. 20.302(a) or Sec. 20.501(a) of this chapter, as
applicable, with a decision of an agency of original jurisdiction on a
benefit claim has a right to a review of that decision under this
section. * * *
* * * * *
PART 19--BOARD OF VETERANS' APPEALS: APPEALS REGULATIONS
Subpart B--Appeals Processing by Agency of Original Jurisdiction
0
20. The authority citation for part 19 continues to read as follows:
Authority: 38 U.S.C. 501(a), unless otherwise noted.
0
21. Add new Sec. Sec. 19.23 and 19.24 to subpart B to read as follows:
Sec. 19.23 Applicability of provisions concerning Notice of
Disagreement.
(a) Appeals governed by Sec. 20.201(a) of this chapter shall be
processed in accordance with Sec. 19.24. Sections 19.26, 19.27 and
19.28 shall not apply to appeals governed by Sec. 20.201(a) of this
chapter.
(b) Appeals governed by Sec. 20.201(b) of this chapter shall be
processed in accordance with Sec. Sec. 19.26, 19.27, and 19.28.
Sec. 19.24 Action by agency of original jurisdiction on Notice of
Disagreement required to be filed on a standardized form.
(a) Initial action. When a timely Notice of Disagreement in
accordance with the requirements of Sec. 20.201(a) of this chapter is
filed, the agency of original jurisdiction will reexamine the claim and
determine whether additional review or development is warranted.
(b) Incomplete and complete appeal forms--(1) Incomplete appeal
forms. In cases governed by paragraph (a) of Sec. 20.201 of this
chapter, if VA determines a form filed by the claimant is incomplete
and requests clarification, the claimant must timely file a completed
version of the correct form in order to initiate an appeal. A claimant
is not required to cure or correct the filing of an incomplete form by
filing a completed version of the correct form unless VA informs the
claimant or his or her representative that the form is incomplete and
requests clarification.
(2) Complete appeal forms. In general, a form will be considered
complete if the following information is provided:
(i) Information to identify the claimant;
(ii) The claim to which the form pertains;
(iii) Any information necessary to identify the specific nature of
the disagreement if the form so requires. For compensation claims, this
criterion will be met if the form enumerates the issues or conditions
for which appellate review is sought, or if it provides other
information required on the form to identify the claimant and the
nature of the disagreement (such as disagreement with disability
rating, effective date, or denial of service connection); and
(iv) The claimant's signature.
(3) Timeframe to complete correct form. In general, a claimant who
wishes to initiate an appeal must provide a complete form within the
timeframe established by Sec. 20.302(a) of this chapter. When VA
requests clarification of an incomplete form, the claimant must provide
a complete form in response to VA's request for clarification within
the later of the following dates:
(i) 60 days from the date of the request; or
(ii) 1 year from the date of mailing of the notice of the decision
of the agency of original jurisdiction.
(4) Failure to respond. If the claimant fails to provide a
completed form within the timeframe set forth in paragraph (b)(3) of
this section, the decision of the agency of original jurisdiction will
become final.
(5) Form timely completed. If a completed form is received within
the timeframe set forth in paragraph (b)(3) of this section, VA will
treat the completed form as the Notice of Disagreement and VA will
reexamine the claim and determine whether additional review or
development is warranted. If no further review or development is
required, or after
[[Page 57698]]
necessary review or development is completed, VA will prepare a
Statement of the Case pursuant to Sec. 19.29 unless the disagreement
is resolved by a grant of the benefit(s) sought on appeal or the NOD is
withdrawn by the claimant.
(c) Issues under appellate review. If a form enumerates some but
not all of the issues or conditions which were the subject of the
decision of the agency of original jurisdiction, the form will be
considered complete with respect to the issues for which appellate
review is sought and identified by the claimant. Any issues or
conditions not enumerated will not be considered appealed on the basis
of the filing of that form and will become final unless the claimant
timely files a separate form for those issues or conditions within the
applicable timeframe set forth in paragraph (b)(3) of this section.
(d) Disagreement concerning whether Notice of Disagreement has been
filed. Whether or not a claimant has timely filed a Notice of
Disagreement is an appealable issue, but in such a case, appellate
consideration shall be limited to the question of whether the correct
form was timely filed.
PART 20--BOARD OF VETERANS' APPEALS: RULES OF PRACTICE
0
22. The authority citation for part 20 continues to read as follows:
Authority: 38 U.S.C. 501(a) and as noted in specific sections.
Subpart A--General
0
23. Revise Sec. 20.3(c) to read as follows:
Sec. 20.3 Rule 3. Definitions.
* * * * *
(c) Appellant means a claimant who has initiated an appeal to the
Board of Veterans' Appeals by filing a timely Notice of Disagreement
pursuant to the provisions of Sec. 20.201, and either Sec. 20.302(a)
or Sec. 20.501(a), as applicable.
* * * * *
Subpart C--Commencement and Perfection of Appeal
0
24. Revise Sec. 20.200 to read as follows:
Sec. 20.200 Rule 200. What constitutes an appeal.
An appeal consists of a timely filed Notice of Disagreement
submitted in accordance with the provisions of Sec. 20.201, and either
Sec. 20.302(a) or Sec. 20.501(a), as applicable and, after a
Statement of the Case has been furnished, a timely filed Substantive
Appeal.
(Authority: 38 U.S.C. 7105)
0
25. Revise Sec. 20.201 to read as follows:
Sec. 20.201 Rule 201. Notice of Disagreement.
(a) Cases in which a form is provided by the agency of original
jurisdiction for the purpose of initiating an appeal.
(1) Format. For every case in which the agency of original
jurisdiction (AOJ) provides, in connection with its decision, a form
for the purpose of initiating an appeal, a Notice of Disagreement
consists of a completed and timely submitted copy of that form. VA will
not accept as a notice of disagreement an expression of dissatisfaction
or disagreement with an adjudicative determination by the agency of
original jurisdiction and a desire to contest the result that is
submitted in any other format, including on a different VA form.
(2) Provision of form to the claimant. If a claimant has
established an online benefits account with VA, or has designated an
email address for the purpose of receiving communications from VA, VA
may provide an appeal form pursuant to paragraph (a)(1) of this section
electronically, whether by email, hyperlink, or other direction to the
appropriate form within the claimant's online benefits account. VA may
also provide a form pursuant to paragraph (a)(1) of this section in
paper format.
(3) Presumption form was provided. This paragraph (a) applies if
there is any indication whatsoever in the claimant's file or electronic
account that a form was sent pursuant to paragraph (a)(1) of this
section.
(4) Specificity required by form. If the agency of original
jurisdiction gave notice that adjudicative determinations were made on
several issues at the same time, the specific determinations with which
the claimant disagrees must be identified to the extent a form provided
pursuant to paragraph (a)(1) of this section so requires. If the
claimant wishes to appeal all of the issues decided by the agency of
original jurisdiction, the form must clearly indicate that intent.
Issues not identified on the form will not be considered appealed.
(5) Alternate form or other communication. The filing of an
alternate form or other communication will not extend, toll, or
otherwise delay the time limit for filing a Notice of Disagreement, as
provided in Sec. 20.302(a). In particular, returning the incorrect VA
form, including a form designed to appeal a different benefit does not
extend, toll, or otherwise delay the time limit for filing the correct
form.
(b) Cases in which no form is provided by the agency of original
jurisdiction for purpose of initiating an appeal. A written
communication from a claimant or his or her representative expressing
dissatisfaction or disagreement with an adjudicative determination by
the agency of original jurisdiction and a desire to contest the result
will constitute a Notice of Disagreement relating to a claim for
benefits in any case in which the agency of original jurisdiction does
not provide a form identified as being for the purpose of initiating an
appeal. The Notice of Disagreement must be in terms which can be
reasonably construed as disagreement with that determination and a
desire for appellate review. If the agency of original jurisdiction
gave notice that adjudicative determinations were made on several
issues at the same time, the specific determinations with which the
claimant disagrees must be identified.
(c) Simultaneously contested claims. The provisions of paragraph
(b) of this section shall apply to appeals in simultaneously contested
claims under Sec. Sec. 20.500 and 20.501, regardless of whether a
standardized form was provided with the decision of the agency of
original jurisdiction.
(Authority: 38 U.S.C. 7105)
[FR Doc. 2014-22633 Filed 9-24-14; 8:45 am]
BILLING CODE 8320-01-P