Summary of Precedent Opinions of the General Counsel, 13991-13997 [2019-06855]
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Federal Register / Vol. 84, No. 67 / Monday, April 8, 2019 / Notices
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[FR Doc. 2019–06902 Filed 4–5–19; 8:45 am]
VAOPGCPREC 1–2018
BILLING CODE 4830–01–P
DEPARTMENT OF VETERANS
AFFAIRS
Summary of Precedent Opinions of the
General Counsel
Department of Veterans Affairs.
Notice.
AGENCY:
ACTION:
The Department of Veterans
Affairs (VA) is publishing a summary of
legal interpretations issued by the Office
of the General Counsel (OGC) involving
Veterans’ benefits under laws
administered by VA. These
interpretations are considered
precedential by VA and will be followed
by VA officials and employees in claim
matters involving the same legal issues.
This summary is published to provide
the public and, in particular, Veterans’
benefits claimants and their
representatives, with notice of VA’s
interpretations regarding the legal
matters at issue.
FOR FURTHER INFORMATION CONTACT:
Suzanne Hill, Law Librarian, Office of
General Counsel, 810 Vermont Avenue
NW, Washington, DC 20420, (202) 461–
7624.
SUPPLEMENTARY INFORMATION: A VA
regulation at 38 CFR 2.6(e)(8) delegates
to the General Counsel the power to
designate an opinion as precedential,
and 38 CFR 14.507(b) specifies that
precedential opinions involving
Veterans’ benefits are binding on VA
officials and employees in subsequent
matters involving the legal issue
decided in the precedent opinion. The
interpretation of the General Counsel on
legal matters, contained in such
opinions, is conclusive as to all VA
officials and employees, not only in the
matter at issue, but also in future
adjudications and appeals involving the
same legal issues, in the absence of a
change in controlling statute or
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SUMMARY:
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regulation or a superseding written legal
opinion of the General Counsel or a
judicial decision.
VA publishes summaries of such
opinions in order to provide the public
with notice of those interpretations of
the General Counsel that must be
followed in future benefit matters and to
assist Veterans’ benefits claimants and
their representatives in the prosecution
of benefit claims. The full text of such
opinions, with personal identifiers
deleted, may be obtained by contacting
the VA official named above or by
accessing the opinions on the internet at
https://www.va.gov/ogc/precedent
opinions.asp.
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Question Presented: How does a
claimant’s opt-in to the Rapid Appeals
Modernization Program (RAMP) affect
an existing fee agreement?
Held: If a claimant, who is
represented by a claims agent or
attorney, withdraws his or her notice of
disagreement to opt-in to RAMP, that
withdrawal does not obstruct the
representative’s eligibility for fees. VA
does not construe the RAMP election as
returning the claimant and
representative to a period in the VA
administrative process for which fees
may not be charged or as otherwise
affecting a legal existing fee agreement.
Effective Date: August 6, 2018.
James M. Byrne,
General Counsel, Department of
Veterans Affairs.
VAOPGCPREC 1–2017
Question Presented: 1. Is obesity per
se a ‘‘disease’’ for purposes of
establishing entitlement to service
connection under 38 U.S.C. 1110 and
1131?
2. If obesity is a disease, may obesity
be considered the result of a veteran’s
willful misconduct for purposes of lineof-duty determinations under 38 U.S.C.
105(a)?
3. Is obesity per se a ‘‘disability’’ for
purposes of secondary service
connection under 38 CFR 3.310?
4. If obesity is not a disease, could it
be an ‘‘in-service event’’ from which a
service-connected disability may result?
5. If obesity is not a disease, could it
be an ‘‘intermediate step’’ between a
service-connected disability and a
current disability that may be service
connected on a secondary basis under
38 CFR 3.310(a)?
Held: 1. The longstanding policy of
VA, that obesity per se is not a disease
or injury for purposes of 38 U.S.C. 1110
and 1131 and therefore may not be
service connected on a direct basis, is
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13991
consistent with title 38, United States
Code.
2. Because obesity is not considered a
disease for purposes of 38 U.S.C. 1110
and 1131, we do not need to determine
whether it may be considered the result
of a veteran’s willful misconduct for
purposes of line-of-duty determinations
under 38 U.S.C. 105(a).
3. Obesity per se is not a ‘‘disability’’
for purposes of 38 CFR 3.310. If, in a
particular case, obesity resulting from a
service-connected disease or injury is
found to produce impairment beyond
that contemplated by the applicable
provisions of VA’s rating schedule, VA
may consider an extra-schedular rating
under 38 CFR 3.321(b)(1) for the serviceconnected condition based on that
impairment.
4. Obesity cannot qualify as an inservice event because it occurs over
time and is based on various external
and internal factors, as opposed to being
a discrete incident or occurrence, or a
series of discrete incidents or
occurrences.
5. Obesity may be an ‘‘intermediate
step’’ between a service-connected
disability and a current disability that
may be service connected on a
secondary basis under 38 CFR 3.310(a).
Effective Date: January 6, 2017.
Richard J. Hipolit,
Acting General Counsel, Department of
Veterans Affairs.
VAOPGCPREC 1–2015
Question Presented: 1. May VA pay
individuals appointed under 38 U.S.C.
7405(a)(2) on a time basis either per
hour or per annum?
2. If so, may these individuals be
granted a full-time appointment under
38 U.S.C. 7401 or 7401(3) concurrently
with an appointment under 38 U.S.C.
7405(a)(2) at the same facility without
violating or compromising 5 U.S.C. 5533
or Department conflict of interest
regulations (38 CFR, part 0)?
3. If VA is able to appoint individuals
under 38 U.S.C. 7405(a)(2) and
compensate these individuals on a timebasis, would such appointees, if retired
annuitants, be subject to a salary offset
under 5 U.S.C. 8344 or 8468?
Held: 1. VA may not pay individuals
appointed under 38 U.S.C. 7405(a)(2) on
a time basis.
2. Since the answer to the first
question is ‘‘no,’’ it is unnecessary to
respond to this question.
3. Since the answer to the first
question is ‘‘no,’’ it is unnecessary to
respond to this question.
Effective Date: February 19, 2015.
Leigh A. Bradley,
General Counsel, Department of
Veterans Affairs.
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VAOPGCPREC 2–2015
Question Presented: Does VA’s
express statutory authority to accept
gifts, contained in sec. 8301, of title 38,
United States Code, include the implied
authority to solicit gifts?
Conclusion: VA’s express statutory
authority to accept gifts under 38 U.S.C.
8301 includes the implied authority to
solicit gifts.
Effective Date: March 20, 2015.
Leigh A. Bradley,
General Counsel, Department of
Veterans Affairs.
VAOPGCPREC 3–2015 (Withdrawn)
Update: 1. VAOPGCPREC 3–2015
held that the designated cemetery
official may be a proper applicant for a
government-furnished headstone or
marker under 38 CFR 38.632(b)(1). The
opinion also held that Civil-War era
graves at Oakwood Cemetery in
Richmond, Virginia, which are currently
identified with marble stones that do
not show the names of each soldier but
have identifying numbers that are
tracked in a burial ledger, are not
‘‘unmarked graves’’ for purposes of VA
furnishing a headstone or marker under
38 U.S.C. 2306(a)(3), even if such stones
denote the location of more than one
soldier.
2. This is to inform you that
VAOPGCPREC 3–2015 is withdrawn.
Effective Date: December 7, 2016.
Leigh A. Bradley,
General Counsel, Department of
Veterans Affairs.
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VAOPGCPREC 3–2015 (Original
Opinion)
Question Presented: 1. Is the
designated cemetery official a proper
applicant for a government-furnished
headstone or marker under 38 CFR
38.632(b)(1)?
2. Do Civil-War era graves currently
identified with marble stones that do
not show the names of each soldier
constitute ‘‘unmarked graves’’ for
purposes of VA furnishing a headstone
or marker under 38 U.S.C. 2306(a)(3)?
3. Do Civil-War era graves currently
identified with marble stones that do
not show the names of each soldier
constitute ‘‘unmarked graves’’ for
purposes of VA furnishing a headstone
or marker under 38 U.S.C. 2306(a)(3) if
such stones denote the location of more
than one soldier?
Conclusions: 1. The designated
cemetery official may be a proper
applicant for a government-furnished
headstone or marker under 38 CFR
38.632(b)(1).
2. Assuming the facts as stated in this
opinion are accurate, Civil-War era
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graves at Oakwood Cemetery currently
identified with marble stones that do
not show the names of each soldier but
that have identifying numbers that are
tracked in a burial ledger are not
‘‘unmarked graves’’ for purposes of VA
furnishing a headstone or marker under
sec. 2306(a)(3).
3. Assuming the facts as stated in this
opinion are accurate, Civil-War era
graves at Oakwood Cemetery currently
identified with marble stones that do
not show the names of each soldier but
that have identifying numbers that are
tracked in a burial ledger are not
‘‘unmarked graves’’ for purposes of VA
furnishing a headstone or marker under
sec. 2306(a)(3) even if such stones
denote the location of more than one
soldier.
Effective Date: August 28, 2015
through December 6, 2016.
Leigh A. Bradley,
General Counsel, Department of
Veterans Affairs.
VAOPGCPREC 4–2015
Question Presented: 1. Is the Board of
Veterans’ Appeals (Board), upon a
veteran’s death, required to dismiss the
veteran’s dispute as to payment of
potential attorney’s fees under 38 U.S.C.
5904(d) from money withheld from
past-due disability benefits awarded to
the veteran during the veteran’s
lifetime?
2. If the Board is required to dismiss
the dispute, may a party pursue
payment of the withheld money as
accrued benefits pursuant to 38 U.S.C.
5121?
3. If the Board is required to dismiss
the dispute, what effect does that
dismissal have on the underlying
decisions regarding that issue?
Held: 1. Upon a veteran’s death, the
Board is required to dismiss the
veteran’s dispute as to payment of
potential attorney’s fees under 38 U.S.C.
5904(d) when the money withheld from
past-due disability benefits awarded to
the veteran meets the statutory
definition for accrued benefits.
2. A claim, pending at the time of a
veteran’s death, challenging an
attorney’s entitlement to payment of
attorney fees under sec. 5904 from the
veteran’s retroactive periodic monetary
benefits may provide a basis for an
accrued benefits claim under sec. 5121,
because such a claim concerns
entitlement to periodic monetary
benefits allegedly due and unpaid to the
veteran at the time of death.
3. The Board’s dismissal of the
veteran’s dispute regarding payment of
attorney’s fees renders all underlying
decisions regarding that issue that were
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not final at the time of the veteran’s
death legal nullities.
Effective Date: December 3, 2015.
Leigh A. Bradley,
General Counsel, Department of
Veterans Affairs.
VAOPGCPREC 1–2014
Question Presented: Is a State home
domiciliary required to provide primary
care to a resident on whose behalf VA
pays per diem for that care?
Held: In order for a State to receive
per diem payments form VA for a
resident in its State home domiciliary,
the home must provide primary care to
the resident.
Effective Date: March 21, 2014.
Will A. Gunn,
General Counsel, Department of
Veterans Affairs.
VAOPGCPREC 2–2014
Question Presented: Are claims for
burial benefits administered by the
National Cemetery Administration
(NCA) subject to the notice
requirements in sec. 5103, of title 38,
United States Code, in light of the
unique time requirements associated
with such claims?
Held: The notice requirements of 38
U.S.C. 5103 apply to all claims for
benefits administered by VA, including
claims for benefits administered by
NCA. However, NCA may determine
that notice under 38 U.S.C. 5103 is
unnecessary in particular cases, either
because VA has sufficient evidence to
grant the requested benefit or because
applicable law and undisputed facts
establish that the claimant is ineligible
for the claimed benefit. Further,
pursuant to a recent amendment to sec.
5103(a), NCA may provide the notice
required by that section ‘‘by the most
effective means available,’’ which may
include providing such notice on a
benefit application form or transmitting
it to the claimant electronically. Finally,
NCA has discretion to adopt reasonable
procedures for applying the
requirements of sec. 5103 in the context
of time-sensitive claims for burial
benefits.
Effective Date: May 19, 2014.
Will A. Gunn,
General Counsel, Department of
Veterans Affairs.
VAOPGCPREC 5–2014 (Revised)
Question Presented: 1. Is VA legally
obligated under 38 U.S.C. 5103A(a) to
obtain the service and other related
records (including investigation reports,
service treatment records, service
personnel records, Service Record
Books, etc.) that belong or pertain to a
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Servicemember other than the Veteran
who is seeking VA benefits, when such
records may be potentially relevant to
the Veteran’s claim for benefits?
2. Do the special processing
procedures set forth in 38 CFR
3.304(f)(5) for developing and deciding
claims involving post-traumatic stress
disorder (PTSD) asserted to be due to
personal assault and/or military sexual
trauma (MST) impose a requirement on
VA to obtain records that belong or
pertain to a Servicemember other than
the Veteran claimant when such records
may be useful for corroborating the
Veteran’s account of the stressor
incident or to provide evidence of
behavior changes following the
incident?
a. Would it be required, and/or would
it be legally appropriate, to attempt to
solicit a written statement from, or
depose during a hearing, the asserted
Servicemember assailant for purposes of
obtaining information concerning a
claim of personal assault or MST that
has been raised by a Veteran claimant?
3. If VA is legally obligated to obtain
the records of a Servicemember other
than the Veteran:
a. Does the Privacy Act, 5 U.S.C. 552,
prohibit VA from obtaining and
associating with a Veteran claimant’s
claims file service and other related
records that belong or pertain to another
Servicemember? What legal factors are
for consideration in making this
determination?
b. Assuming the Privacy Act does not
prohibit VA from obtaining and
associating a non-claimant
Servicemember’s records with a Veteran
claimant’s claims file, must VA obtain
permission to request those records, and
from whom must VA obtain such
permission? Is the answer to this
question the same or different if the
Servicemember whose records are being
sought is deceased? If permission is
denied, does VA have any additional
duty to assist the claimant in obtaining
the records?
c. If records related to the nonclaimant Servicemember are obtained,
how should they be handled? May
copies of the records be associated with
the Veteran claimant’s claims file? If so,
must the records first be redacted in
order to remove all personally
identifiable information?
i. If VA is permitted to associate the
non-claimant Servicemember’s redacted
records in the Veteran claimant’s claims
file, is VA also required to conduct a
full and complete search of the Veteran
claimant’s claims file for other named
references to the Servicemember and
redact them (such as in this case where
the alleged assailant is named in both
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records located in the claims file and in
the remand decision of the Court of
Appeals for Veterans Claims)?
Held: 1. In adjudicating a particular
Veteran’s claim for benefits, VA
generally would be obligated under 38
U.S.C. 5103A to make reasonable efforts
to obtain records pertaining to another
individual if: (a) Those records were
adequately identified, would be relevant
to the Veteran’s claim, and would aid in
substantiating the claim; and (b) VA
would be authorized to disclose the
relevant portions of such records to the
Veteran under the Privacy Act and 38
U.S.C. 5701 and 7332. VA adjudicators
generally may not consider documents
that cannot be disclosed to the claimant.
2. Pursuant to the Privacy Act, 5
U.S.C. 552a, and 38 U.S.C. 5701, VA
records pertaining to another individual
generally may be disclosed to a claimant
only: (1) Pursuant to the written consent
of the individual to whom the records
pertain; (2) pursuant to a court order; or
(3) where there is both an applicable
routine use under the Privacy Act and
a VA finding under 38 U.S.C. 5701(e)
that disclosure of records other than
names and addresses would serve a
useful purpose. Because there currently
is no applicable routine use, disclosure
of another individual’s VA records to a
VA claimant for purposes of the latter’s
benefits claim generally requires written
consent or a court order. Further, if the
records at issue contain information
protected by 38 U.S.C. 7332, any written
consent or court order must comply
with the specific requirements of that
statute and VA’s implementing
regulations.
3. If a claimant identifies relevant
records pertaining to another individual
that are in the custody of the
Department of Defense or another
Federal agency, it would be consistent
with VA’s statutory duty to assist for VA
to ask the custodian agency to furnish
such records, but only if they may be
disclosed to the VA claimant. The
custodian agency would be responsible
for determining whether its records may
be disclosed to the VA claimant for the
requested purpose. In making such
requests, VA should clearly explain to
the custodian agency the circumstances
and conditional nature of the request.
Specifically, VA should explain that the
records are requested on behalf of a VA
claimant who is not the individual to
whom the record pertains and that VA
requests a determination by the
custodian agency as to whether such
records may be disclosed to the VA
claimant under the Privacy Act and any
routine uses applicable to the relevant
system of records of the custodian
agency.
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4. VA’s duty under 38 U.S.C. 5103A
to make ‘‘reasonable efforts’’ to assist
claimants in obtaining evidence may in
some cases include the duty to request
that a third party provide written
consent for VA to disclose records
pertaining to the third party to the
claimant. The Veterans Benefits
Administration (VBA) may wish to
consider issuing regulations or
establishing uniform procedures to
address the unique and sensitive issues
that may arise where the records of an
alleged assailant or other third party
may be relevant to a claim. In the
absence of regulations or procedures
specifically addressing this issue, it
generally must be resolved on a case-bycase basis. In determining whether
‘‘reasonable efforts’’ include such a
request in a particular case, VA may
consider factors including the third
party’s privacy interest in his or her
records; the likelihood that the records
exist; the likelihood that the request
would result in consent to disclose the
records to the claimant; and the
potential for such requests to generate
conflict or otherwise adversely affect the
safety, health, or rights of either the
claimant or the third party. A
determination that ‘‘reasonable efforts’’
do not require seeking a third-party’s
consent to disclose his or her records to
the claimant would be most strongly
justified in a case where the interests of
the third party are adverse to the
claimant’s interest, such as where the
claimant alleges that the third party
assaulted the claimant or engaged in
other improper or unlawful behavior. In
contrast, where the interests of the
claimant and the third party are not
adverse, there ordinarily would be a
stronger basis for a finding that VA’s
‘‘reasonable efforts’’ may include asking
the third party to consent to disclosure
of his or her records to the claimant.
5. If the individual to whom a record
pertains is deceased, the Privacy Act
would not apply, but other limitations
would apply. First, under the Freedom
of Information Act (FOIA), 5 U.S.C.
552(b)(6), VA may be required to
balance the privacy interests of a
decedent’s surviving family members
against the public interest in disclosure
of information concerning the decedent
in order to determine whether
disclosure is warranted. Second, VA
must ensure compliance with 38 U.S.C.
5701 and 7332. Under sec. 5701(e), VA
records other than names and addresses
may be disclosed if VA finds that such
disclosure would serve a ‘‘useful
purpose.’’ Alternatively, the next of kin
of the person to whom the records
pertain may provide written consent to
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disclose the records to a VA claimant.
However, the next of kin cannot consent
to disclosure of information protected
by sec. 7332 for purposes of supporting
a claim by a person other than a
survivor or dependent of the person to
whom the records pertain.
6. The provisions of 38 CFR
3.304(f)(5) do not impose on VA any
duty to assist beyond that provided
under 38 U.S.C. 5103A. Section
3.304(f)(5) identifies the types of
evidence that may be relevant to
corroborate a Veteran’s claim of an inservice assault and seeks to ensure that
the Veteran is aware of the types of
evidence that may support his or her
claim. The existence and extent of any
duty on VA’s part to obtain relevant
records is governed by sec. 5103A and
VA’s regulations implementing that
statute.
7. VA is not required to solicit a
written statement from, or to depose
during a hearing, the individual who
allegedly assaulted a claimant who is
seeking VA benefits for disability due to
the alleged assault. Further, to prevent
disparate treatment of similarly situated
claimants and disparate commitment of
VA adjudication resources, 38 CFR
3.159(g) reserves to the Secretary of
Veterans Affairs the authority to
authorize assistance beyond that
currently specified in statute and
regulation. Accordingly, VA generally
may not, in an individual case, solicit
statements or testimony from an alleged
assailant, as doing so would give rise to
the disparities § 3.159(g) was designed
to prevent.
8. If records pertaining to an
individual other than the claimant are
obtained and considered in relation to
the claim, VA must include them in the
claims file. However, VA should
exercise care in ensuring that the
protected information included in the
claims file is limited to the information
that VA is authorized to disclose under
the applicable written consent, routine
use, useful purpose determination, court
order, or other authority. Accordingly, it
may be necessary to redact the records
to remove identifying information that
is not relevant to the claim or not
otherwise within the scope of the
relevant authorization, such as the
individual’s address, telephone number,
and Social Security number. However, if
the claimant provided VA with the
Servicemember’s name, VA would not
need to redact that name from the
documents placed in the file. If VA
includes records pertaining to a third
party in a VA claims file, it ordinarily
would not need to search the entire file
for other records containing protected
information, unless it has reason to
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believe that the file may contain
protected third-party information that
was not provided by the claimant.
Effective Date: January 5, 2017.
Richard J. Hipolit,
Acting General Counsel, Department of
Veterans Affairs.
VAOPGCPREC 5–2014 (Original
Opinion)
1. Is VA legally obligated under 38
U.S.C. 5103A(a) to obtain the service
and other related records (including
investigation reports, service treatment
records, service personnel records,
Service Record Books, etc.) that belong
or pertain to a Servicemember other
than the Veteran who is seeking VA
benefits, when such records may be
potentially relevant to the Veteran’s
claim for benefits?
2. Do the special processing
procedures set forth in 38 CFR
3.304(f)(5) for developing and deciding
claims involving PTSD asserted to be
due to personal assault and/or MST
impose a requirement on VA to obtain
records that belong or pertain to a
Servicemember other than the Veteran
claimant when such records may be
useful for corroborating the Veteran’s
account of the stressor incident or to
provide evidence of behavior changes
following the incident?
a. Would it be required, and/or would
it be legally appropriate, to attempt to
solicit a written statement from, or
depose during a hearing, the asserted
Servicemember assailant for purposes of
obtaining information concerning a
claim of personal assault or MST that
has been raised by a Veteran claimant?
3. If VA is legally obligated to obtain
the records of a Servicemember other
than the Veteran:
a. Does the Privacy Act, 5 U.S.C. 552,
prohibit VA from obtaining and
associating with a Veteran claimant’s
claims file service and other related
records that belong or pertain to another
Servicemember? What legal factors are
for consideration in making this
determination?
b. Assuming the Privacy Act does not
prohibit VA from obtaining and
associating a non-claimant
Servicemember’s records with a Veteran
claimant’s claims file, must VA obtain
permission to request those records, and
from whom must VA obtain such
permission? Is the answer to this
question the same or different if the
Servicemember whose records are being
sought is deceased? If permission is
denied, does VA have any additional
duty to assist the claimant in obtaining
the records?
c. If records related to the nonclaimant Servicemember are obtained,
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how should they be handled? May
copies of the records be associated with
the Veteran claimant’s claims file? If so,
must the records first be redacted in
order to remove all personally
identifiable information?
i. If VA is permitted to associate the
non-claimant Servicemember’s redacted
records in the Veteran claimant’s claims
file, is VA also required to conduct a
full and complete search of the Veteran
claimant’s claims file for other named
references to the Servicemember and
redact them (such as in this case where
the alleged assailant is named in both
records located in the claims file and in
the remand decision of the Court of
Appeals for Veterans Claims)?
Held: 1. In adjudicating a particular
Veteran’s claim for benefits, VA
generally would be obligated under 38
U.S.C. 5103A to make reasonable efforts
to obtain records pertaining to another
individual if: (a) Those records were
adequately identified, would be relevant
to the Veteran’s claim, and would aid in
substantiating the claim; and (b) VA
would be authorized to disclose the
relevant portions of such records to the
Veteran under the Privacy Act and 38
U.S.C. 5701 and 7332. VA adjudicators
generally may not consider documents
that cannot be disclosed to the claimant.
2. Pursuant to the Privacy Act, 5
U.S.C. 552a, and 38 U.S.C. 5701, VA
records pertaining to another individual
generally may be disclosed to a claimant
only:
(1) Pursuant to the written consent of
the individual to whom the records
pertain;
(2) pursuant to a court order; or (3)
where there is both an applicable
routine use under the Privacy Act and
a VA finding under 38 U.S.C. 5701(e)
that disclosure of records other than
names and addresses would serve a
useful purpose. Because there currently
is no applicable routine use, disclosure
of another individual’s VA records to a
VA claimant for purposes of the latter’s
benefits claim generally requires written
consent or a court order. Further, if the
records at issue contain information
protected by 38 U.S.C. 7332, any written
consent or court order must comply
with the specific requirements of that
statute and VA’s implementing
regulations.
3. If a claimant identifies relevant
records pertaining to another individual
that are in the custody of the
Department of Defense or another
Federal agency, it would be consistent
with VA’s statutory duty to assist for VA
to ask the custodian agency to furnish
such records, but only if they may be
disclosed to the VA claimant. The
custodian agency would be responsible
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for determining whether its records may
be disclosed to the VA claimant for the
requested purpose. In making such
requests, VA should clearly explain to
the custodian agency the circumstances
and conditional nature of the request.
Specifically, VA should explain that the
records are requested on behalf of a VA
claimant who is not the individual to
whom the record pertains and that VA
requests a determination by the
custodian agency as to whether such
records may be disclosed to the VA
claimant under the Privacy Act and any
routine uses applicable to the relevant
system of records of the custodian
agency.
4. VA’s duty under 38 U.S.C. 5103A
to make ‘‘reasonable efforts’’ to assist
claimants in obtaining evidence may in
some cases include the duty to request
that an individual to whom a relevant
record pertains provide written consent
for VA to disclose that record to the
claimant. The Veterans Benefits
Administration may wish to consider
issuing regulations or establishing
uniform procedures to address the
unique and sensitive issues that may
arise where the records of an alleged
assailant or other third party may be
relevant to a claim. In the absence of
such regulations or procedures, VA
adjudicators must make case-by-case
determinations as to whether the duty to
assist requires VA to seek another
individual’s consent to disclosure of his
or her records to the claimant. That
determination may be based on, among
other things, the extent to which the
claimant has identified specific records
likely to contain relevant evidence and
the feasibility and appropriateness, in
the particular case of seeking the
consent of the individual to whom the
record pertains. Where the records at
issue pertain to an individual who
allegedly assaulted the claimant, it
would be advisable to determine
whether the claimant wants VA to
contact that individual.
5. If the individual to whom a record
pertains is deceased, the Privacy Act
would not apply, but other limitations
would apply. First, under FOIA, 5
U.S.C. 552(b)(6), VA may be required to
balance the privacy interests of a
decedent’s surviving family members
against the public interest in disclosure
of information concerning the decedent
in order to determine whether
disclosure is warranted. Second, VA
must ensure compliance with 38 U.S.C.
5701 and 7332. Under sec. 5701(e), VA
records other than names and addresses
may be disclosed if VA finds that such
disclosure would serve a ‘‘useful
purpose.’’ Alternatively, the next of kin
of the person to whom the records
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pertain may provide written consent to
disclose the records to a VA claimant.
However, the next of kin cannot consent
to disclosure of information protected
by sec. 7332 for purposes of supporting
a claim by a person other than a
survivor or dependent of the person to
whom the records pertain.
6. The provisions of 38 CFR
3.304(f)(5) do not impose on VA any
duty to assist beyond that provided
under 38 U.S.C. 5103A. Section
3.304(f)(5) identifies the types of
evidence that may be relevant to
corroborate a Veteran’s claim of an inservice assault and seeks to ensure that
the Veteran is aware of the types of
evidence that may support his or her
claim. The existence and extent of any
duty on VA’s part to obtain relevant
records is governed by sec. 5103A and
VA’s regulations implementing that
statute.
7. VA is not required to solicit a
written statement from, or to depose
during a hearing, the individual who
allegedly assaulted a claimant who is
seeking VA benefits for disability due to
the alleged assault. Further, to prevent
disparate treatment of similarly situated
claimants and disparate commitment of
VA adjudication resources, 38 CFR
3.159(g) reserves to the Secretary of
Veterans Affairs the authority to
authorize assistance beyond that
currently specified in statute and
regulation. Accordingly, VA generally
may not, in an individual case, solicit
statements or testimony from an alleged
assailant, as doing so would give rise to
the disparities § 3.159(g) was designed
to prevent.
8. If records pertaining to an
individual other than the claimant are
obtained and considered in relation to
the claim, VA must include them in the
claims file. However, VA should
exercise care in ensuring that the
protected information included in the
claims file is limited to the information
that VA is authorized to disclose under
the applicable written consent, routine
use, useful purpose determination, court
order, or other authority. Accordingly, it
may be necessary to redact the records
to remove identifying information that
is not relevant to the claim or not
otherwise within the scope of the
relevant authorization, such as the
individual’s address, telephone number,
and Social Security number. However, if
the claimant provided VA with the
Servicemember’s name, VA would not
need to redact that name from the
documents placed in the file. If VA
includes records pertaining to a third
party in a VA claims file, it ordinarily
would not need to search the entire file
for other records containing protected
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information, unless it has reason to
believe that the file may contain
protected third-party information that
was not provided by the claimant.
Effective Date: August 12, 2014
through January 5, 2017.
Tammy L. Kennedy,
Acting General Counsel, Department of
Veterans Affairs.
VAOPGCPREC 6–2014
Question Presented: Whether,
pursuant to 38 U.S.C. 5103(a)(1), VA is
required upon receipt of a claim to
reopen based upon new and material
evidence to provide notice of the
information and evidence necessary to
substantiate the particular factual
element or elements that were found
insufficient in the previous denial of the
claim.
Response: Pursuant to 38 U.S.C.
5103(a)(1), upon receipt of a claim to
reopen a previously denied claim, VA is
not required to provide notice of the
information and evidence necessary to
substantiate the particular factual
element or elements that were found
insufficient in the previous denial of the
claim.
Effective Date: November 21, 2014.
Tammy L. Kennedy,
Acting General Counsel, Department of
Veterans Affairs.
VAOPGCPREC 1–2012
Question Presented: What is the
Secretary’s responsibility for managing
and distributing funds held in escrow
for a Specially Adapted Housing (SAH)
construction case if a Veteran decides
not to complete the purchase of the
property after grant funds have been
deposited into an escrow account?
Held: When a Veteran decides not to
complete the purchase of a property
after SAH grant funds have been
disbursed, the Secretary must determine
whether the contractor has both
performed his obligations under the
construction contract and satisfied the
SAH guidelines. If the contractor has
done so, VA should release the funds to
the contractor in accordance with 38
CFR 36.4410 and the escrow agreement.
If the contractor has not, the funds
should remain in the escrow account
pending civil litigation.
Effective Date: January 24, 2012.
Will A. Gunn,
General Counsel, Department of
Veterans Affairs.
VAOPGCPREC 2–2012
Question Presented: With regard to
the implementation of Public Law 112–
154—
a. Are new regulations necessary
before implementing sec. 202?
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b. When are secs. 204 and 205
effective?
c. Are surviving spouses under sec.
206 exempt from paying the statutory
loan fee usually required under 38
U.S.C. 3729? Are such spouses eligible
for double entitlement?
d. Is sec. 701 consistent with current
regulations and policies? What
regulations, if any, are necessary before
implementing the provision?
Held: a. Regulations are not necessary
before implementing sec. 202, as a new
regulation would merely be a
restatement of the statute. VA may
provide the assistance, effective as of
October 1, 2012. VA is still required,
nevertheless, to promulgate a new final
regulation, not subject to notice and
comment, to address the statutory
change.
b. In accordance with the plain
meaning of the statute, the Department
should implement sec. 204 on August 6,
2013, which is one year from the date
of enactment of Public Law 112–154,
and should have already implemented
sec. 205, as it became effective August
6, 2012.
c. Surviving spouses under sec. 206
are, to the same extent as surviving
spouses under 38 U.S.C. 3701(b)(2),
exempt from paying the statutory loan
fee. Also, sec. 206 surviving spouses are
eligible for double entitlement.
d. Section 701 is not inconsistent with
current regulations and policies and, for
the most part, can be implemented
before a final rule is published. To the
extent VA is required to implement a
new policy decision not expressly
prescribed in the statute or addressed in
current regulations, VA should publish
a proposed rule and allow the public to
comment on VA’s plans for
implementation.
Effective Date: October 31, 2012.
Will A. Gunn,
General Counsel, Department of
Veterans Affairs.
VAOPGCPREC 3–2012
Question Presented: VBA plans to
contact individuals whose claims for
compensation for PTSD due to MST
(also called in-service personal or sexual
assault) have been previously denied
and to offer them the opportunity to
have their claims reviewed. The
purpose of the review is to ensure that
VBA properly developed and decided
the claims. As necessary, VBA plans to
take corrective action to remedy errors
identified in the review. In connection
with this review, your staff has asked for
our advice on the following questions:
1. Under what legal authority can
VBA undertake such a review of
previously denied claims for
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compensation? Can VA undertake such
review and corrective action without
requiring the submission of new and
material evidence or an allegation of
clear and unmistakable error (CUE)?
Does this authority apply to review of
conditions other than PTSD which may
be claimed as a result of MST? Would
that authority apply to a review and
possible reconsideration of the claim
without the express written consent of
the claimant?
2. What information should VBA
include in its letter to claimants
regarding this review?
3. After its review, if VBA should
decide to grant the benefit originally
sought, what factors affect the assigning
of an effective date? In particular, would
VBA be able to apply 38 CFR 3.114,
‘‘Change of law or Department of
Veterans Affairs issue’’ to claims which
are granted as a result of the review?
4. Does VA have the authority, by
regulation or otherwise, to extend the
liberalized evidentiary standards
associated with compensation claims
involving MST to claims based upon
mental disorders other than PTSD or
any physical disorders also alleged to
involve MST?
5. If VA does not have this authority,
what options may it consider to
liberalize evidentiary standards for
disabilities other than PTSD that may
involve MST?
6. What is the legal basis, if any, for
VA to use difference-of-opinion
authority in this review to grant
compensation for disabilities caused by
MST after adverse decisions have
become final, i.e., decisions for which
the appeal period has elapsed?
7. What consequences, if any, might
VA expect from the use of difference-ofopinion authority to overturn final
decisions as described above?
Held: 1. VBA has authority under 38
U.S.C. 303 to initiate a review of any
class of claim decisions and may revise
the decisions subject to the statutes and
regulations governing finality. The
consent of the claimant is not required
to conduct such a review.
2. If the appeal period has elapsed or
a final Board decision has issued, a
decision on a claim may be revised only
on the basis of submission of new and
material evidence or a determination by
VBA or the Board, as appropriate, that
the original decision was the product of
CUE. VBA may accept a claim to reopen
and may develop for new and material
evidence even if the claimant does not
proffer new and material evidence at the
time of the request to reopen. If new and
material evidence is obtained and the
claim is ultimately reopened and
benefits are awarded, the effective date
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would be based on the date that the
application to reopen was filed and the
facts found, unless the new and material
evidence consists of official service
department records, in which case the
effective date may be as early as the date
of the original claim, if supported by the
facts found. Decisions that are not
timely appealed become final and are
not subject to revision on the basis of
difference of opinion.
3. If the appeal period has not elapsed
and VBA wishes to revise the claim
decision based on the evidence in the
file, VBA may revise the decision in a
manner favorable to the claimant based
on difference of opinion, if the matter is
referred to Central Office. 38 CFR
3.105(b). If review of the file leads VBA
to believe that the claim may not have
been adequately developed, VBA may
conduct the necessary development. If
development leads to an award of
benefits prior to the expiration of the
appeal period, the effective date would
be the date entitlement arose or the date
of receipt of the claim, whichever is
later. If the claimant submits new and
material evidence prior to the expiration
of the appeal period and receives an
award of benefits on that basis, the
effective date would be the date
entitlement arose or the date of original
receipt of the claim, whichever is later.
If a review of the file reveals the original
decision was a product of CUE, the
original decision must be revised, and
the effective date would be the date
entitlement arose or the date of the
original receipt of the claim, whichever
is later.
4. Neither 38 CFR 3.304(f)(5), nor
documents issued by VA providing
guidance on the implementation of that
provision, would constitute a
liberalizing administrative issue for
purposes of the effective date rules of 38
CFR 3.114.
5. VA has authority to extend by
notice and comment rulemaking
evidentiary rules associated with
compensation claims involving MST to
claims involving physical and mental
disabilities other than PTSD. Further,
under existing statutes and regulations,
VA may in a particular case find that
evidence from alternative sources, such
as those described in § 3.304(f)(5), is
sufficient to establish a particular fact at
issue, such as that a personal assault
occurred during service.
Effective Date: December 20, 2012.
Will A. Gunn,
General Counsel, Department of
Veterans Affairs.
VAOPGCPREC 1–2011
Question Presented: A. What
procedures are used to designate
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documents as constituting Veterans
Health Administration (VHA) medical
quality-assurance documents?
B. What types of documents qualify as
quality-assurance documents?
C. Is the Board authorized to examine
quality-assurance records or documents
to determine whether they are protected
by 38 U.S.C. 5705?
D. Does VA’s duty to assist in claim
development under 38 U.S.C. 5103A
require the Board to attempt to obtain
quality-assurance records?
Held: A. Under 38 U.S.C. 5705(a),
records and documents created by VA
as part of a medical quality-assurance
program are confidential and privileged
and may not be disclosed to any person
or entity except as provided in sec.
5705(b). For a record or document to be
protected from disclosure by sec.
5705(a), VA must designate the VA
systematic health-care review activities
to be carried out by or for VA for
purposes of improving the quality of VA
medical care or the utilization of VA
health-care resources in VA health-care
facilities, and VA must specify in
regulations prescribed to implement sec.
5705 those activities so designated. VA
has designated, at 38 CFR 17.501(a),
four systematic health-care review
activities to be carried out by or for VA
for the stated purposes. In addition,
only records or documents and parts of
records or documents resulting from
those activities that have been described
in advance and in writing by the Under
Secretary for Health (USH), a Veterans
Integrated Service Network (VISN)
director, or a VHA medical facility
director as being included under the
four designated classes of healthcare
quality-assurance reviews are protected
by sec. 5705 and implementing VA
regulations. Further, if the activity that
generated the document was performed
at a VA medical treatment facility,
either the activity must have been
performed by staff of that facility or the
non-staff individuals who performed the
activity must have had their roles in
performing the activity designated in
writing before performing the activity.
Whether these statutory, regulatory, and
policy requirements were met in any
particular case is a matter for
determination by the appropriate VHA
official in the first instance and, if the
VHA determination is affirmative, by
the General Counsel or Deputy General
Counsel on appeal.
B. The types of documents that
qualify as quality-assurance documents
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are described in 38 CFR 17.501. They
may be in written, computer, electronic,
photographic, or any other form.
Generally, to constitute a VHA quality
assurance record or document that is
privileged and confidential, a record or
document: (1) Must have been produced
by or for VA in conducting a medical
quality-assurance activity; (2) must have
resulted from a quality-assurance
activity described in advance in writing
by the USH, a VHA VISN director, or a
health-care facility director as being
within the classes of healthcare quality
assurance reviews listed in 38 CFR
17.501(a); and (3) must either: (A)
Identify individual practitioners,
patients, or reviewers; (B) contain
discussions, by healthcare evaluators
during a review of quality-assurance
information, relating to the quality of
VA medical care or the utilization of VA
medical resources; (C) be individual
committee, service, or study team
minutes, notes, reports, memoranda, or
other documents either produced by
healthcare evaluators in deliberating on
the findings of healthcare reviews or
prepared for purposes of discussion or
consideration by healthcare evaluators
during a quality-assurance review; (D)
be a memorandum, letter, or other
document from a medical facility to a
VISN director or VA Central Office that
contains information generated by a
quality-assurance activity; or (E) be a
memorandum, letter, or other document
produced by a VISN director or VA
Central Office that either responds to or
contains information generated by a
quality-assurance activity. Clinical
treatment records would generally not
satisfy these criteria. Records and
documents that do not qualify for
protection under 38 U.S.C. 5705(a), even
if they otherwise meet the criteria under
§ 17.501(a)–(c) for quality-assurance
documents, are described in 38 CFR
17.501(g).
C. Under 38 U.S.C. 5705(b)(5),
nothing in sec. 5705 is to be construed
as limiting the use of quality-assurance
records and documents within VA, and
38 U.S.C. 5705(b)(1) explicitly requires
disclosures of quality-assurance records
or documents under certain specified
circumstances. However, under 38 CFR
17.508(a), access within VA to
confidential and privileged qualityassurance records and documents is
restricted to employees who need such
information to perform their
governmental duties and who are
authorized access by the VA medical
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13997
facility director, VISN director, or USH,
by their designees, or by VA’s
implementing regulations at 38 CFR
17.500 through 17.511. Neither sec.
5705(b)(1) nor VA’s implementing
regulations at 38 CFR 17.500 through
17.511 authorize disclosure of qualityassurance records or documents to an
agency of original jurisdiction or the
Board for purposes of adjudicating a
claim or an appeal to the Secretary of a
claim decision.
D. Section 5103A, of title 38, United
States Code, requires agencies of
original jurisdiction and the Board to
make reasonable efforts to request from
VHA any quality-assurance records or
documents that are relevant to a claim,
provided the claimant furnishes
information sufficient to locate the
records or documents, and, if VHA
denies access to the records and
documents on the basis that they are
protected by sec. 5705 and
implementing regulations, to appeal
VHA’s denial to OGC under 38 CFR
17.506. Under 38 CFR 17.508(c), any
quality-assurance record or document,
whether confidential and privileged or
not, may be provided to the General
Counselor any attorney within OGC,
wherever located. If VHA and OGC
conclude that the records and
documents are protected by sec. 5705
and implementing regulations, VA may
not consider them and rely on them in
the adjudication of the claim. If VHA or
OGC concludes that the records and
documents are not confidential and
privileged, VA may consider them in
adjudicating the claim.
Effective Date: April 19, 2011.
Will A. Gunn,
General Counsel, Department of
Veterans Affairs.
Signing Authority
The 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. Robert L.
Wilkie, Secretary, Department of Veterans
Affairs, approved this document on
September 27, 2018, for publication.
Dated: April 3, 2019.
Luvenia Potts,
Program Specialist, Office of Regulation
Policy & Management, Office of the Secretary,
Department of Veterans Affairs.
[FR Doc. 2019–06855 Filed 4–5–19; 8:45 am]
BILLING CODE 8320–01–P
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[Federal Register Volume 84, Number 67 (Monday, April 8, 2019)]
[Notices]
[Pages 13991-13997]
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[FR Doc No: 2019-06855]
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DEPARTMENT OF VETERANS AFFAIRS
Summary of Precedent Opinions of the General Counsel
AGENCY: Department of Veterans Affairs.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Department of Veterans Affairs (VA) is publishing a
summary of legal interpretations issued by the Office of the General
Counsel (OGC) involving Veterans' benefits under laws administered by
VA. These interpretations are considered precedential by VA and will be
followed by VA officials and employees in claim matters involving the
same legal issues. This summary is published to provide the public and,
in particular, Veterans' benefits claimants and their representatives,
with notice of VA's interpretations regarding the legal matters at
issue.
FOR FURTHER INFORMATION CONTACT: Suzanne Hill, Law Librarian, Office of
General Counsel, 810 Vermont Avenue NW, Washington, DC 20420, (202)
461-7624.
SUPPLEMENTARY INFORMATION: A VA regulation at 38 CFR 2.6(e)(8)
delegates to the General Counsel the power to designate an opinion as
precedential, and 38 CFR 14.507(b) specifies that precedential opinions
involving Veterans' benefits are binding on VA officials and employees
in subsequent matters involving the legal issue decided in the
precedent opinion. The interpretation of the General Counsel on legal
matters, contained in such opinions, is conclusive as to all VA
officials and employees, not only in the matter at issue, but also in
future adjudications and appeals involving the same legal issues, in
the absence of a change in controlling statute or regulation or a
superseding written legal opinion of the General Counsel or a judicial
decision.
VA publishes summaries of such opinions in order to provide the
public with notice of those interpretations of the General Counsel that
must be followed in future benefit matters and to assist Veterans'
benefits claimants and their representatives in the prosecution of
benefit claims. The full text of such opinions, with personal
identifiers deleted, may be obtained by contacting the VA official
named above or by accessing the opinions on the internet at https://www.va.gov/ogc/precedentopinions.asp.
VAOPGCPREC 1-2018
Question Presented: How does a claimant's opt-in to the Rapid
Appeals Modernization Program (RAMP) affect an existing fee agreement?
Held: If a claimant, who is represented by a claims agent or
attorney, withdraws his or her notice of disagreement to opt-in to
RAMP, that withdrawal does not obstruct the representative's
eligibility for fees. VA does not construe the RAMP election as
returning the claimant and representative to a period in the VA
administrative process for which fees may not be charged or as
otherwise affecting a legal existing fee agreement.
Effective Date: August 6, 2018.
James M. Byrne,
General Counsel, Department of Veterans Affairs.
VAOPGCPREC 1-2017
Question Presented: 1. Is obesity per se a ``disease'' for purposes
of establishing entitlement to service connection under 38 U.S.C. 1110
and 1131?
2. If obesity is a disease, may obesity be considered the result of
a veteran's willful misconduct for purposes of line-of-duty
determinations under 38 U.S.C. 105(a)?
3. Is obesity per se a ``disability'' for purposes of secondary
service connection under 38 CFR 3.310?
4. If obesity is not a disease, could it be an ``in-service event''
from which a service-connected disability may result?
5. If obesity is not a disease, could it be an ``intermediate
step'' between a service-connected disability and a current disability
that may be service connected on a secondary basis under 38 CFR
3.310(a)?
Held: 1. The longstanding policy of VA, that obesity per se is not
a disease or injury for purposes of 38 U.S.C. 1110 and 1131 and
therefore may not be service connected on a direct basis, is consistent
with title 38, United States Code.
2. Because obesity is not considered a disease for purposes of 38
U.S.C. 1110 and 1131, we do not need to determine whether it may be
considered the result of a veteran's willful misconduct for purposes of
line-of-duty determinations under 38 U.S.C. 105(a).
3. Obesity per se is not a ``disability'' for purposes of 38 CFR
3.310. If, in a particular case, obesity resulting from a service-
connected disease or injury is found to produce impairment beyond that
contemplated by the applicable provisions of VA's rating schedule, VA
may consider an extra-schedular rating under 38 CFR 3.321(b)(1) for the
service-connected condition based on that impairment.
4. Obesity cannot qualify as an in-service event because it occurs
over time and is based on various external and internal factors, as
opposed to being a discrete incident or occurrence, or a series of
discrete incidents or occurrences.
5. Obesity may be an ``intermediate step'' between a service-
connected disability and a current disability that may be service
connected on a secondary basis under 38 CFR 3.310(a).
Effective Date: January 6, 2017.
Richard J. Hipolit,
Acting General Counsel, Department of Veterans Affairs.
VAOPGCPREC 1-2015
Question Presented: 1. May VA pay individuals appointed under 38
U.S.C. 7405(a)(2) on a time basis either per hour or per annum?
2. If so, may these individuals be granted a full-time appointment
under 38 U.S.C. 7401 or 7401(3) concurrently with an appointment under
38 U.S.C. 7405(a)(2) at the same facility without violating or
compromising 5 U.S.C. 5533 or Department conflict of interest
regulations (38 CFR, part 0)?
3. If VA is able to appoint individuals under 38 U.S.C. 7405(a)(2)
and compensate these individuals on a time-basis, would such
appointees, if retired annuitants, be subject to a salary offset under
5 U.S.C. 8344 or 8468?
Held: 1. VA may not pay individuals appointed under 38 U.S.C.
7405(a)(2) on a time basis.
2. Since the answer to the first question is ``no,'' it is
unnecessary to respond to this question.
3. Since the answer to the first question is ``no,'' it is
unnecessary to respond to this question.
Effective Date: February 19, 2015.
Leigh A. Bradley,
General Counsel, Department of Veterans Affairs.
[[Page 13992]]
VAOPGCPREC 2-2015
Question Presented: Does VA's express statutory authority to accept
gifts, contained in sec. 8301, of title 38, United States Code, include
the implied authority to solicit gifts?
Conclusion: VA's express statutory authority to accept gifts under
38 U.S.C. 8301 includes the implied authority to solicit gifts.
Effective Date: March 20, 2015.
Leigh A. Bradley,
General Counsel, Department of Veterans Affairs.
VAOPGCPREC 3-2015 (Withdrawn)
Update: 1. VAOPGCPREC 3-2015 held that the designated cemetery
official may be a proper applicant for a government-furnished headstone
or marker under 38 CFR 38.632(b)(1). The opinion also held that Civil-
War era graves at Oakwood Cemetery in Richmond, Virginia, which are
currently identified with marble stones that do not show the names of
each soldier but have identifying numbers that are tracked in a burial
ledger, are not ``unmarked graves'' for purposes of VA furnishing a
headstone or marker under 38 U.S.C. 2306(a)(3), even if such stones
denote the location of more than one soldier.
2. This is to inform you that VAOPGCPREC 3-2015 is withdrawn.
Effective Date: December 7, 2016.
Leigh A. Bradley,
General Counsel, Department of Veterans Affairs.
VAOPGCPREC 3-2015 (Original Opinion)
Question Presented: 1. Is the designated cemetery official a proper
applicant for a government-furnished headstone or marker under 38 CFR
38.632(b)(1)?
2. Do Civil-War era graves currently identified with marble stones
that do not show the names of each soldier constitute ``unmarked
graves'' for purposes of VA furnishing a headstone or marker under 38
U.S.C. 2306(a)(3)?
3. Do Civil-War era graves currently identified with marble stones
that do not show the names of each soldier constitute ``unmarked
graves'' for purposes of VA furnishing a headstone or marker under 38
U.S.C. 2306(a)(3) if such stones denote the location of more than one
soldier?
Conclusions: 1. The designated cemetery official may be a proper
applicant for a government-furnished headstone or marker under 38 CFR
38.632(b)(1).
2. Assuming the facts as stated in this opinion are accurate,
Civil-War era graves at Oakwood Cemetery currently identified with
marble stones that do not show the names of each soldier but that have
identifying numbers that are tracked in a burial ledger are not
``unmarked graves'' for purposes of VA furnishing a headstone or marker
under sec. 2306(a)(3).
3. Assuming the facts as stated in this opinion are accurate,
Civil-War era graves at Oakwood Cemetery currently identified with
marble stones that do not show the names of each soldier but that have
identifying numbers that are tracked in a burial ledger are not
``unmarked graves'' for purposes of VA furnishing a headstone or marker
under sec. 2306(a)(3) even if such stones denote the location of more
than one soldier.
Effective Date: August 28, 2015 through December 6, 2016.
Leigh A. Bradley,
General Counsel, Department of Veterans Affairs.
VAOPGCPREC 4-2015
Question Presented: 1. Is the Board of Veterans' Appeals (Board),
upon a veteran's death, required to dismiss the veteran's dispute as to
payment of potential attorney's fees under 38 U.S.C. 5904(d) from money
withheld from past-due disability benefits awarded to the veteran
during the veteran's lifetime?
2. If the Board is required to dismiss the dispute, may a party
pursue payment of the withheld money as accrued benefits pursuant to 38
U.S.C. 5121?
3. If the Board is required to dismiss the dispute, what effect
does that dismissal have on the underlying decisions regarding that
issue?
Held: 1. Upon a veteran's death, the Board is required to dismiss
the veteran's dispute as to payment of potential attorney's fees under
38 U.S.C. 5904(d) when the money withheld from past-due disability
benefits awarded to the veteran meets the statutory definition for
accrued benefits.
2. A claim, pending at the time of a veteran's death, challenging
an attorney's entitlement to payment of attorney fees under sec. 5904
from the veteran's retroactive periodic monetary benefits may provide a
basis for an accrued benefits claim under sec. 5121, because such a
claim concerns entitlement to periodic monetary benefits allegedly due
and unpaid to the veteran at the time of death.
3. The Board's dismissal of the veteran's dispute regarding payment
of attorney's fees renders all underlying decisions regarding that
issue that were not final at the time of the veteran's death legal
nullities.
Effective Date: December 3, 2015.
Leigh A. Bradley,
General Counsel, Department of Veterans Affairs.
VAOPGCPREC 1-2014
Question Presented: Is a State home domiciliary required to provide
primary care to a resident on whose behalf VA pays per diem for that
care?
Held: In order for a State to receive per diem payments form VA for
a resident in its State home domiciliary, the home must provide primary
care to the resident.
Effective Date: March 21, 2014.
Will A. Gunn,
General Counsel, Department of Veterans Affairs.
VAOPGCPREC 2-2014
Question Presented: Are claims for burial benefits administered by
the National Cemetery Administration (NCA) subject to the notice
requirements in sec. 5103, of title 38, United States Code, in light of
the unique time requirements associated with such claims?
Held: The notice requirements of 38 U.S.C. 5103 apply to all claims
for benefits administered by VA, including claims for benefits
administered by NCA. However, NCA may determine that notice under 38
U.S.C. 5103 is unnecessary in particular cases, either because VA has
sufficient evidence to grant the requested benefit or because
applicable law and undisputed facts establish that the claimant is
ineligible for the claimed benefit. Further, pursuant to a recent
amendment to sec. 5103(a), NCA may provide the notice required by that
section ``by the most effective means available,'' which may include
providing such notice on a benefit application form or transmitting it
to the claimant electronically. Finally, NCA has discretion to adopt
reasonable procedures for applying the requirements of sec. 5103 in the
context of time-sensitive claims for burial benefits.
Effective Date: May 19, 2014.
Will A. Gunn,
General Counsel, Department of Veterans Affairs.
VAOPGCPREC 5-2014 (Revised)
Question Presented: 1. Is VA legally obligated under 38 U.S.C.
5103A(a) to obtain the service and other related records (including
investigation reports, service treatment records, service personnel
records, Service Record Books, etc.) that belong or pertain to a
[[Page 13993]]
Servicemember other than the Veteran who is seeking VA benefits, when
such records may be potentially relevant to the Veteran's claim for
benefits?
2. Do the special processing procedures set forth in 38 CFR
3.304(f)(5) for developing and deciding claims involving post-traumatic
stress disorder (PTSD) asserted to be due to personal assault and/or
military sexual trauma (MST) impose a requirement on VA to obtain
records that belong or pertain to a Servicemember other than the
Veteran claimant when such records may be useful for corroborating the
Veteran's account of the stressor incident or to provide evidence of
behavior changes following the incident?
a. Would it be required, and/or would it be legally appropriate, to
attempt to solicit a written statement from, or depose during a
hearing, the asserted Servicemember assailant for purposes of obtaining
information concerning a claim of personal assault or MST that has been
raised by a Veteran claimant?
3. If VA is legally obligated to obtain the records of a
Servicemember other than the Veteran:
a. Does the Privacy Act, 5 U.S.C. 552, prohibit VA from obtaining
and associating with a Veteran claimant's claims file service and other
related records that belong or pertain to another Servicemember? What
legal factors are for consideration in making this determination?
b. Assuming the Privacy Act does not prohibit VA from obtaining and
associating a non-claimant Servicemember's records with a Veteran
claimant's claims file, must VA obtain permission to request those
records, and from whom must VA obtain such permission? Is the answer to
this question the same or different if the Servicemember whose records
are being sought is deceased? If permission is denied, does VA have any
additional duty to assist the claimant in obtaining the records?
c. If records related to the non-claimant Servicemember are
obtained, how should they be handled? May copies of the records be
associated with the Veteran claimant's claims file? If so, must the
records first be redacted in order to remove all personally
identifiable information?
i. If VA is permitted to associate the non-claimant Servicemember's
redacted records in the Veteran claimant's claims file, is VA also
required to conduct a full and complete search of the Veteran
claimant's claims file for other named references to the Servicemember
and redact them (such as in this case where the alleged assailant is
named in both records located in the claims file and in the remand
decision of the Court of Appeals for Veterans Claims)?
Held: 1. In adjudicating a particular Veteran's claim for benefits,
VA generally would be obligated under 38 U.S.C. 5103A to make
reasonable efforts to obtain records pertaining to another individual
if: (a) Those records were adequately identified, would be relevant to
the Veteran's claim, and would aid in substantiating the claim; and (b)
VA would be authorized to disclose the relevant portions of such
records to the Veteran under the Privacy Act and 38 U.S.C. 5701 and
7332. VA adjudicators generally may not consider documents that cannot
be disclosed to the claimant.
2. Pursuant to the Privacy Act, 5 U.S.C. 552a, and 38 U.S.C. 5701,
VA records pertaining to another individual generally may be disclosed
to a claimant only: (1) Pursuant to the written consent of the
individual to whom the records pertain; (2) pursuant to a court order;
or (3) where there is both an applicable routine use under the Privacy
Act and a VA finding under 38 U.S.C. 5701(e) that disclosure of records
other than names and addresses would serve a useful purpose. Because
there currently is no applicable routine use, disclosure of another
individual's VA records to a VA claimant for purposes of the latter's
benefits claim generally requires written consent or a court order.
Further, if the records at issue contain information protected by 38
U.S.C. 7332, any written consent or court order must comply with the
specific requirements of that statute and VA's implementing
regulations.
3. If a claimant identifies relevant records pertaining to another
individual that are in the custody of the Department of Defense or
another Federal agency, it would be consistent with VA's statutory duty
to assist for VA to ask the custodian agency to furnish such records,
but only if they may be disclosed to the VA claimant. The custodian
agency would be responsible for determining whether its records may be
disclosed to the VA claimant for the requested purpose. In making such
requests, VA should clearly explain to the custodian agency the
circumstances and conditional nature of the request. Specifically, VA
should explain that the records are requested on behalf of a VA
claimant who is not the individual to whom the record pertains and that
VA requests a determination by the custodian agency as to whether such
records may be disclosed to the VA claimant under the Privacy Act and
any routine uses applicable to the relevant system of records of the
custodian agency.
4. VA's duty under 38 U.S.C. 5103A to make ``reasonable efforts''
to assist claimants in obtaining evidence may in some cases include the
duty to request that a third party provide written consent for VA to
disclose records pertaining to the third party to the claimant. The
Veterans Benefits Administration (VBA) may wish to consider issuing
regulations or establishing uniform procedures to address the unique
and sensitive issues that may arise where the records of an alleged
assailant or other third party may be relevant to a claim. In the
absence of regulations or procedures specifically addressing this
issue, it generally must be resolved on a case-by-case basis. In
determining whether ``reasonable efforts'' include such a request in a
particular case, VA may consider factors including the third party's
privacy interest in his or her records; the likelihood that the records
exist; the likelihood that the request would result in consent to
disclose the records to the claimant; and the potential for such
requests to generate conflict or otherwise adversely affect the safety,
health, or rights of either the claimant or the third party. A
determination that ``reasonable efforts'' do not require seeking a
third-party's consent to disclose his or her records to the claimant
would be most strongly justified in a case where the interests of the
third party are adverse to the claimant's interest, such as where the
claimant alleges that the third party assaulted the claimant or engaged
in other improper or unlawful behavior. In contrast, where the
interests of the claimant and the third party are not adverse, there
ordinarily would be a stronger basis for a finding that VA's
``reasonable efforts'' may include asking the third party to consent to
disclosure of his or her records to the claimant.
5. If the individual to whom a record pertains is deceased, the
Privacy Act would not apply, but other limitations would apply. First,
under the Freedom of Information Act (FOIA), 5 U.S.C. 552(b)(6), VA may
be required to balance the privacy interests of a decedent's surviving
family members against the public interest in disclosure of information
concerning the decedent in order to determine whether disclosure is
warranted. Second, VA must ensure compliance with 38 U.S.C. 5701 and
7332. Under sec. 5701(e), VA records other than names and addresses may
be disclosed if VA finds that such disclosure would serve a ``useful
purpose.'' Alternatively, the next of kin of the person to whom the
records pertain may provide written consent to
[[Page 13994]]
disclose the records to a VA claimant. However, the next of kin cannot
consent to disclosure of information protected by sec. 7332 for
purposes of supporting a claim by a person other than a survivor or
dependent of the person to whom the records pertain.
6. The provisions of 38 CFR 3.304(f)(5) do not impose on VA any
duty to assist beyond that provided under 38 U.S.C. 5103A. Section
3.304(f)(5) identifies the types of evidence that may be relevant to
corroborate a Veteran's claim of an in-service assault and seeks to
ensure that the Veteran is aware of the types of evidence that may
support his or her claim. The existence and extent of any duty on VA's
part to obtain relevant records is governed by sec. 5103A and VA's
regulations implementing that statute.
7. VA is not required to solicit a written statement from, or to
depose during a hearing, the individual who allegedly assaulted a
claimant who is seeking VA benefits for disability due to the alleged
assault. Further, to prevent disparate treatment of similarly situated
claimants and disparate commitment of VA adjudication resources, 38 CFR
3.159(g) reserves to the Secretary of Veterans Affairs the authority to
authorize assistance beyond that currently specified in statute and
regulation. Accordingly, VA generally may not, in an individual case,
solicit statements or testimony from an alleged assailant, as doing so
would give rise to the disparities Sec. 3.159(g) was designed to
prevent.
8. If records pertaining to an individual other than the claimant
are obtained and considered in relation to the claim, VA must include
them in the claims file. However, VA should exercise care in ensuring
that the protected information included in the claims file is limited
to the information that VA is authorized to disclose under the
applicable written consent, routine use, useful purpose determination,
court order, or other authority. Accordingly, it may be necessary to
redact the records to remove identifying information that is not
relevant to the claim or not otherwise within the scope of the relevant
authorization, such as the individual's address, telephone number, and
Social Security number. However, if the claimant provided VA with the
Servicemember's name, VA would not need to redact that name from the
documents placed in the file. If VA includes records pertaining to a
third party in a VA claims file, it ordinarily would not need to search
the entire file for other records containing protected information,
unless it has reason to believe that the file may contain protected
third-party information that was not provided by the claimant.
Effective Date: January 5, 2017.
Richard J. Hipolit,
Acting General Counsel, Department of Veterans Affairs.
VAOPGCPREC 5-2014 (Original Opinion)
1. Is VA legally obligated under 38 U.S.C. 5103A(a) to obtain the
service and other related records (including investigation reports,
service treatment records, service personnel records, Service Record
Books, etc.) that belong or pertain to a Servicemember other than the
Veteran who is seeking VA benefits, when such records may be
potentially relevant to the Veteran's claim for benefits?
2. Do the special processing procedures set forth in 38 CFR
3.304(f)(5) for developing and deciding claims involving PTSD asserted
to be due to personal assault and/or MST impose a requirement on VA to
obtain records that belong or pertain to a Servicemember other than the
Veteran claimant when such records may be useful for corroborating the
Veteran's account of the stressor incident or to provide evidence of
behavior changes following the incident?
a. Would it be required, and/or would it be legally appropriate, to
attempt to solicit a written statement from, or depose during a
hearing, the asserted Servicemember assailant for purposes of obtaining
information concerning a claim of personal assault or MST that has been
raised by a Veteran claimant?
3. If VA is legally obligated to obtain the records of a
Servicemember other than the Veteran:
a. Does the Privacy Act, 5 U.S.C. 552, prohibit VA from obtaining
and associating with a Veteran claimant's claims file service and other
related records that belong or pertain to another Servicemember? What
legal factors are for consideration in making this determination?
b. Assuming the Privacy Act does not prohibit VA from obtaining and
associating a non-claimant Servicemember's records with a Veteran
claimant's claims file, must VA obtain permission to request those
records, and from whom must VA obtain such permission? Is the answer to
this question the same or different if the Servicemember whose records
are being sought is deceased? If permission is denied, does VA have any
additional duty to assist the claimant in obtaining the records?
c. If records related to the non-claimant Servicemember are
obtained, how should they be handled? May copies of the records be
associated with the Veteran claimant's claims file? If so, must the
records first be redacted in order to remove all personally
identifiable information?
i. If VA is permitted to associate the non-claimant Servicemember's
redacted records in the Veteran claimant's claims file, is VA also
required to conduct a full and complete search of the Veteran
claimant's claims file for other named references to the Servicemember
and redact them (such as in this case where the alleged assailant is
named in both records located in the claims file and in the remand
decision of the Court of Appeals for Veterans Claims)?
Held: 1. In adjudicating a particular Veteran's claim for benefits,
VA generally would be obligated under 38 U.S.C. 5103A to make
reasonable efforts to obtain records pertaining to another individual
if: (a) Those records were adequately identified, would be relevant to
the Veteran's claim, and would aid in substantiating the claim; and (b)
VA would be authorized to disclose the relevant portions of such
records to the Veteran under the Privacy Act and 38 U.S.C. 5701 and
7332. VA adjudicators generally may not consider documents that cannot
be disclosed to the claimant.
2. Pursuant to the Privacy Act, 5 U.S.C. 552a, and 38 U.S.C. 5701,
VA records pertaining to another individual generally may be disclosed
to a claimant only:
(1) Pursuant to the written consent of the individual to whom the
records pertain;
(2) pursuant to a court order; or (3) where there is both an
applicable routine use under the Privacy Act and a VA finding under 38
U.S.C. 5701(e) that disclosure of records other than names and
addresses would serve a useful purpose. Because there currently is no
applicable routine use, disclosure of another individual's VA records
to a VA claimant for purposes of the latter's benefits claim generally
requires written consent or a court order. Further, if the records at
issue contain information protected by 38 U.S.C. 7332, any written
consent or court order must comply with the specific requirements of
that statute and VA's implementing regulations.
3. If a claimant identifies relevant records pertaining to another
individual that are in the custody of the Department of Defense or
another Federal agency, it would be consistent with VA's statutory duty
to assist for VA to ask the custodian agency to furnish such records,
but only if they may be disclosed to the VA claimant. The custodian
agency would be responsible
[[Page 13995]]
for determining whether its records may be disclosed to the VA claimant
for the requested purpose. In making such requests, VA should clearly
explain to the custodian agency the circumstances and conditional
nature of the request. Specifically, VA should explain that the records
are requested on behalf of a VA claimant who is not the individual to
whom the record pertains and that VA requests a determination by the
custodian agency as to whether such records may be disclosed to the VA
claimant under the Privacy Act and any routine uses applicable to the
relevant system of records of the custodian agency.
4. VA's duty under 38 U.S.C. 5103A to make ``reasonable efforts''
to assist claimants in obtaining evidence may in some cases include the
duty to request that an individual to whom a relevant record pertains
provide written consent for VA to disclose that record to the claimant.
The Veterans Benefits Administration may wish to consider issuing
regulations or establishing uniform procedures to address the unique
and sensitive issues that may arise where the records of an alleged
assailant or other third party may be relevant to a claim. In the
absence of such regulations or procedures, VA adjudicators must make
case-by-case determinations as to whether the duty to assist requires
VA to seek another individual's consent to disclosure of his or her
records to the claimant. That determination may be based on, among
other things, the extent to which the claimant has identified specific
records likely to contain relevant evidence and the feasibility and
appropriateness, in the particular case of seeking the consent of the
individual to whom the record pertains. Where the records at issue
pertain to an individual who allegedly assaulted the claimant, it would
be advisable to determine whether the claimant wants VA to contact that
individual.
5. If the individual to whom a record pertains is deceased, the
Privacy Act would not apply, but other limitations would apply. First,
under FOIA, 5 U.S.C. 552(b)(6), VA may be required to balance the
privacy interests of a decedent's surviving family members against the
public interest in disclosure of information concerning the decedent in
order to determine whether disclosure is warranted. Second, VA must
ensure compliance with 38 U.S.C. 5701 and 7332. Under sec. 5701(e), VA
records other than names and addresses may be disclosed if VA finds
that such disclosure would serve a ``useful purpose.'' Alternatively,
the next of kin of the person to whom the records pertain may provide
written consent to disclose the records to a VA claimant. However, the
next of kin cannot consent to disclosure of information protected by
sec. 7332 for purposes of supporting a claim by a person other than a
survivor or dependent of the person to whom the records pertain.
6. The provisions of 38 CFR 3.304(f)(5) do not impose on VA any
duty to assist beyond that provided under 38 U.S.C. 5103A. Section
3.304(f)(5) identifies the types of evidence that may be relevant to
corroborate a Veteran's claim of an in-service assault and seeks to
ensure that the Veteran is aware of the types of evidence that may
support his or her claim. The existence and extent of any duty on VA's
part to obtain relevant records is governed by sec. 5103A and VA's
regulations implementing that statute.
7. VA is not required to solicit a written statement from, or to
depose during a hearing, the individual who allegedly assaulted a
claimant who is seeking VA benefits for disability due to the alleged
assault. Further, to prevent disparate treatment of similarly situated
claimants and disparate commitment of VA adjudication resources, 38 CFR
3.159(g) reserves to the Secretary of Veterans Affairs the authority to
authorize assistance beyond that currently specified in statute and
regulation. Accordingly, VA generally may not, in an individual case,
solicit statements or testimony from an alleged assailant, as doing so
would give rise to the disparities Sec. 3.159(g) was designed to
prevent.
8. If records pertaining to an individual other than the claimant
are obtained and considered in relation to the claim, VA must include
them in the claims file. However, VA should exercise care in ensuring
that the protected information included in the claims file is limited
to the information that VA is authorized to disclose under the
applicable written consent, routine use, useful purpose determination,
court order, or other authority. Accordingly, it may be necessary to
redact the records to remove identifying information that is not
relevant to the claim or not otherwise within the scope of the relevant
authorization, such as the individual's address, telephone number, and
Social Security number. However, if the claimant provided VA with the
Servicemember's name, VA would not need to redact that name from the
documents placed in the file. If VA includes records pertaining to a
third party in a VA claims file, it ordinarily would not need to search
the entire file for other records containing protected information,
unless it has reason to believe that the file may contain protected
third-party information that was not provided by the claimant.
Effective Date: August 12, 2014 through January 5, 2017.
Tammy L. Kennedy,
Acting General Counsel, Department of Veterans Affairs.
VAOPGCPREC 6-2014
Question Presented: Whether, pursuant to 38 U.S.C. 5103(a)(1), VA
is required upon receipt of a claim to reopen based upon new and
material evidence to provide notice of the information and evidence
necessary to substantiate the particular factual element or elements
that were found insufficient in the previous denial of the claim.
Response: Pursuant to 38 U.S.C. 5103(a)(1), upon receipt of a claim
to reopen a previously denied claim, VA is not required to provide
notice of the information and evidence necessary to substantiate the
particular factual element or elements that were found insufficient in
the previous denial of the claim.
Effective Date: November 21, 2014.
Tammy L. Kennedy,
Acting General Counsel, Department of Veterans Affairs.
VAOPGCPREC 1-2012
Question Presented: What is the Secretary's responsibility for
managing and distributing funds held in escrow for a Specially Adapted
Housing (SAH) construction case if a Veteran decides not to complete
the purchase of the property after grant funds have been deposited into
an escrow account?
Held: When a Veteran decides not to complete the purchase of a
property after SAH grant funds have been disbursed, the Secretary must
determine whether the contractor has both performed his obligations
under the construction contract and satisfied the SAH guidelines. If
the contractor has done so, VA should release the funds to the
contractor in accordance with 38 CFR 36.4410 and the escrow agreement.
If the contractor has not, the funds should remain in the escrow
account pending civil litigation.
Effective Date: January 24, 2012.
Will A. Gunn,
General Counsel, Department of Veterans Affairs.
VAOPGCPREC 2-2012
Question Presented: With regard to the implementation of Public Law
112-154--
a. Are new regulations necessary before implementing sec. 202?
[[Page 13996]]
b. When are secs. 204 and 205 effective?
c. Are surviving spouses under sec. 206 exempt from paying the
statutory loan fee usually required under 38 U.S.C. 3729? Are such
spouses eligible for double entitlement?
d. Is sec. 701 consistent with current regulations and policies?
What regulations, if any, are necessary before implementing the
provision?
Held: a. Regulations are not necessary before implementing sec.
202, as a new regulation would merely be a restatement of the statute.
VA may provide the assistance, effective as of October 1, 2012. VA is
still required, nevertheless, to promulgate a new final regulation, not
subject to notice and comment, to address the statutory change.
b. In accordance with the plain meaning of the statute, the
Department should implement sec. 204 on August 6, 2013, which is one
year from the date of enactment of Public Law 112-154, and should have
already implemented sec. 205, as it became effective August 6, 2012.
c. Surviving spouses under sec. 206 are, to the same extent as
surviving spouses under 38 U.S.C. 3701(b)(2), exempt from paying the
statutory loan fee. Also, sec. 206 surviving spouses are eligible for
double entitlement.
d. Section 701 is not inconsistent with current regulations and
policies and, for the most part, can be implemented before a final rule
is published. To the extent VA is required to implement a new policy
decision not expressly prescribed in the statute or addressed in
current regulations, VA should publish a proposed rule and allow the
public to comment on VA's plans for implementation.
Effective Date: October 31, 2012.
Will A. Gunn,
General Counsel, Department of Veterans Affairs.
VAOPGCPREC 3-2012
Question Presented: VBA plans to contact individuals whose claims
for compensation for PTSD due to MST (also called in-service personal
or sexual assault) have been previously denied and to offer them the
opportunity to have their claims reviewed. The purpose of the review is
to ensure that VBA properly developed and decided the claims. As
necessary, VBA plans to take corrective action to remedy errors
identified in the review. In connection with this review, your staff
has asked for our advice on the following questions:
1. Under what legal authority can VBA undertake such a review of
previously denied claims for compensation? Can VA undertake such review
and corrective action without requiring the submission of new and
material evidence or an allegation of clear and unmistakable error
(CUE)? Does this authority apply to review of conditions other than
PTSD which may be claimed as a result of MST? Would that authority
apply to a review and possible reconsideration of the claim without the
express written consent of the claimant?
2. What information should VBA include in its letter to claimants
regarding this review?
3. After its review, if VBA should decide to grant the benefit
originally sought, what factors affect the assigning of an effective
date? In particular, would VBA be able to apply 38 CFR 3.114, ``Change
of law or Department of Veterans Affairs issue'' to claims which are
granted as a result of the review?
4. Does VA have the authority, by regulation or otherwise, to
extend the liberalized evidentiary standards associated with
compensation claims involving MST to claims based upon mental disorders
other than PTSD or any physical disorders also alleged to involve MST?
5. If VA does not have this authority, what options may it consider
to liberalize evidentiary standards for disabilities other than PTSD
that may involve MST?
6. What is the legal basis, if any, for VA to use difference-of-
opinion authority in this review to grant compensation for disabilities
caused by MST after adverse decisions have become final, i.e.,
decisions for which the appeal period has elapsed?
7. What consequences, if any, might VA expect from the use of
difference-of-opinion authority to overturn final decisions as
described above?
Held: 1. VBA has authority under 38 U.S.C. 303 to initiate a review
of any class of claim decisions and may revise the decisions subject to
the statutes and regulations governing finality. The consent of the
claimant is not required to conduct such a review.
2. If the appeal period has elapsed or a final Board decision has
issued, a decision on a claim may be revised only on the basis of
submission of new and material evidence or a determination by VBA or
the Board, as appropriate, that the original decision was the product
of CUE. VBA may accept a claim to reopen and may develop for new and
material evidence even if the claimant does not proffer new and
material evidence at the time of the request to reopen. If new and
material evidence is obtained and the claim is ultimately reopened and
benefits are awarded, the effective date would be based on the date
that the application to reopen was filed and the facts found, unless
the new and material evidence consists of official service department
records, in which case the effective date may be as early as the date
of the original claim, if supported by the facts found. Decisions that
are not timely appealed become final and are not subject to revision on
the basis of difference of opinion.
3. If the appeal period has not elapsed and VBA wishes to revise
the claim decision based on the evidence in the file, VBA may revise
the decision in a manner favorable to the claimant based on difference
of opinion, if the matter is referred to Central Office. 38 CFR
3.105(b). If review of the file leads VBA to believe that the claim may
not have been adequately developed, VBA may conduct the necessary
development. If development leads to an award of benefits prior to the
expiration of the appeal period, the effective date would be the date
entitlement arose or the date of receipt of the claim, whichever is
later. If the claimant submits new and material evidence prior to the
expiration of the appeal period and receives an award of benefits on
that basis, the effective date would be the date entitlement arose or
the date of original receipt of the claim, whichever is later. If a
review of the file reveals the original decision was a product of CUE,
the original decision must be revised, and the effective date would be
the date entitlement arose or the date of the original receipt of the
claim, whichever is later.
4. Neither 38 CFR 3.304(f)(5), nor documents issued by VA providing
guidance on the implementation of that provision, would constitute a
liberalizing administrative issue for purposes of the effective date
rules of 38 CFR 3.114.
5. VA has authority to extend by notice and comment rulemaking
evidentiary rules associated with compensation claims involving MST to
claims involving physical and mental disabilities other than PTSD.
Further, under existing statutes and regulations, VA may in a
particular case find that evidence from alternative sources, such as
those described in Sec. 3.304(f)(5), is sufficient to establish a
particular fact at issue, such as that a personal assault occurred
during service.
Effective Date: December 20, 2012.
Will A. Gunn,
General Counsel, Department of Veterans Affairs.
VAOPGCPREC 1-2011
Question Presented: A. What procedures are used to designate
[[Page 13997]]
documents as constituting Veterans Health Administration (VHA) medical
quality-assurance documents?
B. What types of documents qualify as quality-assurance documents?
C. Is the Board authorized to examine quality-assurance records or
documents to determine whether they are protected by 38 U.S.C. 5705?
D. Does VA's duty to assist in claim development under 38 U.S.C.
5103A require the Board to attempt to obtain quality-assurance records?
Held: A. Under 38 U.S.C. 5705(a), records and documents created by
VA as part of a medical quality-assurance program are confidential and
privileged and may not be disclosed to any person or entity except as
provided in sec. 5705(b). For a record or document to be protected from
disclosure by sec. 5705(a), VA must designate the VA systematic health-
care review activities to be carried out by or for VA for purposes of
improving the quality of VA medical care or the utilization of VA
health-care resources in VA health-care facilities, and VA must specify
in regulations prescribed to implement sec. 5705 those activities so
designated. VA has designated, at 38 CFR 17.501(a), four systematic
health-care review activities to be carried out by or for VA for the
stated purposes. In addition, only records or documents and parts of
records or documents resulting from those activities that have been
described in advance and in writing by the Under Secretary for Health
(USH), a Veterans Integrated Service Network (VISN) director, or a VHA
medical facility director as being included under the four designated
classes of healthcare quality-assurance reviews are protected by sec.
5705 and implementing VA regulations. Further, if the activity that
generated the document was performed at a VA medical treatment
facility, either the activity must have been performed by staff of that
facility or the non-staff individuals who performed the activity must
have had their roles in performing the activity designated in writing
before performing the activity. Whether these statutory, regulatory,
and policy requirements were met in any particular case is a matter for
determination by the appropriate VHA official in the first instance
and, if the VHA determination is affirmative, by the General Counsel or
Deputy General Counsel on appeal.
B. The types of documents that qualify as quality-assurance
documents are described in 38 CFR 17.501. They may be in written,
computer, electronic, photographic, or any other form. Generally, to
constitute a VHA quality assurance record or document that is
privileged and confidential, a record or document: (1) Must have been
produced by or for VA in conducting a medical quality-assurance
activity; (2) must have resulted from a quality-assurance activity
described in advance in writing by the USH, a VHA VISN director, or a
health-care facility director as being within the classes of healthcare
quality assurance reviews listed in 38 CFR 17.501(a); and (3) must
either: (A) Identify individual practitioners, patients, or reviewers;
(B) contain discussions, by healthcare evaluators during a review of
quality-assurance information, relating to the quality of VA medical
care or the utilization of VA medical resources; (C) be individual
committee, service, or study team minutes, notes, reports, memoranda,
or other documents either produced by healthcare evaluators in
deliberating on the findings of healthcare reviews or prepared for
purposes of discussion or consideration by healthcare evaluators during
a quality-assurance review; (D) be a memorandum, letter, or other
document from a medical facility to a VISN director or VA Central
Office that contains information generated by a quality-assurance
activity; or (E) be a memorandum, letter, or other document produced by
a VISN director or VA Central Office that either responds to or
contains information generated by a quality-assurance activity.
Clinical treatment records would generally not satisfy these criteria.
Records and documents that do not qualify for protection under 38
U.S.C. 5705(a), even if they otherwise meet the criteria under Sec.
17.501(a)-(c) for quality-assurance documents, are described in 38 CFR
17.501(g).
C. Under 38 U.S.C. 5705(b)(5), nothing in sec. 5705 is to be
construed as limiting the use of quality-assurance records and
documents within VA, and 38 U.S.C. 5705(b)(1) explicitly requires
disclosures of quality-assurance records or documents under certain
specified circumstances. However, under 38 CFR 17.508(a), access within
VA to confidential and privileged quality-assurance records and
documents is restricted to employees who need such information to
perform their governmental duties and who are authorized access by the
VA medical facility director, VISN director, or USH, by their
designees, or by VA's implementing regulations at 38 CFR 17.500 through
17.511. Neither sec. 5705(b)(1) nor VA's implementing regulations at 38
CFR 17.500 through 17.511 authorize disclosure of quality-assurance
records or documents to an agency of original jurisdiction or the Board
for purposes of adjudicating a claim or an appeal to the Secretary of a
claim decision.
D. Section 5103A, of title 38, United States Code, requires
agencies of original jurisdiction and the Board to make reasonable
efforts to request from VHA any quality-assurance records or documents
that are relevant to a claim, provided the claimant furnishes
information sufficient to locate the records or documents, and, if VHA
denies access to the records and documents on the basis that they are
protected by sec. 5705 and implementing regulations, to appeal VHA's
denial to OGC under 38 CFR 17.506. Under 38 CFR 17.508(c), any quality-
assurance record or document, whether confidential and privileged or
not, may be provided to the General Counselor any attorney within OGC,
wherever located. If VHA and OGC conclude that the records and
documents are protected by sec. 5705 and implementing regulations, VA
may not consider them and rely on them in the adjudication of the
claim. If VHA or OGC concludes that the records and documents are not
confidential and privileged, VA may consider them in adjudicating the
claim.
Effective Date: April 19, 2011.
Will A. Gunn,
General Counsel, Department of Veterans Affairs.
Signing Authority
The 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. Robert L. Wilkie, Secretary, Department of Veterans
Affairs, approved this document on September 27, 2018, for
publication.
Dated: April 3, 2019.
Luvenia Potts,
Program Specialist, Office of Regulation Policy & Management, Office of
the Secretary, Department of Veterans Affairs.
[FR Doc. 2019-06855 Filed 4-5-19; 8:45 am]
BILLING CODE 8320-01-P