## Section B. Determining the Issues

#### Overview

+------------+---------------------------------------------------------+
| #          | > This section contains the following topics:           |
| #### In th |                                                         |
| is Section |                                                         |
+------------+---------------------------------------------------------+

  ------------ ---------------------------------------------- ------------
  Topic        Topic Name                                     See Page

  2            Types of Issues                                6-B-2

  3            Inferred Issues and Ancillary Benefits         6-B-4

  4            Qualifying Disabilities Under 38 CFR 3.383     6-B-9

  5            Extra-Schedular Consideration                  6-B-10

  6            Other Issues to Consider                       6-B-12
  ------------ ---------------------------------------------- ------------

#### 2. Types of Issues

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about the various     |
| troduction | > types of issues, including                            |
|            |                                                         |
|            | -   recognizing issues when preparing a decision        |
|            |                                                         |
|            | -   clarifying partial or ambiguous claims, and         |
|            |                                                         |
|            | -   examples of issues addressed in decisions.          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| **Change   | > December 13, 2005                                     |
| Date**     |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > When preparing a decision, the Rating Veterans        |
| ## a. Reco | > Service Representative (RVSR) must recognize,         |
| gnizing Is | > develop, and/or decide all issues, whether            |
| sues When  |                                                         |
| Preparing  | -   expressly claimed                                   |
| a Decision |                                                         |
|            | -   implied                                             |
|            |                                                         |
|            | -   informal                                            |
|            |                                                         |
|            | -   potential                                           |
|            |                                                         |
|            | -   mandated, or                                        |
|            |                                                         |
|            | -   ambiguous.                                          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b    | > Partial or ambiguous claims should be clarified to    |
| . Clarifyi | > ensure that the decision is complete and appropriate. |
| ng Partial | >                                                       |
|  or Ambigu | > When a claim is ambiguous, indicate in the decision   |
| ous Claims | > that the appropriate clarification or evidence will   |
|            | > be separately requested.                              |
+------------+---------------------------------------------------------+

Continued on next page

2\. Types of Issues, Continued

+------------+---------------------------------------------------------+
| ##### c. E | > The table below contains examples of different types  |
| xamples of | > of issues that are addressed in rating decisions.     |
|  Issues Ad |                                                         |
| dressed in |                                                         |
|  Decisions |                                                         |
+------------+---------------------------------------------------------+

+-----------------+----------------------------------------------------+
| Types of Issues | Examples                                           |
+-----------------+----------------------------------------------------+
| Expressed       | Elevated cholesterol is listed as a disability     |
|                 | being claimed on *VA Form 21-526*.                 |
+-----------------+----------------------------------------------------+
| Implied         | A congressional inquiry indicates the veteran's    |
|                 | job is in jeopardy due to service-connected (SC)   |
|                 | disability.                                        |
+-----------------+----------------------------------------------------+
| Informal        | A veteran says he cannot work due to one or more   |
|                 | SC conditions.                                     |
+-----------------+----------------------------------------------------+
| Irrelevant      | The history reads, "*General Medical Examination*  |
|                 | (*GME) 11 months after service indicates treatment |
|                 | for post-service fracture*."                       |
+-----------------+----------------------------------------------------+
| Potential       | -   Department of Veterans Affairs (VA)            |
|                 |     examination report indicates the veteran       |
|                 |     believes a new condition should be SC          |
|                 |                                                    |
|                 | -   VA examination report indicates an undiagnosed |
|                 |     illness that was not previously claimed in a   |
|                 |     Gulf War case                                  |
|                 |                                                    |
|                 | -   medical evidence shows lumbosacral strain may  |
|                 |     be due to SC knee instability                  |
|                 |                                                    |
|                 | -   former prisoner of war (POW) examination       |
|                 |     report notes additional disabilities that may  |
|                 |     be related to service, or                      |
|                 |                                                    |
|                 | -   service medical records (SMRs) show            |
|                 |     epididymectomy due to epididymitis that could  |
|                 |     qualify for Special Monthly Compensation (SMC) |
|                 |     at the (*k*) rate.                             |
+-----------------+----------------------------------------------------+
| Mandated        | Aid and Attendance (A&A) or Housebound benefits    |
|                 | when a 100 percent SC or nonservice-connected      |
|                 | (NSC) rating is assigned.                          |
+-----------------+----------------------------------------------------+
| Ambiguous       | -   VA examination indicates veteran or examiner   |
|                 |     mistakenly assumes a disability already is SC  |
|                 |                                                    |
|                 | -   veteran mentions a new disability in his       |
|                 |     individual unemployability (IU) claim without  |
|                 |     elaboration, or                                |
|                 |                                                    |
|                 | -   hypertension without a date of onset is noted  |
|                 |     during a general medical examination 16 months |
|                 |     after service.                                 |
+-----------------+----------------------------------------------------+

#### 3. Inferred Issues and Ancillary Benefits

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about inferred issues |
| troduction | > and ancillary benefits, including                     |
|            |                                                         |
|            | -   the definition of the term ***inferred issue***     |
|            |                                                         |
|            | -   the definition of the term ***ancillary benefits*** |
|            |                                                         |
|            | -   types of ancillary benefits, and                    |
|            |                                                         |
|            | -   examples of inferred issues.                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > August 1, 2006                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > An ***inferred issue*** is derived from the           |
|  a. Defini | > consideration or outcome of related issues. Often the |
| tion: Infe | > primary and inferred issues share the same fact       |
| rred Issue | > pattern.                                              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > ***Ancillary benefits*** are secondary benefits that  |
| Definition | > are considered when evaluating claims for             |
| : Ancillar |                                                         |
| y Benefits | -   compensation                                        |
|            |                                                         |
|            | -   pension, or                                         |
|            |                                                         |
|            | -   Dependency and Indemnity Compensation (DIC)         |
|            |     entitlement.                                        |
|            |                                                         |
|            | > Eligibility for ancillary benefits is contingent on   |
|            | > the type of disability entitlement the veteran has or |
|            | > the circumstances of the veteran's death.             |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Some types of ancillary benefits are                  |
| c. Types o |                                                         |
| f Ancillar | -   Dependents' Educational Assistance under [38 U.S.C. |
| y Benefits |     Chapter                                             |
|            |     35](http://straylight.law.cornell.ed                |
|            | u/uscode/html/uscode38/usc_sup_01_38_10_III_20_35.html) |
|            |                                                         |
|            | -   specially adapted housing under [38 CFR             |
|            |     3.809](http://                                      |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_809.DOC) |
|            |                                                         |
|            | -   special housing adaptation grants under [38 CFR     |
|            |     3.809a](http://                                     |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_809.DOC) |
|            |                                                         |
|            | -   automotive and adaptive equipment under [38 CFR     |
|            |     3.808](http://                                      |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_808.DOC) |
|            |                                                         |
|            | -   vocational rehabilitation and employment (VR&E),    |
|            |     and                                                 |
|            |                                                         |
|            | -   loan guaranty for surviving spouses under [38 CFR   |
|            |     3.805](http://w                                     |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_805.DOC). |
|            |                                                         |
|            | > ***Reference***: For more information on ancillary    |
|            | > benefits, see M21-1MR, Part IX, Subpart i.            |
+------------+---------------------------------------------------------+

Continued on next page

3\. Inferred Issues and Ancillary Benefits, Continued

+------------+---------------------------------------------------------+
| #####      | > The table below shows examples of inferred issues.    |
| d. Example | >                                                       |
| s of Infer | > ***Note***: In general, infer an issue only when      |
| red Issues | > entitlement can be granted. Do not put a benefit at   |
|            | > issue merely to deny it.                              |
|            | >                                                       |
|            | > ***Exceptions***: Consider the following inferred     |
|            | > issues in all applicable ratings, regardless of       |
|            | > whether benefits are granted or denied:               |
|            |                                                         |
|            | -   a ten percent evaluation under [38 CFR              |
|            |     3.324](http://w                                     |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_323.DOC), |
|            |     and                                                 |
|            |                                                         |
|            | -   service connection for hypertension as secondary to |
|            |     diabetes mellitus with diabetic nephropathy.        |
+------------+---------------------------------------------------------+

+----------------------------------+-----------------------------------+
| If ...                           | Then infer entitlement to ...     |
+----------------------------------+-----------------------------------+
| a total and permanent            | Dependents' Educational           |
| service-connected evaluation is  | Assistance.                       |
| established                      |                                   |
|                                  | ***Note***: Also infer            |
| -   on a schedular basis, or     | entitlement to Dependents'        |
|                                  | Educational Assistance whenever   |
| -   based on entitlement to      | permanency of a total evaluation  |
|     individual unemployability   | is subsequently established. Do   |
|                                  | *not* put entitlement at issue    |
|                                  | merely to deny it.                |
|                                  |                                   |
|                                  | ***Reference***: For more         |
|                                  | information on determining        |
|                                  | entitlement to Dependents'        |
|                                  | Educational Assistance, see       |
|                                  | M21-1MR, Part IX, Subpart ii,     |
|                                  | 2.1.                              |
+----------------------------------+-----------------------------------+
| there is a severe degree of      | SMC.                              |
| disability involving             |                                   |
|                                  |                                   |
| -   the loss or loss of use of   |                                   |
|     an extremity or sensory      |                                   |
|     organ, or                    |                                   |
|                                  |                                   |
| -   any other functional loss    |                                   |
|     providing entitlement to     |                                   |
|     SMC.                         |                                   |
+----------------------------------+-----------------------------------+
| a single 100 percent evaluation  | A&A.                              |
| is assigned in a compensation or |                                   |
| pension case                     | ***Note***: Do *not* put A&A      |
|                                  | benefits at issue if the evidence |
|                                  | does not show entitlement.        |
+----------------------------------+-----------------------------------+
| -   a single 100 percent         | Housebound.                       |
|     evaluation is assigned in a  |                                   |
|     compensation or pension      | ***Note***: Do *not* put          |
|     case, and                    | Housebound benefits at issue if   |
|                                  | the evidence does not show        |
| -   A&A is not payable           | entitlement.                      |
+----------------------------------+-----------------------------------+

Continued on next page

3\. Inferred Issues and Ancillary Benefits, Continued

  -----------------------------------------------------------------------
  d\. Examples of Inferred Issues (continued)

  -----------------------------------------------------------------------

+----------------------------------+-----------------------------------+
| If ...                           | Then infer entitlement to ...     |
+----------------------------------+-----------------------------------+
| retroactive disability pension   | retroactive benefits.             |
| is not claimed, but a qualifying |                                   |
| disability may exist             | ***Note***: Advise the claimant   |
|                                  | that retroactive benefits may be  |
|                                  | payable.                          |
|                                  |                                   |
|                                  | ***Reference***: For more         |
|                                  | information on retroactive        |
|                                  | pensions, see [38 CFR             |
|                                  | 3.400(b)(1)(ii)(B                 |
|                                  | )](http://www.warms.vba.va.gov/re |
|                                  | gs/38CFR/BOOKB/PART3/S3_400.DOC). |
+----------------------------------+-----------------------------------+
| a pension claimant fails to meet | extra-schedular consideration     |
| the schedular requirements for   | under [38 CFR                     |
| permanent and total disability   | 3.321(b)(2                        |
|                                  | )](http://www.warms.vba.va.gov/re |
|                                  | gs/38CFR/BOOKB/PART3/S3_321.DOC). |
+----------------------------------+-----------------------------------+
| a veteran has                    | a ten percent rating under [38    |
|                                  | CFR                               |
| -   no compensable               | 3.32                              |
|     evaluation(s), and           | 4](http://www.warms.vba.va.gov/re |
|                                  | gs/38CFR/BOOKB/PART3/S3_323.DOC). |
| -   more than one                |                                   |
|     non-compensable              | ***Important***: This benefit     |
|     evaluation(s)                | *must* be considered in all       |
|                                  | applicable ratings, including     |
|                                  | confirmed ratings, even when      |
|                                  | entitlement is denied.            |
+----------------------------------+-----------------------------------+
| a claim for service connection   | treatment for psychosis under     |
| for a psychosis based on wartime |                                   |
| service is denied                | [38 U.S.C.                        |
|                                  | 1702](http://assembler.law.c      |
|                                  | ornell.edu/uscode/html/uscode38/u |
|                                  | sc_sec_38_00001702----000-.html). |
+----------------------------------+-----------------------------------+
| -   there is a reasonable        | DIC.                              |
|     probability that the         |                                   |
|     veteran's death may be SC    |                                   |
|     whether from                 |                                   |
|                                  |                                   |
| ```{=html}                       |                                   |
| <!-- -->                         |                                   |
| ```                              |                                   |
| -   disease                      |                                   |
|                                  |                                   |
| -   injury, or                   |                                   |
|                                  |                                   |
| -   self-infliction, and         |                                   |
|                                  |                                   |
| ```{=html}                       |                                   |
| <!-- -->                         |                                   |
| ```                              |                                   |
| -   a claim for death benefits   |                                   |
|     is received                  |                                   |
+----------------------------------+-----------------------------------+

Continued on next page

3\. Inferred Issues and Ancillary Benefits, Continued

  -----------------------------------------------------------------------
  d\. Examples of Inferred Issues (continued)

  -----------------------------------------------------------------------

+----------------------------------+-----------------------------------+
| If ...                           | Then infer entitlement to ...     |
+----------------------------------+-----------------------------------+
| -   at the time of death the     | -   DIC under [38 U.S.C.          |
|     veteran was rated 100        |     1318](http://assembler.law.   |
|     percent disabled due to SC   | cornell.edu/uscode/html/uscode38/ |
|     disabilities or entitled to  | usc_sec_38_00001318----000-.html) |
|     individual unemployability,  |     , if service connection for   |
|     and                          |     cause of death cannot be      |
|                                  |     granted, and                  |
| -   a claim for death benefits   |                                   |
|     is received                  | -   Dependents' Educational       |
|                                  |     Assistance under [38 U.S.C.   |
|                                  |     Chapter                       |
|                                  |     35](http://straylight.law.    |
|                                  | cornell.edu/uscode/html/uscode38/ |
|                                  | usc_sup_01_38_10_III_20_35.html). |
+----------------------------------+-----------------------------------+
| a rating initially establishes   | Specially Adapted Housing         |
| service connection for permanent |                                   |
| and total disability due to the  | ***Reference***: For more         |
| loss or loss of use (L/LOU) of   | information on entitlement to     |
|                                  | Specially Adapted Housing, see    |
| -   one lower extremity,         |                                   |
|     requiring the use of braces, | -   [38 U.S.C.                    |
|     crutches, canes, or a        |                                   |
|     wheelchair for mobility due  |    2101(a)](http://assembler.law. |
|     to                           | cornell.edu/uscode/html/uscode38/ |
|                                  | usc_sec_38_00002101----000-.html) |
| ```{=html}                       |                                   |
| <!-- -->                         | -   [38 CFR                       |
| ```                              |     3.80                          |
| -   the L/LOU of the other lower | 9](http://www.warms.vba.va.gov/re |
|     extremity                    | gs/38CFR/BOOKB/PART3/S3_809.DOC), |
|                                  |     and                           |
| -   the L/LOU of an upper        |                                   |
|     extremity, or                | -   M21-1MR, Part IX, Subpart i,  |
|                                  |     3.                            |
| -   another organic condition    |                                   |
|     which affects balance or     |                                   |
|     propulsion                   |                                   |
|                                  |                                   |
| ```{=html}                       |                                   |
| <!-- -->                         |                                   |
| ```                              |                                   |
| -   one lower extremity plus     |                                   |
|     bilateral vision loss, with  |                                   |
|     only light perception, or    |                                   |
|                                  |                                   |
| -   both upper extremities at or |                                   |
|     above the elbows             |                                   |
+----------------------------------+-----------------------------------+
| a rating initially establishes   | Special Housing Adaptation grant. |
| service connection for           |                                   |
|                                  | ***Reference***: For more         |
| -   bilateral vision loss, with  | information on entitlement to the |
|     visual acuity of 5/200 or    | Special Housing Adaptation grant, |
|     less, or                     | see                               |
|                                  |                                   |
| -   L/LOU of both hands          | -   [38 U.S.C.                    |
|                                  |                                   |
|                                  |    2101(b)](http://assembler.law. |
|                                  | cornell.edu/uscode/html/uscode38/ |
|                                  | usc_sec_38_00002101----000-.html) |
|                                  |                                   |
|                                  | -   [38 CFR                       |
|                                  |     3.809a                        |
|                                  | ](http://www.warms.vba.va.gov/reg |
|                                  | s/38CFR/BOOKB/PART3/S3_809a.DOC), |
|                                  |     and                           |
|                                  |                                   |
|                                  | -   M21-1MR, Part IX, Subpart i,  |
|                                  |     3.                            |
+----------------------------------+-----------------------------------+

Continued on next page

3\. Inferred Issues and Ancillary Benefits, Continued

  -----------------------------------------------------------------------
  d\. Examples of Inferred Issues (continued)

  -----------------------------------------------------------------------

+----------------------------------+-----------------------------------+
| If ...                           | Then infer entitlement to ...     |
+----------------------------------+-----------------------------------+
| a rating initially establishes   | -   automobile, and               |
| service connection for permanent |                                   |
| and total disability due to      | -   automobile adaptive           |
|                                  |     equipment.                    |
| -   L/LOU of a hand or foot      |                                   |
|                                  | ***Reference***: For more         |
| -   bilateral vision loss with   | information on entitlement to an  |
|     corrected acuity 20/200 or   | automobile or automobile adaptive |
|     worse in the better eye, or  | equipment, see                    |
|                                  |                                   |
| -   bilateral vision loss with   | -   [38 CFR                       |
|     field constricted to 20      |     3.80                          |
|     degrees in the better eye    | 8](http://www.warms.vba.va.gov/re |
|                                  | gs/38CFR/BOOKB/PART3/S3_808.DOC), |
|                                  |     and                           |
|                                  |                                   |
|                                  | -   [38 U.S.C.                    |
|                                  |     3902](http://assembler.law.c  |
|                                  | ornell.edu/uscode/html/uscode38/u |
|                                  | sc_sec_38_00003902----000-.html). |
+----------------------------------+-----------------------------------+
| service connection is            | automobile adaptive equipment.    |
| established for ankylosis of the |                                   |
| hip or knee                      |                                   |
+----------------------------------+-----------------------------------+
| -   service connection is        | service connection for            |
|     established for              | hypertension as secondary to      |
|                                  | diabetes mellitus.                |
| ```{=html}                       |                                   |
| <!-- -->                         | ***Important***: This benefit     |
| ```                              | *must* be considered in all       |
| -   diabetes mellitus, and       | applicable ratings, even when     |
|                                  | entitlement is denied.            |
| -   diabetic nephropathy, and    |                                   |
|                                  | ***Reference***: For information  |
| ```{=html}                       | on evaluating an inferred claim   |
| <!-- -->                         | for hypertension, see M21-1MR,    |
| ```                              | Part III, Subpart iv, 4.F.22.e.   |
| -   there is a diagnosis of      |                                   |
|     hypertension                 |                                   |
+----------------------------------+-----------------------------------+
| -   the schedular disability     | IU.                               |
|     requirements for IU under    |                                   |
|     [38 CFR                      | ***Reference***: For more         |
|     4.16(a                       | information on inferring a claim  |
| )](http://www.warms.vba.va.gov/r | for IU, see                       |
| egs/38CFR/BOOKC/PART4/S4_16.DOC) |                                   |
|     are met, *and*               | -   *Norris v. West*, 12 Vet App. |
|                                  |     304 (1999), and               |
| -   there is evidence in the     |                                   |
|     veteran's file or under VA   | -   M21-1MR, Part IV, Subpart ii, |
|     control that indicates       |     2.F.25.h.                     |
|     he/she may be unemployable   |                                   |
|     due to SC disability.        |                                   |
+----------------------------------+-----------------------------------+

+-----------------------------------------------------------------------+
| > ***Reference***: For information on inferring the issue of          |
| > competency while evaluating other evidence, see M21-1MR, Part III,  |
| > Subpart iv, 8.A.2.a.                                                |
+-----------------------------------------------------------------------+

#### 4. Qualifying Disabilities Under 38 CFR 3.383

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about qualifying      |
| troduction | > disabilities under 38 CFR 3.383, including            |
|            |                                                         |
|            | -   the provisions of 38 CFR 3.383, and                 |
|            |                                                         |
|            | -   qualifying disabilities under 38 CFR 3.383.         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Under [38 CFR                                         |
|  a. Provis | > 3.383](http://w                                       |
| ions of 38 | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_383.DOC), |
|  CFR 3.383 | > special consideration for paired organs and           |
|            | > extremities is payable for various combinations of SC |
|            | > and NSC disabilities, provided the NSC disability was |
|            | > not the result of the veteran's own misconduct.       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > Qualifying disabilities for special consideration     |
| #### b. Qu | > under [38 CFR                                         |
| alifying D | > 3.383](http://                                        |
| isabilitie | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_383.DOC) |
| s Under 38 | > include                                               |
|  CFR 3.383 |                                                         |
|            | -   SC blindness in one eye and NSC blindness in the    |
|            |     other eye                                           |
|            |                                                         |
|            | -   SC L/LOU of one kidney and NSC impairment of the    |
|            |     other kidney                                        |
|            |                                                         |
|            | -   SC hearing impairment compensable to a degree of 10 |
|            |     percent or more in one ear and NSC hearing          |
|            |     impairment that meets the provisions of [38 CFR     |
|            |     3.385](http://                                      |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_384.DOC) |
|            |     in the other ear                                    |
|            |                                                         |
|            | -   SC L/LOU of one hand and NSC L/LOU of the other     |
|            |     hand                                                |
|            |                                                         |
|            | -   SC L/LOU of one foot and NSC L/LOU of the other     |
|            |     foot, and                                           |
|            |                                                         |
|            | -   permanent SC impairment of one lung, rated 50       |
|            |     percent disabling, and NSC impairment of the other  |
|            |     lung.                                               |
+------------+---------------------------------------------------------+

#### 5. Extra-Schedular Consideration

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about extra-schedular |
| troduction | > consideration, including                              |
|            |                                                         |
|            | -   extra-schedular evaluations in compensation claims  |
|            |                                                         |
|            | -   approving extra-schedular evaluation in             |
|            |     compensation claims                                 |
|            |                                                         |
|            | -   submitting compensation claims for extra-schedular  |
|            |     evaluation                                          |
|            |                                                         |
|            | -   extra-schedular consideration in pension claims,    |
|            |     and                                                 |
|            |                                                         |
|            | -   preparing copies of rating decisions.               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > Consider the issue of entitlement to an               |
| Extra-Sche | > extra-schedular evaluation in compensation claims     |
| dular Eval | > under                                                 |
| uations in |                                                         |
|  Compensat | -   [38 CFR                                             |
| ion Claims |     3.321(b)(1)](http://                                |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_321.DOC) |
|            |     only where                                          |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   the issue is expressly raised by the veteran, or    |
|            |                                                         |
|            | -   there is evidence of *exceptional* or *unusual*     |
|            |     circumstances indicating that the rating schedule   |
|            |     may be inadequate to compensate for the average     |
|            |     impairment of earning capacity due to disability    |
|            |     (for example, marked interference with employment   |
|            |     or frequent periods of hospitalization)             |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   [38 CFR                                             |
|            |     4.16(b)](http:/                                     |
|            | /www.warms.vba.va.gov/regs/38CFR/BOOKC/PART4/S4_16.DOC) |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   whenever the issue is expressly stated              |
|            |                                                         |
|            | -   when there is evidence that the veteran may be      |
|            |     unable to secure or follow a substantially gainful  |
|            |     occupation because of disability, or                |
|            |                                                         |
|            | -   total disability based on individual                |
|            |     unemployability (IU) cannot be granted on a         |
|            |     schedular basis.                                    |
|            |                                                         |
|            | > ***Reference***: For more information on total        |
|            | > disability claims, see                                |
|            |                                                         |
|            | -   VAOGCPREC 6-96 dated August 16, 1996                |
|            |                                                         |
|            | -   *Floyd v. Brown*, 9 Vet. App. 88 (1996), and        |
|            |                                                         |
|            | -   *Bagwell v. Brown*, 9 Vet. App. 337 (1996).         |
+------------+---------------------------------------------------------+

Continued on next page

5\. Extra-Schedular Consideration, Continued

+------------+---------------------------------------------------------+
| ##### b.   | > Only the Director of the Compensation and Pension     |
|  Approving | > (C&P) Service may approve extra-schedular evaluations |
|  Extra-Sch | > in compensation cases submitted under [38 CFR         |
| edular Eva | > 3.321(b)(1)](http://w                                 |
| luation in | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_321.DOC). |
|  Compensat |                                                         |
| ion Claims |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Submit compensation claims to C&P Service for         |
| ## c. Subm | > extra-schedular consideration under [38 CFR           |
| itting Com | > 3.321(b)(1)](http://                                  |
| pensation  | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_321.DOC) |
| Claims for | > if                                                    |
|  Extra-Sch |                                                         |
| edular Con | -   the schedular evaluations are considered to be      |
| sideration |     inadequate for an individual disability, or         |
|            |                                                         |
|            | -   a total rating cannot be assigned solely because    |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   the minimum schedular requirements of [38 CFR       |
|            |     4.16](http:/                                        |
|            | /www.warms.vba.va.gov/regs/38CFR/BOOKC/PART4/S4_16.DOC) |
|            |     of the rating schedule are not met, and             |
|            |                                                         |
|            | -   a total rating is considered warranted.             |
|            |                                                         |
|            | > ***Note***: Prepare a memorandum to accompany the     |
|            | > claims folder providing a clear and concise statement |
|            | > of the facts including medical and lay evidence of    |
|            | > symptoms and a discussion of the                      |
|            |                                                         |
|            | -   fact with relevant laws                             |
|            |                                                         |
|            | -   issue or issues to be resolved, and                 |
|            |                                                         |
|            | -   recommended evaluation.                             |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > In pension claims consider the issue of entitlement   |
| d. Extra-S | > to an extra-schedular evaluation under [38 CFR        |
| chedular C | > 3.321(b)(2)](http://                                  |
| onsiderati | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_321.DOC) |
| on in Pens | > whenever a veteran fails to meet the schedular        |
| ion Claims | > requirements for permanent and total disability. If   |
|            | > approval is recommended, forward the rating decision  |
|            | > and file to the Veterans Service Center Manager       |
|            | > (VSCM) or designee for signature.                     |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > When rating decisions are approved under the          |
|  e. Prepar | > provisions of [38 CFR                                 |
| ing Copies | > 3.321(b)(2)](http://                                  |
|  of Rating | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_321.DOC) |
|  Decisions |                                                         |
|            | -   prepare an extra copy of rating decisions           |
|            |                                                         |
|            | -   maintain the copies for a period of two years, and  |
|            |                                                         |
|            | -   then destroy the copies.                            |
+------------+---------------------------------------------------------+

#### 6. Other Issues to Consider

+------------+---------------------------------------------------------+
| ##### C    | > August 1, 2006                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > The table below provides information about other      |
|  Other Iss | > issues to consider when evaluating the evidence       |
| ues to Con | > submitted with a claim.                               |
| sider When |                                                         |
|  Evaluatin |                                                         |
| g Evidence |                                                         |
+------------+---------------------------------------------------------+

+----------------+-----------------------------------------------------+
| If the issue   | Then consider ...                                   |
| is ...         |                                                     |
+----------------+-----------------------------------------------------+
| service        | -   expressly claimed conditions, and               |
| connection     |                                                     |
|                | -   unclaimed disabilities based on the evidence of |
|                |     record.                                         |
|                |                                                     |
|                | ***Reference***: For more information on the types  |
|                | of claims for service connection, see M21-1MR, Part |
|                | III, Subpart iv, 6.B.2.c.                           |
+----------------+-----------------------------------------------------+
| secondary      | whether the                                         |
| service        |                                                     |
| connection     | -   NSC condition is the direct result of the SC    |
|                |     condition, or                                   |
|                |                                                     |
|                | -   SC condition aggravated the NSC condition and,  |
|                |     if so, what was the baseline level of           |
|                |     disability prior to aggravation and what is the |
|                |     level currently.                                |
|                |                                                     |
|                | ***Examples***:                                     |
|                |                                                     |
|                | -   A veteran has an SC left knee injury. As a      |
|                |     result of favoring the left knee, a right knee  |
|                |     disability develops that is secondary to the    |
|                |     original SC disability.                         |
|                |                                                     |
|                | -   A veteran develops a heart condition or         |
|                |     impotence secondary to SC diabetes.             |
|                |                                                     |
|                | ***Reference***: For more information on claims for |
|                | secondary service connection based on the           |
|                | aggravation of an NSC condition, see                |
|                |                                                     |
|                | -   *Allen v. Brown*, 7 Vet. App. 439 (1995), and   |
|                |                                                     |
|                | -   M21-1MR, Part IV, Subpart ii, 2.B.6.            |
+----------------+-----------------------------------------------------+

Continued on next page

6\. Other Issues to Consider, Continued

  -----------------------------------------------------------------------
  a\. Other Issues to Consider When Evaluating Evidence (continued)

  -----------------------------------------------------------------------

+----------------+-----------------------------------------------------+
| If the issue   | Then consider ...                                   |
| is ...         |                                                     |
+----------------+-----------------------------------------------------+
| service        | whether the claimed stressor                        |
| connection for |                                                     |
| posttraumatic  | -   can be confirmed through available military     |
| stress         |     records, or                                     |
| disorder       |                                                     |
| (PTSD)         | -   should be referred to the U.S. Army and Joint   |
|                |     Services Records Research Center (JSRRC) for    |
|                |     verification.                                   |
|                |                                                     |
|                | > ***Reference***: For more information on rating   |
|                | > PTSD, see M21-1MR, Part III, Subpart iv, 4.H.31.  |
+----------------+-----------------------------------------------------+
| service        | evidence of                                         |
| connection for |                                                     |
| an undiagnosed | -   active military, navy, or air service in the    |
| illness (Gulf  |     Southwest Asia theater of operations during the |
| War)           |     Gulf War                                        |
|                |                                                     |
|                | -   the manifestation of one or more signs or       |
|                |     symptoms of undiagnosed illness                 |
|                |                                                     |
|                | -   objective indications of chronic disability     |
|                |     during the relevant period of service, or to a  |
|                |     degree of disability of ten percent or more     |
|                |     within the specified presumptive period, and    |
|                |                                                     |
|                | -   a nexus between the chronic disability and the  |
|                |     undiagnosed illness.                            |
|                |                                                     |
|                | ***Reference***: For more information on service    |
|                | connection for disabilities associated with Gulf    |
|                | War service, see M21-1MR, Part IV, Subpart ii, 2.D. |
+----------------+-----------------------------------------------------+

Continued on next page

6\. Other Issues to Consider, Continued

  -----------------------------------------------------------------------
  a\. Other Issues to Consider When Evaluating Evidence (continued)

  -----------------------------------------------------------------------

+----------------+-----------------------------------------------------+
| If the issue   | Then consider ...                                   |
| is ...         |                                                     |
+----------------+-----------------------------------------------------+
| entitlement to | whether                                             |
| compensation   |                                                     |
| under [38      | -   hospital, medical, or surgical treatment or     |
| U.S.C.         |     vocational rehabilitation was rendered by VA,   |
| 1151](htt      |     and                                             |
| p://assembler. |                                                     |
| law.cornell.ed | -   an increase in disability occurred and, if so,  |
| u/uscode/html/ |     was it due to an                                |
| uscode38/usc_s |                                                     |
| ec_38_00001151 | ```{=html}                                          |
| ----000-.html) | <!-- -->                                            |
|                | ```                                                 |
|                | -   instance of fault of VA, or                     |
|                |                                                     |
|                | -   event not reasonably foreseeable, such as an    |
|                |     accident.                                       |
|                |                                                     |
|                | ***Reference***: For more information on            |
|                | compensation under [38 U.S.C.                       |
|                | 1151](http://assembler.law.cornell.edu/usco         |
|                | de/html/uscode38/usc_sec_38_00001151----000-.html), |
|                | see M21-1MR, Part IV, Subpart ii, 2.G.              |
+----------------+-----------------------------------------------------+
| evaluation of  | -   old and new criteria, if applicable (see        |
| a disability   |     M21-1MR, Part III, Subpart iv, 7.B.3.b)         |
|                |                                                     |
|                | -   *DeLuca* *v*. *Brown*, 8 Vet. App. 202 (1995),  |
|                |     if applicable to the musculoskeletal condition, |
|                |     and                                             |
|                |                                                     |
|                | -   whether a referral for consideration of an      |
|                |     extra- schedular evaluation is warranted.       |
+----------------+-----------------------------------------------------+
| entitlement to | whether the disabilities meet the schedular         |
| pension        | requirements.                                       |
|                |                                                     |
|                | ***Note***: The extra-schedular provisions of [38   |
|                | CFR                                                 |
|                | 3.321(b)(2)](http://www.                            |
|                | warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_321.DOC) |
|                | must also be considered if schedular requirements   |
|                | are not met.                                        |
|                |                                                     |
|                | ***Reference***: For more information on schedular  |
|                | requirements, see                                   |
|                |                                                     |
|                | -   [38 CFR                                         |
|                |     4.16](http://www.                               |
|                | warms.vba.va.gov/regs/38CFR/BOOKC/PART4/S4_16.DOC), |
|                |     and                                             |
|                |                                                     |
|                | -   [38 CFR                                         |
|                |     4.17](http://www.                               |
|                | warms.vba.va.gov/regs/38CFR/BOOKC/PART4/S4_17.DOC). |
+----------------+-----------------------------------------------------+
| entitlement to | entitlement under [38 CFR                           |
| retroactive    | 3.400(b)(1)(ii)](http://www.w                       |
| pension        | arms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_400.DOC), |
|                | if a qualifying disability exists.                  |
+----------------+-----------------------------------------------------+
| disallowance   | assigning the next higher evaluation.               |
| of maximum     |                                                     |
| evaluation     |                                                     |
+----------------+-----------------------------------------------------+

Continued on next page

6\. Other Issues to Consider, Continued

  -----------------------------------------------------------------------
  a\. Other Issues to Consider When Evaluating Evidence (continued)

  -----------------------------------------------------------------------

+----------------+-----------------------------------------------------+
| If the issue   | Then consider ...                                   |
| is ...         |                                                     |
+----------------+-----------------------------------------------------+
| a disability   | -   entitlement to the higher evaluation under [38  |
| falling        |     CFR                                             |
| between        |     4.7](http://www                                 |
| schedular      | .warms.vba.va.gov/regs/38CFR/BOOKC/PART4/S4_3.DOC), |
| grades         |     if the disability picture more nearly           |
|                |     approximates the criteria required for the      |
|                |     higher rating, or                               |
|                |                                                     |
|                | -   assigning the lower evaluation.                 |
+----------------+-----------------------------------------------------+
| individual     | if entitlement was claimed, or if there is evidence |
| u              | of disability supporting entitlement not            |
| nemployability | specifically claimed.                               |
+----------------+-----------------------------------------------------+
| a death case   | accrued benefits if                                 |
|                |                                                     |
|                | -   *VA Form 21-534, Application for Dependency and |
|                |     Indemnity Compensation, Death Pension and       |
|                |     Accrued Benefits by a Surviving Spouse or Child |
|                |     (Including Death Compensation if Applicable),*  |
|                |     is filed, and                                   |
|                |                                                     |
|                | -   a disability claim was pending at the time of   |
|                |     death.                                          |
|                |                                                     |
|                | ***Reference***: For more information on accrued    |
|                | benefits, see M21-1MR, Part VIII.                   |
+----------------+-----------------------------------------------------+
| a disability   | the issue with a formal coded rating.               |
| pension claim  |                                                     |
| that was       |                                                     |
| previously     |                                                     |
| denied but is  |                                                     |
| being reopened |                                                     |
| due to         |                                                     |
|                |                                                     |
| -   evidence   |                                                     |
|     of new     |                                                     |
|                |                                                     |
|  disabilities, |                                                     |
|     or         |                                                     |
|                |                                                     |
| -   a change   |                                                     |
|     in the     |                                                     |
|     evaluation |                                                     |
|     of any     |                                                     |
|     previously |                                                     |
|     evaluated  |                                                     |
|                |                                                     |
|   disabilities |                                                     |
+----------------+-----------------------------------------------------+