## Chapter 2. Ratings for Special Purposes

#### Table of Contents

> 1\. Rating Determination for Dependents Educational Assistance (DEA)
>
> Under 38 U.S.C. Chapter 35 2-1
>
> 2\. Rating for Dental Treatment 2-8
>
> 3\. Rating Principles for Dental Conditions 2-14
>
> 4\. Rating for Medical Care 2-18
>
> 5\. Rating for Service Connection for Psychosis Under 38 U.S.C. 1702
> 2-19
>
> 6\. Rating for Insanity Determination 2-21
>
> 7\. Rating Determination for Veteran's Civil Service Disability
> Preference 2-22
>
> 8\. Rating Determination for Discharge of Liability for Educational
> Loans
>
> 38 U.S.C. 3698 2-23
>
> 9\. Rating to Extend the Delimiting Dates for Educational Assistance
> 2-25
>
> 10\. Rating for Insurance Purposes 2-29
>
> 11\. Rating for the Polish and Czechoslovakian Armed Forces Under 38
> U.S.C. 109(c) 2-32

## Chapter 2. Ratings for Special Purposes

#### 1. Rating Determination for Dependents Educational Assistance (DEA) Under 38 U.S.C. Chapter 35

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on the rating         |
| troduction | > determination for Dependents Educational Assistance   |
|            | > (DEA) under 38 U.S.C. Chapter 35, including           |
|            | > information on                                        |
|            |                                                         |
|            | -   · eligibility based on the entitlement of a member  |
|            |     of a current or former active service member        |
|            |                                                         |
|            | -   · regaining entitlement to DEA                      |
|            |                                                         |
|            | -   · responsibility for determining basic eligibility  |
|            |                                                         |
|            | -   · when to refer claims to rating activity           |
|            |                                                         |
|            | -   · when a rating decision is required                |
|            |                                                         |
|            | -   · the definition of the term ***total disability,   |
|            |     permanent in nature***                              |
|            |                                                         |
|            | -   · cases meeting the criteria of a total disability  |
|            |     permanent in nature for DEA                         |
|            |                                                         |
|            | -   · death cases meeting the criteria of a total       |
|            |     disability permanent in nature for DEA              |
|            |                                                         |
|            | -   · evaluation of cases where the veteran is          |
|            |     permanently and totally disabled                    |
|            |                                                         |
|            | -   · the effective date when permanency is             |
|            |     established, and                                    |
|            |                                                         |
|            | -   · the rating conclusion.                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > November 16, 2004                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

1\. Rating Determination for Dependents Educational Assistance (DEA)
Under 38 U.S.C. Chapter 35, Continued

+------------+---------------------------------------------------------+
| ##### a. E | > To be eligible for Dependents Educational Assistance  |
| ligibility | > (DEA) under 38 U.S.C. Chapter 35, the eligible person |
|  Based on  | > may derive entitlement from                           |
| the Entitl |                                                         |
| ement of a | -   · a veteran discharged under conditions other than  |
|  Former or |     dishonorable                                        |
|  Current A |                                                         |
| ctive Serv | -   · a former active service member who                |
| ice Member |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   \- has a total service-connected (SC) disability,   |
|            |     permanent in nature, including a total disability   |
|            |     evaluation for the loss of paired organs or         |
|            |     extremities under 38 U.S.C. 1160                    |
|            |                                                         |
|            | -   \- died as the result of a SC disability, or        |
|            |                                                         |
|            | -   \- had a permanent and total SC disability at the   |
|            |     time of death, or                                   |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   · a current active service member who, as a member  |
|            |     of the Armed Forces on active duty, has been listed |
|            |     for more than 90 days as                            |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   \- missing in action                                |
|            |                                                         |
|            | -   \- captured in the line of duty by a hostile force, |
|            |     or                                                  |
|            |                                                         |
|            | -   \- forcibly detained or interned in the line of     |
|            |     duty by a foreign government or power.              |
|            |                                                         |
|            | > ***Note***: Disability or death under 38 U.S.C. 1151  |
|            | > does not establish eligibility.                       |
|            | >                                                       |
|            | > ***Reference***: For more information on a total      |
|            | > disability evaluation for the loss of paired organs   |
|            | > or extremities under 38 U.S.C. 1160, see *Kimberlin   |
|            | > v. Brown*, 5 Vet. App. 174 (1993).                    |
+------------+---------------------------------------------------------+

Continued on next page

1\. Rating Determination for Dependents Educational Assistance (DEA)
Under 38 U.S.C. Chapter 35, Continued

+------------+---------------------------------------------------------+
| ##### b    | > Under the provisions of 38 U.S.C. 1311(e), a          |
| . Regainin | > surviving spouse who is ineligible for Dependency and |
| g Entitlem | > Indemnity Compensation (DIC) because he/she has       |
| ent to DEA | > remarried or is living with someone and holding       |
|            | > himself/herself out openly as a spouse, may regain    |
|            | > eligibility for DIC upon the termination of such      |
|            | > relationships.                                        |
|            | >                                                       |
|            | > VAOPGCPREC 13-98 held that eligibility for DIC        |
|            | > regained under these provisions did not entitle the   |
|            | > surviving spouse to Civilian Health and Medical       |
|            | > Program (CHAMPVA) benefits, DEA, or loan guaranty     |
|            | > benefits. However, *Public Law (PL) 106-117*,         |
|            | > effective November 30, 1999, explicitly restored      |
|            | > eligibility for these ancillary benefits.             |
|            | >                                                       |
|            | > ***Note***: These benefits are not payable for the    |
|            | > period from October 1, 1998 to November 30, 1999.     |
|            | >                                                       |
|            | > ***Reference***: For more information on regaining    |
|            | > entitlement to DEA, see                               |
|            | >                                                       |
|            | > M21-1MR, Part III, Subpart iii, 5.F.39 (TBD) or       |
|            | > M21-1, Part IV, 12.14g.                               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c    | > The rating activity is responsible for a              |
| . Responsi | > determination of basic eligibility for a child,       |
| bility for | > spouse, or surviving spouse(s) for DEA under 38       |
|  Determini | > U.S.C. Chapter 35.                                    |
| ng Basic E |                                                         |
| ligibility |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

1\. Rating Determination for Dependents Educational Assistance (DEA)
Under 38 U.S.C. Chapter 35, Continued

+------------+---------------------------------------------------------+
| ##         | > The issue of entitlement to DEA under 38 U.S.C.       |
| ### d. Whe | > Chapter 35 is inferred from service connection for    |
| n to Refer | > the cause of death or the assignment of a total SC    |
|  Claims to | > disability evaluation. If the issue of entitlement to |
|  the Ratin | > DEA has *not* been previously addressed,              |
| g Activity | > authorization refers claims to the rating activity    |
|            | > unless                                                |
|            |                                                         |
|            | -   · the rating of record                              |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   \- denies service connection for the cause of death |
|            |     and for permanent and total SC disability at the    |
|            |     time of death                                       |
|            |                                                         |
|            | -   \- shows death was either directly or presumptively |
|            |     SC                                                  |
|            |                                                         |
|            | -   \- shows SC total disability either on a schedular  |
|            |     basis or due to individual unemployability, with no |
|            |     future examination scheduled                        |
|            |                                                         |
|            | -   \- shows that a 100 percent evaluation has been     |
|            |     granted under the provisions of 38 CFR 4.28, 38 CFR |
|            |     4.29, or 38 CFR 4.30, or                            |
|            |                                                         |
|            | -   \- denies service connection for all disabilities,  |
|            |     or                                                  |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   · death is SC without a determination by the rating |
|            |     activity in accordance with M21-1MR, Part IV,       |
|            |     Subpart iii, 1.2 (TBD) or M21-1, Part III, 3.06.    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > A rating decision is *required* if the issue of       |
| ## e. When | > permanency has not been disposed of in a prior        |
|  a Rating  | > decision.                                             |
| Decision I | >                                                       |
| s Required | > A rating decision is also *required* following a      |
|            | > rating establishing a total disability, permanent in  |
|            | > nature, where                                         |
|            |                                                         |
|            | -   · no payment was made, or                           |
|            |                                                         |
|            | -   · payment was begun and was properly discontinued   |
|            |     (other than because of total recoupment as in       |
|            |     severance pay cases) before the expiration of the   |
|            |     20-year period (for example, because of election to |
|            |     receive retired pay) and the propriety of           |
|            |     continuing that rating can be determined only by    |
|            |     reexamination or other adequate medical evidence.   |
+------------+---------------------------------------------------------+

Continued on next page

1\. Rating Determination for Dependents Educational Assistance (DEA)
Under 38 U.S.C. Chapter 35, Continued

+------------+---------------------------------------------------------+
| ##### f.   | > The term ***total disability, permanent in nature,*** |
|  Definitio | > includes cases where the disabilities are evaluated   |
| n: Total D |                                                         |
| isability, | -   · 100 percent under a schedular or extra-schedular  |
|  Permanent |     evaluation other than for 38 CFR 4.28, 38 CFR 4.29, |
|  in Nature |     or 38 CFR 4.30, or                                  |
|            |                                                         |
|            | -   · on the basis of individual unemployability based  |
|            |     on impairment reasonably certain to continue        |
|            |     throughout the lifetime of the veteran as           |
|            |     determined in accordance with 38 CFR 3.340 and 38   |
|            |     CFR 3.341.                                          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### g.   | > The criteria for a total disability permanent in      |
| Cases Meet | > nature are met if                                     |
| ing the Cr |                                                         |
| iteria of  | -   · the rating activity has determined the total      |
| a "Total D |     disability is static and no future examination is   |
| isability, |     required under the provisions of 38 CFR             |
|  Permanent |     3.327(b)(2), or                                     |
|  in Nature |                                                         |
| ," for DEA | -   · a total rating for compensation purposes has been |
|            |     in force for 20 years per 38 CFR 3.951.             |
+------------+---------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Note***: For historical purposes, it should be noted that cases  |
| > in which there is a 100 percent rating under the 1925 rating        |
| > schedule per 38 CFR 3.952 also meet the criteria of a "total        |
| > disability, permanent in nature," for DEA.                          |
+-----------------------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > When a veteran who is totally disabled from SC causes |
|  h. Death  | > dies of a nonservice-connected (NSC) disability,      |
| Cases Meet | > concede permanency of the total SC disability unless  |
| ing the Cr | > the total rating was assigned under 38 CFR 4.28, 38   |
| iteria of  | > CFR 4.29, or 38 CFR 4.30.                             |
| a "Total D | >                                                       |
| isability, | > ***Reference***: For more information on death        |
|  Permanent | > benefits, see M21-1MR, Part III, Subpart iv (TBD) or  |
|  in Nature | > M21-1, Part VI, Chapter 5.                            |
| ," for DEA |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

1\. Rating Determination for Dependents Educational Assistance (DEA)
Under 38 U.S.C. Chapter 35, Continued

+------------+---------------------------------------------------------+
| ##         | > Veterans who are considered permanently and totally   |
| ### i. Eva | > disabled prior to the assignment of a 100 percent     |
| luation of | > evaluation under a diagnostic code with a limited     |
|  Cases Whe | > duration and future examination will be considered    |
| re the Vet | > permanently disabled during the total evaluation.     |
| eran Is Pe | >                                                       |
| rmanently  | > ***Example***: A veteran who is considered            |
| and Totall | > permanently and totally disabled because of a heart   |
| y Disabled | > disorder undergoes coronary artery bypass surgery.    |
|            | > The veteran would continue to be considered           |
|            | > permanently and totally disabled for the duration of  |
|            | > the one-year convalescent period under diagnostic     |
|            | > code 7017 despite a scheduled future examination. The |
|            | > status of permanency is reconsidered following        |
|            | > completion of the examination.                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > When permanency is subsequently established, the      |
| # j. Effec | > effective date is either the date of                  |
| tive Date  |                                                         |
| When Perma | -   · examination that established permanency           |
| nency Is E |                                                         |
| stablished | -   · new evidence warranting cancellation of future    |
|            |     examination, or                                     |
|            |                                                         |
|            | -   · review when a future examination is canceled.     |
|            |                                                         |
|            | > ***Important***: A rating decision *must* be prepared |
|            | > whenever permanency is established, whether the       |
|            | > permanency is based on new evidence and/or on         |
|            | > cancellation of a future examination. This applies    |
|            | > regardless of whether or not there appear to be any   |
|            | > potential dependents.                                 |
+------------+---------------------------------------------------------+

Continued on next page

1\. Rating Determination for Dependents Educational Assistance (DEA)
Under 38 U.S.C. Chapter 35, Continued

+------------+---------------------------------------------------------+
| #####      | > Whenever a total evaluation, either schedular or      |
| k. Rating  | > based on individual unemployability, is granted for   |
| Conclusion | > an SC disability, one of the following statements     |
|            | > must be included in the rating conclusion:            |
|            |                                                         |
|            | -   · "*Basic eligibility under 38 U.S.C. Chapter 35 is |
|            |     established from* **\[date\]**," or                 |
|            |                                                         |
|            | -   · "*No eligibility under 38 U.S.C. Chapter 35*."    |
|            |                                                         |
|            | > In death ratings, whenever the issue of service       |
|            | > connection for cause of death is resolved, one of the |
|            | > following statements must be included in the rating   |
|            | > conclusion:                                           |
|            |                                                         |
|            | -   · "*Basic eligibility under 38 U.S.C. Chapter 35 is |
|            |     established*," or                                   |
|            |                                                         |
|            | -   · "*No eligibility under 38 U.S.C. Chapter 35*."    |
+------------+---------------------------------------------------------+

#### 2. Rating for Dental Treatment

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains general information on rating for |
| troduction | > dental treatment. It includes information on          |
|            |                                                         |
|            | -   · responsibility for handling dental claims and     |
|            |     requesting dental ratings                           |
|            |                                                         |
|            | -   · when to prepare a dental rating                   |
|            |                                                         |
|            | -   · referring dental claims to the clinic of          |
|            |     jurisdiction                                        |
|            |                                                         |
|            | -   · handling a claim for a dental disability          |
|            |     submitted on *VA Form 21-526, Veteran's Application |
|            |     for Compensation and Pension*                       |
|            |                                                         |
|            | -   · non-disabling conditions                          |
|            |                                                         |
|            | -   · denying claims for service connection             |
|            |                                                         |
|            | -   · outpatient dental treatment classifications       |
|            |                                                         |
|            | -   · treatment eligibility based on other entitlements |
|            |                                                         |
|            | -   · rating involving dental trauma                    |
|            |                                                         |
|            | -   · claims based on extracted teeth                   |
|            |                                                         |
|            | -   · cases in which a dental examination may be        |
|            |     required                                            |
|            |                                                         |
|            | -   · the use of service records from the               |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   \- Navy, and                                        |
|            |                                                         |
|            | -   \- Army, and                                        |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   · tooth-numbering systems used by the service       |
|            |     departments and VA.                                 |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > November 16, 2004                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a. R | > Claims for dental treatment under 38 CFR 17.161 are   |
| esponsibil | > normally handled by the outpatient clinic, without    |
| ity for Ha | > referral to the Veterans Service Center (VSC) and the |
| ndling Den | > rating activity.                                      |
| tal Claims | >                                                       |
|  and Reque | > When necessary, requests for dental ratings are       |
| sting Dent | > referred by the VA outpatient or dental clinic to the |
| al Ratings | > VSC through Automated Medical Information Exchange    |
|            | > (AMIE)/ Compensation and Pension Record Interchange   |
|            | > (CAPRI) or on *VA Form 10-7131, Exchange of           |
|            | > Beneficiary Information and Request for               |
|            | > Administrative and Adjudicative Action*.              |
|            | >                                                       |
|            | > ***Reference***: For more information on the handling |
|            | > of *VA Form 10-7131* prior to, and after, rating      |
|            | > activity action, see M21-1MR, Part III, Subpart v, 7  |
|            | > (TBD) or M21-1, Part IV, 23.03.                       |
+------------+---------------------------------------------------------+

Continued on next page

2\. Rating for Dental Treatment, Continued

+------------+---------------------------------------------------------+
| ##### b. W | > Prepare a dental rating *only* at the request of the  |
| hen to Pre | > dental clinic pursuant to a claim for dental          |
| pare a Den | > treatment.                                            |
| tal Rating | >                                                       |
|            | > ***Reference***: For more information on preparing    |
|            | > dental ratings, see the *RBA 2000 User's Guide* at    |
|            | > http://152.1                                          |
|            | 24.64.28/VetsNet/RBA2000_Docs/Webhelp/RBA2000_Help.htm. |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > Refer copies of dental claims for compensation, as    |
| ### c. Ref | > well as for treatment, to the outpatient or dental    |
| erring Den | > clinic responsible for the veteran's residence.       |
| tal Claims | >                                                       |
|  to the Cl | > ***Reference***: For more information, see M21-1MR,   |
| inic of Ju | > Part III, Subpart ii, 2.B.6.C (TBD) or M21-1, Part    |
| risdiction | > III, 2.02e.                                           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d    | > Treat a claim for dental disability on *VA Form       |
| . Handling | > 21-526*, *Veteran's Application for Compensation or   |
|  a Claim f | > Pension,* as a claim for compensation *except* when   |
| or a Denta | > the veteran makes it clear that he/she is seeking     |
| l Disabili | > dental treatment only.                                |
| ty on VA F |                                                         |
| orm 21-526 |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > The following conditions are *not* disabling and may  |
| ## e. Non- | > be SC *solely* for the purpose of determining         |
|            | > entitlement to outpatient dental treatment or         |
| #####      | > examination under 38 CFR 17.161:                      |
| Disabling  |                                                         |
| Conditions | -   · treatable carious teeth                           |
|            |                                                         |
|            | -   · replaceable missing teeth                         |
|            |                                                         |
|            | -   · dental or alveolar abscesses, and                 |
|            |                                                         |
|            | -   · periodontal disease (pyorrhea).                   |
|            |                                                         |
|            | > ***Reference***: For more information on service      |
|            | > connection for dental treatment purposes, see 38 CFR  |
|            | > 3.381.                                                |
+------------+---------------------------------------------------------+

Continued on next page

2\. Rating for Dental Treatment, Continued

+------------+---------------------------------------------------------+
| #####      | > Consider the issue of service connection for the      |
| f. Denying | > conditions listed in                                  |
|  Claims fo | >                                                       |
| r Service  | > M21-1MR, Part IX, Subpart ii, 2.2.e in a formal       |
| Connection | > rating and deny the claim if                          |
|            |                                                         |
|            | -   · a veteran claims compensation for one of these    |
|            |     conditions on *VA Form 21-526* or elsewhere, and    |
|            |                                                         |
|            | -   · the record shows no complicating condition        |
|            |     subject to service connection.                      |
|            |                                                         |
|            | > In the Reasons for Decision part of the rating        |
|            | > decision, cite the provisions of 38 CFR 3.381 and     |
|            | > note if dental treatment in service was limited to    |
|            | > conditions affecting only the teeth or gums.          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > The table below outlines dental treatment             |
| ### g. Out | > classifications and provides a reference for more     |
| patient De | > information on each classification.                   |
| ntal Treat |                                                         |
| ment Class |                                                         |
| ifications |                                                         |
+------------+---------------------------------------------------------+

  ----------------------------------- -----------------------------------
  Dental Treatment Classifications    Reference

  Class I: Compensable dental         See M21-1MR, Part III, Subpart v,
  disabilities                        7.B.14 (TBD) or M21-1, Part IV,
                                      Chapter 23.03.

  Class II: Non-compensable dental    See M21-1MR, Part III, Subpart v,
  disabilities                        7.B.15 (TBD) or M21-1, Part IV,
                                      Chapter 23.03.

  Class II(a): Combat wounds or       See M21-1MR, Part III, Subpart v,
  service trauma                      7.B.16 (TBD) or M21-1, Part IV,
                                      Chapter 23.03.

  Class II(b): POW status             

  Class III: Dental disability        See M21-1MR, Part III, Subpart v,
  aggravating SC medical condition    7.B.17 (TBD) or M21-1, Part IV,
                                      Chapter 23.03.

  Class IV: SC disabilities evaluated 
  at 100% or entitlement to           
  individual unemployability          

  Class V: Enrolled in vocational     
  rehabilitation training             

  Class VI: Dental disability         
  aggravating medical condition being 
  treated under 38 U.S.C. 1710        
  ----------------------------------- -----------------------------------

Continued on next page

2\. Rating for Dental Treatment, Continued

+------------+---------------------------------------------------------+
| ##### h.   | > Most classes of eligibility for outpatient dental     |
|  Treatment | > treatment can be decided by other entitlements of     |
|  Eligibili | > record, such as entitlement to                        |
| ty Based o |                                                         |
| n Other En | -   · total compensation under class IV, or             |
| titlements |                                                         |
|            | -   · vocational rehabilitation under class V.          |
|            |                                                         |
|            | > Class II eligibility allows one-time dental treatment |
|            | > for veterans who apply within 90 days after military  |
|            | > discharge, and is usually accomplished without rating |
|            | > action under the provisions of 38 CFR 17.162.         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### i.   | > Veterans who have a dental condition resulting from   |
| Rating Den | > combat wounds or service trauma may receive any       |
| tal Trauma | > reasonably necessary treatment under class II(a).     |
|            | >                                                       |
|            | > If a request for a dental trauma rating is received   |
|            | > from the dental clinic, prepare a rating identifying  |
|            | > the specific tooth number(s) that were injured.       |
|            | >                                                       |
|            | > ***Reference***: For the specific tooth numbers used  |
|            | > by Department of Veterans Affairs (VA), see M21-1MR,  |
|            | > Part IX, Subpart ii, 2.2.n.                           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### j. C | > Resolve the issue of service connection in accordance |
| laims Base | > with the provisions of 38 CFR 3.381 in claims based   |
| d on Extra | > on for treatment under 38 CFR 17.162(b) for extracted |
| cted Teeth | > teeth.                                                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > Generally, a dental claim is rated on service records |
| #### k. Ca | > without a dental examination, regardless of whether   |
| ses in Whi |                                                         |
| ch a Denta | -   · compensation is claimed on *VA Form 21-526*, or   |
| l Examinat |                                                         |
| ion May Be | -   · a dental rating is requested on *VA Form          |
|  Required  |     10-7131*.                                           |
|            |                                                         |
|            | > However, a dental examination may be required to      |
|            | > identify teeth or chronic periodontal disease for     |
|            | > which service connection for treatment or examination |
|            | > purposes may be in order under 38 CFR 17.160.         |
+------------+---------------------------------------------------------+

Continued on next page

2\. Rating for Dental Treatment, Continued

+------------+---------------------------------------------------------+
| #####      | > Copies of dental records have not always been usable  |
|  l. Use of | > for rating purposes because, prior to 1953, different |
|  Navy Dent | > colored markings on the original Naval records        |
| al Records | > represented either disease or fillings and these      |
|            | > markings could not be distinguished on photocopies.   |
|            | >                                                       |
|            | > Accept the record of subsequent dental operations on  |
|            | > the bottom of *Navy* *Form H-4, Navy Dental Records   |
|            | > (Examination)*, as sufficient to authorize service    |
|            | > connection, even though the reverse side of that form |
|            | > may not record the insertion of fillings.             |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Army regulations require that every individual        |
|  m. Use of | > entering active service for more than 60 days have an |
|  Army Dent | > initial dental examination within 60 days of entry on |
| al Records | > active service.                                       |
|            | >                                                       |
|            | > In the absence of a suitable enlistment examination,  |
|            | > for example, if the only examination notation was     |
|            | > indefinite, such as "*acceptable*,"                   |
|            | > "*non-disqualifying*," or "*not examined*," accept    |
|            | > the first examination within a reasonable period      |
|            | > after entrance on active duty as recording the        |
|            | > missing or defective teeth at enlistment.             |
|            | >                                                       |
|            | > ***Note***: Facts in individual cases, such as when a |
|            | > first examination report is *more* than 90 days after |
|            | > enlistment, may warrant an exception to this general  |
|            | > rule.                                                 |
+------------+---------------------------------------------------------+

Continued on next page

2\. Rating for Dental Treatment, Continued

+------------+---------------------------------------------------------+
| ##         | > Tooth numbering by VA and service departments has     |
| ### n. Too | > been the same since 1953, but differed previously.    |
| th Numberi | > Listed below are the numbering systems for the        |
| ng Systems | > service departments prior to 1953 and the VA          |
|            | > numbering system.                                     |
+------------+---------------------------------------------------------+

  ---------------- ---------------------------- -------------------------
                   Upper                        

                   Right                        Left

                                                

  VA               1 2 3 4 5 6 7 8              9 10 11 12 13 14 15 16

  Army (WWI)       8 7 6 5 4 3 2 1              1 2 3 4 5 6 7 8

  Army (WWII)      8 7 6 5 4 3 2 1              1 2 3 4 5 6 7 8

  Navy             1 2 3 4 5 6 7 8              9 10 11 12 13 14 15 16

                                                

                   Lower                        

                   Right                        Left

                                                

  VA               32 31 30 29 28 27 26 25      24 23 22 21 20 19 18 17

  Army (WWI)       8 7 6 5 4 3 2 1              1 2 3 4 5 6 7 8

  Army (WWII)      16 15 14 13 12 11 10 9       9 10 11 12 13 14 15 16

  Navy             17 18 19 20 21 22 23 24      25 26 27 28 29 30 31 32
  ---------------- ---------------------------- -------------------------

+-----------------------------------------------------------------------+
| > ***Note***: The Coast Guard and Public Health Service (PHS) have    |
| > the same tooth numbering system as VA.                              |
+-----------------------------------------------------------------------+

#### 3. Rating Principles for Dental Conditions

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on the principles for |
| troduction | > making rating decisions and granting service          |
|            | > connection for various dental conditions. It includes |
|            |                                                         |
|            | -   · general information on dental rating principles   |
|            |                                                         |
|            | -   · information on rating principles when a veteran   |
|            |     has two periods of service                          |
|            |                                                         |
|            | -   · separate consideration by the rating activity of  |
|            |     each tooth or each disease of the teeth for         |
|            |     purposes of service connection                      |
|            |                                                         |
|            | -   · considering dental conditions existing at the     |
|            |     time of entry into active service                   |
|            |                                                         |
|            | -   · service connection for dental conditions noted at |
|            |     entry and treated during service                    |
|            |                                                         |
|            | -   · dental conditions not considered SC, and          |
|            |                                                         |
|            | -   · rating bony abnormalities of the jaw.             |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > November 16, 2004                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a. G | > When a tooth is SC on a dental rating, service        |
| eneral Pol | > connection is solely for purposes of entitlement to   |
| icy on Ent | > dental treatment or examination under 38 CFR 17.160   |
| itlement t | > or 38 CFR 17.161. On such dental ratings, do *not*    |
| o Treatmen |                                                         |
| t When a T | -   · differentiate between carious and missing teeth,  |
| ooth Is Ra |     or                                                  |
| ted as SC  |                                                         |
|            | -   · show *only* the conditions that are considered as |
|            |     requiring correction at the time of the latest      |
|            |     dental examination.                                 |
|            |                                                         |
|            | > Identify by number on the dental diagram each tooth   |
|            | > for which service connection for dental treatment or  |
|            | > examination purposes is established.                  |
|            | >                                                       |
|            | > ***Reference***: For more information on preparing a  |
|            | > dental rating, see the *RBA 2000 User's Guide* at     |
|            | > http://152.1                                          |
|            | 24.64.28/VetsNet/RBA2000_Docs/webhelp/RBA2000_help.htm. |
+------------+---------------------------------------------------------+

Continued on next page

3\. Rating Principles for Dental Conditions, Continued

+------------+---------------------------------------------------------+
| ##### b. R | > If a veteran has two periods of service and, during   |
| ating Prin | > the second period of service, incurs a new condition  |
| ciple When | > in the same tooth or aggravates a dental condition    |
|  the Veter | > that was previously service connected based on the    |
| an Has Two | > first period of service, show the incurrence of the   |
|  Periods o | > new condition or the aggravation of the preexisting   |
| f Service  | > condition in the second period of service.            |
|            | >                                                       |
|            | > This is done to ensure the veteran's entitlement to   |
|            | > treatment based on the subsequent service.            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > The rating activity must consider each defective or   |
| ### c. Sep | > missing tooth and each disease of the teeth and       |
| arate Cons | > periodontal tissues separately to determine whether   |
| ideration  | > the condition was incurred or aggravated in the line  |
| by the Rat | > of duty during active service.                        |
| ing Activi | >                                                       |
| ty of Each | > When applicable, the rating activity must             |
|  Tooth or  |                                                         |
| Each Disea | -   · determine whether the condition is due to combat  |
| se of the  |     or other in-service trauma, or                      |
| Teeth for  |                                                         |
| Purposes o | -   · consider whether the veteran was interned as a    |
| f Service  |     former POW.                                         |
| Connection |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > In determining service connection, the condition of   |
| # d. Consi | > teeth and periodontal tissues at the time of entry    |
| dering Den | > into active duty must be considered.                  |
| tal Condit | >                                                       |
| ions Exist | > Treatment during service, including filling or        |
| ing at Tim | > extraction of a tooth, or placement of a prosthesis,  |
| e of Entry | > must not be considered evidence of aggravation of a   |
|  Into Acti | > condition that was noted at entry, unless additional  |
| ve Service | > pathology developed after 180 days or more of active  |
|            | > service.                                              |
|            | >                                                       |
|            | > Teeth extracted because of chronic periodontal        |
|            | > disease are SC *only* if they were extracted after    |
|            | > 180 days or more of active service, per 38 U.S.C.     |
|            | > 1712.                                                 |
+------------+---------------------------------------------------------+

Continued on next page

3\. Rating Principles for Dental Conditions, Continued

+------------+---------------------------------------------------------+
| #          | > The table below lists the principles that apply to    |
| #### e. Se | > the establishment or denial of service connection for |
| rvice Conn | > dental conditions noted at entry and treated during   |
| ection for | > service.                                              |
|  Dental Co |                                                         |
| nditions N |                                                         |
| oted at En |                                                         |
| try and Tr |                                                         |
| eated Duri |                                                         |
| ng Service |                                                         |
+------------+---------------------------------------------------------+

  --------------------------- -------------------------------------------
  If teeth are noted at entry Then service connection must be \...
  as \...                     

  normal                      established if they were filled or
                              extracted after 180 days or more of active
                              service.

  filled                      established if they were extracted, or if
                              the existing filling was replaced, after
                              180 days or more of active service.

  carious but restorable      denied on the basis that they were filled
                              during service. However, new caries that
                              developed 180 days or more after such a
                              tooth was filled must be SC.

  non-restorable              denied, regardless of treatment during
                              service.

  missing                     denied, regardless of treatment during
                              service.
  --------------------------- -------------------------------------------

+------------+---------------------------------------------------------+
| ####       | > The following must not be considered SC for treatment |
| # f. Denta | > purposes:                                             |
| l Conditio |                                                         |
| ns Not Con | -   · calculus                                          |
| sidered SC |                                                         |
|            | -   · acute periodontal disease                         |
|            |                                                         |
|            | -   · third molars, unless disease or pathology of the  |
|            |     tooth                                               |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   \- developed after 180 days or more of active       |
|            |     service, or                                         |
|            |                                                         |
|            | -   \- was due to combat or in-service trauma, and      |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   · impacted or malposed teeth, and other             |
|            |     developmental defects, unless disease or pathology  |
|            |     of these teeth developed after 180 days or more of  |
|            |     active service.                                     |
+------------+---------------------------------------------------------+

Continued on next page

3\. Rating Principles for Dental Conditions, Continued

+------------+---------------------------------------------------------+
| #####      | > Rate bony abnormalities of the jaw that are subject   |
|  h. Rating | > to service connection according to the 99-series of   |
|  Bony Abno | > diagnostic codes in the rating schedule.              |
| rmalities  |                                                         |
| of the Jaw |                                                         |
+------------+---------------------------------------------------------+

#### 4. Rating for Medical Care

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on rating for medical |
| troduction | > care, including information on                        |
|            |                                                         |
|            | -   · receiving requests for eligibility                |
|            |     determinations, and                                 |
|            |                                                         |
|            | -   · the action to take after eligibility is           |
|            |     determined.                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > November 16, 2004                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > VHA submits requests for eligibility determinations   |
|  Receiving | > under 38 U.S.C. 1710 advising what information is     |
|  Requests  | > required                                              |
| for Eligib |                                                         |
| ility Dete | -   · via AMIE/CAPRI, or                                |
| rminations |                                                         |
|            | -   · on *VA Form 10-7131*.                             |
|            |                                                         |
|            | > ***Reference***: For more information on eligibility  |
|            | > for VA treatment, see M21-1MR, Part III, Subpart v, 7 |
|            | > (TBD) or M21-1, Part IV, Chapter 23, Subchapter I.    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > If the authorization activity has already made a      |
|  b. Action | > determination of eligibility, furnish the requested   |
|  to Take A | > information as provided in M21-1MR, Part III, Subpart |
| fter Eligi | > v, 7 (TBD) or M21-1, Part IV, Chapter 23, Subchapter  |
| bility Is  | > I.                                                    |
| Determined | >                                                       |
|            | > For any condition not covered in a prior rating       |
|            | > decision, prepare a rating using the following        |
|            | > statement under the part "Decision": "*Eligibility    |
|            | > for medical care under 38 U.S.C. 1710* **\[is\] \[is  |
|            | > not\]** *established.*"                               |
+------------+---------------------------------------------------------+

#### 5. Rating for Service Connection for Psychosis Under 38 U.S.C. 1702

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on rating to          |
| troduction | > determine service connection for psychosis under 38   |
|            | > U.S.C. 1702, including information on                 |
|            |                                                         |
|            | -   · the entitlement criteria for service connection   |
|            |     for psychosis under 38 U.S.C. 1702                  |
|            |                                                         |
|            | -   · when to infer service connection for psychosis    |
|            |                                                         |
|            | -   · the presumption of soundness                      |
|            |                                                         |
|            | -   · the forms used to request a determination of      |
|            |     service connection under 38 U.S.C. 1702, and        |
|            |                                                         |
|            | -   · the rating conclusion.                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > November 16, 2004                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a    | > A veteran of World War II, Korean Conflict, Vietnam   |
| . Entitlem | > Era service, or Gulf War service is entitled to       |
| ent Criter | > service connection for psychosis under 38 U.S.C. 1702 |
| ia for Ser | > to provide hospital and medical treatment, including  |
| vice Conne | > outpatient treatment, if he/she develops an active    |
| ction for  | > psychosis either                                      |
| Psychosis  |                                                         |
| Under 38 U | -   · during or within two years from the date of       |
| .S.C. 1702 |     separation (under other than dishonorable           |
|            |     conditions) from such service, or                   |
|            |                                                         |
|            | -   · within two years of the end of the war period,    |
|            |     whichever is earlier.                               |
|            |                                                         |
|            | > ***Note***: It is *not* necessary for the veteran to  |
|            | > have had 90 days of service to qualify.               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > The issue of entitlement to medical treatment under   |
|  b. When t | > 38 U.S.C. 1702 is routinely inferred whenever service |
| o Infer Se | > connection for a psychosis based on World War II,     |
| rvice Conn | > Korean Conflict, Vietnam Era service, or Gulf War     |
| ection for | > service is denied.                                    |
|  Psychosis |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

5\. Rating for Service Connection for Psychosis Under 38 U.S.C. 1702,
Continued

+------------+---------------------------------------------------------+
| ###        | > The law provides a presumption of soundness that      |
| ## c. Pres | > applies to                                            |
| umption of |                                                         |
|  Soundness | -   · the two-year period following discharge, and      |
|            |                                                         |
|            | -   · veterans with a diagnosis of active psychosis     |
|            |     during service despite a history of preservice      |
|            |     existence.                                          |
|            |                                                         |
|            | > ***Note***: The presumption is equally applicable to  |
|            | > psychosis resulting from misconduct.                  |
|            | >                                                       |
|            | > ***Reference***: For more information on a request    |
|            | > for a physical examination, see M21-1MR, Part III,    |
|            | > Subpart iv, 3 (TBD) or M21-1, Part VI, Chapter 1.     |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d.   | > VHA submits requests for determination of service     |
| Forms Used | > connection under 38 U.S.C. 1702 via AMIE/CAPRI on *VA |
|  to Reques | > Form 10-7131* accompanied by                          |
| t a Determ |                                                         |
| ination of | -   · a copy of a completed                             |
|  Service C |                                                         |
| onnection  | ```{=html}                                              |
| Under 38 U | <!-- -->                                                |
| .S.C. 1702 | ```                                                     |
|            | -   \- VA Form 10-10, Application for Medical Benefits, |
|            |     or                                                  |
|            |                                                         |
|            | -   \- VA Form 10-10r, Reapplication for Medical        |
|            |     Benefits, and                                       |
|            |                                                         |
|            | -   \- VA Form 10-10m, Medical Certificate, and         |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   · any other available professional report submitted |
|            |     with, or developed in conjunction with, the         |
|            |     application for hospital or outpatient treatment.   |
|            |                                                         |
|            | > ***Note***: The authorization activity furnishes the  |
|            | > requested information after a determination has been  |
|            | > made as provided in M21-1MR, Part III, Subpart v, 7   |
|            | > (TBD) or M21-1, Part IV, Chapter 23.                  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > In the rating conclusion, show either                 |
| e. Rating  |                                                         |
| Conclusion | -   · "*Active Psychosis\--SC for treatment purposes    |
|            |     only*," or                                          |
|            |                                                         |
|            | -   · "*Active Psychosis\--Not SC; 38 U.S.C. 1702*."    |
+------------+---------------------------------------------------------+

#### 6. Rating for Insanity Determination

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on rating for an      |
| troduction | > insanity determination, including information on      |
|            |                                                         |
|            | -   · when a rating for insanity is required, and       |
|            |                                                         |
|            | -   · making a rating decision.                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > November 16, 2004                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > A rating of insanity is required to determine whether |
|  a. When R | > the veteran was insane at the time of commission of   |
| ating for  | > an act or acts that resulted in a service department  |
| Insanity I | > character of discharge, line-of-duty, or misconduct   |
| s Required | > determination which precludes entitlement to          |
|            | > benefits.                                             |
|            | >                                                       |
|            | > Ratings of insanity are prepared only at the request  |
|            | > of the authorization activity because of a            |
|            |                                                         |
|            | -   · specific allegation by the claimant, or           |
|            |                                                         |
|            | -   · question raised by the evidence in the claims     |
|            |     folder.                                             |
|            |                                                         |
|            | > ***Reference***: For more information on cases        |
|            | > involving the sanity of a beneficiary involved in     |
|            | > homicide, see M21-1MR, Part III, Subpart v, 1.D.22    |
|            | > (TBD) or M21-1, Part IV, 11.10d.                      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Prior to making a determination as to whether a       |
| ## b. Maki | > veteran was insane at the time he/she committed an    |
| ng a Ratin | > offense leading to his/her court-martial, discharge,  |
| g Decision | > or resignation                                        |
|            |                                                         |
|            | -   · request all obtainable evidence related to the    |
|            |     period involved                                     |
|            |                                                         |
|            | -   · state under Decision on the rating decision,      |
|            |     "*The veteran* **\[was\] \[was not\]** *insane at   |
|            |     the time* **\[he\] \[she\]** *committed an          |
|            |     offense*," and                                      |
|            |                                                         |
|            | -   · apply the definition of insanity found in 38 CFR  |
|            |     3.354.                                              |
|            |                                                         |
|            | > ***Result***: A rating decision finding the veteran   |
|            | > to have been sane at the time in question, supported  |
|            | > by the necessary explanation, is sufficient as to the |
|            | > particular period of service or offense at issue.     |
+------------+---------------------------------------------------------+

#### 7. Rating Determination for Veteran's Civil Service Disability Preference

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on rating             |
| troduction | > determination for veteran's civil service disability  |
|            | > preference, including information on                  |
|            |                                                         |
|            | -   · certifying civil service disability preference    |
|            |                                                         |
|            | -   · the requirements for civil service evaluations    |
|            |                                                         |
|            | -   · when a rating is required, and                    |
|            |                                                         |
|            | -   · the rating conclusion.                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > November 16, 2004                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > For the purpose of certifying civil service           |
|  a. Certif | > disability preference, a SC disability may be         |
| ying Civil | > assigned an evaluation of "*less than ten percent*"   |
|  Service D | > for any directly or presumptively SC disease or       |
| isability  | > injury that exhibits some extent of actual            |
| Preference | > impairment.                                           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > For noncombat disabilities, there must be             |
| #### b. Re | > ascertainable residuals before a "*less than ten      |
| quirements | > percent*" evaluation may be assigned. "Ascertainable  |
|  for Civil | > residuals" means symptoms that can be objectively     |
|  Service E | > verified on examination.                              |
| valuations | >                                                       |
|            | > Combat incurred noncompensable disabilities warrant   |
|            | > an evaluation of "*less than ten percent*."           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > A rating is necessary if a previous rating did not    |
| # c. When  | > establish entitlement to compensation, which includes |
| a Rating I | > Special Monthly Compensation (SMC) or entitlement     |
| s Required | > under 38 CFR 3.324.                                   |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > In the rating conclusion, show the diagnostic code,   |
| d. Rating  | > diagnosis, and an evaluation of either                |
| Conclusion |                                                         |
|            | -   · "*less than ten percent*," or                     |
|            |                                                         |
|            | -   · "*The noncompensable service-connected            |
|            |     disabilities have no ascertainable residuals*."     |
+------------+---------------------------------------------------------+

#### 8. Rating Determination for Discharge of Liability for Educational Loans Under 38 U.S.C. 3698

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on rating             |
| troduction | > determinations for discharge of liability for         |
|            | > educational loans under 38 U.S.C. 3698, including     |
|            | > information on                                        |
|            |                                                         |
|            | -   · when the liability for an educational loan may be |
|            |     discharged                                          |
|            |                                                         |
|            | -   · when to request a rating determination            |
|            |                                                         |
|            | -   · when to schedule an examination, and              |
|            |                                                         |
|            | -   · rating decision.                                  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > November 16, 2004                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Remaining liability for an educational loan under 38  |
|  a. When L | > U.S.C. 3698 may be discharged when the recipient of   |
| iability f | > the loan                                              |
| or an Educ |                                                         |
| ational Lo | -   · dies, or                                          |
| an May Be  |                                                         |
| Discharged | -   · becomes permanently and totally disabled and the  |
|            |     claimant's disabilities either combine to 100       |
|            |     percent, or if less than 100 percent, are           |
|            |     sufficient to produce unemployability in accordance |
|            |     with the requirements of 38 CFR 4.16.               |
|            |                                                         |
|            | > ***Note***: Base the decision on the criteria set     |
|            | > forth in 38 CFR 3.340 and 38 CFR 3.341.               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b    | > The finance activity requests a rating determination  |
| . When to  | > for discharge of liability when medical evidence      |
| Request a  | > submitted by the claimant shows permanent and total   |
| Rating Det | > disability.                                           |
| ermination | >                                                       |
|            | > ***Note***: If the evidence of record is insufficient |
|            | > for rating purposes, the authorization activity       |
|            | > requests evidence from the claimant or next of kin.   |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c. W | > Schedule an examination only after all attempts to    |
| hen to Sch | > secure adequate evidence have failed.                 |
| edule an E |                                                         |
| xamination |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

8\. Rating Determination for Discharge of Liability for Educational
Loans Under 38 U.S.C. 3698, Continued

+------------+---------------------------------------------------------+
| ####       | > In the rating decision, under the part "Decision,"    |
| # d. Ratin | > show "*Discharge of liability for an educational      |
| g Decision | > loan* **\[is\] \[is not\]** *granted*."               |
|            | >                                                       |
|            | > In the coded conclusion, use the statement            |
|            | > "*Permanent and Total disability for discharge of     |
|            | > liability* **\[is\]\[is not\]** *established*."       |
|            | >                                                       |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   · Do *not* combine the decision for discharge of    |
|            |     liability with any other rating decision.           |
|            |                                                         |
|            | -   · Provide a copy of the rating decision to the      |
|            |     finance activity, which will notify the claimant of |
|            |     the decision.                                       |
+------------+---------------------------------------------------------+

#### 9. Rating to Extend the Delimiting Dates for Educational Assistance

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on rating to extend   |
| troduction | > the delimiting dates for educational assistance based |
|            | > on disability, including information on               |
|            |                                                         |
|            | -   · when the delimiting dates may be extended         |
|            |                                                         |
|            | -   · determining whether the disability was the result |
|            |     of willful misconduct                               |
|            |                                                         |
|            | -   · when medical infeasibility may be found           |
|            |                                                         |
|            | -   · the time limitation for requesting a delimiting   |
|            |     date extension                                      |
|            |                                                         |
|            | -   · when to refer claims to the rating activity, and  |
|            |                                                         |
|            | -   · the rating conclusion.                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > November 16, 2004                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > The delimiting date for educational assistance may be |
| a. When De | > extended for the following beneficiaries, if the      |
| limiting D | > rating activity determines that mental or physical    |
| ates May B | > disability not the result of misconduct, prevented    |
| e Extended | > their initiation or completion of a chosen program of |
|            | > education within the applicable 10 or 12-year period  |
|            | > of eligibility:                                       |
|            |                                                         |
|            | -   · veterans eligible for 38 U.S.C. Chapter 30, 38    |
|            |     U.S.C. Chapter 31, and 38 U.S.C. Chapter 32         |
|            |     benefits                                            |
|            |                                                         |
|            | -   · reservists eligible for 38 U.S.C. Chapter 1606    |
|            |     benefits, and                                       |
|            |                                                         |
|            | -   · spouses or surviving spouses eligible for 38      |
|            |     U.S.C. Chapter 35 benefits.                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b. D | > A determination as to whether the disability was the  |
| etermining | > result of willful misconduct is made by the rating    |
|  Whether t | > activity or authorization activity according to the   |
| he Disabil | > provisions of M21-1MR, Part III, Subpart v, 1.D (TBD) |
| ity Was th | > or M21-1, Part IV, Chapter 11.                        |
| e Result o |                                                         |
| f Willful  |                                                         |
| Misconduct |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

9\. Rating to Extend the Delimiting Dates for Educational Assistance,
Continued

+------------+---------------------------------------------------------+
| ##### c.   | > Medical infeasibility to pursue training ordinarily   |
|  When Medi | > may *not* be found for any period during which the    |
| cal Infeas | > claimant was employed full-time *unless* either       |
| ibility Ma |                                                         |
| y Be Found | -   · the medical evidence indicates that the           |
|            |     employment was part of a medically prescribed       |
|            |     rehabilitation program                              |
|            |                                                         |
|            | -   · the employment was of a marginal nature and the   |
|            |     disability can reasonably be deemed to have         |
|            |     restricted the claimant from concurrent pursuit of  |
|            |     the chosen program of training, or                  |
|            |                                                         |
|            | -   · the nature of the disability actually precluded   |
|            |     the claimant from pursuing the desired program of   |
|            |     training.                                           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > Use the table below to determine the appropriate time |
| ### d. Tim | > limit for requesting a delimiting date extension.     |
| e Limit fo |                                                         |
| r Requesti |                                                         |
| ng a Delim |                                                         |
| iting Date |                                                         |
|  Extension |                                                         |
+------------+---------------------------------------------------------+

+----------------------------------+-----------------------------------+
| If applying for educational      | Then ...                          |
| benefits under ...               |                                   |
+----------------------------------+-----------------------------------+
| 38 U.S.C. Chapter 31             | there is no time limitation for   |
|                                  | requesting a delimiting date      |
|                                  | extension.                        |
+----------------------------------+-----------------------------------+
| -   · 38 U.S.C. Chapter 30       | the application for an extension  |
|                                  | of the delimiting date must be    |
| -   · 38 U.S.C. Chapter 32       | received in VA within one year of |
|                                  | the latter:                       |
| -   · 38 U.S.C. Chapter 35, and  |                                   |
|                                  | -   · the last date of the        |
| -   · 38 U.S.C. Chapter 1606     |     delimiting period, otherwise  |
|                                  |     applicable, or                |
|                                  |                                   |
|                                  | -   · the termination of the      |
|                                  |     period of mental or physical  |
|                                  |     disability.                   |
+----------------------------------+-----------------------------------+

Continued on next page

9\. Rating to Extend the Delimiting Dates for Educational Assistance,
Continued

+------------+---------------------------------------------------------+
| ##         | > Claims are referred to the rating activity when the   |
| ### e. Whe | > following evidence is of record:                      |
| n to Refer |                                                         |
|  Claims to | -   · the claimant's statement as to                    |
|  the Ratin |                                                         |
| g Activity | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   \- the origin, if known, and nature of the          |
|            |     disability upon which the claim for extension is    |
|            |     based and the period(s) during which training was   |
|            |     precluded because of disability                     |
|            |                                                         |
|            | -   \- employment history during the period(s) in which |
|            |     educational pursuit was prevented by disability,    |
|            |     including the dates and weekly hours of employment, |
|            |     names and addresses of employers, and types of jobs |
|            |     held, and                                           |
|            |                                                         |
|            | -   \- the exceptional circumstances which prevented    |
|            |     the claimant from enrolling in or pursuing a        |
|            |     program of education during the period of           |
|            |     disablement, if the disabling period was 30 days or |
|            |     less, and                                           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   · medical evidence of the disability, including a   |
|            |     statement by a physician, indicating                |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   \- diagnosis and treatment, the period(s) of        |
|            |     disability, the dates during which, in the          |
|            |     physician's opinion, training was medically         |
|            |     infeasible, and an evaluation of current            |
|            |     feasibility of employment or training, and          |
|            |                                                         |
|            | -   \- hospital reports, laboratory tests, and other    |
|            |     relevant medical evidence referred to by the        |
|            |     claimant or the attending physician.                |
+------------+---------------------------------------------------------+

Continued on next page

9\. Rating to Extend the Delimiting Dates for Educational Assistance,
Continued

+------------+---------------------------------------------------------+
| #####      | > In the rating decision, under the *Decision*, show    |
| f. Rating  | > either                                                |
| Conclusion |                                                         |
|            | -   · "*Extension of Delimiting Date Under Ch. 30, 38   |
|            |     U.S.C. 3031(d)* **\[is\] \[is not\]** *granted*"    |
|            |                                                         |
|            | -   · "*Extension of Delimiting Date Under Ch. 31, 38   |
|            |     U.S.C. 3103* **\[is\] \[is not\]** *granted*"       |
|            |                                                         |
|            | -   · "*Extension of Delimiting Date Under Ch. 32, 38   |
|            |     U.S.C. 3232(2)(A) and (B)* **\[is\] \[is not\]**    |
|            |     *granted*"                                          |
|            |                                                         |
|            | -   · "*Extension of Delimiting Date Under Ch. 35, 38   |
|            |     U.S.C. 3512(B)* **\[is\] \[is not\]** *granted*,"   |
|            |     or                                                  |
|            |                                                         |
|            | -   · "*Extension of Delimiting Date Under Ch. 1606, 10 |
|            |     U.S.C. 16133(b)(3)* **\[is\] \[is not\]**           |
|            |     *granted*."                                         |
|            |                                                         |
|            | > In the coded conclusion, show either                  |
|            |                                                         |
|            | -   · "*Training medically infeasible from*             |
|            |     **\[date\]** *through* **\[date\]**," or            |
|            |                                                         |
|            | -   · "*Disability did not make training medically      |
|            |     infeasible*."                                       |
+------------+---------------------------------------------------------+

#### 10. Rating for Insurance Purposes

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on rating for         |
| troduction | > insurance purposes, including information on          |
|            |                                                         |
|            | -   · eligibility for Service-Disabled Veterans         |
|            |     Insurance (SDVI)                                    |
|            |                                                         |
|            | -   · when to apply for SDVI                            |
|            |                                                         |
|            | -   · who may apply for SDVI                            |
|            |                                                         |
|            | -   · eligibility for Gratuitous SDVI after death       |
|            |                                                         |
|            | -   · when a rating decision is required                |
|            |                                                         |
|            | -   · handling coma incident to the terminal state      |
|            |                                                         |
|            | -   · handling suicide, and                             |
|            |                                                         |
|            | -   · the rating decision.                              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > November 16, 2004                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > Veterans may apply for non-participating              |
| Eligibilit | > Service-Disabled Veterans Insurance (SDVI) if they    |
| y for SDVI |                                                         |
|            | -   · were released from active service on or after     |
|            |     April 25, 1951, under other than dishonorable       |
|            |     conditions, and                                     |
|            |                                                         |
|            | -   · have a SC disability or disabilities evaluated at |
|            |     zero percent or higher.                             |
|            |                                                         |
|            | > ***Note***: SDVI is also called "RH Insurance"        |
|            | > because the policies are prefixed with "*RH*."        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > Application for SDVI must be made within two years    |
| #### b. Wh | > from the date of notice initially granting service    |
| en to Appl | > connection for a disability.                          |
| y for SDVI |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

10\. Rating for Insurance Purposes, Continued

+------------+---------------------------------------------------------+
| #          | > The veteran must be in good health to apply for SDVI, |
| #### c. Wh | > except for SC disability.                             |
| o May Appl | >                                                       |
| y for SDVI | > If the applicant is shown to have been mentally       |
|            | > incompetent during any part of the two-year period,   |
|            | > only a legal guardian may apply for this insurance,   |
|            | > and if required by State law, after the court has     |
|            | > authorized the guardian to make such application.     |
|            | >                                                       |
|            | > ***Note***: Since the veteran must be in good health  |
|            | > except for the SC disability, the mental incompetency |
|            | > must be SC.                                           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > Gratuitous SDVI may be granted on behalf of mentally  |
| ### d. Eli | > incompetent veterans who were otherwise eligible to   |
| gibility f | > be granted SDVI but due to mental incompetency died   |
| or Gratuit | > without filing an application.                        |
| ous SDVI A | >                                                       |
| fter Death | > The mental incompetency must have arisen from a SC    |
|            | > disability either                                     |
|            |                                                         |
|            | -   · at the time of release from active service        |
|            |                                                         |
|            | -   · during any part of the two-year period from the   |
|            |     date any disability is first determined to be SC,   |
|            |     or                                                  |
|            |                                                         |
|            | -   · any time after release from service if service    |
|            |     connection is not established until after death.    |
|            |                                                         |
|            | > ***Note***: To be eligible for Gratuitous SDVI, the   |
|            | > veteran must have remained continuously mentally      |
|            | > incompetent until date of death, and must have died   |
|            | > before the appointment of a guardian, or within two   |
|            | > years after the appointment of a guardian.            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > A rating decision is required when the Insurance      |
| ## e. When | > Center (IC) refers                                    |
|  a Rating  |                                                         |
| Decision I | -   · an e-mail request, or                             |
| s Required |                                                         |
|            | -   · *VA Form 29-4373*, "*Request for Disability       |
|            |     Compensation Rating for Insurance                   |
|            |     Purposes\--Government Life Insurance*."             |
+------------+---------------------------------------------------------+

Continued on next page

10\. Rating for Insurance Purposes, Continued

+------------+---------------------------------------------------------+
| ###        | > Brief periods of coma incident to the terminal state  |
| ## f. Hand | > are commonly encountered.                             |
| ling Coma  | >                                                       |
| Incident t | > In the absence of other manifestations of mental      |
| o the Term | > incapacity to contract, manage personal affairs, or   |
| inal State | > disburse funds, such brief periods of coma may be     |
|            | > insufficient to support a rating of mental            |
|            | > incompetency under 38 U.S.C. 1922(b).                 |
|            | >                                                       |
|            | > The fact that service connection has been established |
|            | > for the cause of death does not carry with it the     |
|            | > implication that the veteran was mentally incompetent |
|            | > at the time of death or at any time during the        |
|            | > critical period for purposes of 38 U.S.C. 1922(b).    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > A finding in a death rating that a veteran was of     |
|  g. Handli | > unsound mind at the time of suicide under the         |
| ng Suicide | > provisions of 38 CFR 3.302 does not mean the veteran  |
|            | > was mentally incompetent for purposes of 38 U.S.C.    |
|            | > 1922(b).                                              |
|            | >                                                       |
|            | > Make a rating under 38 U.S.C. 1922(b) based on all    |
|            | > the evidence of record, and support any rating of     |
|            | > mental incompetency by objective evidence that shows  |
|            | > the veteran's state of mind.                          |
|            | >                                                       |
|            | > ***Reference***: For a definition of mental           |
|            | > incompetency, see 38 CFR 3.353.                       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > When preparing the rating decision                    |
| # h. Ratin |                                                         |
| g Decision | -   · prepare a copy of the rating for the IC           |
|            |                                                         |
|            | -   · under the *Decision*, show either                 |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   \- "Incompetency for insurance purposes **\[is\]    |
|            |     \[is not\]** established," or                       |
|            |                                                         |
|            | -   \- "Entitlement to Gratuitous Insurance under 38    |
|            |     U.S.C. 1922 **\[is\] \[is not\]** established"      |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   · show the veteran's address, including the zip     |
|            |     code above the *Jurisdiction* section               |
|            |                                                         |
|            | -   · dispose of conditions listed on *VA Form          |
|            |     29-4373*, which are considered to be symptoms of a  |
|            |     rated disability by a statement to this effect in   |
|            |     the *Reasons for Decision* part of the rating       |
|            |     decision, and                                       |
|            |                                                         |
|            | -   · in the coded conclusion, show the codes and       |
|            |     evaluations appropriate to compensation             |
|            |     entitlement.                                        |
+------------+---------------------------------------------------------+

#### 11. Rating for the Polish and Czechoslovakian Armed Forces Under 38 U.S.C. 109(c)

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on rating for the     |
| troduction | > Polish and Czechoslovakian Armed Forces Under 38      |
|            | > U.S.C. 109(c), including information on               |
|            |                                                         |
|            | -   · the jurisdiction for determinations               |
|            |                                                         |
|            | -   · basing rating determinations on the evidence, and |
|            |                                                         |
|            | -   · the rating decision.                              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > November 16, 2004                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > The Veterans Service Center (VSC) of the Wilmington   |
| ## a. Juri | > VA Medical and Regional Office Center (VAM&ROC) has   |
| sdiction f | > sole jurisdiction for all rating determinations       |
| or Determi | > required for the Polish and Czechoslovakian Armed     |
| nations Un | > Forces under 38 U.S.C. 109(c) per 38 CFR 3.359.       |
| der 38 U.S | >                                                       |
| .C. 109(c) | > Route requests received by any other RO to the        |
|            | > Wilmington VAM&ROC with information as to the         |
|            | > referral provided to the submitting health care       |
|            | > facility.                                             |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Base rating determinations on the evidence submitted  |
| ## b. Basi | > with the request.                                     |
| ng Rating  | >                                                       |
| Determinat | > The medical facility is responsible for fully         |
| ions on th | > developing the claim before sending the request       |
| e Evidence | > directly to MAS (136) in the Wilmington VAM&ROC.      |
|            | >                                                       |
|            | > ***Reference***: For more information on jurisdiction |
|            | > over claims folders, see M21-1MR, Part III, Subpart   |
|            | > ii, 5.A (TBD) or M21-1, Part II, 4.01.                |
+------------+---------------------------------------------------------+

Continued on next page

11\. Rating for the Polish and Czechoslovakian Armed Forces Under 38
U.S.C. 109(c), Continued

+------------+---------------------------------------------------------+
| ####       | > In the rating decision, under the part Decision, show |
| # c. Ratin | > "*Eligibility for hospital or outpatient treatment    |
| g Decision | > Under 38 U.S.C. 109(c)* **\[is\] \[is not\]**         |
|            | > *established*."                                       |
|            | >                                                       |
|            | > In the coded conclusion, evaluate conditions          |
|            | > established as SC with a statement of either "*50     |
|            | > percent or more*" or "*less than 50 percent*."        |
|            | >                                                       |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   · Apply existing criteria for the determination of  |
|            |     service connection and degree of disability.        |
|            |                                                         |
|            | -   · Return the completed rating and all other         |
|            |     materials to the Medical Administration Service,    |
|            |     Wilmington, for their maintenance of eligibility    |
|            |     records.                                            |
+------------+---------------------------------------------------------+