## Chapter 5. Evaluating Evidence and Making a Decision

#### 1. Guidelines for Evaluating Evidence

+------------+---------------------------------------------------------+
| ##### In   | > This topic includes information about the guidelines  |
| troduction | > for evaluating evidence, including                    |
|            |                                                         |
|            | -   when to evaluate evidence                           |
|            |                                                         |
|            | -   points to consider when evaluating evidence         |
|            |                                                         |
|            | -   provisions applied by the Rating Veterans Service   |
|            |     Representative (RVSR)                               |
|            |                                                         |
|            | -   determining the value of testimony, and             |
|            |                                                         |
|            | -   determining the issues.                             |
+------------+---------------------------------------------------------+

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

+------------+---------------------------------------------------------+
| ####       | > If VA's duty to assist has been fulfilled, analyze    |
| # a. When  | > the evidence for and against the claim.               |
| to Evaluat | >                                                       |
| e Evidence | > ***Note***: Evaluate *all* the evidence, including    |
|            | > oral testimony given under oath and certified         |
|            | > statements submitted by claimants.                    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > When evaluating evidence and making decisions         |
| ### b. Poi |                                                         |
| nts to Con | -   maintain objectivity                                |
| sider When |                                                         |
|  Evaluatin | -   never allow personal feelings to enter into the     |
| g Evidence |     process, and                                        |
|            |                                                         |
|            | -   show fairness and courtesy at all times to          |
|            |     claimants.                                          |
|            |                                                         |
|            | > ***Example***: An antagonistic, critical, or even     |
|            | > abusive attitude on the part of the claimant should   |
|            | > not in any way influence the handling of the case.    |
|            | >                                                       |
|            | > ***Reference***: For more information on the attitude |
|            | > of the rating officers, see 38 CFR 4.23.              |
+------------+---------------------------------------------------------+

Continued on next page

1\. Guidelines for Evaluating Evidence, Continued

+------------+---------------------------------------------------------+
| ##### c.   | > When making decisions or taking action on claims that |
| Provisions | > require a rating decision, the Rating Veterans        |
|  Applied b | > Service Representative (RVSR) must apply the          |
| y the RVSR | > provisions of all pertinent                           |
|            |                                                         |
|            | -   laws                                                |
|            |                                                         |
|            | -   regulations                                         |
|            |                                                         |
|            | -   schedules for rating disabilities                   |
|            |                                                         |
|            | -   policy statements                                   |
|            |                                                         |
|            | -   procedures                                          |
|            |                                                         |
|            | -   administrators' decisions                           |
|            |                                                         |
|            | -   Secretaries' decisions                              |
|            |                                                         |
|            | -   Court of Appeals for Veterans Claims (CAVC)         |
|            |     precedents, and                                     |
|            |                                                         |
|            | -   other legal precedents governing Department of      |
|            |     Veterans Affairs (VA).                              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > The RVSR determines the probative value of medical or |
| ## d. Dete | > lay testimony.                                        |
| rmining th |                                                         |
| e Value of |                                                         |
|  Testimony |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > The issues in some claims will be clear and           |
| #### e. De | > unambiguous, while others may involve interpreting    |
| termining  | > difficult to understand claims.                       |
| the Issues | >                                                       |
|            | > ***Reference***: For more information on determining  |
|            | > the issues, see M21-1MR, Part III, Subpart iv, 6.B.   |
+------------+---------------------------------------------------------+

#### 2. Evidence to Consider

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

+------------+---------------------------------------------------------+
| ##### a.   | > Consider the following evidence when making           |
|  Types of  | > decisions:                                            |
| Evidence t |                                                         |
| o Consider | -   medical records, such as                            |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   service medical records                             |
|            |                                                         |
|            | -   VA examination reports                              |
|            |                                                         |
|            | -   private and VA hospital reports, and                |
|            |                                                         |
|            | -   outpatient treatment reports                        |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   lay evidence, such as letters from                  |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   veterans and claimants, including reports of        |
|            |     specific traumatic experience related as stressors  |
|            |     for post-traumatic stress disorder (PTSD) claims,   |
|            |     and                                                 |
|            |                                                         |
|            | -   other people who have knowledge of the claimed      |
|            |     disability or relevant events                       |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   medical opinions by examining or treating           |
|            |     physicians, and                                     |
|            |                                                         |
|            | -   medical treatises regarding                         |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   etiology of a disability                            |
|            |                                                         |
|            | -   complications of a disease process, and             |
|            |                                                         |
|            | -   employment records.                                 |
+------------+---------------------------------------------------------+

#### 3. Responsibility for Reviewing Evidence

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

+------------+---------------------------------------------------------+
| ##### a    | > The RSVR is responsible for reviewing the evidence,   |
| . Who Is R | > including                                             |
| esponsible |                                                         |
|            | -   recognizing the need for evidence in relation to a  |
|            |     claim, and                                          |
|            |                                                         |
|            | -   determining the                                     |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   admissibility of the evidence                       |
|            |                                                         |
|            | -   weight to be afforded evidence that is presented    |
|            |                                                         |
|            | -   need for additional evidence, and                   |
|            |                                                         |
|            | -   need for a physical examination.                    |
+------------+---------------------------------------------------------+

#### 4. Credible and Probative Evidence

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about credible and    |
| troduction | > probative evidence, including                         |
|            |                                                         |
|            | -   evaluating the evidence                             |
|            |                                                         |
|            | -   definition of the term ***credible evidence***      |
|            |                                                         |
|            | -   definition of the term ***probative evidence***     |
|            |                                                         |
|            | -   assessing the credibility of evidence               |
|            |                                                         |
|            | -   an example of credible evidence                     |
|            |                                                         |
|            | -   an example of non-credible evidence                 |
|            |                                                         |
|            | -   determining the probative value of evidence, and    |
|            |                                                         |
|            | -   explaining the persuasiveness of evidence.          |
+------------+---------------------------------------------------------+

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

+------------+---------------------------------------------------------+
| ##### a.   | > Evaluating evidence                                   |
|  Evaluatin |                                                         |
| g Evidence | -   is the heart of the *Reasons for Decision* section  |
|            |     of a rating decision, and                           |
|            |                                                         |
|            | -   may entail assessing the credibility and probative  |
|            |     value of evidence before weighing the evidence in   |
|            |     order to arrive at a decision on the claim.         |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   Accept evidence at face value unless called into    |
|            |     question by other evidence of record or sound       |
|            |     medical or legal principles.                        |
|            |                                                         |
|            | -   In the presence of questionable or conflicting      |
|            |     evidence, further development may be needed to      |
|            |     reconcile the disparity.                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > ***Credible evidence*** refers to evidence that is    |
|  Definitio | > inherently believable or has been received from a     |
| n: Credibl | > competent source.                                     |
| e Evidence |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

4\. Credible and Probative Evidence, Continued

+------------+---------------------------------------------------------+
| ##### c.   | > ***Probative evidence*** must be                      |
| Definition |                                                         |
| : Probativ | -   relevant to the issue in question, and              |
| e Evidence |                                                         |
|            | -   have sufficient weight, either by itself or in      |
|            |     combination with other evidence, to persuade the    |
|            |     decision-maker about a fact.                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Weigh the evidence by assessing its credibility and   |
| d. Assessi | > probative value in regard to the pending issue or     |
| ng the Cre | > issues. Weigh *only* credible evidence in reaching    |
| dibility o | > the ultimate decision. Evidence that is incredible    |
| f Evidence | > carries no weight or probative value.                 |
|            | >                                                       |
|            | > ***Example***: Joseph Smith, a World War II veteran,  |
|            | > submitted a statement from his primary care physician |
|            | > that noted the veteran's seizure disorder was         |
|            | > secondary to his service-connected (SC) head injury.  |
|            | >                                                       |
|            | > Upon recent neurological examination, conducted at    |
|            | > the VA Medical Center (VAMC) in West Palm Beach, the  |
|            | > examiner opined there was no evidence linking the     |
|            | > veteran's current seizure disorder to the veteran's   |
|            | > head injury in service. Specifically, the neurologist |
|            | > stated that the veteran's nonservice-connected (NSC)  |
|            | > vascular condition was causing the seizures. He went  |
|            | > on to say that this is one of the most common causes  |
|            | > of seizures that have their onset after age 60.       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e    | > VA receives a statement from a physician who          |
| . Example  | > expresses an opinion regarding the nexus, or link,    |
| of Credibl | > between the veteran's current disability and an       |
| e Evidence | > injury or disease in military service.                |
|            | >                                                       |
|            | > ***Note***: As a result of the physician's medical    |
|            | > expertise, the physician's statement is considered    |
|            | > *credible*.                                           |
+------------+---------------------------------------------------------+

Continued on next page

4\. Credible and Probative Evidence, Continued

+------------+---------------------------------------------------------+
| #          | > VA receives a statement from a claimant's spouse      |
| #### f. Ex | > regarding the link between the veteran's current      |
| ample of N | > disability and an injury in service. The spouse is    |
| on-Credibl | > not known to be a medical professional.               |
| e Evidence | >                                                       |
|            | > ***Note***: Since the spouse is not a medical         |
|            | > professional, and a lay person is not considered      |
|            | > capable of answering questions of medical causation   |
|            | > or diagnosis, the evidence is *not* considered        |
|            | > credible.                                             |
|            | >                                                       |
|            | > ***Exception***: If the spouse is a medical           |
|            | > professional, then the evidence is considered         |
|            | > credible and weighed during the decision-making       |
|            | > process.                                              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > Determine the probative value of the evidence once    |
| ### g. Det | > the evidence has been determined credible.            |
| ermining t | >                                                       |
| he Probati | > ***Note***: It is not necessary to accord equal       |
| ve Value o | > weight to each item of evidence contained in the      |
| f Evidence | > record.                                               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### h. E | > Clearly explain in the rating decision why the        |
| xplaining  | > evidence is found to be persuasive or not.            |
| the Persua | >                                                       |
| siveness o | > ***Example***: Service connection for a seizure       |
| f Evidence | > disorder secondary to the veteran's SC head injury is |
|            | > denied. Although the veteran's private physician      |
|            | > provided an opinion linking the veteran's seizure     |
|            | > disorder to his SC head injury, more weight was       |
|            | > assigned to the VA examiner due to his specialization |
|            | > in neurological disorders.                            |
+------------+---------------------------------------------------------+

#### 5. Medical Evidence

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about evaluating      |
| troduction | > medical evidence, including                           |
|            |                                                         |
|            | -   non-adversarial adjudication                        |
|            |                                                         |
|            | -   weighing physicians' opinions                       |
|            |                                                         |
|            | -   evaluating medical evidence                         |
|            |                                                         |
|            | -   rejecting medical evidence                          |
|            |                                                         |
|            | -   supporting medical conclusions                      |
|            |                                                         |
|            | -   considering the POW protocol examination report     |
|            |                                                         |
|            | -   evaluating service medical records (SMRs)           |
|            |                                                         |
|            | -   statements from physicians as acceptable evidence,  |
|            |     and                                                 |
|            |                                                         |
|            | -   considering information in the claims folder**.**   |
+------------+---------------------------------------------------------+

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

+------------+---------------------------------------------------------+
| ##### a    | > VA's system of claims adjudication is                 |
| . Non-Adve | > non-adversarial.                                      |
| rsarial Ad | >                                                       |
| judication | > Do not minimize the weight of a treating physician's  |
|            | > opinion based upon the idea that he/she has become an |
|            | > advocate for the patient, since doing so may appear   |
|            | > adversarial and biased.                               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > Greater weight may placed on one physician's opinion  |
|  Weighing  | > than another's, depending on several factors, such as |
| Physicians |                                                         |
| ' Opinions | -   the specialty of the physician                      |
|            |                                                         |
|            | -   the reasoning employed by the physician, and        |
|            |                                                         |
|            | -   the extent to which the physician reviewed prior    |
|            |     clinical records and other evidence.                |
|            |                                                         |
|            | > An opinion may be discounted if it materially relies  |
|            | > on a layperson's unsupported history as the premise   |
|            | > for the opinion.                                      |
|            | >                                                       |
|            | > ***Note***: Treating physician records are not        |
|            | > necessarily dispositive of an issue and must be       |
|            | > analyzed and discussed like all other evidence.       |
|            | >                                                       |
|            | > ***Reference***: For more information on discounting  |
|            | > opinions based on unsupported history, see *Wood v.   |
|            | > Derwinski*, 1 Vet. App. 190 (1991).                   |
+------------+---------------------------------------------------------+

Continued on next page

5\. Medical Evidence, Continued

+------------+---------------------------------------------------------+
| #####      | > Consider the key elements listed below when           |
| c. Evaluat | > evaluating medical evidence.                          |
| ing Medica |                                                         |
| l Evidence | -   Basis for the physician's opinion, such as          |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   theory                                              |
|            |                                                         |
|            | -   observation                                         |
|            |                                                         |
|            | -   practice                                            |
|            |                                                         |
|            | -   clinical testing                                    |
|            |                                                         |
|            | -   subjective report, and                              |
|            |                                                         |
|            | -   conjecture.                                         |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   Physician's knowledge of the veteran's accurate     |
|            |     medical and relevant personal history.              |
|            |                                                         |
|            | -   Length of time the physician has treated the        |
|            |     veteran.                                            |
|            |                                                         |
|            | -   Reason for the physician's contact with the         |
|            |     veteran, such as for                                |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   treatment, or                                       |
|            |                                                         |
|            | -   substantiation of a medical disability claim.       |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   Physician's expertise and experience.               |
|            |                                                         |
|            | -   Degree of specificity of the physician's opinion.   |
|            |                                                         |
|            | -   Degree of certainty of the physician's opinion.     |
|            |                                                         |
|            | > ***Reference***: For more information on determining  |
|            | > a physician's expertise and experience, see *Black v. |
|            | > Brown*, 10 Vet. App. 279, (1997).                     |
+------------+---------------------------------------------------------+

Continued on next page

5\. Medical Evidence, Continued

+------------+---------------------------------------------------------+
| #####      | > Unless the historical facts upon which a medical      |
|  d. Reject | > conclusion is based are dubious or untenable, reject  |
| ing Medica | > medical evidence *only* on the basis of other medical |
| l Evidence | > evidence.                                             |
|            | >                                                       |
|            | > The RSVR may *not* rely upon his/her own              |
|            | > unsubstantiated medical conclusions to reject expert  |
|            | > medical evidence provided by the claimant.            |
|            | >                                                       |
|            | > ***Reference***: For more information on the basis    |
|            | > for rejecting medical evidence, see                   |
|            |                                                         |
|            | -   *Shipwash v. Brown*, 8 Vet. App. 218, (1995), and   |
|            |                                                         |
|            | -   *Colvin v. Derwinski*, Vet. App. 175 (1991).        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e.   | > Support medical conclusions with evidence in the      |
| Supporting | > claims folder.                                        |
|  Medical C | >                                                       |
| onclusions | > Cite medical information and reasoning to             |
|            |                                                         |
|            | -   link or separate two disabilities, or               |
|            |                                                         |
|            | -   establish or refute prior inception or aggravation. |
|            |                                                         |
|            | > Cite recognized medical treatises or an independent   |
|            | > medical opinion to support a conclusion.              |
|            | >                                                       |
|            | > ***Note***: If evidence such as medical treatises or  |
|            | > independent medical opinions were relied upon when    |
|            | > the rating decision was made, explain this in the     |
|            | > rating decision.                                      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Carefully consider the prisoner of war (POW) protocol |
| f. Conside | > examination reports, because they may provide         |
| ring the P | > sufficient background information to relate the       |
| OW Protoco | > veteran's current symptomatology to the POW           |
| l Examinat | > experience.                                           |
| ion Report |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > Service medical records (SMRs) are generally highly   |
| # g. Evalu | > probative, but not necessarily determinative, in the  |
| ating SMRs | > resolution of service connection.                     |
+------------+---------------------------------------------------------+

Continued on next page

5\. Medical Evidence, Continued

+------------+---------------------------------------------------------+
| ##### h.   | > A statement from any physician can be accepted for    |
|  Statement | > rating purposes without further examination if it     |
| s From Phy |                                                         |
| sicians as | -   is otherwise adequate for rating purposes, and      |
|  Acceptabl |                                                         |
| e Evidence | -   includes clinical manifestations and substantiation |
|            |     of diagnosis by findings of diagnostic techniques   |
|            |     generally accepted by medical authorities.          |
|            |                                                         |
|            | > ***Examples***: Diagnostic techniques generally       |
|            | > accepted by medical authorities are                   |
|            |                                                         |
|            | -   pathological studies                                |
|            |                                                         |
|            | -   x-rays, and                                         |
|            |                                                         |
|            | -   appropriate laboratory tests.                       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > The information in the claims folder must support the |
| ## i. Cons | > medical conclusions.                                  |
| idering In | >                                                       |
| formation  | > Consider the following information in the claims      |
| in the Cla | > folder:                                               |
| ims Folder |                                                         |
|            | -   applicable dates of events such as                  |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   treatment reports, and                              |
|            |                                                         |
|            | -   hospitalizations                                    |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   dates covered by the service medical record,        |
|            |     identifying at least the month and year             |
|            |                                                         |
|            | -   names of                                            |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   VA and private medical facilities                   |
|            |                                                         |
|            | -   private physicians, and                             |
|            |                                                         |
|            | -   other information sources, and                      |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   items of evidence that were requested but not       |
|            |     received.                                           |
+------------+---------------------------------------------------------+

#### 6. Insufficient Examinations

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about insufficient    |
| troduction | > examinations, including                               |
|            |                                                         |
|            | -   improper denials, and                               |
|            |                                                         |
|            | -   explaining necessary but unscheduled examinations.  |
+------------+---------------------------------------------------------+

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

+------------+---------------------------------------------------------+
| #####      | > Do *not* deny a claim or reduce an evaluation based   |
|  a. Improp | > upon an insufficient examination.                     |
| er Denials |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > If the rating activity decides to rate a case where a |
|  Explainin | > specialist exam has been recommended by the medical   |
| g Necessar | > examiner but *not* scheduled by the Veterans Health   |
| y But Unsc | > Administration (VHA), explain the reason in the       |
| heduled Ex | > rating decision.                                      |
| aminations |                                                         |
+------------+---------------------------------------------------------+

#### 7. Reviewing Hospital Reports for Adequacy

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about reviewing       |
| troduction | > hospital reports, including                           |
|            |                                                         |
|            | -   handling inadequate VA hospital reports, and        |
|            |                                                         |
|            | -   handling inadequate non-VA hospital reports.        |
+------------+---------------------------------------------------------+

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

+------------+---------------------------------------------------------+
| ##### a.   | > Request the original clinical records, including the  |
|  Handling  | > nurses' and doctors' orders, if a VA report of        |
| Inadequate | > hospitalization is inadequate for rating purposes in  |
|  VA Hospit | > cases involving either                                |
| al Reports |                                                         |
|            | -   injury, aggravation of injury, or death as the      |
|            |     result of                                           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   hospitalization                                     |
|            |                                                         |
|            | -   medical treatment                                   |
|            |                                                         |
|            | -   surgical treatment, or                              |
|            |                                                         |
|            | -   examination, or                                     |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   the death of a veteran from NSC causes if           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   the veteran had an SC neuropsychiatric disability   |
|            |     that reasonably may have impeded, obstructed, or    |
|            |     otherwise interfered with the treatment of the      |
|            |     condition that caused death , and                   |
|            |                                                         |
|            | -   the hospital report does not clarify this issue.    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > Request clarification of any hospital report that is  |
| ### b. Han | > inadequate for rating purposes and is received from a |
| dling Inad |                                                         |
| equate Non | -   State hospital                                      |
| -VA Hospit |                                                         |
| al Reports | -   county hospital                                     |
|            |                                                         |
|            | -   municipal hospital                                  |
|            |                                                         |
|            | -   contract hospital, or                               |
|            |                                                         |
|            | -   private hospital.                                   |
|            |                                                         |
|            | > ***Important***: Authorize a VA examination if a      |
|            | > satisfactory corrected report cannot be obtained      |
|            | > within a reasonable period of time.                   |
+------------+---------------------------------------------------------+

#### 8. Reviewing Testimony

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on sworn or certified |
| troduction | > testimony, including                                  |
|            |                                                         |
|            | -   using testimony, and                                |
|            |                                                         |
|            | -   handling unsworn or uncertified testimony.          |
+------------+---------------------------------------------------------+

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

+------------+---------------------------------------------------------+
| ####       | > To be admitted as proper evidence, certain types of   |
| # a. Using | > testimony must be sworn under oath or properly        |
|  Testimony | > certified.                                            |
|            | >                                                       |
|            | > ***Examples***: Evidence from court proceedings,      |
|            | > depositions, and so on.                               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b. H | > Make an exact copy of unsworn or uncertified          |
| andling Un | > testimony and return the original copy for            |
| sworn or U | > notarization or certification to the                  |
| ncertified |                                                         |
|  Testimony | -   claimant                                            |
|            |                                                         |
|            | -   representative, or                                  |
|            |                                                         |
|            | -   person testifying.                                  |
|            |                                                         |
|            | > ***Note***: Return unsworn or uncertified testimony   |
|            | > only if the RVSR or Decision Review Officer (DRO)     |
|            | > considers the evidence material to a favorable        |
|            | > determination of a claim.                             |
|            | >                                                       |
|            | > ***Reference***: For more information on certifying   |
|            | > testimony, see M21-1MR, Part III, Subpart iii, 1.B.8. |
+------------+---------------------------------------------------------+

#### 9. Lay Evidence

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about lay evidence,   |
| troduction | > including                                             |
|            |                                                         |
|            | -   acceptable lay evidence, and                        |
|            |                                                         |
|            | -   when to use lay evidence.                           |
+------------+---------------------------------------------------------+

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

+------------+---------------------------------------------------------+
| ##         | > Lay evidence is acceptable for the purpose of         |
| ### a. Acc | > establishing service incurrence or aggravation, in    |
| eptable La | > the absence of SMRs, for a combat veteran or former   |
| y Evidence | > POW, if the evidence                                  |
|            |                                                         |
|            | -   is satisfactory                                     |
|            |                                                         |
|            | -   is consistent with the circumstances, conditions,   |
|            |     or hardships of combat or POW internment, and       |
|            |                                                         |
|            | -   can prevail in spite of the absence of official     |
|            |     records showing incurrence or aggravation of the    |
|            |     disease or injury during service.                   |
|            |                                                         |
|            | > ***Important***: Medical evidence of a link to a      |
|            | > current condition is still needed to establish        |
|            | > service-related incurrence or aggravation.            |
|            | >                                                       |
|            | > ***Reference***: For more information on lay          |
|            | > evidence, see the *Judicial* *Review* *Conference*    |
|            | > *Call* dated April 4, 1996.                           |
+------------+---------------------------------------------------------+

Continued on next page

9\. Lay Evidence, Continued

+------------+---------------------------------------------------------+
| ###        | > A medically untrained individual is not competent to  |
| ## b. When | > offer medical opinion regarding the etiology of       |
|  to Use La | > disorders, and such an opinion is generally assigned  |
| y Evidence | > to little probative weight.                           |
|            | >                                                       |
|            | > The value accorded to other types of lay evidence     |
|            | > depends on such factors as                            |
|            |                                                         |
|            | -   the accuracy or clarity of the individual's memory  |
|            |                                                         |
|            | -   direct personal knowledge or experience, and        |
|            |                                                         |
|            | -   the competence of the reporting person.             |
|            |                                                         |
|            | > ***Note***: An opinion may be discounted if it        |
|            | > materially relies on a layperson's unsupported        |
|            | > history as the premise for the opinion.               |
|            | >                                                       |
|            | > ***References***: For more information on             |
|            |                                                         |
|            | -   discounting opinions that rely upon a layperson's   |
|            |     history, see *Wood v. Derwinski*, 1 Vet. App. 190   |
|            |     (1991), and                                         |
|            |                                                         |
|            | -   using lay evidence to support a claim, see          |
|            |     *Espiritu v. Derwinski*, 2 Vet. App. 492 (1992).    |
+------------+---------------------------------------------------------+

#### 10. Requiring Further Development

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

+------------+---------------------------------------------------------+
| ##### a    | > Further development may be needed to corroborate      |
| . Evidence | > testimony if the evidence is questionable or          |
|  Requiring | > conflicting.                                          |
|  Further D | >                                                       |
| evelopment | > This development may include field examinations       |
|            | > and/or social surveys to obtain transcripts of        |
|            | > original or other appropriate records.                |
+------------+---------------------------------------------------------+

#### 11. Evidence From Non-Department of Veterans Affairs (VA) Sources

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about evidence from   |
| troduction | > non-VA sources, including                             |
|            |                                                         |
|            | -   evaluating evidence from non-VA sources, and        |
|            |                                                         |
|            | -   considering conflicting evidence.                   |
+------------+---------------------------------------------------------+

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

+------------+---------------------------------------------------------+
| ##### a.   | > When evaluating medical and lay evidence from non-VA  |
|  Evaluatin | > sources                                               |
| g Evidence |                                                         |
|  From Non- | -   accept it at face value unless there is reason to   |
| VA Sources |     question it, and                                    |
|            |                                                         |
|            | -   question it if it is conflicting.                   |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > Use good judgment when evaluating conflicting         |
| #### b. Co | > evidence.                                             |
| nsidering  | >                                                       |
| Conflictin | > Consider the following issues:                        |
| g Evidence |                                                         |
|            | -   whether witnesses have a personal interest in the   |
|            |     issue                                               |
|            |                                                         |
|            | -   if there is a basis for bias                        |
|            |                                                         |
|            | -   if one party had a better opportunity to know the   |
|            |     facts, and                                          |
|            |                                                         |
|            | -   which version is more reasonable and probable.      |
+------------+---------------------------------------------------------+

#### 12. Weighing the Evidence

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about weighing the    |
| troduction | > evidence, including                                   |
|            |                                                         |
|            | -   assigning weight to the evidence                    |
|            |                                                         |
|            | -   questions to ask when weighing evidence             |
|            |                                                         |
|            | -   handling imbalanced evidence                        |
|            |                                                         |
|            | -   handling evidence in equipoise                      |
|            |                                                         |
|            | -   considering reasonable doubt                        |
|            |                                                         |
|            | -   an example of evidence in equipoise, and            |
|            |                                                         |
|            | -   reaching a conclusion.                              |
+------------+---------------------------------------------------------+

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

+------------+---------------------------------------------------------+
| #          | > After assigning weight to the evidence                |
| #### a. As |                                                         |
| signing We | -   review the evidence in its totality, and            |
| ight to th |                                                         |
| e Evidence | -   determine the *balancing of scales*.                |
|            |                                                         |
|            | > ***Note***: Do not assign weight unjustly or          |
|            | > arbitrarily.                                          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > Ask the questions listed below when weighing          |
|  Questions | > evidence.                                             |
|  to Ask Wh |                                                         |
| en Weighin | -   Did the evidence originate in service or in close   |
| g Evidence |     proximity to service?                               |
|            |                                                         |
|            | -   Is the medical opinion supported by clinical data?  |
|            |                                                         |
|            | -   How detailed is the opinion?                        |
|            |                                                         |
|            | -   Is the opinion based on personal knowledge or on    |
|            |     history provided by another person?                 |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c    | > If the evidence shows an overwhelming imbalance, then |
| . Handling | > the evidence requires a decision in that direction,   |
|  Imbalance | > either for or against.                                |
| d Evidence | >                                                       |
|            | > ***Note***: The claim must be granted if all of the   |
|            | > evidence is favorable.                                |
+------------+---------------------------------------------------------+

Continued on next page

12\. Weighing the Evidence, Continued

+------------+---------------------------------------------------------+
| ##### d.   | Resolve reasonable doubt in *favor* of the claimant if  |
| Handling E | all procurable evidence, after being weighed, is found  |
| vidence in | in approximate balance or equipoise. 38 CFR 3.102       |
|  Equipoise | dictates that the veteran prevails when the evidence    |
|            | neither satisfactorily proves nor disproves an issue.   |
|            |                                                         |
|            | > ***Reference***: For more information on applying     |
|            | > reasonable doubt, see *Alemany v. Brown*, 9 Vet. App. |
|            | > 518 (1996).                                           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e    | > Consider reasonable doubt *only* when the evidence is |
| . Consider | > in equipoise, *not* when the evidence weighs either   |
| ing Reason | > in favor or against the claimant.                     |
| able Doubt |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > In the following example there is no compelling       |
| #### f. Ex | > justification to side with either expert:             |
| ample of E | >                                                       |
| vidence in | > "*Evidence supportive of the claim includes the July  |
|  Equipoise | > 1991 opinion of Dr. T., who treated the veteran for   |
|            | > several years prior to his death, that PTSD had been  |
|            | > the major factor in the veteran's suicide. Evidence   |
|            | > against the claim includes the January 1992 opinion   |
|            | > of the VA physician that the evidence did not point   |
|            | > to PTSD as the actual cause of suicide and that the   |
|            | > veteran's suicide had occurred in the setting of      |
|            | > alcohol dependence, family breakdown, and             |
|            | > depression.*"                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### g. R | > When weighing the evidence to reach a conclusion      |
| eaching a  |                                                         |
| Conclusion | -   discuss the evidence in favor of the claim          |
|            |                                                         |
|            | -   discuss the evidence against the claim, and         |
|            |                                                         |
|            | -   explain that                                        |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   one set of evidence outweighs the other set, or     |
|            |                                                         |
|            | -   the evidence is in equal balance for and against    |
|            |     the claim.                                          |
+------------+---------------------------------------------------------+

#### 13. Handling Other Considerations in the Analysis

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about miscellaneous   |
| troduction | > concerns that should be addressed in the analysis,    |
|            | > including                                             |
|            |                                                         |
|            | -   explaining grants                                   |
|            |                                                         |
|            | -   explaining denials                                  |
|            |                                                         |
|            | -   supporting denials                                  |
|            |                                                         |
|            | -   the danger of paraphrasing                          |
|            |                                                         |
|            | -   addressing complex issues, and                      |
|            |                                                         |
|            | -   handling inferred issues.                           |
+------------+---------------------------------------------------------+

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

+------------+---------------------------------------------------------+
| #####      | > Grants may not require as extensive an explanation as |
| a. Explain | > denials and may be simply explained with a statement, |
| ing Grants | > such as "*The service medical records demonstrate     |
|            | > that the veteran fractured his left leg in service*." |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b    | > Provide a more in-depth recitation of the facts and a |
| . Explaini | > citation or paraphrase of pertinent law and           |
| ng Denials | > regulations to explain the basis for a denial.        |
|            | > Carefully craft the explanation to provide basic      |
|            | > information as succinctly as possible.                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c    | > Support the denial of NSC pension or individual       |
| . Supporti | > unemployability due to failure to meet the schedular  |
| ng Denials | > requirements by explaining                            |
|            |                                                         |
|            | -   how the disability percentages were assigned for    |
|            |     each disability by applying the pertinent           |
|            |     diagnostic codes to the evidence, and               |
|            |                                                         |
|            | -   why the veteran is considered to be able to perform |
|            |     work duties, given his/her employment background,   |
|            |     and the degree or nature of the SC or NSC           |
|            |     disabilities.                                       |
+------------+---------------------------------------------------------+

Continued on next page

13\. Handling Other Considerations in the Analysis, Continued

+------------+---------------------------------------------------------+
| #          | > Paraphrasing in easy-to-understand language requires  |
| #### d. Da | > care because the paraphrase might                     |
| nger of Pa |                                                         |
| raphrasing | -   misstate the law, or                                |
|            |                                                         |
|            | -   misstate or mistake medical facts.                  |
|            |                                                         |
|            | > ***Example***: Use paraphrased language to help       |
|            | > explain why the claim has been disallowed, but do not |
|            | > expressly state, "*The law says that....*" Simply     |
|            | > insert the paraphrase.                                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > Discuss complex issues, such as secondary service     |
| # e. Addre | > connection and aggravation of NSC disabilities by SC  |
| ssing Comp | > disabilities, more thoroughly than simple issues of   |
| lex Issues | > service connection.                                   |
|            | >                                                       |
|            | > ***Example***: In claims for secondary service        |
|            | > connection, address the relationship of the           |
|            | > disability claimed by the veteran to the condition    |
|            | > for which service connection has already been         |
|            | > established.                                          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > When an inferred issue is considered in a rating      |
| ## f. Hand | > decision, explicitly address the inferred issue in    |
| ling Infer | > the *Reasons for Decision*.                           |
| red Issues | >                                                       |
|            | > If the inferred issue and the primary issue           |
|            |                                                         |
|            | -   share the same fact pattern, then the inferred      |
|            |     issue may be incorporated in the same *Issue*,      |
|            |     *Decision*, and *Reasons for Decision* numbered     |
|            |     item as the primary issue, or                       |
|            |                                                         |
|            | -   are each itemized in a separate *Decision* and      |
|            |     *Reasons for Decision* paragraph, then the          |
|            |     discussion of the common fact pattern may be        |
|            |     confined to the *Reasons for Decision* of the       |
|            |     primary issue.                                      |
|            |                                                         |
|            | > ***Example***: The issue statement on the rating      |
|            | > decision could be worded as follows: "*1. Evaluation  |
|            | > of psychotic disorder currently evaluated as 30       |
|            | > percent disabling; Competency to handle disbursement  |
|            | > of funds*."                                           |
|            | >                                                       |
|            | > ***Reference***: For more information on inferred     |
|            | > issues, see M21-1MR, Part III, Subpart iv, 6.B.3.     |
+------------+---------------------------------------------------------+