#### Department of Veterans Affairs M21-1MR, Part III

**Veterans Benefits Administration Subpart iv**

**Washington, DC 20420 August 1, 2006**

#### Transmittal Sheet 

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| #####      | > Veterans Benefits Manual M21-1MR, Part III, Subpart   |
|  M21-1MR,  | > iv, "General Rating Process," is changed as follows:  |
|            | >                                                       |
| #####      | > The following pages are updated in this change:       |
| Part III,  |                                                         |
| Subpart iv | -   3-i and 3-A-1 through 3-A-44                        |
|            |                                                         |
| #####      | -   4-ii                                                |
|            |                                                         |
|            | -   4-D-3                                               |
|            |                                                         |
|            | -   4-H-1, 4-H-4, and 4-H-10 through 4-H-22             |
|            |                                                         |
|            | -   6-B-5 and 6-B-13                                    |
|            |                                                         |
|            | -   6-C-6                                               |
|            |                                                         |
|            | -   8-A-7 and 8-A-8, and                                |
|            |                                                         |
|            | -   8-E-4 through 8-E-7, and 8-E-9.                     |
|            |                                                         |
|            |     ***Notes***:                                        |
|            |                                                         |
|            | -   M21-1MR changes are released at the chapter or      |
|            |     section level. Change numbers will no longer be     |
|            |     assigned to M21-1MR changes. The date of the change |
|            |     will continue to show in the "Change Date" block    |
|            |     located on the first page of each topic.            |
|            |                                                         |
|            | -   "TBD" (to be determined) after a reference          |
|            |     indicates that the referenced material is located   |
|            |     in a part of M21-1MR that has not yet been          |
|            |     published.                                          |
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Transmittal Sheet, Continued

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| #####      | > Part III, Subpart iv, Chapter 3, Section A, Topic 1,  |
|  Changes I | > Block d (III.iv.3.A.1.d) is added to describe the     |
| ncluded in | > three terms commonly used to distinguish the basic    |
|  This Part | > categories of compensation and pension (C&P)          |
|            | > examinations: general medical examinations, specialty |
|            | > examinations, and specialist examinations. Subsequent |
|            | > blocks are renumbered.                                |
|            | >                                                       |
|            | > Block III.iv.3.A.1.e is revised to state that the     |
|            | > claims folder must be sent for the examiner's review  |
|            | > in cases involving a request for a formal medical     |
|            | > opinion, an initial claim for service connection for  |
|            | > posttraumatic stress disorder (PTSD), or a Board of   |
|            | > Veterans' Appeals remand. References are also added   |
|            | > for information on requests for medical opinions and  |
|            | > handling examinations in claims for service           |
|            | > connection for PTSD.                                  |
|            | >                                                       |
|            | > Block III.iv.3.A.3.a is revised to clarify that when  |
|            | > a general medical examination is scheduled to         |
|            | > evaluate an original compensation claim, specialty    |
|            | > examination worksheets should not be requested,       |
|            | > except when a specialist examination is required.     |
|            | > This policy applies regardless of whether the         |
|            | > examination is requested from the Veterans Health     |
|            | > Administration or from a private provider under VA    |
|            | > contract.                                             |
|            | >                                                       |
|            | > Block III.iv.3.A.9.a is added to clarify the          |
|            | > authority of Veterans Service Representatives, Rating |
|            | > Veterans Service Representatives, and the Veterans    |
|            | > Service Center Manager in requesting medical          |
|            | > opinions. Subsequent blocks in this topic are         |
|            | > renumbered.                                           |
|            | >                                                       |
|            | > Block III.iv.3.A.9.b is revised to indicate that the  |
|            | > medical opinion request should include a summary of   |
|            | > the evidence available in the case.                   |
|            | >                                                       |
|            | > Block III.iv.3.A.9.e is revised to clarify that to    |
|            | > prevent confusion, the word "opinion" should not be   |
|            | > used in examination requests unless a formal medical  |
|            | > opinion is being requested. Individual                |
|            | > unemployability is added as an example of an issue    |
|            | > not requiring a formal medical opinion.               |
|            | >                                                       |
|            | > A note is added to Block III.iv.3.A.9.f to explain    |
|            | > what the term "independent medical opinion" means     |
|            | > under VA's contract examination program.              |
|            | >                                                       |
|            | > Blocks III.iv.3.A.9.g through i are revised to        |
|            | > clarify that the blocks pertain to independent        |
|            | > medical opinions under 38 CFR 3.328.                  |
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Transmittal Sheet, Continued

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| Changes    | > The sample medical opinion request form in Block      |
| Included   | > III.iv.3.A.14.a is revised to include spaces for the  |
| in This    | > name and phone number of the employee requesting the  |
| Part       | > opinion and the date of the request.                  |
| (          | >                                                       |
| continued) | > Block III.iv.4.D.16.e is corrected to state that the  |
|            | > 100 percent evaluation following a spontaneous total  |
|            | > pneumothorax should continue for three months from    |
|            | > the first day of the month after hospital discharge.  |
|            | >                                                       |
|            | > Block III.iv.4.H.29.h is revised to show that         |
|            | > verification of receipt of Combat/Imminent            |
|            | > Danger/Hostile Fire Pay, available through the        |
|            | > Veterans Information Solution (VIS), may be used, in  |
|            | > combination with other evidence, to corroborate a     |
|            | > veteran's involvement in combat.                      |
|            | >                                                       |
|            | > Block III.iv.4.H.31.b is added to state that when     |
|            | > evidence of exposure to combat-related stressors is   |
|            | > established by a veteran's individual decoration(s),  |
|            | > the Remarks section of the examination request should |
|            | > include a statement to that effect. This evidence,    |
|            | > however, does not relieve the examiner of the         |
|            | > responsibility of eliciting details of a specific     |
|            | > traumatic event or events in order to render a        |
|            | > diagnosis. The subsequent block is renumbered.        |
|            | >                                                       |
|            | > The first note in the table in Block III.iv.6.B.3.d   |
|            | > is revised to emphasize that entitlement to           |
|            | > Dependents' Educational Assistance should not be put  |
|            | > at issue merely to deny it.                           |
|            | >                                                       |
|            | > Block III.iv.6.B.6.a is corrected to change the       |
|            | > reference citation for information on rating PTSD to  |
|            | > "M21-1MR, Part III, Subpart iv, 4.H.31."              |
|            | >                                                       |
|            | > Block III.iv.6.C.11.a is corrected to replace the     |
|            | > phrase "next higher effective date" with "next higher |
|            | > evaluation."                                          |
|            | >                                                       |
|            | > The label of Block III.iv.8.A.4.d.is changed to       |
|            | > "Evidence Required to Restore Competency" to better   |
|            | > reflect its content. Block III.iv.8.A.4.d is          |
|            | > corrected to reflect that under 38 CFR 3.328, a       |
|            | > beneficiary is not required to undergo a psychiatric  |
|            | > examination and/or field examination before his/her   |
|            | > competency may be restored. However, these            |
|            | > examinations may be requested, if needed to evaluate  |
|            | > the beneficiary's capacity to handle funds.           |
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Transmittal Sheet, Continued

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| Changes    | > Block III.iv.8.E.16.c is corrected to change the      |
| Included   | > reference citation to "M21-1MR, Part III, Subpart iv, |
| in This    | > 8.E.16.b."                                            |
| Part       | >                                                       |
| (          | > The label of Block III.iv.8.E.17.c is changed to      |
| continued) | > "Severing Service Connection for a Psychosis" to      |
|            | > better reflect its content.                           |
|            | >                                                       |
|            | > The note in Block III.iv.8.E.17.g is corrected to     |
|            | > replace the word "insure" with "ensure." This block   |
|            | > is also revised to state that the final decision      |
|            | > severing service connection requires referral to the  |
|            | > VSCM or VSCM-designee for approval only if new        |
|            | > evidence has been received since the proposed         |
|            | > decision was approved.                                |
|            | >                                                       |
|            | > Block III.iv.8.E.18.a is amended to delete reference  |
|            | > citations for rescinded paragraphs from M21-1, Part   |
|            | > IV, Chapter 11.                                       |
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| ##### R    | > None                                                  |
| escissions |                                                         |
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| #####      | > By Direction of the Under Secretary for Benefits      |
|  Authority |                                                         |
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| #####      | Renée L. Szybala, Director                              |
|  Signature |                                                         |
|            | > Compensation and Pension Service                      |
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| ##### Di   | > RPC: 2068                                             |
| stribution | >                                                       |
|            | > FD: EX: ASO and AR (included in RPC 2068)             |
|            | >                                                       |
|            | > LOCAL REPRODUCTION AUTHORIZED                         |
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