Source: http://helpdesk.newmobility.com/index.php?pg=kb.printer.friendly&id=81
Timestamp: 2017-09-23 00:24:17
Document Index: 14499659

Matched Legal Cases: ['§ 3', '§ 3', '§ 5121', '§ 101', '§ 5121', '§ 5121', '§ 3', '§ 7261']

A claim for benefits, whether formal or informal, remains pending until it is finally adjudicated ("rated"). Ingram v. Nicholson, 21 Vet. App. 232 (2007); 38 C.F.R. § 3.160(c); see John Fussell & Jonathan Hager, The Evolution of the Pending Claim Doctrine, 2 VETERANS L. REV. 145, 164-69 (2010). A "pending claim" is "[a]n application, formal or informal, which has not been finally adjudicated." 38 C.F.R. § 3.160(c). "Consistent with this regulation . . . [the] Court has held that a claim remains pending – even for years – if the Secretary fails to act on a claim before him." Ingram, 21 Vet. App. at 240.
Section 5121(a)(2) provides that upon the death of a veteran, payment should be made to the living person first listed: the "veteran's spouse," "the veteran's children," or "the veteran's dependent parents." 38 U.S.C. § 5121(a)(2). In order to be eligible for accrued benefits, therefore, the claimant must qualify as a member of one of the statutorily enumerated categories of recipients. See Burris v. Principi, 15 Vet. App. 348, 352–53 (2001) (concluding that 70-year-old appellant was ineligible for accrued benefits because he did not satisfy statutory definition of "child" in 38 U.S.C. § 101(4)(A), which excludes anyone over age 23 unless they were "permanently incapable of self-support" before attaining age 18); Marlow v. West, 12 Vet. App. 548, 551 (1999) (noting that section 5121(a) "limits qualifying survivors to the deceased veteran's spouse, child ... or dependent parents"). Subsection (a)(5) provides: "In all other cases, only so much of the accrued benefits may be paid as may be necessary to reimburse the person who bore the expense of last sickness and burial." 38 U.S.C. § 5121(a)(5). A surviving spouse's estate is not in the class of "persons" designated in 38 U.S.C. § 5121(a)(3) as eligible to receive accrued benefits. See Wilkes v. Principi, 16 Vet. App. 237 (2002) (holding that the nephew of the veteran who was co-executor of the veteran's estate was not eligible to receive accrued benefits).
"It is the responsibility of the [Hearing Officer] to explain fully the issues and suggest the submission of evidence which the claimant may have overlooked and which would be of advantage to the claimant's position." 38 C.F.R. § 3.103(c)(2); Robinson v. Peake, 21 Vet. App. 545, 552 (2008) (Board must address issues raised by the appellant or reasonably by the record). There is prejudice when a claimant is not given a hearing before all Board members who adjudicated his claim and credibility is at issue. Arneson v. Shinseki, 24 Vet. App. at 379, 387-89 (2011). If the hearing officer failed to fulfill his duties, the Court must determine whether any resulting error was prejudicial to the appellant. Id. at 497–98; see 38 U.S.C. § 7261(b)(2) (providing that the Court shall take due account of the rule of prejudicial error); Mayfield v. Nicholson, 19 Vet. App. 103, 116 (2005) (stating that the key to determining whether an error is prejudicial is the effect of the error on the essential fairness of the adjudication), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006).
The Court has specifically required VA to follow its own regulations when it attempts to reduce a veteran's rating. See Fugere v. Derwinski, 1 Vet. App. 103 (1990) (holding that VA was required to give notice and opportunity to be heard prior to deleting provision of VA Adjudication Procedure Manual M21–1MR that had provided regulatory-like procedural protections prior to reducing veteran's rating, and noting: "Where the rights of individuals are affected, it is incumbent upon agencies to follow their own procedures." (citations omitted)), aff'd, 972 F.2d 331 (Fed. Cir. 1992). The Court determines de novo whether VA has followed and applied its own regulations in reducing or terminating VA benefits. See Wilson (Merritte) (making determination de novo without so stating) and Fugere (same), both supra; Brown (Kevin) v. Brown, 5 Vet. App. 413, 416–21 (1993) (same); cf. Buzinski, supra (reviewing de novo compliance with VA regulation regarding mortgage foreclosure).