Determination That Review Examination Should Not Be Scheduled actions cancellation of the future examination control prior to maturation, or determination that a review examination should not be scheduled at the time the future examination control matures. When the action is based on ... Then ... a determination that the examination control was initially set up in error Example: In violation of , a future examination control is set for a condition, like amyotrophic lateral sclerosis (ALS), that can only be rated at 100 and is, by its nature, permanent. set the date of P&T disability as if the future examination control was never established. Explanation: The examination control was erroneous; therefore, the condition was static at the time of the rating decision establishing SC. a difference in judgment rather than a specific error in the initial future examination control Example: The rating activity determines, prior to scheduling, that a review examination should not be scheduled as planned because the conclusion of likely future improvement used to set the future examination control was not well justified by the facts. use the date of review or the date of cancellation for the date of P&T disability. Explanation: This is essentially a new determination of permanency on the date of review caused by reexamination of the facts. new evidence that changes the prior assessment that the total disability is likely to improve, as indicated by a future examination control use the date that the new evidence is received for the date of P&T disability. Exception: When the new evidence consists of a VA medical record generated after the date of the rating in which the future examination control was set, use the date of the record. o. Regaining Entitlement to DIC for a Surviving Spouse Upon Termination of a Relationship Upon Which Entitlement Was Previously Precluded Under the provisions of , a surviving spouse who is ineligible for DIC because he/she has 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. 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) 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
a disorder that can be SC for compensation purposes, and evaluated under, or by appropriate analogy to, the , 9900-series DCs, and a disorder that is not listed in (treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, or periodontal disease) or in (calculus, acute periodontal disease, third molars, impacted or malposed teeth, or other developmental defects). clearly seeks “compensation” for a dental/oral condition that is not a dental disability. the issue is entitlement to SC for compensation purposes of the specified condition. clearly seeks only “dental treatment,” “service connection for dental treatment purposes,” or equivalent wording refer the claim to the nearest VA medical center (VAMC) dental clinic of jurisdiction or eligibility clerk for determination of eligibility, and do not develop and/or decide the claim unless or until the medical center requests a determination on VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative Action. seeks “service connection” for a dental/oral condition that is not a dental disability clarify the claim before taking other action. Explanation: SC can be established for compensation purposes and/or for treatment purposes. RO personnel must neither refer a claim to the medical center as a treatment claim if not clear, nor decide the issue of SC for compensation purposes of a dental/oral condition that is not a dental disability unless the claimant is clearly seeking compensation. seeks “service connection” for an unspecified dental disorder (wording such as “dental “or “dental condition”) clarify the claim before taking other action. Explanation: The intent could be to seek a determination of SC for compensation purposes or for treatment purposes and the description is insufficient to determine whether the dental disorder or condition is a dental disability. seeks treatment for a dental disability for which SC for compensation purposes is possible but not previously established clarify the claim before taking other action. Explanation: The claimant could be seeking treatment only, but could also be eligible for SC for compensation purposes, which may be relevant treatment eligibility. Treatment can be provided for
a 0-percent evaluation, or conditions that can only be SC for treatment purposes and, therefore, are not entitled to any compensation payments. c. VHA and VBA Roles in Dental Treatment Eligibility Determinations Authorization of dental treatment under is normally handled by the Business Office at the VHA facility nearest the Veteran’s residence or the VHA Health Eligibility Center (HEC) without referral to the Veterans Service Center (VSC) and the rating activity. However, when a claim for dental treatment received by VBA is referred to VHA, or if the Veteran requests treatment at a VHA clinic, VHA may complete VA Form 10-7131 to request information or a rating from VBA for use in its determination of eligibility to treatment under Class I, II, II(a), II(c), or Class IV. References: For more information on the classes of dental treatment eligibility, see M21-1, Part IX, Subpart ii, 2.2.b, or M21-1, Part III, Subpart v, 7.B determinations VBA may make for dental treatment purposes, see M21-1, Part IX, Subpart ii, 2.2.d, and processing dental claims, see M21-1, Part III, Subpart v, 7.C. d. Determinations VBA Makes for Dental Treatment Purposes Per , VHA may request determinations from VBA including, but not limited to, whether a dental condition or disability is a result of combat wounds a dental condition or disability is a result of service trauma the Veteran has a non-compensable SC dental condition or disability the Veteran has a compensable SC disability the Veteran is totally disabled due to an SC disability, or the Veteran has FPOW status. Note: This does not mean a formal rating determination is always required. In many cases, eligibility for outpatient dental treatment can be decided by VHA without VBA rating action based on information of record such as one-time dental treatment for Veterans who apply within 180 days after military discharge (Class II) FPOW status (Class II(c)), and total disability (Class IV). In lieu of a dental treatment rating decision, annotate VA Form 10-7131 that the Veteran is totally disabled. References: For more information on conditions that can be SC only for treatment purposes, see M21-1, Part IX,
Disability c. Denying Dental Claims for SC Compensation Consider the issue of SC for compensation purposes for the conditions listed in in a formal rating and deny the claim if a Veteran claims compensation for one of these conditions, and the record shows no complicating condition that is subject to SC. In the Narrative of the rating decision, discuss that under , SC for such conditions can be established only for treatment purposes, and note if dental treatment in service was limited to conditions affecting only the teeth or gums. d. Evaluating Bony Abnormalities of the Jaw Evaluate bony abnormalities of the jaw that are subject to SC according to the 9900-series DCs contained in . e. Definition and Evaluation Guidelines for Bruxism Bruxism is defined as excessive grinding of the teeth and/or excessive clenching of the jaw. Bruxism cannot be evaluated as a stand-alone SC disability. However, as the condition may be a symptom of an anxiety disorder, temporomandibular joint (TMJ) dysfunction, or some other disability, it may be considered on a secondary basis as a symptom of an SC disability for rating purposes. Important: If an examination solely diagnoses bruxism and does not provide an etiology for bruxism, return the examination to the examiner and request the etiology of bruxism in order to determine whether bruxism is secondary to an SC disability. References: For more information on requirements for examination reports generally, see M21-1, Part III, Subpart iv, 3.D.2 bruxism examination report review, see M21-1, Part III, Subpart iv, 3.D.4, and returning examination reports as insufficient for rating purposes, see M21-1, Part III, Subpart iv, 3.D.3.
f. Avoiding Pyramiding With Conditions Rated on Motion In assigning an evaluation for TMJ or any other dental disability on the basis of limited motion of temporomandibular articulation under , do not assign separate evaluations for limited inter-incisal motion involving each side of the jaw. Doing so is pyramiding. Only one evaluation may be assigned. If both sides of the jaw are affected, use the limitation of motion on the side that affords the highest evaluation. Example: Inter-incisal motion is limited to 35 mm on the right and 25 mm on the left. Assign a single 20-percent evaluation under . Do not assign separate 10-and 20-percent evaluations. Reference: For more information on the prohibition against pyramiding, see . 4. Rating for Medical Care Introduction This topic contains information on rating for medical care, including RO role in eligibility determinations for medical care, and taking rating action for medical care purposes. Change Date March 10, 2016
a. Certifying Civil Service Disability Preference For the purpose of certifying civil service disability preference, an SC disability may be assigned an evaluation of “less than ten percent” for any directly or presumptively SC disease or injury that exhibits some extent of actual impairment. b. Requirements for Civil Service Evaluations For noncombat disabilities, there must be ascertainable residuals before a “less than ten percent” evaluation may be assigned for civil service preference purposes. Ascertainable residuals means symptoms that can be objectively verified on examination. Note: Combat incurred non-compensable disabilities warrant an evaluation of “less than ten percent.” c. When a Rating Is Required for Civil Service Preference A rating is required for civil service preference purposes if a previous rating did not establish entitlement to compensation, which includes special monthly compensation (SMC) or entitlement under . d. What to Include in the Rating Narrative for Civil Service Preference Determinations In the Narrative of the civil service preference determination, show the DC, diagnosis, and an evaluation of either “less than ten percent,” or “The noncompensable service-connected disabilities have no ascertainable residuals.” 8. Extending the Delimiting Dates for Educational Assistance
Introduction This topic contains information on extending the delimiting dates for educational assistance based on disability, including Regional Processing Office (RPO) jurisdiction in claims for extension of the educational assistance delimiting date when the delimiting dates for educational assistance may be extended determining whether the disability was the result of willful misconduct when medical infeasibility to pursue training may be found for any period during which the claimant was employed full-time time limit for requesting a delimiting date extension when to refer claims for delimiting date extensions to the rating activity processing claims for delimiting date extensions reviewing medical records for evidence relating to non-Education Service benefits, and rating conclusion for determinations of delimiting date extensions. Change Date February 3, 2011 a. RPO Jurisdiction in Claims for Extension of the Educational Assistance Delimiting Date The jurisdiction of all rating determinations required in claims for extension of the educational assistance delimiting date resides with the Regional Processing Offices (RPO) in Atlanta Buffalo St. Louis, and Muskogee. If an RO receives a request for a delimiting date extension, the RO should route the request to the RPO of jurisdiction. Note: The address of the claimant’s educational facility determines which RPO has jurisdiction over the claim. Reference: For more information on the alignment of ROs and RPOs, see M21-1, Part IX, Subpart ii, 2, 11. b. When the Delimiting Dates for Educational Assistance May Be Extended The delimiting date for educational assistance may be extended for the following beneficiaries if the rating activity determines that mental or physical disability, not the result of misconduct, prevented their initiation or completion of a chosen program of education within the applicable 10, 12, 15, or 20-year period of eligibility Veterans eligible for , , , and benefits reservists eligible for benefits, and spouses or surviving spouses eligible for or benefits.
a. Alignment of ROs and RPOs for Jurisdiction of Education Claims The jurisdiction of an RPO over an education claim is based on the address of the educational facility where the beneficiary is enrolled. For example, if the beneficiary attends a college in Ohio, the St. Louis RPO would have jurisdiction over the education claim. The table below indicates which ROs are aligned with RPOs in Atlanta Buffalo St. Louis, and Muskogee. RPO Atlanta RPO Buffalo RPO St. Louis RPO Muskogee Atlanta Baltimore Chicago Albuquerque San Juan Boston Cleveland Anchorage Winston-Salem Buffalo Des Moines Boise District of Columbia, Washington Detroit Fort Harrison Hartford Fargo Houston Wilmington Denver Little Rock Manchester Indianapolis Los Angeles Newark Lincoln Manila New York Louisville Muskogee Philadelphia Milwaukee New Orleans Pittsburgh Nashville Oakland Providence Sioux Falls Phoenix Roanoke St. Louis Portland Togus St. Paul Reno White River Junction Wichita Salt Lake City Cheyenne San Diego Huntington Seattle Honolulu Waco Columbia St. Petersburg Jackson Montgomery