SUBCHAPTER I—CLAIMS
Editorial Notes
Amendments
1988—
§5100. Definition of "claimant"
For purposes of this chapter, the term "claimant" means any individual applying for, or submitting a claim for, any benefit under the laws administered by the Secretary.
(Added
§5101. Claims and forms
(a)(1)(A) Except as provided in subparagraph (B), a specific claim in the form prescribed by the Secretary (or jointly with the Commissioner of Social Security, as prescribed by
(B)(i) The Secretary may pay benefits under chapters 13 and 15 and
(ii) For purposes of this subparagraph and
(I) The date on which the survivor of a veteran (or the representative of such a survivor) notifies the Secretary of the death of the veteran through a death certificate or other relevant evidence that establishes entitlement to survivors' benefits identified in clause (i).
(II) The head of any other department or agency of the Federal Government notifies the Secretary of the death of the veteran.
(iii) In notifying the Secretary of the death of a veteran as described in clause (ii)(I), the survivor (or the representative of such a survivor) may submit to the Secretary additional documents relating to such death without being required to file a formal claim.
(2) If an individual has not attained the age of 18 years, is mentally incompetent, or is physically unable to sign a form, a form filed under paragraph (1) for the individual may be signed by a court-appointed representative, a person who is responsible for the care of the individual, including a spouse or other relative, or an attorney in fact or agent authorized to act on behalf of the individual under a durable power of attorney. If the individual is in the care of an institution, the manager or principal officer of the institution may sign the form.
(b)(1) A claim by a surviving spouse or child for compensation or dependency and indemnity compensation shall also be considered to be a claim for death pension and accrued benefits, and a claim by a surviving spouse or child for death pension shall be considered to be a claim for death compensation (or dependency and indemnity compensation) and accrued benefits.
(2) A claim by a parent for compensation or dependency and indemnity compensation shall also be considered to be a claim for accrued benefits.
(c)(1) Any person who applies for, signs a form on behalf of an individual to apply for, or is in receipt of any compensation or pension benefit under laws administered by the Secretary shall, if requested by the Secretary, furnish the Secretary with the social security number of such person, or TIN in the case that the person is not an individual, and the social security number of any claimant, dependent, or beneficiary on whose behalf, or based upon whom, such person applies for or is in receipt of such benefit. A person is not required to furnish the Secretary with a social security number for any person to whom a social security number has not been assigned.
(2) The Secretary shall deny the application of or terminate the payment of compensation or pension to a person who fails to furnish the Secretary with a social security number or TIN required to be furnished pursuant to paragraph (1) of this subsection. The Secretary may thereafter reconsider the application or reinstate payment of compensation or pension, as the case may be, if such person furnishes the Secretary with such social security number or TIN.
(3) The costs of administering this subsection shall be paid for from amounts available to the Department of Veterans Affairs for the payment of compensation and pension.
(d) In this section:
(1) The term "mentally incompetent" with respect to an individual means that the individual lacks the mental capacity—
(A) to provide substantially accurate information needed to complete a form; or
(B) to certify that the statements made on a form are true and complete.
(2) The term "TIN" has the meaning given the term in section 7701(a)(41) of the Internal Revenue Code of 1986.
(
Editorial Notes
References in Text
Section 7701(a)(41) of the Internal Revenue Code of 1986, referred to in subsec. (d)(2), is classified to
Prior Provisions
Prior section 5101 was renumbered
Amendments
2016—Subsec. (a)(1).
2012—Subsec. (a).
Subsec. (c)(1).
Subsec. (c)(2).
Subsec. (d).
2003—Subsec. (a).
1991—
Subsec. (a).
1990—Subsec. (c).
1986—Subsec. (b)(1).
1982—Subsec. (a).
Statutory Notes and Related Subsidiaries
Effective Date of 2016 Amendment
Effective Date of 2012 Amendment
Plan for Processing Legacy Appeals and Implementing New Appeals System
"SEC. 3. COMPREHENSIVE PLAN FOR PROCESSING OF LEGACY APPEALS AND IMPLEMENTING NEW APPEALS SYSTEM.
"(a)
"(1) the processing of appeals of decisions on legacy claims that the Secretary considers pending;
"(2) implementing the new appeals system;
"(3) timely processing, under the new appeals system, of—
"(A) supplemental claims under
"(B) requests for higher-level review under section 5104B of such title, as added by section 2(g); and
"(C) appeals on any docket maintained under section 7107 of such title, as amended by section 2(t); and
"(4) monitoring the implementation of the new appeals system, including metrics and goals—
"(A) to track the progress of the implementation;
"(B) to evaluate the efficiency and effectiveness of the implementation; and
"(C) to identify potential issues relating to the implementation.
"(b)
"(1) Delineation of the total resource requirements of the Veterans Benefits Administration and the Board of Veterans' Appeals, disaggregated by resources required to implement and administer the new appeals system and resources required to address the appeals of decisions on legacy claims.
"(2) Delineation of the personnel requirements of the Administration and the Board, including staffing levels during the—
"(A) period in which the Administration and the Board are concurrently processing—
"(i) appeals of decisions on legacy claims; and
"(ii) appeals of decisions on non-legacy claims under the new appeals system; and
"(B) the period during which the Administration and the Board are no longer processing any appeals of decisions on legacy claims.
"(3) Identification of the legal authorities under which the Administration or the Board may—
"(A) hire additional employees to conduct the concurrent processing described in paragraph (2)(A); and
"(B) remove employees who are no longer required by the Administration or the Board once the Administration and the Board are no longer processing any appeals of decisions on legacy claims.
"(4) An estimate of the amount of time the Administration and the Board will require to hire additional employees as described in paragraph (3)(A) once funding has been made available for such purpose, including a comparison of such estimate and the historical average time required by the Administration and the Board to hire additional employees.
"(5) A description of the amount of training and experience that will be required of individuals conducting higher-level reviews under
"(6) An estimate of the percentage of higher-level adjudicators who will be employees of the Department of Veterans Affairs who were Decision Review Officers on the day before the new appeals system takes effect or had experience, as of such date, comparable to that of one who was a Decision Review Officer.
"(7) A description of the functions that will be performed after the date on which the new appeals system takes effect by Decision Review Officers who were Decision Review Officers on the day before the date the new appeals system takes effect.
"(8) Identification of and a timeline for—
"(A) any training that may be required as a result of hiring new employees to carry out the new appeals system or to process appeals of decisions on legacy claims; and
"(B) any retraining of existing employees that may be required to carry out such system or to process such claims.
"(9) Identification of the costs to the Department of Veterans Affairs of the training identified under paragraph (8) and any additional training staff and any additional training facilities that will be required to provide such training.
"(10) A description of the modifications to the information technology systems of the Administration and the Board that the Administration and the Board require to carry out the new appeals system, including cost estimates and a timeline for making the modifications.
"(11) An estimate of the office space the Administration and the Board will require during each of the periods described in paragraph (2), including—
"(A) an estimate of the amount of time the Administration and the Board will require to acquire any additional office space to carry out processing of appeals of decisions on legacy claims and processing of appeals under the new appeals system;
"(B) a comparison of the estimate under subparagraph (A) and the historical average time required by the Administration and the Board to acquire new office space; and
"(C) a plan for using telework to accommodate staff exceeding available office space, including how the Administration and the Board will provide training and oversight with respect to such teleworking.
"(12) Projections for the productivity of individual employees at the Administration and the Board in carrying out tasks relating to the processing of appeals of decisions on legacy claims and appeals under the new appeals system, taking into account the experience level of new employees and the enhanced notice requirements under
"(13) An outline of the outreach the Secretary expects to conduct to inform veterans, families of veterans, survivors of veterans, veterans service organizations, military service organizations, congressional caseworkers, advocates for veterans, and such other stakeholders as the Secretary considers appropriate about the new appeals system, including—
"(A) a description of the resources required to conduct such outreach; and
"(B) timelines for conducting such outreach.
"(14) Timelines for updating any policy guidance, Internet websites, and official forms that may be necessary to carry out the new appeals system, including—
"(A) identification of which offices and entities will be involved in efforts relating to such updating; and
"(B) historical information about how long similar update efforts have taken.
"(15) A timeline, including interim milestones, for promulgating such regulations as may be necessary to carry out the new appeals system and a comparison with historical averages for time required to promulgate regulations of similar complexity and scope.
"(16) An outline of the circumstances under which claimants with pending appeals of decisions on legacy claims would be authorized to have their appeals reviewed under the new appeals system.
"(17) A delineation of the key goals and milestones for reducing the number of pending appeals that are not processed under the new appeals system, including the expected number of appeals, remands, and hearing requests at the Administration and the Board each year, beginning with the one year period beginning on the date of the enactment of this Act [Aug. 23, 2017], until there are no longer any appeals pending before the Administration or the Board for a decision on a legacy claim.
"(18) A description of each risk factor associated with each element of the plan and a contingency plan to minimize each such risk.
"(c)
"(1)
"(A) assess such plan; and
"(B) notify the appropriate committees of Congress of the findings of the Comptroller General with respect to the assessment conducted under subparagraph (A).
"(2)
"(A) An assessment of whether the plan comports with sound planning practices.
"(B) Identification of any gaps in the plan.
"(C) Formulation of such recommendations as the Comptroller General considers appropriate.
"(d)
"(e)
"(1) the plan required by subsection (a); and
"(2) the periodic progress reports required by subsection (d).
"(f)
"(1) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and
"(2) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.
"SEC. 4. PROGRAMS TO TEST ASSUMPTIONS RELIED ON IN DEVELOPMENT OF COMPREHENSIVE PLAN FOR PROCESSING OF LEGACY APPEALS AND SUPPORTING NEW APPEALS SYSTEM.
"(a)
"(1)
"(2)
"(b)
"(1)
"(2)
"(A)
"(i) The notice of disagreement under
"(ii) All evidence that the claimant believes is needed for the appeal as of the date of the filing.
"(iii) A statement of the argument in support of the claim, if any.
"(B)
"(C)
"(D)
"(i)
"(ii)
"(E)
"(i) The Secretary shall provide to the claimant (and to the representative of record of the claimant, if any) information regarding—
"(I) the program, including the advantages and disadvantages of the program;
"(II) how to make an election under subparagraph (A);
"(III) the limitation on the use of new evidence described in subparagraph (C) of paragraph (3) and the development of information under subparagraph (D) of such paragraph;
"(IV) the ability of the claimant to seek advice and education regarding such process from veterans service organizations, attorneys, and claims agents recognized under
"(V) the circumstances under which the appeal will automatically revert to the standard appeals process, including by making a request for a hearing.
"(ii) The Secretary shall collaborate, partner with, and give weight to the advice of the three veterans service organizations with the most members and such other stakeholders as the Secretary considers appropriate to publish on the Internet website of the Department of Veterans Affairs an online tutorial explaining the advantages and disadvantages of the program.
"(3)
"(A)
"(i) not provide the claimant with a statement of the case nor require the claimant to file a substantive appeal; and
"(ii) transfer jurisdiction over the fully developed appeal directly to the Board of Veterans' Appeals.
"(B)
"(i)
"(I) maintain fully developed appeals on a separate docket than standard appeals;
"(II) decide fully developed appeals in the order that the fully developed appeals are received on the fully developed appeal docket;
"(III) except as provided by clause (ii), decide not more than one fully developed appeal for each four standard appeals decided; and
"(IV) to the extent practicable, decide each fully developed appeal by the date that is one year following the date on which the claimant files the notice of disagreement.
"(ii)
"(C)
"(i)
"(I) a claimant may not submit or identify to the Board of Veterans' Appeals any new evidence relating to a fully developed appeal after filing such appeal unless the claimant reverts to the standard appeals process pursuant to paragraph (2)(D); and
"(II) if a claimant submits or identifies any such new evidence, such submission or identification shall be deemed to be an election to make such a reversion pursuant to paragraph (2)(D).
"(ii)
"(iii)
"(D)
"(i) in accordance with subparagraph (E), take such actions as may be necessary to develop such records, opinions, or examinations in accordance with
"(ii) retain jurisdiction of the fully developed appeal without requiring a determination by the Veterans Benefits Administration based on such records, opinions, or examinations;
"(iii) ensure the claimant, and the representative of record of a claimant, if any, receives a copy of such records, opinions, or examinations; and
"(iv) provide the claimant a period of 90 days after the date of mailing such records, opinions, or examinations during which the claimant may provide the Board any additional evidence without requiring the claimant to make a reversion pursuant to paragraph (2)(D).
"(E)
"(i)
"(ii)
"(I) ensure that the Veterans Benefits Administration cooperates with the Board of Veterans' Appeals in carrying out clause (i); and
"(II) transfer employees of the Veterans Benefits Administration who, prior to the enactment of this Act [see Tables for classification], were responsible for processing claims remanded by the Board of Veterans' Appeals to positions within the office of the Board established under clause (i) in a number the Secretary determines sufficient to carry out such subparagraph.
"(F)
"(4)
"(A)
"(B)
"(5)
"(A)
"(B)
"(i) filed by a claimant in accordance with paragraph (2)(A); and
"(ii) considered in accordance with this subsection.
"(C)
"(c)
"SEC. 5. PERIODIC PUBLICATION OF METRICS RELATING TO PROCESSING OF APPEALS BY DEPARTMENT OF VETERANS AFFAIRS.
"The Secretary of Veterans Affairs shall periodically publish on an Internet website of the Department of Veterans Affairs the following:
"(1) With respect to the processing by the Secretary of appeals under the new appeals system of decisions regarding claims for benefits under laws administered by the Secretary, the following:
"(A) For the Veterans Benefits Administration and, to the extent practicable, each regional office of the Department of Veterans Affairs, the number of—
"(i) supplemental claims under
"(ii) requests for higher-level review under section 5104B of such title, as added by section 2(g), that are pending.
"(B) The number of appeals on any docket maintained under section 7107 of such title, as amended by section 2(t), that are pending.
"(C) The average duration for processing claims and supplemental claims, disaggregated by regional office.
"(D) The average duration for processing requests for higher-level review under section 5104B of such title, as added by section 2(g), disaggregated by regional office.
"(E) The average number of days that appeals are pending on a docket of the Board of Veterans' Appeals maintained pursuant to section 7107 of such title, as amended by section 2(t), disaggregated by—
"(i) appeals that include a request for a hearing;
"(ii) appeals that do not include a request for a hearing and do include submittal of evidence; and
"(iii) appeals that do not include a request for a hearing and do not include submittal of evidence.
"(F) With respect to the policy developed and implemented under section 7107(e) of such title, as amended by section 2(t)—
"(i) the number of cases moved from one docket to another pursuant to such policy;
"(ii) the average time cases were pending prior to moving from one docket to another; and
"(iii) the average time to adjudicate the cases after so moving.
"(G) The total number of remands to obtain advisory medical opinions under
"(H) The average number of days between the date on which the Board remands a claim to obtain an advisory medical opinion under section 5109(d) of such title, as so added, and the date on which the advisory medical opinion is obtained.
"(I) The average number of days between the date on which the Board remands a claim to obtain an advisory medical opinion under section 5109(d) of such title, as so added, and the date on which the agency of original jurisdiction issues a decision taking that advisory opinion into account.
"(J) The number of appeals that are granted, the number of appeals that are remanded, and the number of appeals that are denied by the Board disaggregated by docket.
"(K) The number of claimants each year that take action within the period set forth in section 5110(a)(2) of such title, as added by section 2(l), to protect their effective date under such section 5110(a)(2), disaggregated by the status of the claimants taking the actions, such as whether the claimant is represented by a veterans service organization, the claimant is represented by an attorney, or the claimant is taking such action pro se.
"(L) The total number of times on average each claimant files under section 5110(a)(2) of such title, as so added, to protect their effective date under such section, disaggregated by the subparagraph of such section under which they file.
"(M) The average duration, from the filing of an initial claim until the claim is resolved and claimants no longer take any action to protect their effective date under section 5110(a)(2) of such title, as so added—
"(i) of claims under the new appeals system, excluding legacy claims that opt in to the new appeals system; and
"(ii) of legacy claims that opt in to the new appeals system.
"(N) How frequently an action taken within one year to protect an effective date under section 5110(a)(2) of such title, as so added, leads to additional grant of benefits, disaggregated by action taken.
"(O) The average of how long it takes to complete each segment of the claims process while claimants are protecting the effective date under such section, disaggregated by the time waiting for the claimant to take an action and the time waiting for the Secretary to take an action.
"(P) The number and the average amount of retroactive awards of benefits from the Secretary as a result of protected effective dates under such section, disaggregated by action taken.
"(Q) The average number of times claimants submit to the Secretary different claims with respect to the same condition, such as an initial claim and a supplemental claim.
"(R) The number of cases each year in which a claimant inappropriately tried to take simultaneous actions, such as filing a supplemental claim while a higher-level review is pending, what actions the Secretary took in response, and how long it took on average to take those actions.
"(S) In the case that the Secretary develops and implements a policy under section 5104C(a)(2)(D) of such title, as amended by section 2(h)(1), the number of actions withdrawn and new actions taken pursuant to such policy.
"(T) The number of times the Secretary received evidence relating to an appeal or higher-level review at a time not authorized under the new appeals system, disaggregated by actions taken by the Secretary to deal with the evidence and how long on average it took to take those actions.
"(U) The number of errors committed by the Secretary in carrying out the Secretary's duty to assist under
"(V) An assessment of the productivity of employees at the regional offices and at the Board, disaggregated by level of experience of the employees.
"(W) The percentage of cases that are decided within the goals established by the Secretary for deciding cases, disaggregated by cases that involve a supplemental claim, cases that involve higher-level review, and by docket maintained under section 7107(a) of such title, as amended by section 2(t), or in the case that the Secretary has not established goals for deciding cases, the percentage of cases which are decided within one year, two years, three years, and more than three years, disaggregated by docket.
"(X) Of the cases that involve higher-level review, the percentage of decisions that are overturned in whole or in part by the higher-level adjudicator, that are upheld by the higher-level adjudicator, and that are returned for correction of an error.
"(Y) The frequency by which the Secretary readjudicates a claim pursuant to section 5108 of such title, as amended by section 2(i), and the frequency by which readjudication pursuant to section 5108 of such title, as so amended, results in an award of benefits.
"(Z) In any case in which the Board decides to screen cases for a purpose described in section 7107(d) of such title, as amended by section 2(t)(1)—
"(i) a description of the way in which the cases are screened and the purposes for which they are screened;
"(ii) a description of the effect such screening has had on—
"(I) the timeliness of the issuance of decisions of the Board; and
"(II) the inventory of cases before the Board; and
"(iii) the type and frequency of development errors detected through such screening.
"(2) With respect to the processing by the Secretary of appeals of decisions on legacy claims, the following:
"(A) The average duration of each segment of the appeals process, disaggregated by periods in which the Secretary is waiting for a claimant to take an action and periods in which the claimant is waiting for the Secretary to take an action.
"(B) The frequency by which appeals lead to additional grant of benefits by the Secretary, disaggregated by whether the additional benefits are a result of additional evidence added after the initial decision.
"(C) The number and average amount of retroactive awards of benefits resulting from an appeal.
"(D) The average duration from filing a legacy claim with the Secretary until all appeals and remands relating to such legacy claim are completed.
"(E) The average number of times claimants submit to the Secretary different claims with respect to the same condition, such as an initial claim, new and material evidence, or a claim for an increase in benefits.
"(F) An assessment of the productivity of employees at the regional offices and at the Board, disaggregated by level of experience of the employees.
"(G) The average number of days the duration of an appeal is extended because the Secretary secured or attempted to secure an advisory medical opinion under
"(H) The frequency by which claims are reopened pursuant to section 5108 of such title and the frequency by which such reopening results in an award of benefits.
"(3) With respect to the processing by the Secretary of appeals of decisions on legacy claims that opt in to the new appeals system, the following:
"(A) The cumulative number of such legacy claims.
"(B) The portion of work in the new appeals system attributable to appeals of decisions on such legacy claims.
"(C) The average period such legacy claims were pending before opting in to the new appeals system and the average period required to adjudicate such legacy claims on average after opting in—
"(i) with respect to claims at a regional office of the Department of Veterans Affairs, disaggregated by—
"(I) supplemental claims under
"(II) requests for higher-level review under section 5104B of such title, as added by section 2(g); and
"(ii) with respect to appeals, disaggregated by docket of the Board maintained under section 7107 of such title, as amended by section 2(t).
"SEC. 6. DEFINITIONS.
"In this Act [see Tables for classification]:
"(1)
"(2)
"(A) that was submitted to the Secretary of Veterans Affairs for a benefit under a law administered by the Secretary; and
"(B) for which notice of a decision under
"(3)
"(A) section 2(x)(3); or
"(B) such other mechanism as the Secretary may prescribe for purposes of carrying out this Act and the amendments made by this Act.
"(4)
Pilot Programs on Expedited Treatment of Fully Developed Claims and Provision of Checklists to Individuals Submitting Claims
"(a)
"(1)
"(2)
"(3)
"(4)
"(A) for which the claimant—
"(i) received assistance from a veterans service officer, a State or country [probably should be "county"] veterans service officer, an agent, or an attorney; or
"(ii) submits along with the claim an appropriate indication that the claimant does not intend to submit any additional information or evidence in support of the claim and does not require additional assistance with respect to the claim; and
"(B) for which the claimant—
"(i) submits a certification in writing that is signed and dated by the claimant stating that, as of such date, no additional information or evidence is available or needs to be submitted in order for the claim to be adjudicated; and
"(ii) for which the claimant's representative, if any, submits a certification in writing that is signed and dated by the representative stating that, as of such date, no additional information or evidence is available or needs to be submitted in order for the claim to be adjudicated.
"(b)
"(1)
"(2)
"(A) for original claims filed after the date of the enactment of this Act [Oct. 10, 2008], during the one-year period beginning on the date that is 60 days after the date of the enactment of this Act; and
"(B) for claims to reopen and for claims for increased ratings that were filed after the date of the enactment of this Act, during the three-year period beginning on the date that is 60 days after the date of the enactment of this Act.
"(3)
"(4)
"(A) shall be construed to be an addendum to a notice provided under
"(B) shall not be considered as part of such notice for purposes of reversal or remand of a decision of the Secretary.
"(c)
"(1)
"(2)
"(3)
"(A) Data concerning the number and type of claims covered by the respective pilot program.
"(B) The findings of the Secretary with respect to the respective pilot program.
"(C) The recommendations of the Secretary on the feasibility and advisability of continuing or expanding the respective pilot program and any necessary modifications to such pilot program for continuation or expansion.
"(D) Such other information as the Secretary considers appropriate.
"(4)
Study of Performance Measures for Claims Adjudications of the Veterans Benefits Administration
"(a)
"(1) to measure and manage the work production of employees of the Veterans Benefits Administration who handle claims for compensation and pension benefits; and
"(2) to evaluate more effective means of improving performance.
"(b)
"(1) measures to improve the accountability, quality, and accuracy for processing claims for compensation and pension benefits under laws administered by the Secretary that are adjudicated by the Veterans Benefits Administration;
"(2) accountability for claims adjudication outcomes;
"(3) the quality of claims adjudicated;
"(4) a simplified process to adjudicate claims;
"(5) the maximum use of information technology applications;
"(6) rules-based applications and tools for processing and adjudicating claims efficiently and effectively;
"(7) methods of reducing the time required to obtain information from outside sources; and
"(8) the elements needed to implement—
"(A) performance standards and accountability measures, intended to ensure that—
"(i) claims for benefits under the laws administered by the Secretary are processed in an objective, accurate, consistent, and efficient manner; and
"(ii) final decisions with respect to such claims are consistent and issued within the target identified in the most recent annual Performance and Accountability report submitted by the Secretary to Congress for the most recent fiscal year;
"(B) guidelines and procedures for the identification and prompt processing of such claims that are ready to rate upon submittal;
"(C) guidelines and procedures for the identification and prompt processing of such claims submitted by severely injured and very severely injured veterans, as determined by the Secretary; and
"(D) requirements for assessments of claims processing at each regional office for the purpose of producing lessons learned and best practices.
"(c)
"(1) the study conducted under subsection (a); and
"(2) the components required to implement the updated system for evaluating employees of the Veterans Benefits Administration required under subsection (d).
"(d)
Review and Enhancement of Use of Information Technology in Veterans Benefits Administration
"(a)
"(1) conduct a review of the use of information technology in the Veterans Benefits Administration with respect to the processing of claims for compensation and pension benefits; and
"(2) develop a comprehensive plan for the use of such technology in processing such claims so as to reduce subjectivity, avoidable remands, and regional office variances in disability ratings for specific disabilities.
"(b)
"(1) The use of rules-based processing or information technology systems utilizing automated decision support software at all levels of processing such claims.
"(2) The enhancement of the use of information technology for all aspects of the claims process.
"(3) Development of a technological platform that—
"(A) allows for the use of information that members of the Armed Forces, veterans, and dependents have submitted electronically, including uploaded military records, medical evidence, and other appropriate documentation; and
"(B) to the extent practicable—
"(i) provides the capability to such members, veterans, and dependents to view applications for benefits submitted online; and
"(ii) complies with the provisions of subchapter III of
"(4) The use of electronic examination templates in conjunction with the schedule for rating disabilities under
"(5) Such changes as may be required to the electronic health record system of the Department of Veterans Affairs and the Department of Defense to ensure that Veterans Benefits Administration claims examiners can access the available electronic medical information of the Department of Veterans Affairs and the Department of Defense.
"(6) The provision of bi-directional access to medical records and service records between the Department of Veterans Affairs and the Department of Defense.
"(7) The availability, on a secure Internet website of the Department of Veterans Affairs, of a portal that can be used by a claimant to check on the status of any claim submitted by that claimant and that provides information, if applicable, on—
"(A) whether a decision has been reached with respect to such a claim and notice of the decision; or
"(B) if no such decision has been reached, notice of—
"(i) whether the application submitted by the claimant is complete;
"(ii) whether the Secretary requires additional information or evidence to substantiate the claim;
"(iii) the estimated date on which a decision with respect to the claim is expected to be made; and
"(iv) the stage at which the claim is being processed as of the date on which such status is checked.
"(c)
"(1) best practices and lessons learned within the Department of Veterans Affairs; and
"(2) the use of the technology known as 'VistA' by other Government entities and private sector organizations who employ information technology and automated decision support software.
"(d)
"(e)
"(f)
Temporary Authority for Performance of Medical Disabilities Examinations by Contract Physicians
"(a)
"(b)
"(c)
"(d)
"(1)
"(2)
"(A) has a current unrestricted license to practice the health care profession of the physician;
"(B) is not barred from practicing such health care profession in any State, the District of Columbia, or a Commonwealth, territory, or possession of the United States; and
"(C) is performing authorized duties for the Department of Veterans Affairs pursuant to a contract entered into under subsection (b).
"(e)
Pilot Program for Use of Contract Physicians for Disability Examinations
"(a)
"(b)
"(1) In fiscal years before fiscal year 2015, through not more than 10 regional offices of the Department of Veterans Affairs.
"(2) In fiscal year 2015, through not more than 12 regional offices of the Department.
"(3) In fiscal year 2016, through not more than 15 regional offices of the Department.
"(4) In fiscal year 2017 and each fiscal year thereafter, through such regional offices of the Department as the Secretary considers appropriate.
"(c)
"(1)
"(2)
"(A) has a current unrestricted license to practice the health care profession of the physician;
"(B) is not barred from practicing such health care profession in any State, the District of Columbia, or a Commonwealth, territory, or possession of the United States; and
"(C) is performing authorized duties for the Department of Veterans Affairs pursuant to a contract entered into under subsection (a).
"(d)
"(e)
Expedited Treatment of Remanded Claims
Veterans' Claims Adjudication Commission
§5102. Application forms furnished upon request; notice to claimants of incomplete applications
(a)
(b)
(c)
(2) This subsection shall not apply to any application or claim for Government life insurance benefits.
(Added
Editorial Notes
Prior Provisions
A prior section 5102,
Another prior section 5102 was renumbered
Amendments
2003—Subsec. (c).
Statutory Notes and Related Subsidiaries
Effective Date of 2003 Amendment
§5103. Notice to claimants of required information and evidence
(a)
(2)(A) The Secretary shall prescribe in regulations requirements relating to the contents of notice to be provided under this subsection.
(B) The regulations required by this paragraph—
(i) shall specify different contents for notice based on whether the claim concerned is an original claim or a supplemental claim;
(ii) shall provide that the contents for such notice be appropriate to the type of benefits or services sought under the claim;
(iii) shall specify for each type of claim for benefits the general information and evidence required to substantiate the basic elements of such type of claim; and
(iv) shall specify the time period limitations required pursuant to subsection (b).
(3) The requirement to provide notice under paragraph (1) shall not apply with respect to a supplemental claim that is filed within the timeframe set forth in subparagraphs (B) and (D) of
(b)
(2) This subsection shall not apply to any application or claim for Government life insurance benefits.
(3) Nothing in paragraph (1) shall be construed to prohibit the Secretary from making a decision on a claim before the expiration of the period referred to in that subsection.
(4) Nothing in this section shall require the Secretary to provide notice for a subsequent claim that is filed while a previous claim is pending if the notice previously provided for such pending claim—
(A) provides sufficient notice of the information and evidence necessary to substantiate such subsequent claim; and
(B) was sent within one year of the date on which the subsequent claim was filed.
(5)(A) This section shall not apply to any claim or issue where the Secretary may award the maximum benefit in accordance with this title based on the evidence of record.
(B) For purposes of this paragraph, the term "maximum benefit" means the highest evaluation assignable in accordance with the evidence of record, as long as such evidence is adequate for rating purposes and sufficient to grant the earliest possible effective date in accordance with
(Added
Editorial Notes
Prior Provisions
A prior section 5103,
Another prior section 5103 was renumbered
Amendments
2017—Subsec. (a)(1).
Subsec. (a)(2)(B)(i).
Subsec. (a)(3).
2012—Subsec. (a)(1).
Subsec. (b)(4), (5).
2008—Subsec. (a).
2003—Subsec. (b)(1).
Subsec. (b)(3).
2001—Subsec. (b)(1).
Statutory Notes and Related Subsidiaries
Effective Date of 2017 Amendment
Amendment by
Effective Date of 2012 Amendment
"(1)
"(2)
Effective Date of 2003 Amendment
Amendment effective as if enacted Nov. 9, 2000, immediately after the enactment of the Veterans Claims Assistance Act of 2000,
Construction
Applicability of Regulations
Readjudication of Certain Claims; Notice
"(d)
"(2) For purposes of this subsection, a claimant is qualified within the meaning of paragraph (1) if the claimant—
"(A) received notice under
"(B) did not submit such information or evidence within a year after the date such notice was sent;
"(C) did not file a timely appeal to the Board of Veterans' Appeals or the United States Court of Appeals for Veterans Claims; and
"(D) submits such information or evidence during the one-year period referred to in paragraph (1).
"(3) If the decision of the Secretary on a readjudication under this subsection is in favor of the qualified claimant, the award of the grant shall take effect as if the prior decision by the Secretary on the claim had not been made.
"(4) Nothing in this subsection shall be construed to establish a duty on the part of the Secretary to identify or readjudicate any claim that—
"(A) is not submitted during the one-year period referred to in paragraph (1); or
"(B) has been the subject of a timely appeal to the Board of Veterans' Appeals or the United States Court of Appeals for Veterans Claims.
"(e)
"(1) to provide notice under section 5103(a) of such title with respect to a claim insofar as the Secretary has previously provided such notice; or
"(2) to provide for a special notice with respect to this section and the amendments made by this section."
§5103A. Duty to assist claimants
(a)
(2) The Secretary is not required to provide assistance to a claimant under this section if no reasonable possibility exists that such assistance would aid in substantiating the claim.
(3) The Secretary may defer providing assistance under this section pending the submission by the claimant of essential information missing from the claimant's application.
(b)
(2)(A) Whenever the Secretary, after making such reasonable efforts, is unable to obtain all of the relevant records sought, the Secretary shall notify the claimant that the Secretary is unable to obtain records with respect to the claim. Such a notification shall—
(i) identify the records the Secretary is unable to obtain;
(ii) briefly explain the efforts that the Secretary made to obtain such records; and
(iii) explain that the Secretary will decide the claim based on the evidence of record but that this section does not prohibit the submission of records at a later date if such submission is otherwise allowed.
(B) The Secretary shall make not less than two requests to a custodian of a private record in order for an effort to obtain relevant private records to be treated as reasonable under this section, unless it is made evident by the first request that a second request would be futile in obtaining such records.
(3)(A) This section shall not apply if the evidence of record allows for the Secretary to award the maximum benefit in accordance with this title based on the evidence of record.
(B) For purposes of this paragraph, the term "maximum benefit" means the highest evaluation assignable in accordance with the evidence of record, as long as such evidence is adequate for rating purposes and sufficient to grant the earliest possible effective date in accordance with
(4) Under regulations prescribed by the Secretary, the Secretary—
(A) shall encourage claimants to submit relevant private medical records of the claimant to the Secretary if such submission does not burden the claimant; and
(B) in obtaining relevant private records under paragraph (1), may require the claimant to authorize the Secretary to obtain such records if such authorization is required to comply with Federal, State, or local law.
(c)
(A) The claimant's service medical records and, if the claimant has furnished the Secretary information sufficient to locate such records, other relevant records pertaining to the claimant's active military, naval, or air service that are held or maintained by a governmental entity.
(B) Records of relevant medical treatment or examination of the claimant at Department health-care facilities or at the expense of the Department, if the claimant furnishes information sufficient to locate those records.
(C) Any other relevant records held by any Federal department or agency that the claimant adequately identifies and authorizes the Secretary to obtain.
(2) Whenever the Secretary attempts to obtain records from a Federal department or agency under this subsection, the efforts to obtain those records shall continue until the records are obtained unless it is reasonably certain that such records do not exist or that further efforts to obtain those records would be futile.
(d)
(2) The Secretary shall treat an examination or opinion as being necessary to make a decision on a claim for purposes of paragraph (1) if the evidence of record before the Secretary, taking into consideration all information and lay or medical evidence (including statements of the claimant)—
(A) contains competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of disability; and
(B) indicates that the disability or symptoms may be associated with the claimant's active military, naval, or air service; but
(C) does not contain sufficient medical evidence for the Secretary to make a decision on the claim.
(e)
(2) The Secretary's duty to assist under this section shall not apply to higher-level review by the agency of original jurisdiction, pursuant to
(f)
(2)(A) If the Board of Veterans' Appeals, during review on appeal of an agency of original jurisdiction decision, identifies or learns of an error on the part of the agency of original jurisdiction to satisfy its duties under this section, and that error occurred prior to the agency of original jurisdiction decision on appeal, unless the Secretary may award the maximum benefit in accordance with this title based on the evidence of record, the Board shall remand the claim to the agency of original jurisdiction for correction of such error and readjudication.
(B) Remand for correction of such error may include directing the agency of original jurisdiction to obtain an advisory medical opinion under
(3) Nothing in this subsection shall be construed to imply that the Secretary, during the consideration of a claim, does not have a duty to correct an error described in paragraph (1) or (2) that was erroneously not identified during higher-level review or during review on appeal with respect to the claim.
(g)
(h)
(i)
(Added
Editorial Notes
Amendments
2017—Subsec. (e).
Subsec. (f).
Subsecs. (g) to (i).
2012—Subsec. (b).
"(1) As part of the assistance provided under subsection (a), the Secretary shall make reasonable efforts to obtain relevant records (including private records) that the claimant adequately identifies to the Secretary and authorizes the Secretary to obtain.
"(2) Whenever the Secretary, after making such reasonable efforts, is unable to obtain all of the relevant records sought, the Secretary shall notify the claimant that the Secretary is unable to obtain records with respect to the claim. Such a notification shall—
"(A) identify the records the Secretary is unable to obtain;
"(B) briefly explain the efforts that the Secretary made to obtain those records; and
"(C) describe any further action to be taken by the Secretary with respect to the claim.
"(3) Whenever the Secretary attempts to obtain records from a Federal department or agency under this subsection or subsection (c), the efforts to obtain those records shall continue until the records are obtained unless it is reasonably certain that such records do not exist or that further efforts to obtain those records would be futile."
Subsec. (c).
"(1) The claimant's service medical records and, if the claimant has furnished the Secretary information sufficient to locate such records, other relevant records pertaining to the claimant's active military, naval, or air service that are held or maintained by a governmental entity.
"(2) Records of relevant medical treatment or examination of the claimant at Department health-care facilities or at the expense of the Department, if the claimant furnishes information sufficient to locate those records.
"(3) Any other relevant records held by any Federal department or agency that the claimant adequately identifies and authorizes the Secretary to obtain."
Statutory Notes and Related Subsidiaries
Effective Date of 2017 Amendment
Amendment by
Effective Date of 2012 Amendment
"(1)
"(2)
§5104. Decisions and notices of decisions
(a) In the case of a decision by the Secretary under
(b) Each notice provided under subsection (a) shall also include all of the following:
(1) Identification of the issues adjudicated.
(2) A summary of the evidence considered by the Secretary.
(3) A summary of the applicable laws and regulations.
(4) Identification of findings favorable to the claimant.
(5) In the case of a denial, identification of elements not satisfied leading to the denial.
(6) An explanation of how to obtain or access evidence used in making the decision.
(7) If applicable, identification of the criteria that must be satisfied to grant service connection or the next higher level of compensation.
(Added
Editorial Notes
Prior Provisions
Prior section 5104 was renumbered
Amendments
2017—Subsec. (b).
1994—Subsec. (a).
1991—
Statutory Notes and Related Subsidiaries
Effective Date of 2017 Amendment
Amendment by
Effective Date
§5104A. Binding nature of favorable findings
Any finding favorable to the claimant as described in
(Added
Statutory Notes and Related Subsidiaries
Effective Date
Section applicable to all claims for which the Secretary of Veterans Affairs provides notice of a decision under
§5104B. Higher-level review by the agency of original jurisdiction
(a)
(2) The Secretary shall approve each request for review under paragraph (1).
(b)
(A) in writing in such form as the Secretary may prescribe; and
(B) made within one year of the notice of the agency of original jurisdiction's decision.
(2) Such request may specifically indicate whether such review is requested by a higher-level adjudicator at the same office within the agency of original jurisdiction or by an adjudicator at a different office of the agency of original jurisdiction. The Secretary shall not deny such request for review by an adjudicator at a different office of the agency of original jurisdiction without good cause.
(c)
(1) reflecting whether evidence was not considered pursuant to subsection (d); and
(2) noting the options available to the claimant to have the evidence described in paragraph (1), if any, considered by the Department.
(d)
(e)
(Added
Statutory Notes and Related Subsidiaries
Effective Date
Section applicable to all claims for which the Secretary of Veterans Affairs provides notice of a decision under
§5104C. Options following decision by agency of original jurisdiction
(a)
(A) File a request for higher-level review under
(B) File a supplemental claim under
(C) File a notice of disagreement under
(2)(A) Once a claimant takes an action set forth in paragraph (1), the claimant may not take another action set forth in that paragraph with respect to the same claim or same issue contained within the claim until—
(i) the higher-level review, supplemental claim, or notice of disagreement is adjudicated; or
(ii) the request for higher-level review, supplemental claim, or notice of disagreement is withdrawn.
(B) Nothing in this subsection shall prohibit a claimant from taking any of the actions set forth in paragraph (1) in succession with respect to a claim or an issue contained within the claim.
(C) Nothing in this subsection shall prohibit a claimant from taking different actions set forth in paragraph (1) with respect to different claims or different issues contained within a claim.
(D) The Secretary may, as the Secretary considers appropriate, develop and implement a policy for claimants who—
(i) take an action under paragraph (1);
(ii) wish to withdraw the action before the higher-level review, supplemental claim, or notice of disagreement is adjudicated; and
(iii) in lieu of such action take a different action under paragraph (1).
(b)
(Added
Statutory Notes and Related Subsidiaries
Effective Date
Section applicable to all claims for which the Secretary of Veterans Affairs provides notice of a decision under
§5105. Joint applications for social security and dependency and indemnity compensation
(a) The Secretary and the Commissioner of Social Security may jointly prescribe forms for use by survivors of members and former members of the uniformed services in filing application for benefits under
(b) When an application on any document indicating an intent to apply for survivor benefits is filed with either the Secretary or the Commissioner of Social Security, it shall be deemed to be an application for benefits under both
(
Editorial Notes
References in Text
The Social Security Act, referred to in text, is act Aug. 14, 1935, ch. 531,
Prior Provisions
Prior section 5105 was renumbered
Amendments
2012—Subsec. (a).
Subsec. (b).
1994—Subsec. (a).
Subsec. (b).
1991—
Subsec. (a).
Subsec. (b).
1983—
1982—
Statutory Notes and Related Subsidiaries
Effective Date of 1994 Amendment
Amendment by
§5106. Furnishing of information by other agencies
The head of any Federal department or agency shall provide such information to the Secretary as the Secretary may request for purposes of determining eligibility for or amount of benefits, or verifying other information with respect thereto. The cost of providing information to the Secretary under this section shall be borne by the department or agency providing the information.
(Added
Editorial Notes
Amendments
2000—
1991—
1986—
Statutory Notes and Related Subsidiaries
Effective Date
Section effective Sept. 30, 1976, see section 405(a) of
§5107. Claimant responsibility; benefit of the doubt
(a)
(b)
(Added
Editorial Notes
Amendments
2000—
"(a) Except when otherwise provided by the Secretary in accordance with the provisions of this title, a person who submits a claim for benefits under a law administered by the Secretary shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. The Secretary shall assist such a claimant in developing the facts pertinent to the claim. Such assistance shall include requesting information as described in
"(b) When, after consideration of all evidence and material of record in a case before the Department with respect to benefits under laws administered by the Secretary, there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. Nothing in this subsection shall be construed as shifting from the claimant to the Secretary the burden specified in subsection (a) of this section."
1991—
Subsec. (a).
Subsec. (b).
Statutory Notes and Related Subsidiaries
Effective Date of 2000 Amendment
"(a)
"(1) filed on or after the date of the enactment of this Act [Nov. 9, 2000]; or
"(2) filed before the date of the enactment of this Act and not final as of that date.
"(b)
"(2) A denial or dismissal described in this paragraph is a denial or dismissal of a claim for a benefit under the laws administered by the Secretary of Veterans Affairs that—
"(A) became final during the period beginning on July 14, 1999, and ending on the date of the enactment of this Act; and
"(B) was issued by the Secretary of Veterans Affairs or a court because the claim was not well grounded (as that term was used in
"(3) A claim may not be readjudicated under this subsection unless a request for readjudication is filed by the claimant, or a motion is made by the Secretary, not later than 2 years after the date of the enactment of this Act.
"(4) In the absence of a timely request of a claimant under paragraph (3), nothing in this Act [see Short Title of 2000 Amendments note set out under
Effective Date
Section effective Sept. 1, 1989, see section 401(a) of
§5108. Supplemental claims
(a)
(b)
(2) Assistance under paragraph (1) shall not be predicated upon a finding that new and relevant evidence has been presented or secured.
(Added
Editorial Notes
Amendments
2017—
1991—
Statutory Notes and Related Subsidiaries
Effective Date of 2017 Amendment
Amendment by
Effective Date
Section effective Sept. 1, 1989, see section 401(a) of
Construction of 2017 Amendment
§5109. Independent medical opinions
(a) When, in the judgment of the Secretary, expert medical opinion, in addition to that available within the Department, is warranted by the medical complexity or controversy involved in a case being considered by the Department, the Secretary may secure an advisory medical opinion from one or more independent medical experts who are not employees of the Department.
(b) The Secretary shall make necessary arrangements with recognized medical schools, universities, or clinics to furnish such advisory medical opinions. Any such arrangement shall provide that the actual selection of the expert or experts to give the advisory opinion in an individual case shall be made by an appropriate official of such institution.
(c) The Secretary shall furnish a claimant with notice that an advisory medical opinion has been requested under this section with respect to the claimant's case and shall furnish the claimant with a copy of such opinion when it is received by the Secretary.
(d)(1) The Board of Veterans' Appeals shall remand a claim to direct the agency of original jurisdiction to obtain an advisory medical opinion from an independent medical expert under this section if the Board finds that the Veterans Benefits Administration should have exercised its discretion to obtain such an opinion.
(2) The Board's remand instructions shall include the questions to be posed to the independent medical expert providing the advisory medical opinion.
(Added
Editorial Notes
Amendments
2017—Subsec. (d).
1991—
Subsec. (a).
Subsecs. (b), (c).
Statutory Notes and Related Subsidiaries
Effective Date of 2017 Amendment
Amendment by
Effective Date
Section effective Sept. 1, 1989, see section 401(a) of
§5109A. Revision of decisions on grounds of clear and unmistakable error
(a) A decision by the Secretary under this chapter is subject to revision on the grounds of clear and unmistakable error. If evidence establishes the error, the prior decision shall be reversed or revised.
(b) For the purposes of authorizing benefits, a rating or other adjudicative decision that constitutes a reversal or revision of a prior decision on the grounds of clear and unmistakable error has the same effect as if the decision had been made on the date of the prior decision.
(c) Review to determine whether clear and unmistakable error exists in a case may be instituted by the Secretary on the Secretary's own motion or upon request of the claimant.
(d) A request for revision of a decision of the Secretary based on clear and unmistakable error may be made at any time after that decision is made.
(e) Such a request shall be submitted to the Secretary and shall be decided in the same manner as any other claim.
(Added
Statutory Notes and Related Subsidiaries
Effective Date
§5109B. Expedited treatment of returned and remanded claims
The Secretary shall take such actions as may be necessary to provide for the expeditious treatment by the Veterans Benefits Administration of any claim that is returned by a higher-level adjudicator under
(Added
Editorial Notes
Amendments
2017—
Statutory Notes and Related Subsidiaries
Effective Date of 2017 Amendment
Amendment by