M21-1 Manual / Part IV, Subpart ii, Chapter 2, Section A

Rating Action on Review Examination Results and Cancellations

M21-1, Part IV, Subpart ii, Chapter 2, Section A

Overview

In This Section

This section contains the topic “Rating Action on Review Examination Results and Cancellations.”

1. Rating Action on Review Examination Results and Cancellations

Introduction

This topic contains information about taking rating action on the results of review examinations and cancellations, including rating action on review examination

results
- showing worsening symptomatology, and
- demonstrating development of additional residual or secondary disabilities, and
cancellations.

Change Date

September 15, 2021

IV.ii.2.A.1.a. Rating Action on Review Examination Results Showing Worsening Symptomatology

Use the table below to determine the rating action to take if results of a review examination demonstrate worsening symptomatology in a service-connected (SC) disability.

If review examination results and/or associated medical evidence demonstrate that an SC disability ...	Then ...
has worsened so as to warrant a higher evaluation under schedular rating criteria	consider the disability’s evaluation an issue raised on Department of Veterans Affairs (VA) initiative, and award entitlement to the appropriate increased evaluation from the date of the examination’s performance.
renders the Veteran unemployable	consider the issue of entitlement to individual unemployability (IU) reasonably raised follow procedural instructions found in M21-1, Part VIII, Subpart iv, 3.B and C for reasonably raised claims of IU, and continue end product (EP) 310 until all issues are decided.
required hospitalization or observation at VA expense for a period in excess of 21 days	consider entitlement to a temporary total rating a reasonably raised subordinate issue award entitlement to a temporary 100-percent evaluation under 38 CFR 4.29 for the duration of the hospitalization or treatment/observation period, and assign an appropriate schedular evaluation based on current examination results following discontinuance of the temporary 100-percent evaluation.
required surgical or other treatment necessitating at least one month of convalescence at any point in time, if administered at a VA or military treatment facility, or within the year prior to the date of the examination’s performance, if administered by a private or civilian provider	consider entitlement to a temporary total rating a reasonably raised subordinate issue award entitlement to a temporary 100-percent evaluation under 38 CFR 4.30 for the duration of the convalescence period, and assign an appropriate schedular evaluation based on current examination results following discontinuance of the temporary 100-percent evaluation.

Note: Under the circumstances described above, do not raise the issue of entitlement to a temporary total rating under 38 CFR 4.29 or 4.30 unless the evidence of record supports a grant of such benefits. References: For more information on

effective dates of
- increased compensation, see M21-1, Part V, Subpart ii, 4.A
- hospitalization ratings, see M21-1, Part VIII, Subpart iv, 8.B, and
- convalescent ratings, see M21-1, Part VIII, Subpart iv, 8.C
preparing hospitalization ratings, see M21-1, Part VIII, Subpart iv, 8.B
preparing convalescent ratings, see M21-1, Part VIII, Subpart iv, 8.C, and
actions to take when a review examination demonstrates development of additional residual or secondary disabilities, see M21-1, Part IV, Subpart ii, 2.A.1.b.

IV.ii.2.A.1.b. Rating Action on Review Examination Results Demonstrating Development of Additional Residual or Secondary Disabilities

Use the table below to determine the rating action to take if results of a review examination demonstrate that a primary SC disability has progressed to involve the development of one or more additional residual complications or secondary disabilities.

If the newly developed disability discovered on review examination is …

Then ...

the residual of a primary SC disease or disability whose diagnostic code criteria under 38 CFR Part 4
- required re-examination, and
- instruct that residuals be rated according to the body system involved, or
one that 38 CFR Part 4 and/or other sources of official VA guidance identify as an accepted part of the underlying SC disability, such as
- complications of systemic disease processes, including diabetes mellitus
- scars associated with surgical interventions, or
- peripheral nerve involvement associated with spinal pathology

award entitlement to service connection (SC) for the newly developed residual or secondary disability(ies), as well as any corresponding ancillary benefits, effective the date of the examination that resulted in discovery. Example: A Veteran SC for prostate cancer attends a review examination intended to assess that disability’s severity on January 1, 2016, at which time he is diagnosed with residual erectile dysfunction. Outcome: The rating activity will establish SC for erectile dysfunction and entitlement to special monthly compensation under 38 U.S.C. 1114(k) for loss of use of a creative organ effective January 1, 2016, the date of the review examination’s performance.

affirmatively related to the primary SC disability as per the conclusions of a favorable medical opinion, but
not considered an accepted part of the underlying SC disability, as discussed in the cell above

solicit a claim for benefits in accordance with M21-1, Part V, Subpart ii, 3.A.3.a. Example: A Veteran SC for lumbar spinal stenosis attends a review examination intended to assess that disability’s severity, at which time the VA examiner diagnoses right knee patellofemoral pain syndrome and provides a medical opinion that the latter is at least as likely as not related to the former. Outcome: The rating activity will

evaluate the severity of the SC lumbar spinal stenosis based on the facts of the case, and
solicit a claim for SC for right knee patellofemoral pain syndrome.

Note: If, during the course of the VA examination, the Veteran expresses intent to seek compensation for the new disability, handle such communication as a request for application in accordance with M21-1, Part II, Subpart iii, 2.G.

IV.ii.2.A.1.c. Rating Action on Review Examination Cancellations

Use the table below to determine the rating action to take if the expiration of a future examination control results in review and the conclusion that the examination is not warranted and should be canceled.

If it is determined that a future examination should be canceled, and the Veteran’s combined evaluation ...	Then prepare a rating decision establishing permanence by ...
reflects total disability, either by reason of a 100-percent schedular evaluation, or entitlement to IU	awarding basic eligibility to Dependents’ Educational Assistance (DEA). *References*: For more information on ratings for DEA and permanent and total (P&T) disability, see M21-1, Part XIII, Subpart i, 1.A, and date of P&T disability upon cancellation or dismissal of review examination control, see M21-1, Part V, Subpart ii, 3.D.4.g.
does not reflect total disability	confirming and continuing the existing evaluation of any disability for which review examination was originally scheduled, and identifying the disability(ies) as static, warranting no additional or future examination.

References: For more information on

EP control following cancellation of a review examination, see M21-1, Part IV, Subpart ii, 1.B, and
when not to schedule review examinations, see
- M21-1, Part IV, Subpart ii, 1.A, and
- 38 CFR 3.327.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part IV, Subpart ii, Chapter 2, Section A (U.S. government work, reproduced for reference). Browse all sections →