M21-1 Manual / Part VIII, Subpart iii, Chapter 11

Presumptive Service Connection (SC) for Coronavirus Disease (COVID-19)

M21-1, Part VIII, Subpart iii, Chapter 11

Overview

In This Chapter

This chapter contains the following topics:

Topic	Topic Name
1	General Information on Presumptive SC for COVID-19
2	Qualifying Periods of Service for Presumptive SC for COVID-19
3	COVID-19 Claims Intake
4	COVID-19 Claims Development
5	COVID-19 Examination Requests
6	COVID-19 Rating Decisions

1. General Information on Presumptive SC for COVID-19

Introduction

This topic includes general information on presumptive SC for COVID-19, including

presumption of SC for COVID-19
nomenclature for COVID-19
applicable theories of SC
definition of symptoms of COVID-19, and
manifestation period.

Change Date

August 2, 2022

VIII.iii.11.1.a. Presumption of SC for COVID-19

Effective January 5, 2021, 38 U.S.C. 1164 established the presumption of service connection (SC) for Coronavirus disease (COVID-19). Reference: For more information on the establishment of the presumption of SC for COVID-19, see Public Law (PL) 116-315, Section 4101, the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020.

VIII.iii.11.1.b. Nomenclature for COVID-19

A claim for SC for the following conditions should be construed as a claim for the same disease:

novel coronavirus
Coronavirus
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2
coronavirus disease, and
COVID-19.

VIII.iii.11.1.c. Applicable Theories of SC

38 U.S.C 1164 provides that if symptoms of COVID-19 manifest within a defined period for individuals with qualifying service, COVID-19 shall be presumed to have occurred during the qualifying period of duty. Important: While the law is specific to establishing SC on a presumptive basis, there is no preclusion to other avenues of entitlement, such as

direct SC under 38 CFR 3.303
on the basis of aggravation under 38 CFR 3.306, or
on a secondary basis under 38 CFR 3.310.

Reference: For more information on considering multiple theories of SC, see M21-1, Part II, Subpart iii, 1.A.2.f.

VIII.iii.11.1.d. Definition: Symptoms of COVID-19

Symptoms of COVID-19 are defined as symptoms that competent medical evidence demonstrates are experienced by an individual and directly related to COVID-19. Important: For the most up-to-date list of known symptoms, refer to the Centers for Disease Control and Prevention’s (CDC’s) COVID-19 website, Symptoms of COVID-19 | CDC.

VIII.iii.11.1.e. Manifestation Period

The manifestation period for development of symptoms or death due to COVID-19 is as follows:

during a qualifying period of duty, if that period was more than 48 continuous hours in duration, or
within 14 days following the date of separation from a qualifying period of duty.

Reference: For more information on the qualifying periods of duty for presumptive SC, see
38 U.S.C. 1164(b) and (c), and
M21-1, Part VIII, Subpart iii, 11.A.2.a.

2. Qualifying Periods of Service for Presumptive SC for COVID-19

Introduction

This topic includes guidance on qualifying periods of service for presumptive SC for COVID-19, including

qualifying period of service requirements
required duration of service, and
inactive duty for training (IADT) as qualifying service.

Change Date

August 2, 2022

VIII.iii.11.2.a. Qualifying Period of Service Requirements

Qualifying service for presumptive SC for COVID-19 is

active duty from March 1, 2020, until January 5, 2024
active duty for training (ADT) under Title 10 or full-time National Guard duty (as defined in Section 101 of Title 10) under orders issued on or after March 13, 2020, until January 5, 2024, or
certain periods of inactive duty for training (IADT) during which COVID-19 is presumed to have been incurred occurring between March 13, 2020, and January 5, 2024.

References: For more information on
considering certain periods of IADT as qualifying service, see M21-1, Part VIII, Subpart iii, 11.2.c, and
verifying periods of ADT and IADT, see M21-1, Part III, Subpart i, 1.A.2.e.

VIII.iii.11.2.b. Required Duration of Service

As noted in M21-1, Part VIII, Subpart iii, 11.1.e, when COVID-19 symptoms develop during an applicable qualifying period of service, the duty period must have been more than 48 hours for presumption to apply relative to exposure to COVID-19 during that period. When COVID-19 manifests within the 14 days following a qualifying period of service, there is no minimum length of service for the qualifying period.

VIII.iii.11.2.c. IADT as Qualifying Service

SC for COVID-19 may be established on a presumptive basis for certain periods of IADT. 38 U.S.C. 1164(c)(2) provides this authority by stating that benefits based on application of the presumptions will be paid as if the individual was a Veteran, without regard to whether the period would constitute active military, naval, air, or space service under 10 U.S.C. 101. IADT occurring between March 13, 2020, and January 5, 2024, is qualifying service for consideration of presumptive SC only if a service member develops symptoms or tests positive for COVID-19

during a period of IADT, if the period of service was more than 48 continuous hours, or
in the 14-day manifestation period following a period of IADT of any duration.

Note: A period of qualifying IADT service is considered active service under 38 CFR 3.6only when SC is established for a residual disability associated with the COVID-19 infection. Reference: For more information on the prohibition of direct SC for COVID-19 based on IADT service, see M21-1, Part VIII, Subpart iii, 11.6.c.

3. COVID-19 Claims Intake

Introduction

This topic contains information on intake procedures for claims for presumptive SC for COVID-19, including

use of the COVID-19 special issue indicator, and
handling allegations of COVID-19 exposure.

Change Date

August 2, 2022

VIII.iii.11.3.a. Use of the COVID-19 Special Issue Indicator

Append the COVID-19 special issue indicator to each associated contention on the end product.Reference: For more information on the use of special issue indicators, see M21-4, Appendix E.2.

VIII.iii.11.3.b. Handling Allegations of COVID-19 Exposure

Exposure to COVID-19, without association with an underlying disability, is not a substantially complete claim as required by 38 CFR 3.160. Follow the procedures in M21-1, Part II, Subpart iii, 1.C.2.b and c for handling allegations of exposure to COVID-19 without a claimed disability.

4. COVID-19 Claims Development

Introduction

This topic contains policies and procedures for COVID-19 claims development, including

COVID-19 claims development, and
referral to the rating activity.

Change Date

August 2, 2022

VIII.iii.11.4.a. COVID-19 Claims Development

Complete development for claims for SC for COVID-19 in accordance with general development procedures. If needed, ascertain COVID-19 residuals. Follow the procedures in M21-1, Part III, Subpart i, 2.D.1.c to contact the claimant when it is unclear whether the individual is claiming residuals of COVID-19.

VIII.iii.11.4.b. Referral to the Rating Activity

When all required development is complete and all disability benefits questionnaires (DBQs) are received, including DBQs completed for residual conditions, refer the claim to the rating activity. References: For more information on
referring claims to the rating activity after development is complete, see M21-1, Part V, Subpart i, 1.B.1.a, and
requesting examinations for claims for SC for COVID-19 and residuals, see M21-1, Part VIII, Subpart iii, 11.5.

5. COVID-19 Examination Requests

Introduction

This topic contains policies and procedures for requesting medical examinations for claims for SC for COVID-19, including

evidence needed to request an examination
requesting medical opinions to confirm a COVID-19 diagnosis, and
guidelines for examinations.

Change Date

August 2, 2022

VIII.iii.11.5.a. Evidence Needed to Request an Examination

Schedule any necessary medical examination(s) when the evidence shows a/an

qualifying period of duty
competent lay or medical evidence of a current disability or persistent or recurrent symptoms of a disability, and
allegation of the onset of those symptoms during the manifestation period that is credible and consistent with all other facts of record.

Notes:
A positive COVID-19 test is not required before requesting an examination.
For claims based on ADT and IADT, treat the qualifying period of duty as active service for the purpose of scheduling an examination or medical opinion under 38 CFR 3.159.
Reference: For more information on the competency of lay testimony as it pertains to establishing a diagnosis of a condition, see
M21-1, Part IV, Subpart i, 1.B.1.a and b, and
Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

VIII.iii.11.5.b. Requesting Medical Opinions to Confirm a COVID-19 Diagnosis

Request a medical opinion and examination (as needed) concerning whether a diagnosis of COVID-19 is warranted when the following conditions are present:

a claimant has qualifying service, and
symptoms arose during the applicable manifestation period, regardless of whether the condition was formally diagnosed, but there is question as to whether the symptoms experienced by the claimant are attributable to COVID-19.

Note: A medical opinion may also be needed if there is a question as to the date of manifestation of COVID-19. Reference: For more information on requesting medical opinions for cause of death, including COVID-19 related death, see M21-1, Part XII, Subpart i, 1.B.1.h.

VIII.iii.11.5.c. Guidelines for Examinations

Follow the guidelines below when an examination is needed.

Request the Infectious Diseases Disability Benefits Questionnaire for all COVID-19-related claims, even if the record indicates that COVID-19 has resolved.
Request separate DBQs appropriate for the claimed residual conditions.
Note on the examination request the date of any COVID-19 test(s) and the results.
Ensure any specifically claimed COVID-19 residual condition is identified in the examination request so the examiner is fully aware of any residual condition(s) that must be addressed.
If the evidence indicates the claimed disability or symptoms may be associated with COVID-19, request a medical opinion as needed.

6. COVID-19 Rating Decisions

Introduction

This topic contains policies and procedures for rating decisions for claims for presumptive SC for COVID-19, including

presumptive SC applicability
presumptive vs. direct SC for COVID-19
prohibition of direct SC for COVID-19 based on IADT
considering presumptive vs. direct SC for COVID-19
rebuttal of presumptive SC for COVID-19, and
effective date considerations for presumptive SC for COVID-19.

Change Date

August 2, 2022

VIII.iii.11.6.a. Presumptive SC Applicability

SC may be established for residuals of COVID-19 on a presumptive basis if evidence supports symptoms or a positive test for COVID-19 within the defined manifestation period. References: For more information on
the defined manifestation period, see
38 U.S.C. 1164(a)(2)(A), and
M21-1, Part VIII, Subpart iii, 11.A.1.e, and
rating considerations for evaluating COVID-19, see M21-1, Part V, Subpart iii, 3.6.

VIII.iii.11.6.b. Presumptive vs. Direct SC for COVID-19

Although 38 U.S.C. 1164 establishes provisions for granting SC on a presumptive basis, SC for residuals of COVID-19 has been and continues to be available on a direct basis without regard to the presumptive provisions.

An in-service diagnosis of COVID-19 is sufficient to concede an in-service event for the purposes of establishing direct SC. This applies even when the service records do not explicitly include the results of a COVID-19 test.
If evidence shows that chronic residuals of COVID-19 are related to service through a medical nexus, direct SC is warranted.

Important: When SC for COVID-19 can be granted on a direct basis, default to direct SC and do not apply the presumptive provision except when presumptive SC allows for assignment of a more favorable effective date under 38 CFR 3.114. Exception: Direct SC is generally not available for COVID-19 incurred during a period of IADT, as discussed in M21-1, Part VIII, Subpart iii, 11.6.c. Reference: For more information on maximizing effective date determinations, see M21-1, Part V, Subpart ii, 4.A.1.i.

VIII.iii.11.6.c. Prohibition of Direct SC for COVID-19 Based on IADT

As provided in 38 CFR 3.6(a), IADT is considered active service only when the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident. COVID-19 is a disease, not an injury. The incurrence of COVID-19 during a period of IADT does not provide a basis for establishing direct SC. Exception: If the period of IADT is established as active service by virtue of the grant of SC for an injury or qualifying condition listed in 38 CFR 3.6(a), SC for COVID-19 would be evaluated under the standard principles for direct SC. References: For more information on

SC for a disability that results from administration of a COVID-19 vaccination during IADT, see M21-1, Part V, Subpart iii, 3.6.f, and
adjudicating claims based on ADT and IADT, see M21-1, Part III, Subpart i, 1.A.2.k.

VIII.iii.11.6.d. Considering Presumptive vs. Direct SC for COVID-19

Refer to the table below for guidance on determining whether to apply presumptive or direct SC provisions, when warranted, for COVID-19.

If COVID-19 becomes manifest ...	Then consider entitlement to SC compensation on a ...
during a period of *active duty*	direct basis.
within the 14-day period after separating from *active duty*	presumptive basis.
a period of *ADT*	direct basis.
within the 14-day period after separating from *ADT*	presumptive basis.
a period of *IADT*	presumptive basis.
within the 14-day period after separating from *IADT*	presumptive basis.

Exception: As noted in M21-1, Part VIII, Subpart iii, 11.6.b, when SC on a direct and presumptive basis may be supported, apply presumptive SC if it allows a more favorable outcome.

VIII.iii.11.6.e. Rebuttal of Presumptive SC for COVID-19

Consider rebuttal of the presumption of SC when there is competent, credible, and persuasive medical evidence showing COVID-19 is more likely related to a non-service-related cause. Reference: For more information on the rebuttal of presumption, see
38 U.S.C. 1113, and
M21-1, Part V, Subpart ii, 2.B.1.d.

VIII.iii.11.6.f. Effective Date Considerations for Presumptive SC for COVID-19

The general effective date rules for SC under 38 CFR 3.400 apply when granting SC for the chronic residuals of COVID-19. Consider the following important reminders when assigning effective dates:

The establishment of the presumptive provision is a liberalizing rule that warrants consideration of 38 CFR 3.114.
The availability of direct SC for chronic residuals of COVID-19 incurred in or caused by a period of active duty or ADT is not based on a liberalizing provision.
Statutory provisions for presumptive SC were added effective January 5, 2021. Presumptive SC cannot be established prior to that date.

Reference: For more information on effective dates for Dependency and Indemnity Compensation (DIC) when COVID-19 is associated with the cause of death, see M21-1 Part XII, Subpart i, 3.A.2.e.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part VIII, Subpart iii, Chapter 11 (U.S. government work, reproduced for reference). Browse all sections →