M21-1 Manual / Part VIII, Subpart iv, Chapter 6, Section A
Developing Claims Filed Under 38 U.S.C. 1151
M21-1, Part VIII, Subpart iv, Chapter 6, Section A
Overview
In This Section | | This section contains the topic “Developing Claims Filed Under 38 U.S.C. 1151.” |
1. Developing Claims Filed Under 38 U.S.C. 1151
Introduction | | This topic contains information on developing claims filed under 38 U.S.C. 1151, including- general information about claims filed under 38 U.S.C. 1151
- possible sources of information about the incident
- requesting information from the medical facility, and
- quality assurance investigative reports.
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Change Date | | August 18, 2025 |
VIII.iv.6.A.1.b. Possible Sources of Information About the Incident | | Documentary evidence pertinent to the incident upon which the claim is based may assume many possible forms, including- medical records
- surgical records
- hospital clinical records, and/or
- nurses’ notes.
Upload to the Veteran’s electronic claims folder any and all clinical reports, progress notes, and hospital summaries associated with the incident in question housed in the - Compensation and Pension Record Interchange (CAPRI), and/or
- Joint Logitudinal Viewer (JLV).
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VIII.iv.6.A.1.c. Requesting Information From the Medical Facility | | For all claims under 38 U.S.C. 1151, request comprehensive evidence of the claimed incident using CAPRI’s electronic VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action, request functionality. Select the 7131 REQUEST tab in the patient’s CAPRI record; check the OTHER/EXAM (REVIEW REMARKS) box; and cut and paste the following text into the COMMENTS field, populating necessary details about the claimant where appropriate: We have received a claim from the person identified below for benefits under 38 U.S.C. 1151 based on alleged injury while at your facility.Name:File Number:SSN:Date of Birth:The claimant alleges sustaining an injury to the [condition]. This injury occurred on [MM-DD-YYYY].To assist us in making a determination, please furnish all of the following evidence, if available, for this patient for the period of medical care from [MM-DD-YYYY] to [MM-DD-YYYY]:- medical records
- surgical records
- hospital clinical records
- nurses’ notes, and
- any other documentation of patient injury.
Note: The electronic VA Form 10-7131 in CAPRI- supports text entry of up to four pages, and
- maintains tracking information regarding the status of requests.
References: For more information on - obtaining VA medical records, see M21-1, Part III, Subpart ii, 1.A.2
- obtaining records in 1151 claims, see M21-1, Part VIII, Subpart iv, 6.B.5.f, and
- requesting medical opinions for 1151 claims, see
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VIII.iv.6.A.1.d. Quality Assurance Investigative Reports | | Request quality assurance investigative reports only if the claimant- identifies these records as evidence necessary to substantiate the claim
- identifies quality assurance records consistent with 38 U.S.C. 5103A(b)(1), and
- furnishes sufficient information to locate the records consistent with 38 U.S.C. 5103A(c)(2).
Notes:- If the Veterans Health Administration (VHA) denies access to these records, request an Office of General Counsel (OGC) review.
- An OGC review is not appropriate when VHA denies access to these records because they are no longer available.
References: For more information on - the documents that qualify as quality assurance reports, see
- when and how to contact OGC, see M21-5, Chapter 7, Section G, 1.j.
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Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part VIII, Subpart iv, Chapter 6, Section A (U.S. government work, reproduced for reference). Browse all sections →