M21-1 Manual  /  Part X, Subpart ii, Chapter 6, Section G

Competency Determinations for the Insurance Center (IC)

M21-1, Part X, Subpart ii, Chapter 6, Section G

Overview

In This Section

This section contains the topic “Competency Determinations for the IC.”

1. Competency Determinations for the IC

Introduction

This topic contains information on requests for competency determinations from the IC, including
  • eligibility for Veterans Affairs Life Insurance (VALife)
  • applying for VALife
  • requests the IC sends to the regional office (RO) of jurisdiction (ROJ)
  • contents of requests the IC sends to the ROJ
  • processing insurance cases involving
    • coma incident to the terminal state, and
    • suicide
  • processing IC requests for competency determinations
  • hearing requests, and
  • preparing the rating decision for insurance purposes.

Change Date

October 15, 2024

X.ii.6.G.1.a. Eligibility for VALife

Veterans may be eligible for Veterans Affairs Life Insurance (VALife) if they
  • are age 80 or younger, and
  • have a service-connected (SC) disability or disabilities evaluated at 0 percent or higher.
Veterans who are age 81 or older may be eligible if they
  • apply for service connection (SC) for a new condition before age 81
  • receive the rating granting SC for that new condition after turning 81, and
  • apply for VALife within 2 years of receiving notification of their disability rating.
Note: VALife policy numbers are prefixed with “G”.

X.ii.6.G.1.b. Applying for VALife

Award transactions generate release of VALife eligibility letters to Veterans with potential eligibility anytime the Department of Veterans Affairs (VA) grants SC for a new disability.Veterans aged 80 and under may apply for VALife any time after being granted SC for a condition. Veterans over age 80 must meet the criteria in M21-1, Part X, Subpart ii, 6.G.1.a. VALife applications can be submitted by the
  • Veteran
  • Veteran’s appointed Veterans service organization, agent, or attorney
  • VA-appointed fiduciary, or
  • court-appointed guardian.
If the Veteran is mentally incompetent, only the VA-appointed fiduciary or court-appointed guardian may apply for this insurance.

X.ii.6.G.1.c. Requests the IC Sends to the ROJ

The Insurance Center (IC) requests a determination of competency and/or certification of a fiduciary from the regional office (RO) of jurisdiction (ROJ) when the IC receives
  • a court decree of incompetency, or
  • other information (not constituting a judicial determination) indicating that the insured may be incompetent.
Note: The IC requests competency determinations without regard to
  • the Veteran’s status as a claimant for compensation or pension benefits, or
  • whether or not a claims folder exists.

X.ii.6.G.1.d. Contents of Requests the IC Sends to the ROJ

Requests for a competency determination that the IC sends to the ROJ will include
  • VA file number of the insured
  • VA insurance policy number(s)
  • the name and address of the person for whom the determination is requested
  • the names and address of the next of kin
  • an indication of the relationship of the beneficiary to the insured
  • copies of all medical and other evidence alleging incompetency, and
  • the amount of insurance benefits or proceeds payable and the method of payment.

X.ii.6.G.1.e. Processing Insurance Cases Involving Coma Incident to the Terminal State

Brief periods of coma incident to the terminal state are commonly encountered. In the absence of other manifestations of mental incapacity to contract, manage personal affairs, or disburse funds, such brief periods of coma may be insufficient to support a rating of mental incompetency under 38 U.S.C. 1922(b). The fact that SC has been established for the cause of death does not carry with it the implication that the Veteran was mentally incompetent at the time of death or at any time during the critical period for purposes of 38 U.S.C. 1922(b).

X.ii.6.G.1.f. Processing Insurance Cases Involving Suicide

A finding in a rating decision for survivors benefits that a Veteran was of unsound mind at the time of suicide under the provisions of 38 CFR 3.302 does not mean the Veteran was mentally incompetent for insurance purposes of 38 U.S.C. 1922(b). Prepare a rating decision under 38 U.S.C. 1922(b) based on all of the evidence of record and support any rating of mental incompetency by objective evidence that shows the Veteran’s state of mind. Reference: For more information on a definition of mental incompetency, see 38 CFR 3.353.

X.ii.6.G.1.g. Processing IC Requests for Competency Determinations

Follow the steps in the table below when processing requests from the IC for competency determinations.
StepAction
1Review the Veteran’s claims folder to include any evidence the IC uploaded into it.
2Is the person for whom the rating is requested a Veteran without a VA file number?
  • If yes,
    • assign a file number, and
    • create an electronic claims folder (eFolder).
  • If no,
    • do not assign a file number, and
    • use an alphabetical holding file under the person’s last name to maintain temporary control of cases in which a file number is not assigned, or which does not relate to an existing file.
3Inform the Veterans Service Center (VSC) Manager if payments are
  • being made to a fiduciary
  • being made on a supervised direct pay basis, or
  • not being made, but the person has been previously determined to be incompetent for VA purposes.
4Is a current VA Form 21P-555, Certificate of Legal Capacity to Receive and Disburse Benefits and Fee Authorization, of record?
5If evidence of a judicial determination of incompetency or of appointment of a guardian by reason of incompetency is received for an individual in receipt of benefits, refer the competency determination to the rating activity. If the beneficiary is found incompetent, make a request for appointment of a fiduciary as provided in M21-1, Part X, Subpart ii, 6.C.1.Reference: For more information on evidence of incompetency, see M21-1, Part X, Subpart ii, 6.D.2.
6If the evidence submitted is other than a judicial determination of incompetency, follow the procedures established in M21-1, Part X, Subpart ii, 6.D.2.b prior to referral for rating activity consideration under 38 CFR 3.353. In these instances, apply due process procedures set forth in M21-1, Part X, Subpart ii, 6.D.3. Note: Do not request VA examinations in these cases. However, field examinations may be requested as determined necessary.
7For any other insurance beneficiary, prepare rating decisions as provided in M21-1, Part X, Subpart ii, 6.G.1.i.
8Following completion of a final rating of incompetency
  • complete VA Form 21-592, and
  • refer the form to the hub of jurisdiction for formal certification in all cases.
References: For more information on
9Notify the IC that the requested decision has been made.

X.ii.6.G.1.h. Hearing Requests

If a hearing is requested after the VSC prepares a rating proposing incompetency, the VSC transfers the claims folder (or jurisdiction over the eFolder) to the RO having jurisdiction based on the person’s place of residence. The RO responsible for conducting the hearing
  • holds the hearing
  • prepares the final rating decision regarding competency, and
  • notifies the IC.

X.ii.6.G.1.i. Preparing the Rating Decision for Insurance Purposes

When preparing the rating decision for insurance purposes,
  • prepare a copy of the rating for the IC
  • under the Decision, show Incompetency for insurance purposes [is] [is not] established
  • show the Veteran’s address, including the zip code, above the Jurisdiction section
  • dispose of any contentions included in the IC’s request for determination that are symptoms of an evaluated disability by a statement to this effect in the Narrative part of the rating decision, and
  • in the coded conclusion, show the codes and evaluations appropriate to compensation entitlement.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part X, Subpart ii, Chapter 6, Section G (U.S. government work, reproduced for reference). Browse all sections →