M21-1 Manual  /  Part XI, Subpart ii, Chapter 1

Referral for Consideration of Survivor's Benefits

M21-1, Part XI, Subpart ii, Chapter 1

Overview


In This Chapter

 This chapter contains the following topics:
TopicTopic Name
1 Referring Claims Involving Death After Service
2 Special Purpose Rating Determinations in Survivors Benefits Claims


1. Referring Claims Involving Death After Service



Introduction

 This topic contains information on referring claims to the rating activity that involve death after service, including
  • general responsibilities of a claims processor
  • general policy regarding the referral of survivors benefits claims to the rating activity
  • award of Survivors Pension prior to rating decision regarding service-connected (SC) death
  • specific situations in which survivors benefits claims must be referred to the rating activity
  • determining when a review for implicit service connection (SC) for the cause of death is needed and referring the claim to the rating activity, and
  • rating activity’s responsibilities upon review of an implicit claim for SC death.

Change Date

 June 25, 2024

XI.ii.1.1.a. General Responsibilities of a Claims Processor

 A claims processor must review the evidence of record to determine if a claim for survivors benefits
  • should be submitted to the rating activity, or
  • can be decided without a rating decision.

XI.ii.1.1.b. General Policy Regarding the Referral of Survivors Benefits Claims to the Rating Activity

 Refer each claim for survivors benefits to the rating activity if death occurred within five years of separation from military service. Exception: A claims processor may deny a claim for survivors benefits without referral to the rating activity if the death was due to
  • homicide
  • execution for a crime, or
  • accident or disaster.

c. Award of Survivors Pension Prior to Rating Decision Regarding SC Death

To avoid any delays due to necessary development for service-connected (SC) death, award Survivors Pension benefits, if applicable, prior to referring the claim to the rating activity for a decision on service connection (SC) for the cause of death. Annotate the award with “Decision on SC deferred.” Continue end product (EP) control. If, after evidence is received, the claim is denied, the authorization activity must enter the notation, “Cause of death not due to service, M21-1, Part XI, Subpart ii, 1.1.c,” on the last award, followed by the
  • authorizer’s initials, and
  • date when the decision notice was released to the claimant.
If development is needed to determine eligibility for Survivor Pension, develop at the same time as the SC cause of death, if all other eligibility factors are met.

XI.ii.1.1.d. Specific Situations in Which Survivors Benefits Claims Must Be Referred to the Rating Activity

 If one or more of the following situations arise, forward the claim for survivors benefits to the rating activity for consideration of SC for the cause of death: Exceptions: Notes:
  • If the rating activity determines the facts do not warrant a formal determination of SC, the claim may be
    • annotated that there is no evidence of SC death, and
    • returned to the authorization activity for resolution of the formally claimed issues.
  • If a claim for survivors benefits cannot be referred to the rating activity for a formal determination of SC, the authorization activity must deny the issue administratively.
References: For more information on

XI.ii.1.1.e. Determining When a Review for Implicit SC for the Cause of Death Is Needed and Referring the Claim to the Rating Activity

 The development activity must ensure all necessary evidence relating to SC death, as outlined in M21-1, Part XII, Subpart i, 1.B.1.g, is obtained and if applicable, award any Survivors Pension benefits prior to referring the claim to the rating activity in accordance with M21-1, Part XI, Subpart ii, 1.1.c. Upon expiration of the development timeframe and/or receipt of the requested evidence, review the evidence of record to determine if the claim must be referred to the rating activity. If the development activity is unsure if a grant of SC death is warranted, refer the claim for an implicit SC death review by the rating activity. The table below describes the additional responsibilities of the development activity and of the rating activity in ensuring that a claim for an implicit SC death under a non-SC death EP or claim label is properly reviewed.
StageWho is ResponsibleDescription
1 development activity
  • Reviews the claim and all associated evidence.
  • Makes a determination that an implicit SC death review is needed by a Rating Veterans Service Representative (RVSR).
2 development activity Prevents the claim’s recall by the National Work Queue and routes it for the rating activity’s review by performing the following actions within five business days of receiving the claim in their work queue:
  • appending the RVSR Examination special issue to the DIC contention
  • adding the Review SC Death tracked item, and
  • referring the claim to a coach or designee no lower than an assistant coach for routing to the rating activity for review.
3 rating activity Reviews the claim and all associated evidence to determine if an SC death grant is warranted.
4 rating activity Performs one of the identified actions outlined in M21-1, Part XI, Subpart ii, 1.1.f. Note: In all cases, the rating activity must reflect the implicit SC death review’s completion by performing the following actions within five business days of receiving the claim in their work queue:
  • marks the Review SC Death tracked item as received, and
  • removes the RVSR Examination special issue indicator.

f. Rating Activity’s Responsibilities Upon Review of an Implicit Claim for SC Death

Upon review of an implicit claim for SC death, the rating activity must use the table below to take the actions outlined for the applicable situation.
If ...Then ...
SC death is grantable a formal determination of SC will be made and the EP must be changed to the appropriate SC death EP. Note: A grant of SC death by rating activity will automatically move the claim status from Open status to Rating Decision Complete status. Exception: If the EP is for a burial claim, then the claim label would be changed to one designating it as an SC burialby the rating activity instead of changing the EP.
the rater deems that SC death is potentially grantable, but further development is needed
  • change the EP to the appropriate SC death EP, and
  • create a Veterans Benefits Management System (VBMS) note documenting what development is needed for the claims processor to initiate.
Exception: If the EP is for a burial claim, then the claim label would be changed to one designating it as an SC burial by the rating activity instead of changing the EP.
SC death is not warranted
  • create a VBMS note that there is no evidence of SC death, and
  • route to the authorization activity for resolution of last award notation and pending notification to the claimant while leaving the EP unchanged.


2. Special Purpose Rating Determinations in Survivors Benefits Claims



Introduction

 This topic contains information on the various special purpose rating determinations in survivors benefits claims, including special purpose determinations that
  • do not require a claim for survivors benefits, and
  • require a claim for DIC.

Change Date

 April 24, 2015

XI.ii.1.2.a. Special Purpose Determinations That Do Not Require a Claim for Survivors Benefits

 The table below describes special purpose determinations which may be made whether or not a claim for survivors benefits has been received.
Special Purpose Determination Reference
Burial Allowance See M21-1, XI, Subpart iii, 1.B.
Accrued Benefits See M21-1, XI, Subpart ii, 3.C-E.
Death Gratuity See M21-1, Part XI, Subpart ii, 4.
Dependents’ Educational Assistance See M21-1, Part XIII, Subpart i, 1.A.
Loan Guaranty See M21-1, Part XIII, Subpart i, 7.A.
Service Academy Appointments See M21-1, Part XIII, Subpart ii, 5.A.
Special Allowance Under 38 U.S.C. 1312(a) See M21-1, Part XII, Subpart ii, 2.B.
Testamentary Capacity for Insurance Purposes See M21-1, Part X, Subpart ii, 6.G.
Special Allowance–Public Law 97-377, Section 156, Restored Entitlement Program For Survivors See M21-1, Part XII, Subpart ii, 3.A.

XI.ii.1.2.b. Special Purpose Determinations That Require a Claim for DIC

 The table below describes special purpose determinations in which a claim for DIC is required before the special purpose determination may be made. Note: If a claim for DIC has not been filed
Special Purpose Determination Reference
Public Housing Preference See M21-1, Part XIII, Subpart ii, 3.A.
State Bonus and Tax Exemption See M21-1, Part XIII, Subpart ii, 4.B.
Retired Serviceman’s Family Protection Plan See M21-1, Part VI, Subpart ii, 1.B.3.
Survivor Benefit Plan See M21-1, Part XII, Subpart i, 4.C.

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