M21-1 Manual / Part XI, Subpart ii, Chapter 3, Section D

Rating Accrued Claims

M21-1, Part XI, Subpart ii, Chapter 3, Section D

Overview

In This Section

This section contains the following topics:

Topic	Topic Name
1	General Information on Accrued Rating Decisions
2	Preparing the Rating Decision

1. General Information on Accrued Rating Decisions

Introduction

This topic contains general information on accrued rating decisions, including

when to make accrued rating decisions
procedures governing accrued rating decisions
determining the retroactive period based on the date of death
considering a rating decision based on the date of death
consideration of evidence for requests for substitution
obtaining all evidence for accrued claims, and
payment of accrued benefits for the month of death.

Change Date

March 26, 2024

XI.ii.3.D.1.a. When to Make Accrued Rating Decisions

Address accrued in a rating decision when, after the original claimant’s death, there is an accrued claim and

an issue within the jurisdiction of the rating activity for claims pending at death, including
- informal claims received before March 24, 2015
- initial and supplemental claims
- higher-level reviews (HLR)
- previously denied claims that had new and material evidence to support the claim in or deemed in the claims folder at the date of death, and
- claims of clear and unmistakable error (CUE) pending at death, and
any substantive appeals or administrative appeals pending at the time of death.

Notes:
The evidence requirements for an accrued decision based on new and relevant evidence are the same as the evidence requirements imposed on the original claimant to support a supplemental claim.
Benefits are not payable when a claim for accrued benefits raises a CUE in a previously denied finally adjudicated claim.
References: For more information on
appeals pending at death, see M21-5, Chapter 7, Section J.3
pending claims and appeals, see M21-1, Part XI, Subpart ii, 3.A.2, and
issues within the jurisdiction of the rating activity, see M21-1, Part V, Subpart i, 1.C.1.

XI.ii.3.D.1.b. Procedures Governing Accrued Rating Decisions

Accrued rating decisions are governed by the same procedures applicable to other ratings. Reference: For more information on general rating decision procedures, see M21-1, Part V, Subpart i, 1.A.

XI.ii.3.D.1.c. Determining the Retroactive Period Based on the Date of Death

The table below shows the limitations in the retroactive period covered by the rating decision based on the date of the original claimant’s death.

If death occurred …	Then the retroactive period covered by the rating decision is …
on or after January 1, 1958, but before October 9, 1996	limited to any one-year period before death.
on or after October 9, 1996, but before December 16, 2003	limited to any two-year period before death.
on or after December 16, 2003	not limited.

Exception: When accrued benefits are payable to the survivors or estate of a Nehmer class member under 38 CFR 3.816(f), there is no limitation in the retroactive period, regardless of the date of death. References: For more information on

the time limits to
- submit an application for accrued benefits, see M21-1, Part XI, Subpart ii, 3.C.1.e
- submit a request for substitution, see M21-1, Part XI, Subpart ii, 3.C.1.f, and
- responding to a notice for additional information in an accrued claim or a request for substitution, see M21-1, Part XI, Subpart ii, 3.C.3
payment of accrued benefits when death occurs
- on or after January 1, 1958, but before October 9, 1996, see Public Law (PL) 85-857
- on or after October 9, 1996, but before December 16, 2003, see PL 104-275, and
- on or after December 16, 2003, see PL 108-183
limitation of payment, see Terry v. Principi, 367 F.3d 1291 (Fed. Cir. 2004), and
accrued benefits under Nehmer, see M21-1, Part VIII, Subpart i, 2.B.

XI.ii.3.D.1.d. Considering a Rating Decision Based on the Date of Death

A rating decision dated

prior to the claimant’s death is valid and may be processed by authorization for accrued purposes, or
after the claimant’s death is not valid and may not be processed by authorization for accrued purposes.

Notes:
If a valid rating decision cannot be promulgated, create a Veterans Benefits Management System (VBMS) note to serve as a flash for potential accrued benefits. Add the following VBMS note to the Rating Decision: Potential benefits under PL 110-389, the Veterans’ Benefits Improvement Act of 2008.
Whether or not a rating decision has been promulgated has no impact on the validity of the rating decision for accrued benefit purposes.
Example: The Veteran submitted a compensation claim for coronary artery disease (CAD) on February 1, 2023. An award was authorized on April 15, 2023, granting CAD based on a rating decision dated dated April 11, 2023. The benefit payment was returned as undeliverable on April 20, 2023, because the Veteran died on April 1, 2023. The Veteran’s surviving spouse submitted a claim for accrued benefits on April 22, 2023. Result: A new rating decision is required because the rating decision is dated after the Veteran’s death.

XI.ii.3.D.1.e. Consideration of Evidence for Requests for Substitution

Review the table below to determine what evidence to consider in the rating decision.

If a request for substitution has ...	Then base the rating decision ...
been granted and the claim pending at death was a formal claim an initial claim supplemental claim, or legacy appeal	on evidence contained within the file on the date of death, and additional evidence submitted by the substitute claimant who has the same rights as that of the deceased claimant. *Reference*: For information on the rights of a substitute claimant, see M21-1, Part XI, Subpart ii, 3.B.3.
been granted and the claim pending at death was a request for an HLR	on evidence contained within the file on the date of the notification letter addressing the issue that the request is based on
not been granted	on the evidence contained within the file on the date of death. *Reference*: For information on evidence in the file at the date of death, see M21-1, Part XI, Subpart ii, 3.A.4.

Note: The monetary benefit sought in both situations is called an accrued benefit.

XI.ii.3.D.1.f. Obtaining All Evidence for Accrued Claims

The following evidence must be in the claims folder even if the reports are not reduced to writing or are not physically placed in the claims folder until after death:

service department records at the Records Management Center
reports of Department of Veterans Affairs (VA) hospitalization
reports of hospitalization, treatment, or examinations authorized by VA, and
reports of autopsy made by VA on the date of death.

References: For more information on

evidence in the file at the date of death, see M21-1, Part XI, Subpart ii, 3.A.4
the rights of a substitute claimant, see M21-1, Part XI, Subpart ii, 3.B.3, and
required development for requests for substitution, see M21-1, Part XI, Subpart ii, 3.C.

XI.ii.3.D.1.g. Payment of Accrued Benefits for the Month of Death

The Veteran’s rate for the month of death is generally not payable as an accrued benefit. It is available only to the surviving spouse under 38 U.S.C. 5110(d) and 38 U.S.C. 5310. A rating decision is required, however, if it is needed to establish the Veteran’s rate of benefits for the month of death for payment purposes for the surviving spouse under 38 U.S.C. 5310. References: For more information on

determining the amount of accrued benefits, see M21-1, Part XI, Subpart ii, 3.E.3, and
determining month of death benefit rates payable to a surviving spouse, see M21-1, Part XI, Subpart ii, 2.

2. Preparing the Rating Decision

Introduction

This topic contains information on accrued rating decisions, including

format for an accrued rating decision
addressing the issue of accrued or substitution in the rating decision
handling the accrued rating decision, and
preparing the coded conclusion for accrued claims.

Change Date

February 19, 2019

XI.ii.3.D.2.a. Format for an Accrued Rating Decision

Prepare an accrued rating decision in the same format as a rating decision for disability or survivor benefits. Reference: For more information on completing an accrued benefit rating decision narrative, see M21-1, Part V, Subpart iv, 1.A.7.

XI.ii.3.D.2.b. Addressing the Issue of Accrued or Substitution in the Rating Decision

The issue statement for an accrued claim should be worded as Entitlement to Accrued Benefits, even if the accrued is a result of a request for substitution.

XI.ii.3.D.2.c. Handling the Accrued Rating Decision

Use the information in the table below to handle the accrued rating decision.

If an accrued rating decision is ...	Then ...
favorable	use the template language generated by selecting the accrued grant radio button in VBMS – Rating. *Note: The accrued template is only available for selection if the Veteran is deceased. When generated, the accrued grant template will appear at the top of the first page of the Codesheet* below the data tables. *Reference: For more information, see the VBMS Rating User Guide*.
unfavorable, because necessary evidence was not received to support the claim	include that discussion in the reasons for decision.

XI.ii.3.D.2.d. Preparing the Coded Conclusion for Accrued Claims

Prepare the coded conclusion in the same manner as for live or survivor cases. Reference: For more information about preparing the coded conclusion, see M21-1, Part V, Subpart iv, 1.C.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part XI, Subpart ii, Chapter 3, Section D (U.S. government work, reproduced for reference). Browse all sections →