What this means
m21-1:IV.ii.2.A explains rating action on review examination results and cancellations. In plain terms, the official guidance says use the table below to determine the rating action to take if results of a review examination demonstrate worsening symptomatology in a service-connected (SC) disability. It also addresses under the circumstances described above, do not raise the issue of entitlement to a temporary total rating under 38 CFR 4.29 or 4.30 unless the evidence of record supports a grant of such benefits.
How this may help with a claim
Use m21-1:IV.ii.2.A when organizing evidence or checking VA's handling of rating action on review examination results and cancellations. Compare your application, supporting records, and notice with this source-specific point: Use the table below to determine the rating action to take if results of a review examination demonstrate worsening symptomatology in a service-connected (SC) disability. Under the circumstances described above, do not raise the issue of entitlement to a temporary total rating under 38 CFR 4.29 or 4.30 unless the evidence of record supports a grant of such benefits. Save proof of submission and identify the exact condition, exception, or missing development step before requesting correction or choosing a review option.
What to review in your file
- Check the file against this official condition: Use the table below to determine the rating action to take if results of a review examination demonstrate worsening symptomatology in a service-connected (SC) disability.
- Confirm that the record or notice addresses this source point: If review examination results and/or associated medical evidence demonstrate that an SC disability... — Then...;
- Document how this stated step or exception applies: required hospitalization or observation at VA expense for a period in excess of 21 days — consider entitlement to a temporary total rating a reasonably raised subordinate issue award entitlement to a temporary 100-percent evaluation under 38 CFR 4.29 for the duration of the hospitalization or treatment/observation period, and assign an appropriate schedular evaluation based on current examination results following discontinuance of the temporary 100-percent evaluation.
Important limits
m21-1:IV.ii.2.A explains VA guidance for rating action on review examination results and cancellations; it does not guarantee an award or replace the statutes, regulations, binding decisions, and review instructions that control an individual claim. Conditions and exceptions still matter, including this source point: Use the table below to determine the rating action to take if results of a review examination demonstrate worsening symptomatology in a service-connected (SC) disability. Use the table below to determine the rating action to take if results of a review examination demonstrate that a primary SC disability has progressed to involve the development of one or more additional residual complications or secondary disabilities.
Search terms when useful
Phrases that may help when searching your claim file or this library.
- Rating Action on Review Examination Results and Cancellations
- m21-1:IV.ii.2.A
- Rating Action Review
- Examination Results Cancellations
- Rating Action Review Examination
- results
- demonstrating development additional residual
- cancellations.
Original VA guidance
The official VA text of this section
Overview
In This Section
This section contains the topic “ Rating Action on Review Examination Results and Cancellations.”
1. Rating Action on Review Examination Results and Cancellations
Introduction
This topic contains information about taking rating action on the results of review examinations and cancellations, including rating action on review examination
- results
- demonstrating development of additional residual or secondary disabilities, and
- cancellations.
Change Date
September 15, 2021
IV.ii.2.A.1.a. Rating Action on Review Examination Results Showing Worsening Symptomatology
Use the table below to determine the rating action to take if results of a review examination demonstrate worsening symptomatology in a service-connected (SC) disability.
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| If review examination results and/or associated medical evidence demonstrate that an SC disability... | Then... |
|---|---|
| has worsened so as to warrant a higher evaluation under schedular rating criteria | consider the disability’s evaluation an issue raised on Department of Veterans Affairs (VA) initiative, and award entitlement to the appropriate increased evaluation from the date of the examination’s performance. |
| renders the Veteran unemployable | consider the issue of entitlement to individual unemployability (IU) reasonably raised follow procedural instructions found in M21-1, Part VIII, Subpart iv, 3.B and C for reasonably raised claims of IU, and continue end product (EP) 310 until all issues are decided. |
| required hospitalization or observation at VA expense for a period in excess of 21 days | consider entitlement to a temporary total rating a reasonably raised subordinate issue award entitlement to a temporary 100-percent evaluation under 38 CFR 4.29 for the duration of the hospitalization or treatment/observation period, and assign an appropriate schedular evaluation based on current examination results following discontinuance of the temporary 100-percent evaluation. |
| required surgical or other treatment necessitating at least one month of convalescence at any point in time, if administered at a VA or military treatment facility, or within the year prior to the date of the examination’s performance, if administered by a private or civilian provider | consider entitlement to a temporary total rating a reasonably raised subordinate issue award entitlement to a temporary 100-percent evaluation under 38 CFR 4.30 for the duration of the convalescence period, and assign an appropriate schedular evaluation based on current examination results following discontinuance of the temporary 100-percent evaluation. |
Note: Under the circumstances described above, do not raise the issue of entitlement to a temporary total rating under 38 CFR 4.29 or 4.30 unless the evidence of record supports a grant of such benefits.
References: For more information on
- effective dates of
- increased compensation, see M21-1, Part V, Subpart ii, 4.A
- hospitalization ratings, see M21-1, Part VIII, Subpart iv, 8.B, and
- convalescent ratings, see M21-1, Part VIII, Subpart iv, 8.C
- preparing hospitalization ratings, see M21-1, Part VIII, Subpart iv, 8.B
- preparing convalescent ratings, see M21-1, Part VIII, Subpart iv, 8.C, and
- actions to take when a review examination demonstrates development of additional residual or secondary disabilities, see M21-1, Part IV, Subpart ii, 2.A.1.b.
IV.ii.2.A.1.b. Rating Action on Review Examination Results Demonstrating Development of Additional Residual or Secondary Disabilities
Use the table below to determine the rating action to take if results of a review examination demonstrate that a primary SC disability has progressed to involve the development of one or more additional residual complications or secondary disabilities.
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| If the newly developed disability discovered on review examination is … | Then... |
|---|---|
| the residual of a primary SC disease or disability whose diagnostic code criteria under 38 CFR Part 4 required re-examination, and instruct that residuals be rated according to the body system involved, or one that 38 CFR Part 4 and/or other sources of official VA guidance identify as an accepted part of the underlying SC disability, such as complications of systemic disease processes, including diabetes mellitus scars associated with surgical interventions, or peripheral nerve involvement associated with spinal pathology | award entitlement to service connection (SC) for the newly developed residual or secondary disability(ies), as well as any corresponding ancillary benefits, effective the date of the examination that resulted in discovery. Example: A Veteran SC for prostate cancer attends a review examination intended to assess that disability’s severity on January 1, 2016, at which time he is diagnosed with residual erectile dysfunction. Outcome: The rating activity will establish SC for erectile dysfunction and entitlement to special monthly compensation under 38 U.S.C. 1114(k) for loss of use of a creative organ effective January 1, 2016, the date of the review examination’s performance. |
| affirmatively related to the primary SC disability as per the conclusions of a favorable medical opinion, but not considered an accepted part of the underlying SC disability, as discussed in the cell above | solicit a claim for benefits in accordance with M21-1, Part V, Subpart ii, 3.A.3.a. Example: A Veteran SC for lumbar spinal stenosis attends a review examination intended to assess that disability’s severity, at which time the VA examiner diagnoses right knee patellofemoral pain syndrome and provides a medical opinion that the latter is at least as likely as not related to the former. Outcome: The rating activity will evaluate the severity of the SC lumbar spinal stenosis based on the facts of the case, and solicit a claim for SC for right knee patellofemoral pain syndrome. Note: If, during the course of the VA examination, the Veteran expresses intent to seek compensation for the new disability, handle such communication as a request for application in accordance with M21-1, Part II, Subpart iii, 2.G. |
IV.ii.2.A.1.c. Rating Action on Review Examination Cancellations
Use the table below to determine the rating action to take if the expiration of a future examination control results in review and the conclusion that the examination is not warranted and should be canceled.
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| If it is determined that a future examination should be canceled, and the Veteran’s combined evaluation... | Then prepare a rating decision establishing permanence by... |
|---|---|
| reflects total disability, either by reason of a 100-percent schedular evaluation, or entitlement to IU | awarding basic eligibility to Dependents’ Educational Assistance (DEA). References: For more information on ratings for DEA and permanent and total (P&T) disability, see M21-1, Part XIII, Subpart i, 1.A, and date of P&T disability upon cancellation or dismissal of review examination control, see M21-1, Part V, Subpart ii, 3.D.4.g. |
| does not reflect total disability | confirming and continuing the existing evaluation of any disability for which review examination was originally scheduled, and identifying the disability(ies) as static, warranting no additional or future examination. |
References: For more information on
- EP control following cancellation of a review examination, see M21-1, Part IV, Subpart ii, 1.B, and
- when not to schedule review examinations, see
- M21-1, Part IV, Subpart ii, 1.A, and
- 38 CFR 3.327.