Determining the Issues

Overview

In This Section

This section contains the following topics:

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1. Types of Issues and Claims

Introduction

This topic contains information about the various types of issues and claims, including

• recognizing issues and claims when preparing a rating decision
• definition and example of
• expressly claimed issue
• issues within scope
• unclaimed subordinate issues
• ancillary benefits, and
• compensation entitlement issues
• considering intent of new claims, and
• clarifying claims and issues.

Change Date

June 24, 2025

V.ii.3.A.1.a. Recognizing Issues and Claims When Preparing a Rating Decision

When preparing a rating decision, the decision maker must recognize, develop, clarify, and/or decide all issues and claims, whether they are

• expressly claimed
• within scope of an expressly claimed issue, such as
• complications/residuals of the claimed condition, or
• unclaimed subordinate issues and ancillary benefits, or
• compensation entitlement issues that arise based on the Department of Veterans Affairs’ (VA’s) review of evidence, such as
• reductions of service-connected (SC) disability evaluation
• clear and unmistakable errors (CUEs)
• entitlement under the Nehmer stipulation, or
• competency reviews.

References: For more information on

• considering subordinate issues and ancillary benefits, see M21-1, Part V, Subpart ii, 3.A.2
• solicitation of claims, see M21-1, Part II, Subpart iii, 2.G
• issues within scope of a claim, see
• M21-1, Part V, Subpart ii, 3.A.1.c, and
• 38 CFR 3.155(d)(2)
• treating complications/residuals of a disability as within the scope of a claim, see M21-1, Part V, Subpart ii, 3.A.2.c
• ancillary benefits, see
• 38 CFR 3.155(d)(2), and
• M21-1, Part XIII, Subpart i, and
• compensation entitlement issues that arise based on VA’s review of evidence, see M21-1, Part V, Subpart ii, 3.A.1.f.

V.ii.3.A.1.b. Definition and Example: Expressly Claimed Issue

An expressly claimed issue is defined as when a disability and the benefit sought are both explicitly identified on a standardized VA form.

Example: Epilepsy is listed as a claimed disability on VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits.

References: For more information on

• how to file a claim, see 38 CFR 3.155
• standardized VA forms, see M21-1, Part II, Subpart iii, 1.A.1.a, and
• status of claims, see 38 CFR 3.160.

V.ii.3.A.1.c. Definition and Example: Issues Within Scope

An issue within scope is one that is not explicitly identified by the claimant on one of the forms listed in M21-1, Part II, Subpart iii, 1.A.1.a, but is identified upon review of the claims folder during the decision-making process for an expressly claimed issue. An issue within scope arises based on a sympathetic reading of the claimant’s statements and/or evidence of record. It encompasses such things as entitlement to

• any ancillary benefits that arise as a result of the adjudication decision
• additional benefits for complications/residuals of an expressly claimed condition, and
• unclaimed primary or causal disabilities, when service connection (SC) is warranted for the expressly claimed secondary disability and the unclaimed causal disability.

Notes:

• VA does not expect, nor does the law require, claimants to articulate with medical precision the disabilities for which compensation is sought. Veterans regularly claim disability compensation for a specific clinical entity and ultimately establish SC for a similar, but clinically distinct, condition.
• When an individual expressly claims a specific disability and is later diagnosed with a different but potentially related condition, if a sympathetic reading of the claim shows that the diagnosed condition is encompassed by the claim, VA must address the claim as including the diagnosed condition, as discussed in Grimes v. McDonough, 34 Vet.App. 84 (2021).

Example 1: VA may, in developing a Veteran’s claim for SC for sinusitis, provide the Veteran with an examination that renders a diagnosis of a similar condition, such as allergic rhinitis, rather than sinusitis.

Result: In the event that the examination is otherwise sufficient for rating purposes and the condition is associated with service, the decision maker awards SC for allergic rhinitis as within the scope of the claim for sinusitis.

Example 2: The Veteran’s VA examination shows that there is sufficient evidence to justify an increased evaluation of 70 percent for SC posttraumatic stress disorder (PTSD). In addition, the Veteran reported being fired from several jobs due to an inability to deal with stress, and the VA examiner identified the Veteran’s stress management problem as a symptom of PTSD.

Result: The decision maker addresses the issue of individual unemployability (IU) in the rating decision as described in M21-1, Part VIII, Subpart iv, 3.C.3.

Example 3: The Veteran submits a claim for SC for right knee strain. The evidence of record, including the resulting examination, shows that SC for the knee strain is warranted. The examination also reveals a knee scar that resulted from a post-service arthroscopy procedure. The examination indicates the arthroscopy was associated with the SC right knee strain. The examination also shows that the scar is not painful or unstable and is less than 6 square inches.

Result: In the event that the examination is otherwise sufficient for rating purposes, the decision maker awards SC for the knee condition and separate SC for the noncompensable knee scar as within the scope of the claim for SC for right knee strain.

Example 4: The Veteran submits a claim for SC for hearing loss, earaches, and sinusitis. Later, the Veteran submits a lay statement reporting that everyday sounds cause discomfort. Private medical records show a diagnosis of hyperacusis. Hyperacusis was also diagnosed during the VA audiology examination.

Result: In view of the evidence, the expressly claimed issue of SC for hearing loss and earaches must be sympathetically read as encompassing the diagnosed disability hyperacusis. Decreased sound tolerance (hyperacusis) reasonably falls within the the scope of the claim for an audiological condition manifested by hearing deficits and ear pain. If the examination is otherwise sufficient for rating purposes, make a decision on SC for hyperacusis. Otherwise defer for a new and/or adequate examination or other required development.

References: For more information on

• sympathetic reading of a claim, see
• Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009), and
• Grimes v. McDonough, 34 Vet.App. 84 (2021)
• scope of claim, see
• 38 CFR 3.155(d)(2), and
• M21-1, Part V, Subpart ii, 3.A.2
• identifying and developing reasonably raised IU claims, see M21-1, Part VIII, Subpart iv, 3.B.1.f and g, and
• tinnitus associated with claims for SC for hearing loss, see M21-1, Part V, Subpart iii, 2.B.2.a.

V.ii.3.A.1.d. Definition and Example: Unclaimed Subordinate Issues

Unclaimed subordinate issues are issues derived from the consideration or outcome of related issues. Often, the primary and subordinate issues share the same fact pattern.

Example: SC for treatment purposes under 38 U.S.C. 1702 based on a denial of SC for compensation purposes is considered a subordinate issue

• for a psychosis based on wartime service, or
• for any mental disorder based on Gulf War service, and
• when entitlement is shown under 38 U.S.C. 1702.

References: For more information on

• subordinate issues, see M21-1, Part V, Subpart ii, 3.A.2, and
• when to address entitlement to SC for treatment purposes under 38 U.S.C. 1702 by rating, see M21-1, Part XIII, Subpart i, 3.C.1.f.

V.ii.3.A.1.e. Definition and Example: Ancillary Benefits

Ancillary benefits are secondary benefits that are considered when evaluating claims for

• compensation
• pension, or
• Dependency and Indemnity Compensation (DIC).

Note: Eligibility for ancillary benefits is derived from a Veteran’s entitlement to disability benefits or the circumstances of the Veteran’s death.

Example: The Veteran is granted a 100-percent SC evaluation for amyotrophic lateral sclerosis (ALS) and complications. VA examination shows that the Veteran requires assistance with activities of daily living.

Result: The rating activity addresses the issues of special monthly compensation (SMC) for aid and attendance (A&A), Dependents' Educational Assistance (DEA), specially adapted housing (SAH), and automobile allowance and adaptive equipment in the rating decision.

Reference: For more information on subordinate issues and ancillary benefits, see M21-1, Part V, Subpart ii, 3.A.2.

V.ii.3.A.1.f. Definition and Example: Compensation Entitlement Issues

Compensation entitlement issues arise upon VA’s review of evidence and do not require a claim from the beneficiary in order to be brought to issue. This includes issues such as

• reductions of SC disability evaluations
• CUEs
• entitlement under the Nehmer stipulation, or
• competency reviews.

Example 1: A Veteran, who is SC for bilateral knee arthritis, claims an increased disability evaluation for the left knee. The examination includes a full evaluation of both knees. The Veteran’s SC right knee, which has been evaluated as 30-percent disabling for three years, shows improvement consistent with 38 CFR 3.344 and M21-1, Part X, Subpart ii, 4.A.1.b. The treatment reports are consistent with the examination findings.

Result: The rating decides the expressly claimed left knee evaluation and proposes a reduced evaluation for the right knee, as the overall combined evaluation will be reduced.

Rationale: The examination report and treatment records both show the condition has improved and warrants reduction. The evaluation has been in effect for less than five years and may be reduced on one examination. As the combined evaluation is affected, the regional office (RO) must apply the provisions of 38 CFR 3.105(e) and propose the reduction.

Example 2: A Veteran files a claim for an increased disability evaluation for SC lumbar strain. While processing the claim, the rating activity notices an earlier effective date under the Nehmer stipulation is warranted for the SC ischemic heart disease based on treatment records that were in file at the time a prior claim was decided.

Result: The rating decision decides both the expressly claimed lumbar spine issue and awards entitlement to an earlier effective date under the Nehmer stipulation.

Rationale: Claimants do not have to file claims for consideration of an earlier effective date under the Nehmer stipulation. As records support entitlement, the decision maker should award the earlier effective date under 38 CFR 3.816.

References: For more information on

• reductions, see M21-1, Part X, Subpart ii, 4.A
• CUEs, see M21-1, Part X, Subpart ii, 5.A
• the Nehmer stipulation, see
• M21-1, Part VIII, Subpart i, 2.B, and
• the Nehmer Training Guide, and
• competency reviews, see M21-1, Part X, Subpart ii, 6.A.

V.ii.3.A.1.g. Considering Intent of New Claims

Avoid confusing the "sympathetic reading" doctrine and within-scope analysis discussed in M21-1, Part V, Subpart ii, 3.A.1.c with a reading that

• misconstrues or makes generalized assumptions about the Veteran's intent in contending a specific disability, and/or
• narrows the scope of potential for the claim's consideration.

Unless adjudicative judgment and/or review of available evidence suggests that an alternative reading would better serve the Veteran and result in maximizing the potential for benefit entitlement, decide each expressly claimed issue on its factual merits.

Example 1: A Veteran who received an Afghanistan Campaign Medal was previously denied SC for depression on the basis that no mental health symptoms became manifest during service. The decision notice communicating the denial was dated August 17, 2016. On January 5, 2018, VA receives a claim for SC for PTSD.

Result: The RO must decide the PTSD claim on its individual merits, without regard to the previous denial of SC for depression, in spite of the contentions’ symptomatic similarities, as

• the holding in Clemons v. Shinseki, 23 Vet.App. 1 (2009), does not require that all mental health claims be treated as one
• 38 CFR 3.304(f) provides additional means by which SC for PTSD can be established, and
• receipt of the Afghanistan Campaign Medal would generally satisfy the requirement for a stressor involving service in an area of potential hostile military or terrorist activity.

Example 2: A Veteran who is currently SC for bronchial asthma, evaluated as 30-percent disabling, files a claim for SC for obstructive sleep apnea requiring the use of a continuous positive airway pressure (CPAP) device.

Result: The RO must decide the sleep apnea claim on its individual merits and not generally assume that the Veteran, in contending a separate respiratory condition, intended to seek an increased evaluation for SC asthma. Although 38 CFR 4.96(a) would prohibit the assignment of separate compensable evaluations for both asthma and sleep apnea if SC for the latter were ultimately awarded, 38 CFR 4.97, diagnostic code (DC) 6847, may permit assignment of a greater collective evaluation in light of the required CPAP use.

References: For more information on

• clarifying issues and claims, see M21-1, Part V, Subpart ii, 3.A.1.h, and
• considering diagnosed conditions as bases for separate and distinct claims, see
• Boggs v. Peake, 520 F.3d 1330 (Fed. Cir. 2008), and
• Velez v. Shinseki, 23 Vet.App. 199 (2009).

V.ii.3.A.1.h. Clarifying Issues and Claims

Whenever the disability claimed is not clearly identified, ensure that the claim clarification procedures outlined in M21-1, Part III, Subpart i, 2.D.1.c have been followed and documented prior to issuing a rating decision.

2. Considering Issues Within Scope of a Claim

Introduction

This topic contains information about considering issues within scope of a claim, including

• types of ancillary benefits
• when to address subordinate issues and ancillary benefits
• considering complications of an expressly claimed issue, and
• considering an unclaimed primary disability associated with a claimed complication or secondary condition.

Change Date

June 24, 2025

V.ii.3.A.2.a. Types of Ancillary Benefits

Some types of ancillary benefits are

• DEA under 38 U.S.C. Chapter 35
• SAH under 38 CFR 3.809
• special home adaptation (SHA) grants under 38 CFR 3.809a
• automobile allowance and adaptive equipment under 38 CFR 3.808
• vocational rehabilitation/employment services under 38 U.S.C. Chapter 31, and
• loan guaranty for surviving spouses under 38 CFR 3.805.

Reference: For more information on ancillary benefits, see

• M21-1, Part V, Subpart ii, 3.A.1.e, and
• M21-1, Part XIII, Subpart i.

V.ii.3.A.2.b. When to Address Subordinate Issues and Ancillary Benefits

Use the table below to determine when to address entitlement or basic eligibility as applicable to subordinate issues and ancillary benefits in a rating decision.

Note: In general, address entitlement to or eligibility for a subordinate issue or ancillary benefit only when it can be awarded. Do not put a benefit at issue merely to deny it.

Exception: Consider a 10-percent evaluation under 38 CFR 3.324 in all applicable ratings regardless of whether the benefit is awarded or denied.

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Reference: For information on raising the issue of competency while evaluating other evidence, see M21-1, Part X, Subpart ii, 6.A.2.a.

V.ii.3.A.2.c. Considering Complications of an Expressly Claimed Issue

When deciding expressly claimed issues, decision makers must consider entitlement to compensation for any complications/residuals that are within scope of the claim, including, but not limited to, those identified by the rating criteria for that condition in 38 CFR Part 4. A specific claim is not required to award a within-scope complication/residual.

Decision makers will consider all lay and medical evidence of record in order to adjudicate entitlement to any additional benefits for complications or other residuals of a claimed issue, such as:

• complications of diabetes mellitus
• residuals of cancer or treatment for the SC cancer
• scars as the result of surgical intervention for an SC disability
• neurological disabilities related to the spine
• complications of progressive disorders, such as
• ALS, or
• multiple sclerosis (MS), or
• constitutional symptoms caused by systemic disorders, such as
• rheumatoid arthritis (RA), or
• ankylosing spondylitis.

Notes:

• The above list is not intended to be comprehensive. Decision makers must consider the evidence in each case and determine whether additional issues are within scope.
• With respect to residuals of cancer or treatment, in Bailey v. Wilkie, 33 Vet.App. 188 (2021), the Court of Appeals for Veterans Claims held that although residuals of prostate cancer under 38 CFR 4.115b, DC 7528 are rated as voiding dysfunction or renal dysfunction, whichever is predominant, other residual disability caused or aggravated by cancer, or its treatment, may be within scope if reasonably raised by the evidence. 38 CFR 3.155(d)(2) and 38 CFR 3.160 require VA to develop and adjudicate related claims for secondary SC for disabilities that are reasonably raised during the adjudication of a formally initiated claim for the primary SC disability.
• Entitlement to SC for the complication/residual, unless explicitly claimed, should only be placed at issue when entitlement is established. When entitlement is not established, but relevant evidence is present, discussing the relevant evidence is appropriate for inclusion in the Reasons for Decision of the expressly claimed issue.
• When evidence shows the presence of a potential complication/residual, decision makers must ensure there is adequate medical evidence, including an examination, if needed, in order to determine entitlement.

References: For more information on

• complications of diabetes, see M21-1, Part V, Subpart iii, 11.2
• evaluating cancers and associated impairments, see M21-1, Part V, Subpart ii, 3.D.5
• when to consider scars as part of a claim, see M21-1, Part V, Subpart iii, 10
• neurological complications of the spine, see M21-1, Part V, Subpart iii, 1.B.3.d, and
• rating
• ALS and MS, see M21-1, Part V, Subpart iii, 12.C
• RA, see M21-1, Part V, Subpart iii, 1.C, and
• ankylosing spondylitis, see M21-1, Part V, Subpart iii, 1.B.3.

V.ii.3.A.2.d. Considering an Unclaimed Primary Disability Associated With a Claimed Complication or Secondary Condition

When a claim for SC for a disability is pending and subsequent development of the claim reveals that the claimed disability is caused by an unclaimed disability that may be associated with service, the decision maker must investigate the possibility of SC for the unclaimed primary (or causal) disability, as well as SC on a secondary basis for the claimed disability.

• The duty to investigate SC for the causal disability is within scope of the claimed condition when the
• evidence suggests that an expressly claimed disability arises from, is secondary to, or has been aggravated by the unclaimed causal disability, and
• criteria under 38 CFR 3.159(c)(4) have been satisfied.
• If the unclaimed causal disability is shown to be related to service, the pending claim reasonably encompasses a claim for benefits for the causal disability. A separate claim form is not required when this fact pattern exists and the unclaimed causal disability can be adjudicated as within the scope of the expressly claimed disability.

Example: A Veteran files a claim for SC for right shoulder pain as the result of a fall caused by instability of the right knee, which is not SC and has not otherwise been expressly claimed. Development of the claim confirms a diagnosis of right shoulder impingement that is secondary to the unclaimed knee condition. The knee injury (resulting in recurrent instability of the right knee) was sustained in service, and current medical evidence shows treatment for continued symptoms since the Veteran’s discharge. Sufficient evidence to establish SC for the knee disability is of record, and the medical evidence shows the right shoulder disability was directly caused by the fall that occurred when the Veteran’s knee buckled unexpectedly. Consider the unclaimed knee disability within scope of the claimed shoulder disability.

References: For more information on

• scope of claim, see 38 CFR 3.155(d)(2)
• establishing causation for secondary SC, see M21-1, Part V, Subpart ii, 2.D.1.b
• when a medical opinion is required, see M21-1, Part IV, Subpart i, 1.B.1, and
• the correlation between effective date for primary and secondary SC disabilities, see M21-1, Part V, Subpart ii, 4.A.3.g.

3. Other Issues to Consider

Change Date

May 1, 2026

V.ii.3.A.3.a. Other Issues to Consider When Evaluating Evidence

The table below lists matters to consider, in addition to determining issues within the scope of the claim as discussed in M21-1, Part V, Subpart ii, 3.A.1 and 2, when evaluating the evidence submitted with a claim.

Note: In all substantially complete claims, consider the provisions of 38 CFR 3.155(d)(2) and M21-1, Part V, Subpart ii, 3.A.1 and 2, and adjudicate any issues considered within scope of the claim.

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Reference: For more information on the requirement for a complete claim, see

• 38 CFR 3.155(d)(1)
• 38 CFR 3.159
• 38 CFR 3.160(a), and
• M21-1, Part I, Subpart i, 1.A.