Developing Claims Filed Under 38 U.S.C. 1151

Overview

In This Section

This section contains the topic “ Developing Claims Filed Under 38 U.S.C. 1151.”

1. Developing Claims Filed Under 38 U.S.C. 1151

Introduction

This topic contains information on developing claims filed under 38 U.S.C. 1151, including

• general information about claims filed under 38 U.S.C. 1151
• possible sources of information about the incident
• requesting information from the medical facility, and
• quality assurance investigative reports.

Change Date

August 18, 2025

VIII.iv.6.A.1.a. General Information About Claims Filed Under 38 U.S.C. 1151

38 U.S.C. 1151 provides for the payment of compensation for additional disability or death proximately caused by

• Department of Veterans Affairs (VA)
• hospital care
• medical or surgical treatment, or
• examination
• participation in vocational rehabilitation training, or
• participation in compensated work therapy.

Disabilities and/or causes of death recognized under this provision of law are compensated “ as if ” service-connected (SC), but are not actually SC.

• entitlement to benefits under 38 U.S.C. 1151, see M21-1, Part VIII, Subpart iv, 6.B, and
• considering direct and presumptive service connection in 1151 claims, see M21-1, Part VIII, Subpart iv, 6.B.6.a.

VIII.iv.6.A.1.b. Possible Sources of Information About the Incident

Documentary evidence pertinent to the incident upon which the claim is based may assume many possible forms, including

• medical records
• surgical records
• hospital clinical records, and/or
• nurses’ notes.

Upload to the Veteran’s electronic claims folder any and all clinical reports, progress notes, and hospital summaries associated with the incident in question housed in the

• Compensation and Pension Record Interchange (CAPRI), and/or
• Joint Logitudinal Viewer (JLV).

VIII.iv.6.A.1.c. Requesting Information From the Medical Facility

For all claims under 38 U.S.C. 1151, request comprehensive evidence of the claimed incident using CAPRI’s electronic VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action, request functionality.

Select the 7131 REQUEST tab in the patient’s CAPRI record; check the OTHER/EXAM (REVIEW REMARKS) box; and cut and paste the following text into the COMMENTS field, populating necessary details about the claimant where appropriate:

We have received a claim from the person identified below for benefits under 38 U.S.C. 1151 based on alleged injury while at your facility.

Name:

File Number:

SSN:

Date of Birth:

The claimant alleges sustaining an injury to the [condition]. This injury occurred on [MM-DD-YYYY].

To assist us in making a determination, please furnish all of the following evidence, if available, for this patient for the period of medical care from [MM-DD-YYYY] to [MM-DD-YYYY]:

• medical records
• surgical records
• hospital clinical records
• nurses’ notes, and
• any other documentation of patient injury.

Note: The electronic VA Form 10-7131 in CAPRI

• supports text entry of up to four pages, and
• maintains tracking information regarding the status of requests.

References: For more information on

• obtaining VA medical records, see M21-1, Part III, Subpart ii, 1.A.2
• obtaining records in 1151 claims, see M21-1, Part VIII, Subpart iv, 6.B.5.f, and
• requesting medical opinions for 1151 claims, see
• M21-1, Part IV, Subpart i, 2.A.7.g, and
• M21-1, Part VIII, Subpart iv, 6.B.5.g.

VIII.iv.6.A.1.d. Quality Assurance Investigative Reports

Request quality assurance investigative reports only if the claimant

• identifies these records as evidence necessary to substantiate the claim
• identifies quality assurance records consistent with 38 U.S.C. 5103A(b)(1), and
• furnishes sufficient information to locate the records consistent with 38 U.S.C. 5103A(c)(2).

Notes:

• If the Veterans Health Administration (VHA) denies access to these records, request an Office of General Counsel (OGC) review.
• An OGC review is not appropriate when VHA denies access to these records because they are no longer available.

References: For more information on

• the documents that qualify as quality assurance reports, see
• 38 CFR 17.501, and
• VAOPGCPREC 1-2011, and
• when and how to contact OGC, see M21-5, Chapter 7, Section G, 1.j.