5.20 Medical Evidence Of Probable Entitlement

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M21-1-3 Claims Development

5.20 MEDICAL EVIDENCE OF PROBABLE ENTITLEMENT

a. General. A private physician's statement meeting the requirements of 38 CFR 3.326(d) or a hospital or examination report from any of the sources provided in 38 CFR 3.326© may be accepted for rating purposes if it is adequate. In all cases, permit simultaneous development of evidence [38 CFR 3.326(;)]. Both lay statements and medical reports of treatment by an attending physician, if available, may be used.

b. Prompt Submission to the Rating Activity. Evidence or current disability may be contained in reports from a VA or a non-VA medical facility at VA expense or in evidence already of record showing the existence of a chronic condition likely to interfere with employability. If so, submit the claim to the rating board.

c. Requesting Medical Information from Social Security Administration. When considering a claim for pension if there is indication that the veteran is receiving disability Social Security benefits, request copies of the medical records on which the SSA decision was based. See chapter 9 for instructions on making this request.

d. Procurement of Evidence. In the absence of any of the conditions listed in subparagraph b above, medical evidence must be provided before the claim is referred to the rating activity or a VA physical examination is ordered. Follow the procedures in paragraph 1.02 re steps to take to fulfill VA’s duty to assist the claimant. If necessary evidence is not received, deny the claim for record purposes and notify the veteran that the evidence must be provided to reopen the claim.