Hospitalization-- An Informal Claim?

[Guest morgan]

Somewhere I think I read that a veteran's hospitalization should be considered an informal claim. Has anyone else read that? If so, would he hospitalization have to be in a VA hospital?

[broncovet]

I do recall reading this. A hospitilization or VA doctor visit can be an informal claim for increase.

IMHO you still have to ask for initial benefits by using a 21-526 application for benefits. If you have already applied for benefits, this hospitilization could be an informal claim for increase.

[sharon]

You must file a claim for an increase on your sc conditon or request compensation for a new condition. The hospitalization will be considered and Dr visit will be used as evidence. Repeat, you need to file a claim. If you have already filed a VA 21-526 you only have to write in to file a claim. If it is a service connected condition it will be reported to the VA for consideration for A/A, H/B or increase. Do not rely on the VA to consider it a claim for increase.

[timetowinarace]

VARO can open an infered/informal claim if they get information of a possible SC condition, such as medical records.

However, it doesn't happen often.

1. It's not likely they will recieve the information unless you send it to them, and in that case you should making a claim.

2. It's not likely they will recognize a possible SC condition unless they are working on another claim for you.

3. More often than not, even if VARO sees the information and your records do indicate SC, they will ignore it.

You need to file the claim and when it has had a decision made, review your c-file. If VARO had the information it may be possible to get the EED. Or you can request the earleir effective date when you file the claim.

Edited January 11, 2009 by timetowinarace

[carlie]

§ 3.157 Report of examination or hospitalization

as claim for increase or

to reopen.

(a) General. Effective date of pension

or compensation benefits, if otherwise

in order, will be the date of receipt of

a claim or the date when entitlement

arose, whichever is the later. A report

of examination or hospitalization

which meets the requirements of this

section will be accepted as an informal

claim for benefits under an existing

law or for benefits under a liberalizing

law or Department of Veterans Affairs

issue, if the report relates to a disability

which may establish entitlement.

Acceptance of a report of examination

or treatment as a claim for increase

or to reopen is subject to the requirements

of § 3.114 with respect to action

on Department of Veterans Affairs

initiative or at the request of the

claimant and the payment of retroactive

benefits from the date of the report

or for a period of 1 year prior to

the date of receipt of the report.

(Authority: 38 U.S.C. 5110(a))

(b) Claim. Once a formal claim for

pension or compensation has been allowed

or a formal claim for compensation

disallowed for the reason that the

service-connected disability is not

compensable in degree, receipt of one

of the following will be accepted as an

informal claim for increased benefits

or an informal claim to reopen. In addition,

receipt of one of the following

will be accepted as an informal claim

in the case of a retired member of a

uniformed service whose formal claim

for pension or compensation has been

disallowed because of receipt of retirement

pay. The evidence listed will also

be accepted as an informal claim for

pension previously denied for the reason

the disability was not permanently

and totally disabling.

(1) Report of examination or hospitalization

by Department of Veterans

Affairs or uniformed services. The date of

outpatient or hospital examination or

date of admission to a VA or uniformed

services hospital will be accepted as

the date of receipt of a claim. The date

of a uniformed service examination

which is the basis for granting severance

pay to a former member of the

Armed Forces on the temporary disability

retired list will be accepted as

the date of receipt of claim. The date

of admission to a non-VA hospital

where a veteran was maintained at VA

expense will be accepted as the date of

receipt of a claim, if VA maintenance

was previously authorized; but if VA

maintenance was authorized subsequent

to admission, the date VA received

notice of admission will be accepted.

The provisions of this paragraph

apply only when such reports relate

to examination or treatment of a

disability for which service-connection

has previously been established or

when a claim specifying the benefit

sought is received within one year from

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189

Department of Veterans Affairs § 3.159

the date of such examination, treatment

or hospital admission.

(Authority: 38 U.S.C. 501)

(2) Evidence from a private physician or

layman. The date of receipt of such evidence

will be accepted when the evidence

furnished by or in behalf of the

claimant is within the competence of

the physician or lay person and shows

the reasonable probability of entitlement

to benefits.

(3) State and other institutions. When

submitted by or on behalf of the veteran

and entitlement is shown, date of

receipt by the Department of Veterans

Affairs of examination reports, clinical

records, and transcripts of records will

be accepted as the date of receipt of a

claim if received from State, county,

municipal, recognized private institutions,

or other Government hospitals

(except those described in paragraph

(b)(1) of this section). These records

must be authenticated by an appropriate

official of the institution. Benefits

will be granted if the records are

adequate for rating purposes; otherwise

findings will be verified by official examination.

Reports received from private

institutions not listed by the

American Hospital Association must be

certified by the Chief Medical Officer of

the Department of Veterans Affairs or

physician designee.

[26 FR 1571, Feb. 24, 1961, as amended at 27

FR 4421, May 9, 1962; 31 FR 12055, Sept. 15,

1966; 40 FR 56434, Dec. 3, 1975; 52 FR 27340,

July 21, 1987; 60 FR 27409, May 24, 1995]

[john999]

The VA used the date of my last hospitalization to establish an EED for my TDIU. I was asking for them to use the date I was awarded SSDI, but they chose to go with the hospitalization date which was the same as the SSDI anyway.

[deltaj]

The VA used the date of my last hospitalization to establish an EED for my TDIU. I was asking for them to use the date I was awarded SSDI, but they chose to go with the hospitalization date which was the same as the SSDI anyway.

Please check out V.A. General Counsel Precedent Opinion 5-2003.