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 the hospitalization have to be in a VA hospital?

[Guest morgan]

This should help

Title 38: Pensions, Bonuses, and Veterans' Relief

PART 3—ADJUDICATION

Subpart A—Pension, Compensation, and Dependency and Indemnity Compensation

Claims

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§ 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 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 (:D(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]

Thanks! This is exactly what I was looking for.

[deltaj]

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

This is written by Delta Jackson. There is a V.A. Precedent Opinion I have read on that topic.

[Berta]

This reg always bothers me-

If a vet is hospitalized for a service connected condition or a comdition that could potentially be service connected-how does the RO know this?

Are these med recs automatically generated to the RO that holds the veteran's claims file? Is that what triggers the RO to consider the hospital records as an informal claim?What if the vet has no claims file yet?

When Rod was in the 21 day PTSD program, a rep made sure these vets applied for the one month total disability comp right at the VA hospital.

When a vet friend of mine was hospitalized at VA for surgery (which was untimately service connected) I dont think the VA ever considered the hospital records as an informal claim.He filed a claim himself.

Just wondering how this really works-

Edited January 14, 2009 by Berta

[john999]

My hospital records were used by the VA to award me an EED. I don't think you get it automatically without making a claim except it the rare, odd case. I did not just get the EED from the VA's goodwill. I had asked for an EED on my TDIU based on my SSD records, but the VA used my earlier hospitalization to justify the EED. I think they purposely avoided using my SSD records to justify the EED, and, instead, used the hospital records. It amounted to exactly the same date for the EED. If they had used my SSD date then that would mean that they should use that date to justify awarding many vets an EED who got SSD years before TDIU or 100% from the VA. The VA does not scan our VAMC medical records for potential claims. In the process of a ongoing claim they might make a inferred claim or decide that hospital records were an inferred or informal claim to benefits, but you have to have made a claim first. It is like the AO exam. The doctor may find AO related conditions but that does not spark an automatic claim for benefits at all. You have to file a claim and go for a C&P exam. In the last 40 years I have never gotten a letter from the VA saying "Mr. King, on examination of your medical and hospital records we are making a claim on your behalf for benefits".

[carlie]

Berta,

I agree - 3.157 is hard to get a handle on.

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

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.

I have a denial from 1978 that state's:

Your disability compensation claim has been carefully considered.

To establish entitlement to this benefit, the evidence must show;

(a) that you have a disability incurred or aggravated in service, in the line of duty;

and (b) must be 10 percent or more disabling.

So, I'm trying to figure out if 3.157 applies to the Medical Evidence

compiled after this decision.

And I am trying to figure out why these disabilities were not SC'd even at zero percent,

on the original decision.

Any thoughts ?

carlie

[Berta]

Carlie -did the VA use both the a and the b part to deny your claim?