3.13 Reasons And Bases

[allan]

M21-1-6 Rating Board Procedure

3.13 REASONS AND BASES

a. General. Conclusions without supporting analysis and explanation do not comply with statutory requirements. Explain why the decision was made in the reasons and bases. Each disability at issue in a rating must be discussed separately in its own reasons and bases paragraph. Reasoning deductively from the general to the particular, dedicate the first paragraph to the legal justification and the second to the supporting evidence. Reasons and bases paragraphs containing conclusory statements such as, "The evidence does not warrant any change in the prior evaluation" are inadequate without an analysis of the credibility and value of the evidence considered.

b. Review of Evidence. Concisely cite and evaluate all evidence that is relevant and necessary to the determination. Rating decisions must evaluate all the evidence, including oral testimony given under oath and certified statements submitted by claimants, and must clearly explain why that evidence is found to be persuasive or unpersuasive. Decisions must address all pertinent evidence and all of the claimant's contentions. Do not quote at length from letters, affidavits, hospital reports, etc.

(1) If service connection is granted, do not relate all the details of treatment in service. A simple statement that the enlistment exam was negative and that beginning on a particular date prior to separation the veteran was treated for whatever condition was diagnosed is usually sufficient. The next entry in the paragraph should be the findings from the current exam or a citation of whatever evidence is necessary to establish chronicity and continuity. If the cause of several claimed disabilities is the same, such as one accident, information concerning the origin need only be discussed in detail once in the reasons and bases paragraph for the first disability of common origin.

(2) When granting service connection, extensive discussion of post service treatment is only necessary if essential to the evaluation.

(3) Cite evidence, both favorable and unfavorable, without partiality, especially when a decreased benefit is under consideration. Compare relevant findings at the time of previous rating with present findings.

c. Current and Next Higher Evaluations. Whenever a separate disability evaluation is assigned for compensation purposes, describe the criteria of the particular diagnostic code which justifies the assigned evaluation. If a higher percentage under that code would be possible, also discuss the criteria for the next higher evaluation. Confine the explanation of the criteria for the assigned and next higher evaluations to the diagnostic code under which the disability is evaluated. In the case of hearing loss or visual impairment, a general statement such as "higher evaluations are assigned for greater loss of hearing (or vision)" will be sufficient.

d. Medical Conclusions. Cite medical information and reasoning linking or separating two disabilities or establishing or refuting prior inception or aggravation. Medical conclusions must be supported by evidence in the claims file. Rating specialists cannot refute medical evidence submitted by the claimant with their own medical opinions. Rating decisions can cite recognized medical treatises or an independent medical opinion to support a conclusion. Such authority, when relied upon, must be identified in the decision.

[Ricky]

Allan - was this recinded by M21R? I could not get a full print so I went to the M21 and it said it was recinded. I looked at M21R and boy is it worded different. the rewrite is not so specific as to how the reasons and basis is supposed to look and what it is to contain. No wonder we get such outlandish information in the reasons and bases section. If you don't mind let me know what you think about this as I was going to quote it in my arguments next monday at may DRO hearing but if it has truly been recinded then I may be out of luck.

Thanks

[allan]

Sorry Ricky,

it was recended in 2003. Will pull the info up for you & delete this out of my folders so I don't post it again.

[allan]

Paragraph 3.13 has been changed from Reasons & Basis, to “Reasons for Decision”

See below...............

allan

***************************************************

Veterans Benefits Administration M21-1, Part VI

Department of Veterans Affairs Change 100

Washington, DC 20420 February 13, 2003

Veterans Benefits Manual M21-1, Part VI, "Rating Board Procedures," is changed as follows:

Pages 3-i through 3-II-13: Remove these pages and substitute with pages 3-i through 3-II-13, attached.

The entire chapter has been updated to incorporate “RBA 2000,” remove references to “well-grounded” and the Special Issues Rating System (SIRS) which is no longer in use.

Paragraph 3.13 has been changed to “Reasons for Decision” and paragraphs 3.13a and b are updated. Other minor formatting and editorial changes have also been made.

Rescission: M21-1, Part VI, Change 69, dated May 14, 1999.

By Direction of the Under Secretary for Benefits

Ronald J. Henke

Director, Compensation and Pension Service

Distribution: RPC: 2068

FD: EX: ASO and AR (included in RPC 2068)

SOURCE:

http://www.warms.vba.va.gov/Admin21/M21_1/PART6/chg100.doc

[allan]

3.13 REASONS FOR DECISION

a. General. Support conclusions with the necessary level of analysis and explanation. For example, where service connection is being granted, state or discuss the

• benefit being granted,

• basis for the grant, focusing on the in-service event and/or subsequent developments that link the condition to service,

• basis for the evaluation,

• requirements for the next higher evaluation, and

• basis for the effective date.

(1) Grants of service connection must include an explanation or analysis that shows how the entitlement or disability was determined to be service-connected. Computer-generated paragraphs standing alone or conclusory statements without explanation do not satisfy the requirement to state the basis for the grant. See Training Letter

02-02 dated June 19, 2002.

(2) When assigning a disability evaluation, it is not enough to simply list the criteria for the evaluation followed by a statement that a particular evaluation is assigned because the disability meets the criteria. Instead, relate what the evidence shows to the criteria assigned. For example, when explaining the reasons for assigning a thirty percent evaluation to a knee disability state, “You meet the criteria for a thirty percent evaluation because at your examination, severe instability was found in your left knee,” rather than, “Thirty percent is assigned because your disability meets the above criteria.”

b. Review of Evidence. Concisely cite and evaluate all evidence that is relevant and necessary to the determination. Rating decisions must evaluate all the evidence, including oral testimony given under oath and certified statements submitted by claimants, and must clearly explain why that evidence is found to be persuasive or unpersuasive. Decisions must address all pertinent evidence and all of the claimant's contentions. Do not quote at length from letters, affidavits, hospital reports, etc.

c. Next Higher Evaluations. When assigning a disability evaluation, if a higher evaluation is possible under a particular diagnostic code, discuss the criteria for the next higher evaluation. If the reason the veteran does not meet the requirements for the next higher evaluation is not readily apparent, be sure to explain why. Confine the explanation of the criteria for the assigned and next higher evaluations to the diagnostic code under which the disability is evaluated. In the case of hearing loss or visual impairment, a general statement such as “higher evaluations are assigned for greater loss of hearing (or vision)” will be sufficient.

(1) If service connection is granted, do not relate all the details of treatment in service. A simple statement that the enlistment exam was negative and that beginning on a particular date prior to separation the veteran was treated for whatever condition was diagnosed is usually sufficient. The next entry in the paragraph should be the findings from the current exam or a citation of whatever evidence is necessary to establish chronicity and continuity. If the cause of several claimed disabilities is the same, such as one accident, information concerning the origin need only be discussed in detail once in the reasons and bases paragraph for the first disability of common origin.

(2) When granting service connection, extensive discussion of post service treatment is only necessary if essential to the evaluation.

(3) Cite evidence, both favorable and unfavorable, without partiality, especially when a decreased benefit is under consideration. Compare relevant findings at the time of previous rating with present findings.

3-II-4

September 23, 2004 M21-1, Part VI

Change 118

d. Medical Conclusions. Cite medical information and reasoning linking or separating two disabilities or establishing or refuting prior inception or aggravation. Medical conclusions must be supported by evidence in the claims file. Rating Veteran Service Representatives (RVSRs) cannot refute medical evidence submitted by the claimant with their own medical opinions. Rating decisions can cite recognized medical treatises or an independent medical opinion to support a conclusion. Such authority, when relied upon, must be identified in the decision.

SOURCE: http://www.warms.vba.va.gov/Admin21/M21_1/PART6/CH03.DOC

********************************************************************

M21-1, Part VI Veterans Benefits Administration

Change 125 Department of Veterans Affairs

April 19, 2005 Washington, DC 20420

Paragraph 7.24l is updated to change the phrase “Reasons and Bases” to “Reasons for Decision” and the term “rating specialist” to “rating veterans service representative (RVSR).”

SOURCE: http://www.warms.vba.va.gov/Admin21/M21_1/PART6/TRANS.DOC

[Ricky]

Thanks allan. See the difference. No where does the new wording provide specific details when it comes to the denial of a claim. Guess its just another way to get around the law. I like the wording in the original one better as it would have helped me to argue a point during my upcoming DRO hearing.