Section B. Revision of Decisions



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Section B. Revision of Decisions

Overview




In This Section

This section contains the following topics




Topic

Topic Name

1

Finality of Decisions

2

Considering Additional Service Records

3

Reopening a Previously Denied Claim Based on New and Material Evidence

4

Clear and Unmistakable Error (CUE)

5

Jurisdiction When There Has Been a Board of Veterans’ Appeals (BVA) Decision


1. Finality of Decisions




Introduction

This topic contains general information on revising prior determinations, including
final and binding determinations

significance of final and binding determinations

finally adjudicated claims

final and binding but not finally adjudicated claims, and

requests for an earlier effective date.




Change Date

June 25, 2015



a. Final and Binding Determinations

Under 38 CFR 3.104 a decision of a duly constituted rating agency or other agency of original jurisdiction is final and binding on all field offices of the Department of Veterans Affairs (VA) as to the conclusions made based on the evidence on file at the time VA issues written notification in accordance with 38 U.S.C. 5104.



b. Significance of Final and Binding Determinations

Final and binding means, for the purpose of regional office (RO) adjudication, that RO employees may not revise the conclusion of a decision on the same factual basis.
Exceptions: A decision may be amended on the same factual basis by RO employees as follows

upon de novo review of a timely notice of disagreement (NOD) as provided by 38 CFR 3.2600

when there is difference of opinion authority when permitted by 38 CFR 3.105(b), or

when there is clear and unmistakable error (CUE) as provided by 38 CFR 3.105(a).





c. Finally Adjudicated Claims

A finally adjudicated claim is defined in 38 CFR 3.160(d). It refers to the status of an award or denial of benefits when either
the appeal period has expired without an appeal being initiated, or

an appeal is initiated and denied on appellate review.





d. Final and Binding but not Finally Adjudicated Claims

A claim that has not been finally adjudicated (which includes claims where a final and binding decision has been issued but the appeal period has not expired) is still considered a pending claim under 38 CFR 3.160(c).
For more information on reconsideration and new and material evidence in the appeal period, see M21-1, Part III, Subpart iv, 2.B.3.a.



e. Requests for an Earlier Effective Date

In Rudd v. Nicholson, 20 Vet. App. 296 (2006), the U.S. Court of Appeals for Veterans Claims (CAVC) held that VA has no authority to adjudicate a “freestanding” request for an earlier effective date in an attempt to overcome the finality of an unappealed RO decision.
Although VA cannot consider a request for an earlier effective date on a final RO decision, the claimant may allege CUE with respect to the assignment of the effective date in that prior final RO decision. In order for the CUE claim to be considered valid, the claimant must specify the factual or legal errors at issue.
Example: A claimant’s statement that “my effective date is wrong, or “I want an earlier effective date” does not sufficiently specify the factual or legal error at issue.
References: For more information on

revising decisions based on CUE, see

38 CFR 3.105(a), and

M21-1, Part III, Subpart iv, 2.B.4

responding to requests for an earlier effective date, see M21-1, Part I, 1.B.1.g, and

prescribed forms for a specific benefit, see M21-1, Part III, Subpart ii, 2.B.




2. Considering Additional Service Records





Introduction

This topic contains general information on considering additional service records after VA issues a decision on a claim including


  • reconsidering additional service records

  • service records that warrant reconsideration under 38 CFR 3.156(c)(1)

  • service records that do not justify reconsideration under 38 CFR 3.156(c)(1)

  • effective dates under 38 CFR 3.156(c)(1), and

  • procedures for rating activity review.



Change Date

June 25, 2015




a. Reconsidering Additional Service Records

If VA receives or associates with the claims folder additional qualifying service records that existed and had not been associated with the claims folder when VA first decided a claim, VA will reconsider the claim under the provisions of 38 CFR 3.156(c). See M21-1, Part III, Subpart iv, 2.B.2.b for what is considered “qualifying service records.”
Important: The qualifying service records discussed under this Topic are not to be analyzed under 38 CFR 3.156(a) or 38 CFR 3.156(b).
Reference: For more information on the effective date rule that applies when records received under 38 CFR 3.156(c)(1) result in favorable reconsideration, see M21-1, Part III, Subpart iv, 2.B.2.d.




b. Service Records That Warrant Reconsideration under 38 CFR 3.156(c)(1)

Qualifying service records for the purpose of 38 CFR 3.156(c)(1) are any service records forwarded to VA from the Department of Defense (DoD) or service departments, including


  • records related to a claimed in-service event, injury, or disease, regardless of whether such records mention the Veteran by name, and

  • declassified records that could not have been obtained because they were classified when VA decided the claim.


Exception: Records identified in M21-1, Part III, Subpart iv, 2.B.2.c are not qualifying records for the purpose of 38 CFR 3.156(c)(1).



c. Service Records That Do Not Justify Reconsideration under 38 CFR 3.156(c)(1)

The receipt of service records in the following two scenarios will not trigger reconsideration under the provisions of 38 CFR 3.156(c)(1)
the service records did not exist when VA decided the claim, or

the claimant failed to provide sufficient information to enable VA to identify and obtain the service records (for example, the claimant failed to provide stressor information that would have allowed VA to contact the Joint Services Records Research Center).


Explanation: In the first category above, the evidence did not exist to support entitlement when VA decided the prior claim. In the second category, VA would have fulfilled its duty to assist in attempting to procure such records at the time of the prior claim if it had the information necessary to submit the request.
Important: Receipt of service records that do not warrant application of 38 CFR 3.156(c)(1) will still trigger review under 3.156(a) and/or (b), as applicable.




d. Effective Dates Under 38 CFR 3.156(c)(1)

An award made based on the receipt of additional qualifying service records under 38 CFR 3.156(c)(1) is effective on the date entitlement arose or the date VA received the previously decided claim, whichever is later. Any other effective date provision applicable to the previous claim shall also be considered. See 38 CFR 3.156(c)(3).
Important: In Blubaugh v. McDonald, 773 F. 3d 1310 (Fed. Cir. 2014), the court held that VA, under the provisions of 38 CFR 3.156(c)(1), must consider an earlier effective date only if VA awards benefits resulting from reconsideration of the merits of the claim. This applies “when VA receives official service department records that were unavailable at the time that VA previously decided a claim for benefits and those records lead VA to award a benefit that was not awarded in the previous decision.”
Example: VA denied service connection (SC) as “not incurred in service” for low back strain for a claim received on December 5, 1999. Although medical evidence at that time revealed the existence of “lumbosacral strain,” service treatment records (STRs) did not reveal treatment in service. On March 3, 2003, VA received additional STRs not part of the claims folder at the time of the original decision and that revealed treatment in service for a low back injury. Assuming that a current disability and link to service exists, VA may establish SC for the low back condition effective December 5, 1999.
As noted in 38 CFR 3.156(c)(4), any retroactive disability evaluation assigned based on the receipt of additional service records must be supported adequately by medical evidence.
References: For additional information on

  • effective dates for claims based on receipt of additional service records, see Stowers v. Shinseki, 26 Vet.App. 550, 554 (2014), and

  • effective dates and reconsidering the merits of claims based on additional service records, see Mayhue v. Shinseki, 24 Vet. App. 273 (2011).




e. Procedures for Rating Activity Review

All additional non-duplicate service records received at any time after VA makes a decision on a claim shall be forwarded to the rating activity for review. See the table below for actions to take when reviewing the additional service records.




If service records...

Then the rating activity must ...

do not require reconsideration of the merits of a previous claim

  • see Example 1 below

indicate “no action necessary” on VA Form 21-6789, Deferred Rating Decision. End product (EP) 699 will be cleared.

require reconsideration of the merits of a previously claimed issue(s)

  • See Example 2 below




complete a formal rating decision under EP 020 and include all pertinent issues that warrant reconsideration.

contain a chronic unclaimed condition

refer the claim to authorization to solicit a claim. See M21-1, Part IV, Subpart ii, 2.A.1.f.




Examples:

#1: Military dental records are received five years after a previous rating decision awarded SC for hypertension, low back strain, and hearing loss. No formal rating is required.

#2: Additional STRs received indicate treatment from a private doctor while the Veteran was on leave during active duty. Several issues were previously denied SC in two separate rating decisions. All of these issues must now be reconsidered in a formal rating decision.





3. Reopening a Previously Denied Claim Based on New and Material Evidence




Introduction

This topic contains information on reopening a previously denied claim based on new and material evidence, including
making a new decision after a claim has been finally denied

making a new decision before a claim is considered finally adjudicated

section 5103 requirements

definition of new and material evidence

cumulative evidence

requirement for reopening a claim

examples of evidence not sufficient to reopen a previously denied claim

benefit of the doubt under 38 USC 5107(b)

presuming the evidence to be credible

handling cases in which VA has requested new and material evidence

appealing a new and material evidence determination, and

effective date for revisions based on new and material evidence, and

effective date for revisions based on new and material evidence within the appeal period.




Change Date

June 25, 2015



a. Making a New Decision After a Claim Has Been Finally Denied

Under the provisions of 38 CFR 3.156(a), once a claim has been finally denied, and therefore is considered a finally adjudicated claim under 38 CFR 3.160(d), it cannot be reopened unless new and material evidence is received.
Important: The principles of reopening a claim under 38 CFR 3.156(a) do not apply when making a new decision on a claim that is final and binding, but not finally adjudicated (that is, within the one-year appeal period). In such cases, the claim must be reconsidered. See M21-1, Part III, Subpart iv, 2.B.3.b for details on reviewing evidence on claims for reconsideration.
References: For more information on

  • new and material evidence, see

M21-1 Part III, Subpart iii, 1.B.6.

38 U.S.C. 5108, and



Shade v. Shinseki, 24 Vet. App. 110 (2010), and

Manio v. Derwinski, 1 Vet. App. 140 (1991)

  • the definition of a “reopened claim,” see M21-1 Part III, Subpart ii, 2.E.1.b, and

  • finality, see M21-1, Part III, Subpart iv, 2.B.1.




b. Making a New Decision Before a Claim Is Considered Finally Adjudicated

Evidence received after a decision and prior to the expiration of the appeal period, or prior to the appellate decision if a timely appeal has been filed, must be analyzed to determine if it is new and material. See 38 CFR 3.156(b) for more information on how such evidence will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period.
Important: The purpose of the review for new and material evidence under this Topic is not to determine if the claim can be reopened (since the claim is not yet final). Therefore, it is not necessary to include the standard new and material language in the rating narrative.
In Beraud v. McDonald, 766 F.3d 1402 (Fed. Cir. 2014), the court held that VA, under 38 CFR 3.156(b), must directly respond to a new submission of evidence received prior to the expiration of the one-year appeal period, and that, until it does, the claim remains open. Therefore to comply with the court’s decision, ROs must continue to


  • respond directly to any and all evidence submitted during the appeal period or before disposition of appellate decision (reconsideration), and

  • evaluate such evidence on its merits and complete a formal decision that addresses the new evidence.







c. Section 5103 Requirements

There is no need to provide a case-specific Section 5103 notice to the claimant when he/she is attempting to reopen a previously denied claim as the prior decision denying the claim will have included a written statement of the specific reasons for the denial and evidence considered.
Reference: For more information on Section 5103 requirements when a claimant attempts to reopen a previously denied claim, see

  • VAOGCPREC 6-2014, and

  • M21-1 Part III, Subpart ii, 2.E.2.c



d. Definition: New and Material Evidence

Evidence is new if it has not previously been considered.
Evidence is material if, by itself, or when considered with previous evidence of record, it relates to any unestablished fact necessary to substantiate the claim.
New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial, and must raise a reasonable possibility of substantiating the claim.
Important: In Shade v. Shinseki, 24 Vet. App. 110 (2010), the court held that the phrase, “must raise a reasonable possibility of substantiating the claim,” does not create a third element for new and material evidence. Instead, it provides guidance in determining whether submitted evidence meets the new and material requirements. The case further held that when SC was previously denied because multiple facts necessary to substantiate the claim were not established, new and material evidence relating to only one of these facts is sufficient to raise a reasonable possibility of substantiating the claim.
Examples of new and material evidence include


  • written and sworn testimony of the claimant or witnesses to an event

  • lay statements from a family member or friend, and

  • a medical nexus opinion with supporting rationale.


Note: To substantiate a previously denied claim does not necessarily mean to prove a claim, but the evidence supports a claim or provides substance to a claim.
References: For more information on new and material evidence, see

  • M21-1, Part III, Subpart iii, 1.B.6

  • VAOPGCPREC 6-2014

  • Cuevas v. Principi, 3 Vet. App. 542 (1992)

  • Barnett v. Brown, 8 Vet. App. 542 (1995), and

  • Bostain v. West, 11 Vet. App. 124 (1998).



e. Cumulative Evidence

Evidence that is merely cumulative is not to be considered new evidence.
Cumulative evidence reinforces a previously proven or conceded element of the claim, or merely rehashes previously submitted statements.
Important: Corroborating witness statements and supplemental medical nexus opinions are neither cumulative nor redundant if they address an element of the claim that has not already been proven or conceded.


f. Requirement for Reopening a Claim

A previous, finally denied claim is considered reopened only when the evidence submitted is both new and material, as described in M21-1, Part III, Subpart iv, 2.B.3.d.
38 CFR 3.156 must be read as creating a low threshold for reopening claims.
Evidence considered as sufficient to reopen a previously denied claim includes any competent medical or lay evidence that was not considered in the prior

claim and that now relates to (not necessarily proves) one or more of the

unestablished facts from the previous denial.
Examples of New and Material Evidence:

After VA denies SC due to “no nexus,” the Veteran submits a new opinion from a specialist.

After VA denies SC because “disability does not exist,” the Veteran submits a medical report showing the existence of the disability.

After VA denies SC for back injury as “not incurred in service,” the Veteran submits a buddy statement for the first time from a friend who witnessed the Veteran injure his back in service.


Important: On or after March 24, 2015, a request to reopen a claim based on new and material evidence must be received on a prescribed form.
Reference: See M21-1, Part III, Subpart ii, 2.D.2.b for form requirements for claims to reopen.



g. Examples of Evidence Not Sufficient to Reopen a Previously Denied Claim

The following are examples of evidence not considered new and material and therefore, not sufficient to reopen a denied claim
a record photocopied from the claims folder that was considered in the previously denied claim.

a new medical nexus opinion incorporating an inaccurate history. See Reonal v. Brown, 5 Vet. App. 458 (1993)for more information.

written testimony from an eyewitness that is substantially identical to a statement already on file.

a layperson’s assertion about the cause (but not the onset) of a disability, or

medical evidence that reveals the existence of a disability when previous evidence already revealed that the disability existed.





h. Benefit of the Doubt Under 38 USC 5107(b)

The benefit of the doubt under 38 USC 5107(b) cannot take the place of the standard for reopening claims. The standard for reopening claims, as stated in 38 U.S.C. 5103A(f), requires only that new and material evidence be presented or secured. The weight of the evidence is not considered.
Reference: For more information on the benefit-of-the-doubt rule, see Martinez v. Brown, 6 Vet. App. 462 (1994).




i. Presuming the Evidence to be Credible

When determining whether new and material evidence has been submitted to justify reopening a claim, presume the new evidence to be credible.
Note: Once a claim has been reopened, the presumption of the credibility of the evidence no longer applies, and the evidence must be weighed.
Reference: For more information on credible evidence, see

Justus v. Principi, 3 Vet. App. 510 (1992).



j. Handling Cases in Which VA Has Requested New and Material Evidence

The table below shows how to handle cases in which VA has requested new and material evidence.





If …

Then …

the evidence submitted is new and material

the development and/or rating activity will
reopen the claim,

complete any necessary development including a VA exam, and

reconsider the claim on its merits based on all previously existing and newly submitted evidence.


the evidence submitted is new, but not material

the rating activity will prepare a rating decision that
confirms the previous decision, and

indicates that the claim is not considered to have been successfully reopened.


Important: The rating decision must explain the reason for the continued denial and why the submitted evidence is considered to be new, but not material.

the evidence submitted is not new, because it is clearly duplicate

the authorization activity will
deny the claim administratively without a rating decision, and

advise the claimant why the claim is not considered to have been successfully reopened.



no evidence has been submitted in response to the request for new and material evidence

the authorization activity will
deny the claim administratively, and

advise the claimant why the claim is not considered to have been successfully reopened.






k. Appealing a New and Material Evidence Determination

A claimant may appeal a determination that evidence is not new and material.

Limit the statement of the case (SOC) to that issue, citing all of the following in the summary of evidence and adjudicative actions

the date of the

original denial

notification of that denial

receipt of the evidence submitted to reopen the claim

finding that the evidence was not considered to be new and material

notification of that decision, and

the evidence submitted.





l. Effective Date for Reopened Claims Based on New and Material Evidence

A claim that is reopened based on new and material evidence and awarded is generally effective the date of receipt of claim or the date entitlement arose, whichever is later. See 38 CFR 3.400(r) for more information.
Example:

VA issues a rating decision on March 1, 2010 denying SC for hypertension because there was no evidence of a current disability. On July 3, 2014, the Veteran submits new and material evidence that revealed the existence of hypertension as of June 2014. In this case, SC is awarded and the effective date, pursuant to 38 CFR 3.400(r), is established as of the date of the receipt of the reopened claim, which is July 3, 2014.d



Important: If there was an intent to file associated with a reopened claim, the effective date may be the date the intent to file was submitted per 38 CFR 3.155(b).



m. Effective Date for Revisions Based on New and Material Evidence Within the Appeal Period

When new and material evidence other than service department records is received within the appeal period or prior to an appellate decision, as provided by 38 CFR 3.156(b), and the pending claim is reconsidered and SC awarded, the effective date will be as though the former decision had not been rendered. See 38 CFR 3.400(q) and M21-1, Part III, Subpart iv, 2.B.3.a for more information.
Example 1:

VA issues a rating decision on March 1, 2010 denying SC for a claim for hypertension, which was received on December 2, 2009. On May 5, 2010, the Veteran submits new and material evidence, which results in VA awarding SC for hypertension. Because the claim is still open, (i.e., “pending” in accordance with 38 CFR 3.156(b)), the evidence is considered as having been filed with the prior pending claim and, thus, an earlier effective date of December 2, 2009 is warranted based on the provisions of 38 CFR 3.400(q).


Example 2:

VA issues a rating decision on March 1, 2010 denying SC for hypertension. On May 5, 2010, the Veteran requests a reconsideration and submits evidence for the hypertension issue that is not considered new and material evidence. In this case, VA issues a decision on its merits that continues the denial of SC for hypertension.




4. CUE




Introduction

This topic contains information on CUEs, including
definition: CUE

provisions of 38 CFR 3.105(a)

identifying a CUE

considering requests for revision based on CUE

determining a case of CUE

applying the benefit of the doubt under 38 USC 5107(b)

approval of ratings prepared under 38 CFR 3.105(a), and

preparing a CUE decision.





Change Date

June 25, 2015



a. Definition: CUE

The court, in Russell v Principi, 3 Vet. App. 310 (1992), held that a clear and unmistakable error (CUE) exists if all three of the following requirements are met
either the correct facts, as they were known at the time, were not before the adjudicator, (e.g., the adjudicator overlooked them) or the statutory or regulatory provisions extant at the time were incorrectly applied,

the error must be the sort which, had it not been made, would have manifestly changed the outcome at the time it was made, and

the determination must be based on the record and the law that existed at the time of the prior adjudication in question.
CUEs are undebatable, so that it can be said that reasonable minds could only conclude that the original decision was fatally flawed at the time it was made.
References: For more information on the definition of CUE, see


  • 38 CFR 3.105(a)

  • Grover v. West, 12 Vet. App. 199 (1999)

  • Wilsey v Peake, 535 F.3d 1368 (Fed. Cir. 2008)



b. Provisions of 38 CFR 3.105(a)

38 CFR 3.105(a) provides that if a CUE is established in a previous, final and binding decision, then the
previous decision is reversed or amended, and

the effect is the same as if the corrected decision had been made on the date of the reversed decision.


Exceptions:

protection of evaluation in effect for 20 years or more under 38 CFR 3.951(b), and

protection of SC in effect for 10 years or more under 38 CFR 3.957.


References: For more information on

revision based on CUE, see 38 U.S.C. 5109(a)

severance and its relationship to CUE, see M21-1 Part III, Subpart iv, 8.E.2

adverse action resulting from CUE or severance of SC, see M21-1 Part IV, Subpart ii, 3.A.2

reductions in disability evaluations and CUE see M21-1 Part IV, Subpart ii, 3.A.3

the effective date of an allowance based on CUE, see 38 CFR 3.400(k)

protection of disability evaluations under 38 CFR 3.951(b), see M21-1, Part III, Subpart iv, 8.C.1, and

protection of SC under 38 CFR 3.957, see M21-1, Part III, Subpart iv, 8.C.2.




c. Identifying a CUE

A CUE will fall into one or more of the following categories
the decision maker failed to apply or incorrectly applied the appropriate laws or regulations. (Note: These legal errors commonly involve pre-reduction due process or the failure to apply a statutory or regulatory presumption)

the decision maker overlooked material facts of record, or

the decision maker failed to follow a procedural directive that involved a substantive rule (a rule that regulates a right).
Important: A duty to assist deficiency such as an insufficient examination cannot form a basis for CUE since such deficiency creates only an incomplete rather than an incorrect record. See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012) and Caffrey v. Brown, 6 Vet.App.377, 384 (1994).
Exception: A failure to consider VA medical records, which were in VA’s constructive possession at the time of the prior decision, may constitute a CUE, if such failure affected the outcome of the claim. See VAOPGCPREC 12-95.
References: For more information on

checking CAPRI even if the claimant does not indicate treatment at a VA medical center, see M21-1, Part III, Subpart iii, 1.C.4.a

potential errors in following procedures, see

Allin v. Brown, 6 Vet. App. 207 (1994)


  • Cook v. Principi, 258 F. 3d 1311 (Fed. Cir. 2001), and

CUEs based on VA’s failure in duty to assist, see

  • Tetro v. Principi, 314 F.3d 1310 (Fed. Cir. 2003)

  • Cook v. Principi, 258 F. 3d 1311 (Fed. Cir. 2001).



d. ConsideringRequests for Revision Based on CUE

Determine the precise nature of the allegation when a claimant requests revision based on CUE. ROs shall deny requests for CUE if the claimants do not specify the factual or legal errors at issue.
In a valid claim of CUE, the claimant must assert more than a disagreement as to how the facts were weighed or evaluated. There must have been an error in the prior adjudication of the claim. See Russell v Principi, 3 Vet. App. 310 (1992).
A claimant is not entitled to request CUE again once there has been a final decision denying CUE on the same basis.
If the CUE alleged is different from a CUE issue previously rejected, use a rating to determine whether or not a CUE was made on the new issue.
Important: If a CUE finding has been determined, it may affect subsequent rating decisions to the extent that revisions in the subsequent rating decisions may be required. See Pirkl v. Shinseki, 718 F. 3d 1379 (Fed. Cir. 2013).



e. Determining a Case of CUE

When determining whether there is a CUE
consider only

the law that existed at the time of the prior decision, and

the full record that was before the rating activity at the time of the prior decision (to include medical records in VA’s constructive possession), and

determine whether the error would have by necessity changed the original rating decision.


Notes:

Errors that would not have changed the outcome are harmless and the previous decisions do not need to be revised.

A new medical diagnosis (not erroneous diagnosis that warrants severance) that corrects an earlier diagnosis ruled in a previous rating would not be considered an error in the previous adjudication of the claim.
Important: Although CUEs are based on the record that existed at the time of the prior adjudication in question, a CUE finding that SC was predicated on a clearly erroneous diagnosis may be based on evidence that accumulated after the original decision to award SC. In such cases, if severance of SC is warranted, follow the provisions of 38 CFR 3.105(d). See Stallworth v. Nicholson, 20 Vet.App. 482,488 (2006) and Daniels v. Gober, 10 Vet.App. 474 (1997).
References: For more information on


  • CUEs based on VA’s constructive notice of medical records, see VAOPGCPREC 12-95, and

  • correcting errors in a rating decision, see M21-1, Part III, Subpart iv, 7.B.3.



f. Applying the Benefit of the Doubt Under 38 USC 5107(b)

The benefit of the doubt under 38 U.S.C. 5107(b) is not applicable to a CUE determination since
an error either undebatably exists, or

there was no error within the meaning of 38 CFR 3.105(a).


Reference: For more information on applying the benefit of the doubt under 38 USC 5107(b), see Russell v. Principi, 3 Vet. App. 310 (1992).



g. Approval of Ratings Prepared Under 38 CFR 3.105(a)

All rating decisions preparedunder 38 CFR 3.105(a) require the approval of the Veterans Service Center Manager (VSCM) or Pension Management Center Manager (PMCM), or designee at the Coach level or higher.
Ratings prepared by Decision Review Officers (DROs) require the approval of the VSCM, PMCM, or Assistant VSCM or PMCM if they address

severance of SC, or

a reduction in evaluation of an SC disability(ies).
Exception: Approval of the VSCM, PMCM, or designee is not necessary if the rating decision is the result of a BVA or CAVC decision.




h. Preparing a CUE Decision

Use the table below to prepare a CUE decision




If…

And…

Then…

a DRO


  • finds a CUE on a prior decision

  • prepares a draft decision that proposes on the basis of the CUE to

  • reduce an SC evaluation, or

  • sever SC for a disability

the VSCM or PMCM agrees

a DRO


  • finds a CUE on a prior decision

  • prepares a draft decision that proposes on the basis of a CUE to

  • reduce an SC evaluation, or

  • sever SC for a disability

the VSCM or PMCM does not agree

the VSCM or PMCM documents his/her disagreement on VA Form 21-0961, Rating Decision/Administrative Decision/Formal Finding/Statement of the Case (SOC)/Supplemental Statement of the Case (SSOC) (Electronic Signatures), and

  • the DRO must revise the decision to remove the proposed CUE and confirm the existing decision.

a DRO
finds a CUE on a prior decision, and

writes up an allowance on the basis of a CUE



---

  • the DRO signs the decision.

a Rating Veterans Service Representative (RVSR)
believes there is a CUE, and

prepares a draft decision



the VSCM or PMCM agrees

  • the RVSR finalizes and signs the decision,

  • the VSCM or PMCM signs the decision.

an RVSR
believes there is a CUE, and

prepares a draft decision



the VSCM or PMCM disagrees

  • the VSCM or PMCM documents his/her disagreement on VA Form 21-0961, and

  • the RVSR removes the proposed CUE and confirms the existing decision.




Important:

If the CUE involves a rating issue, the DRO or RVSR must include a certificate of error on the Codesheet.

The final decision reducing the evaluation or severing SC does not require the signature and approval of the VSCM, PMCM, Assistant VSCM or PMCM unless new evidence has been received since the proposed decision was approved.

In all cases where a decision is revised through CUE authority, a copy of the revised decision should be provided to the person who prepared the original decision (or his/her supervisor) as a training tool.





5. Jurisdiction When There Has Been a BVA Decision




Introduction

This topic contains information on determining jurisdiction for BVA determinations, including
determining jurisdiction for review of a CUE allegation, and

finality of BVA decisions.





Change Date

June 25, 2015



a. Determining Jurisdiction for Review of a CUE Allegation

Whether a decision was appealed to BVA or not determines the jurisdiction for review of a CUE allegation, either in fact or in substance.
Use the table below to determine
who has jurisdiction to review an allegation for a CUE determination, and

how to notify the claimant.






If …

Then the RO …

And the Veterans Service Representative (VSR) or RVSR …

a decision has been affirmed by BVA

does not have jurisdiction to review the claim for a CUE determination
Rationale: The RO does not have jurisdiction to consider a claim of CUE in a decision that has been subsumed by a BVA decision.

notifies the claimant
that the RO does not have jurisdiction to review the claim for a CUE determination

of his/her appellate rights, and

that he/she should file a motion for reconsideration by BVA, if a review at that level is desired.


the decision was not appealed, but

a later reopened claim was followed by a BVA affirmance



does not have jurisdiction to review the claim for a CUE determination
Rationale: The General Counsel has concluded that the RO does not have jurisdiction to consider a CUE claim where BVA has

reviewed the entire record of the claim following reopening, and

denied the benefits previously denied in the unappealed decision.


notifies the claimant
that the RO does not have jurisdiction to review the claim for a CUE determination

of his/her appellate rights, and

that he/she should file a motion for reconsideration by BVA, if a review at that level is desired.
Note: All SOCs for appeals in which the issue on appeal involves a prior unappealed RO decision, followed by a claim to reopen the claim that was decided by BVA, should contain a citation to VAOPGCPREC 14-95.


the decision was not appealed, and

a subsequent BVA decision merely

concludes that new and material evidence sufficient to reopen a prior unappealed RO decision has not been submitted, and

denies reopening



does have jurisdiction to review the claim for a CUE determination
Rationale: The BVA decision does not bar a claim of CUE in the prior unappealed RO decision. The General Counsel has concluded that when BVA determines that evidence sufficient to reopen has not been submitted, it does not decide the merits of the issues raised in the claim.

reviews the unappealed decision for CUE.

the allegation of CUE involves an issue that has not been affirmed by a BVA decision

does have jurisdiction to review the claim for a CUE determination

reviews the unappealed decision for CUE.



b. Finality of BVA Decisions

Unless overruled by the CAVC, BVA decisions are final and binding on the Veterans Benefits Administration decision makers, but only with regard to the specific case decided.
Appellants disagreeing with BVA’s decision on his/her appeal may file
an appeal with CAVC,

a motion asserting CUE with BVA, or

a motion for reconsideration with BVA.
Notes:

In the absence of new and material evidence, ROs do not have the authority to award a benefit denied by a BVA decision.



A motion for reconsideration of a BVA decision is not a claim; therefore, the motion does not need to be submitted to BVA on a prescribed form.
References: For more information on

  • BVA decisions, see M21-1, Part I, 5.G.1

  • the non-precedential value of BVA decisions, see 38 CFR 20.1303

  • what to do with a communication from the appellant or his/her representative that disagrees with a BVA decision, see M21-1, Part I, 5.G.1

  • requesting a motion of reconsideration, see 38 CFR 20.1001.





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