December 16, 2011M21-1MR, Part IV, Subpart ii, Chapter 2, Table of Contents

Chapter 2. Rating

Table of Contents

Section A: Deciding Claims for Disability Compensation

Overview...... 2-A-1

1.Issues to Consider When Deciding Claims for Disability Compensation...... 2-A-2

2.(Empty – Reserved for Future Use)...... 2-A-9

Section B: Determining Service Connection

Overview...... 2-B-1

3.Determining Direct and Presumptive Service Connection...... 2-B-2

4.Determining Service Incurrence of an Injury...... 2-B-7

5.Determining In-Service Aggravation of Pre-Service Disability...... 2-B-10

6.Determining Secondary Service Connection, Including by Aggravation...... 2-B-12

  1. Determining Service Connection for Congenital, Developmental, or Hereditary

Disorders...... 2-B-15

Section C: Service Connection for Disabilities Resulting From Exposure to Environmental Hazards or Service in the Republic of Vietnam (RVN)

Overview...... 2-C-1

  1. Service Connection for Disabilities Resulting From Exposure to Ionizing

Radiation...... 2-C-2

9.Service Connection for Disabilities Resulting From Exposure to Asbestos...... 2-C-5

  1. Service Connection for Disabilities Resulting From Exposure to Herbicides

or Based on Service in the Republic of Vietnam (RVN)...... 2-C-10

  1. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure

to Herbicide Agents...... 2-C-33

12.Service Connection for Disabilities Resulting From Exposure to Other

Specific Environmental Hazards...... 2-C-41

Section D: Service Connection for Qualifying Disabilities Associated With Service in

Southwest Asia

Overview...... 2-D-1

13.General Information on Certain Disabilities Associated With Service in

Southwest Asia...... 2-D-2

14. Rating Claims for Service Connection for Qualifying Disabilities...... 2-D-11

15. General Information on Rating Decisions for Qualifying Disabilities ...... 2-D-16

16. Granting Service Connection for Qualifying Disabilities...... 2-D-20

17. Denying Service Connection for Qualifying Disabilities...... 2-D-26

Continued on next page

Table of Contents, Continued

Section E: Service Connection for Disabilities Incurred as a Prisoner of War (POW)

Overview...... 2-E-1

18.General Information on POW Rating Activities...... 2-E-2

19.Deciding Claims Involving Former POWs...... 2-E-4

20.Presumption of Service Connection Under 38 CFR 3.309(c)...... 2-E-8

  1. Considering Service Connection for Residuals of Frostbite, Peptic Ulcer Disease,

Peripheral Neuropathy, and Posttraumatic Arthritis...... 2-E-12

22.Preparing a Rating Decision Involving a Presumption of Service Connection....2-E-16

  1. History of Disabilities Subject to a Presumption of Service Connection Under

38 CFR 3.309(c)...... 2-E-20

Section F: Compensation Based on Individual Unemployability (IU)

Overview ...... 2-F-1

24.General Information on IU Claims...... 2-F-2

  1. Evaluating Evidence to Establish Entitlement to IU...... 2-F-3

26.Evaluating Evidence of Self-Employment or Employment With a Tightly

Held Corporation...... 2-F-8

27.Preparing a Rating Decision Addressing the Issue of IU...... 2-F-10

28.Special Considerations in IU Claims...... 2-F-16

29.Exhibit 1: Rating Decision Addressing Veteran’s Failure to Complete a Field

Examination...... 2-F-25

  1. Exhibit 2: Rating Decision Addressing Veteran’s Failure to Respond to a

Notice of Proposed Adverse Action After Failure to Complete a Field

Examination...... 2-F-26

31.Exhibit 3: Rating Decision Addressing the Subsequent Receipt of Evidence That

Restores IU After Failure to Complete a Field Examination...... 2-F-27

32.Exhibit 4: Poverty Threshold Information...... 2-F-29

Section G: Benefits Under 38 U.S.C. 1151

Overview...... 2-G-1

33.General Information on Entitlement to Benefits Under 38 U.S.C. 1151...... 2-G-2

34.Determining Entitlement to Benefits Under 38 U.S.C. 1151...... 2-G-9

  1. Preparing a Rating Decision Involving a Claim for Benefits Under

38 U.S.C. 1151...... 2-G-12

Continued on next page

Table of Contents, Continued

Section H: Special Monthly Compensation (SMC)

Overview...... 2-H-1

36.General Information on SMC...... 2-H-2

37.Combining Disabilities When Entitlement to SMC is at Issue...... 2-H-5

38.Hospital Adjustments Under 38 CFR 3.552...... 2-H-8

39.Entitlement to SMC Under 38 U.S.C. 1114(k)...... 2-H-10

  1. SMC for Blindness With Other Disabilities Affecting Hearing and the

Extremities...... 2-H-16

41.SMC for Additional 50- and 100-Percent Evaluations Under 38 CFR 3.50(f)(3)

and 38 CFR 3.350(f)(4)...... 2-H-24

42.Additional SMC for L/LOU of Three Extremities Under 38

CFR 3.350(f)(5)...... 2-H-28

43.Entitlement to Specially Adapted Housing Under 38 U.S.C. 2101 Based on the

L/LOU of Both Lower Extremities...... 2-H-31

44.Entitlement to SMC Based on the Need for Aid and Attendance (A&A)...... 2-H-32

45.Entitlement to a Higher A&A Allowance Under 38 U.S.C. 1114(r)(2)...... 2-H-37

46.Entitlement to Housebound Benefits...... 2-H-40

Section I: History of SMC

Overview...... 2-I-1

47.General Information on the History of SMC...... 2-I-2

48.SMC Under 38 U.S.C. 1114(k)...... 2-I-4

49.SMC Under 38 U.S.C. 1114(l)...... 2-I-7

50.SMC Under 38 U.S.C. 1114(m)...... 2-I-9

51.SMC Under 38 U.S.C. 1114(n)...... 2-I-11

52.SMC Under 38 U.S.C. 1114(o)...... 2-I-13

53.SMC Under 38 U.S.C. 1114(p)...... 2-I-15

54.SMC Under 38 U.S.C. 1114(q)...... 2-I-21

55.SMC Under 38 U.S.C. 1114(r)...... 2-I-22

56.SMC Under 38 U.S.C. 1114(s)...... 2-I-24

57.SMC Under 38 U.S.C. 1114(t)...... 2-I-25

58.Considering Maximum Allowable Rates Under 38 U.S.C. 1114(p)...... 2-I-26

Continued on next page

Table of Contents, Continued

Section J: Compensation Under 38 CFR 4.28, 38 CFR 4.29, and 38 CFR 4.30

Overview...... 2-J-1

59.Prestabilization Ratings Under 38 CFR 4.28...... 2-J-2

60.General Information on Hospitalization Ratings Under 38 CFR 4.29...... 2-J-6

61.Preparing the Rating Decision for Hospitalization Ratings Under 38 CFR 4.29..2-J-10

62.General Information on Convalescent Ratings Under 38 CFR 4.30...... 2-J-12

63.Preparing the Rating Decision for Convalescent Ratings Under 38 CFR 4.30....2-J-15

64.Diagnostic Codes (DC) That Provide for Periods of Convalescence...... 2-J-16

Section K: Other Compensation Considerations

Overview...... 2-K-1

65.Compensation for Paired Organs or Extremities...... 2-K-2

66.Disability or Death From Use of Alcohol...... 2-K-5

67.Disability or Death From Use of Drugs...... 2-K-9

68.Disability or Death From Use of Tobacco Products...... 2-K-11

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