Section A - Developing Compensation Claims - Updated 9/22/14

Subpart II - Compensation
Chapter 1 - Development

Overview


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In this Section
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1.   General Information on Developing Compensation Claims
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Introduction
This topic contains general information on developing compensation claims, including
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 ·      when to develop for the status of the Veteran’s dependents

 ·      reviewing the claims folder

 ·      when to submit evidence justifying a partial grant to the rating activity

 ·      submitting requests for service records, and

<span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      handling other requests for information. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">September 5, 2008 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   When to Develop for the Status of the Veteran’s Dependents
<p class="MsoBlockText">Since the number or status of the Veteran’s dependents is not a factor in determining entitlement to compensation, do not develop for this information until a rating is received showing a combined evaluation of 30 percent or more.
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<p class="MsoBlockText">

<p class="MsoBlockText">Exception:   Undertake simultaneous development when it is apparent that the Veteran’s service-connected (SC) disability will warrant at least a 30 percent evaluation, such as in the case of a Veteran who has lost both legs in service.

<p class="MsoBlockText">

<p class="MsoBlockText">References:   For more information on developing for relationship and dependent status, see

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      M21-1MR, Part III, Subpart iii, 5

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      M21-1MR, Part III, Subpart iii, 6, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      M21-1MR, Part III, Subpart iii, 7. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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b.   Reviewing the Claims Folder
<p class="MsoBlockText">Review the claim to identify the alleged disabilities and any dental conditions, as well as the dates and places of examination or treatment.
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<p class="MsoBlockText">

<p class="MsoBlockText">Review the service treatment or dental records in the claims folder to find records supporting the claimed disabilities. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 1. General Information on Developing Compensation Claims, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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c.   When to Submit Evidence Justifying a Partial Grant to the Rating Activity
<p class="MsoBlockText">After initiating development, send the claims folder to the rating activity if a partial grant of any claim may be awarded based on the evidence already of record.
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<p class="MsoBlockText">

<p class="MsoBlockText">References:   For information on

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      prestabilization ratings under 38 CFR 4.28, see M21-1MR, Part IV, Subpart ii, 2.J.59, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      hospitalization ratings under 38 CFR 4.29, see M21-1MR, Part IV, Subpart ii, 2.J.60. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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d.   Submitting Requests for Service Records
<p class="MsoBlockText">For more information on developing for service records, see M21-1MR, Part III, Subpart iii, 2.
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e.   Handling Other Requests for Information
<p class="MsoBlockText">For information on requesting records from
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Social Security Administration, see M21-1MR, Part III, Subpart iii, 3.A, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      other Federal and State agencies, see M21-1MR, Part III, Subpart iii, 4. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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2.   Other Issues to Consider When Developing Compensation Claims
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Introduction
<p class="MsoBlockText">This topic contains information on other issues to consider when developing compensation claims, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-bidi-font-style:italic"> ·      establishing entitlement based on an original VA Form 21-526, Veteran’s Application for Compensation and/or Pension    

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      action to take when a Veteran’s SC disabilities are evaluated at 30 percent or more disabling

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      handling claims for dental treatment

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      developing for continuity of symptoms

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the definition of acute disability, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      handling claims for acute disabilities. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">September 22, 2014 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Establishing Entitlement Based on an Original VA Form 21-526
<p class="MsoBlockText">If an original VA Form 21-526, Veteran’s Application for Compensation and/or Pension, is processed as a claim for one type of benefit, compensation or pension, and a claim for the other type of benefit is received within one year of the original VA Form 21-526, the effective date of entitlement is the earliest date allowable under the original claim or the date entitlement arose, whichever is later.
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<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on processing original disability claims, see

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 CFR 3.151, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      M21-1MR, Part III, Subpart ii, 2.B.6. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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b.   Action to Take When a Veteran’s SC Disabilities Are Rated 30 Percent or More Disabling
<p class="MsoBlockText">When a Veteran’s SC disabilities are rated 30 percent or more disabling
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      include information concerning possible additional benefits for dependents in the award letter, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      do not establish or maintain an end product (EP) 130 control until the claim for dependents is received.

<p class="MsoBlockText">

<p class="MsoBlockText">References:   For information on

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      EP codes, see M21-4, Appendix C, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Aid and Attendance qualification for spouses of Veterans, see M21-1MR, Part V, Subpart iii, 2.A.1.e. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 2. Other Issues to Consider When Developing Compensation Claims, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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c.   Handling Claims for Dental Treatment
<p class="MsoBlockText">References:   For more information on claims for dental treatment, see
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<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      M21-1MR, Part III, Subpart v, 7, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      M21-1MR, Part IX.ii.2.2. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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d.   Developing for Continuity of Symptoms
<p class="MsoBlockText">Request evidence of continuity of symptoms for each disability claimed when developing claims for direct service connection.
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<p class="MsoBlockText">

<p class="MsoBlockText">Note:   VA is only required to consider “continuity of symptomatology” as a distinct theory of service connection in cases involving a chronic disease identified in 38 CFR 3.309(a). However evidence of continuity may always be relevant to a nexus between a current disability and service.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on continuity of symptoms, see

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Walker v. Shinseki, 7098 F.3d 1311 (Fed.Cir. 2013).

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 CFR 3.303(b), and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      M21-1MR, Part IV, Subpart ii, 2.B. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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e.   Definition:   Acute Disability
<p class="MsoBlockText">An acute disability is a disease or injury that
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      has definite symptoms

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      is short in duration, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      results in a recovery without apparent residuals.

<p class="MsoBlockText">

<p class="MsoBlockText">Examples:   Acute disabilities include

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      nasopharyngitis or catarrhal fever (common cold)

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      pneumonia, or

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      a bruise. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 2. Other Issues to Consider When Developing Compensation Claims, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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f.   Handling Claims for Acute Disabilities
<p class="MsoBlockText">If a claim is substantially complete as described in M21-1MR, Part I, 1.B.3.a, take the following steps:
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      develop for evidence of continuity of symptoms and any other relevant medical records, including evidence showing the present existence of the disabilities claimed, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      refer the claim to the rating activity for a decision

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     as soon as the evidence is received, or

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     if the claimant or custodian of the requested evidence fails to respond within the prescribed time period.

<p class="MsoBlockText">

<p class="MsoBlockText">Important:   If the claim is denied, preparation of a formal rating decision and code sheet is required. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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3.   Developing Claims Filed Under 38 U.S.C. 1151
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Introduction
<p class="MsoBlockText">This topic contains information on developing claims filed under 38 U.S.C. 1151, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      requesting information from the medical facility

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      possible sources of information about the incident, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      quality assurance investigative reports. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">September 22, 2014 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Requesting Information From the Medical Facility
<p class="MsoBlockText">When requesting information from the medical facility, provide as much information as possible about the claimed incident.
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<p class="MsoBlockText">

<p class="MsoBlockText">The electronic VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action request functionality in the Compensation and Pension Record Interchange (CAPRI) supports text entry up to four pages and maintains tracking information regarding the status of requests.

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<p class="MsoBlockText">Use the 7131 Request tab in the patient record. Copy and paste the text from the Modern Award Process – Development (MAP-D) letter 1151 development to VAMC into the general comments area. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 3. Developing Claims Filed Under 38 U.S.C. 1151, Continued {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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b.   Possible Sources of Information About the Incident
<p class="MsoBlockText">Request all evidence and documents pertinent to the incident upon which the claim is based. Possible sources of information about the incident may include
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      medical records

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      surgical records

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      hospital clinical records, or

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      nurses’ notes. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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c.   Quality Assurance Investigative Reports
<p class="MsoBlockText">Do not request quality assurance investigative reports.
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<p class="MsoBlockText">

<p class="MsoBlockText">Quality assurance investigative reports are confidential under 38 U.S.C. 5705 and cannot be used as evidence in the adjudication of a claim.

<p class="MsoBlockText">

<p class="MsoBlockText">If quality assurance investigative reports are received from a VA medical facility, return the reports immediately. Do not file copies of these reports in the Veteran’s claims folder. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> <p class="MsoNormal">
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