EFFECTIVE DATES
COMPENSATION
Casey Matuszak
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MOPH NSO Basic Training March 2014 Orlando, FL
EFFECTIVE DATES
PURPOSE
 Understand the rules to insure correct
payment
– Review beginning dates
– Review ending dates

Use scenarios
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MOPH NSO Basic Training March 2014 Orlando, FL
EFFECTIVE DATES
DEFINITIONS – 38 CFR 3.160
 Original claim. An initial formal application on a form
prescribed by the Secretary.
 Pending claim. An application, formal, which has not
been finally adjudicated.
 Finally adjudicated claim. An application, formal or
informal, which has been allowed or disallowed by the
agency of original jurisdiction (AOJ), the action finalized
by the expiration of 1 year after the date of notice of an
award or disallowance, or by denial on appellate review,
whichever is the earlier.
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MOPH NSO Basic Training March 2014 Orlando, FL
EFFECTIVE DATES
DEFINITIONS– 38 CFR 3.160

Reopened claim. Any application for a benefit
received after final disallowance of an earlier
claim,

Claim for increase. Any application for an
increase in rate of a benefit being paid under a
current award, or for resumption of payments
previously discontinued.
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MOPH NSO Basic Training March 2014 Orlando, FL
EFFECTIVE DATES
38 CFR § 3.400 General:
Except as otherwise provided, the effective date of
an original claim, a claim reopened after final
disallowance, or a claim for increase will be the
date of receipt of the claim or the date
entitlement arose, whichever is the later.

Unless specifically provided: on basis of facts
found.
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MOPH NSO Basic Training March 2014 Orlando, FL
EFFECTIVE DATES
38 CFR 3.400(b)(2)(i)
Day following separation from active service
..; otherwise, date of receipt of claim, or
date entitlement arose, whichever is later.
Separation from service…under conditions
other than dishonorable
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MOPH NSO Basic Training March 2014 Orlando, FL
EFFECTIVE DATES
FOUR MAIN CRITERIA
Date of receipt of claim
 Date entitlement arose
 Facts found
 Specific provision of the law

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MOPH NSO Basic Training March 2014 Orlando, FL
EFFECTIVE DATES
TYPES OF DATES
Date of rating
 Date of award letter
 Effective date for entitlement
 Effective date for monetary benefit

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MOPH NSO Basic Training March 2014 Orlando, FL
EFFECTIVE DATES
Direct service connection
 Presumptive service connection
 Reopened claims
 Resumption of benefits
 Increases
 Reductions
 Informal claims

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MOPH NSO Basic Training March 2014 Orlando, FL
DIRECT SERVICE
CONNECTION
Scenario 1
Vet served 2-3-2005 to 2-4-2010. Claim
filed 2-1-2011. SC granted for back.
Effective date of service connection is?
2-5-2010
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MOPH NSO Basic Training March 2014 Orlando, FL
DIRECT SERVICE
CONNECTION
Scenario 2
Vet served 2-3-2005 to 2-4-2010. Claim
filed 2-7-2011. SC granted for back.
Effective date of service connection is?
2-7-2011
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MOPH NSO Basic Training March 2014 Orlando, FL
PRESUMPTIVE SERVICE
CONNECTION
38 CFR 3.400(b)(2)(ii)


Date entitlement arose, if claim is received
within 1 year after separation from active duty;
otherwise ,
date of receipt of claim, or date entitlement arose,
whichever is later.
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MOPH NSO Basic Training March 2014 Orlando, FL
PRESUMPTIVE SERVICE
CONNECTION
Scenario 3
Vet separated 5-1-2010. First diagnosis of
hypertension was 7-1-2010. Vet files claim
on 4-25-2011. Effective date of service
connection is?
7-1-2010
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MOPH NSO Basic Training March 2014 Orlando, FL
QUESTION
Is PTSD a presumptive condition?
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MOPH NSO Basic Training March 2014 Orlando, FL
PRESUMPTIVE SERVICE
CONNECTION
Scenario 4
Vet separated 5-1-2010. First diagnosis of
hypertension was 7-1-2010. Vet files claim
on 5-25-2011.Effective date of service
connection is?
5-25-2011
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MOPH NSO Basic Training March 2014 Orlando, FL
What is New & Material Evidence?
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MOPH NSO Basic Training March 2014 Orlando, FL
NEW & MATERIAL EVIDENCE
38 CFRr 3.156(A)



New evidence = evidence not previously
submitted,
Material evidence = evidence that, by itself or
when considered with previous evidence of
record, relates to unestablished fact necessary to
substantiate claim.
N&M not cumulative or redundant, must raise
reasonable possibility in light of all the evidence
of substantiating claim
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MOPH NSO Basic Training March 2014 Orlando, FL
NEW & MATERIAL EVIDENCE
Shade v. Shinseki
New and material evidence is evidence
that—if found credible—would either
entitle the claimant to benefits or to
some further assistance from the
Secretary in gathering evidence that
could lead to the granting of the claim
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MOPH NSO Basic Training March 2014 Orlando, FL
REOPENED CLAIM
38 CFR 3.400(q) N & M evidence other than
service department records:
(1) Received within appeal period or prior to
appellate decision. The effective date will be as
though the former decision had not been rendered.
(2) Received after final disallowance. Date of
receipt of new claim or date entitlement arose,
whichever is later.
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MOPH NSO Basic Training March 2014 Orlando, FL
REOPENED CLAIM
Scenario 5
Vet filed a claim on 7-9-2009. Denied on 315-2010. Submits N&M evidence on 2-282011. Rating of 9-5-2011 grants SC
effective what date?
7-9-2009
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MOPH NSO Basic Training March 2014 Orlando, FL
REOPENED CLAIM
Scenario 6
SC denied for back on 6-25-2009. Reopened
claim with N&M evidence on 5-25-2011.
SC granted. Effective date of service
connection is?
5-25-2011
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MOPH NSO Basic Training March 2014 Orlando, FL
REOPENED CLAIM
Scenario 7
Vet separated on 5-15-2008. Files claim for a
back on 4-12-2009. VA notifies him on
10-10-2009 that claim denied. Vet submits
N&M evidence on 5-15-2010. Rating 117-2010 grants SC effective what date?
5-16-2010
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MOPH NSO Basic Training March 2014 Orlando, FL
REOPENED CLAIM
Scenario 8
Vet honorably separated 6-19-2000. Filed claim for
back on 10-15-2000. SC denied on 1-13- 2001.
Reopened claim on 5-25-2011 with service
treatment records found at St. Louis RMC. SC
granted. Effective date of service connection is?
6-20-2000
38 CFR 3.156(c)
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MOPH NSO Basic Training March 2014 Orlando, FL
REOPENED CLAIM
Scenario 9
Vet honorably separated 6-19-2000. Claim filed
on 2-12-2004 and denied on 12-15-2004.
Reopened claim on 5-25-2011 with service
treatment records found at St. Louis RMC. SC
granted. Effective date of service connection is?
2-12-2004
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MOPH NSO Basic Training March 2014 Orlando, FL
REOPENED CLAIM
Scenario 10
Vet honorably separated 6-19-2000. Filed claim for
back on 10-15-2000. SC denied on 1-13- 2001.
Reopened claim on 5-25-2011 with service
treatment records found at his Mom’s house. SC
granted. Effective date of service connection is?
5-25-2011
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MOPH NSO Basic Training March 2014 Orlando, FL
RESUMPTION OF BENEFITS


38 CFR 3.654(b)(1)Where Vet returns to active
duty, award will be stopped the day preceding
reentrance into active duty status.
38 CFR 3.654(b)(2)Payments, will be resumed
effective the day following release from active
duty
– if claim for recommencement of payments is received
within 1 year from the date of such release:
– otherwise payments will be resumed effective 1 year
prior to the date of receipt of a new claim.
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MOPH NSO Basic Training March 2014 Orlando, FL
RESUMPTION OF BENEFITS
Scenario 11
Vet 20% for spleen removal. Re-enters active duty
and benefits are stopped. Separated on 5-152009. Files a claim to resume 20%
 On 12-1-2009. What is effective date?
5-16-2009
 On 12-11-2010.What is effective date?
12-11-2009
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MOPH NSO Basic Training March 2014 Orlando, FL
INCREASES
38 CFR 3.400(o)

(1) General, date of receipt of claim or date
entitlement arose, whichever is later…..

(20 Earliest date as of which it is factually ascertainable
that an increase in disability had occurred if claim is
received within 1 year from such date otherwise, date of
receipt of claim.
MOPH NSO Basic Training March 2014 Orlando, FL
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INCREASES
38 CFR 3.157(b)(1) Report of examination or
hospitalization by Department of Veterans Affairs
or uniformed services
GENERAL COUNSEL PRECEDENT
OPINION ASSESSMENT, VAOPGCPREC 52003, September 15, 2003
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MOPH NSO Basic Training March 2014 Orlando, FL
INCREASES
Scenario 12
Vet 0% for hearing loss. Files a claim for increase
on 5-15-2010. VA Exam of 2-20-11 shows an
increase to 10%. Effective date is?
5-15-2010
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MOPH NSO Basic Training March 2014 Orlando, FL
INCREASES
Scenario 13
Vet is 10% for DM II. On 5-15-2009 PMR shows
insulin required. Increased claim filed 12-142009. Effective date of increase is?
5-15-2009
What if date of claim was 5-17-2010?
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MOPH NSO Basic Training March 2014 Orlando, FL
INCREASES
Scenario 14
Vet admitted to a hospital for a stress test for his
10% SC Ischemic heart on 7-4-2008. Test
shows an increase to 60% Files a claim for
increase on 9-13-2010. What is the effective
date of increase if
1.
It was a private hospital?
2.
VAMC?
3.
Military hospital?
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MOPH NSO Basic Training March 2014 Orlando, FL
INCREASES
Scenario 14 Continued:
4.
5.
Admitted for testing and uses
TRICARE?
The test was done to determine severance
pay as vet was on TDRL?
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MOPH NSO Basic Training March 2014 Orlando, FL
INCREASES
Scenario 14 Continued:
6.
7.
Admitted to non-VA hospital on 7-12008 but with VA pre-approval?
Admitted to non-VA hospital 6-30-2008
and notified VA on 7-6-2008 and
maintenance is then authorized?
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MOPH NSO Basic Training March 2014 Orlando, FL
INCREASES
Scenario 15
Veteran is SC for psoriasis 0%. On 1- 27-2010 he
awakes & finds that psoriasis is covering ½ his
face. He sees a MD on 2-16-2010 who confirms
this. He claims an increase on 4-4-2010 &
submits a 4138 from him and his wife detailing
the facts. What is the effective date of increase?
1-27-2010
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MOPH NSO Basic Training March 2014 Orlando, FL
LIBERALIZING LEGISLATION
38 CFR 3.114
Where a monetary allowance…is awarded or
increased pursuant to a liberalizing law or VA issue
…… to be eligible for a retroactive payment
…evidence must show that the claimant met all
eligibility criteria …. on the effective date of the
law or VA issue and that such eligibility existed
continuously from that date to the date of claim or
administrative determination of entitlement.
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MOPH NSO Basic Training March 2014 Orlando, FL
LIBERALIZING LEGISLATION
38 CFR 3.114 Cont.


If a claim reviewed on the initiative of VA or the
claimant within 1 year from the effective date
benefits may be authorized from the effective
date of the law or VA issue.
If a claim is reviewed on the initiative of VA or
claimant more than 1 year after the effective date
benefits may be authorized for a period of 1 year
prior to the date of a determination of entitlement
or date of receipt of request from the claimant.
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MOPH NSO Basic Training March 2014 Orlando, FL
LIBERALIZING LEGISLATION
38CFR 3.114 Cont.
EXAMPLE - 8-31-2010 - coronary artery disease
(CAD) Liberalizing issue –Agent Orange condition
If a VN vet had CAD diagnosed on 2-5-2010 what
is the efective date of entitlement if claim filed
 2-1-2011?
 9-2-2011?
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MOPH NSO Basic Training March 2014 Orlando, FL
LIBERALIZING LEGISLATION
38CFR 3.114 Cont.
EXAMPLE - 8-31-2010 - coronary artery disease
(CAD) Liberalizing issue –Agent Orange condition
If a VN vet had CAD diagnosed on 2-5-2011 what
is the efective date of entitlement if claim filed
 March 1-2011?
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MOPH NSO Basic 2014 Orlando, FL
REMINDERS
Determine
date of receipt of claim
 if a special provision exists
 if the decision to grant or increase is based on
a liberalizing law or VA issue

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MOPH NSO Basic Training March 2014 Orlando, FL
REMINDERS
Determine
if evidence shows a factually ascertainable
increase in disability within one year of date of
receipt of claim
 if an acceptable exam or hospital report may
provide a basis for an earlier date of receipt of
claim
 if a change in the rating schedule may provide an
earlier effective date of increase than the date of
receipt of claim

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MOPH NSO Basic Training March 2014 Orlando, FL
REDUCTION
EVALUATION
RULES
What is the 5 year rule?
 What is the 10 year rule?
 What is the 20 year rule?

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MOPH NSO Basic Training March 2014 Orlando, FL
REDUCTION
EVALUATION
Scenario 16
Vet SC 70% for PTSD. VAE of 7-5-2010 shows
improvement. Notice sent 11-15-2010 notifies
vet that PTSD will be reduced to 50%. Vet
doesn’t respond. Rating & notice dated 2-2-2011
makes a reduction effective?
5-1-2011
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MOPH NSO Basic Training March 2014 Orlando, FL
REDUCTION
EVALUATION
Scenario 16 Continued
Vet receives 11-15-2010 notice & requests a
hearing. Held on 4-4-2011. No evidence
submitted. Rating & notice prepared 6-3-2011
formalizes the reduction to 50% effective?
9-1-2011
What if reduction letter is dated 7-2-2011?
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MOPH NSO Basic Training March 2014 Orlando, FL
REDUCTION
Failure to Report
Scenario 17
Vet rated 30% for psoriasis. He FTR for a 6-192010 VA exam. VA notifies him on 8-12-2010
that he is being reduced to 0% effective 11-12010. Vet does not respond within 60 days.
When is the award stopped when the VSR has
the case on
1.
10-15-2010 to process?
2.
12-1-2010 to process?
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MOPH NSO Basic Training March 2014 Orlando, FL
REDUCTION
Failure to Report
Scenario 17 – Continued
Vet requests a hearing on 9-1-2010. Hearing held
12-15-2010. No change! Rater on 2-3-11 has
case. Effective date of reduction is?
5-1-2011
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MOPH NSO Basic Training March 2014 Orlando, FL
REDUCTION
VA Form 21-4140
Scenario 18
Vet rated 70% for PTSD but has IU. Fails to return
VA Form 21-4140. 60 day notice dated 6-82010 sent to vet reducing him to 70% rate. No
response. What is effective date of reduction
when the VSR has the case on
1.
2.
8-14-2010 to process?
11-12-2010 to process?
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MOPH NSO Basic Training March 2014 Orlando, FL
REDUCTION
VA Form 21-4140
Scenario 18 – Continued
 What
happens when the vet timely
requests a hearing?
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MOPH NSO Basic Training March 2014 Orlando, FL
REMINDERS
DO
 Review the proposed rating carefully.
 Call the vet when a reduction is
proposed
– Explain process
– Check if address correct
– Check if vet received notice
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MOPH NSO Basic Training March 2014 Orlando, FL
REMINDERS
DO NOT request a hearing solely to give
the client more money
 DO NOT purposely delay the
promulgation of the rating proposing
reduction.

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MOPH NSO Basic Training March 2014 Orlando, FL
INFORMAL CLAIM
Requirements
Communication or action
Intent to apply for VA benefits
Identifies the benefit sought
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MOPH NSO Basic Training March 2014 Orlando, FL
INFORMAL CLAIM
Who can file an informal claim?
Claimant
 Authorized representative
 Member of Congress
 Next of Friend …Sui Juris

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MOPH NSO Basic Training March 2014 Orlando, FL
INFORMAL CLAIM
CAVEAT
Authorized representative must have a
properly executed power of attorney at the
time of the communication!
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MOPH NSO Basic Training March 2014 Orlando, FL
EXAMPLE
On 5/15/09 you interviewed a veteran. POA
completed. On 5-17-09 you filed an informal
claim for compensation. VA sends a vet an
application on 7-25-09.
1.
2.
Claim filed on 7-24 -10. Effective date is?
Claim filed on 7-27-10. Effective date is?
Same facts but vet separated on 3-15-2009.
1. Claim filed on 7-24 -10. Effective date is?
2. Claim filed on 7-27-10. Effective date is?
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MOPH NSO Basic Training March 2014 Orlando, FL
INFORMAL CLAIM
What are the benefits of filing an
informal claim?
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MOPH NSO Basic Training March 2014 Orlando, FL
SUMMARY
Impact of correct effective dates
 Covered basic effective date regulation
 Reviewed common exception
 Established basic parameters on review
 Informal claims & their use

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MOPH NSO Basic Training March 2014 Orlando, FL
QUESTIONS?
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MOPH NSO Basic Training March 2014 Orlando, FL