Tdiu M21 1MR
Tdiu M21 1MR
Tdiu M21 1MR
This section contains the following topics: Topic 24 25 26 27 28 29 30 Topic Name General Information on IU Claims Evaluating Evidence to Establish Entitlement to IU Evaluating Evidence of Self-Employment or Employment With a Tightly Held Corporation Preparing a Rating Decision Addressing the Issue of IU Special Considerations in IU Claims Exhibit 1: Rating Decision Addressing the Veterans Failure to Complete a Field Examination Exhibit 2: Rating Decision Addressing the Veterans Failure to Respond to a Notice of Proposed Adverse Action After Failure to Complete a Field Examination Exhibit 3: Rating Decision Addressing the Subsequent Receipt of Evidence That Restores IU After Failure to Complete a Field Examination Exhibit 4: Poverty Threshold Information See Page 2-F-2 2-F-4 2-F-8 2-F-10 2-F-15 2-F-20 2-F-21
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This topic contains general information on individual unemployability (IU), including establishing entitlement to increased compensation based on IU considering a 100-percent evaluation understanding unemployability vs. unemployed and unemployable, and the definition of substantially gainful employment.
Change Date
December 13, 2005 To establish entitlement to compensation as if 100 percent disabled based on individual unemployability (IU), a veteran must be unable to secure or retain employment by reason of service-connected disability. The veteran must be unemployable in fact by reason of SC disability and either meet the schedular requirements of 38 CFR 4.16, or have an extra-schedular evaluation approved by the Compensation and Pension (C&P) Service (211B).
Notes: IU is also referred to as total disability based on individual unemployability (TDIU). IU must be established on a factual basis.
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Decide whether the veteran meets the requirements for a schedular 100percent evaluation before considering the issue of IU. Note: If a 100 percent SC evaluation is awarded, any pending claim for a total disability evaluation based on IU is moot.
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c. Unde rstan ding Une mplo yabil ity vs. Une mplo yed and Une mplo yable
The term unemployability is not synonymous with the terms unemployed and unemployable for the purpose of determining entitlement to increased compensation. A veteran may be unemployed or unemployable for a variety of reasons. A determination as to entitlement to a total evaluation based on unemployability is appropriate only when a veterans unemployability is a result of SC disabilities.
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Substantially gainful employment is defined as employment at which nondisabled individuals earn their livelihood with earnings comparable to the particular occupation in the community where the veteran resides.
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This topic contains information on evaluating evidence to establish entitlement to increased compensation based on IU, including general evidence requirements medical evidence requirements handling incomplete medical evidence employment history requirements requesting employment information from employers when to obtain Social Security Administration (SSA) reports, and vocational rehabilitation records identifying inferred claims of IU, and processing inferred claims of IU.
December 13, 2005 A completed VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability, is required for a grant of IU. Use the information supplied by the veteran on this form as the basis for development of evidence to support the claim when rating claims for IU. The evidence should be sufficient to evaluate both the veterans current degree of disability, and employment status.
A claim for IU must contain sufficient medical evidence to support a current evaluation of the extent of all the veterans disabilities. The evidence should reflect the veterans condition within the past 12 months and include, but need not be limited to, the results of VA examination(s) hospital reports, and/or outpatient treatment records.
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If the medical evidence of record is incomplete or inconsistent, schedule a medical examination. Request special tests only when required for proper evaluation of the degree of severity of relevant disabilities. Reference: For more information on scheduling examinations, see M211MR, Part III, Subpart iv, 3.B.
d. Employment VA Form 21-8940 requires the veteran to furnish an employment history for Histo the ry Requ five-year period preceding the date on which the veteran claims to have irem become too disabled to work, and ents
entire time after the date on which the veteran claims to have become too disabled to work.
Request each employer for whom the veteran worked during the 12-month period prior to the date the veteran last worked complete and return VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits. Note: If the information on VA Form 21-4192 only states that the veteran retired, then request additional information as to whether the veterans retirement was by reason of disability. If so, ask the employer to identify the nature of the disability for which the veteran was retired.
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Obtain and consider complete copies of the Social Security Administration (SSA) reports, if available, when evidence of record is insufficient to award increased compensation based on IU, and the record shows that the veteran is receiving Social Security (SS) benefits because of disability. Note: Decisions by SSA regarding a veterans unemployability are not controlling for VA determinations (and vice versa). References: For more information on requesting information from SSA, see M21-1MR, Part III, Subpart iii, 3.A, and the effect of SSA decisions regarding unemployability on VA determinations, see Murincsak v. Derwinski, 2 Vet. App. 363 (1992).
Obtain and consider vocational rehabilitation records in IU claims whenever there is an indication that training was not found to be medically feasible, or a veterans attempt to be trained was unsuccessful.
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The Rating Veterans Service Representative (RVSR) is responsible for identifying claims with potential entitlement to increased compensation based on IU even when no specific claim for the benefit has been made. A claim of IU is reasonably raised or inferred when the evidence shows that a veterans schedular rating meets the minimum criteria found in 38 CFR 4.16(a), and evidence in the claimants file or under Department of Veterans Affairs (VA) control shows the veteran might be unemployable as a result of SC disability. Reference: For more information on inferring a claim of IU, see Norris v. West, 12 Vet. App. 413 (1999), and VAOPGCPREC 6-99.
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When an inferred claim of IU is identified, VA will send the veteran VA Form 21-8940 for completion take the existing end product (EP) credit by award action or PCLR, if no other issues remain pending, and establish a new EP 021, using the date VA Form 21-8940 is sent to the veteran as the date the claim. Notes: A veteran should not be sent VA Form 21-8940 to complete if the schedular requirements of 38 CFR 4.16 are met, but there is no evidence of SC unemployability. If a rating decision is prepared in connection with other issues, show entitlement to IU as deferred. A subsequent formal rating decision will always be required to dispose of the issue of entitlement to a total evaluation based on IU.
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This topic contains information on evaluating evidence of self-employment or employment with a tightly held corporation. It includes information on developing claims involving self-employed individuals deciding whether self-employed individuals are unemployable due to a SC disability the definition of a tightly held corporation, and evaluating evidence showing income from a tightly held corporation.
Change Date
December 13, 2005 Development to produce the evidence necessary to establish the degree to which SC disability has impaired the veterans ability to engage in selfemployment must generally be more extensive than development in cases in which the veteran worked for others. Request that the veteran furnish a statement regarding the types of work performed number of hours worked per week, and amount of time lost in the previous 12 months due to SC disabilities.
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26. Evaluating Evidence of Self-Employment or Employment With a Tightly Held Corporation, Continued
b. Deciding Whe ther SelfEmp loyed Indiv idual s Are Une mplo yable Due To SC Disa bility
When determining entitlement of self-employed individuals to increased compensation based on IU, consider the relationship between the frequency and the type of service performed by the veteran for his/her business and the veterans net and gross earnings for the past 12 months. Consider facts of the case, such as low gross earnings that support a finding of marginal employment, especially when the amount of time lost from work due to SC disablement is taken into account, or high gross earnings that indicate the veteran is capable of engaging in a substantially gainful occupation. Notes: Consider low net earnings in conjunction with gross income. The inability to make a profit is not always indicative of the inability to engage in substantially gainful employment. A tightly held corporation (or closely held corporation) is usually a family corporation. A corporation bearing the veterans name is usually indicative of a tightly held corporation.
d. Evaluating Evid ence Sho wing Inco me Fro ma Tigh tly Held Corp orati on
Since the veteran may control the amount of wages paid to himself/herself, do not make a finding of marginal employment solely on the basis of low wages. Keep in mind that the issue for consideration is whether the frequency and type of service performed by the veteran equates to substantially gainful employment. Therefore, consider evidence that the veteran received, or was entitled to receive, other remuneration from the corporation, such as stock dividends or loans, in lieu of wages. Note: If the reported wages appear low for the work performed, request a field examination per M21-1MR, Part III, Subpart vi, 8.7 (TBD) or M21-1, Part III, Chapter 8 to determine the veterans entitlement to the corporation and corporate earnings.
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This topic contains information on preparing a rating decision addressing the issue of IU, including considerations when deciding an IU claim applying the concept of average impairment considering multiple disabilities determining the effect of SC disabilities on employability the definition of marginal employment reasons for denying IU claims formally denying IU, and the information to include in the rating decision.
Change Date
December 13, 2005 When deciding an IU claim, the rating activity must take into account the veterans current physical and mental condition the veterans employment status, including the nature of employment, and the reason employment was terminated, and whether the disability requirements set forth in 38 CFR 4.16 are met, or extra-schedular consideration under 38 CFR 3.321(b)(1) is warranted. Important: Do not defer a decision as to the schedular degree of disability pending receipt of evidence sufficient to adjudicate the issue of IU. Apply the concept of average impairment in earning capacity to determinations of the percentage of disability. Do not apply the concept of average impairment in earning capacity to determinations regarding IU.
b. Applying the Conc ept of Aver age Impa irme nt in Earn ing Capa city
Under certain circumstances, multiple disabilities may be considered one disability for the purpose of meeting the requirements of 38 CFR 4.16. Example: Consider multiple disabilities incurred while a prisoner of war (POW) and disabilities incurred in action prior to, or subsequent to, former POW status, as one disability. Rationale: POW status is a continuation of action against the enemy. Reference: For more information on rating claims involving former POWs, see M21-1MR, Part IV, Subpart ii, 2.E.
Determine whether the severity of the SC conditions precludes the veteran from obtaining or retaining substantially gainful employment. Identify and isolate the effects of extraneous factors, such as age nonservice-connected (NSC) disabilities injuries occurring after military service availability of work, or voluntary withdrawal from the labor market.
Notes: Include sufficient information in the Reasons for Decision section of the rating decision to explain the reasoning behind the decision, either favorable or unfavorable, and justify the conclusion.
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Marginal employment exists when a veterans earned annual income does not exceed the amount established by the U.S. Department of Commerce, U.S. Census Bureau, as the poverty threshold for one person, and/or on a facts-found basis, and includes, but is not limited to, employment in a protected environment, such as a family business or sheltered workshop, when earned annual income exceeds the poverty threshold. Note: The U.S. Census Bureau revises the poverty thresholds annually. When the revised amounts are published, Veterans Benefits Administration (VBA) publishes notices in the Federal Register and revises M21-1MR, Part IV, Subpart ii, 2.F.32.b. Important: Do not consider marginal employment as substantially gainful employment. Reference: For more information on the poverty threshold, see M21-1MR, Part IV, Subpart ii, 2.F.32.
Deny IU claims or reduce compensation that is based on a finding of IU only if the facts demonstrate that the veteran is not precluded from obtaining employment by reason of SC disability, or has in fact obtained gainful employment.
Note: The fact that a veteran is either participating in a program of rehabilitation or has completed such a program and is rehabilitated does not preclude a finding of IU.
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Formally code the rating decision to indicate denial of IU if the veteran specifically claims entitlement to IU, and any of the requirements for 38 CFR 4.16 are not met.
Note: If the veteran disagrees with the decision, the statement of the case (SOC) should cite the relevant portion of 38 CFR 4.16 as the authority of the denial.
h. Information Use the information below to determine what information to include in the to rating decision. Inclu de in the Rati ng Decis ion
If schedular requirements of 38 CFR 4.16 are met, but IU is denied the veteran is considered employable schedular requirements of 38 CFR 4.16 are not met
Then provide an explanation of all pertinent subsidiary determinations. explain the facts that are pertinent to that conclusion. note the absence of a basis for submission of the case to Central Office (CO) (213B) for consideration of an extra-schedular rating, if applicable.
Reference: For more information on extra-schedular submission, see 38 CFR 3.321(b)(1) 38 CFR 4.16(b), and M21-1MR, Part IV, Subpart ii, 2.F.28.a. a veteran is considered unemployable include due to NSC factors an explanation of the reasons for this decision, and the reasoning for finding that SC disabilities alone do not render the veteran unemployable.
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M21-1MR, Part IV, Subpart ii, Chapter 2, Section F Continued on next page
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If IU is established
Then include an explanation or analysis of how impairment from SC disability supports the decision.
Important: A conclusory statement alone that the criteria for a total evaluation based on IU are met does not satisfy the requirement to state the basis for the decision. permanency of the total disability IU dispose of the issue of Dependents evaluation is established Educational Assistance (DEA) under 38 U.S.C. Chapter 35, regardless of whether or not there appear to be any potential dependents. Note: The rating conclusion must include the statement, Basic eligibility under 38 U.S.C. Chapter 35 is established from [date]. References: For more information on IU, see 38 CFR 4.16, and unemployability, see 38 CFR 4.18.
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This topic contains information on special considerations in IU claims, including handling claims requiring CO approval monitoring changes in employability status when monitoring changes in employability status is not required dispatch and control for the return of VA Form 21-4140, Employment Questionnaire the action to take if VA Form 21-4140 cannot be issued by Hines Information Technology Center (ITC) shows continued unemployability indicates the veteran may be employed, or is not returned, and failure of the veteran to participate in a required field examination.
Change Date
December 13, 2005 Submit any claim to CO (211B) for extra-schedular consideration if the schedular requirements of 38 CFR 4.16 are not met but the evidence of record supports a finding that the veteran is unemployable by reason of SC disability. The memorandum prepared to transmit claims folders to CO for review must provide the following: a clear and succinct statement of the facts of the case, including medical and lay evidence of symptoms a discussion of relevant laws and regulations, and a statement of the issues to be resolved, as well as the recommended evaluation(s).
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Changes in the employability of veterans for whom IU is established is monitored through the annual release of VA Form 21-4140, Employment Questionnaire, via the Benefits Delivery Network (BDN), and Income Verification Match (IVM). References: For more information on dispatch and control for the return of VA Form 21-4140, see M21-1MR, Part IV, Subpart ii, 2.F.28.d, and the IVM as it relates to awards based on IU, see M21-1MR, Part X, 9.12. Monitoring changes in employability status is not required when the veteran
c. When
Moni torin is 69 years of age or older g has been rated totally disabled due to unemployability for a period of 20 Cha continuous years, which protects the evaluation from future reduction under nges 38 CFR 3.951(a), or in is assigned a 100-percent schedular evaluation. Emp loya bility Statu s Is Not Requ ired
The table below shows the steps involved in the dispatch and control for return of VA Form 21-4140.
Step 1
Action BDN generates a future diary under reason code 02, Individual Unemployability Review, whenever a rating decision granting a total evaluation based on individual unemployability is processed.
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Hines Information Technology Center (ITC) issues VA Form 214140 annually upon maturation of the future diary established under reason code 02. Note: To control the release of the last VA Form 21-4140, BDN generates a master record diary under reason code 32, Expiration of Employability Control, 19 years from the effective date of the grant of total benefits, or at age 69, whichever is earlier.
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Step 3
Action BDN establishes a future diary 34 to control for the return of VA Form 4140 two months from the month it is issued from Hines ITC. Note: If the future diary 34 is not cleared timely, BDN issues VA Form 21-6560, Notice of Benefit Transaction (Hines), message code 631, Diaried Action Due, reason code 02.
e. Action to Take Whe n Hine s ITC Can not Issue VA For m 214140
When Hines ITC cannot issue VA Form 21-4140, BDN generates a VA Form 20-8270, C&P Master Record Audit Writeout (Hines), with message code 631 or 882, Employability Letter Not Sent. Upon receipt of the writeout, immediately send the veteran VA Form 214140-1, Employment Questionnaire. To control for the return of VA Form 21-4140-1, Hines ITC establishes a future diary under reason code 34 for four months from the month in which VA Form 20-8270 was issued. Note: As a local option, a regional office (RO) may establish a future diary under end product (EP) 310 upon receipt of a writeout with either message code 631 or 882.
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f. Action to Take if VA For m 214140 Sho ws Cont inue d Une mplo yabil ity
If the completed VA Form 21-4140 shows continued unemployability file the completed questionnaire in the claims folder, and clear EP 310, using the PCLR command, and the future diary established under reason code 34, using the DIAR command.
If the completed VA Form 21-4140 indicates the veteran may be employed clear the future diary established under reason code 34 establish a control under EP 310, and refer the claims folder to the rating activity.
The table below shows the action to take if VA Form 21-4140 is not returned. Important: Per 38 CFR 3.103(b)(3)(ii), when a veteran fails to return VA Form 21-4140, requiring reduction of compensation to the schedular level, the authorization activity may furnish contemporaneous notice of the reduction in benefits. Advance notice of the adverse action is not required.
Step 1
Action The authorization activity establishes EP 310 control, and refers the claims folder to the rating activity The rating activity prepares a rating decision reducing the veterans evaluation under 38 CFR 3.501(f) to the appropriate schedular evaluation as of the date of last payment.
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The authorization activity processes the rating decision, and informs the veteran that if the Department of Veterans Affairs (VA) receives evidence establishing continued unemployability within one year of the date of the notification letter, the total evaluation based on unemployability will be restored from the date of reduction.
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Step 1 2
Action Prepare a rating decision proposing a reduced evaluation using the format in M21-1MR, Part IV, Subpart ii, 2.F.29. Use the table below to determine the action to take upon receipt of the veterans response to the notice of proposed adverse action. If the veteran fails to respond to the notice of proposed adverse action is willing to participate in the field examination prior to reduction to the schedular evaluation Then prepare a rating decision to reduce the current evaluation using the format in M21-1MR, Part IV, Subpart ii, 2.F.30. defer the rating action to reduce the evaluation reschedule the examination, and inform the veteran that further failure to cooperate will be cause for a reduction to the schedular evaluation, and the total evaluation based on IU would not be restored until the field examination had been completed and the report reviewed. sends evidence which prepare a rating decision using the warrants continuation format in M21-1MR, Part IV, Subpart of a total rating based ii, 2.F.31. on continued unemployability
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29. Exhibit 1: Rating Decision Addressing a Veterans Failure to Complete a Field Examination
Change Date
December 13, 2005 An example of a rating decision addressing a veterans failure to complete a
a. Rating
Decis field examination is below. ion: Failu re to Com plete a Field Exa mina tion
DECISION: A reduction to the schedular evaluation shown below is proposed because of the veterans failure to cooperate with a required field examination. EVIDENCE: Notice of Failure to Cooperate with field examiner. REASONS FOR DECISION: A total disability rating has been in effect because of unemployability. Notice has been received that the veteran refused to cooperate in completing a required field examination. JURISDICTION: Field Examiner Notification SUBJECT TO COMPENSATION (1.SC)
COMBINED EVALUATION FOR COMPENSATION: Individual Unemployability from NOT SERVICE CONNECTED/NOT SUBJECT TO COMPENSATION (8.NSC)
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30. Exhibit 2: Rating Decision Addressing a Veterans Failure to Respond to a Notice of Proposed Adverse Action After Failure to Complete a Field Examination
Change Date
December 13, 2005 An example of a rating decision addressing a veterans failure to respond to a
a. Rating
Decis notice of proposed adverse action after failure to complete a field examination ion: is below. Failu re to Resp ond to a Notic e of Prop osed Adve rse Actio n
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DECISION: Reduction to the schedular evaluation is in order because of the veterans failure to cooperate in the completion of a required field examination. EVIDENCE: Notice of Failure to Cooperate with field examiner. REASONS FOR DECISION: A total disability rating has been in effect because of unemployability. Notice has been received that the veteran failed to cooperate with a required field examination and the veteran failed to respond to the notice of proposed adverse action sent . JURISDICTION: Field Examiner Notification SUBJECT TO COMPENSATION (1.SC) from from from from from COMBINED EVALUATION FOR COMPENSATION: Individual Unemployability from to
31. Exhibit 3: Rating Decision Addressing the Subsequent Receipt of Evidence That Restores IU After Failure to Complete a Field Examination
Change Date
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a. Rating
Decis that restores IU after failure to complete a field examination is below. ion: Subs eque nt Rece ipt of Evid ence That Rest ores IU DECISION: The total rating based on unemployability is restored. ISSUE: Total Disability Because of Unemployability EVIDENCE: Report of Field Examination 12/11/95
REASONS FOR DECISION: Veterans total disability rating because of unemployability was reduced to the schedular evaluation because of the lack of cooperation in completing a required field examination. Sufficient evidence, including completion of the field examination, has been received establishing continuing unemployability. JURISDICTION: Completion of Field Examination SUBJECT TO COMPENSATION (1.SC) from from from from from COMBINED EVALUATION FOR COMPENSATION
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This topic contains information on the poverty threshold, including information on marginal employment based on income below the poverty level, and the poverty threshold for one person.
Change Date
December 13, 2005 38 CFR 4.16(a) provides that marginal employment is generally deemed to exist when a veterans earned income does not exceed the amount established by the U.S. Census Bureau as the poverty level for one person. Note: When revised poverty threshold amounts are published by the U.S. Census Bureau, VBA publishes notices in the Federal Register and subsequently revises this topic. Reference: For more information on the U.S. Census Bureaus poverty thresholds, see http://www.census.gov/hhes/poverty/threshld/.
a. Marginal Emp loym ent Base d on Inco me Belo w the Pove rty Leve l
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Year 10/19/1990 10/08/1991 09/14/1992 10/08/1993 10/06/1994 10/05/1995 09/26/1996 09/29/1997 09/09/1998 09/30/1999 09/26/2000 09/25/2001 09/24/2002 10/14/2003 08/26/2004 $6,311 $6,652 $6,932 $7,143 $7,363 $7,547 $7,763 $7,995 $8,183 $8,316 $8,501 $8,794 $9,039 $9,183 $9,393
Amount
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