fundamentally different body systems that may clearly warrant separate consideration. If SC for several symptoms or is denied for the same reason, consider such symptoms and signs as a single issue. Assign one hyphenated diagnostic code (DC) on the codesheet to each issue that is separately considered, whether SC is awarded or denied. b. Information The following information is required to determine whether SC for a chronic Required to qualifying disability is in order: Decide the Issue of SC for when the disability arose a Chronic whether the disability was severe enough to warrant the award of a Qualifying compensable evaluation at any time during the presumptive period, unless Disability manifested while in the Southwest Asia theater, and whether the disability chronically persisted for at least six months. For more information on development requirements for claims Reference: based on service in Southwest Asia, see M21-1, Part IV, Subpart ii, 1.E. c. Role of the When considering disabilities the provisions of , a Veteran’s lay Veteran’s statement describing his or her own symptoms of a qualifying disability takes Testimony in on a greater importance than when considering other claims under direct SC Establishing principles. Signs or Symptoms as indicated in M21-1, Part IV, Subpart ii, 1.E.2.a, the threshold for ordering an examination based on claims under is low, as the claimant’s statement alone, describing symptoms, may be sufficient to trigger an examination. Second, lay evidence describing symptoms unsupported by clinical findings is sufficient to establish SC under as long as there is medical evidence showing that medical diagnosis” is present. “no The Federal Circuit, in , 766 F.3d 1939 (Fed. Cir. 2014) held that Important: pain,” that was unsupported by physical examination findings or “neck laboratory tests, may establish an undiagnosed illness that causes a qualifying chronic disability. This demonstrates the importance of the Veteran’s testimony, which is essentially all that is needed for the examiner to characterize the symptoms as an illness” and for SC to be “undiagnosed granted, if all other SC requirements are otherwise met. For more information on References: requesting examinations in GW claims, see M21-1, Part III, Subpart iv, 3.A, and
fundamentally different body systems that may clearly warrant separate consideration. If SC for several symptoms or is denied for the same reason, consider such symptoms and signs as a single issue. Assign one hyphenated diagnostic code (DC) on the codesheet to each issue that is separately considered, whether SC is awarded or denied. b. Information Required to Decide the Issue of SC for a Chronic Qualifying Disability The following information is required to determine whether SC for a chronic qualifying disability is in order: when the disability arose whether the disability was severe enough to warrant the award of a compensable evaluation at any time during the presumptive period, unless manifested while in the Southwest Asia theater, and whether the disability chronically persisted for at least six months. Reference: For more information on development requirements for claims based on service in Southwest Asia, see M21-1, Part IV, Subpart ii, 1.E. c. Role of the Veteran’s Testimony in Establishing Signs or Symptoms When considering disabilities the provisions of , a Veteran’s lay statement describing his or her own symptoms of a qualifying disability takes on a greater importance than when considering other claims under direct SC principles. as indicated in M21-1, Part IV, Subpart ii, 1.E.2.a, the threshold for ordering an examination based on claims under is low, as the claimant’s statement alone, describing symptoms, may be sufficient to trigger an examination. Second, lay evidence describing symptoms unsupported by clinical findings is sufficient to establish SC under as long as there is medical evidence showing that “no medical diagnosis” is present. Important: The Federal Circuit, in , 766 F.3d 1939 (Fed. Cir. 2014) held that “neck pain,” that was unsupported by physical examination findings or laboratory tests, may establish an undiagnosed illness that causes a qualifying chronic disability. This demonstrates the importance of the Veteran’s testimony, which is essentially all that is needed for the examiner to characterize the symptoms as an “undiagnosed illness” and for SC to be granted, if all other SC requirements are otherwise met. References: For more information on requesting examinations in GW claims, see M21-1, Part III, Subpart iv, 3.A, and
11-30-15_Key%20Changes_M21-1IV_ii_2_SecD.docx