HomeVeterans Guide to VA BenefitsTypes of VA ClaimsElements of a Claim

11.1. Elements of a Claim

A claim is "a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement, to a benefit."  Hillyard v. Shinseki, 24 Vet. App. 343, 355 (2011) (citing 38 C.F.R. § 3.1).  For initial claims, a "specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid to any individual under the laws administered by VA."  38 C.F.R. § 3.150(a); 38 U.S.C. § 5101(a).  Subsequent applications for additional claims or increases do not require use of the form.  The law is clear for initial claims, however, that only the approved VA form (currently VA Form 21-526EZ) is acceptable as a formal application for compensation.  For pension benefits use VA Form 21P-527EZ.  Whatever the means, the essential elements for any claim, whether formal or informal, are:

(1)   an intent to apply for benefits;

(2)   an identification of the benefits sought; and

(3)   a communication in writing, or verbally to the VA

Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009); see also MacPhee v. Nicholson, 459 F.3d 1323, 1326-27 (Fed. Cir. 2006) (holding that the plain language of the regulations requires a claimant to have an intent to file a claim for VA benefits); Rodriguez v. West, 189 F.3d 1351, 1354 (Fed. Cir. 1999) (noting that even an informal claim must be in writing); Brannon v. West, 12 Vet. App. 32, 35 (1998).

A claimant "[does] not file a claim to receive benefits only for a particular diagnosis, but for the affliction his . . . condition, whatever that is, causes him."  Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009).  Consequently, VA "should construe a claim based on the reasonable expectations of the non-expert, self-represented claimant and the evidence developed in processing that claim," taking into consideration "the claimant's description of the claim; the symptoms the claimant describes; and the information the claimant submits or that the Secretary obtains in support of the claim."  Id.  VA commits error "when it fail[s] to weigh and assess the nature of the current condition the appellant suffer[s] when determining the breadth of the claim before it."  Id. at 6.

A "claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary."  38 U.S.C. § 5107(a).  Further, VA has no duty to provide notice to claimants to file claims for service connection, and a claimant is bound by governing regulations.  38 C.F.R. § 3.400; see Morris v. Derwinski, 1 Vet. App. 260, 265 (1991) ("[R]egulations are binding on all who seek to come within their sphere, 'regardless of actual knowledge of what is in the [r]egulations or of the hardship resulting from innocent ignorance.'" (quoting Fed. Crop Ins. Corp. v. Merrill, 332 U.S. 380, 385 (1947))).  "The Supreme Court has held that everyone dealing with the Government is charged with knowledge of federal statutes and lawfully promulgated agency regulations."  Id. (citing Fed. Crop Ins. Corp., 332 U.S. at 385).

VA must review all communications in the record that may be interpreted as formal or informal claims and consider whether such communications, in the context of the entire record, reasonably raise a claim for benefits.  See Criswell v. Nicholson, 20 Vet. App. 501, 503-04 (2006) ("[W]here there can be found no intent to apply for VA benefits, a claim for entitlement to such benefits has not been reasonably raised."); Brannon v. West, 12 Vet. App. 32, 35 (1998).  VA is required to address every issue reasonably raised from a liberal reading of the documents or oral testimony submitted prior to the decision and where such review reasonably reveals that the claimant is seeking a particular benefit, VA is required to adjudicate the issue of entitlement to such a benefit.  Dingess v. Nicholson, 19 Vet. App. 473, 498 (2006). 

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