DISABILITYVA program

38 U.S.C. § 1151 Claims (VA-Caused Disability)

Compensation for additional disability or death caused by VA medical treatment, surgery, examination, or vocational rehabilitation training. VA pays it as if the disability were service connected, but it is not service connected, so some benefits, such as VR&E training and dependent education benefits, do not follow from it.

View on VA.gov

Step-by-step guide

What VA looks for: Disability after VA care, treatment, or an exam

An added disability, or one that got worseA disability you did not have before, or a condition that is worse than before. VA compares your condition right before the care with your condition after it ended, one body part or system at a time.
Care given by VAHospital care, medical or surgical treatment, or an exam given by a VA employee or in a VA facility. Care from a community provider under a VA contract, nursing home care VA pays for under 38 U.S.C. 1720, care in a non-VA facility under a sharing agreement, and domiciliary care do not count as VA care for this rule.
The care itself caused itEvidence that the care itself caused the added disability, not something that only happened at the same time; getting care and later having a disability is not enough on its own. The normal course of the condition being treated does not count unless a VA failure to diagnose it in time or treat it properly caused that worsening, and harm from not following properly given medical instructions does not count.
A lapse in care, or a result that was not an ordinary riskEither VA did not give the care a reasonable health care provider would give, or the harm came from an event a reasonable provider would not have considered an ordinary risk of that treatment. That event does not have to be completely unforeseeable, and this route needs no fault.

Source: 38 CFR 3.361(b) (opens in new tab); M21-1 VIII.iv.6.B (opens in new tab); 38 CFR 3.361(e) (opens in new tab); 38 CFR 3.361(f) (opens in new tab); 38 CFR 3.361(c)(1) (opens in new tab); 38 CFR 3.361(c)(2) (opens in new tab); 38 CFR 3.361(c)(3) (opens in new tab); 38 CFR 3.361(d)(1) (opens in new tab); 38 CFR 3.361(d)(2) (opens in new tab); VA.gov: Title 38 U.S.C. 1151 claims (opens in new tab)

Which kind of claim is this?

Disability after VA care, treatment, or an exam
Use this when a disability started or got worse after VA hospital care, medical or surgical treatment, or a VA exam. VA looks for four things. The last one does not require fault: a result a reasonable provider would not have seen as an ordinary risk of the treatment also counts.
Source: 38 CFR 3.361(b) (opens in new tab); 38 CFR 3.361(c) (opens in new tab); 38 CFR 3.361(d)(1) (opens in new tab); 38 CFR 3.361(d)(2) (opens in new tab); M21-1 VIII.iv.6.B (opens in new tab); VA.gov: Title 38 U.S.C. 1151 claims (opens in new tab); VA Form 21-526EZ (opens in new tab)
Treatment without informed consent
Care given without your informed consent counts as VA fault. Before treatment, the VA practitioner explains in language you can understand what the treatment is, its expected benefits, its reasonably foreseeable risks, other options, and what could happen with no treatment. Procedures that use sedation, anesthesia, or narcotic pain medicine, that cause significant discomfort or carry a significant risk of complications, or that inject something into a joint or body cavity need a signed consent form. In an emergency, consent can be implied.
1. The treatment caused an added disabilityThe same before and after comparison, and the same rule that the treatment itself caused the change, as any claim about VA care.
2. Consent was missing or fell shortVA looks at whether your providers substantially followed VA's informed consent rules. Small departures that did not matter in your case do not undo consent, but that exception does not apply when no consent was sought at all.
Source: 38 CFR 3.361(d)(1)(ii) (opens in new tab); 38 CFR 17.32(c) (opens in new tab); 38 CFR 17.32(d) (opens in new tab); M21-1 VIII.iv.6.B (opens in new tab); 38 CFR 3.361(b) (opens in new tab); 38 CFR 3.361(c)(1) (opens in new tab); 38 CFR 3.361(d)(1) (opens in new tab)
Injury in VR&E or compensated work therapy
Use this when a disability came from taking part in a Veteran Readiness and Employment (VR&E) program under chapter 31, or a VA compensated work therapy (CWT) program. No fault is needed here: VA looks at whether doing an essential part of the training, services, or work therapy caused the disability. Injuries in a job after the training ends are not covered.
1. A VR&E or CWT program VA provided or authorizedYou were taking part in training or rehabilitation services in an approved VR&E rehabilitation program, or in a CWT program.
2. An essential part of the program caused itDoing an essential activity of the training, services, or work therapy caused the disability. VA does not need to have approved that exact activity if it is a generally accepted part of the program.
3. An added disability, or one that got worseVA compares your condition right before the program with your condition after it stopped. The program is not treated as the cause of the normal course of a condition it was meant to help.
Source: 38 CFR 3.361(c) (opens in new tab); 38 CFR 3.361(d)(3) (opens in new tab); M21-1 VIII.iv.6.B (opens in new tab); VA.gov: Title 38 U.S.C. 1151 claims (opens in new tab); 38 CFR 3.361(b) (opens in new tab); 38 CFR 3.361(c)(2) (opens in new tab)

What to gather, and what it shows VA

Documents for this benefit: what each is, what it shows VA, and how VA gets it
Document	What it shows	How VA gets it
VA records of the care Records from the VA facility for the care in question: medical and surgical records, hospital records, and nurses' notes.	What VA did, and what happened during and after it	VA will request these for you once you file and name the facility and the dates of care. You can also get a complete copy of your VA medical records from the facility Release of Information office, by secure message or on VA Form 10-5345a.
Consent forms and consent notes The signed consent form for the procedure, or the note in your VA health record about the consent discussion.	What VA explained before the treatment, and what you agreed to	These are part of your VA health record, and VA will request them with the records of the care. For your own copy, ask the facility Release of Information office for a complete copy of your records.
Private records from before and after Records from doctors and hospitals outside VA that show your condition before the VA care or program, and after it.	How your condition changed	Two routes. Send copies to VA yourself, or complete VA Form 21-4142 and VA Form 21-4142a so VA can request them from each provider. The provider name, dates, and condition go on the VA forms, not into BeneVets.
VR&E or CWT program records VA records of your VR&E services or your CWT participation, including records of the injury.	That you were in the program, and what you were doing when hurt	VA will request these for you once you file and name the program and the dates.
VA exam or medical opinion A VA exam, a VA medical opinion, or both, on whether the care caused the added disability and whether it met the expected standard or was a foreseeable risk.	What caused the change	VA orders one when your records show a disability or symptoms that may be tied to the VA care but are not enough to decide. VA does not require you to show fault first.
Medical opinion from your own doctor A written opinion from a doctor outside VA on whether the VA care caused the added disability and whether it met the expected standard of care.	A medical view on what caused the change	Optional. Your doctor writes it and it goes to VA with the claim. VA also orders its own exam or opinion when the record needs one.
Your own statement Your written account of the timeline: your condition before, the care or program, what happened, and how the disability affects you now.	The timeline in your own words	VA Form 21-4138, Statement in Support of Claim. You write it and send it to VA. BeneVets does not collect it.
Statements from people who saw the change Statements from family, friends, or others who saw your condition before and after the care or program, or saw what happened.	The change others saw	VA Form 21-10210, Lay/Witness Statement. The witness completes it and it goes to VA with your claim. Raters weigh what a witness saw; a lay witness is not usually the source for what medically caused a change.

Records and statements go to VA. BeneVets never asks you to upload or type them here.

Steps, in order

Set your start date
Submit an intent to file online, by phone, by mail on VA Form 21-0966, or in person; it works for 1151 claims. A complete claim filed within 1 year after that counts as received on the intent to file date.
Source: 38 CFR 3.154 (opens in new tab); 38 CFR 3.155(b) (opens in new tab); VA.gov: your intent to file (opens in new tab); VA Form 21-0966 (opens in new tab)
Get free help from a VSO
Free help: an accredited VSO can file this with you. Find one near you in the BeneVets VSO directory at Find an accredited VSO near you. VA also accredits attorneys and claims agents, who can charge fees only for work done after VA issues its initial decision on the claim.
Source: VA.gov: accredited representatives (opens in new tab); 38 CFR 14.636(c) (opens in new tab)
Write down the timeline
On paper, note your condition before the care or program, the VA facility or program and the dates, what happened, and what changed after. Keep it with your papers; BeneVets does not ask for it.
Source: 38 CFR 3.361(b) (opens in new tab); M21-1 VIII.iv.6.A (opens in new tab)
Get your VA records of the care
VA will request the records of the care for you once you file. To see them yourself, including signed consent forms, ask the facility Release of Information office for a complete copy, by secure message or on VA Form 10-5345a.
Source: M21-1 VIII.iv.6.A (opens in new tab); VA.gov: get your medical records from your VA health facility (opens in new tab); VA Form 10-5345a (opens in new tab); 38 CFR 17.32(d) (opens in new tab)
Handle private medical records
For each private doctor or hospital that treated you before or after, send copies of the records to VA, or complete VA Form 21-4142 and VA Form 21-4142a so VA can request them.
Source: 38 CFR 3.159(c)(1) (opens in new tab); VA Form 21-4142 (opens in new tab); VA Form 21-4142a (opens in new tab)
Ask witnesses for statements
Ask people who saw your condition before and after whether they will complete VA Form 21-10210 about what they saw. Your own account goes on VA Form 21-4138.
Source: VA Form 21-10210 (opens in new tab); VA Form 21-4138 (opens in new tab); M21-1 V.ii.1.B (opens in new tab)
Consider a private medical opinion (optional)
A medical opinion from your own doctor on what caused the change is optional. VA orders its own exam or opinion when the record shows a disability that may be tied to the VA care but is not enough to decide.
Source: M21-1 VIII.iv.6.B (opens in new tab); 38 CFR 3.159(c)(4) (opens in new tab)
File VA Form 21-526EZ
File VA Form 21-526EZ within the year after your intent to file. List each disability and note it as one for which compensation is payable under 38 U.S.C. 1151, with the VA facility or program and the dates. There is no separate 1151 form.
Source: 38 CFR 3.154 (opens in new tab); VA Form 21-526EZ (opens in new tab); M21-1 VIII.iv.6.B (opens in new tab); VA.gov: Title 38 U.S.C. 1151 claims (opens in new tab)
Go to any exam VA schedules
VA asks for a claim exam only when it needs more information to decide. To reschedule, call the number on your appointment letter at least 48 hours ahead; rescheduling may delay the claim. If you miss the exam on a first claim without good cause, VA rates the claim on the evidence it already has.
Source: VA.gov: VA claim exam (opens in new tab); 38 CFR 3.159(c)(4) (opens in new tab); 38 CFR 3.655(b) (opens in new tab); M21-1 VIII.iv.6.B (opens in new tab)
Track your claim
Track the claim on VA.gov and answer any VA request for more evidence. You can add evidence at any time.
Source: VA.gov: after you file your disability claim (opens in new tab)
Read the decision, issue by issue
Each disability VA decides is a separate issue with its own review options: a Supplemental Claim (VA Form 20-0995), a Higher-Level Review (VA Form 20-0996), or a Board Appeal (VA Form 10182). A review filed within 1 year of the decision notice keeps the original effective date.
Source: 38 CFR 3.151(c) (opens in new tab); 38 CFR 3.2500(h) (opens in new tab); M21-1 VIII.iv.6.B (opens in new tab); VA.gov: decision reviews and appeals (opens in new tab); VA Form 20-0995 (opens in new tab); VA Form 20-0996 (opens in new tab); VA Form 10182 (opens in new tab)

Good to know

Paid as if service connected, but not service connected

VA pays 1151 compensation the same way it would if the disability were service connected, and combines its rating with your service-connected ratings. It can count toward Individual Unemployability, a clothing allowance, adapted housing, and the automobile allowance. It is not actually service connected, so some benefits do not follow from it, including VR&E training, education benefits for your dependents (chapter 35), VALife, the VA home loan funding fee waiver, the 10-point federal hiring preference, and CHAMPVA for your family.

Source: M21-1 VIII.iv.6.A (opens in new tab); M21-1 VIII.iv.6.B (opens in new tab)

There is no separate 1151 form

VA has no form just for 1151 claims. A veteran files on VA Form 21-526EZ, the disability compensation application, and notes the disability as one for which compensation is payable under 38 U.S.C. 1151. An intent to file works for these claims too.

Source: 38 CFR 3.154 (opens in new tab); 38 CFR 3.155(b) (opens in new tab); M21-1 VIII.iv.6.B (opens in new tab); VA Form 21-526EZ (opens in new tab); VA.gov: Title 38 U.S.C. 1151 claims (opens in new tab)

The 1-year window for the start date

If VA receives the claim within 1 year after the injury or the worsening, payments can start from the date it happened. After that, they start from the date VA receives the claim. An intent to file can hold that receipt date while you finish the claim.

Source: 38 CFR 3.400(i) (opens in new tab); 38 CFR 3.155(b) (opens in new tab); M21-1 VIII.iv.6.B (opens in new tab)

Community care is not VA care for this rule

Care from a community provider under a VA contract does not count as VA care under 1151. M21-1 says a claim can still rest on a VA referral or recommendation in some cases, such as when VA was at fault in making the referral, or when an unexpected event happened during the outside care VA referred you to.

Source: 38 CFR 3.361(f) (opens in new tab); M21-1 VIII.iv.6.B (opens in new tab)

A tort claim is a separate route with its own deadline

The Federal Tort Claims Act is a separate way to seek money when a government employee, acting within the scope of the job, causes harm through a wrongful act or omission. The claim goes to VA's Office of General Counsel on Standard Form 95, or in a signed writing that describes what happened in detail and states the total amount claimed; it is not a VA benefits form. VA says it must be received within 2 years of the date the claim accrued. It does not cover non-VA medical facilities, community care providers, or independent contractors, and VA's tort claims staff cannot give legal advice.

Source: VA.gov: claims under the Federal Tort Claims Act (opens in new tab)

A tort award is offset against 1151 compensation

If a court judgment is awarded or a settlement is made under the Federal Tort Claims Act for the same disability, VA offsets your share of it, including your share of the attorney fees, against the 1151 compensation it would otherwise pay. For a structured settlement, the offset is your share of what the settlement cost the government.

Source: 38 CFR 3.362(b) (opens in new tab); 38 CFR 3.362(d) (opens in new tab)

When VA care caused a death

A surviving spouse, child, or parent can claim DIC under the same rules when VA care, VR&E, or CWT caused the veteran's death. The claim goes on VA Form 21P-534EZ for a spouse or child, or VA Form 21P-535 for a parent. A claim received within 1 year of the death lets DIC start the first day of the month of death. Some survivor benefits do not follow from an 1151 death, including the VA home loan benefit for a surviving spouse.

Source: 38 CFR 3.361(g)(2) (opens in new tab); 38 CFR 3.400(i) (opens in new tab); M21-1 VIII.iv.6.B (opens in new tab); VA Form 21P-534EZ (opens in new tab); VA Form 21P-535 (opens in new tab)

A patient advocate is for care concerns, not claims

Each VA medical center has a Patient Advocate who works with staff to resolve concerns about your care. That is separate from a compensation claim, which goes on VA Form 21-526EZ.

Source: VA.gov: Patient Advocacy Program (opens in new tab); VA.gov: Title 38 U.S.C. 1151 claims (opens in new tab); VA Form 21-526EZ (opens in new tab)

BeneVets is informational and is not an accredited representative. Free help: an accredited VSO can work through VA benefits with you at no cost. Find an accredited VSO near you