• Internal VA manual changes bypass established law to restrict service-connection claims
• Veterans with congenital conditions and personality disorders face automatic denials
• Advocates warn guidelines conflict with federal regulations protecting veteran rights

WASHINGTON, DC (TDR) — The Department of Veterans Affairs has implemented significant changes to its internal M21-1 Adjudication Procedures Manual that veterans advocates say effectively reduce disability compensation claims by instructing processors to deny examinations for conditions the agency deems ineligible for service connection.

Internal Guidelines Override Veteran Protections

The M21-1 manual serves as the primary reference handbook for VA employees who adjudicate disability claims. While the manual provides guidance on rules and procedures, federal courts have consistently ruled it does not constitute law. The distinction matters because the changes instruct claims processors not to request medical examinations for conditions the VA has predetermined cannot be service-connected.

“The M21-1 is an internal manual used to convey guidance to VA adjudicators. It is not intended to establish substantive rules beyond those contained in statute and regulation.”

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This creates a troubling gap between VA internal policy and 38 CFR, the federal regulations that govern veterans’ benefits. Under 38 CFR 3.159, the VA has a legal duty to assist claimants in developing their claims, including arranging medical examinations when necessary. The updated M21-1 guidance appears to circumvent this obligation by categorically excluding certain conditions before any examination occurs.

Congenital Conditions and Personality Disorders Targeted

The changes specifically affect veterans claiming disabilities related to congenital conditions and personality disorders. Under 38 CFR 3.303(c), congenital or developmental defects, personality disorders, and mental deficiency are not considered diseases or injuries for VA compensation purposes. However, the regulation includes important exceptions that the M21-1 guidance may effectively nullify.

Veterans can still qualify for benefits if a congenital condition was aggravated by military service or if a separate service-connected condition developed on top of a personality disorder diagnosis. The problem arises when claims processors deny examinations outright, preventing veterans from ever establishing these qualifying circumstances.

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Between 2001 and 2010, the military discharged over 31,000 service members with personality disorder diagnoses, with advocates arguing many were actually suffering from PTSD or other service-connected conditions. Women have been disproportionately affected, representing roughly 26% of personality disorder discharges despite comprising only 17% of military personnel.

Legal Challenges Loom Over Manual Changes

Veterans advocacy organizations including Disabled American Veterans and the National Organization of Veterans’ Advocates have argued that M21-1 additions constitute “interpretive rules” subject to judicial review. In NOVA v. Secretary of Veterans Affairs, the Federal Circuit noted the VA “cannot insulate a rule from pre-enforcement review simply by placing it in the Manual.”

The timing of these changes coincides with the VA’s announcement that it processed a record 3 million disability claims in fiscal year 2025. While the agency touts reduced backlogs, critics question whether faster processing comes at the expense of thorough claim development that veterans deserve under federal law.

Veterans affected by these guideline changes can file supplemental claims with new evidence or seek assistance from VA-accredited attorneys to challenge denials. Legal experts recommend obtaining independent medical examinations and nexus letters that establish service connection before the VA’s internal guidelines can block the claim.

Will Congress intervene to ensure VA internal guidelines align with federal law, or will veterans continue fighting a system that denies examinations before their claims are properly evaluated?

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