[Code of Federal Regulations]
[Title 38, Volume 1]
[Revised as of January 1, 2007]
From the U.S. Government Printing Office via GPO Access
[CITE: 38CFR14.616]

[Page 581-582]
 
            TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF
 
                CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS
 
PART 14_LEGAL SERVICES, GENERAL COUNSEL, AND MISCELLANEOUS
 
Sec.  14.616  Form and place of filing claim.

    (a) Form of claim. Claims arising under 38 U.S.C. 515(b) will be 
prepared in the form of a sworn statement and submitted in duplicate. 
The original copy of the claim will be sworn to or affirmed before an 
official with authority to administer oaths or affirmations and will 
contain the following information, at least:
    (1) The name and address of claimant;
    (2) The amount claimed for injury or death, and for property loss or 
damage;
    (3) If property was lost or damaged, the amount paid or payable by 
the insurer together with the name of the insurer;
    (4) A detailed statement of the facts and circumstances giving rise 
to the claim, including the time, place, and date of the accident or 
incident;
    (5) If property was involved, a description of the property and the 
nature and extent of the damage and the cost of repair or replacement 
based upon at least two impartial estimates;
    (6) If personal injury was involved, the nature of the injury, the 
cost of medical and/or hospital services, and time and income lost due 
to the injury;
    (7) If death is involved, the names and ages of claimants and their 
relationship to decedent;
    (8) The name and official position of the employee of the United 
States allegedly responsible for the accident or injury, or loss or 
damage of property;
    (9) The names and addresses of any witnesses to accident or 
incident; and
    (10) If desired, the law applicable to the claim.
    (b) Place of filing claim. Claims arising in the Philippines under 
38 U.S.C. 515(b) will be filed with the Director, Department of Veterans 
Affairs Regional Office, Manila, Republic of the Philippines. Claims 
arising in other foreign countries will be filed with the American 
Embassy or Consulate nearest the place where the incident giving rise to 
the claim took place.
    (c) Evidence to be submitted by claimant--(1) General. The amount 
claimed on account of damage to or loss of property or on account of 
personal injury or death shall, so far as possible, be substantiated by 
competent evidence. Supporting statements, estimates and the like will, 
if possible, be obtained from disinterested parties. All evidence will 
be submitted in duplicate. Original evidence or certified copies shall 
be attached to the original copy of the claim, and simple copies shall 
be attached to the other copy of the claim. All documents in other than 
the English language will be accompanied by English translations.
    (2) Personal injury or death. In support of claims for personal 
injury or death, the claimant will submit, as may be appropriate, 
itemized bills for medical, hospital, or burial expenses actually 
incurred; a statement from the claimant's or decedent's employer as to 
time and income lost from work; and a written report by the attending 
physician with respect to the nature and extent of the injury, the 
nature and extent of treatment, the degree of disability, the period of 
hospitalization or incapacitation, and the prognosis as to future 
treatment, hospitalization and the like.
    (3) Damage to personal property. In support of claims for damage to 
personal property which has been repaired, the claimant will submit an 
itemized receipt, or, if not repaired, itemized estimates of the cost of 
repairs by two reliable parties who specialize in such work. If the 
property is not economically repairable, the claimant will submit 
corroborative statements of two reliable, qualified persons with respect 
to cost, age of the property and salvage value.
    (4) Damage to real property. In support of claims for damage to 
land, trees, buildings, fences, or other improvements to real property, 
the claimant will submit an itemized receipt if repairs have been made, 
or, if repairs have not been made, itemized estimates of the cost of 
repairs by two reliable persons who specialize in such work. If the 
property is not economically repairable, the claimant will submit 
corroborative statements of two reliable, qualified persons with respect

[[Page 582]]

to the value of the improvements both before and after the accident or 
incident and the cost of replacements.
    (5) Damage to crops. In support of claims for damage to crops, the 
claimant will submit an itemized signed statement showing the number of 
acres, or other unit measure of crop damaged, the probable yield per 
unit, the gross amount which would have been realized from such probable 
yield and an estimate of the costs of cultivating, harvesting and 
marketing the crop. If the crop is one which need not be planted each 
year, the diminution in value of the land beyond the damage to the 
current year's crop will also be stated.

(Approved by the Office of Management and Budget under control number 
2900-0437)

[38 FR 5474, Mar. 1, 1973, as amended at 42 FR 41418, Aug. 17, 1977; 49 
FR 32848, Aug. 17, 1984]