Only way to confirm a bad pressure relief valve is to do a return flow test with a special fitting. Any flow from the PR valve requires replacement.
Symptoms can be hard start, no start, decreased power, etc. Fuel flow test must be done.
Valve can be replaced by itself, and not with the rail. As long as its torqued properly to 45 ft-lb, everything will be ok. Surface cleanliness is critical, and don't ever use and abrasives on the mating surfaces. Price of new valve from Cummins is around $350.