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Monte Phillips

LLC Lawyer Master of Laws in Trial Practice
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HOW TO FILE A VA DISABILITY CLAIM

 

DON'T GO IT ALONE!


Seek Legal Counsel, under new rule in 2007, you can now hire an attorney to help you.


THIS IS A VERY COMPLEX AREA OF THE LAW-LET US HELP YOU GET ALL THE BENEFITS YOU DESERVE- 20% CONTINGENCY FEE-BACK DUE ONLY-YOU DO NOT HAVE TO PUT UP ANY MONEY TO HIRE US


NOTE TO VA CLAIMANTS-IF YOU GET A DENIAL OR DO NOT GET THE PERCENTAGE OF DISABILITY YOU SHOULD RECEIVE-YOU HAVE 1 YEAR TO FILE A NOTICE OF DISAGREEMENT- YOU MAY HAVE OTHER DEADLINES AS SHORT AS 30 DAYS TO RESPOND      DON'T DELAY


BEST ADVICE: CALL US IMMEDIATELY-WE WILL ADVISE YOU EVEN IF YOU DON'T RETAIN US


What are the Steps in Processing My Claim?

Step 1-You file your claim.

Step 2-The VA obtains evidence.

Step 3-You are examined at a VA hospital.

Step 4-Complete record is evaluated.

Step 5-A decision is made.


Other Information
What causes delays in the claims process?
How does the appeal process work?
What is the best way to communicate with the VA?
NationalPersonnelRecordsCenter
Fire Related Cases
Post Traumatic Stress Disorder


DEFINITIONS

In order to make our communications as clear as possible, we'd like to define some VA terms:

Compensation: The benefit paid to veterans whose disabilities arose from service. The disabilities themselves are often referred to as Service Connected or "S/C".

Pension:The benefit paid to veterans whose disabilities are not related to service and who have a financial hardship. The disabilities themselves are often referred to as Non-Service Connected or "NSC".

Rating Schedule:The guide the
VA uses to determine which disabilities they can pay for and the percent to which they are disabling.

Claim Number: How the VA monitors and identifies your claim. Any letters you receive from the VA should have the claim number in the upper right hand corner. The letters "C", "XC", "CSS" or "XSS" will precede your claim number. It is very important that you have this number available whenever you contact the VA.

Step 1: You File Your Claim
The disability claim process begins when you file a claim.
If you have never filed a disability claim with the VA, you will need to complete and submit a VA Form 21-526 (Veteran's Application for Compensation or Pension). You may complete the form with the assistance of a Veterans Service Officer at our office or you may call or write and have this form sent to you. Once you have completed the form, you should call our office and set up an appointment with a veteran service officer.

If you have questions while attempting to complete this form on your own, please call this office. It may save the VA having to delay processing your claim.

If you filed a claim in the past, whether you were granted or denied benefits, you do not need to complete a VA Form 21-526 again. However, the VA does need your signed statement telling the VA what you want to claim, why, and where you were treated for the claimed condition.

Step 2: The VA Obtains Evidence
(this step takes: 1-4 months)
Based on the disability claim you submit, the VA begins compiling evidence to support your claim. Thus, any evidence that you are able to secure beforehand and submit with your claim will expedite this step.

Your disability evaluation will be based on this evidence, so it is essential that the VA has complete and accurate information.

The VA will assist you by verifying your service dates (based on the information that you furnish on your application) and requesting your service medical records. If you send a signed medical release, the VA will also request your private medical records.

The VA may request more information from you. This may include letters detailing specific experiences in service or information on your dependents, employment history or income. You can help speed the process by providing complete addresses for the medical care and be as exact as possible in reporting dates of treatment. Please send requested information in as soon as possible. You don't need to wait until the 60 days the VA has given you have expired. You should also make sure that you include your VA file number on all pages of anything that you submit.


Step 3: You Are Examined at a VA Hospital
(this step takes 1-3 months)
The VA will often request exams while waiting for other evidence to arrive. Sometimes, the VA first has to review the other evidence to be certain they are requesting the proper exams. The exams that the VA request for you will depend on your claim and treatment history.

The VA Medical Center will schedule you for the requested exam. They will contact you directly by mail to let you know when and what exams are scheduled for you. After each exam, an examination report will be prepared and sent to the VA. You can help expedite this process by keeping your exam appointments and by asking your private medical providers to send a copy of your records to the VA. Remember to ask them also to include your VA file number on the records that they submit.

Step 4: Complete Record is Rated
(this step takes: 2-3 months)
As evidence is received; VA places the records in your claims folder. When the VA has all the necessary evidence, your claim is ready to be rated. Due to VA’s current backlog, there may be a two or three month wait before your individual claim can be rated.

VA evaluates the medical evidence and other documents to support your medical condition. The VA then identifies how these conditions correspond to the rating schedule. This schedule designates what disabilities the VA can pay for and at what percent. The schedule is based on the laws passed by Congress.

The VA will consider all evidence submitted and will pay the maximum benefit allowed by law. If there is a change in your disability after you've filed your claim or if you want the VA to evaluate additional disabilities, please let us know as soon as possible.


Step 5: A Decision is Made
(this step takes 1-3 weeks)
After the rating is completed, you will be notified promptly of the decision. The VA will provide you with the reasons for all decisions to grant or deny benefits. If you do not agree with the VA’s decision, you have the right to appeal.


WHAT CAN I DO TO HELP...? 
 

ü      Be as thorough as possible in completing your claim application. Do NOT assume that we have information on file already.

ü      Advise our office when you receive correspondence from the VA.  This is YOUR claim; the VA will not send our office a copy of the correspondence you receive.

ü      Respond as quickly and completely as possible when asked for information.

ü      If you are scheduled for a medical exam, please keep your appointment. If you are unable to keep your appointment (for whatever reason), please contact the VA Medical Center where you were scheduled to report as soon as possible.

ü      If private medical providers have treated you for your disability, please obtain a copy of your treatment record.

ü      Let us know, as soon as possible, if you change your address or phone number.

ü      If you are in doubt about what to do at any time, please contact us at (937) 382-3233.

What Causes Delays?
Claims within a specific category are processed in the order they are received. Time to process is particularly hard to estimate on cases involving PTSD, Persian Gulf illnesses, reserve units, and fire-related cases. The time it takes to process a claim varies for several reasons. First, the VA needs to get the information needed to make a decision; this includes medical records, verification of honorable discharges, copies of certificates, etc. Although the
VA is a government department, they have no special way to get records from private hospitals, other government agencies, records centers (such as the National Personnel Records Center), or military bases, hospitals or reserve units. Claims with records from several sources take longer to get records than others. One way to help is to get as many of your records as possible to submit with your claim.


Appeals of Decisions
An appeal of a local decision involves many steps, some optional and some necessary, and strict time limits. In order, the steps are

 

1.  Notice of Disagreement (NOD)

 

2.  Statement of the Case (SOC)

 

3.  Formal Appeal (VA Form 9 or equivalent)

 

4.  Hearings (Optional)

 

5.  Board of Veterans' Appeals (BVA)

 

6.  United States Court of Appeals for Veterans' Claims (CAVC)

The case may also involve remands at the BVA and/or COVA levels. Someone may have several appeals at once, and several issues may be included in the same appeal. Usually, all issues on one VA decision will be included in the same appeal.

Notice of Disagreement

A Notice of Disagreement is the first step in an appeal. It simply involves a written statement that you disagree with a decision that has been made. Certain things should be kept in mind when submitting a NOD:

Be specific about what you are disagreeing with. If a decision was made on seven issues, specify the ones you are referring to- don't simply say you disagree with the decision.

Make sure that a decision has been made. For most decisions when benefits are reduced or terminated, the VA is required to propose it first; this is called a pre-determination notice. A NOD can only be accepted if a final decision has been made, not if a proposal has been made. If you don't receive paperwork describing the appeals process (a VA Form 4107), check your letter to see if it is a proposal.

Check the time limit. A NOD must be filed within one year of the date of the letter informing you of the decision. If you were notified of a decision in 1994, it is too late to file a NOD. Your option at that point is to file another claim, or request to reopen a claim, for the same condition as before.


Statement of the Case

A Statement of the Case is a summary of the evidence considered, actions taken, and decisions made, plus the laws governing the decision. A SOC must be done when a Notice of Disagreement is filed or when new evidence is received. Once the first SOC is done on an appeal, any ones done after those are Supplemental Statements of the Case (SSOC). An appeal may have several SSOC's.

 

Formal Appeal (VA Form 9 or equivalent)

An appeal must be formal before it can continue to higher levels. The standard form for formalizing (sometimes called perfecting) an appeal is the VA Form 9. This form must be received no later than one of these two dates:

    *one year from the date of the letter notifying you of the decision
    *60 days after the date of the Statement of the Case

 

Hearings (Optional)

Hearings are a chance for claimants to present evidence in person; they are totally optional. A Hearing Officer (HO) holds them at the regional office. If you have a hearing, the HO will review the evidence in conjunction with the testimony and make a decision on your case. If the issue is not resolved in your favor, the appeal will continue.

Board of Veterans' Appeals (BVA)

The Board of Veterans Appeals, located in WashingtonDC , is the highest appellate body in VA. Although most decisions are done in Washington , BVA does have travel boards that come to local offices. Due to a number of reasons, the pending workload at BVA has dramatically increased in the past few years. It is not unusual for an appeal to take 2 years or more from the initial NOD to the final BVA decision.

BVA looks at all of the evidence regarding the issue under appeal. If BVA decides that more information is needed to make a decision, it will issue a remand to the local office. BVA will not reconsider the case until its instructions in the remand are done. If the evidence is sufficient, BVA will issue a decision. This decision is the final VA one on the issue, and the appeal will have ended. However, the Court of Veterans Appeals can review a BVA decision if an appeal to the court is filed within 120 days of the BVA decision.

United StatesCourt of Appeals for Veterans' Claims (CAVC)

The United States Court of Appeals for Veterans' Claims (CAVC), located in WashingtonDC , was created in 1988 to review matters of law about VA benefits and decisions. CAVC is not part of VA; it is an appellate court in the US judicial system. CAVC will only consider decisions made by the Board of Veterans Appeals after 1988. As in most courts, one must have either an attorney or personal knowledge of legal proceedings in order to file the correct legal paperwork and conduct the appeal. CAVC decisions usually concern the procedural, legal issues involved in the "letter of the law". The deadline for filing an appeal to COVA is 120 days after the BVA decision (using the date of the letter to you informing you of the decision).


National Personnel Records Center

The National Personnel Records Center (NPRC), located in St. Louis , is the main center for a military person's records. NPRC has millions of records. Depending on the branch and years of service, the VA will make a request for records to NPRC. If medical records are available at NPRC, the originals will also be sent. No copies are left at NPRC. Any individual can request their records from NPRC using a standard form (SF 180), which we can provide to you upon request. However, to reduce the substantial backlog at NPRC, duplicate requests from VA, individuals, and/or service organizations should not be made at the same time. If you receive notification from the VA that records could not be located, you may find it more efficient to deal with NPRC directly.

 

Fire-related cases

On July 12, 1973, a disastrous fire at NPRC (MPR) destroyed approximately 16-18 million Official Military Personnel Files. The affected record collections are described below.

Branch

Personnel and Period Affected

Estimated Loss

Army

Personnel discharged November 1, 1912, to January 1, 1960

80%

Air Force

Personnel discharged, September 25, 1947, to January 1, 1964
(with names alphabetically after Hubbard, James E.)

75%


No duplicate copies of the records that were destroyed in the fire were maintained, nor was a microfilm copy ever produced. There were no indexes created prior to the fire.  In addition, millions of documents had been lent to the Department of Veterans Affairs before the fire occurred.  Therefore, a complete listing of the records that were lost is not available.  Nevertheless, NPRC (MPR) uses many alternate sources in its efforts to reconstruct basic service information to respond to requests.

 

Reservists

If you are a reservist, you may want to request that your unit forward a copy of your medical records to this office. If you are filing a claim for a disability that occurred while you were on reserve duty, we also need a copy of the paperwork showing your duty status on the day you were injured. We frequently experience significant delays in receiving records from reserve units.



PTSD

PTSD cases often take several months to process. In order to establish a finding of PTSD, as opposed to other mental conditions, a general stressing situation (the stressor) must be identified. Sometimes the stressor is apparent on the discharge document (for example, a Purple Heart). Often, the VA must request personnel and other records from the NationalPersonnelRecordsCenter . However, while personnel records will show units, job classifications, etc., they do not show events that happened. For those records, VA must make an additional request to another records center for information they may have on particular events. This search is why the VA needs as specific information as possible on the stressor form that is sent (names, dates, units, etc.). The current backlog at this records center is several months. This time, added to what it takes to get records from NPRC, is why PTSD cases take longer to process.