Posted on by BNG

The Appeals Process: Appeals at the Board of Veterans’ Appeals

There is a perception that a lot of the regional offices’ decisions are appealed to the Board of Veterans’ Appeals. This is not accurate. Historically, only 4 percent of all claims the Veterans Benefits Administration (VBA) decides are appealed to the board. The perception probably comes from the increasing number of pending appeals, but that growth is explained by looking at the math. In the last four years, VBA has completed more claims than ever before in its history. Because VBA has completed so many more claims, the volume of appeals has also increased, even though the rate of appeals of VA decisions has remained steady.

If after receiving a statement of the case (SOC) from the regional office you still are not satisfied with the regional office’s decision, you can file a VA Form 9, Appeal to the Board of Veterans’ Appeals, within 60 days from the date the SOC is mailed.

Appeals at the Board of Veterans’ Appeals
Once the board receives your appeal, it assigns a docket date based on the date VA received your Form 9. This date is important: under the law, the board must work appeals in docket order. Currently, the median, or middle, docket date of appeals the board is working is July 2014. Some newer appeals can be pushed to the front of the line: those from older Veterans and survivors, those who are terminally-ill or those who have documented financial hardship, etc. It’s important to know that if the board remands (returns) your appeal to the regional office to gather more evidence, you won’t lose your place on the board’s docket.

Just like in the regional offices, several Veterans service organizations are located at the board. If you choose not to have a hearing before the board, your representative will write a legal argument on your behalf. The board will consider that argument when it conducts its own de novo review of your claim. If you choose to have a hearing, your representative will help you explain your case at that hearing. VA will transcribe the hearing and put it in your file. The board can do one of three things: grant your appeal, deny your appeal or send (remand) it back to the regional office for more action.

If you disagree with the board’s decision, you may pursue an appeal to the Court of Appeals for Veterans Claims (CAVC). If the CAVC denies your appeal, you can appeal to the U.S. Court of Appeals for the Federal Circuit. If you lose the appeal there, you can petition the U.S. Supreme Court for review. The Supreme Court grants review in very few appeals. Generally, the Court of Appeals for the Federal Circuit and the U.S. Supreme Court review only legal matters in an appeal, not agency decisions.

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision!

Visit: VA-Claims.org

For Cases & Decisions that Could Save Your VA Service-Connected Claims!

Visit: VAClaims.org ~ A Non-Profit Non Governmental Agency

Posted on by BNG

Segmented Lanes: a Process for Claims

Working at one of the Big Six Veteran Service Organizations taught me a few things about VA. First, the regional offices that process compensation claims are not equal, some are more consistent. But the most important thing I learned during my three years representing Veterans who filed appeals to the Board of Veterans Appeals is this: NO CLAIM IS THE SAME. I learned while some claims may appear similar, little variances in each make all the difference.

The Veterans Benefits Administration’s Transformation Plan is change of giant proportions. We’ve tested and measured more than 40 initiatives that are in some phase of implementation. Each initiative falls into one of three categories: people, process, or technology. It’s not enough to change only our processes, update technology, or only change the way we train our employees. VBA Transformation must take place across all three fronts.

Segmented Lanes is one of our new processes that we have implemented at 16 regional offices. The rest of our regional offices get Segmented Lanes throughout 2013. When you file a claim or send evidence to support your claim, our Intake Processing Centers sort it into one of three Segmented Lanes: Express, Core, or Special Operations. This allows VBA to identify at the earliest possible point any Veteran who requires expedited handling, such as a Veteran experiencing financial hardship, a homeless Veteran, a Veteran over the age of 75 or a Veteran who has a terminal illness.

For the rest of us, Segmented Lanes helps get our claims processed faster, in the hands of the right processor, increases accuracy and standardizes the process across all regional offices. This means that the process at the New Orleans Regional Office is the exact same process at the Salt Lake City Regional Office.

The lanes break down like this:

Express Lane: claims that have one or two contentions, or fully developed claims (an example would be if a Veteran files for an increase in compensation for a back issue and is also seeking to have her left hip condition service connected)
Core Lane: claims that have three or more contentions, or any claim that does not meet the criteria for Express or Special Operations.
Special Operations: All claims that require special handling because of their nature (examples are Post Traumatic Stress Disorder associated with Military Sexual Trauma, former Prisoners of War, Traumatic Brain Injury).
Each lane has dedicated claims processors whose skills and expertise match the lane to which they are assigned. This is how VA will process claims more quickly and more accurately. While no claim is the same, certain aspects of processing are alike, so if you work similar claims the process naturally speeds up and quality increases. When I worked at the Board, I often worked several claims in a row for disorders that resulted from a Military Sexual Trauma because some of the same regulations applied to those claims (like rating criteria), even though the claims themselves varied dramatically. Not having to refer to different parts of the regulations saved time, but I also became really good at claims resulting from MST. If I worked at a regional office today, I would probably be in the Special Operations lane.

Another way the lanes are ensuring speed and quality is through our Fully Developed Claims program. FDCs are claims where the Veteran certifies at the time they submit the claim that he or she has provided all evidence. That certification allows VA to move forward without waiting the mandatory waiting period for the Veteran to submit evidence. Veterans can file an informal claim stating they intend to file a claim for benefits using FDC to preserve an effective date and allow them time to collect evidence. We have assigned these claims to the Express lane, allowing FDC claims to be determined in an average of 100 days.

Veteran Service Organizations are available to help Veterans, their families and survivors file claims using both the traditional process and the Fully Developed Claims process. They provide this service regardless of whether you are a member. Let them help you.

Segmented Lanes is just one part of our Transformation and as such and it alone will not eliminate the backlog. But collectively, the initiatives will give VA the ability to process all claims within 125 days at 98 percent quality.

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision!

Visit: VA-Claims.org

For Cases & Decisions that Could Save Your VA Service-Connected Claims!

Visit: VAClaims.org ~ A Non-Profit Non Governmental Agency

Posted on by BNG · 1 Comment

How Veterans Can Successfully File a VA Compensation Claim

There are two ways to file a VA compensation claim: print the 526EZ and mail/fax it, or submit it electronically through VA and DoD’s eBenefits web portal. Most Veterans opt for the former, cross their fingers, and hope for the best. But unless you are just leaving the military, with well-documented and easily accessible service treatment records, this isn’t the best approach.

Intent to file
The Intent to File is required, but here’s why it’s a good thing: It immediately establishes your effective date for pay purposes. Best of all, it only takes a few minutes to complete online in eBenefits. (You can submit your Intent to File online in eBenefits here)

We know that it may take you some time to gather all the evidence you need to support your fully developed claim (FDC), such as your service treatment records, private treatment records and DBQs, and written witness/buddy/commander/spouse/lay statements. The Intent to File for a VA compensation claim lets VA know that you are planning to file a claim, and it locks in your “backpay” date. You then have one year to complete your claim application.

What info does VA need from me?
To receive VA disability compensation, you must meet three criteria: an event in service that caused or aggravated a disability or illness; a current diagnosis of a medical disability or illness; and a medical opinion connecting the two (the latter as a result/because of the former).

Event in service is something that happened in service that caused or aggravated your current disability. For example, you fractured an ankle in service and now have arthritis in that ankle. Or, you served in Vietnam, were exposed to Agent Orange, and now have a disease that is considered presumptive for Agent Orange exposure;
A current VA or private doctor’s diagnosis showing that you have a medical condition related to the service event; and
A doctor’s opinion that the event in service and current diagnosis are connected. This is called the nexus. Unless the connection is obvious through your medical records, this opinion, or nexus, will usually come from your VA-scheduled Compensation & Pension (C&P) exam. For presumptive illnesses, VA presumes the connection between the documented event in service and the current diagnosed illness. In this case the nexus is established by law.
Without all three of these items, a VA compensation claim can’t be granted. It’s like a three legged stool – without any one of these legs, the stool will fall over. If you provide evidence of the first two items but not the third, VA will schedule you for a C&P exam to determine a doctor’s opinion for the third. Be aware that just because a doctor’s opinion is requested on service connection that that doesn’t mean a doctor will agree that your current condition is related to your service.

Write a statement in support of your claim
When filing your VA compensation claim, include a VA Form 21-4138. This is called the Statement in Support of Claim. It’s important to write a separate paragraph for each disability you are claiming. It’s equally important to explain how the event in service (be specific) affects your current disability or symptoms related to your injury or illness. Provide every piece of evidence from the event that you can think of, such as personnel records, award narratives, pictures, medical records, unit profiles, prescriptions, etc. If you don’t think this event is in your service personnel or medical records, find someone you served with to fill out a form to provide their witness statement to the event. While a witness statement alone usually is not enough to grant a claim, it can be combined with other evidence to strengthen a claim for service connection.

Your statement is considered evidence, just like your military or treatment records, and the rater will use it to make the decision. It also tells the rating team where to look in your records, and the timeframe for information to validate your claim.

Include medical records
VA can access treatment records from other VA and military medical facilities, but don’t assume that “VA has everything it needs.” Remember above: VA and military records are just one leg of the three-legged stool.

If you have your service medical records, include them as evidence. It also helps VA if you include where it was that you’ve been treated for your medical conditions on your application (name of treatment facility). You should also highlight the pages and passages that refer to your medical conditions, such as lab results and diagnoses, which may eliminate weeks or even months of processing time. Providing all of this information with your claim will help the rating team process your claim more quickly.

If you don’t have your service records, VA will request them from your military branch archives, but this can take several weeks or more. If you don’t have them and would prefer to request them yourself, contact the National Personnel Records Center (NPRC) here.

Compensation and Pension: Your C&P exam
Even if you submit all of your medical records, you may still be asked to go to a C&P exam. This is not a typical doctor’s exam. You won’t be diagnosed or treated, and in some cases, the doctor may just review your records—including any statements in your file—and ask you a few questions. While this may seem unusual for an exam, the doctor is actually filling in a Disability Benefits Questionnaire (DBQ), which the rater will use to determine if your claim can be granted, and at what percentage.

So, in the exam, be honest and specific with your answers. For example, if the doctor asks about an injury, instead of saying “I hurt my back in the service,” you should say “I was getting something off of a shelf in the warehouse and fell off a ladder. There is an accident report. My back has given me problems ever since.” This allows the doctor to connect an incident in service to the current disability, and the DBQ the doctor submits will contain an opinion that your disability is either more- or less-likely than not connected to your service. That’s the third leg of the stool.

What if I need help?
If all of this sounds like Greek to you, then you should either follow our helpful tutorials on YouTube that walk you through the VA compensation claim application process, or enlist the help (FREE) of a Veterans Service Organization (VSO) to assist you.

Then what?
Once you or your VSO has submitted your VA compensation claim, you can check on its current status in eBenefits (hover over “Manage,” then click on “View or update your Compensation and Pension (C&P) claim”). On the status page, you can view more detailed information by clicking on the claim date.

It’s important to note that, once you have submitted your fully-developed claim online, or by mail/fax, you are telling VA that you have no further evidence or information to submit. Submitting un-requested evidence or information after it has been submitted will cause a delay in processing.

Did you know?
By providing a more complete picture of your situation to the rating team when you file your VA compensation claim application, you not only make it easier for the raters to find your information and process your claim, but you also increase your chances of having your claim granted. Although it will take a little more effort on your part, it can pay off with faster VA processing, and will increase your chances of a successful claim the first time.

Remember, the rating team—most of whom are Veterans just like you—is on your side, but you can help them by including everything they need to approve your claim.

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision!

Visit: VA-Claims.org

For Cases & Decisions that Could Save Your VA Service-Connected Claims!

Visit: VAClaims.org ~ A Non-Profit Non Governmental Agency

Posted on by BNG

VA to Redesign Benefits Program for Service Members Leaving the Military Service

VA plans to redesign the Benefits Delivery at Discharge program to enable service members to receive disability benefit decisions the day after their discharge. The redesigned program will go into effect October 1.

VA is dedicated to ensuring that Veterans get the benefits they have earned and deserve as quickly and accurately as possible. Changes to the Benefits Delivery at Discharge program will increase VA’s ability to conduct exams, review medical evidence, and process ratings prior to a service member’s release from active duty. In most cases, VA benefits decisions will be provided the day after discharge.

Service member’s using the program can submit their claim from 90 to 180 days prior to discharge from active duty. Previously, the submission time was 60 to 180 days before discharge. This extra time is needed to ensure medical exams can be conducted and evaluated, and claims rated prior to separation. To participate, the service member must be available to attend the VA examination(s) for 45 days from the date of claim submission.

In order to focus resources on those who participate in the redesigned program, the Quick Start program will be eliminated. Quick Start allowed service members who did not meet the Benefits Delivery at Discharge window, to submit their claim and evidence up until one day before discharge from active duty.

While service members can still submit their claim with 89 days or less prior to discharge, the claims will not be processed until after their separation. These claims will be processed as either a fully developed claim or traditional claim as appropriate.

More information on the Benefits Delivery at Discharge program is available on the website, or at military Transition Assistance Program (TAP) offices.

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision!

Visit: VA-Claims.org

For Cases & Decisions that Could Save Your VA Service-Connected Claims!

Visit: VAClaims.org ~ A Non-Profit Non Governmental Agency

Posted on by BNG

VA Apprenticeship Program to Train, Employ Veterans to Assist other Veterans in Properly Filing for VA benefits

Veterans service organizations (VSOs) play a major role as advocates for the Veteran community, and as partners with VA, to ensure this nation’s Veterans receive the benefits they have earned. An important part of this partnership is to support VSOs as they train their advisors on the benefit process.

VA’s Vocational Rehabilitation and Employment (VR&E) program recently entered in to an agreement with Paralyzed Veterans of America to participate in an apprenticeship program to train Paralyzed Veterans’ employees on how to assist Veterans to file for and obtain their benefits. A similar program is currently in effect with the Disabled American Veterans organization.

Paralyzed Veterans is an advocate for quality health care, spinal cord injury and disease research, VA benefits, and civil rights for Veterans and all people with disabilities. As a service oriented non-profit organization, Paralyzed Veterans employs national service officers to serve Veterans.

“The apprenticeship program with Paralyzed Veterans will put much needed resources into communities nationwide to work with our Veterans and assist them in applying for benefits,” stated Tim Johnston, supervisor for rehabilitation services at VR&E. “This not only gives those accepted into the program a skill, but ensures that Veterans in communities, large and small, have access to trained professionals who can help them understand the process and apply for those benefits they have earned and deserve.”

In a memorandum of understanding between the two organizations, Paralyzed Veterans will provide a 36-month on-the-job training program to qualified Veterans who are selected for the apprenticeship program. Most of the apprenticeship is supervised work with some classroom and on-line learning. These are full-time national service officer positions.

Pay during the apprenticeship is supplemented by the VR&E program. For the first 12 months, those selected for the program are paid $2,890 per month by Paralyzed Veterans, and an additional $651 from VA as a training allowance. In the remainder of the apprenticeship, Paralyzed Veterans pays $3,166.66, and VR&E pays $375 per month for training. The VR&E training allowance to the Veteran is tax-free. VA also pays for the training and necessary supplies.

Selection for the program generally comes from two sources. Paralyzed Veterans may notify VR&E that they have a candidate in mind, or a VA vocational rehabilitation counselor can recommend someone for the program.

The current memorandum of understanding will be in effect until May 2021.

How to apply

To be considered for this program, you must be receiving services from VA’s Vocational Rehabilitation and Employment  program. If you are not receiving services from the VR&E program, but would like to, you will need to apply.

To apply to VR&E, please go to eBenefits and click on Vocational Rehabilitation and Employment under Apply.  You may also submit a completed application (VAF 28-1900) at the local VA Regional or outbased office, or mail the completed application to the closest regional office. Remember: not all Veterans are eligible for VR&E benefits, but to become eligible, you must have a service-connected disability of 10 percent or more.

Next, after establishing eligibility, you must also be determined entitled for services under VR&E. Entitlement is based on the Veteran having an employment handicap affecting their ability to obtain and maintain employment. It is after you have been found entitled and you have had an opportunity(ies) to meet with your vocational rehabilitation counselor that you will discuss your interest in the apprenticeship program. If the apprenticeship program seems like a good fit, the counselor may recommend you for the program. Additionally, there must be a need within the local Paralyzed Veterans of America office for a trainee.

Paralyzed Veterans may also notify VR&E that they have a candidate in mind. This candidate must also be receiving VR&E services, or they will need to go through the process explained above.

If you have any further questions, please contact your local VR&E regional office. 

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision!

Visit: VA-Claims.org

For Cases & Decisions that Could Save Your VA Service-Connected Claims!

Visit: VAClaims.org ~ A Non-Profit Non Governmental Agency

Posted on by BNG

How Veterans Can File a Notice of Disagreement on their VA Compensation Claim

If you disagree with the decision VA made on your disability compensation claim, your first step is to formally tell VA that you disagree.

I received my rating and it’s wrong

“I received my rating and it’s wrong” is a statement our call center agents hear every day. You may think that VA shouldn’t have denied your claim, that you should have received a higher percentage, or that the effective date was wrong, but the odds are against it. That’s not to say that VA never makes a mistake, but an overwhelming majority of the time VA makes the correct decision based on the evidence available. In fact, VA’s issue-rating accuracy is 95 percent.

This high level of accuracy is in part because most of the decision-making is now automated. Medical information is input by the rater, and the rating for each issue is calculated and justification is provided.

So, if you aren’t happy with your rating, first carefully read your notification letter and rating decision. These documents should explain, issue-by-issue, why you received your rating, and what is needed for the next higher rating. It should also explain what the effective date is and why. If VA did not service connect your requested condition, the decision letter explains why the condition was not service connected.

If you have questions about your rating decision you can always go to your local Veterans Service Organization (VSO), sit down with a representative at your local VA office, or call the VA National Call Center at 800-827-1000. They can explain your rating so that you can decide what to do next.

If you’ve reviewed the claim decision and still think VA is wrong, you should provide additional evidence to support your condition(s) with your NOD. The claim decision becomes certified after 30 days, but it isn’t final until one year after the date of the decision. You can file a Notice of Disagreement at any time up to one year from the date of decision.

Submitting the Notice of Disagreement

To file the NOD, submit the VA-Form 21-0958, Notice of Disagreement that was included with your claim decision. This is your chance to tell VA how you feel the decision is wrong. If you don’t feel confident enough to do this on your own, your VSO can help you.

The NOD form contains blocks for each issue of contention (the medical conditions for which you filed the claim), for example, knee condition or kidney stones. Only list the conditions on the NOD where you disagree with the rating. For example, if you were rated for three conditions and only disagree with one decision, only list the decision you disagree with. Then check the block indicating what you disagree with (service connection, the rating level, or effective date).

The most important section is the narrative to explain why you feel VA incorrectly decided your claim. Don’t leave this blank. It’s entirely possible that VA missed something, and if you don’t point it out, VA will never know. Tell your story, but be clear and concise. If you need more space, add additional pages and documentation, such as private medical records, to make your point.

As explained above, there are three primary issues with your claim decision that you can disagree with: service connection, effective date and evaluation of disability (rating percentage). There is also an option for “other” if these are not appropriate.

  • Service Connection: If your claim came back “not service-connected,” explain why you think the condition should have been service connected. Was it first diagnosed in service? Was there an injury in service? Is this a condition that was caused or aggravated by a service-connected condition? For example, a service-connected knee condition can lead to back strain. The back issues are then secondary to the knee condition and can be service connected. Be specific and provide the date of the initial injury or illness if possible. That helps the rater find the documentation needed in your service treatment or personnel records. If you have copies of official documentation that prove an event happened in service, for example the write-up for a medal, attach a copy. Most illnesses are compensable if diagnosed within a year of leaving active duty. You may have to include private treatment records to prove this. Buddy statements can provide additional evidence. If there is no connection between your illness and your time in service, VA can’t legally provide benefits.
  • Effective Date of Award: Usually the date of award is the date of claim for that specific issue, but there are instances where the date could be earlier. Some of these include, the date after your discharge for claims filed within a year of leaving active duty; date an Intent to File was received by the VA; or the date of diagnosis or eligibility for a higher level of compensation for increases. Your local Veterans Service Organization can help you determine if the effective date should have been earlier.
  • Evaluation of Disability: The most common area of disagreement is the evaluation of disability. The rating levels are determined by law and are based on your symptoms. In your claim decision letter, look for the description of the rating and the associated legal reference. This reference leads to a listing that shows what symptoms match the rating level for your condition. If you have documented symptoms or test results from your doctor that show you should be in a higher rating level, explain this in your narrative and add copies of the documentation to your submission.

You may want to read over the Schedule for Rating Disabilities (38 CFR, Part 1), which provides all of the information on how claims are rated, how VA math works (38 CFR, Part 1, Section 4.25), and how percentages are based on your symptoms (38CFR, Part 1, Subpart B). Warning: the CFR is dense with legalese and medical information, and it’s why we recommend you ask a VSO for assistance.

If your symptoms don’t meet the next higher rating level, VA cannot increase your rating. In this case, you are better off keeping the current rating, and if your symptoms worsen, you can always file a claim for an increase later.

The NOD also asks you to make a choice between the Decision Review Officer (DRO) process, or the traditional appellate review process.

In the DRO review, an experienced rater will conduct an in-depth review of your claim and any new evidence that you provide. The DRO may schedule you for an additional compensation and pension exam (C&P), or contact you with follow up questions.

In the traditional appellate process, a VA rating specialist will review the prior rating and any new evidence to see if a clear and unmistakable error (CUE) was made on the previous decision.

In both processes, a new decision can be made based upon the evidence of record. If you are uncertain about which option is best for you, check with your VSO for advice.

So what happens next?

After the DRO reviews your file, NOD, and any new evidence, they will make a decision. They may either provide a new rating or continue the current rating decision. Then, you will receive a Statement of the Case that describes the information that was reviewed and how the DRO came to their decision.

If you disagree with the new decision, the next step would be to file a VA Form 9 and appeal to the Board of Veterans Appeals. Depending on the complexity of your case, the formal appeal process can take several years (and every time you submit new evidence before a decision increases that wait). It is much better to ensure you provide all of the information and evidence to tell your story during the NOD phase since it will resolve your issue the fastest.

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision!

Visit: VA-Claims.org

For Cases & Decisions that Could Save Your VA Service-Connected Claims!

Visit: VAClaims.org ~ A Non-Profit Non Governmental Agency