Appeals Reform: An Adjudicator’s Role in Processing Appeals Under the New System

How Do Adjudicators Process Appeals in the Legacy Appeals System?

In the Legacy appeals system, adjudicators must address several tasks at different stages when processing appeals.  Generally speaking, the adjudication process is broken down into three stages:

1. Review. In this initial stage, the adjudicators will review the veteran’s claims file.  Specifically, the adjudicator will go through all of the documents, noting the ones that are relevant to the issues on appeal and contain pertinent evidence.  Adjudicators will also ensure that the issues listed in VACOLS – the current computer application used to manage appeals – accurately reflect the issues on appeal.  After a full review, adjudicators will determine whether additional development or administrative action is needed.

2. Analyze. After reviewing the veteran’s claims file and identifying all relevant evidence and information, the adjudicators will analyze this evidence along with all applicable laws and regulations.  In doing so, the adjudicators will determine whether each issue warrants a grant, denial, or remand.

3. Drafting. The final stage of the adjudicator’s role in processing appeals involves drafting the decision itself.  Decisions must include personal details such as the veteran’s name and file number, periods of service, and contentions.  Additionally, adjudicators must explain the elements of service connection, the criteria for the next higher rating, and any presumptions that may apply.  Most importantly, decisions must include any entitlement to benefits that is awarded, and any development required to receive a more favorable finding.

How Does an Adjudicator’s Role Change Under Appeals Reform?

Based on the information currently available, the adjudicator’s role in processing appeals under Appeals Reform will be very similar.  However, we anticipate the following changes at both the review and drafting stages of the adjudication process:

1. Under Appeals Reform, adjudicators will ensure that the correct issues are listed in Caseflow rather than VACOLS, as Caseflow will be the new computer application used under Appeals Reform.  Additionally, when adjudicators are determining whether additional development is needed, they will only consider pre-decisional duty to assist errors, which occurred before the Agency of Original Jurisdiction’s (RO, VA Medical Center) initial decision.  When reviewing the claims file, the adjudicators will only consider evidence that was submitted during a time period in which it was permitted.  On the other hand, adjudicators will make a note of any evidence that was submitted during a time when it was not permitted.

2. When drafting decisions, adjudicators will likely have to include the same information as mentioned above.  However, we also predict adjudicators will be required to include details about the evidentiary record considered when making the decision and list out any favorable findings that were made.  Under Appeals Reform, favorable findings will be binding on all of VA and only rebuttable by clear and unmistakable evidence.