Filing a Claim for VA Disability Benefits Under Appeals Reform

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How to File a Claim Under Appeals Reform

Appeals Reform consists of many changes directed towards offering greater choice to veterans and faster decisions from VA.  Such changes extend to the process of filing a claim for disability benefits insofar as VA proposes to amend the regulation regarding this procedure (i.e. 38 CFR § 3.155).  Within this amendment, VA suggests modifying the definition of “claim” to include definitions of the terms “initial claim” and “supplemental claim” as follows:

• Initial Claim. A claim for a benefit other than a supplemental claim, including the first filing by a claimant (original claim) and a subsequent claim filed by a claimant for an increase in a disability evaluation, a new benefit, or a new disability.

• Supplemental Claim. A claim for benefits filed by a claimant who had previously filed a claim for the same or similar benefits on the same or similar basis.  Here, VA is required to readjudicate the claim if new and relevant evidence is presented.

Incomplete supplemental claim forms would be considered filed on the date of receipt, as long as a complete supplemental claim is submitted within one year of the filing date of the incomplete claim.  However, the intent to file a claim, would not be applied to supplemental claims.  Under Appeals Reform, the new framework provides that a claimant can maintain his or her effective date by submitting a request for review under any of the three new lanes within one year of the date of the decision denying benefits.  As a result, the intent to file process that exists within the Legacy appeals system would not apply to supplemental claims.

Complete Claims

While VA proposes to add a distinction between “initial” and “supplemental”, the overall definition of a claim itself remains the same.  Namely, a claim is considered to be written communication requesting a determination of entitlement to a specific benefit under the laws administered by VA, submitted on an application form prescribed by the Secretary of Veterans Affairs.  Under Appeals Reform, complete claims must include the following:

• Application form
• Name of the claimant and relationship to the veteran (if applicable)
• Signature of the claimant
• Identification of the benefit sought
• Description of the symptoms/medical condition on which the benefit is based
• For supplemental claims, potentially new evidence must be identified or included

Application Forms

As mentioned above, claims for disability compensation must be submitted on the application form that is specifically required by VA.  The Legacy appeals system currently uses variations of VA Form 21-526, Veteran’s Application for Compensation and/or Pension, when it comes to filing claims.  However, several new forms are proposed under Appeals Reform including the following:

• VA Form 20-0995, Veteran’s Supplemental Claim Application. Claimants will be required to submit this form in order to initiate a supplemental claim for VA disability compensation.  VA suggests this form is necessary to identify the issues that a claimant is dissatisfied with and then determine the claimant’s eligibility to apply for a supplemental claim.

• VA Form 20-0996: Application for Higher-Level Review. Claimants will be required to submit this form in order to request a higher-level review of a VA decision on a claim for benefits.  VA suggests this form is necessary to identify the issues that a claimant is dissatisfied with and then use this information to initiate a higher-level review by an agency adjudicator.

• VA Form 10182: Notice of Disagreement. Claimants will be required to submit this form in order to appeal one or more previously decided issues to the Board.  To be accepted by the Board, a complete NOD must identify the specific determination with which the claimant disagrees, and must indicate if the claimant requests to have a hearing before the Board, an opportunity to submit additional evidence, or neither.  VA suggests this form is necessary to permit claimants to appeal to the Board.

Here, each of the proposed forms corresponds to one of the new lanes within Appeals Reform.  Additionally, the selections within the NOD form relating to hearings and the submission of evidence further correspond to the three lanes that will be operating at the Board level.  Importantly, VA notes that both paper and electronic copies of these forms will be accepted.