Deferred VA Claims: What This Means and What to Do

CCK Law: Our Vital Role in Veterans Law

• VA may defer a disability claim when it lacks the information or context that VA needs to issue a final grant or denial. VA may ask the veteran to provide more evidence or to clarify certain items so that the claim can proceed.
• There are several possible reasons that VA may defer a claim, including a lack of sufficient evidence, the need for an adequate nexus opinion or C&P exam, or even simple clerical mistakes or errors.
• The best way to avoid a deferral is for veterans to provide clear and comprehensive evidence supporting their disability claims. This may include medical records, service records, and lay statements from friends and family.

After filing an initial disability claim with the Department of Veterans Affairs (VA), veterans usually have to wait for a decision from their local VA Regional Office. This decision could be a grant, denial, or deferral of benefits. Grants and denials are straightforward, but deferred VA claims are less understood.

If you are a veteran who has been issued a deferral on your VA claim, then this article will guide you through what a deferred VA claim is and what you can do to resolve the deferral and move your claim along to a final decision.

What Is a Deferred VA Claim?

When VA feels it lacks sufficient evidence to make a decision on a claim, it may “defer” the claim. This pauses the review process until more evidence is gathered. Amy Odom, a Partner at CCK Law, explains:

“A deferred rating decision is issued when the veteran’s claim is either underdeveloped—meaning it lacks evidence necessary to make a decision—or incomplete. A deferral is neither an approval nor a denial. Instead, by issuing a deferral, VA is essentially placing a hold on the veteran’s claim and requiring further evidence or other development to be completed before making a decision.”

Watch CCK Law Partner Amy Odom explain deferred VA claims on YouTube:

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Why Are Deferred VA Claims Issued?

When VA lacks evidence, context, or clarity necessary to make a decision on a disability claim, it must defer the claim, according to VA’s procedures (VA M21-1, Part V, Subpart ii, Chapter 3). VA will then try to obtain the information it needs in order to issue a decision either granting or denying benefits, under its duty to assist (38 C.F.R. § 3.159).

Note that the duty to assist does not mean VA must obtain all evidence by itself. In certain cases, VA may need to ask veterans to obtain and provide any necessary additional information.

Common Reasons for Deferred VA Claims

There are several circumstances that can lead to VA feeling like it lacks the necessary information to approve or deny a disability claim. Some of these situations include:

• Insufficient evidence – If the evidence a veteran provides is inadequate or not detailed enough for VA to make a definitive decision, they may instead opt to defer the claim until more evidence is submitted.
• Need for nexus opinion or C&P exam – Sometimes, a veteran’s private doctor or C&P examiner may not have provided a clear medical nexus opinion linking the veteran’s disability to their military service. In situations like these, VA may defer a veteran’s claim until a nexus letter is secured or a satisfactory C&P exam is undertaken.
• Conflicting information or lack of clarity – If a veteran provides evidence for their claim that is ambiguously worded, contradictory, or otherwise unclear, VA may defer the claim until all the information lines up.
• Incomplete application or clerical errors – It is not unusual for veterans to make mistakes during the application process, or even for VA employees or computer systems to cause errors. In cases like these, VA can defer a veteran’s claim until these minor mistakes are corrected.
• Multiple service-connected conditions – In claims involving multiple service-connected conditions, VA might have enough evidence regarding some of those conditions, but not others. As a result, they may issue a deferral to gather the required information for those specific conditions.

How to Avoid Deferred VA Claims

Since most deferred VA claims are caused by flawed or insufficient evidence, the best way for veterans to avoid deferrals is to make sure any evidence they offer to VA is clear and comprehensive, leaving little room for ambiguity or miscommunication.

“What veterans should really focus on is all the evidence of their symptoms and anything they experience on a day-to-day basis,” says Nicholas Briggs, an Accredited VA Claims Advocate with CCK Law. “Because even if you don’t think it’s relevant, VA may find that it is relevant.”

To that end, some of the strongest pieces of evidence veterans can provide to support their claims include:

• Medical records – Veterans should be sure to submit medical records like diagnoses, treatment history, specialist opinions, and any relevant medical test results or evaluations that could substantiate their claim.
• Service records – Service records are often important in helping veterans prove that their condition is somehow a result of their military service. Relevant documents to submit to VA could include incident reports, personnel files, in-service medical reports, discharge papers, and other official records.
• Medical nexus opinions – A medical nexus is a healthcare professional’s official opinion linking a veteran’s disability to their time in service. Such opinions are crucial in establishing service connection, and providing a strong medical nexus will therefore go a long way toward avoiding a deferral.
• Lay statements – Lay evidence or statements are personal statements from a veteran’s loved ones, coworkers, or fellow servicemembers that attest to the severity of a veteran’s disability. While lay statements can often be useful in providing context for a disability, veterans should read through each statement to ensure that none mistakenly contradict each other or otherwise add ambiguity to a claim.

What to Do About a Deferred VA Claim

If a veteran’s VA claim is deferred, their next steps should be determined by why exactly that deferral was issued.

Typically, a deferral begins with VA notifying the veteran that their claim has been deferred, usually in a Rating Decision from its local Regional Office. In this decision, VA should identify the reason for the deferral.

Depending on the reasoning VA offers, veterans will have a couple of options for handling the deferral, including:

• If the deferral was due to insufficient evidence, then it would be helpful for the veteran to inquire about what further proof VA is looking for, if necessary. From there, the veteran can submit new or clearer evidence in support of their claim so that VA can issue a decision.
• If VA requests a medical nexus opinion or C&P exam, then the veteran should either set up a time to talk with the doctor who diagnosed their condition or reach out to VA to schedule a C&P exam.
• If the deferral was caused by a mistake or clerical error, then VA will likely either take the necessary steps to correct the error itself or instruct the veteran on what information they need.

No matter what, veterans with deferred claims should keep an open line of communication with VA to provide whatever information they may be looking for. This means keeping an eye out for letters, phone calls, or other messages from VA that may detail requests for more information.

Importantly, if VA does request certain information that a veteran is unable to provide, it may issue a decision based on the information that is available.

Deferred VA Claims vs. Other Unclear VA Rulings

In addition to deferred claims, there are several other potentially unclear rulings VA may send to veterans. Some of these include:

• Confirmed and continued claims – This VA ruling typically occurs when veterans have already submitted additional information, but VA determines such information is not persuasive or it is not “new and relevant.” Essentially, a confirmed and continued decision from VA means a veteran needs different evidence, whereas a deferred decision means they needmore 
• Partial decisions – Partial decisions occur when VA has issued a ruling on one or more conditions in a veteran’s claim, while deferring others. This may occur if veterans present sufficient evidence for some of their disabilities, but not for others.
• Remanded decisions – Decisions are “remanded” when the Board of Veterans’ Appeals sends them back to the VA Regional Office that issued them, usually to gather more information, provide clarity, or correct a mistake. The RO follows whatever instructions the Board provides and then issues a new decision on the claim.
• Pending decisions – Pending decisions are those that VA has not yet come to a final decision on. This means a veteran’s claim is still under review. Veterans should be sure to keep a lookout for any correspondence from VA while their claim is pending.

Does VA Ever Mistakenly Defer a Claim?

Yes, they do.

On May 15, 2019, the VA’s Office of Inspector General (OIG) released a report entitled “Deferrals in the Veterans Benefits Management System (VBMS).” In VBMS, there is a distinction between avoidable and unavoidable deferrals. Specifically, the former occurs when claims processors incorrectly determine a claim is ready for decision, whereas the latter are caused by actions outside of the claims processor’s control, such as receipt of records after the claim was made ready for decision.

Avoidable deferrals are assigned to the Regional Office that caused the deferral, while unavoidable deferrals are assigned to any Regional Office based on claim priority and production capacity. Claims processors who receive a deferral are required to resolve it within five business days.

OIG analyzed a total of 116,000 deferrals issued between February and April of 2018. Again, unwarranted deferrals refer to when part or all of the deferral was not necessary and claims processing could have continued without rework. Within the 3-month review period, 23,200 out of 116,000 deferrals (20 percent) were unwarranted. OIG found that unwarranted deferrals could result in needless examination costs, delayed processing, unnecessary rework, and improper guidance to claims processors. Specifically, an estimated 7,000 unwarranted deferrals resulted in avoidable medical examinations.

Based on the rates at the time of the review, the OIG team estimated that VBA could spend at least $8.8 million on unnecessary medical examinations taken over the next five years if corrective actions are not taken. Furthermore, of the 23,200 unwarranted deferrals, 16,200 (70 percent) were delayed. Delays averaged 43 days, with the longest delay being 232 days.

Ultimately, OIG concluded that VBA staff need to improve accuracy when creating deferrals to minimize unnecessary medical examinations, claims processing delays, incorrect instructions provided to claims processors, and unreliable tracking data used to train staff.

Did VA Mistakenly Defer or Deny Your Claim? Contact CCK Law

If you were issued a deferral or disagree with another VA decision, then Chisholm Chisholm & Kilpatrick may be able to assist. Per our documentation, our team of VA-accredited attorneys and representatives has secured favorable outcomes before VA for 99 percent of our past clients and has helped recover over $1 billion in wrongfully denied compensation.

Call CCK Law today at (800) 544-9144 or contact us online for a free case evaluation.

Frequently Asked Questions:

How Long Does a Deferred VA Claim Take to Resolve?

Generally, only 1-3 months, so long as the issue is straightforward (e.g., conducting a C&P exam or correcting an error on a form). However, more complex issues may take longer than that, such as 4-6 months. This might be the case if more extensive evidence needs to be collected and submitted to VA.

Either way, knowing what evidence to submit the first time around should help most veterans avoid deferrals and other delays.

Can a Deferred VA Claim Be Appealed?

No, you cannot. This is because a deferral is just a pause that VA places on a claim until additional evidence is collected or clarified. Only a final decision can be appealed (per 38 U.S.C. § 7105).

Are Deferred Claims Less Likely to Be Approved Later On?

No, a deferred claim is just as likely to be approved or denied as a claim that was never deferred.

A deferral simply means VA needs more information before issuing its decision. Once the necessary evidence is gathered and reviewed, a deferred claim can move forward, and VA will issue a decision just as it does for claims that were never deferred at all.