VA Claim Process Explained
Veterans with disabling conditions related to their military service may be eligible for compensation benefits from the Department of Veterans Affairs (VA). To receive compensation, or VA disability benefits, veterans first need to file a claim. If that claim is denied by VA, veterans have the option to file an appeal. Continue reading for a complete guide to the VA claims and appeals process.
How to File a VA Claim
Types of VA Claims
Prior to filing a claim and starting the VA claim process, veterans should consider the specific claims they will be making, and the evidence required to support such claims. There are several types of VA disability benefit claims, such as:
- Initial Claim for Service Connection – This type of claim is when a veteran files for VA disability benefits for a specific condition for the first time. Initial claims are filed via VA Form 21-526EZ.
- Increased Rating Claim – Increased rating claims are filed when a veteran believes they are entitled to a higher rating than the one already granted by VA. These claims are also filed via VA Form 21-526EZ.
- Secondary Service Connection Claim – Secondary service connection is a method of service connection for conditions that have been caused or aggravated by another, already service-connected condition. To file for secondary service connection, veterans use the same form as direct service connection (VA Form 21-526EZ).
- Total Disability Based on Individual Unemployability (TDIU) Claim – Total disability based on individual unemployability, TDIU, is a disability benefit that allows for veterans to be compensated at VA’s 100 percent disability rate, even if their combined disability ratingdoes not equal 100 percent. Oftentimes, a claim for TDIU is included within an increased rating claim, however veterans can use VA Form 21-8940 to apply for TDIU.
- Special Claims – Specialty claims are those for special equipment for a service-connected disability. Forms for these claims can vary depending on the claim. For example, veterans can use VA Form 10-1394 to apply for adaptive equipment for motor vehicles.
- Dependency and Indemnity Compensation (DIC) – DIC is a monthly benefit that VA awards to surviving spouses or dependent children of a service member who died in action or from a service-connected condition. To apply for DIC, survivors must submit VA Form 21P-534.
4 Ways to File a VA Claim
There are four different ways to file VA Form 21-526EZ, or another claim form, with VA:
- Online – using VA’s eBenefits platform
- By mail – print, fill out, and send to the Department of Veterans Affairs, Claims Intake Center, PO Box 444, Janesville, WI 53547-4444
- In person – bring completed form to the nearest VA Regional Office
- With a legal representative – completing the form with the assistance of a Veterans Service Organization (VSO) or a VA-accredited attorney or agent
Generally, filing a VA claim online is the fastest and most convenient way to apply for disability compensation. Electronic records can be processed using a variety of automated tools, allowing VA to complete certain tasks with greater speed.
Filing a Fully Developed Claim
If a veteran believes they have all the evidence necessary for VA to decide on their claim right away, they can submit a fully developed claim (FDC). The FDC program is an optional expedited process for having a VA claim reviewed. When a veteran chooses this option, they are indicating to VA that no additional evidence is needed to support their claim, thus enabling VA to reach a decision more quickly.
If a veteran selects FDC upon filing but then discovers additional evidence they want to include, they still can submit that evidence; however, they will be placed into the standard claim process upon their submission. Likewise, if VA determines that more evidence is needed, the veteran’s claim will be moved to the standard claim process.
How to Establish Service Connection for Your Claim
To qualify for VA disability compensation, veterans must establish service connection for their condition. VA grants service connection to veterans who have evidence that their disability is “at least as likely as not” connected to their military service. There is more than one way to prove service connection.
Direct Service Connection
To secure VA disability benefits on a direct basis, veterans must have evidence that their disabling condition is the result of their military service. Generally, this requires proof of three things:
- An in-service event, injury, or illness;
- A current diagnosis by a medical professional; and
- A medical nexus, or link, between the in-service event, injury, or illness and current diagnosis.
The medical nexus element is essential to proving service connection. Often, VA will schedule a veteran for a Compensation and Pension (C&P) exam to determine if that link exists. Veterans may also ask their private physicians to provide a medical nexus opinion to satisfy this requirement. A positive medical nexus will indicate that it is “at least as likely as not” that the veteran’s condition was caused or aggravated by their time in service.
Secondary Service Connection
As mentioned above, secondary service-connected conditions are conditions caused or aggravated by an already service-connected disability. Importantly, to prove secondary service connection, there is certain evidence that a veteran should submit alongside their claim. Veterans will need to demonstrate two things to VA to be granted service connection for a secondary condition:
- A current diagnosis of the secondary injury, illness, or disability; and
- Medical evidence showing a link between the primary service-connected condition and secondary condition.
Veterans must clearly establish a nexus, or link, between their primary service-connected condition and their secondary condition to be granted additional disability benefits.
Service Connection by Aggravation
Veterans who had a preexisting condition that worsened due to military service can qualify for service connection based on aggravation. Service connection based on aggravation can also apply to service-connected conditions that aggravated a preexisting condition.
When assigning a disability rating to a veteran’s aggravated condition, VA will try to determine what the rating would have been prior to any aggravation. VA will then assign a rating based on the current severity of the condition. From there, VA will take the difference between the baseline level and the current level to determine the level of aggravation.
Presumptive Service Connection
VA presumes service connection for certain conditions based on the time and location of the veteran’s service. The intention is to make it easier for veterans to secure disability compensation.
Presumptions eliminate the need for veterans to provide a nexus opinion. They simply must show they were in a certain place at a certain time and have a specific condition, and the link between the two is presumed.
For reference, some VA presumptions include conditions related to Agent Orange exposure, MUCMIs, and presumptive respiratory conditions related to particulate matter exposure.
Stages of the VA Standard Claims Process
After filing a VA disability claim, claimants are entered into VA’s standard claims process. Their claim will progress through the following stages:
Stage 1: Claim Received
If the claim was filed on eBenefits, there should be an on-screen notification following submission stating that the claim was received. On the other hand, if the claim was mailed to the Evidence Intake Center, brought to a VA Regional Office, or completed with a representative, veterans will receive a letter in the mail confirming receipt of the claim. If the veteran missed information or used the incorrect form, VA will respond via letter indicating the changes that need to be made prior to processing the claim.
Stage 2: VA Claim Under Review
After the claim is received, VA will begin the review process. Basically, veteran service representatives (VSRs) at VA will assess the evidence and information submitted thus far and determine whether there is anything else that is needed from the veteran. This development usually begins with reviewing any VA or private treatment records the veteran may have included with their claim. One common misconception is that if you treat at a VA medical center (VAMC), VA will already be in receipt of all relevant medical records; however, this is not the case. Instead, veterans must direct VA to obtain such records. Again, during the review process VA is examining the evidence of record and deciding what evidence is still needed in order to make a decision on the veteran’s claim.
Stage 3: Gathering of Evidence
If VA determines additional evidence is needed, it will engage in the evidence-gathering stage of the claims process. Oftentimes, this is the longest part of the process as there is a lot of back-and-forth between VA and the veteran to obtain the necessary documentation and information. Ultimately, VA has a duty to assist the veteran in obtaining evidence that can support their claim. At this stage in the claims process, VA will send the veteran a letter in the mail, indicating that the department is working on their claim.
Furthermore, the letter often includes a list of documents or information that VA is attempting to gather (e.g., treatment records, employment history, etc.). If veterans have access to such information directly, it may be beneficial to submit the records to VA in order to save time. Importantly, if it is determined that the veteran’s claim requires more evidence further along in the process, their claim will be returned to this stage. If veterans believe they have all the evidence necessary for VA to make a decision on their claim right away, they can submit a fully developed claim (FDC).
Stage 4-6: Preparation for Decision, Pending Decision Approval, and Claim Complete
After all the evidence is gathered and reviewed, VA prepares documentation showing their decision recommendation. From there, the claim will go to the decision approval stage. Following review, a final decision will be determined.
When it is time to notify the veteran, the local VA Regional Office will either grant, deny, or partially grant the claim. Unfortunately, decisions are not always mailed out and issued right away, which may cause some delay.
If the decision is an initial decision, veterans will receive two documents in the mail: (1) a Notice of Action letter; and (2) a Rating Decision narrative. The Notice of Action letter summarizes VA’s decision and notes if there is any additional compensation that comes along with a grant of benefits. The Rating Decision will explain the reasoning behind VA’s decision for each issue raised in the claim. If the decision is unfavorable, veterans have one year to file an appeal.
How to Expedite Your Claim
While VA’s disability claims process can be lengthy, it is important to note that there are several situations in which veterans may be eligible to have their claims expedited.
- Extreme Financial Hardship or Homelessness: Veterans can request to expedite a VA disability claim if they are experiencing extreme financial hardship, or if they are homeless or at imminent risk of becoming homeless.
- Advanced Age: If a veteran is over a certain age, they can request to have a claim expedited. The age requirement for expediting a veteran’s claim or appeal is different at the VA Regional Office level than at the Board level. Specifically, at the Regional Office, a veteran must be 85 years of age or older whereas at the Board, a veteran must be 75 years of age or older.
- Terminally Ill: VA is instructed to prioritize claims in which the veteran is terminally ill. Veterans must submit evidence of a terminal illness in order for VA to expedite the claim.
Unfortunately, there is no way to predict how much faster a claim will be decided when it is expedited, but VA employees are instructed to handle “priority” claims before “non-priority” claims. Nonetheless, expedited claims still enter a queue of other expedited claims, meaning veterans will still have to wait in a line.
Compensation and Pension (C&P) Exams and the Role They Play in the Claims and Appeals Process
VA usually schedules a Compensation and Pension (C&P) examination to evaluate the veteran’s condition before issuing a decision. Most commonly, C&P exams are used to 1) confirm or deny service connection, and/or 2) establish the severity of a veteran’s disability.
A C&P exam is typically performed by a VA-contracted healthcare provider. Before the exam, the examiner will review they veteran’s entire claims file, which includes medical treatment records and other submitted evidence.
During a C&P examination, veterans should be upfront and honest about their symptoms so that they can be properly documented. Bringing a friend or family member to an exam may be beneficial as well.
Importance of Attending Your C&P Exam
It is essential to attend a C&P exam once it is scheduled. Veterans who do not attend their exams will likely receive denials on their claims. Therefore, to avoid delays or denials, veterans should attend all scheduled VA exams. If the veteran needs to reschedule an exam, they should contact VA as soon as possible to make the change.
C&P exams are often considered the most important piece of evidence in a veteran’s claim file. If an exam is incomplete or not conducted, VA is not fulfilling its duty to assist. If you are a veteran who filed a claim but have not had an examination yet, we recommend insisting on an exam at every stage of the claims and appeals process until you get one. If no examination is performed, it can be very difficult to prove service connection, and may delay the entire process.
Getting a Copy of Your C&P Exam
Veterans have the right to request a copy of their C&P exams by contacting their Regional Office or the Medical Center where the exam was conducted.
VA decision makers often place significant weight on C&P exams when deciding claims. Therefore, it can be helpful to review the exam to determine if the results are favorable and to ensure that the exam was filled out completely and thoroughly and reflects the most accurate information possible. Requesting to see the examiner’s credentials can also be helpful, as it can reveal whether they were qualified to issue a medical opinion on your disability.
Types of Evidence for Your Claim or Appeal
Veterans can submit evidence to prove service connection alongside their VA claim. Veterans may also indicate to VA where certain evidence is located so that VA can retrieve it. However, submitting relevant documents upfront or during the claims review process may prevent VA from engaging in a lengthy evidence-gathering process or denying your claim.
The following are examples of evidence that can be used to prove service connection:
- Service personnel records – These records include documentation of various achievements, educational records from time in service, and evaluations which can show, for example, that a veteran missed training due to a condition or was noted to have poor performance.
- Service medical records – Service medical records can have important documented information, such as visits to sick bay, a clinic, or even a private doctor.
- DD Form 214 – This is a document service members receive when they are discharged from service. Importantly, it shows the veteran’s discharge status, which is needed to determine if they are eligible for benefits. A DD-214 also documents any awards or commendations the veteran received and dates of service. Sometimes, a DD-214 will not always list every location the veteran served, but if locations are listed, the form can be used to prove that a veteran served in that specific place.
Veterans can obtain these records by either: 1) requesting them from the VA Regional Office; 2) submitting VA Form 180 to obtain relevant records; OR 3) submitting a Freedom of Information Act (FOIA) request or Privacy Act request.
- In-service medical records – These records include enlistment and separation examinations, as well as any hospital stays or sick calls during service.
- Private medical records –To obtain these records, veterans can typically request them directly from their private healthcare provider.
- VA medical records – If a veteran wants to obtain these records themselves, they can request them directly from the VA medical center.
- Compensation and Pension (C&P) examinations – The medical evidence collected during a C&P exam can be used as evidence for the veteran’s claim.
- Medical opinions – Veterans can request a medical opinion from their treating doctor to help substantiate their claim. Medical opinions are especially useful if the veteran has an unfavorable C&P exam.
Employment records can be helpful in claims for TDIU and increased ratings. If a veteran has difficulty performing a job or is receiving special accommodations at work due to a service-connected condition, this can help show VA the level of severity of their disability. Some helpful employment records that veterans can submit include:
- VA Form 21-4192 – This form is used by VA to gather information regarding a veteran’s past or current employment. The form is sent to the veteran’s employers for them to fill out basic employment information such as dates of employment, as well as details regarding the veteran’s ability to perform the job or why the veteran left that job.
- Record of disciplinary action or performance reports – These types of records can be useful in showing how a veteran’s service-connected disability negatively impacts their work. If a veteran has a service-connected psychiatric condition that causes them to be violent at work or have angry outbursts, records of these incidents can be used to show entitlement to an increased rating or TDIU.
Finally, lay evidence (i.e., lay statements and buddy statements) can be helpful pieces of evidence to substantiate disability claims. Veterans can use VA Form 21-10210 to submit their statements directly to VA.
A lay statement is a written statement from a veteran, family member, friend, or coworker that can be submitted to VA in support of a veteran’s claim. Statements can be especially useful for veterans to document and report their symptoms and frequency of symptoms. Buddy statements, those written by a fellow service member on behalf of the veteran filing the claim, can help to corroborate an in-service event or injury.
It is important to note that lay evidence can give rise to credibility issues. If a veteran submits multiple statements that contradict each other, VA may decide that veteran is not credible based on the inconsistency of those statements. When submitting lay evidence, veterans should ensure that the statements are consistent support their case.
How to File a VA Appeal
If VA denied a veteran’s claim for disability benefits, the veteran typically has one year from the date of the Rating Decision to file an appeal. This also ensures that their effective date (i.e., the date of the original claim) remains in place.
- A veteran’s effective dateis the date which VA uses as a start date to pay the veteran disability benefits for their claim. The effective date essentially determines how much the veteran will be entitled to in retroactive benefits.
The Appeals Modernization Act (AMA), the law governing VA’s appeal process, has been in place since February 19, 2019. All new appeals are processed under the AMA system.
AMA Appeals System
Claimants seeking to appeal an unfavorable VA decision must choose one of the following three review options (also known as lanes):
- Higher-Level Review – Request a review of the current claim by a senior VA employee
- Supplemental Claim – Submit new and relevant evidence as part of a Supplemental Claim
- Notice of Disagreement – File an appeal to the Board of Veterans’ Appeals.
In the Higher-Level Review Lane, a more experienced VA Regional Office employee will review your claim. Here, you cannot submit any additional evidence in support of your claim. VA will issue a new decision based on the same evidence that was available at the time of the prior decision.
- Veterans can fill out VA Form 20-0996 to request a Higher-Level Review.
- VA’s current goal for Higher-Level Review decisions is an average of 125 days, or four to five months.
The Supplemental Claim Lane allows for the submission of new and relevant evidence to support your claim. New and relevant means that the evidence must be new, as in not considered in a prior decision, and relevant, as in pertinent to the reason your claim was denied.
VA will determine whether the evidence submitted meets this standard and, if so, VA will readjudicate your claim.
- Veterans can fill out VA Form 20-0995 to request a Supplemental Claim review.
- VA’s current goal for completing Supplemental Claims is an average of 125 days, or four to five months.
In choosing to file a Notice of Disagreement, the veteran’s appeal will go directly to the Board of Veterans’ Appeals. The Board has three dockets:
- Direct Docket: For veterans who do not wish to submit additional evidence to the Board and do not want a hearing before a Veterans Law Judge.
- Evidence Docket: For veterans who want to submit additional evidence but do not want a hearing.
- Hearing Docket: For veterans who wish to submit new evidence and have their claims reviewed Veterans Law Judge.
- Veterans can fill out the Decision Review Request: Board Appeal (VA Form 10182) and check off option 1 (direct review), option 2 (evidence submission), or option 3 (Board hearing).
What Happens if Your Appeal is Denied?
If a veteran receives an unfavorable result following their appeal in the AMA system, they have the option to continue the appeal.
- Higher-level Review Rating Decision – If a veteran receives an unfavorable decision in the Higher-Level Review lane, they have one year to file either a Supplemental Claim or a Notice of Disagreement.
- Supplemental Claim Rating Decision – If a veteran receives an unfavorable Rating Decision in the Supplemental Claim lane, they have one year to file an appeal in any of the three lanes.
- Board Decision – If a veteran receives an unfavorable Board decision, they can either file a Supplemental Claim within one year or appeal to the Court of Appeals for Veterans Claims (CAVC) within 120 days.
- CAVC Decision – If a veteran receives an unfavorable decision from the CAVC, they have one year to file a Supplemental Claim or 60 days to appeal to the Federal Circuit.
Tracking a VA Claim
One of the simplest ways to check the status of a VA claim is to visit a local Regional Office and inquire about the status of the claim. VA also has a hotline number that veterans can call to check the status of their claims: 800-827-1000, or alternatively, veterans can use VA’s online tracker: eBenefits.
How to Get Help with Your Appeal for VA Disability Benefits
The VA claims and appeals process can be overwhelming. There are a multitude of different paths a veteran’s claim can take and navigating this process by yourself if often complicated and time-consuming. An accredited VA disability lawyer or claims agent can help alleviate some of the confusion, stress, and frustration that can be involved in this process.
The representatives at Chisholm Chisholm & Kilpatrick have decades of collective experience helping veterans navigate the appeals process and we may be able to help you too. Call our office today for a free case evaluation.
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