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Veterans Law

VA Disability Claims and Appeals Process Timeline

April 30, 2019
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The length of the VA claims and appeals process can vary tremendously based on many factors, including the number of issues for which a veteran is filing a claim, the complexity of the case, and whether the veteran is in the old appeals system (i.e. the legacy appeal system) or the new appeals system (i.e. Appeals Modernization).

Veterans Appeals Deadlines in the Legacy System

The legacy appeals system only involves one “lane” in the veterans’ claims and appeals process.  In other words, all veterans filing for VA disability benefits go through the same steps and must adhere to the following appeal deadlines:

  • After filing an initial claim, the local Regional Office will issue a Rating Decision that grants, denies, or partially grants the claim. Veterans have one year to file a Notice of Disagreement (NOD).
  • VA will then issue a Statement of the Case (SOC), explaining why the claim was denied or only partially granted. Veterans have 60 days from when VA issues the SOC to file a VA Form 9 Substantive Appeal to the Board of Veterans’ Appeals.
  • The Board will then issue a decision granting, denying or remanding the claim for further action. If veterans are appealing a further denial, they have 120 days to appeal to the Court of Appeals for Veterans Claims (CAVC).
  • If veterans are denied at the CAVC, they have 60 days to appeal to the Federal Circuit.

While veterans are required to follow these deadlines, VA is not obligated to work under any timeframes of its own.

Legacy System Claims and Appeals Process Timeline

In March of 2017, the United States Government Accountability Office (GAO) released a report titled “VA Disability Benefits: Additional Planning Would Enhance Efforts to Improve the Timeliness of Appeals Decisions”.  The report outlines VA’s current backlog in working on the claims and appeals for disability benefits in the legacy system.  According to GAO’s report, these are some of the average wait times starting when the veteran files an appeal to when VA issues a decision on that appeal:

  • 419 days: average time between when VA receives an NOD to when they issue an SOC
  • 537 days: average time between when VA receives an appeal to the Board to when they certify that appeal
  • 222 days: average time between when the appeal is certified to the Board to when it is placed on the Board’s docket
  • 270 days: average time between when the appeal is docketed to when the Board issues a decision

It is important to note that these wait times are averages and veterans may experience longer or shorter wait times.

average legacy va appeal timelines

 

Veterans Appeals Deadlines Under the Appeals Modernization Act (AMA)

Under Appeals Reform, veterans will still receive a Rating Decision after every claim is filed.  However, if a veteran disagrees with VA’s decision, he or she has one year to appeal by choosing one of the following three lanes: the higher-level review lane, supplemental claim lane, or Notice of Disagreement lane (i.e. Appeal to the Board of Veterans’ Appeals).  After appealing through one of those three lanes, veterans will then receive another decision.  Specifically, both the higher-level review and supplemental claim lanes will yield additional Rating Decisions while the Notice of Disagreement lane will produce a Board decision.

Upon receiving a decision on their first appeal via one of these three appeal lanes, veterans have the option to file a subsequent appeal.  However, there are some important stipulations to note:

  • Higher-level Review Rating Decision. If a veteran receives an unfavorable decision in the higher-level review lane, he or she has 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, he or she has one year to file an appeal in any one of the three lanes.
  • Board Decision. If a veteran receives an unfavorable Board decision, he or she can either file a supplemental claim within one year or appeal to the CAVC within 120 days.
  • CAVC Decision. If a veteran receives an unfavorable decision from the CAVC, he or she has one year to file a supplemental claim, or 60 days to appeal to the Federal Circuit

Appeals Modernization Act (AMA) Claims and Appeals Process Timeline

Similar to the legacy appeals system, VA does not operate under any mandated deadlines.  However, VA has proposed several timeframe goals regarding the processing of decisions under Appeals Reform.  For both the higher-level review and supplemental claim lanes, VA has set forth a 125-day goal for issuing decisions.  Additionally, in the Notice of Disagreement lane, there are an additional three dockets veterans must choose from: the direct docket, evidence docket, and hearing docket.

VA has set forth a 365-day goal for issuing decisions in the direct docket, but estimates the evidence and hearing dockets will be subject to longer wait times.  The hearing docket in particular may have an average wait time of 5-7 years.  VA intends to provide regular wait time updates so that veterans can remain informed and up to date on the status of their claims and appeals.  Overall, VA expects the appeals process timeline to drop from 5 years to 3 years in the new system, and eventually hopes to process claims and appeals within a 12-18-month timeframe.

How Long Does It Take VA to Make Decisions Under AMA?

As of July 2020, it takes VA an average of 124.8 days to finalize a decision on initial disability-related claims.  However, this average rate is on the verge of exceeding VA’s 125-day goal to decide on initial claims, and the department was previously completing them in only 96 days on average (Fiscal Year 2019 data).  The onset of the global pandemic, COVID-19, likely accounts for the recent delays in VA’s decision making.

Nonetheless, VA still seems to be issuing decisions faster when compared to the Legacy appeals system.  This improvement may be due in part to the various appeal options available under AMA.  About 75 percent of veterans have been filing supplemental claims while the other 20 percent or so are opting into the higher-level review lane.  Both of these options are intended to move quicker as the higher-level review lane operates on a closed record (i.e., no new evidence) and the supplemental lane only accepts new and relevant evidence which was previously missing.  Furthermore, VA often indicates the evidence that was missing in a veteran’s case within the unfavorable decision.  Therefore, veterans should theoretically speaking have guidelines for how to proceed.

As for the Board of Veterans’ Appeals, it decided about 95,000 claims in 2019, exceeding its goal by 5,000.  This increase in decisions is significant, seeing as four years ago VA was only issuing 35-38,000 decisions annually.  The higher number of decisions is in part due to an increase in the number of employees at the Board.  Specifically, Board staffing has gone from around 540 full-time employees to around 1,250.  However, veterans who appealed to the Board and requested a hearing are still experiencing the longest wait times as VA has given these cases last priority.  Initially, VA estimated veterans could wait from 3-5 years for a hearing under AMA.  Nonetheless, the number of hearings VA held in 2019 went up 38 percent from the previous year, which is a good sign for veterans.

What Does VA Say About Wait Times?

VA steadily maintains that the amount of time it takes to review veterans’ disability claims depends on the following:

  • The type of claim that is filed (see above)
  • How many injuries or disabilities that are being claimed and how complex they are
  • How long it takes VA to collect the evidence needed to decide on claims

How Does VA Describe the Claims and Appeals Process?

Claim Received

After submitting a claim for disability benefits, VA will confirm that it was received.  The way in which this confirmation occurs depends upon the method of claim submission.  For example:

  • If a veteran files a claim online, VA will send an on-screen message after the form has been successfully submitted.
  • If a veteran files a claim on eBenefits, they will see a notice from VA in their claims list within approximately one hour of applying.
  • If a veteran sends their claim in by mail, VA will send a letter confirming that it has been received. This may take the longest, averaging 2-3 weeks to receive confirmation.

Initial Review

During the initial review process, a Veterans Service Representative (VSR) will review the veteran’s claim.  This should update the veteran’s online claims status on eBenefits to “Under Review”.  As long as VA does not need additional evidence from the veteran in order to proceed, the VSR will move on to the next step.  However, in most cases, VA needs to request additional evidence from veterans before moving forward.  As a result, it typically takes between 7-21 business days to complete this stage of the claims process.

Evidence Gathering, Review, and Decision

 During the evidence gathering, review, and decision phase of the claims process, the VSR will likely do three things:

  • Ask for evidence from the veteran, health care providers, governmental agencies, and others;
  • Review the evidence; and
  • Make a decision.

Similar to the previous step, if VA realizes it needs more evidence during the review, the veteran’s claim may return to this step more than once prior to moving on.  Once all of the necessary evidence is received, it will be reviewed by the VA adjudicator assigned to the veteran’s case.  In total, this stage can take anywhere from 3-6 months, and sometimes more or less time depending on the details of the case.  During this time, the VA adjudicator is reviewing the veteran’s entire VA disability claim file, including the initial claim application, medical records, supporting documents and information, and Compensation & Pension (C&P) exam results.

After the VA adjudicator’s decision recommendation documents are reviewed, a final award approval on the veteran’s claim is made.  This final approval is typically sent to a second tier reviewing authority for the ultimate approval.  The next step involves preparing the finalized decision to be sent out to the veteran.

 Preparation for Notification

 After the decision is made in the previous step, VA will move into the preparation for notification phase.  Here, VA will prepare a disability claim decision packet, including all aspects of the decision (e.g., the initial claim, the veteran’s history, facts of the case, decision outcome).  Once completed, it will be mailed to the veteran.

 Decision Notification Sent

 The last step of the VA claims process involves the mailing of the decision as discussed above.  Once it is mailed, veterans should receive this within 7 to 10 business days; however, veterans can always call 1-800-827-1000 and ask to speak to a representative about the status of their VA disability claim.

Claim Complete

At this point, the veteran’s claim has been completed!  Nonetheless, if a veteran is unhappy with VA’s decision, they have the right to file an appeal, thus beginning the appeals process.

Expediting VA Disability Claims

While the VA disability claims and appeals process can be lengthy, it is important to note that there are several situations in which veterans may be eligible to have their claims and appeals 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.  VA requires
  • Advanced Age. If a veteran is over a certain age, he or she can request to have a claim expedited.  The age requirement for expediting a veteran’s claim or appeal is different at the Regional Office level and 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.