Veterans (VA) Appeals Reform: Supplemental Claims
What is a Supplemental Claim?
Upon full implementation of the Appeals Modernization Act (AMA), VA amended the definition of “claim” to include a definition of the term supplemental claim. Specifically, a “supplemental claim” is 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. VA is required to readjudicate the claim if new and relevant evidence is presented.
Overview of Appeals Modernization Act (AMA)
Under AMA, veterans can choose one of three different appeal lanes following an initial decision on a claim:
- Higher-level Review Lane: The veteran requests that a more experienced rating specialist issue another decision. In this lane the record is closed, meaning the veteran cannot submit any additional evidence.
- Supplemental Claim Lane: The veteran can submit new and relevant evidence in support of their claim (see more below).
- Notice of Disagreement Lane (i.e., Appeal to the Board of Veterans’ Appeals): The veteran can appeal their case directly to the Board. There are three additional lanes at the Board that veterans can choose from: (1) direct docket; (2) hearing docket; and (3) evidence docket. In the direct docket, the Board considers only the evidence that was on record at the time of the prior agency of original jurisdiction’s (i.e., the Regional Office) decision. The hearing docket closes the record 90 days after the Board hearing. For the evidence docket, the record is closed 90 days after the veteran files the Notice of Disagreement.
After appealing through one of these three lanes, the veteran will then receive another decision. Specifically, both the higher-level review and supplemental claim lanes will yield Rating Decisions while the Notice of Disagreement lane will produce a Board decision.
Supplemental Claim Lane Explained
Again, the supplemental claim lane allows the submission of new and relevant evidence. Importantly, the “new and relevant” evidence standard was implemented under AMA. This standard is supposed to reflect a lower evidentiary threshold than the “new and material” standard that was used in the Legacy appeals system.
When filing a supplemental claim, veterans must submit or point VA to new and relevant evidence. From there, they have up until the time VA issues a decision on the claim to submit additional evidence. Here, “new” means that the evidence must not have been of record at the time VA was previously reviewing the claim, and “relevant” tends to prove or disprove an issue related to the veteran’s claim. Examples of new and relevant evidence include medical diagnoses, medical nexus opinions, service personnel records, service treatment records, and more.
Issues with the New and Relevant Evidence Standard in Supplemental Claims
A major problem with the new evidence standard, however, is that VA has been applying it inconsistently when adjudicating claims and appeals. There have been decisions where VA is still referring to new and material evidence, thereby continuing to use the old standard, or adjudicating claims in a way that suggests the new standard is higher (i.e., harder to meet) than the previous one.
The supplemental claim lane under Appeals Reform is the only appeal lane in which VA has a duty to assist veterans in gathering evidence to support their claims. VA does not have a duty to assist during the higher-level review process, or in appeals to the Board of Veterans’ Appeals. Overall, VA has a 125-day goal for issuing decisions in the supplemental claim lane.
How to File a Supplemental Claim
In recent years, VA has become very focused on forms and is insistent that veterans and claimants fill out the correct forms before it will address the filed claim. In the new appeals system, VA created all new forms for the different review options.
Veterans can file a supplemental claim after any adjudicative action including a Rating Decision, Board decision, and CAVC decision by submitting new and relevant evidence. Additionally, the supplemental claim itself must be filed within one year of VA’s decision in order for the effective date to remain the date of the original underlying claim. On the other hand, if the supplemental claim is filed more than one year after the decision, the effective date will be the date the supplemental claim was filed. There is no limit on the number of supplemental claims a veteran can submit.
Under AMA, veterans will be required to submit VA Form 20-0995, Decision Review Request: Supplemental Claim, in order to initiate a supplemental claim for VA disability compensation. VA believes this form is necessary to identify the issues that a veteran is dissatisfied with and determine the veteran’s eligibility to apply for a supplemental claim. If a veteran submits an incomplete supplemental claim, VA will consider the claim to have been filed on the day it receives the incomplete form, as long as a complete version is submitted within one year. By submitting the completed form within one year of the incomplete form, veterans can preserve their effective dates.
A veteran can also submit a supplemental claim with new and relevant evidence if he or she received an unfavorable decision from higher-level review. In other words, veterans are allowed to switch to the supplemental claim track even after initially selecting the higher-level review option. If this switch occurs within the one-year period following the date VA issued the decision on appeal, the veteran’s effective date will be preserved.
How to Fill Out VA Form 20-0995
The supplemental claim form is broken up into the following sections:
- Claimant’s Identifying Information: This section requires claimants to fill out the following information: full name, Social security number, date of birth, current mailing address, telephone number, and benefit type (e.g. compensation, pension/survivors benefits, etc.).
- Issue(s) for Supplemental Claim:In this section, claimants must list each issue decided by VA that they would like VA to review as part of the supplemental claim. Each specific issue must be included along with the date of the VA decision notice in which it was originally denied or partially granted. This section also includes a check-box to indicate if claimants will be opting in to the new appeals system following a Statement of the Case (SOC) or Supplemental Statement of the Case (SSOC) from the legacy appeals system. By checking that box, claimants are electing to participate in the new system and withdrawing all eligible appeal issues listed on the form from the legacy system.
- New and Relevant Evidence: To complete a supplemental claim, claimants must submit new and relevant evidence to VA or tell VA about new and relevant evidence to assist in gathering. If claimants want VA to get federal records, such as treatment records from VA medical centers, claimants must list the name and location of the facility and the dates of the records.
- Certification and signature:This section is mandatory, and completion is required for VA to process the supplemental claim. By signing, veterans are indicating that the information in the supplemental claim is true and correct.
Veterans should be sure to adhere to the instructions listed on the form to ensure their supplemental claim is accepted and processed by VA. Failing to do so may result in unnecessary delays.
How Quickly Does VA Process Supplemental Claims?
Under AMA, about 75 percent of veterans have been filing supplemental claims. Most veterans are choosing this lane after an unfavorable decision from VA indicated that evidence was missing in their case. For example, a veteran gets an unfavorable decision indicating that they are missing a diagnosis. As a result, the veteran goes to their doctor and obtains a diagnosis. This evidence would be considered new and relevant, and therefore, the supplemental claim lane would be most appropriate.
Many veterans find that this lane is straightforward. Fortunately, VA has been processing supplemental claims at a moderate rate. Specifically, veterans who filed supplemental claims are receiving decisions in about 60 days. This average is only slightly higher when compared to the higher-level review lane, which is producing decisions in about 45 days.
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