VA Disability Compensation: an overview of the claims and appeals process

VA Disability Compensation: an overview of the claims and appeals process

What is VA disability compensation?

VA disability compensation is a monthly tax-free benefit paid to Veterans who are disabled because of an injury or disease that was incurred in or aggravated during active duty, active duty for training, or inactive duty training. The term disability applies to physical conditions, such as a chronic back condition, as well as mental health conditions, such as post-traumatic stress disorder (PTSD). VA reports that, as of September 2016, 4.36 million veterans receive VA disability compensation.

VA disability compensation is awarded if a veteran can show that his/her disability is sufficiently severe and service connected. Service connection is established if a veteran can demonstrate, through submission of a claim and relevant evidence, that he/she 1) has a current, diagnosed disability, 2) had some precipitating disease, injury, or event in service, and 3) has “medical nexus” evidence, i.e. a nexus, or link, between his/her current disability and the in-service disease, injury, or event. VA determines compensation awards based on a rating of the severity of the veteran’s disability.

Sometimes disabilities are easily service connected and rated at the appropriate level. However, you may disagree with VA decisions about service connection or the severity and functional impact of your disability, especially if your disability is more complex or the link to your service is less clear. Fortunately, disability compensation decisions can be appealed.

So, what does the initial disability claims process look like? What about the appeals process?

Claims Process

The VA disability compensation initial claims process is managed by your local VA Regional Office.

  1. You file a claim with your VA Regional Office or Medical Center. You can do this online through the VA website or by mail using VA Form 21-526, Application for Compensation and/or Pension.
  2. Your claim is received and reviewed by VA. A Veterans Service Representative will be assigned to your claim and will review your application to determine if additional evidence is needed. If they do not need additional evidence, your claim will move straight to step 5 and your local VA will prepare a decision on your claim.
  3. VA gathers evidence. If your claim requires additional evidence, the Veterans Service Representative will request evidence from the necessary sources – for example, a medical professional who has treated or examined you, a government agency, or another authority. You may also send your own evidence or statements from friends, family, or fellow veterans. It is common for claims to return to this stage throughout the claims process.
  4. VA reviews evidence. Once the evidence has all been received, your Veterans Service Representative will review it to determine if more evidence is required. If so, the claim will be sent back to the evidence gathering phase.
  5. VA recommends and prepares a decision. The Veterans Service Representative recommends a decision about service connection, disability rating, and the effective date. They prepare required documents explaining that decision.
  6. Recommended decision reviewed and final decision made. The recommended decision is reviewed and, if service connection has been granted, a final award approval is made.
  7. VA notifies you of their decision. This is called a Rating Decision. VA will send a decision packet to you by U.S. mail. The packet contains details of the decision and award. These details include whether service connection has been granted and, if it has, a disability rating (for example, a chronic knee condition might be rated 30 percent disabling) and an effective date for the rating. The effective date, usually the same date of your claim submission, identifies when you start receiving compensation. If the date is in the past, you may receive retroactive benefits.

After being notified, you decide whether VA has made an appropriate decision regarding service connection and disability rating. If you do not agree with any part of the decision, you may choose to appeal it.

Appeals Process

The VA disability compensation appeals process has two main stages. The first stage takes place within your local VA Regional Office. The second takes place within the Board of Veterans’ Appeals (BVA) in Washington, D.C.

  1. You file a Notice of Disagreement (NOD) with the decision. You have one year from the date of the letter notifying you of your rating decision (see Step 7 of the Claims Process). Usually, a Notice of Disagreement is filed using VA Form 21-0958. You will be asked to choose either a traditional appeal process or a “de novo” review of your claim by a Decision Review Officer (DRO). If you choose the traditional appeals process, your claim will be reviewed again by the same claims officer. If you choose the DRO process, a senior claims officer (the DRO) will review your claim and has the power to reverse or confirm the previous decision.
  2. Your local VA office prepares and sends you a Statement of the Case (SOC). If the original denial is confirmed, the Regional Office will send you an SOC. The Statement of the Case explains why your case was denied.

If you disagree with the Statement of the Case, you may choose to appeal to the Board of Veterans’ Appeals (a.k.a. The Board or the BVA).

  1. You file a Substantive Appeal and choose whether you want an optional hearing before a Veterans Law Judge. You have 60 days from the date of the letter sent with the Statement of the Case (see Step 2 of the Appeals Process) to file your appeal. A Substantive Appeal is filed using VA Form 9. If you do not submit any additional evidence and the Regional Office determines no additional development is necessary, your appeal will be transferred to the Board. However, if with your appeal you submit any evidence or request that VA obtain additional evidence, your local VA office will review it and send a Supplemental Statement of the Case that explains their decision with the additional evidence.  At this point, your appeal will be transferred to the BVA.
  2. Optional: You have a hearing with a Veterans Law Judge. On your Substantive Appeal (Step 3), you have the option to choose an in-person or teleconference hearing with a Veterans Law Judge. There are three different types of BVA Hearings. These hearings are informal and normally last about one hour. The Veterans Law Judge will not make a decision at your hearing. Rather, a transcript of the hearing will be added to your file and reviewed with the rest of your evidence in deciding your appeal.
    • Travel Board Hearing – Usually the BVA visits each regional office every year to hold hearings for about 5 days. Hearings are conducted on a first-come, first-served basis.
    • Hearing in Washington, D.C. at the Board of Veterans’ Appeals Central Office.
    • Videoconference Hearing – You will be in a conference room in your VA Regional Office and the judge will be in a hearing room in Washington, D.C.
  3. The BVA makes a decision and notifies you by U.S. mail. The decision will grant, remand, or deny each issue (each disability) on your claim. If an issue is granted, your VA Regional Office will implement the BVA’s decision and issue a rating decision. If an issue is remanded, that means it will be sent back to your Regional Office for further evidence collection or for other procedural reasons. A remand usually happens when the BVA finds that it does not have enough information about an issue in your appeal to make a decision.  Your appeal will be sent back to the BVA for a decision once the Regional Office has followed the Board’s remand instructions.

What if the Board denies my claim for VA disability compensation?

If an issue is denied by the BVA and you disagree with this decision, you can:

File a Notice of Appeal with the United States Court of Appeals for Veterans Claims (a.k.a. The Court or CAVC). You have 120 days from the date of the decision by the BVA (see Step 5 of the Appeals Process). The CAVC is part of the United States judiciary, not part of the Department of Veterans Affairs. The Court’s review of Board decisions is based on the evidence previously compiled by the Board (this is called the “record before the agency”) and on legal arguments from the Board and from your attorney, which are presented in a written brief. It is rare that the Court requires oral arguments. The Court may affirm the BVA’s decision, meaning the Court agrees with the BVA and will uphold all or part of its decision. Alternatively, the Court may reverse (overturn), vacate (cancel or annul), or remand all or part of the decision. If your case is remanded it will be sent back to the BVA or VA Regional Office. The Court may also dismiss the appeal, leaving the BVA decision in effect.

Category: Veterans Law