I. VA Claims and Appeals Process Interactive Tool

Table of Contents

1. VA Claims and Appeals Process Interactive Tool
2. How Does the VA Disability Claims and Appeals Process Work?
3. Switching Lanes in the VA Claims and Appeals Process
4. Key Terms to Know in the VA Claims and Appeals Process
5. What Veterans Need to Know About the VA Claims and Appeals Process
6. Why Modernize the VA Claims and Appeals Process?

VA Disability Claims and Appeals Process

The Veterans Appeals Improvement and Modernization Act of 2017 restructured the way VA processes veterans disability compensation claims. The modernization was done in an effort to simplify and streamline the old appeals process, while giving veterans, their families, and survivors more choice in handling disagreements with VA decisions.

What began as a collaborative effort involving VA, Veterans Service Organizations, Congressional Staff, and other stakeholders, quickly gained bipartisan support and was signed into law on August 23, 2017 and implemented across the VA disability benefits system on February 19, 2019. All requests for review of VA decisions that were issued on or after that date will be processed in the new system, “AMA.”

NOTE: If you received your VA decision prior to February 19, 2019 your VA disability claim may be processed under the old appeals system, known as the Legacy system. Learn how the Legacy Appeals System works here.

How Does the VA Disability Claims and Appeals Process Work?

Following an unfavorable rating decision on an initial VA compensation claim, VA’s new disability appeals process allows veterans to choose from three different review options, or lanes, when filing an appeal:

• Higher-Level Review Lane. By choosing this lane, veterans are requesting that the Regional Office (RO) issues another decision based on a higher level of review. This review is conducted by a more experienced rating specialist at the Regional Office who evaluates the veteran’s claim de novo (i.e. new look). The higher-level reviewer has the ability to overturn a previous decision based on a number of factors including a clear and unmistakable error (CUE). In this lane, veterans are not allowed to submit additional evidence in support of their claims. Instead, the RO will issue a new decision based on the same evidence of record that was available at the time of the prior decision.
• Supplemental Claim Lane. This lane allows for the submission of new and relevant evidence. Furthermore, it is the only lane in which VA has a duty to assist veterans in gathering evidence to support their claims. Importantly, veterans will maintain the same effective dates for their claims when submitting new and relevant evidence as long as the supplemental claim is submitted within one year of the RO’s initial decision. Veterans can also submit a claim with new and relevant evidence after receiving an unfavorable decision from the higher-level review process, after receiving a denial from the Board of Veterans’ Appeals, or a denial from the Court of Appeals for Veterans Claims (CAVC). Again, if veterans do so within one year of the decision, their effective date will be preserved.
• Notice of Disagreement Lane (i.e. Appeal to the Board of Veterans’ Appeals). In this lane, veterans can appeal their cases directly to the Board following an initial decision from the RO, or an unfavorable decision in either the higher-level review lane or supplemental claim lane. With this change under AMA, veterans are able to skip the second level of review at the RO that previously existed under the Legacy system. There are an additional three dockets at the Board from which veterans can choose: the direct docket, hearing docket, and evidence docket.

III. Switching Lanes in the VA Claims and Appeals Process

Importantly, veterans can change their request for a certain review option at any time prior to VA issuing an initial decision on their claim. Moreover, receipt of an unfavorable decision also presents an opportunity to change appeal lanes. Specifically, if veterans disagree with the decision VA made in one of the AMA lanes, they have the option to appeal to another lane based on the circumstances of their case.

Generally speaking, veterans will have one year to appeal in order to preserve the effective date of their claim. However, after a Board decision, veterans can either file a supplemental claim within one year, or appeal to the Court of Appeals for Veterans Claims within 120 days. In both cases, the effective date will be preserved. Again, veterans must appeal any unfavorable decision within one year in order to preserve their effective date.

Veterans are also permitted to switch dockets at the Board level by modifying their Notices of Disagreement. All requests to modify must be made within one year of the Agency of Original Jurisdiction decision on appeal, or 30 days after the Notice of Disagreement is received by the Board, whichever is later.

IV. Key Terms to Know in the VA Claims and Appeals Process

There are several important terms that veterans should understand prior to selecting an appeal option, as these concepts have been modified in the new system. Under the new appeals process VA has changed certain evidentiary standards, the ways in which the Department is obligated to assist veterans in finding evidence to support their claims, and deadlines for preserving effective dates.

VA’s Duty to Assist

The duty to assist requires VA to gather information that may help develop and support the veteran’s claim, such as service personnel records and VA medical records. The new regulations under VA’s new claims and appeals process limit VA’s duty to assist veterans insofar as it is only required when a veteran files an initial claim for benefits, and when a veteran files a supplemental claim with new and relevant evidence. VA’s duty to assist veterans does NOT apply to the Board, meaning the Board is not obligated to remand decisions for the purpose of developing additional evidence for the claim.

New and Relevant Evidence

Under the Veterans Appeals Improvement and Modernization Act of 2017, VA’s standard of evidence has been changed to “new and relevant.” VA defines “new” evidence as evidence that was not previously submitted to VA. “Relevant” evidence is evidence that tends to prove or disprove a veteran’s claim. An example of “new and relevant” evidence may include service records related to an in-service event to establish service connection. As a reminder, veterans must submit “new and relevant” evidence in order to file an appeal in the supplemental claim lane.

However, if the Board finds that the RO made a duty to assist error, it can remand the case and instruct the RO to fix that error. Therefore, while the Board can find that the RO did not fulfill its duty to assist, the Board itself no longer has that obligation.

Effective Dates and Final VA Claims Decisions

Effective dates are based on the date of the substantially complete initial claim, the date of the supplemental claim if filed more than one year after a final decision, or the date entitlement arose. If a veteran’s claim is continuously pursued, the effective date will be preserved. If the claim is not continuously pursued, VA’s regulations include guidelines for when a decision becomes final. When a claim decision becomes final, veterans will lose their effective dates since the claim will no longer be continuous.

Decisions become final when the appeal period for that decision has passed without the veteran filing an appeal. Under VA’s claims and appeals process, veterans always have one year to appeal no matter what type of decision they receive if they choose to file an appeal in any of the aforementioned lanes. Keep in mind, however, that veterans only have 120 days to appeal an unfavorable Board decision to the Court of Appeals for Veterans Claims (CAVC).

Favorable Findings

Favorable findings made by an adjudicator during the claims process are binding on all subsequent adjudicators (within the VA system), in the absence of clear and unmistakable evidence to the contrary. Favorable findings will also be outlined in decisions issued under VA’s claims and appeals process.

V. What Veterans Need to Know About the VA Claims and Appeals Process

Can I switch lanes in VA’s claims and appeals system?

Yes. Claimants can change their request for a certain review option at any time prior to VA issuing a decision on their claim. If the claimant’s lane withdrawal occurs within the one-year period following the date VA issued the decision being reviewed, the claimant can choose another review option and their effective date will be preserved. For example, a claimant who received a denial of benefits and appeals via the higher-level review lane, but then discovers new and relevant evidence, could withdraw from the higher-level review lane and request that his/her appeal be moved to the Supplemental Claim lane for review.

Receipt of an unfavorable decision also presents an opportunity to change your appeal lane. For example, a claimant can submit a supplemental claim with new and relevant evidence after receiving an unfavorable decision from higher-level review, even though he or she did not select the supplemental claim lane to begin with.

Can I switch dockets at the Board of Veterans’ Appeals?

Yes. Veterans are also permitted to switch dockets at the Board level by modifying Notices of Disagreement. In creating this policy, VA sought to provide claimants with an opportunity to change their initial election if their circumstances and preferences changed. However, VA also wanted to prevent claimants from unfairly gaining the advantage of two dockets. For example, at the Board level, claimants will not be permitted to take advantage of the faster direct docket if he or she has already submitted evidence or testified at a Board hearing. Therefore, VA proposes to limit the time period in which claimants may request to modify their Notices of Disagreement.

Under VA’s new claims and appeals system, this request to modify must be made within one year of the agency of original jurisdiction decision on appeal, or 30 days after the Notice of Disagreement is received by the Board, whichever is later. As indicated above, the request will be denied if the claimant has already submitted evidence or testimony.

Can I have multiple appeals pending in different lanes at the same time?

Yes. Veterans may select different review options for each issue on appeal. For example, if a veteran receives two unfavorable rating decisions for a low-back disability and tinnitus, they can choose to appeal those decisions in whichever lane is most appropriate for their specific case. So, a veteran could appeal the low-back decision to the higher-level review lane, while appealing the tinnitus claim in the supplemental claim lane.

How long will VA take to decide my claim?

The Department of Veterans Affairs has listed timely decision-making goals for each review option, or lane. Each VA claim is different, however, and your wait time may depend on many variables.

• Supplemental Claims: VA’s goal for completing Supplemental Claim decisions is an average of 125 days.
• Higher-Level Review: VA’s stated goal for completing Higher-Level Reviews is an average of 125 days.
• Appeals to the Board of Veterans Appeals: VA lists varying adjudication timelines for each docket.
  • Direct Docket: VA has set a goal to decide claims in this docket within 365 days.
  • Evidence Docket: VA states that claims in this docket may take longer than 365 days.
  • Hearing Docket: Appeals in this docket are projected to take the longest amount of time to adjudicate, with wait times that may exceed 365 days.

Can I opt in to VA’s new claims and appeals system from the Legacy (old) System?

Yes. Veterans with pending Legacy appeals who have received a Statement of the Case (SOC) or Supplemental Statement of the Case (SSOC) within the past 60 days can choose to move their case from the Legacy system to VA’s modernized appeals process. To opt in to the new system, veterans can complete the appropriate form for the review option they choose to participate in and check the SOC/SSOC Opt-in box. Veterans must submit the completed application form(s) within 60 days from the date of an SOC or SSOC, or within one year of the appeal period on an initial rating decision, whichever is later. You can read more on VA’s Modernized Decision Review System SOC/SSOC Opt-In Fact Sheet.

Can I have appeals in the Legacy system and the modernized system at the same time?

Yes. Existing appeals in the Legacy system will continue to be adjudicated in that system until a new decision is received. All decisions received after February 19, 2019, even if the claim originally began in the Legacy system, will decided in the new appeals system. Veterans can begin an appeal under the AMA system even with existing claims still in the Legacy process.

Can I return to the Legacy system after opting into the Modernized VA Claims and Appeals Process?

No. Once a claimant opts in to VA’s new claims and appeals process, the decision is permanent and they cannot return to the Legacy system. Switching systems triggers VA to formally withdraw veterans’ claims from the old system to be processed in the new system. Furthermore, all new requests for review (appeals) will be processed under VA’s new, multi-lane process.

VI. Why Modernize the VA Claims and Appeals Process?

Generally speaking, VA’s total restructuring of the appeals system was prompted by the Legacy system’s overall inefficiency. VA was unable to keep up with its workload while serving veterans in a timely manner. The number of claims received increases every year, adding onto the current VA backlog.

In the Legacy system, there was no defined endpoint or timeframe in regards to processing appeals. Instead, it featured an open record and ongoing duty to assist. Such continuous evidence gathering and readjudication prolongs VA’s ability to reach a final decision. For example, in Fiscal Year 2016, it took an average of seven years from the date a Notice of Disagreement was filed to eventually receive a decision from the Board.

Additionally, VA recognizes that the current system is too complicated as it contains too many steps and is difficult to communicate with veterans. The new appeals process intends to address the above-mentioned issues by implementing an understandable review system that leads to the earlier resolution of disagreements.