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Fully Developed Claims

Video Transcription:

Emma: Welcome to another edition of Facebook Live with CCK. Today, we’re going to be breaking down everything that you need to know about a fully developed VA claim. My name is Emma Peterson, and I’m joined today by Nicholas Briggs and Michelle Detore. The three of us are going to be discussing fully developed claims. So first and foremost, what is a fully developed claim?

Emma: While the fully developed claim program is an optional way to file your claim with VA, veterans can file all different kinds of claims using this program. It includes claims for disability compensation, pension, secondary service connection, claims to reopen, and others. Veterans may choose to use this program if they have collected all the evidence that they want VA to consider when making their decision. In other words, it’s the way of a veteran to signal to VA that this is everything that I have, no additional evidence is needed, and please make a decision as soon as possible on my claim.

Emma: That’s really the point. The idea is to allow the VA to make a decision quickly and as soon as possible if a veteran submits all the evidence they need to upfront. Once you decide to use this program, you have a full year to get all the evidence in and to complete it. If VA approves your claim, you’re going to get retroactive benefits back to the day that you first filed it. Nick, can you tell us a little bit about how the fully developed claims program is different than filing a regular claiming VA?

Nick: Sure, Emma. The main difference here is going to be how VA goes about collecting the evidence. Under the standard claims process, they will obviously consider anything the veteran submits with their claim. However, the duty to assist applies under the standard claims process. It means that VA is going to go through a lot of additional development on their own end to try and get evidence that they think is relevant and useful to the veterans claim. Obviously, that will include any VA treatment records, any private treatment records that the veterans identified, any other records that are in the possession of federal government agencies, and anything else that has been raised by what the veterans submitted and might be helpful to their claim.

Nick: On the other hand, under the fully developed claim system like you mentioned, the idea is for the veteran to submit all of their own evidence upfront and have that considered by VA. VA needs to take fewer steps on its own for the claim to be adjudicated. If you want your claim to be adjudicated under the standard claims process, you want to check that box on the 526 easy. But it’s important to keep in mind that if VA needs to go out and develop evidence on their own. This could delay their initial adjudication of your case. So, if, whenever possible, you have all the evidence that you think you need, it can be useful to submit a fully developed claim because it will allow them to adjudicate it faster.

Emma: Michelle, can I add evidence no later on if I file a fully developed claim and I think “oh gosh, I wish I’d added this”. Is that possible?

Michelle: Absolutely. It’s possible for claims processing to submit additional evidence. What will likely happen is your case will likely get moved from the fully developed claim to a standard claims process. It is under debate whether you would actually get notified that it’s been moved. You may get notified when VA receives the evidence or you might not get notified until they receive a decision. At that point in time, when you start to submit additional evidence or you ask VA to go out and get additional evidence, it’s likely going to be moved out of the fully developed claim to a standard claim processing.

Emma: Okay. If you want more information about the standard claims process, check out our video and our interactive tool. We will put a link to it in the comments. You can also check that out on our website at cck-law.com.

Emma: Like anything, there are always advantages and disadvantages to picking certain lanes, tracks, and programs when filing your VA claim. There certainly are a number of advantages for using the FDC. It means that you do the work getting the evidence that you think is needed to support your claim. Though this task is traditionally done by VA, it does give you some control over the evidence gathering. Also, if you’re concerned about the time it might take for VA to gather that evidence, this certainly could speed it up. So if you’re concerned about a long processing time for your claim, you’re concerned that it might take VA a while to get the evidence and you readily have it available, the FTC might be the best option for you. It’s all certainly risk-free as Michelle mentioned.

Emma: If VA decides that they need more evidence or you end up asking them to gather evidence, they’ll just move you to the standard claims processing system. There’s no harm or penalty for filing an FDC and then being moved to a standard claim. It may also result in a faster decision. Certainly under the AMA, decisions are coming relatively more quickly out from the regional offices. So you may see decisions even faster times using FDC. But if you collect the evidence yourself, you eliminate the time that VA would spend gathering that evidence. That’s where you’re really cutting down on the time. There are certainly disadvantages, too. Nick, why don’t you tell us a little bit about some of the disadvantages to using the FDC?

Nick: Sure. At the end of the day, when you’re doing an FDC claim, we’re really talking about you submitting all the evidence you need to support your case. Because of the evidentiary requirements inherent to VA system, it’s often difficult and hard to understand what you need to submit to win. This comes down primarily to VA exams or a medical examination nexus opinion because oftentimes veterans don’t have the resources or the medical training to provide or get their own nexus opinion.

Nick: In the standard claims process, VA has that duty to assist. If there’s sufficient evidence indicating a relationship between your service and you’re currently diagnosed condition, they’ll get that exam for you. It’s not necessarily going to be a favorable exam. In those cases, you might still need to get your own medical evidence. But at the very least, VA is going to make that attempt to get the VA examination when it’s necessary. Because veterans don’t necessarily have the resources or know how to navigate getting a medical opinion from their own provider or contacting an outside specialist, it’s helpful to be able to get VA’s assistance because they do know how to get that information. They can assist veterans in navigating that process.

Emma: For a complete list of the types of evidence that you might need for your claim, you can visit VA’s website. Do a simple Google search for VA disability how to file a claim, they have evidence tables available. You can compare what you have with what VA is going to require.

Nick: Again, it’s important to remind them that once VA gets all the information that you’ve submitted and they determine they need more, that’s not the end of the deal. It will still get moved back to the standard claims process. They’ll go through the motions of getting additional evidence and doing any additional development that they need. So even if the veteran submits what they can and VA determines it’s not enough, they’ll do what they can if they realize more information is needed.

Emma: Michelle, how do I go about filing a fully developed claim?

Michelle: I think the first thing to talk about here is we’re talking about fully developed claims and that you should really have all your evidence together. Usually when you decide you need to or want to file a claim, you may not have all the evidence. I think it’s very important to talk about the fact that VA has what we call an “intent to file form”. It’s 21-0966. I usually will tell people that if you’re interested in filing and you want to get things together, send this form. It preserves your effective date. You have a year from the date you sent this into VA to file the actual form.

Michelle: So there’s multiple ways you can file the form. The first way is through eBenefits. There’s a section in eBenefits called “apply for benefits” and it walks you through what you may need. You can actually also upload documents in eBenefits which is very helpful because you are trying to submit all your evidence for the fully developed claim. You can also mail it. Here you would want to go on VA’s website. You’d want to get the 526EZ form. I will say the form is the same for the standard claims processing and the fully developed claims processing. There’s just a checkbox you’re marking at the top of the form saying which process you would like your claim reviewed. The form is going to ask the same questions as kind of when you want to apply online. It’s going to go through what type of claim you’re going for. Are you going for increased rating claim or you going for service connection? It’s going to ask you how the condition is related to service if it’s service-connected. It’s going to ask you about treatment information. It’s going to ask you about social security records that might be out there or service records that might be out there. It’s going to ask you about your service information.

Michelle: Again, this is why it’s very important to have this information handy because it is going to ask a lot of information. You really do want to be submitting this evidence with it. I think another important thing that you can go and submit with the stuff is going to be lay evidence. That’s additional evidence. Lastly, you can go and apply in person at the regional office. I’m not sure if you can actually do that currently with the Covid restrictions. I would say right now your best process is to either do it online or mail it. But again, like Nick said, you want to be making sure that you’re submitting as much evidence as possible if you want it to go through the fully developed claim process. Otherwise, if you’re asking VA to go out and get records, and you’re not submitting them with it, you might be ultimately setting your case to the standard claims processing.

Emma: It’s important to note too that if you do have the evidence handy on that eBenefits site, it allows you to upload the documents you as you’re filling in the information. Everything is sort of neat and tidy in that respect. But, as Michelle noted, you’re certainly free to mail. I think some regional offices, probably depending on where you are in the country, are open. But certainly reach out and check before you head down there. Including any paperwork because you want to make sure you’re gonna be able to get in. All right.

Emma: That pretty much covers the fully developed claims process. It’s not too complicated. It is an option available to veterans out there who are looking to try to get a faster decision out of VA which is really something everyone desires. With that, Nick, you have any final thoughts about fully developed claims out there for people watching?

Nick: We briefly alluded to this earlier, but some of the best candidates for fully developed claims are issues that necessarily require less evidence because VA may already concede certain aspects of the fact pattern for service connection. The prime example that comes to mind are presumptive service-connected conditions, such as veterans who have conceded exposure to herbicides in Vietnam. In those cases, they really only need to provide medical evidence of a diagnosis of coronary artery disease, diabetes, or any of the other presumptive conditions. Those in particular can be good candidates for the FDC program because you just need basically that diagnosis along with your service records.

Emma: Converse to that, are there any cases that will never be allowed to flow through the FDC?

Nick: I think PTSD is one example because there are special procedures that VA needs to go through in order to identify and verify the stressor. Typically, those aren’t adjudicated in the FDC program. They need to go through the motions of stressor verification through the traditional claims process.

Emma: Michelle, what about you? Any final thoughts on FDC?

Michelle: The only thing I would say is with appeals modernization system. What form you can submit and when can you submit it has got a little more complicated. You actually might not be able to be submitting a 526 and going for a fully developed claim through this process anymore. You might have to actually be filing what we call a supplemental claim form. It’s geared towards reopening a previously denied claims. I think it’s very important to make sure that you’re reaching out to a representative, whether it’s a service organization, a creditor practitioner, or attorney, to see if there’s some assistance you may need when knowing which form is correct to be filing. This is just to prevent some unnecessary delays in processing a claim.

Emma: Well, thank you so much for joining us today to talk about FDC or fully developed claims. Please be sure to leave questions in the comment section and we’ll get back to you just as soon as we can. Check out our other CCK live videos to learn more about the claims process. As always, feel free to check out our blog for more in-depth information and lots of interactive tools. Don’t forget to follow us on social media. Thanks so much for tuning in.