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Understanding VA Decision Letters

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Emma Peterson: Good afternoon, and welcome to another edition of CCK live. I am Emma Peterson, and I am joined today by my colleagues Erin Collins and Michelle DeTore. Today, we are going to be talking to you. about understanding VA disability decision letters. The information you need to know and what to look for. As always, if you have any questions or comments. Please leave them in the comments section and we will do our very best to get back to you. Any further reading or information you want, we do have a couple of blog posts about this information on our website at cck-law.com. So, please be sure to check that out. With that, we will just dive right in. As I said, we are going to be talking about decision letters and sometimes go through those called notice of action letters, a cover letter. Basically, it is the couple of pages that are before your actual rating decision that you receive from VA. They have changed a little bit under the AMA, the Appeals Modernization Act, to be more transparent and clear cut for you, the veteran. We are going to explain why it is important to understand each section of your decision letter, to see if you know where your case stands, what benefits you have or are receiving, and what the next steps are, what options you have available to you. Erin, why do not you tell us a little bit about what is included in the introduction of a VA rating decision.

Erin Collins: Sure. In the introduction, it includes information such as your name, your claims file number, it also could include a brief history of your timing service to include the era in which you serve. Vietnam is an example of that and the years that you served as well. Then, it also includes a brief history of your claim. When you sent your claim to VA, maybe one day they will send you a decision

Emma: Michelle, what did the decision section talk about?

Michelle DeTore: This is the point where you are going to find out what we decided. You are going to have, usually, listed out by issues and they will say whether it was granted, whether it was denied. You will also see maybe two other possibilities, you will maybe see that something was deferred. Meaning that VA is not issuing a decision on it yet, and it will explain a little bit later in the decision, why not. But typically it is to get additional evidence. You also see a new possibility with new Appeals Modernization Act rules. If you have an appeal that you put in the higher-level review laid in AMA, you will get a decision, sometimes it says.” They found a duty to assist error.” That basically means that in the prior decision, VA, they believe did not do something, they should have maybe gotten medical records or an examination and they are, basically, we call it kicking it back, but sending it to the supplemental claim laid in order for them to do that said development and then issue a decision. Those are some other possibilities rather than the grant or denial. If they do grant your condition, they will tell you the effective date that they are granting it from and they will also give you the rating they are assigning on it. I think at this point, it is really good to make sure that all issues you applied for are listed on the decision, and if not, then it is time to maybe check to see what happened to it because sometimes things do get missed. But that is typically what you will see in the next section of the decision letter.

Emma: Also, included in that section of some dependency information. Is that correct?

Michelle: Yes. Sometimes, VA will include in that point whether or not they are warning your dependence benefits, especially if it was on appeal. Usually, the full version is in the notification letter that comes in a company’s rating decision letter. But it is a lot, sometimes you will also see it contained in there, and it also references back to a point that if you have dependents and you are rated at 30 percent or higher, you should be checking to make sure VA is compensating you for them and be aware of the fact that you have a year from that decision to submit the proper forms to get that person added so that you get your effective date to go back to the date in the decision.

Emma: Erin, what in the evidence section of a rating decision?

Erin: Within the evidence section, this is where VA list out everything that they considered when they were making the decision on your case. Basically, it is important to make sure that you review that list and know what the VA is looking for. Something, also, to keep in mind is that if there is something not listed that you can submit that within your appeal as new and relevant evidence.

Emma: After you look at the list of evidence and make sure that everything you submitted or you know what involved in there, VA is going to get right into the meat of the decision, right? There are going to tell you their reasons and rationale. Sometimes it is more in-depth than others, oftentimes a few sentences, but their rationale for the decision they made and it is going to be broken down by issue. So they will reference the evidence. Maybe, maybe not. They will give you this kind of outline and a chronology of what happened in your claim and they may or may not reference any applicable laws and regulations they used in making the termination[?]. For example, you claim some service connection claim and it is granted, they will tell you why for example, a ten percent rating was granted for your right elbow because there is an instance where you were injured your right elbow in service medical record, documented  notes right elbow injury. Your VA examiner provided an opinion that it is at least as likely as not related to that injury and you have painful motion. Therefore we are assigning you a ten percent rating. They will tell you the diagnostic code that they are using to rate that particular disability and that is something you might want to check too because the diagnostic codes go over the various requirements for each rating. So it is good to compare what VA has assigned you with what you have been awarded. The same thing if it has been denied, they are going to tell you why it has been denied, what evidence would be needed to grant, the issue, and what was missing. That kind of leads into the enhanced notice that you get under AMA. Michelle, why do not you go ahead and tell us about the favorable findings they are supposed to be including in these decisions.

Michelle: I love the idea of this. In the Appeals Modernization Act, they came out with the fact that now rating decisions include variable bindings. So if one adjudicator finds that you have said diagnosis or that your stressor is conceded that is now binding on VA, meaning that beforehand one adjudicator could say, “Yes, I think this meets the criteria, it falls under post-military activity” or “Yes, I think this makes our primary criteria for a diagnosis of a disability,” but then one adjudicator could see it differently and then the case would take that away. Now, these findings once one finds that, it is finding in the fact that VA cannot take it away unless they find it clear and unmistakable error in the fact that that the adjudicator made that favorable binding, and clearing out unmistakable error is a very high burden to me. It is very rare that somebody could find it as a clear unmistakable error. When you think about that that basically means that, everybody sitting in the room has to come to the same understanding when they look at something and that is not very easy to come by. It is not based on a difference of opinion. So it is a very high standard. That is a new thing that I think is very pro-veteran. I will say that you kind of see be done differently in each decision, as I was saying sometimes some decisions have a lot of information. Some do not have any information. Sometimes the federal findings will have a lot of good information and it will really help you understand what elements for service connection or the higher rating that you are meeting as well as maybe the ones who are not meeting. So I think that this is more important so much for our service connection because it will tell you, VA has conceded that you have a diagnosed disability. Here is the diagnosis. VA has conceded that you experience a stressful event. Sometimes, then you know that you have met two of the three elements for service connection, and then VA is only denying you because you have not met the third element which is a Nexus record. So I think it is very helpful for veterans when it is done right, it is done very well. Sometimes the federal findings will say none, and sometimes they will say information that is not necessarily relevant. But the idea behind it, I believe is very pro-veteran and I think it is very helpful in the sense that you could go back and forth. It is like, once somebody is conceded it, it is kind of set in stone for you. So I think that is a really good thing to be seeing a decision moving forward.

Emma: Yes. To echo Michelle, I think that is what we have been seeing in our practice and that our agency side is that these are sort of inconsistent. They are supposed to be including favorable findings and there may in fact be a favorable finding noted in the rationale awarding you a certain benefit. For example, it is related to service or Nexus found or diagnosis found. If it is then not listed under favorable findings, I think that is something that you should certainly talk to your accredited rep , your VSO, your attorney. Whoever you are working with about if it is going to be an issue down the road. Because they are supposed to be doing this, but it is. I would say more than inconsistent about whether they are or not including favorable findings in each decision. But that pretty much is going to be the meat of what you receive from VA. So we have the cover letter kind of outlining what you have received, the actual decision itself, which tells you all the evidence they looked at in a rationale for their decision. This used to be sent along to veterans, but now it is not always, it sometimes in copies that we receive as representatives for our client and I think you can ask for it, but I do not think that VA is automatically sending these out. Erin, why do not you go ahead and tell us a little bit about a rating code sheet.

Erin: With the rating code, it includes all of your conditions that are subject to compensation. Everything your service-connected for. Each condition is broken down. It includes the diagnostic code, the name of the condition and then the effective date and the ratings followed by the list are then what we called combined list. So that is the combination of all of your service-connected conditions, your total combined rating, and the effective date for that. After the combined ratings, you will see a list of the conditions that you have previously claimed but are not subject to compensation. It could include medical conditions that you claim years ago. But they are just still listed on that sheet as previously claimed.

Emma: Also, sometimes you will see on the code sheet if you are receiving any special monthly compensation that will be listed sometimes beneficiary information is listed there too. If you have had a pension in the past that information can be listed there. So there is a lot of really good information in that code sheet and it is worth taking a look at if you can get your hands on a copy of it. So after that code sheet if it is included you will get a list of appeal options that you have under the AMA and we a lot of information on our website. We have a lot of Facebook videos about this, your different choices. So certainly check those out if you want more information about the choices that you have to appeal a decision. If you do not agree with any determination VA has made but your three general choices are to file a supplemental claim with new and relevant evidence. You can file for higher-level review by a more experienced VA employee or you can appeal to the Board of Veterans Appeals and select one of their three dockets, their hearing docket, their direct docket, or their evidence docket, and then you have one year from the date of that decision to appeal unless you are appealing a board decision to the Court of Appeals for veterans claims and then you have a hundred and twenty days to do so.

Emma: Maybe just in closing if you all could share from your experience some tips for veterans seeking benefits and looking at these decision letters sure.

Erin: I guess the most important thing is you know about a decision that you request a full copy of it and if it lists something like an exam within the evidence and you are not sure what that exam is that you request a copy of it, so you can see everything that VA is actually looking at when they are making decision on your claim.

Michelle: I think for me, a big thing for people to look at it is just to read the whole decision, to carefully and thoroughly read it because there are things in there they will tell you you are entitled to like we briefly mentioned dependency benefits, there are points and times where you need to be and maybe asking for additional benefits that are not included in your decision but the benefits you are entitled to which usually typically the VA decisions do let you know. So a lot of times when you get the decision you go right to the meat of it as we are saying like you flip right over, we do it too, we were very curious right away and you kind of glazed over all the other stuff. They tell you in the beginning because you are so focused on what they decided and the benefits are favorable you might not go back and read the beginning of it. But there are additional benefits like your dependency maybe special monthly compensation, automobile auction stuff like that, that you might really want to be paying attention to that you might need to file for, so that is usually my advice, is to read it very clearly and carefully, making sure you are checking the evidence as well because sometimes there is evidence that you are submitting that VA did not get and it is also going to dictate what lane you are choosing to go into when you are appealing.

Emma: I think that brings us to the final point, which is that if you do disagree or there is something a little bit more complicated in your decision that you are not quite sure about please be sure to reach out to a VSO or veteran service organization, an accredited representative, an attorney, whoever you want to work with on these claims because as we have mentioned time and time again, the AMA is complicated. It is unknown and we are all in the process of learning it together. So you want to be sure to reach out to someone that has got some expertise in the area to help you navigate the wider range of options and lanes and choices you need to make once you get your decision.

Emma: With that, thank you so much for joining us for this discussion on VA decision letters. Once again, I am Emma Peterson and I am joined today with Erin Collins and Michelle DeTore, please be sure to leave comments and we will get back to you just as soon as we can our feel free to check out our website at cck-law.com and have a good afternoon