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VA Claims Process

VA Disability Claim Process 2020 | The 8 Stages Explained

Video Transcription:

Michael Lostritto: Good afternoon, everyone and welcome to CCK live. My name is Michael Lostritto, and I am an attorney here at CCK. As an attorney at CCK, I represent veterans who are filing claims for VA disability compensation benefits before the Department of Veterans Affairs. And joining me today, I have Kathleen Smith who is an accredited VA claims agent here at CCK, and also Kaitlyn Degnan who is an attorney at our firm’s core practice. So, today we are going to be discussing the VA disability claim process and we are really going to go through it step by step and this is really from the perspective of how VA treats your claim once it has been filed all the way through the issuance of an initial decision. So, I will begin first by discussing some considerations to think about when filing a claim for benefits and then, I will turn it over to you, Kathleen, and Kaitlyn to take us through the process once a claim has been filed up until that initial decision. So, before you file a claim, it is really important to think of a few things. First, veterans want to be thinking about what specifically they are going to be claiming and what evidence is going to need to be required, to be submitted in order to prove that claim. And so, generally speaking, we are going to be discussing three types of claims here today. There are many others but these are perhaps the most common claims. The first type of claim is a claim for service connection and this is essentially a claim where veterans can apply for disability compensation benefits if they can show that they have a current disability that is related to or caused by some event, injury, or occurrence from their time and active service. And here, when veterans are thinking about filing a claim for service connection, it is really important that they submit evidence that shows that they do have a current disability, that there was an incident in service perhaps service medical records or lay testimony describing that in-service event. And then, in most cases, veterans are going to need to provide some sort of medical Nexus and that Nexus is the link between their current disability and the event that occurred in service. The second type of claim is a claim for an increased rating or TDIU, which is often encompassed within a claim for an increased rating. And here, veterans really need to think about submitting evidence that shows that their condition has worsened or increased in severity in some way. So, they may be able to show that through providing lay testimony describing the severity of their condition by providing updated treatment records from their treating provider that shows increased severity or in the case of a claim for a TDIU, veterans should submit any type of evidence which shows that their service-connected condition in some way prevents them from working.

And then, finally, the third type of claim that we are talking about here today is a claim for what is known as DIC or dependency and indemnity compensation and this really is a claim that survivors may submit oftentimes. A surviving spouse may submit for compensation if they are allowed to show or if they are able to show rather that their spouse, the veteran’s disability led to his or her death. So here, evidence oftentimes medical evidence is needed to show that the veteran’s cause of death was due to a service-connected condition.
And again, this is just a very general recap of these types of claims. We have video and information in our blog posts. If you would like more information, please visit us online. For veterans that are looking to file a claim, one thing that is important to know and remember is that to ensure the fastest possible decision and hopefully the best result. It is really encouraged for veterans to submit as much evidence that they have up front with their initial claim. And that will allow VA to hopefully adjudicate their claim as quickly as possible. As of July 2020, through some information that our firm has been able to obtain, the average wait time for a decision from the filing of an initial claim is approximately a hundred and twenty-eight days or so. And decision time certainly very case-by-case, mostly depending on the nature of the type of claim, the severity or complexity of the type of claim it is, how many disabilities a veteran is claiming as part of a claim. And also, finally, weather VA needs to go out and gather evidence to help adjudicate that claim as part of their duty to assist. And so, as I said, it is really important for veterans when they are filing a claim to submit as much evidence that they have that supports their condition whether it is an increased rating or a claim for service connection upfront with their claim to hopefully prevent VA from having to go through that sometimes lengthy evidence gathering process.
So, there are essentially four different ways for veterans to file a claim and those usually consist of the veterans’ ability to just go online to VA’s eBenefits portal and I am sure some of you out there are familiar with this but this is a pretty easy way for veterans to go through a process of going through some online questions and submitting a claim that way. Maybe the most common way I am guessing would be through the next option which would be to just mail a claim, good old sending in a paper copy of a claim and those claims are sent to what is known as the Evidence Intake Center and this is a designated location within VA that is responsible for taking in claims and other evidence.
Third, veterans are allowed to walk down to their local VA Regional Office and in-person file a claim that may be a little different at the moment due to the current COVID-19 pandemic, but normally speaking, veterans are allowed to drive down, walk into their local VA Regional Office and fill out a claim and submit it right then and there. And then finally, if a veteran is using the assistance of a VA accredited representative or VSO or an attorney of some kind, certainly their representative would be able to take a look at the case and potentially file a claim on the veterans’ behalf.

So, that is a little introduction, some background about filing a claim. Kathleen, I am going to turn it over to you to get us started here on the actual claims process. So, my first question for you Kathleen is if you could take us through the first step essentially that VA must undergo once a veteran files his or her initial claim. Can you tell us a little bit about what happens next?

Kathleen Smith: Of course. So, once the claim is filed, any of the methods you just mentioned. If it was filed on eBenefits, there should be an on-screen notification after you submit the claim and be able to post a notice about it in the claims list. If you mail the claim to the Evidence Intake Center or for VSO, they will– once VA has received the claim, they will send you a letter confirming that they have received it and they will be processing your claim.
Often, especially when a veteran is new to filing claims, sometimes there is maybe missing information or maybe the incorrect form was used. In those situations, they will send a letter notifying you that they avoid the information they need whether it is on a form. They will let you know exactly what you need to do to complete your claim and then, you can just submit that information to VA, and once they determine that the proper complete information has been received, they will place the claim in line to be reviewed by a veteran service representative.

Michael: Yeah, that is exactly right here. And then, once the claim has been received and that process that you just described kind of takes place, what might be the next step in the process? What might veterans will see if they were to click on eBenefits and try to look at what the status is of their claim.

Kathleen : So this time, once the claim has been in line to be reviewed when your claims turn comes up for a veteran service representative to review it, they will assess what has been submitted with your claim and then, they will determine at that point if there is anything they need to do on their end. This development usually begins with any VA or private treatment you might have reported when you filed your claim. One common misconception is that if you treat at a VA Hospital, a lot of veterans assume that VA is already in receipt of all of your medical records. They can easily obtain them, but you have to tell VA where it was that you treated so that they know where to go to get those records. So, it is just them determining based on what can you file. It could be if you are claiming service connection with PTSD. They want to verify what your stressor is. So, they are at this point assessing whether or not anything needs to be done before they make their decision.

Michael: That is so true and oftentimes, this is a very frustrating part of the process because a list of veterans who I have represented in the past will maybe click on to eBenefits as we have described, and they constantly see the under review notification pop-up and they are wondering what is going on in the claim. And oftentimes, it is because the VA is examining what evidence is needed. What do they need to go out and gather to help substantiate the claim? So Kathleen, maybe you could then take us a little through that and let us know if there are certain instances where veterans might anticipate being scheduled for a VA compensation and pension examination or maybe any other evidence gathering that might need to be undertaken. Can you take us through that a little bit?

Kathleen: Yes. So, a VA has a duty to assist the veteran in obtaining evidence that can support their claim. And for this reason, typically when the veteran service representative is going through in determining, what or if they need additional information. At this stage in the planning process, they will send you a letter in the mail, letting you know that they are working on your claim and the letter will typically have some bullet points of what documents or information they are seeking that they would like you to either let them know, where you are treated, the address. If it like I mentioned the PTSD stressor if they need you to submit a statement of what the stressor is, if it was unclear. That is some of the typical development that they will do. This is often where delays can occur in the claims process because it does take them some time to gather the necessary evidence. And if it is determined that your claim requires more evidence further along in the process, your claim will be returned to this stage which happened a few times. If you believe that you have all the evidence you need when you file a claim, you can submit a fully developed claim which can reduce the delays at this stage, but VA may still determine that they need some more information. The last step after they have gathered the evidence that they believe they need or was missing when the claim was filed, once they have all of that in the file, the last step of the development is when they will determine whether or not a compensation and pension exam is required. They will typically wait until the last step to do this because they want to make sure that the examiner has all the information they need to make an informed decision. And they will contact you to schedule the examination and it is very important that you do attend it because if you do not, it will likely result in a denial of your claim because they do not have an examination to base their decision on. So, the compensation pension exam is one of the more important steps of this development in determining the claim.

Michael: Yeah. That is an excellent point, Kathleen. And that really underscores what we were speaking about earlier, about how important it is for veterans if they can do some of that evidence gathering initially even before they file the claim or at the time they are filing the claim. Hopefully, that cuts down on some of the delays it will take for a VA to actually make a decision. And also your point about waiting for or attending rather, compensation and pension examinations. I am sure we have all seen here. I do not want to speak for anybody but I am sure we have all seen here many instances where VA will use the veterans’ failure to attend an examination as a kind of low-hanging fruit for a denial. It is a very quick easy way VA can identify a reason for denial or say, “You know what? We scheduled you for an examination. You did not attend. We do not have enough information to adjudicate your claim. Therefore, we are going to deny”. I think it is worth noting actually that on that point due to the current COVID-19 pandemic if veterans out there have been denied because they were unable to attend an examination, that is something that they are going to want to reach out to either the Regional Office about or certainly consider appealing because VA has issued an instruction that really claims should not be denied during this time for that purpose of veterans do miss examinations. Given veterans’ difficulty oftentimes, attending in-person exams at a local medical center. So yes, that is terrific. Thank you, Kathleen. Moving on now, Kaitlyn, maybe you can kick us off here a little bit as to what happens next. So, VA has received the claim. It has been under review. Maybe VA has gone out and gathered some evidence. They have reviewed the evidence. At this point in the process, can you take us through what the next step is?

Kaitlyn Degnan: Yeah. So, the next thing that is going to happen is that a veteran service representative is going to look at all the evidence and then make the decision. So, they will make  on whether or not that satisfaction that can increase we are creating whatever the sought that if it might be. And the veteran service representative will then repair documentation showing their recommendation. After that, the claim will go to decision approval and then, that adjudicator will review the veteran service representatives from [inaudible] recommendation and then, a decision will be made.

Michael: Yeah, that is a great point. I think this stage of the process can also be equally frustrating for veterans who think that they have been checking eBenefits. They see that the evidence has been gathered, that the file has been under review. And now, a decision is just pending. Unfortunately, oftentimes, decisions are not then mailed out and issued right away. So, there is still some delay that we see but I think it is important to know that at this stage at least the evidence has been reviewed and a decision is now hopefully coming within a short amount of time. And then next up, if you could take us through kind of the next step at that point, how VA then goes to prepare for notification of a decision?

Kaitlyn: So, VA will prepare the decision to mail it. They use the U.S. Mail to send out these decisions. They should send a copy of the decision to you and they should also send a copy of it if you have representation whether that be a VSO or some other kind of accredited agent, they should also send that decision to them as well.

Michael: That is right. And I think it can be a little confusing but veterans should often receive one complete document but two subsets of documents, perhaps within a decision. Can you take us through maybe what the difference between what is known as rating decision narrative is, first notice of action letter?

Kaitlyn: Sure. So, the two documents if you will that you would receive when a decision is made, the first is as Mike said, the rating decision narrative and that explains the decision that VA made on each of the claims and the reasons for that decision. So, if they decided to grant service connection, it will go through that evidence that it considered in deciding to grant service connection and state why it was granted. If they are denying an increased rating, it will go through the rating criteria for that particular disability and explain why or why not your facts do or do not meet the criteria. The second document that comes along with the decision is called the notice of action letter and it basically just summarizes, this is the decision that VA made. We granted your claim or we denied your claim. If there is any additional compensation that comes along with that grant of benefits, it will explain what the different compensation will be in there. And will also include information on how to appeal that decision. So, if you are unsatisfied with the decision that the VA made, that notice of action letter, that whole package should provide information to you on how you can take action to disagree with that decision.

Michael: That is a great point. And I think it is important to know that the date that is a fixed to the notice of action letter has a lot of significance in the VA world because that oftentimes is the date that VA will use for effective date purposes or just for notification purposes, not necessarily effective date purposes, but notification purposes. And that is the date by which the appeal period is judged. So, if a veteran has a year to appeal, it is oftentimes calculated from the date that is on the notice of action letter, not necessarily on the date that is on the narrative. And certainly, that is as you can imagine widely important and so, I think that is a nice recap taking us through the process. Kaitlyn, could you provide us with a little bit of information about how veterans could maybe check the status of their VA claim? If they have filed a claim, they have submitted it, it is pending, maybe they have checked eBenefits and they have seen that one of these different steps in the process or maybe it is stuck on one of these different steps in the process. How can they go about checking that?

Kaitlyn: Sure. So, of course, one of the simplest ways to check the status of your claim, you can visit your local regional office and inquire about the status of your claim there. VA also has a hotline number that veterans can call, that number is 800-827-1000, and then alternatively, veterans can use the VA’s online tracker to determine, you know, we are in the process of their claims.

Michael: And Kaitlyn, so, they have said a veteran’s gone through this process, they filed their claim, they have been tracking it all along, they finally receive a decision, they receive the narrative and the notice of action letter like we were just discussing and say they are unhappy with the result. What options do they have at that point to continue their claim?

Kaitlyn: So, under the new appeal system that AMA, there are three different kinds of reviews that veterans can pursue if they do disagree with their claim. And again, all of that information is included, what the different lane options are included in the decision when it is sent to the veterans. So, if the veteran does disagree with their decision or if they are in any way unsatisfied with it. As you mentioned earlier, they have one year from the date of the notice of action letter, and based on their individual circumstances, they can choose whatever lane they want to appeal that decision and then, continue pursuing their claim that way. And if veterans are looking for more information on the different appeal lanes, we have tons of information about it on our website. So, we would encourage you to go and look there and kind of use that as a guide if you need it.

Michael: Yeah, absolutely. Thank you, Kaitlyn. That is great. And I think that was overall a great recap of the kind of taking veterans through the claims process. Again, from VA’s perspective and how they internally look at and review these cases. So, I guess I would open it up both to you Kathleen and Kaitlyn. Do you all have any closing thoughts here?

Kathleen: Yeah. One thing I would always suggest is anytime you file a claim, anytime VA sends you a letter, whether it is requesting information or anything, make sure that you read it carefully, see what it is that they are asking you for to complete your claim and make sure you respond to them if they are asking for an answer or information. It can see if the process significantly by staying on top of those letters that they send you relating to your claims.

Kaitlyn: And I would just echo that, I practice in appeals mostly and it is so much easier for us to challenge decisions of VA when the veteran has been interactive with VA as they are seeking evidence. They like to say that the duty to assist is a two-way street. So, it is not helpful to just– you know, while you are claiming, wait for VA to go out and get all of the evidence. That interaction, that response is really really important especially to preserve issues for an appeal later on.

Michael: Yeah. I think those are both great pieces of advice. So, thank you for everybody who has tuned in today. That concludes our CCK live presentation for today. Please feel free to visit us on our website where we have a whole host of other information about this topic and other topics as well and we hope to see you again next time.