How To File A Va Disability Claim Appeal

Filing A Claim For Va Disability Compensation

When you file a claim, the VA has a duty to assist you to win your claim. This duty could mean the VA must go to get service records, health care records and social security records. Sometimes the duty to assist includes getting the veteran a C& P exam. The VAs goal is to issue a rating decision within 125 days. Although similar to the way the rating decisions used to be laid out, now it must include the following:

• Identification of the issues decided.
• Summary of evidence considered by the VA.
• Summary of applicable laws.
• Identification of findings favorable to the claimant.

The VA is then bound by these favorable findings throughout the adjudication appeal. Absent clear and convincing evidence to the contrary. If denied, identification of elements leading to denial. Explanation of how to obtain or access evidence used in making the decision and identification of criteria that must be satisfied to grant service connection or the next higher level of compensation.

Once an initial decision is issued, a veteran can hire an attorney or agent. It used to be that a veteran had to file an NOD first, but now a veteran can hire and advocate and the advocate can help decide what way to move the case forward. If you disagree with the decision, then you have three choices to move forward. Those options again are:

When Is A Supplemental Claim Used

Whether or not you should file a VA supplemental claim depends on your situation. If you believe a mistake was made by your original adjudicator on your prior claim, you should pursue a Higher-Level Review . An HLR is when all the existing facts in your case are submitted to a more experienced adjudicator who can decide if the original reviewer missed something or did not make a proper decision. The downside of an HLR is that no new evidence is allowed to be submitted. If you received an unfavorable decision because you didnt include everything you needed to in your claim, you may consider filing a VA supplemental claim.

A supplemental claim is used when an individuals case lacks information necessary for benefits. One of the most common examples of missing information is a current medical diagnosis. To prove disability to the VA, a veteran must submit a medical diagnosis from a qualified health professional that corroborates their claim. If their original claim is denied because that was not included, the veteran can go to a doctor, receive a current medical diagnosis, and file a supplemental claim that includes the new and relevant evidence.

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• Find out if youre eligible for VA disability compensation
• Gather any evidence youll submit yourself when you file your VA disability claim.
• Be sure your claim is filled out completely and you have all the supporting documents ready to send in along with your claim. This will help us process your claim quickly.

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Dont Forget About Your Secondary Service

Do not forget to include all your secondary service-connected disabilities. The best way to get your VA Disability benefits rating up is to interweave all your medical conditions.

For example, suppose you are a veteran with service-connected ischemic heart disease, any condition that is from your heart disease may also be considered service-connected. If you take medicine for your heart disease, the side effects may be considered service-connected.

Veterans who are claiming PTSD may also want to consider their secondary service-connected mental conditions. If you have anxiety or depression because of your PTSD, they may also be considered service-connected. Stress from PTSD may also be related to heart conditions and other physical disorders.

Learn More: Figure out your monthly disability payment with our VA Disability Rating Calculator

Here is a video of one of our Veterans Disability Lawyers teaching you how to use our VA Disability Combined Ratings Calculator.

Tip #3 Be Aware Of Va Disability Deadlines

Generally speaking, veterans will have one year to appeal unfavorable VA decisions. However, there are exceptions to this timeframe. As such, all deadlines within VAs new appeals system based on the decision veterans receive are outlined below:

• Initial Rating Decision: Veterans have one year to appeal by opting in to one of three appeal lanes: the supplemental claim lane, higher-level review lane, or Notice of Disagreement lane.

• Supplemental Claim Rating Decision: Veterans have one year to appeal by opting in to one of the three above-mentioned lanes.

• Higher-Level Review Rating Decision: Veterans have one year to appeal by filing either a supplemental claim or a Notice of Disagreement.

• 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.

• CAVC Decision: Veterans can either file a supplemental claim within one year or appeal to the Court of Appeals for the Federal Circuit within 60 days of judgement.

Importantly, if veterans do not appeal within the Appeals Reform deadlines, their decisions will become final. When a decision becomes final, veterans will lose their effective dates since the claim will no longer be continuous.

• Submitting evidence in the hearing docket: Veterans can submit additional evidence to the Board during their hearing or up to 90 days.

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What Qualifies As Advanced Age

You can also request an expedited disability determination on the basis of advanced age. Advanced age for purposes of seeking expedited handling of your disability claim is generally 85 years of age or older, but for matters at the Board of Veterans Appeals, the qualifying age is 75 years of age or older. How to get an expedited disability determination

In order to apply to have your claim expedited, veterans who meet the criteria for one of the above categories will need to submit a Priority Processing Request via VA Form 20-10207. The five-page form contains instructions for applying to have your claim expedited.

To make a request based on financial hardship, the veteran will need to fill out VA form 10-10hs. This simple form asks for the reason for the financial hardship . Attached supporting documentation If you are in the process of a claims appeal and have an attorney, talk with them about this process.

Requests that are based upon illness will require military records of discharge, or medical records establishing the military operation-related injury/illness or terminal illness from other causes. To request that the VA obtain your private medical records, youll need to complete and submit VA Form 21-4142 or 21-4142a.

Requests based on your status as a former POW, Medal of Honor, or Purple Heart recipients should include DD Form 214, or other records verifying this status.

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Get Help Filing Your Claim Or Appeal

If you need help filing a claim or appeal, you may want to work with an accredited attorney, a claims agent, or a Veterans Service Officer . We trust these professionals because theyre trained and certified in the VA claims and appeals processes and can help you with VA-related needs.

VSOs work on behalf of Veterans and service membersas well as their dependents and survivors. Find out more about accredited representatives and how they can help you.

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Filing A Supplemental Claim

The first of three options for appealing a denial of VA disability benefits under the new system is filing a supplemental claim. This allows you to provide additional evidence to the VA that is both new and relevant. According to VA policy, new evidence must be information the agency did not receive in the original application and did not have when making its initial decision, and relevant evidence is information that could impact the agencys understanding of some element of the claim.

Applicants who wish to submit a supplemental claim can do so by filing VA Form 20-0995. In this form, you should indicate what type of benefit you are seeking and what issue you want the VA to review, and you should either submit new and relevant evidence, identify evidence for the VA to gather and review on its own, or both.

Veterans Appeals Deadlines Under The Appeals Modernization Act

Under Appeals Reform, veterans will still receive a Rating Decision after every claim is filed. However, if a veteran disagrees with VAs decision, he or she has one year to appeal by choosing one of the following three lanes: the higher-level review lane, supplemental claim lane, or Notice of Disagreement lane . After appealing through one of those three lanes, veterans will then receive another decision. Specifically, both the higher-level review and supplemental claim lanes will yield additional Rating Decisions while the Notice of Disagreement lane will produce a Board decision.

Upon receiving a decision on their first appeal via one of these three appeal lanes, veterans have the option to file a subsequent appeal. However, there are some important stipulations to note:

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What Types Of Claims Can Be Reopened

Not all types of VA disability claims are eligible to be reopened. Generally, claims that you can request to have reopened are claims for:

• service-connected disability compensation
• dependency indemnity compensation , or
• burial benefits.

Other types of benefit denials, such as denials of VA pensions or increased disability ratings, must be refiled as brand new claims.

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Ask A Lawyer About The Va Appeals Process

While appealing the VAs decision on your disability benefits works differently than it used to, the process can still be very complicated and difficult to manage on your own. Wait times for appellate decisions range from months to years, and any mistakes or problems with your appeal could significantly increase those delays and ultimately lead to another denial.

Fortunately, help is available from our qualified team of lawyers. To find out how legal counsel could help you through the VA appeals process, .

• United Center | 500 Virginia St. E. Ste. 710

Board Of Veterans Appeals

If you asked for a BVA appeal, the VA will prepare your Statement of the Case and send it to you. The Statement of the Case is a summary of the VA’s denial decision, and it will take months for the VA to send it to you. You will also receive a Statement of the Case if the DRO denies your appeal.

Once you receive the Statement of the Case, you have only 60 days to file your BVA appeal. Use VA Form 9 to file your BVA appeal. You can find VA Form 9 at www.va.gov/vaforms.

VA Form 9 is more difficult to complete than a Notice of Disagreement, so you may need the help of an attorney.

After you file Form 9, you will again have to wait several months for your VA regional office to transfer your file to the BVA. When you get a letter from the BVA with instructions for your appeal, you will know that the BVA have received your file.

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Can I Keep Going With More Appeals

If you are unhappy with the Veterans Court decision, you can appeal to the Federal Circuit Court of Appeals. This is the appellate court that also reviews government contracts, patents and copyright cases, and many other types of issues. It is a very formal court with little patience for ill-conceived appeals. If you are thinking about appealing to the Federal Circuit, I advise that you seek opinions from more than one lawyer about whether the case has any legal chance of success. The Federal Circuit is limited to reviewing legal errors made by the Veterans Court. Again, it cannot and will not consider arguments that VA made a bad decision or made fact findings that you disagree with.

Finally, you can appeal a decision of the Federal Circuit Court to the United States Supreme Court. This is a very specialized Court and preparing an appeal is complicated. If you get this far in the process, you simply must consult with an experienced lawyer. Otherwise, you have no realistic chance of being heard by the Supreme Court.

Requesting A Board Appeal

The third option in the new VA appellate process is the Board of Veterans Appeal, which you can submit an appeal to after an initial claim, a supplemental claim, or a higher-level review. Individuals seeking a Board Appeal can either request that a Veterans Law Judge reconsider a claim based on existing evidence, submit additional evidence for the VLJ to review, or request a hearing to testify before a VLJ.

You can indicate which path you want to take and get the Board Appeal process started by filing VA Form 10182. A qualified legal professional from our firm can provide crucial guidance about which option may be best for you.

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File For Tdiu For An Increase In Compensation To The 100% Rate

TDIU, or total disability based on individual unemployability, is a benefit that allows veterans who are unable to work due to a service-connected disability, or disabilities, to receive disability compensation equal to a 100 percent rating, even if their combined disability rating does not reach a schedular 100 percent.

Veterans unable to obtain and maintain substantially gainful employment due to service-connected conditions can qualify for Individual Unemployability benefits. A substantially gainful occupation is defined as a job that pays above the poverty threshold. Marginal employment and protected work environments do not equate to substantially gainful employment. An example of this would be a family business where extra accommodations are made for you, enabling you to continue working.

Veterans may qualify for Individual Unemployability on a schedular or extraschedular basis if they meet VAs requirements.

The schedular requirements for Individual Unemployability are as follows:

• The veteran has one service-connected disability rated at least60 percent disabling OR
• The veteran has more than one service-connected disability, with one condition rated at least 40 percent, and a combined rating of at least 70 percent.

Va Supplemental Claim Effective Dates And Va Ramp

While AMA was signed in the summer of 2017, it didnt go into effect until early 2019. On April 1st, 2018, a temporary law called the Rapid Appeals Modernization Act allowed veterans to enter the AMA program before its start date. The RAMP VA disability compensation program allowed individuals to opt-in to supplemental claims or HLRs. When AMA began in February of 2019, RAMP was discontinued and all eligible veterans were offered the opportunity to switch into the new AMA system which allows all veterans to take advantage of the quicker appeal lanes.

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Va Supplemental Claim Timeline

The goal of the AMA is to streamline the VA decision making process and reduce wait times for veterans who submitted a claim. In the supplemental claim lane, the VA has a 125-day goal for issuing decisions. On average, theyve been able to return claims in around 60 days. You can check your VA supplemental claim status at any time by logging in to VAs Appeals Tracker, going to your local VA regional office, or calling the VA at 827-1000.

Tip #7 Obtain Your Claims File

A VA claims file, often called a C-file, is a collection of records kept by VA in connection to a veterans VA disability claim. When a veteran first files a claim for benefits, VA will request the veterans service records and any medical records relevant to the claim. This is the beginning of a VA claims file. As your claim progresses and if you file more claims, your claims file will grow. It is recommended that veterans seeking disability benefits obtain their c-file to ensure that it contains all of the evidence necessary to prove their claim. While VA has a duty to assist veterans in gathering evidence for their claim, the responsibility for ensuring VA receives those records is ultimately that of the veteran.

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Understanding The Va Claim Process

Step 1: File Your Claim

You must file a claim at your local VA office or medical facility to receive veterans disability benefits. There is at least one office like this in each state and locations in Puerto Rico and Manila. Claims can also be filed online through the VA.

A legal representative can help you file a claim or you can ask for assistance from an organization like Disabled American Veterans. Generally speaking, the claim process involves several steps and begins when you complete VA Form 21-526. Once the form is complete, three additional steps must be completed.

Step 2: Provide Information

First, you will be given a list of information that you need to provide in order to for a decision to be made about your claim.

This information will help you substantiate your claim so that you stand a better chance of obtaining the compensation you need and deserve.

Step 3: VA Review

The next phase of the filing process occurs when the VA reviews all of your information and makes a decision about your claim. If any information is missing from your file, the claim will be pushed back to the first phase.

After all of your information has been collected, a decision will be made about the claim.

Step 4: Receive Decision

The final portion of the claim filing process occurs when the VA notifies you of its decision. Once you receive your notification letter, you will know whether or not your claim was approved.

Contact us today to receive assistance filing your claim.