What Happens When I File a Claim?
The claims process with the VA is often cumbersome and complicated. It has gone through some streamlining in the last few years thanks to legislation and an attempt to reduce the backlog, which the VA has done quite successfully, but there is still a lengthy wait and many hoops to go through before a claim reaches the end of its run. While every claim is different based on the outcome at each step, here is a basic rundown of the entire process of a new, first claim.
The Claim is Received by the VA
When the VA receives a claim from an eligible veteran, it is processed and date stamped. That date stamp is very important, as it is the official effective date of your claim. The date stamp is now an electronic marker noting the date and time a veteran actually submitted the claim electronically or when it was received via fax or mail. It is a good idea to verify receipt of the claim, otherwise, the effective date may be changed. Veterans can verify receipt of their claim by logging into the VONAPP Direct Connect account no earlier than one hour after electronic submission or one week after mailing date. It is suggested that veterans submit any evidence that will support their claim at the time of submission to reduce processing time.
Review of Initial Claim
Once received, the claim is assigned to a Veterans Service Representative (VSR). The VSR will contact the veteran and inform the veteran of the VA”s duty to assist (VCAA) and request any other evidence the VA may require to make a decision on the claim. The VSR is identified by the number that will be found at the top all the correspondence the veteran receives relevant to this particular claim, otherwise known as the “In Reply To” number. For every claim a veteran files, this number will be different, so do not use the same number on paperwork for different claims, as it will increase the time it takes to be processed.
Evidence Gathering and Review
After the VSR has determined what evidence is required to support the claim, they will request releases of information from the veteran and begin to gather the information from various facilities that are pertinent to the claim. This may include private medical records, federal or military records, and/or social security records. The veteran will also be able to submit any evidence they want to support the claim such as lay evidence and/or buddy statements from friends, family, and fellow troops or coworkers, police or accident records, school records, etc. Veterans can actually submit evidence to support a claim at any time, even after it has been rated on. But the more supporting evidence available, the better chance of a positive rating.
Reviewing the Evidence
The VSR will then review all the evidence and determine if they are ready to make a decision or if more evidence is required. If needed, they will request the additional evidence. When the VA sent the VCAA notice, they asked the veteran if they wished to have a hearing before the VSR. If they veteran has requested a hearing, that will be scheduled and a notice sent to the veteran informing them of the date and time of the hearing. Hearings can be held in person or via videoconference if the veteran is unable to go to the VA office in person. Hearings are part of the evidence review phase.
Making a Decision
The VSR, after reviewing all the available evidence, will recommend a decision and prepare the documentation that explains the decision and how it was determined, what evidence was reviewed, and what regulations or laws support the decision or rating if applicable. Once the decision has been reviewed and a final approval is made, the veteran will be notified. Decisions will either be favorable, where a veteran is awarded service connection (see types of service connection); or unfavorable, where the veteran is denied service connection.
Notification of Decision
This is a time sensitive point, as the notification date of the decision starts the clock ticking for appeal. If the veteran wants to appeal for either service connection if denied disability or a higher rating or earlier effective date if awarded, the time limit is one year from the date of the Notice of Action, the letter from the VA informing the veteran of the decision. There are some ways to keep this appeal open but the best way is to file a Notice of Disagreement before the deadline.
What if I am Denied?
Just because a claim is denied, does not mean it is over. Denial does not mean that the claim is not legitimate, it sometimes only means that the VA does not have enough evidence to prove the claim. Proving a claim, despite the VA’s regulation of giving veteran’s the benefit of a doubt, is very difficult in many cases. At this point, after the first rating has been decided, whether favorable or a denial, a veteran can retain legal representation to assist with their case. Legal representation can help by avoiding mistakes commonly made when filing appeals, ensure that all possible claims are filed to ensure the highest possible award, and legal representation can actually increase the chances of a veteran being awarded disability by 32%.
How Long Does the Process Take?
Well, that is a whole other blog called ironically enough, “How Long Must I Wait?” The process can be quite lengthy, but fortunately not as long as it has been in the past. The ability to track claims online has also helped as veterans do not always have to wait for the mail or return phone calls to check on the status of their claims. Veterans can track their claims through their eBenefits account. The process is lengthy and time-consuming, but with the right people by your side, it can be worth the effort.
