Claims for VA Disability Benefits
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There are now numerous ways to apply for VA disability benefits:
• The claimant can file online using an eBenefits account (https://www.ebenefits.va.gov/ebenefits/homepage)
• The claimant can complete and mail the appropriate claim form to the VA.
• The claimant can go to an RO and have a VA employee assist with filing the claim. To find the nearest RO, use the Veterans Affairs National Facilities Locator (https://www.va.gov/directory/guide/home.asp) or call the VA toll free at 1-800-827-1000.
• Of course, the claimant can work with an accredited representative or agent (https://www.benefits.va.gov/vso/index.asp).
Claims for service-connected compensation benefits go into the national work queue (NWQ). The NWQ was fully implemented in 2016. It allows the VA to have underused VA regional offices adjudicate claims when the local office has a backlog. It also means that local representatives, such as service officers, lose contact with the VA raters who decide most claims. Also, when a decision is made, the service officer is not notified. He or she is expected to search a database to find the notification letter, but the representative has not been notified that a decision is made. We advise advocates to urge their clients to send them copies of all VA correspondence.
When a veteran first files a claim, the RO first examines basic eligibility issues—for example, verifying the veteran’s period of military service and type of discharge. If the claimant does not meet the basic eligibility requirements, the VA will deny the claim. The VA will send the veteran a letter explaining the reason for the denial and informing the veteran of the right to appeal the determination.
If basic eligibility is established, the VA begins to develop the evidence necessary to prove the claim. For example, the VA may try to obtain important records missing from the veteran’s claims file, and may write to the veteran to ask for more information or evidence.
Any response or inquiry from the VA to a veteran or representative about a particular claim will include the claim number (claims file number or c-file number). This number is assigned to a claimant by the VA when the claimant files his or her first claim with the VA. It is an identifier unique to the veteran and should be included in all correspondence.
The veteran, after consulting with his or her representative, should always respond (through the advocate) to the VA’s letters requesting more information. If the veteran does not respond within a certain period of time (usually 60 days), the RO may deny the claim based on the veteran’s failure to take steps to prosecute the claim. If a veteran needs more time, he or she (or, preferably, his or her representative) should ask the VA for additional time to respond, before the 60-day deadline expires. In any event, the claimant typically has one year to submit the requested evidence. Therefore, even if the claim is denied after 60 days, if the claimant submits the requested evidence and benefits are granted, the VA can pay from the original date of claim. The VA is also responsible for providing claimants and their representatives with information about the status of their claims, and for providing proper notice to claimants of their right to seek review of or appeal denials.
Once basic eligibility requirements are met and the VA has obtained most, if not all, of the evidence necessary to adjudicate the claim, the claim is transferred to the rating activity if a medical or legal determination is needed. The rating activity reviews all the evidence in a case, orders additional development (requests more evidence) if needed, applies the relevant law, and then decides whether to grant or deny the claim. Rating activities decide, for example, whether a particular injury or disease is connected to a period of military service, the level of the veteran’s disability, and whether a disability is permanent and total. If the rating activity determines that the evidence in the case is not sufficiently well developed to make an informed decision, it will send the case back to the authorization unit for further evidentiary development.
A claimant may also file a claim at the RO under the Fully Developed Claim (FDC) program, which has the benefit of expedited processing time. The requirements to be eligible for this program are rigorous. With a few exceptions, the claimant must submit with the claim all of the evidence necessary to establish entitlement to the particular benefit sought, such as medical evidence and lay evidence.
Once the RO makes a decision, it notifies the claimant and the claimant’s representative by letter. The RO is required by law to provide in writing, among other things, a summary of the evidence considered, a listing of any findings by the adjudicator that are favorable to the claimant, and, for denied claims, the claim elements that were not satisfied. The RO’s letter must also explain how the claimant can seek review of the decision.