Overview: VA Claims System

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There are approximately 22 million veterans and many more millions of family members of veterans potentially eligible for federal veterans’ benefits. Millions of determinations relating to benefits are made each year within the 58 VA regional offices (ROs). For a listing of all the VA regional offices go to: https://benefits.va.gov/benefits/offices.asp

The VA has a dual role: it is a friend to veterans, but it is also a guardian of the taxpayers’ money. This means that the VA is required to investigate applications so that it can reject unsupported claims. Because some claims depend on the VA accepting the word of the veteran, it is important that claimants be consistent and accurate when they communicate with the VA. That is why all communications by the veteran to the VA should be reviewed by the advocate.

The VA claims system is unique in several respects. First of all, “final” VA denials are not really final. A claimant can file a supplemental claim to attempt to obtain previously denied benefits by presenting new and relevant evidence. “New” evidence is evidence that was not part of the record (claims file) that was before the previous VA adjudicator. “Relevant” evidence is evidence that tends to prove or disprove a matter in issue. When a veteran files a supplemental claim, the RO performs a three-step analysis. First, the RO determines whether the claimant submitted a substantially complete supplemental claim, which includes the proper completion of VA Form 20-0995, Decision Review Request: Supplemental Claim, with the submission or identification of potentially new evidence. If so, the RO next determines whether the potentially new evidence submitted or identified by the claimant is “new and relevant.” If so, the RO moves on to the third step—readjudication of the claim on the merits based on all of the evidence of record.

In some cases, an RO decision can be changed if the veteran can show that the decision was based on clear and unmistakable error. That is, the veteran must show that, based on the facts and the law existing at the time the claim was previously denied, the VA was clearly wrong. Claimants must first identify the error made by the VA and then show that they would have been entitled to benefits if the error had not been made. Another unique feature of the VA claims system is that the system is intended to be non-adversarial—that is, the VA is supposed to be fair and help the claimant, and no one is supposed to be arguing against the claimant.

Veterans and advocates alike must know that the VA claims system does not always work the way it is should. As in any complex system run by human beings, mistakes, misinterpretations, and honest errors are common. Do not become discouraged if a meritorious claim does not succeed at first. The VA must operate under set legal rules, and a claim that has been initially denied at the RO level may be granted on review or appeal.