Navigating the VA Claims Dispute Process

Posted by Admin

VA-Department_MilitaryAuthorityIn 2013 the number of 125+ day old VA Claims waiting for process reached a record 611,000. As of this week, that number was less than 124,000. Whether or not the VA will reach its goals of having zero claims older than 125 days and a 98 percent accuracy rate by their self-imposed deadline of September 30th is anybody’s guess.

And although reducing the number of backlogged claims is good news for claimants, the bad news is that in order to tackle the backlog beast, the VA has pulled resources away from other needs- like dependency adjustments and appeals.

If you’ve gone through the lengthy claims process and received either a rejection or a reduction, you have one year from the date of notification to file an appeal. 

The types of appeals are as varied as the types of claims; typical appeals are for disability compensation, pension, education benefits, recovery of overpayments, reimbursement for unauthorized medical services, and denial of burial or memorial benefits.

The first step:  Written Notice

What you’ll do: You must file a written Notice of Disagreement (form VA 21-0958) with the VA regional office, medical center or NCA office that made the decision.

What you’ll get next: Once they’ve received the written notice, the VA must send you (the claimant) a “Statement of the Case (SOC).” The SOC describes the facts, laws and regulations used to decide your case.

The second step: Decision Point

What you’ll do:  Read the SOC in its entirety. Enlist the help of your VA Representative to clarify anything that needs explanation. The SOC should provide you with an understanding of why the VA reduced or denied your claim. With this information in mind, you need to decide whether or not you will want to continue pursuing your appeal. 

If you don’t want to pursue your appeal any further, simply do nothing. The VA will close out your appeal. If you wish to continue with your appeal, keep reading.

The third step:  Board of Veterans’ Appeals 

What you’ll do: If you want to move forward with your appeal, you must complete an Appeal to the Board of Veterans’ Appeals form. You may want help from your VA Representative to complete the form.

A couple of things about the form:

  • Ironically, filing on time is important. If you think you’ll need more time to complete the forms, write your VA office and advise them of how much time you’ll need before your original deadline.
  • A BVA hearing is not always necessary. If you feel strongly that a hearing is required, use Block 8 to select one of the hearing options. If you leave the block blank, the BVA will assume you do not wish to have a hearing and will decide your case based on the information included on your completed form.
  • If you do have a hearing, please note that the Judge does not make a decision at the hearing. Decisions will be made afterward, with the Judge compiling a transcript of your hearing along with the other documentation associated with your case.

About the Board of Veterans’ Appeals: The BVA makes decisions on appeals on behalf of the Secretary of Veterans Affairs. Although it is not required, a Veterans service organization, an agent, or an attorney may represent a claimant. If they desire, appellants may present their cases in person to a member of the Board at a hearing in Washington, D.C., at a VA regional office or by videoconference.

What you’ll get next:  The BVA will make a decision and send it to you in writing. You’ll receive notification of one of three outcomes for each issue:  Grant, Remand, or Deny.

Grant means that your local VA office will receive and implement direction from the BVA on your issue.

Remand means that the BVA did not have enough information to make a decision on your issue. The BVA will instruct your local VA office to collect additional information from you in order to complete the appeals process.

If your issue is denied, you have another appeals option with the U .S. Court of Appeal for Veterans’ Claims.

The fourth step: U.S. Court of Appeal for Veterans’ Claims

The U.S. Court of Appeals for Veterans Claims is an independent court, separate from the Department of Veterans Affairs. It does not hold trials or receive new evidence, but appellants may make personal appearances before the court.

What you’ll do: File a written notice of appeal (available here) with the Clerk of the Court of Appeals for Veterans Claims. It must be received within 120 days after the BVA mailed its decision.



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