UPDATE: 12/15/2017: Most of the information in the following post is no longer applicable as VA has modernized and updated its appeals process to better ensure Veterans receive the benefits they deserve in a more-timely manner. The following post remains available to better understand the evolution of the appeals process. For updated information, please read the blog titled VA launches program to resolve compensation appeals sooner.
When I represented Veterans at the Board of Veterans’ Appeals, my clients usually had a lot of questions about the appeals process and the differences between a claim and an appeal. Even in my current position as a public affairs specialist for the Veterans Benefits Administration, I continue to get asked the same questions, so I thought I’d explain the process and address common questions through a series of blog posts.
What’s the difference between a claim and an appeal?
Often when I speak to many of you, you will say something like, “I have had a claim pending for 10 years.” Almost always, you have an appeal pending and not a claim. I don’t say this to undermine the frustration you feel from being in an appellate status for so long. But understanding the difference between a claim and an appeal, and using the correct term can help your VA representative know where to look, or advise you when discussing your case.
Claims defined
You submit a claim when seeking VA disability benefits (or increased benefits) for one or more medical conditions you believe are related to military service. These claims can be filed online through eBenefits, submitted by mail or in person at the nearest VA regional office. The claim submission, the military service and health care records and any other evidence associated with the claim are reviewed in order to provide you a rating determination.
Every claim in VA’s inventory is as distinct as the Servicemember, Veteran or survivor who filed it. A complex set of laws, regulations and court decisions govern how, and to whom, VA administers benefits. The laws and the process allow Veterans and their survivors ample opportunity – and even assistance – to provide VA the evidence necessary to approve their claims.
Under those laws, VA grants service connection and pays disability compensation (if warranted) for a disability when evidence shows three things: injury or illness in service, a current disability and a link — usually medical evidence — connecting the two. The laws also allow for service connection for conditions caused or aggravated (permanently worsened) by conditions that are already service connected.
Once the decision is made to grant service connection, VA examines the medical evidence and assigns a level of disability under the VA Schedule for Rating Disabilities. You are always afforded the benefit of the doubt. This means that if the evidence is weighed equally, 50 percent in your favor and 50 percent against, the claim is granted or the higher of two evaluations is assigned.
You can work with a state, county or Veterans service organization. These accredited service officers can help you sort out the best option for you claim. They cannot charge a fee during the claim process, and they provide guidance that can help identify and obtain the evidence necessary for VA to grant a claim. Remember, there are options for receiving assistance with a claim, so look for someone who files online, provides information about the Fully Developed Claims Program and takes time to answer questions.
What I continue to find interesting is that the accuracy of claim decisions has little bearing on whether we appeal our claims. In fact, regional offices with the highest quality can often have the highest appeal rates. That’s not to say processing errors don’t happen, they do, and VA continues to work to improve claims accuracy. Currently, VBA’s accuracy rate at the issue (or medical contention) level is 96 percent and the percentage of claim decisions being appealed remains in line with historical averages of 10 to 12 percent.
The Appeals Process
The multi-stage appellate process is available to you after you have already received one or more decisions on your claim, but disagree with some aspect of VA’s decision. During the appellate process, an appeal undergoes additional independent reviews, often multiple times and by different adjudicators, as you or your representative submit new evidence and/or a new argument. Nearly 74 percent of appeals are from Veterans who are already receiving VA disability compensation, but are seeking either a higher level of compensation or payment from an earlier effective date.
Once an appeal has been filed, a Veteran may also engage an attorney, but at his or her own expense. Attorneys’ fees are typically taken straight off the top of any retroactive award received from VA.
An appeal is different from a claim. I know firsthand that sending one or the other to VA can seem like the same thing, but understanding the difference and using the right terminology will help VA and your designated representative provide the best information in the quickest amount of time.
In my next piece, we will talk more in detail about the appeals process. In the meantime, I look forward to your comments below.
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Has anyone noticed that VA has been using an obsolete version of their on-line request for compensation Form 21-526EZ (January, 2014) to transfer the on-line application data to? The new version of the form (May 2015) clearly states that the January, 2014 version “will not be used” yet VA has continued to use the obsolete form to make decisions. My regional office used this obsolete form on the eBenefits site to stop my 100% VA disability compensation because they said that’s what I had requested! I had filed a new claim in July of 2015 and when my claim data was transferred to the 21-526EZ form, which is not shown anytime during the process, they said I had placed an “X” in block 17 saying I did not want my VA compensation and only wanted my retired service pay. So not only was my VA compensation stopped but I received a bill for over $10,000.00 for overpayment! My retired pay was also made taxable and their (the VA’s) action also resulted in the loss of my CRSC being stopped!! Their mistake and I’m left waiting and waiting for it to be corrected; only God knows how long it will take.
The appeals process is beyond messed up. I’ve written to every department involved in my appeal over the past year, making sure that any deadlines were reached by certified mail. I’ve received only one reply, and that was unsigned and not related to what I asked about or needed. I attempted E-benefits and received a response that I had reached a technician and he didn’t understand my question I’m not sure how I could have reached that person. It could have been my fault. I am not computer literate nor do I understand the initials nor technical words that they used. My eyes are so bad that even when I can use a larger font I’m not completely sure what I am reading and struggle with the simplest instruction. That is a result of open heart surgery twenty years ago.I understand it is a common complaint. My appeal is based on the fact that I was adjudicated 110% disabled but granted a 70% pay for the disability. Since the grant, I’ve had additional medical information that speaks to why they only granted 70%, both from VA doctors and outside providers. I have also suffered long periods of being unable to walk and spent six months of the year without the ability to drive. My condition continues to deteriorate and yet I can not get anyone to even return a letter. This is a personnel affront, and poor way to say thank you for your service.
Catherine has been great. She has been trying to help us. Nobody has all the answers. Jack
Hello Catherine,
My VA claim decision letter contained the following statement:
“While reviewing your medical records, we noted that you may be entitled to an additional benefit. Effective March 24, 2015, V A regulations now require all claims to be submitted on a standardized form. Therefore, if you would like to file a claim for the strain of your left wrist strain, and bilateral carpal tunnel syndrome, please send a completed VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits”.
I have some questions, is this considered a reconsideration regarding the bilateral carpal tunnel and left wrist strain? There were several claims that they could not find the evidence in the medical record and were rated “0%” I have the evidence to submit is this also considered reconsideration? I am well within the one year time frame for leaving service and there is a new medical issue to submit….is that a new claim or reconsideration?
What is the time frame for reconsideration in Texas?
Thank you
I really think this blog is helpful for frustrated Veterans but we need to remember many still do not have computers and in NM we do not have internet everywhere yet.
Unbelievable! I have been reading all these posts and am saddened by the hardships all these have endured. It isn’t right, and yet it seems these government employees are trying their best to help the situation. Always kind, respectful and helpfull. That’s tough too. Keeping a positive attitude while being faced with such negativity. I think your blog is very helpful, your attitudes refreshing. You are doing a great job of producing a positive result from a less than perfect system. Hats off! Now I can submit a claim. And undoubtedly join the ranks of the ignorred, oppressed and forgotten. Thanks for your efforts.
I do not understand why you cannot tell me how long it takes for an appeal to be heard. I appealed a denial for tinnitus 18 months ago and have heard nothing. With this appeal I provided all military records supporting it’s existence. I haven’t even received a letter advising who my rep is. I have requested this info from you on two previous occasions with no response. I guess your silence is a big “I don’t know”. It is probably quicker to have a court marshal hearing appealed than for honorably discharged troopers to have their cases responded to. You are a perfect example of the VA attitude. How do you sleep?
My father, a disabled WWII vet, died last year. We filed a claim for survivors benefits for my 87 year old mother. After 8 months and countless phone calls, her claim was denied.
We need to appeal but the process is so protracted. Mom will be 88 in June. She tries to live on $700 per month and has no assets or financial resources. Her advanced age and medical condition require around-the-clock care. I fear that the appeal process will outlive her as the claims process did my father.
My father died waiting for a decision on a nursing-home-qualifying enhanced VA benefit. It’s sad that he lost a benefit he earned because of an overwhelmed system. His assets were exhausted paying for his care; dad died penniless. I am 20K in debt from settling his expenses and for wages lost caring for dad and mom. We can’t afford to wait years…even months to process an appeal.
I understand that the VA is overwhelmed with claims. And so many young vets have more pressing needs. But my mother’s needs must be addressed as well.
It is obvious that the VA is grossly understaffed. The country can’t keep creating more combat vets without factoring in the costs of its aftermath.
Mom will be 88 in June. She is not in good health. Will she die waiting for a VA decision as my father did? Should she have to survive on $700 per month? She dedicated her adult life caring for the disabled man her country gave to her.
Please help.
Try American Veterans Aid at 949 407 5937. They have a good track record and there will be a cost involved for filing. Talk to them and find out what they can do
It has been 18 months since filing an appeal. I provided all military medical and VA records supporting my appeal. I have heard nothing. How long does this process take and how can I check on the status of the appeal
I am putting a claim in for agent orange I had 4 cancer operations in 11 months I was in nam in 1967 at bearcat the 9th division my cancer is fast growing and one doctor saw one of these before and the radioligest never did. can you give me any help on this.
Richard,
Please take a look at this website for information on filing a claim for a medical condition related to exposure to Agent orange in Vietnam: http://www.benefits.va.gov/compensation/claims-postservice-agent_orange.asp
If your cancer is terminal, VA can expedite your claims processing.
My husband passed away on July 7 2012, I buried him on July 13 2012 in the VA Cemetery. On July 19 2012 I filed a claim with the VA for his death benefits. In May of 2013 I received a letter that I made too much to claim his death benefits. I took the letter to the VA Consumers Affairs. He helped me to get the appeal going, plus his death cert. had to be amended. This is 2016, I have been calling about 3 to 4 months and I hear the same thing. They are looking into it, it takes 465 days to complete it. How long is 465 days to these people. My husband and I lived together for 33 years. We called each other husband and wife. We made official on March 30 2012, we was sick from cancer. I wish they would let me know something. I am tired of waiting.
Mary,
I’m sorry you are frustrated. Be on the lookout for a message from one of us at VA in the coming days so we can try and get you an update.
Hello Ms. Catherine Trombley. I did hear from Miss Small via email. I called her today and left a message for her. In my email response to her, thanking the both of you for taking interest in my situation, I said I would send a Thank You to you via this forum. Thank you so much for putting her in touch with me. No one, to this point has given me assistance in my search, as far as I can tell. What you did means so much to me. Thank you for caring. I believe you wondered where I took Basic (Fort McClellan, at Anniston, AL) and AIT (Ft. Sam Houston, at San Antonio TX). You are likely familiar with those bases. I did get medical record information from Brook Army Medical Ctr. to send to St. Louis on my inpatient hospitalization there, which I sent to NARA. I was told by NARA that they sent it to the VA, but the VA said they hadn’t received it. That was all in a short span of time. I don’t know what happened to those records in such a short amount of time. That was just inpatient. My home unit has been dismantled (don’t know when), but all parties of contact at New Orleans Army National Guard turned up nothing…all over the state of Louisiana. People saying…in New Orleans and in other part of Louisiana after the flood…that they would help (but didn’t) or just passing me off to contact person-after-person. Prior to the flood, upon my request, I was only sent non-medical records that were stamped as copies from microfilm. After the flood, one NCO that I spoke to, said that records were sent to somewhere in Alabama before the flood. He said he’d remember if my records had been among those files. I’m not convinced. I decided to call and ask him if I may contact that place in Alabama, as I didn’t sense real concern from him. His voice mail came on and I left a message for him, explainig my concern that I make every effort to try to find my records. I never heard from him. Since I wasn’t serving in FL, where I’ve resided for some years, I thought the New Orleans Regional VA might be in a better position to find my records, so I requested my claim transferred there. They considered my claim as reopened (I never knew what happened to the request for extension)…then sent it back to FL and I just got denied, as it had been the pattern. Exhaustedly, I was even more bewildered, and I didn’t know what else to do. I subsequently decide that I’d put in too many years of looking for my records and almost as many years filing claim, to let it end that way. I guess, if I have to, I will appeal at some point. I feel I failed to give you a better explanation of my situation before. As you can see, it’s multi-difficult…and that’s just some of it. I realize you have put Ms. Small in contact with me…for which, I thank you; however, I wanted to give you a better explanation. Thank you, very much.
With all the hoopla that the press releases from VA have garnered, Congress or their staffers should read these comments that really show the ineptness of the VA.
During my several years in the Army I did every assignment I was given, even to the point of receiving the Army Commendation Medal for my service. I did escort duty out of Dover AFB Delaware. I went on TDY several times from stateside to MAAG-V. After I was discharged I came down with Type !! Diabetes, Melonoma, and Congenital Heart condition requiring by-pass surgery. I was forced to take early retirement from my civilian position and have been unable to work these past 13 years. When I was told to resubmit a claim because exposure to agent orange was being approved for navy personnel on carriers servicing aircraft, I did. I was told by VA that none of my ailments could have been caused by exposure even tho my physicians say otherwise. But I guess VA knows better. I am still awaiting results of my appeal. Just don’t tell me how efficient the claims process is.
About a month ago VA released a list of 644 Navy vessels that where indeed in waters contaminated with Agent Orange. I has the days and assignments and therefore should be now o honored. I get news releases everyday and like you many Navy Veterans were told that and now many have died the posted the list. You should be able to go to the Washington site and google for the list. No one will fight for you that gets a check from VA because they get a check no matter what. Try Vietnam Veterans National group
I’ve noticed that Catherine hasn’t respond to many of the post and have avoided the ones where it’s very apparent the VA has NO followed 38 CFR.
Hi Paul,
I am responding as fast as I can. A lot of these question take research, as I have not worked appeals in several years. I am trying to be careful to make sure I give correct information. I take pride in my work and don’t want to give people the run around. Where there is a question, I answer it. Do you have one?
I need help!!! My husband was a Chief Warrant Officer, and he flew helicopters in Vietnam in 1969-1970. During the time he was in Vietnam his duty was to drop Agent Orange. He had wanted to wait until his retirement prior to collecting his benefits. However, he passed away during the time he became sick, and had determined now was the time to collected on his benefits. I have been fighting with the VA fir the past 9 going on 10 years to collect on the Agent Orange Benefits. I had a represent initially that seemed like he was helping me, then one day I received an email that stated he’d done everything he could, he was being transferred and good luck to me.
It’s very disheartening to fight for benefits when the VA knows it’s benefits due. To fly a helicopter in Vietnam, for a full year, dropping Agent Orange, how do you say that’s not enough to qualify to collect on these benefits????
If there’s anyone out there whom can help me, or point me in the direction of honest help, I would definitely appreciate hearing from you.
Kindest regards.
There are no Agent Orange Benefits. When the law suit was won the chemical company paid the VA but none of it was ever distributed to the Vietnam Veterans. I heard about a new class action suit starting up but it also will heed nothing for the Veterans. I think VA kept the money to treat the medical conditions arrived from the chemical but as you read all these posts that is not happening either.
What does it mean when they say that “the issue for compensation is differed”?
I was denied my PTSD claim reasoning that basically after 24 years not claiming to have a problem & drinking & drugging myself numb until I am just bat shit crazy makes it not ” service connected ” How do I proceed with this as well ?
Hi Kenith,
“Deferred” simply means that VA is waiting to make a determination. We probably don’t have everything we need to make the decision, but you filed other conditions and we had everything on those. Rather than hold up your entire claim/appeal, we processed what we could while we wait for the rest. You can appeal by submitting a standard notice of disagreement. It should have been attached to your decision.
I had an appeal for PTSD in at VFW since march 2012 when I called for the last three months I’m being told they are working on 2011 and the are only up to july for three months they are working on july I’m wondering who they have working on these cases
I feel that the Veterans affairs personnel in the New Orleans regional office are not objective but take the cases personal and denies them based on personal opinion. I also feel that VA regional should be manned by veterans, as should the President of the United States. One that has some idea of military strategy in a very crucial time. These are the end times we must be prepared spirituality and mentally.
I have an appeal in progress since February 14 2014. I filed for compensation in march of 1971 was repeatedly denied i submitted new evidence on numerous ocasions was told your doctor opinion was more convincing than mine who is the nurosurgeon that formed my last surgery. I had five back surgeries nervous condition stents depression drop foot, heart condition. In August of 2003 I was put on non service connected compensation after I started receiving S/S it was taken away. I am even more depressed I filed for hardship to have my case heard I lost my house my life is in total disseray. I am 67 years of age have had five baCk surgeries. IA am Vietnam Era Veteran. I was in a medical unit in Germany. I was sent to Ammon Jordan on what was considered a mercy mission in a war zone. My life was threatened by a Jordanian nurse who though I tried to kiss her while I was on a ward talking to wounded children. She said to me I am going to kill you I call e D my commanding officer about three weeks later I was really afraid for my life we had no weapons they did this is a Muslim country and they stick to gather. I never slept another night it was as if I could see someone over me at all times. I have some first hand experience with Muslims.
If you cleaned or repaired equipment from Vietnam you are possibly exposed to agent orange.
Carolie, VA has not added an Agent Orange presumption for “Cleaning or repairing equipment from Vietnam.” Again, many of your comments have been spot on and I appreciate you jumping in. But I caution you from telling people things that are not accurate. It sets false expectations. There has been no credible scientific evidence to show that veterans who cleaned this equipment were exposed. If these Veterans were to file a claim, they would have to prove it without the presumption and VA will consider it case-by-case.
I have a had claims approved for this and Carc paint also. I get newsletters daily and read all of them and have for 17 years been helping Veterans with claims and am retiring March 1st so will not answer any more posts. When Veterans has IHD this has been sucecssful.
It has been 18 months since filing my appeal. Four months ago I received a letter from the VA asking me to select one of two representatives. This was done. I have heard nothing. All I can say is that if an insurance company were to handle claims in such a chaotic manner they would be subject to punitive damages. Perhaps the VA should hire from the insurance claim pool. They would get responsible and professional people. I also recommend that rather than placing an ex-commissioned officer/CEO who is wealthy over the VA , put a retired NCO in the slot.
I am presently in the Appeals process. I was able to access the comments from my C&B exam and strongly disagree with the results. I am presently working on a rebuttal but need to know if I should submit the rebuttal immediately or do I have to wait for a response from the VA? If I submit more information now would that delay the process? Should I wait for a decision on the appeal and then submit?
Any info would be appreciated.
Al Anderer
Albert, submit it immediately. The sooner the better.
My husband was denied in December 2015 and now he passed away January 10th of 2016 before having time to appeal his case. I was told that I can’t file his appeal now because he didn’t do it before he passed. So basically the VA denies until the service member dies and then the family is screwed. My husband wasn’t in during the war so he doesn’t matter. It’s crap he was on a ship and exposed to asbestos and now he is dead because he was poisoned and it caused so many other health issues but instead of approving his claim we have been fighting for since 2008 he gets denied again and now he’s dead. What is even more irritating is the fact that people I have worked with or know get approved due to a so call back injury and can still work and play soccer and everything else. My husband couldn’t walk two feet without gasping for air. It is bull. The people that see the veteran to give their opinion are there to get people denied. The woman we saw was rude and didn’t even want to be bothered. The entire system is crap but yet we are going to help refugees. Give me a break.
Hi Diana,
I am sorry to hear of your husband’s death. You were given wrong information.
According to 38 CFR, Section 3.1010-3(g)(i): A claim is considered to be pending if the claimant had filed the claim with an agency of original jurisdiction but dies before the agency of original jurisdiction makes a decision on the claim. A claim is also considered to be pending if, at the time of the claimant’s death, the agency of original jurisdiction has made a decision on the claim, but the claimant has not filed a notice of disagreement, and the period allowed by law for filing a notice of disagreement has not expired.
This is not what NM Regional Office tells widows and some had to return checks made to Veterans days after his death
Have been denied twice. Was told that injuries that occured in Marines happened after I got out of the military. Was told that they cannot locate my medical records and therefore nothing is service connected. The VA has seen and treated me for my knees, back and ankles problems which are part of my claim. Filed a NOD, but truly believe the VA is hoping that I go away.
Have had a claim in the appeals process since January 2013 and all I ever hear from the local VA in Columbia SC is that “its in process”.
Hard to believe that with all the issues the VA has had and still has that they would not do something to speed up the process.
If its any consolation the retro pay will be one nice dollar amount for sure.
Im an iraq war vet that has been fighting with the Va and Now the BVA on my claim for bulging disks in my neck and upper back i have an lod from a fall over there and two sworn statements from some guys i was stationed with.I am still waiting on a Veteran Law Judge to reveiw my case and render a decision.I had my video hearing at the Des Moines Regional office in June 2015 and still no word.
On July 09, 2014 I received notice of decision on my claim for service connected disability compensation. On August 22, 2014 I submitted VA Form 21-0958 Notice of Disagreement (NOD) with supporting documentation to VA.
e-benefits web page shows that Notice of Disagreement was received on August 26, 2014.
On October 01, 2014. e-benefits web page shows that Appeal is Pending. On October 28, 2914, I received a letter from VA dated Oct 23, 2014 acknowledging my disagreement with the VA decision of July 9, 2014. This letter asked if I want to select the DRO or traditional process to settle my claim.
On November 13, 2014 I submitted VA Form 21-4138 Statement in Support of Claim indicating that it is my desire to select the DRO process. On March 25, 2015 the e-benefits page does not indicate that my request for the DOR process was received. It still shows Appeal is Pending.
I have tried to find out the status of my NOD appeal, but have not have any success as of yet. All I get from the VA is that they have my appeal, and that the processing of DOR’s average 209 days. Well, they are way beyond that point now.
It took 17 months for my initial claim to be completed. My appeal is only on a couple of items, and it has already been 18 months. Trying to get any straight answers from the VA is like pulling teeth
I would appreciate any information as to when I can expect the VA to settle my NOD Appeal. The VA could do a better job at keeping veterans up to date with status of their claims or appeals.
My husband has 4th stage COPD, which is rapidly getting worse. He is on oxygen 24 hr a day, and does not have very much strength. A Naval friend of ours told us for him to apply for his pension for people who became disabled outside of the Navy. My husband served 6 years in the Naval Reserves with almost 3 years Active Duty. My husband, Howard B Rotti, filled out all needed paperwork and had the West Boylston VA representative act on his behalf, so he mailed them to the proper place in Boston, MA. After 3 months we received an answer that our income was too high for Howard to receive his pension. We only collect social security. We have no savings, etc. We do not have enough money to live in a nice apartment, so we live in a very small apartment, having had to give away or sell most of our possessions. We both have very high medical bills, and Howard’s will dramatically rise in the near future. We can never afford to purchase all the groceries that we need. It very often becomes a quandary; do we buy meds, go to this doctor appointment, or buy food. How can they say that we make too much money? My husband was so proud of his time in the Navy during the Vietnam War. There should NOT be an income level for that Naval pension, and if there is one it should be high enough to at least include those Veterans who are struggling every day. There should be a line on that form that includes how much we spend on our medical conditions. I am very discouraged by the way the Navy treated my husband.
Sincerely,
Carol A Rotti
My reply dated February 5, 2016 at 1:20 pm. [redacted]
Note: Personally identifiable information redacted by Vantage Point staff per VA social media policy
February 05, 2015
I was ordered to Vietnam on January 26, 1967. I also was ordered to 505th Graves Registration to Collect, Process, and Escort our deceased Military Personal to the Main Mortuary in Tan Son Nhut Vietnam. This duty turned my life upside down and over. I could not sleep, eat or function in a normal manner which continues today. I was on edge thereafter my entire life. I had hardly ever been to an occasional funeral before age 19. Here I am now in Vietnam handling dead bodies. It was overwhelming then and continues because of the nightmares, flashbacks, unexpected loud noises and the inability to get along with others. My first contact with the VA was in 1968 when the Doctors there were trying to diagnose me as Paranoid Schizophrenic and asking me were there any members of my family with mental issues. They then were trying to offset the horrors of what I has seen and forced to endure. I was in many areas of this war in the beginning without my weapon. Many months went by asking for my weapon when collecting bodies but denied the ONE piece that could give me some avenue of support. I went through three PTSD programs and was diagnosed with Extreme, Severe PTSD and was denied the financial support my family needed. I struggled through school after Vietnam and I was continued to be denied the support while in school. I finally was awarded a 100 Percent for PTSD in 1995. However I was awarded $12,000 for a payment. This is not a one year payment of 100 Percent from the year 1995. I continued to appeal this decision. The Board of Veterans’ Appeals Department of Veterans Affairs in Washington, DC 20402 Remanded this appeal back to The Department of Veterans (VA) Regional Office (RO) in Denver, Colorado. Dated January 06, 2015. DOCKET NO. 09-31-461. This is a year later after this case have been remanded back to the office it originated from. It states on the issues Whether the RO committed clear and unmistakable error (CUE0 when, by rating decisions entered in January 1994 and June 1996, it failed to assign a 100 percent rating for posttraumatic stress disorder (PTSD) for periods prior to August 27, 1995 (exclusive of periods of temporary total rating from August 2, 1992, 20 November 2, 1992 and from September 14, 1993 to November 9, 1993). However there has been no ruling in this matter.
Sincerely,
When the Regional Office does not follow the remand from Washington to correct whatever the issue is and they don’t you can resend to the Judge that heard the claim and let him know this much time has passed and nothing has been done. I worked with a New Mexico Veteran on this same issue and the Regional Office got fined and had to double the percentage and backdate the compensation paid. He was also a Vietnam Vet and got a large back pay that started his life on a better road.
Carolie,
I worked appeals for a number of years as an advocate for Veterans — as in I argued appeals on behalf of veterans before the Board of Veterans Appeals. Not once did I never see a judge fine an RO for failing to follow a remand. Nor do they bump the veteran up in disability for failure to comply. Disability ratings are regulated in law and must be prescribed according to the disability picture the veteran presents. It is already a confusing process. Please don’t add to with these type of stories.
I’m sure your veteran did get double the percentage, but failure to comply with the remand was not the reason. In my experience, when the RO did comply with the remand, new evidence surfaced that warranted the increased rating.
Joke city V.A. Vietnam vet…been waiting two years for NOD. Just contacted Senator Tom Cotton last week for some help…his staff was very responsive!
Can I pull my appeal back? After reading some of the comments, I didn’t know my rating could be reduced.
Rachel,
It is very rare for a rating to be reduced. And should VA propose to do so, we have to give you due process, meaning time to give evidence showing why you should not be reduced. And of course you can appeal that too. If you feel justified in your current appeal, you should continue it. But yes, you can withdraw an appeal in writing at any time.
This was very helpful piece of information. keep up the good work!
Good Morning:
I have appeal twice and was denied twice. I applied for Compensation and whoever processed my loan gave me pension disability. The pension started in November of 2012. Nonetheless, I decided that it didn’t seem right so to make sure I sent them a letter and a copy of my income and said that it was imperative to stop payment and investigate this matter to make sure I was on the track. They never answer my letter until I wrote to them again around 2015. Again I never asked for a pension. They keep saying it’s my fault and I don’t see how since I applied for Compensation not pension. Should I get an attorney to assist me on this matter. Do you know any in El Paso that is a professional in Military Law?
Israel Sarabia
This happens a lot because the 526 form says both at the top yet the 526EZ says disability and the 527 says pension. You need to make sure you sent the correct form and not the 527 Hope this helps
Hello Catherine — Thank you for your very helpful clarification article. I too am a victim of a botched C&P exam when my full case file with substantial data and supporting medical records were not thoroughly read by 1 of 2 VA medical folks conducting the exam. My NOD has been in the system for over 13 months now. But that is a story for another day!!! … My reason for writing is to make a suggestion for your future article(s). It takes a long time to work our way through the appeal process. Assuming a positive decision eventually happens, please let us know how we can “protect” the benefit for our beneficiaries/survivors –JUST IN CASE WE DIE BEFORE THE DECISION IS REACHED. Thank you.
I know you meant this tongue in cheek, but my husband tells a story of when he was a service officer of an old man who was service connected and in fading health. The man came in to fill out DIC papers and my husband put them in a file and kept them. One day the wife came in without the man to submit the DIC papers. Some Vets have to think about their minor children then same way. This is actually a great idea for a future piece.
Please help me get a VA physical. I have been tyrying to make an appointment since 2004 and I am stationed abroad. I was given a percentage based off of my medical record but never received a full physical. Would like to appeal my denial of Colon cancer since the polyps developed while I was on active duty. Can you assist?
Thank you
I am writing to request information on what the VA policy is with reference to the assignment of a hardship flash on claims, and appeals at the RO level, and BVA, or where the written guidelines can be found. I had a home fire in January 2015 and applied for a hardship request for processing of my claims (I have 2 pending) and was granted the hardship flag in May 2015. The RO removed the hardship flash on November 20, 2015 allegedly due to the issuance of a SOC on one of my claims, which issued on May 15, 2015. A letter was faxed to Secretary McDonald on November 5, 2015, but this apparently had no impact on the RO decision. On December 4 2015 I was instructed that a new request for hardship needed to filed if I still desired consideration for processing under hardship basis. This was done in December and was posted in the RO on December 18, 2015. On January 20, 2016 my request was denied as I do not meet the Department of Veterans Affairs Policy or Guidelines for hardship processing. The December request contained the exact same documents as the May request, plus a letter from our contractor that our home would not be finished until at least July 1, 2016, and a statement from me that I am undergoing spinal surgery on February 23, 2016 and will down for 2 or more months. I walk with a cane, and we have been living in our camper since January 2015, and will be here until our home is completed, or my back pay and benefits are approved. If you could send us a copy of the VA policy, or at least where we can find it we would be greatly appreciative. Thank you.
Most faxes to Washington do not get to Secretary McDonald but an office person but if you go to the VA website there is an opportunity to send a male about your situation. Each State seems to have some RO’s that do not appreciate their freedom or are themselves disabled in someway yet still able to work and think everyone else can work also.
Donald,
You can find all our policies online, but I have included the reference for financial hardship. http://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ss/#!portal/554400000001018/article/554400000020037/M21-1-Part-III-Subpart-ii-Chapter-1-Section-D-Claims-That-Require-Priority-Processing?fromQuery=financial%20%3Chttp://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ss/#!portal/554400000001018/article/554400000020037/M21-1-Part-III-Subpart-ii-Chapter-1-Section-D-Claims-That-Require-Priority-Processing?fromQuery=financial%3Ehardship
My brother is on disability with the VA and that is his only source of income, he has been told that if he applies for Social Security that they will take this amount off of his VA check, is this true. Also he is afraid to apply for Medicare due to using the VA for all his medical care and I told him he needs the Medicare due to all the benefits they get such as hospice which the VA evidently does not pay for. My little brother was a disabled veteran and 2 years ago he passed away and the
VA would not put in hospice, they put him in a homeless facility and had a hospice nurse come in when he should have been in a hospice facility.
This is incorrect. There is no offset between VA benefits and SSD benefits. If your brother wins his SSD claim, he will get full SSD benefits and full VA benefits. In addition, he will be automatically eligible for Medicare as of the 24th month of his eligibility for payment. Most claims are retroactive, so he will not be waiting 24 months in most cases and, in fact, could already be eligible for Medicare.
The following statement “There is no offset between VA benefits and SSD benefits” is true if the “disability with the VA” is service connected disability compensation. This isn’t the case if the veteran receives Non-Service Connected Pension (NSP). If the veteran was told he may have his VA check reduced or offset because of SSD Benefits he might consider contacting an advocate or the VA Call Center 1-800-827-1000 to discuss this in detail before going forward. It’s a common problem for veterans receiving NSP to apply for SSD without notifying the VA, creating an over payment with the VA and they’ll have their VA benefit reduced.
I have been practicing Social Security law for 25 years and have taken hundreds of cases to hearings and to Federal Court. If a Vet is applying for SSD (not the case for SSI) there is no offset of the VA benefit, whether service-connected or not. In addition, after 24 months of eligibility for SSD, (calculated from the onset date awarded, not from the date the checks start) an SSD recipient is eligible for Medicare coverage, o matter his/her age (but must of course be adult not child).
Veterans get both Social Security and VA disability. As for medicare, I am not sure.
My husband is a Vietnam veteran and signed up for benefits over 2 years ago, he has type 2 diabetes which is suppose to qualify him since he was in Vietnam, he also has gum problems which is related to agent orange. He bought a home using a VA loan when he was in his early 20’s and then got a divorce and was unable to keep up on the house payments. This is still being used against him after 40 years!!! This supposedly been in appeals for months now. This is ridiculous!!! Is there anyway else we can proceed with this any faster?
Deborah
A foreclosure is removed from a credit report after seven years but you must initiate that yourself. Bankruptcy with a home is on credit report 10 years and again you must get it removed and straighten your credit up yourself. Years ago VA guaranteed about $20,000 for a Veterans to purchase a home and now it is up to $250,000. Guarantee of the loan just means it is backed by the government should the borrower default. If he was guaranteed $20,000 on the loan years ago he would still be able to buy a home after seven years or the ten having $230,000 worth of guarantee left. Need to call VA Home Loan Eligibility directly and then get corrections made. A VA loan is also assumable but this does not release any of the amount you used for that home. Example used $130,000 for a home and sold letting someone assume the Mortgage then they would only have $120,000 left but if we are looking at your husband you would also have to deduct the original loan for $20,00 leaving him only $100,000 for a new loan. Many lenders do not like to do VA loans because they cannot add points to the loan like they can other types of loans. Use a Mortgage Company backed by a bank not just a lender on the street.
Why was e-benefits put online piece by piece. VOS states don’t use it. Data is incorrect, even my DOB is wrong.
Should have been completed 100% before going online.
My name is Dee. I was certainly amazed at the ability of the VA adjudicators to lie and misrepresent the content of my military records and deny my AO claim. These VA directives tell you well if you have already applied for a claim you need not reapply again (Regarding a recent change in a AO law passed by congress.) They state your file will be reviewed. This was a lie. I did reapply in the form of a reconsideration. The law had changed to included my job classification at specific Air Bases and in specific USAF squadrons I was assigned. The ability of the adjudicators to either lack first grade reading skills of a 5 year old child, or knowingly and with sinister intent lie on the decision letter misstating the content of my military records. I feel for a disabled veteran who files a claim. These people will ignore their own VA directives and certainly any case law finding in a previous appellate decision. Get a lawyer please. The lawyer will be able to reveal the rule of laws that govern our country that these VA adjudicators that pretend do not exist and veterans throughout the country has become seriously physically and emotionally hurt protecting laws that VA adjudicators completely ignore.
Why does the VA print in blue? Some people are color blind. Would like to your article but can’t..
I’m not sure, but I will ask the folks on the web side of the house. In the meantime, I emailed you this piece.
80 % disabled ! Had to go to a C and P within 30 days or claimed dropped . Why the rush ? Called VA and was told a min. of 2 years for an answer .
I hear you. And so do my coworkers here and on the health side. In fact we are working that one. Hopefully, if you ever need another C&P exam, it won’t be like that again.
I retired from the USAF (22 years) in 1992 and was then granted a 10% disability. In 2007 I was diagnosed with cancer as a result of exposure to Agent Orange (medically verified), and filed a claim. It was denied and I filed a NOD, and the appeal process dragged on until 2013 when I finally had a hearing with a VBA Judge. That judge granted my appeal, the VARO paid me compensation (lump sum in 2014) that only covered the time I was treated for cancer. I have had residual effects of my chemo treatments that left me totally disabled, that were filed for in my original claim. So I filed a NOD to the VARO (in January 2015) because they did not consider these additional secondary effects which will last through my remaining life time.
I get my medical treatments through Medicare and Tricare and my disabilities have been medically verified. I sent this evidence in with my NOD and requested a DRO review because the VARO told me this is the fastest way through this appeal. It has now been over a year since I filed this latest appeal. I read where you said appeals take an average of 3 years, but you also said only 10%-12% of all claims are appealed. If the number of appeals are that small, why does it take so long to get a DRO review?
E.,
FANTASTIC question. In each of the last six years, we have processed more than 1 million claims and in the last four years, we have broken records each year. When you process that many claims, and 10-12% is appealed, it means more appeals.
Combine that with our open-ended appeals system. Unlike other appeals systems in government, you and other veterans can add new evidence at any point in the appeals process. When this is done, VA has to start over and issue a new decision, even if you already had a decision, or two or more. This add considerable time to the appeal. Think about it: If I have to look at the same appeal three or four times to consider new evidence and issue a decision, that is time, I am not working another appeal. (I don’t actually work appeals, but you get the idea). On average, appeals that reach the Board (about 4-5% of all claims) arrive there with two additional decisions beyond the original decision that is being appealed. And its worse if its been remanded.
I send a letter of disagreement about 5 years ago. A t today I still waiting for a decision. How long I have to spect that they make a decision . Is this the same to have and appeal?
Thank.
Adalberto Gutierrez
Thanks for you comments and answers which I find very informative.
I suffered 2 ischemic heart attacks in 2012. I received three stent from the first attack and two more stents from the second. In 2015 I found out that one of my stents is blocked. Due to this I was forced into retirement. My question is; what percent of disability might I see from this?
Hi Jay,
Without seeing the entire file, it is hard to say. The claims processor looks at the entire file when making a determination. However, if you are no longer working because of it, I would suggest you file for IU as well. My coworker wrote a blog on that recently. (https://news.va.gov/17608/individual-unemployability-understanding-basics/)
I FILED A CLAIM WHEN I RETIRED IN MARCH 2000 FOR SERVICE CONNECTED INJURIES I RECEIVED IN SERVICE
MY CLAIM GOT DENIED I FILED AN APPEAL THEY SAID IT WAS BEING PROCESSED. LATER THEY SAY IT WENT TO BVA NOW EBENEFITS SAY I NEVER FILED AN APPEAL NOTHING SHOWS ON FILE CONCERNING MY APPEAL.
LATER I GOT RATED 100% BUT THEY DID NOT PAY ME BACK TO MY EFFECTIVE DATE OF CLAIM. THEY CLAIM THEY DID NOT SEE THE EVIDENCE WHEN I FIRST FILE BUT LATER IT SHOW UP IN RECORDS AS SERVICE CONNECTED. IT HAVE TAKEN ME 16 YEARS AND MY CONDITION WORSEN BECAUSE THE NAVY FAIL TO TREAT
ME FOR INJURIES I RECEIVE IN THE NAVY. ON TOP OF THAT I DID RETIRE FROM THE NAVY AND THIS IS HOW I WAS TREATED. I FEEL THE NAVY OWES ME NOT ONLY FOR PAIN AN SUFFERING BUT MISS DIGNOSED AN FAIL TO TREAT ME MEDICALLY SO I HAD TO GO OUTSIDE TO SEEK HELP. WHY DIDNT THEY PAY ME FROM MY EFFECTIVE DATE AFTER I HAD TO PROVE MY INJURIES WERE SERVICE CONNECTED.
What is an Administrative Review and is it considered an appeal? My VSO put this in for me 3 years ago after I was denied IU.Who determines the final decision?
Claim filed Feb 2013 Denver RO; RO decided on their own to bifurcate my claim. Did not notify me or attorney about that.
SOC 2014 – laughable but raise my blood pressure. Explainable if you saw medical records.
NOD and Form 9 – Sept. 2014
Collecting dust and spider droppings
Am taking wagers on whether or not liver goes before RO acts.
By the way RO told me 502 days for some action to occur. Have sent at least three letters from my attorney to expedite but they just told me that they will be sending it to BVA to sit for another three years. God bless america.
To add to this is that case management in D.C. has sent inquiries to the Denver VARO. To its credit the VARO under Sec. McDonald’s involvement did grant my lower back claim via DRO review which increase my rating to 70%. Then the said VARO did one of the separate issues in the BVA remand which was my ankle claim hence was granted which raised my rating to 80%. But like I said in my previous posting the VARO has stopped all work on my remand. Have spoken to a DRO coach by the name of Carol a few times. She has stated in a round about way that my remand will be done in “6 to 8 months”. 8 months have come and gone. If no action is taken soon I will calling McDonald again to end this 10 year ordeal. Maybe thru a Secretary order will the VARO comply to the BVA remand order as it seems the VAROs are too disconnected from D.C.?
*hears crickets*
I have been trying to establish the fact of my miltitary service from 1963-1966 Both in Vietnam & Thailand since getting back in touch with the VA in 2005 until now. The reason of course is having been exposed to Agent Orange herbacide in those locations and have type ll diabetes. The C-130B Aircraft Recon. missions we flew in those locations were top secret, so no other Base Personnel at YOKOTA AB knew of our envolement except those with a need to know status, primarily because of having Japanese employees working in various office locations and maintaince shops. I received TDY pay & predium, as well as combat along with my flight pay, so why these records can’t be found is on believable. My claims have been denied, an are presently in appeal status, I didn’t know that some other Vets were waiting years to get their replies, and was amazed to hear about that! At any rate I would be happy to receive my dession without so long a period.
Thank You So Much, Sincerely, James
*ill* (I’ll) and *their*(there)
Thank you for taking time to explain the “apples & oranges” however, it still doesn’t explain what takes so long with both processes especially appeals. I think if you had an appeals call center versus having to go via the primary line would be better; since there responses all ways make them seem I’ll prepared for inquiry calls. The update computer generated letter, spit in your face; C & P appointment, salt in the wounds; silence during the appeals process, veteran psychological genocide. The VA is my domestic adversary vs advocate; politicians from the Whitehouse to the “at-large-city councilman” could careless about those who served. Why, 99% of them have never served and nerver will; neither will any of there sons or dauthers…and please don’t insult my 23 years plus of service with company line response you’ve given above. The latter was feedback and fed-up with talk!
Howdy Catherine,
Interesting blog post.
It’s about as realistic as “Alice in Wonderland” but it was interesting to read.
The main problem is that the VA operates on the “Lie and Deny” policy where the VA doesn’t follow 38 CFR, rarely even looks at the “medical evidence”, performs C&P exams from a combination of the “Lie and Deny” policy and the “Veteran is lying” POV.
And the “Benefit of a doubt” is NEVER given to a Veteran.
Plus, my local Regional Office, Little Rock, has “LOST”100% of of everything I mailed to them until the last time when I sent it certified with signature required.
Not only that, but they have lost over 1/3 of my c-file when it was paper and lost my entire c-file when I originally filed for compensation.
After fighting with the VA for 13 years both knees are service connected ( another story for another day ) and as a result I have a minor fall every month and a major fall about once a year where I suffer lasting injuries.
December 2014 I fell due to my SC knees and tore my right rotator cuff. After going to PC, PT, Ortho and receiving a cortisone injection I filed a claim on my torn rotator cuff.
The VARO denied my claim because it was impossible for me to have a fall due to my knees, my shoulder condition was due to an A/C joint injury from either work or sports.
The VA’s decision wasn’t based on medical evidence and was part of their “Lie and Deny” policy.
My shoulder pain is in my rotator cuff, it didn’t hurt before my fall, and I have been diagnosed with a rotator cuff tear due to a fall by my PC doc, PT tech, and 4 different Ortho dos all at the VAMC.
The VARO based their decision on entirely on the C&P exam that was performed by a +70yo man that had NEVER worked in Ortho, never performed any type of shoulder surgery, and made a CUE during the exam by missing the fact that in 2004 I had surgery on my right A/C joint and stated that I had NEVER had surgery and did NOT have any type of surgery scar on my A/C joint even though I have a 2″ long scar across the top of my A/C joint.
Now as a result of the VARO’s denial I will spend the next ten years fighting the VA before I’m Service Connected as a secondary condition.
During this ten year battle it will cause farther backlogs at the VARO and the BVA plus cost the American Taxpayers $100,000.00 on a simple claim that will NOT change my overall disability rating or increase my monthly compensation check a single penny.
A sad but true story from a Veteran that fought the enemy to make the USA a safer and freer country that now has to fight the VA to receive the benefits that I’ve already paid for.
I returned from Iraq in 2005. Since returning I drink regularly but don’t consider myself an alcoholic. I do binge at times. I feel vulnerable unless I have a gun on my person. Which is most of the time. I can’t sleep and to top it all off my wife put me out because she’s afraid of me. I’ve never sought help because I’m ashamed. I feel I should be able to handle this. I’m now to the point where I am no longer sure if I can hide anymore.
Hi Ronald,
I never deployed, but my husband is a combat veteran and many of my close friends are. The most important thing you need to know is you are not alone — EVER. So many people have gone through and are going through what you describe.
There are several things to know — first there is no shame in getting help — none. As Vets we feel we are invincible, we were told to suck it up, get it done, work through the pain. But when it comes to our mental and physical health, we need to take better care of ourselves. We can only care for others if we feel well. Second, you can get mental health care at any VA medical facility, and I encourage you to do so (leave the gun at home). Have someone take you and wait for you, if it would make you feel more comfortable. Try a vet center. These are all Veterans who have similar experiences as you, but more importantly just like you, they are seeking help. As a vet, I know you have done all kinds of hard things that your civilian buddies will never experience, this will be another and just like all the other, you can do this too.
If you ever feel like you may harm yourself or others, please call 1-800-273-8255 and Press 1.
Thanks for clarifying a Claim and Appeal differences. Wish you could assist the VA employees in reading the evidence submitted for claims and appeals. It appears the standard is to reject all claims, than ask for additional evidence, and additional evidence. This is a continuous cycle that appears to never end. That is where the big PROBLEM LIES. Help! Lesson 101 on how to submit a claim that is accepted on the first attempt is needed.
Hi Charlene,
We actually have about a 70 percent grant rate, but I know that does little when you are trying to get your claim granted. Without knowing details it is hard to tell you what to do. My best advice is to find a good VSO, one you trust, can talk to easily, who files electronically. I wrote another piece a while back that might be helpful for you. https://news.va.gov/7769/getting-your-claim-processed-favorably-and-quickly-some-helpful-hints/
Hi how are you legitimate comment and request I have been dealing with trying to get VA healthcare for 3 years I was at first approved and then shortly thereafter a certain gentleman that works in A facility and Pennsylvania decided that he would determine my eligibility for va purses without even having a dd214 his hands. Currently I can log onto ebenefits and it says order va documents that I am enrolled in VA health care and also I have credible prescription coverage. This past time I had tried to make an appointment again because I was told by the main v hey Medical phone number that I was eligible as of July of this year and that the things that happened prior were mistakes. And then all the sudden I get a call staying my appointment was cancelled for my primary care physician my initial one. I would like to know how in any plausible way 15 people from various agencies and positions can tell me and others like me that they can get health care from the VA and that they are enrolled and they could go but then when you when it’s time to go you get a phone call from somebody who changes Records on the computers stating that the local clinic cancelled the appointment when in fact it was not the local clinic some honest answers
When I first retired from the Air Force VA rated my neck and lower back 10% each for degenerative joint/disc disease. Over the years I had both neck and lower back surgery. I presented the CT scan reports and surgical notes from my neuro-surgeon. The PA that did the C and P evaluation ordered ex rays and did not see a problem. She ignored my complaint of radiating pain in my leg and shoulder. She ignored the surgeons report showing degeneration of the discs causing pressure on the nerves. The radiating pain alone should be at 20 %. I did not get an increase. I wonder has the PA hired by C and P have any real medical experience.
Hi Arnorld,
We are working on the C&P process as we get it’s the only real time you interact with one of us and the doc you see is not a claims expert. In fact, they are only there to collect the medical info the claims people need. The PA was probably told to only look at your neck and back. In order for you to consider your radiculopathy, the claims processor would have had to tell her to do so and for that to have occurred you needed to file a claim for radiculopathy secondary to your back conditions with proof of a diagnosis of the radicuopathy.
Also know, your back is rated on range of motion with pain (though the diagnosis may change), so for instance, I have an old fracture in my spine, but you may have rods and be fused up and down your entire spine, but we will both be rated on how far we can bend over and where the pain starts.
I hope that helps clarifies things and if you did indeed file a claim for radicuopathy due to your back, you can appeal (but wait to read my next piece cause I have a few tips for you).
My husband was awarded a 0 percent on PTSD but service connected. That was in 2010. It took two years for a letter stating the VA received his request for a review. Now a new C&P exam done in 9/2015 awaiting for someone to rate it in Cleveland Ohio. Mean while we have raised two kids have a grandson who just turned 7 (who we are raising). My husband had not worked since 2010 and is permanently disabled with Social.Security. He has never seen a doctor outside the VA so its a matter of them reading their own material about their own patient. It is so very frustrating. Can you possibly answer how a 0 percent rating is received? He has been on medication and sees a psychiatric doctor and counselour since sometime in 2002.
Dawn,
Without looking at the file, I would be purely speculating. That is not intended as a cop-out, but to do so would not be fair to you, your husband or VA. If he had a C&P in September, it should not be too much longer. I would also suggest working with a VSO.
My claim should never been denied in the first place! I served 2 tours in Vietnam from 1965-1967 for a total of 19 months.
I was exposed to the chemical “Agent Orange” and ultimately I now have acute peripheral neuropathy in both the upper and
lower extremities. I proved in my claim that this is a “presumptive decease” as stated in a document issued by the Department of Veterans Affairs themselves. I also proved by various doctors reports that I have serious anxiety disorder,
mood swings, and depression. I also at their request furnished the name of the sailor who walked into a moving propeller
on the flight deck aboard the USS Bennington CVS-20 which was a horrible experience for a 19 year old to witness. I was
experiencing many casualties wounded or deceased, but still after these horrific events during the Vietnam war the DVA
still denied my claim for PTSD stating is was not combat related! I have several other medical problems which I believe
was attributed to the war in Vietnam! I presently am appealing my denial for the proper disability benefits I should be
receiving.. It’s just a shame that veterans like myself have to go through this miscarriage of justice after serving their
country honorably during war time.. Thank you for letting me speak my piece on this issue and just to mention I will
be 70 years old next month and I hope I can receive some overdue compensation from USA before I go.. With my claim
and appeal I have been waiting since 03/2012..
Hi Robert,
First, let me thank you for your service. I know the appeals process is frustrating, which is why I decided to write this series. I hope it helps you understand why the process is so long, why VA ask for the information it asks and why we don’t have a true appeals system.
On your issue of peripheral neuropathy, I want to make you aware, so that your expectations are managed, that you had to be diagnosed within a year of the last exposure (this is typically when you left Vietnam). Many Vietnam veterans I meet think they can be diagnosed at any time, but the law states you had to have been diagnosed within a year. Best of luck on your appeal.
How do you get a deferred rating for PTSD?
What’s a Fully Developed Claims Program ?
Hi Steve,
I wrote another piece on it a while back. (https://news.va.gov/9648/get-the-fastest-claim-decision-file-a-fully-developed-claim/). Essentially, you submit your claim with all your evidence, and tell VA where to find any federal records and VA expedites your claim. Since the program launched, the FDCs have received faster claims than traditional claims. They also have a 20 percent lower appeal rate.
Finally, if you have to submit new evidence, we just remove the claim from the program and process it traditionally.
First of all thanks for this much needed sight, Next, I receive 70% service connected disability for injuries while serving in the 101st Airborne Unit Ft.Campbell Kty, In Dec of 1985, the incident of Gander were 248 soldiers were killed in a plane crash, if not for a injury I may have been on that very plane, for 36 year’s I have nightmares of this event and finally filed a claim for PTSD, only to be denied and I filed a appeal, I have other friends who were there with me, who all received 100% disability for PTSD due to this tragic event, why am I denied, I have been to several V.A. doctor’s and outside doctor’s as well and was told I suffer from PTSD, If the other survivors were awarded PTSD, why not me ??
I appealed an award for compensation made by the Housron RO. The Board increased the award and that decision was referred to the Court by a law firm provided by the DAV because the Board’s decision failed to properly address pain levels as well as some other irregularities. The Court agreed and remanded the appeal back to the Board for action and ordered the Board to expedite the appeal. The Board then remanded the appeal back down to the Houston RO again indicating that the appeal be expedited. This occurred in May 2015. Not only has the RO failed to act, it hasn’t even acknowledged that it has the appeal and is working on it.
Please help.
Hello, what’s the difference between an appeal, a reconsideration and adjustment?
An appeal is a disagreement with a decision of the agency.
A reconsideration occurs when evidence not previously provided to VA is received. We will then reconsider a prior decision.
An adjustment? We will adjust an award where a Veteran has a change in his or her dependents (adding or losing a spouse/child) or where an adjustment is made to the rate of payment based on hospitalization.
My husband’s appeal was submitted in June of 2014 currently waiting on a DMO to look at it. The claim that was denied was for 100% individual unemployability (currently he is rated at 80%). At his mental health exam, the doctor spent ten minutes with him, on a “good day”, had him fill out a questionnaire and declared his 70% PTSD in “remission”. Ridiculous. He can’t work. He won’t leave the house. He was diagnosed with Generalized Anxiety Disorder long before PTSD. I am working full time to make ends meet and worry constantly about how things are at home. I am overwhelmed.
Hi,
Understand the DRO will look at the entire file, including any medical records from VA or the Vet center you identify, so if he sees a doc there the record will present his entire disability picture, not just his “good days.” As a claims person, having that entire picture is helpful, because the doctor gets his bad days and his good days and we rate the symptoms. Best of luck and remember to take care of yourself too. You can only take care of everyone else if you are healthy and happy.
Hello, that was nice of you to explain the difference between claim and appeal. My Nov 2008 claim was denied back in Feb 2010, send in NOD back in Feb 2011. DRO went through my file and give me a rating for PTSD in August 2012 which was dated back to July 2010 and an increase rating in Dec 2012 for another disability, but my file is still in appeal process in the WACO Regional Office, while going through this appeal process in April 2013 I was in 45 day in-patient program for PTSD, received 100% temporary for 30 days and then my rating date changed to May 2013 instead of the original July 2010 date,but my appeal is still pending as of Feb 2016. So what I am saying is that it has taken longer than the 3 years for me. I was told that Waco RO is 2 1/2 years behind. How long will it take for me to hear anything?
Hi Sandra,
I really don’t know. Every time you submit new information it can add up to 400 days on the process. That is the way the system is built into law. The time tables I give are national averages.
I was granted service connected disability for my carpool TUNNEL in both hands in Jan of 2014 and my case for left knee injury was remained cause they can’t find my files from when I was in the service between 04/82-04/86. This was an apeall that I been fight since 1988 when they first denied my claim. Now with that being said I have been calling the number that they say to call and get the same information all the time and you guys say you are working to make the system better. Well when it’s 2106 and it’s the same shit. My question to U is being that I was warranted service connected disability for my Carpool Tunnel, shouldn’t I start getting paid until they figure out what to do about the remained part?
Hi, Rhonda! I believe you should be receiving compensation for your partial grant as long as the rating grants your carpal tunnel at more than 0%. Still, we’d need more information to give you an accurate update. Someone will be reaching out to you in the coming days to get more information.
I my case which is now in the appeal process a physicians assistant sumerized my medical issues incorrectly when reviewing my case for the regional office. This person had no contact reaction with me, no interaction with any of the physicians that diagnosed the laryngeal cancer that they said was due to exposure to AO. The regional office took this “summery” at face value and ignored the rest of the records that had led up to two or three surgeries to remove the polyps on my vocal cords. There denial was based on the fact that I had a similar cancer on my tongue 10 years earlier. Their logic was that because I had cancer 10 years earlier this was considered the same cancer. All medical authority that I have consulted, including the VA doctors that have been and still are caring for me have stated in no uncertain terms that that conclusion is a medical impossibility. I started the appeal two and a half years ago and we have heard absolutely nothing from the VA. If they continue to drag this out they won’t have to worry about the case anymore, just the death benefits.
So my question is this. Why does the VA not require the medical reviews that are used to determine the viability of a claim be submitted by the attending physicians that produce the original diagnosis, preform the surgery and analyze the biopsies instead of relying on the information gleaned for the patients records and in my doctors opinion are unqualified to be making these decisions to begin with?
Sorry, I may sound bitter but in reality I spent a year in the RVN and AO was just another threat but little did he think ” friendly fire” would be the way we would get hurt 30 + years later. Do you happen to know what the RVN vets cancer rates are? I do. And I’m a luck one.
Sad isn’t it.
Robert,
The simple answer is not all veterans see a VA doc and many VA docs are not willing to give the opinion because the form and records review require a lot of time. This would take time away from clinicals. To make a blanket requirement as you suggest would mean vets don’t get the health appointments they need.
Of course your case is a little different and may require certain measures. From what you have told me, I would have expected the rater to apply more weight to any opinion supplied by your doctor than by a PA. I wonder, has your doc supplied an opinion, or just treatment records? If your doc only supplied treatment records and no opinion, that left only the other opinion, which VA had to use. Still, I would have expected someone to know the synopsis was wrong. Hopefully you are successful on appeal.
Is it true that there are ex-Boiler Techs, ex-Boatswain’s Mates and others whose fields of expertise and training were far from the medical field are given the delicate task of rating a service connected disability claim?
Bruce,
You don’t need a medical background to rate a claim. Its a legal and process-driven system. Our raters go through 8-12 weeks of in-house training and then have on the job training and then perform refresher training every couple of weeks. Doctors and nurses supply the medical nexus opinion when it is needed. So the answer to your question is yes, I am sure we can find an ex-boiler tech or ex-boatswain’s mate. I did public affairs in the Air Force, and I was a dang good advocate at the Board. The best claims processors I know don’t have medical backgrounds, others do.
I was rated by va t 30% by rating officer. He did not read my whole report from phycologist because if he had he would have seen that the rating by physcologist falls under the 50% rate. He gave 30% but I didnt get any pay because the rater said that was what I was before my claim was submitted. Hoe long does it take for a DRO review. Mines been going on for 10 months and nothing has happened. I was told a DRO review would be much faster. Seems slow to me.
Walter,
In FY 15, it was about 14 months. Hang in there and if you experience financial warship, make sure the RO knows by either calling or telling your VSO.
I am now a crippled veteran because of lack of follow up.
I can hardly walk lots of pain in both legs on disability and requested increase due to neglect of treatment
I have a few appointments set up I think they made me wait to long’
I now have neurology issues with my left arm and left neck.
Medications changes conflict ion of drugs interaction and different doses on same drugs and misinformation on drugs
not to mix.
My latest Arterial Defibrillation diagnosed sent to hospital discharged no secdudaled blood work no monitored medicine
amount or refills .
Followed up with doctor from Hospital and he assisted with drugs and amount and side effects never received info from va
I have signed up with a cardiologist I have new tests and possible implant heart moniter depending outcome of tests.
Richard
I need help. I am prior Army National Guard. I have been searching for my service medical records for many years. I’ve searched every place that I’ve been told to inquire…in writing and by phone. My home unit sent me only non-medical records, stating that was all they had. How could my file not include medical records of my extensive treatment? I went to physical therapy so much, I was kept on medical hold at the end of my original M.O.S., for a second M.O.S. While on medical hold, for appriximately 2 months, I was still seeing doctors by appointments. When I first learned that I could file for complications while enlisted–which included injuries sustained in Basic Training, subsequent physical therapy several times a week while in AIT, treatment at Troop clinics at Basic Trng and AIT, and hospitalization at AIT–I filed a claim Some years prior to that, I’d gone to the regional VA and provided my DD214; and was told no info on me was in the system. When I learned that I could file a claim, I did so, followed by years of reconsiderations filing. I lost those years, as I was told, via phone, that a request for an extension was being made on my behalf, which I consented to(once I learned I could do that). I was waiting on someone via phone to get back to me, because she said she was going to help look for my records. I’d been directed to speak with her as I continued my years-long search. She never got back to me, and seemed to be avoidingly, unavailable, each time I called for her. When someone’s avoiding you, it becomes insultingly, obvious; but, I needed help. I tried to explain what had transpired to the VA, but my claim got determined as newly re-opened and eventually lapsed, because I ran out of what to do to get my records. Last July, I submiited, via phone, an Intent-to-file. I still am not sure what is expected of me. I fail to see how I have the responsibility for my records that were solely the responsibility of the military / VA, to maintain. One representative at the VA call center told me I’m responsible for locating my records. That can’t be so. I didn’t keep them. My unit had the records. Maybe they never retired my records. St. Louis (two departments) said they couldn’t find them. I presented civilian medical records, to show to some degree, that I had, and still do have. the same and extended conditions. I even submitted a letter in support. St. Louis(NARA) and one other department in St. Louis even said they couldn’t find location information that the treating hospital at AIT gave me; which I sent to NARA(Military Service Personnel Records Center). I’m planning to send SF180s for inpatient and outpatient to St. Louis prior to filing a new claim. It’s all I know to do. After reading my dilemma…you tell me, please…what can I do? Thank you for you time. I look forward to hearing from you.
Hi Ruth,
I’ve met a lot of Veterans with similar issues. I am not an expert by any means on National Guard records, but I know someone who may be able to help. She will be reaching out, so please be on the look out for an email very soon. Good luck.
If you were in the National Guard, then the National Archives do not have your records. The State Adjutant General of wherever you were in the national guard holds those medical records thus; they are in the state J1/G1, or the state archives, the medical aid station responsible for your former unit, or the state medical command. You didn’t say what state, so I can’t help you more. You will have to call the office of the State Adjutant General and ask them how to request copies of your military and medical records. If you went to basic training at Fort Jackson, SC, it is highly likely that you can get a copy of your clinic treatment records that are still in the physical therapy clinic and at the troop medical clinic. You should call them immediately because Moncrief Army Hospital is going through a conversion to a clinic and all inpatient services stopped last month. You can call the physical therapy clinics there to ask them to look at the records using your social security number and birthdate. Just simply tell them that the National Archives has said your treatment records are not with them. You received treatment and were hospitalized there for the period you were in basic training, and those records never made it to your medical records, AND you know the hospital has to maintain those records for the joint council on accreditation. The Orthopedic Clinic may be reached directly Monday through Friday from 0730 to 1630 by calling (803) 751-2257 or (803) 751-2428. Physical therapy clinics are TMC: 803-751-3021, MACH: 803-751-2408 You will need to send them a copy of DD form 2870 http://www.dtic.mil/whs/directives/forms/eforms/dd2870.pdf.
If instead you trained at Fort Leonard Wood or Fort Benning then you will need to google the physical therapy clinic number and the medical records departments for those locations and find them. If you had surgery, then you will need the surgical department records. If you had a bone break, then you will need the orthopedic clinic records. What you want is copies of the documents sent to you, not to VA. If you send your only copy to the VA, and they lose them, then you will have to pay to get a second copy from the military facilities. By law, the VA cannot process your claims request without military medical records.
Thanks Duane!
First off the whole of the system you describe did not exist in the early 2000’s. I went to the American Legion to get help
in filing my claim for service connect resultant form a auto accident disability the claim was denied saying there was no ongoing record in my medical records to prove service connection. During the process of the original claim I changed
my state of residence and VA facility to another state and that started the process all over in the new state is were the denial took place I went to the State veterans affair person who told me I had no appeal coming,
I then moved back to the original state after 3 years and one day I saw the original American Legion consular and told him what happened. He looked over my info and said I could have filed an appeal but since three years had lapsed I no longer
could. he then helped me file appeals on things that I could, All of the appeals since have put me at a 80% SC disability with one still pending. The medical records which I was advised to get from the VA are in fact severely missing information on three hospital stays and many out patient visits the I went to the records cent with a request The replied that the turned the records over to the VA in the state (VA) when I first filed and that they kept no copy. live and learn never trust the government
to look out for anything but how they can screw the vet and get their bonuses.
Hi Dean,
In 2000 I was joining the military, but this appeals process was in place. What was not in place, was our electronic processing system, VBMS. So back then we were shuffling paper files back in fourth all across the country. My best guess is every time you moved, there was a 6-month lag for your paper claims file to catch up with you and that was if you remembered to tell the RO that you moved. What? You told the VAMC? That did not count because the two did not talk to each other. I know, frustrating. I don’t blame you for being skeptical and non trusting of VA. In fact when I joined VA in 2011 (11 years AFTER you filed a claim) everything I just described still existed.
But in the last several years, the employees of VA have been busting thier chops to provide you with better service and that meant modernizing how it processed claims. We continue to modernize with our Sectary’s MyVA focus. Give us another try. You don’t have to blindly trust us, but we aren’t the same VA from 16 years ago.
Why do veterans that have served in actual combat, been diagnosed with traumatic brain injury and Ptsd have to wait three or more years to get their appeal taken care of. We didn’t take those three or more years to served our country. My friend had been waiting for over five years for his appeal, and then got some upset and angry, he kill himself saying he was ashamed of serving this country. I am starting to feel the same way, i already lose my home and wife has left me saying you were a stupid fool in serving this country, they are going drag your appeal out until you are dead, they don’t care.
This happens a lot in New Mexico also and most that have extensive medical care to help support their claim disappear. It looks like the have cookie monster that eats records
Kevin
I am sorry to hear of your friend. Any time a Vet chooses suicide it breaks my heart. I hope you are not leaning that way and keep the Veterans Crisis Line phone number with you — 1-800-273-8255 and Press 1.
In a traditional appeals process, the appeal is decided based on the claim you submitted. Our appeal system is not a traditional appeals system, meaning you can add new evidence throughout the entire process. Each time you do so, it triggers laws that VA must act upon, lengthening the process considerably. We work appeals in the order they come in.
I am prior Army National Guard. I have been searching for my service medical records for many years. I’ve searched every place that I’ve been told to inquire…in writing and by phone. My home unit sent me only non-medical records, stating that was all they had. How could my file not include medical records of my extensive treatment? I went to physical therapy so much, I was kept on medical hold at the end of my original M.O.S., for a second M.O.S. While on medical hold, for appriximately 2 months, I was still seeing doctors by appointments. When I first learned that I could file for complications while enlisted–which included injuries sustained in Basic Training, subsequent physical therapy several times a week while in AIT, treatment at Troop clinics at Basic Trng and AIT, and hospitalization at AIT–I filed a claim Some years prior to that, I’d gone to the regional VA and provided my DD214; and was told no info on me was in the system. When I learned that I could file a claim, I did so, followed by years of reconsiderations filing. I lost those years, as I was told, via phone, that a request for an extension was being made on my behalf, which I consented to(once I learned I could do that). I was waiting on someone via phone to get back to me, because she said she was going to help look for my records. I’d been directed to speak with her as I continued my years-long search. She never got back to me, and seemed to be avoidingly, unavailable, each time I called for her. When someone’s avoiding you, it becomes insultingly, obvious; but, I needed help. I tried to explain what had transpired to the VA, but my claim got determined as newly re-opened and eventually lapsed, because I ran out of what to do to get my records. Last July, I submiited, via phone, an Intent-to-file. I still am not sure what is expected of me. I fail to see how I have the responsibility for my records that were solely the responsibility of the military / VA, to maintain. One representative at the VA call center told me I’m responsible for locating my records. That can’t be so. I didn’t keep them. My unit had the records. Maybe they never retired my records. St. Louis (two departments) said they couldn’t find them. I presented civilian medical records, to show to some degree, that I had, and still do have. the same and extended conditions. I even submitted a letter in support. St. Louis(NARA) and one other department in St. Louis even said they couldn’t find location information that the treating hospital at AIT gave me; which I sent to NARA(Military Service Personnel Records Center). I’m planning to send SF180s for inpatient and outpatient to St. Louis prior to filing a new claim. It’s all I know to do. After reading my dilemma…you tell me, please…what can I do? Thank you for you time. I look forward to hearing from you.
Knowing the difference between a claim and an appeal doesn’t the presumptive conditions for Agent Orange give the Veteran a fast track through both processes? It is hard to get the New Mexico RO to follow regulations posted by Washington and many or the VIetnam Vets do believe it is an attempt to let them die so benefits do not have to be paid. RO office also said VIetnam Vets were not promised Medical Care for life but I found a regulation that stated since Agent Orange was a presumptive condition and medical care would be provided for all those stepping foot in Vietnam because of the presumption of diseases that were possible.
Caolie,
It depends on what you mean by “fast track.” AO claims are not expedited if they are filed today. They were expedited when a new presumptive condition was announced, VA went back and found every claim that had previously filed for that condition and re examined the file to award benefits — only those were expedited. However, AO claims arrive further down the line than other claims because VA presumes the nexus opinion (you need three things for service connection: 1. a current disability, 2. an incident in service 3. a nexus medical opinion connecting 1 & 2 ).
As for medical care, I am unfamiliar with that as well, but it does not mean you are wrong. RO employees are seeped in benefits policy, it is our job to know it inside and out. We get a little foggy on the health care side. Rather than tell you you are wrong, we should try to find you the right person. I suggest checking with the enrollment people or the public health department at your local VAMC. I did find on this website (http://www.publichealth.va.gov/exposures/agentorange/) that AO vets do receive a free exam. Hope that can help. If not, let me know and I will do more digging.
I am helping two Vietnam Veterans that were never contacted about their heart conditions. My husband was also not contacted until I called Washington and they got it processed promptly. So, New Mexico did not contact all of them and we have written and written and still no response for benefits. Thanks
WHAT IS A DEFURRED STATEMENT., I PUT IN A CLAIM FOR PTSD,AFTER WAITING FOR 2 YEARS THEY DEFURRED IT. I ASKED FOR A FORM 9 FOR APPEAL. THEY SAID THAT THEY WILL REVIEW IT BEFORE I CAN DO A FORM 9. WHERE DOES THAT COME IN AT?? AT PRESENT THEY HAVE BEEN REVIEW IT FOR THREE YEARS NOW. IS THERE ANYTHING I CAN DO???
Hi Jimmie,
Deferred usually means that the RO is waiting on a piece of evidence on that specific condition. But has all the other information it needs to issue a determination on any other conditions you filed or appealed. So the RO defers (or postpones) a decision on that one condition until it receives every thing it has while giving you a decision on the other condition. The thought is to not hold up benefits for Veterans, assuming they could grant some of the other conditions. Hopefully, that was the case in your appeal. The RO will issue a decision on the deferred issue, once it receives the need evidence. it is probably important.
I am currently at 70% disability for P.T.S.D. and other disabilities. After my last physical my Doctor informed me that my A1C level is at 6.5 putting me as a diabetic. I know being exposed to Agent Orange can cause diabetes. How high does my A1C have to be before I can put in a claim? Does it make a difference if I am at the low end or should I wait and see if it gets worse?
Hi Earl,
If you have a diagnosis for Diabetes Melitus, and you were exposed to Agent Orange, you can and should file a claim for service connection. The rating of DM is based not on you A1C levels, but on your severity — does it only require regulation of diet, or do you need insulin as well? Is insulin and the regulation of diet still not enough and you require hospitalizations and so forth. Hope this helps. And look at filing a fully developed claim.
I have a 80 dissabilty I also went to a psychologist in about 18 min. this draft dodger said i was cured and the VA cut me 20% the Worthless DAV never even contacted me . The psychologist never talked to the VA doc. who has been treating me or anyone that I’m seeing at the VA menmental health for the last 10 years.Had to hire a outside lawer. I have 3 purple hearts and they are treating me like she!t.
The VARO in Denver Colorado is a serious joke. I filed a claim for several conditions from my feet, leg muscles, knees. All my service connections are from appeals only whereas the VARO denied every valid claim I put before them since 2006. Why is this VARO denying valid initial claims from the start? Is there a bonus in it for raters to deny valid claims? Thanks to a phone call to Sec. McDonald saved my butt from being evicted from my home hence I was finally raised to 80% service disabled from 30%. McDonald is a blessing here. But, the VARO in question will not grant my 100% TDIU even tho the evidence supports it. BTW TDIU would be retroactive back 10 years. Is the VA that broke to pay me about $300,000 in back pay by holding up my TDIU? To add insult to injury is that the BVA took all my V-9s in system and made a huge remand order in 01-2015 under the Finanical Hardship provisions that the Vice Chairman granted. The VARO is ignoring the BVA remand to expedite the appeal. Question why would the VARO ignore the BVA remand? Here we sit as of 02-2016 one year after the Board issued it’s remand order.
Why didn’t you answer my question about reconsiderations? You just deleted it?
Good morning! Your comment hasn’t been deleted — we just got through posting all of the comments that have come in. We’ll ask our colleagues at VBA to see if they can answer it for you.
Gee, looks like you would delete my post instead of answer it.
I’m sending a note to your boss. I’m sure Bob will understand you’re refusal to reply to a legitimate, on topic question.
Very nicely explained between a claim and an appel.
Here is a the problem I now face with my appeal for my Adjustment Disorder. After winning the appeal, and getting it remanded, I had a new C&P. The following year I was rated, my VSO and RO have verified this to me. My new problem is my award letter. It is not being generated.
I applied for temporary 100% PTSD and filed a claim for PTSD this past year (I am diagnosed with PTSD and have been through a 45 day inpatient program). Then, under the guidance of my VSO, I cancelled my PTSD related requests in order to speed up my award letter for the Adjustment Disorder. My regional office says the IT folks are working on a glitch in the system that is preventing my award letter from being generated.
Suffering 6 years through the appeals process, one year for the award process, and now I’m waiting months for a computer glitch to get fixed, is there anything you can do to help me? Thank you for reading this.
Hi Steven,
We looked into a couple systems and see what you are describing. A couple people were troubleshooting the issues this morning and I hope to have an answer for you soon. Thank you for being patient with us. I can’t imagine how frustrating this is for you. And thank you for bringing it to my attention. Once I get an update, I will give you a call.
Thank you so much for the update Catherine, and I look forward to hearing from you.
There is one item that I do want to mention about the appeal process for everyone else to remember. It is called “Continuous Prosecution”.
Continuous Prosecution means that you have stayed on top of your appeal and sent your reply back to the VA before the deadlines ran out. Such as, “You have 30 days to reply to this letter stating that you wish to move ahead with a board hearing”. Meeting every deadline keeps things going. Once you fail to do so, you may lose everything.
Even though I went through years of appeals until finally reaching the Veterans Court of Appeals, which judged unanimously in my favor against the RO, I kept up with each letter from the VA and didn’t give up. Every letter from my lawyers to my latest congressional inquiry is kept together in one folder. If the VA loses something I will have a copy, or my VSO will. Hope this helps some of you out.
Steven,
It was great talking to you. And you are absolutely right. Only about 4-5 percent of appeals make it to the Board, far less to the Court. Many appeals are resolved within the RO part of the appeals process. However, if the appeal is not resolved to your satisfaction, it is imperative you stay on top of those deadlines.
My 1996 claim became an appeal and was ajudicated at the court of Veterans Appeals in 2015 19 years later. Va did not like that so they unfairly rated my per centage low now that is in appeal. How many years will that take?
Hi Johnny,
That is a really long appeal. And I have seen them and personally argued some of them before the Board of Veterans Appeals. But most appeals never make it the Board, let alone the Court. I will discuss this, as well as why it takes so long in my next few posts, so stay tuned! Thanks for your service.
Catherine: Most appeals never make it to the Board? Hmmmmm, I wonder why that is? Could it be because the BVA is tied up trying to clear cases which are being dumped on them from ineptness at the RO level. If you doubt that I am sincere try looking into the figures from 2013, 2014 and 2015 as to the number of cases being sent to the BVA. The VA is playing the dealer but the BVA can never win because they get all of the crappy cards from the bottom of the deck. Fully developed claims my behind! A “fully developed claim” is VA speak for coloring outside the lines. During the hearings over the last 10 years, at least, I have heard BS coming forth from many who deemed themselves worthy of our gratitude and service and yet here we are in 2016 and nothing has changed much except if you believed the VAs version of the land of milk and honey instead of dog and pony.
Randall, I’ll take your bait, but in my opinion I suspect that you won’t believe anything I say simply because I work for VA. That is your choice. But I want to help people understand the process. Historically, about 4-5% of claims are appealed to the Board. This is because most appeals are resolved at the RO level. As to looking at the figures from 2013, 2014, 2015 you are correct, more appeals are being sent to the Board because VA processed more claims in each of those years than ever in its history. It’s simple math –
5% of 1 million = more appeals.
I discuss this in my future posts.
I was once just as you are and had VERY little trust for VA. In fact, it is the main reason I came to work here. I am ashamed to say I expected to come to VA and find it an agency filled with people who don’t care. Instead I found a place filled with passionate people who care deeply about Veterans and their families and are trying extremely hard to do the right thing. If you are able, join our ranks and help us find solutions to provide better services and care. But take care when you throw stones at VA. Because you are throwing them at your fellow Veterans and their family members — people like me, my husband who has two Purple Hearts and several Combat Action Ribbons, and my coworker who is the daughter. Every office you walk into in VA, you will find similar stories of Vets and family members. We continue to serve because, honestly, there is no greater calling in my opinion than serving Veterans. Service could be better in some areas, but don’t discount the work that has been done to improve service over the last few years.
The request for increase from the VA is a laugh. My husband has been waiting since June of 2014 for the final 10% that takes him to 100%. His claim is ALL service connected from diabetes/agent orange. No one can give us a straight answer. Many here in the Philadelphia area face the same garbage answers. “Your claim is on the desk of the deciding officer”. That is crap! My husband has gone from walking, to walking with a cane, to a walker and is now almost in a wheelchair. The VA waits until the Veteran dies. Older Vets are being ignored. Sorry, but this is just so much crap. Hearings, examinations, etc. are all met and still they make no decisions. Sad
Patricia: visit us on the blog askNOD and we will see what we can do to assist you and your husband. We do not charge a dime for anything we do as we are all brothers and sisters with family members. We made it home from foreign countries and others served here at home but we all served. Has your husband been denied benefits or the increase?
How. Do you get to askNog
I was rated at 70% service connected for PTSD in 2014. I have filed a claim requesting an increase in compensation. I have attended a new C&P exam. The Psychologist that I met was very young(not a veteran), not married and quite cold. I could see the handwriting on the wall. I should have got up and walked out, instead I stayed and listened to him tell me that he probably would not have time to complete the questions if we discussed each of them. His report was sent to the Regional Office in Waco and I subsequently received a letter telling me that they were going to reduce my rating because “I had gotten so much better”. I am a raving lunatic and an alcoholic.How does that make me seem better? How do you get better from PTSD? I want to fight this and I will. Marines do not give up.
William,
I am sorry you had this experience. It is you right to appeal. If VA proposed to reduce you rating, you need to provide as much evidence as possible to show that it is not warranted. You should work with a good claims representative and write a description of your C&P experience. VA has to propose to reduce you first and afford you due process, before they can actually reduce your rate. Good luck.
Get an attorney brother. Seek us out at askNOD. Hepper is the moniker. Stat strong and we can help get you there.
If you are applying for a increase in your disability compensation and have been seen solely by VA doctors. Can they use the notes in my ebenefits (blue button) or will I have to go to a private dr fir a C&P exam
Hi. If you have only been seeing a VA doctor, VA will use those records as evidence in your claim or appeal. You only need tell VA what facility you receive treatment at. It depends on what you doc caption on whether VA will send you for an exam. For example: if you are seeking an increase for a joint, many of those are rated based on limited range of motion. If a recent range of motion test does not exist in your medical file, VA will need to send you for a C&P to gather the information in order to properly rate you.
If the VA does send you for a C&P exam do some investing time to seek out the examiners specialty and when you go for the appointment ask him/her if they have read your entire file. Never assume that the person doing the exam is a doctor in a specialty field. For example an Endocrinologist doing an Orthopedic exam.
I am 90% disability rates fornParkinson’s (which by the way is a progressive disease and won’t improve) headaches, seizures, bladder problems just to name a few..I have been seen solely by VA drs.. I do not get dental care because of my rating. On my last visit to the VA neurologist he noted that my symptoms had worsen. I went to my local VSO to try to get help to increase to 100% and was told “you might get a cut in your rating if you try to increase” so where does that leave me. What can Indo to try to be rated 100% by using my VA records instead of being sent to an outside Dr for C&P exam BTW I am a Vuetnam Vet.Now I have a torn meniscus in my knee and the VA choice said it would do not good to operate because my knee is bone on bone and my health was not good enough for a knee replacement. I have written my Senator to try to get some help
How does the reconsideration process work? I recently was given an increase in my disability rating through this process after my claim was approved. They gave me a 10% rating when it should have been higher, they ignored 9 examinations by VA Doctors in my VA Treatment record when they gave me the lowballed rating. In the reconsideration, they corrected this and gave me the correct rating in about 90 days. There is no mention of reconsideration in the CFR or the USC.
Can you detail the correct regulation and authorities that cover this process?
I believe it’s under effective dates (Authority: 38 U.S.C. 5110(a)). Look in the C.F.R. under §3.400(h Difference of Opinion).
38 USC 5110A is about effective dates. It has nothing to do with reconsideration of rating decisions.
CFR 3.400(h) is about the same thing.
They don’t have anything to do with the subject I brought up.
This is what I am asking about;
M21-1 Part 3. General Claims Process
Subpart II-Chapter 2 – Benefit Programs and Types of Claims
Section F – Requests for Reconsideration – Updated 7/15/15
For the purpose of this topic, a request for reconsideration is a request from a claimant for the Department of Veterans Affairs (VA) to reconsider one of its decisions that has not yet become final (the one-year appeal period, which begins on the date the claimant was notified of the decision at issue, has not yet expired). A prescribed form is not required for a request for reconsideration.
A request for reconsideration differs from a claim to reopen in that the decision at issue in a claim to reopen has become final.
A reconsideration happens when you submit additional evidence after you receive a rating decision. We look at that additional evidence and determine if it warrants a higher evaluation or different decision on service connection. You must submit the reconsideration request within one year of our rating decision.
Many times a reconsideration is more appropriate than an appeal. Think of it this way:
VA makes a decision, you disagree and have additional evidence=reconsideration.
VA has all the evidence and makes a decision that you disagree with=appeal.
I know what a reconsideration is.
What I was asking, in the original post, is where the process described in M21 Part 3 Subpart II Chapter 2, Section F is regulated under the USC or CFR.
How long should an appeal take? It has been 9 mo. and I have not heard anything from VA,
Hi Gerald, currently the average processing time for appeals resolved is fiscal year 2015 was a little over 3 years. Typically, these included two additional decisions beyond the one you already received. It may be more than 14 months before you hear something on your appeal after you file your notice of disagreement. I will go into why it takes so long in my next few posts. Thanks for your service.
My appeal has been in since September 2014. When do you think I will hear something ?
First – since I have been a disabled veteran of the Viet Nam war – wounded in action by enemy gun fire – my claims were constantly denied for increase in compensation rating. It appears or at least appeared that the intent of the VA was to award absolutely the minimum they could get by with. In a combat assault mission in July of 1968 in Viet Nam with the 101st Airborne Division I was shot in the head by enemy gun fire, instantly paralyzed my left side. After many months of hospitalization I did manage to recover some of the movement in my leg and marked weakness in my entire upper extremity. Anything from my left hip down does not work. I was granted a 70% disability rating and that never changed until I finally got tired of hearing “NO” from the VA and started filing appeals. After about 6 visits to the VA hospital in SLC, numerous letters from myself, my physicians, verification of service and the fact that I was in combat when the injury happened – and the fact that the VA finally conceded that a gunshot wound to the head with brain injury qualified as falling under the definition of Traumatic Brain Injury (imagine that – now a soldier gets a concussion from an IED that does not draw blood and they get 100% ratings immediately for TBI) – plus the Agent Orange (I had open heart surgery and was told by the physicians that it was directly attributable to Agent Orange Exposure) – and the VA finally, after 43 years, increased my disability rating to 100%. It should have been that way from the time I was discharged from the Army and applied for benefits and benefit increases. The VA does not work for the veteran unless you are a veteran of one of the current conflicts.
That is a real low blow to our combat vets of today ,saying if you served in todays wars the VA throws out the carpet..A real disrespectful statement from a soldier.Let me tell you sir ,A Marine would never disparage another Marines service.I guess soldiers are selfish and are 100% individuals and fake there injuries like you who arse lazy and want 100% handout from the Va.
Semper Fi USMC Desert Storm Somalia Iraq Liberia
Paul
I did not read what you did in his statement. He wasn’t cutting the veterans of recent conflicts. He was making a total truthful statement that the government and VA neglected the veterans of passed conflicts.
Hello Gerald,
I have been working on my appeal since 1996, Now all of a sudden my file is gone from the Veterans Affairs office in Philadephia, PA office. This is unable. Come April it will be 20 hears. I have a deformed leg because of my primary care doctor who was definitely not from this country. How or who do I get a hold of so that I can get what I deserve? I have contacted so many people and of course no one ever calls me back. I am in desperate need of your help. My name is Cheryl and you can reach me at [redacted]
Thank you, for your time and consideration
NOTE: Identifying information redacted for public view by Vantage Point staff.
My Service Officer said my appeal should take 60-90 days because it’s “expedited” due to the fact the only reason I am not homeless right now is I got my rent paid through charity. (Expedited is for people who are homeless or immanently homeless). He told me I should have gotten approved right away because there was positive proof I had depression and panic disorder while in the service. That should have gotten me 50%.
However, I’m seeing posts on here that are saying appeals take years. So I’m not sure now.
I think that the VA should give people who are low or no income some money pending their appeal that could be paid back from the back pay when they get their benefits so they don’t “starve” waiting for benefits. Especially since I have 2 doctors saying I can no longer work in my case.
I am also trying to get disability for MS. While I was in the service, I had mono. There is a link between mono and MS. That should get me 70%, however my Service Officer said that one will be a battle. I attached a NIH study that showed the link to my appeal. So we’ll see.
Elizabeth, it sounds like your service officer is a good one. We do expedite homeless cases. Your service officer is right on.
I read your article and I believe the information you’ve given here is only the best of circumstances. I spent 20 years in the Air Force and have been fighting with the VA for over 30 years to get a correct rating. The local RO denies everything that I put in. Let me give you a couple of examples. I became very ill the last 2 1/2 years of Air Force and got a zero rating from the VA. I’ve been trying to get this upgraded for all 30 years and the VA refuses to look at my medical records. I don’t see VA doctors and all my medical records are from doctors outside. In ratings all the way back to 2005, the VA lists those medical records from the different doctors offices but never refers to them anywhere in the rating associated to a particular claim item. This means that even though they have constructive possession of the evidence, they ignore it. This, in itself is a refusal to follow the laws in all cases. Even though my SPR reflects combat exposure in 1968, ’69 and ’70, the RO always denies PTSD because I don’t have a combat ribbon. The reason for NO combat ribbon is QUITE SIMPLE, because I’m in the Air Force and the Air Force does not have a combat ribbon. Furthermore since the laws for PTSD verification/qualification changed in July 2010 that specifically detail what requirements must exist to be certified as suffering from PTSD and diagnosed accordingly. I have been treated by a VA MD Psychiatrist and a VA PhD Psychologist since August 2008 through the present. The present being 2016. All rating DENIALs, every year states that no records exist indicating DIAGNOSIS, treatment, symptoms etc. etc. for PTSD. The RO stated recently, I must fill out their form for PTSD but that is incorrect because the law states if you’re already DSM-IV diagnosed by the VA doctors then you don’t need to fill out that form. Just another example plainly demonstrating the local RO does not do their job, abide by the laws, or even read and comprehend existing evidence. In November 2014 I submitted a NOD and included 124 pages of VA medical records from the mental health clinic for all of those years and the RO sent me a SOC stating they had received my information that “discusses my symptoms” but did not see any diagnosis of PTSD. It appears that they are calling a diagnosis, a “discussion’. Even today, the VISTA system plainly shows a diagnosis of PTSD, ANXIETY, DEPRESSION and a GAF of 40. Why do you think we call this process the “hamster wheel”. What you explain above is what is supposed to happen with this supposedly non-adversarial system. Most people think that all of the problems with the VA are related to just the medical side, the hospital, the clinics, the scheduling, and the treatment. So if they read or hear that veterans are getting better medical service than they think everything is okay. Unfortunately, the VA also controls the rating system which is accomplished by nonmedical people in an environment where numbers are important to them and I don’t mean accuracy, I mean how many of the claims can they push out the door every month unfortunately the national information shows that the accuracy of what the RO’s put out is roughly 25% and that guarantees that most of the claims will have to come back to the RO for re-adjudication. Let me explain the timeline. A veteran puts a claim in. If the claimed concerns only one item and the VCAA requirements can be met quickly chances are a rating will be returned within a few months. I didn’t say approved or denied. One thing for sure if it’s approved it is never approved at the correct percentage with the correct effective date. This means the veteran must turn in a NOD that might take another year to respond to and again I am not talking approval or denial. Let’s assume when the NOD was turned in, a DRO video conference was requested. Scheduling for that may take a whole year just by itself. Let’s assume that the DRO video conference is completed and within six months you receive another rating. Again I am talking the same problems effective dates, percentage of the rating etc. etc.. So if you’re still not happy with your rating, now you must go to the BVA and in order to even get on the docket to be scheduled that might take an additional two years and then even after you’re on the docket it still might take up to a year to actually have a review of your claim or if you’ve requested a DRO video conference that might also take up to a year. Let’s assume you have the DRO video conference with the BVA and there are still problems with the rating, or the effective date or the percentage. Your only options now are to take it before the CAVC and unless you are a lawyer your chances of survival are slim. The VA has a whole gaggle of attorneys and you have you and maybe you have someone that can still offer guidance but is not an attorney. That’s why it’s called the ”hamster wheel”. How many years have we burned up now just getting to this point hasn’t been one or two or we coming up on 8 to 10. Just saying. Until 2008, I was still on antidepressant medication from the last 2 1/2 years of my Air Force career, almost continuous counseling but not by professionals that understood PTSD. You got to remember that the term PTSD was not in existence before 1988. I was continually depressed and very moody, did not want to go to work, did not want to talk with most people, had all the symptoms but nobody knew what it was until I met the VA psychiatrist and she immediately doubled all of my antidepressant prescriptions and added one additional one because she said I wasn’t getting enough antidepressants to treat my symptoms. I wasn’t doing any dating, I couldn’t hold down a full-time job, I went through two divorces, a bankruptcy all of which contributed to my depression and not being able to fight with the VA. It wasn’t that high on my list. In late 2008 I started reading, researching, and fighting back with the VA. I hope this clarifies a few things that you haven’t addressed in your editorial. BTW, I had a VSO since 2006 and he did nothing to help. If you can show me an RO that is fair, honest, and legal, I will show you 20 that are not. BTW I am 68.