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VA’s “Benefit of the Doubt” Doctrine

Courtesy of VeteranBenefitGroup.com

Many veterans know of the existence of VA’s “benefit of the doubt” doctrine, but question how the doctrine is applied in a case.

I. What is the “benefit of the doubt” doctrine?

VA claimants have the burden to prove their claim to the VA, that is, when making a person makes a claim to VA that person has the responsibility to present evidence that will establish entitlement to the benefits that person is seeking. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA will give the “benefit of the doubt” to the claimant.” 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102 (2010); see Gilbert v. Derwinski, 1 Vet. App. 53, 55 (1990) (the benefit of the doubt standard is similar to the sandlot baseball rule that the tie goes to the runner).

II. Does this mean the VA has to always give me the benefit of the doubt and therefore believe all of the evidence I submit to support my claim?

No, as the adjudicator of the claim, VA has the duty to weigh the evidence and determine whether that evidence if probative or not. Sometimes VA will find some evidence has more probative weight than other pieces of evidence. The “benefit of the doubt” doctrine only comes into play when two pieces of evidence are of equal weight, in that instance, VA must give the favorable evidence the “benefit of the doubt.” For example, let’s say that a veteran is trying to establish service connection for a right knee condition that developed due to an in-service fall. VA affords him an examination where the examiner reviews his claims file and determines that the condition is not related to service. The veteran then obtains a medical opinion from his doctor that is also based on a complete review of his claims file, and provides a thorough medical opinion and rationale as to why his right knee condition was caused by service. In that instance, having all things be equal between both examinations, VA should give the “benefit of doubt” to the favorable medical opinion and thus probably grant the claim.

Here’s one way to look at when the benefit of the doubt applies and when it doesn’t.

Let’s say that Joe Veteran is trying to get service connection for the arthritis in his back. Joe had an accident in service in 1968 when he fell out of the back of a moving jeep, hitting his low back. Now, 40 years later, he has arthritis in his lumbar spine and believes that his low back problem was caused by the Jeep accident. In order to be service-connected, VA rules require that there be a medical opinion that relates the currently diagnosed disability to the Jeep accident. Here, Joe gave his service medical records to his doctor who wrote an opinion saying that the current arthritis is likely due the in-service accident. VA then gets its own opinion; but its doctor says that the back problem is more likely caused by old age. In this case, there are two pieces of evidence both addressing the same question—was Joe’s Jeep accident the cause of the arthritis 40 years later. If there’s nothing about either opinion that makes it better than the other, VA is required to give the benefit of the doubt to the veteran and accept the favorable opinion.

Now, let’s change the facts around. In this case, Joe has explained that he believes the Jeep accident caused the current back problems, saying that this was the only injury he ever had to his back. In this case, however, Joe doesn’t get a medical opinion from his doctor and VA doesn’t get one either. Here, there’s no medical opinion at all answering the question about whether the arthritis was caused by the Jeep accident. Because there’s no favorable opinion, there’s just not enough evidence to allow VA to grant the claim, and no evidence to which the benefit of the doubt rule can apply.

Veterans Claims Assistance Act of 2000

posted Jun 4, 2014, 11:27 PM by Dawn Olsen   [ updated Jun 4, 2014, 11:28 PM by Neslo Ventures ]

114 STAT. 2096             PUBLIC LAW 106–475—NOV. 9, 2000

Public Law 106–475
106th Congress

An Act to amend Title 38, United States Code, to reaffirm and clarify the duty of the Secretary of Veterans Affairs to assist claimants for benefits under laws administered by the Secretary, and for other purposes. 

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,


SECTION 1. SHORT TITLE.

This Act may be cited as the ‘‘Veterans Claims Assistance Act of 2000’’.

SEC. 2. CLARIFICATION OF DEFINITION OF ‘‘CLAIMANT’’ FOR PURPOSES OF VETERANS CLAIMS.

Chapter 51 of title 38, United States Code, is amended by inserting before section 5101 the following new section:

‘‘§ 5100. Definition of ‘claimant’

‘‘For purposes of this chapter, the term ‘claimant’ means any individual applying for, or submitting a claim for, any benefit under the laws administered by the Secretary.’’.

SEC. 3. ASSISTANCE TO CLAIMANTS.

(a) REAFFIRMATION AND CLARIFICATION OF DUTY TO ASSIST.—
Chapter 51 of title 38, United States Code, is further amended
by striking sections 5102 and 5103 and inserting the following:

‘‘§ 5102. Application forms furnished upon request; notice to claimants of incomplete applications

‘‘(a) FURNISHING FORMS.—Upon request made by any person claiming or applying for, or expressing an intent to claim or apply for, a benefit under the laws administered by the Secretary, the Secretary shall furnish such person, free of all expense, all instructions and forms necessary to apply for that benefit.

‘‘(b) INCOMPLETE APPLICATIONS.—If a claimant’s application for a benefit under the laws administered by the Secretary is incomplete, the Secretary shall notify the claimant and the claimant’s representative, if any, of the information necessary to complete the application.

‘‘§ 5103. Notice to claimants of required information and evidence

‘‘(a) REQUIRED INFORMATION AND EVIDENCE.—Upon receipt of a complete or substantially complete application, the Secretary shall notify the claimant and the claimant’s representative, if any, of any information, and any medical or lay evidence, not previously
provided to the Secretary that is necessary to substantiate the claim. As part of that notice, the Secretary shall indicate which portion of that information and evidence, if any, is to be provided by the claimant and which portion, if any, the Secretary, in accordance with section 5103A of this title and any other applicable provisions of law, will attempt to obtain on behalf of the claimant.

‘‘(b) TIME LIMITATION.—(1) In the case of information or evidence that the claimant is notified under subsection (a) is to be provided by the claimant, if such information or evidence is not received by the Secretary within 1 year from the date of such notification, no benefit may be paid or furnished by reason of the claimant’s application.

‘‘(2) This subsection shall not apply to any application or claim for Government life insurance benefits.

‘‘§ 5103A. Duty to assist claimants

‘‘(a) DUTY TO ASSIST.—(1) The Secretary shall make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the claimant’s claim for a benefit under a law administered by the Secretary.

‘‘(2) The Secretary is not required to provide assistance to a claimant under this section if no reasonable possibility exists that such assistance would aid in substantiating the claim.

‘‘(3) The Secretary may defer providing assistance under this section pending the submission by the claimant of essential information missing from the claimant’s application.

‘‘(b) ASSISTANCE IN OBTAINING RECORDS.—(1) As part of the assistance provided under subsection (a), the Secretary shall make reasonable efforts to obtain relevant records (including private records) that the claimant adequately identifies to the Secretary and authorizes the Secretary to obtain.

‘‘(2) Whenever the Secretary, after making such reasonable efforts, is unable to obtain all of the relevant records sought, the Secretary shall notify the claimant that the Secretary is unable to obtain records with respect to the claim. Such a notification shall—

    
    ‘‘(A) identify the records the Secretary is unable to obtain;

        ‘‘(B) briefly explain the efforts that the Secretary made to obtain those records; and

        ‘‘(C) describe any further action to be taken by the Secretary with respect to the claim.

‘‘(3) Whenever the Secretary attempts to obtain records from a Federal department or agency under this subsection or subsection (c), the efforts to obtain those records shall continue until the records are obtained unless it is reasonably certain that such records do not exist or that further efforts to obtain those records would be futile.

‘‘(c) OBTAINING RECORDS FOR COMPENSATION CLAIMS.—In the case of a claim for disability compensation, the assistance provided by the Secretary under subsection (b) shall include obtaining the following records if relevant to the claim:

        ‘‘(1) The claimant’s service medical records and, if the claimant has furnished the Secretary information sufficient to locate such records, other relevant records pertaining to the claimant’s
active military, naval, or air service that are held or maintained by a governmental entity.

        ‘‘(2) Records of relevant medical treatment or examination
of the claimant at Department health-care facilities or at the expense of the Department, if the claimant furnishes information sufficient to locate those records.

        ‘‘(3) Any other relevant records held by any Federal department or agency that the claimant adequately identifies and authorizes the Secretary to obtain.

‘‘(d) MEDICAL EXAMINATIONS FOR COMPENSATION CLAIMS.—(1) In the case of a claim for disability compensation, the assistance provided by the Secretary under subsection (a) shall include providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on the claim.

‘‘(2) The Secretary shall treat an examination or opinion as being necessary to make a decision on a claim for purposes of paragraph (1) if the evidence of record before the Secretary, taking
into consideration all information and lay or medical evidence (including statements of the claimant)—

        ‘‘(A) contains competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of disability; and

        ‘‘(B) indicates that the disability or symptoms may be associated with the claimant’s active military, naval, or air service; but

        ‘‘(C) does not contain sufficient medical evidence for the Secretary to make a decision on the claim.

‘‘(e) REGULATIONS.—The Secretary shall prescribe regulations to carry out this section.

‘‘(f ) RULE WITH RESPECT TO DISALLOWED CLAIMS.—Nothing in this section shall be construed to require the Secretary to reopen a claim that has been disallowed except when new and material evidence is presented or secured, as described in section 5108 of this title.

‘‘(g) OTHER ASSISTANCE NOT PRECLUDED.—Nothing in this section shall be construed as precluding the Secretary from providing such other assistance under subsection (a) to a claimant in substantiating a claim as the Secretary considers appropriate.’’.

(b) REENACTMENT OF RULE FOR CLAIMANT’S LACKING A MAILING ADDRESS.—Chapter 51 of such title is further amended by adding at the end the following new section:

‘‘§ 5126. Benefits not to be denied based on lack of mailing address

‘‘Benefits under laws administered by the Secretary may not be denied a claimant on the basis that the claimant does not have a mailing address.’’.

SEC. 4. DECISION ON CLAIM.

Section 5107 of title 38, United States Code, is amended to read as follows:

‘‘§ 5107. Claimant responsibility; benefit of the doubt


‘‘(a) CLAIMANT RESPONSIBILITY.—Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary.

‘‘(b) BENEFIT OF THE DOUBT.—The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.’’.

SEC. 5. PROHIBITION OF CHARGES FOR RECORDS FURNISHED BY OTHER FEDERAL DEPARTMENTS AND AGENCIES.

Section 5106 of title 38, United States Code, is amended by adding at the end the following new sentence: ‘‘The cost of providing information to the Secretary under this section shall be borne by the department or agency providing the information.’’.

SEC. 6. CLERICAL AMENDMENTS.

The table of sections at the beginning of chapter 51 of title 38, United States Code, is amended—

(1) by inserting before the item relating to section 5101 the following new item:

‘‘5100. Definition of ‘claimant’.’’;

(2) by striking the items relating to sections 5102 and 5103 and inserting the following:

‘‘5102. Application forms furnished upon request; notice to claimants of incomplete applications.

‘‘5103. Notice to claimants of required information and evidence.

‘‘5103A. Duty to assist claimants.’’;

(3) by striking the item relating to section 5107 and inserting the following:

‘‘5107. Claimant responsibility; benefit of the doubt.’’; and

(4) by adding at the end the following new item:

‘‘5126. Benefits not to be denied based on lack of mailing address.’’.

SEC. 7. EFFECTIVE DATE.

(a) IN GENERAL.—Except as specifically provided otherwise, the provisions of section 5107 of title 38, United States Code, as amended by section 4 of this Act, apply to any claim—

(1) filed on or after the date of the enactment of this Act; or

(2) filed before the date of the enactment of this Act and not final as of that date.

(b) RULE FOR CLAIMS THE DENIAL OF WHICH BECAME FINAL AFTER THE COURT OF APPEALS FOR VETERANS CLAIMS DECISION IN THE MORTON CASE.—(1) In the case of a claim for benefits denied or dismissed as described in paragraph (2), the Secretary of Veterans Affairs shall, upon the request of the claimant or on the Secretary’s own motion, order the claim re-adjudicated under chapter 51 of such title, as amended by this Act, as if the denial or dismissal had not been made.

(2) A denial or dismissal described in this paragraph is a denial or dismissal of a claim for a benefit under the laws administered by the Secretary of Veterans Affairs that—

        (A) became final during the period beginning on July 14, 1999, and ending on the date of the enactment of this Act; and

        (B) was issued by the Secretary of Veterans Affairs or a court because the claim was not well grounded (as that term was used in section 5107(a) of title 38, United States Code, as in effect during that period).

(3) A claim may not be readjudicated under this subsection unless a request for readjudication is filed by the claimant, or a motion is made by the Secretary, not later than 2 years after the date of the enactment of this Act.

(4) In the absence of a timely request of a claimant under paragraph (3), nothing in this Act shall be construed as establishing a duty on the part of the Secretary of Veterans Affairs to locate and readjudicate a claim described in this subsection.

Approved November 9, 2000.

Get the Fastest Claim Decision: File a Fully Developed Claim

posted Jul 6, 2013, 4:16 PM by Neslo Ventures   [ updated Jul 6, 2013, 4:16 PM ]

When I talk to my friends about filing a VA claim, I hear the same response: “Isn’t there a checklist for this stuff?” It’s a fair question. Whether you spent four or 34 years in the military, we are all very familiar with “the checklist.”

There were safety checklists, pre-flight checklists, checklists for deployments, changes of station, adding dependents, and the longest checklist I remember – the separation/retirement checklist. In the military, we like checklists about as much as we like acronyms because they keep things simple. We hear you – VA needs a checklist on how to file a digital claim for compensation through our new Fully Developed Claims program (FDC) – the fastest way to get a decision. Here it is:

1)  WHAT IS FDC?  A program designed to rapidly process VA compensation claims.

2)  WHAT KIND OF RECORDS DO YOU NEED? Military personnel and treatment records are vital to establishing your claim for compensation.  Military personnel records can contain deployment orders, pay records, medals and certificates not reflected on the DD-214. Obviously, your military treatment records may keep a log of any conditions or injuries you suffered in service.  Other federal records, like those from Social Security Administration (SSA), are often necessary too – they may contain a lot of medical evidence and sometimes even evidence as to the cause of a disability.  Non-federal records, like medical files from your private doctor, are also important to establishing your claim. These can tell us the degree of your condition, if it has become worse over time and general information needed for rating purposes.

3) WHY SUBMIT AN FDC?  You get a faster decision because it saves VA time.  When you file a claim, the law requires VA to make an exhaustive search on your behalf to obtain service records and other relevant evidence held by federal agencies and requires VA to ask at least twice for relevant evidence held by private parties, unless we get them on the first request.  This translates into months of waiting for evidence before VA can decide your claim.  By submitting all your evidence with your FDC, identifying any relevant records held by federal agencies and verifying that you have no more evidence to submit, you shave a lot of the wait time off the process.

With an FDC, VA will still collect all federal records you identify.  What we won’t do is spend time asking for non-federal records like private medical files.  We also won’t ask for National Guard and Reserve medical and personnel records, which are usually in the custody of your unit or state.  So, if you are or were in the National Guard or Reserve, make sure you go to your units and obtain those records.  Right now, it takes us more than 300 days on average to obtain National Guard and Reserve records, and if you don’t submit them with your FDC, we will have to process your claim the traditional way.

There is no risk in filing an FDC — if we find that there is a piece of relevant evidence you did not submit, but should have included (like private medical records), we will obtain that evidence on your behalf and process your claim the traditional way.

The Fully Developed Claims checklist (click to expand)

4) HOW DO I FILE AN FDC?  Go on to the internet and log on to your eBenefits account.  Click Apply for Benefits and then Apply for Disability Compensation.

eBenefits will guide you through the process. You can answer the questions and upload all your supporting evidence all at once, or you can start and save your claim online, collect your supporting evidence and log back in to finish applying.

Once you hit Save, you have one year to return to eBenefits, upload your evidence and click Submit.  Don’t forget to save – in many cases VA may be able to pay benefits as early as the date you first save that application. Your Veterans Service Officer can also log into the Stakeholder Enterprise Portal – a VSO’s window into your eBenefits account – to look over your claim and give you advice before you press Submit.

5) WHERE IS THAT CHECKLIST YOU PROMISED?  Follow the checklist below to make sure you submit the right type of evidence for your compensation FDC claim.  If you have questions about what is relevant, call VA at 1-800-827-1000 or contact your VSO:

FDC CHECKLIST

Identify Federal Records, if any (not all of these may apply to your claim)

  • If you received VA medical care, tell us where and when
  • Tell us if you receive Social Security benefits for a service-related disability
  • Tell us where your Military Treatment or Personnel Records are, if you know, or where your last duty station was
  • Identify any other relevant records in the custody of a federal agency, like federal worker’s compensation (OWCP) or the Public Health Service

If you have a copy of your Military Treatment or Personnel records, or records from other federal agencies, save time by submitting them with your claim by uploading them to eBenefits.  If not, VA will go get them, but this will slow down the claim.

Gather Records (not all of these may apply to your claim)

  • If your private doctor is treating you for a service-related disability, get a copy of those records
  • If you don’t believe the incident is recorded in you military records,  get statements from you, your friends or family explaining in detail why you should be service connected
  • If you are or were a National Guard / Reserve member: include all service medical and personnel records in the custody of your unit (Collecting and submitting these will expedite your decision because they are difficult for VA to collect). VERY IMPORTANT!

Upload the documents you gathered to eBenefits

  • Scan the documents
  • Under the Upload Documents tab, select Manage Files
  • Upload your documents

Verify you have No More Evidence

  • If you have additional evidence to collect and submit, SAVE your record now. You have one year to collect and upload additional evidence.  During this time, a VSO can log-on, view your application online and provide guidance on filing an FDC before you submit the claim.  When you have finished uploading your evidence you are ready to

Click Submit

6) MORE ABOUT COLLECTING AND SUBMITTING EVIDENCE

To get the fastest, most accurate claims decision, collect and submit the following evidence along with your online application: 

Private health care:  It’s important to collect and send all of your relevant private medical records.  This reduces the time it takes VA to request and wait for these documents from your private physician.

Statements from friends and family:  These optional statements may be useful to describe when onset of your disability, details about the injury or event that caused your disability (if they were there and saw it), and the disability’s impact on you.  These types of statements are especially helpful if the disability or event or injury that caused the disability is not recorded in your military records.

Personal statements:  You are your own best advocate. While VA and VSOs stand by ready to assist, both need to hear from you why you think you should be service-connected, especially if the incident or condition is not recorded in your military records.

Once you have collected all your supporting evidence, log back into eBenefits and upload all your documents. There is no limit to number of documents you can upload, but each file must be 5 megabytes or smaller (about 150 black and white pages at 300 resolution).  Once you verify that you have no more evidence, VA can start processing your claim right away. If you do submit more evidence after you submit the claim, VA will remove your claim from the FDC program and process it through our regular channels. For more tips on submitting your claim, click here.

The FDC program is the fastest way to get an accurate decision on your VA claim.  By ensuring you submit all your evidence with your claim, you allow us to get you an accurate decision as quickly as possible.

Cat Trombley is a public affairs specialist with the Veterans Benefits Administration. Prior to working for VA, she was an assistant director at a Veteran Service Organization and represented Veterans before the Board of Veterans’ Appeals. She is also an Air Force Veteran.

Enhance Your VA Medical Records

posted Nov 10, 2012, 8:26 PM by Neslo Ventures   [ updated Nov 10, 2012, 8:26 PM ]

Your communications to your VA primary care provider (PCP) are often rushed.  The PCP is focused on the signs and symptoms that he or she believes are most important to keep you healthy. The PCP isn't likely to talk with you about your service connected joint problem but will probably be focused on things like your blood pressure, diabetes, tobacco use and the sorts of things that may kill you.

With proper preparation, you can control some of the conversation and influence what is written into your medical records. Over the long run, these little notes are important to you when you want to review your claim and consider asking for an increase due to your condition becoming worse. If there are no records of your increasing pain or immobility, the person who is tasked to rate your claim won't have much evidence to go on.

Be prepared when you go to see your PCP or any other health specialist. I urge every patient to make brief notes...talking points...about the things that are most important to them. The key to success here is to keep these notes very brief. The notes are only reminders so that you don't forget to ask for what you want. Make your notes neat enough that you can hand them to your PCP and tell him/her "I'd really like to tell you a little about this. You may keep my notes if that helps."

You may ask that your PCP enter your discussion points into the record. Always be courteous and as brief as you can. You may explain that you will be seeking an increase of your rating % and that the notes made by the PCP will be of value.

You may also ask the PCP to write a statement that will support your request for an increase. You can also use the new "Secure Communications" to write a message directly to your PCP that will become a part of your records. Both of these techniques are described in detail further down on this page.

Every few months, get a copy of your recent medical records and review them for accuracy. These are your records and your benefits. It's up to you to ensure that they're correct.


Notice of Disagreement

posted Nov 9, 2012, 5:29 PM by Neslo Ventures   [ updated Nov 9, 2012, 5:40 PM ]

What should you do if you disagree with the final determination? 

The first the thing you should do is write this letter. 
Next make sure that you send it with a tracking number.


DATE

VIA Certified Mail, RRR


VARO Address


Reference (Your Name, SSN, Claim number and any other reference numbers on the award [denial] letter)


Dear Sir/Madame;


I am in receipt of your letter of DATE. In that letter you have denied my application for a disability rating I claimed DATE.


Please accept this letter as my Notice of Disagreement (NOD) with your decision.


My reason for this NOD is (briefly describe).


I request a Decision Review Officer Process (DRO) appeal and I request a personal hearing.


Respectfully,


YOUR NAME

ADDRESS
************************

Note that the appeal letter does not go into detail. That can come later. DO NOT display anger or frustration. This is a business letter and it is counterproductive to believe that you should tell them all that's on your mind at this point in time.  Once again...there is a time and place for everything. You will soon receive a notice that your appeal is in process.

Now is the time to decide if you will find a lawyer to help you appeal this decision. We recommend that almost every appeal be referred to a veterans attorney unless you are well versed at medical and legal jargon.


How To Hire A Lawyer 

Tips for Filing a VA Disability Claim

posted Oct 6, 2012, 2:29 PM by Neslo Ventures   [ updated Nov 10, 2012, 8:28 PM ]


January 4, 2011 by Tom Pamperin
Courtesy of Vantage Point

Filing a first claim for disability compensation can be a stressful experience. The stress can originate from one or more of the following factors:

Physical or mental discomfort
Financial need
That transitional feeling when you are no longer in the military but not really a civilian
Concern about the outcome
Lack of knowledge of the process
Unrealistic expectations
Erroneous assumptions
Things you have heard from other Veterans and the media and, just
Dealing with a bureaucracy

During this discussion I’d like to use my experience as both a Veteran and a senior VA official to demystify the process and empower you with information you need and what you can expect.

Recommendations

Dealing with large organizations can be frustrating. Some things that appear clear and certain to you may not be to others. Additionally, legal requirements can sometimes be confusing and time consuming. To have the best experience possible I recommend the following:

  1. If you are still on active duty and thinking about getting out and filing a claim, go through the Benefit Delivery At Discharge or BDD program at your installation. To qualify you must have between 60 and 180 days left on active duty. We will take your claim and get you examined before you go home. Normally, decisions are available about two months after you separate or retire.If you are still on active duty but have less than 60 days to go, you can still file a “Quick Start” claim. Quick Start claims are processed at dedicated facilities so decisions are quicker for most Veterans.

  • If you are out of service for less than a year, think you might have a claim, but are unsure if you want to “go through the hassle” apply. The evidence is fresher and cleaner, there are unlikely to be what we refer to as “inter-current injuries” (i.e. your back hurts a little but when you get out you get a job as a long hall truck driver or a construction working and don’t file a claim for years. In such cases even if there is some documentation of “something in service” without evidence of treatment for the condition within the first year, service connection is less certain).

  • If you’re concerned that it might not be appropriate to take money for a condition because “I’m fine, was just doing my duty and I have a job”–there are a lot of people who feel that way–consider this. I think you should file your claim. If granted you can always decline to receive the money. If, at a later date, your condition worsens or you age and it interferes with our work, or you decide you want compensation after all you can always contact us. That way we will examine you and determine your current level of disability. We won’t be trying to determine whether you warrant service connection in the first place.

  • If you have been out of the service longer but still think you have a condition related to your service apply! There is no filing time limit. It just might be a little more complex and take a little longer because of the need to develop more records.

  • Our goal is to complete all claims within 125 days or four months by 2015 with 95 percent accuracy. Right now more than 30 percent of our claims have been pending longer than that. Some claims, such as those involving participation in nuclear tests, covert operations, military sexual trauma or other similar circumstances where records may be difficult to locate can and frequently do take longer, sometimes much longer.

  • To meet the challenge of a rapidly growing claims volume, VA has been provided with significant numbers of new staff in the last couple of years. Their jobs are complex and it takes a while to become fully qualified so if you think we made a mistake, ask you may be right. As I said earlier, one of our goals is to get our quality level to 95 percent by 2015. Currently our quality level is 84 percent. While a significant portion our quality problems reflect process errors rather than errors in the final decision with respect to the granting or denying of benefits, rates paid and effective dates of payment, we do make mistakes.
  • How You Can Help Yourself and VA


    The claims process doesn’t need to be a hassle. Here is what you can do to help yourself and VA:

    1. Communicate, communicate, communicate
    2. Appoint a representative. While there are attorneys who will represent you for a fee, it is rarely necessary to pay to have your claim processed efficiently and successfully. National Service Organizations such as the Disabled American Veterans, Veterans of Foreign Wars, American Legion, Vietnam Veterans of America, Paralyzed Veterans of America, as well as State Departments of Veterans Affairs or Veterans Commissions and County Veteran Service Officers can give excellent assistance and its free. Call your local regional office to see what organizations are available at that office.
    3. Consider what you want to claim. Many Servicemembers and veterans have been told they should go through their service medical records and claim everything they have ever had or been treated for. While you can do that, it is likely to significantly increase your frustration level, result in unnecessary examinations, and slow the process without getting added benefits. You should not claim acute disabilities or illnesses you had in service unless they left a residual. For example, if you got the flu in service and got over it, the claim will be denied. On the other hand if you broke your leg and recovered from it you should claim that because the fracture, if found on x-ray, can be service connected. While it might only warrant a zero percent evaluation now, if you develop arthritis at the site later, you are covered. Don’t claim things like personality disorders, baldness, the fact that you wear glasses, or similar kinds of things because they are considered “constitutional or developmental abnormalities” that you would have gotten whether or not you were in service. The law doesn’t permit payment for these. Don’t claim lab results like hematuria (blood in the urine) or high cholesterol. We don’t pay for those either. On the other hand, you should claim pseudofolliculitis barbae (a skin condition that affects some black people).
    4. If private providers have treated you, get the records and send them to us. While the application you fill out does offer the opportunity to sign a release and we will request the records for you, we cannot compel providers to send us records nor can we pay for them. It is my experience that many times–maybe even most–when VA sends a release a private provider, the provider ignores the request. If the provider does respond, many times they will ask that we pay them in advance for the records. In either case, we will have to write to you and tell you that if you want the records considered you will have to get them and send them. In the worse case this can add two to three months to the process.
    5. Show up for your examinations.
    6. The first thing you will get from VA once you file your claim is a lengthy letter commonly referred to as a “VCAA letter.” This is a letter required by the law that tells you what we will do, what you will be expected to do, and in very general terms tell you how we will decide. The letter may also include specific requests from your local regional office for information. Read it carefully for specific requests for information from us. Finally, the letter offers the option of completing an attachment telling us you have no more information. If that is the case, complete the form and return it immediately. If you don’t and you have no more information, we will wait for 30 days before proceeding for no good reason. Even if, during the course of working the claim you do get additional information you can always submit it when you get it.
    7. When you get your decision, read it carefully. It will have attached to it the text of the actual rating decision explaining why we decided what we did. If you think our decision didn’t consider something, didn’t cover a topic, or is wrong, call your representative right away. If we have made a mistake, we would rather just fix it now than get involved in a lengthy appeal that isn’t terribly satisfying for you or VA.

    Final Note: VA exists to serve those who served and their survivors. I have worked for VA for over 36 years and the overwhelming majority of people who work for VA are committed to the mission. If we are not clear or you think we have made a mistake, let us know so we can both fix it, and provide a learning opportunity for our staff to serve other Veterans better.

    After serving in Vietnam as an Infantry Platoon Leader with the 101st Airborne Division, Thomas Pamperin began his career with VA in 1974. Having risen through the ranks, he is currently VA’s Deputy Under Secretary for Disability Assistance and is responsible for oversight of Compensation Service, Pension Service, Benefits Assistance Service, Fiduciary Service, and Insurance Service in the Veterans Benefits Administration.

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