Presentation on theme: "Navigating the VA Disability Compensation Claims Process"— Presentation transcript:
1 Navigating the VA Disability Compensation Claims Process Legal Meets Practical, LLCDISCLAIMER This presentation is for informational purposes and is not legal advice, as every claim is different. Viewing this presentation does not form an attorney-client relationship with Sarah Schauerte of Legal Meets Practical, LLC. If you have specific questions regarding your claim, consult with a veterans attorney.
2 Before You BeginKnow to expect delay – the VA currently has nearly 900,000 disability compensation claims pending (Roanoke is the 8th slowest RO)Talk to someone who can help (lawyer, veteran advocate)Make a list of potential witnessesMake a list of medical records available
3 What is Service Connected Disability Compensation? Money paid to veterans who are disabled by an injury or illness that was incurred or aggravated during active military service.Show two things: 1) current disability; and 2) disability incurred or aggravated during active military service.
4 How Do You File?Fill out VA Form (Veterans Application for Compensation and/or Pension)Include, if possible:Discharge or separation papersDependents’ recordsMedical evidenceThis can be done online through the Veterans On-Line Application (VONAPP). Preferable because faster, easier to verify have completed all sections, and easy to verify receipt by VA
5 Establishing a Claim for Service Connected Disability Compensation Five Elements to Establish a S/C Disability Claim:Veteran StatusDischarged under conditions other than dishonorable(2) Existence of a current disabilityMedical diagnosis of a current disability. Also, the VA has recently recognized that a medical diagnosis is not necessary as it relates to some disabilities (may submit lay witness statements documenting observable symptoms)
6 Establishing a Claim for Service Connected Disability Compensation Connection between in-service injury and the currentdisabilityShow a link or nexus between the in-service injury or aggravation (of a disability that existed before service but was aggravated in service) and the current disability
7 Establishing a Claim for Service Connected Disability Compensation Degree of disabilityAssessment by a VA rating officer based on average impairment of earning capacity (objective standard)Effective dateDate from which claim will be paid; file claim immediately to preserve the earliest possible effective date (as long as deadlines met, effective date is generally the first of the month after the month in which claim is filed)
8 Looking at Elements in Greater Detail Element #1: Veteran Status: VA defines a veteran as “a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable”Generally providing DD Form 214 establishes veteran status
9 Looking at Elements in Greater Detail Element #2: Current Disability: Veteran must currently suffer the disability for which he is seeking compensationPain itself is not a disabilityNo entitlement for pre-existing disabilities or congenital defectsIf the disability has healed itself, no entitlement.Example – Veteran breaks leg during active duty. No residual effects. Not entitled to disability compensation.
10 Looking at Elements in Greater Detail Element #3: Link Between In-Service Injury and Current Disability:Show the injury – Use Military Personnel Records (MPRs) and Service Medical Records (SMRs/STRs)Part of VA’s duty to assist entails obtaining these records to substantiate claimShow the connection with current disabilityBest way – get private physician to opine that the current disability was “as likely as not” caused by the in-service injury.Submit lay witness statements based on personal observation
11 Looking at Elements in Greater Detail Element #3: Link Between In-Service Injury and Current Disability:Standard – “as likely as not” that the disability is caused by the in service event (lower standard than civil cases). If an equal balance between positive and negative evidence, claim is granted (called “benefit of the doubt” rule)Presumption of Soundness – Unless VA produces evidence to contrary, presumed that the disability did not exist before service
12 Looking at Elements in Greater Detail Element #4: Degree of Disability:Degree of disability can range from 0% to 100%VA will rate a disability based on its “Schedule of Disabilities” (located at 38 C.F.R. Part 4)The rating based on the severity of the symptoms related to the disabilityIf you have more than one disability, the ratings will not necessarily add up mathematically (ie, 10% + 10% +10% + 10% = 30% in VA land)
13 Looking at Elements in Greater Detail Element #5: Effective Date of Award:In general, is the first of the month following the month in which the claim is filed (Ex., if claim is filed on April 15, 2008, effective date would be May 1, 2008)To preserve effective date, remember:Comply with all applicable deadlines (ALWAYS get return receipts or send by certified mail, put important dates on calendar)Submit needed evidence in time (VA will instruct you of due dates applicable to your claim)
14 Practical Advice Practical Tip #1: Cover yourself Never miss deadlines Keep copies of EVERYTHING sent to or received from the VABe proactive – seek help when you have questionsFor important documents sent to the VA, get certificates of serviceLabel documents sent to the VA with your service number (the VA loses documents)
15 Practical Advice Practical Tip #2: Use lay witness statements Statements from individuals who have had an opportunity to personally observe facts relevant to your claim (ex, military buddy who witnesses the injury, family member who witnesses symptoms of the disability)Get an example before writing your ownMake sure the statement shows how the witness “personally observed” the symptoms of the disability (ie, “I noticed him limp when he came to my house, and he asked me for help up the stairs.”)Get the statements notarized
16 Practical AdvicePractical Tip #3: Obtain a private physician’s opinionMore sympathetic than VA doctorsSaves time (can take a long time for the VA to set up a VA examination)Magic language: “It is at least as likely as not that the veteran’s current disability is service-connected”Make sure the doctor says what he reviewed in giving his opinion, and gives a rationale for his opinion
17 Practical Advice Practical Tip #4: Make it Easy for the VA Don’t send records that are irrelevant (for example, if your claim is for your back, don’t send records about an ankle injury)Don’t send duplicate records
18 Practical Advice Practical Tip #5: Expect Delay Might take up to nine months for an initial decisionDo what you can: submit all relevant evidence timely, look into whether a medical examination is neededWriting to elected officials generally will not speed things up
19 When You’re Not Satisfied With the Decision VA decision may be appealed by filing a Notice of Disagreement (NOD) within 1 year of the date that VA mailed the original decision denying the claimAfter VA receives NOD it will create a Statement of the Case (SOC) which is a detailed explanation of the evidence and laws and regulations used in deciding the claim. It takes roughly 7 months to receive SOCThe SOC is mailed to the claimant along with VA Form 9 Substantive Appeal Form to the Board of Veterans Appeals. Appeal to the Board of Veterans Appeals (BVA) must be made within 60 days of receipt of the SOC or within the remainder of the 1 year period from the date of mailing of the NOD to the VARO, whichever period ends later.If the claim goes to the BVA, expect a long delay (RO must certify it to the BVA, and then BVA decides issue – can take years)
20 Two Types of VA Administrative Reviews Decision Review Officer (DRO) reviewRequest in NOD or w/in 60 days of VA Notice of Right to ReviewAll evidence is reviewed anewNon adversarial informal hearingVeteran can submit additional new evidence at hearingDRO denial proceeds to BVA
21 Two Types of VA Administrative Reviews Board of Veterans Appeals ReviewAdministrative Law Judge will review record for errorVeteran may request an informal hearingRoughly 2.5 years from the time the NOD is filed for case to be certified to Board and another 2.5 years for the Board to decide the caseBVA decision is the last step in the administrative processBVA can remand the claim back to VARO for further development, grant the claim, or deny the claimIf BVA denies the claim the vet may:Re-open claim at the VARO with new and material evidenceFile motion with BVA asking for review based on clear & unmistakable errorAppeal final Board decision to the U.S. Court of Appeals for Veterans Claims within 120 days (strongly advised to seek legal representation)
22 DISCLAIMER This presentation is for informational purposes and is not legal advice, as every claim is different. Viewing this presentation does not form an attorney-client relationship with Sarah Schauerte of Legal Meets Practical, LLC. If you have specific questions regarding your claim, consult with a veterans attorney.