Understanding The VA Disability Claims Process
In recognition of Veterans' Day, I want to take the opportunity to provide a quick overview of the Veterans Administration claims process for my fellow vets.
Types of Claims
The Veterans Administration recognized different types of claims:
Original claim—the first claim for disability compensation related to a specific disability. (i.e., you have two claims, one for tinnitus and one for a knee injury, both are separate original claims because they are unrelated.)
Increased claim—a claim seeking more compensation for a disability that the VA has already determined to be service-connected.
New claim—a claim for an added benefit related to an existing VA-approved service-connected disability. (i.e., you receive monetary compensation for your leg injury but seek VA support getting a service dog based on the same injury.)
Secondary service-connected claim—a claim for a new disability linked to a VA-approved service-connected disability.
Special claim—a claim for special needs linked to your service-connected disability.
Supplemental Claim—a claim related to a previously denied claim providing new evidence to support the originally denied benefit.
This post focuses on original claims, and while much of the information applies to other claims, there are nuances. Therefore, you must review the specific requirements associated with your specific claim type before filing.
Requirements to File an Original Claim
A veteran initiates a new claim with the Veterans’ Administration by filing an Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ). The form may be filed online, mailed, or delivered in-person to a VA office.
The VA addresses your claim for disability benefits through a three-part test. First, the veteran bears the responsibility to show they meet the VA’s definition of a veteran for purposes of a disability review. The VA’s definition of “veteran” includes both a period of service requirement and that the discharge is “other than dishonorable.”
Second, you must demonstrate the existence of a current disability. A vague or incomplete claim may result in the VA’s rejection of a claim.
Lastly, the disability must be related to the veteran’s service.
The VA has a “duty to assist” the veteran in making a claim. While the VA staff consists of dedicated professionals, it is vital that the veteran carefully review their record and ensure the submission is complete and, if required, supported by a doctor’s statement to minimize the chance of an errant denial.
What happens after filing a disability claim with the VA?
A veteran should first receive notification from VA that the claim was received—which may take up to two weeks after filing a paper form or within a matter of hours if the claim was submitted electronically.
A VA representative reviews your claim to determine if any additional information is needed. The VA will contact the appropriate sources—whether you, a medical professional or a government agency—to collect that information. This evidence-gathering portion can be the longest part of the claims process and may require further medical examinations.
Once the VA determines that all necessary evidence is present, the claim receives a review and a final rating recommendation. If you have an appointed representative, they will be provided a copy of the recommendation and a chance to comment on the recommendation. A final determination packet is then mailed to the veteran containing the rating decision, additional information regarding your disability rating, and the veteran’s appeal options if applicable.
What should I do after receiving a claim decision from the VA?
If you are satisfied with your decision, no further action is necessary. However, if you are not satisfied with any part of the outcome, you have the right to appeal the VA’s ruling.
The Veterans Appeals Improvement and Modernization Act of 2017 established three options if the VA denies an initial claim. You may request a Higher Level Review by another VA claim adjudicator.
As part of this review, you may not submit new evidence, but the reviewer looks at the record without deference to the initial adjudicator’s decision.
Alternatively, you may submit a Supplemental Claim supported by new and relevant evidence. The VA has a responsibility to aid you in gathering the new and relevant evidence to support your supplemental claim.
Lastly, you may choose to pursue a direct appeal to the Board of Veterans Claims. An appeal to the Board may, but does not have to, include new evidence. You may also request an actual hearing before the Board.
An experienced attorney or Veterans Service Organization can assist in developing your supplemental claim and is highly recommended for an appeal to the Board. An attorney can help you identify the elements of your claim that were lacking and gather the records and evidence necessary to sufficiently prove your claim.
You have one year from the date of the VA notification letter to appeal a claims decision.
What resources are available, or who can I contact for help?
VA Accredited Attorney - Accredited attorneys or representatives, like myself, are individuals recognized by VA as legally authorized and capable of assisting claimants in pursuing benefits before the Department of Veterans Affairs. The VA maintains a searchable database to find attorneys in your area.
Disabled American Veterans (DAV) Organization – DAV helps veterans navigate their VA benefits and provide counseling for veterans on claims and appeals—all at no cost to the veteran.
American Legion – The American Legion maintains a benefits center designed to educate veterans on the benefits to which they are entitled and aid the veteran in gaining those benefits.
Veterans of Foreign Wars – The VFW’s vision is to “ensure that veterans are respected for their service, always receive their earned entitlements, and are recognized for the sacrifices they and their loved ones have made on behalf of this great country.” Like the American Legion, the VFW maintains a clams and benefits office to aid veterans pursuing their VA claims.
In addition to these organizations, many states and other non-profit organizations have offices designed to assist veterans. An internet search for those in your area may be very informative. I do advise caution, though. To successfully navigate the VA claims process requires you to exchange personal information with those helping you. Ensure those you are working with are who they claim to be and do not provide such information in response to unsolicited contacts by someone claiming to represent such an organization.