Note: The information provided here was developed to help veterans better understand the claims process and the laws which govern it. It is a compilation of the personal experiences of other Veterans and much research. It is not intended to replace the use of Trained Veteran Service Officers (VSOs). Seeking professional advice is always advisable.                      

           Contents:                                 

  Basics                               

                       The claims process is one of the most frustrating and intimidating areas of a Veterans life after service. Anyone who has struggled with getting a claim approved, or has had to wait as finances ran out, relationships became strained, or has just given up and surrendered to the system, will tell you it takes its' toll emotionally, physically and often times financially. This section of the site is designed to help those already in the claims process, or about to open a claim to better understand  how the VA works, what they are looking for, where to find help, and provide many helpful tips and information that will equip you to file a " Ready to Rate" claim and get the all   the benefits you deserve under the law.

Enrollment

No benefits can be sought from the VA until the Veteran has enrolled at the local VA Facility. This process has become easier over the past year, as is noted below.

Enrollment Alternatives

There are several other ways to enroll:

1) You can enroll in person at any VA Medical Center or Clinic.

2) You can obtain enrollment assistance by calling the VA Enrollment Service Center, Monday through Friday between the hours of 8:00 AM and 8:00 PM (Eastern Time) at 1-877-222-VETS.

3) You can also enroll by mailing or faxing the completed Form10-10EZ  to the  Medical Center or Clinic of your choice.  See VHA Facilities Locator

4) You can also obtain additional assistance by contacting your State or County Veterans Service Officer. For telephone listings please consult the blue pages of your local phone book under "United States Offices", then look for "Veterans Affairs" or check our VSO Listing.

application for health benefits Form 10-10ez

Getting Help:    

 Veteran Service Officers are the main source of claims help in the VA system. They can be found within Veteran Service Organizations such as the DAV or VFW, VA satellite centers and VA Hospitals. Finding a good service officer is paramount to your claim. Do not be hasty in choosing one. Ask other Vets which Officers have been helpful to them. If you don't have any Vet friends, you need to be reading the PTSD section of this site first and then return here. VSOs can be organizational representatives, a State or County representative, or  a National representative as is the Disabled American Veterans. (DAV). It is best when seeing a Rep, that you have an understanding of your claim and what you are requesting. Most Service Officers will simply file a claim from saying you want to open a claim for whatever and leave it at that, no real information is provided. Whomever you chose, if any, be sure he is going to work with you on your claim and take an interest in your needs. I personally have had great success the DAV, however, I only give them the copies of the paper work that I have completed for their review.   This is your second option for filing;do it yourself. This option will be discussed in detail.

Evidence:

    Every Veteran who has been getting services from a VA hospital, should request a copy of his or her medical records. You are entitled by law to one full copy of all records. These records can take up to 30 days, if your VA Facility is still working with paper records and not using a centralized data base. If you have yet to visit the VA Medical Center for help, the following link will give you much of the information to get you started in the right direction, it includes locations of all VA Medical Centers,a Vet Center Directory, Claim forms and endless information about Veteran benefits. Just press        If you do not have a copy of your DD 214, you need to complete a form  this link will get you a copy which can be filled out and in Windows and then printed.

 Types of Evidence:

      Evidence for your claim can come in varied forms. Records from private Physicians, military medical records (link for service/medical records is given in the links section), letters from friends, employers, employees, wife or significant other, can all help your claim. For information on how to obtain a copy of your military or service medical records click the  National Archives and Records Administration button

Tip: Letters should be typed, notarized, and only give information about your specific illness, injury, disease, disorder, and how it impacts your day to day life. They should NOT give any medical opinion as the VA will not use such evidence from a nonprofessional.

 This is a Web site where veterans and their families can access information and forms to request copies of military personnel records.  As in the past, they must still mail or fax the form, but this site makes it much easier and more understandable.

The URL is http://www.archives.gov/research_room/vetrecs/index.html

VA Disability Claims Processing

         VA Fact Sheet  March 2005

The Department of Veterans Affairs (VA) fulfills the government's obligation to help those who leave the military injured or ill.  In service to their country, military members give up the right to decline dangerous assignments.  Their occupations lack conventional workers compensation coverage.

Administered through a network of 57 VA regional offices, disability compensation benefits cover chronic illnesses or injuries incurred during or worsened by military service.  It is one of the VA's most extensive benefits and among the most complex, posing a challenge to timely service.

Current payment rates and background on the basis for determining the severity of a disability are available at http://www.va.gov/OPA/fact/05comprates.html.

In fiscal year 2004, more than 703,000 veterans received decisions on their disability claims, and an additional 752,800 beneficiaries received decisions on claims not requiring a rating decision.  VA added approximately 62,000 beneficiaries to its compensation and pension rolls, bringing the total number of beneficiaries of VA compensation and pension to nearly 3.5 million.  Compensation and pension payments last year exceeded $30 billion.

VA has made a commitment to keeping its rating claims inventory to 250,000 claims with an average processing time of 145 days.  As recently as 2002, VA had more than 432,000 disability claims pending and a processing time in excess of 233 days.  A September 2003 decision by the Federal Circuit Court significantly affected both workload and the timeliness of VA decisions in 2004.  The decision held that denial of a claim is premature before the expiration of the one-year period established by the Veterans Claims Assistance Act of 2000.  As a result, decisions on more than 62,000 claims were deferred, many for as much as 90 days or longer.  A provision of the Veterans Benefits Act of 2003 subsequently allowed VA to issue decisions on all of those cases deferred.  VA's disability claims inventory is currently approximately 336,000, and the timeliness of completed claims is once again declining with average processing speed at 171 days.  The inventory is also affected by an increasing volume of claims from veterans who served in Iraq and Afghanistan.

Claims Processing Improvement Task Force Spur Reforms

In response to a growing backlog of disability claims, coupled with an increasing number of days required to render a decision, VA commissioned a task force to study the processing methods and other performance drivers within the Veterans Benefits Administration and to make recommendations for corrective action.  The Claims Processing Improvement Task Force made a number of recommendations early in fiscal year 2002.  Key was the recommendation to shift the work processing method from the case management concept to that of the claims process improvement (CPI) model.  The CPI model changed the manner in which claims are processed.

The CPI model differs from the case management model in a number of ways.  For one thing, the CPI model allows for specialization of processing through the use of six specialized teams.  Four of these teams address specific, critical cycles in claims processing:  triage, pre-determination, rating, and post-determination.  Two additional teams address important areas related to the process itself:  Public Contact and Appeals.  By shifting from an individual focus to a process focus, a number of improvements were gained.  First, it became easier to spot process or flow disruptions since the work was organized around process flow and not individual assignments.  Second, training and development could be very specific and focused.  Third, the tools to monitor inventory were more effective in a process environment versus a case managed environment.

The Claims Processing Improvement Task Force also made a significant number of additional recommendations, the majority of which have been implemented.  Additional information is available at http://www.va.gov/opa/fact/claimstf.  Taken together, these recommendations created an integrated performance management system that not only complements the CPI model but has greatly enhanced the outcome.

Accountability, Performance Management Key to Reforms

The concept of accountability was a hallmark of the Task Force report.  The specific methods used to convert the accountability concept to reality were in four linked areas.

First, performance became a factor in resource allocation.  Prior to CPI, resource allocation was based upon expected workload as well as other factors generally related to the existing inventory.  The new Resource Allocation Model provides more resources to those offices that demonstrate sustained high performance and increased productivity.  This would ultimately be a large driver for those offices achieving very high performance.

Second, the prior method of annual office evaluations was abandoned in favor of very detailed monthly targets for VA regional offices.  These targets covered a vast array of performance measures including output, inventory, quality, older cases, and two measures for timeliness (a leading indicator and a lagging indicator).  Offices were tracked each month with respect to progress toward meeting these targets.  Focus on these targets became a significant driver in improving performance.

Third, these targets were integrated into the performance plans of each VA Regional Office director.  This linkage of resources and clear expectations with a rapid feedback cycle for results had a dramatic affect on performance, particularly rating output.

Fourth, VA developed a sophisticated reward and recognition system with three levels of recognition.  High performing offices could receive significant award money for performing at levels well above the national averages.  A study by a VA team reviewing cycle time in VA has looked at the impact of these performance drivers in VA and concluded that they are making a significant difference.

There were two other drivers of performance that worked in concert with the integrated performance management system.  These also had their genesis in the recommendations from the Task Force.  The first involved dynamic brokering of claim work from offices unable to keep pace to offices with excess capacity or to teams specifically developed to work bordered cases.  VA developed both a network of resource centers, teams within certain offices whose mission was to work brokered cases, and a Tiger Team dedicated to processing cases involving older veterans whose claims had been pending more than one year.

VA developed a number of automated tools specifically aimed at improving process cycle times.  These include the Inventory Management system, the Modern Award Processing-Development tool, and a number of specific reports generated weekly and monthly that allow VA Central Office and field managers to monitor progress toward goals as well as spot cycle time delays in time to take corrective actions.

How to Ensure VA Benefits for Undocumented Trauma, Injury or Illness 

Facts About the 1973 St. Louis Fire and Lost Records

The National Archives and Records Administration is the official depository for records of military personnel separated from the U. S. Army, Navy, Air Force, Marine Corps and Coast Guard. The records are housed in three locations: the National Archives Building in Washington, D.C., the Washington National Records Center in Suitland, Md., and the National Personnel Records Center (NPRC) in St. Louis, Mo.

· Naval officers separated after 1902, and naval enlisted personnel separated after 1885.

The Fire

A fire at the NPRC in St. Louis on July 12, 1973, destroyed about 80 percent of the records for Army personnel discharged between November 1, 1912, and January 1, 1960. About 75 percent of the records for Air Force personnel with surnames from "Hubbard" through "Z" discharged between September 25, 1947, and January 1, 1964, were also destroyed.

What Was Lost

It is hard to determine exactly what was lost in the fire, because:

Millions of records, especially medical records, had been withdrawn from all three groups and loaned to the Department of Veterans Affairs (VA) before the fire. The fact that one's records are not in NPRC files at a particular time does not mean the records were destroyed in the fire.

Reconstruction of Lost Records

If veterans learn that their records may have been lost in the fire, they may send photocopies of any documents they possess -- especially separation documents -- to the NPRC. The address is National Personnel Records Center, Military Personnel Records, 9700 Page Blvd., St. Louis, MO 63132-5100. The NPRC will add those documents to the computerized index and file them permanently.

Alternate Sources of Military Service Data

When veterans don’t have copies of their military records and their NPRC files may have been lost in the St. Louis fire, essential information about their military service may be available from a number of other sources.

By using alternate sources, NPRC often can reconstruct a veteran's beginning and ending dates of active service, the character of service, rank, time lost on active duty, and periods of hospitalization. NPRC can issue NA Form 13038, "Certification of Military Service," considered the equivalent of a Form DD-214, "Report of Separation From Active Duty," to use in establishing eligibility for veterans benefits.

Necessary Information for File Reconstruction

The key to reconstructing military data is to give the NPRC enough specific information so the staff can properly search the various sources. The following information is normally required:

· Full name used during military service · Place of entry into service

· Branch of service · Last unit of assignment

· Approximate dates of service · Place of discharge

· Service number or Social Security number

 Filing Your Claim

The sooner you file your claim the better, as your date of claim will be the date that the VA will determine that your payment will start. Do not wait to have all your evidence, or any evidence for that matter, just file. You have two options when filing a claim. 1) visit a Veteran Service Officer and have them submit the claim (you will have to sign a Power of Attorney for them to represent you. This can be changed if you are unhappy with your Rep) or 2) file your claim electronically thru the electronic Filing (VONAPP) this system is easy to use and will instantly file your claim with the Regional Office that services your area. In about 3 to four weeks you will receive a Claims Packet from the VA, with instruction and information on what they need from you. REMEMBER, the VA has a duty to assist you in getting what evidence you or your rep believe you need to establish your claim. Let the Regional Office know what that evidence is, and send them signed release forms if that evidence is from a source outside the VA.

Keeping Records

 Keeping good records is the single most important area of claims. Start by getting a very large file folder, as the amount of paperwork can be enormous. Be sure to keep copies of ALL correspondence to the VA Regional Office. Send ALL document via Certified mail with a return receipt requested. When the receipt is received by you, attach it to the copies of what was mailed. I personally use the form below for each claim I have filed. I use the back to keep a record of all phone or E mail contacts with the VA. I include the date, time, name of person I talked with or e mailed (keep a copy of ALL e mails, what was discussed and answers I received to my questions. 

Worksheet For VA Claim

The purpose of this worksheet is to help you keep track of important deadlines and to help guide you in working on your claim. WARNING: The description of the VA claims and appeals process contained in this guide is not intended to substitute for advice from a competent representative. Important laws, rules or procedures may have changed since this guide was published. Consult a representative for the latest information.

 

Your Name _________________________________
VA Claim #: _________________________________
SSN: _______________________________________
Address, Phone of VARO handling your case
(The nearest VARO can usually be reached by calling 1-800-827-1000):
___________________________________________
___________________________________________

Representative’s name: _________________________
organization: _________________________________
address: ____________________________________
___________________________________________
phone: ______________________________________
date signed Power of Attorney: ___________________

APPLICATION
date of first contact with VA: _____________________
name of VA employee: __________________________
date formal application filed: _______________________

VA INFORMATION REQUESTS
date of 1st VA request: ___________________________
date you mailed to VA: ___________________________
date scheduled for VA medical exam: ________________
name of examiner: _______________________________
Did the examiner have your C-file on hand? ____________
date scheduled for VARO hearing: ___________________
date of VARO denial: _____________________________

AFTER VARO DENIAL
deadline to file Notice of Disagreement (add one year to date of VA denial) =
date you filed NOD with VARO: ______________________
date VA mailed Statement of Case: _____________________
date VA mailed Supplemental SOC: _____________________
deadline to file appeal, VAF 9: (whichever comes later:)
60 days from date VA mailed SOC = OR _________________
one year from date of VA denial = ________________________

BVA PROCEEDINGS
date you mailed appeal, VAF 9, to VARO: __________________
date pre-hearing appointment with rep: ______________________
location of BVA hearing: _________________________________
date of hearing before BVA: ______________________________
date of BVA decision: BVA docket #: _________________________
BVA action: _____ denial _____ allowance ____ remand

AFTER BVA PROCEEDINGS

deadline to file Notice of Appeal with U.S. Court of Veterans Appeals
(120 days from date of the BVA decision) = ________________
date you mailed appeal: ________________
CVA docket #: __________________ 

Copyright © 1996, Vietnam Veterans of America. All Rights Reserved. ISBN 0-964-3980-5-2.

This guide may be excerpted or reproduced for counseling, self-help, and scholarly purposes, but not for profit, without further permission; we request only that proper credit be given. Any other use requires written authorization of VVA, ATTN: National Service Representative, 1224 M Street, NW, Washington DC 20005-5183. This guide is one of a series that is being published by VVA under a contract with Keith D. Snyder of the Veterans Education Project. 3/96

What Next ?

  Within 4 to 6 weeks of filing your claim, you will receive a packet from your VA Regional office, requesting additional information and evidence. will also ask if there is any evidence that the VA can assist in getting for you. DO NOT overlook the offer, it will save some time in the claims process. Be sure to furnish all of the information they require, especially when you are asked how your disability affects your day to day life. Be sure to list your limitations as to work, social activities, household chores, or your ability to care for yourself. Remember, you only have 60 days to respond to this request. You may not have all of the evidence needed, but you can submit additional information. Be sure to place your VA claim number on every document. If this is your first claim, the VA will have the number on the documents they send, along with a reference number. This number designates the team that will be working on your claim. When writing VA or making a request via E-Mail, be sure to include both the claim and reference number. I can not stress enough the importance of keeping copies of ALL correspondence, and sending EVERYTHING via certified mail with a request for a return receipt.The next step will be a compensation and pension exam. DO NOT miss this appointment, it is the major part of the adjudication process.

Index To Examination Worksheets

COMPLETE LISTING OF ALL EXAMINATION WORKSHEETS. THIS WILL LET YOU KNOW IN ADVANCE WHAT THE DOCTORS WILL BE LOOKING FOR.

Code Of Federal Regulations

        Title 38, United States Code, Chapter 1 is the section of Federal law which deals with Veterans pensions (compensation), bonuses, and Veterans' Relief. Being familiar with this code will help you greatly in perfecting your claim. A person who knows and understands his/her rights under this code will be far more successful than the person who doesn't

 Take time to look at the full code, however, your main focus should be in  Part 3   Adjudication and  Part 4   Schedule for rating disabilities.

For the full electronic version of title 38 just click on the link below.

 38 CFR Ch. I (-06 Edition)