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VA Claims Appeals Process

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VA Disability Claim Appeals Process — A ‘Multi-Step Adjudication Process’

Our experienced VA benefits attorney can be your guide in the complex appeals process

Any veteran, survivor of a veteran or others involved in a claim for VA disability benefits has the right to appeal a VA benefits claim decision they are not satisfied with. However, the Department of Veteran Affairs states in multiple publications that the VA’s appeal process is “complex,” “non-linear” and “unique” among other federal and judicial processes.

Experienced legal help is strongly recommended for anyone appealing a VA benefits decision. The veterans disability claims lawyers of George Sink, P.A. Injury Lawyers have the knowledge and experience necessary to help you through a VA disability benefits appeal. We know the VA and we know what its bureaucracy requires.

The knowledgeable work of George Sink, P.A. Injury Lawyers can help move your appeal through the VA bureaucracy faster. We can ensure your claim file is complete and accurate on appeal, and that it contains evidence the VA requires to make a favorable decision for you.

Finding Your Way Through the VA Claim Appeals Process

In addition to the many steps required to appeal a VA disability benefits claim, the veteran awaiting needed benefits must be concerned with the lengthy time an appeal takes. Due to the hundreds of thousands of active claims at any point in time, each step in an appeal could take several months. This makes it crucial to have no mistakes, omissions or unclear material in an appeal, which could add to the delay as the VA asks for clarification or additional information.

The two most common reasons people appeal VA benefit decisions are:

  • The VA denied benefits for a disability the vet believes is service-connected.
  • The vet believes their disability rating should be higher than the VA rated it.

To be successful, an appeal must present evidence not already in the claim file that would cause the VA examiner to rule in the vet’s favor. Most evidence in VA disability claims comes from military records and medical records. At appeals hearings, the veteran and others may testify about the veteran’s disabilities.

The VA appeals process includes these steps:

1. An appeal begins with a vet disagreeing with the VA’s decision regarding benefits sought in a claim. The veteran files a Notice of Disagreement (NOD). The NOD must be filed within one year of the date on the claim decision letter. Normally the NOD is filed with the vet’s local VA office.

The NOD is a form that asks for explanations of each issue the vet disagrees with. It also requires the vet to indicate which appeals process he or she would like to pursue:

  • Decision Review Officer (DRO) Review, which means “a senior technical expert” who has not seen the initial claim reviews it and renders a decision.
  • Traditional Appellate Review, in which a VA staff member examines the file and any new evidence the vet submits. In most cases, the vet will want to submit new or additional evidence, or identify evidence for the VA to obtain, to strengthen their claim.

After either DRO or Traditional review, the VA’s original decision could be changed.

2. After the VA receives a Notice of Disagreement, it reviews the claim and issues a Statement of the Case (SOC), which explains the decisions the VA made previously. If there is additional evidence accompanying the NOD, the VA may issue a Supplemental Statement of the Case based on the newly reviewed evidence.

3. Once the vet receives the SOC (and/or the Supplemental Statement), he or she may then file a Substantive Appeal. This form requires an explanation of the issue(s) being appealed and why the vet thinks the VA was wrong. This is where new evidence comes in, which the vet may provide or ask the VA to obtain. However, the VA will not look for evidence cited unless the vet provides the document’s valid Office of Management and Budget (OMB) Control Number.

At this point, the vet also has to decide whether to request a hearing before a Veterans Law Judge or simply to have the Board of Veterans’ Appeals review the claim file plus information in the Substantive Appeal.

Asking for a hearing adds significant delay to the process, as well the need for the vet and anyone assisting him or her to travel to the hearing or a VA video conference facility at their own expense. (A video conference hearing is typically scheduled faster than a live, in-person hearing.)

It is useful to note the first instruction on the Substantive Appeal form:

  • CONSIDER GETTING ASSISTANCE: We have tried to give you the general information most people need to complete this form in these instructions, but the law about veterans’ benefits can be complicated. If you have a representative, we encourage you to work with your representative in completing this form. If you do not have a representative, we urge you to consider getting one. Most people who appeal to the Board of Veterans’ Appeals (Board) do get a representative. …

Another option is to request a hearing before VA regional office personnel, instead of before a Veterans Law Judge. Such a request is made by writing directly to the regional office and does not require the Substantive Appeal form. However, requesting a hearing before VA regional office personnel does not extend the one-year deadline for filing the Substantive Appeal request, should the vet not be satisfied with the informal review and then want to pursue an appeal.

Hearings are informal, though all testimony is under oath. The Judge may ask questions, but will not conduct a cross examination. The Veterans Law Judge will not rule at the end of the hearing. Instead, he or she will take the time to review a transcript of the hearing and all evidence in the claim file.

4. Once the local VA office receives a Substantive Appeal, it is forwarded to the Board of Veterans Appeals. If no hearing was requested, the Board will make a decision and mail the results to the vet.

In a Board review or a hearing, there are three possible decisions for each issue of an appeal:

  • Grant: The Board or Judge agrees with the vet and grants the request(s) made in the appeal. The local VA office will acknowledge the decision in a letter to the vet.
  • Remand: The Board or the Judge sends the case back to the local VA office. This usually occurs to have the local VA office gather additional evidence on behalf of the vet or to clear up a technical problem with the Substantive Appeal. A remand causes a potentially lengthy delay, which can be avoided by ensuring the Substantive Appeal is clear and complete before it is submitted.
  • Deny: The Board or Judge may still disagree with the veteran’s claim and deny the appeal.

5. If a Substantive Appeal is denied, the veteran has three additional options to appeal further:

  • File a new claim with the local VA office. A new claim may address the same issues but is based on entirely new evidence.
  • File a motion for reconsideration by the Board of Veterans Appeals. There is no time limit on filing this motion.
  • File a Notice of Appeal with the United States Court of Appeals for Veterans Claims. This must be done within 120 days from the date of the decision by the Board of Veterans’ Appeals (stamped on the first page of the decision). This takes the case into a formal court setting, with the application of rules of evidence, testimony under oath, and cross-examination of witnesses before the presiding judge.

Once the case is in the courts system, the veteran could conceivably continue to appeal adverse decisions to the Federal Circuit Court and, finally, to the U.S. Supreme Court. A ruling by either court would set precedent applied to future claims with like or similar issues.

It is important to note that at any point during the appeals process the veteran may submit additional evidence to strengthen his or her claim. However, this requires the VA to examine and rule on that evidence, which delays the process. Alternatively, the vet may ask the VA to obtain evidence the vet identifies, which also creates a substantial delay.

Any disabled veteran should consider appealing if they are unhappy with a decision handed down by the VA. However, they must keep in mind that an appeal is a lengthy process that requires clear and convincing evidence to succeed.

The veterans’ disability claims lawyers of George Sink, P.A. Injury Lawyers, can work to ensure your benefits claim appeal meets the Board of Veterans’ Appeals standards for completeness, accuracy and compelling evidence. This eliminates unnecessary delays and greatly increases the likelihood of a ruling in your favor.

Start Your VA Disability Benefits Claim Appeal Today

The backlog of disabled veterans’ claims and appeals pending with the VA makes it important that any work on your claim is not unduly delayed. Contact George Sink, P.A. Injury Lawyers today to start the work on your appeal of a faulty VA benefits decision.

Our experienced veterans’ claims attorneys, many of whom are vets themselves, can make sure your appeal makes a clear and persuasive case from the start. Our objective is to obtain all of the money you have coming to you through VA disability benefits, and to do it as fast as possible.

Remember, an appeal must be filed within a year of receiving an adverse decision from the VA. We can make sure you do not miss this deadline and get money into your hands ASAP.

Don’t go it alone. Don’t waste time. Call George Sink, P.A. Injury Lawyers today.