September 26, 2013
You or your VSO has submitted your claim. After it is received at your local VA Regional Office, a claim is “established” in the VA computer system. The paperwork you sent in (either through mail or electronically) is scanned to see which types of benefits you are seeking, and “end products” are established. The DEERS database is checked to verify your dates of military service. An end product is VA-speak for type of claim, and allows your individual claims to be tracked. One end product may contain multiple parts: a claim for disability compensation may include claims for three different disabilities.
General Stages of the Process for Disability Compensation Claims:
Following are the general stages of the process for disability compensation claims. Other types of claims such as education and loan guaranty have different steps and are usually simpler and easier to process. The VA made many automated improvements to the education process and as a result, was able to shift employees from processing education claims to disability claims to reduce the backlog.
Once your claim is established, it will be sent to “triage” where it will be reviewed and assigned to a “lane” for completion. The VA sends claims with one or two issues to the “express lane”. There are also different lanes for specialized issues and standard claims.
When your claim is assigned to a “lane”, a VA employee called a “VSR” or veteran service representative will “develop” your claim. This means they will make sure you have all the evidence necessary to make a fair decision on your claim. The VSR will look at the evidence you have submitted, and request federal records such as military medical records, social security administration disability records, and VA medical records. The VA will also request private medical records if you have supplied the addresses and dates you saw each physician.
There are some standard form letters that the VA sends out. One is called a “VCAA notice letter”. This letter explains the types of evidence that may be needed to support your claim. Sometimes, this notice is sent out before the VA actually reviews what you have sent in, so don’t be alarmed. Other times, this notice is sent after the VA reviews what you’ve sent in, and is therefore more helpful. Either way, pay attention to the types of evidence the VA says it needs. If you haven’t sent in something that might be helpful to your claim, alert your representative. If you do not have a representative, look at free resources for more information on www.va.gov and think about visiting the public contact office at the VA Regional Office. You can also call 800-827-1000 for assistance: Press “1” and then “0” to wait to speak to a VA employee. If you are on eBenefits, you may get notices electronically as well as by mail.
The VA will also periodically send letters that let you know they are still working on your claim and apologizing for delay. This is a good sign that your claim is in the queue and being worked, but doesn’t give you a status one way or the other.
Once all the records you need are in, the VA may schedule you for an examination. These are called “C&P” exams because they are intended to help the VA decide on Compensation and Pension benefits. The exams are meant to answer such questions as when you were disabled, whether your disability is related to military service, and your level of disability. They are not meant for treatment purposes. Make sure you go to any exams that the VA orders. They may order exams that you don’t feel are necessary, but some disabilities cause other problems you may not be aware of: for example, diabetes may cause complications with loss of feeling of the limbs. You should answer all questions in an exam and make sure not to minimize or overemphasize symptoms. If you have a condition that gets better and worse, such as depression, you may find it helpful to keep a journal of your symptoms. It is easy to feel overly optimistic on a good day or feel like the world is coming to an end on a bad day. It’s helpful to have a log of how you’ve felt over the past month or even year. The VA can also look at your medical records to see how you’ve been doing over a period of time. Sometimes, the doctor will have to make an opinion about whether your disability is related to service. Other times, this decision will already have been made by law or in a previous claim.
If you are filing a claim for increased rating, and all that is needed is your current disability level, your doctor can fill out what is called a “DBQ” or disability benefits questionnaire. This form mirrors the VA’s exam and answers the questions the doctor would ask. Find DBQs for your medical condition. If you are able to have your doctor fill out the appropriate DBQs, you may not need to wait for a separate C&P exam. However, you will want to make sure your doctor covers all the relevant DBQs. Sometimes, the VA can even make a decision based on your VA medical records, if there is “acceptable clinical evidence”.
After your exams are completed, your claim will be decided by a VA employee called an “RVSR” or “rater” which stands for rating veterans service representative. Remember, at each stage of the process you are waiting behind others so even though you’ve gotten an exam, you may need to wait a few more months for a decision.
Decision and Award or more Development
Once a rater gets your claims package, he or she will decide if there is enough evidence to “rate the claims”. If the VSR and C&P doctors have done a good job, the rater will either grant or deny the claims. Sometimes, if there is enough evidence to decide one claim but not another, the rater can make what is called a “deferred rating decision” on the claim that needs more evidence, and grant or deny the other claims. Often this is done when one claim may be granted and the veteran may begin receiving some compensation.
There may be different reasons that more evidence is needed: the doctor may not have given the opinion in the language the VA needed, or medical records or military records that were unable to be obtained suddenly come in. Or something new may have happened that needs to be considered, such as if a veteran undergoes an operation or begins to receive social security disability or workers' compensation.
If all the issues are ready for decision, then the rater will prepare a decision which grants, denies, or “confirms and continues” a previous decision. In practice, a “confirmed and continued” rating still may be appealed, if the rater did not consider all the evidence or something changed while the claim was in the decision-making process. When the rater has input the reasons for their decision, the claim goes to the “post-decision team”. The post-decision team writes up a letter showing the outcome, reasons for decision, and evidence considered. If a claim was granted, and it results in an increase in benefits or new award of benefits, the “authorization” team alerts the Department of the Treasury to begin paying the veteran or claimant. The authorization team calculates any retroactive payments due: usually, benefits may be paid back to the date of claim, as long as the veteran or claimant qualified at the time the claim was filed. The authorization team also should add dependents to the award, and show when dependents will be removed from the award (normally upon reaching age 18, although other circumstances may apply).
Checking the Status
You can check the status of your claims by signing up for an eBenefits account. Once you receive “level 2” access, you’ll be able to securely log on and see what stage of the process your claim is in. After your claim is established, the phases it goes through are evidence development, rating, post-decision review, and authorization. Your claim may go back to the gathering evidence phase at any point if the VA discovers more information is needed. The VA’s website shows the stages of the claim you’ll see on eBenefits and provides a link to the VA's ASPIRE website to see the average days to process claims at your regional office. Note: you will need to click on the type of benefits (compensation, education), etc. for which you want to see the statistics, and then click on the “plus sign” to expand the information table.
You can also check the status on your claims by calling the VA at 1-800-827-1000, or calling your VSO representative. Often, VSO representatives have access to the same computer system that the VA call center does. However, VSO representatives cannot change or edit information, while the VA call center can. If you need to update your contact information, please call both the VA and your VSO representative so both will be able to contact you with updates. Your VSO representative should be aware of how long different stages of the process take. Generally, you should check on your claims about every 30 days so you do not miss a deadline, but in some stages you may be waiting a few months for the VA to gather evidence. This is where it is helpful to check eBenefits or talk with your VSO representative. You may be able to see that the VA is working on getting federal records, for example. Some stages of the appeals process may take many months.
Is that the VA Calling?
A representative from the VA may call you for any number of reasons regarding your claim. Be aware that you may need to provide the last four digits ONLY of your social security number to verify your identity. The VA will not ask for your full social security number or any credit card numbers over the phone. If you contact the VA regarding an issue, you may need to provide your VA claim number for quicker service.
Make sure you understand what the caller is asking and confirm before you hang up. If you are being scheduled for an examination, you may be called by a company called “QTC” that contracts with the VA to provide exams. Always double check which hospital or clinic you have to go to for the exam. It may not be the usual place you receive care. If the VA is requesting more evidence, be sure to be clear on what they are asking, and if you have a representative, be sure to contact him or her for advice.
Be sure you know where to send the evidence: sometimes your Regional Office may send out your claim to another regional office that has special expertise. For example, the VA has four regional processing centers for education benefits, located in the VA Regional Offices in: Buffalo, St. Louis, Muskogee, and Atlanta. Claims for survivor benefits are handled by three regional pension maintenance centers, located in: Philadelphia, Milwaukee, and St. Paul. Also, claims may be sent to another Regional Office to distribute the workload and allow the VA to process more claims. So ask the caller where you should send information. This may not be to a specific person, but rather a number for a department. Each VA office has a large mailroom and the VA often has internal codes that they post on your letters that say “reference number”, which you will want to include as well as your claim number.
We recommend sending any correspondence by certified mail, return receipt requested, so you have proof of delivery. The VA is updating its electronic portal eBenefits (and Stakeholder Enterprise Portal, which VSO representatives use) so that you can receive an electronic receipt. When this is fully functional, we also recommend this method of sending information.
Expediting a Claim
The best way to expedite a claim is to give the VA all the evidence you can up front to support your claim, using the assistance of a VSO but understanding the system yourself. Still, the VA may be able to expedite your claim for certain reasons. Let the VA and your VSO representative know as soon as possible if you become terminally ill or are in danger of homelessness. Also, respond to all requests for information from the VA or your VSO as soon as possible. Make sure to update your contact information if it changes, so you do not miss an appointment or letter from the VA or your VSO.
Congressional Representatives have employees that inquire about VA claims for their constituents as well as work on legislation and other matters. The VA must stop what they were doing on your claim to answer a Congressional inquiry. Therefore, you should first try to determine your claim status and whether you need to submit any information to the VA before requesting help from your Congressional Representative. If you have submitted everything on your end, contact your VSO for assistance: they may be able to talk to or write someone at the VA to make sure you are not waiting longer than you should be. At each stage of the process you will have to wait behind others whose claims have already arrived at that stage. Congressional representatives can help get claims “unstuck” and back in the process, which may be necessary, but often you can resolve the issues on your own or with the help of a VSO, freeing up your Congressional representative for making large scale changes on behalf of veterans. We encourage you to contact your congressional representative and senators when there is a veterans' issue you feel needs attention in your state or nationally. Sign up for MOAA’s Legislative Update, and check out the House and Senate Veterans Affairs Committees, and the House and Senate Armed Services Committees, for the latest legislative news.