Filing a VA disability claim can be an overwhelming and tedious process. The process can take anywhere from a few months to a few years, depending on the circumstances of the claim. Once you determine you are disabled, you should apply for benefits as soon as possible.
You have several options to file a VA disability claim. A disability advocate can help you file a claim or walk you through the decision review process.
A VA Disability Advocate Can Help With the Burden of Proof VA Puts on You
Many disabled veterans are surprised when they first apply for VA benefits, and VA throws up its hands and says it’s all up to you. Yet, despite the many forms and records the military maintains about service members, VA requires the disabled vet seeking compensation to submit service and medical records in a claim or tell VA where to find them.
VA denies many initial veterans’ disability claims because they do not contain enough information. It is not unusual for a vet to cite disability due to a “leg condition” or “back pain,” but not understand that VA requires a specific diagnosis backed by medical records, and service records that explain when and how the injury occurred. Most vets simply do not have the necessary information.
A disability advocate understands what VA requires of a veterans’ disability claim and how to efficiently obtain evidence to prove eligibility for benefits. A disability advocate will fight for the VA benefits you are entitled to receive with as little burden on you as possible. They aim to get all the disability benefits you have earned into your hands as quickly as possible.
VA Claims Advocate: Applying for Veterans’ Disability Benefits
Like so much else, the application process for veterans’ disability benefits has moved online. VA says using the online process is “the best way to apply,” though the claim form — VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits — is also available for printing and mailing in.
VA Form 21-526EZ (the EZ or “easy” version) is 10 pages long, six of which are instructions that refer the applicant to additional forms, which may be necessary to fully substantiate a benefits claim.
According to VA disability laws, to apply for benefits, a veteran must have access to:
- Discharge or separation papers (DD214 or equivalent)
- Medical evidence (doctor and hospital reports)
- Dependency records (marriage and children’s birth certificates)
When applying, the vet may submit a Fully Developed Claim (FDC) or file through the Standard Claim Process.
An FDC is faster, according to VA, and may be pursued if the vet has or can obtain or identify all relevant evidence necessary to substantiate the claim. This includes the records above, and:
- All, if any, relevant, private medical treatment records.
- An identification of any relevant treatment records available at a federal facility, such as a VA medical center. VA will retrieve relevant records the veteran adequately identifies and authorizes VA to obtain.
- Any forms required for special circumstances benefits, e.g., Post-Traumatic Stress Disorder (PTSD), Individual Unemployability (IU), Aid and Aid Attendance benefits, etc.
As VA advises, if you file a claim in the FDC program and it is determined that other records exist that VA needs to decide your claim, VA will remove the claim from the FDC Program and process it in the Standard Claim Process.
In the Standard Claim Process, a veteran relies on VA to obtain evidence of their disability. This may include government records, such as from the service or VA medical facilities, private medical providers, or others. The vet must give VA enough information about the evidence so VA can request it from the person or agency that has it.
If the holder of the evidence declines to give it to VA, asks for a fee to provide it, or otherwise cannot get the evidence, VA will notify the vet and give him or her the opportunity to obtain and submit that information. In both the FDC and Standard Claim Process it is the veteran’s responsibility to make sure the VA receives all necessary records — federal, state, and private — to process and substantiate a claim.
What Is the Timeline to File a Decision Review?
A veteran has up to a year after the VA receives an initial claim to provide additional information to support the claim. If additional information is provided for a claim in the FDC process, it becomes a standard claim.
The VA must assess and evaluate all evidence in a claim, so anytime additional information is added to a claim file, the evaluation process is lengthened, and a decision delayed.
The VA may also require the vet to undergo a medical examination by a VA doctor or seek a medical opinion based on the evidence in the claim, if necessary to decide the claim. The vet may have their medical provider or a VA doctor complete a VA Disability Benefits Questionnaire (DBQ) for their specific conditions. DBQs provide medical information directly relevant to determining disability ratings and ensure that VA’s ratings specialists have precise information.
Proving Eligibility in an Initial Veterans’ Disability Claim
It is not enough for a veteran to provide VA with service and medical records and claim a disability in an initial benefits application. An original veterans’ disability claim must make the case that the veteran’s medical condition is due to military service and is disabling to a degree that qualifies for benefits.
As it examines benefit claims, VA assesses and rates the extent of the veteran’s disability or disabilities in 10% increments from 0% to 100%. If the vet claims more than one disability, VA develops a combined disability rating between 0% and 100% according to a VA formula calculated and set down in a table.
To qualify for veterans’ disability benefits, a former service member’s claim must show that he or she was not dishonorably discharged, and has at least one physical injury, or illness or mental disorder that:
- Is rated by the VA system as 10% disabling or more if a physical disability.
- Makes the veteran unable to work for a living if a mental disorder.
The veteran must also prove that their disability is service connected. VA recognizes five categories of service connection for disabling injuries or illnesses. For many specific disabilities — including for PTSD or Certain Disabilities Associated With Gulf War (GW) Service — there are additional, separate requirements for determining service connection.
Establishing service connection for a disability may require not just DD214 discharge order, but additional information from the service member’s 201 files or OMPF (Official Military Personnel File), which would document specific deployments during which injuries or exposure-based illness occurred.
VA presumes that certain military veterans are eligible for disability benefits, including:
- Former prisoners of war (FPOWs)
- Veterans who have certain chronic or tropical diseases that manifest within a specific time after discharge from service
- Veterans exposed to ionizing radiation, mustard gas, or Lewisite in the service
- Veterans exposed to certain herbicides, such as Agent Orange in Vietnam
- Veterans of service in Southwest Asia during the Gulf War
However, all disabled veterans must detail the extent of their disability in their claim so VA can determine a disability rating and the benefit amount.
VA has developed step-by-step assessment guidelines for each imaginable physical or mental medical condition, as well as some specific to military service (e.g., Agent Orange exposure), which claims examiners are required to follow. From these resources and the Combined Ratings Table, the VA examiner decides the vet’s disability rating and benefit payment.
What Happens if VA Denies My Disability Claim?
If VA denies your disability claim, you can have the decision reviewed. When filing for a decision review, you have three options. An advocate can help you decide which option is best for you based on the circumstances of your case. The three options include a supplemental claim, higher-level review, or a Board Appeal.
Supplemental Claims
Supplemental claims are for veterans who have additional evidence to provide. A reviewer will look at the new evidence and determine if it changes the prior decision. You will only choose this option if you have new and relevant evidence to include. New and relevant evidence includes anything that could prove or disprove something in your original claim.
The timeline for a supplemental claim takes around 4-5 months to complete. If you are unhappy with the decision made on your supplemental claim, you can file a higher-level review or a Board Appeal.
Higher-Level Review
A higher-level review is for veterans who disagree with the original decision but do not have additional evidence to submit. A senior-level reviewer will review your claim and determine if the decision should be changed due to an error or difference of opinion with the original examiner.
During a higher-level review, you will speak with the senior-level reviewer on the phone and explain why you believe the decision should be changed. The higher-level review process takes 4-5 months to complete. If you disagree with the higher-level review decision, you can request a supplemental claim or a Board Appeal.
Board Appeal
During a board appeal, you will bring your claim to a Veterans Law Judge at the Board of Veterans’ Appeals. A Veterans Law Judge is an expert in veterans’ law. With a Board Appeal, you have three options:
- Request a direct review: This option does not allow you to submit more evidence. Instead, a Veterans Law Judge will decide based on the evidence presented in the prior claim.
- Submit more evidence: Within 90 days of submitting your Board Appeal request, you must submit additional evidence. The Veterans Law Judge will review the new evidence and determine if they will reverse the previous decision.
- Request a hearing: You can request a hearing with the Veterans Law Judge. They could conduct a virtual hearing from your home, a videoconferencing hearing at a VA location near you, or an in-person hearing in Washington, D.C.
If you disagree with a Board of Veterans’ Appeals decision, you can file a supplemental claim if you have new evidence to submit. However, you could also appeal to the U.S. Court of Appeals for Veterans Claims. The Board Appeals timeline can last over one year.
How a VA Disability Claims Advocate Can Help You
The complexity of the veteran’s disability benefits claims process is necessary to meet all potential needs of disabled veterans and ensure those who obtain benefits truly deserve them. However, even the expedited FDC process can prove daunting to many disabled veterans as well as loved ones trying to assist them.
A disability claims advocate could help you obtain the benefits you deserve faster and with less of a burden on you or your family members. An experienced disabled veterans’ benefits advocate knows the VA disability claims process and the rules and regulations that guide it.
A disability advocate can do the following for their clients:
- Represent you in a decision review process: If you disagree with a denied disability claim, they can help you gather more compelling evidence. Your advocate can also help you determine which decision review process option will be best for your circumstances.
- Seek a higher disability rating: Your disability rating makes an enormous difference in the amount of money you receive each month. If you disagree with your current disability rating, your advocate can help you raise it.
Regardless of your circumstances, an advocate can assist you with what you need.
Call a VA Claims Advocate for Help Now
A disability advocate can make sure your original veterans’ disability benefits claim is accurate and complete when filed. They can obtain records on your behalf and identify records you may not have complete information to find.
An advocate’s primary objective is to ensure your VA benefits claim processes without unnecessary delay. You should receive all the money you were promised for your sacrifices and you should get it fast. Don’t fight the VA on your own. Call for a free case review today!
