Filing a VA disability claim can seem overwhelming, but understanding the process step-by-step makes it manageable. This comprehensive guide walks you through every phase of the VA claims process, from initial preparation to potential appeals.
Determine Eligibility and Condition
Disability compensation is a tax-free monetary benefit for Veterans who incurred or aggravated a physical or mental illness or injury during military service. To be eligible, you must have a current illness or injury affecting your mind or body, and have served on active duty, active duty for training, or inactive duty training.
Document Health Issues
It is crucial to document all conditions on your medical record prior to separation, including chronic conditions, allergies, or injuries (e.g., back, legs, ankles). If you identify medical issues that were not documented in your medical record, you should make an appointment with your primary care manager to get them documented.
Gather Records
You should collect all necessary evidence to support your claim. Necessary documents include:
- ◦Separation documents, such as the DD Form 214 (Certificate of Release or Discharge from Active Duty)
- ◦Military medical records, VA medical records, and hospital reports related to your disability
- ◦Private medical records and hospital reports. You may grant VA permission to obtain non-VA records using VA Form 21-4142
- ◦Direct Deposit Information (account number, financial institution name, and routing/transit number)
- ◦Supporting documents for dependents, such as birth certificates or marriage certificates, if applicable
Conduct a Self-Assessment
Use forms such as the VA Separation Health Assessment (SHA) Disability Benefits Questionnaire – Part A Service Member Identification and Self-Assessment and DD Form 2807-1 Report of Medical History to thoroughly review and assess your health issues.
Seek Assistance
The VA highly recommends completing disability claims with the assistance of an advocate, such as a Veterans Service Organization (VSO), agent, or accredited attorney. These accredited professionals can help file claims for free. To appoint a VSO, you would use VA Form 21-22 (Appointment of Veterans Service Organization as Claimant's Representative).
How to File
You can file a disability claim online at VA.gov, by phone, by mail, or in person. The preferred method for applying for benefits is often online. The primary application form is VA Form 21-526EZ (Application for Disability Compensation and Related Compensation Benefits).
Timing Matters
The date you apply impacts the effective date of your benefits. Claims filed within one year of separation are effective retroactive to the day after separation or retirement.
Benefits Delivery at Discharge (BDD) Program
The BDD program is the preferred claim type for separating Service members, allowing them to file for disability compensation before separation.
- ◦Timeline: Claims must be filed between 180 and 90 days prior to separation (the closer to 180 days, the better)
- ◦Goal: The BDD timeframe allows VA time to review Service Treatment Records (STRs), schedule necessary exams, evaluate the claim before separation, and ideally deliver a decision within 30 days after separation
- ◦Requirements: Know your separation date, provide completed SHA Part A Self-Assessment, provide copy of STRs for current period of service, be available for 45 days from submission date to attend VA exams
Fully Developed Claims (FDC)
FDC is an option to expedite processing compared to a Standard Claim.
- ◦Timeline: FDCs can be submitted starting 89 days before separation and at any time after separation
- ◦Requirements: Include all the evidence you have or can easily get, confirm that there are no more records that VA needs to make a claim decision, go to a VA medical (or C&P) exam, if required
- ◦Note: If VA has additional questions during processing, the FDC is converted into a Standard Claim
Standard Claims
Timeline: Standard claims can be filed at any time after separation. Supporting evidence is not required to be submitted upfront, but this leads to significantly increased processing time compared to BDD or FDC.
Claim Acknowledgment and Review
After submission, you will receive a confirmation number to track the status. Status updates progress through 'Claim Received' and 'Initial Review'. VA will examine your claim to determine if additional evidence is needed. A VA representative should contact you within 90 days of claim submission.
Evidence Gathering
The process enters the 'Evidence Gathering, Review, and Decision' phase where VA gathers and reviews required evidence from the claimant, healthcare providers, or government agencies. You must respond quickly and completely to VA requests for information.
Physical Exam (SHA/C&P)
You may be required to attend a Separation Health Assessment (SHA) or a Compensation and Pension (C&P) exam.
- ◦The C&P Exam is scheduled by the VA to assist in determining if you have a service-connected disability and to rate that disability
- ◦If you filed a BDD claim, a VA representative will contact you to schedule the SHA, which documents your health status and supports the claim evaluation
- ◦It is crucial not to miss these exams, as failure to report means the regional office will lack necessary information to complete the claim
Rating and Decision
Once all necessary evidence is received, VA rates the claim. VA rates the service-connected disability from 0% to 100% in 10% increments based on the severity of the disability and the average impairment of earning capacity. If you have more than one service-connected disability, VA uses a formula ('VA math') to determine the combined rating.
Notification and Payment
VA prepares and sends a notification letter detailing the rating decision. If the application is approved, you receive a Certificate of Eligibility (COE) or award letter.
- ◦If the claim was filed within one year of separation, benefits are retroactive to the day after separation
- ◦The first disability pay installment will typically come on the first of the month two months following the disability rating date
Notice of Disagreement (NOD)
If you disagree with any part of VA's claim decision (e.g., a denial of service connection, low percentage rating, or effective date), you may appeal. The appeal process is initiated by filing a Notice of Disagreement. This written statement must be filed within one year of the date of VA's decision letter.
Statement of the Case (SOC)
VA responds to the NOD by issuing a Statement of the Case, which summarizes the evidence, actions, decisions, and governing laws.
Formal Appeal
If you still disagree, you file a Formal Appeal (VA Form 9) after receiving the SOC.
Review and Board Appeal
You may request a review by a Decision Review Officer at the regional office. If you still disagree, you can appeal to the Board of Veterans' Appeals (BVA) in Washington, D.C., which is the highest appellate body within VA.
Court Appeal
Decisions made by the BVA can be appealed further to the United States Court of Appeals for Veterans' Claims (CAVC), which reviews matters of law.
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