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Archive for the ‘Veterans Benefits Claims’ Category

Veterans Benefit Group Participated in Legal Clinic for Veterans

May 2nd, 2012

On April 14, 2012, four attorneys and a paralegal from Goodman, Allen and Filetti’s Veterans Benefit Group participated in a free legal clinic for veterans and their dependents in Virginia Beach, Virginia. The clinic, which was sponsored by the American Bar Association and the Old Dominion University Student Veteran Association, was attended by 85 veterans, who were able to meet with an attorney to discuss their case and get free legal advice on how to proceed. Another free clinic is scheduled to take place in late Summer, and the attorneys and paralegals from Goodman, Allen and Filetti will be there once again.

Daniel G Krasnegor FAQs, Veterans Benefits Claims , , , , , ,

COURT REVIEW (APPEAL) OF VA CLAIMS

April 23rd, 2012

Veteran claimants are often mystified by the nature of court review of the VA’s actions on their claims, and with good reason. The nature of that review is not what one might expect from the general understanding of what courts do.

First, what sort of agency action can be reviewed by the courts? There must be a final agency decision, i.e., a decision of the Board of Veterans’ Appeals finally resolving a particular issue. Note, importantly, that a BVA decision that denies some claims and remands others must still be appealed (within 120 days of the Board decision) as to the finally denied claims or the claimant loses the opportunity to do so. Note also that if the Board addresses and grants a claim, say for sinusitis, but there is evidence of a related condition such as rhinitis and the Board does not discuss it, it may be determined that VA “implicitly denied” the latter by granting the former, even though it didn’t mention it. The law on whether the Board can implicitly deny a claim is not entirely clear as yet, so if you have any doubt, consult a lawyer.

If you have a final Board decision, you appeal by filing a notice of appeal with the Court of Appeals for Veterans Claims. What will the court consider and resolve? One thing it will almost never resolve is whether you ultimately get benefits. This seems contrary to what we think of courts doing, based on what we read in the media or see on TV, but it has to do with the nature of these courts. Unlike the trial courts familiar from the media, the Veterans Court and the court above it, the Court of Appeals for the Federal Circuit, are appellate courts that do not make ultimate resolution of cases. Instead, their responsibility is to police the process, to make sure the law was followed correctly.

Claim adjudication involves application of rules of law to the facts of a claim. The law includes the procedures for claim development and the requirements to establish entitlement to benefits. The facts will determine whether the claim succeeds under the law. So there are two components – law and fact – to every claim. Courts thoroughly review the agency’s handling of the law but examine its consideration of the facts only in a very limited fashion. This is based on a congressional determination that the agency has special expertise in understanding the facts of veteran claims.

When a court finds error in a claim, it is because the VA has done something it ought not to have done, or failed to something it was required to do, under the law. That is why the court sends the case back (remands) to the agency to be redone, so the legal error can be corrected. Notice that this review has little to do with the facts and whether you ultimately win your claim. The Veterans Court will intervene in a fact determination by the agency only if it is “clearly erroneous,” so plainly wrong that there can be virtually no disagreement about it. Because evidence is rarely indisputably supportive of only one side of a claim, it is very difficult to show that a factual finding is clearly erroneous. On appeal of a Veterans Court decision, the Federal Circuit is not permitted to review factual findings at all, and may not even review “application of law to fact,” which makes its scope of review very narrow indeed.

This is why court review of agency decisions almost never resolves the ultimate question of entitlement to benefits. Once the courts correct the legal procedure, the VA must then make the ultimate application to the facts to determine the question of benefits. Unfortunately, it sometimes takes several challenges through the courts to get VA to handle the claim properly under the law.

David E Boelzner FAQs, Veterans Benefits Claims , , , ,

C&P Exam: What is it and do I have to go?

March 14th, 2012

What is a C&P Examination?

Three things must be shown for a veteran to be eligible for disability compensation benefits from VA.

1) The veteran must have a current disability.
2) The veteran must have been injured or developed a disease in service, or have had a pre-existing condition which was made worse by service.
3) There must be a nexus between the in-service event or injury and the current disability. This usually means that a veteran needs to provide medical evidence that his or her current disability was caused or made worse by something that occurred during military service.

If a veteran is seeking service connection for a disability, the Compensation and Pension Exam (C&P Exam) is used by VA to establish the above requirements. The exam can be used to determine whether the veteran has a current condition and whether that condition is related to his or her service.

If a veteran is seeking an increased rating for a disability because it has gotten worse, a C&P exam can be used to determine the severity of a current condition.

Along the same lines, if VA believes that a veteran’s condition has improved or if the condition is one that requires reevaluation, VA can order an examination to determine the current severity of the condition.

If you are applying for disability compensation for multiple disabilities, each disability will be separately evaluated. Some facilities will complete all of the examinations at once; others will require you to report for multiple exams. It is important that you report to all of your scheduled exams.

What happens if I don’t go?

It is vital that you attend any scheduled C&P examinations. Failure to attend an exam can result in denial or termination of benefits.

• Newly filed claim for compensation

When a veteran fails to report for an examination, without good cause, the claim will be rated based on the evidence already contained in the file.

• Reopened claim or Claim for Increase

When a veteran fails to report for an examination, without good cause, the claim will be denied.
• Reexamination

When a veteran fails to report for a reexamination, VA will issue a pre-termination notice advising the veteran that payment will be terminated or reduced. The veteran will be provided with 60 days to indicate his or her willingness to report for the reexamination.

Good cause may include the illness or hospitalization of a veteran or the death of an immediate family member.

What if the date doesn’t work for me?

If you have a conflict with the scheduled date and time of your VA examination, contact the individual listed on your exam notification letter. C&P exams can be rescheduled on a one-time basis when the veteran requests that the examination be postponed for a valid reason. You should reschedule your examination as soon as you realize you have a conflict. Remember, if you do not reschedule your exam and you fail to attend, your benefits may be denied or terminated.

kwaldron FAQs, Veterans Benefits Claims , , , ,

Appeal to the United States Court of Appeals for the Federal Circuit – Is it worth it?

March 6th, 2012

On December 19, 2011, the United States Court of Appeals for the Federal Circuit (Federal Circuit) issued a decision in Murton v. Shinseki , 2011 U.S. App. LEXIS 25123, 2011-7058 (Dec. 19. 2011) (nonprecedential) vacating that part of the United States Court of Appeals for Veterans Claims (Veterans Court) decision that addressed the merits of the veteran’s psychiatric disability claim.

The Federal Circuit issued a decision finding, in particular, that “[b]ecause the Veterans Court did not have jurisdiction over [Mr.] Murton’s psychiatric claim, it should not have addressed that claim, and that portion of its opinion cannot be sustained.”

David Lowenstein argued the case before the Federal Circuit on behalf of the veteran, Mr. Murton. Although the decision is nonprecedential, in other words, it lacks binding authority over other cases, the Federal Circuit’s decision has essentially upheld the rule of law that stands for the proposition that the Veteran’s Court lacks jurisdiction to review a claim on the merits when VA has not yet decided it in the first instance.

The purpose of the appeal to the Federal Circuit, or any appeal of an unfavorable decision, is to make what is wrong correct. Having a right to appeal a decision does not necessarily make it proper to appeal. It is recommended that a detailed review of a decision be made before any appeal is filed. Understanding why the decision was made is just as critical as understanding what an appeal would accomplish, if anything.

If you are in need of deciding whether an appeal is warranted in a veterans-related case or are in need of representation, please contact David Lowenstein at http://www.goodmanallen.com/people/bio/david-j-lowenstein, or any other attorney in our veterans practice at http://www.goodmanallen.com/practice-areas/detail/veterans-benefits, or http://www.veteransbenefitgroup.com/

David J Lowenstein FAQs, Veterans Benefits Claims , , , ,

Should I just withdraw my claim and start over?

January 18th, 2012

We hear from many of our clients that they have been advised to just withdraw their claims and file new claims, rather than submit additional evidence in support of the pending claim.  Is this a good idea? 

Absolutely not!

This often comes up when you have a claim with missing evidence – let’s say you had a back injury in service and you have a back disability now, but you didn’t have any medical opinion saying that your current back disability is related to your injury in service (a “nexus opinion”).  You filed the claim in 2008 and it’s been at the Regional Office since then.

You talk to a doctor who tells you that he does think there’s a relationship between the two, and he writes you an opinion, explaining why he believes that there is a relationship.  The best thing to do is to submit that opinion to the Regional Office (be sure to keep a copy and to either take it in person or send it certified mail!)

Someone tells you, “Oh, no, things will happen much faster if you withdraw your claim, then submit a new one with all the evidence.”  Here’s the problem – if you do that and are then granted benefits, your claim would be effective as of the date you filed your new claim, not the date you filed your original claim.  So, you could lose as much as 4 years of back benefit payments if you do this.

Under the law, the “effective date” of a claim is generally the later of the day the claim arose (say, when you developed your current back disability) or the date VA received your claim.  If you withdraw the claim filed in 2008 and file a new claim to reopen with your new evidence in 2012, the effective date of your claim will be 2012, not 2008.

The bottom line – it’s always better to continue an ongoing claim when you obtain new evidence than to withdraw the claim and start over.

Sandra W Wischow FAQs, Veterans Benefits Claims , , , ,

Filing a New Claim with VA

November 4th, 2011

VA Form 526 is used to initiate a new claim. Use this form if you wish to file a new claim for disability or pension benefits. VA Form 526b is also used to file claims for increased ratings or to reopen a previously denied claim. Be sure to follow the directions closely. Claims for VA benefits are initially made in writing to your VA Regional Office (“RO”). You can contact your local RO to obtain forms for filing your claim by calling 1-800-827-1000. After developing your case, the RO will send you a decision, called a “rating decision.”

The following information is provided as a general guideline. Providing the information listed below is not a guarantee that you will win your case, however, if VA doesn’t have this evidence, it is likely that your claim will be denied.

Service connection: In order to have the best chance of getting a claim for service connection granted, you should make sure VA has the following evidence: (1) medical evidence (in writing from a doctor) saying what your current disability is, (2) evidence (from yourself or your service records) showing that you had some sort of injury in service, or medical evidence that you contracted a disease or that your condition got permanently worse in service, and (3) evidence in writing from a doctor that the condition you now have began in service, or, if it began before service, that it was permanently aggravated during service.

If you are applying for service connection for post-traumatic stress disorder (PTSD), a veteran will now be able to establish the occurrence of an in-service stressor through his or her own testimony, provided that: (1) the Veteran is diagnosed with PTSD; (2) a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted confirms that the claimed stressor is adequate to support a PTSD diagnosis; (3) the Veteran’s symptoms are related to the claimed stressor; and (4) the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service and the record provides no clear and convincing evidence to the contrary.

Reopening a claim: If you have made a claim for service connection for a disability and the claim was denied, but not appealed, the law requires that you “reopen” your claim before VA will consider it again. In order to reopen the claim, you must first submit “new and material” evidence. Basically, this means you must look at the reasons the VA denied the claim the first time, and submit some new evidence that fixes the problem. For example, if your claim was denied the first time because you had no evidence that your current condition was related to service, you will need to submit some evidence that does link your condition to service.

Increased rating: If your claim is for entitlement to an increased rating, you can learn what criteria will be used to assign your rating, by looking at 38 C.F.R. (Code of Federal Regulations) Part 4. (This should be available at your local library or courthouse). If you look at a rating decision, there will be a four-digit code listed next to each condition. These codes, called “Diagnostic Codes” are listed in the CFR. You can see there what you need to show in order to get a higher rating for your condition. The best thing to do to prove your case is to document (preferably through medical evidence) that you have the symptoms listed for the higher rating.

Total disability due to individual unemployability: To receive unemployment benefits from VA, you must have evidence that your service-connected disabilities, by themselves, make it so that you can’t work or that even if you can work a bit, you can’t do so in such a way as to make income to meet the poverty line. The best way to document this is to have your doctor explain that you can’t work as a result of your service-connected disabilities by themselves. Just showing that you can’t work or that you can’t find work is not enough to receive this benefit.

Brenda Keener is a paralegal with Goodman Allen & Filetti.

bkeener FAQs, Veterans Benefits Claims , , , ,

WHAT IS A DRO REVIEW? AND WHY SHOULD YOU CHOOSE IT?

October 7th, 2011

When a veteran is not satisfied with the decision reached by the Regional Office (RO), he/she must file a Notice of Disagreement (NOD). The RO then offers two options for appeal, review by a Decision Review Officer (DRO) or the traditional appeal process. The RO will issue a letter outlining these two options. You have 60 days from the date of the letter to respond with your selection. If you do not respond, your appeal will be sent through the traditional process. In either process, the reviewer can (1) award a full grant of benefits, (2) award a partial grant of benefits, or (3) confirm the original RO decision.

Traditional Appeals Process
This process involves a review of the claims file and any additional information that is submitted. The reviewer can hold a formal hearing with the veteran to gather additional evidence. However, he is only allowed to change the original decision in two instances, (1) new evidence has been submitted, or (2) the original decision was based on clear and unmistakable error. This means the original reviewer made a mistake. The decision can also be changed based on a difference of opinion, BUT the new decision must be approved by the Central Office.

The RO will then issue a Statement of the Case (SOC) explaining the decision. In order to continue to appeal to the Board of Veterans Appeals, you must return the enclosed Form 9 with 60 days of the mailing of the SOC, or within one year of the original decision, whichever is later.

DRO Review Process
This process also involves a review of the entire claims file and any new information that is submitted; however, the DRO considers the evidence without deference to the original decision made by the RO.

DROs can hold formal hearings, just like in the traditional review process, but they are also allowed to hold informal conferences with the veteran or his representative to discuss the appeal.

If the DRO does not award a full grant of benefits, a Statement of the Case (SOC) will be issued and the appeal process will continue in the same way as the traditional appeal process explained above.

Why Should You Choose a DRO Review?
1. DROs are senior level RO employees; therefore, they are more experienced than the average VA decision makers that denied your original claim.

2. DROs have broader powers than regular reviewers. This includes the power to change the original decision without approval from the Central Office.

3. DROs have the ability to hold informal conferences with veterans to discuss the facts or evidence.

4. The DRO process takes, on average, a month longer than the traditional appeals process. This is the time period between when you file a NOD and when you receive a SOC. However, a study by the U.S. Government Accountability Office (GAO), found that you are more likely to receive at least partial benefits if you choose the DRO process instead of the traditional appeals process.

5. According to the same report, the average wait time for decision by the Board of Veterans Appeals is more than 1,000 days from the time a NOD is filed. The average wait time for a decision by a DRO is only 266 days from the time the NOD is filed. Therefore, if you receive a partial grant from the DRO, you will begin receiving your benefits much faster than if you appealed directly to the Board.

6. If your claim is not granted by the DRO, you can still continue your appeal to the Board without having to start the process over again.

Overall, the DRO review process gives veterans an additional chance for a favorable decision, is more likely to result in a grant of benefits early on, provides an opportunity to speak directly with the individual making the decision, and does not forfeit the right to appeal to the Board of Veterans Appeals. There is no real downside to choosing this option, and it may end up being more beneficial.

You can find the complete report by the GAO at:
http://www.gao.gov/new.items/d11812.pdf

Krystle D. Waldron, J.D. is a May 2011 graduate of William and Mary Law School.

kwaldron FAQs, Veterans Benefits Claims , , , ,

WHY IS VA SO SLOW? What Can You Do About It?

August 17th, 2011

Why is VA so slow to process claims?

VA is a huge government bureaucracy. All bureaucracies, whether government or corporate, are slow, inefficient, subject to channeled thinking. They are inherently cautious and have many interconnected parts, and actions require multiple reviews and sign-offs. Political influences on, and scrutiny of, government bureaucracies increase the natural cautiousness.

Understaffed, undertrained, overworked, overwhelmed. VA handles hundreds of thousands of claims. Many have merit but not all do. Some people, seeing a federal fund of money, regard VA benefits as a possible source of easy money. With responsibility for the use of taxpayer money, VA must sort through all the claims to separate the bogus from the legitimate. The agency is challenged to find, train, and retain enough qualified employees to deal with this burden of work.

Conflicting incentives. Sometimes the very measures taken by VA to speed processing of claims result in losing ground. For example, when VA creates incentives for clearance of claims faster, the easiest way to deal with a claim quickly is to deny it, often without doing all the proper development. This results in appeals and redoing the claims, sometimes over and over.

Creeping bias. Most VA employees, however effective or ineffective, are sincerely trying to do their jobs properly. Dealing with such a vast number of claims, however, sometimes creates a sense of skepticism on the part of reviewers. This suspicion that most claims are without merit can result in denial because of a tendency to favor evidence adverse to the claim or insist upon corroboration of evidence that should not require it.

What can be done about it?

The short answer is that there is no cure-all; to a certain degree the system is what Congress has established, limited by realities of claim volumes and the labor market. But there are some things that can help avoid undue delay.

Support claims. If you are preparing to file a claim, collect or think about the necessary evidence to prove it. Claims for service connection require showing a current disability that is related to an event of injury or disease manifestation in service. Unless the disability is obvious, such as an amputation or scar, you will need medical records to demonstrate it. VA will request necessary records if you identify sources, but as the patient you can often save time by requesting them yourself. If your injury or illness in service is reflected in military records, that will suffice; if not, you can describe it in a statement but VA will usually want corroboration, so you should solicit statements from witnesses – fellow soldiers, family members, co-workers who are familiar with the events. Finally, unless you have documented symptoms that have continued since service, you will need to establish an evidentiary connection between the in-service event and your disability. This usually requires a medical opinion, which VA may or may not obtain on its own; again, time can be saved if you get an opinion yourself.

Simplify. Having multiple claims also causes delay, especially if they are not proceeding simultaneously. VA cannot rub its stomach and pat its head at the same time. Claims at different stages require attention by different personnel in VA, and the claims file can only be in one place at a time.

Heed notices. If your claim is denied, pay close attention to the reasons given in the Rating Decision or Statement of the Case and consider how to address them. You may need to obtain additional evidence on the elements discussed above.

Be insistent but polite. Bureaucrats are human beings (strange but true!). Like any human, a government employee responds better to courtesy and respect than to threats or anger. Dealing with VA is often infuriating, but losing your cool accomplishes nothing because, realistically, VA employees have little pressure on them to handle any particular claim promptly. But it is important to keep steady pressure on VA. Call or write VA about pending action at regular but reasonable intervals, about every 30-60 days. Writing to your congressional representative cannot force any particular decision by VA but it can sometimes help focus some attention on a file if it has been languishing without action for a long time. Do not resubmit evidence, as this simply bulks up the claims file and causes delay.

Last resort. There is one mechanism to compel attention and possibly action by VA if delay becomes extraordinary. It is possible to petition the Veterans Court for an extraordinary writ of mandamus, an order directing the agency to do something. It is called extraordinary because the court regards it as an extreme measure, to be done only in the most egregious cases. The court very seldom actually issues a writ; sometimes just filing the petition, however, prompts the agency to get something moving again.

We would be happy to answer questions about any of this information.

David E Boelzner FAQs, Veterans Benefits Claims , , , , ,

Marines Stationed at Camp Lejeune

August 2nd, 2011

Marine veterans who were stationed, lived or worked at Camp Lejeune before 1987 may have been exposed to contaminants in the drinking water supply. The Department of Veterans Affairs is recommending all those who believe they were at Camp Lejeune before 1987 to register to receive notifications regarding Camp Lejeune Historic Drinking Water.

The Department of the Navy is funding independent research studies to ascertain what effects, if any, the drinking supply had on individuals. At this time, the Agency for Toxic Substances and Disease Registry (ATSDR) is conducting a study to determine if certain illnesses are linked to exposure to contaminated drinking water. The results are expected to be complete in late 2011.

For the past several years, the Marine Corps has worked on reaching out to those it believes may have lived or worked at Camp Lejeune before 1987. To date, more than 155,000 names are in the Registry.

Detailed information about this can be found at https://clnr.hqi.usmc.mil/clwater/index.aspx

David J Lowenstein FAQs, Veterans Benefits Claims, veterans health care

Tips – When mailing documents to the VA

July 19th, 2011

Filing a claim for VA benefits can be a daunting task. It often requires the veteran to fill out and submit many forms or documents to the VA. Gathering this information can be very time consuming and in some cases costly. Therefore you want to ensure that the documents you sent are received at the VA and added to your claims file eliminating the need to resubmit if lost or misplaced.

Keeping track of what documents or forms that are sent to the VA can be challenging yet very important. The VA is a large agency and the possibility of documents being lost or misplaced is great. Here are few things to remember when submitting anything to the VA:

1. Always maintain a copy of what you are sending to the VA for yourself.
2. Do not send the original document unless otherwise instructed by the VA to do so.
3. If possible, send documents to the VA by certified mail requiring a signature confirming receipt.
4. Make sure the documents you send have your name and claims file number clearly listed on the document.
5. If you received a letter from the VA requesting that you send a document(s) pay close attention to what address you are instructed to send the document to.
6. Make a phone call to the VA to confirm receipt of the documents you sent.
7. If you are represented by an Attorney or Service Organization, before you submit anything to the VA discuss with them best practices when mailing documents to the VA.

Following these simple tips may alleviate the need to resend documents and diminish the possibility of your documents being lost or misplaced.

To locate VA forms or find out more information regarding the VA claims process, visit the VA’s website at www.va.gov .

mglover FAQs, Uncategorized, Veterans Benefits Claims , , , ,