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Posts Tagged ‘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 , , , , ,

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 , , , ,

Senate Bill Proposes to Increase VA Compensation Rates Automatically

May 31st, 2011

On May 5, 2011, a bill was introduced in the U.S. Senate to provide a cost-of-living adjustment in the benefits paid to those receiving disability compensation, compensation for dependents, clothing allowances, dependency and indemnity compensation benefits, and dependency and indemnity compensation benefits for children.

U.S. Senator Patty Murray of Washington, the chairperson of the Senate Committee on Veterans’ Affairs, and every member of the Committee co-sponsored the legislation.

If enacted, this legislation would not establish a set amount paid. Rather, the amount paid would be increased based on increases in the Consumer Price Index, which is the leading indicator of cost of living in America. That is, if the cost of living in America increases by 3% then VA compensation benefits will be increased by 3% automatically. The payment rates would be calculated yearly, rounded down to the nearest whole dollar. Any increases in compensation would be based on the rates in effect on November 30, 2011.

The bill would remove from the political process adjustments in compensation paid to veterans and their dependents and guarantee an adjustment in compensation that keeps pace with the cost of living.

The text of the legislation may be found at http://thomas.loc.gov/cgi-bin/query/z?c112:S.894: .

Todd M Wesche Veterans Benefits Claims, Veterans Benefits Legislation , ,

VA Study Shows Link Between Kidney Cancer and Agent Orange Exposure

May 16th, 2011

Even if a particular condition is not on VA’s “presumptive list” as a condition caused by Agent Orange exposure, a veteran can present medical evidence to show that his or her individual condition is “as likely as not” related to that exposure.

A new VA study suggests a link between Agent Orange exposure and kidney cancer, a condition that is not on VA’s “presumptive list.” While this is a limited study, this type of evidence may be helpful in establishing that this exposure is “as likely as not” related to kidney cancer, and can provide support for an opinion by your doctor that the two are related.

For more about the study, see http://health.usnews.com/health-news/family-health/cancer/articles/2011/05/14/agent-orange-linked-to-kidney-cancer-study

Sandra W Wischow Agent Orange, Veterans Benefits Claims , ,

Service Connection for Agent Orange Related Conditions

April 21st, 2011

Under VA regulations, a veteran who was exposed to herbicides in service and develops a disease which is listed on the “presumptive list” is presumed to have developed the disease because of his or her exposure to herbicides. For a list of these conditions, see http://www.publichealth.va.gov/exposures/agentorange/diseases.asp.
Generally, VA refers to this as exposure to Agent Orange, although there were also other herbicides used with different names. If your condition is on the list, establishing service connection is a relatively straightforward process.

Suppose your condition is not on the presumptive list? Unfortunately, VA will often deny service connection, without much more explanation than that the disability is not included on the presumptive list. While the Regional Office may stop there, that may not be the end of your claim and you should not necessarily accept this as a final answer.

In a case called Combee v. Brown, 34 F.3d 1039 (Fed.Cir. 1994), the Federal Circuit Court of Appeals determined that even if a particular condition was not included on the presumptive list for radiation exposure, the veteran could still establish service connection independently – that is, by submitting evidence that his or her disability was as likely as not related to radiation exposure in service. This rule has also been applied to claims involving Agent Orange.

So, let’s suppose you served in Vietnam. You are presumed to have been exposed to Agent Orange, so an “event in service” is established. If you now have one of the diseases on the presumptive list (for example, prostate cancer or diabetes), service connection is relatively simple to establish.

Suppose that instead you have one of the forms of leukemia that is not listed on the presumptive list, such as CML or AML? You can still establish service connection with a medical opinion that the leukemia was “as likely as not” caused by your exposure to Agent Orange. This is certainly a more difficult process than establishing service connection for a presumptive condition, but it can be done.

Bottom line? If your claim is denied because your condition is not on the presumptive list, but there is medical evidence of a link between your condition and Agent Orange, you should file a notice of disagreement and continue to pursue your claim.

The missing element in your claim is nexus – a connection between exposure to Agent Orange and your current illness. You’ll need a medical opinion to establish this connection, so you should discuss this with your doctor. It will help him or her if you do some research yourself – check the literature, to see if you can find any studies linking your condition to Agent Orange, or, more generally, to dioxin. If you provide study data to your doctor, he or she will be better able to provide a solid opinion linking your condition to Agent Orange exposure.

A second thing to look at is whether there is medical evidence linking your condition to benzene. Agent Orange was typically mixed with diesel fuel to distribute it, so exposure to Agent Orange generally would include exposure to benzene. There is also a chemical link between dioxin and benzene. So, don’t limit your research to dioxin – look for medical evidence linking your condition to benzene as well.

Presumptive service connection is not the only way to establish service connection for conditions caused by Agent Orange exposure. You’ll have a harder time establishing the connection for conditions that are not on the presumptive list, but with a strong medical opinion and supporting medical literature, it can be done.

Sandra W Wischow Agent Orange, Veterans Benefits Claims , , , , , ,

If there is a government shutdown, what VA services will be impacted?

April 8th, 2011

If Congress cannot reach an agreement on the 2011 budget by midnight tonight, April 8, 2011, the government will shut down. While many questions and issues remain unknown as to how a shutdown will truly impact the nation, the Department of Veterans Affairs just issued a field guide explaining what services will and will not be impacted by a shutdown.

Here are some highlights:

VA hospitals and clinics will remain open and fully functional. You should have no problem getting your prescription, and can attend your scheduled appointment for treatment or go to the emergency room.

Payments of disability (service-connected) and pension (non-service-connected) will continue as usual.

Processing of claims for benefits will continue, but may be slowed down significantly.

Many people at the VA Regional Offices and the Board of Veterans’ Appeals will not be working—phone calls to these offices will not be answered, and it is unlikely that decisions on claims will be made.

For all the details, click on the following link http://va.gov/FieldGuide_Flyer_Final_6261.pdf

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

CRUCIAL DEADLINES

March 21st, 2011

The United States Supreme Court does not often hear cases from the veterans claims system, but it recently issued a decision in Henderson v. Shinseki that was favorable to veterans, though the claimant in this case is not completely out of the woods.

All appellate systems have prescribed periods for appealing to a higher court. In many instances the filing of a document to initiate the appeal, a notice of appeal (NOA), is “jurisdictional,” meaning that failure to file it properly deprives the court of the power to hear the appeal. The issue for the Supreme Court was whether Mr. Henderson’s claim had suffered this fatal blow when, because of a paranoid schizophrenic episode, he missed the filing deadline for his appeal to the Veterans Court. That court and the Federal Circuit above it held that this failure required dismissal of the claim.

The Supreme Court reversed, however. It recognized that veterans’ appeals are part of a unique administrative scheme, and it said that the statute containing the appeal deadline indicated Congressional concern for veterans, such that Congress would not have intended the deadline to be jurisdictional.

The high court noted that the deadline was an important rule, however, and it sent the case back for further consideration as to whether there was any exception that should be applied. There is a principle called “equitable tolling” that may allow the court to hear the appeal if it is found that ultimate fairness and justice so requires.

While it is a victory for veterans that the court allowed for the possibility of some exceptions to the strict deadline, there is no assurance in advance that an exception would apply. This reinforces the crucial importance of filing a notice of appeal on time and in the proper place.

To appeal to the Veterans Court from the agency (Board of Veterans’ Appeals), the notice must be filed within 120 days of the Board’s decision and it is filed with (sent to) the Veterans Court itself, not the agency. To appeal from the Veterans Court to the Federal Circuit, one has 60 days from the entry of judgment by the Veterans Court (usually about 21-22 days after the decision), but the filing is made with the Veterans Court, not the Federal Circuit.

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