Table of Contents

What are the Steps in Processing My Claim? What you can do ...? Step 1-You file your claim Step 2-We obtain evidence Step 3-You are examined at VA hospital Step 4-Complete record is evaluated Step 5-A decision is made

(Scroll down for more!)

Other Information

1. What causes delays in the claims process?
2. How does the appeal process work?
3. What is the best way to communicate with the VA?
4. National Personnel Records Center
5. Fire Related Cases
6. Post Traumatic Stress Disorder

DEFINITIONS

In order to make our communications as clear as possible, we'd like to define some of our terms:

Compensation: The benefit paid to veterans whose disabilities arose from service. The disabilities themselves are often referred to as Service Connected or "S/C".

Pension: The benefit paid to veterans whose disabilities are not related to service and who have a financial hardship. The disabilities themselves are often referred to as Non-Service Connected or "NSC".

Rating Schedule: The guide we use to determine which disabilities we can pay for and the percent to which they are disabling.

Claim Number: How we monitor and identify your claim. Any letters you receive from this office should have the claim number in the upper right hand corner. The letters "C", "XC", "CSS" or "XSS" will precede your claim number. It is very important that you have this number available whenever you contact this office.

Step 1: You File Your Claim

The disability claim process begins when you file a claim.

If you have never filed a disability claim with us, we need you to complete and submit a VA Form 21-526 (Veteran's Application for Compensation or Pension). You may complete the form with the assistance of a case manager at our office or you may call or write and have this form sent to you. Once you have completed the form, you should return it to this office.

If you have questions while attempting to complete this form on your own, please call this office. It may save our having to delay processing your claim while we attempt to get clarification of your answer to the question about which you were unsure.

If you filed a claim in the past, whether you were granted or denied benefits, you do not need to complete a VA Form 21-526 again. However, we do need your signed statement telling us what you want to claim, why, and where you were treated for the claimed condition.

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Step 2: We Obtain Evidence

(this step takes:1-4 months)

Based on the disability claim you submit to us, we begin compiling evidence to support your claim. Thus, any evidence that you are able to secure beforehand and submit with your claim will expedite this step.

Your disability evaluation will be based on this evidence, so it is essential that we have complete and accurate information.

We will assist you by verifying your service dates (based on the information that you furnish on your application) and requesting your service medical records. If you send us a signed medical release (there are copies attached to VA Form 21-526), we will also request your private medical records.

We may request more information from you. This may include letters detailing specific experiences in service or information on your dependents, employment history or income. You can help speed the process by providing complete addresses for the medical care and be as exact as possible in reporting dates of treatment. Please send requested information in as soon as possible. You don't need to wait until the 60 days we have given you have expired. You should also make sure that you include your VA file number on all pages of anything that you submit.

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Step 3: You Are Examined at a VA Hospital

(this step takes 1-3 months)

Often we request exams while we wait for other evidence to arrive. Sometimes, we first have to review the other evidence to be certain we are requesting the proper exams. The exams that we request for you will depend on your claim and treatment history.

The VA Medical Center will schedule you for the requested exam. They will contact you directly by mail to let you know when and what exams are scheduled for you. After each exam, an examination report will be prepared and sent to our office. You can help expedite this process by keeping your exam appointments and by asking your private medical providers to send a copy of your records to our office. Remember to ask them also to include your VA file number on the records that they submit.

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Step 4: Complete Record is Rated

(this step takes: 2-3 months)

As evidence is received, VA places the records in your claims folder. When we have all the necessary evidence, your claim is ready to be rated. Due to our current backlog, there may be a two or three month wait before your individual claim can be rated.

We evaluate the medical evidence and other documents to support your medical condition. We then identify how these conditions correspond to the rating schedule. This schedule designates what disabilities we can pay for and at what percent. The schedule is based on the laws passed by Congress.

We will consider all evidence submitted and will pay the maximum benefit allowed by law. If there is a change in your disability after you've filed your claim or if you want us to evaluate additional disabilities, please let us know as soon as possible.

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Step 5: A Decision is Made

(this step takes 1-3 weeks)

After the rating is completed, you will be notified promptly of our decision. We will provide you with the reasons for all decisions to grant or deny benefits. If you do not agree with our decision, we will explain the appeal process.

If you have any questions, please call our toll-free number at 1-800-827-1000.

WHAT CAN I DO TO HELP ... ?

1. Be as thorough as possible in completing your claim application. Do NOT assume that we have information on file already. ALWAYS sign your name on the application form.

2. Respond as quickly and completely as possible when we ask you for information.

3. If you are scheduled for a medical exam, please keep your appointment. If you are unable to keep your appointment (for whatever reason), please contact the VA medical Center where you were scheduled to report as soon as possible.

4. If you have been treated for your disability by private medical providers, please ask them to send us a copy of your treatment record.

5. On any application that you submit, ALWAYS provide a complete mailing address (to include your specific apartment number if you live in an apartment building) and, if possible, a daytime phone number (including the area code) where you can be reached in case we need to obtain clarification on any part of your application. Let us know, as soon as possible, if you change your address or phone number.

6. If you are in doubt about what to do at any time, please contact us at
    1-800-827-1000.

7. Any time you call this office about your claim, please have your VA file number available to give to the person who assists you. You can find this number in the upper right hand section of any correspondence from this office. If you can't remember and can't find your VA file number, please have your Social Security number (or - if you are a survivor of a veteran - have the veteran's Social Security number) available since (starting in the mid-1970's) this is usually the number assigned as the VA file number.

8. Any time that you write to VA, you should include your VA file number not only on your letter but also on any documents that you submit in support of your claim - in case they become detached from your letter.

You were there when we needed you - now we're here for you.

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What Causes Delays?

Claims within a specific category are processed in the order they are received. Time to process is particularly hard to estimate on cases involving PTSD, Persian Gulf illnesses, reserve units, and fire-related cases. The time it takes to process a claim varies for several reasons. First, we need to get the information needed to make a decision; this includes medical records, verification of honorable discharges, copies of certificates, etc. Although we are a government department, we have no special way to get records from private hospitals, other government agencies, records centers (such as the National Personnel Records Center), or military bases, hospitals or reserve units. Claims with records from several sources take longer to get records than others. One way to help is to get as many of your records as possible to submit with your claim.

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Appeals of Decisions

An appeal of a local decision involves many steps, some optional and some necessary, and strict time limits. In order, the steps are:

1. Notice of Disagreement (NOD)
2. Statement of the Case (SOC)
3. Formal Appeal (VA Form 9 or equivalent)
4. Hearings (Optional)
5. Board of Veterans' Appeals (BVA)
6. United States Court of Appeals for Veterans' Claims (CAVC)

The case may also involve remands at the BVA and/or COVA levels. Someone may have several appeals at once, and several issues may be included in the same appeal. Usually, all issues on one VA decision will be included in the same appeal.

• Notice of Disagreement

A Notice of Disagreement is the first step in an appeal. It simply involves a written statement that you disagree with a decision that has been made. Certain things should be kept in mind when submitting a NOD:

Be specific about what you are disagreeing with. If a decision was made on 7 issues, specify the ones you are referring to- don't simply say you disagree with the decision.

Make sure that a decision has been made. For most decisions when benefits are reduced or terminated, we are required to propose it first; this is called a pre-determination notice. A NOD can only be accepted if a final decision has been made, not if a proposal has been made. If you don't receive paperwork describing the appeals process (a VA Form 4107), check your letter to see if it is a proposal.

Check the time limit. A NOD must be filed within one year of the date of the letter informing you of the decision. If you were notified of a decision in 1994, it is too late to file a NOD. Your option at that point is to file another claim, or request to reopen a claim, for the same condition as before.

• Statement of the Case

A Statement of the Case is a summary of the evidence considered, actions taken, and decisions made, plus the laws governing the decision. A SOC must be done when a Notice of Disagreement is filed or when new evidence is received. Once the first SOC is done on an appeal, any ones done after that are Supplemental Statements of the Case (SSOC). An appeal may have several SSOC's.

• Formal Appeal (VA Form 9 or equivalent)

An appeal must be formal before it can continue to higher levels. The standard form for formalizing (sometimes called perfecting) an appeal is the VA Form 9. This form must be received no later than one of these two dates:

• one year from the date of the letter notifying you of the decision
• 60 days after the date of the Statement of the Case

• Hearings (Optional)

Hearings are a chance for claimants to present evidence in person; they are totally optional. They are held at the regional office by a Hearing Officer (HO). If you have a hearing, the HO will review the evidence in conjunction with the testimony and make a decision on your case. If the issue is not resolved in your favor, the appeal will continue.

• Board of Veterans' Appeals (BVA)

The Board of Veterans Appeals, located in Washington DC, is the highest appellate body in VA. Although most decision are done in Washington, BVA does have travel boards that come to local offices. Travel boards have been limited the past couple of years, and Manchester would not expect more than one week of travel board hearings in a year. Due to a number of reasons, the pending workload at BVA has dramatically increased in the past few years. It is not unusual for an appeal to take 2 years or more from the initial NOD to the final BVA decision.

BVA looks at all of the evidence regarding the issue under appeal. If BVA decides that more information is needed to make a decision, it will issue a remand to the local office. BVA will not reconsider the case until its instructions in the remand are done. If the evidence is sufficient, BVA will issue a decision. This decision is the final VA one on the issue, and the appeal will have ended. However, a BVA decision can be reviewed by the Court of Veterans Appeals if an appeal to the court is filed within 120 days of the BVA decision.

• United States Court of Appeals for Veterans' Claims (CAVC)

The United States Court of Appeals for Veterans' Claims (CAVC), located in Washington DC, was created in 1988 to review matters of law about VA benefits and decisions. CAVC is not part of VA; it is an appellate court in the US judicial system. CAVC will only consider decisions made by the Board of Veterans Appeals after 1988. As in most courts, one must have either an attorney or personal knowledge of legal proceedings in order to file the correct legal paperwork and conduct the appeal. CAVC decisions usually concern the procedural, legal issues involved in the "letter of the law". The deadline for filing an appeal to COVA is 120 days after the BVA decision (using the date of the letter to you informing you of the decision).

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Communicating with the Veterans
Service Center

COMMUNICATION IS NOT ONLY WHAT WE SAY, IT'S WHAT YOU THINK WE SAID.

If you get a letter from this office that is confusing, please let us know. We are truly interested in improving our communication. When doing so, provide the date of the letter in question.

Methods of contacting/communicating with VA/Veterans Service Center:

1. You can write us at:

   DEPARTMENT OF VETERANS AFFAIRS

   Veterans Service Center

   500 Gold Ave. S.W.

   Albuquerque, NM 87102

In all correspondence to the VA please provide:

• the VA claim number
• veteran's social security number
• veteran's complete name

Please be sure to keep us informed of address changes.

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National Personnel Records Center

The National Personnel Records Center (NPRC), located in St. Louis, is the main center for a military person's records. NPRC has millions of records. Depending on the branch and years of service, we will make a request for records to NPRC. If medical records are available at NPRC, the originals will be sent to us. No copies are left at NPRC. Any individual can request their records from NPRC using a standard form (SF 180), which we can provide to you upon request. However, to reduce the substantial backlog at NPRC, duplicate requests from VA, individuals, and/or service organizations should not be made at the same time. If you receive notification from us that records could not be located, you may find it more efficient to deal with NPRC directly

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Fire-related cases

In July 1973, a fire broke out at NPRC. The majority of records for Army and Air Force veterans discharged before 1963 were destroyed. There are no alternate sources for personnel or other non-medical records. In the late 1980's, there were Surgeon General studies discovered that listed names of patients treated in Army hospitals during World War II and the Korean War. These records, usually containing only one line of information, can be requested if you were treated in an Army hospital during one of the wars. Unfortunately, there remains no alternate sources for the other burned records.

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Reservists

If you are a reservist, you may want to request that your unit forward a copy of your medical records to this office. If you are filing a claim for a disability that occurred while you were on reserve duty, we also need a copy of the paperwork showing your duty status on the day you were injured. We frequently experience significant delays in receiving records from reserve units.

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PTSD

PTSD cases often take several months to process. In order to establish a finding of PTSD, as opposed to other mental conditions, the event causing the stress disorder (the stressor) must be identified. Sometimes the stressor is apparent on the discharge document (for example, a Purple Heart). Often, we must request personnel and other records from the National Personnel Records Center. However, while personnel records will show units, job classifications, etc., they do not show events that happened. For those records, we must make an additional request to another records center for information they may have on particular events. This search is why we need as specific information as possible on the stressor form that we send (names, dates, units, etc.). The current backlog at this records center is several months. This time, added what it takes to get records from NPRC, is why PTSD cases take longer to process.

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If you have questions about VA benefits, e-mail our Veterans Assistance Staff.