Filing...and winning...a claim at your VA isn't rocket science.   

No matter what others would have you believe, if you take a little time to understand the rules and if you have a well grounded claim, you'll prevail.

To prevail will take some time. How long that will be will vary with a lot of different circumstances and there's not much you can do to control some things that happen.

But if you are willing to learn how VA insists the game be played. you'll win. It really is that easy. The rules aren't difficult. You must be eligible. You must have evidence of an event in service that caused you illness or injury. You must have evidence that the in service event is the source of the condition(s) you claim today.

How hard is that?

VAWatchdog believes that most veterans are intelligent. We know that nobody cares about your claim the way you do. We strongly recommend that veterans file their own claims without the assistance of and sort of representative...except for an appeal. We urge veterans to retain a veterans law attorney for every appeal.

To DIY means that there is no middleman, no lost papers and no misunderstandings. If you DIY you won't be pressured into buying a life membership in some organization that you have little use for.

The VA rules and regulations must be followed. That's not a big deal once you grasp just how simple your claim can be.

So...get started. File your claim today.

If you have a condition, any injury or illness, and you reasonably believe that the condition was caused by or aggravated by your military service,
you are eligible to file a claim for VA disability compensation.


On this page you'll learn what it takes to win as you file your claim.

The process is really pretty simple. Don't believe all the chatterboxes that plague the Internet with horror stories. Most of the nameless, faceless, whining voices you'll hear in chat rooms either didn't have a well grounded claim to begin with or they turned it over to a stranger so that person could "represent" them.

When they lose their claim, they're always pissed off at the VA. There's plenty of reason to be pissed off at the VA...that's a fact. But, if you follow each and every one of the tips you'll read here, you will win your claim.

The VA process of adjudication (making a decision) on your claim is straightforward. If you stick to the rules from the start, your claim is more likely to have a smooth trip through that VA Regional Office of yours. If you try to manipulate the process or if you don't think the rules should apply to you, you will lose.

All the things you'll read on this page are compiled from years of experiences helping vets with claims. The items below are presented to you in no particular order. Each one is as important as the next.

There is work involved. You have to do the work. This page contains a lot of facts and references. We've answered a few of your most common questions here.

If you aren't willing to read all of this page thoroughly, stop here. You're wasting your time and our bandwidth.

If you like winning, please proceed. We're doing our part to help. We've laid out this page, the entire web site, to make the world of the VA benefit claim as simple as we can for you.

The rest is up to you.

File That Claim!

The claim that isn't filed can't be won.

This is a simple concept, yet many veterans spend months and years debating with themselves whether or not it's worth the trouble.

We hear it all the time..."I don't have the time to mess with the VA."

Let's see; It will take you an hour or two at most to complete the VA Form 21-526 if this is your first claim and about that same amount of time to write a letter if you have an existing benefit already.

 Then, at some point after you submit your claim, you'll be scheduled to attend a C & P examination.  That may take a day or two, depending on how far away you are from the facility where the exam will take place.

Along the way, you'll probably get a handful of letters from the VA that make no sense at all to you and reading those will consume a few hours.

Eventually you'll get your award letter. That's probably going to take 2 years. If you've done it right the first time and you get the award you believe is correct, you're finished. You'll probably be notified of a few thousand dollars of retro pay being deposited in your bank account.

You don't have time for all that? I don't believe it and neither does anyone else.

If you believe that you have a disabling condition that is somehow linked to your military service, go ahead and file. You may have to give up a few episodes of your favorite TV show to get it done but the reward will be cash money. If you don't want to do it for yourself, do it for your family.

File the claim. Right now.  

Do you really have a claim?

Veterans are allowed to file for anything (injury, illness) they believe is connected to their military service. Not that long ago VA required that your claim be "well grounded" or they didn't have to adjudicate it.

Today you can file for anything that comes to your mind. However, if your claim doesn't have evidence, if you don't have a current condition, if you haven't been treated for what you want to claim, do your homework before you file.

Yes, it's important to get the claim in so that the effective date is recorded as early as possible. However, if you don't have a claim, why bother?

This is difficult to discern in a lot of cases. We get email from vets all the time who are clearly trying to milk the system.

Be reasonable. If you really believe you have an injury of illness that your military service caused or contributed to, file. If you just want some extra money and you think this is a good way to get it, don't bother.

Understand the VA Disability Claims Process.

The more you know about how VA really works, the better.

Businesses large and small are similar in many ways. Each business has a product. Whether manufacturing widgets, caring for patients in a hospital or selling flowers, what a business does at the end of the day is its product.

One of the important products of VA is the fair and timely adjudication of a veterans claim for disability benefits. This occurs within the Compensation and Pension (C&P) division of the Veterans Benefits Administration (VBA). The VBA is one part of the Department of Veterans Affairs.

To build the VA product means that raw material (The VA Form 21-526 application and supporting evidence) enters via the mail room and through a defined process, the accumulated material is formed into an adjudicated decision. Subsequently a letter of award or denial is delivered to the veteran.

Businesses are often divided into categories that define how they operate. Some businesses are customer driven. In a customer driven business the customers largely define the end products that the business produces. This might be true of Ben and Jerry's ice cream, for example.

Other businesses are driven by a pre-defined, complex and rigid process. Companies or entities that are regulated by strict laws are often process driven; The IRS, medical device manufacturers and pharmaceutical manufacturers are oriented to numerous processes, laws, rules and regulations that control how they operate.

The VA is a process driven business. To the VA the process of adjudication of the claim is a goal unto itself. VA "customers" are paid scant attention. Crossing T’s and dotting I’s are seen as integral to accomplishing daily goals.

There is little room for “customer” error in the VA process. Mistakes in completing the process are not often overlooked or forgiven.

The process of getting the VA Form 21-526 from input to decision and notification is the driver for everything done at the VA Compensation and Pension service.

The veteran and/or advocate who may try to skirt around the process will do so at their own peril. If a notice received by mail tells the veteran that an adverse action is being proposed, it also tells the vet that in order to disagree with the proposal the veteran must take certain actions. Usually the required actions involve a timely written communication to the VA from the veteran.

Many veterans ignore this step in the process and start a series of phone calls in hopes of finding a sympathetic ear who can fix the problem without all the fuss of letter writings. This is always a mistake. The process must be followed or the veteran will lose.

The veteran or advocate who takes time at the start of the process to learn basic VA expectations and requirements will fare better than anyone who chooses to wing it.

Do It Right The First Time

When you first file a claim with VA, it sets the tone for the rest of the process for that claim. Your claim may be sent to appeals hell if you don't cross the T's and dot those I's in the first round. Sure...if you're confident of your claim, go ahead and file today so you can set the effective date. And then get to work.

Submitting clean copies of your evidence is one of the keys to winning your earned benefits. Don't think someone will do this stuff for you...that isn't going to happen.

Read below and then read them again. You'll be glad you did.

The game is changing. Stay alert to the new rules.

Dear Jim,

 

I am a service officer in New York & I'm a Disabled Veteran. I agree with you that DBQ's are, at best, a mixed bag. However, I have had some success with them in the past 18 months. They tend to work better if you can get a VA Doctor to complete one at a VA Clinic or VA Hospital and if the claim is simple. For example, A Vietnam Veteran who served "In Country" and now has Type II Diabetes caused by Agent Orange. This is a presumptive claim and a DBQ for DMII is likely to speed up the process a great deal.

However, a more complicated claim like a Service Connection claim For ALS (Amyotrophic Lateral Sclerosis ) is not likely to be helped much by a DBQ. I do know that the VA is contacting doctors to verify the DBQ's.

I have also had a VSR  call my office and ask me to get a DBQ completed for a Veteran and fax it to him. We did and the Veteran got a very favorable result in a timely manner.

 

What has been your experience with DBQ's? What have you heard from other Vets and/or Service Officers?

 

Thank you for your time. Have a great day.

CVSO

The above message inspired me to ask an expert.

I wrote to a friend who is an RVSR...a senior "rater" who is one of the many good people at your VARO who is working hard to get your claim right.

This "rater" is one of the many resources we use at your VAWatchdog to ensure that we get our intel right. Rumors or misinformation won't help you.

VAWatchdog delivers the facts that can make a difference to your claim...and your life.

Jim


Dear RVSR,

I'm getting a fair amount of feedback on the Fully Developed Claim (FDC) process. The comments run about 50/50, negative or positive.

However, the FDC process seems to be gaining traction with some advocates.

If you have any thoughts to share, I'd enjoy hearing them.

As we consider the FDC process, does adding a DBQ bring value?

If a veteran is in my recommended mode of DIY his/her own claim, how does the veteran submitted FDC get attention at the RO? Our impression of the receiving process of claims at each RO veries a bit but mostly it seems chaotic and scattered. Does an FDC really get any particular attention?

Thanks.

Reply,

With the current focus on working old claims, the Fully Developed Claim (FDC) is the best way to go as it is considered a high priority claim to be worked with the older claims and not after the old claims are worked. There were problems with the FDC program early on because there was some confusion as to what “fully developed” meant. We are still in a learning curve here but the process is much clearer since the most recent fast letter and the change of the forms to “ez”. 

FDC claims are “flashed” when they entered into the system and tracked closely. RO's are reminded regularly that FDC claims are priority and some of my Veteran co-workers have used them (with DBQ's) and gotten their claims adjudicated within weeks, not months.

An FDC claim is one where the Veteran acknowledges he or she has received VCAA notification (now called 5103 notices), has submitted all of the evidence he or she has and waives the 30 day period VA usually has to wait before rating the claim.  Unless the Veteran submits some medical evidence with the claim, he or she may have to undergo a VA examination which will delay the claim somewhat. There is also some other development that is allowed under FDC but keep in mind that even with a priority claim, the more work VBA has to do, the longer that claim is going to take to get done. This is where the DBQ comes in.

The DBQ's that are available to the private sector are much simpler documents than those used within the VHA system.  They are designed to align with the rating schedule so that RVSR’s can more easily assign an evaluation. There was a time when raters were requesting examinations even when DBQ’s were submitted but it was mandated some months ago that unless the DBQ appeared to be altered in some way it is to be accepted and used for rating purposes unless there a credible reason such as the need for a medical opinion.

What the DBQ frequently does not do is establish the nexus which is why a VA medical opinion (C & P exam) might be required. For example, the Veteran is diagnosed with a knee strain in 1980, gets treated twice that same year, is released from active duty in 1986 and the separation examination shows no residual knee problems. He sends in a DBQ in 2013 that shows a diagnosis of arthritis in 2012 of that same knee.  Unless the provider writes somewhere on the DBQ that the arthritis of the knee is progression of the strain, you can bet that a VA examination will be ordered to get a nexus opinion.

Nexus opinions are a large percentage of the reason why examinations are ordered because there is frequently a gap of many years between the time of the injury and the time of the claim. If the arthritis was diagnosed in service, there would be no need for the nexus opinion no matter how many years have passed.  

There are times when private treatment records are as effective as a DBQ but most of the time the private records do not include the information needed to rate a claim according to the rating schedule. Examples of this include notes on joints with no ranges of motion or mental health records without the multiaxial assessment, including GAF score, cardiac treatment records with no ejection fraction or METS. In these cases, an examination would be needed which is why the DBQ works best. Using DBQ’s takes the pressure off of the Veteran to figure out what to send in. I have seen Veterans send in lab results, bills, etc. None of this is useful information.

I will give you some idea of when treatment records are just as good as a DBQ. If the Veteran is service connected for arthritis of the knee and undergoes a knee replacement. The hospital or surgical summary is good. This holds true for just about any condition already service connected and surgery is performed. Newly diagnosed cancer claims that are still in the active stage. ALS claims.

Because most of the claims we see these days are so very complicated, RVSR’s (at least those in my office) love to see FDC’s or claims that can be rated quickly as they are a refreshing break.

I'll get back to you soon with more details about what excludes a claim from FDC.


Now, read up on the details about...

Fully Developed Claims  

Disability Benefit Questionnaires (DBQs)  

Documentation of Medical Evidence for Disability Evaluation Purposes  

This Veterans Health Administration (VHA) Directive defines policy for the useof Disability Benefit Questionnaires (DBQs) to provide medical information for disability evaluations or examinations for eligible Veterans in support of the disability compensation process.

Read the Fine Print

To begin a disability claim requires that the veteran complete the VA Form 21-526. This is an intimidating tome of some 26 pages of seeming gobbledygook and jargon.

When one reads it, you discover that only 3 of the pages are required to be completed. The rest is boilerplate and covers a great deal about options for claims other than disability compensation.

Most of the verbiage is included so as to meet the VA’s burden of the “duty to assist”. VA provides many pages of detailed information in an attempt to avoid criticism by veterans that may begin with, “I didn’t know...”.

This same hint holds true throughout the rest of the process. Any mailing from VA may be critically important to the outcome of the case. There are numerous requirements regarding timeliness of replies and filings and to miss a deadline is to ensure that your case will be derailed. Carefully reading, understanding and following through with every communication from VA will save a lot of time going forward.

Be Patient

This is going to take 2 years. From start to finish, you're looking at a 2 year time period for your claim to be adjudicated.

There is no way to expedite your claim. There is no way to track your claim. You must prepare to wait 2 years for your claim to be completed.

VA will not help you financially while you wait. You're on your own.

I have compared working with VA to a tennis match. There are two players, one on either side of the net and there is one ball. The first player begins by hitting the ball to the other side. While the ball is traveling and while it's on the other side of the net, the first player is patient and prepares for the second player to send it back.

If player #2 is slow to react and seemingly isn’t paying any attention to the ball, player #1 may become impatient and lob another ball across the net. When this out-of- sequence play begins, the game is soon out of order and confusion reigns. Too many balls in play will bring about chaos.

Don't allow yourself to become impatient. Don’t begin writing letters or making phone calls to try to move the claim along. Don’t start calling the local newspaper or your Senator or Congressperson.

Currently VA is way behind in processing claims...possibly as many as one million claims are languishing for weeks or months with no action. That figure is debatable but even if we agree to cut that in half, the backlog is daunting.

If you follow the hints here you’ll know that your claim is in process (the certified mail RRR). When you submitted the claim you were sure it was well grounded and you made it easy for the Rater at VA to read and understand.

While the claim processes, take up a time-consuming hobby, read War and Peace, go for long walks and otherwise wait quietly.

The decision on your claim will be made when it is made, not a moment sooner.

In the final analysis, filing a claim for disability benefits at VA is simple. If done precisely and correctly from the beginning, the claim is likely to move through the process with no problems. Paying close attention to details and playing strictly by the VA rulebook will result in more favorable claims with fewer frustrations.

Spell It Correctly

I don't believe that veterans should have to become professors of literature to file a claim.

However, if you don't bother to spell anything correctly, your message will be that much harder to decipher. Take the extra time to get this done right. Use the correct terminology to describe your condition.

Most browsers and all word processing programs these days have spell check programs. Take the time to use one. You'll make the task of processing your claim easier.

Denied? Retain A Lawyer

Once you receive a denial in the mail, you are eligible to retain a lawyer to help you with your appeal. Don't hesitate. Don't waste time wondering what you should do. Go to the  How To Hire A Lawyer  page right now and once you've studied that, get busy with your appeal.

Know Who Is Giving You Advice About Your Claim

You're searching on the Internet seeking help in dealing with the VA. Hey, you're here right now. There are dozens of sites that are available today by a simple Google search. Many are interactive, old-style bulletin boards. You can look around for a thread that covers your topic and find a place to post your question.

Before you are allowed to post a question, you'll probably have to register. That's no big deal depending on how much information about yourself you want to give up to strangers.

Before you do that, think it over. Look around at the postings. Is the site full of dancing images, silly icons flashing at you and moderators with handles like "BitterAngryVet"? Do you detect an aura of a few senior people who appear to enjoy their authority over others and puff out their chests at how expert they are?

Are the postings you see filled with angry diatribes about how the author was screwed by the VA?

Most importantly...are you able to contact the owner of the web site by email and get a reply? Does that person tell you his name? Do you feel like you know who he is based on his openness to share information with you?

If you run into excuses like "I can't tell you because VA will punish me for going public" or "You don't need to know who I am, you just need to listen to me", you should probably shy away.

The VAWatchdog, since the beginning, has published names and email addresses of contributors. We don't require registration. We have no plans to capture your personal information so we can send you spam. If you don't contact us, we don't contact you. There is no record kept by us about your visit. We treat ever email confidentially and respect your privacy.

The data you find here is derived from reliable sources. Skilled veterans attorneys, other accredited advocates and VA executives all guide us with the guidance and articles posted here.

Before you listen to someone on the Internet, give it a lot of thought. You may end up buying the Brooklyn Bridge and wondering what happened to your claim.

Enhance Your VA Medical Records

Your communications to your VA primary care provider (PCP) are often rushed.  The PCP is focused on the signs and symptoms that he or she believes are most important to keep you healthy. The PCP isn't likely to talk with you about your service connected joint problem but will probably be focused on things like your blood pressure, diabetes, tobacco use and the sorts of things that may kill you.

With proper preparation, you can control some of the conversation and influence what is written into your medical records. Over the long run, these little notes are important to you when you want to review your claim and consider asking for an increase due to your condition becoming worse. If there are no records of your increasing pain or immobility, the person who is tasked to rate your claim won't have much evidence to go on.

Be prepared when you go to see your PCP or any other health specialist. I urge every patient to make brief notes...talking points...about the things that are most important to them. The key to success here is to keep these notes very brief. The notes are only reminders so that you don't forget to ask for what you want. Make your notes neat enough that you can hand them to your PCP and tell him/her "I'd really like to tell you a little about this. You may keep my notes if that helps."

You may ask that your PCP enter your discussion points into the record. Always be courteous and as brief as you can. You may explain that you will be seeking an increase of your rating % and that the notes made by the PCP will be of value.

You may also ask the PCP to write a statement that will support your request for an increase. You can also use the new "Secure Communications" to write a message directly to your PCP that will become a part of your records. Both of these techniques are described in detail further down on this page.

Every few months, get a copy of your recent medical records and review them for accuracy. These are your records and your benefits. It's up to you to ensure that they're correct.

State Your Claim Clearly and Precisely

Although VA is often forgiving when the veteran isn't clear about what benefit they seek, the advantage always goes to the veteran who clearly communicates why they are making a claim and what they believe the outcome should be.

Consider:

"I want to claim my agent orange benefits because I am sick from that stuff. Also I need the money before I lose my house in the divorce."

"I am a Vietnam veteran. I claim that exposure to Agent Orange has caused my diabetes. I have read The Schedule For Rating Disabilities and according to the criteria set by VA, I am eligible to have a disability compensation rating of 40%. I have included my medical records."

If you were the "Rater" who opened those files on your desk at about the same time, which statement do you believe would get through the process of adjudication the quickest?

Note that the claim and expectation is in plain English. The veteran or advocate doesn't have to copy and paste in large segments of the law...that VA Rater already knows all that. Writing to the person at VA just as if you were speaking to them works well.

A brief but thorough written communication to the VA Regional Office is a prime ingredient to encourage VA to swiftly generate a fair award to the deserving veteran.

Use certified mail with return receipt requested.

This is one of the most important things you can do when filing your claim!

Telephone calls, emails and so on are lost and have little meaning. The certified letter gives you solid evidence of your communication date and what it was you said to VA.

DO NOT fax, email, rely on eBenefits, IRIS or the toll free number.. If you don't want to bother with this extra little bit of trouble, you lose.

The Well Written Letter is Your Best Friend

Veterans want to talk to someone.

Most of us believe that, "If I can just get to that one individual who will listen to me, this can be resolved in minutes."

When vets call VA they may notice that a single toll free number is available to contact VA from anywhere in the U.S. The number does not connect to a Regional Office where files are located, it connects to a "call center". The call center staff do not have access to any files, they are not decision makers and can not take any actions on any aspect of the case.

(If you are an accredited attorney or agent, you may have access to internal phone numbers and systems not available to others. This hint may not apply to you.)

Once the veteran hangs up, the call is lost to history. There is no record of what was said or of any commitments made by the call center representative.

Any and all communication to VA should be made via certified letter, return receipt requested.

Letters should be brief and strictly factual. There should be no venting or any release of any frustrations. Letters to VA should be as respectful as any documents VA will send to the veteran. Always double check to ensure the accuracy of addresses, that the document is signed and that any reference numbers have been included on each page.

The veteran or advocate who communicates via certified mail, RRR and who carefully builds an organized paper trail is usually at the head of the race for benefits.

Writing a letter isn't a big deal. Even if you aren't the most accomplished writer on earth, we've made it easy. Click here to find a template to use.

Request your complete C-File

Do this as soon as you begin to perfect your claim. It may take months to get it so don't delay. Many attorneys won't do this for you. Make a copy to work with and keep a  clean copy in a safe place. Get your medical records, both civilian and VA. VA often can't get civilian records due to the costs imposed by civilian facilities for copying. Read more about your C-File here.

Veteran Scott Millard has a tip for you

Jim;

I may be stating the obvious, but I want to give every Veteran a heads up. If you are an active user of the MyHeathEvet website, listen up. When you use the new Secure Messaging system to communicate with your Primary Care doctor, each message is instantly entered into the VISTA system and becomes a permanent part of your medical record. I use it to document symptoms, medication reactions, and consult requests.

I really think this is a great tool for the veteran. I used to have to write everything down and then hand it to the doctor for them to translate and evaluate. This gives me the opportunity to document symptoms in the "moment", as they are happening. I totally believe that this can be a win-win tool for both Veterans and their physicians, as long as it is used properly.

Ranting and raving obviously, whether in person or though Secure Messaging is counter-productive no matter what. One simple rule...if you can't control your tongue or keyboard, have a spouse or friend as a "mediator".

Scott;

Thanks for sharing this discovery. This has the potential to revolutionize how we get important data into our records. That last sentence may be the most important of all. Don't risk losing your credibility by ranting.

Important Points to Remember  

As you work with VA to secure all the benefits you earned by your honorable military service, there are a great many steps you must take to ensure that your claim will be given fair and accurate treatment. You must always remember that VA is an agency that is operating in a crisis and chaos mode every day. If you make any errors in submitting your claim, the VA staff will compound those errors.

Do it right the first time. That isn't difficult. It does require that you do it yourself and that you pay attention to details and the simple rules of submitting a claim.


* Nomenclature is very important. You must take the time to understand the language of the VA. It's not so different from the language you used on active duty. If you aren't sure of a word, a term or your spelling, look it up. VAWatchdog has compiled a page of common terms for you here.


* Get your C-File. Do that today. It doesn't take long to request it although it may take a while to receive it. Read more about the c-file here.

How Long Does It Take? 

"how long after va compensation approval letter before payment"   

This question is asked every day. There is no way to accurately predict how long it will take to process any particular claim or payment. There is also no way to track a claim as it travels through the VA process of adjudication. Your claim may have a decision in as little as 6 months or it may take 24 months...or longer. The claim may be "brokered" to another VA Regional Office to be serviced where it will get lost in the shuffle. The majority of claims, once adjudicated, will contain so many errors that you will have to appeal. There is no way to speed up the process. There are no effective programs in place that will expedite a claim. To learn more, click Track Your Claim and The Backlog.


"va presumptive benefit wait time after filing"

The wait time to process a benefit varies from one claim to the next. There is no preference given to a presumptive claim. VAWatchdog estimates that a claim filed in the 2010 through present time will take from 12 to 24 months. This will bring the veteran the first award/denial letter. VAWatchdog estimates that 70% of these first-round letters will have significant errors and the decision will warrant an appeal. The first step appeal should normally be at the DRO Process level and will add another 12 to 24 months to the process. If that appeal is not successful (most are) then the next appeal is to the BVA via a Form 9. The BVA appeals process may add another 2 years or more. After the BVA appeal is the CAVC and an appeal there can add many years to the wait time. There is no expedited process.


"how long will my comp and pen claim be in preparation for notification phase"   

VA commonly uses phrases like "notification phase" when communicating with veterans. You may also hear things like "decision phase" and many other ambiguous terms that have no real meaning. This always happens when the veteran uses the toll free number, IRIS or the eBenefits site to try and track a claim. The phrases are meaningless. Every claim is in "the decision phase" from the moment it comes in the mail room to that moment when you get your decision letter. The use of these terms is a sort of ruse that VA uses to make you think that there is progress on your claim. The truth is that nobody knows where your claim is at any given moment.