What is the VA Claim Process
Where do I file?
The VA process for deciding claims has two levels. The first level is filed at the “agency of original jurisdiction.” These are the fifty-eight VA regional offices (ROs), or in some cases other VA field level offices located around the country.
Claims filed at the RO:
- Original claims
- Reopened claims
RO decisions can be appealed to the second level, the Board of Veterans’ Appeals (BVA or Board). Once a decision is mailed, you have one-year to begin the appellate process.
What are the steps to an appeal?
- Start the appeal by filing a Notice of Disagrement (NOD) at the RO.
- The RO will ask whether you want a “de novo” review. “De novo” means a complete review without consideration of the original decision.
- If a de novo is either denied by the RO or not requested then the RO will mail a Statement of the Case (SOC). This is an explanation of the reasons for the RO’s denial of the claim.
- When the SOC is mailed, the clock starts ticking. A claimant has one year to file an appeal. This is sometimes referred to as “perfecting the appeal.”
- Perfecting the appeal requires filing a “Substantive Appeal.” The appeal is typically filed on a special form (VA Form 9) http://www4.va.gov/vaforms/va/pdf/VA9.pdf
- There is a timeline for filing the “Substantive Appeal.” The deadline is the later of either:
- Sixty day (60) days from the date of the SOC; or
- The remainder of the one-year period from the date of the RO’s decision notice.
- Once the Substantive Appeal is filed, the case is transferred to the Board of Veteran Appeals (BVA).
Who decides claims at the RO level?
There are different decision-makers within the RO. Typically, it starts with an RO rating decision. If the claim is denied at the rating level, a claimant may request a “hearing” or “review” at the RO level. The hearing or review will be conducted by a different person, a Decision Review Officer (DRO).
When can I submit new evidence?
Once an appeal has been filed, evidence may be submitted at any time until the Board decides your case. Sometimes this results in multiple RO decisions, or a Supplemental Statement of the Case if evidence is submitted after the original SOC. Be aware that that submitting new evidence can delay the transmittal of the case to the BVA. At the BVA claimants can also submit new evidence and new arguments. Therefore, good legal representation can make a difference when a person losses at the RO level and seeks to have the BVA consider their claim.
Who is responsible for gathering evidence?
In most courts the burden is solely upon the claimant. The VA is different because the VA shares that burden. The VA has a statutory duty to assist the claimant in developing evidence supporting their claim. This duty can include conducting medical exams and obtaining medical opinions when necessary, and assisting the veteran in obtaining government records as well as private medical records or employment records that are relevant to the claim.
Where does my case go when I file a Notice of Disagreement? (jurisdiction)
Although filing a NOD begins the appeal, the Regional Office (RO) remains involved. The record does not leave the RO. It remains there during the period between the filing of the NOD and the Substantive Appeal, and the period after the filing of the Substantive Appeal and before the case is transferred to the Board. During this time claimants may submit additional evidence, request an RO hearing, or request DRO review.
Is there any hope after the VA issues a final decision denying a claim?
The VA is different than a typical court because it does not strictly follow res judicata. This means that after the VA issues a final decision a claimant is not prevented from obtaining the benefit from the VA later on. However, res judicata may be applied by the Court of Appeals for Veterans Claims (CAVC).
New Evidence after a final decision
A claimant may reopen a previously final RO or BVA decision by filing “new and material” evidence at the RO level. When new evidence is submitted as part of a reopened claim, the rules and procedure are the same as for the original claim.
The second way to obtain a benefit after a previously denied claim is to file a new claim alleging that the previous final decision was a product of “clear and unmistakable error.”
3 Types of claims may be initiated at the RO for the same benefit
- Original or “new” claim
- Reopened claim
- Claim for revision of a prior final RO decision based upon “Clear and Unmistakable Error (CUE).”