VA Claims Manual Contents

Transcription

1 Contents Introduction... 1 Can I file my claim by myself?... 1 Where can I find a VSO, Attorney, or Accredited Claims Representative?... 2 Recent Legislation Impact... 7 Claims Overview... 7 Burden of Proof Secondary Connection Know the rules of the game - Don t get ambushed! Disability Benefit Questionnaire (DBQ) The Roadmap to Needed Medical Evidence Veterans Administration Schedule for Rating Disabilities VASRD - 38 CFR Part 4 The Roadmap to How the VA Rates Your Claim Intent to File How to File Decision Ready Claims DRC Fully Developed Claims FDC Standard Claims Clear and Unmistakable Error ( CUE ) Claims Compensation and Pension ( C&P ) Exam Gathering Documents Get Your Medical Files Active Duty Files VA Medical Center Files Private Medical Records VA Claims File FOIA REQUEST FOIA APPEAL FOIA Lawsuit Waiver of Filing Fee David Jacquot

2 Summons Civil Cover Sheet Military Personnel File Unit Records Joint Services Records Research Center Records Kept at JSRRC How to Make a Request of JSRRC National Archives and Records Administration (NARA) FOIA Request Addresses FOIA Request Form FOIA Appeal FOIA Lawsuit Waiver of Filing Fee Summons Civil Cover Sheet Buddy Statements Finding Buddies VA Forwarding of Messages Google Facebook, Linkedin and Other Social Media Internet People Locators Private Investigators Classified Information Prepare Your Claim Form Compensation for Dependants Narrative Sample Narrative Current Hot Issues Post-Traumatic Stress Disorder PTSD Disability Benefit Questionnaires ( DBQs ) David Jacquot

3 Review DBQ Rating Schedule for PTSD Special Forms for PTSD Traumatic Brain Injury TBI Disability Benefits Questionnaires ( DBQs ) DBQ Initial Evaluation of Residuals of Traumatic Brain Injury Initial Exam DBQ Review Evaluation of Residuals of Traumatic Brain Injury Review Exam Rating Schedule for Traumatic Brain Injuries TBI Total Disability for Individual Unemployability TDIU Index of Exhibits Sample Index File Your Claim Rating Letter Appeal Notice of Disagreement ( NOD ) Reconsideration or Traditional Review Decision Review Officer DRO Board of Veterans Appeals ( BVA ) CAVC U.S. Court of Appeals for the Federal Circuit Supreme Court APPENDIX Blank Forms Va Schedule of Rating Disabilities (VASRD) Public Disability Benefits Questionnaire (DBQs) Internal DBQs David Jacquot

4 Introduction If your health was damaged while in the service, your VA claim can be worth hundreds of thousands of dollars in a lifetime, but only if you win your claim. There is no reward for losing. Take your claim seriously and put in the work. No one cares about your claim more than you do! TM You will probably work with a veteran services officer ( VSO ), attorney, or accredited claims agent on your claim. The operative word is work. Don t just hand off your claim and hope for the best. Help the VSO help you by understanding the process and doing your homework. This guide will take you step-by-step through the claims and appeals process. Recent legislation intended to speed up the appeals process makes it vitally important that your initial claim be complete, because it limits your right to submit additional evidence on appeal. See more details in the Appeals section below. Good luck and let s get started. Can I file my claim by myself? Yes, you can file your own claim and represent yourself on appeals. However, you may want to use the services of a veteran s service officer ( VSO ), attorney, or accredited claims representative. These individuals have training in claims procedure and experience with VA claims. But, as said earlier, your claim is your responsibility, so don t just blindly delegate your claim. Page David Jacquot.

5 Where can I find a VSO, Attorney, or Accredited Claims Representative? Veteran Service Officers ( VSOs ) work for approved veterans organizations such as the Military Order of the Purple Heart, Veterans of Foreign Wars ( VFW ), the Disabled American Veterans ( DAV ), the American Legion and others. You can find a VSO, attorney or accredited claims representative in your area by going to: VSOs cannot charge a fee for representation at any state of your claim. Attorneys and accredited claims agents cannot charge a veteran for assisting with an initial claim, but can charge reasonable fees for assistance after an appeal has been filed. To appoint a representative, you will file a VA Form for VSOs and a 21-22a for attorneys and accredited claims agents. Copies of these forms are shown below and in the Appendix as Forms 1 and 2. You can make a change of representative, but it is not a good idea to just jump around. You will likely be working with your representative for years. They are your partner in collecting thousands of dollars, so choose wisely. You should interview the person and decide whether they are the right fit for you. Don t just use the VSO at the local post because you belong to it. Page David Jacquot.

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10 Recent Legislation Impact Recent legislation intended to speed up the appeals process makes it vitally important that your initial claim be complete, because it limits your right to submit additional evidence on appeal. See more details in the Appeals section below. Claims Overview A claim starts when you either file an Intent to File, or file your actual Claim, whichever is earliest. To file your claim, you will file one of three VA forms and submit evidence, such as medical records. After your claim is filed, the VA will review it and maybe ask for more evidence. Also, you will likely be scheduled for a Compensation and Pension medical exam (C & P Exam). After the evidence is gathered, a rating officer will review the file and issue a Decision Letter. If your rating is satisfactory, the process is over. If you were denied or disagree with the rating, you will file a Notice of Disagreement (NOD). The NOD must be filed within one year of the decision or the decision is final. If you file a NOD, you get the choice of going back to the same rating officer or to a more senior official called a Decision Review Officer ( DRO ). A decision will be made on your appeal. If it is unfavorable, you can file VA Form 9 and appeal the case to the Board of Veterans Appeals ( BVA ). The BVA will either hold a hearing or decide on the evidence you submit, depending on whether you request a hearing or not. The BVA will issue its decision and if you disagree the next appeal is to the Court of Appeals for Veterans Claims ( CAVC ). If you disagree with the CAVC you can file an appeal with the U.S. Circuit Court of Appeals for the Federal Circuit and then the U.S. Supreme Court. The Claims Flowchart below shows an overview of the process described above. Page David Jacquot.

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13 Burden of Proof The burden of proof is on you to win a VA claim. You must prove: You have a current disability (it can be an injury or disease), The current disability has a service connection, i.e., caused or aggravated by military service. (a combat injury is not required), and More likely than not your current disability is a result of the service connected injury or disease. Secondary Connection If your disability is service connected and causes a secondary problem, then you can be approved for the secondary problem. Example. A veteran has service connected diabetes. After leaving the service, the veteran must have a leg amputated due to complications from the diabetes. The amputated leg is service connected and the veteran can receive compensation for the leg. Know the rules of the game - Don t get ambushed! The VA has policies and procedures it must follow in handling claims. You do not need to know all of them, but you should not go into the claims process blind. The information that follows will give you two things: Page David Jacquot.

14 1. What will happen at the Compensation and Pension Exam (C&P Exam). 2. What the claims rater is looking for when rating your file. Disability Benefit Questionnaire (DBQ) The Roadmap to Needed Medical Evidence Disability Benefits Questionnaires (DBQs) are used by VA Compensation and Pension examination (C&P Exam) doctors to summarize their findings for use by the rating officers of claims. You can also have your VA primary care doctor fill out the form. Using your VA primary care doctor that is familiar with your condition may be better than using a C&P examiner who has never met you. DBQs also provide veterans with the option of visiting a private health care provider instead of a VA facility to complete their disability evaluation form. There are more than 70 DBQs to cover a wide range of disabilities, which you can download and printed for use. The VA will not pay for a private provider to conduct the medical exam. Using a private doctor that is familiar with your condition may be better than using a C&P examiner who has never met you. To find DBQs by the form name visit: For DBQs by symptom visit: Page David Jacquot.

15 There are no public DBQs for the following medical examinations: Initial Examination for Post-Traumatic Stress Disorder Hearing Loss and Tinnitus Residuals of Traumatic Brain Injury (Initial and Review) Cold Injury Residuals Prisoner of War Examination Protocol Gulf War Medical Examination General Medical Examination for Compensation Purposes General Medical Examination for Pension Purposes However, there are DBQs for these conditions that are for VA internal use. Some of them can be found in the Appendix. Although these forms cannot be completed and sent to the VA, they are useful to see what the VA is looking for, so you can provide medical records that are relevant. Additionally, they could be used as a guide for a private doctor to write a letter regarding your condition. For mental conditions, the following individuals can complete a DBQ for an initial exam: a board-certified or board-eligible psychiatrist; a licensed, doctorate-level psychologist; a doctorate-level mental health provider under the close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist; Page David Jacquot.

16 a psychiatry resident under close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist; or a clinical or counseling psychologist completing a one-year internship or residency (for purposes of a doctorate-level degree) under close supervision of a board-certified or boardeligible psychiatrist or licensed doctorate-level psychologist. To conduct a review examination for mental disorders, the examiner must meet one of the following criteria: any criteria from above; or be a licensed clinical social worker (LCSW), a nurse practitioner, a clinical nurse specialist, or a physician assistant, under close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist Once completed, veterans and/or their physicians may mail or securely fax completed DBQs to the VA Regional Office handling the Veteran's claim. To find mailing addresses, visit the VBA website at: To find fax numbers, visit the VA website at A sample DBQ for Chronic Fatigue is shown below: Page David Jacquot.

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