Claims 101 for veteran

Discussion in 'General Claims' started by stumpy, Aug 27, 2004.

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  1. stumpy

    stumpy New Member

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    Claims 101 for veteran Was written by Networker67 who posts regularly on the Veterans Benefits Network Board and is a disabled Vet and also works for the VA. He has given me permission to repost his helpfull advice to this board. Thanks Networker67 for your assistance.

    This will be sorta long and sorry won't have any Medical Statements in it, won't tell you to have your doctor write verbatim what's in the rating schedule on your diagnosis or any of that.

    It will tell you however what happens to that 21-526, 4138, or plain peice of paper you submit to your Regional Office and the processes that poor peice of paper will be subjected too.

    When you claim initially you file what is called a VA Form 21-526 (Veterans Application for Compensation or Pension). Very long form that 21-526, asks a lot of questions, and I'll admit can be confusing even after you read the instructions 3 or more times. But no matter what you don't put on that form or choose to put on that form PLEASE SIGN IT. We gotta file cabinet full of them waiting for signatures and we gotta keep them for one year waiting for that signature. And no one seems to look at the old ones they just stuff the new files in there and close the drawer.

    Your claim goes to what is called the Development Team. From there it goes to a VSR (Veterans Service Representative), who will review your submission and figure out what it is you are claiming. When they have done that they prepare what we call a DUTY TO ASSIST LETTER (DTA). That letter explains what we think you are claiming, what the requirements are to support that claim, and what we need from you to process your claim.

    1. NEVER ASSUME VA Knows anything because you go to the VA Hospital for all your treatment. We REALLY don't know unless you tell us when and where you recieved the treatment.

    2. If you are treated by a private doctor and you want VA to obtain those records to support your claim. By law we must assist you in doing so, you must complete the VA Form 4142, so we can request the records. Due to the privacy act, you must complete ONE VA Form 4142 for each doctor that has treated you.

    3. If your treatment is SOLELY at VAMC's complete a listing of the approximate dates and locations. You don't have to be very specific, but please be specific enough so that a record pull from the VAMC gets the TREATMENT RECORDS RELEVANT TO YOUR CLAIM.

    4. If your service has never been verified by VA, always send a copy of your DD 214 or Separation Documents.

    5. If what your DTA says you are claiming is not what you thought you were claiming do not hesitiate to WRITE and get clarification on this issue. I say WRITE because VSR's that work the phones do not have access to your actual C-FILE. So this is one of those things that is very difficult to get resolved in a phone call.

    6. If you need more time to obtain something that is requested, PLEASE WRITE and request MORE TIME. That request can be done over the phone, but I DO NOT RECOMMEND IT.

    7. No matter how silly those letters sound and trust me I send them daily. Please respond to whatever silly thing they are asking for. What might seem silly to you might be the reason the VSR can't get your claim out of development.

    While Development is in process you may or may not be scheduled for a VA Exam. If you are scheduled PLEASE do everything within your power to make that exam. Should by circumstance you can't make it, call the number on that letter. If you don't have that number handy, call the toll-free number and explain, BUT WRITE AND SAY you missed the exam and REQUEST ANOTHER ONE. Even if you called WRITE A LETTER.

    Do not gamble that the call note made it to the development team. Many do and just as many do not

    Once that report from the C&P is received and we have your private records along with everything else that was requested or needed. Your file is sent to the Rating Board. There at some point in time a Rating Decision will be made.

    When that decision is made, your file goes to Adjudication. Here the rating data is inputed and hopefully loose ends are tied up. When I say loose ends, a lot of veterans do not think it important when they filled out the 21-526, to LIST THEIR WIVES SSN. Well if you got rated over 30%, her number becomes important, you get more compensation. Same goes for information about your children under 18. Many people in Adjudication will try and use the phone for this information. By law we cannot be specific on an Answering Machine.

    Once it is inputted and the Award or Inability to Grant letter is generated it goes to authorization to final check the work. Once authorized if there are no deferred issues the file is stored. If the rating authority deferred an issue and it will say that on the rating. The file is returned to DEVELOPMENT to Develop the deferred issue.

    If you have a deferred issue

    Read why it was defered, and make sure you don't have anything to add.

    If you have gotten married or other dependent issues

    If you have gotten married from the time you filed your claim to the time it was awarded. No Problem send us the documents, we'll cheerfully add the dependents. If you have gotten divorced and your initial award was processed with your wife, tell us so we can remove her. If you have children over 18 but under 23 and IN COLLEGE or other VA Approved Higher Education programs, tell us we will cheerfully add the dependents.

    In closing the claim process is really 5 steps: How fast a file goes through those steps is up to the Veteran and the Office Processing the Claim. I placed the veteran first, because if the veteran sends what is requested, follows up that it was received, and makes his exams. His file will move through those steps VERY QUICKLY.

    But if the VETERAN, doesn't respond to letters, and brings all his treatment records to his C & P Exam, well all I can say is WE WILL EVENTUALLY GET IT SORTED OUT AND RATED.

    If you are seeking increased benefits: the following applies but add this peice of advisement.

    Carefully document your VA Treatment on a 4138. Dates and locations, ONLY LIST DATES of treatment since your last rating decision. Treatment before your last rating VERY SELDOMLY is helpful. UNLESS YOU HAVE AN APPEAL PENDING OF A PRIOR DECISION that needs these records.

    If your treatment is from private doctors THERE IS NO RULE THAT SAYS WE CAN ONLY USE RECORDS WE OBTAIN. The Rule says we have to assist you in getting them. I said that to say if you are seeking increase GET THE RECORDS AND SEND THEM IF YOU CAN. VA getting the records is a 30 to 60 day process. You getting them 7 of 10 is a matter of just asking for the reports from day 1 to day so and so.

    And like with VA Treatment Records, we don't need any records that are before your last rating. Again very seldomly will these records result in an increase. UNLESS YOU HAVE AN APPEAL PENDING OF A PRIOR DECISION that needs these records.

    If you have an appeal pending and you are seeking increase in a condition that is the subject of a pending appeal. TELL THE VA WHEN you first file that new claim for increase.

    PS At your exam tell the doctor more of the effect of your condition on your life and daily activity and less it hurts when he examines you. The purpose of the C and P is to determine the effect of disability on lifestyle, daily activity, and most important ability to pursue meaningful gainful employment. Not how much you hurt on that day.

    If anyone was offended I apologize in advance. But it gets frustrating to see claims that are held up because and ONLY because we waiting 60 days for the veteran to answer. And then add this 60 days into the FIVE processes above and you get 300 days of delay. And that is why averages are running almost a year NATIONWIDE.

    SSGTVOL Super Moderator Staff Member

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