Getting Your VA Claim Processed – The Simple Truths

Written by Catherine Trombley

After serving for several years in the Air Force, I worked at the Board of Veterans Appeals advocating on behalf of Vets as an appeals representative.

In that time, I saw all kinds of claims. As a result, I learned that there were certain truths and methods that many veterans did not know about. As I talked my veterans through the process, I often shared some simple truths. And now that I work for the Veterans Benefits Administration at VA, I’d like to share them with you.

Simple Truth #1: Make your claim easy to approve

As a veterans representative, it was most difficult to move a claim through the process when it was submitted with no evidence to go with it. Sometimes I would get claims for “leg condition” or “back pain,” leaving me with nothing but questions: Which leg? What part of the leg? What is the actual condition causing back pain? Too many times, there were no medical records to show a diagnosis, or worse, nothing that would tell VA where to look for medical records.

When I would talk with the veteran, I often found that the veteran did not understand that he or she needed to submit supporting evidence. That’s understandable, because of complex legal requirements for compensation claims. So I often explained that the best way to get a claim granted is to make it easier for VA to grant it, or easier for your representative to help you.

Simple Truth #2: Tell VA where to find evidence

Sometimes I hear people say that VA will develop your claim to the fullest and you just have to file it. But you have to tell VA where to look. If you don’t, it can be like looking for a needle in a haystack of Federal agencies, each with its own set of records. And if veterans don’t tell VA where their records are, we may not know where to find them. This becomes even more important if you’ve received treatment from a private sector doctor.

Simple Truth #3: Often, you can obtain evidence easier than VA

Usually, veterans can get evidence about their own history more easily than VA can. Private medical records are a good example of this, since VA cannot compensate private medical providers for records. We have a duty to assist the veteran in finding evidence, but it can take a lot longer. If you do not at least tell them where the evidence is, it becomes much harder to find and less likely VA will be able to obtain it and grant your claim. To put it another way, if it was hard for me as a veterans representative, it was hard for VA.

Simple Truth #4: YOU MUST GO TO THAT APPOINTMENT (this is true of any claim)

VA sends you for an exam to obtain updated medical evidence or a nexus opinion stating the condition is indeed due to service. If VA does not get this information, it may not give you the correct rating, or worse, deny the claim. We expedite exams for veterans using the FDC program. However, submitting a Disability Benefits Questionnaire (DBQ) with your FDC would satisfy the need for an exam and move your claim to the next stage of processing.

Simple Truth #5: Filing a fully developed claim cuts down on waiting time

It was with the four truths above in mind that VA created the Fully Developed Claims (FDC) program. The Fully Developed Claims program allows veterans more control over their claims and to serve as co-advocates with their chosen representatives. When a veteran files a claim, you submit all evidence that you can easily obtain and then certify that you have no more evidence to submit.

The claims form, cleverly called an EZ form, outlines exactly the evidence you should obtain and the evidence VA must obtain on your behalf. Generally, veterans submit private treatment records and notify VA where other records exist, like VA Medical Center records or Social Security Administration records. VA will go get Federal records and schedule you for an exam.

On average, VA spends 175 days per claim gathering evidence on the veteran’s behalf.   That is time veterans spend waiting to hear about decisions.  If that evidence is provided to VA up front, we can reduce wait time.

Trade Secret #1: Filing an FDC claim with a DBQ is like a super fully developed claim

If you have the ability to get your medical provider to fill out the DBQ form, you should. Doing so essentially means that VA only has to gather federal records. But if there are no federal records to collect, your claims will breeze through the staff that develops claims to the staff that rates claims.

Trade Secret #2: FDC can help you avoid lengthy appeals

For veterans who filed claims the traditional route, FDCs can help us avoid the appeals process. If you get your decision and are not pleased with it, you can work with your representative to get the evidence needed and ask for reconsideration as a Fully Developed Claim.  For example, veterans in Illinois are avoiding lengthy appeals by submitting reconsideration requests as an FDC.

Nothing is more helpful for getting the benefits you earned and deserve than your participation in the claims process. VA owes you a transparent and streamlined process, but that process can be made more difficult and cumbersome without your involvement. With that in mind, here is my final truth: If you want your claim processed in 110 days and to have less of a reason to appeal, participate in the process with your representative and file a Fully Developed Claim.

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Written by Catherine Trombley
From www.blogs.va.gov

Cat Trombley is a communications specialist with the Veterans Benefits Administration. Prior to working for VA, she was an assistant director with one of the Veteran Service Organizations and represented veterans before the Board of Veteran Appeals.  She is also an Air Force veteran.

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  • Angel L Martinez

    I have done all of this but for some reason my records magically disappeared or they tell me I never submitted nothing. I am homeless with a 4 month old daughter that I now cant see because of my economic situation. I am 40% disable but my condition has gotten worse with time I now need surgery to repair my shoulders. I was laid off from a Federal job last year in June 06, 2011 due to my disability and ever since then I have been trying to get help and increase my compensation to temporary 100% until I get surgery and I am able to gain and maintain employment. I am in a really bad stage of depression because of this often think about taking my life and VA just dont care they make everything so difficult. Please i am sing you for help I cant live like this no more. I cant even go to the VA medical center because I have no money at all. I jump from house to house or simply sleep outside in the street.

  • asknod

    Unfortunately Ms. Trombley overlooks one glaring fact. VA has a habit of failing to go after that which you inform them of. I gave VA the name , location and everything but the GPS coordinates of the civilian hospital I was in during the Vietnam Boundary dispute. Six times. In the 21-526, in my Hearing at the RO, in my SOC, in my SSOC and in evidence submitted to the BVA on appeal. Results? Negative. They said the records they had were adequate. At what point will it occur that VA will not feel sufficiently motivated to even query St. Louis’ NPRC over your STRs?
    As for DBQs, I suggest Ms. Trombley, an admitted Veterans Service Representative, look carefully and tell us where the space is for the doctor’s nexus? There is none. Nevertheless, we are admonished to provide a) proof of current disease/injury; proof of smae in service and doctor’s nexus letter linking the two aforementioned items. It appears the VA would prefer that they be allowed to supply the nexus. Since 85% of all compensation claims are denied, we can assume that many arrive without this. Can we blame the poor Vet for his ignorance? There are only two venues for compensation claims. Either you DIY or you allow a VSO to represent you. I have had three and none proffered the need for the nexus. I did it myself the fourth time and won everything at the RO without an appeal (100%+40% +10%). I finally wrote a book about it to show other Vets why they lose (asknod.org) Ms. Trombley would do us all a great favor if she more clearly identified why a fast track claim is better. DBQs simply take the VA off the hook for assembling the claim. It does nothing to ensure success and may be more harmful in its present configuration. Stick with the guaranteed requirements of the Caluza triangle above. Lack of nexus sinks more claims than any other factor and Vets are not apprised of it until they get good legal representation.
    Considering this is a non adversarial venue in which to present our claims. I would hope Ms. Trombley can explain why the BVA needs a phalanx of 500 lawyers against unrepresented Vets or even VSOs with no juris doctor degree. Veteran friendly? Yes. They smile when they deny. If we’d just give them more evidence, we’d win? No one has explained why there are so many deadbeat Vets filing claims. One can only assume that from the horrific denial statistics.

    As for accuracy in claims decisions, by who’s measurement is it 86%? When the fox is in charge of the hen house and egg production, one must look more closely at the purported statistics. Entrusting that measurement to the selfsame fellows who work there is not scientifically or statistically defensible.

  • rmc

    i submitted a claim with evidence and a nexus letter, I just found out that the va still requested internally a medical opinion. I have been waiting nearly 2 years. I submitted a fully developed claim, but I guess I don’t know what they consider a fully developed claim