IS IT WORTH FILING A CLAIM MYSELF?
If you aren't confident you can do everything on your own, then you
should look for an advocate. Let’s assume you are going to represent
yourself in this claim. Before you file, you'll need to understand the
Eligible Military Service: You must have done military service, and you must have a discharge that is other than dishonorable. If your discharge is other than honorable but not dishonorable, you may be qualified for only some types of benefits.
Current “Condition”: You must have a current injury or illness (condition) that can be connected to your military service. This means that you should have a fairly clear diagnosis. It should be stated in a medical record prepared by a qualified healthcare provider (preferably a doctor). The more precisely defined the condition is in the record, the better.
Evidence: The best evidence is an event that is recorded in a Service Medical Record (SMR). This is a detailed description of the cause of the injury or illness leading to your condition, how it was treated, and any residual effects of the event. If the condition is related to a non-combat event, you will need documentation clear enough to prove that your current condition is connected to the in-service event. Called ”Service Connection" or “Nexus
Getting Your Claim Processed Favorably and Quickly: Some Helpful Hints
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 YOUR APPOINTMENTS
(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.
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.
Visit www.VADisabilityAdvocate.com or Call 702-209-5722
for your free consultation.