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Understanding Claims

Understanding Claims

A claim is an application seeking benefits of the Department of Veterans Affairs – as defined by the Code of Federal Regulations 38 C.F.R, Chapter 1, Part 3.

How to File a Claim

Our Benefits Advisors are available statewide to represent you in filing an appeal on your current rating decision. These services are free of charge and our Benefits Advisors are all Veterans who have chosen to serve their fellow Veterans and Veteran families. All our Benefits Advisors are well versed on communicating your unique situation to the VA efficiently and effectively. Let us do what we do best. Serve you.

Checklist to File a Claim

Claim for disability benefits (Compensation)

  1. Copy of DD-214 (Member 4 Copy)
  2. Copy of Service Medical Record/Service Treatment Record (if available)
  3. Copy of any private medical records (if any outside care completed)

Claim for disability pension (Pension)

An individual (veteran) must have served during a recognized period of war to receive the benefit, and it is subject to income limitations.

  1. Copy of DD-214
  2. All necessary income and asset information (for all members of a household)
  3. If under 65, any military, VA, SSA, or private records showing disability or inability to work.

Claim for Special Monthly Compensation/Pension (SMC/SMP)

  1. Healthcare provider is required to complete VA Form 21-2680 to submit with application to show a need for assistance with activities of daily living (ADL’s).

How to File a Claim

To file a claim with the Department of Veterans Benefits Administration (VBA):

  1. The first step to filing a claim for an individual should be completing what is known as an “Intent to File” (VA Form 21-0966). This document will preserve a date of claim for up to one year (364 days) from the date of receipt by the VA. The VA WILL NOT recognize more than one intent to file concurrently (back to the date of filing) for the same benefit (i.e.- Compensation, Pension) (38 C.F.R. ⸹3.155(b)(6)).
  2. If the claimant intends to have representation by an advocacy organization (i.e. Texas Veterans Commission), the Veterans Service Organization (VSO) must be appointed by that individual by completing a VA Form 21-22.
  3. The next step would be to complete the actual “claim” document for the claim being sought. The actual form used will vary depending upon the benefit being sought:
    1. 21-526ez, Application for Disability Compensation & Related Compensation Benefits
    2. 21P-527ez, Application for Pension
    3. 21-686, Declaration of Status of Dependents
    4. Etc. as applicable

* Note – Ensure that you are using the correct and most current and up-to-date forms as the VA will often deny or reject forms submitted on outdated forms.

Claims Process

After you have applied or submitted your claim, there are eight distinct steps that most claims for disability compensation follow. These phases may vary in time depending on the complexity of the claim, the amount of evidence that must be gathered to support the claims, and the type of evidence. You are strongly encouraged to submit as much evidence as possible with your claim to help minimize processing time. This also helps to make your claim as much of a fully-developed claim (FDC) as possible. The eight steps of claims processing are as follows:

  1. Claim Received
    Your claim has been received by the VA. If you applied online with E-Benefits, you should see receipt in your list of Open Claims within one hour. If you applied through the U.S. mail, please allow mailing time plus processing to record receipt of your claim.
  2. Under Review
    Your claim has been assigned to a Veterans Service Representative and is being reviewed to determine if additional evidence is needed. If the VA does not need any additional information, your claim will move directly to the Preparation for Decision phase.
  3. Gathering of Evidence
    The Veterans Service Representative will request evidence from the required sources. Requests for evidence may be made of you, a medical professional, a government agency, or another authority. It is common for claims to return to this phase, should additional evidence be required.

    This is often when Compensation and Pension (C&P) examinations occur in support of claims, which “may” be conducted by third party medical examiners of the Department of Veterans Affairs to evaluate the existence of a claimed medical condition.
  4. Review of Evidence
    VA has received all needed evidence. If, upon review, it is determined that more evidence is required, the claim will be sent back to the Gathering of Evidence phase.
  5. Preparation for Decision
    The Veterans Service Representative has recommended a decision, and is preparing required documents detailing that decision. If more evidence is required, the claim will be sent back in the process for more information or evidence.
  6. Pending Decision Approval
    The recommended decision is reviewed, and a final award approval is made. If it is determined that more evidence or information is required, the claim will be sent back in the process for more information or evidence.
  7. Preparation for Notification
    Your entire claim decision packet is prepared for mailing.
  8. Complete
    The VA has sent a decision packet to you by U.S. mail. The packet includes details of the decision or award. Please allow standard mailing time for your packet to arrive before contacting a VA call center, 1(800) 827-1000.

How long will this process take?

The length of time it takes to complete a claim depends on several factors, such as the type of claim filed, complexity of your disability or disabilities, the number of disabilities you claim, and the availability of evidence needed to decide your claim.

Compensation and Pension Examinations (C&P Exams)

As a claimant you may be requested to attend what is known as a Compensation and Pension examination. This is an examination by a third party medical examiner of the Department of Veterans Affairs to evaluate the existence and severity of a claimed medical condition.

Primary Types of Claims

The Department of Veterans Affairs has six basic types of VA disability claims:

  • Original Claim – the first claim ever filed for disability compensation.
  • Increased Claim – this is filed after an individual is already service-connected for a disability, and the claimant is filing to have their rating increased due to the disability having gotten worse.
  • Special Claim – this is a claim for special needs associated to their service-connected disability, to include but not be limited to:
    1. Specially equipped vehicle due to the service-connected disability prevents your driving, or
    2. Temporary 100% due to recovery from surgery or hospitalization of a service-connected disability, or
    3. Individual Unemployability if your service-connected disability prevents your gainful employment (providing certain criteria are met).
  • New Claim – this is a claim for benefits by a claimant for a condition or disability which has never been filed for, and is not related to any currently rated service-connected disabilities.
  • Secondary Claim – this is a claim for a disability which is linked to, or caused by an already service-connected disability.  An example of this would be a knee injury caused by an ankle injury.
  • Supplemental Claim– You can file a Supplemental Claim if you meet all of the requirements listed below. All of these must be true:
    1. VA denied your disability claim, and
    2. You didn’t file an appeal at that time, and
    3. You have new and relevant evidence (new supporting documents like a doctor’s report or medical test results) that we haven’t seen before and that’s directly related to your claim. For example, you might file a Supplemental Claim if you were treated for pain in your elbow while on active duty, but you were denied disability benefits because your VA health exam didn’t find a problem. Then 2 years later, an X-ray of your elbow showed signs of arthritis (a painful swelling and sometimes wearing down of a joint). In this case, you would need to send your new exam and X-ray results to us as new evidence related to the claim.


How does a claim get expedited, or prioritized?

Certain criteria must be met for a veteran’s claim to be “flashed” or expedited for claim processing.  Although many calls are received by the VA requesting to expedite a claim, evidence is needed to do so for the following reasons to prioritize a claim:

  • Homeless (verification of homeless services, HHS, etc.); or,
  • Extreme Financial Hardship (past due notices, or notifications of eviction/foreclosure, etc.); or,
  • Seriously Ill/Injured (Active duty); or
  • Terminally Ill (evidence from health care provider, hospice, etc.); or
  • Former Prisoner of War (FPOW); or
  • Medal of Honor/Purple Heart (MOH/PH); or
  • More than 85 years of age (typically verified with DD-214, service records); or
  • Participant in Fully-Developed Claim (FDC) program; or
  • Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s Disease.

How to Track Your Claim Status

You can track the status of your claim by either calling your Benefits Advisor or you can register for eBenefits at: www.ebenefits.va.gov, or by calling them at 1-800-827-1000. On the VA’s ASPIRE site, you can find the average processing days for the regional office that is working on your claim. To find the average processing days for your state:

  • Find your state on the map, place your cursor within the state and click
  • This will open the Veterans Benefits Administration Aspire Benefits site. Click “Enter”
  • You should see a split table. On the left table click on “Compensation”
  • This will expand the table. Approximately five rows down is “Rating Claims Processing Time”
  • Follow that row to the right until you locate the cell located within the column of your regional office.

The number you see is the average processing days to complete a claim that requires a disability rating. The average is based on completed claims since October 1, in a given fiscal year.

Frequently Asked Questions

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