If you are a veteran, you are entitled to specific benefits by the government that are provided through the Department of Veterans Affairs. Veterans must go through a claims process to ensure they received the benefits that they deserve, but occasionally benefits are denied for various reasons. When veterans who are denied a claim feel that the denial was unjust, they have the right to appeal their claim. The appeals process is complex and can be very confusing.
An appeal is a formal request that a veteran can make at their servicing Veterans Affairs office. Each state has at least one Veterans Affairs offices and many states have multiple offices. Once an appeal is filed by the veteran, the Veterans Affairs office is mandated by law to research the claim and make a decision to overturn or sustain the original claim denial.
There may be many different reasons why the Veterans Affairs office may have originally denied a claim, but there are two common reasons. The most common reason for denial is that the Veterans Affairs office may have believed that the disability was not incurred during military service. The other common reason for denial is that the Veterans Affairs office rated the disability below what the veteran believed it was. However, the veteran can appeal to the Board of Veterans’ Appeals for any reason. It is illegal for any entity to deny the appeals process to a veteran.
To start the appeals process, the veteran must file a claim. A claim can be filed at any Veterans Affairs office, Veterans Affairs medical facility, or on the Internet. The claim form can be daunting and confusing, so veterans are encouraged to ask for assistance from organizations such as the American Legion, the Disabled American Veterans organization, attorneys, or other agents recognized by the Veterans Affairs. We have compiled a list of chartered and non-chartered veteran service organizations which can be found here. We highly advise you get help.
The Veterans Affairs office that the claim is filed with will make a decision on the claim and send the veteran their decision in the mail. The time that this process takes varies based on location. If the claim is accepted, there is no further action required by the veteran.
However, if the claim is denied, the veteran has the right to appeal the decision. The first step in the appeals process is for the veteran to file a Notice of Disagreement. A Notice of Disagreement is a formal statement by the veteran that they do not agree with a claims decision and it is sent to the Veterans Affairs office that denied the claim. A Notice of Disagreement must be sent to the Veterans Affairs office within one year of the date that the claim was denied.
Once the Veterans Affairs office receives the Notice of Disagreement, they will create a Statement of the Case. The Statement of the Case is drafted by the Decision Review Officer at the Veterans Affairs office that denied the claim. They are a second party who did not have any part in the decision to deny the original claim. The veteran has the right to request a personal meeting with a Decision Review Officer.
The Decision Review Officer will mail an explanation of denial, including the regulations and evidence that was used by the Veterans Affairs office when denying the original claim. If the veteran still feels that the claim denial was unjust after receiving this information, the veteran may file a Substantive Appeal (VA Form 9) to the Veterans Affairs office that denied the claim. A VA Form 9 will be included in the mailed package and it can also be found online.
The Substantive Appeal must be sent back to the Veterans Affairs office that denied the claim within 60 days of when the explanation of denial was sent by the Veterans Affairs office or within one year of the date that claim was originally denied, whichever is later. The Substantive Appeal must include the veteran’s justification for appealing the denied claim.
The veteran has the right to request a personal hearing when they file the Substantive Appeal. A personal hearing is a formal meeting between the veteran and the representative from the Veterans Affairs who will decide the outcome of the appeal. The veteran has the right to have a representative acting on their behalf, such as an attorney, present.
A personal hearing provides the veteran and their representatives the opportunity to meet face-to-face with the appeals board to personally make their case and provide additional evidence. Personal hearings vary and can be conducted in person or through videoconferencing. Personal hearings may also require that the veteran travel. However, videoconferencing oftentimes is the preferred method as opposed to requiring veterans to travel.
A typical personal hearing will start with all parties introducing themselves followed by the Board Member ensuring that all parties understand the claim and why it is being appealed. All parties who testify will be required to take an oath to tell the truth before they are able to provide any testimony. All parties will make their cases to the Board Member, who will make the final decision.
The final decision will not be made that day. The Board Member may take some time to make a final decision, which will come in one of three forms: allow, deny or remand. An allow decision means that the Board Member has ruled in favor of the veteran and their claim will be honored. A deny decision means that the Board Member has ruled against the veteran and the original denial will be upheld. A remand decision means that the Board Member was unable to allow or deny the appeal, usually because insufficient evidence was presented. The veteran will be required to present further evidence that is requested by the Board Member to make a final ruling.
In the event that the appeal is denied and the veteran does not agree with the decision, they have three options. The first is to go back to the Veterans Affairs office and have their claim reopened for review. The second option is to file a motion with the Board Member to review the case again due to a clear and unmistakable error. Lastly, the veteran has the right to further appeal the decision to the U.S. Court of Appeals for Veterans Claims.