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Steps In The Claims Process Questions?

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retiredat44

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Steps in the claims process questions?

Is thyere a chart somewhere with the steps?

I am curious..

there is the claim, then if denied, there is the NOD, if denied, there is a hearing..

but in between the NOD and hearing there is a DRO (review)?

Who does the review, and does anyone ask you questions? or is it still a one way process where the process just pushes you around with no ability to interact and talk to anyone asking questions or caliry anything?

How does the DRO work and when?

I have a couple questions and statements that could clear a couple things up, and one would think the VA would welcome clarity and understanding and not make things worse with this unfair process..

ok, a little update:

I read this:

"The VA’s highest appellate body is the Board of Veterans’ Appeals, (BVA) located in Washington, D.C. If you do not request a DRO review in your Notice Of Disagreement, the VA will send you and your representative, if any, a letter that acknowledges receipt of your NOD and asks whether you desire a DRO review or would rather have your appeal forwarded to the BVA for consideration. "

So Does This Mean That:

They will ask me if I would like to do a DRO, and ask questions/make statements before the hearing?

Wil I then be able to ask why they only look at part of the evidence, and expalin to them the part they totally ignored?

thanx,

I appreciate this,,

I am stil totally baflled why they overlooked or purposley never addressed al the evidence. I am desperately wanting ot ask them why they ignored it.. I find it criminal for them to have done such an outrageous mistake.. and am dying ot find out how such a blunder was not corrected..

Edited by retiredat44
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as I understand it, the first step after nod denial, is then DRO, then BVA.. so I am going to use these steps..

now I am confusesd how I confused you??

if I did not use the DRO step, I would have missed that opportunity... and went straight to BVA..

retired,

Well of course I would not suggest not having a DRO/ Hearing - it's of utmost importance

to keep your claims at the VARO level to try and get the issues sorted out there.

The way you confused me is actually quite clear in what you posted earlier,

" I called my rep from the American Legion, and asked her about the DRO and BVA hearing, she said, yes, I can do it, and whiel I am unclear how much it could delay the BVA video hearing.. I chose to have both the DRO and BVA hearing.. after all if I win at the DRO, there wil be no reson to go to BVA, but if I lose the DRO, I wil stil have the BVA.. I signed the for for it.. and faxed it back to her.."

It doesn't work that way, when your dealing with the same claim issues.

You can't have a request in for a DRO/Hearing and a Form 9 (I-9) in at the same time.

This is how it goes:

Lets say:

1) Vet files claim on Jan 1990

2) VBA promulgates a rating decision that is a denial dated Jan 1991

3) Vet files a timely NOD (within one year of said rating decision) dated July 1991.

Vet tells VBA -

a) I want a DRO De Novo Review

or

b) I want a DRO Hearing

4) About 6 - 18 months goes by and VBA notifies vet they have scheduled

a BVA Hearing for them to attend and that they are entitled to get representation

if they so desire. The DRO Hearing is scheduled for Dec. 1992.

5) After the DRO Hearing, the DRO decides some additional development is needed

and an additional C&P exam is scheduled for the vet in May 1992.

6) The DRO promulgates a new decision in March 1993 (probably a SOC) that is a rubber stamped

denial of the prior denial. Additional information the vet receives with this is a Form 9

Appeal to the Board of Veterans Appeals, with instructions on how to file this substantive appeal

along with the time limits in which to file it.

7) In April 1993 Vet files Form 9 substantive Appeal to the Board of Veterans Appeals (and hopefully

VSO does a Form 8 along with this,) and hopefully the vet and/or VSO requests either a BVA video conference hearing

or a BVA travel board hearing.

8) The VARO does a little more work getting the file in order and buttoning up their denials

makes sure a VCAA form was sent to the claimant, etc...

And for now the claim just sits and sits and sits at the VARO - until the BVA tells the VARO to

transfer your file to them.

9) By now it's around September 1994 - the BVA has your claim under their jurisdiction and assigns

it a docket number. The BVA is aware you have requested a BVA Hearing.

In February 1995 the veteran receives a letter from the BVA stating they will schedule your BVA Hearing

as soon as possible, but Hearing are scheduled in the order they are received (going by docket number).

They will notify you when the Hearing is scheduled and you have the right to continue submitting additional

information and evidence right up until a decision is made.

The veteran continues to amass additional information and evidence and sends it into the BVA

to continue to help support their claim.

10) In June 1996 the veteran/VSO receive notice that a DRO Hearing has been scheduled at their local VARO.

The Hearing date is scheduled for August 1996 and that you are responsible for your own expenses to attend the

Hearing as they can not pay for your transportation.

11) Vet / VSO attend BVA Hearing June 1996. The Hearing is recorded and lasts one hour.

At the Hearing all of your file is sitting either next to or behind the BVA Administrative Law Judge,

but he never touches it although he does smile nicely and appears to write a few notes.

The Hearing is concluded and if it has been requested you or your VSO will get a written copy

of the Hearing transcripts.

12) December 1996 the vet / vso receives a big manila envelope in the mail.

It's a written copy of the Hearing transcripts.

13) July 1997 vet / vso get another manilla envelope in the mail, finally an decision from

the BVA, or so they thought. It (hypothetically) reads something like this.

Order:

Issue -

1) The claim for Hearing loss is granted as service connected. The available medical evidence shows

air conduction at XXX, pure tone at XXX, speech recognition at XXX. According to the tables

in 38 CFR Part 4 - Hearing loss is evaluated at zero percent.

2) The claim for Tinnitus remains denied. The examiner stated the veteran relates he has

experienced Tinnitus a time or two in his life, but the SMR's revealed no acoustical trauma on active duty

and the Tinnitus is non-recurrent. It is the examiner's opinion that the veterans rare symptoms of Tinnitus

are less likely than not related to any active duty experience.

3) The claim for TDIU is denied as the veteran does not meet the criteria shown in 38 CFR 4.16

and has not been found to be unable to hold substantial gainful employment.

Remanded Issues:

The issue of gunshot wound to the second index finger right hand is remanded to the AOJ / VARO.

Although the veteran has submitted additional evidence to the BVA, showing this injury may have

been sustained while on active duty, this evidence has not yet been considered by the

Agency of Original Jurisdiction / VARO.

The veteran has at no time submitted a Waiver of AOJ or VARO consideration.

For this reason the issue of gunshot wound second index finger right hand is remanded.

1) Here they type in the remand instructions.

2) Here they apprise the AOJ / VARO that all BVA remands are to be given expeditious treatment,

38 USC XXX, 38 CFR XXXX, etc....

retired,

Sorry to hit you up with this crummy news, but this is the way I know it to go

because me and many claimants I have helped - have lived it.

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I read what you wrote and am confused, I really need things in simple form, I have been sick to long to go through a maze..

sorry, I don't mean you puposely made it a maze, but I need it simplified..

I have al the evidence right now.. the evidence was ignored. I need to contront those repsonsible to find out why it was ignored..

i was sick on active duty with the issues I am claiming..

I continue to get sicker..

I have the documents..

I have the IMHO

I am already rated 50% for the undelying causes..

When I orignally signed the form 9 (think,, it was..)

asking for the BVA, I for some reason didn't get clairity on going to both the DRO asnd BVA,

and thinking it through I had it changed to both a DRO and BVA, I don't want to throw a way a chance at one more opportunity..

what is wrong with that??

I appreciate your help, but I have to understand it to give a better reponse..

being really sick sucks because every decision is hard, hoping that the fog of illnesses doesn't causes more problems..

I feel that no one else can help me because they have no clue what it like to be in a fight while very sick.. they just have the passion needed not the patience..

at 5pm they can go home and live their life, I can't leave illness at 5pm..

retired,

Well of course I would not suggest not having a DRO/ Hearing - it's of utmost importance

to keep your claims at the VARO level to try and get the issues sorted out there.

The way you confused me is actually quite clear in what you posted earlier,

" I called my rep from the American Legion, and asked her about the DRO and BVA hearing, she said, yes, I can do it, and whiel I am unclear how much it could delay the BVA video hearing.. I chose to have both the DRO and BVA hearing.. after all if I win at the DRO, there wil be no reson to go to BVA, but if I lose the DRO, I wil stil have the BVA.. I signed the for for it.. and faxed it back to her.."

It doesn't work that way, when your dealing with the same claim issues.

You can't have a request in for a DRO/Hearing and a Form 9 (I-9) in at the same time.

This is how it goes:

Lets say:

1) Vet files claim on Jan 1990

2) VBA promulgates a rating decision that is a denial dated Jan 1991

3) Vet files a timely NOD (within one year of said rating decision) dated July 1991.

Vet tells VBA -

a) I want a DRO De Novo Review

or

b) I want a DRO Hearing

4) About 6 - 18 months goes by and VBA notifies vet they have scheduled

a BVA Hearing for them to attend and that they are entitled to get representation

if they so desire. The DRO Hearing is scheduled for Dec. 1992.

5) After the DRO Hearing, the DRO decides some additional development is needed

and an additional C&P exam is scheduled for the vet in May 1992.

6) The DRO promulgates a new decision in March 1993 (probably a SOC) that is a rubber stamped

denial of the prior denial. Additional information the vet receives with this is a Form 9

Appeal to the Board of Veterans Appeals, with instructions on how to file this substantive appeal

along with the time limits in which to file it.

7) In April 1993 Vet files Form 9 substantive Appeal to the Board of Veterans Appeals (and hopefully

VSO does a Form 8 along with this,) and hopefully the vet and/or VSO requests either a BVA video conference hearing

or a BVA travel board hearing.

8) The VARO does a little more work getting the file in order and buttoning up their denials

makes sure a VCAA form was sent to the claimant, etc...

And for now the claim just sits and sits and sits at the VARO - until the BVA tells the VARO to

transfer your file to them.

9) By now it's around September 1994 - the BVA has your claim under their jurisdiction and assigns

it a docket number. The BVA is aware you have requested a BVA Hearing.

In February 1995 the veteran receives a letter from the BVA stating they will schedule your BVA Hearing

as soon as possible, but Hearing are scheduled in the order they are received (going by docket number).

They will notify you when the Hearing is scheduled and you have the right to continue submitting additional

information and evidence right up until a decision is made.

The veteran continues to amass additional information and evidence and sends it into the BVA

to continue to help support their claim.

10) In June 1996 the veteran/VSO receive notice that a DRO Hearing has been scheduled at their local VARO.

The Hearing date is scheduled for August 1996 and that you are responsible for your own expenses to attend the

Hearing as they can not pay for your transportation.

11) Vet / VSO attend BVA Hearing June 1996. The Hearing is recorded and lasts one hour.

At the Hearing all of your file is sitting either next to or behind the BVA Administrative Law Judge,

but he never touches it although he does smile nicely and appears to write a few notes.

The Hearing is concluded and if it has been requested you or your VSO will get a written copy

of the Hearing transcripts.

12) December 1996 the vet / vso receives a big manila envelope in the mail.

It's a written copy of the Hearing transcripts.

13) July 1997 vet / vso get another manilla envelope in the mail, finally an decision from

the BVA, or so they thought. It (hypothetically) reads something like this.

Order:

Issue -

1) The claim for Hearing loss is granted as service connected. The available medical evidence shows

air conduction at XXX, pure tone at XXX, speech recognition at XXX. According to the tables

in 38 CFR Part 4 - Hearing loss is evaluated at zero percent.

2) The claim for Tinnitus remains denied. The examiner stated the veteran relates he has

experienced Tinnitus a time or two in his life, but the SMR's revealed no acoustical trauma on active duty

and the Tinnitus is non-recurrent. It is the examiner's opinion that the veterans rare symptoms of Tinnitus

are less likely than not related to any active duty experience.

3) The claim for TDIU is denied as the veteran does not meet the criteria shown in 38 CFR 4.16

and has not been found to be unable to hold substantial gainful employment.

Remanded Issues:

The issue of gunshot wound to the second index finger right hand is remanded to the AOJ / VARO.

Although the veteran has submitted additional evidence to the BVA, showing this injury may have

been sustained while on active duty, this evidence has not yet been considered by the

Agency of Original Jurisdiction / VARO.

The veteran has at no time submitted a Waiver of AOJ or VARO consideration.

For this reason the issue of gunshot wound second index finger right hand is remanded.

1) Here they type in the remand instructions.

2) Here they apprise the AOJ / VARO that all BVA remands are to be given expeditious treatment,

38 USC XXX, 38 CFR XXXX, etc....

retired,

Sorry to hit you up with this crummy news, but this is the way I know it to go

because me and many claimants I have helped - have lived it.

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I made the same choice when I filed my Form 9. I chose a BVA hearing in Washington, DC.

The Buffalo Regional Office also included a form with which I could request a DRO hearing in addition to the BVA hearing. I chose to add the DRO hearing. My understanding of this process from talking with my VSO is that I will attend a DRO hearing, the DRO will make changes to the decision if he/she sees fit. Following the hearing, I will be issued a new decision and a Supplemental Statement of the Case. Then, and only then, if everything is not granted, I can accept the DRO decision or decide to continue with the appeal to the BVA. If I decide to continue the appeal, the appeal will then be certified to the BVA.

I agree with everything Carlie said, especially the part about keeping the claim in the RO as long as possible. Good luck in your quest!

Edited by JustPLS
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What you said is exactly what I am doing..

I made the same choice when I filed my Form 9. I chose a BVA hearing in Washington, DC.

The Buffalo Regional Office also included a form with which I could request a DRO hearing in addition to the BVA hearing. I chose to add the DRO hearing. My understanding of this process from talking with my VSO is that I will attend a DRO hearing, the DRO will make changes to the decision if he/she sees fit. Following the hearing, I will be issued a new decision and a Supplemental Statement of the Case. Then, and only then, if everything is not granted, I can accept the DRO decision or decide to continue with the appeal to the BVA. If I decide to continue the appeal, the appeal will then be certified to the BVA.

I agree with everything Carlie said, especially the part about keeping the claim in the RO as long as possible. Good luck in your quest!

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Retired, as I said before take a look at this link to a little publication by the BVA

http://www.bva.va.gov/docs/Pamphlets/010202A.pdf it is an illustrated little booklet that is very simple of the

claim/appeal process. It will help you understand clearly what is happening and will happen with your appeal.

Good Luck to you!

Edited by stillhere
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I read what you wrote and am confused, I really need things in simple form, I have been sick to long to go through a maze..

sorry, I don't mean you puposely made it a maze, but I need it simplified..

I am sick too, but I took the time in my last post to simply post the steps for you

in regards to a DRO and a BVA.

If you have requested a DRO hearing - which is an APPEAL - then your APPEAL is still at the local level.

The BVA CAN'T EVEN ACCEPT YOUR APPEAL to them yet - BECAUSE you have APPEALED at the local

level by requesting a DRO Hearing.

You CAN NOT HAVE an APPEAL going at BOTH levels at the same time, on the same issues !

In other words - while you are waiting for your DRO Hearing, you are not also at this same time

waiting on anything at all, to do with the BVA on your claim, because your claim is under the jurisdiction

of the VARO.

Your claim can not be waiting in line at both levels on the same issues.

The BVA can not accept nor take action on your Form 9 (Substantive Appeal) to be under their jurisdiction

until AFTER your APPEAL at the local level has been adjudicated.

Your claim can not even start waiting in line for any action at the BVA

until it has finished at the local level.

I have put it as simple as I know how to.

If what I've posted is wrong, someone will come along and correct it.

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