The Appeal Process, Steps

[Guest jangrin]

If there is someone who feels comfortable in giving a synopsis of what happens in the claim process if the initial claim is denied and the veteran elects to appeal the decision to the BVA. What is the process the veteran needs to do to have the claim looked at by the BVA.

Maybe someone could go through process of asking for an RO review (?) or NOD (?) as well. Time limits etc. We are trying to decide which way we will go when we appeal the findings on the initial claim.

It would be nice to be able to keep this post as a reference for use later.

Thank you very much.

[Guest jangrin]

Lets say a veteran had filed multiple "conditions" on his claim and he just got his rating notification from the VARO. In the rating decision the veteran believes that there were some issues that were not rated correctly.

Can a veteran appeal one condition and ask for a reconsideration on something else at the same time? Can some issues be worked right away then the other issues be worked as the vetran developes the information or addtional evidense.

My husbands claim had so many conditions that were listed as primary or secondary I am absolutely sure we will disagree with some of the findings. Some things we will have addtional evidence for right away, others we won't and we will have to develop. Are there any options for this scenerio?

Jangrin

Edited January 14, 2007 by jangrin

[Philip Rogers]

Jangrin - I'm going to add my 2 cents, here. Generally the VA can only do one thing at a time. Bear in mind they are "end product" oriented, meaning the file moves from the in-box to the out-box, not whether the job is done right in the moving process. A reconsideration, to me, is a complete waste of time. The reviewer generally doesn't go any further reviewing than the previous decision. They assume the previous party did everything correctly. I used the DRO system about 10 yrs ago, when it began, and made gains each time there, eventually getting TDIU, however, I also had an appeal into the BVA and won 100% schedular, back to my original claim date. BVA appeals are frequently remanded back to the RO, for further development, due to a lack of original development. This is where much of the delay happens. Actually, we are at their mercy. Hopefully this lawyer rep thing will remain but who knows.

You've received some excellent advice from very knowledgable people here but the VA is the VA.

The aforementioned are just my experiences and they are years old. The VA has learned from the Insurance industry to deny, deny, deny, thereby delaying, delaying, delaying payment. They know eventually many will give up and the VA wins. I believe it is intentional but then what do I know! jmo

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[Vike17]

Jangrin,

The short answer to your question is, yes, you can request a reconsideration on some things and file a NOD on other conditions with a rating decsion addressing multiple issues.

Philip,

While it is true the VA works towards the "End Product," they also, believe it or not, try to make as few as mistakes as possible because this will ultimately have an affect on the decision makers bonuses. VA is very bonus driven. By this I mean VA employees receive pay bonuses when they meet their production quotas and when they make quality decisions. Many claims decisions are reviewed by what is called a Quality control review where a certain amount of claims folders per regional office per year are pulled and reviewd by the Central Office in Washington, D.C. for quality and accuracy. Furthermore, if a claimant appeals a decision to a DRO and the DRO finds errors, such as CUE's, they must report those and they ultimately will reflect on the previuos decision makers record.

When VA does make mistakes and as everyone knows they make some pretty wild ones sometimes, they aren't intentional. There isn't some VSR or RVSR sitting at your regional office saying "Ok, how can I dely and deny Mr. x's claim today, I really need to stick it to him somehow!" With the enormous amount of claims pending and the production quotas applied to VA employees, mistakes are bound to happen, but they aren't intentional. Now, like I've said before, has there been that occasional VA employee that has actually denied a veterans claim intentionally and acted by themselves? Yes, there has, but there isn't a VA wide conspiracy to deny and dely veterans claim.

Vike 17

[john999]

I know from first hand experience that there are people at my VARO that do throw away claims and evidence. This was not an accident.

[Guest jangrin]

Thank you all for the answers and the various opinions. Thats what makes this websight great. Everyone can share their own experiences and can say how they feel and people do not get upset.

I have really learned a lot this week about how the claims process is suppose to work and also about our options in handling the appeals. I think it use to be a lot quicker if you filed a NOD and asked for a DRO hearing. I believe that was probably a faster way to go in getting issues resolved more quickly.

But NOW, the process is so damn sloooow any way that going straight to the BVA for the claims appeal is probably just as fast, and it seems that at least they have to go by some legal quidelines. Also at the BVA the claim is numbered and tracked for the docket even when it is remanded to the VARO and then returns to the BVA the file is placed back in line by it's file number. That is deffinately something that the VARO does not do.

It will depend on what happens when we finally get the initial claim rating from the VARO what we do. But right now other than doing a request for reconsideration on something that is blantantly obvious, I think we are leaning toward going straight to the BVA with the claim and possibly having an attorney help us with submitting addtional documentation and maybe IMO's and mailing in stuff for the records soVARO can't say they never recieved it. After all an attorney is an officer of the court unlike a claims adjuster. So if the attorney mails it in and then the VA says they lost it or never recieved it, hmmm, who would the court give more credence to, the attorney or the adjuster. I think the officer of the court. I believe we will appeal straight to the BVA for the courts system of "regulation and laws" as opposed to the VARO and their "self-regulation". For the moment the BVA just sounds like a better run ship. JMO

Just thinking out loud today. Is does get interesting.

Jangrin

Edited January 14, 2007 by jangrin

[Stretch]

Some claims, like Blue-Water AO, are put on hold with a directive from the Sec. of VA, to the detriment of health and benefits of a class of Veterans.

I can only think that the Haas Hold-Letter, from the VARO, explaining that the VA was putting claims on hold until further clarification of the Sec. of VA, was because of the agencies miss-interpretation of congressional law by the Sec. of VA in the first place.

While this may not be a conspiracy, it is a deliberate illegal act directed at a class of people, and this act has been carried on through out the entire department, as well as service organizations connected with the VA. I recieved my AO hold letter from the Veterans Service Center Manager not the Sec. of the VA.

The VA has split AO BW claims from regular claims, giving the AO cliams a code. This code is not supposed to hold up the other claims according to the AO hold directive. If the VA actually did this, then there would be more than one c-file or other claims would just be put-off. I don't know if the Veteran, can split the claims up without going through the process for each claim separately.