What is an Unadjudicated Claim

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What Are Unadjudicated Claims And How Do They Affect The Amount Of Retroactive/Back Pay Benefits? 

An unadjudicated claim refers to a claim which remains open due to an oversight in VA system. 

This can occur during different stages of a claim. In the past, (before the VA instituted mandatory application forms), claimants would often file a morass of written submissions. 

Buried in these submissions might be statements requesting service-connected benefits, constituting informal claims. Overwhelmed by all the busy text, a VA adjudicator might overlook or even ignore these informal claims.

In theory, upon the claimant’s request, these claims can be activated at any time, with a potential effective date relating back to the filing of the claim.

Unadjudicated claims can also arise during the appellate stage.  For instance, a claim will remain unadjudicated if the VA fails to issue a Statement of the Case following the timely filing of a Notice of Disagreement.

Likewise, a claim will remain unadjudicated if the Board of Veterans’ Appeals fails to adjudicate a claim following the timely filing of a Substantive Appeal.

For effective dates, unadjudicated claims can be gold mines.  Recall that effective dates are usually determined by the date of the claim.  Therefore, if you find an unadjudicated claim in the file, which has remained dormant for years, maybe even decades, the entitled retroactive/back pay may reach as far back as the filing date of the unadjudicated claim. 

Simple Guide to VA Retroactive/Back Pay Benefits | Veterans Law Group

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I began this post last year when the BVA had already deemed that I had an Unadjudicated Claim (AN NOD) that I filed that the VARO never processed. Because the BVA stated that my NOD was never processed they remanded it back to the VARO to implement their decision and to rate my claim. The VARO then low balled my rating and I immediately filed for an increase and the VARO immediately increased my rating but assigned an effective date of my increased rating claim and not my original claim.

I filed a new NOD and to make a long story short, I had to file a second NOD because the VA and the BVA refused to consider all my evidence of record and I finally had to file a claim to the court for the BVA to finally review my entire file to grant my increased claim (To get the maximum rating) for the entire time of my appeal period. The BVA finally agreed and granted my maximum rating in which I was awarded an EED of my TDIU once for my initial rating and a second EED for my increased rating that gave me an additional five years of TDIU benefits and just over the 20 years protection period.

  

[Dustoff1970]

As of 2010 here is a long list of all the U.S. CAVC veterans court and Fed Appeals Circuit court decisions directly about TDIU Claims and Appeals.  This list produced by the VA General Counsel Office and known as a FAST letter to  VAROs and BVA.  Could not upload the PDF file from my pc.

I remember Bradley v. Peak, Roberson v. Principle and Faust v. West.

Roberson is the most important here for this discussion about VA duty to assist and implied/inferred TDIU claims.

Bradley was the court confirming that 1 single disability could qualify for TDIU and that TDIU was a 100% rating and that SMC-S could be granted with other combined or single disabilites equal to at least 60% and TDIU vets could receive retro pay for SMC-S.

In Faust the court defined what amount of income limit a TDIU vet could make before he was then considered employable and also meaning of unemployability.

My comment is not legal advice as I am not a lawyer, paralegal or VSO.

Edited July 14, 2023 by Dustoff1970