What is the Difference Between a VA Disability Appeal and an Initial Claim? Initial Claims and Appeals at the Local Regional Office
Published August 18, 2020
An initial claim starts with the filing of a VA claim form called an Application for Disability Compensation and Related Disability Benefits, and numbered: 21-526EZ. This form can be obtained online at: https://www.vba.va.gov/pubs/forms/VBA-21-526EZ-ARE.pdf.
The 21-526EZ form, once filled out, can be filed at one of the VA regional offices located nearest the veteran’s residence, online at www.ebenefits.va.gov, or through mail & fax to the Evidence Intake Center. (Make sure to send certified mail, keep your receipt and/or fax, and keep the confirmation page for your records to show proof of submission).
Department of Veterans Affairs
Evidence Intake Center
PO Box 4444
Janesville, WI 53547-4444
Foreign Claims Fax: 248-524-4260
Your initial claim(s) will be adjudicated by a Rating Specialist. The rating specialist is responsible for gathering all the relevant evidence (e.g., medical treatment records, C & P medical examinations, personnel file, etc.) and determining the relevant legal issues (e.g., service connection, disability level, effective date, and so forth) pertaining to the claim(s). And, of course, the veteran is free to submit their own evidence supporting the claim(s). Based upon the evidence and the applicable law, the rating specialist issues a Rating Decision, their determination of the relevant issues.
If the veteran disagrees with one or more of the determinations in the rating decision, then the veteran has one year from the date of the decision to file a VA disability appeal.
If your Rating Decision is dated prior to February 19, 2019: The appealing document is called a Notice of Disagreement or NOD. The NOD should be mailed to the veteran along with the rating decision, but it can be easily obtained online at: https://www.vba.va.gov/pubs/forms/vba-21-0958-are.pdf. Once filled out, the NOD should be filed at the same regional office which issued the rating decision.
At this point, the claim(s) still remains at the same regional office but is now handled by the appeals section. In theory, the appeals section is managed by more experienced personnel. The VA employee who assumes responsibility for adjudicating the claim(s) at this level is named a Decision Review Officer or DRO. A DRO revisits the same issues decided earlier by the rating specialist but will often obtain additional evidence that the rating specialist might have overlooked. And, the veteran may submit additional evidence to support the claim(s). Moreover, a veteran has the right to request a hearing before the DRO, during which the veteran can offer testimony and submit additional evidence.
A DRO can issue two types of decisions. If the DRO grants one or more benefits, the DRO will issue a rating decision similar to the rating decision issued initially by the rating specialist. (If the veteran believes that the rating decision did not grant the correct amount of benefits, then the veteran can begin the VA disability appeal process all over again by filing a NOD). On the other hand, if the DRO denies the claim(s), then they will issue a so-called Statement of the Case or SOC. A veteran may receive both a rating decision and a SOC if the DRO decides two or more claims with mixed results.
If the veteran wishes to appeal the SOC, they must do so within 60 days of the date of the SOC. A SOC is appealed by the filing of a Substantive Appeal, also called a Form 9, at the local regional office. A Form 9 should be attached to the SOC. However, a Form 9 can be easily obtained online at: https://www.va.gov/vaforms/va/pdf/va9.pdf.
Once the Form 9 is filled out and filed, the veteran has perfected his VA disability appeal to the Board of Veterans’ Appeals located in Washington, DC. The appellate process at this level will be the subject of another blog.
If your Rating Decision is dated after February 19, 2019: You can choose from three different types of appeal lanes. The appeal information should be mailed to the veteran along with the rating decision, but it can be easily obtained online at the links listed below for each.
1. Supplemental Claim Lane: If you choose this appeal process, you will need to submit additional “new and relevant” evidence. It is best to file the Supplemental Claim request along with your additional evidence to speed the decision process up. The VA will review the additional evidence and send a new Rating Decision. You can easily obtain this form online at https://www.vba.va.gov/pubs/forms/VBA-20-0995-ARE.pdf
2. Higher Level Review Lane: This is a request for a new review of your claim by a higher-level adjudicator. The higher-level reviewer WILL NOT consider any evidence received after the notification date of the prior decision (the date on the Rating Decision). You are able to request an Informal Conference with the Higher Level Reviewer to discuss your claim(s). It is recommended that you have the Informal Call with them to address any questions they might have or point out which evidence you feel may have been overlooked in the initial decision-making. You can easily obtain this form online at https://www.vba.va.gov/pubs/forms/VBA-20-0996-ARE.pdf
3. Decision Review Request for Board Appeal (Notice of Disagreement) Lane: This lane will appeal your case directly to the Board of Veterans Appeals, and your case will be reviewed by a Veterans Law Judge (VLJ). You have the option to have the VLJ review the current evidence only, submit additional evidence, and/or request a hearing with the VLJ. You can choose to appeal all or only some of the issues previously decided. However, ONLY those issues you list on your Notice of Disagreement will be considered on appeal. You can easily obtain the form online at https://www.va.gov/vaforms/va/pdf/VA10182.pdf
It is important that you keep a copy of all completed forms and materials you give to VA. Contact an experienced attorney for further information.