VA Claims Information

STEP 8: FILING AN APPEAL

Here's a quick rundown of the appeal system. It is not intended as anything but a guide as to the process. It should help you understand your next steps to take when the original claim has been decided by the VA. Whether you decide to use a VSO or not, it helps to understand what the appeal process is.

Notice of Disagreement (NOD):

If after receiving your decision on your claim(s), you disagree with that decision, you are entitled to file an appeal. In order to begin the process, you must file a Notice of Disagreement (NOD).

There is no specific form for this. However, VA Form 21-4138 (Statement in Support of Claim) may be used or just write a letter.

- You will have one (1) year from the date of the Decision Letter to file your NOD.

- Submit it to your local VA Regional Office (not the medical center).

- Include your name, claim number, and date.

- Mention ALL decisions with which you disagree taken from the VA's decision letter to you.

- You may simply state the decisions with which you disagree without going into detail. However, you must submit additional reasons/documentation before your time limit expires.

- Make sure the veteran or the authorized representative of the veteran signs it.

Two Appeal Options

Once filed, you will be sent information giving you a choice of a Decision Review Officer or going the traditional appeal process.

• Decision Review Officer (DRO)

  A Decision Review Officer is usually a good option to follow. The link to the M21-1MR section (See ADDITIONAL LINKS, this website) can give you more information, but in its simple form-

  A DRO reviews claims in the local Regional Office. The DRO can make decisions on the claim(s). If a person disagrees with the DRO's decisions, then the traditional appeal can be invoked.

• Traditional Appeal aka Board of Veterans Appeals (BVA)

  If the traditional appeal avenue is invoked then the DRO cannot review the claim.

  The claim goes into the BVA appeal process that ALL regional offices are inputting. Instead of just local regional office claims being processed, all regional offices' claims being traditionally appealed are involved.

  As mentioned under the DRO paragraph, a traditional appeal can be invoked after the DRO reviews the claim, BUT if the BVA traditional appeal is chosen instead of a DRO, then the DRO cannot review the claim and decide.

  A longer wait time is very probable.

  If you go into the BVA traditional appeal avenue, then a Statement of Case (SOC) or Supplemental Statement of Case (SSOC) provided by the regional office is created. At that time Form 9 becomes part of the process.

  All of the above is to just give you an idea of the process. I am no expert on the inner workings of the steps, but in STEP 6: Online Research, sites are mentioned where you can get more detail. See also ADDITIONAL LINKS, which has pertinent links to explore.

  Regardless of which you choose, you can make the process better if you take the time to organize your arguments. Again, the steps in this website can be helpful.

Creating Your Appeal Documentation

Many of you have probably already created a claim via this website so your documentation is already organized. However, for those who have not used these steps before, take time to examine and organize your information for easier access when you begin to prepare your appeal arguments.

Additional Documentation

There are some additional documentation you should probably acquire in order to put together an informed, pertinent appeal document-

• C-File:

  This file is your Department of Veterans Affairs file that should contain ALL documentation that they are using to work your claim(s). Mentioned in STEP 10 is the procedure needed to obtain a copy of it.

  By getting a copy of this file, you will have the ability to see what exactly the VA has used to make a decision on your claim(s). You will be able to discover what may have been missed in their documents or see what documents are not included that you might have to submit.

  All of this is good additional information when creating your appeal details.

• C&P Exams (Evaluation Exams/Worksheets):

  These should be found in your C-File if you have had any C&P exams.

  These can be extremely important. A lot of raters rely heavily on these exams.

  (Note: You can also request them from the VA Medical Center if that is where you had them.)

  You need to closely scrutinize these exams!

  We discovered in my hubby's exams that there were discrepancies we could bring to the attention of the DRO, providing medical documentation as proof of these discrepancies.

(Note: Follow my STEPS in order to organize and analyze the C-File and the C&P exams.)

Writing the Appeal Document

• Utilize all the steps mentioned.
   
• When you write the attachment, include the following as part of your paragraph under the condition:
   
  • For each individual point, write the VA's finding(s) found on the decision explanation for the original claim(s). Use quotation marks around the VA's information if it is word for word.
     
   

  Using these findings as a beginning for the condition paragraph gives you the ability to submit the specific information needed to make your case on appeal for that decision.
  
  

  • Give the reasons for your disagreement with the VA's decision.
     
  • Write clearly listing the documentation already submitted or being submitted with this letter that shows your disagreement.
     
  • Mention any nexus letters that pertain to the decision.
     
  • Mention any buddy letters that clarify the specific circumstances.
    
   
• Continue listing information as mentioned in STEP 7 for the rest of the condition.
   
• If you mention in this attachment records already submitted to the VA, be sure to state they have been previously submitted.
   
• When you type the Enclosure section of the attachment, you can also make a heading that notes all items previously submitted. This allows you to group everything so the VA knows what is in previously submitted records and can look for them.
   

Example:

Previously Submitted:
Dr. Reed Allot, 7/08/07, nexus letter
Dr. Feel Good Evaluation
Dr. Hi deHoe 7/10/02-6/26/03
Article: "Joe's Coffee Stimulus affects Sleep," I'm Not Sleepy Magazine, Oct. 2010 Issue

Enclosures This Attachment:
Cpl. U. P. Ures, 9/15/08, buddy letter
Dr. Nose Gaye 6/03/03
Dr. M. Tee 5/9/04