If your health was damaged while in the service, your VA ... · Decision Review Officer “DRO” ... The burden of proof is on you to win a VA claim. You must prove: • You have

VA Claims Manual

No one cares about your claim more than you do! TM

www.vaclaimsmanual.com © 2017. David Jacquot

Contents

Introduction .................................................................................................................................................. 1

Can I file my claim by myself? ....................................................................................................................... 1

Where can I find a VSO, Attorney, or Accredited Claims Representative? .................................................. 2

Recent Legislation Impact ............................................................................................................................. 7

Claims Overview ............................................................................................................................................ 7

Burden of Proof ........................................................................................................................................... 10

Secondary Connection ................................................................................................................................ 10

Know the rules of the game - Don’t get ambushed! .................................................................................. 10

Disability Benefit Questionnaire (DBQ) ...................................................................................................... 11

“The Roadmap to Needed Medical Evidence” ............................................................................................ 11

Veterans Administration Schedule for Rating Disabilities “VASRD” - 38 CFR Part 4 “The Roadmap to How the VA Rates Your Claim” ............................................................................................................................ 17

Intent to File ................................................................................................................................................ 19

How to File .................................................................................................................................................. 21

Decision Ready Claims “DRC” ..................................................................................................................... 22

Fully Developed Claims “FDC” .................................................................................................................... 24

Standard Claims .......................................................................................................................................... 36

Clear and Unmistakable Error (“CUE”) Claims ............................................................................................ 48

Compensation and Pension (“C&P”) Exam. ................................................................................................ 49

Gathering Documents ................................................................................................................................. 51

Get Your Medical Files ................................................................................................................................ 52

Active Duty Files .......................................................................................................................................... 52

VA Medical Center Files .............................................................................................................................. 56

Private Medical Records ............................................................................................................................. 59

VA Claims File .............................................................................................................................................. 59

FOIA REQUEST ............................................................................................................................................. 59

FOIA APPEAL ............................................................................................................................................... 61

FOIA Lawsuit ............................................................................................................................................... 63

Waiver of Filing Fee..................................................................................................................................... 69

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VA Claims Manual



Summons .................................................................................................................................................... 69

Civil Cover Sheet ......................................................................................................................................... 70

Military Personnel File. ............................................................................................................................... 76

Unit Records ................................................................................................................................................ 82

Joint Services Records Research Center ..................................................................................................... 82

Records Kept at JSRRC ................................................................................................................................ 82

How to Make a Request of JSRRC ............................................................................................................... 82

National Archives and Records Administration (NARA) ............................................................................. 83

FOIA Request Addresses ............................................................................................................................. 84

FOIA Request Form ..................................................................................................................................... 85

FOIA Appeal ................................................................................................................................................ 86

.................................................................................................................................................................... 87

FOIA Lawsuit ............................................................................................................................................... 88

Waiver of Filing Fee..................................................................................................................................... 94

Summons .................................................................................................................................................... 94

Civil Cover Sheet ......................................................................................................................................... 95

Buddy Statements ..................................................................................................................................... 101

Finding Buddies ......................................................................................................................................... 106

VA Forwarding of Messages ...................................................................................................................... 106

Google ....................................................................................................................................................... 107

Facebook, Linkedin and Other Social Media ............................................................................................. 107

Internet People Locators........................................................................................................................... 107

Private Investigators ................................................................................................................................. 107

Classified Information ............................................................................................................................... 108

Prepare Your Claim Form .......................................................................................................................... 114

Compensation for Dependants ................................................................................................................. 114

Narrative ................................................................................................................................................... 117

Sample Narrative ...................................................................................................................................... 117

Current Hot Issues..................................................................................................................................... 125

Post-Traumatic Stress Disorder PTSD ....................................................................................................... 125

Disability Benefit Questionnaires (“DBQs”) .............................................................................................. 125


VA Claims Manual



Review DBQ............................................................................................................................................... 133

Rating Schedule for PTSD. ......................................................................................................................... 139

Special Forms for PTSD ............................................................................................................................. 141

Traumatic Brain Injury TBI. ....................................................................................................................... 146

Disability Benefits Questionnaires (“DBQs”) ............................................................................................ 146

DBQ Initial Evaluation of Residuals of Traumatic Brain Injury .................................................................. 147

Initial Exam ................................................................................................................................................ 147

DBQ Review Evaluation of Residuals of Traumatic Brain Injury Review Exam ......................................... 160

Rating Schedule for Traumatic Brain Injuries “TBI”. ................................................................................. 172

Total Disability for Individual Unemployability – “TDIU” .......................................................................... 185

Index of Exhibits ........................................................................................................................................ 193

Sample Index ............................................................................................................................................. 193

File Your Claim .......................................................................................................................................... 194

Rating Letter.............................................................................................................................................. 194

Appeal ....................................................................................................................................................... 194

Notice of Disagreement – (“NOD”) ........................................................................................................... 197

Reconsideration or Traditional Review ..................................................................................................... 202

Decision Review Officer “DRO” ................................................................................................................. 202

Board of Veterans Appeals (“BVA”) .......................................................................................................... 209

CAVC .......................................................................................................................................................... 212

U.S. Court of Appeals for the Federal Circuit ............................................................................................ 212

Supreme Court .......................................................................................................................................... 213

APPENDIX .................................................................................................................................................. 214

Blank Forms ............................................................................................................................................... 214

Va Schedule of Rating Disabilities (VASRD) ............................................................................................... 214

Public Disability Benefits Questionnaire (DBQs) ....................................................................................... 214

Internal DBQs ............................................................................................................................................ 214


VA Claims Manual


Page 1 www.vaclaimsmanual.com © 2017. David Jacquot.

Introduction

If your health was damaged while in the service, your VA claim can be worth hundreds of

thousands of dollars in a lifetime, but only if you win your claim. There is no reward for losing.

Take your claim seriously and put in the work. No one cares about your claim more than you

do! TM You will probably work with a veteran services officer (“VSO”), attorney, or accredited

claims agent on your claim. The operative word is “work.” Don’t just hand off your claim and

hope for the best. Help the VSO help you by understanding the process and doing your

homework. This guide will take you step-by-step through the claims and appeals process.

Recent legislation intended to speed up the appeals process makes it vitally important that your

initial claim be complete, because it limits your right to submit additional evidence on appeal.

See more details in the Appeals section below.

Good luck and let’s get started.

Can I file my claim by myself?

Yes, you can file your own claim and represent yourself on appeals. However, you may want to

use the services of a veteran’s service officer (“VSO”), attorney, or accredited claims

representative. These individuals have training in claims procedure and experience with VA

claims. But, as said earlier, your claim is your responsibility, so don’t just blindly delegate your

claim.


VA Claims Manual



Where can I find a VSO, Attorney, or Accredited Claims

Representative?

Veteran Service Officers (“VSOs”) work for approved veterans’ organizations such as the

Military Order of the Purple Heart, Veterans of Foreign Wars (“VFW”), the Disabled American

Veterans (“DAV”), the American Legion and others. You can find a VSO, attorney or

accredited claims representative in your area by going to:

https://www.ebenefits.va.gov/ebenefits/vso-search.

VSOs cannot charge a fee for representation at any state of your claim. Attorneys and accredited

claims agents cannot charge a veteran for assisting with an initial claim, but can charge

reasonable fees for assistance after an appeal has been filed.

To appoint a representative, you will file a VA Form 21-22 for VSOs and a 21-22a for attorneys

and accredited claims agents. Copies of these forms are shown below and in the Appendix as

Forms 1 and 2. You can make a change of representative, but it is not a good idea to just jump

around. You will likely be working with your representative for years. They are your “partner”

in collecting thousands of dollars, so choose wisely. You should interview the person and decide

whether they are the right fit for you. Don’t just use the VSO at the local post because you

belong to it.


https://www.ebenefits.va.gov/ebenefits/vso-search

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Recent Legislation Impact

Recent legislation intended to speed up the appeals process makes it vitally important that your

initial claim be complete, because it limits your right to submit additional evidence on appeal.

See more details in the Appeals section below.

Claims Overview

A claim starts when you either file an Intent to File, or file your actual Claim, whichever is

earliest. To file your claim, you will file one of three VA forms and submit evidence, such as

medical records. After your claim is filed, the VA will review it and maybe ask for more

evidence. Also, you will likely be scheduled for a Compensation and Pension medical exam (C

& P Exam). After the evidence is gathered, a rating officer will review the file and issue a

Decision Letter. If your rating is satisfactory, the process is over. If you were denied or disagree

with the rating, you will file a Notice of Disagreement (NOD). The NOD must be filed within

one year of the decision or the decision is final. If you file a NOD, you get the choice of going

back to the same rating officer or to a more senior official called a Decision Review Officer

(“DRO”). A decision will be made on your appeal. If it is unfavorable, you can file VA Form 9

and appeal the case to the Board of Veterans Appeals (“BVA”). The BVA will either hold a

hearing or decide on the evidence you submit, depending on whether you request a hearing or

not. The BVA will issue its decision and if you disagree the next appeal is to the Court of

Appeals for Veterans Claims (“CAVC”). If you disagree with the CAVC you can file an appeal

with the U.S. Circuit Court of Appeals for the Federal Circuit and then the U.S. Supreme Court.

The Claims Flowchart below shows an overview of the process described above.


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Burden of Proof

The burden of proof is on you to win a VA claim. You must prove:

• You have a current disability (it can be an injury or disease),

• The current disability has a service connection, i.e., “caused” or “aggravated” by military

service. (a combat injury is not required), and

• “More likely than not” your current disability is a result of the service connected injury or

disease.

Secondary Connection

If your disability is service connected and causes a secondary problem, then you can be approved

for the secondary problem.

Example. A veteran has service connected diabetes. After leaving the service, the veteran

must have a leg amputated due to complications from the diabetes. The amputated leg is

service connected and the veteran can receive compensation for the leg.

Know the rules of the game - Don’t get ambushed!

The VA has policies and procedures it must follow in handling claims. You do not need to know

all of them, but you should not go into the claims process blind. The information that follows

will give you two things:


VA Claims Manual



1. What will happen at the Compensation and Pension Exam (C&P Exam).

2. What the claims rater is looking for when rating your file.

Disability Benefit Questionnaire (DBQ)

“The Roadmap to Needed Medical Evidence”

Disability Benefits Questionnaires (DBQs) are used by VA Compensation and Pension

examination (C&P Exam) doctors to summarize their findings for use by the rating officers of

claims. You can also have your VA primary care doctor fill out the form. Using your VA

primary care doctor that is familiar with your condition may be better than using a C&P

examiner who has never met you.

DBQs also provide veterans with the option of visiting a private health care provider instead of a

VA facility to complete their disability evaluation form. There are more than 70 DBQs to cover

a wide range of disabilities, which you can download and printed for use. The VA will not pay

for a private provider to conduct the medical exam. Using a private doctor that is familiar with

your condition may be better than using a C&P examiner who has never met you.

To find DBQs by the form name visit:

https://www.benefits.va.gov/COMPENSATION/dbq_ListByDBQFormName.asp.

For DBQs by symptom visit:

https://www.benefits.va.gov/COMPENSATION/dbq_ListBySymptom.asp.


https://www.benefits.va.gov/COMPENSATION/dbq_ListByDBQFormName.asp

https://www.benefits.va.gov/COMPENSATION/dbq_ListBySymptom.asp

VA Claims Manual



There are no public DBQs for the following medical examinations:

• Initial Examination for Post-Traumatic Stress Disorder

• Hearing Loss and Tinnitus

• Residuals of Traumatic Brain Injury (Initial and Review)

• Cold Injury Residuals

• Prisoner of War Examination Protocol

• Gulf War Medical Examination

• General Medical Examination for Compensation Purposes

• General Medical Examination for Pension Purposes

However, there are DBQs for these conditions that are for VA internal use. Some of them can be

found in the Appendix. Although these forms cannot be completed and sent to the VA, they are

useful to see what the VA is looking for, so you can provide medical records that are relevant.

Additionally, they could be used as a guide for a private doctor to write a letter regarding your

condition.

For mental conditions, the following individuals can complete a DBQ for an initial exam:

• a board-certified or board-eligible psychiatrist;

• a licensed, doctorate-level psychologist;

• a doctorate-level mental health provider under the close supervision of a board-certified or

board-eligible psychiatrist or licensed doctorate-level psychologist;


VA Claims Manual



• a psychiatry resident under close supervision of a board-certified or board-eligible

psychiatrist or licensed doctorate-level psychologist; or

• a clinical or counseling psychologist completing a one-year internship or residency (for

purposes of a doctorate-level degree) under close supervision of a board-certified or board-

eligible psychiatrist or licensed doctorate-level psychologist.

To conduct a review examination for mental disorders, the examiner must meet one of the

following criteria:

• any criteria from above; or

• be a licensed clinical social worker (LCSW), a nurse practitioner, a clinical nurse specialist,

or a physician assistant, under close supervision of a board-certified or board-eligible

psychiatrist or licensed doctorate-level psychologist

Once completed, veterans and/or their physicians may mail or securely fax completed DBQs to

the VA Regional Office handling the Veteran's claim.

To find mailing addresses, visit the VBA website

at: https://www.benefits.va.gov/benefits/offices.asp.

To find fax numbers, visit the VA website

at https://benefits.va.gov/compensation/dbq_fax_numbers.asp.

A sample DBQ for Chronic Fatigue is shown below:


https://www.benefits.va.gov/benefits/offices.asp

https://www.benefits.va.gov/COMPENSATION/dbq_fax_numbers.asp

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