Upload
duongkhuong
View
220
Download
0
Embed Size (px)
Citation preview
Working document to be approved
1
Working Document • To Be Approved
Working document to be approved
2
Welcome and Introduction
What You Need to Know about Veterans Disability
Appeals
Presented by Brett BuchananVA-Accredited Claims Agent
Working document to be approved
3
Brett Buchanan bio
• Attended Truman State University in Kirksville, Mo., and participated in the Army ROTC program.
• Commissioned into the U.S. Army as a field artillery officer and stationed in Germany.
• Deployed in Operation Iraqi Freedom and earned a Bronze Star for combat operations.
• After the Army, attended St. Louis University School of Law.
• After graduation, assisted veterans at the VA Regional Office and Board of Veterans' Appeals.
• Became an Allsup VA-accredited Claims Agent in 2012.
• Member of the National Organization for Veterans' Advocates.
Working document to be approved
4
Overview
• Department of Veterans Affairs (VA) Overview
• VA disability programs
• Basic criteria for approval of disability benefits
• Advanced criteria for approval of Compensation Benefit
• Application and appeal process
• Why veterans need help
Working document to be approved
5
Department of Veterans Affairs
• The United States has authorized some type of disability benefit for veterans since the Revolutionary War.
• In 1930, various agencies were consolidated into the Veterans Administration.
• In 1989 the Department of Veterans Affairs was established as a Cabinet level position.
Working document to be approved
6
Department of Veterans Affairs
• National Cemetery Administration
• Veterans Health Administration• 23 Veterans Integrated Systems Network
• Veterans Benefits Administration• 56 Regional Offices-Average 1 per state
• Texas-Waco, Houston• California-Los Angeles, Oakland, San Diego
Working document to be approved
7
Veterans Benefits Administration
• Administers many benefit programs• GI Bill and dependent educational benefits• VA Home Loan • Vocational rehabilitation & employment services• Survivor benefits• Life insurance
• The focus of this presentation is the VA Compensation Benefit
Working document to be approved
8
Veterans Disability Benefits
Two Disability Programs
• Disability Compensation• Service-connected disability
• Non Service Connected Pension• A needs-based program designed to
keep wartime service veterans out of poverty
Working document to be approved
9
Basic Criteria for VA Pension
• Served during a war time period
• Totally disabled OR 65 years or older• Disabilities do not have to be service related.
• Income-based• Low to zero income and assets• Income offsets the approximately $1,000 a month
benefit.• Medical expenses offset income.
Working document to be approved
10
Basic Criteria for VA Compensation
• Discharged or released under conditions other than dishonorable.
• Disease or injury was incurred or aggravated in the line of duty.
• The disability is not a result of their own willful misconduct or abuse of alcohol or drugs.
Working document to be approved
11Advanced Criteria for Compensation Approval
Must show a current disability that is medically related to an event or injury in service
• Current disability• In-service event or injury• Causation
Working document to be approved
12
Current Disability
• Claimant must have a Disability• Current medical diagnosis• Contracting a disease or suffered an injury while on
active duty is not enough.• Pain alone is not sufficient.
• Evidence• Medical records
• Both VA and private acceptable• May get diagnosis after claim is filed or during
appeal
Working document to be approved
13
Inservice Event or Injury
• The claimant must have suffered an event, disease or injury in service• Does not have to be directly related to military
duties• Must take place between military entrance and
discharge
• Evidence• Service medical records• Military personnel records • Testimony• Lay evidence such as letters, emails or media
Working document to be approved
14
Causation or Nexus
• Claimant must show the current disability is caused by the event or injury in service.• Most common reason a VA claim for compensation is
not granted
• Evidence• Medical opinion• Legal presumption
Working document to be approved
15
Most prevalent veteran disabilitiesVA 2013 Annual Benefits Report
Working document to be approved
16Compensation Example
Matt enlisted in the Army and was assigned to an airborne infantry unit. During one of his training airborne jumps, Matt landed on the drop zone, but a gust of wind caught his parachute.
Matt was dragged 100 yards across rough terrain, suffering neck whip lash and head trauma. The military doctors diagnosed a concussion and neck sprain. He later develops headaches after the accident and has constant pain in his neck. He completed his enlistment and was honorably discharged.
As a civilian, Matt is diagnose with a chronic headache disorder and degenerative arthritis in the neck. Matt applies for VA Compensation. The VA examiner feels Matt’s current disabilities are related to his parachute accident.
The Veteran Benefits Administration grants the claim.
Working document to be approved
17Service Connection Established: Disability Rating
• A Rating is given to each disability from 0% to 100%, in increments of 10%, based on current severity.
• Multiple ratings are combined.• 30% + 10% = 37 = 40• 30% + 10% + 10% = 43 = 40
• See 38 C.F.R. 4.25 (2013)
• Purpose: Veteran is compensated for the decreased ability to earn a living for themselves and their family.
Working document to be approved
18Disability Ratings for a Single Veteran with No Dependents
Monthly Amounts
10% = $130.9420% = $258.8330% = $400.9340% = $577.5450% = $822.1560% = $1041.3970% = $1312.4080% = $1525.5590% = $1714.34
100% = $2858.24
Annual Amounts
10% x 12 months = $1,571.28
50% x 12 months = $9,865.80
100% x 12 months = $34,298.88
2014 SSDI Avg = $13,776
SSDI + 100% VA = $48,075
Working document to be approved
19
Application Process
• Written application with VA Regional Office (VARO) or online at www.ebenefits.va.gov.
• Claimant must identify all disabilities thought to be related to service.
• Claimant must provide the VA with a list of current medical providers, even if it is a VA medical center.
Working document to be approved
20
Initial Decision-Rating Decision
• Regional Office will issue a Rating Decision• Explain the issues.• Discuss relevant law.• List and discuss the evidence relied on.• Provide the explanation for the decision.
• Current average processing time is 264 days.*
• One year to appeal
* 7/25/14- http://www.benefits.va.gov/REPORTS/aspire_dashboard.asp
Working document to be approved
21
Notice of Disagreement
• VA Form 21-0958 or a written statement
• Express disagreement or dissatisfaction with the rating decision and request appellate review.
• Requesting reconsideration is often not enough. • May submit new evidence
• Filed with the Regional Office that issued the Rating Decision within one year.
Working document to be approved
22
Decision Review Officer
• Optional second decision maker• Senior level employee at RO
• De Novo ReviewNot bound by first decision
• Must request within 60 days of RO notification of DRO review
• Can also request a personal hearing with a DRO
Working document to be approved
23
Statement of the Case
• VA official notice to the claimant of its reasons for denying the claim in whole or in part
• The claimant has 60 Days or the remainder of the one year period from the date of the mailing of the Rating Decision, whichever is later to file a VA Form 9-Substantive Appeal
• Average days pending for NOD is 397*
* Monday Morning Workload Report July 21, 2014
Working document to be approved
24Appeal to Board of Veterans Appeals
• Second Appeal Form• VA Form 9
• Transfers jurisdiction of the appeal to the Board of Veterans Appeals
• If the claimant introduces evidence while the appeal is pending, the RO will issue a Supplemental Statement of the Case
• Allows the claimant to specifically address the VA’s version of the issues in dispute
Working document to be approved
25
Board of Veterans Appeals
• Final VA decision maker located in Washington, D.C.• 64 Veteran Law Judges (VLJs)• Each VLJ has approximately seven staff attorneys
• 2012- 44,300 decisions• 12,334 personal hearings
• 2012- VA Form 9 to Board decision took an average of 1,040 days
• Current average day pending for VA 9s is 6,212
1- 2012 Board of Veterans Appeals Annual Report to Congress
2- Monday Morning Workload Report July 21, 2014
Working document to be approved
26
Board Personal Hearings
• Personal hearing is optional
• Travel board hearing• VLJ travels to Regional Office approx. 2-3 times a
year
• Video conference hearings• VLJ in Wash. D.C., claimant is at RO
• In-person Washington, D.C. hearing• Claimant must bear the expense
Working document to be approved
27
Why Appeal a VA Decision?
• Appealing a VA decision maintains the effective date of the award
• Effective Date• Date of the claim or• Date of the disability• Whichever is later
• Allowed to introduce new evidence throughout the appeal process
Working document to be approved
28
Why Appeal a VA Decision?
Example #1• Claim submitted month one• Claim denied month 12• Claim appealed, new evidence submitted, granted
month 36• Effective date is month one, 36 months of past
due benefits
Example #2• Claim submitted month one• Claim denied month 12• Decision becomes final month 24• Claim submitted to reopen month 25 • Claim reopened and granted month 36• Effective date is month 25, 11 months of past
due benefits
Working document to be approved
29
Why Appeal a VA Decision?
Example #1 vs Example #2
• Same disability rating awarded• Example #2 lost 24 months of past due benefits• If the rating was a 100%, then 24 months is
$66,456
Working document to be approved
30Why People Need Help Appealing a VA Decision
• An application can have many “claims”• It is not uncommon for an application to have 9-14
claimed conditions
• Confusing appeal process • Two-step appeal• Optional second decision maker• Optional personal hearings• Service connection, rating, effective date• High Board remand rate-45 percent
Working document to be approved
31Why People Need Help Appealing a VA Decision• Overwhelmed VA
• 556,000+ current pending initial claims1
• Appeals level have increased by more than 78 percent since 2008.
• Appeals can last five to seven years
• The VA breaks down the total claims inventory as follows:• Post-9/11 (Iraq and Afghanistan conflicts) claims make up 25
percent.• Gulf War (1990s conflict) claims make up 25 percent.• Peacetime (the end of Vietnam to the first Gulf War) claims
make up 11 percent.• Vietnam War claims make up 33 percent.• Korean War claims make up 3 percent.• World War II claims make up 2 percent.• Other era claims make up less than 1 percent.
1 Monday Morning Workload Report July 21, 2014
Working document to be approved
32Why People Need Help Appealing a VA Decision
• Complex laws and regulations• New diseases and locations associated with Agent
Orange exposure• Gulf War illness • Combat veterans• Revised PTSD regulations • Total disability due to unemployability
• Medically complex issues• PTSD and other psychiatric conditions• Orthopedic conditions• Secondary issues• Cancers, cardiovascular and respiratory disease• There has been a 200 percent increase over the last
10 years in original claims containing eight or more specific medical issues, or contentions.
Working document to be approved
33Why People Need Help Appealing a VA Decision
• Iraq/Afghanistan veterans• Traumatic brain injury and associated conditions• Women veterans• Multiple deployments
• Chemical exposure• Agent Orange list expanded• Camp Lejeune water contamination• Burn pits
Working document to be approved
34
How Much Does it Cost?
• Federal law allows a fee only to be charged for services performed after a Notice of Disagreement (first appeal) is filed.
• No fee allowed at the initial level.
• The VA has deemed a 20 percent contingency fee based on the retro award to be reasonable. If the individual does not receive a retro award, no fee is due.
• The future monthly benefit is not part of the fee.• The fee is monitored by the VA’s Office of General
Counsel.
Working document to be approved
35
Resources
Veterans.Allsup.com or (888) 372-1190For information on Veterans disability appeals
Use.Allsup.com or (888) 841-2126For information on Social Security Disability Insurance
• Veterans Living with Disabilities: A Closer Look at Factors Affecting the Veterans Disability Compensation Program
• Veterans with TBI May Qualify for Additional Disability Pay
• Veterans Should Review Their Disability Denials Following Study on Military Sexual Trauma Claims
• Social Security Initiative to Expedite Select Veterans’ Disability Claims for SSDI
• Raising Awareness of Military Sexual Trauma and VA Disability
Working document to be approved
36
Questions?
Thank you for your service.