How the VA Improvement and Modernization Act Changed the Appeals Process

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By on November 12, 2019 in Pay & Benefits with 0 Comments
Close up of the side of a wheelchair with an individual wearing military camouflage sitting in the chair depicting disabled veterans/military service

The Veteran’s Appeals Modernization Act was signed into law in 2017 and officially went into effect in February 2019. The Department of Veterans Affairs has since set forth to create a system that improves the overall experience of filing a disability benefits claim including reducing the wait time for decisions and reducing complicated appeal processes. 

What Has Changed About the Claims and Appeals Process?

The VA now has one way to file an original claim; the VA Form 21-526EZ. This is the first time a claimant files for a specific issue. Veterans will no longer be able to file on plain paper, on a Statement in Support of Claim or any other document. 

A rating decision is supposed to occur within 90 days. The veteran is afforded Duty to Assist during this period by the VA, so for any medical records the veteran wishes the VA to obtain, they must request them before their appeal. Once a rating decision has been made, Duty to Assist no longer applies.

Three Appeals Options

After the any decision at the Regional Office, the veteran has three options for appealing:

1. Supplemental Claim

At this level of appeal, the veteran can submit new evidence within one year of the decision. Evidence must be new and relevant and the VA will attempt to make a decision within 125 days.

If the veteran is not satisfied with the outcome, they may submit additional evidence within one year or move to a different appeal lane. As long as the appeal stays open in any lane, the effective date remains the date of the original claim. 

2. Higher Level Review

A Higher Level Review is an option when the veteran does not wish to submit new evidence but feels that the decision needs fresh eyes. Veterans must file this appeal also within one year of any decision.

In a Higher Level Review, a person other than the original adjudicator will review the claim, without giving weight to the prior decision, and make a new decision or keep the prior decision.

3. Board Review

If a veteran wishes to take their appeal to the Board of Veteran’s Appeals, the veteran would file a Notice of Disagreement (NOD) within one year of the last decision and file it with the Board. There are three options at this level:

  1. Claim that is ready to be reviewed and no additional evidence is needed;
  2. Hearing request with the option to submit additional evidence; or
  3. Request to submit additional evidence without a hearing. 

Requesting a Board review can take over 300 days or more to receive a decision. After a Board decision, a veteran has 120 days to appeal to the Court of Appeals for Veteran’s Claims (CAVC).

What is No Longer Applicable?

The VA reduced many forms to streamline the process of getting a claim through the system. Some forms were consolidated and some are gone entirely. The Statement of the Case and the VA Form 9 are no longer in existence.

A veteran can no longer request a claim be “reopened;” it will be a new claim rather than an original claim. New and relevant evidence replaced new and material evidence, which is more favorable towards the veteran. There will no longer be DRO decisions; those have been replaced with Higher Level Reviews.

A rating decision will also have much more information required on it, such as:

  1. What issues were decided; 
  2. Summary of evidence considered;
  3. Summary of applicable laws and regulations;
  4. Identification of findings favorable to the claimant; 
  5. Explanation of why claim was denied; 
  6. Explanation of how to get evidence used in making the decision; 
  7. And identification of criteria that must be satisfied to grant service connection or the next higher rating. 

This process defines exactly what the veteran needs to win their case. Unfortunately, as simple as the VA has attempted to make this system, the results have so far proven to be much more complicated for veterans than originally believed and even the VA is having difficulty understanding their own processes and regulations during this transition, resulting in continued delays and frustrated veterans.

Cassandra Crosby is a Veteran’s Claims Advocate for Hill & Ponton. She has over 20 years of experience in the management of non-profits programs specializing in Mental Health, Substance Abuse, and Victim Services.

© 2020 Cassandra Crosby. All rights reserved. This article may not be reproduced without express written consent from Cassandra Crosby.

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