Filing the claim:
Once you have determined that you have met three basic criteria of disability compensation, you should then file the claim with your local Regional Office. There are two types of claims for initial service-connection;
Before applying for benefits a veteran or the surviving spouse of a veteran (in either case, the claimant) may wish to establish an Effective Date by using an “Intent to File” form (VBA Form 21-0966). “Intent to File,” formerly known as an Informal Claim, can be sent to VA even though a claimant is not yet prepared to apply. This is done to ‘lock-in a date’ while the claimant is gathering supporting evidence to include in their application. Supporting evidence can take time to gather and may include any of the following:
- Military Records
- Doctor’s Examinations and other Medical Evidence
- Marriage and Death Certificates
- Banks Statements
- Statements from Care Providers
Using an “Intent to File” to establish an Effective Date before the claimant has sufficiently prepared his or her application will allow the claimant to receive a larger lump sum retroactive payment than he or she otherwise would have
I would recommend that you get together all of your medical records and so forth that will support your claim. If you send the VA your formal claim within the one-year time period of the informal claim and VA grants your claim, the effective date, or the day you start to receive disability compensation, is the date of your informal claim.
This could mean a lot of money in retro!
A Formal Claim for disability compensation is the VA Form 21-526. You should fill this out to the best of your ability. You should attach any Service Medical Records, Private Treatment records relevant to your claimed disability(ies), certified copy of your DD 214, copies of marriage certificates divorce decrees and dependent birth certificates. By attaching these documents, you’ll speed up the processing of your claim quite a bit. However, you do not need to attach those documents if you do not have them in your possession. If you do not have any of those medical records, the VA will assist you in obtaining those by asking you to fill out VA Form 21-4142 for each facility were those records are located. One important side note; make sure you sign the VA Form 21-526!!
Important: You do not need to submit an Informal claim. You can file VA form 21-526 without informing VA of your intention to file for disability compensation.
What happens after I file my Formal claim?
After you send VA your Formal claim, there are a number of “teams” at your local regional office that process your application. There are essentially six “teams” at a Regional office that make up the “process.” When a veteran files a claim for benefits with VA, it is received at what is called a ‘Triage Team.’ This is where the incoming mail is sorted and routed to the different sections or other “teams” to be worked. Picture this as a Triage unit at a Hospital. There they decide who goes where according to the injury/condition involved. This is the way it works at VA too. The main function of the Triage Team is to screen all incoming mail. Within the Triage Team there are other sub components; the Mail Control Point, Mail Processing Point, and to a certain extent supervision of the files activity. The mail control point is staffed with VSR (Veteran Service Representatives) who are actually trained in claims processing. This is also where they receive and answer the IRIS inquiries. The mail processing point is where chapter 29/30 claims (a bit later on theses types of claims) are processed/awarded, and to a certain extent dependency issues are resolved.
The next step is the “Pre-Determination Team.” This is where your claim for benefits is sent to be developed, meaning verification of service from the Service Department if a certified copy of the DD 214 is not submitted by the veteran, SMR’s are obtained from St. Louis if they weren’t sent in already by the veteran, any CURR verifications are done for PTSD stressors, any private treatment records are obtained under the “Duty to Assist,” and inferred issued are identified. Once the Pre-Determination Team figures out what you’re claiming, they’ll send you what’s known as a “Duty to Assist” letter. This letter states what type of claim you are filing, what conditions you are claiming, and what the regulations say you must show to have your claim granted. It will also state the evidence needed by VA to support your claim, and what VA is doing or has done. The letter will also explain VA’s “Duty to Assist” you in obtaining the evidence to support your claim. There will also be a response form that you should fill out and return. If you do not return this form or mark the box that you have additional evidence to submit, the VA must wait 60 days to further process your claim. As your claim progresses further though the Pre-Determination Team, you may or may not receive other letters. Examples of those letters include: follow-up letters to let you know VA requested something from a third party and there is a delay in their reply, letters requesting that you provide something to VA to support your claim. The Pre-Determination Team may also send you a computer-generated letter telling you they are still working on your claim. That letter is pretty interesting because it means a couple of things have happened with your claim; 1) your claim was reviewed by someone recently or 2) your claim has aged where the computer system is telling the regional office that they must look at your claim. One thing to keep in mind is that every time VA sends you a letter, regardless if it’s for information you already sent them, you should always respond with a letter via certified Mail with return receipt. If you already sent something to VA that they previously requested, just send them a letter stating that you already submitted the information and when you sent it. Once all the developmental work has been done on a claim, it is then designated as “Ready to Rate” and sent to the Rating Activity.