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BENEFITS PROTOCOL: CLAIMS
Filing a disability claim is mission-critical. The steps provided are general knowledge and in no way constitute legal advice. Every outcome is different and we share our knowledge to help get the best outcome for our veteran brothers and sisters. Feel free to email us if you have anything to add to this sequence.
01
DATA ACQUISITION
- ***The best practice before filing a claim is to seek outside medical attention.*** If it is a PTSD claim, seek mental health providers ahead of time, if it is an injury, seek help from a specialist before filing, this step alone is crucial in establishing your nexus, which is discussed later in these steps.
- **Service Connection:** Acquire DD-214 and Service Treatment Records (STRs).You can request records from the National Archives online, by mail, or by fax. (If you’re submitting an application for VA benefits, VA will request your DD214 for you when they receive your application. You don’t need to do this yourself through the National Archives.) If you already have a copy, you can upload it with your claim. You can request your military service records online using the National Archives’ eVetRecs tool. When you get to eVetRecs, select Make a new request. There is also a link and instructions here (MILITARY SERVICE RECORDS). You’ll then need to sign in with an identity-verified ID.me account. The National Archives may ask you to take a “live selfie” photo with your smartphone as an added step to verification. Option 2: Fill out the National Archive’s request form (to mail or fax) Fill out a Request Pertaining to Military Records (Standard Form 180). You can get the form here (VA FORM SF180). Mail or fax your completed form to the appropriate address or fax number listed on the last page of the form. To find the right address or fax number for you, you’ll need to use the first chart on that page to find your branch of service, separation date, and type of record.
- **Medical Evidence:** Secure your Service Treatment Records (STRs): These documents detail any medical issues you experienced during your active duty. They serve as direct evidence of in-service events or injuries that may have contributed to your current condition. VA and Private Medical Records: Include records from both VA facilities and private healthcare providers. These documents help establish a history of treatment and demonstrate the progression and severity of your condition. Independent Medical Opinions (IMOs) and NEXUS Letters: A NEXUS letter from a qualified medical professional is crucial. It should explicitly state whether your condition is "at least as likely as not" related to your military service, providing a clear connection for the VA. Diagnostic Test Results: Include results from X-rays, MRIs, lab tests, and other diagnostic procedures that confirm your diagnosis. This evidence is particularly important for conditions like PTSD, chronic pain, and orthopedic injuries. Lay Evidence (Buddy Statements): Statements from fellow service members, family, or friends who can attest to the onset or worsening of your condition can support your medical evidence, especially if your service records are incomplete.
- **Nexus:** As stated above, this step is crucial in linking current status to service actions (e.g., doctor's statement). (!!! BE AWARE!!!) Several companies are filing claims for veterans' benefits, often charging fees for services that are legally required to be free. Here are some key points: For-Profit Consultants: Many for-profit companies charge veterans fees for help filing disability claims, operating in a legal loophole where only accredited agents and Veterans Service Organizations (VSOs) can assist with claims. Legislative Actions: States like Maine, New Jersey, and New York have passed laws to crack down on these practices, while Louisiana has allowed companies to charge up to $12,500 for services that should be free. Opposition to Legislation: Advocacy groups, including the Veterans of Foreign Wars, oppose bills that would allow for-profit companies to charge veterans for initial claims assistance, arguing that free help is already available through accredited representatives. Predatory Practices: Some companies exploit veterans' trust by offering misleading services, often resulting in financial strain and limited improvement in claims outcomes. These practices raise significant concerns about the integrity of the veterans' claims process and the exploitation of vulnerable populations.!!! Please look into these with caution if you decide to go this route. Although some say you do not have to pay unless your claim is accepted, many take large portions or all of the backpay you would recieve.
02
SUBMISSION ROUTE
- **Fast Track:** Utilize the VA digital portal (VA.gov). Although this is a "fasttrack", the VA takes time to review all of your information. This is really only a "fast track" in the sense that it is an easy way to submit your application. All claims are different and some may be faster than others. Be patient, but file your Intent To File ASAP. More on this later.
- **Priority Channel:** Contact a Veterans Service Officer (VSO) for free, expert support. This is a prefered channel. VSO's are there to help and navigate the VA system of forms and filing. One of the issues that can arise though is the speed at which you can be seen. Depending on location and number of VSO's, it can take some time to schedule to meet and go throguh your filing process.
- (!!!Effective Date Lock!!!): File an Intent to File immediately!!! You can do so here (INTENT TO FILE). An intent to file is a formal notification to the VA that a veteran plans to submit a claim for disability compensation, pension, or survivors' benefits. This process allows veterans to gather necessary documentation while protecting the earliest possible effective date for their claim, which can lead to retroactive benefits if the claim is approved. This means if you are getting backpay it will be retroactive to the date of your intent to file.
03
C&P EVALUATION
- **Compliance:** Attend all mandated Compensation & Pension (C&P) exams. A claim (C&P) exam isn’t like a normal medical exam. The provider won’t treat you for any illness or injury, give you referrals to other providers, or prescribe medicine. The purpose of the exam is to gather information that will help the VA make a decision on your claim. During your exam, the provider may do any or all of these things: Perform a basic physical exam. (This may or may not include physical contact) Ask you questions based on the medical records in your claim file. These may include questions from the Disability Benefits Questionnaire (DBQ) for each service-connected condition you’re claiming. Ask you to get other tests (like X-rays or blood work), at no cost to you. Note: If you have questions about what’s happening during your exam, you can ask the provider. But they can’t answer questions about the claims process, tell you the exam results, or make decisions about your claim.
- **Reporting:** Describe your condition's CURRENT impact on daily function. Make sure to be thorough in your descriptions. If you have trouble sleeping, let them know how many nights in any given week you may have trouble. The more info given, the better the VA can assess and treat when your claim is accepted.
04
RESOLUTION & APPEAL
- **Review:** Confirm the rating accuracy upon decision.
- **Recourse:** If denied, consult VSO immediately to initiate Supplemental, HLR, or Board Appeal.
:: DISCLOSURE: THIS IS A GUIDANCE TOOL, NOT OFFICIAL VA DIRECTIVE. CONSULT VSO. ::
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