Veterans Benefits Administration Appeals Process Overview
Learn about the appeals process for Veterans Benefits Administration compensation services, including how claimants can file appeals, the role of Decision Review Officers, and common appeals terminology. Understand the jurisdiction of appeals and get insights into key regulations and guidelines for handling appeals effectively.
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Presentation Transcript
Veterans Benefits Administration Compensation Service October 2016 Appeals Overview
Objectives Describe the appeals process Identify an issue that is currently under appeal 2 Compensation Service
References 38 U.S.C. Chapter 71, Board of Veteran s Appeals 38 U.S.C. Chapter 72, U.S. Court of Appeals for Veterans Claims 38 CFR 19, Board of Veterans Appeals: Appeals Regulations 38 CFR 20, Board of Veterans Appeals: Rules of Practice M21-1 Part I, Chapter 5, Appeals M21-1 Part III, Subpart I, 1.5, Appeals Team M21-1 Part I, Chapter 3, Power of Attorney VACOLS User Guide Note: All M21-1 references are found in the Live Manual Website 3 Compensation Service
What is the Appeal Process? Claimants not satisfied with decision(s) made by the local VA Regional Office on their claims for benefits may elect to have the decision(s) reviewed on appeal. An appeal consists of a timely filed NOD (on the proper form) and, after a Statement of the Case (SOC) has been furnished, a timely filed substantive appeal (VA Form 9, Appeal to Board of Veterans Appeals). An appeal preserves the date of claim for the issues on appeal. 4 Compensation Service
Appeal Process 5 Compensation Service
Jurisdiction of Appeals At the regional office level, the responsibility for appeals belongs to the Appeals Team. An issue on appeal should not be rated by the rating board. If the BVA determines a remand is in order, they will send the remanded appeal directly to the AMC or the ROJ for processing. Some appeals are the jurisdiction of the VAMC. 6 Compensation Service
Common Appeals Terminology/Definitions Appellant A claimant who has initiated an appeal to BVA by filing a timely NOD with the Agency of Original Jurisdiction (AOJ). Decision Review Officer (DRO) A senior technical expert whose duties include reviewing and deciding appeal cases. In the course of their duties, DROs may: hold informal conferences or conduct formal hearings complete de novo or traditional review of claims 7 Compensation Service
Common Appeals Terminology/Definitions Statement of the Case (SOC) An explanation of the decision made on the appeal that provides the appellant with a complete understanding of the decision so the appellant can prepare an effective substantive appeal with specific allegations of errors of fact or law. Supplemental Statement of the Case (SSOC) An explanation of changes or additions to the SOC, usually based on additional evidence received after issuance of the SOC, before or after receipt of a substantive appeal, or after a remand. 8 Compensation Service
Appeal Forms VA Form 21-0958 Notice of Disagreement VA Form 9 Appeal to Board of Veterans Appeals VA Form 8 Certification of Appeal VA Form 646 Statement of Accredited Representative in Appealed Case 9 Compensation Service
Appeal vs. Claim The two most common types of disagreement: denial of service connection disagreement with an assigned evaluation Reconsideration Is it an option? What s best for the appellant? 10 Compensation Service
Appeals vs. Claim Issue under Appeal Can the VSR work the claim Claim for SC (same condition as appeal) NO Service Connection Increase claim (same condition under appeal) NO Evaluation Secondary claim for SC or Increase (secondary to issue under appeal) - YES Evaluation 11 Compensation Service
Other Considerations Downstream Issue(s) Issue(s) which arise as a direct result of a favorable decision on an appealed issue and must be addressed by the decision maker. A decision on a downstream issue may or may not confer new appeal rights. Inextricably Intertwined Issues An issue is inextricably intertwined with a matter(s) on appeal when a decision on that issue by the RO could have significant impact on the matter(s) under appeal. All matters that are inextricably intertwined must be adjudicated before any determination by BVA may be made. 12 Compensation Service
End Products EP 170: Appeal Control EP 070: Appeals Processing EP 172: SOC/Grant of Benefits EP 173: Hearings conducted by an employee other than a DRO / Informal DRO Hearings (Not always appeals EPs) EP 174: Hearings Conducted by DRO/Decisions 13 Compensation Service
Veterans Appeals Control and Locator System (VACOLS) VA s computer application used to manage and locate appeals. Effective tracking of appeals requires accurate and timely updates of VACOLS each time the end user takes action on a pending appeal. 14 Compensation Service
Questions http://r3.emsworld.com/files/base/EMSR/image/2015/10/16x9/640x360/Navy_SEAL.561b029c1a4e9.jpg 15 Compensation Service
