Behind the curtain: The VA Claims Process

In my last post I wrote about my experience with the Veterans Administration during my physical exam process.  It took a few months to get through the paperwork and and to actually see doctor or two, and now I am waiting for the results.  And I am now in month three of waiting…

So why does it take so long?  Sure, there are zillions of us new veterans entering the system, but there must be a method to their madness.  After doing a little research, I found out that there is indeed such a method and that is what this post is about: the VA Claims Process.

My faithful readers have already seen the first part of the process in previous posts, but to make sure nobody gets left behind I will recap my adventures up to this point for those who are just joining the party:

The purpose of the VA medical evaluations and claims process is to document any injuries or physical issues that were caused or exacerbated by military service.  The evaluation is important for two specific reasons; first, if a servicemember is injured while on active duty it is important for that injury to be documented in case it requires treatment after they get out of the military and second, in cases where the servicemember has incurred chronic conditions or disabling injuries they are eligible for financial compensation.

If a veteran breaks his ankle while on active duty, for example, and gets out while while he is still going through physical therapy he isn’t out of luck.  His injury still requires treatment, so it is annotated during the physical exam and he will be able to use the VA medical system to get through the necessary physical therapy and get back on his feet.  Once he is better he goes on his way and he may never need the VA again.  However, since the VA evaluated his ankle and documented the injury, in case the veteran needs future treatment he is in the system and can still have that service-related injury treated by the VA in the future.  Taking the example further, if the veteran with the broken ankle is left with a limp for the rest of his life he will likely be evaluated as having incurred a disability.  Depending on the rating that the disability is assigned (I will devote an entire future post to disability assessment and ratings- don’t worry!) he may be eligible for a small disability check every month.

So being evaluated by the VA is important!

Back to my case.

I started my VA evaluation process as soon as I went on terminal leave, and before my EAS I had completed all of my physicals.  As I posted earlier, however, I slowed down the evaluation and claims process because I submitted the incorrect DD-214, which was caught by the case manager and rectified after I sent in the correct copy.  Although it seemed a bit random to me, there actually is a pretty well defined process that claims go through, which shouldn’t have surprised me because after all the VA is a governmental agency that runs on thoroughly bureaucratic processes.

Here is a breakdown of just what those claims processes are, starting from when my claim was initiated in my first meeting with the VA representative after going on terminal leave:

“Claim Received” – Your claim has been received by the VA. If you applied online with VONAPP (Veterans On Line Application – the web based application for VA benefits) Direct Connect, you should see receipt in your list of Open Claims below within one hour. If you applied through the U.S. mail, please allow mailing time plus one week for us to process and record receipt of your claim.  (Note – the process steps and descriptions are from the VA website)

“Under Review” – Your claim has been assigned to a Veterans Service Representative and is being reviewed to determine if additional evidence is needed. If we do not need any additional information, your claim will move directly to the Preparation for Decision phase.

It is during this phase that my errant paperwork was discovered.  It took about a month, but the system works because the claims representative discovered that I had submitted the incorrect paperwork and notified me.  It cost me a little time, but once I sent in the right documentation, my claim continued along to the next step.

“Gathering of Evidence” – The Veterans Service Representative will request evidence from the required sources. Requests for evidence may be made of you, a medical professional, a government agency, or another authority. It is common for claims to return to this phase, should additional evidence be required.

“Review of Evidence” – We have received all needed evidence. If, upon review, it is determined that more evidence is required, the claim will be sent back to the Gathering of Evidence phase.

I was contacted during this phase to provide a more detailed description of how I incurred an injury while in Iraq.  Again, the system works because the VA identified, through their due diligence, that I did not have enough documentation to support a portion of my claim.  So I filled out the form and described the situation in greater detail, and with receipt of the completed form my claim moved further along the path to completion.

“Preparing for Decision” – The Veterans Service Representative has recommended a decision, and is preparing required documents detailing that decision. If more evidence is required, the claim will be sent back in the process for more information or evidence.

This is where my case currently sits.  It has been there for a couple of months.  I did receive a letter last week from the VA apologizing for the delay in processing, so I know that my file isn’t lost behind a filing cabinet or being used as a doorstop.  I do appreciate that they took the time to let me know that they were just behind schedule and that they were still working on my case.

“Pending Decision Approval” – The recommended decision is reviewed, and a final award approval is made. If it is determined that more evidence or information is required, the claim will be sent back in the process for more information or evidence.

“Preparation for Notification” – Your entire claim decision packet is prepared for mailing.

“Complete” – The VA has sent a decision packet to you by U.S. mail. The packet includes details of the decision or award. Please allow standard mailing time for your packet to arrive before contacting the call center.

So I have three steps to go, and hopefully it won’t take too long!  The good news is that I am eligible for VA healthcare because I am a veteran regardless of when they complete my package.  Having it done will be helpful, however, because then all of my information will be in the system.  It will also be good to know if any of the mileage that comes with a 27 year career in the Marines results in a disability rating…


Lessons Learned:

1.  It takes time.  A lot of time.  I have been working through the process for six months, with the clock starting with my first VA appointment.  It is important to meet with the VA as promptly as possible once you have your DD-214 in your possession because the process is so lengthy.  You procrastinate at your own peril…as I wrote about in a previous post, if you can get your case initiated within 60 days before your EAS you will have your case reviewed by the locally by the VA instead of having it sent to their main evaluation center.  The anecdotal difference is about eight months- I was informed that it should take about four months after all of your information is provided for a local review as opposed to a year or so for a national level review.  It pays to be prompt!

2.  Get all of your ducks in a row before you initiate your package.  Missing or incorrect paperwork will stymie you progress, so avoid having the VA go through the nutroll of contacting you to update the package.  In my case, I provided the incorrect DD-214 and had to provide greater detail about an injury, and both of those transactions took time.  I recommend that when you fill out the pre-appointment paperwork that you go into excruciating detail in regards to any injuries that you suffered. The few extra minutes that you take filling out the form may save you the loss of a month in processing time later.