8/18/2019 When VA Says No - Updated 9-16-15

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8/18/2019 When VA Says No - Updated 9-16-15

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VETERANS BENEFITS ADMINISTRATION

Overview of Event

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• Veterans Claims Con eren!e is inten"e" toe"#!ate t$e p#bli!

•

T$eme is %&$at to "o '$en VA sa(s )no*+• ,#estion an" ans'er perio" to ollo'• In"i-i"#al.!laim spe!i/! #estions !an be

ans'ere" b( VA representati-es in ba!an" si"e o t$eater

8/18/2019 When VA Says No - Updated 9-16-15

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VETERANS BENEFITS ADMINISTRATION

Getting to “Yes” – How VA Grants Claims

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To understand why VA has to say “no,” youneed to know how VA says “yes”• VA rants !laims or ser-i!e !onne!te" "isabilit(!ompensation base" on t$e ollo'in 3

• Dire!t Ser-i!e Conne!tion 4in ser-i!e e-ent6 !#rrent"ia nosis o t$e !on"ition6 ne7#s lin in t$e t'o8

• 9res#mpti-e Ser-i!e Conne!tion 4basis orentitlement6 !#rrent "ia nosis8

•

Se!on"ar( Ser-i!e Conne!tion 4establis$e" ser-i!e!onne!te" "isabilit(6 !#rrent "ia nosis6 ne7#s8• A ra-ation 4pre ser-i!e baseline o !on"ition6

e-i"en!e o 'orsenin in ser-i!e8

8/18/2019 When VA Says No - Updated 9-16-15

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VETERANS BENEFITS ADMINISTRATION

Getting to “Yes” – How VA Determines Level of Disabilit

!

To understand why VA has to say “no,”you need to know how VA says “yes”•

VA is bo#n" b( a ratin s!$e"#le• It i"enti/es "isabilities re!o ni:e" b( VA• Sets t$e le-el o impairment base" on

establis$e" !riteria•

VA relies on !#rrent $ealt$ assessment o!on"ition• E-i"en!e rom pri-ate pro-i"ers• E-i"en!e rom VA e7amination res#lts

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VETERANS BENEFITS ADMINISTRATION

Getting to “Yes” – How VA De"i#es $ni%&e 'ss&es

(

To understand why VA has to say “no,” youneed to know how VA says “yes”• VA !an rant In"i-i"#al ;nemplo(abilit(

• 9a(s at t$e 100 per!ent rate• Base" on emplo(ment $istor(6 !#rrent emplo(ment

stat#s6 reason or #nemplo(ment6 an" !#rrent "isabilities• An!illar( bene/ts are relate" to primar("eterminations

•

C$apter

8/18/2019 When VA Says No - Updated 9-16-15

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VETERANS BENEFITS ADMINISTRATION

VA )ai# “*o” – *ow +,at-

.

If the VA denied your claim, you may not need to lean appeal • I (o#r !laim 'as "enie" be!a#se (o# aile" to report or aVA e7amination

• Conta!t VA to re!onsi"er (o#r !laim '$en (o# are rea"( to report• M#st be 'it$in one (ear o noti/!ation o "enial."e!ision

• I (o#r !laim 'as "enie" base" on no "ia nosis o#n" on VAe7amination

• S#bmit an( pri-ate me"i!al e-i"en!e o a "ia nosis> T$is !anres#lt in anot$er VA e7amination• M#st be 'it$in one (ear o t$e noti/!ation o "enial."e!ision

• I (o#r !laim 'as "enie" base" on no lin to militar( ser-i!e• S#bmit an( pri-ate me"i!al opinion lin in t$e !on"ition tomilitar( ser-i!e• M#st be 'it$in one (ear o t$e noti/!ation o "enial."e!ision

8/18/2019 When VA Says No - Updated 9-16-15

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VETERANS BENEFITS ADMINISTRATION

VA )ai# “*o” – *ow +,at-

/

If the VA denied your claim, you may notneed to le an appeal • I (o#r !laim 'as "enie" be!a#se VA !o#l" not-eri ( an( or all o (o#r militar( ser-i!e

• Conta!t VA to re!onsi"er (o#r !laim an" s#bmitproo o ser-i!e 4DD 21?8• M#st be 'it$in one (ear o noti/!ation o "enial."e!ision

• I (o#r !laim 'as "enie" be!a#se (o# aile" tos#bmit an( re #este" e-i"en!e

• S#bmit t$at e-i"en!e as soon as possible• M#st be 'it$in one (ear o t$e noti/!ation o

"enial."e!ision

8/18/2019 When VA Says No - Updated 9-16-15

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VETERANS BENEFITS ADMINISTRATION

VA )ai# “*o” – *ow +,at-

0

If the VA denied your claim and youdisagree, you can le an appeal •

S#bmit a Noti!e o Disa reement on VAForm 21 0@5• M#st be 'it$in one (ear o t$e noti/!ation o

"enial."e!ision•

Be spe!i/!> Tell #s e7a!tl( '$at (o# "o not a ree 'it$an" are appealin• S#bmit an( a""itional e-i"en!e at one time6 as soon as

possible

8/18/2019 When VA Says No - Updated 9-16-15

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VETERANS BENEFITS ADMINISTRATION

VA )ai# “*o” – *ow +,at-

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How do I nd out why the VA made thedecision they did?

o#r Noti/!ation etter• hat e !ecided" VA pro-i"es a brea "o'n o t$e

"e!ision t$at in!l#"es an E7planation or ea!$Iss#e.Contention

• #$idence %onsidered 3 T$is se!tion 'ill list all t$ee-i"en!e re-ie'e" prior to a "e!ision on (o#r !laim

8/18/2019 When VA Says No - Updated 9-16-15

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VETERANS BENEFITS ADMINISTRATION

VA )ai# “*o” – *ow +,at-

hat e !ecided"

8/18/2019 When VA Says No - Updated 9-16-15

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VETERANS BENEFITS ADMINISTRATION

VA )ai# “*o” – *ow +,at-

#$idence %onsidered"

8/18/2019 When VA Says No - Updated 9-16-15

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VETERANS BENEFITS ADMINISTRATION

VA )ai# “*o” – *ow +,at-

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hat should I do if I missed an e&amand you denied my claim?

• Conta!t VA to re!onsi"er (o#r !laim '$en (o# are rea"(to report• M#st be 'it$in one (ear o noti/!ation o "enial."e!ision

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VETERANS BENEFITS ADMINISTRATION

+,at to #o +,en VA )a s “*o”

3

VA grants when it can,denies when it '()T*