Navigating the complexities of Department of Veterans Affairs (VA) disability claims can be a daunting task. Understanding the various avenues available for veterans seeking to appeal or supplement their claims is crucial. In this article, we will delve into VA Supplemental Claims explained by Garren Cone, an accredited claims agent from AVET appeals, as he thoroughly explains what is a VA supplemental claim, sheds light on their significance in the VA claims process, and the types of new and relevant evidence required, which gives veterans additional tools to challenge denied claims and pursue fair disability compensation.
The Power of Supplemental Claims
Garren Cone acknowledges the pros and cons, especially the benefits of supplemental claims under the Veterans Appeals Improvement and Modernization Act (AMA) of 2019, which allows veterans to challenge denied claims by presenting new and relevant evidence. The VA estimates that about 60% of pending claims are supplemental claims while 40% are original. Around 81% of veterans who file supplemental claims are receiving some form of monetary compensation from the Veterans Benefits Administration (VBA). This reflects a high success rate of supplemental claims.
Supplemental claims provide flexibility by permitting reconsideration of decisions as far back as 2007, often surpassing the standard one-year limit. The AMA, effective since February 19, 2019, offers three appeal options:
- Higher-Level Review
- Appeal to the Board of Veterans’ Appeals (BVA)
- Supplemental Claims
A supplemental claim is ideal if the initial claim lacked essential information, such as a current medical diagnosis, nexus opinions, service records, or if the veteran has new documentation connecting their disability to military service.
The VA is responsible for assisting in gathering this evidence, unlike the Higher-Level Review process. The submission must meet the “new and relevant” evidence standard, a more relaxed criterion than the “new and material” evidence required under the Legacy system.
When to File a Supplemental Claim?
Filing a VA Supplemental Claim is an appropriate decision in several scenarios. Garren details that you can file a supplemental claim if you have new and relevant evidence that was not included in your original claim, such as a medical diagnosis or you’re requesting a review based on a change of law, for example, the PACT Act. Additionally, if your condition has worsened, a supplemental claim can be filed to seek a more favorable decision.
Veterans should also file a supplemental claim if they believe the VA’s initial rating was too low or based on incomplete information. Claims must be filed within one year of the initial decision using VA Form 20-0995. This main advantage of this process is that it offers a quicker, evidence-based alternative to the longer BVA appeal process.
The Core Requirement: New and Relevant Evidence
One crucial distinction with VA supplemental claims is the requirement to submit new and relevant evidence. Garren stresses the importance of understanding what constitutes “new and relevant” evidence. New evidence refers to information not previously considered by the VA, such as a medical diagnosis or documentation not included in your original claim file (C-File). Relevant evidence directly proves or disproves an aspect of your claim, like linking a disability to your military service or supporting your claim for a higher rating.
Previously, the term used was “material,” a legal term, but now the emphasis is on relevance. The evidence must have the potential to change the outcome, convincing the VA that their initial decision was incorrect.
The Role of VA and Providers in Gathering Evidence
The VA’s “duty-to-assist” plays a critical role in helping veterans gather evidence for supplemental claims. This includes obtaining records from VA facilities, private healthcare providers, and federal agencies like the Social Security Administration. Veterans should submit new, relevant evidence or request the VA’s assistance to strengthen their claims. For example, a new personal statement or diagnostic test results can support a claim and potentially increase a disability rating.
Reliable providers, such as Prestige Veteran, also play a key role in this process. Veterans, whether working alone or with a claims agent, should ensure the VA receives new and compelling evidence, which may include updated medical records or statements from reputable providers. This collaboration is crucial for building a stronger case for disability benefits.
Examples of New and Material Evidence
The discussion delves into examples of evidence that can be considered new and material. Garren notes that a migraine buddy log could serve as effective medical evidence. Furthermore, veterans need to consider the “well-grounded” nature of their claims. This involves establishing a connection between the incident in service and its current impact through relevant, impactful evidence.
- New Medical Diagnosis: A previously denied claim for back pain may now be supported by a recent medical report showing increased severity or a new related diagnosis. For instance, an MRI scan revealing a worsening condition since the original claim is considered new and relevant.
- Buddy Statement: If your claim was denied due to a lack of eyewitness accounts, submit a lay statement from a military colleague or family members describing the incident that caused your injury and its ongoing effects on your health.
- Independent Medical Opinion: A medical nexus letter from a healthcare professional linking your current condition to military service can also serve as new evidence. For example, if your post-traumatic stress disorder (PTSD) claim was denied due to lack of service connection, a new nexus letter explaining how the PTSD is directly related to stressor events during your deployment would be highly relevant.
- Old Evidence Missing from C-File: Sometimes, evidence not included in your original claim file such as old medical records can be resubmitted as new evidence. If these records were overlooked or not provided during the initial review, they could support your VA supplemental claim.
- Social Security Administration (SSA) Disability Determination: If the SSA has found the veteran to be disabled due to related conditions, this information can serve as supporting evidence for a VA disability claim.
Evidence Required for Presumptive Conditions
If you have a presumptive condition now covered due to changes in law, such as those under the PACT Act, you only need to provide medical evidence documenting your diagnosis and its severity. With qualifying military service, the VA automatically presumes that your service caused the claimed condition. The PACT Act expands to 23 presumptive conditions, including those related to burn pits, Agent Orange, and radiation exposure, making it easier to establish a service connection.
The Weight of Evidence in the VA Process
Garren sheds light on the VA’s process of developing a claim and how evidence is weighed. He explains the concept of equipoise, where evidence from the veteran and the VA are weighed against each other. If the scale is even, the Reasonable Doubt Doctrine dictates that the decision must be in favor of the veteran. This underscores the importance of submitting substantial evidence, such as reports from reputable organizations like Prestige Veterans, to tilt the scales in the veteran’s favor.
Filing a Supplemental Claim: Key Steps and Documentation
To successfully file a VA supplemental claim, veterans must ensure all required documentation is accurate and complete. The key components of appeals process include:
- VA Form 20-0995: This form, known as the Supplemental Claim Application, is necessary to begin the process. Veterans must provide personal details, list the conditions they are claiming, and outline the new evidence they are submitting.
- New and Relevant Evidence: Veterans need to provide evidence not previously considered by the VA. This can include updated medical records, witness statements from fellow service members, Social Security disability determinations, or a nexus letter linking their condition to military service.
- How to Submit: Veterans can file their supplemental claim online, by mail, or in person at a local VA office.
Once submitted, the VA will begin reviewing the new evidence to assess whether it justifies altering the original decision.
The Review Process for Supplemental Claims
After the claim is submitted, the VA assigns a Veterans Service Representative (VSR) or a Rating Veterans Service Representative (RVSR) to review the evidence. The steps in this process include:
- Initial Review: The representative evaluates all new and relevant documentation provided with the claim.
- Additional Medical Exams or Opinions: The VA may require further medical examinations or expert opinions from the veteran, healthcare providers, or government agencies to assess the impact of the new evidence on the claim.
- Final Decision: Based on the evidence, the VA will either grant the requested changes, such as increasing a disability rating or establishing service connection for denied conditions or uphold the original decision if the new evidence does not warrant a change.
In case of an unfavorable decision, veterans may opt for a higher-level review, a board appeal, or an additional supplemental claim.
On average, the review process for a supplemental disability compensation claim usually takes around 151 days to complete.
The Human Element and the Role of Advocates
Leah Bucholz emphasizes the human element in the adjudication process, acknowledging that mistakes can occur. She highlights the importance of having a knowledgeable guide in the form of a claims agent, attorney, or a Veterans Service Organization (VSO) to navigate potential roadblocks. Garen supports this by stating that veterans can represent themselves but having a seasoned professional can be immensely beneficial, especially when facing challenges.
Conclusion
In conclusion, VA supplemental claims offer veterans a valuable opportunity to introduce new and impactful evidence into their claims process. Understanding the intricacies, requirements, and weight assigned to evidence is crucial. The insights provided by an accredited claims agent like Garren Cone and the support of reliable organizations like Prestige Veteran can significantly enhance a veteran’s chances of success in their pursuit of VA benefits. Veterans are encouraged to leverage the resources available to them and make informed decisions throughout the claims process.
Also read: VA Higher Level Reviews Explained by an Accredited Claims Agent
At Prestige Veteran Medical Consulting, a veteran-owned company, we specialize in Independent Medical Opinions (IMOs) known as Nexus letters.
Our purpose is to empower YOU, the veteran, to take charge of your medical evidence and provide you with valuable educational tools and research to guide you on your journey.
Understanding the unique challenges veterans face, our commitment lies in delivering exceptional service and support.
Leveraging an extensive network of licensed independent medical professionals, all well-versed in the medical professional aspects of the VA claims process, we review the necessary medical evidence to incorporate in our reports related to your VA Disability Claim.
Prestige Veteran Medical Consulting is not a law firm, accredited claims agent, or affiliated with the Veterans Administration or Veterans Services Organizations. However, we are happy to discuss your case with your accredited VA legal professional.
