A) Your initial claim has been filed and acknowledged by the V.A. Expect to get a notice of DENIAL. It is almost automatic for a denial on a “first time out of the chute”. I feel the reason for this is to simply sort out the “phony vets”, and diminish the desire of the true veteran to pursue the claim any further. I honestly don’t believe they actually “look” at the evidence. Your claim will be denied. So now it is time to move onto the next step.
B) Now your are at a point of decision. Whether to take the claim to the B.V.A. in D.C. or to elect for an appeal to be reviewed by a “Decision Review Officer” at the regional office. At this level the D.R.O. will look at the evidence presented, including diagnosis’ and other medical and military records. This is when the D.R.O. has the responsibility to the V.A. to shoot holes in the evidence of the claim and support the first denial. Believe it or not, they will actually concoct a bullshit cover to deny evidence, or even state that the evidence was not presented in the claim. Expect to receive another denial in the mail. In fact you can bank on it. The back pay is adding up. Tick-tock.
To get to this point now has probably consumed from 13 to 18 months, and all you have gotten is a run-around and a headache. When the claiming veteran has waited for close to a year and a half to be awarded a disability rating, and has now been denied for the second time, can be a real devastating blow to have to absorb. I am still convinced that it is a part of the “phony vet” sorting out phase. At this point the “phony vet” will realize that their bullshit isn’t going to fly any further, they can not produce the evidence. They do not appeal any further. Unfortunately, at this stage of the game many of the legitimate vets have said “screw it” and quit in disgust or in not wanting anymore stress from the whole experience, which actually started close to 40 years ago. So the V.A. wins that claim. One more claim they won’t have to put in the budget.
C) Alright, so you’ve pursued the claim with yet another appeal. This time you‘ve requested a hearing at the regional office in front of a V.A. examiner, At this point the V.A. will acknowledge your request for a hearing. Some time after that you will be mailed a copy of the “Regulations of Federal Code 38”. These are the accords that I mentioned earlier concerning rating percentages, disability ratings etc. Shortly afterward you should receive a notice in the mail of your date and time to meet for your examination.
D) You have had your meeting with an examiner at the regional office. Your VSO and you have presented all the evidence to support your claim. All the bullshit reasons that the V.A. had used to deny the first two levels of the claim have been addressed and shut down. You have had to once again, “bare your soul“, to an examiner. This is your only opportunity to get that “human inter-action” to “sell” your claim. It’s just a damn shame that you basically have to “sell” your claim, even after all the diagnosis’ and doctor reports supporting the facts of the claim. It seems the V.A.’s mission here is to find a reason for denial, even up to the last opportunity. Don’t let the bastards wear you down. By the way, the entire hearing will be recorded for transcription and future reference.E) At this point, after your hearing, the examiner will make a preliminary decision and pass the file onto the “Adjudicators Office” The adjudicator will review the file to make sure all the T’s are crossed and all the proper boxes are checked and all necessary forms are included. These forms could be a doctors’ report or a finding from Social Security. Although they deny it, Social Security and the V.A. actually work close together because they both have to abide by the Federal Code Regulations. The V.A. has noted in my file receiving documents from Social Security.
After the adjudicator is finished the file goes back to the examiners’ office. Here the transcription of the hearing is produced. If you request it, you will receive a copy of the transcription in the mail. After that the examiner sorts through all the facts and evidence and requests any of the records that were not included in the file at the adjudicators office. It is only after all these hurdles have been crossed that a decision of rating is rendered. Remember, even at this point the V.A. is still looking for ways to deny the claim.
So now the examiners’ office has finished and the claim is closed. It is now sent onto “Post Determinations”. This is the point to which you have waited almost three years for. Post determinations is where they input all of your information into the system. They will type the “Notification of Award” letter, or your “Notice of Denial“. One very important thing is that you will not get a favorable rating until after you have had a “Compensation & Pension Hearing” This is where, yet another V.A. doctor gives a quick exam and determines the severity of disability percentage he or she thinks you are entitled to. My experience is that they are not too interested looking to confirm what your V.A. psychologist has already diagnosed. You may ask your VSO to request a C&P Exam at any time, after all, you must have one before the V.A. awards any level of disability Tick-tock.
F) It is at this point in which my VSO & I appealed my denial to the Bureau of Veterans Affairs (BVA) in Washington D.C. We also included new evidence in support of my claim and asked the regional VBA to take another look at the facts and make the proper decision.
G) I was sent for my “Compensation & Pension Hearing.” This is where another V.A. doctor asks you some questions to determine the severity of your disability.
During this hearing, which only lasts about 15 or 20 minutes. During mine, the examiner never asked me anything Vietnam and very little at all concerning my military service, but did ask me if I ever did hard drugs, or if I had ever been in prison! The answer to both was NO. But trust me, what the doctor is actually doing is observing your answers and actions to determine if it is in agreement with what your V.A. psychologist has already diagnosed. You absolutely will not be able to receive any disability rating without a C&P Exam. You may ask your VSO to request a C&P Exam at any time. May as well get it done and maybe it will expedite your claims process.(But probably not in a positive direction.)
Now here is a very important thing to remember, the C&P exam is set-up, and prepared, to give grounds for the V.A. to award a lower rating percentage than what you actually may deserve. In my case, I met with the C&P examiner for 10-15 minutes, tops!
The examiner asked not one single question about my experiences in Vietnam. Yet the examiner noted that I did not meet the DSM-IV criteria for PTSD. A complete contradiction of my doctors at the V.A. clinic where I have been receiving treatment for PTSD for several years. The examiner then made a “complete” five point diagnosis !! The examiner also gave a very high GAF rating (almost twice as high as I had received in seven different diagnosis’).
I highly suggest that in a week or two after your exam, you go to the clinic or hospital that you normally attend and fill out an ROI (release of information) form requesting a copy of the C&P exam. Be sure to state exactly what you want. Give the date, time, and place of the exam. I got my copy and absolutely could not believe the load of bullshit that was in the report. Contradictions, falsehoods and fabrications. My VSO (veterans service officer) then read the crap and immediately wrote a letter to the regional director of the V.A., asking that the exam be completely thrown out as unprofessional, incompetent, and completely unacceptable. This effort in obtaining a copy and subsequent letter may just have saved me a whole world of grief in appealing for a more appropriate rating ! Do it !!
If your rating is less than 100 % you can appeal for a higher percentage under certain conditions. In order to apply for “individual un-employability”, which will get you 100% permanent disability, you must have a rating of at least 60% for one claim that has only one diagnosis of disability. If your claim has more than one diagnosis of disability, they must add up to at least a 70% rating. So even if you end up winning your claim and have received a favorable determination on your claim, the appeal process is not necessarily over. I have actually talked with veterans who are perfectly content with their 70% rating because they don’t want to deal with the V.A. process any further. When a person considers the difference between a 70% and a 100% rating, it just seems stupid to me not to pursue the claim for a more accurate rating. After all, you have given about three years of your life to get to the point that you are. So why stop now?
I hope that the information that I have laid out to is going to be of help. Mind you, I am not a professional in this field, I am not a doctor or a service representative or any type of authority. What I am is a veteran who has been through the process. And now I just want to take my experience and gained knowledge of the V.A. claims process and pass it onto any of you veterans who are embarking on this course. GOOD LUCK !!
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