Category: Veterans Disability Law
VA Supplemental Claim: Timeline, Back Pay, & Effective Date
The U.S. Department of Veterans Affairs (VA) is responsible for handling the disability compensation of former military members. Prior to 2017, if a veteran were unhappy with the amount of compensation they received (or didn’t receive), they would’ve had to submit an appeal to the Board of Veterans Appeals (BVA). Due to the high number of appeals submitted annually, new legislation was designed to streamline the appeals process and relieve pressure on the BVA.
With the full implementation of the Appeals Modernization Act of 2017 (AMA), there are now three new va appeal process lanes for challenging a VA disability claim decision:
- Supplemental Claims
- Higher-Level Review
- Go directly to the Board
By delegating less complicated cases to offices specifically trained for resolving VA disputes such as Decision Review Officers (DROs) who work at decision review operations centers (DROCs), the process has become more efficient for the VA and for veterans.
What is a VA Supplemental Claim?
A VA supplemental claim is a claim filed by an individual, who already submitted a prior claim that lacked required or valuable information, to receive a more favorable decision. The VA must readjudicate the claim when presented with new and relevant evidence. This allows veterans to challenge an unfavorable decision without the lengthy process of going through the BVA. Supplemental claims are a quicker alternative that allow claimants to submit additional information which wasn’t included in the original claim.
When is a Supplemental Claim Used?
Whether or not you should file a VA supplemental claim depends on your situation. If you believe a mistake was made by your original adjudicator on your prior claim, you should pursue a Higher-Level Review (HLR). An HLR is when all the existing facts in your case are submitted to a more experienced adjudicator who can decide if the original reviewer missed something or did not make a proper decision. The downside of an HLR is that no new evidence is allowed to be submitted. If you received an unfavorable decision because you didn’t include everything you needed to in your claim, you may consider filing a VA supplemental claim.
A supplemental claim is used when an individual’s case lacks information necessary for benefits. One of the most common examples of missing information is a current medical diagnosis. To prove disability to the VA, a veteran must submit a medical diagnosis from a qualified health professional that corroborates their claim. If their original claim is denied because that was not included, the veteran can go to a doctor, receive a current medical diagnosis, and file a supplemental claim that includes the new and relevant evidence.
New and Relevant Evidence
One downside to supplemental claims is the definition of “new and relevant evidence.” While the term “relevant” implies that the information will be accepted as long as it makes a decision more or less likely, the VA has referred to its old standard on multiple occasions. The old standard was “new and material evidence,” the word “material” implying that it must prove something. It will take a few more years of data to discern whether this new expectation is helping or hurting veterans.
It is worth noting, however, that VA supplemental claims are the only type in which the VA has a duty to assist in evidential gathering. Unlike Higher-Level Review and BVA cases, there is an expectation that the VA will help you collect the proof necessary to earn the claim you deserve.
Examples of New and Relevant Evidence
Evidence submitted in a VA supplemental claim must be both new and relevant. New information is evidence that the VA has not seen before which also does not repeat anything already reviewed. For example, if the VA has already seen a diagnosis, the same diagnosis from another professional will not be accepted because it has already been seen. On the other hand, a diagnosis that shows an increase in severity or a new diagnosis that deals with the same issue will be considered new.
Relevant evidence has to do with the issue or issues that are being appealed. The information presented must be linked in some way to the condition being disputed. Secondary condition diagnoses are considered relevant.
Here are some examples of new and relevant evidence:
- Service Records: Documentation from active service detailing medical treatment for an issue or statements from other service members that communicate disability severity or service connection.
- Medical Treatment Records: A new diagnosis, observation of increased severity, or secondary condition recorded by a treatment provider.
- Independent Medical Opinions: An unbiased opinion on the VA claim evidence and decision from a provider with nothing to gain from the case.
- Lay Evidence: Statements from individuals in the claimants life that state their experiences with the veteran’s behaviors or physical conditions which had not been submitted to the VA before.
This evidence will be presented at the beginning of the process when filing a supplemental claim.
Understanding VA Supplemental Claim Effective Date
A VA disability claimant will receive an effective date, which is the day that benefits begin being paid for a disability. Because a supplemental claim is a secondary appeal claim, it’s important to take steps to preserve the effective date of an original claim. Supplemental claims must be filed within one year of a VA decision in order to preserve the effective date.
Disabled veterans waiting for case decisions are eligible for VA supplemental claim back pay, also called retroactive benefits. This occurs when the VA owes benefits that have accrued since the claimant’s effective date. To deal with this VA supplemental claim compensation issue, the VA grants a lump sum benefit to the claimant if/when their case is approved.
If a veteran preserves the effective date from their original claim, they will receive benefits from that time. If a veteran waits more than a year after the decision before filing for a VA supplemental claim, their new effective date will be the date of the new supplemental claim. This means the VA would only pay out retroactive benefits for the time since the supplemental claim.
A veteran can submit any number of VA supplemental claims.
VA Supplemental Claim Effective Dates and VA RAMP
While AMA was signed in the summer of 2017, it didn’t go into effect until early 2019. On April 1st, 2018, a temporary law called the Rapid Appeals Modernization Act (RAMP) allowed veterans to enter the AMA program before its start date. The RAMP VA disability compensation program allowed individuals to opt-in to supplemental claims or HLRs. When AMA began in February of 2019, RAMP was discontinued and all eligible veterans were offered the opportunity to switch into the new AMA system which allows all veterans to take advantage of the quicker appeal lanes.
VA Supplemental Claim Timeline
The goal of the AMA is to streamline the VA decision making process and reduce wait times for veterans who submitted a claim. In the supplemental claim lane, the VA has a 125-day goal for issuing decisions. On average, they’ve been able to return claims in around 60 days. You can check your VA supplemental claim status at any time by logging in to VA’s Appeals Tracker, going to your local VA regional office, or calling the VA at (800) 827-1000.
VA Supplemental Claim Success Rate
According to the BVA’s 2018 annual report, the success rate for VA disability appeals was about 35.75 percent. Since the AMA only reached full implementation in 2019, there is not yet accurate data surrounding the success rates of VA supplemental claims, but around 75 percent of veterans filing appeals through the AMA have been filing supplemental claims. The combination of more straightforward forms and the VA’s duty to assist in gathering information means claimants are more likely to receive the compensation they deserve.
Contact Tuley Law Office
The experienced lawyers at Tuley Law Office understand the potential complications when applying for VA benefits. If you have questions or are interested in a no-obligation case evaluation, contact us today. We look forward to working with you.
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