Anatomy of the administrative claims process for service connected disability

Veteran files a claim at regional office (RO) of VA or through a service officer

• you can file an informal claim just by writing to the VA and telling them you believe you have a disability, the VA is required to provide you with an application to formalize the claim 

VA schedules a compensation and pension (C&P) exam at a VA hospital and also sends for your service medical records (SMRs) 

When the C&P exam is completed it is transmitted to the RO for adjudication

• the VA doctor does NOT make the decision whether or not you are disabled, the doctor just provides a medical assessment and medical opinion or diagnosis 

The RO will review the C&P exam, your SMRs and any other relevant medical records you have submitted and will make a decision based on the following:

• Do you have a medical condition(s) and, if so,

• Was that condition(s) incurred in or aggravated by your military service and, if so,

• Is that condition(s) disabling and, if so,

• What is the severity of the condition(s)

• Based on the severity of the condition, what disability compensation rate should be assigned 

The RO will issue an award letter that awards disability based on the above determinations or that will deny an award if it is determined your condition(s) was not incurred in or aggravated by your military service 

Upon receipt of your decision you have the right to appeal a decision denying your claim in whole or in part, or the rating assigned to any approved conditions. 

It is important to pay careful attention to time limits if appealing and to carefully choose a representative.  While veterans can manage their own claims they can also choose a veterans service officer and, at least for the time being, hire legal counsel after filing a notice of disagreement with a decision at the RO.  Most attorneys will need to concentrate their efforts on cases of total disability or total disability based on individual unemployability but veterans can also choose to hire an accredited claims agent who may have a much lower overhead than attorneys for those cases that have no potential for total disability. 

NOTE: LEGAL FEES ARE LIMITED TO 20% OF PAST DUE BENEFITS.  FEE AGREEMENTS ARE USUALLY CONTINGENT ON WINNING YOUR CLAIM BUT IF AN HOURLY CHARGE IS AGREED TO, ANY FEE EXCEEDING 20% OF PAST DUE BENEFITS WILL VERY LIKELY BE LOOKED AT UNFAVORABLE BY THE VA AND THE COURT OF APPEALS FOR VETERANS CLAIMS.