By Larry Dandridge
This is the first in a series of five articles on VA decision reviews, appeals, and what veterans need to know about:
- Reviews and appeals of Non-Medical Treatment Decisions.
- Appeal of a VA Medical Treatment Decision.
- Patient Advocates and the Ralph H. Johnson VA Patient Advocate Team.
- The top nine reasons why veterans’ VA disability claims are denied.
- What to Do If Your VA Disability Claim is Denied.
- How to check your claim status.
- Managing your legacy appeal.
- Getting help requesting a decision review.
- Choosing a decision review option.
- Answers to frequently asked questions.
- What happens after you request a decision review.
- The Appeals Modernization Act.
Reviews, appeals of VA non-medical treatment decisions
According to the “VA Decision Reviews and Appeals” webpage (https://www.va.gov/decision-reviews/) if you are a veteran, or the spouse, dependent, survivor, or family caregiver of a veteran, who disagrees with a VA decision, contact a VA-accredited Veterans Service Officer (VSO), whose services are FREE, or a VA-accredited attorney or VA-accredited Claims Agent. These VA-accredited representatives can help you find the decision review option that is right for you.
Appeal of a VA medical treatment decision
If you disagree with a VA medical treatment decision, a VA-Patient Advocate can help you file a Clinical Appeal. If you have a compliment, suggestion, or concern regarding your care, first speak with your treatment team. Your treatment team includes your doctor, nurse, social worker, dietitian, pharmacist, chaplain, therapist, and other medical care professionals. If you feel your concerns are not being addressed by your treatment team, you may contact a VA Patient Advocate.
Patient advocates
A Patient Advocate is a VA employee specifically designated and empowered at each Veterans Health Administration (VHA) facility to manage feedback from veterans, family members, and friends. The Patient Advocate works directly with management and VA employees to facilitate resolutions for the veteran or the veteran’s family member, survivor, or caregiver. Find VA facility locations using the VA “Find VA Locations” search tool at https://www.va.gov/find-locations. Learn more about VA Patient Advocates at https://www.va.gov/HEALTH/patientadvocate/.
The Ralph H. Johnson VA Medical Center and Healthcare System (RHJVAMC&HCS) Patient Advocates
According to the RHJVAMC&HCS “Patient Advocates” webpage (https://bit.ly/45368i6) their patient advocates are specially trained to help you resolve issues with your care. If you have experienced any problems that you haven’t been able to resolve by talking with your care team, please reach out to one of our patient advocates.
The RHJVAMC&HCS Patient Advocate Team
Hanna McCoy is the VA Charleston Health Care System Patient Advocate Supervisor, with six Patient Advocates on her team. Traviell Hartsfield is the North Charleston and Goose Creek VA Outpatient Clinics Patient Advocate; Amanda Ware is the Myrtle Beach VA Outpatient Clinic Patient Advocate; Elisha Boyd is the Patient Advocate for the Beaufort, S.C., Clinic, and the Savannah, Hinesville, and Brunswick VA Outpatient Clinics; and Traciee Prioleau, Valerie Edwards, and Cleon Smith are VA Charleston Patient Advocates.
Call 843-789-6066 to speak with a Charleston, North Charleston, Goose Creek, or Myrtle Beach VA Patient Advocate. Call 912-920-0214, Ext. 412205 to speak with the Savannah, Hinesville, Beaufort, and Brunswick VA Outpatient Clinic Patient Advocate.
Top 9 reasons why a veteran’s VA disability claim may be denied
One of the most important and generous of the many VA benefits is military service-connected disability compensation. According to the “VA Disability compensation” webpage (https://www.va.gov/disability/), “VA disability compensation (pay) offers a monthly tax-free payment to veterans who got sick or injured while serving in the military and to veterans whose service made an existing condition worse. You may qualify for VA disability benefits for physical conditions (like a chronic illness or injury) and mental health conditions (like PTSD) that developed before, during, or after service.” It is a terrible disappointment when a veteran applies for service-connected disability, and the VA denies the claim. Nine of the most common reasons why a veteran’s VA Disability Claim is denied include:
- The veteran gave incomplete information on the application forms. The VA prefers what it calls Fully Developed Claims (FDCs), which are complete claims with as much information and evidence as the veteran can muster to help the VA decide as quickly and easily as possible. The FDC process includes a built-in layer that allows for reconsideration. If the veteran disagrees with all or part of the decision on their FDC, they can work with their VA-accredited VSO (or VA-accredited attorney) to obtain any additional evidence needed and, if possible, resolve the issue by requesting reconsideration. With FDCs, the VA usually notifies the veteran in detail of the reasons for denial. The veteran then has the option to obtain any necessary evidence and request reconsideration as an FDC. Learn more about FDCs at the VA webpage “Fully Developed Claims Program” at https://bit.ly/4pT8CsE.
- The veteran submitted the wrong forms. For the VA to consider a Fully Developed Claim (FDC), the veteran must submit an Application for Disability Compensation and Related Compensation Benefits (VA From 21-526EZ), submit all evidence (supporting documents such as medical records, military personnel records, Lay Witness Statements, Nexus Letters, Personal Statement, Line-of-Duty Investigation Reports, Photos, Accident Reports, Purple Heart awards and citations, etc.) the veteran has along with the claim, certify that there is no more evidence the VA needs to decide the claim, and attend any and all VA medical exams (called Cost & Pension Exams or C&P Exams) that the VA schedules. Download the VA Form 21-526EZ at https://www.va.gov/forms/21-526ez/. Find out if a veteran needs to complete additional forms for his or her disability claim at the VA “File Additional Forms for Your Disability Claim” webpage https://bit.ly/4fJH5a1 and the VA webpage “Supporting Forms for VA Claims” at https://www.va.gov/supporting-forms-for-claims/.
- The veteran missed a deadline. The VA does not require a veteran to apply for VA disability within a certain time after their injury or illness. However, it might give you deadlines for furnishing additional evidence or forms necessary to process your claim. The VA may also require you to schedule doctor’s visits to support your claim within a specific period. Veterans must also complete a C&P exam, which will assist the VA in determining your disability rating and compensation. If you miss this appointment or any other deadline set by the VA, your claim could be denied.
Continued next week.
Larry Dandridge is a Vietnam War wounded warrior, a combat and 100% service-connected disabled veteran, an ex-Enlisted Infantryman, an ex-Warrant Officer Pilot, and a retired Lt. Colonel. He is a former Veterans Service Officer, a Patient Adviser at the RHJ VA and Durham VA Medical Centers, a Fisher House Charleston Goodwill Ambassador, and the Veteran Benefits Advisor for the AUSA Coastal Carolina Chapter, MOPH Chapter, MOAA Triangle Chapter, and VFW Post 7383. Larry is also the author of the award-winning Blades of Thunder (Book One) and a contributing freelance writer with the Island News. Contact him at LDandridge@earthlink.net or 843-276-716