Our Claims Benefits Advisors are available statewide to help you process your VA claim. These services are free of charge and our Benefits Advisors are all Veterans who have chosen to serve their fellow Veterans and Veteran families. All our Benefits Advisors are well versed on communicating your unique situation to the VA efficiently and effectively. Let us do what we do best. Serve you.

 

Understanding Claims:

What is a Claim?

A claim is an application seeking benefits of the Department of Veterans Affairs – as defined by the Code of Federal Regulations 38 C.F.R, Chapter 1, Part 3.

CHECKLIST TO FILE A CLAIM

  • Claim for disability benefits (Compensation)
    1. Copy of DD-214 (Member 4 Copy)
    2. Copy of Service Medical Record/Service Treatment Record (if available)
    3. Copy of any private medical records (if any outside care completed)
  • Claim for disability pension (Pension)
    1. Copy of DD-214
    2. All necessary income and asset information (for all members of a household)
    3. If under 65, any military, VA, SSA, or private records showing disability or inability to work.
  • Claim for Special Monthly Compensation/Pension (SMC/SMP)
    1. Healthcare provider is required to complete VA Form 21-2680 to submit with application to show a need for assistance with activities of daily living (ADL’s).

HOW TO FILE A CLAIM

To file a claim with the Department of Veterans Benefits Administration (VBA):

  1. The first step to filing a claim for an individual should be completing what is known as an “Intent to File” (VA Form 21-0966).  This document will preserve a date of claim for up to one year (364 days) from the date of receipt by the VA.  The VA WILL NOT recognize more than one intent to file concurrently (back to the date of filing) for the same benefit (i.e.- Compensation, Pension) (38 C.F.R. ⸹3.155(b)(6)).
  2. If the claimant intends to have representation by an advocacy organization (i.e.- Texas Veterans Commission), the Veterans Service Organization (VSO) must be appointed by that individual by completing a VA Form 21-22.
  3. The next step would be to complete the actual “claim” document for the claim being sought.  The actual form used will vary depending upon the benefit being sought:
    1. 21-526ez, Application for Disability Compensation & Related Compensation Benefits
    2. 21P-527ez, Application for Pension
    3. 21-686, Declaration of Status of Dependents
    4. Etc. as applicable

* Note – Ensure that you are using the most current and up-to-date forms, as the VA will often deny or reject forms submitted on outdated forms.

CLAIMS PROCESS

After you have applied or submitted your claim, there are eight distinct steps that most claims for disability compensation follow. These phases may vary in time depending on the complexity of the claim, the amount of evidence that must be gathered to support the claims, and the type of evidence. You are strongly encouraged to submit as much evidence as possible with your claim to help minimize processing time. This also helps to make your claim as much of a fully-developed claim (FDC) as possible. The eight steps of claims processing are as follows:

  1. Claim Received
    Your claim has been received by the VA. If you applied online with E-Benefits, you should see receipt in your list of Open Claims within one hour. If you applied through the U.S. mail, please allow mailing time plus processing to record receipt of your claim.
  2. Under Review
    Your claim has been assigned to a Veterans Service Representative and is being reviewed to determine if additional evidence is needed. If the VA does not need any additional information, your claim will move directly to the Preparation for Decision phase.
  3. Gathering of Evidence
    The Veterans Service Representative will request evidence from the required sources. Requests for evidence may be made of you, a medical professional, a government agency, or another authority. It is common for claims to return to this phase, should additional evidence be required.
  4. Review of Evidence
    VA has received all needed evidence. If, upon review, it is determined that more evidence is required, the claim will be sent back to the Gathering of Evidence phase.
  5. Preparation for Decision
    The Veterans Service Representative has recommended a decision, and is preparing required documents detailing that decision. If more evidence is required, the claim will be sent back in the process for more information or evidence.
  6. Pending Decision Approval
    The recommended decision is reviewed, and a final award approval is made. If it is determined that more evidence or information is required, the claim will be sent back in the process for more information or evidence.
  7. Preparation for Notification
    Your entire claim decision packet is prepared for mailing.
  8. Complete
    The VA has sent a decision packet to you by U.S. mail. The packet includes details of the decision or award. Please allow standard mailing time for your packet to arrive before contacting a VA call center 1(800) 827-1000.

How Long Will This Process Take?

The length of time it takes to complete a claim depends on several factors, such as the type of claim filed, complexity of your disability (ies), the number of disabilities you claim, and the availability of evidence needed to decide your claim.

More Information on Compensation Benefits

PRIMARY TYPES OF CLAIMS

The Department of Veterans Affairs has six basic types of VA disability claims:

  • Original Claim – the first claim ever filed for disability compensation
  • Increased Claim – this is filed after an individual is already service connected for a disability, and the claimant is filing to have their rating increased due to the disability having gotten worse.
  • Special Claim – this is a claim for special needs associated to their service-connected disability, to include but not be limited to:
    1. Specially equipped vehicle due to the service-connected disability prevents your driving, or
    2. Temporary 100% due to recovery from surgery or hospitalization of a service-connected disability, or
    3. Individual Unemployability if your service-connected disability prevents your gainful employment (providing certain criteria are met).
  • Re-Opened Claim – a claim for benefits was denied in the past (greater than 1-year) and an appeal was not filed for the claim, and the claimant now has “New and Relevant Evidence” in support of their claim for establishing service connection.
  • New Claim – this is a claim for benefits by a claimant for a condition or disability which has never been filed for, and is not related to any currently rated service-connected disabilities.
  • Secondary Claim – this is a claim for a disability which is linked to, or caused by an already service-connected disability.  An example of this would be a knee injury caused by an ankle injury.

 

HOW DOES A CLAIM GET EXPEDITED, OR PRIORITIZED?

Certain criteria must be met for a veteran’s claim to be “flashed” or expedited for claim processing.  Although many calls are received by the VA requesting to expedite a claim, evidence is needed to do so for the following reasons to prioritize a claim:

  • Age 75 years or older (typically the DD-214, or other documentation will suffice for verification of age), or
  • Suffer from a serious illness (typically a letter from a physician explaining the diagnosis, hospice letter, or other evidence of severity of serious illness), or
  • Are in financial distress (provide past due mortgage/rent statements, utility statements, etc.), or
  • Homelessness, or
  • Have other sufficient cause (a reason for needing the claim reviewed faster must be provided and will be reviewed by VA for just cause)

HOW TO TRACK YOUR CLAIM STATUS

You can track the status of your claim by either calling your Benefits Advisor or you can register for eBenefits at: www.ebenefits.va.gov, or by calling them at 1-800-827-1000. On the VA’s ASPIRE site, you can find the average processing days for the regional office that is working on your claim. To find the average processing days for your state:

  • Find your state on the map, place your cursor within the state and click
  • This will open the Veterans Benefits Administration Aspire Benefits site. Click “Enter”
  • You should see a split table. On the left table click on “Compensation”
  • This will expand the table. Approximately five rows down is “Rating Claims Processing Time”
  • Follow that row to the right until you locate the cell located within the column of your regional office.

The number you see is the average processing days to complete a claim that requires a disability rating. The average is based on completed claims since October 1, in a given fiscal year.

FREQUENTLY ASKED QUESTIONS
  • Where can I file a claim
    1. If a claimant has an account through eBenefits, that individual “can” file their own claim through that website. However, it is strongly encouraged that the individual utilizes our trained staff (Veteran Service Officers) to review and submit claims to prevent delays and ensure that the claim is submitted as a “Fully-Developed Claim” (FDC).
    2. Texas Veterans Commission Veteran Service Officers
    3. County Veteran Service Officers
    4. Other Veteran Service Organizations (i.e.: Military Order of Purple Heart, Veterans of Foreign Wars, Paralyzed Veterans of America, Disabled American Veterans).
  • How do I know if I am eligible for VA Compensation?
    1. Disability Compensation is a tax-free monetary entitlement paid to Veterans as a result of an injury or disease suffered, incurred, or aggravated as a direct result of one’s military service
  • What is DIC (Dependents Indemnity Compensation)?
    1. Dependents Indemnity Compensation is a tax-free benefit payable to a surviving spouse, child, or parent of a Veteran or servicemember who died either on active duty or as a result of their service-connected disabilities.
  • What is Veterans Pension?
    1. Veterans Pension is a tax-free benefit payable to low-income wartime Veterans (provided they meet military and income requirements).
  • What is a Veterans Service Organization(VSO)?
    1. There are over seventy recognized veteran service organizations as well as State Veteran’s Affairs which are recognized by the Department of Veterans Affairs. Many are non-profit groups which advocate on behalf of Veterans, Servicemembers, dependents, and survivors.
  • What is a Veteran Services Representative (VSR)?
    1. The Veteran Services Representative has undergone a formal application process, extensive training, and been recognized by the VA as being capable of assisting claimants with their affairs before the VA. VSR’s have passed the necessary examinations, background checks, and must maintain proficiency standards to remain as VSR’s.
    2. VSR’s assist with the completion of a claimants application for benefits as well as the reviewing claims for accuracy.
    3. If necessary, assist in the development of a “Fully-Developed Claims” (FDC’s) with the gathering of evidence on the claimant’s behalf.
  • What is a Veteran County Services Officer?
    1. Texas Government Code, Chapter 434, Subchapter B requires that if a Texas County has a population of more than 200,000 there shall be a County Veteran Services Officer assigned.
    2. VCSO’s have also undergone the formal application process, extensive training, and been recognized by the VA as being capable of assisting claimants with the filing of claims.
    3. In some cases, VCSO’s may be “Certified” but not “Accredited”. This simply would mean that they have the knowledge and skill to perform the necessary tasks at hand but must submit any claims to the VA Regional Office for review and ultimate submittal.
  • I received a Statement of Case (SOC), why did I get denied again?
    1. A SOC is NOT another denial. When an individual is going through the appeal process, and after the Notice of Disagreement has been processed…the next step is the Board of Veterans Appeals (BVA) will send a “Statement of Case” or SOC. The SOC is simply an explanation of what evidence was used in making the previous decision, and exactly how/why the VA came to their conclusions. Upon receipt of the SOC, the claimant MUST respond within 60-days to the BVA otherwise their claim/appeal will be dropped for failure to respond.
  • If I filed an Intent to File (21-0966), how many claims can I submit within that 1-year?
    1. The Intent to File holds a “Date of Claim” open for up to 1-year from date of receipt by the VA. Upon submittal of ANY claim for benefits, the 21-0966 is considered utilized or used.
    2. The VA WILL NOT recognize more than one intent to file concurrently (back to the date of filing) for the same benefit (i.e.- Compensation, Pension) (38 C.F.R. ⸹3.155(b)(6)).
  • Is there a phone number where I can talk with a TVC representative?
    1. You may contact our Waco Regional Office at (254) 299-9950 or our Houston Regional Office at (713) 383-2756.
  • If TVC does not represent me, is there a VA phone number I can call for questions?
    1. The VA toll-free number is 1-800-827-1000