Every application for benefits must meet all of the elements of what the VA calls “the Fully Developed Claim”. The concept behind a fully developed claim is that you will give the Regional Office all of the relevant and probative evidence you can get your hands on to make your case. You provide this information up front when you make your formal application by filling out the appropriate benefit forms and including all of your evidence with it. The goal is for all of the evidence to be sufficient enough for the Regional Office development team to pass on to the rating activity for a final decision. This fully developed claim concept could get you a decision within a matter of a few months instead of the typical 8 to 18 months that it takes by simply applying and waiting for VA to assist you in developing your evidence.
Here are the steps in the process that would you will use for every claim that you file. Since each type of claim is different, you may not need every step for a particular type of claim.
1. Decide Whether the Condition Warrants Making a Claim
Many veterans seem to think that because of their service, they have an entitlement to disability benefits even if they aren’t currently disabled. Or, if they are currently disabled they seem to think that all of their ailments are a result of being a veteran. This attitude causes a number of veterans or their survivors to make application thinking that VA owes them something whether they qualify are not. Unfortunately, this attitude leads to a great number of claims that are filed where there is no benefit. It is also unfortunate that many people with this attitude come away from their experience with a bad taste in their mouth.
Please don’t misunderstand. Always file a claim if you believe that your disability is a result of service connection. Don’t file a claim if you are pretty sure that your disability condition is a result of non-service connection. If the disability is non-service-connected, don’t file a claim anyway just to see what you can get. This is not fair to you or to the other veterans who are waiting for their claims to be adjudicated. An unjustified claim – or so-called claim without merit – is only going to add to the current backlog in the system making it harder for everyone else.
2. Always File an Informal Claim
Once you feel that you can justify a claim for benefits and not waste your time or VA’s time, you should proceed to do an informal claim. An informal claim allows you to notify your Regional Office that you will be submitting a substantially complete claim and the appropriate claims form in order to start the process at some future date. You have one year from filing an informal claim to providing the formal application for a substantially complete claim.
An informal claim is typically used for application for new benefits. If you are applying for a re-evaluation of existing benefits or a change in existing benefits, you should use a formal request either on the appropriate VA form or using VA Form 21-4138, to establish an effective date.
Do not send a copy of the discharge at this time. The discharge along with the other information above will cause VA to treat the informal claim as a substantially complete claim and it will start the process of VA’s duty to assist. You don’t want to start this process at this point until you can get together all of the evidence to submit at one time. Submitting the evidence piecemeal, based on requests from VA due to VA’s duty to assist, destroys the fully developed claim process and reverts it back to the old, time-consuming process we are trying to avoid .
The primary purpose of an informal claim is to establish an effective date. When the informal claim is received in the Regional Office, it will be date stamped and that date will become your effective date under most conditions. The effective date could be a later date if you don’t meet the qualifications for the benefit at the time of filing the informal claim. On the other hand, we have already warned you about this issue and you should not file an informal claim unless you are sure that you do have a valid claim for benefits.
3. Get a Copy of Your Discharge and Locate Your Own Service Treatment Records (STR)
You will need a certified copy of your discharge for filing the formal fully developed claim. If you do not have the original, you can order a certified copy using Form SF 180. If you have an original of the discharge, and you do not want to send it in with your formal application, generally the County Recorder’s Office may provide a certified copy for the veteran. If your state has an archive of discharge records, which many states do, call your state Department of Veterans Affairs and they will send you a certified copy.
If your claim is going to be tied to service treatment records – which not all claims are – then you should use Form SF 180 to get those records from the Service Center in St. Louis as part of the evidence collection you will be doing for your fully developed claim.
The Official Military Personnel Files (OMPF), held at the National Personnel Records Center (NPRC), are administrative records containing information about the subject’s military service history. Many OMPFs contain both personnel and former active duty health records, but the service branches discontinued retiring the health record portion to the NPRC in the 1990s.
In the past, all of the military services retired the individual health record, along with the personnel record, to the NPRC upon a service member’s separation from service. The Army and the Air Force retired its health records with the Official Military Personnel File, while the Department of the Navy (including the Navy, Marine Corps and Coast Guard) retired these files separately to the NPRC until the 1980s.
Health records cover the outpatient, dental and mental health treatment that former members received while in military service. Health records include induction and separation physical examinations, as well as routine medical care (doctor/dental visits, lab tests, etc.) when the patient was not admitted to a hospital.
In comparison, clinical (hospital inpatient) records were generated when active duty members were actually hospitalized while in the service. Typically, these records are NOT filed with the health records but are generally retired to the NPRC by the facility which created them (see clinical records for more information). Medical records from the Department of Veterans Affairs (VA) are also not included.
4. Obtain Your Own Private Medical Records
As part of the fully developed claim process, you should never have VA order your medical records. Your doctors and specialists are used to being paid a fee to provide copies of your records to third-party organizations. Sometimes these copy fees can be as much as $100 or more. As a general rule, you will not be charged for copies of your own private medical records. When VA puts in a request for your medical records, it will not pay a fee because it is prohibited by the regulation cited below. This does not mean that your doctors can refuse to supply copies, because they are required to respond to government agencies.
5. Have Your Private Doctors or Specialists Do Disability Evaluations
For many of the presumptive service connected conditions such as cancer, heart disease, diabetes and other chronic diseases or disorders, description of the disease process, symptoms and past and current treatment protocols are enough to guide the rating activity to assign a level of disability. Debilitating diseases or disorders are already inherently disabling. Your private medical records might be enough for the rater to make a decision. On the other hand, some conditions or diseases need a level of disability to be determined in order to make a rating decision. This is especially true for conditions involving range of motion limitations, requirements for assistance from others and cognitive impairment.
The VA has designed disability rating forms for private consultation for most of the disorders or diseases for which applications are made. There are currently 70 of these and they are called Disability Benefits Questionnaires. There are no DBQ’s for hearing loss or mental disorders (other than PTSD) as these require specialists from VA to do the evaluations. Even though these conditions do not have DBQ’s, you should still obtain a private evaluation for any condition that is not covered by the DBQ’s to include hearing loss and mental disorders.
It is extremely important for you to establish your own line of evidence and not rely on VA to provide all the evidence for your disability or your service connection. Whether the application you are making is presumptive service-connected or not, always do your own private disability evaluation. VA will often not consider your application to be a fully developed claim unless you complete one of these forms – prerequisite filing of a DBQ depends on the condition. So go ahead and do it anyway.
For more information, or to schedule a consultation for your veterans benefits related claim, contact one of our VA accredited attorneys today at (860) 900-0900.