A new system aims to speed up appeals
Effective February 19, 2019, the Department of Veterans Affairs has implemented a new system for veterans appealing an adverse disability rating decision.
With adoption of a new Veteran’s claim processing and appeals system, there are a lot more options for veterans to choose from when pursuing a Veterans Affairs (VA) benefits’ claim.
The AMA was enacted to streamline and simplify a complex appeals system. Under the older Legacy system, there were varying dates to perfect an appeal that was confusing for many individuals. Under the new system, veterans generally have one year to appeal an adverse decision.
What drove the creation of a new system?
Disability claims with decisions prior to February 19, 2019 will still use the already established procedures to resolve the older claims. It is aptly referred to as the Legacy System. Most [KC1] [KE2] new appeals for decisions after February 19, 2019 will be processed under the Appeals Modernization Act system.
Legacy is the older system for claims prior to February 19, 2019.
Legacy: all claims filed prior to February 19, 2019 are now characterized as ‘legacy” with the VA having an ambitious goal to process all claims under the new system by the end of 2020. There may be exceptions for claims that come from the Court of Appeals of Veterans Appeals. Legacy cases are the priority for resolution. Ninety percent of the VA’s resources will still be focused on these in order to get rid of the backlog of old cases still awaiting review. Even if your case is in the legacy system, you still have two opportunities to opt into the new AMA. Before opting into the new system, we highly recommend contacting an attorney first so that you understand how all the new options of AMA work.
Appeals Modernization Act system: In the old Legacy system, the first decision that a veteran receives after they file a claim is called a Rating Decision. Now it will be called an Initial Decision. In the older Legacy system, if a claim is denied, it can be appealed to the Regional Office who may issue a Statement of the Case (SOC) in denying the claim a second time. If additional information is submitted upon which to base an appeal, the Regional Office will issue another decision called the Supplemental Statement of the Case (SSOC) if the claim is denied a third time.
Appeals Modernization Act (AMA) system is for claims after February 19, 2019.
In the new VA AMA system, there are three lanes for veterans to choose from depending upon their situation after the claim is filed and an Initial Decision denying the benefit claim is rendered. Appeals under the new AMA system have a deadline of being filed within one year after receiving an adverse decision.
The three new lanes are:
- Higher-Level Review: This is a fresh look at the claim – what attorneys call de novo –with a higher-level adjudicator. You need to be comfortable with everything in your file. There is no duty for the VA to assist. And most importantly, there is no new evidence allowed in this lane
- Supplemental Claim: If you need to submit more evidence but aren’t desiring to go to the Board of Veterans’ Appeals yet, choose this lane. The VA is mandated with a duty to assist an individual with gathering additional information for your case. Such additional evidence may include health records, Compensation and Pension exams, or even assisting you in obtaining your service records.
- Appeal to the Board of Veterans’ Appeals: After an Initial Decision, or even after a higher-level decision, a veteran may file a Notice of Disagreement (NOD) with the Board of Veterans’ Appeals in Washington, D.C. This lane cuts out the middleman and will allow you to obtain a Board hearing faster than under the traditional appeal system (remember though, that Legacy appeals will continue to be processed before new AMA appeals, so it is best to consult with someone before switching from the Legacy appeals system to the new AMA system). Under the AMA, the Board no longer has a duty to assist; however, if the Board judge sees errors in the duty to assist below, they can send your case back to the regional office to assist. Under the Board Appeals lane, there are three different dockets:
- Direct Review Docket – If you have no additional evidence to submit and do not desire to have a hearing before a Veterans Law Judge, this is the lane for you. The Board has a stated goal of issuing a decision within 365 days under the Direct Review Docket.
- Evidence Docket: This lane is useful if you have additional evidence to submit to the Board. Upon filing your NOD with the Board, you will have 90 days to submit any additional evidence. Under this lane you will not receive a hearing before a Veterans Law Judge.
- Hearing Docket: This lane is most useful if you have additional evidence to submit and you want to have a hearing before a Veterans Law Judge. While this will increase the wait time, a hearing may be most beneficial for your case. Hearings are held before a Veterans Law Judge either in DC or by videoconference at your local VA Regional Office. If you choose to submit additional evidence, you can present it either at the hearing, or within 90 days after the hearing is held. Under the AMA, you have the right to continuously appeal under the different lanes with limited exceptions. For example, you cannot request a Higher-Level Review of a Higher-Level Review decision, but you can request a Supplemental Claim Review. This is why it is crucial to choose the right lane, as choosing the wrong one may cause unnecessary delay in your desired outcome.
For adverse Board decisions, you may appeal through a Supplemental Claim or take it to the Court of Appeals for Veterans Claims (CAVC). If you desire to go to the CAVC, you have a 120-day appeal deadline.
It is important to note that under the new AMA, you have one year from the date of your adverse decision to appeal.
If you have received an adverse VA decision regarding your disability claim, either under the Legacy or AMA, the skilled attorneys at Rocky Mountain Disability Law Group may be able to assist you in your appeal. Contact our office for a free consultation today at (303) 534-1958.