What Happens to My Claim After it Gets Submitted

Many Veterans wonder “What happens to my claim once it’s submitted?”  The standard government answer is “It depends on the current VA pending workload and the complexity of your claim.”  What does that really mean, and how can I make my claim stand out to go faster?

What You Need to Know on How VA Claims Processing Works

The Veterans Benefits Administration (VBA) is the arm of the VA in charge of all things benefits related for VA.  In each Regional Office, there is a Claims Team that works Original Claims that are submitted via Fax, Mail, or Electronically (via eBenefits or an approved VSO, CVSO, or Attorney).  Once a Claim is submitted, it is indexed and prepared by a Claims Assistant (CA) for placement into the work queue for the Veteran’s Service Representative (VSR), who does the majority of the work on the Claims.  The VSR does all of the work to prepare it for a decision, sends it to a Senior VSR for review, and is sent to a Rating VSR for approval.  Once that is approved, a Rating Award Letter is generated and sent to the Veteran and the digital record is updated.

The VSRs are on a point system for everything they do, and have a daily, weekly, and monthly quota.  Closing a file by recommending an award action is the highest point total for them.  While the VA has a mandated “Duty to Assist” the Veteran in the assembly and processing of their claim, that is the lowest point value in the quota system.  If a Claim requires too much work, it will be pushed aside for another claim that is easier to process in order for the VSR to make their point quotas.  Members of our team saw that first-hand when they worked for VBA in in recent years. It sucks for both sides (the VSR & Veteran), but knowing how to approach it can help you in the end.

What does VBA consider to be “Complex”

VBA classifies a Claim as “Complex” if a Claim has multiple claimed conditions and/or supporting documentation is incomplete.  Incomplete documentation can be anything from not providing proof of military service, not providing full medical documentation, to not defining what conditions you’re claiming.  These will result in your claim being pushed aside for easier to work on claims and your claim taking longer to be worked on, and subsequently, decided on.

How Can I Make My Claim Not Be Complex

The goal is to make the VSR’s job easy so they will snag your file quicker and do yours first before someone else’s that may be less complicated.  The goal is to make the VSR at VA that opens your file look at it and say “this looks like a claim I can look through and finish quickly.” Make it so that the dots of what you’re claiming and the evidence to support it are easily connected & supported – that’s how to make a claim more appealing to a VSR to work on first, and hopefully, produce a more successful outcome.  Here are some tips on how to organize your files in your claim:

  • Organize the documents in a way where everything is separated by each claimed condition.
  • In each file, start with when the first sign of the condition when it was documented during service
  • Proceed chronologically with each reference to that condition until present day
  • Label each file with the condition name as it is listed in the Schedule of Ratings, Citing the Condition Number and Name (for example: 5242 – Degenerative arthritis of the spine)
  • Again, this is to make the VSR’s job easier.

No matter which way you choose to submit your claim, organizing it in a way to make it complete and more appealing to a VSR to complete will work well not only for you, but the VSR as well.  As far as the best way to submit your claim (self-represent, Veteran Service Organization, County Veteran Service Officer; paper by mail, fax, electronic), it all depends on what you feel most comfortable with.  We will cover that topic in another post.


Veterans Choice Act – Getting Care through the Choice Act

Getting Care Through the Veterans Choice Act


We have had a lot of questions come our way in regard to how to get care through the Veterans Choice Act and what’s covered and when it’s covered.  We want to provide all of you with guidance, what to make sure you have done, and what pitfalls to avoid and be aware of.

The Veterans Choice Act care is an optional alternative to getting care at an outside medical facility if you qualify for it.  It is not mandatory to use Choice Act for care – you can choose to wait until the next appointment is available, but you do have to inform the VA that you are waiving this option.


How Do I Get Authorized to Use the Choice Act?

  • The local VA Facility will inform you if you are authorized for Choice Act coverage based one of these qualifiers:
    • Told that you have to wait longer than 30 days for an appointment for care, OR
    • Live more than 40 miles from the closest VA Facility, OR
    • Unusual or Excessive Burdon
      • Geographic Challenges – A Veteran needs to travel around a large body of water, over a mountain, or needs to navigate a similar geographic barrier.
        • The Veteran resides in a location other than Guam, American Samoa, or the Republic of the Philippines and needs to travel by air, boat, or ferry to the VA medical facility closest to his/her home.
        • The Veteran faces an unusual or excessive burden traveling to a VA medical facility based on geographic challenges, environmental factors, or a medical condition. Staff at the Veteran’s local VA medical facility will work with him/her to determine if he/she is eligible for any of these reasons.
        • The Veteran resides in a State or a United States Territory without a full-service VA medical facility that provides hospital care, emergency services and surgical care having a surgical complexity of standard, and resides more than 20 miles from such a VA facility.
        • NOTE: This criterion applies to Veterans residing in Alaska, Hawaii, New Hampshire, Guam, American Samoa, Commonwealth of the Northern Mariana Islands and the U.S. Virgin Islands. Also note that some Veterans in New Hampshire reside within 20 miles of White River Junction VAMC and are therefore not eligible for the Choice Program.
      • Environmental Factors – A Veteran’s trip to the closest VA medical facility is blocked by traffic conditions such as a road that is inaccessible to the general public, or a prolonged road closure, or by hazardous weather conditions.
      • Medical Conditions – A Veteran has a medical condition, as confirmed by the local medical facility’s Primary Care Patient Aligned Care Team (PACT Team), that impacts his or her ability to travel.
      • Other Factors – A Veteran could be determined eligible based on the nature, simplicity, or frequency of the care he or she needs. This includes instances where a Veteran’s VA medical provider confirms that he or she requires an attendant to accompany him or her to a medical appointment either because of a medical condition or the type of procedure needed.


  • When the VA Facility calls to inform you of your eligibility, they inform you to wait for a phone call from the Veterans Choice Act in order to set up care. Each VA Facility has a Choice Act Coordinator that you can contact if you do not hear from the facility in a few days after being notified on your eligibility for Choice Act coverage.
  • The local VA Facility will then send the referral to the company running the Choice Act in your region:
    • Health Net Federal Services covers VA Veteran Integrated Service Networks (VISN) 1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12, 19, & 23 (Regions 1, 2, & 4)
    • TriWest covers VA Veteran Integrated Service Networks (VISN) 9, 15, 16, 17, 18, 20, 21, 22 (Regions 3, 5A, & 5B)
  • After the request from the local VA facility is received, The Choice Act Contractor will contact the Veteran directly to arrange the authorization for care at a private medical facility. The will need the following information:
    • Verify your address
    • Collect any Other Health Insurance (OHI) information if you have any
      • Your OHI will be billed as the Primary Insurance and Choice Act will be billed as the Secondary Insurance.
    • Your availability for an appointment based on your schedule
    • Help you in identifying a provider close to your home
      • NOTE: The Choice Act will tell you that any provider that accepts Medicare rates for care can be set up as a Choice Act provider. However, we recommend talking with the Choice Act personnel to find out who is already registered as a Choice Act provider, as the provider is not required to accept Choice Act patients.  Doing this will avoid headaches and limit problems down the road.
    • The Choice Act will then reach out to the provider to schedule your appointment based on your availability. Once it is scheduled, the Choice Act will contact you to verify your appointment time.
      • NOTE: The provider may contact you as well to get information from you ahead of your appointment time, or send you paperwork to have filled out before your first appointment, so be on the lookout for correspondence from the provider


Now I have Care through Choice Act – Now What?

  • Do NOT go to an appointment for care before you have an authorization or before the start date of your authorization. If you do not follow the timelines, you can be held responsible for the costs of the visit(s) or services.
    • Some Veterans have been asked to do lab testing before the first appointment, but if the lab draw is before the start date of the authorization, it will not be covered. If your provider requests testing before the start date, have them contact the Choice Act Contractor BEFORE services are done so your authorization can be modified.
  • When you go to your first appointment with the Choice Act provider, be sure to bring your identification (Driver’s License, State ID Card) and your Choice Act Card.
  • Copays – There are no up-front copays that you will be responsible for at the time of your appointment. Any copays will be billed to you by the VA if they apply after services are completed.  The copays rules you are subject to at the VA is also they copay rules that apply to your Choice Act providers.  If you are VA copayment exempt then you will not be required to make the VA copayment under the Choice Program.
    • If the Choice Act provider tries to bill you for services, refer them to the Choice Act for billing issues. You are not responsible for paying the Choice Act provider.
  • Additional Services at Request of Choice Act Provider
    • If your Choice Act Provider wants to request additional visits or additional testing, they must submit a Request for Additional Services in order to be covered for the expenses.


As long as you keep on top of things, you should have no problems using a Choice Act Provider.


Let us know what your experience has been using the Veterans Choice Act – we want to share people’s experiences with everyone so we can all use it to the best of its ability and function.



Asbestos Exposure and VA Benefits – What’s Out There?

A topic that was just brought to our attention was Navy Veterans that were exposed to Asbestos and who decades later are diagnosed with Cancer, to include Mesothelioma.  For decades, the DOD used Asbestos in many things, and Service Members were exposed, even with documentation that states that the DOD knew the risks to exposure.

Many work fields in the military were exposed to Asbestos, to include:

  • mining
  • milling
  • shipyard work
  • insulation work
  • demolition of old buildings
  • carpentry and construction,
  • the manufacturing and installation of products such as:
    • flooring
    • roofing
    • cement sheet
    • pipe products
    • servicing of friction products such as clutch facings and brake linings.

Also,  some have the misconception that only older era Veterans were exposed to Asbestos, but that is not the case.  OIF/OEF/Global War on Terror Veterans could have been exposed to Asbestos when older buildings were damaged and the contaminant was released into the air.

A Veteran that was exposed to Asbestos and has developed cancers associated with it can apply for disability compensation to obtain a VA Disability Rating and access to VA Health Care at little to no cost.

Eligibility Requirements for Disability Compensation:

  • You must be a Veteran who was discharged under conditions other than dishonorable
  • You must have been exposed to asbestos while in military service
  • You must have a disease or disability related to the asbestos exposure that occurred in military service

Evidence Requirements:

  • The evidence must show asbestos exposure while in military service. This may include your military occupation specialty and/or where you were stationed.
  • The evidence must show you have a disease or disability related to asbestos and a relationship exists between the exposure to asbestos in military service and the disease/disability.
  • You must claim a disease or disability. Exposure, in and of itself, is not a condition that is subject to service connection.

Points Where the VA Will Push Back On:

  • The VA will want additional proof that you were not exposed to Asbestos in any other way outside of your military service – if the VA can find another way a Veteran was exposed, they will use it to deny the claim.

If you are the Surviving Spouse of a Veteran who died from cancer from asbestos exposure, you can also apply for Dependency and Indemnity Compensation based on the same evidence.

Also, many Veterans and family members have consulted lawyers that specialize in Mesothelioma and Asbestos exposure in order to file a lawsuit for their exposure.  If you feel you may be eligible for a lawsuit, please seek out a lawyer that specifically practices on cases for Mesothelioma and Asbestos-related diseases and conditions.


Links for more information:

If you have any topic that we have not covered, please message us through our FaceBook page, and we will be more than happy to find answers.  If you think you may be the only one dealing with an issue involving what’s out there for any conditions for Veterans, you are probably not alone, and you can help us get content together to post for everyone in the Veteran Community to find.




The Secretary and Undersecretary Want to Hear From You – Does It Work?

A few months ago, the new Secretary of the VA, Robert McDonald, and the Undersecretary for Benefits (USB), Allison Hickey, decided that that wanted to hear directly from Veterans who have experience long delays in any VA Services.  To find out what was going on, they publically published their contact information so that Veterans could contact them.

Most of our team here were skeptical of this at first, thinking it was nothing more than lip service for the media to pick up.  As things have moved forward, we have been hearing of more cases of contacting them that have produced fast and successful results.  Recently, several members of the VBRG Team have used these lines of communication, and got immediate contact back from the USB, who also copied in the Director of the Regional Offices involved, and made fast work of the issues at hand, resolving most long-standing issues in under a week.  The USB has made it her mission to tackle any long backlogged claims (claims over 125 days since filing) and delayed appeals and get them moving forward and completed.  The USB has assembled an investigative team to tackle any and all inquiries.

The question is how do I contact them effectively?

  • First off, Keep It Respectful – they are more likely to help a Veteran who is being calm, cool, and collected than one who is just yelling through the email.
  • Provide as Many Details as Possible – Keep a Timeline of Contact on your case – exams, phone calls, letters, and/or major events.They want to help you, but they also want to take the information and help others by making improvements in processes.
  • Let Them Know If you’re experiencing hardships because of delays in your case – Are At-Risk of losing your home, unable to pay utility bills, facing bankruptcy, debt collections, repossessions?If so, let them know.  Where normal hardship letters seem to fall on deaf ears in the past, going right to the top has produced results in many cases.

If they take the time to respond, respond back to let them know you have seen it, and again, keep it respectful.  Here is a sanitized response that one Veteran received from the USB 9 hours after emailing her:


That made me tired just reading all the back and forth you have endured.  Let me ask [Regional Office Director] to get an expert on this asap and lets get this resolved with minimal back and forth moving forward.

[Regional Office Director] – please let me know the way forward.


If you feel that your case has been bogged down and want to see something happen, this is the way to go.  Below is a graphic of the contact information for the Secretary and USB:


We wish you all the best of luck, and we will keep the information coming.



Veterans Day – How to Thank a Veteran Every Day, Not Just on November 11th

On this years Veterans Day, we want to address the question we get the most from people in asking “What can we do to thank you?”  There are many things you can do, no matter who you are and what you do.

Everyone can simply approach a Veteran and say “Thank You for your Service” any day of the year.  Veterans served every day of their time in service of the military, and more continue to serve in numerous ways once their military career is completed.

If you are at  a restaurant and have the means to, offer to pay part of a Veterans’ bill as a way of saying thanks.  You can choose to do it directly, or simply with the server and surprise that Veteran.

If you own a business, you can choose to offer goods and services for military members, veterans, and/or family members at a discount.  We know some businesses can’t afford to do it all the time, and a Veteran will be appreciative of whatever token you can extend.  Some businesses offer a discount one day a month, some select days of the year, and some every day.  If you do offer a discount, have a sign that announces the discount.  Also, there are some great websites that list discounts for Veterans that you can submit your discount to that Veterans follow.  Our favorite site is Military and Veteran Discount Center.  Also, if you are hiring, consider hiring a Veteran.  A Veteran can offer many skills that will help you succeed as a business and it’s a great way to give back to a Veteran every day.

Send a reminder to your elected officials (local, state, and federal) to remind them that this country owes a debt to its Veterans, and they need to make sure that any and all benefits and services for Veterans are accessible to all.

If you have a Veteran in your life that is having a hard time to do things, offer to help them, whether it be cooking a meal, helping them clean their house, or giving them a ride somewhere (grocery store, doctors office, errands, etc.).  Any gesture that you can provide shows your appreciation to that Veteran.

Remember to also thank that Veteran’s family for what they have done.  They have sacrificed for their Veteran in many ways, from putting a career on pause, being a single parent when they’re gone on deployment, training, or other duties.  Their sacrifice is just as big as the Veteran, for that Veteran could not do what they do without the support of their family.

Thank you to all who are serving, have served, and their families and supporters.  Happy Veterans Day!


The Yellow Ribbon Program – What is it?

There is a great benefit program that is a complimentary program to the Post-9/11 GI Bill that can open up opportunities to attend other colleges that may not be fully covered under the GI Bill – The Yellow Ribbon Program.

The Yellow Ribbon Program is a matching funds agreement between institutions of higher learning who choose to participate and the VA.  Each school sets the amount they want to contribute to covering the gap after the Post-9/11 GI Bill, and the VA then matches the contribution.  Schools can choose to put a limit on the dollar amount, the number of beneficiaries they will award it to a year, both.  In some cases, schools will contribute unlimited matching to cover all costs combined with the VA’s matching funds.  A school makes the choice of if they wish to be a Yellow Ribbon Program Participating School, and schools are added every year.

We would like to hear from you:

  • Have you or any of your family members used the Yellow Ribbon Program?
  • Was it beneficial to you?
  • Were there any problems getting the Yellow Ribbon Benefit?

We want to hear from you!



The In-State Tuition for Veterans at All Public Universities

In all of the talk about the Veterans Access, Choice, and Accountability Act of 2014 passed recently, there is a key benefit that has not gotten a lot of press that will be of great benefit to Veterans attending any public university.

Buried deep within the Act (Page 4, Section 702 if you want to read it), any Veteran using the Post-9/11 GI Bill has to be afforded the in-state tuition starting the Fall Semester of 2015.

When a Veteran separates from the military and goes to attend school, typically they will either go to school where they got out of the military, or somewhere else where they may not have established residency for a long enough period of time to qualify for in-state tuition.  Members of Congress and the Veteran Community recognized that this was making a large financial burden on Veterans paying out-of-state tuition for the year or longer it takes to establish residency.  As things get set up by all the public colleges and universities, this will greatly improve access to education for Veterans and dependents utilizing the Post-9/11 GI Bill.