On August 23, President Trump signed into law the “Veterans Appeals Improvement and Modernization Act of 2017” (“The Act”). The Act is meant to speed up the appeals process for veterans seeking VA disability compensation. By February of 2019, The Act is intended to simplify the current appeals process by allowing veterans to choose one of three paths to appeal their claims. Under The Act, the disabled veterans can do ONE of the following:
Ø request a “higher-level” VA rater to review their case (without new evidence) and issue a decision; or
Ø appeal, with new evidence or information, to the same rater who originally denied their claim; or,
Ø have the appeal sent straight to the Board of Veterans’ Appeals (BVA).
Q: When will this new appeals process take effect?
A: The earliest the appeals reform bill will become effective is February 14, 2019 which is 540 days from the signing of the bill. The bill was signed on August 23, 2017 so there will be no change to the appeals process until February 14, 2019 or later.
Q: Should I wait to start my NEW claim until after The Act takes effect?
A: No. You should file your initial claim as soon as possible. If your claim is granted, VA will pay past-due benefits starting from the date you filed your claim. So, waiting to submit your claim until after The Act becomes effective WILL cause you to receive less compensation.
Q: Should I wait to file an appeal until The Act takes effect?
A: Again, No. You only have one year from the date of your Rating Decision (VA’s decision on your initial claim) in which to file an appeal. So DO NOT WAIT!
Q: Can I opt in to the new system once it’s enacted?
A: YES, Veterans with pending claims will be able to opt in to the new appeals process if they receive notice of a decision on an initial claim on or after the date the Act is enacted (likely February 14, 2019). You can also opt in after receiving a Statement of the Case or Supplemental Statement of the Case on or after the date the Act is enacted. Further the new RAMP initiative will allow select disabled veterans the right to opt-in to SOME of the new process.
The new appeals process, in theory, is supposed to streamline the process that tends to increase wait times. Mainly, the new changes target the processes surrounding new evidence and hearings. As it is right now, veterans can submit new evidence at any point during their appeal, which causes an additional round of reviews and drives up wait times (UNTIL THE APPEAL IS “CERTIFIED” TO THE BVA). The disabled veterans wait years just to get a hearing scheduled.
In this step, after receiving an Initial Denial, you appeal and the appeal goes back to your VA Regional Office (usually). However, you can request the review to be done at a DIFFERENT Regional Office in some circumstances.
A “more senior” VA Rater will then perform a completely new (de novo) review of your entire claims file. BUT, you cannot send in new evidence and the decision will be made based ONLY on the evidence already in your claims file. The VA has NO DUTY TO ASSIST the disabled veteran in getting evidence required to prove the claim.
Choosing this track after an initial denial results in your appeal going back to your VA Regional Office (usually). This basically becomes a “new” claim in my opinion, because this is a claim for the exact same benefits you were just denied, BUT you are also REQUIRED to send in “New & Relevant” evidence. Here, the VA does have a “Duty to Assist” you in getting the evidence required to win your claim. It is really no different than the current appeals process of just starting all over.
This third and final track of the New Appeals Process means that once your original claim is denied, you can SKIP the review at your VA Regional Office and instead decide whether or not you want a “Hearing” either in-person or by videoteleconference with the BVA Veterans Law Judge.
The BVA will separate appeals into those wishes a Board Hearing and those not wanting a Board Hearing, supposedly to speed up the entire process. Here, new evidence is supposedly optional, but we really just don’t know yet.
As mentioned above, the VA’s “Duty to Assist” the disabled veteran (for example, their obligation to help veterans get their medical records, service records and private records) during the claims process will only apply to original claims and supplemental claims. The duty to assist law would no longer apply to the Board or to claims filed on the Higher Level Adjudication track.
This means that the VA will ONLY help disabled veterans locate and submit medical records, military service records and/or private medical care records at the initial and supplemental claims stages. After that, you are on your own.
Read my post on RAMP to find out if you should enroll.
As many disabled veterans have heard by now, the President signed into Law the Veterans Appeals Improvement and Modernization Act of 2017 ("The Act") which is an attempt by Congress and the VA to speed up the backlogged Disability Hearing and Appeals Process.
The Dept. of Veterans Affairs (VA) rolled out RAMP on November 2nd, 2017, which is the first chance for disabled veterans to enter the new appeals process outlined in "The Act".
"The Act", signed into law on August 23, 2017, will not take full effect until February 2019. But the new program – "RAMP" (Rapid Appeals Modernization Program), will allow some veterans currently appealing their claims the right to participate in some, BUT NOT ALL parts of the new appeals system.
After "The Act" became law, VA immediately began the 18-month implementation of the new process. The new system is intended to streamline the VA’s current appeals process (now called "legacy appeals process"), which has received much criticism for its inefficiency and excessive wait-times.
By February 2019, all appeals should be processed under the new system. For now, though, veterans who want to appeal a VA decision can choose to remain in the legacy appeals process or participate in RAMP.
All of these new, old, and in-between systems are very confusing, even to experienced representatives and veterans. What follows is an attempt to explain exactly what is happening:
The "Legacy appeals process" is nothing more than the current VA appeals process.
All veterans who have already filed appeals are participating in this process. Veterans who are just now getting ready to appeal a denial, will be placed into the "legacy appeals process", UNLESS they are allowed to participate in the RAMP program.
The new appeals process ("The Act") presents a "three-lane appeals process" that will not take full effect until AT LEAST February 2019.
You can read all about how the new process will work and see it in visual form on this webpage.
RAMP (Rapid Appeals Modernization Program) is the "in-between", and optional appeals process that allows certain veterans filing their first appeal to participate in two out of three of the “lanes” that will make up the new appeals system
Participation in RAMP is voluntary, and in fact, the VA is currently only "inviting" select disabled veterans to participate. However, disabled veterans who do elect to participate in the RAMP program will not be able to return to the legacy appeals process, EVER. In other words, can you opt in to the new appeals process but you cannot opt out.
Veterans who submitted a claim, and have been denied (for the first time) by VA, can choose participate in RAMP. The program allows participants to have their decisions reviewed in the "Higher-Level" or "Supplemental Claim" review lanes outlined in "The Act".
The "Higher-Level Review Lane" allows a "higher-up" (more senior) VA official to review and maybe overturn previous decisions based on a difference of opinion, or return the decision for correction. But the veteran cannot submit new evidence to be reviewed.
The "Supplemental Claim Lane" allows veterans to submit new evidence in support of their claim. This is the only lane in which VA has a duty to assist veterans in finding or obtaining evidence.
Veterans participating in RAMP will NOT be able to use the third lane in the new appeals process, meaning they cannot submit their claims directly to the Board of Veterans Appeals (BVA).
IT IS VERY IMPORTANT TO UNDERSTAND THAT If a disabled veteran’s claim is again denied during participation in RAMP (either at the Higher-Level review or Supplemental Claim lane), then that disabled veteran will only be able to appeal to the BVA after February 2019, which is when the new appeals process is supposed to be in full effect.
The “Compassionate Allowance Initiative (CAL) was established in 2008 to fast track claimants through the disability determination process who are likely to be approved because they have certain eligible medical conditions. This was an excellent process, in theory.
But, for those disabled individuals who DO NOT have an attorney experienced in Social Security Disability (SSDI) or SSI Disability (SSI), qualifying for CAL is hit and miss at best.
However, the Social Security Administration (SSA) DOES NOT have a formal or systematic approach for identifiying certain medical conditions for CAL. SSA has in recent years instead relied on advocates for individuals seeking disability benefits due to certain diseases and disorders to bring these conditions to its attention. SSA therefore, may overlook disabling conditions for individuals who have no advocates, potentially resulting in individuals with these conditions not receiving expedited processing. Further, SSA does not have clear, consistent criteria for designating conditions for potential CAL inclusion, which is inconsistent with federal internal standards. As a result, the SSA lack key information about how to recommend conditions for inclusion on the CAL list.
To identify disability claims for expedited CAL processing, SSA primarily relies on software that searches for key words in claims. However, if claimants include incorrect or misspelled information in their claims, the software is hindered in its ability to flag all claimants with CAL conditions or may flag claimants for CAL processing that should not be flagged. SSA has guidance for disability determination services (DDS) staff on how to manually correct errors made by the software, but the guidance does not address when such corrections should occur (see flow chart below). Without clear guidance on when to make manual changes, DDS examiners may continue to take actions that are not timely and may hinder expedited processing for appropriate claims, and this can also impact the accurate tracking of CAL claims.
SSA has taken some steps to ensure the accuracy and consistency of decisions on CAL claims, including developing detailed descriptions of CAL conditions, known as impairment summaries. These summaries help examiners make decisions about whether to allow or deny a claim.
However, nearly one-third of the summaries are 5 or more years old. Experts and advocates that GAO spoke to suggested that summaries should be updated every 1 to 3 years. This leaves SSA at risk of making disability determinations using medically outdated information. In addition, GAO found that SSA does not leverage data it collects to assess the accuracy and consistency of CAL adjudication decisions. Without regular analyses of available data SSA is missing an opportunity to ensure the accuracy and consistency of CAL decision-making.
SSA in October 2008 implemented CAL to fast track individuals with certain conditions through the disability determination process by prioritizing their disability benefit claims. Since then, SSA has expanded its list of CAL conditions from 50 to 225. GAO was asked to review SSA's implementation of CAL.
This report examines the extent to which SSA has procedures for (1) designating CAL conditions, (2) identifying claims for CAL processing, and (3) ensuring the accuracy and consistency of CAL decisions. GAO reviewed relevant federal laws, regulations, and guidance; analyzed SSA data on disability decisions for CAL claims from fiscal years 2009 through 2016 and on CAL claims with manual actions in fiscal year 2016; reviewed a nongeneralizable sample of 74 claim files with fiscal year 2016 initial determinations; and interviewed medical experts, patient advocates, and SSA officials in headquarters and six DDS offices selected for geographic dispersion and varied CAL caseloads.
GAO is making eight recommendations including that SSA develop a process to systematically gather information on potential CAL conditions, communicate criteria for designating CAL conditions, clarify guidance for manual corrections on CAL claims, update CAL impairment summaries, and use available data to ensure accurate, consistent decision-making. SSA agreed with GAO's recommendations.