You won’t hear any disagreement that the Department of Veterans Affairs is a bureaucratic monster. The reality is, no matter how monstrous the VA is, we have to understand its process in order to have a benefit granted.
Here is a brief overview of the VA and its organizations.
VBA v. VHA v. NCA
Within the VA, there are three major organizations- the VHA (Veterans Health Administration), VBA (Veterans Benefits Administration) and NCA (National Cemetery Administration).
The VHA manages a Veteran’s Healthcare. A Veteran’s primary care provider and other healthcare providers are all housed under this organization. When a Veteran receives care from the local VA Hospital, is it under the umbrella of the VHA.
The VBA manages Veteran’s benefits, including disability compensation, pension, and DIC claims. The VBA also provides home loan guaranty, education, and insurance programs. The VBA maintains 57 regional offices in the 50 states, Puerto Rico, and the Philippines.
This is a completely separate entity from the VA healthcare system, and unfortunately these organizations don’t communicate. Often times, I hear complaints from Veterans that they were treated for a specific disability at the VA Hospital, but never received disability compensation for it. This is because the VBA follows strict regulations about how to process benefit claims while the VHA has no duty to handle a benefits claim.
The NCA is a rather narrow organization that handles burial-related claims. Veterans, their spouses, and dependent children are eligible for burial in VA’s national cemeteries and the NCA will provide a headstone or marker for veterans buried in any cemetery in the world. NCA also presents Presidential Memorial Certificates bearing the President’s signature to acknowledge and commemorate the memory of honorably-discharged, deceased veterans.
The VA is made up of several levels of appeals. The lowest level is the Regional Office. This is where the DAV, American Legion and other VSOs are most helpful because they can help with claims applications.
When you apply for a benefit, the claim goes to the Regional Office. A few years ago, the VBA used the Veteran’s geographic location to determine to which regional office the claim should be sent. Presently, the VBA utilizes a national workflow system so your claim from Colorado could be sent to the Regional Office in St. Petersburg, Florida for processing.
When you receive your first claim denial, it comes from the Regional Office. You have the option of multiple appeal “lanes.” One option is submitting more evidence with an appeal and another requesting a higher-level review. You also have the option of putting one claim into one appeal lane, and another claim into a different lane. This flexibility did not exist in the appeals system prior to February 2019 and has greatly improved a Veteran’s options for appeals.
Board of Veteran Appeals
Once the Veteran has exhausted their appeal opportunities at the Regional Office, the next step is to appeal at the Board of Veteran Appeals (BVA). The BVA reviews decisions and procedural errors the lower-level Regional Office made while processing your claim. If the BVA finds an error in the way the Regional Office processed the claim, it will send it back, or “remanded,” to the Regional Office for further processing. The BVA also has the power to overturn the Regional Office’s decision and grant a claim.
Court of Appeals for Veterans Claims
If the Board does not overturn the Regional Office’s denial, you are not out of options. The Court of Appeals for Veterans Claims (CAVC) will hear the case. The types of issues that get to the CAVC often include very niche legal issues. For example, a common issue is whether a particular C&P exam included an adequate medical opinion. If the CAVC finds that the medical opinion was inadequate, it will remand the case back down to the Regional Office for further processing. The CAVC can also tell the BVA to grant a claim on a legal basis, if the court feels that would be most appropriate.
Federal District Court
The next step is the Federal District Court in the state where the Veteran resides. The Federal Circuit has limited jurisdiction to review legal rulings by the CAVC, but is not permitted to review factual determinations or the application of law to fact.