Your Right to Veterans Medical Benefits
by Ron Honberg, J.D., national director for Policy and Legal Affairs
In recent years, significant advances have occurred in protecting the rights of veterans to medical and other benefits within the VA system. However, veterans with mental illnesses sometimes still have difficulty obtaining medical and other benefits through the VA. This situation may be attributable, in part, to lack of understanding about these illnesses and their connection to military service. It may also be attributable in some cases to the difficulties that some veterans with mental illnesses have in following complex VA procedures for filing claims and submitting information in support of the claims.
Veterans with mental illnesses can encounter a number of challenges in obtaining and using medical benefits. These include:
• Overcoming "bad paper" (other than honorable) discharges due to the onset of mental illness that may make them ineligible for medical or other veterans’ benefits;
• Proving that their disability is service-connected;
• Proving that their disability is of sufficient severity to warrant priority status for veterans’ medical benefits; and
• Coping with denial of necessary treatment or services after they have obtained veterans’ medical benefits.
Applying for Veterans Benefits
Veterans can apply for medical benefits in a number of ways, including applying in person at VA Regional Offices (VAROs) or at VA medical centers. Applications for VA medical benefits can also be filed through third parties. Disabled American Veterans (DAV), an officially designated veterans service organization, employs 260 highly trained national service officers (NSOs) who can help individuals and their families apply for benefits and advocate for these individuals throughout the application and appeals processes. More information about this valuable and important program can be obtained on the DAV Web site, www.dav.org.
Appealing VA Decisions
Step One: When a claim for veterans’ medical benefits is denied, the veteran receives a denial letter from the VA, along with information about why the decision was made. A veteran who disagrees with the decision must file a Notice of Disagreement with the local VA office within one year of the denial. The VA will respond by creating a Statement of the Case (SOC), a detailed explanation of the medical and legal basis for denying the application or claim.
Step Two: When the VA sends the SOC, it will include a VA Form 9. Filling out the VA Form 9 is necessary to complete the appeal request. The form should be filled out and sent back to the local VA office within 60 days of the date the SOC is received.
Step Three: Applicants may request personal hearings in connection with their appeals. Veterans may request a hearing with someone from their local VA office or a hearing with a member of the Board of Veterans’ Appeals (BVA). Hearings with board members may occur in person or by videoconference. Videoconference hearings are generally the quickest way to get a hearing. Veterans may be accompanied at this hearing by their personal representatives, including family members. Hearings are informal, and veterans may present medical evidence to support their claims.
Generally, BVA decisions are provided in writing sometime after the hearing. The claim will be allowed, denied, or remanded. A remand occurs when the BVA feels it needs more information to make the decision.
Step Four: If the BVA denies the application or claim, the next step is to file an appeal with the U.S. Court of Appeals for Veterans Claims. Appeals must be filed within 120 days of the final decision from the BVA.
The Court of Appeals for Veterans Claims is an independent body and not part of the VA. It is advisable, although not required, that the veteran retain an attorney to prepare the appeal. In 1992, Congress created a program for free legal assistance to veterans filing appeals. This program is run by the Veterans Consortium Pro Bono Program. Information about this program can be found at www.vetsprobono.org. Information about private attorneys authorized to represent veterans in appeals can be found by contacting the National Organization of Veterans’ Advocates at 1-800-810-VETS or www.vetadvocates.com.
If the Court of Appeals for Veterans Claims agrees with the veteran’s case, it will usually remand the case back to the VA for further action. If it rules against the veteran, the veteran can seek further review by the U.S. Court of Appeals for the Federal Circuit in which the claim originated. That court may or may not accept the case for further review.
Initial denials of benefits or claims by veterans with mental illnesses are frequently reversed on appeal. Therefore, veterans and their advocates should be knowledgeable about the process of filing appeals and encouraged to appeal whenever a decision by the VA seems unjust.