VA Changes Forms for Filing Claims

In October 2013, VA proposed to amend its adjudication regulations in 38 CFR parts 3, 19, and 20, to require the use of standard forms to initiate claims for benefits, and to initiate appeals of Regional Office decisions on those claims.  This proposed rulemaking can be found in the Federal Register [http://www.gpo.gov/fdsys/browse/collection] at 78 FR 65490 (December 30, 2013). VA stated that the purpose of this proposed rulemaking was to improve the timeliness of accurate claims adjudication and appeals.

In this regard, VA noted in the proposed rule, that although the rules in effect at the time of the proposed rule permitted claimants to apply for benefits using an “informal claim,” doing so, although convenient for claimants, created ambiguities for VA adjudicators; the result was delayed adjudications of claims, with inconsistent levels of accuracy. VA also stated that its effort to adjudicate claims via an electronic or digital system would be enhanced by the use of standard claims forms, since less time would be required for individual claims adjudicators to review submissions and determine if claimant communications with VA, constituted a claim.

VA, however, also noted that in connection with Web Based, or electronic submissions, that under the proposed rule “Any communication submitted through or action taking place in a claims submission tool within a VA Web-based electronic claims application system that indicates an intent to apply for one or more benefits administered by VA that does not meet the standards of a complete claim may be considered an incomplete claim.”

VA further stated that, “If a complete electronic claim is filed within 1 year of the submission of the incomplete electronic claim, the electronic claim would be considered filed as of the date of submission of the incomplete electronic claim.”

This VA proposed change raised questions, particularly – what happens to veterans who do not have access to a computer, and how does VA go about defining the word, “intent,” as this potentially subjective term is applied to a all veterans and dependents who apply to VA for benefits.

VA published in the Federal Register in March 2015, at 79 FR 57660 (March 24, 2015), the Final Rule, which implements the changes from the October 2013 proposal.

In the Final Rule, VA stated, in part “VA received many comments regarding the elimination of the informal claim under current § 3.155. The majority of the commenters expressed concern that eliminating the current informal claim process would be burdensome to claimants since the favorable effective date treatment of the current informal claim process would not exist for claimants who file paper claims.”

VA responded, agreeing that changes to the proposed rule were necessary, stating that “the ‘‘intent to file’’ process will share similarities with the current informal claim process. However, one major difference is that it requires the submission holding a claimant’s effective date to be in a standard format in order for claimants to preserve the date of a claim for a complete claim that is filed within 1 year of receipt of such intent to file a claim.”

Continuing, VA noted, “VA considers this change responsive to comments urging VA to maintain a way for all veterans to secure an effective date placeholder while the formal application form is completed, and responsive to comments urging that paper and electronic claims receive identical treatment for effective date purposes.”

So, apparently the Final Rule [March 2015] equally recognized the needs all claimants, computer based and paper. VA also drafted the Final Rule to maintain the application of effective dates for all claims submissions, for both electronically submitted and those claims that are submitted on paper, using standard forms that are published by VA.

But, has the elimination of the “informal claim” option really created efficiencies for VA?

Does this new rule really help veterans?

Do not VA claims adjudicators have to receive, and successfully complete predicate training, training that still requires VA employees to discern someone’s “intent?”

And, although headlining by VA, that VA now requires the use of standard claims forms, appears good and positive, more in line with the private sector – is the VA system really faster and more quality driven, because of these new rules?

 

 

 

 

 

 

 

 

 

 

 

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