- Hi and welcome back to Hill & Ponton V.A disability blog.
I'm Natalia Jofre the company COO.
- And I'm Attorney Rachel Cheek.
- And like I mentioned in a previous blog
or a couple of them, you know, obviously
we're doing this new format
because social distancing is so important.
And we wanna continue to put this information out there
because it is important for you in your claims.
One of the big changes that happened this year
was the change in the way VA processes claim.
Rachel I mean those different paths
and we hear about legacy and AMA and all that good stuff.
So, I guess what we'll go over today are common questions
with the new VA system called AMA.
So, let me start at the very beginning,
what does AMA stand for?
- AMA stands for Appeals Modernization Act.
And this is something that had been in the works
for quite sometime.
The VA had been planning this.
They did a pilot program starting in 2018.
Then the system officially transitioned in February 2019
and now we're at the point where essentially
every decision that comes out now is made under AMA.
For a time, there were decisions coming out
that were made under the legacy system
that's could have some claims under AMA,
some claims under legacy, it's just been a lot to entangle
and a lot to learn even though this has been
in place for past year, we're still coming across
new things all the time.
- Okay, so, under the new system,
how do effective date work?
- So, it depends, it's gonna be the best, you know,
and it's my favorite lawyer answer, it depends.
- I'll be shocked by the way the day you tell me,
"Natalia, this is a cut and dry question answer,
there is no exclusion, that'll be the day
I know that'll be your first so don't worry.
We know there is always they, well, the after explanation
but in general.
- Exactly, in general.
So, I'll just start by kind of
doing a brief overview basically.
The legacy system or the system that claims used
to be processed under, essentially, you get a decision
and you file an appeal and then wait for years
for the VA to get back to you.
Now, there when you get a decision under AMA,
you have different appeal options.
So it not just one form that you use.
You can file an appeal to what's called
The Higher-Level Review Lane.
What that is, is essentially you're saying,
"Hey, VA, have got this decision,
"I don't agree with it."
You have the information that it's in my claims file.
I already submitted it.
You have the information you need to look at this again.
And the VA will re-evaluate what the evidence
that has already been submitted.
You can't submit new evidence.
You can also appeal with something that's called
a Supplemental Appeal which is essentially saying,
"Hey, you got this decision wrong and here is the evidence
"that I now have."
I didn't at the time the decision
that you can now make a decision
and make it right this time.
So, with the Supplemental Claim, this is where things
get kinda fun.
You know, as fun as the VA can be,
and by that I mean a nightmare.
(Natalia laughs)
- All right.
- No, you got that supplemental Appeal I just mentioned.
You can file that to a decision that you've received
within the last year and continue your appeal forward.
The effective date should be the same
as the claim that you initially filed
that you got the decision on,
provided that you appealed it within a year.
That's how the legacy system work as well.
As long as you appeal decisions within a year,
you can preserve that effective date.
With Supplemental Claims, you can also
file, now you have to file this.
Sorry, I'm just laughing because the way
that I'm explaining this.
This is my job, this is all I do,
and it is difficult to explain.
So, imagine having to navigate this yourself as of that.
You can file a Supplemental Claim basically
if you've received a decision in the last year
or if you've received a decision at any point and time.
In 1985 you received decision
on PTSD and it was the denial, say.
Now, instead of being able to file just a new
claim form, you have to file that Supplemental Claim form
and you have to submit evidence with it.
When you file the appeal you can't just say,
"Hey, I'd like service connection for PTSD."
You have to say,
"Okay, well I filed for service connection for PTSD in 1985
"you denied it.
"Here is my supplemental claim form
"and it must be submitted with evidence
"that wasn't in the record at the time."
There your effective date is not gonna be 1985,
when you filed your first claim.
It's gonna be the date of the time
that you're filling Supplemental Claim now.
So, it get's a little confusing.
- It's a lot of confusing but it's okay, gotcha.
- There's a whole other level of appeal that I haven't
even gotten into, not even.
- Wow. Wow, wow.
So real, cut and dry real straightforward step?
Let's stick to what's maybe a little easier then.
Is submitting evidence any different with the new system
and can people submit evidence whenever they want
just like in the legacy system?
'Cause I guess before you could pretty much submit evidence
at any time.
So, is the submission of evidence different
and can you submit it at anytime?
- Okay. Good and I'm glad you said it's a legacy system.
This is something that used to
be able to do a file evidence at any time
because that's true.
That is why a lot of veterans might be used to.
This is not the case with the AMA system.
So when you first submit a claim, you can file evidence
until they make a decision on it.
As long as you're submitting a new claim.
Now, if you are submitting Supplemental Claim
for a condition that's been denied before,
you have to submit new evidence with it at the time
that you file.
Otherwise the VA's not even gonna consider it.
So that is also similar even if you're doing appeals.
So say you got a rating decision,
you don't like what it says and you submit, like we talked
about, Higher-Level Review Appeal.
You can't submit any other evidence with that.
That is asking the VA to look at
what's already on the record.
With a Supplemental Appeal, again ,
just like filing a new claim on the Supplemental forum
whenever you file a Supplemental Appeal you have to file
the new evidence with it.
You can't submit at anytime.
There are some time limit restrictions.
The VA has been pretty loose on them.
We don't have a specific, you know, it's 45 days
that you that you must submit new evidence.
We don't have anything like that.
They haven't come out with guidance like that.
Our general rule now is just don't file this claim
or don't pile this appeal until we have that evidence.
We wanna get that evidence,
so we can submit it in at the same time.
- Okay. All right.
Someone post this question.
If I fill out an old form will the VA still look at it
or consider it with the new system?
- No.
That's an easy one.
I definitely can tell you that answer.
- Yay, easy answer.
That is the first I'm sure will be the last.
- Yes, now, what they'll do, they may, they don't always.
They may send you a letter saying,
"Hey this is the wrong form.
"We need the new one."
And they should send you the updated form
but they don't always.
- Right, okay.
Has the law changed with the new VA system
or is it just the process that changed?
That's a really good question.
So did the launching or did the just the process change?
- So the general principles of say service connection,
secondary service connection increased rating,
those are all the same.
It's basically the appeals process and the claim process
that has been changed.
So I mean it is the law but the general principles
that apply once you actually get your claim and appeal
and you know the VA to look at it are the same.
- Okay, how does TDIU work with the AMA system?
Is anything different there?
We have some people with TDIU.
- Sure, so TDIU is basically I would say it's abbreviation,
but it might take longer to say
that individual unemployability which is when the VA
recognizes that although you're not a 100%
your combined rating isn't a 100%,
your conditions aren't rated at 100.
You do have conditions
that are service connected that prevent you from working
and therefore you are essentially 100% disabled.
Because you're not able to work, you're not able
to earn income.
You might as well be 100% disabled.
And in that case, the VA will compensate you at a 100% rate.
Even though you aren't rated at 100%.
- Gotcha, gotcha.
- So, the question was whether the process
for IU is different.
Not any different from what I've already discussed.
So if you are appealing, you got to decide
which appeal form you wanna use.
You do still use the same form for individual
unemployability, the VA 218940.
That's got to go out with individual unemployability claims.
- Okay, the million dollar question.
Right because when this was rolled out, it was done
with the promise, pardon me, that this was gonna be faster.
People were gonna get their benefits so much faster
and they were to get decisions so much faster.
And so the million dollar question
is are decisions now faster with AMA?
And I guess the second part of that would be,
are they more accurate?
- I'm glad you added the second part.
- Because I have a feeling they're intertwined, but yeah.
- Yes, ma'am. So, yeah.
So as far as getting decisions faster, I would say yes.
On average, I am seeing a quicker turnaround.
Are they more accurate?
Not anymore than they were
under the old system and maybe even less
because I know that the VA is under a lot of pressure
to get these cases moving.
That was the big promise.
You know, we can get through so many of that cases,
just check out our turnaround,
look at how many decisions we made?
Okay, that's all well and good but if the decisions
that are made are just kind of rubber stamp denials,
they're not actually taking the time
to look at these cases and really, thoroughly evaluate them.
That's not gonna help much to get a denial faster.
- Right right right right.
That's been historically been the problem.
It doesn't matter which system it's been under care,
always getting denied and not really having
an affair with a thorough evaluation.
It doesn't matter which claim, which process your claim
is being reviewed under.
Should veterans request a hearing with the board?
- So I can't speak for all veterans,
but I can say what we've been doing in our practice,
which is that we're advising veterans
to not request a hearing with the board.
So, let me actually backup and real quick
I wanna go over the different options of the board.
So this that the appeal options I was speaking
about earlier, Higher-Level-Review
and a Supplemental Appeal,
those are at the regional office level.
When you get a decision maybe it's a second denial
from the regional office or if you still have an old case
still working its way, get through the system,
you might be issued a statement of the case,
which is a document essentially from that you can appeal
to the board of veteran's appeals.
And so that's the levels higher than the regional office.
So you get a decision, you want to appeal it to the board.
Similarly too at the regional office level, you can submit
and appeal that as for VA to say, "Hey, it's direct review."
Board look at this evidence that we've submitted.
It's all in there we can't submit anything else.
Just take a look and make the decision again.
You also have evidence lane submission,
and that's similar to the supplemental claim
in that you're saying, "Hey, got the decision,
"don't love it.
"We are going to be submitting some new evidence showing
"why you should be granting what I'm asking for."
That does have a straight deadline.
That's 90 day's to submit evidence.
Well, Supplemental Claim lane is still
kind of up in the air and they haven't
given us any guidance.
The evidence submission lane at the board
is a whole 90 days.
The third option for a board appeal,
is you request a hearing.
And so with that you're saying,
"Okay, I don't agree I want my day in court,
"I deserve to heard."
And with that, you cannot submit before the hearing
but once after the hearing is scheduled, you can submit
evidence at the hearing and you get to submit it
90 days after the hearing.
So the reason that we don't advise that
is because we got some timelines.
This is from the VA themselves, this is the best light
they can paint this in.
They predicted timeline for this direct review
cases at the board to have the under 365 day turnaround.
So if you submit direct review appeal,
you don't have any other evidence to submit
the board saying,
"Okay, we think we can make a decision on that
"in under a year."
When you do the evidence lane, submitting evidence
within 90 days, the VA says that it's probably
gonna be over a year.
For the board hearing lane, we don' have any guidance.
They basically say, "Well, that gonna take a long time."
They know that's going to be their longest time.
We don't even have a prediction on turn arounds
because I mean you think about it, if I was a veteran
and was just going you know this case by myself.
I think, heck yes I want to hear it.
You guys haven't gotten it right since now.
How about, we talk about it.
You know we discuss and I actually get to say my piece.
So I definitely understand the appeal.
However, there is no telling of when a hearing
can be scheduled.
It could be years.
It could be like the old system.
So we're not advising on that.
We're advising either you do director view if you've got
all your evidence in or an evidence submission lane.
And of course if you have a pending board appeal,
you can always call us.
- Because so I take it based on what you're saying,
the risk there is once you pick a lane,
you have to stay in that lane, right?
So you can't say, "Wow, I've now been waiting
"for a hearing two years.
"Lemme go ahead and pick the evidence review link now."
- So, you can, technically you can switch lanes
when the board says,
"Hey, we've received your appeal."
They'll send you a letter basically saying,
"Hey you're on the docket."
You can switch lanes within 60 days
of receiving that, but that's not something
we don't really recommend that because it's
just depending on the VA to get things right
and make sure the appeals get put in the right place.
We think, might as well just try to make,
decide what the best appealing is for each case at the time.
Now yes, if you're at a point where you requested
a board hearing and you haven't heard from anything
in two years, it's too late at that point.
It's past the time you got your letter
you're just gonna have to keep waiting.
- Gotcha and all of that is time that you could
have invested in one of the other two lanes
and probably received a decision by now?
- Yes.
It's almost like it's better to kind of know what to expect
than to have no idea what to expect in terms of a timeframe.
- Right.
- Gotcha, all right, would you say in general,
do you think the AMA system is better for veterans?
- Can you tell?
(Both laughs)
I personally, I mean your mileage may vary for each person,
each advocate, each veteran going through it.
Personally, I have worked in both systems
and I find that the AMA system
is a lot more convoluted and confusing.
I think there's a lot of traps that veterans can fall into.
I've seen claims denied, appeals that a veteran went to file
denied because they didn't check a little
X-Box on one of the forms in rather than,
and then that's a new thing under the AMA system.
It's just little tiny nitpicky things that weren't an issue
in the legacy system that continue to pop up.
I just mentioned what, five separate appeal
options that you can do once you get a decision.
That's a lot to navigate through.
I mean that's a lot for our office to navigate.
We look at every single case and try to figure out
what the best option is.
If you're doing that alone, I would prefer the legacy
if it were me.
- Okay. Well, Rachel, thank you so much
for all of your input and insight.
And we thank everyone for joining us.
We hope you stay happy and healthy and on our end,
we will continue to put out this information
as much as we can but if you have any questions,
please feel free to visit our website or call our office.
And otherwise I thank you for joining us
and we hope to see you again.
- Thank you.
(upbeat music)