Veterans Benefits Administration Appeals Management Office VA Appeals

Veterans Benefits Administration Appeals Management Office VA Appeals Modernization Act FOR VA INTERAL USE ONLY 1

Appeals Modernization Act (AMA) • The Veterans Appeals Improvement and Modernization Act of 2017 (AMA) was signed into law on August 23, 2017 and became effective on February 19, 2019 • What does this law change? – VBA’s claims and appeals processes – VBA’s decision notification requirements • Who does this law impact? – All VA administrations (VBA, VHA, NCA) – All VBA claimants (Veterans, survivors, and other beneficiaries) – All VBA Business Lines (Compensation Service, Pension and Fiduciary Service, Loan Guaranty Service, Vocational Rehabilitation and Employment Service, Insurance Service, and Education Service) – All VBA claims and appeals personnel FOR VA INTERAL USE ONLY 2

AMA • AMA features a three option framework for claimants to choose from when dissatisfied with VA’s decision on their claim: Supplementa l Claim Higher-Level Review Board Appeal • Additional changes found in the new law include: § § Improved notification of all VA decisions (8 -point requirement) Effective date protections for continuously pursued claims Findings favorable to a claimant are binding on VA and Board adjudicators Elimination of the split jurisdiction between VBA and the Board for appeals processing (no certification process) FOR VA INTERAL USE ONLY 3

Three Review Options VBA Supplemental Claim • Replaces “reconsiderations” and “reopening” claims with “new and material” evidence • VA will readjudicate a claim if “new and relevant” evidence is presented or identified with a supplemental claim (open record). • • VA will assist in gathering new and relevant evidence (duty to assist). Effective date for benefits is always protected when submitted within 1 year of prior decision. BVA Higher-Level Review • More experienced VA employee takes a second look at the same evidence (closed record and no duty to assist). • Option for a one-time telephonic informal conference with the higherlevel reviewer to discuss the error in the prior decision Board Appeal • Evidence only docket: The appellant may submit evidence within the 90 day window following submission of the NOD. The Board does not have a duty to assist and the record is otherwise closed. • Direct docket: The appellant receives direct review by the Board of the evidence that was before VBA in the decision on appeal. The Board has a 365 -day timeliness goal for this docket. Quality feedback loop for VBA. • De novo review with full difference of opinion authority • Duty to assist errors returned to lower-level for correction • (quality feedback) Tracked and controlled under EP 030 series Decisionmakers are Decision Review Officers (DROs) and Senior VSRs • Tracked and controlled under • EP 040 series Decisionmakers are Veterans Service Representatives (VSRs) and Rating VSRs (RVSRs) FOR VA INTERAL USE ONLY Hearing docket: The appellant will be scheduled for a Board hearing. Additionally, the appellant may submit evidence within the 90 day window following the scheduled hearing. The Board does not have a duty to assist and the record is otherwise closed. 4

New Decision Review Process Veterans Benefits Administration Board of Veterans’ Appeals The Claim Establishes Effective Date VBA Decision (Improved Notice) Higher-Level Review Same Evidence 125 -Day Avg. Goal Supplemental Claim New Evidence 125 -Day Avg. Goal Appeal (NOD) 3 Options 365 -Day Avg. Goal 120 Days Except for appeals to the Court and Supplemental Claims, all filing deadlines are one year. FOR VA INTERAL USE ONLY Court of Appeals for Veterans Claims 5

New AMA Application Forms • VBA now includes VA Form 20 -0998, Your Rights to Seek Further Review of Our Decision, with all decision notices. This form provides claimants with information on the available decision review options. • Claimants now use new enterprise wide VA forms to file under one of the new review options: § VA Form 20 -0995, Decision Review Request: Supplemental Claim § VA Form 20 -0996, Decision Review Request: Higher-Level Review § VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) Important: VA no longer sends claimants VA Form 4107 and VA Form 210958, Notice of Disagreement. FOR VA INTERAL USE ONLY 6

Forms Submission Notice letter with rating decision is dated before February 19, 2019 Notice letter with rating decision is dated on or after February 19, 2019 If you disagree…. • • If you disagree…. Within one year of the notice letter: − File VA Form 20 -0995, Decision Review Request: Supplemental Claim; OR − VA Form 21 -0958, Notice of Disagreement After one year • Within one year of the notice letter: − VA Form 20 -0995, Decision Review Request: Supplemental Claim; − VA Form 20 -0996, Decision Review Request: Higher-Level Review; OR − VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) • After one year of the notice letter: − To reopen a previously denied claim file VA Form 20 -0995, Decision Review Request: Supplemental Claim. *To request an increased rating within or after one year of the notice letter (due to worsening of − To request an increased rating, file VA Form 21526 EZ, Application for Disability Compensation* the disability – not a disagreement with the initial − To file a new claim for a claim that has not rating), file VA Form 21 -526 EZ, Application for previously been filed (or is not substantially similar Disability Compensation. to a previously-filed claim), file VA Form 21 -526 EZ. FOR VA INTERAL USE ONLY 7

“Opt-in” Opportunities for Legacy Appeals Initially, there were two opportunities for some claimants with a pending legacy appeal to “opt-in” to the new modernized review system. Although the test programs have ended, claimants may still opt-in from a SOC/SSOC. 1. Test Programs (Prior to February 19, 2019) – Completed – – Rapid Appeals Modernization Program (RAMP) Board Early Applicability of Appeals Modernization (BEAAM) 2. Opt-in from a SOC/SSOC (After February 19, 2019) – Ongoing – – SOC/SSOC includes notice of opt-in opportunity through the following enclosures: § VA Modernized Decision Review System SOC/SSOC Opt-In Fact Sheet § VA Form 20 -0998, Your Rights to Seek Further Review of Our Decision Claimants must opt-in within 60 days of receipt of SOC/SSOC FOR VA INTERAL USE ONLY 8

RAMP Summary MEASURE VALUE RAMP Opt-in Letters Mailed 339, 875 (November 2017 – April 2019) RAMP Opt-in Elections Received 64, 481 total (19% total election rate) Unsolicited Opt-in Elections 10, 021 total RAMP Lane Choices HLR 63%, Supp. 37% Claim Grant Rate HLR 26%, Supp. 40% (32% total) Total benefits awarded $369, 243, 664. 09 Average Days to Complete 131 Days NOD to Opt-in Days (Avg. ) 697 Days Total Legacy Appeals Withdrawn 88, 808 Note: data as of April 30, 2019. FOR VA INTERAL USE ONLY 9

AMA Claims Update MEASURE VALUE AMA Claims Established (February - April 2019) HLR 2, 480 (27%) Supp 6, 769 (73%) Total 9, 249 Total Claims Completed 2, 496 Average Days to Complete 27. 6 Total Days Total Claims Pending 6, 756 Note: data as of April 30, 2019 FOR VA INTERAL USE ONLY 10

Discontinuation of RAMP • VBA accepted initial opt-in forms postmarked through February 15, 2019; initial RAMP opt-in forms are no longer accepted • Veterans who submitted an initial opt-in form postmarked by February 15, 2019 that was improperly completed are provided an additional 60 days to provide a properly-completed form (VBA will send a letter to inform the Veteran) Veterans who have opted in to RAMP and received a RAMP decision are already in the modernized system. If a Veteran received a RAMP decision and wants to pursue a new lane: Within one year of the most recent RAMP decision notice, file: • VA Form 20 -0995, Decision Review Available options after one year: • To reopen a claim of service connection, file VA Form 20 -0995, Decision Review Request: Supplemental Claim • To request an increased rating, file VA Form • VA Form 20 -0996, Decision Review 21 -526 EZ, Application for Disability Request: Higher-Level Review Compensation* • VA Form 10182, Decision Review • To file a new claim that has not previously Request: Board Appeal (Notice of been filed (or is not substantially similar to a Disagreement) previously-filed claim), file VA Form 21526 EZ, Application for Disability 11 FOR VA INTERAL USECompensation ONLY

VBA Workload Distribution VBA established new Decision Review Operations Centers (DROCs) in FY 2018 to process AMA Higher-Level Reviews (HLRs) and Board decisions. VBA distributes AMA claims and legacy appeals to ROs for processing based on the following workload distribution: RO VSCs RO Appeals Teams New Process & RAMP Supplemental Claims Legacy Appeals & Full Board Grants New Process & RAMP HLR Receipts DROC St. Pete DROC Seattle New Process Board remands New Process Board Full Grants New Process HLR Returns DROC D. C. Legacy Board Remands FOR VA INTERAL USE ONLY 12

AMA Benefits • Understandable process • Multiple options for the claimant instead of one • Improved notice to decide which option might be best • Early resolution of disagreements • Each lane with a clearly defined start/end point • Higher-Level Review and Board Appeal options provide quality feedback to VBA • Workload transparency for better workload/resource projections • VBA as claims agency; Board as appeals agency FOR VA INTERAL USE ONLY 13

AMA Resources & Materials The following AMA resources can be found on the VA. gov website at https: //benefits. va. gov/benefits/appeals. asp • • • Brochure FAQs Fact Sheet Infographic Video Poster Claimants can find information on filing requirements and the forms to apply at https: //www. va. gov/decisionreviews. FOR VA INTERAL USE ONLY 14

References • PL 115 -55, Veterans Appeals Improvement and Modernization Act of 2017 • 38 CFR 3. 2400, Applicability of modernized review system • 38 CFR 3. 2500, Review of decisions • 38 CFR 3. 2501, Supplemental claims • 38 CFR 3. 2601, Higher-level review • 38 CFR 20. 202, Notice of Disagreement • Appeals Modernization – VA. gov https: //benefits. va. gov/benefits/appeals. asp FOR VA INTERAL USE ONLY 15