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What is an “Informal Claim” for VA Compensation Benefits?

The phrase “informal claim” is a type of claim that a veteran could file with the Department of Veterans Affairs (VA) before March 2015.  It allowed the veteran to start a claim without filing a full application for benefits, and gave the veteran a year to complete the filing process while still maintaining the original filing date of the informal claim for purposes of when benefits would be paid. This preserved the effective date, so a claim could be paid retroactively to the date the informal claim notice was given to the VA.  In March 2015, VA changed its regulations, and deleted the phrase “informal claim” from its processes.  See 79 Fed.Reg. 57660, 57664 (Sept. 25, 2014).

VA’s M-21 Manual has been revised to explain that only informal claims received before March 25, 2015 will be recognized. It explains that the following would identify an informal claim before that date:

• any communication or action that shows an intent to apply for benefits under laws administered by the Department of Veterans Affairs (VA)
• an original claim not filed on the prescribed form
• an unsigned application (except for those received via the Veterans On-Line Application (VONAPP) or VONAPP Direct Connect (VDC), for which VA accepts an electronic signature in lieu of a handwritten signature)
• evidence of examination or hospitalization in a VA or uniformed services health care facility for a service-connected disability under 38 CFR 3.157 (b)(1), or
• any communication regarding the death of the appellant in an appeal submitted to the United States Court of Appeals for Veterans Claims (CAVC), and furnished to VA b by  CAVC

The M-21 goes on to explain that “Informal claims were important prior to March 24, 2015 because VA could grant entitlement to benefits as early as the date of receipt of an informal claim as long as the claimant submits a formal claim within one year of the date VA sent the claimant the application form.”

After March 24, 2015, the VA replaced informal claims with a new process called the “intent to file a claim for benefits.”  The M-21 explains

A claimant may submit an Intent to File (ITF) any of the following ways:

• by submitting a completed VA Form 21-0966, Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC,
• by calling the National Call Center (NCC) at 1-800-827-1000 or the National Pension Call Center (NPCC) at 1-877-294-6380 and notifying a Public Contact Representative (PCR) of his or her intent to file a claim for compensation, pension, or survivors benefits, and
• by initiating an application for benefits via eBenefits/Veterans On-Line Application Direct Connect (VDC) or Stakeholder Enterprise Portal (SEP).

So, to qualify as in an intent to file after March 24, 2015, all of the following requirements must be met:

• the claimant has identified the general benefit sought (compensation and/or pension, or survivors pension and/or dependency and indemnity compensation (DIC)),
• the claimant can be identified, and
• the VA Form 21-0966 is signed by the claimant or authorized representative (Veterans Service Organization (VSO), VA public contact representative, attorney, or agent if a valid power of attorney has been completed).

If you file a Form 21-0966, it will give you what the VA describes as an effective date placeholder.  You will preserve your effective date for purposes of a getting retroactive award as the date you file your Form 21-0966.

If you want to file an intent to file claim, click on this link to the VA Form 21-0966.

 

If you have been denied VA benefits and would like to discuss your options, call VA Disability Attorney John V. Tucker today at (866) 282-5260.  Please note:  under the current law, a veteran may not hire an attorney to assist with filing a new claim or an intent to file a claim.

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    Can you please give me advise/recommendation on the following: VA granted service connection for left knee osteoarthritis (noncompensable evaluation) based on, “X-ray evidence of degenerative arthritis without painful or limited motion”. My claim was for Gout Arthritis and I submitted an MRI that states, “osteoarthritis, gout, as well as other arthritides”. I have a minimum of 10 to 12 documents that show left knee pain, walks with limp, requires crutches and required injections in the knee. They had all these documents in my packet. What to do???

    Sorry, but I don’t have enough information to give you advice about what to do, but this may help: Keep in mind that just having a condition is not the same as getting a compensable rating. VA may service-connect something, but will typically rate it and assign a percentage over zero percent only if there are current symptoms that are limiting. It sounds like you have two conditions that could be rated. First, a knee condition is usually rated based on range of motion under the following codes in the Rating Schedule :
    5256 Knee, ankylosis of:
    Extremely unfavorable, in flexion at an angle of 45° or more 60
    In flexion between 20° and 45° 50
    In flexion between 10° and 20° 40
    Favorable angle in full extension, or in slight flexion between 0° and 10° 30
    5257 Knee, other impairment of:
    Recurrent subluxation or lateral instability:
    Severe 30
    Moderate 20
    Slight 10
    5258 Cartilage, semilunar, dislocated, with frequent episodes of
    “locking,” pain, and effusion into the joint 20
    5259 Cartilage, semilunar, removal of, symptomatic. 10
    5260 Leg, limitation of flexion of:
    Flexion limited to 15° 30
    Flexion limited to 30° 20
    Flexion limited to 45° 10
    Flexion limited to 60° 0
    5261 Leg, limitation of extension of:
    Extension limited to 45° 50
    Extension limited to 30° 40
    Extension limited to 20° 30
    Extension limited to 15° 20
    Extension limited to 10° 10
    Extension limited to 5° 0

    It seems from what you are saying that VA should also rate you for gout (so you would have two ratings). Gout is usually rated under diagnostic code 5002 as follows:

    5002 Arthritis rheumatoid (atrophic) as an active process
    With constitutional manifestations associated with
    active joint involvement, totally incapacitating 100
    5002 Arthritis rheumatoid (atrophic) as an active process (cont.)
    Less than criteria for 100% but with weight loss and anemia
    productive of severe impairment of health or severely
    incapacitating exacerbations occurring 4 or more times a year
    or a lesser number over prolonged periods 60
    Symptom combinations productive of definite impairment of
    health objectively supported by examination findings or
    incapacitating exacerbations occurring 3 or more times a year 40
    One or two exacerbations a year in a well-established diagnosis 20

    I hope that information helps. Good luck! Feel free to call us at (866) 282-5260 if you want assistance with your appeal.

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