Claim Process Part 2
Curious about the claims process?
Feeling a little lost with all the incoming mail regarding your claim? There are many duties that VA owes to a claimant during the claims process and this generates a lot of mail that can be quite bewildering. We’re going to break down some of these common letters here!
The Standard 5103 Letter
So named because 38 U.S.C §5103 is the law that codifies VA’s notice requirements to claimants under its Duty to Assist. This is the likely the first letter that you will receive from VA after a claim is submitted. As letters go, it is undeniably an attention grabber – it starts with “IMPORTANT – REPLY NEEDED WITHIN 30 DAYS.”
The letter then states “we may need additional evidence from you,” and then proceeds the list the plethora of evidence that VA may need:
The first thing you need to know about this letter is that everyone gets it. It is not specific to you or your claim (which is why is says VA may need evidence). It’s a generic, and widely, auto-generated letter. VA’s use of automation means that an actual person may not have put eyes on your claim before this letter is sent. Thus, there hasn’t been anyone checking to see what has or has not been provided yet. But that will come later! If you have already submitted any of the evidence that is mentioned in the letter, you don’t need to submit it again and you don’t need to respond to this letter.
However, if you have not yet submitted any of the included information, such as a request for VA to obtain private treatment records (VA Form 21-4142), then now is a great time to get that information into VA.
What about the 30 days?
VA does ask for the information within 30 days. However, VA will consider any new evidence that comes into the record during an initial or supplemental claim process at any time prior to the final decision. So if you’ve just started treatment with a private treatment provider and that information comes into VA on day 32 or even day 62 – it’s okay! Our office will help you every step of the way and respond to any VA letters as necessary.
The Subsequent Development Letter – Employment Information
So-named because this letter usually comes after the “Initial 5103 Letter” and will usually be curated to you and your claim. You’ll recognize this letter when it comes because it will say “We need additional information from you” and then list one or two items that are relevant to your claim.
For example, in a claim involving entitlement to Individual Unemployability, the first Subsequent Development Letter received usually asks for a VA Form 21-4192, Request for Employment Information.
If the employer contact information has already been provided to the VA (for example, on the VA Form 21-8940), then VA will also send the VA Form 21-4192 directly to the employer as well, with a copy to you. That letter looks like this (below), but will be addressed at the top of the letter directly to the employer.
What if my employer doesn’t return the VA Form 21-4192?
That’s okay! VA must give the employer the opportunity to complete the verification and return it to VA. Sometimes the employers don’t know whether to respond, sometimes the employers are no longer in business or otherwise refuse to complete the form. As part of VA’s Duty to Assist, it must at least try to get your prior employers to complete the verification form. However, Individual Unemployability may still be awarded even if your employer doesn’t complete the VA Form 21-4192. However, alternative evidence may be recommended, such as information from the Social Security Administration or the Internal Revenue Service to verify your last income from wages.
The Subsequent Development Letter – Private Treatment Provider Information
If private treatment was indicated on your initial claim, a Subsequent Development Letter may ask for a VA Form 21-4142 and 21-4142a, Authorization to Disclose Information to the Department of Veterans Affairs, and General Release for Medical Provider Information to the Department of Veterans Affairs.
Once that form has been provided, VA will then begin making requests to your healthcare provider. VA generally wait 60 days after an initial request before reaching out a second time. Typically, VA is only required to make two requests to the provider, so it is generally a good practice to let your provider know that VA will be requesting records so they know to respond. VA will accept records directly from the claimant, but generally, it will still make its required requests to the provider as well.
You will know that VA has received your VA Form 21-4142 and has made requests from your treatment provider because you will get a letter that says the following:
And as above, you’ll generally get this letter twice informing you of VA’s attempts to obtain your private treatment records. You don’t need to do anything with these subsequent letter.
This process ONLY applies to requests from private treatment providers. If you seek care exclusively through the VA Medical Center, VA will have direct access to those records and you will not receive letters like the above. Just be sure that all VA facilities that you seek treatment at have been reported to the VA with your initial claim.
End of Day Letters
End of Day Letters are a bit of a letdown. Generally, when you get this letter, your claim has been with VA for several months and you’ve likely had little communication from VA in the prior month. Essentially, this letter just informs you that the claim is still pending. No need to respond to the letter and there’s little to do about it. But at the “end of the day” – you know VA is still working on your claim.
