When applying for disability benefits from the VA and going through the appeals process to get compensation, most veterans have a lot of questions when getting started. Maybe you wonder what to do once you have filed your appeal, or what you can do to help your claim, or simply why it’s taking so long to get the process moving. When we first take on a case, many veterans call within a few weeks or months wanting to know the status of their case, what we have done, and why the case is not moving along faster. While we cannot speak for the VA, we can shed some light on one of the most important facets of the claim that we spend a significant amount of time on: the Claims File.
The first few months of an appeal tend to be stagnant solely because we are waiting for the VA to send us the veteran’s claims file. We cannot proceed with a claim until we receive this file from the VA. This is a crucial component to establishing a claim for disability benefits because it contains the information we need to understand the claim and how to prove it. And unfortunately, obtaining this file comes with a wait-time.
What is the C File?
The Claims file, also known as the C File, is the compilation of all of the documents the VA has pertaining to the veteran since released from service. These are the records that the VA has looked at and taken into consideration when evaluating a veteran’s claim for compensation. It contains everything the VA has collected over the course of a claim, from the initial claims, to the decisions made by the VA as well as service records, service treatment records, medical records (from VA facilities and private doctors), compensation and pension exams, social security records, and buddy statements (witness statements from family and friends) filed or used in support of the claim. Because it contains so many documents, it tends to be hundreds to thousands of pages long, and sometimes with pages out of order, duplicated, or missing.
How do you get it?
To get the C File, you have to request it from your local Regional Office (RO) under the Freedom of Information Act (FOIA). It takes the RO anywhere from 2-6 months on average to process the request and provide a copy of the C file. Unfortunately, sometimes it can take much longer, even up to a year. When the RO fails to produce the file in a reasonable amount of time, you can file an appeal to compel them to produce it. Getting disability benefits is a long and difficult process, and unfortunately the long wait tends to start from the very beginning with the first crucial step of obtaining the C File.
Why is it so important?
Once you acquire a copy of the C File, it is best to review it thoroughly to assess all of the evidence. It is important to look at the C File piece by piece so that you know what evidence the VA has taken into consideration when making a decision and what is still missing or what would be helpful to prove your claim. Doing this not only helps you determine what evidence is favorable, it also helps to see what has already been done on the claim and what still needs to be done. You’ll want to look for the history of each claim to make sure that there are no decisions pending or claims that were never considered. Finding mistakes from the VA could potentially lead to a clear and unmistakable error, and lead to past due benefits. The VA may also have not fully developed a claim, such as by failing to request certain medical or service records that would have been helpful. And remember, the VA has a duty to assist veterans in developing their claims, including obtaining records.
Another way that we use the C File is to obtain additional medical evidence through an Independent Medical Examination or Opinion. Usually when there is an unfavorable Compensation & Pension Exam, a good way to rebut that evidence is with a medical opinion that contradicts the C&P Exam. Once we determine that a private medical opinion is needed, we determine what kind of medical opinion we need, such as a nexus statement from a psychiatrist or an increased rating opinion from a cardiologist. We then usually send the C File to the doctor for review with the relevant medical records and C&P exams, to be able to formulate a comprehensive and thorough opinion.
This is why the C File is so important, and why we have to wait until we receive it before we can effectively take action on the appeal.
Author Melanie Franco, Hill & Ponton, P.A. Attorney