To file an initial or second appeal, you'll need to request your claims file from the VA. Here's what you'll find.
When you apply for disability benefits, the VA creates a claims folder. Information you send to the VA, records the VA obtains on your behalf, and documents created by the VA are all in this folder. The claims file is commonly referred to as the “C-file.”
Requesting Your Claims File
If you have been denied disability, you will want to obtain a copy of your VA Claims file to obtain information that will help you in filing your appeal.
Request it from the VA Regional Office where you submitted your claim for benefits. If you do not receive it in a timely manner, make a PRIVACY ACT for the file. This link is a WORD TEMPLATE to use to request your C-File. You are entitled to receive one copy of your claims folder for free. Your accredited VSO, attorney or claims agent will also be able to get a copy from VBMS.
For almost immediate access to your VBA claims file C-File) get a representative with VA “efolder express” access.
Many VSOs, claims agents and attorneys have this new electronic access to your records once you sign a POA with them and can download your records for you.
Typical Documents in a VA Claims Folder
When you receive your VA Claims Folder, don't be surprised if the documents are somewhat disorganized. Also, there may be several copies of documents even though you really only need one copy. It can take a while to sort it all out. If you want some help with this, you may want speak with your accredited Veteran Service Officer, Accredited Claims Agent or Accredited VA Attorney.
Here are some basic documents you might find in your C-file if you have applied for VA benefits. This is not an exhaustive list but merely a description of the most common and important documents you should find in your file. If any of these documents are missing, you will want to obtain them.
DD-214, Report of Separation From Service
This is a very important document. It includes information about your character of service, which can determine your eligibility for benefits. Your DD-214 will also include your dates of service, specialties, any medals received, and other information about your term(s) of service.
Application for Benefits
Any applications for benefits that you have previously made should be included in your C-file. This can be important if you did not keep copies before submitting an application.
Denial Letter, Ratings Decision, and Code Sheet
If you have been denied benefits, there should be a letter in your file notifying you of the decision to deny you benefits. Until recently, the VA also issued detailed ratings decisions explaining why benefits were granted or denied, and why certain ratings were assigned to service-connected disabilities. Now the ratings decisions do not provide much information and tend to be quite brief.
The Rating Code Sheet contains several pieces of important information. For example:
- The name of the veteran’s attorney or representative on file with the VA, if any (i.e. the Power of Attorney/POA)
- The VA File Number
- The dates of military service on file with the VA (including character of discharge)
- The dates the VA believes the current claims were filed
- A list with the exact names of every medical condition for which the veteran is service-connected
- A list of the current ratings for each service-connected condition, along with the effective dates for each rating
- A list of the past ratings for each service-connected condition, along with accompanying effective dates for each of the past ratings
- If the veteran is receiving non-service-connected pension, all of the conditions that are considered disabling for pension purposes will be listed, along with accompanying ratings as assigned by the VA to reflect the severity of each condition
- A statement as to the veteran’s current and past combined/overall rating percentages per the VA’s “special math” (including the bilateral factor and special monthly compensation, if applicable)
- A list of the medical diagnostic codes that were used to rate any service-connected disabilities; and
- A list of prior claims that have been filed at some point in the past, but denied
Considering the wealth of information that is contained in the Rating Code Sheet, one would think the VA would automatically send this document to all veterans when the actual rating decisions are mailed. However, for some reason, this just doesn’t seem to happen. In my experience, veterans will get the notification letter from the VA and they’ll get the rating decision; however, they very rarely ever get the Rating Code Sheet.
If you are going to hire an attorney or claims agent, one of the first things they will ask you for is a copy of the denial letter, ratings decision, and code sheet. If you have signed a POA (Power of Attorney) VBA Form 21-22 for a Veteran Service Organization or Veteran Service or a VBA Form 21-22a for a VA accredited Claims Agent or VA accredited attorney, then they will have access to all this information.
SEE EXAMPLES OF RATING CODE SHEETS AT THE END OF THIS ARTICLE:
Service Treatment Records (STRs)
You may find copies of your service medical records in the file, if the VA requested these while gathering information to decide your claim. An important document in these records is the report from your enlistment examination. This exam report contains information about whether you suffered from certain medical conditions at the time you entered service.
VA Medical Records
Your file may contain records from the ROI (Release of Information) office at the VA Medical Center where you receive treatment, but it may not. Or, it may contain an incomplete set of your medical records. You can request your medical records directly from the VA Medical Center by requesting them in person or over the phone. You can also obtain the latest VA medical Records on the MyHealtheVet website:
https://www.myhealth.va.gov/mhv-portal-web/web/myhealthevet/home in the ‘Blue Button’ section.
Compensation and Pension exam
Another document a lawyer will want to see is a copy of your compensation and pension exam report. This is the exam you went to where the VA doctor evaluated your disabilities and made a recommendation to the Veterans Benefits Administration about whether or not your disabilities were service connected.
Service Personnel Records
Your file may also include copies of your active duty personnel records. This will include information about where you served, copies of certificates for medals you received, performance evaluations, and other information.
Appeal Documents in a Claims File
If you have already filed an appeal and had an appeal denied, the following documents may be in your C-file.
- The Supplemental Claim, Higher Level Review or Notice of Disagreement you filed, telling the VA you disagreed with their decision.
- Statement of the Case, a document describing in detail how the conclusions in the ratings decision were reached.
- A transcript of a hearing before a Decision Review Officer (DRO) or the Board of Veterans Appeals (BVA), if you had a hearing.
- Information about your representative or attorney (if you had one).
EXAMPLES OF RATING CODE SHEETS:
EXAMPLE 4 PAGE 1
EXAMPLE 4 PAGE 2
NOTE: ANCILIARY DECISION: Basic Eligibility under 38 USC Ch 35 means the person is Permanent & Total affording more benefits for dependents including CHAMPVA medical benefits and CHAP 35 Dependent Education Assistance (DEA)
This link is to the VA M-21-1 Benefits Manual describing all aspects of the VA RATING CODE SHEET: