Fillable Appeal To Board Of Veterans Appeals (Page 3 of 5) in pdf

We are required by law to give you the information in this box. Instructions for filling out the form follow the box.

RESPONDENT BURDEN: VA may not conduct or sponsor, and the respondent is not required to respond to, this collection of

information unless it displays a valid Office of Management and Budget (OMB) Control Number. The information requested is

approved under OMB Control Number (2900-0085). Public reporting burden for this collection of information is estimated to

average one hour per response, including the time for reviewing instructions, searching existing data sources, gathering and

maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden

estimate or any other aspects of this collection, including suggestions for reducing this burden to: VA Clearance Officer (005R1B),

810 Vermont Ave., NW, Washington, DC 20420. DO NOT send requests for benefits to this address.

PRIVACY ACT STATEMENT: Our authority for asking for the information you give to us when you fill out this form is

38 U.S.C. 7105(d)(3), a Federal statute that sets out the requirement for you to file a formal appeal to complete your appeal on a VA

benefits determination. You use this form to present your appeal to the Board of Veterans' Appeals (Board). It is used by VA in

processing your appeal and it is used by the Board in deciding your appeal. Providing this information to VA is voluntary, but if you

fail to furnish this information VA will close your appeal and you may lose your right to appeal the benefit determinations you told

us you disagreed with. The Privacy Act of 1974 (5 U.S.C. 552a) and VA's confidentiality statute (38 U.S.C. 5701), as implemented

by 38 C.F.R. 1.526(a) and 1.576(b), require individuals to provide written consent before documents or information can be disclosed

to third parties not allowed to receive records or information under any other provision of law. However, the law permits VA to

disclose the information you include on this form to people outside of VA in some circumstances. Information about that is given in

notices about VA's "systems of records" that are periodically published in the Federal Register as required by the Privacy Act of

1974. Examples of situations in which the information included in this form might be released to individuals outside of VA include

release to the United States Court of Appeals for Veterans Claims, if you later appeal the Board's decision in your case to that court;

disclosure to a medical expert outside of VA, should VA exercise its statutory authority under 38 U.S.C. 5109 or 7109, to ask for an

expert medical opinion to help decide your case; disclosure to law enforcement personnel and security guards in order to alert them

to the presence of a dangerous person; disclosure to law enforcement agencies should the information indicate that there has been a

violation of law; disclosure to a congressional office in order to answer an inquiry from the congressional office made at your

request; and disclosure to Federal government personnel who have the duty of inspecting VA's records to make sure that they are

being properly maintained. See the Federal Register notices described above for further details.

INSTRUCTIONS

1. CONSIDER GETTING ASSISTANCE: We have tried to give you the general information most people need to complete this

form in these instructions, but the law about veterans' benefits can be complicated. If you have a representative, we encourage you to

work with your representative in completing this form. If you do not have a representative, we urge you to consider getting one.

Most people who appeal to the Board of Veterans' Appeals (Board) do get a representative. Veterans Service Organizations (VSOs)

will represent you at no charge and most people (more than 80 percent) are represented by VSOs. You can find a listing of VSOs on

the Internet at: Under certain circumstances, you may pay a lawyer or "agent" to represent you. Your local

VA office can further assist you with questions regarding how to appoint a VSO, attorney, or agent to represent you. You can reach

your local VA office toll-free at 1-800-827-1000. Your local bar association may be able to provide you with the names of attorneys

who specialize in veterans' law.

2. WHAT IS THIS FORM FOR? You told your local VA office that you disagreed with some decision it made on your claim for

VA benefits, called filing a "Notice of Disagreement." That office then mailed you a "Statement of the Case" (SOC) that told you

why and how it came to the decision that it did. After you have read the SOC, you must decide if you want to go ahead and complete

your appeal so that the Board will review your case. If you do, you or your representative must fill out this form and file it with VA.

"Filing" means delivering the completed form to VA in person or by mailing it based on the instructions you received with your

SOC. Paragraph 4 tells you how much time you have to file this form and paragraph 7 tells you where you file it.

When we refer to "your local VA office" in these instructions, we mean the VA Regional Office that sent you the SOC or, if you

have moved out of the area served by that office, the VA Regional Office that now has your VA records.

3. DO I HAVE TO FILL OUT THIS FORM AND FILE IT? Fill out this form and file it with VA if you want to complete your

appeal. If you do not, VA will close your appeal without sending it to the Board for a decision. If you decide that you no longer

want to appeal after you have read the SOC, you don't have to do anything.

4. HOW LONG DO I HAVE TO COMPLETE THIS FORM AND FILE IT? Under current law, there are three different ways

to calculate how much time you have to complete and file this form. The one that applies to you is the one that gives you the most

time:

(a) You have one year from the day your local VA office mailed you the notice of the decision you are appealing.

(b) You have 60 days from the day that your local VA office mailed you the SOC.

If that SSOC was provided to you in response to evidence you or your representative submitted within the one-year period

described in paragraph 4(a) of these instructions, above, and if you have not already filed this form, then you have at least 60

days from the time your local VA office mailed you the SSOC to file it even though the one-year period has already expired.

See 38 C.F.R. 20.302(b)(2).

There is one special kind of case, called a "simultaneously contested claim," where you have 30 days to file this form instead of the

longer time periods described above. A "simultaneously contested claim" is a case where two different people are asking for the

same kind of VA benefit and one will either lose, or get less, if the other wins. If you are not sure whether this special exception

applies, ask your representative or call your local VA office.

Appeal To Board Of Veterans Appeals Page 3

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