VA Claim Deferred? What to Expect and How to Prepare!

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In this article, we’ll explore why your VA claim might be deferred along with what to expect and how to prepare.

A deferred claim can be frustrating, but it’s not necessarily a bad thing.

It simply means the VA needs more information before making a final decision; this can sometimes lead to a more favorable outcome.

Sometimes the VA Rater will issue a partial rating decision, deciding on some parts of your VA claim while deferring others.

Common reasons for a VA claim deferral include:

• Additional Claim Development Needed: More evidence or information is required.

• Request for More Rationale or Clarification: The C&P examiner needs to provide more details.

• Incomplete Disability Benefits Questionnaire (DBQ): Critical information is missing.

Okay, let’s explore these reasons in detail and how you can best respond.

Summary of Key Points

• Deferred VA Claims: A deferred VA claim means the VA needs more information before making a final decision. While deferred status is neither good nor bad, it can sometimes lead to a more favorable outcome.

• Partial Rating Decisions: The VA may issue a partial rating decision, addressing some parts of your claim while deferring others if more evidence or clarification is needed. This is becoming more common.

• Common Reasons for Deferral: These include the need for additional claim development, requests for more rationale or clarification from medical examiners, and incomplete Disability Benefits Questionnaires (DBQs).

• Response to Deferrals: If your claim is deferred, provide any requested documentation promptly and ensure all information is complete to expedite the process and potentially lead to a favorable decision. Oftentimes, there’s nothing you need to do except hurry up and wait.

VA Claim Deferred? The 3 Most Common Reasons Explained!

Reason #1: Your VA Claim Needs Additional Development

Sometimes, the VA Rater requires additional evidence or clarification of existing evidence to properly review and rate your claim.

A development error under 38 CFR § 3.159 is the most common reason for a VA claim deferral.

For example, your claim might be missing Service Treatment Records (STRs), private medical records, or personnel records that could provide the VA Rater with essential evidence.

Alternatively, you may have submitted a Statement in Support of a Claim that can’t be corroborated, or there may be conflicting evidence in your VA Claims File (VA C-File).

The VA has a statutory duty to assist veterans throughout the VA claim process.

This means the VA is obligated to help you by attempting to obtain evidence on your behalf.

Additional development to obtain evidence, such as a medical examination or other records, may be needed if:

• It would provide a more complete picture of the issue, or

• The evidence of record is questionable or conflicting.

Pro Tip: VA Raters may not arbitrarily refuse to assign weight to a claimant’s evidence or develop with the purpose of obtaining evidence to justify a denial of the claim. VA Raters must be able to support the determination that further development is necessary.

References: Here are three cases regarding deferred claim situations.

• Ordering further development in cases where uncorroborated lay evidence is presented [see Douglas v. Shinseki, 23 Vet. App. 19 (2009)]

• A Veteran’s submission of evidence and refusal to attend a VA examination [see Kowalski v. Nicholson, 19 Vet. App. 171 (2005)]

• Developing with the purpose of denying and explaining the need for development [see Mariano v. Principi, 17 Vet. App. 305 (2003)]

Reason #2: The RVSR Needs More Rationale (or Clarification) from the C&P Examiner

The second most common reason for a VA claim deferral is the need for a more detailed explanation or clarification of the Compensation and Pension (C&P) examiner’s medical opinion.

For instance, the C&P examiner may not have conducted a thorough examination or failed to adequately explain their medical opinion regarding service connection.

In such cases, the VA Rater will request the Veteran Service Representative (VSR) assigned to your case to obtain more information from the C&P examiner or order a new C&P exam entirely.

Pro Tip: Only the VA Rater (known as the “RVSR”) has the authority to defer a claim. Remember, a deferral is not necessarily a negative outcome. The VA Rater is doing so to ensure they have all the necessary evidence or clarification (e.g., from a C&P exam or DBQ) before making a final decision on your claim. This process can ultimately work in your favor by providing a more complete assessment of your case.

Reason #3. The C&P examiner submitted an incomplete Disability Benefits Questionnaire (DBQ)

The third most common reason for a VA claim deferral is when the C&P examiner submits an incomplete DBQ.

This can occur if the examiner forgets to check certain boxes or misses entire sections of the form.

Additionally, if the C&P examiner provides a negative medical opinion without proper justification or includes statements like “can’t give a medical opinion without resorting to mere speculation,” the VA Rater may need further clarification.

In these cases, the VA Rater will defer your claim until they receive the necessary information from the C&P examiner.

How Often is a VA Deferred Claim Approved?

A deferred VA claim has the same potential for approval as any other claim, provided that the additional information requested by the VA Rater is thorough and supportive.

The approval rate for deferred claims varies, depending on factors like the reasons for deferral, the quality and completeness of the additional evidence, and the specifics of the veteran’s condition.

A deferred claim signals that the VA requires more information before reaching a decision.

The outcome largely hinges on how effectively the additional information addresses the issues or gaps identified by the VA Rater.

Although there isn’t a specific statistic available on the approval rate of deferred claims, the key to a favorable outcome lies in promptly and thoroughly providing the necessary information and evidence.

When the additional development results in a well-documented and compelling case, the likelihood of approval can be quite favorable.

What is “VA Claim Deferred for Additional Development?”

“VA claim deferred for additional development” refers to a situation where the VA has temporarily paused the processing of a veteran’s disability claim to gather more evidence or information necessary to make a final decision.

This deferral can occur for several reasons:

• Incomplete Evidence: The VA may need more medical records, service treatment records, or other documentation to fully assess the veteran’s condition and its connection to military service.

• Clarification Needed: The VA may require additional clarification from medical professionals or other sources regarding the veteran’s condition, symptoms, or treatment history.

• Further Medical Examination: The VA might request a new or follow-up Compensation & Pension (C&P) exam to obtain more detailed medical information.

• Complex Cases: In some cases, the nature of the veteran’s condition or the complexity of the evidence may necessitate additional time and resources to gather the required information.

This deferral is a routine part of the VA claims process and is not an indication of denial or approval.

It simply means the VA needs more information to ensure a thorough and accurate evaluation of the claim.

What is “VA Claim Deferred Pending Medical Opinion?”

After submitting your VA claim, you will typically undergo a C&P exam conducted by a contracted private medical provider.

During this exam, the examiner will ask you questions, conduct a physical examination (if necessary), and complete the electronic version of the Disability Benefits Questionnaire (DBQ) for your claimed condition.

The DBQ form requires the C&P examiner to provide their medical opinion on the service connection of your condition.

If you check your VA.gov account and see “VA claim deferred pending medical opinion,” it means that the C&P examiner either did not provide a medical opinion or did not adequately justify the opinion they provided.

In such cases, the VA Rater may request clarification from the C&P examiner or order a new C&P exam to obtain a more complete and properly justified medical opinion.

What Does “VA Claim Deferred for Exam Clarification” Mean?

When your VA claim is marked as “VA claim deferred for exam clarification,” it means the VA Rater needs more detailed information or a clearer explanation from the C&P examiner about your examination results.

This could be due to inadequate exam results, an unjustified medical opinion, or an incomplete Disability Benefits Questionnaire (DBQ).

If this happens, there’s typically nothing you need to do; it’s an internal process where the VA Rater communicates with the C&P examiner to resolve the issues.

What Does “VA Claim Deferred for PACT Act” Mean?

“VA claim deferred for PACT Act” refers to a situation where the processing of a veteran’s VA claim is temporarily paused, pending further information or clarification related to the PACT Act.

The PACT Act (Honoring Our Promise to Address Comprehensive Toxics Act) expands VA health care and benefits for veterans exposed to burn pits and other toxic substances during their military service.

The deferral might occur if the VA requires additional information to determine if the conditions claimed by the veteran are covered under the PACT Act or to clarify the veteran’s exposure to specific toxins.

The PACT Act includes provisions for presumptive conditions, meaning certain conditions are presumed to be service-connected if the veteran served in specific locations or during specific times.

In summary, the deferral indicates that the VA needs more information or clarification to properly evaluate the claim under the guidelines established by the PACT Act.

What is the VA Deferred Claim Timeline?

The timeline for resolving a deferred VA claim can vary widely depending on the specific reasons for deferral and the type of additional information required.

Generally, a deferred claim may be resolved within 30 to 90 business days, but this period can extend depending on the complexity of the information needed.

For instance, if the deferral is due to a need for a simple clarification from a C&P examiner, it might only take a couple of weeks to resolve.

However, if the deferral involves obtaining missing Service Treatment Records (STRs) or other significant documentation, the process could take 90 days or more, especially if these records need to be sourced from different agencies or archives.

While the VA works to gather the necessary information, the timeline can be influenced by factors such as the availability of medical experts for additional examinations or the efficiency of record retrieval.

It’s essential to stay informed and responsive to any requests from the VA to help expedite the process.

VA Deferred Claim: Frequently Asked Questions (FAQs)

What Does It Mean When My VA Claim Is Deferred?

A deferred VA claim indicates that the VA requires additional information or evidence before making a final decision on your claim. This status is neither an approval nor a denial; it’s a pause to gather the necessary information to ensure a thorough evaluation.

Why Might a VA Claim Be Deferred?

Common reasons for a VA claim deferral include:

• Additional Claim Development Needed: The VA requires more evidence or documentation.

• Request for More Rationale or Clarification: The VA needs further explanation from medical examiners or other sources.

• Incomplete Disability Benefits Questionnaire (DBQ): The form lacks critical information.

What Is a Partial Rating Decision?

A partial rating decision occurs when the VA issues a decision on some aspects of your claim while deferring others. This can happen if certain conditions are ready for decision while others need more evidence or clarification.

How Long Does It Take to Resolve a Deferred VA Claim?

The timeline for resolving a deferred claim can vary. It generally ranges from 30 to 90 business days, but complex cases requiring additional records or examinations can take longer.

What Should I Do If My VA Claim Is Deferred?

If your claim is deferred, promptly provide any requested documentation and ensure all required information is complete. You generally don’t need to do anything unless the VA specifically asks you for something.

Can I Appeal a Deferred VA Claim?

No, you can’t appeal a deferral itself, as it is not a final decision. However, you can appeal if you disagree with the reasons for the deferral once the VA has made a final decision.

How Can I Prevent My VA Claim from Being Deferred?

To minimize the chances of deferral, ensure that all submitted documents are complete, accurate, and comprehensive. Include all relevant medical records, detailed personal statements, and any supporting evidence.

What Happens If I Can’t Provide the Additional Information Requested by the VA?

If you cannot provide the requested information, the VA may proceed with the available evidence, which could potentially result in a denial. It’s crucial to communicate any difficulties in obtaining the required information to the VA.

Can a Deferred Claim Impact My Benefits Back Pay?

A deferred claim may delay the final decision on your benefits, which could impact the timing of your back pay. However, once approved, back pay is generally calculated from the effective date of the claim. Your effective date is typically the date of your Notice of Intent to File.

How Does a Deferred Claim Affect Other Pending Claims or Appeals?

A deferred claim can potentially delay the resolution of other pending claims or appeals if they are related. It’s important to manage and respond to each issue separately to avoid unnecessary delays.

What Does “VA Claim Deferred Pending Medical Opinion” Mean?

This status means the VA is waiting for a medical opinion to provide clarity on your condition. It may indicate that the initial medical examination was incomplete or lacked sufficient detail.

What Does “VA Claim Deferred for Exam Clarification” Mean?

This indicates that the VA requires a clearer explanation or additional details from a medical examiner regarding your exam results. It’s typically an internal process between the VA and the medical professionals.

Can a Deferred Claim Result in a Favorable Decision?

Yes, a deferred claim can result in a favorable decision if the additional information provided addresses the issues identified by the VA. Properly addressing the reasons for deferral can lead to a successful outcome.

How Often Is a Deferred VA Claim Approved?

There is no specific approval rate for deferred claims, as it depends on the quality and completeness of the additional information provided. However, thorough and well-supported evidence can significantly improve the chances of approval.

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