M29-1, Part III\
January 14, 1980 Change 3

CONTENTS

CHAPTER 10. PROCESSING APPEALS

PARAGRAPH PAGE

10.01 Notification of Right to Appeal 10-1\
10.02 Notice of Disagreement 10-1\
10.03 Control of Appeal Cases 10-1\
10.04 Processing of Notice of Disagreement 10-2\
10.05 Review of the Original Decision 10-2\
10.06 Statement of the Case 10-3\
10.07 No Response 10-4\
10.08 Substantive Appeal 10-5\
10.09 Certification of Appeals 10-6\
10.10 Supplemental Statement of the Case 10-6\
10.11 Remands 10-7\
10.12 Withdrawal 10-8

FIGURE\
10.01 FL 1-25A, Statement of the Case 10-9

10.02 VA Form 1-646, Statement of Accredited Representative in Appealed
Case 10-10\
10.03 VA Form 1-8, Certification of Appeal 10-11

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M29-1, Part III\
January 14, 1980 Change 3

CHAPTER 10. PROCESSING APPEALS

10.01 NOTIFICATION OF RIGHT TO APPEAL

a\. When a decision is made which is adverse to the allegation made by
the claimant, or benefits are terminated, a notice of such adverse
action will be sent by certified mail, with a VA Form 1-4107, Notice of
Procedural and Appellate Rights, or equivalent information to the
claimant and his/her representative, if any. The term \"representative\"
includes agent, attorney or authorized representative. Only one
attorney, agent or service organization will be recognized at any one
time.

b\. The letter will show the date of the decision, reason(s) therefor
and advise the claimant and authorized representative of the right to
initiate an appeal by filing a notice of disagreement and that such
notice must be filed within 1 year from the date of notification. In the
event of death, the beneficiary(ies) may exercise the right of appeal.

10.02 NOTICE OF DISAGREEMENT

a\. It is the responsibility of the Adjudicator to determine whether a
communication is a notice of disagreement. Any written expression of
dissatisfaction or disagreement with a decision made on a claim is
considered a notice of disagreement. One important factor to be
considered when making a determination as to whether an objection raised
by the claimant is a notice of disagreement is the intent of such
claimant. A mere complaint letter or a mere inquiry for additional or
more clarifying information should not automatically be accepted as a
notice of disagreement. In most instances, such complaint letters can be
handled by a letter of explanation which should also contain a statement
reminding the claimant of the time limit for filing a notice of
disagreement.

b\. A notice of disagreement may be filed by the claimant or his/her
appointed representative. This representative may be a service
organization (VA Form 23-22, Appointment of Veterans Service
Organization as Claimant\'s Representative, needed); a third party
granted power of attorney (VA Form 2-22a, Appointment of Attorney, or
Agent as Claimant\'s Representative); or an attorney who states under
his/her letterhead that he/she represents the claimant. If the claimant
is incompetent the notice may be filed by the legal guardian or other
fiduciary, or in the absence of one of these, by the next of kin or
friend.

c\. The notice of disagreement must be filed within 1 year from the date
of mailing of the notification of adverse decision. Failure to file a
notice of disagreement within 1 year shall make the original decision
final and the claim will not thereafter be reopened or allowed.

d\. A notice of disagreement postmarked prior to the expiration of the
1-year period will be accepted as timely. In computing the time limit
for filing, the 1st day of the period will be excluded, but the last day
of the period will be included. If the last day falls on a Saturday,
Sunday or holiday, the period will be extended to the next workday. The
filing of new evidence after receipt of notification of adverse decision
does not extend the time limitation for filing a notice of disagreement.

e\. While it is contemplated that proper notice of the right to appeal
and the time limit involved will be given, failure to notify the insured
of his/her right to appellate review or the time limit applicable to a
notice of disagreement or substantive appeal will not extend the time
limit allowed for taking this action.

f\. The BVA (Board of Veterans Appeals) will make a final determination
of any appellate jurisdiction when the timely filing of a notice of
disagreement or substantive appeal is in question; e.g., a few days late
or claimed extenuating circumstances. This final determination will be
made after a statement of the case or the equivalent in correspondence
has been furnished the claimant-appellant and the issue has been
certified to the BVA.

10.03 CONTROL OF APPEAL CASES

a\. All insurance appeal cases are controlled by the Appeal Record
Control Clerk in the Insurance Division under VARMS (Veterans Appeals
Records Management System) as outlined in M23-l, part I, chapter 7.

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M29-1, Part III January 14, 1980

Change 3

b\. VARMS is an automatic record keeping system designed to maintain
controls on appeals, which utilizes ADP (automatic data processing)
equipment to maintain appeal records on magnetic tape.

c\. A master record is created for each appealed case and is updated
with each action as the case moves through the various stages of the
appeal until disposition. VARMS will generate edit-update message
listings, suspense listings, master listings, and quarterly reports to
the BVA as outlined in M23-l, part I, chapter 7.

d\. Upon receipt of a notice of disagreement, and at each subsequent
stage of the appeal process (release of a statement of the case, receipt
of a substantive appeal, hearing requested, certification to BVA, and
receipt of a BVA decision), the insurance file should be forwarded to
the Appeal Record Control Clerk to establish and update the master
record in VARMS.

10.04 PROCESSING OF NOTICE OF DISAGREEMENT

a\. When correspondence is initially received in the ICS (Insurance
Claims Section) and it is identified as a notice of disagreement, the
Adjudicator will review all the evidence of record to determine if the
benefits sought can be granted.

b\. If no change in the decision is warranted, the following actions
will be taken:

\(l\) Release FL 29-660a, Acknowledgment of Dissatisfaction or other
appropriate letter to the applicant and authorized representative, if
any, to acknowledge receipt of the notice of disagreement.

\(2\) Prepare VA Form 29-5895a, Pending Transaction Input Card, to
insert a standard nonfreeze diary (callup code type 974) with a callup
date of 45 days.

\(3\) Prepare VA Form 29-5716b, DIC Diary Card-NSLI-USGLI, (paper diary)
with a 45-day callup, if no insurance master record exists.

\(4\) Notify the General Clerk who will prepare and maintain a 5 x 8
control card for ICS on all appeals pending.

\(5\) Prepare VA Form 3230, Reference Slip, routing the case to the
Appeal Record Control Clerk in the Insurance Division for preparation of
a VA Form 1-670a, Appeal Record Card (VARMS), and VA Form 20-8772,
Veterans Appeal Record Code Sheet, with instructions to return the case
to ICS after recording the appeal as outlined in M23-l, part I, chapter
7.

\(6\) Request any records which are necessary to prepare the statement
of the case.

\(7\) If the claims folder is needed, prepare VA Form 60-7216a, Request
For and/or Notice of Transfer of Veterans Records. The claims folder
will be held until the substantive appeal is subsequently received, or
the time limit for filing expires.

10.05 REVIEW OF THE ORIGINAL DECISION

a\. The original decision will be reviewed to determine its correctness.
Any additional development necessary will be undertaken at this time.
Such development may include a request for the claims folder and/or
discussions with the medical consultant, etc.

\(1\) If the review results in granting of all benefits claimed, the
notice of disagreement will be considered withdrawn and the appellant so
advised. The case will be forwarded to the Appeal Record Control Clerk
for the recording of the proper disposition code (70) in the VARMS
master record as outlined in M23-l, part I, chapter 7.

\(2\) If substantially all benefits are allowed while the notice of
disagreement is pending, the appellant will be so advised and told that
unless he/she informs the VA within 30 days of the desire to continue
the appeal process. VA will withdraw the notice of disagreement. The
claimant still has the right to reinstate the notice of disagreement and
file and appeal within the 1-year appeal period or 30 days from the date
of the letter of notification, whichever is later.

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January 14, 1980 M29-1, Part III\
Change 3

\(3\) After a notice of disagreement is filed, the allowance of less
than substantially all benefits sought will not justify closing he case.

b\. When more than one issue was involved in VA\'s decision and it is
not clear with which issue the claimant disagrees, clarification will be
requested.

10.06 STATEMENT OF THE CASE

a\. When a timely notice of disagreement is received and the issue in
question is not resolved by granting the benefits sought or through the
withdrawal by the claimant or his/her representative of the notice of
disagreement, FL 1-25A, Statement of the Case, will be prepared (see
fig. 10.01) and sent to the claimant and his/her representative, if any.

b\. The purpose of the statement of the case is to provide the claimant
and representative with all the facts pertinent to the issue or issues
involved, VA\'s decision and the basis or reason for the decision. All
possible assistance will be given the claimant and representative in
obtaining evidence and in the development of the appeal.

c\. The statement of the case should not quote from material such as
decisions or memorandums or contain insignificant information as to
dates a claims folder was requested or received, etc. It should
specifically state the issue(s) to be decided. Laws should be quoted but
long quotations should be avoided, and the statement of the case should
be in language the claimant can understand.

d\. It is essential that the statement of the case be complete. It
should consist of the following:

\(1\) Issue The issue which is to be decided should be entered in the
space provided on the FL 1-25A. If there is more than one issue, each
should be separately stated and numbered. Issues are generally set forth
as questions.

\(2\) Contentions Claimant\'s contentions should be given under separate
heading and should follow the issue(s) to be decided. All contentions,
even if they appear frivolous or groundless, should be shown and each
must be disposed of in the Reasons section. Contentions may be
paraphrased.

\(3\) Evidence and Adjudicative Action Taken

\(a\) Basically, the summary of evidence should deal with the facts in
the case which are pertinent to the issue(s) with which disagreement has
been expressed. Begin by citing the date the claim was filed and total
disability was alleged. Following this should be a recitation of the
pertinent evidence, generally presented in chronological order. It is
not necessary to enter material concerning the insured\'s service dates,
age, occupation, type of insurance plan, the date term insurance was
converted to a permanent plan, etc., unless this material has a direct
bearing on the issue that is being appealed. Following this should be a
statement of the adjudicative action taken.

\(b\) When the sole issue is failure to file timely, it is not necessary
to recite the medical evidence, unless the evidence would have bearing
on the insured\'s failure to file timely.

\(4\) Laws The Adjudicator should cite the pertinent sections of title
38, United States Code, Code of Federal Regulations, and paraphrase any
other instructions or General Counsel opinions approved by the
Administrator. Since departmental manuals and other procedural
instructions do not have the force and effect of law or Agency policy,
they should not be set forth here, but rather in Reasons for Decision,
as appropriate.

\(5\) Decision The decision on the issue or issues.

\(6\) Reason(s)

\(a\) The reasons should be specific and based on the facts presented in
the evidence section and the laws and regulations cited in the Laws
section. Each argument in the Contentions section should be disposed of
here. The language should be as simple and non technical as necessary,
depending upon the educational level and apparent understanding of the
claimant.

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January 14, 1980

M29-1, Part III

Change 3

\(b\) A statement of the case may not disclose matters that would be
contrary to 38 U.S.C. 3301 or otherwise contrary to the public interest.
Matters considered injurious to the physical or mental health of the
applicant include those so considered by responsible medical authority,
especially the more severe psychiatric disorders, diseases where
prognosis is poor and those of misconduct origin. Sources of information
which might provoke feelings of hostility, resentment or rejection on
the part of the applicant to his/her family should not be revealed. If
the Medical Consultant\'s opinion is requested and used as evidence, the
physician should be referred to by title rather than by name. Such
matters may be disclosed to the applicant\'s designated representative
unless the relationship between the applicant and the representative
would make disclosure as harmful as if made to the applicant. Thus,
sometimes it is necessary to prepare two different versions of the
statement of the case; one for the claimant and another for the
representative.

NOTE: Any information on disease or impairment supplied by the applicant
will be made apart of the statement of the case, regardless of its
severity.

e\. FL 1-25, Transmittal of Statement of the Case 19 Claimant, will be
used to forward the statement of the case to the claimant and his/her
representative, if any, with a VA Form 1-9, Appeal to Board of Veterans
Appeals. This is the form on which the claimant makes his/her formal
appeal.

f\. If it is necessary to obtain the claims folder in order to prepare
the statement of the case, it will be retained for 60 days. The ICS
appeal control card will be annotated charging the folder to the
requester. The claims folder will be maintained in the office of the
supervisor. At the end of the 60-day period, if no appeal has been
received, the claims folder will be returned to the regional office.
Should the regional office request return of the folder before
expiration of the 60-day appeal period, the Adjudicator will contact the
regional office by telephone to see if the information needed can be
furnished over the telephone.

g\. After the Adjudicator prepares and signs the statement of the case,
it will be forwarded to the unit supervisor for review. The unit
supervisor will sign the statement of the. case and forward it to the
Medical Consultant and the Chief, Insurance Claims Section, for
concurrence and signature.

h\. Only the original (file copy) of the statement of the case will be
signed. The number of copies necessary are:

\(1\) Original (file copy);

\(2\) Claimant\'s copy; and

\(3\) Representative\'s copy or copies. (If a service organization, the
number of copies will depend on the service organization, see ch. 12,
par. 12.03). A copy of the claimant\'s copy, if not identical, will also
be included.

i\. The Authorizer will also prepare:

\(1\) VA Form 29-5895a, to update the nonfreeze diary, with a callup
date of 75 days.

\(2\) VA Form 29-5716b, if no insurance master record exists.

\(3\) VA Form 3230, routing the case to the General Clerk to update the
ICS control card and to the Appeal Record Control Clerk to update the
VARMS master record.

10.07 NO RESPONSE

a\. If no reply (substantive appeal) is received by the end of the 60
days after release of the statement of the case to the claimant, and
upon receipt of the followup 974 diary RPO (record printout) (75 days),
the Adjudicator will assume the claimant does not intend to complete the
appeal and close the records.

b\. This is procedural only and the claimant\'s substantive rights are
not affected as long as the substantive appeal is filed within the
remainder of the 1-year period from the notice of the original decision.

c\. The Authorizer will take the following actions:

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January 14, 1980 M29-I, Part III\
Change 3

\(1\) Prepare VA Form 29-5895a to delete the diary, if there is one on
tape, or destroy VA Form 29-5716b on an off-tape case in accordance with
Records Control Schedule VB-1, part I.

\(2\) Prepare VA Form 3230 routing the case to the General Clerk with
instructions to close out the ICS control card and then to the Appeal
Record Control Clerk with instructions to close the case on the VARMS
master record as outlined in M23-l, part I, chapter 7.

10.08 SUBSTANTIVE APPEAL

a\. A VA Form 1-9, adequately executed, or its equivalent in
correspondence from a claimant or his/her representative following the
furnishing of a statement of the case, will constitute a substantive
appeal.

b\. The appeal should clearly identify the benefits sought and set out
specific allegations of error in fact or law. These allegations should
be related insofar as possible to the specific items in the statement of
the case.

c\. The substantive appeal should be filed within 60 days from the date
of mailing of the statement of the case or within the remainder of the
1-year period from the date of mailing of the notification of the
adverse decision being appealed, whichever is greater.

d\. When a substantive appeal is postmarked after the expiration of the
time limit set above, the claimant and representative, if any, will be
notified that the failure to submit the substantive appeal on time
prevents further action on the case. The envelope in which the appeal
was mailed will be filed in the insurance folder, thus retaining the
postmark date.

e\. If the claimant appeals our finding that appeal was not timely
filed, the decision as to whether an appeal has been timely filed will
be made by the BVA after development and certification on such issue.
Development should include the statement of the case or an equivalent in
correspondence.

f\. When the substantive appeal (VA Form 1-9 or its equivalent) is
received from the claimant, the Receipt and Dispatch Unit will forward
the appeal to the Appeal Record Control Clerk.

NOTE: lf the VA Form 1-9 is inadvertently received directly in ICS, it
will be hand carried to the Appeal Record Control Clerk for the
necessary action.

g\. The Appeal Record Control Clerk, upon receipt of the appeal, will
take the following actions.

\(1\) Obtain the claimant\'s insurance folder;

\(2\) Enter the date recorded on the reverse side of the VA Form 1-9 in
the space provided;

\(3\) Update VA Forms 1-670a and 20-8772 filed in the insurance folder;

\(4\) Make all necessary inputs to update the VARMS master record to
reflect receipt of the substantive appeal as outlined in M23-l, part I,
chapter 7; and

\(5\) Forward the insurance folder and substantive appeal to ICS for
action.

h\. Upon receipt in ICS of the substantive appeal, the Adjudicator will
take the following actions:

\(1\) Check to see that the VA Form 20-8772 has been noted by the Appeal
Record Control Clerk to show receipt of the substantive appeal;

\(2\) Check to see if appeal is timely filed;

\(3\) Analyze appeal to determine if benefits sought may be granted, or
new issues raised, possibly requiring development and! or a supplemental
statement of the case;

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January 14, 1980

M29-1, Part III

Change 3

\(4\) Check to see if a hearing is requested (see ch. 12);

\(5\) Obtain claims folder from the regional office of jurisdiction; and

\(6\) After completion of the above, prepare the case for certification
to the BVA.

10.09 CERTIFICATION OF APPEALS

a\. Before certifying and preparing VA Form 1-8, Certification of Appeal
(which is necessary when forwarding a substantive appeal to the BVA),
all effort must be taken to assure that a complete case is being
submitted.

b\. The following is a checklist of factors to consider in the
preparation of VA Form 1-8:

\(1\) All pertinent evidence required under existing instructions is a
matter of record;

\(2\) The claimant was given an opportunity to make a personal
appearance when there was a request for a hearing and a complete
transcript of the record is in file if a hearing was held; and

\(3\) A completed VA Form 1-646, Statement of Accredited Representative
in Appealed Case, is of record or there is evidence that the accredited
service organization representative was given an opportunity to make a
presentation in support of the appeal. If the representative is not
stationed at the VA center, check \"No\" in item 9A and annotate item 9B
of the VA Form 1-8, \"Service Representative Not on Station.\"

\(4\) The insured\'s claims folder must accompany the insurance folder
when certified to the BVA.

c\. The Adjudicator, after reviewing the case, will take the following
actions:

\(l\) Prepare top portion of VA Form 1-646 (original only) (see fig.
10.02), attach it to the outside of the insurance and claims folders,
and place the case in the designated area for certification by the
accredited service organization representative, if any.

\(2\) Upon return of the case from the representative, the Adjudicator
will prepare VA Form 1-8 (original only) and initial in item 17A (see
fig. 10.03). Omissions of any material from the case could result in a
remand of the case.

\(3\) Prepare FL 1-26 to notify the claimant and his/her representative
that the appeal and the records in the case are being forwarded to the
BVA for disposition.

\(4\) Prepare VA Form 60-7216a to transfer the records (insurance and
claims folders) to the BVA.

\(5\) Prepare VA Form 29-5895a, transaction type 098, to delete the 974
appeal pending diary.

\(6\) The VA Form 1-8 with the case will be forwarded to the medical
consultant for concurrence and signature, and the Chief, ICS, who must
sign as the certifying official.

\(7\) The entire case will be routed to the Appeal Record Control Clerk
via the General Clerk who will remove the 5 8 control card from the ICS
appeals pending file and place it in the certification file. The General
Clerk will also remove the VA Form 29-57l6b, from file, if any, and
destroy it in accordance with Records Control Schedule VB-1, Part l.

10.10 SUPPLEMENTAL STATEMENT OF THE CASE

a\. A supplemental statement of the case, as the name implies,
supplements the original statement of the case so that due process
requirements of the law are properly met.

b\. A supplemental statement of the case may be required when:

\(1\) Additional evidence is received;

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January 14, 1980 M29-I, Part III\
Change 3

\(2\) A material defect in the original statement of the case is
discovered or when for any reason the original statement of the case is
not adequate to effect the letter and intent of the law; or

\(3\) The BVA in reviewing the original record finds that omissions or
error of substance affecting due process have been made and remands the
case for a supplemental statement before proceeding with the final
decision.

c\. It is generally necessary to furnish a supplemental statement of the
case when additional evidence is received after the basic statement of
the case was released. There is one exception, however, and that is when
additional evidence was submitted by the claimant or his/her
representative, and the contents and facts of the evidence so furnished
were obviously known by

them. Thus, if the claimant has been adequately informed in the original
statement of the case as to the pertinent facts, the applicable laws and
regulations, and the decision made, including the reasons for the
decision, a supplemental statement of the case need not be furnished.
Instead, FL 1-26 to the claimant will be properly noted to explain why
the additional evidence did not warrant a change in the prior denial of
the benefits for which appealed. A brief statement to that effect will
also be noted on the VA Form 1-8 in Remarks (item 14).

d\. Additional evidence received after the records have been transferred
to the BVA will be forwarded to the Board if it has a direct bearing on
the issues being appealed. The Board will then determine what procedural
steps are required with respect to the new evidence.

e\. If the evidence has no direct bearing on the issue before the Board,
it will be forwarded to the Insurance Files Section for filing in a
temporary folder pending return of the insurance folder from the BVA.

f\. The Adjudicator, when preparing the supplemental statement of the
case, should not repeat the prior statement of the case in its entirety.

g\. Generally, the supplemental should be limited to essential changes
or additions to the section of the original statement adequate to give
complete information to the claimant.

h\. Attaching a copy of the original statement is not necessary, except
when good judgment so dictates.

i\. \"Attachment to FL 1-25\" will not be used as the first page. All
pages of a supplemental statement of the case will be on plain white
bond paper in the format of an original statement.

j\. Prepare FL 1-28, Transmittal of Supplemental Statement of the Case
to Claimant. This letter gives the claimant a period of 30 days to
respond.

k\. Prepare VA Form 29-5895a to update the 974 appeal pending diary with
a callup date of 45 days or update VA Form 29-5716b if an off-tape case.

l\. It will be necessary to have the supplemental statement of the case
reviewed for concurrence and signatures. (see par. 1 0.06g).

m\. Forward the case to the Appeal Record Control Clerk via the ICS
General Clerk, for updating the VARMS master record (code 42, suspense
date 1st day, 1 month after release) and update the VA Form 20-8772 in
the insurance folder.

n\. At the end of the period if there has been no response to the
supplemental statement of the case, certify the appeal to the BVA on the
evidence of record.

10.11 REMANDS

a\. When the BVA determines that additional evidence or clarification of
evidence is necessary, they will remand the case to the office of
original jurisdiction directing what further development is to be
undertaken.

b\. Upon receipt of the case, the Appeal Record Control Clerk will
update VA Form 20-8772 in the insurance folder, the VARMS master record
and forward the remanded case to ICS. The Adjudicator should always
check the VA Form 20-8772 to see that VARMS has been updated. (See
M23-l, p. I, ch. 7.)

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M29-1, Part III January 14, 1980

Change 3

c\. The Adjudicator will prepare VA Form 29-5895a to insert a standard
nonfreeze diary (callup code type 974) with a callup date of 45 days.

d\. When the case is remanded only for assembly of records which were
previously considered, a review need not be made. Records will be
assembled and the case will be resubmitted to the BVA. It will not be
necessary to obtain a VA Form 1-646 from the service organization.

e\. If development of the case results in a supplemental statement of
the case and, after receiving a response to the supplemental statement,
benefits sought still cannot be granted, it will be necessary to prepare
a new VA Form 1-646 for review by the service organization
representative or to place a notation on the original VA Form 1-646
indicating they have reviewed the case.

f\. If the claimant does not respond to the supplemental statement of
the case within 30 days, the remanded case will be recertified to the
BVA.

g\. The original VA Form 1-8 which is in the folder will be used for
recertification of the above cases to the BVA. Item 14, Remarks, will be
noted: \"Determination of *(insert date shown in date block)* Confirmed.
*(Date) (Signature and title).\"*

h\. Prepare VA Form 60-7216a for transfer of the case. Item 14, Reason
for Transfer, will be noted: \"Remanded-Appellate Review Being
Returned.\"

i\. The case will be routed to the Chief, ICS, who is the certifying
official. It is not necessary to forward the case to the Medical
Consultant for concurrence unless a supplemental statement of the case
is prepared.

j\. Forward the case to the Appeal Record Control Clerk via the General
Clerk.

10.12. WITHDRAWAL

a\. The claimant or his/her representative may withdraw a notice of
disagreement at any time before a timely substantive appeal is filed or
expiration of the time allowed.

b\. A substantive appeal may be withdrawn at any time before the BVA
enters a decision, except when withdrawal would be detrimental to the
appellant or the Government.

c\. Once a notice of disagreement or substantive appeal has been filed,
the appeal may not be closed because of the claimant\'s failure to
cooperate by furnishing evidence or submitting to an examination. In
such cases, entitlement is based on the evidence of record.

d\. A withdrawal may be made by the claimant or his/her representative
except that a representative may not withdraw either a notice of
disagreement or a substantive appeal filed by the claimant personally.

e\. An appeal will be withdrawn when all benefits sought are granted
without appellate review. This includes a remanded case when a
supplemental statement of the case may be involved.

f\. The Authorizer will take the following actions when a case is
withdrawn:

\(l\) Prepare an amended decision when all benefits sought are granted
and notify the claimant, representative, if any, and the BVA if the case
was remanded with a dictated letter.

\(2\) Prepare VA Form 29-5895a, to delete the nonfreeze diary. If no
insurance master record exists destroy VA Form 29-5716b in accordance
with Records Control Schedule VB-1, part I.

\(3\) Forward the case to the Appeal Record Control Clerk.

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January 14, 1980 M29-1, Part III\
Change 3

Veterans April l, 1979\
Administration JONES, JOHN C.

P O. Box 8079 V 000 00 00\
Philadelphia, PA 19101 c 12 345 678

STATEMENT OF THE CASE

IN THE APPEAL

OF

JOHN C. JONES

FROM THE DECISION OF THE

VETERANS ADMINISTRATION

**[NOTICE TO APPELLANT]{.underline}:**

This is not a decision on the appeal you have initiated. It is a
\"Statement of the Case\" which the law requires us to furnish to help
you in completing your appeal.

Please read the forwarding letter carefully, as well as the instructions
on the enclosed appeal form. These explain your appeal rights and tell
you what you must do to complete your appeal.

A copy of this \"Statement of the Case\" has been furnished your
representative:

[ISSUE]{.underline}:

Whether the insured is entitled to waiver of premium

on his Veterans Service-Rated Insurance policy.

FL 1-25A, Feb. 1980(R)

Figure 10.01 FLI-25A, Statement of the Case

10-9

M29-1, Part III January 14, 1980

Change 3

Form Approved

OMB No. 76-022I

VETERANS ADMINISTRATION

STATEMENT OF ACCREDITED REPRESENTATIVE IN APPEALED CASE

SERVICE ORGANIZATION (Name and Routing Symbol*)* DATE

TO

Am . 4-14-79

LAST NAME - FIRST NAME MID OF VETERAN FILE NO.\
Jones, John C. V 000 00 00

All evidence in connection with this appeal has been considered. Please
complete and return the

statement below on or before the date indicated. If we do not receive
either the statement or a request

for extension by that date, it will he necessary for us to certify the
appeal to the

Board of Veterans Appeals

on the present record.

REPLY REQUESTED BY (Oslo) ORGANIZATIONAL ELEMENT MAKING REQUEST (NAME
AND ROUTING SYMBOL)l

4-21-79 Insurance Claims (297C)

TO BE COMPLETED BY ACCREDITED REPRESENTATIVE

**NOTE:** Section 40O5(a) and (b)(2) Title 38. United States Code, gives
the claimant the right to be represented and gives the accredited
representative the right to file claims far the claimant. The
presentation of on agreement by the accredited

representative is voluntary and not necessary for completion of the
appeal. The opportunity for argument is given

the accredited representative in order to accord the claimant the right
of full representation at this stage of the appellate

process. Failure to file this form may delay the appellate process.

I HEREBY CERTIFY that a Statement of the case was furnished; that
appellate review is desired on the evidence now of record; and that the
issues for consideration of the Board of Veterans Appeals are clearly
defined.

\[ \] I REST THE APPEAL ON THE ANSWER TO THE STATEMENT OF THE CASE AND
THE HEARING ON APPEAL *(If Conducted*).

\[ \] I WISH TO MAKE THE FOLLOWING ARGUMENT TO SUPPLEMENT THE ANSWER TO
THE STATEMENT OF THE CASE AND OTHER ARGUMENT OF RECORD.

**VA** FORM 1-646 OCKS OF VA FORM 1545. JUL 1955.

Figure 10.02 VA Form 1-646, Statement of Accredited Representative in
Appealed Case

10-10

January 14, 1980 M29-I, Part III

Change 3

CERTIFICATION OF APPEAL

IA. NAME OF APPELLANT 1b. RELATIONSHIP TO VETERAN 2. FILE NO.

C 12 345 678

3\. LAST NAME FIRST NAME MID NAME OF VETERAN 4. INSURANCE FILE NO OR
LOAN NO.

Jones John C. V 000 00 00

THE APPEAL IS FOR *(State the question(s) at issue clearly and
concisely.\
*

5A. SERVICE CONNECTION FOR 5B. DATE OF NOTIFICATION OF

SERVICE CONNECTION

6A. INCREASED RATING FOR 6B.. DATE OF NOTIFICATION OF

ACTION APPEALED

7A. OTHER 7B. DATE OF NOTIFICATION OF\
ACTION APPEALED

Entitlement to **NSLI waiver of premium** July 14, 10976

8A. APPELLANT REPRE SENTED IN THIS APPEAL BY (Name of organization,
attorney or agent)

American Legion

8B. ONE OF THE FOLLOWING IS ON FILE AS AUTHORITY FOR REPRESENTATIVE IN
THIS APPEAL

\[ \] POWER OF ATTORNEY SERVICE ORGANIZATION \[ \] CERTIFICATION THAT
VALID POWER OF ATTORNEY OR DECLARATION OF REPRESEN- TATION IS IN ANOTHER
VA FOLDER

\[ \] DECLARATION OF REPRESENTATIVE (WHEN ATTORNEY IS REPRESENTATIVE)