Veteran 

Appeals 

Experience

Listening to the Voices of Veterans and 

their Journey in the Appeals System



Veteran Appeals 

Experience

Listening to the Voices of Veterans and 

their Journey in the Appeals System

Findings Report | January 2016
VA Center for Innovation (VACI) is a team of innovators and doers within VA who are dedicated to driving innovation at the largest civilian agency in the United States Government. 

The team at VACI does not believe in innovation for its own sake, but rather, in innovation 

that provides a tangible value to VA and to Veterans. The work of VACI is driven by a strong 

commitment to a Veteran-centered approach to service delivery, a dedication to data-driven 

decision making, and a commitment to design thinking.

Since 2011, VACI has worked to identify, test, and evaluate new approaches to VA’s most pressing challenges. Balancing the practical with the aspirational, VACI enables a steady influx of 

high value innovations into VA, moving them from concept to operational implementation.

This project was led by the Veteran-Centered Design Lab (VCD) and the Veterans 

Engineering Resource Center (VERC). The VCD Lab informs the design and development of innovative solutions to transform the Veteran experience utilizing principles of 

Human-Centered Design and Design Thinking. The VERC provides Operational Systems 

Engineering, Informatics, and Implementation Science to facilitate transformation within 

VA healthcare delivery systems.

PROJECT TEAM

Chris Hughes, Principal Design Strategist, Veterans Engineering Resource Center 

Luke Hawbaker, Co-Lead & Storyteller

Andrew Carlstrom, Veteran-Centered Design Lab Program Manager, Veterans Engineering Resource Center

Crystal Lumby, Clinical Systems Integration Program Manager, Veterans Engineering Resource Center

Jessica Pierce, Program Analyst, Veterans Engineering Resource Center 

Chris Hluchyi, Senior Program Analyst, Veterans Experience

THANK YOU

Patrick Littlefield, and the entire team at VA Center for Innovation

Amber Schleuning, Deputy Director, VA Center for Innovation

James Ridgway, Veterans Law Judge & Chief Counsel, Board Of Veterans’ Appeals

Elisabeth Maher, Sr. Management & Program Analyst, Veterans Benefits Administration

WEBSITES

Location of this report

http://www.blogs.va.gov/VAntage/25331/listening-to-the-voices-of-veterans-and-their-journey-in-the-appeals-system/

Prior Human-Centered Design work

http://www.innovation.va.gov/hcd.asp

VA Center for Innovation sends a special thank you to the staff at BVA, VA, and RO facilities 

in St Petersburg, Atlanta, Las Vegas, Phoenix, Portland, Lincoln, and Washington, D.C. who 

were critical in making this research a reality. And to the Veterans and families who shared 

their stories and offered us a glimpse into their experience with the appeals process. 

Respondents of this pilot participated willingly. Names have been changed to anonymize data. 
TABLE OF CONTENTS

1 Introduction – Research Findings

3 Methods – Why Human-Centered Design

5 Appeals Process – The System is Broken

7 Appeals Process – What VA Employees & Veterans See

9 Veteran Journey Map

Key Themes 

11 The length and labor of the process takes a toll on Veterans’ lives.

17 Like in the military, Veterans care deeply about the outcomes of 

other Veterans.

23 Veterans grow to feel alone in a process they barely understand.

27 The appeals process feels like a fight.

33 Veterans want to be heard.

Narratives

13 Reggie – The Interplay of Injuries and Delays

19 Lawrence – The Wear on Those Who Need Help Most

25 Bill – The Frustrations of Compensation & Pension Exams

29 Lisa – The Compounding of Heartache 

35 Diego – The Fervent Desire to be Heard

41 Moving toward a Veteran-Centered VA
 

1

// INTRODUCTION

VETERAN APPEALS EXPERIENCE

Every year, over a million Veterans 

file claims with the Veterans Benefits 

Administration. They file for injuries 

ranging from the annoying to the 

life-altering, for increases in existing 

disability ratings, for benefits for 

family members. They come right 

after the military, young but prudent, 

or late in life, when their body has 

started to betray them. It could be 

their first claim or their fortieth.

The vast majority of Veterans, when 

they receive their decision, won’t 

appeal. But over one hundred thousand will. They’ll appeal because they 

disagree with their decision, because 

they don’t understand their denial, or 

because it’s their right. They’ll appeal 

because they want to be heard. 

When they do—whether they know 

it or not—they will enter into a 

process that takes years, sometimes 

decades, to complete. It will stretch 

across the Veterans Benefits Administration into the Board of Veterans’ Appeals and likely back again, 

often without them realizing it, and 

perhaps dozens of times. It might 

even transcend VA and head to the 

U.S. Court of Appeals for Veterans 

Claims. Some will be satisfied, many 

will not. Everyone will have to jump 

through hoops, absorb dozens of 

letters, fill out confusing paperwork, 

and learn to live with waiting. They’ll 

have “to fight.”

From the inception of the claims 

process until today, hundreds of 

cases and laws and tens of thousands 

of rules, well-intended in isolation, 

have piled on top of, underneath, 

and in between each other creating a 

staggering level of complexity. With 

permutations numbering in the millions, the process is barely comprehensible to experts and completely 

opaque to the Veterans who depend 

on its outcomes.

When the current appeals process 

was established in 1933, hospitals 

were few, most care was provided 

by house call, and medical records 

were virtually non-existent. Today, 

increases in medical knowledge, 

clinical practice, and the acceleration 

of the modern world have slowed 

the appeals system to a crawl as it 

struggles to keep up with expanding 

mandates, legal requirements, and 

documentation.

To better understand how Veterans 

experience the appeals process - how 

the process fits into the context of 

their lives - a group of six researchers 

spoke at length with more than 90 

Veterans whose service spanned the 

periods from World War II, Korea, 

and Vietnam, to the current conflicts 

in Iraq and Afghanistan. 

We spoke to Veterans at every stage 

in the process, from those receiving 

their initial decision to those with final, complete results from the Board 

of Veterans’ Appeals. Some were new 

to the process. Others, such as those 

who had just had their hearings 

with the Board, were years into their 

appeals.

What we heard was not easy. The 

limits of a system designed in an 

earlier time for a different set of 

challenges are increasingly born by 

the Veterans whom the system was 

intended to serve.

Here’s what we heard, told in the best 

way we know how – the Voices of 

Veterans themselves. 

Our goal is to better understand how 

Veterans experience the appeals process and 

how the process fits into the context of their lives.
2

RESEARCH FINDINGS

In our conversations, we heard many stories, both of the appeals process and Veterans’ lives. Five of these 

stories are highlighted in narratives in this document. These stories, coupled with this document’s themes 

and insights, illuminate findings ubiquitous across Veterans’ experiences, findings that should be considered in any conversation examining the appeals process. 

NARRATIVES OF

VETERANS

Nothing conveys the effects of the 

appeals process like hearing the 

stories of Veterans. We’ve included 

five narratives telling the stories of 

men and women we spoke with on 

the road:

Reggie – The Interplay of 

Injuries and Delays

Lawrence – The Wear on 

Those Who Need Help Most

Bill – The Frustrations of 

Compensation & Pension 

Exams

Lisa – The Compounding of 

Heartache 

Diego – The Fervent Desire 

to be Heard

KEY THEMES 

AND INSIGHTS

Our research surfaced five key 

themes surrounding Veterans’ needs, 

perceptions, and expectations in 

their experiences with the appeals 

process. These insights can serve as a 

guide across VA for redesign of appeals and related services that better 

meet the needs of Veterans and their 

families.

1. The length and labor of 

the process takes a toll 

on Veterans’ lives. 

2. Like in the military, Veterans care deeply about 

the outcomes of other 

Veterans.

3. Veterans feel alone in a 

process they don’t understand.

4. The appeals process 

feels like a fight.

5. Veterans want to be 

heard.

A JOURNEY IN THE

APPEALS PROCESS

Journey maps take the reader along a 

customer’s or user’s journey interacting with a product or service. 

A journey map seeks to show the 

different stages of the journey as well 

as what a Veteran thinks, feels, and 

does in a given stage. Here we’ve 

outlined a typical journey through 

the VA appeals process in five stages 

of increasingly bleak emotions: 

The Cautious Start

“The Fight” Begins

The Process Grinds

The Wear Takes its Toll

The Resignation
3

// METHODS

WHAT IS HUMAN-CENTERED DESIGN?

DEFINITION:

“An approach to systems design and development that aims to make interactive systems more usable by focusing 

on the use of the system and applying human factors/ergonomics and usability knowledge and techniques.”

INTERNATIONAL STANDARDS ORGANIZATION1

WHY HCD:

“Rather than requiring users to adapt their attitudes and behaviors in order to learn and use a system, a system 

can be designed to support its intended users’ existing beliefs, attitudes, and behaviors as they relate to the tasks 

that the system is being designed to support.” 

USABILITYFIRST.COM2

“A human-centered approach to innovation draws from the designer’s toolkit to integrate the needs of people, 

the possibilities of technology, and the requirements for business success.”

TIM BROWN, IDEO PRESIDENT & CEO3

Human-centered design (HCD) 

is a discipline in which the needs, 

behaviors and experiences of an 

organization’s customers (or users) 

drive product, service, or technology design processes. It is a practice 

used heavily across the private sector 

to build a strong understanding of 

users, generate ideas for new products and services, test concepts with 

real people, and ultimately deliver 

easy-to-use products and positive 

customer experiences.

HCD is a multi-disciplinary methodology which draws from the practices 

of ethnography, cognitive psychology, interaction and user experience 

design, service design, and design 

thinking. It is closely tied to “user-centered design,” which applies 

parallel processes to technology 

projects, and “service design” which 

address the service specific experiences.4

METHODS

CONTEXTUAL INQUIRY:

In-person individual conversation style interviews, in which our 

researchers met with Veterans in the 

context of the appeals hearing.

CUSTOMER JOURNEY MAP:

Translated the steps a user currently 

takes through a system or service, 

identifying the highs and lows of the 

experience from their perspective.

NARRATIVES:

Telling a compelling Veteran story 

that highlights a unifying aspect of 

the appeals experience.

This report is often referred to as the 

‘discovery’ phase of a user-driven 

design process – the initial research 

and analysis phase into the needs and 

behaviors of users and user experience of existing services.

Building on our conversations, we 

performed qualitative ethnographic 

and design activities, driven by a 

robust and evolving set of questions. 

Using design thinking and service 

design practices, we then mapped, 

visualized, and synthesized our 

findings, which are detailed in this 

report.

DESIGN

DELIVER

DISCOVER

RESEARCH 

SYNTHESIZE 

DEFINE
4

WHERE WE WENT AND 

WHO WE TALKED TO

RESEARCH LOCATIONS

CITIES VISITED

Atlanta, Georgia

Las Vegas, Nevada

Phoenix, Arizona

Portland, Oregon

St. Petersburg, Florida

Washington, D.C.

INTERVIEW BREAKDOWN

ERA # INTERVIEWS

OEF/OIF

Persian Gulf

Vietnam

Korean

WWII 2

4

50

20

16

AGE # INTERVIEWS

65+

50-64

40-49

30-39

18-29

48

16

10

12

6

TOTAL INTERVIEWS: 92

HUMAN-CENTERED TOOLS:

UNCOVERING “THICK” DATA

Typically VA conducts surveys or focus groups to 

understand Veterans’ opinions about our services. 

While this kind of data offers immense value, it 

does not provide deep insight into the qualitative 

characteristics of a service experience or the human 

motivations of our customers. 

Design approaches to user research focus less on 

people’s opinions, and more on understanding 

their lives and experiences. By doing ethnographic 

fieldwork with a range of Veterans—from different 

service eras, different geographic areas, etc—and visiting them in their homes and at their jobs, we were 

able to gather a complex and nuanced understanding 

of their everyday needs.

Jared Spool, a leading usability researcher, explains 

the value of research which facilitates the observation of human behavior:

“Users can’t describe activities that they don’t focus 

on. When you have an audience that is experienced 

at what they do, they often don’t pay attention to 

the small steps involved. An outside observer will 

see these ‘unspeakables’ and can document them in 

ways that the participants can’t. It’s these details that 

will make the user experience feel natural and well 

considered. 

Innovation happens when the designers get direct 

exposure to the users’ entire context and its subtle 

variations and accidental similarities. Some of the 

most innovative designs in the last 5 years are the 

result of paying attention to the little details in the 

user’s context.

‘Intuitive’ interfaces are easier to build when designers have a deep understanding of the users’ context, 

terminology, and processes. It’s the combination of 

these three elements that make an interface seem 

intuitive, because the familiarity to users is already 

built in.”5
5

// APPEALS PROCESS

THE SYSTEM IS BROKEN

We are reaching a tipping point. 

440,000 Veterans have appeals pending

80,000 Veterans have appeals older than 5 years 

5,000 Veterans have appeals older than 10 years

5 years will be spent resolving a typical appeal

Veterans, VSOs, and VA employees are working 

harder than ever and we are still losing ground. 

There is no limit to the number of steps the process could require. 

The process can restart an unlimited number of times. 

There is no end in sight.

0 

200

400

600

800

1000

Appeals Reference 

Materials

Washington 

Monument

Statue of 

Liberty

White 

House

Human

Height

5’7” 70’ 305’ 554’ 921’

HOW THE APPEALS PROCESS STACKS UP

There are over 921 linear feet of appeals reference 

materials that the Board may have to consult in

any given case, from statutes passed after the 

Korean War to regulations drafted during the 

Great Depressions to medical reference 

materials from the Vietnam War era. 

Height

in feet

6
6

AS NEW RULES HAVE INCREASED 

SYSTEM COMPLEXITY...

Rating Decision Notice of

Disagreement

Prepare Case for

BVA Review &

Certify

The Board

Full Grant of

Benefits

Sought

Partial Grant

of Benefits

Sought

Case Requires

Development

Remand to

Agency of

Original

Jurisdiction

Denial of

Benefits

Sought

APPEALS PROCESS IN 1962

Rating Decision

Notice of 

Disagreement

Decision Review 

Officer / De Novo 

Option Selected

Traditional Review 

Option Selected

INFORMAL 

CONFERENCE with 

Veteran and/or VSO

FORMAL HEARING

If requested Decision

Award Action Satisfied? 

Yes

Statement of Case (SOC)

An SOC is a adjudication of the 

appeal by VBA

No

Satisfied? Decision

Award Action

No Yes

Formal Appeal 

(VA Form 9) Appeal Closed

No

Supplemental Statement of the 

Case

Full Grant of 

Benefits Sought

Award Action

PARTIAL GRANT 

with good potential 

for appeal 

resolution

Contact with VSO or 

Veteran for 

Resolution

Award Action Satisfied 

Yes No

New Evidence 

Received? (Can 

occur at any time in 

the process)

Prepare Case for 

BVA Review & 

Certify 

No

Yes

The Board

Full Grant of 

Benefits 

Sought

Partial Grant 

of Benefits 

Sought

Award Action Satisfied? 

Yes

No

Case Requires 

Development 

Remand to 

Appeals 

Management 

Center

Denial of 

Benefits 

Sought

Appeals to Court 

of Appeals for 

Veterans Claims

VHA opinion or Outside Medical Opinion 

Required. Board compeltes this 

development in certain appeals in which 

the medical record is insufficient, and no 

further examination is necessary 

Remand by the 

Court of Appeals for 

Veterans Claims

AGENCY OF ORIGINAL JURISDICTION (VBA)

Appeals in which Veterans are represented by a VSO return to 

the Appeals Management Center for development of 

evidence identified by the Board s remand, and remain with 

this VBA entity until all development is complete, at which 

time the AMC will complete an SSOC

APPEALS PROCESS TODAY

...APPELLATE PROCESSING 

TIME HAS TRIPLED. 

Avg Army 

Vietnam tour 

365 days

WWII U.S.

involvement

 1365 days

462

days

1991

798

days

2001

1407

days

2014

???

days

2020

7
7

// APPEALS PROCESS

WHAT VA EMPLOYEES SEE

VA employees (and VSO’s) see the unique legal principles established by the appeals system that govern their actions. 

These principles—in theory—should create one of the most applicant-friendly systems:

Non-Adversarial: No entity, VA or 

otherwise, opposes a Veteran’s claim. 

Two sets of lawyers do not argue in 

front of a judge. There is no courtroom.

Duty to Assist: VA has a duty to 

assist Veterans in filing their claims, 

informing them of the necessary evidence to prove and bolster their case. 

Open Record: The “open record” 

enables Veterans to add evidence 

at any time in the process—unlike 

the traditional judicial process with 

which most people are familiar.

In the simplest explanation, most appeals begin as claims at the Veterans 

Benefits Administration (VBA). After 

one round or more rounds of appeal 

at VBA, an appeal moves to the 

Board of Veterans’ Appeals (BVA) to 

be ruled on by a judge. Veterans Service Organizations (VSOs) provide 

representatives, to help Veterans. No 

one opposes Veterans’ claims and a 

claim only needs to be granted once. 

No one will challenge a satisfactory 

grant once it’s given. 

In reality, VA employees know they 

wrestle with a jumbled process, limitless in its complexity and repetition. 

Through years of experience, they 

may have come to understand it and 

its varied paths. They may be able 

to explain it to you, slowly. But do 

not think that their view behind the 

curtain illuminates simple levers that 

can speed the process along. Instead, 

they see a complex, multi-stage, and 

non-linear monster. A monster they 

know fails to provide the results 

Veterans need in the time they need 

them. 

They will shake their heads and 

explain how the process got that way. 

They’ll explain the good intentions of 

Congress, the Court, or VA in making a change, but they will then detail 

how, in practice, those new rules 

combined to create today’s dysfunctional process. 

VBA officers will explain how 

nothing limits the number of records 

requests or doctor’s orders they could 

be required to ask for—even if it’s 

infuriating to both Veterans and 

them. The Board’s judges will outline 

how the open record or required 

remands can make the process churn 

to infinity. They’ll talk about combing 

through case files like the one at left. 

You’ll be hard-pressed to find someone who will defend the process. 

EXAMPLE OF A 

LARGE CASE FILE

NONADVERSARIALDUTY TO

 ASSIST OPEN RECORD
8

WHAT VETERANS SEE

Veterans see and feel they have a different experience that contrasts the supposed “friendly” legal principles. 

Adversarial: To most Veterans, the 

appeals process feels like a fight. It’s 

non-adversarial in theory only. 

Labor Intensive: Poor communication and the relentless pursuit of 

records often feels like the opposite 

of assistance, adding more and more 

work for Veterans. 

Endless Churn: There’s a terrible 

hitch to the open record: if you submit new evidence, the claims review 

process starts all over again. 

Veterans and their families struggle 

to understand the process or their 

place in it. They have little understanding of the relationship between 

steps in the process and sometimes 

don’t even realize when they’re 

making a decision—even if it might 

delay their appeal for years. They 

don’t distinguish between VBA and 

Board; instead, they simply see VA. 

Even VSOs are occasionally viewed 

as a part of VA. As will be made 

clear in the coming pages, they do 

know it’s a monster, a broken system. 

The non-adversarial nature of the 

system, VA’s duty to assist, and the 

consequences of the open record are 

lost on Veterans. In fact, they often 

experience the opposite. 

ADVERSARIAL LABOR INTENSIVE ENDLESS CHURN
 

<<< NEED FOR ADDITIONAL EVIDENCE 

<<< BOARD REMAND 

9

// VETERAN JOURNEY MAP

Veterans follow several paths in the appeals process and many will exit the system before seeing a judge. They have different emotional lows, different highs, different moments that affect their experience. From our interviews a common 

emotional journey became clear. The beginning can have positive moments, however the general march is a decline. 

Journey Phases Journey 

Emotional Experience

THE CAUTIOUS START: 

Veterans begin the process of filing a claim 

cautiously optimistic, their expectations 

tempered by stories from other Veterans or 

past negative experiences with VA or the 

military. 

Helpful VBA rep listens and 

explains how to file a claim

My claim was awarded 

to my satisfaction 

 I was not completely satisfied 

with VA’s decision, so I appeal

“THE FIGHT” BEGINS:

The fight begins with the first denial 

and appeal. Subsequent inquisitorial 

Compensation & Pension Exams and lack 

of help and attention quickly cement an 

adversarial outlook.

I receive a confusing letter saying my file has been transfered

Its been years, so I write letters to my congressmen and 

VA leadership seeking help

THE PROCESS GRINDS: 

Veterans enter years of confused waiting. 

The black box of the appeals process 

intermittently sends out additional 

records, marches them to more exams, or 

issues denials or remands. The process is 

confusing and emotionally draining.

VA asks for contact information for a document I haven’t 

seen in 15 years

I drive around to all my 

different doctors as VA 

requests more documents

THE WEAR TAKES ITS TOLL: 

To Veterans, the repeated denials and lack 

of human interaction belittle their service 

and continued struggle. The fight with VA 

adds strain to already difficult situations.

A remand or readjudication from the Board 

sends the process back to the start to collect 

more evidence. While the Veteran waits, 

medical evidence can become outdated.

THE RESIGNATION: 

The process has taken everything that 

it can. If Veterans reach this point, they 

either give up, or plod forward knowing 

that it can’t hurt them more than it has.

I get an order for another C&P 

exam, it feels like an interrogation

I’m just waiting and 

waiting and waiting...

Call to check on status of claim, 

got an unhelpful response
10

The journey map below seeks to foster empathy and understanding by depicting the broad emotional stages Veterans 

will experience as their appeals drag on and on. It depicts their claim and subsequent appeals’ movements in the process along the horizontal, X-axis while the cumulative emotional experience along the vertical, Y-axis.

Time Feeling Thinking

I got a relatively 

quick decision 

with my appeal 

1-2

years

• This will probably take a couple of 

months, couldn’t take more than a year.

• I’ve heard horror stories but my claim is 

simple. 

• It’s very vague online and if you call 

somebody they’re very vague also.

No one’s listened, so I write a 

letter explaining my story and 

in the process introduce new evidence which VA must now track 

down from a doctor

2-3

years

• Made me feel about this big...tiny.

• That comp and claims doctor, he’s not 

listening to [me].

• I just want to tell my story. I just want 

them to hear me.

I’m expecting a ruling but instead 

the Board says I have to get another C&P exam, since my condition 

has gotten worse while waiting 2-3

years

• I tried not to think about it.

• They just keep making me submit the 

same documents over and over again.

• I wrote a nasty letter to the VA Secretary 

telling him the challenges I am facing.

3-5

years

• C&P Exam is a battle.

• I’ve been fighting for five years.

• They are just waiting for me to die, then 

they can close my case and forget about 

me.

I was nervous of my hearing, but the judge listened, 

cared, and helped

5 years 

&

beyond

• They can’t hurt me anymore than they 

already have.

• My husband died while waiting.

• After talking to the judge, I feel some 

hope.

= Positive moment = Trigger to go back in the process
11

// KEY THEMES

The length 

and labor of 

the process 

takes a toll 

on Veterans’ 

lives.
12

Insights

• Instead of assisting Veterans, the current 

process increases the stress and uncertainty of already difficult situations. 

• Delays have a palpable, debilitating effect 

on Veterans’ health and quality of life. 

• Veterans jump through hoops, working 

hard to try to meet the demands of the 

process.

• The required paperwork and records seem 

redundant, cumbersome, and confusing. 

• The factors that take a toll on Veterans 

over the years clearly show themselves as 

symptoms even in the earliest stages of 

the process. 

Design Considerations

• How might we design a faster and

simpler process? 

• How might we minimize the churn and 

delays created by the open record? 

• How might we streamline or reduce records requirements? 

• How might we prioritize Veterans with 

severe health or economic hardship earlier 

in the process? 

• How might we create a system that can 

respond to Veterans’ changing health and 

lives without pushing them back in the 

process? 

“After going through all these, I’m wore 

out. I’m 68 years old, by the time I got an 

answer [on a new appeal] I’d be dead....

There’s a point in time when it’s just not 

worth it.”

“[At the start], I was more optimistic. I knew it wasn’t going to be a 

two month ordeal, but then after 

all this time...my optimism flat 

left.”

“I figured it’d only take a year [when I 

started], not five. Because it’s been five 

years, one month. Isn’t that a long time? 

“I’ve jumped through every hoop.”

“You know I have been disappointed for 

so long going through this situation, 

I don’t think whatever decision they 

make is going to hurt me because I’ve 

been hurt already and I’m about to get 

teared up thinking about it.”

“My wife however didn’t want me to 

[appeal]. Because there’s so much 

stress in waiting and waiting and 

waiting and waiting.”

“The whole time, you’re waiting, just like 

me, your ailments are growing, they’re 

getting worse. And you can’t go back and 

renew your claim now, and say it’s getting 

worse because then you’re pushing that 

first claim back and you’re [basically] 

starting a whole new claim. It’s a really 

stressful process.” 
13

 Date of Original Claim: 12/20/12 

 Total time pending: 4 years, 9 months, 13 days 

 Total number of VA adjudications: 2 (1 Rating Decision, 1 SOC) 

* SSOC = Supplemental Statement of the Case
14

REGGIE The Interplay of Injuries and Delays

“If I appeal this...I have to wait another two or three years. I’ve 

already waited two or three years. No one’s going to talk to me.”

Serious injuries rarely rest. They 

worsen. The leg injury creeps into 

back pain. Diabetes makes a foot 

useless. A heart exposed to Agent 

Orange deteriorates. Injuries don’t 

recognize their neat categorization 

at a 20% or 30% or 60% disability 

rating.

Say you’re Reggie, a young Veteran 

who injured his leg in Iraq during a 

train-up for a military exercise.

In the years after your initial claim, 

your leg injury worsens. It begins 

to damage your back. You file new 

claims to reflect their deterioration 

in 2009. 

You wait. Your injuries, though, 

don’t. They don’t go on hold. Use 

of your right leg and back continue 

to decline severely. Doctors place a 

neurostimulator in your back and 

buttocks to provide relief. While 

you wait, you go under the knife, 

again and again, the doctor cutting through the scars of the last 

operation to make adjustments. 

You beg your doctor not to put you 

on morphine. You don’t like being 

strung out. But it’s the last resort; you 

take it twice a day. Three years later, 

VA denies your claim. VA says the 

pain in your back—never mind the 

morphine or the days bedridden—is 

moderate, not severe. You don’t even 

understand the legalese that denied 

the leg claim. You appeal. 

More waiting. Your wife, Helen, becomes your caretaker. She helps you 

put on your shoes in the morning—

you, a former soldier in your thirties. 

More surgeries. You can’t play with 

your kids. You gradually accept a 

cane. Pain, and the medication for it, 

keeps you from working. Depression 

sinks in. You attempt suicide. You 

survive. You’re still waiting. That appeal is still pending. The country you 

fought for still refuses to acknowledge the extent of your sacrifice. 

How can it care for or support you if 

it doesn’t do that? 

Your claim is old, outdated. Filed 

years ago. In a logical world, you 

would update it—things have gotten 

worse. In fact, VA’s open record 

enables you to add evidence at 

any time, unique in the American 

judicial system. But if you did submit 

that new evidence, it’d send your 

claim back to the very start. Reggie 

explains: 

“The whole time you’re waiting, 

just like me, your ailments are 

growing. They’re getting worse. 

And you can’t go back and renew 

your claim now, and say it’s getting worse because then you’re 

pushing that first claim back and 

you’re [basically] starting a whole 

new claim. It’s a really stressful 

process.”

Any new evidence punts the appeal 

back to the start. All that waiting 

you’ve done will only be repeated as 

it’s pushed back for a fresh review. It’s 

rare that Reggie realizes this—most 

Veterans don’t. They send in new evidence to bolster their claim. They try 

to help the process along; instead, the 

process just sends them backwards. 

It perpetuates an endless churn. The 

waiting makes Veterans give up. 

Reggie continues:

“I think that’s happened to me 

three or four times where I could 

have appealed [a rating], but I 

didn’t because it was like, if I appeal this, I have to go file another 

claim. I have to wait another two 

or three years. I’ve already waited 

two or three years. No one’s going to talk to me. My condition’s 

going to grow even more and I’m 

still not going to be recognized 

for what’s going on.”

He’s not alone. The current process 

is incapable of responding to the 

changing medical conditions in the 

timely manner needed by Veterans. 

The waiting isn’t easy. As Reggie tries 

to maintain a life, tries to restore 

his health and some semblance of 

normalcy, the process sends VA and 

Reggie hunting for more and more 

papers, breeding more and more 

delays. VA confronts him with a lack 

of communication, explanation, and 

personal contact. It infuriates him 

and Helen. Letters pile up saying, 

essentially, that nothing is happening. “It’s very vague online and if 

you call to talk to somebody they’re 

very vague also,” Helen explains. As 

Reggie’s wife, Helen has fought this 
15

just as much as he has. The process 

takes a toll on families. “If they have 

the technology,” she continues, “why 

can’t they put more detail about the 

process, or what the next step is, or 

where you are...They have the eBenefits portal already. What would it 

take to just put more detail in there?” 

Perhaps speaking to a generational 

shift, Reggie and Helen practically 

implore VA to use eBenefits more. 

They want to know where they are in 

the process, what’s coming next, and 

what evidence VA has—especially 

since they keep getting requests for 

documents they’ve already submitted. It’s a common sentiment, in a 

common, infuriating story. Reggie, 

exasperated, sums it up: “I don’t 

understand the whole claims process, 

appeals process. I don’t understand 

it at all. It makes no sense.” He and 

Helen want a process they can understand. 

Reggie and Helen keep pushing 

through it. A grant of the benefits 

would mean a lot of things to them. 

Yes, it entails a larger disability 

payment. But it also means access to 

additional treatment in the VA medical system, including specialized 

care for spinal cord injuries. Most 

importantly, for Reggie and his wife 

Helen, it means that VA acknowledges his sacrifice and the extent of his 

injuries. It’s psychologically important for him and many other Veterans. It lightens his load, makes the 

pain easier to bear, to know that the 

country he fought for recognizes the 

weight he and his family still carry 

from service. 

That he has to fight for that acknowledgment—as he also fights to 

maintain his quality of life—angers 

him. His piercing, ice blue eyes 

narrow. That the system doesn’t trust 

him angers him. When he appealed 

in 2012, he got a note out of the blue 

granting his PTSD claim. 100%. No 

explanation, nothing addressing his 

other claims. It felt like they were 

trying to shut him up: 

“It seemed like it was a political thing: ‘He probably wants 

to be 100% anyways, just give 

him 100%.’ That’s how I felt, 

you know? And that wasn’t the 

point...The point was to get accurately rated for my mental disabilities...So you give me 100% for 

my mental disabilities. So what?”

He doesn’t want VA to just throw 

him 100% and think he is “just 

going to sit back and shut up.” That 

patronizes his intent, his injuries, 

and his sacrifice. It cheapens the 

suicide attempt, the pain, the cane he 

uses before forty. That’s not what he’s 

fighting for in this process. 

What is a good outcome for him? He 

doesn’t hesitate: 

“To know that the VA supports 

me. They’re not just treating me. 

They’re supporting me. It feels 

good to know that you have that 

backup, but as long as they don’t 

acknowledge that you have these 

issues, they’re never going to support you correctly. I hate the fight 

of getting them to acknowledge 

that I have these issues.”

VA can’t provide a rating for not 

being able to play with his kids. It 

can’t capture the difficulty of having 

his wife become his caregiver. But it 

can support him by recognizing how 

the injuries he sustained in service 

weigh on his and his family’s life. It 

can show that VA and his country 

still care. 

“To know that the VA supports me. They’re 

not just treating me. They’re supporting me.” 

// NARRATIVES - REGGIE
16
17

// KEY THEMES

Like in the 

military, 

Veterans care 

deeply about 

the outcomes 

of other 

Veterans.
18

Insights

• Comradery continues beyond service and, 

in the appeals process, the process becomes the new enemy.

• Veterans are willing to sacrifice for their 

fellow Veterans in the system.

• Veterans want VA to support their brother 

and sister Veterans, especially those who 

are worse off.

• Veterans recognize that VA faces serious 

problems in the appeals process.

• Veterans rely upon each other, first and 

foremost, when determining how to interact with VA.

Design Considerations

• How might we design a system that meets 

Veterans’ expectations of both individual 

and collective justice? 

• How might we foster Veteran comradery 

and communication during the appeals 

experience?

• How might we redesign the system to 

help those Veterans struggling the most?

• How might we effectively communicate 

those steps Veterans can individually take 

to alleviate delays in the process?

“I am happy to the see the younger 

Vets have it easier.”

“There are some things that I would [appeal] if I thought that I wouldn’t be taking 

away care from somebody more urgent. 

There’s guilt...Maybe if things change, if 

things in the system changed, I might try 

to [appeal].” 

“That’s all I want, is to be heard, to be 

treated with respect, to have other Veterans not be so scared to file a claim.”

“I’d go out of my way to help a Veteran. 

I think that we should help each other 

and do everything we can because people 

don’t realize some of the things that Veterans see and do over the years.”

“I get help from other Veterans who have 

been through the process before. It is 

confusing though when we have similar 

issues, but get different ratings.”

“It changes your life – it can cause you to be 

depressed, incapacitated, but I can’t let that 

stop me from helping others. I advise them: 

‘Do you have the time and mental commitment to appeal?’ This is my first time going 

through an appeal and I wouldn’t wish that 

on anybody.”

“It’s horrible, I know of other Veterans 

who’ve just given up. I hear it all 

the time.”

“I didn’t go for a long time because 

I figured there were Veterans worse 

off than me that needed it.”
19

 Date of Original Claim: 11/08/07 

 Total time pending: 7 years, 7 months, 8 days 

 Total number of VA adjudications: 

 5 (1 Rating Decision, 1 SOC, 1 SSOC, 2 Board Remands) 

* SOC = Statement of the Case

* SSOC = Supplemental Statement of the Case
20

LAWRENCE The Wear on Those Who Need Help Most

“It’s been a long road. Period. From the day I got out until today. 

That’s been twenty some years. That’s a big, big thing...I just want 

them to hear what I got to say.”

He sunk into depression, drifting into 

homelessness and alcoholism.

Lawrence got the letter from a friend 

he’d once lived with. It was crumpled 

by the time he got it, but it arrived in 

time. The hearing for his VA appeal 

was coming up, the letter told him, 

and soon. His friend had almost 

returned it to sender—had even 

written it out—but since it looked 

important he held on to it a little longer. And when Lawrence happened 

to call his friend about an unrelated 

matter, the letter, improbably, made 

it into his hands. 

Lawrence had been homeless. It’s 

hard to get letters when you’re 

bouncing from apartment to apartment, street to street. He’d missed his 

last hearing for precisely that reason. 

Now, he was finally getting his feet 

under him, with VA’s help in fact. 

He’d forgotten about the appeal for 

years, but somehow here it was and 

he would go, for a claim made eight 

years earlier. 

He had enlisted in the Army in the 

late 1970s. His mother had died 

when he was young and his dad had 

raised him alone in rural Georgia. 

Lawrence joined the Army to make 

him proud. 

When he joined, his medical exam 

noted that he had an eye condition, 

but they brought him in anyway. It 

deteriorated after that. At intervals, it 

would turn red or stick shut. He’d get 

bad headaches and pain. The Army 

offered him a medical discharge— 

with a 10% benefits rating for the 

eye. With no knowledge of what was 

to come, he fought to stay in. He 

wanted to prove himself. He didn’t 

want to fail. He changed his MOS 

(Military Occupational Specialty, his 

job), got support from a commanding officer, and stayed—but only a 

little longer. The Army discharged 

him a year later, without the benefits. 

He felt like a failure. 

His eye problems continue to worsen. A few years after his discharge, 

he remembers, “I woke up blind.” 

The sight in his left eye, always the 

troublesome one, had stolen away in 

a night. 

He didn’t tell anyone. For years. 

“I woke up blind and I didn’t tell no 

one for a long time,” he explains. “My 

sister, my brother, my dad, my family 

members. I didn’t tell them. I made 

it work.” 

He wanted to be strong. He didn’t 

want people to see him as weak. 

When he bumped into people or 

trees or walls, he played it off as 

clumsiness or drunkenness. When he 

missed seeing something he pretended he was absent-minded. The 

left side of his body grew scraped, 

bruised, and scarred from the collisions. People fought him when he 

would accidentally bump into them 

or their girlfriends at bars. 

Eventually he caved and told his family, but they didn’t believe him. He 

decided to keep playing it off. 

“If I can fool them,” he thought. 

“I think I can make it. It’s really 

screwed up, but that’s what I did. I 

tried to make it because I had been 

let down so much, I just tried to 

make it.” 

He stayed away from people, from 

his family. “I hung by myself,” he 

explains. “I didn’t get into any 

relationships, I didn’t let anyone get 

close to me...I know it sounds crazy, 

but that’s my life.” His relationships 

with his family still suffer from it. 

He didn’t pursue stable employment, 

believing he couldn’t be hired if he 

admitted his blindness and couldn’t 

keep the job if he got it on a lie. 

He sunk into depression, drifting 

into homelessness and alcoholism. 

The useless left eye still hurt, sending 

him to the hospital multiple times. 

He kept trying to make it. 

He approached VA for help at one 

point, filed a claim for his eye and 

for financial support. He was denied. 

“They wouldn’t talk to me. They said 

that’s unrelated. I got very upset, the 
21

heck,” he says. “I’ll just start trying 

to make it on the outside.” He did, 

file an appeal and continued to try to 

fight that appeal as he bounced from 

apartment to apartment. 

The paperwork, the hoops that VA 

and Veterans must jump through in 

the process, dogged him and drove 

him to exasperation: “I got fed up 

with everything that was going on. 

I said to hell with it. I didn’t have no 

place to go, I didn’t have no place 

to stay. I couldn’t keep up with all 

this stuff. I could barely keep up 

with myself.” He thinks he left the 

five or six pounds of paperwork he’d 

accumulated in a friend’s apartment 

somewhere. 

Eventually, he gave VA another shot. 

This time, they helped him get back 

on his feet, placing him in a halfway 

house and starting to get him care. 

He now has his own permanent 

address. 

The appeal, even if he’d given up 

on it, though, hadn’t died. He had 

requested a hearing in all that paperwork and so a hearing was still 

scheduled. That letter still got sent to 

that old address. And it ended up in 

his hands. 

Waiting, he explains why he wanted 

a hearing: “I wanted them to see me. 

I wanted to see them. I wanted to 

look at them the way they’re looking 

at me.” If he could have made one 

change to the process, he would have 

cut out all the paperwork and gone 

straight to that conversation: 

“It’s been a long road. Period. 

From the day I got out until 

today. That’s been twenty some 

years. That’s a big, big thing...I 

just want them to hear what I got 

to say because I tried to tell them 

years ago how simple it was: all 

I want is the medical discharge I 

was tried to be given...If I’d have 

knew that you were trying to give 

me a medical discharge because 

I was going to go blind...I’d have 

took it.”

Perhaps he ascribes too much 

foresight to the Army doctors, but 

his request was simple, especially 

since he, like many Veterans, sees the 

military and VA as being far more 

interconnected, if not synonymous, 

than in fact they are. 

The hearing occurred. 

Lawrence told his 

story, explained why 

he thought the matter 

was simple.

If he ends up denied again, though, 

he’s done with the process. “I’m done. 

I’m done,” he sighs. He’s tired: “If I 

keep doing this, I’ll be dead before I 

get any opinion. So if it don’t work 

this time, I’m just going to start living, living as best I can.” The process 

takes too long. 

Still, the hearing was a positive experience for Lawrence and things are 

moving in a better direction. He talks 

about how he now has his own place 

and makes plans for keeping up with 

his prescriptions and seeing a primary care physician for the first time in 

eight years. “I think things are going 

to be a lot better,” he muses. “[I] 

have some hope...I feel better now 

that somebody did listen. If it don’t 

get no further than where it’s at, I’m 

alright...I’m going to start living the 

best I can.” He’ll be trying to make it, 

like he always has. 

Asked to draw how he felt, he drew a 

smiley face—an X where the left eye 

would be. 

Underneath it he wrote one word: 

“Hope.” 

// NARRATIVES - LAWRENCE

“I wanted them to see me. I wanted to see 

them. I wanted to look at them the way 

they’re looking at me.”

“If I keep doing this, 

I’ll be dead before I get 

any opinion.”
22
23

Veterans 

grow to 

feel alone 

in a process 

they barely 

understand.
24

Insights

• No matter how much they want or how 

hard they try, Veterans can’t understand 

the current process beyond the most basic 

elements.

• Veterans go to lengths to find help, and 

the degree to which they find it determines a large part of their experience with 

the process. 

• Veterans want an advocate who cares 

about them and their challenges. 

• Veterans do not see their actions as contributing to the delay in any way. 

• Experiences with VSO representatives—

the current advocates in the system—vary 

widely. 

Design Considerations

• How might we redesign the claims and 

appeals process to make it intuitive? 

• How might we remove the pitfalls of the 

process so that Veterans’ attempts to 

move their appeal along don’t set it back? 

• How might VA connect a Veteran and 

their family with personalized support and 

a trusted advocate across all phases of the 

claims and appeals processes? 

• How might we ensure that Veterans are 

fully prepared and educated on their options and prospects before they start the 

claims and appeals processes? 

“I’ve been doing this on my own, 

with zero help, nothing. I mean I 

think I’ve become an uncertified 

medical doctor and an uncertified 

lawyer.”

“Tell me where I’m at: ‘They’re at this 

stage. They just went over this evidence. This is where you’re standing 

now.”

“Who denied [my claim]? If you’re not 

talking face to face with somebody how are 

you going to deny it. That’s another issue, 

you shouldn’t be denying people a claim 

unless you talk to them face to face.”

“I don’t understand the whole claims process, appeals process. I don’t understand it 

at all. It makes no sense.”

“I wouldn’t even know who to 

try to get a hold of [at VA].” 

 “No one talks to me...It says to call this 

number....Nobody, nobody is going to answer that phone when you call them.”

“I consider it to be all VA.”
25

 Date of Original Claim: 10/05/10 

 Total time pending: 4 years, 8 months, 11 days 

 Total number of VA adjudications: 2 (1 Rating Decision, 1 SOC) 

* SOC = Statement of the Case
26

BILL The Frustrations of Compensation & Pension Exams

“If you get us blown up, I’m going to come back and haunt your ass.”

Sitting in his position as a gunner, 

Bill turned to his buddy, the driver of 

his armored vehicle, and reminded 

him as they moved out of the base in 

Vietnam: “If you get us blown up, I’m 

going to come back and haunt your 

ass.” 

“And wouldn’t you know it,” he recalls, “he got us damn blown up!” 

Ninety days later, Bill, a Marine 

drafted in the late 1960s, and his 

buddy were back in Vietnam with a 

commanding officer incredulous to 

see them: “I’m putting you guys on 

the same truck again, and if you blow 

up again, I’m going to stick my foot 

so far up your [you know what] they 

can’t send you back.” Two months 

later, an explosion threw Bill a hundred feet. This time injuries sent him 

home for good. 

Today, he wears a “Vietnam Veteran” 

hat over long, gray hair a good six 

inches past his shoulders. “I married 

a Hemingway [a granddaughter of 

Ernest to be precise], I don’t have 

kids. I’m the only kid I’ll ever raise 

and I’m not sure I did a great job on 

that,” he regales. He uses a walking 

boot—complications from diabetes 

caused by Agent Orange exposure. 

He boasts a cane, a gregarious nature, and a sense of humor; as he sits 

down, he picks up his cane and hollers “I have PTSD, watch out my cane 

could go off at any moment!” before 

pretending to shoot at the room with 

his cane. 

The self-deprecating humor’s easier 

in the day. At night, he dreams of 

Vietnam: nightmares of explosions 

and combat.

VA’s helped him. He’s seen therapists 

both at VA and privately. VA’s treated 

him for his diabetes, and quickly 

granted him service-connection 

based on Agent Orange. But when he 

put in a claim for PTSD, VA denied 

it. Angry, he appealed. He waited 

four years for a hearing. 

How would you assess whether or 

not someone has PTSD? You could 

ask them, but maybe you want more 

concrete validation. You could ask 

their family—who live their struggle with them. Better yet, from an 

official perspective, you could ask 

their doctor or therapist—the person 

tasked with understanding their hurt 

and helping them work through it. 

Or you could sit them in a room with 

someone who’s never met them and 

have that person decide in a couple 

of hours. That’s the Compensation 

and Pension Exam —almost always referred to by its initials “C&P 

Exam.” 

Typically, when a Veteran files or appeals a claim, they must have a C&P 

Exam. A medical professional—perhaps not even a doctor—examines, 

tests, and probes to determine the 

validity of their claim. For some 

Veterans, it’s one of the most reviled 

parts of the VA process. Veterans liken it to an interrogation, a cross-examination, a hunt to find out the lies 

the examiner is convinced they’re 

telling. 

Veterans and others struggle with 

why the doctors who know and treat 

them don’t suffice, why they aren’t 

more involved in disability determinations. “Let the real people, the 

VA doctors, nurses, the ones that 

care and do the work, take care of 

the process and the soldiers,” Bill 

inveighs. All of his mental health 

doctors, be they VA or private care, 

state his PTSD stems from Vietnam, 

specifically from being blown up 

twice. They’ve worked with him for 

years. 

After a few hours, the C&P Examiner 

felt differently: His PTSD came from 

riding motorcycles. 

Claim denied. Appeal begun. 

How would you assess whether or not someone 

has PTSD? You could sit them in a room with 

someone who’s never met them and have that 

person decide in a few of hours. That’s the Compensation and Pension exam.
27

The 

appeals 

process 

feels like a 

fight.
28

Insights

• Veterans feel belittled and untrusted in 

the process.

• The appeals process is non-adversarial 

only in theory. 

• Veterans think VA hunts for any reason to 

deny.

• The C&P Exam feels like an interrogation 

or an impersonal, insufficient checking of 

the box.

• Veterans will often reach out to the Secretary of VA, their congressmen, and other 

leaders for help. 

Design Considerations

• How might we deliver on our non-adversarial promise at all stages of the process? 

• How might we create a Veteran-centric 

C&P Exam? 

• How might we foster a mutual sense of 

trust between Veterans and VA employees?

• How might we make the appeals process 

a holistic fresh start in a Veteran’s interactions with the government? 

“[The process] needs changing, no question. 

Veterans should be treated with respect 

and dignity. Veterans need to know VA is 

on their side.”

“I’ve been fighting for five years.”

“When I try to go and get help they say I 

had these problems before I went in the 

military. Yet they drafted me and sent me 

to Vietnam. Had me killing folks. And 

when I come back home I have to fight to 

get [benefits].”

“It just seems like you’re fighting 

a losing battle. And its like insurance, they just hope you give up.” 

“They are just waiting for me to die, then 

they can close my case and forget about 

me.”

“Twelve years, they deny, deny, 

deny [bangs table].”

“It seems like when we’re in the examinations for the claim like you’re being interrogated, like you’re doing something wrong 

for being there.”

“Not until we got to the DRO [Decision Review Officer] process [did the system feel 

non-adversarial].”

“I felt I had to write a nasty letter 

to Secretary and Congressmen to 

tell them how bad the process is”
29

 Date of Original Claim: 01/13/11 

 Total time pending: 4 years, 5 months, 3 days 

 Total number of VA adjudications: 4 (3 Rating Decisions, 1 SOC) 

* SOC = Statement of the Case
30

LISA The Compounding of Heartache 

“It was so frustrating. I told you this, I sent you this. I did this. I’ve 

jumped through every hoop.”

The doctors gave Lisa’s husband 

two months to live. A searching 

series of tests to discover the source 

of Jim’s lung problems had ended 

with a cancer diagnosis. It hadn’t 

been COPD or allergies, asthma or 

the pneumonia. No, it was a tumor, 

developed from exposure to asbestos 

decades prior. Everything turned 

upside down for Lisa. 

When had he been exposed to the 

asbestos, they had 

wondered together? 

Jim had worked as 

a salesman after the 

Navy: suits, insurance, cars. His brief 

stint as a building 

inspector had come 

with proper training 

and had occurred 

too recently for 

asbestos to hit him 

like it did. His time 

in the Navy provided a slew of explanations, and the timing made sense. 

He’d certainly been exposed when he 

had deployed to Alaska in the 1960s. 

There he had combed through and 

worked in the wrecked infrastructure 

of the largest earthquake to hit North 

America in the 20th century. Plus old 

vessels like his were known to have 

significant amounts of asbestos in 

their construction. The Navy seemed 

the only logical source of asbestos 

exposure. 

They filed a claim: this dying man, 

his grieving wife, and a VSO representative who worked against the 

clock to help them. 

“My husband signed the first papers 

in December. I probably signed 

papers in February 2011. He died in 

January,” she explains quietly. 

After his death, a letter came from 

VA. Denied. The first of many to 

come. She appealed. She knew the 

process would take longer than a few 

months, but she didn’t expect it to 

take the years it in 

fact dragged out. 

“After he died, 

everything was just 

in turmoil,” she 

remembers. “I’ve 

just been following 

through and I keep 

getting denial, denial, denial. I mean 

some of the denials 

were pretty”—she pauses, looks 

around, whispers—“terrible.” 

Take one of the first denials. She 

filled out a form after Jim’s death that 

asked, “Are you and your husband 

living together?” Understandably, she 

answered no. VA wrote back with a 

denial. You have to be living together, 

the letter explained, to receive benefits. So Lisa had to send in another 

document stating that they had lived 

together until his death. 

She kept fighting, though, for the 

next four years. With occasional 

VSO help, she jumped through every 

hoop VA presented, confident and 

certain she was correct.

“They [VA] treated me like I was 

nothing, like I was some kind of an 

idiot: ‘We’re not going to listen to 

anything you say because you don’t 

know anything,’” she remembers 

tiredly. But it wasn’t just her that was 

saying it was asbestos. His primary 

care physician in his last months and 

the doctor who performed his autopsy both agreed he died from cancer 

caused by asbestos. They said so in 

letters to VA. 

VA, she’s convinced, just looked for 

any reason to deny: “It’s kind of like, 

‘We will do anything, say anything, 

to deny. Nothing she says counts 

because we might have to give her 

benefits.’

“I just felt very, very insignificant in 

this whole thing. Even his doctors 

[didn’t matter]. The only thing that 

counted was the VA: our goal is not 

to give you benefits.” So they denied. 

They denied because she didn’t live 

with her dead husband, denied because he smoked three decades prior, 

denied because he once worked as 

an inspector. She estimated that she’s 

been denied in some manner eight 

different times. 

“It was just one excuse after another. 

It was so frustrating,” she recalls. 

“I told you this, I sent you this. I 

did this. I’ve jumped through every 

hoop and then you come back with 

‘We will do anything, say anything, to deny. 

Nothing she says 

counts because we 

might have to give 

her benefits.’
31

something that doesn’t fit the scenario.” Like maintaining his cancer 

was caused by smoking when every 

medical professional who examined 

his living or dead body pointed to 

asbestos exposure. 

Her frustration comes through when 

she talks about the process. She’s got 

a fire in her. She manages a chuckle 

at some of the sillier denials she’s 

received. But when she talks about 

Jim, one can see how this process 

has dragged out her experience of 

her husband’s death, continuing for 

four years beyond his early death the 

turmoil and enervations of official 

business. 

“I don’t want benefits,” she whispers, 

barely above a hush. “I want Jim 

back....” Her voice trails off and she’s 

quiet for a few moments. “I guess 

closure would be for them to say yes, 

he was exposed to asbestos in service 

and if he hadn’t been I’d probably 

have him today. I know I’d have him 

today.” 

She’s lost a lot, and quickly. Last 

year a car bomb killed her son, who 

worked as a contractor in Afghanistan. 

More appeals documents came from 

VA. She couldn’t deal with it. A 

phone call from her VSO representative said simply, “You know, it’s up to 

you, but I’ll be here for you.” A little 

over a year later, she walked into her 

hearing, belittled by a process that 

purports to support Veterans and 

their survivors, looking for recognition for one of two deaths she’d 

suffered in the last four years. 

// NARRATIVES - LISA

One can see how this process has dragged out 

her experience of her husband’s death, continuing for four years beyond his early death 

the turmoil and enervations of official business. “I don’t want benefits,” she whispers, 

barely above a hush. “I want Jim back....”
32
33

// KEY THEMES

Veterans 

want to be 

heard.
34

Insights

• Some Veterans see their VA rating as the 

country’s formal acknowledgment—or lack 

thereof—of the true measure of their sacrifice. Recognition of service and sacrifice 

is key to the process. 

• Repeated denials tear at the narrative of 

service that many Veterans use to make 

sense of continued pain and struggle.

• Veterans’ satisfaction depends on feeling 

that their story has been acknowledged 

and understood.

• Rating decisions are often about much 

more than just money for many Veterans. 

• Veterans trust decision makers who have 

met with them and listened to them. 

Design Considerations

• How might we foster listening and empathy in the appeals process? 

• How might we communicate decisions to 

ensure Veterans and their families feel like 

they are heard, regardless of the outcome?

• How might we use hearings and conversations to shorten the process instead of 

adding to it? 

• How might we fully acknowledge service 

even if we must deny a claim or appeal?

“I just wanted to tell my story. I just 

want them to hear me.”

“Talking helps. That’s it.”

“I just want them to hear what I got to say 

because I tried to tell them years ago how 

simple it was.”

“I feel better now that somebody did 

listen. If it don’t get no further than 

where it’s at, I’m alright.”

“Last night, we were talking about 

it, about today’s hearing and 

everything. And we were saying a 

prayer and in the prayer it wasn’t 

that we were praying that ‘Oh I 

pray you get the highest disability 

rating and you get that check and 

all that money.’ No, it was ‘I am 

praying that your voice is finally 

heard after all these years.’”

“Somebody needs to hear it even if it’s just 

that gentleman [the judge], somebody 

needs to hear it. Because it’s not nothing. 

It’s his life, it’s our life, it’s our kids’ lives.” “I’m looking for acknowledgment and 

an apology. ”
35

 Date of Original Claim: 04/27/11 

 Total time pending: 4 years, 1 month, 20 days 

 Total number of VA adjudications: 3 (2 Rating Decisions, 1 SOC) 

* SOC = Statement of the Case
36

DIEGO The Fervent Desire to be Heard

“I am praying that your voice is finally heard after all these years.”

His wife took the pills out of his hand in October. His 

dad, speeding from his house nearby, had arrived in 

time to talk him down.

He’d come that close—a raise of the hand, a tilt 

of the head—to killing himself, to ending the pain 

that seemed to radiate unbearably from his toes to 

his brain. The same pain that no one at VA would 

acknowledge. 

Diego joined the Navy after September 11th, serving as a 

personnelman on a newly commissioned battleship. The 

ship, after its commissioning, had made for its homeport 

in San Diego, passing through the Panama Canal and 

turning north. During that Pacific journey, in the midst 

of a storm, Diego injured his back. He was descending a 

ladder well when a massive wave struck the ship. He lost 

his grip, twisting and falling down the well. The ladder 

struck his back at every rung, the whole way down. 

Then at twenty-four years old, he 

got up, went to Medical, and took 

some Motrin. “Let’s roll.”

The ladder, though, had jarred 

askew by ten millimeters one of his 

vertebrae. The injury, and the pain 

from it, would worsen over time. 

Diego’s a big guy, a bear of a man, with a shining, shaved 

head, and a bearing older than his thirty some years. He 

immigrated to the United States as a kid and he’s dedicated his working life to his country, first in the Navy and 

now in work for the Federal Government. He met his 

wife Tara, a Veteran herself, in the Navy. “She couldn’t 

even pronounce my last name and now she carries it,” he 

jokes. Short, with the ramrod posture of an (uninjured) 

Veteran, Tara’s simultaneously a force of resolve and 

compassion.

After leaving the Navy in 2008, Diego, over the years, as 

the pain increased, mentioned the growing pain in his 

back and the old injury to numerous VA doctors. None 

listened, until one VA doctor finally took note, in 2011. 

Upon examination, this doctor immediately ordered Diego into the hospital. A series of tests showed that Diego, 

without surgery, was a week, perhaps two, away from 

paralysis. This doctor assured Diego, however, that even 

after a successful initial surgery, more surgeries and pain 

lay in his future. 

The news jarred him. It also prompted him to do something, seemingly mundane, that he’d been meaning to do 

for years—to file a claim to increase the disability rating 

for his injury with VA. He filed. Then they waited, he and 

Tara. 

Two years later they heard back from VA. A woman from 

his VBA Regional Office called to question him about his 

claim. The questions became a kind of interrogation. “Oh, 

it just happens to be a coincidence 

that you had back surgery and you 

submitted a claim? Really?” he 

remembers her snarling. Years later, 

her distrust and hostility still haunt 

the words in his retelling. “It made 

me feel about this big,” he said, 

gesturing with his thumb and index 

finger. “Tiny.” 

A few months later a decision came. He was given an increased rating, but the decision “didn’t address any of the 

issues” he felt he had raised. The entirety of his injury had 

been categorized under “degenerative arthritis.” VA didn’t 

recognize his thirteen other diagnoses. They ignored the 

fused spine and the numb legs; the four screws, the cage, 

and the metal plate welded into his body didn’t seem to 

matter. “I don’t only have arthritis. If I only had arthritis 

I’d be the happiest man in the world,” he said. “But that’s 

how VA codes it and I don’t think that’s right.” 

To him, this simplistic rating ate at something deeper. 

It trivialized the true scope of his injury. He, along with 

“That’s all I want is to 

be heard. To be treated 

with respect. To have 

other Veterans not be so 

scared to file a claim .”
37

many other Veterans, views his VA rating not simply as a 

response to a claim or a means to a payment check. The 

rating by VA demonstrates his country’s formal acknowledgement of the true measure of his sacrifice. Official 

denials tear at the narrative that he and other Veterans 

like him use to make sense of their continued pain and 

struggle. It seems to belittle their service. 

“Arthritis” isn’t his reality. It’s a few lines in a book he 

hasn’t read. It doesn’t reflect the guilt he feels in telling his 

kids he can’t play with them, the calls for ambulances to 

his job because of blinding pain, the cane and the slow, 

painful rise from the bed at age 33. 

He appealed the decision. The waiting started again. He’d 

call. He’d go online. VA would demand records, again. 

And again. The same records he’d already submitted, two 

maybe three times. 

The law mandates that VA tell him what documents 

it needs. It’s part of their “duty to assist” Veterans in 

the process. In theory, the duty to assist makes the VA 

appeals process one of the most applicant-friendly systems in government or the law. In practice, the law also 

mandates what records VA must collect. The number in a 

case can be daunting. Often compounded by poor communication, those records requests feel like the opposite 

of assistance, making the theory meaningless to affected 

Veterans. 

To Diego, and thousands of Veterans like him, it looks 

like this: “I’ve sent these records to the VA. I’ve walked 

these records to the VA. I’ve mailed these records to the 

VA. [But it’s still:] ‘We need them again.’” 

It seemed to Diego that those demands, formal, baffling, 

inexplicable, were the only times VA paid attention 

during the process. He called to check his status. He 

went online. He asked for help. No one listened. No one 

responded. No one seemed to hear him. 

The pain increased, as the doctor said it would. It grew 

more intense, seized him more often, covered more of his 

body—flashed into his brain. With the deeper pain came 

deeper depression, deeper anxiety. And yet, no one at VA 

listened.

Then, in October 2014, something snapped. His wife 

remembers “a calm before the storm,” a distant quiet in 

Diego, in the days leading up to his attempt at suicide. 

Both Tara and Diego think how lucky they were. His dad, 

terminally ill with cancer, could talk him out of it. He still 

had the mental stability to think, in his words: “Okay, it’s 

not worth it. I have my wife. I have my kids. I’ll [go to the 

clinic] tomorrow.” He survived. But both Tara and Diego—knowing the strain of service, injuries, and fighting 

the process—worry about those Veterans going through 

similar ordeals that “have nobody.” 

Diego got a new decision in early 2015, a few months 

after another out-of-the-blue and unpleasant conversation with someone from VBA who seemed intent on 

haggling with him over his disability rating. The decision 

still failed to acknowledge the extent of his injuries. And 

it contradicted itself—awarding him both 50% and 30% 

for mental health. He appealed. 

What drives someone to keep going in all of this? Four 

years, increased pain, more trips to get records, months 

and months of waiting, belittling phone calls: why keep 

doing it? Diego wants to be heard: “That’s all I want—is 

to be heard. To be treated with respect. To have other 

Veterans not be so scared to file a claim.” 

Tara agrees: “I pushed him to keep going for the simple 

fact that his back condition is listed as arthritis only. That 

really stuck with me. Somebody needs to hear what he’s 

going through. I don’t want to get all emotional again. 

[She starts tearing up]. But somebody needs to hear it 

even if it’s just that gentleman [the judge], somebody 

needs to hear it. Because it’s not nothing. It’s his life, it’s 

our life, it’s our kids’ lives.” 

For Diego, and for many Veterans, a hearing presents the 

first opportunity to tell the story. They worked hard to 

prepare for it, though they didn’t know what to expect. 

Most Veterans don’t. They assumed it would be adversarial, even hostile, A Few Good Men-style. Preparation 

became a family affair, Diego explained: 

“We had our entire dining room table full of papers. 

All of my medical records, bills from my surgery. Me 

// NARRATIVES - DIEGO
38
39

and her were like: Okay, on your phone tell me what 

this means...We had my six-year-old daughter with 

us, my ten-year-old son. Okay, you highlight. You put 

tabs. So it was a family event, trying to figure it out 

to prepare for today. Seeing what I needed to say, 

what I needed to look at. Us Googling and reading 

it; my kids highlighting and tabbing. That’s how we 

did it.“

Their kids even drew pictures and wrote a letter for the 

judge. 

The night before the hearing, Diego and Tara prayed. 

“Last night,” Tara explains, “We were saying a prayer and 

in the prayer it wasn’t that we were praying that ‘Oh I 

pray you get the highest disability rating and you get that 

check and all that money.’ No, it was ‘I am praying that 

your voice is finally heard after all these years.’” Diego 

barely slept he was so nervous. 

The hearing helped, as it often can. The judge listened. He 

cared. He acknowledged the sacrifice and service of both 

Diego and Tara. He heard their story, all while guiding 

their testimony with questions to make ruling on their 

appeal possible, easier. 

Afterwards, they sat together. Drained from an emotional, momentous day, in some sense a culmination of trying 

years, they talked at length about their process, how they 

met, their pride in service, how they hope the process 

improves for other Veterans. 

Under it all, though, that October night, when suicide 

could have been imminent, still lingers: the stark, dire 

example of years of tumult and exhaustion. It brings tears, 

and worry. When asked what the best outcome of this 

whole process with VA could be, Tara answers determinedly, “His back isn’t miraculously going to get better. 

It’s going to continue, like a domino effect, up the rest of 

his spine for the rest of his life. I know that. I’ve come to 

terms with that. I think he’s coming to terms with that.” 

She continues, tears starting to sneak out again: “But the 

best outcome for me would be to know that when he 

does need help, whether it’s just a doctor’s appointment, 

X-ray, MRI, or mental health appointment, that he will 

get it. Not that we’ll be having a repeat of what happened 

in October. There’s no guarantee that something like that 

would never happen again, but there are things that could 

be put in place that could ensure that it’s less likely to 

happen again.” Sitting next to her, Diego stared back with 

the same quiet, tired tears. 

A few seconds later, though, they both sallied forth on 

how to improve the process for Veterans. They’re fighters, 

after all. 

// NARRATIVES - DIEGO
40
41

// MOVING TOWARD A VETERAN-CENTERED VA

HOW MIGHT WE MEET OR EXCEED

VETERAN EXPECTATIONS?

The appeals process should, in theory, be one of the most applicant-friendly systems in the 

world. Instead, it ranges from depersonalized and arduous, to hostile and belittling. Compounding these issues, accelerating changes in medical knowledge and clinical practice add 

both complexity and urgency to the process. In some areas, what made sense when a Veteran’s 

medical profile rarely changed back when now fails in practice. Absent new approaches that 

permit appellate review to be conducted in a complete and timely way, even the best efforts 

of VA and VSO employees are unlikely to be able to meet the challenges of tomorrow. Simply 

adding new patches on top of the old ones risks cutting off one head of the hydra only to see 

two more sprout in its place.

If we started with a blank piece of paper and built a new appeals system for Veterans, what 

would it look like? If we erased the illogical accumulation of regulations and built a system 

designed to meet Veterans’ expectations in the context of today’s challenges, what would it 

look like? What would be expected from Veterans? What would be expected from VA? What 

would be the simplest way to accomplish that? 

With challenges to the current model only increasing over time, we have an opportunity and 

an obligation to contemplate a future that meets Veterans’ needs and expectations in a timely 

and customer friendly way. While none of us may have the answer on our own, we believe 

that together, we do. 

“Somebody’s gotta wake up and smell the coffee, 

especially for us guys that are getting up in age. 

They ain’t got much time left.” 

“[The Process] needs changing, no question. 

Veterans need to know VA is on their side.” 

“Treat people the way you want to be treated.” 
42

The themes and insights we heard point to seven overarching principles:

1. Veterans want a simple, timely system capable of 

responding to the changing needs of their lives. 

2. Veterans want change—for their own sake and for 

their fellow Veterans. 

3. Veterans want to understand the process and their 

position in it. 

4. Veterans want VA to talk to them and to communicate in a language they understand. 

5. Veterans want to be treated with respect and trust. 

6. Veterans want a personal touch and an advocate in 

the process, someone who understands their story 

and can help them. 

7. Veterans want acknowledgment and recognition of 

their service and sacrifice during the process.
43

End Notes

1. “ISO 9241-210:2010 Ergonomics of human-system interaction — Part 210: Human-centred design for interactive systems.” 

International Organization for Standardization. Web. <https://www.iso.org/obp/ui/#iso:std:iso:9241:-210:ed-1:v1:en>

2. “Introduction to User-Centered Design.” Usability First, 1 Jan. 2002. Web. <http://www.usabilityfirst.com/about-usability/introduction-to-user-centered-design/>.

3. “About IDEO.” IDEO, 1 Jan. 2014. Web. <http://www.ideo.com/about/>

4. Pratt, Andy, and Jason Nunes. Interactive Design: An Introduction to the Theory and Application of User-Centered Design: 

Rockport Publishers, 2012. Print.

5. Spool, Jared. “Field Studies: The Best Tool to Discover User Needs.” N.p., 13

Mar. 2007. Web. <http://www.uie.com/articles/field_studies/>.

6. “Department of Veterans Affairs Board of Veterans’s Appeals Annual Report Fiscal Year 2015.” BVA, 2015.

7. “Department of Veterans Affairs Board of Veterans’s Appeals Annual Report Fiscal Year 2015.” BVA, 2015.

Photo Credits

All photos are images of real Veterans and their families. Photos of interviewees of this study were taken with permission of the 

interviewees. 

Websites

Location of this report

http://www.blogs.va.gov/VAntage/25331/listening-to-the-voices-of-veterans-and-their-journey-in-the-appeals-system/ 

Prior Human-Centered Design work

http://www.innovation.va.gov/hcd.asp 
44