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The VA Form 21-0789 is an important document that plays a crucial role in the Department of Veterans Affairs (VA) claims process. This form provides veterans with essential information regarding their rights to representation and the option for a personal hearing. Claimants are informed that they are not obligated to navigate this process alone, as they can seek assistance from various representatives, including recognized veterans organizations, legal aid lawyers, or agents approved by the VA. The form outlines the nature of these representatives, emphasizing their role in articulating the veteran's perspective and assisting with documentation. Additionally, a personal hearing allows veterans to present their cases directly to VA decision-makers, who are responsible for adjudicating claims. The form specifies guidelines surrounding such hearings, including the opportunity to bring witnesses or a Veterans Services Representative for support. Furthermore, veterans must be mindful of the timelines for requesting hearings to ensure their cases are not prematurely decided. This document, therefore, serves not only as a procedural tool but also as a guide to empower veterans during a potentially challenging time in their lives.

Va 21 0789 Example

YOUR RIGHTS TO REPRESENTATION AND A HEARING

You have some important rights in your claim with VA. You don't have to handle your case by yourself, and you don't have to deal with us only through the mail. On this page we'll tell you about your right to have your own representative. We'll also explain your right to a personal hearing.

WHAT IS A REPRESENTATIVE?

A representative is a person who helps you tell us your side of the story. The representative can help you with written materials you send us. He or she can also go with you to a hearing if you decide you want one.

WHO CAN BE MY REPRESENTATIVE?

There are three kinds of representatives. Each is explained below:

You can choose an employee of a veterans organization or other service organization which is recognized by VA. On page 2 of this form we have a list of some service organizations that could represent you free of charge.

OR

You can get a lawyer. The lawyer might work in private practice or for Legal Aid.

OR

You can get an agent. An agent is anyone other than a lawyer or a service organization who is authorized by VA to speak for you or help you tell your side of the story.

If you don't have a representative and would like one, tell us who you want to represent you. then we'll send you the forms and information you'll need to name your representative.

WHAT IS A PERSONAL HEARING?

A personal hearing is a meeting where you can talk to us about a decision we have made or a decision we are going to make. In most cases, the person who "hears" your claim will be the person who makes the decision. You should bring evidence to help us understand your side of the story.

CAN I BRING SOMEONE TO THE HEARING?

Yes. Besides your representative, you can bring witnesses. A witness is anyone who has personal knowledge about your claim and can give us useful information.

If you don't want a representative, but still want someone to help you at the hearing, one of our Veterans Services Representatives (VSRs) can go to the hearing with you. However, you will need to tell us ahead of time so that the VSR can study your case.

WHAT DOES VA PROVIDE FOR THE HEARING?

Generally the hearing is held at the Regional Office that has your records. We'll provide the room and tape the hearing. Where available, your hearing can also be held at a local VA hospital through a closed circuit TV system. These services are free. We will not be able to pay for your travel, meals, or other expenses.

HOW CAN I REQUEST A HEARING?

If you'd like a personal hearing, simply

write to us and tell us you want one. You can request a hearing by writing to your Regional Office of Jurisdiction (ROJ). To find your local office go to the following website: www.benefits.va.gov/benefits/offices.

Click on the state in which the veteran resides to find the address of the benefits office.

WHEN MUST I REQUEST A HEARING?

If we receive your request for a hearing within 30 days from the date of our letter, we will not make any decisions until we hold the hearing and review the hearing testimony and any evidence presented.

After 30 days you may request a hearing, but we may have already made a decision as explained in our letter.

JUN 2017

21-0789

WHICH WILL NOT BE USED.

VA FORM

SUPERSEDES VA FORM 21-0789, NOV 2013,

Page 1

RECOGNIZED SERVICE ORGANIZATIONS

Here is a list of national, regional, or local organizations which are approved to help people with their claims. You don't have to belong to one of these organizations to get their help, and they won't charge you a fee. If you're looking for one of these organizations and you can't find them in your phone book, you can call us toll free at 1-800-827-1000.

African American PTSD Association

Military Officers Association of America (MOAA)

American Defenders of Bataan and Corregidor, Inc.

National Amputation Foundation, Inc.

American Legion

National Association for Black Veterans, Inc.

American Red Cross

National Association of County Veterans Service Officers, Inc.

American Veterans Committee

National Veterans Legal Services Program

AMVETS

National Veterans Organization of America

American Ex-Prisoners of War, Inc.

Navy Mutual Aid Association

American GI Forum, National Veterans Outreach Program

Paralyzed Veterans of America, Inc.

Armed Forces Services Corporation

Polish Legion of American Veterans, U.S.A.

Army and Air Force Mutual Aid Association

Swords to Plowshares, Veterans Rights Organization

Army and Navy Union, USA

The Retired Enlisted Association

Associates of Vietnam Veterans of America

The Veterans Assistance Foundation, Inc.

Blinded Veterans Association

The Veterans Coalition

Catholic War Veterans of the U.S.A.

The Veterans of the Vietnam War, Inc.

Disabled American Veterans

United Spanish War Veterans of the United States

Eastern Paralyzed Veterans Association

United Spinal Association, Inc.

Fleet Reserve Association

Veterans of Foreign Wars of the United States

Gold Star Wives of America, Inc.

Veterans of World War I of the U.S.A., Inc.

Italian American War Veterans of the United States, Inc.

Vietnam Era Veterans Association

Jewish War Veterans of the United States

Vietnam Veterans of America

Legion of Valor of the United States of America, Inc.

Wounded Warrior Project

Marine Corps League

 

Military Order of the Purple Heart

 

Although agency titles vary, the following States and possessions maintain veterans service agencies which are recognized to help people with their claims. You can look in the state government pages of the phone book under "veterans" to see if your state has a Department of Veterans Affairs or Veterans Affairs Commission.

Alabama

Illinois

Nebraska

Puerto Rico

American Samoa

Iowa

Nevada

Rhode Island

Arizona

Kansas

New Hampshire

South Carolina

Arkansas

Kentucky

New Jersey

South Dakota

California

Louisiana

New Mexico

Tennessee

Colorado

Maine

New York

Texas

Connecticut

Maryland

North Carolina

Utah

Delaware

Massachusetts

North Dakota

Vermont

Florida

Michigan

Northern Mariana Islands

Virginia

Georgia

Minnesota

Ohio

Virgin Islands

Guam

Mississippi

Oklahoma

Washington

Hawaii

Missouri

Oregon

West Virginia

Idaho

Montana

Pennsylvania

Wisconsin

 

 

 

Wyoming

Points to Remember:

If you want a representative, you should let us know who you want. We can send you the necessary forms to appoint your representative.

If you want a personal hearing, you should write and tell us.

VA FORM 21-0789, JUN 2017

Page 2

Form Characteristics

Fact Name Fact Details
Right to Representation You have the right to have a representative assist you in your claim with the VA.
Types of Representatives Representatives can be service organization employees, lawyers, or agents authorized by the VA.
Access to Personal Hearing You are entitled to request a personal hearing to discuss decisions regarding your claim.
Bringing Support to the Hearing You may bring witnesses or a Veterans Services Representative (VSR) for assistance during the hearing.
Hearing Location The hearing is typically held at the Regional Office with your records, often free of charge.
Request Process for Hearing You can request a personal hearing by writing to your Regional Office of Jurisdiction.
Hearing Request Timeline You must request a hearing within 30 days of receiving a decision letter, or your case may proceed without it.
Service Organization Support Recognized service organizations can assist with support at no charge; membership is not required.
Contact Information For assistance finding representatives or hearing locations, call the VA at 1-800-827-1000.

Guidelines on Utilizing Va 21 0789

Completing the VA Form 21-0789 is an important step in seeking representation or a personal hearing regarding your claims. After filling out the form, you’ll need to submit it to the appropriate VA office for processing. Below are the steps to guide you through completing the form.

  1. Begin by downloading the VA Form 21-0789 from the VA's official website.
  2. Read the instructions on the first page carefully to understand your rights and options regarding representation and hearings.
  3. Fill in your full name in the designated section at the top of the form.
  4. Provide your Social Security number and, if applicable, your VA file number in the appropriate fields.
  5. Indicate whether you want representation by checking the relevant box.
  6. If you have chosen a representative, write their name, organization, and contact information on the line provided.
  7. Decide whether you would like to request a personal hearing. If you do, check the box indicating your wish to have a hearing.
  8. Provide any additional information or comments regarding your claim in the space allocated for remarks.
  9. Sign and date the form at the bottom before submitting it.
  10. Make a copy of the completed form for your records before sending it in.
  11. Mail the completed form to your Regional Office of Jurisdiction. You can find this information on the VA website.

What You Should Know About This Form

What is the purpose of the VA Form 21-0789?

The VA Form 21-0789 is designed to inform veterans about their rights in the claims process. It outlines the right to have a personal representative who can assist in communicating with the VA. This form also provides information about requesting a personal hearing, where veterans can discuss their claims directly with VA officials.

Who can I choose as my representative?

You have a few options when selecting a representative. You may choose an employee from a recognized veterans organization or another service organization that provides help at no cost. Alternatively, you can hire a lawyer, either from private practice or Legal Aid. Lastly, you may also appoint an agent, who is any person authorized to represent you in your claim, provided they are not a lawyer or a service organization. If you need assistance finding a representative, the VA can send you the necessary forms to name one.

What happens during a personal hearing?

A personal hearing allows you to present your case directly to a VA official. During the hearing, you can share your perspective on the claim decision. It is important to bring any evidence that supports your situation. The hearing typically takes place at the Regional Office that has your records, and it is taped for reference. You can also bring witnesses who have relevant information to contribute.

How can I request a personal hearing?

To request a personal hearing, you simply need to write to your Regional Office of Jurisdiction. In your letter, clearly state that you want a hearing. If you request it within 30 days of receiving a decision letter from the VA, the agency will wait until the hearing occurs before making a decision. If you wait longer than 30 days, there is a chance that a decision may already have been made.

Common mistakes

Filling out the VA Form 21-0789 can be a straightforward process if approached correctly. However, many individuals make mistakes that can delay their claims or lead to complications. Awareness of these common pitfalls can help ensure accurate submissions and smoother interactions with the VA.

One frequent error is not naming a representative when desired. Many people overlook this step, thinking they can manage the process alone. If you want assistance, designate your choice of representative on the form. This helps the VA understand who will be advocating for you and can streamline communication.

Another mistake is not requesting a personal hearing in a timely manner. Applicants often forget that they have a limited window—30 days from the date of the VA's letter—to submit this request. Missing this deadline may result in the VA moving forward with a decision without your input. Being proactive about scheduling your hearing is crucial to ensuring your side is heard.

Inaccurate information can also hinder your application. Many people fail to double-check their personal details, such as names, addresses, and Social Security numbers. Such errors can lead to confusion and further delays. Ensure that all information is correct and consistent throughout the form.

Additionally, neglecting to bring supportive evidence to a hearing is a common oversight. Applicants may assume that their verbal testimony is sufficient, but providing documentation strengthens their case. Gather relevant materials ahead of time to present a compelling argument during the hearing.

Lastly, not utilizing available resources can significantly impact the process. Many individuals are unaware of the representatives and service organizations that can assist them for free. Take the time to explore the options listed on the form to find help that can ease the burdens of navigating the VA system.

Documents used along the form

The VA Form 21-0789 serves as a crucial document in the claims process with the Department of Veterans Affairs. However, several other forms and documents are often used in conjunction with this form to ensure that veterans receive the full support and representation they deserve. Here is a list of some commonly associated documents:

  • VA Form 21-526EZ: This form is a streamlined application for veterans seeking to file a claim for disability compensation. It allows veterans to submit relevant information efficiently and can expedite the processing of their claims.
  • VA Form 21-4138: Known as the Statement in Support of Claim, this document allows veterans to provide additional evidence or statements that may support their claims. It is particularly useful for detailing personal accounts or gathering witness information.
  • VA Form 21-22: This form appoints a representative for veterans who want assistance in managing their claims. It enables the designated representative, such as a lawyer or a service organization, to act on behalf of the veteran in communications with the VA.
  • VA Form 21-8940: This is the Application for Increased Compensation Based on Unemployability. Veterans use this form to claim that their service-connected disabilities prevent them from securing or maintaining substantial gainful employment.
  • VA Form 21-0779: This form, Request to Add or Remove a Dependent, is necessary if there are changes in a veteran's dependents, affecting the compensation rate or entitlement. Accurate information must be provided to ensure that benefits are correctly adjusted.
  • VA Form 21-4142: This is used to authorize the disclosure of medical records. Veterans need to submit this form to obtain private medical records that may support their claims for benefits.

Utilizing these forms alongside the VA Form 21-0789 can significantly aid in the claims process, ensuring that all relevant information and advocacy are brought to the VA’s attention. By understanding these forms and when to use them, veterans can navigate their claims more effectively and efficiently.

Similar forms

  • VA Form 21-4138 (Statement in Support of Claim) - Similar to VA Form 21-0789, this document allows veterans to provide information regarding their claims. It serves as a means to present additional evidence or explain circumstances that might support the claim, just as VA Form 21-0789 assists veterans in articulating their case through a representative.
  • VA Form 21-526EZ (Application for Disability Compensation and Related Compensation Benefits) - This form is vital for veterans seeking compensation, paralleling VA Form 21-0789 in its purpose to gather necessary information for processing claims. Both forms aim to ensure that the VA has all relevant details to make informed decisions.
  • VA Form 21-0779 (Request for Discharge Upgrade) - When seeking a discharge upgrade, veterans must submit this request, akin to the representation and hearing aspects of VA Form 21-0789. Both forms facilitate the process of receiving benefits and advocating for the veteran's rights.
  • VA Form 21-0958 (Notice of Disagreement) - This form is used to formally disagree with a decision made by the VA. Much like VA Form 21-0789, it provides a structured way to challenge decisions, ensuring veterans have the opportunity to present their position effectively.
  • VA Form 21-534EZ (Application for DIC, Death Pension, and Accrued Benefits) - For survivors seeking benefits after the death of a veteran, this form serves a similar function as VA Form 21-0789 in terms of outlining rights and processes for obtaining necessary support.
  • VA Form 21-8940 (Veteran's Application for Increased Compensation Based on Unemployability) - This document allows veterans to request increased compensation due to inability to work, paralleling the representation request of VA Form 21-0789, helping veterans navigate the system for optimal outcomes.
  • VA Form 21-22 (Appointment of Veterans Service Organization as Claimant's Representative) - Like VA Form 21-0789, this form designates a representative to assist with a claim. Both documents ensure that veterans can receive the necessary advocacy for their cases.
  • VA Form 26-1880 (Request for a Certificate of Eligibility) - This form is used by veterans applying for certain benefits like home loans, and it provides a formal way to request support. It shares similarities with VA Form 21-0789 in helping veterans claim the benefits they are entitled to, ensuring that everyone understands their rights to representation.

Dos and Don'ts

When filling out the VA Form 21-0789, it is essential to follow specific guidelines to ensure your application is processed efficiently. Below are some things you should and shouldn't do.

  • Do read all instructions carefully before starting the form.
  • Do make sure to provide your full name and contact information in the appropriate sections.
  • Do indicate clearly if you want a representative and provide their details.
  • Do request a personal hearing if necessary, stating your request explicitly in writing.
  • Do include any supporting documents or evidence relevant to your claim.
  • Don't leave any sections blank; fill in every required field as best as you can.
  • Don't forget to sign and date the form before submission.
  • Don't submit the form without reviewing it for errors or incomplete information.
  • Don't hesitate to contact the VA if you need clarification on any parts of the form.

Misconceptions

Misconceptions about the VA Form 21-0789 can lead to confusion about veterans' rights and processes. Here are some common misunderstandings:

  • You must handle your case alone. Many believe they cannot get help with their claim. However, veterans have the right to choose a representative to assist them.
  • Only lawyers can represent you. While lawyers are one option, veterans can also choose agents or representatives from recognized service organizations, many of which offer free assistance.
  • A personal hearing is not necessary. Some think hearings are optional, but requesting one can be essential for presenting evidence and discussing a decision made by the VA.
  • You cannot bring anyone to the hearing. In fact, veterans can bring witnesses and representatives to support their claims during the hearing.
  • The VA does not provide any support for the hearing. While the VA provides a space and will record the hearing, it does not cover travel or meal expenses.
  • You cannot change your representative once chosen. Veterans can change their representatives at any time by informing the VA and providing the necessary information.
  • There is no time limit for requesting a hearing. A hearing request must be made within 30 days of receiving a decision letter to pause the decision-making process.
  • Your hearing request is automatically approved. While you can request a hearing, it may not be guaranteed if the request is made after the specified timeframe.

Understanding these points can help veterans navigate the claims process more effectively. Seeking assistance and knowing your rights is crucial for getting the support you deserve.

Key takeaways

Key Takeaways for Filling Out the VA Form 21-0789

  • You have the right to representation in your claim. This means you can choose someone to assist you, such as a representative from a recognized veterans organization, a lawyer, or an agent.
  • If you want to have a personal hearing to discuss your claim, you need to communicate that request to the VA. You may do this by writing to your local Regional Office of Jurisdiction.
  • The request for a hearing must be made within 30 days of receiving VA correspondence. If made after this period, a decision may already be reached regarding your claim.
  • You can bring witnesses to your hearing. This includes anyone who can provide helpful information regarding your claim.
  • The VA provides the facility for the hearing, which will be recorded. However, they do not cover travel expenses, meals, or any other personal costs incurred to attend the hearing.