Veterans Benefits Claims Automator

The Veterans Benefits Claims Automator digitizes military service records and claim evidence, and organizes them into a claim file a rater can work from. Rule logic maintained by your policy staff compares each claimed condition with the veteran's service history and flags where a presumption of service connection may apply, with the evidence behind each flag. Every proposal is decided by a person, and every step keeps its reasoning for quality review and oversight.

The problem it solves

Disability compensation claims depend on matching a veteran's claimed conditions to their service: where and when they served, what they were exposed to, and what their records show. Much of that evidence arrives as scanned paper, spread across service treatment records, personnel files and private medical records. Claims processors spend their time finding and reading pages rather than weighing evidence, presumptive provisions that change with new legislation are applied from memory and reference guides, and when a decision is questioned on appeal or in a quality review, the path from evidence to rating is hard to reconstruct.

Who it’s for

• Agencies and offices that adjudicate veterans' disability compensation claims
• Veterans service representatives who develop claims and gather evidence
• Rating specialists who decide service connection and evaluations
• Policy and procedures staff who maintain presumptive rules as law changes
• Quality assurance staff and oversight bodies who review decisions

1. DigitizeService treatment records, personnel files, private medical records and claim forms are scanned or received electronically, read with optical character recognition, and indexed by document type, date and source.
2. MapEach claimed condition is compared with the veteran's service history using rule logic for presumptive provisions, so the claim file shows which conditions may meet a presumption and which need further development.
3. DevelopWhere evidence is missing, the system prepares development tasks such as records requests and examination requests, and tracks them until the evidence arrives or the request is closed.
4. DecideThe rater reviews the evidence summary and the rule results, decides service connection and evaluation for each condition, and records the reasons. Quality reviewers sample decisions against the same evidence.

Record digitization

Scanned and electronic records are read, classified by document type and indexed, with each extracted fact linked back to its page.

Service timeline

Periods of service, units, locations and duties from personnel records shown on one timeline, with the source of each entry.

Presumptive rule library

Rules for presumptive provisions, each documented with its legal citation, effective dates, conditions and service criteria.

Explained rule results

Every possible presumptive match shows the rule applied, the service facts and diagnoses it relied on, and the pages they came from.

Rule versioning

When law or regulation changes, policy staff add a new rule version with its effective date, test it and approve it before it is used.

Evidence summary

A per-condition summary of the diagnoses, treatment and in-service events found in the file, for the rater to verify.

Development tracking

Records and examination requests proposed from evidence gaps, with status and follow-up dates tracked on the claim.

Rater decision record

The rater's decision on each condition and the reasons, recorded beside the proposal so any difference is visible.

Quality review sampling

Sample completed claims for second review, record findings, and see where reviewers and raters disagree.

Workload queues

Claims queued by stage, priority indicators your agency sets and age, with assignment rules by team or station.

Claim file search

Search the full claim file by term, date, document type or condition, with results linked to the page.

Audit trail

Every view, extraction correction, proposal, decision and export recorded with the person and time.

Records technician

Checks digitized documents, corrects classification and extracted facts

Veterans service representative

Develops claims, sends evidence requests and marks claims ready for decision

Rating specialist

Decides service connection and evaluations, accepting or rejecting proposed findings with reasons

Quality reviewer

Reviews samples of completed claims and records findings

Rules and policy analyst

Maintains and tests presumptive rule versions, without deciding claims

Auditor or oversight reviewer (read-only)

Views claims, decisions, rule history and the audit trail, with no ability to change them

Claims and case management

Claim establishment data and status exchanged with your agency's claims processing system, mapped during implementation.

Document repositories and scanning

Documents received from your mail scanning vendor or electronic folder, by scheduled transfer or API.

Service personnel and treatment records

Service records available to your agency through its existing exchanges with the military services, received as documents or structured data.

Examination scheduling

Examination requests approved by a veterans service representative passed to your examination scheduling process.

Single sign-on

Staff sign in through your agency's identity provider, including PIV-based authentication where your provider supports it.

Work API

Claim, development and decision data available to your agency's data warehouse and reporting tools through the Moraph Work API.

Records kept in the United States

Claim files and decision data are hosted in the United States region.

Cleared support lane

Support tickets from federal clients are routed only to US citizens with active security clearances.

Access by role and station

Staff see only the claims for their role, team or station; access to sensitive files can be limited further.

Encryption under controlled keys

Client data is encrypted with keys our staff cannot access without explicit, time-bound authorization.

Complete audit trail

Every view, correction, proposal, decision and export is recorded with the user and time, and cannot be edited.

Independent audits

Moraph's controls are covered by its SOC 2 Type II report and ISO/IEC 27001 certification, available through the Trust Center.

Moraph cloud, United States

Hosted in the United States region, with records kept in the US.

Dedicated environment

A single-tenant environment for agencies that require isolation, scoped in the proposal.

With a managed service

Optionally run alongside a Moraph managed service for administration, integration support and rule library maintenance support.

Discovery and process mapping

We map your claims process, stages, hand-offs and the systems that hold claim data, and agree which claim types are in scope first.

Document and data integration

Connections to your scanning, document and claims systems are built and tested. We need sample documents and a contact from each system's team.

Rule library review

Your policy staff review each presumptive rule against current law, regulation and agency guidance, and approve the versions to be used.

Testing on decided claims

Rules and extraction are run on claims your agency has already decided, and the results compared with the recorded decisions before go-live.

Workflow and roles

Queues, assignment rules, development task types, approval steps and roles are configured to match your procedures.

Training and go-live

Records technicians, representatives, raters and reviewers are trained on their own workflows, and the rollout is phased by station or claim type as you choose.

• It proposes; it never decides. Service connection, evaluations and every other finding are made by your rating staff, and the system does not issue decisions or notices.
• Presumptive rules reflect law and regulation as reviewed and approved by your policy staff. Moraph does not interpret the law for your agency, and rule changes take effect only when you approve them.
• Extraction from scanned records can miss or misread information, especially handwriting and poor-quality scans. Low-confidence pages are flagged, and staff remain responsible for reviewing the evidence.
• It does not assign disability percentages on its own. It can show the rating schedule criteria and evidence, but the evaluation is the rater's decision.
• Moraph holds no FedRAMP authorization for this product. We provide control documentation to support your agency's own authorization decision.
• It is not a replacement for your agency's system of record for claims, payments or notices; it works alongside them.
• Appeals processing is not included beyond making the claim file and decision record available.
• Coverage starts with the claim types and presumptive provisions agreed during implementation; others are added by agreement.

• Run a set of already-decided claims and compare the proposed findings with the recorded decisions
• Ask a rater to work a claim from evidence summary to decision and note what they still have to look up elsewhere
• Check that every proposed finding cites the rule, the service fact and the page it relied on
• Add a test rule version with a new effective date and review the test evidence it produces
• Review how low-confidence pages are flagged and corrected
• Confirm role separation: who can change rules, who can decide, and who can only view