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Click here to download PDF version of Veterans Benefits Representation Agreement. VETERAN BENEFITS LEGAL REPRESENTATION AGREEMENT This contract and agreement for Veteran benefits legal services is entered into between JON BROWN, VETERANS ACCREDITED REPRESENTATIVE AGENT, 7244 YORK AVE SOUTH, EDINA, MN 55435, hereinafter referred as "Agent" and_________________________________, hereinafter referred as "Client". Client and Agent agree as follows: My agent representative and I understand that, for a fee to be payable, the Department of Veterans Affairs (DVA) must approve any fee my representative charges or collects from me for services my representative provides in proceedings before DVA in connection with my claim(s) for benefits. It is clearly understood by both parties that payment will come directly from past due retroactive benefits the client is entitled to and will be paid to the agent directly from the VA. 1. Legal Services to be Provided: Client retains Agent to represent Client before the Department of Veterans Affairs Regional Office and/or Board of Veterans' Appeals (BVA) for award or increase of award of veteran benefits either by appeal, reconsideration or by renewed claim based on new and material evidence on the issues stated or inferred in that decision of denial or partial award described as follows: The source of the Decision: ( ) Regional Office; Date of Decision: _____________________________________ Notice of Disagreement filed: ____________________________________________________ Issues: _________________________________________________________ Client seeks to secure all benefits reasonably stated or inferred in the decision identified above that the Client is entitled to receive as of the date of most recent DVA application. 2. Contingency Fee Agreement: We agree that, if DVA or BVA favorably decides the claim(s), I will pay my representative a fee equal to the lesser of 20 percent of the past due benefits resulting from my claim or a fee of $900.00. Under no circumstances will I pay my representative more than $900.00. Expenses are inclusive in the contingency fee agreement so stated at either $900.00 or as a part of the 20% back pay. If the veteran determines that an Independent Medical Evaluation is necessary, it is understood that is an expense between the medical professional and the veteran and in no way is the Veterans Agent liable for payment of that expense in the conduct of this appeal nor is that expense considered a part of the $900.00 fee or 20% as defined above. 3. Client's Discharge of Agent: Client may discharge Agent upon written notice to Agent If Client discharges Agent without good and adequate cause after the Agent has fully performed, substantially performed, or contributed in any way to the results finally obtained by the Client, the Client shall be liable for payment of the Agents fees and expenses based upon the time invested by Agent in this matter at a rate of ONE HUNDRED FIFTY DOLLARS ($150.00) per hour or upon other reasonable standard decided by the BVA, or DVA based upon applicable law if said amount of quantum meruit agent fees exceed any fees paid as set forth in paragraph 2 above. 4. No Promises or Guarantees About Outcome: The Client has read and understands this contract and agrees that the Agent has made no promises or guarantees regarding the outcome of this matter. 5. Revocation of Prior Powers of Attorney: Client intends that this contract shall revoke all prior Powers of Attorney for representation which may have been filed with the Department of Veterans Affairs by any other agent or veterans service organization or other veteran representative. 6. Interpretation of Agreement: The Client and the Agent understand that the VA Regional Office (Office of Jurisdiction), Department of Veterans Affairs General Counsel or Board of Veterans' Appeals is vested with the authority to determine the reasonableness of this fee Agreement. 7. Commencement of Representation: Actual work on behalf of Client by Agent under this Agreement will not commence until the Agent receives a copy of this Agreement signed by the Client. The effective date of this Agreement to represent shall be the date on which the Agent signs this Agreement. Agent and Client agree that this Contract will be filed with the DVA and/or BVA as appropriate. An original contract will be forwarded to Client by Agent. 8. Mutual Agreement: We agree that the above agreement and contract of TWO pages represents our complete mutual agreement. _____________________________________________ Client Date ___________________________________________ Jon Brown, Accredited VA Agent Date |
