What Makes a Good VA Compensation Claim?
VA disability is like workers compensation. When hurt on active duty, veterans can get VA compensation, just as a civilian worker could get worker’s compensation if hurt on the job. This sounds simple, but the process can be trickier than you might think. If not handled correctly from the outset, a compensation claim could be denied, possibly leaving the veteran mired in the appeals process for years. Yes, that’s right. Years.
The following tips can help veterans avoid the delay and frustration of a denial and have a better chance of obtaining VA benefits from the outset.
Understand what’s required. Basically, VA compensation requires three things: a current diagnosis, an incident, injury, or exposure in service that caused the diagnosis, and a medical “nexus,” or connection between the two. The diagnosis generally needs to be made by a medical professional. The incident, injury or exposure must be established through military records, buddy statements, location/time period of service, or other means. In a few circumstances a nexus is not required nor is proof of the incident, but that’s a subject for a whole other blog so stay tuned for that!
Don’t claim un-winnable conditions. After veterans nail down requirements for specific claims, they may realize a certain condition is not worth claiming. For example, a back injury from a car accident after service is not winnable. Veterans should save time and frustration by not claiming disabilities that are clearly not service connected.
Be proactive. The VA has a duty to assist veterans in obtaining information and evidence that can help establish their claims. However, the reality is that the VA is overwhelmed, so it’s in the veteran’s best interests to gather as much evidence as possible for the claim themselves.
Use the correct forms. For example, the form for a new claim is different than the one needed to appeal a claim that was denied. The same goes for a veteran seeking unemployability benefits. The VA has forms for almost everything and they are all available online. If the correct form isn’t used, a claim can be delayed or rejected.
Get military records. If a veteran doesn’t already have a complete copy of their Official Military Personnel File, they should request it, usually from the National Personnel Records Center in St. Louis. The military file might contain helpful evidence to prove claims. Again, the VA has a duty to help obtain records, but the veteran is best served by taking an active role in this process.
Send in evidence with the claim. After a veteran gathers all the evidence and information possible, it should be sent in with the claim. Helpful evidence may include: service and medical records; witness statements; private doctor statements; and any additional information or documentation that might help the VA make a favorable decision faster.
Show up to VA exams. If a claim has merit the VA will schedule a Compensation and Pension exam. A VA examiner meets with the veteran to confirm diagnoses and opine on whether the claimed conditions resulted from service. The examiner also provides information that helps the VA assign a rating to a claim. The ratings system is complicated and the subject for another future blog but basically, a rating is the VA’s way of establishing how disabling a condition is to the veteran and determines how much the veteran’s monthly payment will be. If a veteran doesn’t show up for an exam, the VA may deny the claim.
Know what the VA exam is about. Often veterans submit claims for many conditions but are then scheduled for just one exam. Don’t go in blind. Contact the examiner’s office to ask what the exam will cover. That way the veteran can get prepared to explain their symptoms and how the condition resulted from service.
Don’t miss deadlines or fail to respond. After getting a claim, the VA sends additional forms that need to be filled out. Sometimes they require clarification of a claim and they will not move forward until they get that. If a veteran ignores these forms or clarification requests the VA might issue a denial. If a deadline is missed the veteran may have to start the entire claims process over again.
Don’t give up. The VA process can be wildly confusing and frustrating. Despite best efforts to send in correct forms and supportive evidence, compensation claims are often still denied. Veterans shouldn’t be afraid to seek help from a knowledgeable veterans attorney if necessary and, above all, shouldn’t give up on the benefits they deserve.
Originally published in U.S. Veterans Magazine, Spring 2017