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Navigating the VA disability system can feel like trying to read a map in the dark.
Some claims move quickly, but others feel impossible—no matter how legitimate your service-connected conditions are.
After helping over 25,000 veterans get the VA disability benefits they’ve earned, I can tell you this: the VA doesn’t make it easy.
In this article, I’ll walk you through the 10 hardest VA disability claims to get approved (in my experience)—why they’re so challenging, what kind of evidence actually wins, and how to avoid the common traps that leave veterans stuck, frustrated, and underrated.
Looking for the easiest VA claims to win right now?
Table of Contents
Summary of Key Points
- Some VA claims are uniquely tough to win. Hearing loss is the #1 heartbreaker because VA rates strict audiogram numbers (not real-life struggle), and many other claims (aggravation of pre-service conditions, sleep apnea, chronic pain post-Saunders, PTSD/MST, Gulf War MUCMI, mild TBI, non-presumptive toxic exposures, dental compensation, and substance abuse secondary to SC) have built-in pitfalls.
- Denials usually trace to one gap in the Caluza Triangle. Most losses stem from missing (1) a clear current diagnosis, (2) an in-service event/aggravation, or (3) a strong medical nexus tying them together—plus weak documentation of functional impact. But remember there aren’t any unprovable VA claims.
- Winning requires targeted evidence, not volume. Use VA-compliant tests (e.g., Maryland CNC for hearing), buddy statements and markers (MST, sleep apnea), deployment/location proof (Gulf War), specialty opinions (occupational/environmental med, neuropsych, ortho/podiatry), and treatment records that show functional loss over time. And keep in mind: MEDICAL EVIDENCE WINS VA CLAIMS!
- These claims are winnable with Brian Reese’s SEM Method: Strategy + Education + Medical evidence. Build a clear theory (direct, presumptive, or secondary), organize evidence to close each gap, and speak the VA’s language in your filings—so you move from stuck and underrated to service-connected and properly rated.
#1. Hearing Loss (and getting it rated above 0%)
Why it’s hard:
VA ratings for hearing loss are based on strict numbers from your audiogram—specifically puretone averages and Maryland CNC word recognition scores. That means you can struggle to hear conversations, TV, or radio chatter and still score 0% because your results don’t fit the VA’s tables. Age-related changes and post-service noise exposure make it even tougher to link directly to service.
Tips to get your claim approved:
- Use a VA-compliant hearing test—Maryland CNC, no hearing aids.
- Have your audiologist describe how your hearing loss affects your work, safety, and daily communication.
- Submit a MOS noise exposure summary and lay statements from family or coworkers.
Example:
A flightline crew chief with documented jet noise, STR threshold shifts, and a spouse statement about missed conversations wins after submitting a strong nexus letter connecting his loss to service.
#2. Aggravation of Pre-Service Conditions (e.g., flat feet/pes planus)
Why it’s hard:
You must prove your condition permanently worsened in service—not just temporary flare-ups. If MEPS noted it, VA often claims “natural progression.” If MEPS didn’t, they may argue it existed beforehand. Without medical proof of a baseline and permanent worsening beyond natural progression, raters deny.
Tips to get your claim approved:
- Establish baseline evidence at entry and in-service aggravation.
- Obtain a medical opinion explaining why the worsening wasn’t natural.
- Include buddy statements or profile restrictions showing how your function declined.
Example:
A veteran with normal arches at enlistment later develops chronic foot pain, needs orthotics, and has a podiatrist confirm the condition permanently worsened due to military boots and marching.
#3. Sleep Apnea (direct or secondary)
Why it’s hard:
Sleep apnea rarely shows up in STRs. Most vets don’t get a sleep study until years later, creating a gap VA uses to deny. Secondary connections (PTSD, rhinitis, meds, or weight gain) are often ignored without clear medical explanation.
Tips to get your claim approved:
- Get a current sleep study and CPAP documentation.
- Use buddy statements describing snoring, gasping, or fatigue during service.
- Ask a doctor to link your OSA to service factors (e.g., nasal obstruction, PTSD meds).
Example:
Iraq veteran with deployment buddy statements about snoring, ENT diagnosis of OSA, and pulmonologist nexus tying OSA to allergic rhinitis developed in service.
#4. Chronic Pain (post-Saunders v. Wilkie)
Why it’s hard:
Pain alone can now qualify as a disability if it causes functional loss—but most records fail to show that impact. Vague “pain 7/10” notes don’t prove functional impairment, and gaps in treatment weaken credibility.
Tips to get your claim approved:
- Document specific limits (lifting, walking, working, sleeping).
- Maintain consistent treatment and therapy notes.
- Get a provider to state your pain limits your ability to function normally.
Example:
Veteran with chronic low-back pain since rucking has no MRI diagnosis, but physician notes reduced range of motion, missed work, and explains functional loss tied to service.
#5. PTSD due to Military Sexual Trauma (MST)
Why it’s hard:
Most MST cases were never reported. Without police or command records, VA raters deny for “no corroboration.” The truth is, MST claims require behavioral markers—sudden changes in behavior, duty performance, or relationships—that indicate trauma occurred.
Tips to get your claim approved:
- Gather markers: transfer requests, counseling visits, sudden performance drops, or medical testing.
- Provide statements from peers, friends, or family about changes after the incident.
- Ensure your mental health provider connects those markers to your current PTSD.
Example: Female soldier’s record shows sudden disciplinary issues after an assault; therapist confirms these changes align with MST-related PTSD—service connection granted.
#6. Gulf War Undiagnosed Illness / MUCMI (CFS, Fibro, IBS)
Why it’s hard:
The VA often misinterprets the rules—denying claims because the symptoms seem “explained.” Many Gulf War vets also don’t realize they must have served in the Southwest Asia theater during specific timeframes.
Tips to get your claim approved:
- Confirm you served in a qualifying location and timeframe.
- Have your doctor say your condition is not fully explained by another disease.
- Show chronic symptoms lasting 6 months or longer.
Example:
Gulf War vet with years of IBS-like symptoms and fatigue; GI specialist confirms it’s a medically unexplained illness consistent with MUCMI—presumptive granted.
#7. Mild TBI Residuals Years Later
Why it’s hard:
Symptoms like headaches, irritability, and poor concentration often overlap with PTSD or depression. VA examiners frequently lump everything together, under-rating or missing cognitive deficits.
Tips to get your claim approved:
- Request a TBI-specific C&P exam with each DC 8045 facet rated separately.
- Include neuropsych testing and statements showing memory or focus issues.
- Document the original injury (LOD report, deployment note, or ER visit).
Example:
Veteran with 2011 IED blast, neuropsych results showing cognitive deficits, and neurologist nexus separates TBI residuals from PTSD—ratings granted for both.
#8. Non-Presumptive Toxic Exposures (outside the PACT Act)
Why it’s hard:
Without a presumption, you must build a direct nexus between exposure and disease. The VA often claims “speculative link” if you can’t show exposure frequency, dose, and medical backing.
Tips to get your claim approved:
- Prove exposure using MOS duties, logs, or environmental reports.
- Work with a specialist in occupational/environmental medicine.
- Cite scientific studies connecting your toxin and diagnosis.
Example:
Aircraft mechanic exposed to JP-8 fuel; expert cites Air Force study linking long-term jet fuel exposure to respiratory damage—VA grants service connection.
#9. Dental Claims for Compensation (not treatment)
Why it’s hard:
Most dental conditions qualify for treatment only, not compensation. Unless there’s bone loss from trauma or jaw damage, VA denies payment claims.
Tips to get your claim approved:
- Prove traumatic injury (accident, fall, combat wound).
- Submit dental imaging showing bone or structural loss.
- If not eligible for compensation, apply for Class I/II dental treatment benefits.
Example:
Training accident caused jaw fracture and tooth loss; X-rays confirm bone loss—veteran approved for dental compensation.
#10. Primary Alcohol/Drug Abuse vs. Secondary to SC Conditions
Why it’s hard:
Direct service connection for substance abuse is barred as willful misconduct. The only path is secondary service connection—showing PTSD, chronic pain, or depression caused or aggravated the substance use.
Tips to get your claim approved:
- File as secondary, not direct.
- Have a psychologist explain how your SC condition led to or worsened substance use.
- Claim the resulting medical issues (e.g., liver disease) as secondary disabilities.
Example:
Combat vet develops alcohol dependence as self-medication for PTSD; psychiatrist explains causation; liver disease approved as secondary to PTSD.
Conclusion & Wrap-Up: The Hardest VA Claims Aren’t Impossible
Yes, these claims are tough—but they’re winnable with the right evidence and approach.
Every denied claim I’ve seen comes down to one of three missing links: a clear diagnosis, an in-service event or aggravation, and a solid nexus tying them together.
Nail those three (the Caluza Triangle) and you’ve got a fighting chance.
The key is strategy, education, and medical evidence—the SEM Method.
If you’re stuck or underrated, don’t go it alone.
Learn the rules, gather your proof, and get expert help if you need it.
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About the Author
Brian Reese
Brian Reese is a world-renowned VA disability benefits expert and the #1 bestselling author of VA Claim Secrets and You Deserve It. Motivated by his own frustration with the VA claim process, Brian founded VA Claims Insider to help disabled veterans secure their VA disability compensation faster, regardless of their past struggles with the VA. Since 2013, he has positively impacted the lives of over 10 million military, veterans, and their families.
A former active-duty Air Force officer, Brian has extensive experience leading diverse teams in challenging international environments, including a combat tour in Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy and earned his MBA from Oklahoma State University’s Spears School of Business, where he was a National Honor Scholar, ranking in the top 1% of his class.
