Receiving a denial for your VA disability claim can feel like a total gut-punch, leaving you angry, stuck, frustrated, underrated, and unsure of what to do next.
I know because I’ve had it happen to me multiple times and I have helped thousands of other veterans overcome denied VA claims.
The good news is that you have options to challenge the VA’s rating decision and potentially turn a denial into an approval.
In this article, VA disability expert Brian Reese breaks down the top 15 reasons why the VA might have denied your claim and what you can do to fight back legally and ethically.
With the right VA claim strategy and medical evidence, you can turn a setback into an opportunity and potentially get your claim approved faster!
Without further ado, let’s begin!
Table of Contents
Summary of Key Points
- VA Claim Denial Isn’t the End: A VA disability claim denial can feel overwhelming, but it’s not final. There are options to appeal and challenge the VA’s decision to potentially turn a denial into an approval.
- Common Reasons for Denied VA Claims: VA disability expert Brian Reese outlines the top 15 reasons claims are denied, such as lacking a current diagnosis, no nexus for service-connection, no symptoms, insufficient medical evidence, missed deadlines, etc., explaining why these denials occur and how to avoid them.
- Strategic Action Steps After a Denial: Key actions include reviewing the VA rating decision letter, choosing the right appeal option (Higher-Level Review or Supplemental Claim), and ensuring medical evidence is complete and accurate.
- Be Proactive, Prepared, and Don’t Give Up: Thorough preparation and gathering all relevant evidence are crucial to overcoming a denial and successfully navigating the VA claims process. And don’t ever quit! There’s always another option if you’re willing to fight back.
Top 15 Reasons Why the VA Denies Disability Claims
Here’s a list of the 15 top reasons why the VA denies disability claims, along with why it can happen and how to avoid it:
1. No Current Diagnosis in a Medical Record
Why It Can Happen: The VA requires a current diagnosis to consider a disability claim. If a veteran does not have a formal diagnosis from a healthcare provider, the claim is likely to be denied. It is not enough to simply report symptoms; there must be an official medical diagnosis documented in the medical records.
How to Avoid It: Ensure that a licensed healthcare professional has diagnosed your condition. Obtain medical records that explicitly state the diagnosis, and submit these with your claim. Keep your medical records updated, especially if you are receiving ongoing treatment.
2. No Nexus for Service Connection
Why It Can Happen: A “nexus” is a clear link between the current disability and military service. If the evidence does not adequately demonstrate that the condition is related to or was aggravated by military service, the VA may deny the claim.
How to Avoid It: Provide a detailed nexus letter from a qualified healthcare provider that explains how the disability is linked to your military service. Include service treatment records and any incident reports that support the connection.
3. No Evidence of Severity of Symptoms
Why It Can Happen: The VA needs evidence showing the severity of symptoms to assign an appropriate disability rating. If the impact of the condition on daily life, work, or social functioning is not documented, the claim may be denied or rated too low.
How to Avoid It: Submit lay statements from family, friends, or coworkers who can attest to the impact of the condition. Include medical records that detail the severity of symptoms, as well as any work or life activities that are limited by the condition.
4. Lack of Sufficient Medical Evidence
Why It Can Happen: If the medical evidence is incomplete, outdated, or does not adequately demonstrate the existence or impact of the condition, the VA may deny the claim due to insufficient proof.
How to Avoid It: Compile all relevant medical records from both VA and private healthcare providers. Ensure these records are comprehensive and include documentation of the diagnosis, treatment history, and progression of symptoms.
5. Missed Compensation & Pension (C&P) Exam
Why It Can Happen: If a veteran fails to attend the scheduled C&P exam, the VA may deny the claim because it lacks the necessary information to evaluate the disability.
How to Avoid It: Attend all scheduled C&P exams, or reschedule them promptly if you cannot attend. Be prepared for the exam by knowing your medical history and discussing how your condition affects your daily life.
6. Pre-Existing Condition Without Aggravation Evidence
Why It Can Happen: If a condition existed prior to military service and there is no evidence showing that service worsened the condition, the claim may be denied.
How to Avoid It: Provide evidence demonstrating how military service aggravated the condition. Include before-and-after medical records that show a worsening of symptoms during or after service.
7. Condition Not Considered a “Disability” by VA Standards
Why It Can Happen: Some conditions may not meet the VA’s criteria for a compensable disability. For example, conditions considered temporary, mild, or not disabling enough may not qualify.
How to Avoid It: Review the VA Schedule for Rating Disabilities (VASRD) to confirm that your condition is recognized as a compensable disability. Submit detailed medical documentation and, if possible, get a medical opinion on how the condition affects your daily life.
8. Insufficient Evidence for Secondary Service Connection
Why It Can Happen: Secondary service connection claims require evidence that links a secondary condition to an already service-connected disability. Lack of proof of this relationship can lead to a denial.
How to Avoid It: Provide a medical opinion or a nexus letter from a qualified professional that clearly explains how the primary service-connected condition has caused or aggravated the secondary condition. Include medical records and treatment notes that show the relationship between the two conditions.
9. Disability Ratings Do Not Meet Minimum Requirements
Why It Can Happen: The VA assigns ratings based on the severity of a condition according to specific criteria in the VASRD. If the symptoms do not meet the minimum criteria, the VA may not assign a compensable rating. Note: the VA might still assign a 0% service-connected rating for the condition; however, it’s non-compensable at this level.
How to Avoid It: Make sure to submit detailed medical evidence showing the full extent of your symptoms. Highlight any limitations or restrictions caused by the condition that negatively impact your work, life, and social functioning.
10. Claims Filed After Separation Without “Continuity of Symptomatology”
Why It Can Happen: If there is a significant gap between the time of military discharge and the date of filing the claim, and there is no documented evidence of ongoing symptoms, the VA may deny the claim.
How to Avoid It: Provide evidence of continuous symptoms or treatment since separation, such as medical records, prescription histories, or statements from healthcare providers. Lay statements from family or friends who observed the symptoms over time can also support your claim.
11. Failure to Establish a Valid Theory of Service Connection
Why It Can Happen: Service connection is a fundamental requirement for VA disability compensation. If the claim lacks sufficient evidence that the condition is linked to military service, it will likely be denied. Note: there are five types of service connection for VA disability benefits.
How to Avoid It: Submit military service records, incident reports, buddy statements, and medical records from your time in service to establish the connection between your condition and military duty. If you’ve been out of the military for more than 12 months, get a Nexus Letter!
12. Missing or Incomplete Information
Why It Can Happen: If there are gaps or missing details in the claim application, the VA may deny it. The application must be thorough and include all relevant information.
How to Avoid It: Carefully review your application for completeness. Make sure to fill out all sections and attach supporting documents, including medical records and service records. Consider consulting with a veteran’s service organization to review your application.
13. Missed Deadlines
Why It Can Happen: The VA operates on strict deadlines for submitting claims, appeals, and additional evidence. Missing a deadline can result in an automatic denial.
How to Avoid It: Keep track of important dates and set reminders for deadlines. If you cannot meet a deadline, notify the VA as soon as possible to request an extension or submit a supplemental claim.
14. Bad C&P Exam
Why It Can Happen: A bad C&P exam can lead to denial if the examiner concludes that the condition is not severe enough or is unrelated to military service.
How to Avoid It: Prepare for the C&P exam by being knowledgeable about your medical history and the ways your condition affects you. Submit additional evidence if the C&P exam results are unfavorable, and consider requesting a second opinion. Call 1-800-827-1000, speak to a VA representative, and request a new C&P exam.
15. Inconsistency in VA Claims
Why It Can Happen: If there are discrepancies between your service records, medical documentation, and statements on your application, the VA may deny the claim due to uncertainty about the condition’s origin or severity.
How to Avoid It: Ensure consistency in all documents and statements submitted. If there are discrepancies, provide a detailed explanation or supporting documentation to resolve the inconsistencies.
By addressing these common reasons for claim denials, veterans can significantly improve their chances of successfully obtaining VA disability benefits.
Being thorough, organized, and proactive in gathering evidence and documentation is key to navigating the VA claims process.
Action Steps to Take After a VA Claim Denial
Step #1: Review Your VA Rating Decision Letter
The first step after a denial or underrating is to review your VA rating decision letter in detail.
Pay particular attention to the reasons for decision and evidence reviewed sections.
A VA rating decision letter is a document prepared by the VA Rater that formally explains the VA’s rationale for approving, denying, or deferring your VA disability claim.
Your VA disability rating decision letter includes the VA’s final rating decision and analysis as well as WHY and HOWthe VA Rater and C&P examiner arrived at their opinions and conclusions for your VA claim.
In my opinion, it’s the #1 most important document you’ll ever receive from the VA!
Step #2: Decide Your Best Appeal Option
The second step is to decide your best course of action to appeal the denied or underrated disability claim.
If you had all the right medical evidence, but still got denied due to an error or you want a second opinion, you should file a VA Higher-Level Review (HLR).
If you didn’t have all the right medical evidence, and want to add new and relevant evidence not previously considered, you should file a Supplemental Claim.
If your Higher-Level Review (HLR), Supplemental Claim, and HLR of your Supplemental Claim are denied, you should consider a records-only Board Appeal.
Step #3: Review Your Medical Evidence
The third step before filing an appeal on your denied VA claim, is to review the medical evidence you submitted with your original claim.
Match what you submitted with the evidence reviewed in your VA rating decision letter – make sure it’s accurate and consistent.
This is also a good time to ensure you provided the VA with a current diagnosis in a medical record, a nexus for service connection, and evidence of your severity of symptoms and negative impacts to your work, life, and social functioning.
If anything important was missing from your original claim, file a Supplemental Claim with the new and relevant evidence not previously considered.
Step #4: File Your VA Appeal Online
The final step to challenge a denied or underrated VA claim decision is to file your VA Higher Level Review (HLR) or Supplemental Claim online.
Friendly reminder that you can’t submit new and relevant evidence with a Higher-Level Review (HLR), but you can with a Supplemental Claim.
After submission, be proactive, patient, and don’t ever give up!
The VA claim process isn’t over unless you quit.
There’s always another option if you’re willing to fight back.
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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.
