I get asked this question all the time. Or what’s worse I get on the phone with a Vet who already has an appeal in. Either their claim was denied, or their claim was way underrated, and they thought their only course of action was to file an appeal.
Almost always that isn’t the case, and usually, there is a better way. Whereas most appeals can take years to win, most claims that are denied or underrated can be gained back in a matter of months if you understand the process and how to get a favorable rating.
Why do claims get denied?
Here’s the thing. There are two reasons claims are denied or underrated: lack of medical evidence and lack of a clear Nexus. This means that it is not clear to the VA how the Vets current symptoms are related to their time in service.
Let’s be honest. Military culture does not promote going to see the Dr. Most people will do the best they can to “soldier on” despite whatever pain they may be experiencing, hoping it will just go away. This is the reason why most Veterans’ military medical records are so empty. It just so happens though that medical records are the first place the VA is going to look when trying to determine the service connection component.
Did the injury occur while on active duty and is there a record of it?
Most claims are denied just because the VA could not find a record of the injury in the Veteran’s military medical records. This is one reason it is so important that you get a copy of your medical files and go through it with a fine tooth comb, so you know exactly what’s in them.
Veterans usually don’t understand how the VA determines compensation for a rated disability. This is especially the case with mental health claims like PTSD. Most Vets tend to focus on the incident itself, believing that it is the severity of the event that will determine the rating. However, this is not the case.
I’ve heard story, after story of Vets surviving horrific experiences to have the VA either deny or underrate their PTSD claim. I’ve personally worked with two Veterans who survived being blown up by an IED and were only rated at 10% for their PTSD. I’ve also worked with Vietnam Vets who survived helicopter crashes only to be awarded 30% their PTSD.
Of course, every one of these conversations went the same way. The Vet was pissed about being way underrated. They were probably also pissed because they’ve heard stories about Vets who went through way less and are rated way higher.
What’s so important to know is that the VA is not evaluating the severity of the INCIDENT. What they are evaluating is the severity of the SYMPTOMS. This is why having an evaluation from a board-certified psychologist and writing a strong Statement in Support of Claim are so important.
The same holds with physical symptoms. Take for example the Veteran who has a back injury and is no longer able to sit or stand for extended periods without being in excruciating pain. The Veteran is, of course, thinking about how much pain they are in, and how much their life has been impacted by this disability. They are no longer able to go on road trips or work without having to get up frequently. No longer able to enjoy the quality of life they used to and as a result feel depressed, angry and frustrated when the VA only gives them 10% for back problems. The Vet knows their symptoms merit a higher rating because they have to live with it, and they’re not wrong. However, they have not proven it.
What the VA is looking at, however, is the range of motion. The VA isn’t evaluating the pain, or the impact of the disability on your life–just range of motion. The truth is that the pain the Vet feels from the limitation and the effect on the Vets life is actually what is sometimes called a “lifestyle impact claim” or “chronic pain claim.” So what the Veteran needs to file for is a secondary claim under their physical limitation. And as always, they’ll need a diagnosis and an evaluation by a Dr.
The truth is, in almost every case you do not need to file an appeal and find yourself in a years-long battle with the VA. All you need is to open a “reconsideration” insider your eBenefits account and obtain “new and material evidence not previously considered.” This simply means seeing the appropriate doctors to get the proper medical evidence. Medical evidence is what wins VA disability claims, period.