How the VA Disability Claims Process Works

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If you are a veteran suffering from a medical condition that was caused or aggravated during your period of active duty in the military, you may qualify for benefits under the Department of Veterans Affairs’ VA Disability Compensation program. The program was established to ensure that veterans obtain the compensation they deserve after suffering injuries or illnesses contracted during their service to our country. However, filing a claim and obtaining benefits can be complicated for those unfamiliar with the process and how disability payments are awarded. An experienced veterans’ disability attorney can assist you with filing the proper paperwork and establishing your claim, but some general information should be helpful as background on how VA disability claims work.
VA Disability Claims Process: When seeking VA disability benefits or increasing the amount you currently receive, you begin the process by filing a claim.
Filing the Claim: You can file your claim for VA disability benefits online at eBenefits; this is also the website where you can manage your benefits and medical records. If you prefer, you can also submit your claim by mail or in person at the VA regional office. The claim application, along with your military service and health care records, and any other paperwork related to the claim are reviewed by the regional office officials to provide a rating determination.
Service Connection: When reviewing your claim for VA disability benefits, officials look to a complex set of laws, regulations, and court case decisions to determine issuance of benefits. After applying all relevant regulations to the facts of your claim, the VA will provide benefits and pay disability compensation if the evidence establishes three things:
The injury, illness, or other medical condition occurred during your military service;
You are suffering from a current disability due to the injury, illness, or other medical condition; and,
A verifiable link, usually proven through medical records, exists between the condition and your current disability.
Establishing a direct service link is relatively straightforward if you were diagnosed with a medical condition during service. However, proving a service connection may require additional proof in certain cases:
Aggravated Service Connection: When you have a condition before entering the military, and it worsens during service, you may be able to establish an aggravated service connection.
Presumptive Service Connection: For certain medical conditions, there is a presumption of service connection where you have served at least 90 days. These include injuries resulting from time spent as a prisoner of war, certain cancers, diseases contracted from service during the Gulf War.
Secondary Service Connection: If you are eligible for VA disability benefits arising from an injury or illness and that condition causes another health issue, you may claim a secondary service connection. Examples would be a leg injury that causes chronic knee pain or a cancer that spreads to another part of your body.
In addition, there are special rules for the service connection when you suffer from Post-Traumatic Stress Disorder. For PTSD, you must provide a statement about the traumatic event that occurred during service and obtain a written opinion from the VA psychologist or psychiatrist that the event was the stressor that caused the condition.
Determining Your Claim: VA Schedule of Rating Disabilities: Once the service connection is established by the VA, officials will re-examine the medical evidence and assign a level under the VA Schedule for Rating Disabilities.
The rating assigned to your case is an indication of the severity of your disability and how much your condition impacts your ability to make a living. This figure is used to establish the amount of the disability payment intended to compensate you for losses incurred as a result of your military service. In general, the lower rating indicates a less serious condition and higher figures are assigned to more severe disabilities.
How the VA Schedule of Rating Disabilities Works: The ratings are based on the average impact a disability has on earning capacity in civilian occupations, and they range from 0-100 percent. The Schedule breaks different medical conditions down into categories based upon the parts of your body affected; it further divides these categories into separate medical issues, along with the diagnosis, code, and symptoms.
Assigning the Rating: To determine your disability rating, a VA official will start with the body system category and locate your diagnosis. Then, he or she will review medical evidence to identify the diagnostic code in the Schedule that matches your symptoms.
Multiple Diagnostic Codes: If your medical disability is closely related to more than one code, you will only be rated and paid for one code. However, the VA official must identify the code that will give the highest rating – and highest amount of disability payment.
Errors in Assessing the VA Schedule of Ratings Disabilities: The Schedule is complicated, and the medical records that typically accompany a claim for VA disability benefits are voluminous. These complexities can lead to errors as VA officials attempt to review your matter, determine service connection, then assign a rating to your disability. An agent may not apply the rating criteria properly, or assign a rating that you feel is too low for your condition.
If you disagree with the VA on any aspect of your claim, you have one year to file an appeal. The basis for your appeal may be based on the assigned rating, effective date of your award, or the denial of your claim. It’s wise to have an experienced veterans’ disability lawyer review your case, assist with your appeal, and represent you through the appeals process.
As you can see, the process for filing a VA disability claim can be challenging. Initially, you’ll need to establish the service connection between your medical condition and your time in the military. Even after overcoming this first step, you must also provide sufficient evidence to ensure an appropriate rating on the VA Schedule of Ratings Disabilities to obtain disability payments. Plus, if your claim is denied or you believe a rating was issued in error, you’ll need to appeal the findings. Having a qualified veterans’ disability attorney to represent your interests greatly increases your chances of being awarded a disability benefit that’s appropriate in your individual case.
J. Robert Surface is a lawyer with more than 36 years’ experience in serving the disabled, including veterans seeking disability benefits. He knows the laws and regulations governing VA disability matters, and has an extensive background in the filing and appeals process. Please contact our office today to schedule a free consultation, or with any questions.