VA claims can be confusing and even frustrating. One of our great VA contacts sent this quick guide that might help Veterans file a well-grounded claim.
A successful claim for service connected disability compensation normally contains all of the following components:
- An event, illness, injury, or hazardous exposure in service
- Evidence of a currently diagnosed chronic condition (or residual side effects of a chronic condition)
- A medical specialist’s evidence-based opinion linking the current chronic condition to the events in service
So, approaching the “What disability or chronic issue do I still have from service?” question is the first step. The application first asks for your current chronic disability. A chronic disease diagnosis usually involves confirmation of symptoms or limitations sufficient to identify the disease and that this condition has been affecting you over time. Acute (temporary or isolated) findings, undocumented complaints, and issues that happened in the past (but now have resolved) are less helpful in supporting your claim. Nonetheless, the application will want you to be as specific as possible so that we can most easily set up any necessary examinations and efficiently evaluate your claim. Suggestions to help in the disability section are:
- If you are claiming arthritis or a joint pain/condition, please be as specific as possible. You aren’t required to name the joint or procedure (e.g., “lateral collateral ligament sprain”), but it doesn’t hurt if you do.
- At the very least, please clearly identify what joint it is (shoulder, knee, hip, ankle, etc.) and if it is the left, right, or bilateral (i.e., both).
- If you are claiming a digestive issue, please be specific if you can. For example, is it intestinal? Reflux or stomach related? There are different specialist exams for each.
- If you are referring to the spine, “low back” may be sufficient because the lumbosacral spine is evaluated as one condition. But if you do mean the cervical spine (i.e., the neck), please clarify that or if you are claiming each separately. Degenerative disc disease may affect the lumbosacral or cervical spine, or both.
- Mental health disorders (like anxiety, depression, and PTSD) generally fall into the same category for evaluation. However, if you are stating that you have “sleep problems”, please first consider if your issue may be insomnia (inability to sleep), nightmares (may be a symptom of PTSD or another mental health issue), or sleep apnea (a respiratory issue where you stop breathing during the night) and choose the most descriptive condition so that we evaluate you for the proper condition.
If you are claiming an illness or injury from service and know approximately when it happened or began, please add that to the application. But please keep in mind that VA can grant service connection on additional bases other than direct (a chronic illness or injury happened while in uniform). If perhaps an existing service connected issue led to or aggravated another disability after service, that additional issue would be considered “secondary” to your existing disability. For example:
- Left hip as secondary to service connected left knee
- Right shoulder as secondary to left shoulder
- GERD as secondary to medication taken for service connected lumbar spine
Also note that all mental health conditions are usually rated together on the same schedule regardless of the assigned diagnosis, as the social and vocational impact on the Veteran is what is being evaluated. All symptoms will be used to evaluate the Veteran with the predominant condition assigned as the issue being rated, so that the Veteran may be awarded the most favorable evaluation. Further, if claiming PTSD or mental health concerns, listing each and every symptom (nightmares, anxiety, anger, relationship issues, sadness, depression, problems sleeping, suspiciousness, suicidal thoughts, etc.) is not necessary.
When we say, “hazardous exposure”, that could be to chemicals (Agent Orange, Camp Lejeune Contaminated Water, Gulf War or respiratory issues), asbestos (aboard ship or on land), or hazardous noise (tinnitus and hearing loss). This list is not all inclusive, but more information about hazardous exposure can be found here: https://www.publichealth.va.gov/PUBLICHEALTH/exposures/index.asp
A hazardous exposure claim must identify at least one chronic illness or disability. Simply being exposed to a substance or serving in a particular area is not a medical disability subject to service connected compensation. For your application based on hazardous exposure, please identify:
- The disability (asthma, ischemic heart disease, bladder cancer, etc.)
- The type of exposure, if known (radiation, Camp Lejeune Water, Southwest Asia / Gulf War, etc.)
- The dates you were exposed and/or how exposed (if known), as some exposure claims require confirmation of service in that particular area or how the duties you had in the military exposed you to that substance. The more information we have up front, the less delays we have in writing to you later, asking for this documentation.
Medical evidence is key to any successful claim. VA may be able to assist or obtain in getting records, but we need to know where to start looking. On your application it will ask if you have had any VA Medical Center, Department of Defense, or Military Treatment Facility care for your chronic disabilities. If known, the name of the facility (or at least the city where it is located) and the month and year you began treatment there (if known). If you have private (non-government) treatment records that you believe might help your claim, please submit them as well. It is notnecessary to have been treated by VA to have a successful VA claim. You may want to pursue medical treatment to get documentation and bolster the evidence, and it is absolutely your choice where to do so. VA just wants to ensure that we have the full picture regarding your claim before making a decision. VA can provide some assistance in obtaining private records, but we can process your claim much faster if you provide those records up front.
As mentioned at the beginning, an evidence-based link between the current chronic disability and military service must be established. VA will sometimes request this medical opinion as a part of developing your claim. However, if you can provide additional evidence from a medical professional up front, this also may be helpful to you. A nexus statement is a conclusion that a specialist in that field has prepared, saying that your condition is “at least as likely as not” (i.e., 50 percent probability or greater) that this issue is due to the documented onset in service or is as likely as not due to the already service connected disability. A good nexus statement refers to specific documentation of record that clearly shows how they arrived at that conclusion and does not require additional clarification.
Sometimes Veterans want to revisit or reopen a previously denied claim. The modernized appeals system took effect on February 19, 2019 and provides streamlined choices for seeking review of your VA claim decision.
If you were notified of your prior decision longer than one year ago,
- The Decision Review Request: Supplemental Claim, VA Form 20-0995 would be the appropriate form to use
- Requires either new and material evidence to reopen the claim, or you are claiming the issue on a new basis (i.e., you were previously denied a condition on a direct basis, but are now filing as secondary to an already service connected issue, and this has not been claimed before)
- The form and information about the Supplemental Claim can be found here: https://www.va.gov/find-forms/about-form-20-0995/
New evidence is records not previously considered by VA decision-makers. Relevant evidence means evidence that tends to prove or disprove a matter at issue in a claim. New and relevant evidence might pertain to the previous reason/s a claim was denied, another basis for service connection, or may otherwise change a previous VA decision in your favor.
If you wish to have a Decision Review Officer review the claim, you may file a Decision Review Request: Higher-Level Review (HLR).
- You must have been notified of the decision you want reviewed less than one year ago
- Instead of submitting new evidence, a HLR is only concerned about the evidence used to file the claim in question. No additional information can be used to change the prior decision because the HLR ensures that the decision was proper (given the exams and evidence of record), considering if all development VA is required to do was completed, and if all laws or issues within scope were applied
- The VA form 20-0996 would be appropriate; obtain this form and additional information about higher level reviews here: https://www.va.gov/find-forms/about-form-20-0996/
Please also note that if you are simply filing for an increased evaluation of an existing disability or wish to add new issues that have not been filed before, a VA Form 21-526EZ would be the appropriate application to use. That form and more information about disability claims may be found here: https://www.va.gov/find-forms/about-form-21-526ez/
Of course, there are other benefits and programs that may be useful. We encourage you to explore more at our website, https://www.va.gov/service-member-benefits/
Thank you for your service.