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Guaranteed VA Disability Claims: How to Guarantee Your VA Claim Is Approved

Guaranteed VA Disability Claims How to Guarantee Your VA Claim Is Approved

Imagine this poll question: “The veterans who nobly serve our country, defend and protect our freedom, and spend time away from their loved ones while doing so deserve our respect and support after their military service comes to an end. Correct?”

For most people, this is an easy “yes.” However, the reality of how this plays out in America today is anything but easy. Disabled veterans are often left to deal with an extremely frustrating and time-consuming claims process with the Department of Veterans Affairs (VA). It can feel like an exhausting battle for many and this is a population of people who have already seen more than enough battle in their lifetime. We will take a look at some effective and proven ways to ensure VA disability claims are guaranteed, in an effort to alleviate this frustration and speed up a process that can be taxing on veterans, their families, and their caregivers. Before we get to those tips, we will review some of the basics of the VA and how it functions. We will explore where things have gone wrong and how we can work toward making it go right in the future. 

A Brief History of the Department of Veterans Affairs

Laws, regulations, and programs related to assisting disabled veterans date back to the 17th century in the United States. Even the Pilgrims at Plymouth Colony were concerned with the support of disabled soldiers, and this would carry on through the Revolutionary War, the Civil War, and others, right up through the start of World War I. In 1917, programs were established to ensure disabled veterans received compensation and care after the war, but three different Federal agencies administering the programs (the Veterans Bureau, the Bureau of Pensions, and the National Home for Disabled Volunteer Soldiers) made for a very confusing and ineffective setup.

Recognizing the need to gather all of these efforts under one umbrella, Congress established the Veterans Administration in 1930. The “VA,” which became the Department of Veterans Affairs in 1989, is responsible for nearly all of the federal benefits programs for veterans. It has three distinct administrations: The Veterans Benefits Administration (VBA), the Veterans Health Administration (VHA), and the National Cemetery Administration (NCA). They function as follows:

VBA: Programs include compensation, pension, rehabilitation, employment assistance, survivor’s benefits, life insurance, education assistance, and home loan guarantees

VHA:The country’s largest integrated health care system with more than 1,400 sites (clinics, counseling centers, domiciliaries, hospitals, and nursing homes)

NCA:Manages and maintains the VA national cemeteries and administers grants to establish state veteran cemeteries

In total, the VA employs more than 250,000 people and is the U.S. Government’s secondlargest cabinet-level department.

When Did Things Start to Go Wrong?

Scandal has rocked the VA for the entirety of its history and veterans have fought back against the administration for assistance owed to them, financial and otherwise. Poorly run and managed VA facilities have been at the forefront of these battles for years and scandals and controversies related to veteran care have been a massive blemish on America’s military history. Some of the most notable examples include:

1932: World War I veterans marched in Washington, D.C. to demand their promised war bonuses and end up being forcibly removed by Federal troops.

1940s: VA administrators Frank Hines and Gen. Omar Bradley are taken to task for poorly run facilities and programs.

1950s: a government reform commission exposes waste and poor quality of care in the VA.

1970s: Vietnam veteran Ron Kovic leads the charge to protest poor treatment of veterans in VA facilities. (Kovic also publishes his memoir Born on the Fourth of July, which is adapted into the 1990 Academy Award-winning film of the same name.)

1980s: A former marine commits suicide after firing shots at a Los Angeles VA facility and claiming his disabilities weren’t treated; VA director Robert Nimmo is pressured by veteran groups to resign.

1990s: A VA hospital in Chicago has most surgeries suspended after it is found that patient results were often ignored and unnecessary surgeries were performed, with the agency later claiming responsibility for eight patient deaths in the facility. A Los Angeles VA facility comes under fire for unethical research practices.

2003: A commission finds that more than 200,000 veterans waited six months or more for initial or follow-up treatment appointments.

2007: News reports reveal some senior VA officials received bonuses of more than $30,000, sparking outrage among veterans.

2011: An Ohio VA dental clinic comes under fire when nine veterans test positive for hepatitis after receiving dental care; the dentist reveals he never washed his hands or changed his gloves between patient visits.

2012-14: A doctor in a Phoenix VA hospital resigns after serving as the “whistleblower” on falsified wait times and a national scandal erupts; Senator John McCain later leads a town hall meeting to promote private treatment options for veterans.

2015: Wait times continue to increase after the 2014 scandal, and a Marine Corp veteran dies in a Wisconsin facility after being given a toxic mixture of drugs.

2018: Veterans Affairs Secretary David Shulkin is fired after allegations of misconduct and mismanagement.

That timeline is just the tip of the iceberg and sadly it seems there may be no end in sight to the controversies that have plagued the VA. Therefore, it can be hard for a veteran seeking disability benefits to fathom how an organization constantly besieged by scandal could be relied upon to be of service. However, it can be done! As with every organization, even among the bad apples, there are plenty of good ones, and knowing how to make the system work in your favor is important. There are proactive steps every veteran (and their family members) can take to try to maximize the support and assistance received from the VA, especially as it pertains to disability benefits.

VA Disability Claims: Getting Started

 

Filing a disability claim can be a long and complicated process. It can, in fact, be overwhelming for veterans already suffering from the side effects associated with a military service-related disability. Veterans already experiencing PTSD, depression, and anxiety have the added burden of trying to piece their lives back together after their time in service ends. They may be struggling with job placement or affordable housing; perhaps they are having a difficult time reconnecting with their family and friends after being away. Stepping back into “normal” everyday life can feel anything but normal for a veteran and this feeling could last a few weeks, a few months, or for the rest of their lives.

However, it is important to get started on a claim quickly if assistance from the VA is needed, and veterans should reach out to their family members for support in this process, be it moral support or having a trusted family member actually walk through the claims process and act as an advocate. If the veteran has any family members who are attorneys, this would be a very good person to call on for support! Not all claims or cases will need legal support, and it is also possible to receive free assistance from a number of veteran groups such as Veterans of Foreign Wars or the American Legion. Before starting the process, reach out to some of these organizations to determine how they can be of assistance in the claim-filing process (and in doing so veterans may discover other ways they can receive support from such organizations, beyond disability claims).

There is no filing time limit for disability claims, although the process may be a bit easier and quicker when claims are started before service ends. Active duty military personnel can start the process through a Benefit Delivery at Discharge (or BBD) program at their installation. In these cases, the individual will be examined before returning home and decisions are made about two months after duty ends. However, a veteran who has been out of service for some time can and should still submit a claim if it appears a condition relates to time in service and perhaps it did not surface immediately.

VA Disability Claims Getting Started

The best way to file the claim is online (https://explore.va.gov/file-claim), though there are also options to have a service organization file for you or to file via hard copies. For claims that are denied or those not granted 100%, there is also an option to file a disagreement. First, however, let’s get started on all the steps you need to take to try and hit 100% the first time!

Eligibility for Claims

Before filing claims, it is important to understand the eligibility requirements. In general, these guidelines apply to veterans seeking disability benefits:

  • Dishonorably discharged veterans are NOT eligible for VA disability benefits.
  • In order to be eligible veterans must have been considered active-duty.
  • Eligibility is also based on mental or physical impairments that are caused or worsened by service in the military.
  • Each branch of the military is eligible for veteran’s disability benefits (Air Force, Army, Coast Guard, Navy, Marines).
  • If National Guard/Reservists were activated by the Federal government, they may be eligible for veteran’s disability benefits as well. 

VA Disability Claims: How to Achieve 100%

The concept of achieving 100% is a fairly simple one: we all remember striving for a perfect score of 100 on a spelling test. And a veteran disability claim is one where the best outcome is also 100%…but what does that “perfect score” mean for the veteran?

Perhaps the most important thing to consider is the compensation level; the highest compensation comes with 100% claims, with veterans receiving almost $3,000 monthly from the VA if the claim is approved at 100%. Additionally, household benefits such as assistance with transportation may be provided, as well as housing, healthcare, education, and other benefits. The amount of money a veteran receives will be directly tied to the percentage/rating, which is assigned by the VA based on the veteran’s conditions.

Whether or not a claim is approved at 100% is based solely on the merits of the claim. The VA does not have a set limit on the percentage of claims that can reach this perfect score. And the claim is strengthened and supported by evidence, which is why veterans must be seeking treatment and the documentation that comes along with it.

Building a strong case is the best way to get a claim approved at 100% and there are a number of important steps that can be taken to get there.

1. Get organized! Think of your VA claim as you would think of filing your taxes: collect and store all of the important documents you need in an organized manner. Save everything: copies of medical records and bills, correspondence with physicians as well as the VA, and any possible evidence to support your claim. While you want to keep electronic files, it is a good idea to keep hard copies as well, and you might organize everything in a large binder that can be referenced easily, with documents organized in chronological order. In addition to medical records, keep a written “diary” of your condition and symptoms, and if possible secure “buddy statements” from people who served with you.

The bottom line is that filing a fully developed and fully supported claim will help your case. The more information you can provide, the better your chances of approval. So, save everything! The VA’s Fully Developed Claims program allows the veteran to submit all of the evidence and supporting documentation, which speeds up the claims process as the VA does not have to gather the evidence and/or seek records from private medical practices.

2. Submit a DBC! The Disability Benefits Questionnaire is one of the best tools available to you to ensure your claim is approved. The forms can be found on the VA website.

3. Get help! The VA may not recommend that you seek the counsel of an attorney, but it is not a bad idea if you are able to do so. If you do not use an attorney, consider reaching out to one of the aforementioned veteran groups for assistance. An appointed representative from a VA group can act as an ally; they are familiar with the disability claims process and can help other veterans navigate these complicated waters.

4. Know the Precedents and Know the Lingo! Even with the support of an attorney or a veteran’s organization, the veteran should still act as their own advocate, and this includes studying the claims process and the terminology used by the VA. Researching previous case law can lead a veteran to information that will support and bolster the claim.

My Claim was Not Approved at 100%: Is There Anything Else I Can Do?

Veterans may be discouraged if the disability claim was not approved, or not approved at 100%. However, there are additional steps that can be taken in these scenarios. The initial VA rating is not necessarily final and action can be taken to appeal the claim. This action must be taken swiftly! Veterans have one year from the date of the decision letter to file an appeal. And because the VA is already backlogged with claims, waiting to do this will only cause further delays. This is a time to act quickly!

When preparing to appeal the rating, consider these important steps:

  1. Don’t Go Back with the Same Evidence! Obviously, something did not work in your favor the first time, so be prepared to gather additional evidence to support your original claim. Remember that you can and should present supporting evidence from non-VA physicians. Unfortunately, many veterans assume the medical information must come from VA doctors only, and this is completely untrue. Your disability claim can, in fact, be bolstered by evidence from private-practice doctors. Reports from psychologists are particularly useful when the veteran appeal relates to a medical condition, and evidence from vocational experts can also support why a veteran may be unable to work.
  2. Revisit Buddy Statements. If you did not include buddy statements in your original evidence, try to add those now. These statements from fellow service members can work as incredible supporting evidence about specific instances in the line of duty that the VA may not be able to confirm in their own records. Their own records are not always accurate or even available and these supporting statements from those present during events where the injury occurred may be your best tool in the appeal.
  3. Make Connections. Think carefully and strategically about how certain physical conditions are connected and how this may not have been fully developed in your original claim. Here is one such example: perhaps your claim for PTSD was approved but not at 100% rating. The resulting anxiety and depression that have surfaced as a result of PTSD can be considered “service connected.” Another example is that a heart condition may be related to the PTSD and also considered “service connected.” Presenting a strong case that covers ALL of your service-connected health issues may help you improve your VA disability rating.
  4. Continue to Seek Treatment! The disability rating appeals process can be long and cumbersome—and this is taxing on veterans. However, continuing to seek the appropriate treatment is not only important as it creates continued evidence for your claim, but it is also incredibly important for your overall health and well-being. Reach out to your support system, be it family and friends or an organization for veterans. While you await the decision on your appeal it is important to seek support and treatment.
  5. Consider an Individual Unemployability Claim. If you are unable to work or have to work with specific accommodations, you may also be eligible for Total Disability Individual Unemployability Benefits (TIDU). This benefit pays the same as a 100% disability rating, but you will need evidence that you are unable to work or are specifically accommodate by an employer as it relates to your service-connected health conditions.

Final Notes on VA Disability Claims: Making Mistakes

The VA makes mistakes, as every organization does, and as illustrated by the earlier “scandal” timeline…they have made plenty! However, this does not mean you cannot successfully file a claim (or appeal one). Understanding a pattern of common mistakes may help you succeed.

When appealing a claim for a higher rating (or a claim that was denied), consider whether any of these common VA mistakes came into play with your own disability claim.

  1. Did the VA fail to provide a medical examination? There are some disability cases where the VA is required to provide you with a medical examination. This happens when there isn’t sufficient medical evidence in the file but there is evidence of a current disability, evidence that you experienced an injury while in service, and evidence that the event or injury may have caused the disability. If the VA failed to provide an examination, this may play into the appeal of your claim.
  2. Was the Medical Examination Inadequate? The medical evaluation provided by the VA is subject to certain requirements. One such example is the physician should be experienced and knowledgeable about the specific type of injury or condition. If you were not examined by someone with the appropriate skill set or background, this may be an error to call out in your appeal.
  3. Did the VA fail to help you obtain records? Even though there are options for filing fully developed claims with your own records, the VA is still required by law to help you obtain records. Provided you have given adequate information to the VA about when and where you were treated, they are obligated to obtain these records for you. If they failed in obtaining records, you will want to include this in your rating appeal.
  4. Did the VA fail to notify you of required evidence? If you can prove that the VA failed to notify you of required evidence, it can also be a basis for your appeal.

Whether you are preparing to submit the first claim, or appeal one that was denied or rated lower than 100%, the key points to remember are be prepared and be patient! A 100% rating is not out of the realm of possibility for you—but it may take some dedicated and consistent effort to get there.

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