This post is a bit of first hand experience and lessons-learned about applying for and appealing a VA Disability claim during the process of helping a family member (whom we’ll call “Joe” for these purposes) through the VA Disability claims application process. Like everything “government” the application process is a hot mess, muddled with confusing information and lots of paperwork. Hopefully, this will help you glean a little more real-world information than what you’ve read off of other websites. As such, everyone’s situation is different, and this information is provided only as anecdotal reference and you should decide for yourself how best to proceed.
Organize Your Claim Or Prepare Your Appeal
We’ve created a Google Sheets spreadsheet to help you develop your VA Disability claim, as well as audit/review a denied claim. It is organized to gather the information you will need both for applying as well as appealing a VA Disability claim.
The spreadsheet has 4 separate sheets. Entries into one sheet are used to pre-fill entries in other sheets.
- Detailed disability worksheet (this sheet helps you develop your claim – or appeal)
- the VA Disability form does not have a lot of room to submit your answers. You can take the information you entered on this sheet and paste it onto a supplemental form to include with your application or appeal.
- Claim File Audit Sheet (this sheet organizes your medical conditions, let’s you check which evidence is being submitted, and documents the criteria listed for denials)
- Evidence Audit (this sheet allows you to enter the evidence you submitted and compare it to the evidence the VA obtained and used in their decision; used to identify discrepancies)
- Checklist (this sheet allows you to create your to-do list, track document requests, and other items)
VA Disability Worksheet
Here is the link; you’ll be prompted to make a copy for yourself for editing purposes.
Here is a link to preview the VA Disability Spreadsheet template
If You Haven’t Already…
If you are eligible, sign up for https://www.myhealth.va.gov/
On the VA’s website, you can view your medical history for any conditions that were treated by the VA. You can also add an unlimited amount of medical information under the Track Health portion. This is a great way to organize medical events or treatments you received outside of the VA. By enabling their Blue Button, you will be able to view detailed medical information, review notes, see detailed test results, etc.
If you aren’t eligible to sign up on the VA’s health website yet, begin creating a spreadsheet to track all your medical information, doctor’s names and addresses, lists of medications, etc.
Criteria To Consider Before Applying
When you submit your claim and list your medical conditions, the VA reviews your application and specifically looks for 3 things for each and every medical condition you are claiming:
- Is there evidence that the medical condition is service-related?
- Is there medical evidence to prove the medical condition exists?
- Is the medical condition severe enough to classify it as a disability?
- Is there evidence that the medical condition is service-related?
Number 4 is intentionally a duplicate of #1. This is because it is the most important part of your claim. You may have a debilitating medical condition, but if you can’t supply evidence that your condition is a direct or indirect result of your military service then it’s not the VA’s problem and you might possibly be denied. As stated further down this page, you should explore all possible theories as to how a service-related incident caused or contributed to your medical condition in your application.
Being honest and not exaggerating is the best policy. You’ll rarely be able to prove a false claim, or a disability that occurred outside of military service.
But what if minor problems you experienced while in service but didn’t get checked while in the military are now interfering with your medical quality of life post-service? That was “Joe’s” situation. He spent 10 years working on jets both on aircraft carriers and on airfield bases.
Everyone in his crew experienced the same issues/exposure to fume and noise everyday and nobody complained; so why would he? He made a vague reference to a few of the issues in his military separation medical checklist, but nothing specific. It wasn’t until a few years after his separation that he was officially diagnosed with mild COPD, hearing loss, etc. For the next 10 years he continued to receive treatment through private health insurance for his conditions as they worsened, but he never connected it to his military service. It wasn’t until he lost his health insurance after becoming too sick to work, and went to a VA Hospital for medical care that a VA doctor asked him (after reviewing his medical history) why he hadn’t applied for VA Disability.
Research, Research, Research
Every case is different. Thanks to the internet, there are endless ways to get specifics related to your unique claim and each of your claimed medical conditions. It can’t be stated enough: you should explore all possible theories as to how a service-related incident caused or contributed to your medical condition in your application.
Online Disability Forums
There are many online forums where people exchange information and share advice about their experience during their VA Disability process. Read those first to get a better idea of what will be involved for your specific medical conditions. Most specifically, read the reasons they were denied or approved for similar medical conditions. Through those denials and approvals, you will learn what you will need to prove your own case.
Take time to review the actual VA Disability claim application to get an idea of what information you will need to provide.
Another good resource to prepare for filing your claim is by reading up on VSO training manuals. These are manuals that Veteran Service Officers use when assisting veterans in filing for and appealing their VA Disability claims. Different chapters of the VSO training manuals can be found online through searches.
Previous VA Board Of Appeal Decisions
You can search the VA’s Board of Appeals records to see how claims for specific conditions were addressed on appeal, such as hearing loss. It’s a great resource for identifying what evidence the board relied on to reach decisions and how that evidence was used to form their decision. https://www.index.va.gov/search/va/bva.jsp
The Board of Appeals opinions provide a great deal of insight as to what information they have accepted as evidence and what is required to prove a service-related condition.
Here is a link to a positive board decision related to an appeal regarding kidney stones. It details what specific evidence was used to formulate the board’s decision.
Your Military Service Record
While your researching medical conditions related to your VA Disability claim, it’s also a good idea to created a detailed list of your military service. When and where were you stationed, how long where you deployed, what was your job title, what were your specific duties, and any significant events that occurred.
These might jog your memory to help you identify how a medical condition is service-related.
(see more below)
What Medical Conditions To List Your On Your VA Disability Claim Application
Generally speaking, you should list all your medical conditions. Why? There’s a chance, however slim, that something that you don’t think is service-related may be a by-product of another medical condition that is service-related. You just need to be prepared to explain how each medical condition is service-related or how it developed subsequent to another service-related medical condition.
Let’s say you get approved for two medical conditions, but get denied for a third condition, if you appeal and are later approved, the approval for the third condition will be back-dated to your original claim application date.
When you list your medical conditions, list them using the exact terminology that is used in your medical records. You may have high blood pressure, but your medical records probably indicate you are diagnosed with and are being treated for hypertension. Use the exact wording as it appears in your medical records or other evidence.
You’ll Probably Get Denied For A Medical Condition If…
If it has been more than one year since your separation and you are claiming disability for a condition that does not exist in your military service or military medical records AND the condition is not considered a presumptive condition based on service, you will possibly get denied.
The exception to this is if you provide enough supplemental evidence to prove the condition is service related. By submitting buddy letters, medical opinions, and citing recent medical studies, you just might be able to demonstrate the condition is tied to your military service. More on this further down the page, including the Other Evidence section.
The Ten Most Common Service-Related Disabilities Claimed in 2019*
Just for reference, here are the 10 most common service-related disabilities that were claimed in initial applications for 2019.
- Limitation of flexion, knee
- Hearing loss
- Lumbosacral or cervical strain
- Limitation of motion of the arm
- Scars, burns (2nd degree)
- Limitation of motion of the ankle
- Post-traumatic stress disorder
- Paralysis of the sciatic nerve
Be Prepared To Explain How/Why A Medical Condition Is Service-Related
“In order to prevail in a claim for service connection there must be medical evidence of a current disability as established by a medical diagnosis; of incurrence or aggravation of a disease or injury in service, established by lay or medical evidence; and of a nexus between the in-service injury or disease and the current disability established by medical evidence.”
The previous statement means:
- You need medical evidence proving you have a medical disability
- You need evidence demonstrating that you were injured or exposed during service
- You need something that ties #1 and #2 together; something that says your disability (#1) was directly or indirectly a result of something that happened or worsened during service (#2)
Again, when you list all your medical conditions, provide a very specific explanation of why you believe each one is service-related. They do not give you much room on the form to provide answers, so use Form 20-0995 to provide additional information as necessary. If you have military medical records that confirm the medical issue, reference those (where/when) in your answer. If your military separation medical exam references any of the issues, make sure to point that out too. Never assume that the VA will connect the dots for you.
The best approach is to pose each answer or explanation of how your condition is service-related as if you were responding to a VA denial due to lack of specific evidence. If you are listing that deployment was a contributing factor to your hearing loss, consider this: “We have denied your claim for service-related Hearing Loss due to deployment“.
In a denial letter for this claim, the VA acknowledged the veteran had a medically diagnosed disability, they acknowledged that he had a high probability of noise exposure due to his military occupational specialty, but that there was not enough evidence to link his hearing loss to his military service due to the amount of time that has passed since his separation.
What they are saying is “Sure, you have a disability, and yes, you were exposed to hazardous noise levels while in the military. But you didn’t seek treatment for it while you were in the military, and you’ve been separated for a few years, so maybe something caused it after you left service.”
If you’ve done your research, you would have discovered that there is a Duty MOS Noise Exposure Listing that breaks down the probability of hazardous noise exposure based on your military job description.
Let’s say you were an aviation electrician who worked aboard aircraft carriers during 2 deployments. Instead of just listing “deployment” as your reason for exposure, you might rephrase your explanation of how your hearing loss is service-related to:
“As an aviation electrician, I had 12 cumulative months of hazardous noise exposure (MOS rated as ‘highly probable’) while deployed and working on F14 jets on the flight deck aboard aircraft carriers. I had an additional 15 months of hazardous noise exposure working on F-14s on the flight line at air station. At the time of my separation, I documented that I believed I might have some hearing loss, which has progressed over the years to now require hearing aids. My post-service career as an electrician has not exposed me to hazardous noise levels nor have I worked in a profession requiring ear protection due to hazardous noise. “
Provide Specific Details
Whenever possible, include reference to any presumptive exposures, how you were exposed, and for how long you were exposed. If it was related to a single incident or injury, be very specific on when and where it occurred. You should explore all possible theories as to how a service-related incident caused or contributed to your medical condition. This includes if you believe one service-related medical condition contributed or caused another medical condition.
Rule Out Other Causes
If you’ve passed the one year post-service time limit on claiming a service-related disability, you should include commentary that explains that you were not exposed to conditions or events that could have caused the condition post-service. Similarly to the flight deck noise exposure example above, here you would (for example) explain that post-service you worked in an office environment and had no additional exposure to hazardous noises.
If you don’t provide enough detail or evidence to prove that the medical condition is service-related, you’ll either get denied for that medical condition or have to go to a C&P exam (Compensation & Pension exam), where a doctor that has never met you and does not know your military service-related work or medical history will decide whether they think your medical condition is service-related.
The exception to this is if your condition is designated by the VA to be a presumptive disability; a medical condition that is presumed to be caused by military service. This also includes a range of illnesses that are diagnosed within one year of separation.
VA regulations provide that where a veteran served continuously for 90 days or more during a period of war or after December 31, 1946, and specified diseases, such as calculi of the kidney become manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C.A. §§ 1101, 1112 (West 2014); 38 C.F.R. §§ 3.307, 3.309 (2015).
Your Medical Records
When you apply for VA Disability, you will be asked to list VA medical providers that can substantiate your medical conditions and treatment received. The VA states that you don’t have to submit your actual medical records; that they will acquire these records on your behalf. Be sure to also include a list of all private medical providers.
The VA says they’ll get any records you list, but what if they don’t? What if one of your private doctors doesn’t respond to their request and never sends your records? Or your doctor retired from private practice. Or your records never reach the right person? If your doctor charges for copies of medical records, the VA won’t get those either. In “Joe’s” case, 6 months into the process he received notice that the VA didn’t have the money to get half of his medical records.
You would think that you shouldn’t have to worry about getting your in-service medical records from your military service, that the VA would automatically get those. Well, you’d be wrong. In Joe’s case, the VA only got his VA Medical Facility treatment records and a portion of his private medical treatment records. There were no medical records while he was deployed at sea.
Get Both Your In-Service AND Private Medical Records
Take time before you apply to get a copy of as many of the medical records related to your claim as you can. You can speed up the process of your claim by submitting your own evidence along with your application. Doctors often include notations of discussions with patients in their medical records.
There’s a possibility that something in those records might jog your memory, such as mentioning to your doctor that you first began experiencing symptoms during training or on your first deployment.
If you are claiming a condition that you haven’t received medical care for yet, you should absolutely go see a doctor before applying. When you see a doctor, be sure to specifically mention that you feel this medical condition is a result of your military service.
In addition to looking at your medical records to see if there is a service-related connection, they will also be looking to see if the medical records attribute your condition to another cause. For example, if you are claiming a back condition but your medical records only show the diagnosis occurred after separation due to a motor vehicle accident then proving a service-connection will be difficult. For certain conditions such as hearing loss, it’s a good thing to describe how your career post-service did not expose you to hazardous noise levels.
Your Military Service Records
To get a copy of your service records, visit https://www.archives.gov/veterans/military-service-records/standard-form-180.html and click the vetrecs.archives.gov link at the top of the page to access and complete Form 180 online. Depending on the records you request, it can take 10-20 days for the request to be processed. At a minimum, you should request your Personal Military History, Military Awards/Decorations, and Medical. If you want your entire Official Military Personnel File, make sure to state this in the Comments box in Step 3 of the form.
The VA will also obtain and review your military service records in evaluating your disability claim. This could include performance records and any details related to your duties. Do not take for granted that the VA will receive or review every record, and do not have an expectation that they will draw a service-related connection to a medical disability. You need to connect the dots for them, and clearly identify connections in your application or appeal. Getting and reviewing your records will help you with establishing specific events and dates.
Depending on the length of your military service, there may be many situations that you no longer remember. Reviewing your service records may help jog your memory.
Some records that might contain the missing link that connects you to a location or event that caused or contributed to your disability might include:
- Letters of appreciation
- Incident reports
In addition to medical records, you can submit supplemental evidence to substantiate your claim.
Layperson/Buddy letter – the VA considers a buddy letter as supplemental evidence submitted by a layperson. Use form 21-4138 to submit a buddy letter. The buddy letter can detail the progression of your medical condition as observed by the person submitting the letter, or link your medical condition by attesting to a situation or event during your military service. Maybe a former military co-worker saw you get injured, or was exposed to the same conditions as you, or can attest to a specific event that contributed to a medical condition while you were in service.
The person that is writing the letter has to be “competent” in the information they provide. This means that they can speak to things they observed, conversations they had with you where you spoke about an accident or incident or just vented about your medical condition, or a shared situation or exposure. What they can’t do is draw conclusions or make a diagnosis (unless they are a board certified physician). Your parent or spouse might write about the symptoms they’ve observed over time or that you’ve told or written to them.
Anyone who might have some relevant knowledge can write a buddy letter on your behalf. Your pastor might reference relevant conversations he had with you about your time in service. Your spouse might remember conversations with you while you were deployed and any changes they observed in you after military separation.
Nexus letter – You can get a doctor to write an opinion letter, a nexus letter, that details the severity of your medical condition after examining you and your medical records, and opines that your condition is at least 50% likely to have been caused by your military service. Having your doctor that is currently treating you write this letter is ideal. But you may have to find a doctor who specializes in your condition and has experience in providing expert witness consultations reviews, an who will review all your medical records; naturally, all of this will cost you money.
Medical Journals/Scientific Studies – OSHA, the CDC, the VA, the NIH, and scientific journals provide study-based data related to hazards for a variety of occupations.
These studies may contain data that supports or reinforces a theory of how a condition is service-related.
Speaking Of Evidence…
Because a high percentage of VA Disability claims get denied the first time around, you will want to have a plan should you get denied.
If you get denied, it’s likely because you didn’t make a strong enough case as to why a medical condition is service-related. Maybe your explanations were vague or the evidence the VA was able to acquire was insufficient. Don’t assume that the people reviewing your claim will connect the dots. They are just trying to get through their backlog of cases and can miss details.
If you get denied, you have 3 avenues of appeal. The easiest is to file a supplemental claim appeal. In order to file a Supplemental Claim, you have to provide evidence that is new (evidence that was not provided to VA previously) and relevant to your case. This is your chance to fine-tune your explanation of how your medical condition is service-related; but you can’t just expand on a previous explanation. You have to include some type of new evidence. Remember Explain How/Why A Medical Condition Is Service-Related from above?
Just rewording your explanations will probably not be enough because it might not be considered new evidence and could result in an instant denial. What type of new evidence would you be able to submit in the event you are denied? Some possibilities include:
- Submit medical records for treatment you have been receiving since the denial.
- A buddy letter
- A medical nexus report
- Medical or service records the VA was unable to get during your initial claim review (see Auditing Your C-File below)
- Scientific studies
Get your hands on anything that may help you prove a service connection. This includes but is not limited to your entrance and separation Medical Examinations and reports (look for which boxes you checked), All your medical and health records (both military and private), Your locations of service, duty stations and deployment information (check to see if this was used in your claims file), performance reports (especially if they mention your responsibilities), incident reports (these may suggest proper PPE wasn’t worn, or help narrow down an injury), training (were you exposed to gases or required to perform strenuous or dangerous tasks), awards and certifications (and, those that relate to your duties).
"New evidence is evidence not previously submitted to agency decisionmakers. Material evidence is evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a)."
Myth: You have a better chance if you have a VA Disability lawyer file your initial disability claim
Literally, the only thing a lawyer will do when you first file a claim for disability (at least in “Joe’s” situation) is send you the claim form, have you complete it and mail it back, and then they submit it for you. They may help answer some basic questions you have, but they will not substantially advise you on what to write down or provide guidance on how to answer questions. This part they have to do for free.
It’s once you are denied and are appealing that lawyers require a contract, 20% of your award, and will provide more meaningful guidance and/or directive. The longer your claim takes to get approved, the more money they make.
Whether you work with a lawyer to file your initial claim is obviously up to you; but there’s nothing wrong with waiting until after you are denied to decide whether to engage a VA Disability lawyer.
A better option might be to seek help from a veteran’s advocacy group in preparing your initial claim.
How To Prepare For Your C&P Exam
Pretty much every website we found about preparing for the C&P exam said to bring all your medical records (and you should). Just know, the examiner will probably never look through them. Not only will they not look through the medical records you brought, they probably haven’t reviewed all your records from the VA.
More than likely, they’ll only have reviewed small, specific snippets of information that the VA reviewer asked them to look at.
At both of “Joe’s” C&P exams, the doctors both stated that they were there to make a determination based on their interview in that “moment”. They never looked at the medical records he brought, briefly checked their computer, and said they hadn’t received any of his most recent test results or records from the VA.
Does that mean you shouldn’t bring your medical records? No. First, you might have the one C&P examining doctor who will take the time to look through them. Secondly, you can use your medical records for reference in your own answers. It’s not a test about your memory; so take time while answering the doctor’s questions to look through your medical records if you need to refresh your memory.
The C&P examiner is asked to do 2 things. Evaluate your medical condition’s severity (are you disabled and if so, how much), and document their reasons on whether they feel (based on your answers) whether your disability is service-related.
So how do you prepare? Know that you are not being asked trick questions that you have to know the answers for on the top of your head. Before you go to the exam, write down your responses on a sheet of paper and refer to them during the exam. Just say that you want to refer to your notes. You don’t have to improvise. For each medical condition addressed in the C&P exam, write down the answers to the following 3 questions:
- Describe your medical condition, what date did it start, and what treatment/medications are you using to treat it.
- What specific event or circumstance, or routine occurrence or exposure in the military caused your medical condition and when. What was your job title and why the nature of your work led to your exposure.
- How does (and how often) does this medical condition impair your daily activities.
The C&P examiner is asked by the VA to give their opinion on whether your medical condition is service-related without knowing anything (or at least very little) about your military service. It’s your job to convince them that your medical conditions are service-related.
Most importantly: the moment your C&P exam is over, write down any observations you had during your interview. Did the doctor make any comments about the lack of records sent by the VA? Did they only interview you about 2 of your medical conditions when your exam was supposed to cover 3 conditions. Did they seem to paraphrase your answers? These are important to note because you might include those in your appeal. Writing them down as soon as your exam is over ensures you’ll remember these details later, because (trust me) you will forget the little details later.
If Your VA Disability Claim Is Denied
- Request a copy of your C-File
- Audit your entire claims file (C-File) (see Auditing Your C-File below)
- For each medical condition you claimed and were denied, identify what additional evidence is needed to:
- Substantiate that it is a disability
- Prove that it was service-related
- Decide what type of appeal you should pursue.
The denial letter will include a list of the medical conditions you claimed along with the reason(s) they were approved or denied, a list of evidence the VA used to reach their decision, the regulations that were applied during the decision, and your appeal options. You have one year from the date on the denial letter to request an appeal in order to have your original VA Disability filing date remain intact.
What that means is if you appeal within one year and your appeal is approved, you will receive a retroactive lump sum payment dating all the way back to when you originally filed your claim.
If you delay and take action after the one year period, the “clock” is reset to the newer date. If you receive an award, it will be much less because it is based on the new date.
Should You Appeal?
The answer is always Yes, if you have a legitimate claim. What’s the worst that could happen? There are several appeals options; which one is best depends on your situation. Starting on the lowest rung of the appeal process is usually best, because you will still have the opportunity to appeal higher up later.
There are several options for appeals.
- Higher-Level Review- A senior claims adjudicator will review your existing claims file. You can not add new evidence. This is an option if you think your claim was strong enough to be initially approved and a senior reviewer would likely approve it.
- Supplemental Claim Review – This is a good starting point if you have new evidence (must be “new and relevant”) to help prove your claim. However, you can get automatically denied if the reviewer does not think your evidence is new or relevant to your claim.
- Board of Veterans’ Appeals – Here you can appeal your claim directly to the Board of Veterans’ Appeals in one of 3 ways:
- The direct review docket – this is similar to the Higher-Level review. You are asking the Board to take a look at your existing claim if you are not adding new evidence and do not want to have a hearing to present your case.
- Evidence submission docket – here you are presenting new and relevant evidence for the Board to review, but do not want a hearing to personally present your case.
- Hearing docket – here you are presenting both new and relevant evidence and you want to appear to personally present your case.
Here is a breakdown of what you should do before your appeal if you decide to do it on your own.
Denied? Get A Copy Of Your C-File
The very first thing you should do is request a copy of your C-File. This is your claims file that is supposed to include every document that the VA reviewed as it related to your claim (more on that below). Of course it won’t contain everything (more on that later).
Your C-File is digitally stored. You can request a copy of your C-File (which will be sent on a CD) by completing and faxing Form 3288 to 1-844-531-7818 or mailing it to:
Department of Veteran’s Affairs
Claims Intake Center
PO Box 3255 Janesville, WI 53547
Faxing the form is the quickest way to request your C-File. If you don’t have a fax machine, you can use a free online service like https://fax.plus.
In at least 3 C-Files, the results of C&P exams were not included and had to be requested separately by calling the VA. They will tell you the results will be in the C-File and to just wait, but insist and ask to have them sent separately.
It can take up to several months before you receive a CD copy of your C-File. It will be sent to you via certified mail. Plan on following up if you haven’t received anything two months after submitting your request; but be aware it has taken as long as 8 months.
While you are waiting for your C-File, you can begin preparing for your appeal by comparing the VA’s list of evidence in their denial letter against the list of medical documents and doctors you submitted in your original application. Despite the fact that the VA said they would obtain all the documentation and medical records you listed in your claim application, there’s a good chance they missed something or a doctor’s office was non-responsive.
Auditing Your C-File
It is important to make a detailed review of your claims file before appealing because it will be used as the basis to reevaluate your appeal, along with any new and relevant evidence you submit.
Depending on how long you were in the service and how much medical evidence you have, your C-File can be a few hundreds to thousands of pages long. That’s a lot of pages to go through. It will not be organized in any meaningful way. It will be confusingly bookmarked.
The good new is that your C-File comes in PDF format and is searchable by text. You will need to carefully go through it…page by page. Use Adobe Reader’s comment tool to make notations as you go through your file. Place comments as markers to identify the names of documents as well as specific evidence for each disability you claimed. Your comments will also be searchable, making it easier to find specific information in the future.
Why go through all this trouble? You’ll need to know exactly what is in your file, and what’s missing to identify what you can use as new evidence in your appeal. You may even find tidbits of information that reveal what specific information was used to make a decision in your case (more on that below).
- Get a copy of the spreadsheet at the top of this article. It will help you drill down through the audit process.
- Enter your claimed disabilities on the Detailed Disability worksheet, then open the Claim Audit sheet
- For each disability you claimed, check the appropriate boxes based on the decisions stated in the letter related to why you were approved or denied for a specific condition.
- Compare the list of medical conditions and their causes that you listed in your original claim application against the reasons for denial.
- Were your explanations and evidence detailed enough to connect a service-related cause?
- Did the VA get all the medical records you listed (these are listed under EVIDENCE in the denial letter) AND did they get it for the dates you listed you received treatment at each provider?
- Did they fail to get certain evidence?
- Is there a provider you listed but they are not in the VA’s list of evidence? The VA will not pay if a provider charges a fee for medical records; they should have notified you via mail if this was the case.
- Are your ALL of your in-service medical records listed as evidence?
- Are your entry and separation medical examinations listed as evidence?
- In Joes’ case, he made specific references to his hearing problems in his separation exam, but the VA did not mention it in their decision.
- Did they only get a portion of medical records from a specific provider?
- In Joe’s case:
- Only 2 years of medical records were listed as evidence rather than the 10 full years he received treatment from that provider.
- Joe submitted Supplemental Evidence while his claim was being reviewed to let the VA know that he had undergone two additional surgeries since applying; however that evidence was not listed in his decision letter.
- In Joe’s case:
- Did they fail to get certain evidence?
- Search your C-File for the Exam Scheduling Request
- The Exam Scheduling Request is single best clue to finding out what the VA reviewer wanted the C&P examiner to do and what specific evidence the C&P examiner was being asked to consider in their evaluation.
Why Is The Information In the Exam Scheduling Request So Important?
The section of your C-File that contains the Exam Scheduling Request will give you insight as to what specific evidence the VA reviewer was using in reaching their decision. It’s probably the only place that you will get a glimpse of what led to their decisions.
Specifically, look for the words POTENTIALLY RELEVANT EVIDENCE and Special Instructions.
POTENTIALLY RELEVANT EVIDENCE
Potentially Relevant Evidence is evidence that has been flagged as being specifically relevant to proving or disproving your claim. This evidence has been earmarked in the VA’s internal system as having importance. You won’t know which document in your C-File this was flagged from. But you will have a better idea of what specific information was being relied on to make their decision.
This Potentially Relevant Evidence is also probably the only snippet of your records that the C&P examiner will review.
So why is this important, especially if you don’t know which medical records this evidence came from? Take a look at the image taken from a C-File above and you’ll see that 2 blood pressure readings were specifically flagged. In this specific case, the medical records had hundreds of blood pressure readings that were substantially higher.
If a reviewer or C&P examiner is evaluating your claim of Hypertension and they only considered the two readings that were flagged, they would likely deny the claim. Granted, there’s disclaimer above the evidence telling the reviewer that they are not limited to just reviewing the Potentially Relevant Evidence. But there’s nothing requiring them to look at every page of your medical records either.
For an appeal in this specific case we would make it a point to itemize all the historical blood pressure readings (not just the two lowest ones).
Just like the Potentially Relevant Evidence above, Special Instructions are internal notes that the reviewer believes may have bearing on a case that warrants further review and is asking the examiner to consider.
In this specific veteran’s claim for hearing loss, he was denied based on the duty MOS that was listed in the Special Instructions. These MOS have a Duty MOS Noise Exposure Listing of “low or moderate probablity”. The only problem here is that the MOS the reviewer based their decision on was just from the veteran’s first few years in the service.
This veteran’s duty MOS for his remaining 12 years in service actually had a duty MOS of “high probablity”. Unless the examiner went through the veteran’s service history they likely evaluated him using the wrong MOS; the one listed in the special instructions.
What Were The C&P Exam Findings?
You should review your C&P results in your C-File to determine if they confirmed a diagnosis of the conditions you claimed and agreed it was at least 50% service-related. If it was not favorable, you should secure a Nexus letter to submit in your appeal of this condition or provide new evidence that substantiates your claim.
Should You Hire A VA Disability Attorney?
Whether you should contract a VA disability attorney to handle your appeal is really dependent on you. Are you a detail-oriented person who is willing to pour over hours of documents and research every aspect of your C-File line by line to compare it against the denial letter? Critical thinking skills go a long way. Are you pursuing a Supplemental Appeal (easier to do on your own – with the right amount of preparation), or wanting to appear before the Board of Appeals (where having an attorney represent you goes a long way)? You know yourself and your capabilities better than anyone.
A VA Disability attorney often acts like an auditor once you are denied. They look through your C-File and evaluate what information is missing or might be needed to improve your claim, they review documents to see if the VA made any mistakes in the denial or rating percentage, and they advise you on what you might need to do to enhance your appeal (get buddy letters, medical opinions, etc).
Having an impartial, fresh set of eyes that are familiar with the appeals process is definitely a good thing.
A disability attorney will typically receive 20% to 33% of your lump sum award. If your case is unique and your appeal goes all the way up to the Court of Appeals for Veteran’s Claims (CAVC) and you win, the VA will pay all attorney’s fees. Just know, only 8% of CAVC cases were affirmed in 2019 The rest were remanded, dismissed, or had mixed outcomes. So plan on paying an attorney 20% if you win on appeal.