Denial of VA Disability Claims – What You Need to KnowUpdated August 27, 2020 Veterans Disability
Although it’s not uncommon for the United States Department of Veterans Affairs (VA) to deny your disability claim, it can still be a frustrating experience. There are several reasons why your VA disability claim denial happened. Understanding the possible causes of a claim denial can help you file an appeal to get the VA disability benefits you deserve.
9 Reasons Why Your VA Disability Claim Was Denied
- You gave incomplete information
- You submitted the wrong forms
- You missed a deadline
- There is a lack of medical evidence
- The VA doesn’t accept your doctor’s statement
- There is a lack of service-related injury or illness evidence
- The VA determines that you don’t have a disability
- The VA doesn’t believe your symptoms warrant compensation
- You have a pre-existing condition
VA disability benefits are put in place to help active duty military veterans get compensation for an injury or illness that occurred or was worsened as a result of their service. The monthly payments aren’t taxed to help veterans further meet their financial obligations.
The VA regularly denies applications for disability benefits that don’t meet its criteria. The reasons above are the more common ones that can affect your claim for disability compensation. If the VA denies an application, the veteran can file an appeal on their own or consult with a veterans service officer (VSO) or a veterans disability attorney to help them through the process of an appeal.
Why was my VA claim denied?
The VA could deny your veterans disability claim for many reasons similar to denials for unemployment benefits, including something as simple as not completing a form correctly. Before you begin a VA disability appeal, be sure to understand the exact reason for your denial, which you can find in your denial letter. If you aren’t sure what the letter says, you can hire a VA attorney or enlist the help of a veterans service officer (VSO) to explain it to you.
The following are common reasons why your veterans claim for disability compensation was denied:
1. You gave incomplete information
As with any benefits you might apply for, like Social Security or unemployment insurance benefits, you will need to complete several forms to apply for veterans benefits. The veterans disability forms require you to fill out information about yourself, your service, and your medical history, including any evidence you have to prove your disability.
If you fail to complete a form or a section of a document, or you don’t submit enough information for the VA to conclude that you have a disability, you could receive a denial. The VA favors what it calls Fully Developed Claims, which are complete claims with plenty of information that can help the VA make a decision as quickly as possible.
Fully Developed Claim
If you decide to utilize the Fully Developed Claim (FDC) process, it contains a layer built in that allows for reconsideration. If you disagree with all or part of the decision on your FDC, you can work with your representative to get additional evidence needed and possibly resolve the problem at that point by requesting reconsideration. With FDCs, the process is usually that the VA notifies the veteran in detail about the reasons for denial. The vet then has the option to obtain any needed evidence and ask for reconsideration as a FDC. There is some evidence in the pilot programs that this avenue can help avoid the long appeals process.
2. You submitted the wrong forms
The VA requires a disabled veteran to fill out specific forms to apply for VA disability. Like submitting incomplete forms or information, submitting an incorrect form can also trigger a denial. The VA typically will deny a claim before it contacts the disabled veteran to notify him or her of submitting incorrect paperwork.
Each veteran fills out a set of base forms, but some veterans may need to fill out additional forms, depending on the details of their service or disability. For instance, National Guard and Reserve members must send in additional service and medical records, and those claiming post traumatic stress disorder (PTSD) must send in a statement on VA Form 21-0781.
3. You missed a deadline
Although the VA does not require you to apply for VA disability within a certain length of time of your injury or illness occurring, it might give you deadlines for furnishing additional evidence or forms necessary to process your claim. The VA may also require you to schedule doctor’s visits to support your claim within a specific period.
Veterans must also complete a Compensation and Pension (C&P) exam, which will assist the VA in determining your disability rating and compensation. If you miss this appointment or any other deadline set by the VA, you could end up with a denied claim.
4. There is a lack of medical evidence
The VA needs sufficient proof of your disability to consider your claim. The claims process relies on a combination of your statement and evidence, evidence from medical doctors, and evidence of your medical visits related to the disability.
When you cannot show sufficient evidence of a disability or a doctor fails to fill out forms correctly or provide enough evidence, you’re likely to face a claim denial. Before you file an appeal, you should speak with a veterans disability lawyer or VSO to determine what else you can do to prove your disability.
5. The VA doesn’t accept your doctor’s statement
Your doctor can provide a statement that supports your disability claim. However, this statement may not adhere to the VA’s requirements to prove sufficient evidence of your disability. The VA’s decision can rely on a few factors, including your doctor’s ability to do the following:
- Thoroughly explain your disability, the symptoms it causes, and why it should be treated as a disability
- Fill out all required paperwork accurately and completely
- Explain why your service-related injury or illness and your current disability are connected
- Use language that the VA looks for in doctor’s statements
- Furnish proof of his or her credentials
6. There is a lack of service-related injury or illness evidence
The VA only pays disability benefits to veterans with service-related injuries or illnesses that were relevant to the disability they’re claiming. This means that you must prove a connection between your service and the symptoms you now experience that triggered your claim.
The VA may not see the evidence you submit as proof enough that your injury or illness is connected to your military service. The brunt of this responsibility falls on you to furnish proof of doctor’s visits while in the service and evidence of the events leading to the injury or illness. However, your doctor can also help you prove your claim by explaining to the VA how the event(s) have contributed to your current symptoms or disability.
A Case of Missing Evidence
A story from the San Francisco ABC affiliate highlighted a case of a Navy veteran whose claim was initially denied. The veteran served in 1983 on a destroyer that saw battle off the coast of Lebanon. In 2008, he filed a disability claim for post-traumatic stress disorder and depression.
The VA denied his claim, because it said it couldn’t find actual evidence that he was in combat. A VA employee later came forward and said she’d done a Google search and actually found that the destroyer was engaged in combat, but the VA still issued the denial. The Navy vet has filed another claim and is waiting to hear a decision.
Since this veteran’s initial claim in 2008, the VA has relaxed its evidence requirements for showing PTSD. However, this case shows a powerful example of how a claim can be denied for the wrong reasons. The Center for Investigative Reporting has concluded that many veterans are unfairly denied their benefits.
7. The VA determines that you don’t have a disability
To qualify for disability benefits through the VA, you need to have a diagnosed disability that stemmed from or got worse because of your service. In most cases, the VA requires you to have a concrete diagnosis from a medical doctor for it to process your claim. Symptoms alone cannot qualify you for a positive VA disability benefit determination.
When working with your doctor before submitting your claim, you should make sure you get a definitive diagnosis. This is especially true when you have a mental health condition, as they’re often difficult to prove unless a diagnosis is in place. The more specific your doctor gets, the easier it will be for your VA disability claim to go through.
8. The VA doesn’t believe your symptoms warrant compensation
The VA rates your disability on a scale that determines how much compensation you’ll get. Some disability claims get approved as far as proving symptoms and disability. Still, the VA determines that those symptoms are not severe enough to meet even its lowest rating that gives compensation.
The rating scale goes from 0% to a 100% disability rating, and they always happen in 10% increments. A 0% rating will not warrant compensation, but a rating of 10% or higher will. The higher your percentage rating, the more monthly benefits you’ll receive. To increase your rating through the appeals process, you’ll need medical proof of the severity of your symptoms and how they affect your daily life.
9. You have a pre-existing condition
If you had a pre-existing condition before entering the service and that condition wasn’t made worse as a result of your service, you can’t file a VA disability claim for that condition. The VA will only approve claims for pre-existing conditions when they become worse because of your service. The VA typically presumes that a condition is a result of your service unless there’s specific proof of you having a pre-existing condition before entering the service.
Error Rate in Claim Processing is Very High
The Department of Veterans Affairs (VA) admits that it makes a lot of errors when evaluating VA disability claims. However, it doesn’t officially agree with the magnitude of the problem. The VA has stated that it has an error rate of 14%. The Center for Investigative Reporting analyzed a group of claims and found an error rate of closer to 38%.
In response to much media and Congressional attention to the problem with errors, the VA claims it has reduced its error rate to 12% in FY 2016. In a recent sampling at the Los Angeles Regional Office, in a batch of 90 disability claims reviewed, 24 claims were found to be incorrectly processed. Incorrect dates to begin payments were assigned in two out of 30 claims reviewed.
What to Do If Your VA Disability Claim is Denied
No veteran wants to hear that their veteran’s disability claim has been denied. Fortunately, a denial letter isn’t the definitive ruling in your case. As a veteran who believes they have a qualifying disability as a result of their military service, you can file an appeal to your denial. This will trigger another decision review by the VA that includes all previous and new evidence to support your claim. You can file an appeal for VA disability compensation on your own. Still, veterans tend to have their appeals accepted more often when they have help from a VSO or a VA disability attorney.
Standard Claim – Review by Decision Review Officer
If you filed a claim through the standard, traditional claims process and you disagree with a decision, you can request a review by a Decision Review Officer. Technically, you must first file the Notice of Disagreement (NOD), stating that you disagree with all or part of the decision and you want to appeal.
According to the VA, “after you send your NOD you may request that your file be reviewed by a Decision Review Officer (DRO) from your local VA office. DROs offer a second review of your entire file and can also hold a personal hearing on your claim.”
The DRO conducts a complete review of the decision based on the record. The DRO can pursue additional evidence, and/or conduct an informal meeting with the applicant. After this review, the DRO can uphold or overturn the original decision.
If the DRO review does not fully resolve your dispute, you can continue to the next phase of the appeal process, which is to file a VA Form 9 (Substantive Appeal). If you choose not to utilize the DRO process, you can move straight to the appeal.
You should know that the U.S. Government Accountability Office (GAO) issued a report on DROs, finding that they are often not well trained. The report also found that veterans are often not given enough information to make informed decisions. While the option for a DRO review before launching a lengthy appeal may bring some advantages, be aware of the limitations. This is a good time to seek advice from a Veterans Service Organization or an experienced attorney to fully understand your rights and what you can expect based on your particular claim.
Talk to Your VSO or VA Disability Attorney
A VSO, or veterans service officer, is someone who can help you through the entire VA claim process. Qualified veterans can receive their help for free with a VA-appointed VSO from your VA regional office. From start to finish, the VSO can work with you to prepare your claim, file it, track its status, and file an appeal, if necessary.
A VA disability attorney is a private attorney who you’ll pay to assist you with the appeal process. These attorneys have experience with filing appeals and fighting denials, so using one could help you see your veterans disability benefits faster. An attorney could be a better option for you than a VSO if you have a particularly complex case that requires a firm understanding of laws surrounding veterans and their benefits.
You have one year from the date of your denial letter to file an appeal, which you can submit to your regional office or the Board of Veterans Appeals (BVA). Both a VSO and a VA disability attorney will use as much medical evidence as possible to prove your current disability and help the board’s decision lean in your favor. A VA regional office decision can take several weeks, while a BVA decision can take several months.
Navigating VA Disability Claim Denial
When you receive a denial letter from the VA, it can be disheartening. But it’s important to remember that this isn’t necessarily a final decision. Veterans’ appeals exist to help veterans fight wrongful denials when a veteran has proof that they’re entitled to benefits from their military service.
A VSO or a veterans disability attorney can assist you in navigating the appeals process that you can submit to the VA or a veterans law judge. The appeals process will work to give you a final claim and monetary determination of the maximum benefits you are eligible to receive.