The Department of Veterans Affairs (VA) denies around 30% of disability claims. It can be frustrating for a patient to learn that a claim for VA compensation was denied, especially after the amount of effort involved. But it is important to remember, that patients can submit appeals within 1 year of denial.
It’s also important to help patients try to understand what went wrong with the initial applications so they know specifically what evidence to provide with an appeal.
There are a number of reasons the VA may deny a claim. These are some of the most common:
1. Missed Deadlines
Probably the most critical reason that a VA disability claim could have been denied, might simply be because the applicant missed the deadline.
While there is no deadline to apply for benefits, patients are only eligible for monthly payments to deal with current disabilities, so waiting around for an injury to fully heal, for example, may make a patient ineligible for compensation.
As a member of their healthcare team, you can help patients remain aware of deadlines to appeal claims. If they do not appeal within the required period following an initial decision, they will need to refile the claim and start over.
2. Not Submitting Enough Evidence
A VA Disability Claims application relies heavily on the support of evidence. It can come in a variety of forms, from medical records, buddy statements, service records, etc. When there is not enough proof submitted about the disability in a veteran’s claim, the VA will likely deny it.
There are strict guidelines of what types of medical conditions qualify as disabilities and what level of compensation a veteran can receive based on the impact of the condition.
Additionally, if the healthcare team did not adequately provide evidence and testing regarding a disability, it could also impact a claim.
3. Lack of a Specific Diagnosis
For the VA to approve a claim for disability compensation, a veteran must have a diagnosed medical condition that is the result of military service.
The diagnosis must also be current. If, for instance, a veteran suffered from depression following their service, but has since made a full recovery, then they are not entitled to receive compensation for the past issue.
4. Not Appearing at the C&P
In most cases, as a requirement for a disability claim, the VA will ask attendance at what is known as a Compensation & Pension (C&P) examination.
This exam determines the extent of the current disability, and whether the condition is service-connected, which qualifies a patient for compensation.
There are a number of things that can occur at these appointments that may have a negative impact on the results of a disability claim.
They can range from having an examiner who may not be qualified to examine your particular disability, appointments being made without adequately informing the veteran, rushed appointments or overly lengthy appointments, important tests or questions being skipped, etc.
Remind patients that these appointments are a crucial part of the VA disability claims process, and should be treated as such.
5. Condition Is Not Considered Service-Connected
To receive disability benefits, a patient must be able to prove that their disability is service-connected. This means that the disability is a direct result of their military service, or was clearly made worse by service.
If the VA determines that a medical condition is independent of time in the military, or it was preexisting (present before military service began), and wasn’t made worse by service, then a patient might not be granted disability benefits.
For a disability to qualify as service-connected, you must undergo a C&P exam by a qualified VA examiner.
6. Disability Rating Does Not Qualify for Benefits
Even though a patient may be accepted by the VA to have a diagnosis that is service-connected, they still may be assigned a disability rating that does not accurately reflect their medical condition.
If a veteran receives a rating of less than 10%, they will not qualify for compensation, leading the VA to deny any financial compensation for their VA disability claim.
Providing further evidence of a disability, be it more medical records, buddy statements, medical bills, service records, etc, can help in potentially increasing the rating.
Reconsideration Requests
Veterans face a potentially challenging appeals process, with long processing times and a growing backlog of pending appeals.
The confusion is further compounded when it comes to deciding between appealing or requesting “reconsideration” for denied claims.
In the legal realm, “reconsideration” is a term commonly used, but in the context of veterans’ benefits, it officially exists only at the Board of Veterans’ Appeals(BVA) level.
It involves filing an official “motion” and is limited to matters concerning potential “clear and unmistakable error.”
However, some veterans and even advocates have mistakenly requested “reconsideration” at the Regional Office (RO) level, where no specific laws or regulations govern this process.
This lack of clarity leads to inconsistent and untimely responses from individual ROs, often confusing “reconsideration” requests with intent to reopen denied claims.
Veterans may inadvertently lose their appellate rights and entitlement to an earlier effective date.
“Reconsideration” at the RO level rarely results in favorable outcomes, as the same VA employee is likely to review the claim again.
Requesting “reconsideration” at the RO level does not grant additional time beyond the 365-day limit to submit an official Notice of Disagreement.
With limited time and low chances of success, it’s crucial to carefully consider the risks and benefits before deciding on “reconsideration” or appeal.
When facing a denied claim, make an informed choice.
Understanding the complexities and potential pitfalls will help you protect your rights and make the best decision for your case.
If you are interested in obtaining benefits and have been denied previously for your claim, please contact a qualified attorney, such as Hill & Ponton, for help with a case.
Disclaimer: The statistics and references mentioned in this article do not imply any formal conclusions on behalf of the author or affiliated organizations. The information provided is intended to foster conversation and encourage further research into this subject. This article was reprinted from with permission.
Written by
Claire Szewczyk is a Digital Content Coordinator for Hill & Ponton,in Florida. She was a former US Air Force civilian employee, who worked at Hill Air Force Base, in Layton, UT, as a flight testing administrator. She has also spent several years working with the Department of Veterans Affairs audiology programs in Salt Lake City, UT, and Pocatello, ID. She enjoys working with the veteran population and keeping them up-to-date with information they need the most.