Tacoma Disability

25 Things You Need to Know To Optimize Your VA Service-Connected Disability Claim & Appeal

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25 Things You Need to Know To Optimize Your VA Service-Connected Disability Claim & Appeal

VA Service-Connected Disability is a Benefit That Exists to Compensate You for an Injury

Speaking plainly, a service-connected disability is an injury, illness, or impairment that was caused or made worse because of some aspect of your service.  This can be a distinct experience, or it can be something that occurs over time.

The benefit itself exists to assign and provide monetary reimbursement for the level of impairment that is said to be connected to your military service.

You can collect VA Service-Connected Disability concurrently with SSDI but probably not SSI

SSI is a means-tested benefit, meaning the amount you receive (if you receive any) is based strictly on your assets and level of income.  However, SSDI – a similar benefit in many ways & also administered by the Social Security Administration, can be awarded at the same time as service-connected disability compensation.

This means that a Veteran could, and many do, collect SSDI for an injury that makes them unable to work, and collect a service-connected compensation at the same time.

*Note, you cannot usually collect SSI w/ VA benefits – and if you do, your award is usually split or offset.

The wait time on VA appeals tends to be longer than Social Security Claims

During the surge of claims that peaked around 2008-2015 it was normal for an initial claim to take almost a year, and for an appeal to a denial or improperly awarded claim to take several years.  In many cases, wait times are down significantly.  However, it may still be very geographically dependent how long your claims and appeals will take.

Another factor affecting the length of claims is the complexity of Veterans Claims.  Many Veterans claims contain multiple claims with multiple sources of origination.  Each of these injuries/impairments are essentially a separate claim unto themselves.  And each of those claims can be appealed, mis-rated, etc.  Veterans often have several claims for several injuries going at one time.  And these claims are not always combined into a single decision, or timeline for decisions.

Many VA Claims Advocates are Overworked

As a result of the complexity of Veterans claims, and also in part to the nature of volunteer work, many Veterans advocates find themselves quickly overworked as they try to help Veterans with service-connected disability claims.

These advocates, VSO’s, are often responsible for doing other benefits based assistance in addition to VA claims.  Including education, burial assistance, and fielding a plethora of questions from Veterans of all ages.  Most of them have a lot of different directions they’re being pulled in, in addition to providing representation on claims.

Despite this, many of the advocates are great.  But some are not in the best place to provide support for Veterans disability claims.  You should keep this in mind when choosing who to work with for your claim.

There is a Lot of Information About How to Win a VA Disability Claim

Forums, Reddit, legal blogs like this one, and so many more… are great places to find information about filing for and appealing a VA disability claim.  It is possible to do this on your own, but it can easily become a complicated mess of moving parts too.

Each Veteran that pursues these benefits finds a different path.  Some of those paths lead to frustration, and we’re here to help with that.

Some great places to start include:

Searching BVA decision citations

VA Watchdog

Veterans Benefits Manual

Awesome Veterans Claims Forum

Not all the Information about Winning a VA Disability Claim is Correct

The links above are great places to look for information on winning a VA disability claim.  However, just as many claims have been butchered by bad information as have been successfully pursued with good.  One of the biggest challenges with going solo on your VA claim is that you usually have little experience to assess whether a piece of advice is good or bad.  Much of the claims process makes sense when you have the perspective to see how it got to be the way it is today.  However, if this is your first, and hopefully only, foray into advocating a claim – be very careful whose advice you follow.  And for the sake of your own claim, double check advice and cross-reference.

^This is the reason bringing on a great advocate is good idea.

The VA has Streamlined Several of the Processes For Claims & Appeals in Recent Years

It used to be that filing a VA service connected disability claim meant sending in a snail mail form filled out in ink.  And it meant submitting all your supporting documentation in large parcel deliveries directly to the VA regional office handling your claim.  Fortunately a couple changes have occurred recently to help Veterans and their advocates.

One of the biggest improvements to the filing process is centralized evidence intake.  It used to be the case that you had to submit your evidence directly to the regional office of record.  This meant 50+ processes at 50+ facilities, and reports of lost (or unopened) files were rampant.  Now you can send your supporting evidence to one location and it will be scanned into your claim c-file, queued up for review, and you sometimes even get a receipt that the files were delivered.

Another fantastic improvement is the newish ability to file and review a claim online (when the system is working). Now you can see exactly where in the process your claim is.

The Burden of Proof for a VA Disability Claim is: “As Likely as Not..”

One of the most important things to know about Veterans disability claims is that you don’t have to prove aspects of them “beyond a reasonable doubt.”  You do not have to be 100% certain of minuscule details, you only have to believe that a cause is “as likely as not” (aka 50/50) the root of your current conditions.  We cover this a lot in some of our other blog articles, but if you take one thing away from this list, remember this phrase, “As Likely As Not.”

Veterans Have a Lot of Choices

As you work to develop your service claim, you have a lot of choices for who you’d like to work with.  From a friend, to a Veterans Service Officer, to a VA Accredited Claims Agent, to even an VA Accredited Attorney – there’s no shortage of people who can provide assistance.  However, not all assistance is created equally.  Here’s how you can identify who to work with and how to assess if they’re who you want to work with.

VA Service-Connected Claims are Handled through the Veterans Benefits Administration (VBA)

The VA is made up of three parts: the Veterans Benefits Administration, Veterans Health Administration, and National Cemetery Association.  Most benefits, including service connected compensation, move through the VBA.  Whereas the VHA usually focuses solely on health care administration.

Once you’ve achieved a certain threshold of disability compensation (usually 30%), some benefits are available through the VHA.  In particular, we’re thinking about Vocational Rehabilitation, which is an educational benefit administered by the VHA.  This is one of the best, essentially secret, benefits for those who have a service connected disability rating.

Receiving a Service-Connected Claim Qualifies You for other Benefits

In addition to the Vocational Rehabilitation (Voc. Rehab) that we talked about just before this section, there is an enormous number of benefits specific to service connected disabled Veterans.  Many states, schools, counties, and businesses provide discounts, free-passes, licenses, and preferential treatment for service-connected disabled Veterans.

Here’s A Resource Group for Veterans

While You Can Still Serve with an active Service-Connected Disability Claim/Award, you Cannot Double-Dip

There are a number of Veterans still serving in the National Guard or Reserve.  Some of these prior active duty troops currently have a service-connected disability rating.  It is typically incumbent upon a specific command to determine when an individual’s ratings preclude them from being able to carry out the capacity of their job.  In a great number of cases, these troops can still function at a high level even with their partial disability rating.

One thing to note; however, is that while actively serving – even if it’s only for a drill weekend – you cannot collect a wage for military service AND service connected compensation.  This usually means offsetting the amount of compensation received from the VA, or through DFAS.

If You Have More than 70% Service Connection and Cannot Work, You Should Consider TDIU

TDIU is short for Total Disability Individual Unemployability.  This is a rating that takes into account your constellation of previous ratings and recognizes that they pose a total barrier to you being able to work.

There’s a quirk about the way the VA does service connected ratings that makes this a great benefit to know about.  As you can surmise from the paragraph above, TDIU provides the beneficiary with a total disability rating even if they are less than 100% by individual ratings (also known as by schedule).  So, you get paid 100% and receive all the benefits of a 100% service connected rating, even though you are technically less than 100% service connected.

This quirk we’re talking about is the VA math used to assign ratings.  If you have 50% for PTSD for instance and you are awarded a second rating of 30% for a physical injury to your back, you might assume that 50% + 30% = 80%.  This isn’t how the VA does it.  What the VA does is take your biggest disability rating and make it your core rating.  In the case above 50%.  The next highest rating is applied to the remainder between that rating and 100%.  So, 100% – 50% (for your PTSD) = 50%.  Then 30% of the remaining 50% = 15%.   50%+15% = 65% (rounded up to 70%).

In the example above, you have 50%+30% = 70% (65%).  Think about what it would take to get that to 100% going by adding disability ratings.  You could have 50% (PTSD) + 30% (Back) + 20% Shoulders + 20% Knees + 10% Tinnitus and still only rate: ~80% service connection.  To get to 100% from here you’d need an additional rating of 60+% from somewhere else.  This exact situation is why TDIU exists.  You can chase down 100% by different body parts and never reach it, but still be completely unable to work because of your disabling physical and mental health challenges.

*In short: You can collect a service-connected disability compensation and SSDI at the same time!

Using the DRO Process for Your VA Claim is Often a Great Idea

VA disability appeals can follow a couple paths on their way to a Board of Veterans Appeals hearing.  One optional path is to request a DRO review of your claim prior to formally requesting a BVA hearing.  A DRO (Decision Review Officer) is a senior adjudicator (often retired from and/or on contract with the VA).   They provide a second in-depth look at your claim and appeal, and you can even request a hearing, or even informal discussion, with the DRO.  If you have a helpful DRO, your claim can be unscrewed prior to needing to go to a BVA hearing.

One of the most important things you can ask a DRO is, “what would you need to see with this claim in order to approve it for what I’m asking?”  When/if you get an answer, do it!  You can argue with the DRO until you’re blue in the face, but your best bet is to help them help you – you still have a BVA hearing if you strike out at the DRO level.

You Can Waive Your Right to a DRO Review in Your VA Claim

One of the biggest drawbacks to requesting a DRO review is timeliness.  It’s not necessarily the case that they take a long time, it is going to take more time though than to request a BVA hearing in lieu of DRO review.  Some claimants want to push an appeal to the BVA as fast as possible, but doing so creates unique risk in a claim.

Once the BVA has made a decision it becomes a lot harder to overturn, and doing so can either cost you more $ in the form of representation fees at the Court of Appeals for Veterans Claims, or in the form of losing your claim date and having to start all over again on a claim that was already previously denied by the BVA.

In many/most cases, there’s little to gain and a lot to potentially lose by waiving your right to a DRO review.  Nonetheless, you have the right to do so.

Your VA Appeal can be Granted at Any Point But Can Only be Denied by a Judge – This is Good for YOU!

This statement might appear ambiguous at first.  Meaning, a granted appeal would be just as formal as a denial.  What we’re going for here is to convey that at any point during your appeal, your appeal may be granted.  The appeal does not need to be heard by a BVA judge in order to be granted, a DRO, or other adjudicator can determine that the threshold of evidence/requirements have been met and issue a rating decision.

And, in contrast, a denial of the appeal can only be issued by a BVA judge.  If you’ve worked the process well, went through a DRO, submitted additional evidence where necessary, added context and reviews similar cases and still don’t have a favorable decision when going to meet with the BVA judge, don’t despair – that happens often.  You can disagree with everyone up to the point of the BVA and still get your appeal ultimately granted.

You Don’t Have to Use an Advocate to Get Your VA Claim Approved, But it Helps

You can work with a lot of people to help get your claim or appeal granted.  However, you can also go it alone.  There’s no requirement to utilize an advocate in your claim or appeal.  Choose to work with an advocate because you want to and when you see the value in doing so.

Your VA Benefits Award is Determined Based on Very Specific Criteria

There is a ratings schedule (table) for impairments.   For instance, if you lost a finger due to some experience in the military, the finger you lost, the loss of function for your hand, the grip strength measurement, and other factors all combine on a table (codified in law) to provide your rating.  So, if you wonder how something is 10% and why it wasn’t rated at 30%, getting to know this table will tell you everything you need to demonstrate to understand the rating provided.

This table is also very useful if you are disagreeing with a rating percentage.  It’s normal to have two people see a ratings criteria applied in different ways.  This table is one of the things that will truly strengthen your appeal claim, if understood & used.

There’s Usually One of Three Things Missing in a Denied VA Claim

If a claim was denied, it is typically one of three reasons.

1) Failure to demonstrated service nexus

Means something happened during your service, you have to demonstrate this in some way

2) No measurable current condition

Something has to exist today. Impairment of some type

3) Your current condition & history since service don’t clearly show a connection

Establishes a clear path between service injury/ailment and current condition and takes into account (or discredits) other possible explanations.

Doctors, Providers, and Friends Don’t Know What All This VA Claim Stuff Is

The items above, the three things most often missing in denied claims, are usually not understood by your treating doctors, therapists, friends, and most other Veterans.  Successful appeals are not usually a matter of how much evidence is provided, but more often a matter of what type and how it supports the whole claim.

The tendency is to try to provide an overwhelming amount of doctor statements, buddy statements, and other similar evidence.  But without context or an understanding of how it fills in the gaps in the originally denied claim, it’s just as likely to confuse and possible harm your appeal as it is to help it.

VA Service-Connected Disability Doesn’t Usually Stop You From Being Able to Work

While various levels of ratings might reflect an inability to do certain tasks, with the exception of TDIU, a service-connected disability rating typically does not reflect an inability to work.  Some ratings thresholds might be based upon their impact on employment.

For instance, 70% for a mental health rating is usually reserved for levels of impairment that provided significant to almost total inability to work.

But for most ratings, the question of how or whether you work is not related at all to your compensation claim.  With the exception of allowances that have to be made for you to be successful at work might be something you want to highlight for your claim.

VA Service-Connected Disability Compensation is Tax-Free

Unlike military retirement pay (non-medical), service-connected disability compensation is tax-free.

VA Service-Connected Disability Compensation is Different from Non-Service Connected Pension

A non-service-connected pension is similar in many ways to SSI.  Generally, it is for a disabling condition that is no service-connected.  Unlike service-connected compensation, a pension is all or nothing (no % ratings), and it is means-tested (based upon income and assets).  You normally would be able to have been awarded SSI (even if you haven’t applied).  For this reason, a lot of potential recipients have concurrent claims with Social Security, though the maximum benefit will be the highest of the two and not a combination of the two (as in the case of SSDI & compensation).

In Many Cases, you cannot collect both VA Service-Connected Disability Compensation and Pension

Service-connected disability compensation provides you a monetary reimbursement for injuries or illnesses that have an effect on you today.  A pension is a ‘backstop’ benefit for other disabling conditions that stop you from being able to work.  The pension is means tested, meaning it is based upon your assets and income – and if you had a disability rating and associated compensation, that would be considered income.  This will reduce the amount of the pension, in an offset like manner.

There is No Limit to When You Can File a VA Disability Claim

You can begin the process of filing your service-connected disability claim at any age, no matter how long you’ve been separated from military service.  Though, the further you get from military service the harder it often gets to demonstrate that your current conditions are a result (in part or in whole) of experiences you had while serving.

As the saying goes: “make hay while the sun shines.”  Filing today is going to be far easier than filing tomorrow.  Evidence will be easier to produce, a service nexus will be easier to identify, and you have more time to work through the process…because in some cases, it can take longer than you would expect.

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