Reasons Similar Claims are Rated Differently by the VA
Reasons Similar Claims are Rated Differently by the VA
The VA claims process can be very complicated. Some Veterans can submit a claim and the claim will be granted right away. That Veteran might have a friend who submits a similar claim and his/her claim is denied, even though they both served together on the same deployment. How does this happen?
First and foremost, every claim is unique to the individual who is submitting the claim. Just because two Veteran’s served together in the same unit on the same deployment does not mean that they both will be service connected and rated the same.
Why Similar Claims are Given Different Ratings
There are a few different reasons why a similar claim may have a completely different rating. First off, one Veteran may have sought treatment in service and the other did not. Anytime a Veteran enters a claim for service connection the VA will review the Veteran’s Service Treatment Records (STRs). These are the Veteran’s medical records from service. To be clear, these are not the treatment records from the VA or private health care after service. These are specifically the records from when the Veteran was seen at a medical facility on base during active duty service. The VA is specifically looking for a Diagnosis, Treatment, Complaint, or Event in Service to link the current claim to the Veteran’s service.
Most Veterans may have sought medical attention from the unit medic or corpsman. The Veteran may not have gone to the medical clinic for treatment. Inherently, the unit medical professional might have offered a generic assessment of the pain and issued an anti-inflammatory, such as Motrin (Ibuprofen). Almost every Veteran can relate to a scenario such as; “Hey Doc, my back hurts” or “Hey Doc, I have this pain in my knee.” Then the response is, “Here. Take this Motrin and drink water.”
The Veteran then takes the 800mg pills and goes back to work. The Medic may never actually go find the Veteran’s medical file and record that the Veteran was treated for an injury.
This bring us to this point: If one Veteran went to a medical facility every time they were in pain and their injuries were documented, the VA will set them up for an exam. If the examination results in a current diagnosis of a disability and the medical examiner can review the Veteran’s STRs and make a medical opinion linking the current condition to service, then the Veteran will be service connected.
If the second Veteran never went to a medical facility or their complaints/ treatments were not recorded in their medical record, the VA may not set up the examination. Even if the Veteran gets to the examination, the examiner could say “I have reviewed the records and find no evidence of a similar injury in service”. This is an over simplified example of how two Veterans could be from the same unit, be on the same deployment, and one gets service connected and the other gets denied.
Establishing Service Connection
Veterans need to address 3 elements for service connection, no matter the claim.
- They need to establish an event, disease, treatment, or injury in service supported by some record.
- They need to have a current medical diagnosis of the condition they are claiming.
- They need to have a medical opinion that says #2 is because of #1, also called a nexus.
Some claims will be denied because the Veteran will complain of pain and they will receive an exam, but the examiner will say that no disability exists. This does not mean that the pain is not real; however, not every instance of pain is medically classified as a disability. Only a medical professional, who has medical education and training is qualified to make such a determination. Sometimes, it can prove beneficial for a Veteran to utilize a private medical examiner who has a better idea of the Veterans injuries.
Veterans will also commonly confuse VA Hospital treatment to mean VA Benefit Administration grants for service connection. The VA Hospital will treat a Veteran because they are a Veteran. The VA Benefit Administration will not grant claims just because the VA hospital is providing care. The 3 Elements of service connection we previously mentioned must still be met.
Utilizing Buddy Statements when a Veteran Doesn’t have STRs
Veterans are allowed to make a personal statement and submit buddy statements to address the onset of disabilities in-service or missing records. These statements need to specifically address the event or injury, what medical attention was sought, and rational for why the records do not reflect the injury.
For example: “While on a training mission I injured my knee. I saw treatment from the medic and was given Motrin and a brace. The training was 3 weeks long and I could not get put on light duty during training without getting dropped from the exercise. After the exercise, I continued to ice and take over the counter medicine. My injury was nagging and never healed but I did not want to be kicked out of the unit. I had to remain 100% mission ready.”
Again, this statement will not grant service connection; however, it does cover a time frame for context (during a 3 week training course). It established what medical attention was sought (the medic issued Motrin). It established why further medical attention was not sought (being put on light duty would have resulted in getting dropped from the course). It also makes a statement about why treatment was not sought after the event (had to remain 100% mission ready)
The purpose for a statement like this is to fill in the gaps in the Veteran’s STRs and justify the VA ordering an examination.
The VA must have an examination that gives a medical opinion linking the claimed disability to service. If the Veteran’s statement triggers the VA to order an examination and the medical examiner gives a medical opinion that the claimed condition is “as likely as not because of service”, the Veteran stands a much better chance for being granted service connection.
Lack of Information for a Claim
In closing, the most common issues with most claims is the lack of information to support the claim. Either lack of recorded medical treatment from service, lack of a current diagnosis, lack of a context, or an explanation as to how they Veteran’s current disability is as a result of military service. Simply being a Veteran, having an ache or pain, and receiving treatment from the VA Hospital does not qualify a Veteran for service connection. The Veteran must establish that their current, diagnosed disability is a result of their service.
Veterans Disability Attorneys
The VA disability attorneys at Berry Law are dedicated to providing Veterans the legal firepower they need to get their VA disability claim granted. If you need assistance appealing an unfavorable VA rating decision, contact Berry Law today for a free case evaluation.
Established in 1965 by Vietnam War veteran and attorney John Stevens Berry Sr., Berry Law Firm is a team of veterans dedicated to defending, safeguarding, and fighting to protect the rights of veterans. Over the decades, thousands of veterans from across the country and all branches of the military have trusted our firm with their cases and, more importantly, their futures.