Why was My VA Claim Denied?

In a perfect world, getting service connection for a veterans disability benefits claim would be as easy as sending in a single form. After all, the Department of Veterans Affairs (VA) has a duty to assist Veterans in developing their claims and an obligation to make sure Veterans get service connection for every disability related to service. Yet, after submitting their claim on the correct form, many Veterans find their VA claim denied without a clear understanding of why. They often ask us as veterans disability attorneys, “If I didn’t send the wrong forms, why did the VA deny my claim?”

Understanding why the VA denies claims can provide insight into what the VA needs to grant a claim. A successful VA disability claim meets the following three elements:

  1. Competent medical evidence of a current disability
  2. Evidence that the disability can be connected to military service, including its causes and symptoms
  3. Medical evidence (usually a medical opinion) connecting the current disability to the in-service disability

If a Veteran can show all three, they will usually get service connection. A claim denial occurs when a Veteran cannot show one or more of those elements during the claims process.

Current Disability

It stands to reason that anyone filing for VA disability benefits would have the stated disability. Due to the simplicity of the element, many disabled Veterans overlook the need to show enough evidence of the disability or their claim will get denied. This happens most often when the Veteran gets their primary treatment through a source other than the VA medical system. For instance, the Veteran might receive psychiatric care through a private psychiatrist who diagnoses them with PTSD. When the Veteran files a claim for PTSD, the VA does not show a diagnosis or any mental health treatment records, so they deny the initial claim.

To prevent the above situation from happening, Veterans should ensure that the VA has every piece of available evidence relevant to their claim. If the Veteran receives treatment through a private provider, it would be best to get the records from that provider directly. Though the VA will help gather records if they’re informed of the existence of private treatment records, obtaining those records directly expedites the process.

Another complication with showing a current disability arises when the Veteran does not have a diagnosis. For instance, the Veteran injured his or her knee in service and has had a bad knee ever since. Without any medical records of treatment, how can they show medical evidence of a knee disability? The Veteran can describe the disability in detail, triggering the VA’s duty to assist by providing an examination. Alternatively, if possible, the Veteran can seek a medical evaluation in preparation for filing the claim. Keep in mind, even if the medical examiner cannot provide a definitive diagnosis, pain alone can be a disability.

Disability Related to Service

The second element required for service connection requires evidence that the disability began in, was caused by, or was aggravated by service. Veterans who have a VA claim denied because the evidence failed to show the connection to service often do not know what kind of evidence they can submit to support the claim. With this element especially, a wide variety of evidence can support the claim.

Take the common example of a Veteran who hurt himself or herself in service while deployed. The Veteran did not seek medical help for the injury for a number of reasons; he or she was afraid to look weak or worried about being sent home early, abandoning the mission. The Veteran was young when the injury occurred and thought the injury would get better on its own. Then, many years down the road, the injury becomes aggravated to the point where it seriously impedes daily life. At that point, the Veteran wants to file a VA claim, but the VA says the injury wasn’t service-related because service medical records are silent for the injury.

The solution in this situation varies. Perhaps the Veteran complained to his or her best friend or family member about the injury. That person can submit a signed statement to the VA corroborating the Veteran’s account of how the injury occurred. Another sign of a physical injury might be a drop in PT test scores, reflected in service records. If the Veteran’s run went from a six-minute mile to a nine-minute mile, that could help attest to the fact that something physically changed in that timeframe. Anything that corroborates the Veteran’s story can help support your VA disability claim.

The above example represents a disability that began in service. Not all service-connectable disabilities manifest during service. An example of this would be diabetes, which manifested years after exposure to Agent Orange. Though diabetes would be presumptively service-connected, many disabilities do not fall within the lists of presumptive conditions for exposure to conceded toxins such as Agent Orange and Camp Lejeune contamination. Say a Veteran developed asthma after getting out of service, and they were exposed to burn pits in Iraq. He or she would need to present some evidence that asthma relates to burn pits, usually in the form of medical studies showing the connection.

As for aggravation, a common reason claims get denied is because the VA did not see that the condition worsened from the beginning of active duty to the end. For example, if a Veteran entered service with mild flat feet, he or she might not be able to easily show that their flat feet got worse through medical records alone. It’s important to tell a clear story of how service affected the disability. In the flat feet example, maybe the Veteran never noticed any pain from flat feet until he or she started doing daily strenuous activity in basic or rucking with eighty pounds of equipment in service.

Nexus 

The final element of service connection tends to be the trickiest to meet. To successfully show a nexus, a medical professional must state that it is at least as likely as not that the current disability is related to the in-service event. This can be a difficult thing to get a medical professional to state in writing, so many Veterans rely on the VA to provide an examination. If the VA examination comes back with a negative nexus, the claim gets denied, and the Veteran is left wondering what they should do next.

There are multiple ways to combat a negative nexus opinion. The most valuable thing would be to pursue a second opinion through a private physician. Much like when seeking medical treatment, a second opinion can be valuable to gauge the options presented. If the second opinion is the same as the first, maybe the Veteran should reevaluate whether they want to pursue the claim. However, if the private physician offers the opinion that the disability is more likely than not related to service, it can be presented to contradict the negative nexus. Since the VA has an obligation to decide cases where the positive and negative evidence is equal in favor of the Veteran, this can be a key to getting the claim service connected.

Next Steps

If a Veteran cannot afford a second opinion or cannot find a doctor, the second option is to attack the VA examination itself and try to show that the examination was inadequate. The Veteran will first want to get a copy of the exam report and look through it. Are the facts correctly stated? Does the examination report reflect everything that happened in the physical examination itself? Perhaps the examination failed to account for the Veteran’s account of what happened and focused solely on the medical records.

The Veterans Appeals Improvement and Modernization Act of 2017 helps Veterans more easily and quickly file claims by:

  • Modernizing the current process for claims and appeals
  • Providing claim resolution earlier
  • Requiring enhanced notification of VA decisions
  • Ensuring you get the earliest possible effective date

The new law also offers three review options for any disagreements with VA decisions, so you have more choices with how to proceed. 

1. Higher-level Review 

A more senior claims adjudicator will review your denied claim for a new case evaluation of the VA’s decision. The decision review officer (DRO) will consider overturning the decision in their review. Submitting new evidence is not allowed for this review, but the new claims adjudicator could find an error from the previous adjudicator or have a different opinion. The claim can then be returned to the regional office for correction. You or your representative can request a phone call to identify specific issues.

2. A Supplemental Claim Lane 

You can submit new and important evidence to support your claim. 

3. Appeal Lane for Appeals to the Board 

A Veteran can directly appeal to the Board of Veterans’ Appeals (BVA) with this option. There are three options to choose from:

  • Direct review: The Veteran does not have new evidence and does not want a hearing.
  • Evidence submission: The Veteran has new evidence to provide but does not want a hearing.
  • Hearing: The Veteran has new evidence to provide and wants to testify before a Veterans Law Judge in the Court of Appeals for Veterans Claims.

Veterans Appeals Attorneys

If you have been given a poor rating by the VA or have had your veteran’s disability claim denied, please contact our VA appeals attorneys. Berry Law is a Veteran-owned and operated law firm that is committed to fighting for the rights of other Veterans. You are entitled to disability compensation from the VA. Let us fight the next battle alongside you. Contact our team to schedule a free consultation today.

 

Sources:

https://www.congress.gov/bill/115th-congress/house-bill/2288