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Overview of the Basics of Veterans Administration Claims

The current state of war began on August 2, 1990 with the original Gulf War conflict, and has not yet ended. That means any veteran meeting eligibility requirements could be eligible for either a non-service connected pension or for a service connected compensation.

VA Pension Benefits:

1) War Time Service requirement

Any veteran who is 100% disabled and who served during a war time period may be eligible for a disability pension.

World War II December 7, 1941 – December 31, 1946

Korean Conflict June 27, 1950 – January 31, 1955

Vietnam Era August 5, 1964 – May 7, 1975

(For actual service in Vietnam, period begins February 28, 1961)

Gulf War Era August 2, 1990 - continuing

2) Other eligibility requirements

  • Must be a veteran

  • Must have served 90 days, at least one of which was within the war time period, or discharged from the military for a service connected reason before 90 days

  • Discharged under other than dishonorable conditions. Qualifying discharge includes:

· Honorable

· General (also called general under honorable conditions)

  • Disqualifying Discharges include:

· Undesirable

· Discharge under other than Honorable conditions

· Bad Conduct discharge

· Dishonorable discharge

  • Must have limited income and assets

  • Must be permanently and totally disabled (not necessarily connected to service)

  • Benefits start the month after the most recent application

3) Some Basic Disability Definitions

a) To receive pension benefits, veteran must be permanently and totally disabled from his or her various medical impairments, none of which need to be “service-connected."

b) Disability: When the conditions would render an average person to follow a substantially gainful occupation as long as it is reasonably certain the disability will continue throughout the life of the person.

c) Disability must be permanent (lifetime), not just 12 consecutive months.

d) Any veteran determined to be eligible for DIB or SSI automatically qualifies.

VA Service Connected Compensation:

Unlike a non-service connected pension, VA service-connected compensation is not a needs based program. As a result, any veteran who establishes that their disability originated while in the military (service connected) is entitled to benefits, regardless of income and assets.

1) Basic eligibility requirements

  • Must be a veteran

  • Not limited to service during war time, unlike pension benefits

  • Discharged under other than dishonorable conditions: Qualifying discharge includes:

Honorable

General (also called general under honorable conditions)

  • Disqualifying Discharges include:

Dishonorable discharge

  • Other discharges which may or may not qualify*

Bad Conduct Discharge

Discharge Under Other Than Honorable Conditions

* The VA will look at the specific facts surrounding the discharge, evaluate these situations and make a determination if the discharge otherwise meets the “under conditions other than dishonorable" standard.

2) Additional eligibility requirements

a) Symptoms of the disease or injury must have occurred in service or, in some cases, within one (1) year after discharge to a 10% disabling degree

b) Disability cannot be the result of veteran’s own willful misconduct or as the result of the abuse of drugs or alcohol

c) There must be a medical diagnosis of current disability

d) There must be medical evidence (or in rare cases, lay evidence) of in service occurrence or aggravation

e) There must be medical evidence of a link or nexus between the in-service occurrence and the current disability

f) Veterans Claims Assistance Act (VCAA) requires VA to provide a doctor to evaluate these issues and offer an opinion where the veteran does not have this evidence (called “Compensation & Pension exams" or “C&P exams")

3) Other eligibility information

  • Benefits Awarded in rating increments of 0% to 100%

  • Sample 2011 benefit rates: 10% = approx. $123 monthly

30% = approx. $376 monthly

70% = approx. $1228 monthly

  • Rating of 30% or higher – additional benefits awarded for spouse and dependent children

  • Employment is irrelevant to a rating percentage

  • An individual may be employed full time and still be rated up to 100% service connected disability

  • An employed individual may not be rated TDIU (total disability due to individual unemployability) while still employed

4) Agent Orange Claims

If a veteran served in Vietnam, with “boots on the ground," there is a presumed exposure to Agent Orange. That means any later developing medical problems such as some kinds of heart problems, cancers, diabetes, etc., is presumed to have been caused by the veteran’s service.

5) Persian Gulf Syndrome

For veterans on active duty in Southwest Asia during the Persian Gulf War who developed objective evidence of chronic disability not otherwise attributable to a known diagnosis, before January 1, 2002, service connection may be established. Chronic disability may be demonstrated by signs or symptoms including fatigue, skin problems, headaches, muscle pain, joint pain, neurologic symptoms, respiratory symptoms, sleep disturbance, GI symptoms, abnormal weight loss, cardiovascular problems, menstrual disorders. Conditions such as chronic fatigue syndrome, fibromyalgia or irritable bowel syndrome are consistent with Persian Gulf Syndrome.

6) Post Traumatic Stress Syndrome

To receive VA compensation for PTSD, a veteran must show two things: exposure to a stressor, and a diagnosis of PTSD.

  • Stressor: Any event that involves actual or threatened death or serious injury could also be considered as a stressor. This could include a battle, an observed death of another, or many other types of events. That event must be consistent with the places, types, and circumstances of the veteran's service. The VA will accept as a stressor the fact that a veteran was in "fear of military or terrorist activity." Moreover, a VA psychiatrist or psychologist, or those working under contract to the VA, must confirm that the claimed stressor is adequate to support a diagnosis of PTSD.

  • Diagnosis: A diagnosis of Post-Traumatic Stress Disorder made by a psychiatrist. Counseling reports prepared by a VA Center may be considered in determining the degree of impairment; however, there must be a diagnosis of PTSD made by a physician specialized in psychiatry.

7) Total Disability based on Individual Unemployability

Total Disability based on Individual Unemployability is a rating that finds a veteran totally disabled as a result of service-connected disability or disabilities. If a veteran is found totally disabled based on individual unemployability, he or she is awarded benefits at a 100 percent rate even though the combined rating of medical disabilities may be less than 100 percen

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