How To Read and Understand Your VA Disability Claim Decision Letter
The VA’s disability decision letter is organized in a format that has four major sections: 1) an introduction, 2) a decision, 3) a listing of evidence considered, and 4) reasons for the decision. This article discusses what to look for when reading your VA disability decision letter.
IntroductionThe U.S. Department of Veterans Affairs administers disability compensation that veterans have for illnesses or injuries which were caused by, or have been made worse during, active military service. The compensation may include financial support and other benefits such as health care. Click here for more information on eligibility requirements for VA disability.
If you believe you are eligible for Veterans Affairs disability, the first step is to gather any supporting documentation for your claim. You will need evidence such as military records related to the injury or illness at issue, your medical treatment records, and your DD214 or other separation documents. Fill out your claim form completely and include all the relevant evidence. Today, you have several options for how you can file a claim:
You can file online at https://www.va.gov/disability/how-to-file-claim/.
Mail the claim form in.
Apply in person.
Consult with a trained professional.
After filing the claim, you do not need to take any further action unless you receive follow up communication from the VA. According to the VA’s website 111.5 days is the average number of days it took the VA to complete disability-related claims in April 2019.
The Disability Decision LetterThe VA’s disability decision letter is organized in a format that has four major sections: 1) an introduction, 2) a decision, 3) a listing of evidence considered, and 4) reasons for the decision. When examining the decision letter you receive, the first thing you should do is read the letter to determine if there have been any mistakes made either by you in not including all relevant information, or by the VA in overlooking something that was included. For example, are the records correct in the introduction section that show the time you served in the military? Or, what was the date you filed your original claim?
When reading the decision section, note the reasons the VA claims for their decision. Here the letter will describe if each claimed disability was granted, and if granted, the percentage awarded from 10% to 100% in increments of 10, or if the claimed disability was denied. The decision section is short, and only gives one sentence for each claimed disability.
When examining the evidence section, think long and hard about whether you have in your possession or believe other documents might exist that could help your case. Helpful evidentiary documents include your service treatment records, your VA screenings completed by a company contracted by the VA, VA forms that may apply (such as VA Form 21-series in support of filing for certain types of disabilities), your private medical records, X-rays, records of injury or illness while on active duty (such as reports from treatment at a troop medical center), physical profile information, or other military medical records.
The VA can only decide your disability claim based on the evidence they find and you find. Thus, if you were injured during a parachute jump in 2005, yet there is no record of this injury listed in the evidence section, then the VA has no way of knowing that such injury is service connected and will thus deny the disability claim(s) that were related to that parachute incident.
Reasons for DecisionThe Reasons for Decision section is the longest portion of the letter from the VA. When reading that section, look for the regulations (CFR) that support the actions the VA takes. For example, the letter might have a section stating, “When an intent to file is properly submitted, and a substantially complete application for disability compensation and related compensation benefits is received within one year of the intent to file, the claim is considered filed as of the date we received the intent to file (38 CFR 3.400).” Thus, to understand where that provision comes from, you could read 38 CFR 3.400 which should state something similar to what is claimed in the letter. Read your evaluation percentages and determine if you agree with the findings of the VA. When the VA grants a disability rating, they explain the percentage granted and state what that finding is based on. They will then cite to the portion of the CFR that describes the criteria for that % of disability evaluation. They may state that a higher rating is not warranted because the evidence did not show that you had more serious symptoms.
A common reason many VA disability claims are denied is because the VA determines the injury is not service connected. They may use language such as, “No evidence shows this injury occurred while on active duty, and the post separation file is silent for those type of complains as well.” For the VA to award disability, you must show a nexus, or link between your claimed issue and an event, injury, or disease which occurred while in the service. Your treatment records during your time in service or within a year of completing the service should show a complaint, treatment, or diagnosis related to the disability for which you are applying. Importantly, even if your claim is denied, the VA will include favorable findings identified in this decision. These favorable findings could show that you do in fact have a diagnosis for the injury or illness for which you applied.
Systematic Approach for AppealOverall, the VA disability benefits decision letter may be difficult for many or most veterans to understand. However, by taking a systematic approach and breaking down the information that is provided in each section, you can better understand why the decisions were made the way they were in your letter and what you could do to best succeed on your appeal. As a military officer myself, I analogize this process to the Military Decision-Making Process (MDMP). During MDMP, one of the most important steps is mission analysis. This is where the team reads the mission that the higher headquarters has established, and they begin to dissect all the parts of the operation within the scope of their roles. Treat reading the VA letter as mission analysis. Find out if there is anything that should be included in your application that has not already been included. Find out if the VA made a mistake by overlooking an important piece of evidence. Perhaps you need to go to a civilian or VA doctor to be treated and can include this next visit in your appeal. If you disagree with the VA’s decision, consult with a close friend or an attorney experienced in VA disability appeals and brainstorm your plan of attack. Just as many military operations were not successful until numerous hours of planning before the attack, so too your VA disability appeal may require some strategic thinking before filing the appeal. This process begins by reading and understanding your VA disability claim decision letter.