Why did the VA deny your claim?
A short guide to explain why many Veterans' Benefits claims are denied - and the most important supporting evidence to prevent a denial
Who's entitled to compensation?In general, the VA is obligated to compensate qualified veterans for their service-connected disabilities. This includes physical and psychological conditions that were incurred or aggravated during military service. Veterans' disability claims are evaluated by each local regional office of the Department of Veterans Affairs (VARO). Each VARO is responsible for adjudicating disability claims submitted by the veteran (or representative) and either approving the claim on its merits, or providing an adequate statement of reasons and bases for its denial.
Easy as 1,2,3? Not exactly...Typically, a successful disability claim before the VA must clearly prove entitlement to service connection. So, the claims paperwork must identify: 1) medical diagnosis or evidence of a disabling condition; 2) an in-service event causing or aggravating that condition; and 3) evidence or medical opinion showing a link or "nexus" between the disabling condition and the in-service event.
If a claimed disability is determined to be service-connected, the VARO will provide a disability rating (assigned as a percentage %) and assign an effective date. An approved disability claim will include all three pieces of information in a written decision letter provided to the veteran for his/her records. If the claim is denied, the VARO will provide an explanation to the veteran in a denial letter.
It is important to remember that a denial letter is not the end: usually, it is just the beginning of a complex and time-consuming appeal process.
Denied. Here's why...In my experience, the most common reason provided by the VA for a denied claim is a determination that the claimed disability is not entitled to service connection. This means that one (or more) of the 3 components for service connection listed above was missing in the claim paperwork.
Without delving into technicalities and legal nuances, the single most convincing document to support service connection is a medical professional's statement connecting the diagnosed disability with a specific in-service event. A claim that does not include this nexus statement is probably doomed from the start. A claim that on its face meets the criteria for service-connection, but is denied nevertheless, should be reviewed by an attorney to determine whether appeal is appropriate.
In short, the most important supporting document in your initial claims paperwork to assure service connection is a nexus statement by a medical professional.
Denied. Now what?First thing to do: roll up your sleeves and prepare for battle.
As any experienced lawyer will tell you, appealing an existing adjudicative decision is an uphill battle. There are no guarantees of success. But, there is hope.
Generally, you have 12 months from the date of the claim denial to file a "Notice of Disagreement." The NOD is a standard form that notifies the VA that the veteran/claimant intends to appeal the claim denial. The NOD can also be used to dispute the rating percentage as well as the effective date. If no NOD is received, the VA denial decision will become final and the claim will be closed.
How can an attorney help?An experienced attorney can help you decide the cost and benefits of appealing a VA claim denial.
Attorneys do not typically offer representation until after the veteran submits the NOD form. If you decide to appeal, be patient - claims may be stuck in administrative limbo for several months or even years. The appeals process has many layers and your attorney will have to navigate between administrative procedures as well as appellate court-style litigation. But, with the right combination of legal experience and supporting evidence, the chances of successfully appealing a VA denial will be dramatically better than without the assistance of counsel.