VietNow National Magazine
Filing Your VA Disability
Claim
Agonizing or rewarding?
There's a lot you can do to influence the
outcome of the claims process.
By Raymond
Gustavson
Submitting
a claim for Department of Veterans Affairs
(VA) benefits can be a rewarding or agonizing
experience, depending on the approach you
take. After having worked for some 31 years
for the VA, I have seen many claims which,
when concluded and the check was in the
mail, warmed my heart. These were cases
where we did everything we could to get
the claim approved for a person who was
in dire need of benefits.
I have also seen
some nightmares which, through the use
of due diligence, could have been easily
avoided. Notwithstanding any errors committed
on the part of the VA, it behooves you,
as an honorably discharged veteran to submit
your application in as complete a manner
as you possibly can. You should also be
honest and forthright in doing so, since
claiming benefits you know you are not
entitled to is a fraudulent act.
Getting
it right
To help you successfully file your
claim for VA Benefits you should consider
the following tips when submitting your
application:
1. You must complete your application
for VA benefits, VA Form 21-526, or other
form, in its entirety, being sure to date
and sign the form, and include your Social
Security number. I cannot stress this point
enough, because a properly executed VA
Form 21-526, is a formal application for
benefits, and its timely receipt by the
VA ultimately determines the date your
benefits will begin. You may submit a copy
of your original service medical records
if you have them in your possession. However,
the VA will still obtain the originals
from your service department.
2. On the
VA Form 21-526 you must list all disabilities
you are claiming. The Rating Specialist
who reviews your claim will then obtain
your Service Medical Records (SMR’s),
private medi-cal and/or hospital reports,
and, if appropriate, schedule you for a
VA examination. If you are asked to submit
private medical reports, send in only relevant
medical evidence pertaining to your claim.
For example, if you are claiming bilateral
hearing loss, do not send in page after
page of medical reports showing you were
treated for cardiac arrhythmia, bronchitis,
knee pain, etc. These records are not relevant
to your bilateral hearing loss claim, and
only serve to clutter your VA claims file.
This makes it harder to process your claim
should you appeal an adverse decision.
Additionally,
remember the -acronym SOAP: Subjective
complaints, Objective evidence, Assessment,
and Prognosis. Look for the “A” (in
Assessment) in the documents you are submitting,
as this will be the relevant diagnosis
that is needed in your claim.
3. You must
submit the evidence the VA requests. Under
federal law the VA is required to assist
you with the processing of you claim. But
be wary of this statement. The VA must
make continued efforts to obtain medical
records that are in their constructive custody. This means records, which are
at a U.S. government facility, either
a VA Medical Center you were in or other
government facility, such as a local US
Navy hospital. The ruling does not apply
to private medical doctors, clinics, or
hospitals. So, if you are sent a release
form (VA Form 21-4142) which the VA needs
you to complete in obtaining your private
doctor’s medical records, you must
fill out the form by putting a date of
treatment and the complete name and address
of your doctor. Failure to do this relieves
the VA of any obligation to secure your
-private medical records.
4. Send in only
current medical evidence. This means you
should submit treatment reports from the
last year or two. Reports for office visits
20 years ago, for example, are of limited
value in determining the current status
of your disability, unless you are trying
to prove continuity of treatment.
5. Read
all correspondence you receive from the
VA. You must study the letter in its entirety
to determine exactly what the VA wants
from you. If you are asked for medical
information, submit it. If you do not understand
the letter, contact your service representative,
or call the VA on its toll-free line. Do
not send long, rambling letters about
your claim, detailed accounts about how
you single-handedly won the war, or make
irrational threats. The rating specialist
needs medical evidence, not histrionics
or intimidation, to rate your claim.
Remember: the more irrelevant information
you submit, the larger your claims file
becomes, and the longer it takes to review.
6.
If you are scheduled for a VA examination
you must show up for the examination. While
at the examination you should be courteous
and cooperative with the doctor. In return
he will treat you the same. If you feel
the examination was inadequate in that
the doctor failed to examine you for a
claimed disability, do not argue with him.
Simply contact the VA Regional Office,
and the rating specialist will either
schedule you for another VA examination
for that particular disability or request
pertinent medi-cal information.
7. Pay attention
to all dates. Generally, you have one year
from the date of a VA letter to respond
to it. Why wait until the last minute to
send a reply and possibly jeopardize your
date of claim? For example, evidence received
after the one-year period expires will
be considered a reopened claim, thus a
new effective payment date will be established.
You lose your original date of claim, and
consequently you lose any retroactive benefits
(money) you may have been entitled to.
8.
You must submit a medical nexus with your
claim. This is a tricky point, although
it seems simple. What this means is that
a medical statement is necessary to establish
a link between some condition you were
treated for in service and the condition
that you now have. Your doctor must state
that “it is as likely as not” that
your claimed disability was incurred in
service. If the doctor beats around the
bush, or doesn’t use these specific
words, your claim will be denied.
9. If
you have a presumptive condition, pay attention
to the requirements for that particular
disability. Presumptive conditions, such
as diabetes, prostate cancer, Hodgkin’s
disease and the like, which are related
to Agent Orange exposure from service in
Vietnam, can be service connected based
simply on the fact that you served in
Vietnam. This is usually easy to establish
if you were in the Army or Marine Corps.
If you were in the Air Force or Navy, however,
this may not be so easy.
Note: for anyone
claiming presumption, you must actually
have touched down on South Vietnamese soil.
Fly bys, and parking on a destroyer off
the coast, do not count. If you flew bombing
missions from your base in Thailand, you
must prove that you touched down on Vietnamese
soil. One case in which I was personally
involved was a flight navigator who landed
one time in DaNang and went on sick call.
His record showed a treatment date and
place of treatment in Vietnam. Presence
in-country was thus established, and the
benefit granted.
10. Combining your service-connected
disabilities can be a complicated business.
Three disabilities rated at 10 percent
add up (or combine) to 30 percent. However,
when you get into the larger evaluations,
simply adding the disabilities won’t
give you the correct percentage. That evaluation
is determined by law in what is called
a combined ratings table. For example,
say you have one disability rated 50 percent
disabling, and are granted another at 30
percent. The correct combined evaluation,
according to the combined ratings table
is 70 percent not 80 percent.
Trust me when
I say that this is correct, because not
only is there a combined ratings table
in the Code of Federal Regulations (CFR),
but there is also a VA computer program
that ensures your combined evaluation will
be computed correctly. Of course, if you
have any doubts, contact the VA, or you
service representative, and request the
evaluation be checked. No harm is done,
and you will rest better at night.
11. Appeals:
This is a tricky and extremely complicated
business, and something you must watch
with the utmost diligence. One reason is
that there are time constraints involved
that affect your claim. And there are other
reasons, so it is probably best to have
a service officer help you with your appeal,
as they are eminently qualified in this
area. If you wish to go it alone, please
heed the following advice: The VA may take
several years to get around to processing
your claim. This is because of the backlog
of appeals, and also the ever-changing
emphasis placed on them either by VA Central
office or Congress. Despite the VA’s
delay in sending you a Statement of the
Case (SOC), do not think that you have
the same privilege in responding. Generally,
once you have received an SOC you have
one year from the date of the initial denial
letter, or 60 days from the date the SOC
was mailed to you, in order to perfect
your appeal. You perfect your appeal by
returning the VA Form 9 that you received.
On this form you don’t
have to go into a lot of detail. Just state
that you wish to continue your appeal.
At this time you may also submit additional
medical evidence to bolster your claim.
You may also request a hearing before the
Board of Veterans Appeals (BVA) Travel
Board, or a hearing in front of a Regional
Office Decision Review Officer.
Finally,
remember to pay strict attention to everything
you are asked to do when submitting a claim
for VA benefits. Attention to this detail
will result in a disability determination
that will be processed in a timely and
correct manner, and hopefully reward you
with monetary benefits.
Raymond Gustavson served
with the U.S.
Army in Vietnam, and is a retired
VA Rating Specialist. He is currently
working on a novel about the Civil
War, and also is writing a self-help
book for veterans who want to better
understand the complexities of the
VA claims process.
Back
to top of page.
Back to the VA Claims page.
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