Top Reasons For Denial of VA Claims

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Have you been denied your VA Disability Benefits?

When trying to file for disability benefits, the odds might seem to be stacked against you.

Part of the problem is because the VA is so backlogged with claims, the VA Raters (RVSRs) at the Regional Offices (RO) don’t have the time to fully develop each case. An average time the RVSR has to adjudicate your claim is about 35 minutes.

Here are the 10 most common reasons for Veteran’s disability claim denial.

Inadequate information provided in your claim—it’s very possible that you simply didn’t provide enough medical evidence in your disability claim for the VA to make an informed decision regarding your true level of disability.

With Disability Benefits Questionnaires (DBQs) Veterans now have more control over the disability claims process. Veterans have the option of visiting a private health care provider instead of a VA facility to complete their disability evaluation form.

Veterans can have their providers fill out any of the more than 70 DBQs that are appropriate for their conditions and submit them to the VBA. It's that easy!

Here is the list on online DBQs you can take to your doctor. https://www.benefits.va.gov/COMPENSATION/dbq_ListByDBQFormName.asp

Missed the deadline—Appeals on denied Veteran’s disability claims must be filed within one year of the date of the ratings decision. However, don’t wait until the last minute to file your appeal as you will waste months. If you missed the deadline and your claim is now finalized, you can choose to REOPEN a claim. To do this you must file a VA Form 20-0995 Supplemental Claim with new and relevant evidence such as a DBQ for nexus letter.

Disability is ruled as non-service connected—to receive Veteran’s disability, you have to show that your disability originated from an event that occurred during service. Sometimes, the VA will try to rate your disability as non-service connected, so you have to appeal the decision of the classification of your disability. Frequently, it is necessary to get “buddy statements” to prove certain disabling events occurred while in service.

Symptoms aren’t deemed severe enough and given an improper rating—In some cases, the VA will recognize that you’re experiencing certain symptoms from a service-related disability, but they’ll state that your symptoms aren’t at a degree or level severe enough to warrant disability compensation or a higher disability rating. It is very important to have continuity of care documented in your current medical records to establish the current severity of the condition you are filing for.

Mistaken reliance on the VA to send the Veteran for a Medical Exam — Frequently the key to proving service connection of a disability is getting a “medical nexus exam.” This is where a doctor gives a written opinion as to whether a current medical condition is service connected. The VA often does not provide this and it is necessary for the Vet to get it themselves. https://vcag.info/The_Nexus_Letter

Ruled a pre-existing or non-aggravated condition—The VA may determine that a pre-existing condition contributed to your disability, meaning that, in their view, you’re not entitled to any compensation because your condition is not service connected.

Filled out the wrong or outdated forms—There are certain forms that must be filed before the process can be started. Filing the wrong forms or completing your forms incorrectly can lead to a veteran’s disability claim denial. Always get the latest versions from the VA website at https://www.va.gov/vaforms/search_action.asp?FormNo=21-&tkey=&Action=Search

Lack of professional representation—It’s certainly within your rights to file your claim on your own, but it’s often a good idea to enlist the help of a professional so you don’t make any costly mistakes that cause delays or a claim denial. Experienced representatives know how to gather and present evidence of service-connected disability effectively.

Mistaken reliance on the VA to fulfill their “Duty to Assist” the Veteran — The VA has a legal duty to assist the veteran in developing their disability claim. This means the VA is supposed to collect the veteran’s military and medical records and anything else necessary to develop their case. This is a mistake as the VA rarely fulfills this duty. The smart thing to do is to collect your own medical and military records and seek your own doctors’ opinions as to why you are disabled.

Claim is still being processed—There’s a chance that your disability claim hasn’t been denied at all. It might just still be in processing. Processing for claims can sometimes take years, so you need to check on the status of your claim before taking any further action.


So, what should you do if you’re facing disability claim denial? The most important thing is to not give up.

The truth is that a lot of Veteran’s disability claims are denied at first, but just because your claim is denied doesn’t mean that your claim isn’t justified. You have the right to appeal your claim, and with some expert help, you stand a chance of winning your claim.

The key is to look for an experienced and accredited advocate that handles disability claims cases just like yours. You need a representative by your side that understands the appeals process, knows the reasons veteran’s disability claims are denied, and more importantly, understands what it takes to win your appeal.

Don’t give up. With perseverance and a helping hand, you can get the VA disability benefits you deserve.

Find an accredited advocate here.

Free Accredited VSOs through your state, county or over 140 Veteran Service Organizations with an average of over 190 per state.  https://www.va.gov/ogc/apps/accreditation/index.asp

Accredited Claims Agents – over 500 available to help you throughout the country, most are also Veterans! Claims agents have no ‘territory’ so they can help you in whatever state you are in or even if you are out of country.  https://www.va.gov/ogc/apps/accreditation/index.asp

Accredited VA attorneys – over 9,000 available to help you throughout the country. VA accredited attorneys have no ‘territory’ so they can help you in whatever state you are in or even if you are out of country.  https://www.va.gov/ogc/apps/accreditation/index.asp

 

 

May 5, 2019 - 2:52pm

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