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Proven tips for higher disability ratings from the VA

by Ben Krause

How to manage your VA claim for disability compensation

I’ll start by explaining what I did and why it was wrong. Another case of do what I say, not what I did. It is important to not repeat the following because it will cause a lengthy appeal process – and there is nothing worse than a 10-year appeal process. It’s like waiting for your IRS tax refund, except its more money and, like Rip Van Winkle, I look a whole lot older.

Don’t be dumb. I hand wrote my initial application for compensation without reviewing my Service Medical Records (SMR). My claim led with the statement: “see supporting medical documentation in my file.” This was dumb. Imagine someone sending you a hand written, 300-page manuscript (doctor’s scribbles plus my own) and allowed you 4 hours to read it. Then they ask you a ton of questions that are legally binding. That is what I asked the VA to do 10 years ago. In reality, the VA adjudication process is very complex and time consuming for the veteran and the VA. Do not expect the VA to connect the dots. This is your job if you choose to take it, or you’ll be older and fatter still fighting the good fight, like me.

Get started. For veterans with copies of their SMRs, get moving. Any condition diagnosed within one year of separation could be considered service connected, even if it was undiagnosed in service. For those without the records, request a copy of your SMR’s from your local regional office. Mail in a Freedom of Information Act (FOIA) request. Click here to find a sample FOIA letter. Once you have the chance to review the documents, you can begin your own research. Since you only have access to a Veteran Service Officer once a disability is established, you’ll need to do this part on your own.

Research every condition and injury you have within your medical records (about the possible presumptive conditions that show up within one year – bring these up too). To do this, identify the key terms and find them in 38 CFR Part 4: Schedule of Ratings. For example, let’s say you have Sinusitis. Within your records, you can document 5 different occasions that you went to the doctor for the condition (like allergies, congestion, etc). Go to the CFR and find Sinusitis. A quick way to do this is to click [Control + F] and type in Sinusitis. This should lead you right to the rating criteria. Notice for the condition, the requirements “either or” tendency. Here, you either have periods of incapacitation or you have “non-incapacitating” episodes. Decide where you currently fall into the rating schedule. Then, you can Google the condition on either regular Google or Google Scholar. Read about what Sinusitis actually is and what causes it. Get educated on each and every condition you are claiming this same way.

Write up a summary of all the conditions and include dates of treatment while in service and after. You do not need to seek medical attention for every issue in order to document it. For example, incapacitating episodes are considered episodes that required a doctor’s visit. Non-incapacitating episodes are not. A person can self-medicate certain conditions. But always remember, the condition needs to be current in order to count. If it stopped hurting last year, then you will likely not get a rating for it.

Now Enters VA Documentation

Next, you can fill out the VA claim online: VONAPP. The non-computer savvy veteran can either download the Form 21-526 and fill it out manually or request that the VA mail one to you by calling 800-827-1000. This begins the process. Be very general about the conditions you are writing down. Do not attempt to diagnose the condition yourself. For the sinus condition, you could merely state “sinus condition” or “problem breathing”. Or, you can be specific and state “sinusitis” if it is in your file. However, do not get cute and diagnose something that is not stated in your SMR.

What VA Does after It Receives Your Claim
Here’s what VA says about the next step:
“After VA receives your Application for Compensation, it sends you a letter. The letter explains what VA needs in order to help grant your claim. It states how VA assists in getting records to support your claim. The letter may include forms for you to complete, such as medical releases. They help VA obtain pertinent medical records from your doctor or hospital. You should try to complete and return all forms VA sends within a month. Your claim can often be processed more quickly if you send a copy of your own medical records.”

Here’s what I say: in addition to this, be sure to read everything very carefully. Sometimes the dates can be wrong or VA might be asking for the wrong information. In addition, when you forward medical release letters to civilian medical providers for their records, be sure to follow up with a phone call to ensure they understand what you are requesting.

What to Expect during the Medical Examination

Here is what VA says about their examinations:
“You should expect the examiner performing your medical examination to evaluate the condition(s) listed on your claim for benefits. Depending on the number and type of disabilities claimed, the length of the examination will vary. Psychiatric examination or that for multiple disabilities requires more time to evaluate. The examiner may ask more questions about your disability’s history, review pertinent medical records, or order additional testing or examinations, if necessary. The examination will not include any form of treatment for disabilities or acute illnesses. Unless additional information, tests, or evaluations are needed, the completed evaluation will be documented and forwarded to the VA Regional Office for processing.”

Here’s what I say: get your act together. For conditions like PTSD, VA has examination criteria online. Google whatever condition to read about the experience of other veterans after their exams. This can help a lot. In addition, write a one-page summary using bullet points with brief explanations of each and every treatment for that particular condition. Be careful to not overwhelm your examiner. Ask if the examiner has viewed your C-File before the exam. If not, you may have a claim for a review if the examiner gives you and adverse finding.

Lastly, be patient. The whole process can take up to two years or longer.