VA Claims Tips:

[xeno]

Good info someone posted (why reinvent the wheel)...

From "SgtDBrownRet" on leatherneck dot com

VA Claims Tips:
Below is a sheet I give to every vet I come in contact. I advise that it be used to help gather evidence to support any VA claim. The main thing that slows up a VA claim is the evidence (in accordance to the 38 C.F.R.) is not in the record. I advise everyone on active duty or off active duty, or reserves to REVIEW YOUR RECORDS!!! Use the website below to see what the VA and DOD is looking for in your records to get the proper rating. This is the law that governs how each condition should be rated by the VA and the DOD. Know your symptoms, discuss them with your doctor, make sure they are documented. For those that records have been destroyed, track down anyone you served with and get statements from them that can back up your injury or illness in service. Lucky for us, the Marine Corps was really good with keeping unit records and morning reports. If your records have been destroyed, or lost, try requesting unit records or morning reports. They should show that you were sent to sickcall; or placed on light/limited duty; or hospital status. If property was damaged or destroyed, you know the unit had to report it in order to deadline or request parts for repair. The average processing time is the national average. Time may vary based on the case load and how much development the VA has to do. It is always good to have a doctor in your corner, because we all know how the VA C&P exams can go.

Hope this helps, it has been working for me for 8 years.

VA CLAIMS TIPS
q SERVICE CONNECTION: There are three criteria that are needed for the grant of service connection. They are (1) treatment for the claimed condition while on active duty or line of duty determination if a member of the Reserves or National Guard; (2) continuous treatment for claimed conditions after service and/or current diagnosis; and (3) a statement from a physician stating your current condition(s) had the onset in service and/or is directly related to and/or aggravated by your military service and/or service-connected condition. Take service medical records that show treatment for the claimed condition in service to your treating physician and have him/her prepare a statement. The statement must include that your service medical records have been reviewed and state whether or not the condition(s) you are applying for service connection had their onset or were aggravated by your military service. (Average process time 6 – 18 months)

q INCEREASED EVALUATION: If you think your service-connected condition(s) has worsened, see the website below to review the criteria needed to support a higher evaluation then submit a medical evidence that documents the symptoms of the higher level.Review of your treatment records is a major part of the exam. Make sure you relay all of the symptoms of your condition(s) and the incident(s) in service that caused the condition(s) to your primary care doctor and the C&P examiners. After each appointment get a copy of the treatment records for your records and review. Check them to ensure the doctor has input the information you both discussed. Treatment records from civilian doctors can be used to file a claim for increased evaluation. Lack of supporting medical evidence to support an increase, may cause a reduction in your current evaluation and prolong the claims process. (Average process time 6 – 18 months)

q NOTICE OF DISAGREEMENTS (NOD): CONTACT YOUR REPRESENTATIVE BEFORE FILNG AN APPEAL. You will need to submit: (1) a statement of exactly what you disagree with, and why; and (2) current medical records that support your contentions; and (3) what would satisfy the issue(s) on appeal. If it has been more that a year since your last rating decision, you cannot appeal the decision. You will need new medical evidence to reopen the claim. The effective date will then be the date of the reopened claim. The appeals process may take years to adjudicate without the proper medical evidence. Only medical evidence can refute the VA’s decision. (Average process time 2 – 7 years)

q SECONDARY SERVICE CONNECTION: If you are filing a claim for a condition that has been caused or aggravated by a service connected condition or its medication, you must provide medical evidence that state the condition you are claiming was either cause or aggravated by your service-connected condition and/or medications taken for service connected condition(s). (Average process time 6 – 18 months)

q The Department of Veteran’s Affairs (VA) and your representative will contact you in writing regarding the status of your claim/appeal (note average process time above), information needed to support your claim/appeal, dates for hearings, and final decision(s).

q The VCAA Reply letter is sent to each veteran when a claim/appeal is filed. It informs you of the information the VA has of record, and asks if you have any additional evidence from non-VA and/or military doctors that can be used to support your claim. Make a selection on the “VCAA Notice Response” sheet, sign, date and send to your representative for review and submission to the VA.

q If you have to have surgery or are hospitalized due to a service connected condition(s), please Submit medical evidence that show the number of months you will be convalescening or hospitalized. The VA pays compensation at the 100% rate during this period.

q For information on the rating criteria used by the VA and the military to evaluate your compensation level go to http://www.warms.vba.va.gov/bookc.html#b1 COMPARE YOUR TREATEMENT NOTES WITH THE RATING CRITERIA Website to request military records: www.archives.gov/veterans/evetrecs/

CONTINUE TREATMENT FOR CLAIMED CONDITION(S) AND MAKE SURE YOU RETRIEVE A COPY OF YOUR TREATMENT RECORDS AFTER EACH MEDICAL APPOINTMENT FOR YOUR REVIEW AND RECORDS!

Direct any questions to your service representative or the VA Regional Office @ 1-800-827-1000.

 

[Jason Perry]

This post has a lot of good points and for most of the issues they are decent explanations.

However, I would say that folks should remember that this is a complicated subject matter and it is extremely difficult to give blanket explanations and there are exceptions or nuances to each of these subjects.

For example

continuous treatment for claimed conditions after service and/or current diagnosis; and (3) a statement from a physician stating your current condition(s) had the onset in service and/or is directly related to and/or aggravated by your military service and/or service-connected condition.

In the first sentence, you need a current diagnosis. If you do not have a current diagnosis, you likely don't have a ratable condition (again, my comment suffers from the same problems as the original post, that is, this can be a complicated area and there may be fact specific exceptions).

Or bullet (3): You don't necessarily need a statement that your condition was directly related to your military service...the standard is "as likely as not" so, while having a definitive clear statement is best, you can still win with opinions such as "as likely as not," "probably," or "more likely than not."

§ 3.102 Reasonable doubt.

It is the defined and consistently applied policy of the Department of Veterans Affairs to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. It is not a means of reconciling actual conflict or a contradiction in the evidence. Mere suspicion or doubt as to the truth of any statements submitted, as distinguished from impeachment or contradiction by evidence or known facts, is not justifiable basis for denying the application of the reasonable doubt doctrine if the entire, complete record otherwise warrants invoking this doctrine. The reasonable doubt doctrine is also applicable even in the absence of official records, particularly if the basic incident allegedly arose under combat, or similarly strenuous conditions, and is consistent with the probable results of such known hardships.

q NOTICE OF DISAGREEMENTS (NOD): CONTACT YOUR REPRESENTATIVE BEFORE FILNG AN APPEAL. You will need to submit: (1) a statement of exactly what you disagree with, and why;

Again, this will likely make your case much easier to win...but, the disagreement can be general and the VA has the obligation to consider all legal theories under which you can be granted the benefit claimed.

If it has been more that a year since your last rating decision, you cannot appeal the decision.

This language is too general if you ask me. Again, there are exceptions.

Only medical evidence can refute the VA’s decision.

Way too general. Lay evidence of medical conditions are competent in a number of circumstances, failure to meet the various obligations under duty to
assist (including "Reasons and bases" for the decision), failure to follow the requirements of 38 CFR.

q SECONDARY SERVICE CONNECTION: If you are filing a claim for a condition that has been caused or aggravated by a service connected condition or its medication, you must provide medical evidence that state the condition you are claiming was either cause or aggravated by your service-connected condition and/or medications taken for service connected condition(s). (Average process time 6 – 18 months)

See above comments.

I think this post is a good "snapshot" of many of the issues and if you have the things described, you will likely be in good shape. However, I posted my comments, not to shoot down or sharpshoot the post, but to emphasize that there are closer cases or issues that may still result in a successful ultimate application or appeal. Way too many Veterans look at the issues and miss important factors that should result in a grant of benefits, but give up because the only look for the most obvious. The VA makes a great many errors, so, I just want folks to be aware that though they may not have a "perfect" or ideal claim, they still may prevail.

My thought is that you can use this as a general guideline, but if your issues are complicated, you need good advice from someone qualified and familiar with VA law issues.

Keep up the fight, you can win.

 

[LillyMommy]

I'm not sure if this is where I post my question- but hopefully someone answers me here! My husband has been deployed twice to Afghanistan and three times to Iraq over the course of his 7 years in the Army. He was diagnosed with PTSD back in January and now TBI. He also has a bulging disc and severe back pain. His therapist told him she was giving him a P3 profile and that with his "issues" he would most likely get 100% disability. My questions are- how long will this all take, how does the board figure a percentage, what could the pay possibly be, & would myself and our 5 month old daughter still be covered under healthcare. I know this is alot...but I am so nervous about all these changes, especially with our little girl. Thanks!