Top Reasons Why VA Denies Claims
CCK Law: Our Vital Role in Veterans Law
There are several reasons why VA denies veteran’s claims. Better understanding these reasons can help veterans avoid falling into certain pitfalls that can get their claims denied.
VA Claims Overview
The best way to avoid making certain mistakes within the VA claims process is to first understand the system itself and how it operates. With the VA disability benefits claims and appeals system, veterans who suffer from an illness or injury related to their military service may qualify for compensation.
In general, veterans must provide proof of three things to be granted service connection and receive disability benefits. These things are:
- A current condition (usually diagnosed by a medical professional);
- An in-service illness, injury, or event; and
- A nexus, or link, between the current diagnosis and the in-service occurrence.
If service connection is awarded, then VA will assign a disability rating that corresponds to the amount of monthly compensation the veteran will receive.
Veterans can file a claim for benefits using VA Form 21-526EZ. They can do so:
- Online using VA’s eBenefits platform;
- By mail;
- In person at a VA Regional Office; or
- With a legal representative.
While these steps seem straightforward, many veterans know how complicated and confusing the VA claims process can be. They also know how often claims are denied.
What are the Top Causes for VA Claim Denials?
VA may deny disability benefits claims for a variety of reasons, but here are some of the most common.
Lack of a Current Disability
Veterans must have a current condition to establish service connection. In this context, “current” means that you are experiencing the symptoms and effects of the condition at this very point in time.
However, VA often overlooks the fact that you do not technically need to have a formal diagnosis. While it is an easier path to service connection if you do have a diagnosis, the law states that you do not need one to be eligible for service-connected compensation.
For example: Chronic pain is not something that gets a formal diagnosis, but it causes functional loss and impairment. As such, it should meet the standard of a current disability that is eligible for compensation.
Ultimately, the condition does not need to be diagnosed, it just needs to be:
- Related to service; and
- Something that impairs your daily functioning and earning capacity.
A good example of a situation where a veteran would not have a current disability may involve a temporary illness. For example, if you were previously diagnosed with cancer but have since gone into remission, then VA would not consider it to be current for rating purposes. This is because the cancer is no longer active.
Psychiatric conditions tend to be much easier to prove when you have some type of formal diagnosis. These types of conditions are examples of disabilities that you do want to have a diagnosis for.
Failure to Prove In-Service Event
Lacking proof of an in-service injury, illness, or event relates to the second element of service connection. Here, VA is looking to see if something happened in service that may have contributed to the onset or aggravation of a current condition.
This can include if you were injured in a training accident, exposed to loud noises, or witnessed a traumatic event. Any of these incidents may lead to a subsequent disability and thereby qualify as an in-service event.
Confusing an In-Service Event with a Disability
Sometimes veterans get confused about whether exposure to Agent Orange or burn pits is an in-service event or a claim in and of itself. Exposure to toxic substances is considered an in-service event, qualifying you for the second element of service connection.
Agent Orange leads to many debilitating conditions for which veterans can claim service connection. Again, veterans might say that they have a certain cancer due to Agent Orange, but they should not simply file for “Agent Orange.”
Lack of Medical Nexus
After the first two elements of service connection are met, you will likely need to provide a nexus. A nexus opinion establishes a link between your current disability and your in-service incident.
It is most common for those nexus opinions to come from VA during a Compensation & Pension (C&P) examination. If the examiner gives a negative nexus opinion, meaning they find that it is “less likely than not” that your condition is due to service, then VA will likely deny your claim for service connection.
However, there are ways for veterans to argue against negative nexus opinions.
After attending a C&P exam, you should request a copy of the results from VA to review it and potentially challenge it. If you determine that the examination was negative, then you may want to consider obtaining a private medical opinion. Further, you can submit additional treatment records or lay statements to support your claim.
Lack of Evidence
VA often denies claims for disability benefits because there is not enough evidence in the veteran’s file to issue a favorable decision.
Generally, VA has a duty to assist, which means VA is required to gather information that may help support the veteran’s claim (such as service personnel records, service medical records, and VA medical records).
If VA is not able to obtain records after making reasonable efforts to do so, then it has a duty to:
- Notify the veteran that it was not able to obtain the records; and
- Notify the veteran that they themselves are ultimately responsible for providing VA with those records.
Like service connection claims, VA denies increased rating claims due to a lack of evidence. VA will typically look through your medical records and schedule a C&P exam to determine whether your condition has worsened over time. Again, veterans should consider seeing a private doctor and submitting those medical records.
VA can obtain these private medical records on its own if you sign and send an authorization to release private medical records. As mentioned, lay statements from family and/or friends who have seen your condition get worse can help support your increased rating claim too.
Veteran Has a Negative C&P Exam/Missed Their C&P Exam Appointment
It is extremely important that veterans attend their C&P exams, because if they do not attend the exam, then VA can outright deny their claim.
A Compensation & Pension (C&P) exam is an examination that VA typically requests for any veteran who files a claim. The purpose of the exam is to evaluate the veteran’s claimed condition and determine if service connection is warranted. During the exam, the examiner will also collect evidence to assign a rating if service connection is granted.
VA adjudicators tend to give a lot of weight to C&P exams, meaning that a negative or unfavorable exam can severely impact a veteran’s likelihood of winning a grant of benefits. An unfavorable C&P exam might state that the veteran’s condition is not related to service or is not as severe as they claimed.
If you have a good reason for not being able to attend, then you must inform VA right away and seek to reschedule. Again, if you do not attend the C&P exam, then VA will likely deny your claim without even considering any of the other evidence you may have submitted.
VA Denies the Veteran’s Claim Because the Veteran Used the Wrong VA Form
As with any other benefits application, failing to include accurate information on the forms can severely hinder your claim’s success. With VA disability forms, veterans are required to fill in detailed information about:
- Themselves, including contact information and family details;
- Previous military service;
- Medical history;
- Evidence proving disability, such as records and lay or buddy statements;
- And more.
Failing to provide the appropriate information or forgetting to fill out a particular document section will limit VA’s ability to approve your claim.
Before filing their claim, veterans should check to make sure they have provided all necessary information; filled out the correct form(s); and are submitting all relevant evidence.
It is also important to be sure that all the information on the forms is consistent.
VA can deny claims if veterans submit the wrong forms associated with their claims. There is a specific VA form for nearly everything within the claims and appeals process. As such, it can be very overwhelming for veterans and hard to keep track of.
One of the most important forms that VA will request is Form 21-8940, Application for Increased Compensation Based on Individual Unemployability.
This form is needed for veterans’ claims for total disability based on individual unemployability (TDIU). TDIU is a disability benefit that allows veterans to be compensated at VA’s 100 percent disability rate, even if their combined schedular rating does not equal 100 percent.
Importantly, TDIU is awarded in circumstances in which veterans are unable to secure or follow substantially gainful employment due to their service-connected conditions.
VA will request Form 21-8940 from veterans to process their TDIU claims. Therefore, if veterans do not submit this form, it is likely that their claims will be denied due to a lack of necessary information.
VA Denies Due to Missed VA Disability Form Deadlines
There are many deadlines that veterans must be aware of when filing claims and appeals. Under AMA, veterans have to choose which appeal lane they would like to file their appeal: supplemental claim; higher-level review; or Notice of Disagreement (appeal to the Board of Veterans’ Appeals). They must choose their appeal lane within one year of the unfavorable decision.
In the AMA system, veterans have 120 days to appeal unfavorable Board decisions to the Court of Appeals for Veterans Claims.
Other important deadlines under AMA include:
- Submitting evidence in the hearing docket. Veterans can submit additional evidence to the Board during their hearing or up to 90 days following their hearing.
- Submitting evidence in the evidence docket. Veterans can submit additional evidence to the Board with their NOD or within 90 days following submission of their NOD.
Know Your Appeal Options
Veterans who receive a denial from VA have the right to appeal the decision within one year. Reaching out to an accredited representative can be beneficial for veterans trying to navigate the appeals process.
Was Your VA Disability Claim Denied? Contact Chisholm Chisholm & Kilpatrick
If VA has denied your disability compensation claim or granted you a lower rating than your medical conditions warrant, do not give up the fight. We may be able to help you appeal this decision. Contact our office today for a free case evaluation at (800) 544-9144.
