Applying for VA Disability Benefits
- Who is eligible for VA disability benefits?
- What does VA consider a disability?
- Types of VA Claims
- What is an “issue” according to VA?
- Effective Dates & Why they matter
- Intent to File
- VA Claim Online Submission
- Other Ways to Submit a VA Claim (mailing address, phone number, in-person, legal representative)
- What is a Claims File, or “C-File”?
- The St. Louis VA Regional Office Fire & lost claims files
- How long do you have to submit evidence for your VA claim?
- Service Connection 101
- VA Presumptions and Presumptive Claims
- VA’s Duty to Assist
- VA help finding your records vs. finding your records yourself
- C&P Exam (a.k.a. Compensation & Pension Exam, VA Exam, VA Claim Exam)
- C&P Exams vs. Private medical exams
- Lay Statements to support your VA claim
- VA Claim Denied – What next?
- VA Claim Granted – What next?
- VA claim granted at 0% – Non-compensable VA Ratings
- VA Diagnostic Codes & Disability Ratings
- Your VA Combined Rating (a.k.a. VA Math)
- CCK’s VA Disability Calculator
- VA Back Pay (a.k.a. Retroactive Benefits)
- When to expect VA disability compensation checks
- Viewer Question: What if you have a copy of your medical records but not the original?
- Reasons you might not get the full amount of VA disability back pay (separation pay, severance pay, and retirement pay offsets)
- Is there still a VA claims backlog?
- Final tips & things to remember
Brad: Good afternoon. Welcome to CCK Facebook Live. My name is Brad Hennings. And I’m joined by VA-accredited attorneys Lindy Nash and Courtney Ross. We’re here today to talk a little about the VA claims process. So, again, if anyone has any questions as we’re going along, please ask them there on Facebook or you can go to the CCK, Chisolm Chisolm & Kilpatrick website, which is at cck-law.com and leave us an email or leave us any messages there with any questions that you may have.
So, let’s talk a little bit about the claims process for Veterans Affairs Benefits. So, who is eligible for VA disability benefits?
Lindy: Sure. So, you have to have served in the US Military, obviously, in one of the branches of the US Military. You have to have served on active duty. And you also have to have other than a dishonorable discharge. So that is an important factor of receiving VA benefits.
Brad: Are other family members potentially eligible? So, let’s say I’m not the veteran, but I’m the veteran’s spouse or the veteran’s children?
Lindy: Yeah. There are certainly circumstances where if a veteran passes away, we can or you can submit a substitution paperwork to kind of step into the shoes of the veteran. So, if you are a dependent parent, an eligible child, or a spouse of the veteran, you are able to step into their shoes.
Brad: Great. So, what does VA consider to be a disability?
Courtney: Sure. So, it can be a physical condition that you might have. So, for example, an orthopedic condition, perhaps a back or knee conditions are more frequently seen. It can be other physical conditions like cardiovascular conditions, certain cancers. It can also be psychiatric conditions, so separate from just physical. If you have any kind of psychological impairment or disability that’s due to your time in service, that can also be considered a disability for VA purposes.
Brad: So, if a veteran is suffering from PTSD, for example, that they think is due to their military service, that’s something that they can receive VA benefits for?
Courtney: Exactly. Yes.
Brad: Okay. So, what types of VA disability claims can a veteran submit?
Lindy: Sure. So, there’s many different types. I think Courtney and I are going to go back and forth in talking about them. Kind of the first one, the most immediate, you’ve never filed a claim for anything before with the VA. You will start with that initial claim which should usually be the claim for service connection and I think we’re going to get into the elements of service connection later. Service connection is, basically, just VA kind of acknowledging that your disability, whether it’s an orthopedic condition or a psychiatric disability, is due to your time in service.
There’s also other ways of getting service connection. We kind of think of direct service connection. That is the first and most basic way of getting it but you can go secondary service connection which means that maybe you’re already service-connected for something and you develop a different condition. That first condition leads to a new one. There’s a bunch of different ways to get service connection. But that is kind of the first original claim of your service-connection for your disability.
Courtney: Yes. So, another type of claim that a veteran might file is where they are already service-connected for a condition. Let’s say PTSD– we’ll continue with that example. They previously filed for service connection. It’s been granted. They were initially happy with the rating. They don’t have any current appeals pending or a claim pending for that condition and now, they feel like their PTSD has worsened. So, they want to file a claim for an increased rating, so to get a higher rating for their already service-connected conditions. That’s another type of claim that a veteran may file.
Lindy: And then I think it’s important to note that now that we are in the new system, the Appeals Modernization Act came into play this past February. So, February of 2019, the new system, if you will, started. Now that we’re in the new system, there is something called a supplemental claim which you are able to file. That basically happens if you– say, you submitted a claim for service connection for a heart condition in 2015 that was denied and you never appealed. Now and you are in 2019, you have maybe a new doctor or something has come up where you want to apply for it again. You can apply for that same heart condition and file a supplemental claim with new and relevant evidence to show why that claim is due to service. That is known as a supplemental claim.
Courtney: And then there’s other things that you can file for that can be claims on their own but can also be raised as part and parcel to appeals that you might already have pending. That’s significant because it matters for the effective date of those things. What I’m thinking of are things like TDIU which is total disability based on individual unemployability or special monthly compensation. You can file for both of those on their own but if you already have an appeal pending for an increased rating, you can also raise it as part of that appeal. You’re more likely to get a better effective date if you raise it as part of the appeal that’s already pending versus filing a new claim for it.
Brad: So those two can just be components attached to these other claims that are being decided?
Courtney: Exactly. Yes.
Brad: Okay. And just to add on, although this is not something that we handle as much at CCK. There are also what they call 1151 claims which are the equivalent of VA Medical Malpractice and then Dependency and Indemnity Compensation or DIC. We’re actually doing it on a number of those cases which are often related to whether a veteran’s death was due to his service-connected disability or if he was suffering from such a serious service-connected disability for at least 10 years, then they’ll be eligible for additional benefits.
So anyway, so what kind of claims are we going to be talking about today?
Lindy: Go ahead.
Courtney: So today, most of the presentation is going to be focused on the initial claim for service connection. We’re talking in the context of that type of claim as we’re going through the next parts of this.
Brad: So, Lind, what is an issue according to VA? Do you need to submit a separate claim for each issue whatever that is?
Lindy: Yes. It’s kind of a gray area. So, it seems like different people have different ideas as to what an issue is or what a claim is. But generally speaking, you don’t need to submit a form or a claim for every different issue. I kind of start from the beginning. If you file that claim for service connection, let’s say for a knee condition, and you get granted service connection and you’re awarded a rating and an effective date, you can appeal that decision. You can include both the increased rating and the effective date. If you just want one, you can keep one, etc. So, you don’t need to file separate forms for each. You can also, on that original form, you can include service connection for your knee, service connection for your back, service connection for PTSD. Whatever you are applying for, you can include on that initial form.
Brad: So that initial form can be– you can have one claim. But let’s say five separate conditions that are pending and then within those conditions there’s separate issues related to those conditions.
Brad: It seems very complicated.
Lindy: Yes. It’s a little confusing. But that is it in a nutshell.
Brad: Okay. So, you mentioned effective date. What is an effective date in the context of VA claims?
Courtney: Sure. So, when VA grants service connection for a condition, they will assign a rating and an effective date for that service-connected condition. Essentially, the effective date is the date the VA is acknowledging that you’re entitled to compensation for that disability from. The way that they decide the effective date is typically based on the date that they received your claim for that condition or the date entitlement arose possibly whichever one is later. But the effective date is really important because like I said before, from that date forward is what VA is saying you’re entitled to compensation for. The earlier the effective date, the more in compensation you’re going to receive retroactively once VA does grant you service connection.
Brad: So really, you’re talking about the potential for a greater lump sum when the decision is finally made. That’s what you mean by earlier effective date. You wanted to go back as far.
Courtney: Yes. Exactly.
Brad: More money fundamental.
Courtney: Exactly. Yes.
Brad: More compensation. So, let’s talk a little bit about– what is an intent to file and does that still matter in sort of our new world under the Appeals Modernization Act?
Lindy: Sure. An intent to file was a big thing during the Legacy Appeals System because it basically saves the date. You could submit an intent to file with VA and kind of say, “Hey, I’m working on this claim and I’m saving my effective date by submitting this intent to file.” It doesn’t mean you have all your ducks in a row just yet. Maybe the form isn’t quite ready, but you are kind of saving that effective date with your intent to file. That was really great and really useful in the Legacy System. It’s our understanding in the new appeals system that intent to files aren’t necessarily accepted anymore, although we are kind of still testing that out. We have been submitting them here and there or we do have cases where maybe we submitted an intent to file prior to AMA beginning, but now the claim is actually ready and we’re submitting it post-AMA. We’re still kind of testing the waters to see what will happen but that is an intent to file.
Brad: So, what I think I hear you saying as it relates to the new system is that although this new system in place, it seems as though VA is still sort of figuring out how it’s all going to actually work in practice. Even though there are regulations that have been published and statutes, the reality on the ground would maybe a little different?
Lindy: Yes, definitely. Although the regulation does state that intent to files are no longer accepted in AMA, we are noticing that VA is still trying to figure that out. Because intent to files are so useful especially for effective dates and retroactive benefit purposes, we are still trying to see if they will be accepted.
Brad: So how does that work with an online claim submission? So, if I’m a veteran and I log onto, I guess it’s eBenefits and submit a claim?
Courtney: Yes. When a veteran logs on the eBenefits, if they start a claim but don’t finish it– just them starting a claim and heading save serves as the intent to file. They could start filing the claim online and you have a year from the day of the intent of file to actually complete the claim. They could start the claim today and they would have until July 18th of 2020 to actually submit a complete claim to VA.
Brad: Let’s say I’m a little less comfortable using computers or using the World Wide Web being online. Are there other ways to file a VA claim?
Lindy: Definitely. You can submit it by mail. Let me read the address, so I don’t get it wrong. The Evidence Intake Center PO Box 4444, that’s in Janesville, Wisconsin, 53547-4444. You can mail it into the Evidence Intake Center, that is one way of doing it. You can also just go in person to your local Regional Office and file it with them. Or you can seek a legal representation. Whether that’s with the VSO or a lawyer or accredited claims agent, you can do it any number of ways.
Brad: Let me just give a plug for getting help with your VA claims. We feel pretty strongly that everybody can benefit from some assistance in working on their cases, again, be it through the Veterans Service Organization like our partners at the Disabled American Veterans, DAV, a VA-accredited agent or attorney. This is a complex area. It is designed to be veteran-friendly. But it can be easily get tripped over by the complexity of the system.
So, moving on, let’s talk a little about evidence that’s involved in VA claims. What is a Claims File or a C-File?
Courtney: Yes. The Claims File is essentially the file that VA puts together for your pending claims and appeals. When you file a claim, anything that gets submitted that’s associated with that claim that you might submit or your representative might submit or any decisions that VA issues, any medical evidence that’s relevant to the claim. Basically, anything that is submitted to VA relevant to your pending claim or appeal gets put into this file. The longer that your appeals or claim is pending, the larger your file gets because more information gets added each year. The C-File is important too because this is what VA is looking out when they’re adjudicating your claim or your pending appeal. They’re going to look at what’s in there to see if there’s enough evidence to match all of the elements that are required for service connection.
Brad: This C-File or Claims File, is this a physical file? Is it in a binder? What is it?
Courtney: No longer is it a physical file. Today for the most part, everything is digitized. If you request a copy of your file, you’ll actually get a CD that has the file in it.
Brad: So, everything is being stored electronically?
Brad: In the old days, before they moved to electronic Claims Files, Claims Files could be gigantic. In fact, some Claims File I saw, when I worked at VA, were up to 14 bankers box. Full of files just of hard copies. What that meant was– and it’s a little bit better now that everything’s been digitized. But what that meant was it was often difficult for the adjudicators to sort of dig through all that and that manner was easy for them to miss things. That’s again why you want to try keep everything streamlined in your submissions and why you may want help. Because if you have that much evidence, it’s hard to know what’s really important. And it’s going to be important to the VA in order to get your benefits.
Courtney: Yeah. Just to piggyback off that, too. Even with the electronic versions of the file, the files aren’t organized by the document or they’re not organized chronologically. I think the problem with finding stuff in it is still relevant today. To your point about streamlining everything with your submissions, I think it’s still just as important with the electronic copies of the file.
Brad: So, talking about records and medical records and service records, what is this about the St. Louis fire?
Lindy: Sure. Unfortunately, because things do happen, there was a fire recently at St. Louis where basically all of the claims or a large portion of the files were destroyed. In situations like this and we’ve seen this happen in many different situations. Basically, the VA has a heightened duty to recreate your file based on the fact that it no longer exists. Although it is extremely stressful and upsetting that VA could lose your file due to a fire or whatever other means, VA does have that heightened duty to kind of recreate it based on anything that it can. Whether that’s lay statements or seeking new private opinions or any kind of evidence or searching online. Whatever it is to kind of prove what you’re looking for, they have a heightened duty to do so.
Brad: And so just to add in a little bit to that. I think everything that Lindy said is spot on. I’ve worked with a number of cases where they suffered from the St. Louis fire. It was in the 1970s, and it was in the National Archives side. It wasn’t actually VA where the fire occurred, it was the National Archives side. But it did contain the service treatment records, service personnel records that go into a VA Claims File. What’s interesting is I saw it back in the days of the paper Claims Files is you would have records that were literally burnt and that were cinched. You can only read half the record, but they were able to recover that. But don’t fear, there’s other ways to recreate these records. It’s not a death nail for your claim if somehow these records are fire-related.
So how long can you submit evidence after filing your claim for VA benefits?
Courtney: So, if you’re filing the initial claim on the 526EZ form, you can submit evidence up until the time that you get that first decision. It might be best practice if possible, to go ahead and submit all the evidence that you plan to submit with the claim. That way VA has everything at their disposal and hopefully you get a quicker decision. But you will still have that additional time up until the time they file– excuse me, issue the initial decision. Keep in mind, too, if you want to file the claim but you don’t necessarily have all of the evidence just yet, you want to keep the effective date in mind.
So, don’t hold on filing the 526 or if you’re going to consider filing an intent to file so that you’re preserving your effective date and then gather all of the evidence you need and file the 526 at that point. If you’re filing a supplemental claim, you should submit the new and relevant evidence at the time that you file the supplemental claim. Again, you’ll have up until the time that they issue a decision to submit additional evidence but you run the risk of VA issuing a decision and now denying it because new and relevant evidence was never submitted as opposed to actually denying or making a decision based on the merits of the case. Again, it might be best practice to– if you have it, submit the new and relevant evidence at the time that you’re filing supplemental claim.
Brad: Great. We’ve talked a little bit about this term. What is service connection and what are the elements of service connection?
Lindy: Sure. I touched on this briefly before. Service connection is what you need for VA to kind of acknowledge and agree that your disability is due to service. There are three major elements for direct service connection. You do need that current diagnosis. Something saying you have been diagnosed with PTSD or a back condition, whatever that maybe. The next is that there needs to be evidence of an in-service event or injury.
Something maybe you were playing basketball while deployed and you injured your knees. You need some sort of record to show that you have that injury. And then the last thing is what we call the nexus opinion. The nexus opinion is usually from a medical provider saying that, yes, you do have this knee condition and it was due or at least as likely as not due to your fall in service or whatever happened to you in service.
Brad: Okay. What about presumptions? I’ve heard of these what they call presumptions in the VA claims process. What is it and does it require any kind of evidence?
Courtney: Yes. Presumptions or presumptive service connection essentially allows you to get service connection without having to prove one or a couple of those three elements that Lindy just took us through. To give us an example, obviously, one of the most common ones is the conditions that VA has said are presumptive. You’re entitled to presumptive service connection if you served in Vietnam and you were therefore presumed exposed to Agent Orange.
That’s your element in terms of meeting with the in-service incurrences. You just need evidence to establish that you have a diagnosis of one of those conditions that VA has outlined and you don’t need that nexus element. You still need evidence when it comes to establishing presumptive service connection, because it still requires some of those three elements, but typically the one that you no longer need is the nexus, the medical nexus linking your current disability to the in-service disease or occurrence or event.
Brad: So, it seems to lower the evidentiary threshold for you to win your case?
Brad: Okay. A lot of people talk about this. What is VA’s duty to assist?
Lindy: Sure. The VA has a duty to assist veterans who are applying for a disability benefit. Say, you apply for service connection for that knee condition. They have a duty to help you whether it’s finding your records from service. They will usually send you for an examination to kind of help get that nexus opinion that you’re looking for. They have this duty to help you gather the evidence that you need for your claim.
Brad: So how can you check whether VA has actually located or not the records that you’ve requested or that you’ve identified for them?
Courtney: Yes. VA will take reasonable efforts to locate the records that you’ve identified for them but at some point, if they’ve made a certain number of attempts and they deem it no longer reasonable to continue to locate the records and gather them. They have a duty to notify you and let you know that they’re no longer moving forward trying to obtain the records.
Brad: So, you’re both experienced practitioners in this area. What has your experience with VA’s duty to assist been? And is a veteran better off to go out and get their own evidence if they’re able to?
Courtney: I think if you’re able to get the evidence that you’ve identified for VA on your own, then you should do so. If for no other reason other than the amount of time that it will take VA to do it versus if you have immediate access to do it, it tends to be quicker. You are going to wait, most likely going to wait, a longer period of time if you’re waiting on VA to gather it. In that way, you can move your case along if you’re able to gather it yourself, submit it to VA, and explain to them how it’s relevant to establish some service connection.
Lindy: I agree a hundred percent.
Brad: So, Lindy, what’s a C&P or Compensation & Pension examination? And what do veterans need to know before they go to one? What’s this about?
Lindy: Sure. The VA will often schedule you for a C&P examination. They basically want to talk with you. Depending if it’s an orthopedic condition or maybe a psychiatric disability or a type of cancer, whatever it maybe, they want to examine you themselves and get to know you and see what happened and what brought you there today. Basically, you should know that you should be honest. That is not the time to be tough and kind of hide your feelings or hide your experience or the pain that you might be in. I would always just tell the veteran to please be honest and let the practitioner know what you’re experiencing on a daily basis and try not to hide anything from them and just be as honest as you can.
Brad: Courtney, what’s your experience with the quality of the C&P examinations versus the kind of examination that perhaps you could go out and get on your own either from your treating, doctor or a clinician or someone you’d be wanting to pay for such an opinion?
Courtney: Yeah. A lot of the times, the C&P examiners are using a form that they’ve been provided by VA. That’s really just a series of check boxes that they’re going through. When they’re asking you questions at the examination, they’re checking off a box that seems most accurate based on your response. You don’t get a lot of detail. You don’t get a lot of explanation or analysis as to why they’re forming the opinions that they are. You really just have the check boxes to go off of. Whereas, if you go out and you get your own independent opinion that you might be paying for, you can ask the doctor to make sure that they are providing a detailed analysis and explanation in support of their opinion.
That way, they’re really laying it out clearly for VA how it is that they form their opinion, what evidence it is that they’re relying on in your record or statements that you’ve made to the expert. That way, when VA is comparing the private opinion that you’ve obtained that has its detailed assessment and then looking at the VA examination again tends to just be a series of check boxes without a lot of detail. In theory, that private opinion should be considered more probative.
Brad: So, in your experience, are those private opinions necessary to win these kinds of cases?
Courtney: I think so, because I think VA places a lot. With the people who are adjudicating your case at VA places a lot of weigh on C&P examinations. When they’re deciding to grant or deny benefits, they’re really looking at what it is that that doctor said. Did that doctor say it’s at least as likely as not your PTSD is related to service? Or did they say it’s less likely they’re not? That tends to be kind of a deciding factor in the decision. If you are able, again, to provide a private opinion that is a positive opinion and support service connection, now the adjudicator has the VA examination but now they also have this detailed favorable opinion to look at as well.
Brad: And so, under the statutory benefit of the doubt as they call it, if the evidence is in relative balance or basically about equal, VA is just supposed to grant the claim that goes to the runner which is in this case is the veteran?
Brad: Okay. What are lay statements and how can you use them to support your claim?
Lindy: Sure. Lay statements are basically statements from someone. It could be a buddy statement, maybe someone you have served with or maybe from a friend or family member. It’s basically just kind of describing– I’m sorry, also from yourself, obviously. It’s basically describing your symptoms or maybe your parent or sibling or friend could describe how you were prior to service, and then how you came back after service. It’s a really great way of kind of establishing your symptoms from someone else’s point of view and just supporting whatever you’re saying. Lay statements can be helpful, sometimes, just as helpful as medical opinions but always helpful in supporting whatever you’re going for.
Brad: So, I think what I hear you saying is with lay statements, you can use them to establish, let’s say, events. For example, you don’t need a doctor to establish that something happened and you don’t need a doctor to say what it is you experienced. So, if your ears started ringing in service, otherwise known as tinnitus or tinnitus, and they’ve been ringing ever since service, you’re competent as they say, to say that.
Lindy: Right. Yeah. I think there’s a difference usually VA will say– if you submit a statement saying, “I have PTSD and I’ve had it for 10 years.” But there’s no medical opinion saying that, VA will often say, “Oh, well, you know, you’re not a doctor. You’re not competent to give that opinion.” However, if you’re saying, “You know, I experienced this in service.” Or maybe your friend or family is saying, “Yes, he left before service like this and came back in a different way.” Those are all things that they can testify to, because that’s all lay evidence that they are able to give an accounting for. Yes, that’s possible.
Brad: Great. Okay. Let’s talk a little bit about what happens if your claim is denied. What can you do about that?
Courtney: Yes. If your claim is denied, you can appeal. If you file a claim today, you’re in the new system. You’re under AMA or the Appeals Modernization Act which means when you get that decision denying it, you have three different review options that you can select. You can select a higher-level review which is a higher-level review by a higher-level adjudicator at VA. You can choose to file supplemental claim which will require new and relevant evidence. Or you can file a NOD which is now an appeal directly to the Board. Even within that board review lane, you have three different docket options to decide how you want the Board to review it. There is an evidence lane which allows you to submit additional evidence. There’s a hearing lane which allows you a hearing with the board and then there’s direct docket which essentially– you cannot submit any additional evidence, but you can make arguments to the board.
So, under the new system, you can still appeal if your claim is denied but you have a variety of different review options that you can select based on what you determine is best for your claim.
Brad: When you say the Board, you mean the Board of Veterans’ Appeals within VA, correct?
Courtney: Yes. Exactly.
Brad: And just to explain, the Board of Veterans’ Appeals within VA is the appellate organization or body that’s tasked with making the final determination on behalf of VA prior to leaving the agency. The folks at the board are attorneys and what they call veterans law of judges or board members. They’re the ones who are looking at that presumably with a greater level of legal training, obviously, looking through the files.
So, let’s talk about if we’ve got a good result, and that is that the VA grants your claim. What do you then? Everything’s fine. Everything’s great, right?
Lindy: Well, that’s great. If you are content with that rating, then that’s awesome and I think you should take that and run. However, if you feel as though maybe– say they granted your claim for service connection. Say you applied for PTSD. Maybe they granted the service connection, gave you a 30-percent rating. But you think that your symptoms warrant a rating higher than 30%, then you can appeal that decision. Even though it was a grant, but you don’t agree with the effective date or the rating itself, you can appeal that decision and seek a higher rating. You can even, as we spoke about earlier, if you want to go for a TDIU or SMC, you can raise those issues within that appeal as well.
Brad: So, what does it mean though when they tell you that service connection is granted but they give you a 0-percent rating? So, they’ve said, “Yeah, it’s related to service,” but I get nothing.
Courtney: Yes. When VA assigns a rating, what they’re intending to do is to compensate you for the average impairment in your earning capacity. What it means when they assign the 0-percent rating is that they’re acknowledging that that condition is due to service but essentially, it’s saying it’s not causing you any impairment and so they just assign a 0-percent rating.
There are benefits to it though, because now you’ve already overcome that first hurdle in terms of getting service connection. Down the road, if that condition worsens and you feel like it is causing impairment now, you don’t have to establish service connection again. Now, it’s just a matter of showing the severity has increased.
Brad: So, since we’re talking about severing. We’re talking about ratings. How does VA determine the severity of your disability? What are they looking at? What are they doing?
Lindy: Sure. There are many different diagnostic codes. Depending on what your disability is whether it’s orthopedic or psychiatric, there are hundreds of diagnostic codes for each disability. They will look at that diagnostic code and see what percentage requires what symptoms. It really depends on what symptoms you have for your condition– orthopedic, psychiatric and they do their best to look at the symptoms you are displaying and what you have going on and compare it to the rating code or the diagnostic code.
Brad: So, the way you’re describing it though, it seems like this will all be very cut and dry, right? You would just a look at how bad the disability is. You look at the code and you plug in the numbers and that’s what you get. Is that the case? Or is there a little more subjectivity to it?
Courtney: There is a little more subjectivity to it. I’ll take the rating criteria for a psychiatric disorder as an example. The ratings are based on occupational and social impairment and each different rating list the number of symptoms that a veteran may have. The symptoms and limitations that are noted in the rating criteria, it’s an exhaustive list. Veterans could have other symptoms that are impairing them occupationally and socially. While they’re not listed in the rating criteria, you can still use those to argue how it is that they’re causing impairment. The key there is showing the veteran has this symptoms, these are the limitations they’re causing, specifically this is how it’s limiting them socially and occupationally. You have to connect the dot for VA a little bit more than just pointing to the rating criteria and fitting in the symptoms perfectly.
Brad: So, what I think I hear you saying is that you shouldn’t just assume that because VA has assigned you a particular rating, that it’s necessarily what you deserve.
Brad: Okay. If you already have other service-connected disabilities, how will VA determine your overall or combined rating? So, let’s say I’ve got a knee condition, a psychiatric condition, a back condition and some high blood pressure.
Lindy: Definitely. VA will give you a combined rating. Depending on what your other ratings are, those combine together to give you one overall rating which also dictates the amount of compensation that you get monthly. The tricky thing is that VA math is not normal math. If you have a 40-percent for one condition and a 40-percent for another condition, that doesn’t mean you have an 80-percent combined disability, unfortunately. I love to use our disability calculator which is on our website but there’s also in the regulations. There is a table you can use kind of the old-fashioned way. I know different organizations have calculators as well. I think calculators are probably the best way to keep up with VA math because it is not user-friendly. Is that fair?
Brad: Well, on that note I’ll say, again, this is Brad Hennings with Chisolm Chisolm & Kilpatrick. We’re here on Facebook Live. I’m joined by Lindy Nash and Courtney Ross. We’re talking a little bit about the VA benefits process right now. To talk a little bit about the disability calculator that Lindy referred to, please check this out at our website at cck-law.com and the disability calculator is at cck-law.com/va-disability-calculator/. Again, if you go to our website and just do a quick search, you can find the disability calculator. It’s a great tool that will help you handle VA math which is not what you think it should be.
Brad: So how does VA backpay work?
Courtney: Yes. Backpay is the money that’s owed to you from the date of your effective date that’s assigned to the date that veteran is granted the benefit. If a veteran is granted service connection for PTSD at 50-percent tomorrow and the VA assigns the effective date of that 50-percent rating from September 2010, the veteran will be compensated for that rating from September 2010 until the date of the grant which will be tomorrow.
Brad: So, this is what they call retroactive benefits, retroactive pay, retro pay. There’s a lot of different words but ultimately, it’s this backpay that VA has determined, “Hey, this is what– you’re doing a lump sum.”
Brad: Okay. When do monthly compensation checks come?
Courtney: It’s typically at the very beginning of the month. The first through the second or it can be at the very end of the month, in the last day or two of the month. It usually just depends honestly on how you’re bank works if you have direct deposit set up. It’s in the very beginning or the very end of the month.
Brad: Okay. We’ve got a question from Marcy Out in Cyberland. The question is, “What if you have a copy of your medical records but VA does not have original? Will they accept my own?”
Lindy: I would think they would. Yes, as long as it looks legitimate. I would think they would definitely accept something like that. That’s great that you have copies and that you can provide your own. I would make a copy before you send it to them just so you can keep a copy but I would assume they would accept that.
Courtney: Yes. I agree.
Brad: That actually–in my experience when I was a veteran’s law judge. That happened quite often. The veterans would submit service records that weren’t in their service file. For whatever reason they’ve gotten lost but they have copies of them and they were able to submit them. It also goes for medical records that sometimes there is even VA medical records that a veteran will have that VA won’t have. That can particularly happen if they’re old records.
So, let’s say you have– you were the VA hospital in the 1950s. For whatever reason, you had them down in your basement for years and years and years and you asked the VA to go out and get those records but they destroyed them or they’ve been lost. You could submit them and say, “These are my VA records,” and VA is sure to accept those.
So, let’s talk a little bit about– Are there any reasons why you wouldn’t get the full amount of backpay or monthly compensation? Let’s say you win your case. The VA finds that your 70-percent occurring to your conditions. But then they’ll say, “Well, we’re actually not going to pay you at the rate you’re entitled to.”
Courtney: Yes. There are certain benefits, retirement benefit, retirement pay, excuse me, severance pay. If you’ve been receiving those in the past, there are some that you can’t receive both that and then the compensation pay for. When VA is calculating the retroactive payment, they’ll do with their calculations in terms of what needs to be offset so that you’re receiving the correct amounts and not the full amounts for both types of benefits. That could be a reason that you’re not receiving the full retroactive payment after a grant.
Brad: So, this should be like military retired pay for example with the idea that congress has set it up that they don’t want veterans double dipping is the term that they often use at the VA. Well, moving along from that. Is there still a backlog of VA claims?
Lindy: Yes. It’s my understanding that the backlog of claims has gone down, although the appeals backlog has ballooned a little bit. We are in better shape claims-wise but that means there are more appeals that are pending. It’s a little bit of a catch-22.
Brad: A little bit of whack-a-mole?
Lindy: Yes, a little bit.
Brad: You get one and then another one pops up.
Lindy: A little bit. We are making progress but slowing down a little bit in other areas.
Brad: So, to sum everything up, are there any tips or things to remember for veterans to file a claim at VA? If you had one important thing that you could tell someone, what would it be?
Courtney: I think, don’t wait. If you want to file a claim and you believe that there is merit to it, the longer you wait, you’re losing out on potential time that you could be receiving compensation once the benefit is granted. Again, it goes back to what we said earlier about the importance of the effective date, because when the benefit is finally granted, it will get paid back to the effective date. The longer you wait, you could be losing out on compensation that you’re entitled to.
Lindy: I would say don’t expect VA to kind of read your mind or know what you’re asking for. I would be as clear and concise as possible and submit the evidence that you have. If you think you have a medical documentation showing that your orthopedic condition is due to service, submit that and be really clear, and say, “This is due to service because of this motor-vehicle accident I was in.” Just don’t expect them to kind of connect the dots for you and I would just be as explicit as you can.
Brad: I echo both of what Courtney and Lindy said. In fact, I often say one of the best things you can do in advocacy before the VA is, ‘Tell the VA what you’re entitled to.” “Explain to them in detail clearly why, how you meet all the criteria they have,” and then tell them again, “This is what I’m entitled to. Please give it to me.” You may think you’re being clear and you may think it’s really obvious, but you’d be surprised. These adjudicators are dealing with thousands and thousands of claims. What you think is clear, they may not find to be so clear. You can’t make it clear enough. You can’t clarify enough for VA with this kind of stuff.
Well, with that, are there any last words before we sign off today?
Lindy: I don’t think so.
Brad: Well, thank you all again for joining us. Again, it’s Brad Hennings at CCK, here with Lindy Nash and Courtney Ross. Thank you for joining us about the VA claims process. Visit us at Facebook. Leave us messages. Come to our website, cck-law.com. We really appreciate spending some time with us. Thank you.
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