The Three Tenets of All Successful VA Claims and Appeals

Like Social Security, many VA claims for service-connected disability compensation are denied in the initial claims process.  The reasons for denial can be varied.  For those seeking service connected claims while employed, or after recently being employed, the arguments of the VA often appear hard to overcome.  In every case, there are three fundamental tenets of all successful VA claims. 

Failing to answer one of these will usually result in claim denial and confusion for the Veteran claiming service connection.


1) Something currently exists that is disabling.

You must present a disabling condition.  This can be either mental or physical or both.  For example bad back, bad knees, poor hearing, lost eyesight, bad sleep, emotional outbursts, anti-social behavior, and other challenges or disabling conditions.  Of course, you’re not a doctor, so you do not have to self-diagnose, you can claim to experience these and get an official diagnosis during the process.

Regardless, for successful VA claims you must have a disabling condition by the time your claim is being decided.


2) Something must have occurred during service to act as a nexus event to your current claim.

An event or series of events can be shown to have had at least a 50% chance of causing or making worse your condition.   This last statement is one that most claimants don’t realize. Neither do many health care providers, doctors, or advocates.

A doctor does not need to be 100% certain that a certain event caused a Veteran’s current condition.  The doctor only needs to be willing to state that in their medical opinion:

“the claimed nexus event is/was as likely as not (50/50) the cause of the Veteran’s current condition.”

Or, that the nexus event made the injury worse.  This last point is often not made clear to doctors.


3) A clear connection between the Nexus service event and today’s current condition must be shown.

For the working disabled, or the recently working disabled, this is often the key piece to detail for successful VA claims.  It is also, the piece most missed when filing a claim or appeal.

Most people will say something to the effect of:

“I have a bad back, it’s caused by a fall while in service.” 

While this meets the criteria of #1 and #2 above, it does not explain how you have been able to work for 20 more years on your bad back.  The argument for #3 is not answered and the result is usually denial.

Denied claims for Veterans who are working are often a result of failing to answer #3 clearly.


 

Successful VA Claims

For item #1, there is not much you as the Veteran can do except to seek the diagnosis of your condition from a doctor or therapist.

#2, is a challenge due to the state of many Veterans’ service records.  The challenge can be overcome by a good advocate or attorney that knows the requirements of VA law.  And one that knows to adapt your claim into an effective appeal strategy.

The best thing an advocate or attorney can do for a Veteran is to get a timeline created of what happened.  Then to start gathering evidence from the time of the injury to today.  Build a timeline.  This is also the best way to approach answering #3 as well.

For #3, an advocate or attorney should detail where you, the Veteran, went after discharge.  Also

Why you discharged.

Whether you were successful in school or work after discharge.

If there were any accommodations made for you to be successful at work or school.

Did you took additional sick time, rest days, or required working from home at any point.

If you have a healthy family life and history of one, e.g. divorce?

All of the pieces of your life since your injury reflect in some manner on your current condition.  You and your attorney have to tell a story that makes sense how you got from your military service to today.  Whether that journey has been 3 months or 30 years.

Lilac City Law advocates on behalf Veterans in appeals for Service Connected Disability Benefits

We provide a Free 30-minute Consultation   

 

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Service Connection: How to Order Your Military Service Records For a Disability Claim, For Free!

At its most basic level, service-connected disability is a loss of physical or mental function as a result of some aspect of your military service.  The way you, me, or a nameless claims evaluator assess these descriptions are often wildly different.  Because of this, it is an absolute must that you order your DD214 and other military records if you’re pursuing any type of disability claim.  


You Are the Expert on You

You, of course, are the person with the best, most intimate, knowledge of your conditions.  However, in most cases, you are also the person with the least amount of knowledge of what “counts” for VA compensation purposes and how to make a claim successful.

So how do you get across what you know about your conditions, and do so in a manner that will enable your advocate or attorney to digest it and make it make sense to the Veterans Administration or Social Security?

The best answer to this question is to obsessively collect your military service records, as well as any other treatment records you may have generated since then.

If you Order your DD214 & Other Records you can Prove your Story

Often the biggest barrier in claims, and especially appeals, is determining to a level of 50/50 confidence that what you claim happened in your service actually did.  Because service records are notoriously porous, drawing conclusions from looking at service clues from the 10,000 ft perspective often helps, a lot!

For Veterans, the process to order your DD214 and other records usually start with the National Archives.  Also known as the National Personnel Records Center (NPRC).  If you recently discharged from military service, you will want to check with your last unit as well.  But for most Veterans, the NPRC is your best first bet at finding what’s been kept by Uncle Sam regarding your service.

When you reach out to the NPRC you want to make sure to request “all items in your military service records.”  Do your best not to be too specific, you only give someone reason to exclude documents by being more specific.  Repeat this mantra to yourself, all service records is better than just the relevant stuff.


  If You’d Like to Order Your Records by Mail or Fax

Fill out the Standard Form 180 (SF-180)

Fax: (314) 801-9195 or…

Mail:

National Personnel Records Center (Military Personnel Records)
1 Archives Dr.
St. Louis, MO 63138-1002


 

If Your Records Aren’t at the NPRC

Sometimes, your records will not be held at the NPRC.  In these cases, the NPRC will respond with a letter describing the situation, and they will often reach out to other record repositories in an attempt to locate your records.  These situations require a bit more follow-through and sometimes require additional steps.

Other avenues of approach you should discuss with an advocate or attorney you are working with, include:

Ordering a copy of your Claims File (C-File) from the VA

Other medical records from healthcare systems

Filing a Freedom of Information Act (FOIA) request

Collecting “buddy statements”

Detailing a timeline of your military service and your professional/personal life after service.  Including jobs, life changes, challenges, etc.

Also, consider talking with an attorney that can go over all these things in a free consultation.  I can certainly help here, but whomever you work with, make sure you’re not paying for this information.

Lilac City Law advocates on behalf Veterans in appeals for Service Connected Disability Benefits

We provide a Free 30-minute Consultation  

 

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Gulf War Illness and Unfair VA Claims Denial Practices

Gulf War Illness and Unfair VA Practices

In our article, How the VA is Failing Gulf War Vets, we described how systematic problems at the VA seem to be resulting in neglect of legitimate service connected claims for Gulf War Illness.  Since we published that article, Anthony Hardie, a Gulf War Veteran and Director for the Veterans for Common Sense published written testimony of his before a Congressional Hearing on Gulf War Veterans & Gulf War Illness service connected detail rates.

It is especially noteworthy to recognize the historical denial rates for service connection are between 30% & 40%.  Some estimate that 60% of those denials are later found to be erroneous. We are going to look into how that compares to other injuries and eras of Veterans.

 

Recent History of Gulf War Illness Claims

Since 2011, denial rates for service-connected claims related to Gulf War Illness climbed from 76% to near 82%.  Remember, historical denial rates for all applications hovers between 30% ~ 40%!  Denials of claims for exposure to the Middle East is 2x the average of all other claims.  And depending on the year, denials for these claims can be almost three times the average rejection rate.

We can take this one step further if you’re saying…

“But I saw Gulf War Illness on the X-Files once, so maybe it’s not so cut and dry as the VA is goofing this up at the expense of Veterans who don’t have data and a clear understanding of the process on their side.”

First of all, we just happen to have a control population of 2 million Veterans that had exposure to the same region and hazards.  That control population we can contrast is the Global War on Terror generation of Veterans (GWOT).  Over 1 million unique service-connected compensation claims were filed by this generation of Veterans, so far.  The denial rate is for these claims is 2%!

 

 

 

 

Gulf War Veterans vs. GWOT Veterans

2% is such an extreme that it deserves another closer look.  We should probably look further into this number at some point in the future.   So, let’s look at this average, taking away the 98% approval rate.  And for the sake of argument, let’s also take away the 81% denial rate on the Gulf War Illness issue. If we normalize this data, it shows us that Gulf War Veterans’ claims are denied 25% more often than the average VA claim!

In conclusion, what’s the recourse?  Education and discussion.  Keep this discussion alive and relevant.  Share this information with friends and Veterans. And educate them on their options.

And please remember, get your claim take care of if you have experienced any of the issues associated with service in the Middle East and Afghanistan.

 

Lilac City Law advocates on behalf Veterans in appeals for Service Connected Disability Benefits

 

 

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The VA is Failing Gulf War Veterans

“All over the country, it’s the same thing being reported. These people walk into a VA hospital or clinic and either the physicians don’t know about Gulf War illness or they pretend they don’t know and the Veteran ends up in the psych ward.”

 ~ Capt. David Winnett (USMC – Ret)

Source


Many Veterans have filed for Service Connected Disability (SCD) compensation from the VA due to Gulf War illness.  Most of them already know the gap that exists between singing up in the Gulf War Registry and getting the VA to accept a relationship between Middle East service and certain disabling conditions.   This huge gap is from lack of compassion & knowledge on the part of the VA and on the part of lawmakers.  Neither the VA nor other Veterans support providers are doing enough, and the situation is getting worse for three generations of Veterans.


Support Gap

As if to highlight this support gap, the VA and the rest of the federal government recently failed to note the 25th anniversary of the end of the Gulf War.  Despite the VA’s poor memory, many American’s  still recall the Gulf War with clarity.

Two and a half decades ago, Saddam Hussein invaded Kuwait and set America and the world on a path that has defined our military service and Veteran care since. One terrible legacy of having served in the Persian Gulf is the often undisclosed and hard to prove exposure and injuries due to a growing list of environmental and chemical hazards.

Including, but not limited to…

Oil Well Fires
Pesticides
Burn Barrels
Pyridostigmine Bromide (PB)
Depleted Uranium
Chemical & Biological Weapons

 

Gulf War Illness (GWI)

These hazards are believed to be associated with what is commonly called Gulf War Illness, or Gulf War Syndrome.  Gulf War illness is characterized by fatigue, skin rashes, joint pain, forgetfulness, and other mental and physical ailments.  So, if you are a Gulf War Era Veteran, you need to consider the following.

If there are no better explanations of what is causing these ailments in you, you have a strong claim for Service Connected Disability compensation.  

Additionally, if these same conditions are keeping you from being able to work, you likely have a strong claim for Social Security benefits as well.

Frustratingly, the VA continues to spend real money ($400 million+) researching the potential causes for each possible condition.  This expenditure is a lot of money to spend chasing tails while Veterans continue to run into barriers to treatment and support.  Veterans are suffering and dying while the VA seeks to find out the cause.  At this point, the VA should focus on the support and the Federal Government should concentrate on the cause!

 

What Can we We Do?

The only way to assert Veterans rights to treatment and compensation for loss of function is to persist in clearing the path for them.  The VA needs to help Gulf War Veterans in seeking better treatments.  They need to offer the correct diagnosis.  And they need to begin awarding reasonable GWI claims at the same rate they grant other claims.

In the meantime, Veterans should seek support from experienced and knowledgeable advocates.  Advocates that can step in to fill the support gap that defines this issue.

 


Read about HOW the VA Should Support Gulf War Veterans in our other Blog Post, HERE

 

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