My Veterans Service Connected Disability Claim Was Denied. Now What?

Though Veterans are entitled to service-connected disability benefits, studies have shown that the Department of Veteran Affairs (DVA) rejects up to 70% of claims for various reasons. 

If you have had a service-connected disability claim rejected and you disagree with the decision, you need to file an appeal. It will not be a simple process, but we’re here to help.

Keep reading to find required forms, tips, and advice on how to make the appeal process as painless as possible. 

Step One in Appealing a Service-Connected Disability Decision

Getting rejected is not fun. Especially when your health is on the line. Before you get frustrated, keep in mind that a lot of Veterans’ disability claims are denied because of simple processing errors. It could be as simple as that. 

The first step in the appeal process is to file a notice of disagreement (NOD). When completing this form, it is best not to go into too much detail about why you disagree with your decision.

While it is tempting to take out your frustration on the readers of this form, all you need to include is the date of the denial letter, the rating decision, and a statement saying you disagree with the decision and intend to appeal. 

Keep it as general as possible. If necessary, you will have time to go into detail later in the appeal process.

Direct or Traditional Review?

Once the NOD is submitted, you will have to make the decision to request a direct review (DRO) or a traditional review.

Traditional reviews are conducted by staff who analyze the claim and check for completeness, but they can only change the original decision if a clear administrative error in processing is detected. 

The benefit of selecting a DRO is that the reviewer will be a senior claims examiner who has the authority to make a decision on your claim, right then and there. 

The drawback of a direct review is that if the reviewer denies the claim, you may have to wait longer to proceed to the next step: the Board of Veterans Appeals (BVA). 

Appeal to the Board of Veteran’s Appeals 

At this point, you have submitted a notice of disagreement (NOD) and the VA is sticking to their decision. You should now submit a VA Form 9 (Appeal to the Board of Veteran’s Appeals). 

This is when & where you can/should go into more detail about why you disagree with the decision and present new evidence. Keep in mind, any new evidence submitted may draw out this process further, especially if it is new and material to your case.

Working with a good advocate or attorney will help you at this point if you have not already retained one. 

Judgement Day

Perhaps the best part of a VA Form 9 is that it means you are going to get your day in court.  If the VA continues sticking to their guns, you will get to argue why they are mistaken in front of a judge.  The judge at this point has several options. 

1) Grant your appeal in full.  Yay, you won and should be getting a check soon for back-due benefits. 

2) Deny your appeal.  You can appeal this denial through a federal lawsuit. 

3) Remand all or part of your claim.  The judge thinks the VA should take another look based off evidence they have seen in the review of your claim or that you presented at the hearing.  They will direct VA staff adjudicators what they want them to review again and why.  The result will be a new determination, which if found to still be a denial of benefits, will give you the option to file a new VA Form 9 and go through another hearing (your case is still alive – but it is going to take more time!)

4) Grant part of your appeal.  Often appeals include multiple items, the judge may find parts of your claims reasonable, and others not supported by current precedent or law.  In this case, yay – you will be getting at least a little compensation. 

But there is also the potential to have a mix of items 2 & 3 above.  It is getting complicated at this point! 

The Best Advice We Can Offer

While the service-connected disability process is long, arduous, and dated, it is in place to make sure the money is going to the right people. 

To avoid extreme delays, submit your paperwork correctly in the first place. While this does not eliminate the risk of processing errors, it will save time down the road if you submit all your evidence together and meet the deadlines.

Send paperwork using certified mail and keep copies of proof of delivery. Keep copies of everything and do routine follow-ups. 

If you are really fed up with the system, you can write to your local state representative and ask that they review and improve the antiquated appeals process.

In the meantime, reach out to us if you need excellent legal assistance with your claim!

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5 Tips to Get the Veterans Disability Compensation That You Deserve

According to the 2015 census, there were 3.8 million Veterans with service-connected disabilities in 2014. 

While this is the statistic we have, there are more Veterans that are service-connected but unable to navigate the confusing world of disability claim submissions. Many Veterans are severely disabled and find it difficult to go through the process.

If you are a Veteran that needs help with your Veterans disability compensation claims, continue reading to learn five tips that will have you well on your way to getting the compensation you deserve.

Veterans Disability Facts You Need to Know

Even after you have served your country, you may find it difficult to get the compensation you deserve. Complicated online systems, phone calls, and requesting records can leave you feeling less than impressed with the process.

Gather All Necessary Paperwork

Whether you were active duty or in the reserves, you need to have your DD-214 form if you are no longer in the military. You will have received this form when you exited the military. It should be noted that only reserves that have been deployed on active duty during their time in the military receive the DD-214 form.

If you are still in the military, it is a little easier to file your claim. However, most people do not apply for their VA disability benefits until after they are out of the service and living civilian life.

Work with Someone – You Have Choices

For assistance, you have a lot of choices. A service officer at an accredited Veterans Service Organization (VSO), a VA Accredited Claims Agent, or a VA Accredited Attorney, like Lilac City Law.  The sooner you get started, the better.  And the less mistakes made along the way, the better.   Remember, the process can take well over a year in many cases.

File Your Claim Right Away

File your claim right away in order to get the most compensation. Even if it takes a while to approve your claim, when it is approved you will be paid back to your filing date.

Another benefit of filing your claim right away is that it will be easier to locate your records. While the military does their best to keep records, they get misplaced occasionally.

Monitor Your Progress Online

Login to the VA website to check your claim status regularly. You will see an estimated date of completion, but you can expect it to change as your case moves forward.

When you monitor your progress, you want to check and see if there is any additional information that is requested of you. If the military requests additional information, get it to them as quickly as you can to keep the process moving forward.

Show up for All Appointments

Make sure to show up early for any appointments for evaluation. You will go through an evaluation for any disabilities you claim ranging from physical to PTSD. If you miss an appointment, it could take you a long time to get another one.

Get Approved for Your Compensation

Veterans disability compensation is your right if you have a service-connected disability. Follow the above steps to get the help you need to file your claim properly.

Continue your education on the topic today by reading our article on PTSD and how it impacts your claim.

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How a PTSD Disability Impacts Your VA Compensation Claim

As 13 million people across the country experience Post Traumatic Stress Disorder (PTSD) in some form, there are many highly-functioning people actively managing their disability on a daily basis. Likewise, there are many more who are unaware they may have PTSD or do not know how to go about getting treatment and compensation for it.

If you struggle with the symptoms of PTSD the last thing you want to deal with is extra hurdles for the help you want or need.

Here are some things you should know about PTSD, filing a PTSD VA claim, and how we can help you.

Understanding PTSD

Post-traumatic stress disorder or PTSD is a term that gets thrown around a lot. If two people go through a terrible weekend at a work conference, they might refer to having PTSD in a tongue in cheek way. However, it’s a pretty serious anxiety disorder. That being said, the trauma that leads one person to exhibit chronic symptoms vs the trauma that another person may have experienced to exhibit a whole other set of symptoms (or none at all) is completely subjective. Fact is, no two people are going to react to a traumatic event the same way.

PTSD usually correlates with an intense situation when someone (self or others) has been either exposed to or has incurred a risk of injury or death of someone close to them. Perhaps the biggest paradox surrounding PTSD is that symptoms can occur days, months, or decades after the event took place.

You Need to Make a Claim with the VA

If your anxiety, depression, lack of sleeping, or any other potential symptoms of PTSD are related (even remotely) to your military service your first step needs to be filing with the VA via their special application for people suffering PTSD.

To qualify for VA compensation and related medical benefits, you need to submit your claim to the Compensation and Pension Service.

You can do this online, via the VA’s own site, at www.ebenefits.va.gov.

Even if you’re not computer savvy, this a fairly simple application that will make a huge difference in your life and treatment if and when you’re successful.

Next Steps

You need to get your official PTSD diagnosis to move on in the process. You will have to relate the stress to a specific traumatic event, which will be documented by your psychiatrist in a VA C&P exam. You will then have to show that your PTSD is related to (or made worse by) an experience in your military record.

Assuming you are successful in your claim, you will be given a certain “percentage” of disability, rating just how debilitating your symptoms are. The rating should take into account how often you experience challenges related to your PTSD, what triggers your challenges, and how long they last.

If your ability to work and to function without assistance turns out to be serious enough, you can file for Total Disability Individual Unemployability (TDIU) benefits, an increase in ratings, and of course – Social Security Disability benefits. (Yes, you can claim SSDI & VA disability at the same time!)

A PTSD Disability Should not Stop You from Enjoying Life

Just because you experience PTSD does not mean you should not be able to do everything you want to with the rest of your life.

If your military service is what caused that problem, America is indebted to you and should help you to manage your challenges through fair compensation and adequate treatment.

If you’re wondering how your benefits balance out with your social security, check out our guide for more info.

Contact Us

Contact us today for assistance in reviewing your current or potential disability claims for Post Traumatic Stress Disorder (PTSD).

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How Long Can You Expect The VA to Spend in Preparation for a Decision?

How Long Can You Expect The VA to Spend in Preparation for a Decision?

If you are applying or have already applied for VA benefits, you might find yourself wondering how will the VA take to make a decision?

Though we would like to gaze into a crystal ball to tell you – in truth, this is a difficult question to answer.

Many separate factors go into a VA decision.  Each of those factors potentially causing the VA’s timeline to extend.  

We’ll explore this more below by breaking down several of the reasons the VA may delay in providing a final determination or decision on your claim.  

Claims Process

Basically, there are eight steps in the VA claim process. 

8 Steps in the VA Claims Process

  1. Claims Received: Your claim was received by the VA.
  2. Under Review: Your claim has been assigned to a Veteran’s Service Representative. It will be reviewed to determine if additional medical evidence is needed to support your claim.
  3. Gathering of Evidence: Your medical evidence will be gathered from you, a medical professional, a government agency, or another authority. Your claim can return to this step multiple times.
  4. Review of Evidence: Your medical evidence will be reviewed by the Veteran’s Service Representative. If more evidence is needed, your claim will go back to Step 3: Gathering of Evidence.
  5. Preparation for Decision: A decision will be recommended. Your claim may be sent back to Step 3: Gathering of Evidence if there is not enough medical evidence to make a decision.
  6. Pending Decision Approval: The recommended decision will be reviewed, and a final award will be made.
  7. Preparation for Notification: Your claim decision packet is ready to be mailed
  8. Complete: Your decision packet has been mailed and includes

Length of Process

The timeline for how long the VA will take in preparation for your decision depends on the type of claim you filed, the complexity of your disability, the number of disabilities you claimed, and the availability of your medical records during the claims process (see eight steps above). 

During the preparation for decision, the VA Veteran’s Service Representative (assigned in Step 2 above) recommends a decision.  If there is not enough evidence to decide your claim, then your claim will go back to Step 3: Gathering of Evidence.  Your claim will then go through steps 3 through 5. This will repeat until your Veteran’s Service Representative feels he or she has enough evidence to make a decision.

According to the US Department of Veteran’s Affairs website:

You can track the status of your claim by registering for eBenefits at www.ebenefits.va.gov. You can also visit the VA’s ASPIRE web site. Here you can find the average processing days for the regional office that is working on your claim. To find the average processing days for your state:

  • Find your state on the map, place your cursor within the state and click
  • This will open the Veterans Benefits Administration Aspire • Benefits site. Click “Enter”
  • You should see a split table. On the left table click on “Compensation”
    • This will expand the table. Approximately five rows down is “Rating Claims Processing “
  • Follow that row to the right until you locate the cell located within the column of your regional office.

The number you see is the average processing days to complete a claim that requires a disability rating. The average is based on completed claims since October 1 in a given fiscal year

Can My VA Claim Be Sped Up?

Waiting can be frustrating, but unfortunately is part of the process.  Feel free to contact us if you need any help with your Veterans benefits claim or want to know if there are any ways to speed it up.

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What Can I Expect In My VA C&P Exam?

What Can I Expect In My VA C&P Exam?

As part of your disability application & evaluation process, you will experience a VA C&P Exam.

 The C&P Exam is short for, Compensation and Pension exam, and it is typically performed by a VA doctor or contracted health care professional.

Here’s what can you expect from your VA C&P Exam.

Before Your VA C&P Exam, Know The Purpose of the Exam

Before your exam, you will want to be prepared to recount the entire medical history of your conditions.  This is something that the doctor(s) will ask you during your exam.  Regarding your medical concerns, when did it begin, how have you treated it, what is the severity now.  Recall, this all points to a nexus, you need to understand how service nexus plays into your disability claim, it will matter to how you answer these questions.  After the exam, the doctor will be writing up an opinion on the current condition, when it began, and whether or not it is related to your military experience.

During Your VA C&P Exam

The VA C&P exam is simply a doctor’s appointment that evaluates your physical or psychological conditions that you are claiming to be service connected. If you have more than one condition, the doctor will evaluate each one, and you may be sent to a specialist for certain conditions.  For instance, the doctor will probably be a general practitioner, so anything special, such as Vision, Hearing, Dental, Psychiatric, and other conditions, will be referred out.

When you arrive for your C&P exam, you will be given an opportunity to file a travel claim for mileage re-reimbursement.

During your exam, the doctor may do any or all of these things:

  • Review your claim file with you
  • Ask you questions based on the medical records in your claim file. These may include questions from the Disability Benefits Questionnaire for each service-connected condition you’re claiming.
  • Take a look at the Disability Benefits Questionnaires (DBQs).
  • Perform a basic physical exam
  • Ask you to get other tests—like X-rays or blood work—if needed

*Source* 

If you have a psychological condition or disorder the doctor will ask you questions and have you describe the symptoms you have experienced.  Be sure also to tell the doctor how the stress has affected you.  You may be asked to complete some standard psychological tests.

If you have a physical condition, illness, or injury, the doctor will ask you questions, order lab work, and conduct standard medical tests specific to your condition.  Remember to be completely honest with all questions you are asked.  For example, if the doctor asks how you are, do not say fine.  Be truthful and tell him or her that you are depressed or in pain if that is how you feel.  Make sure you don’t leave things unsaid.  If it’s unsaid, it cannot be claimed.

After Your VA C&P Exam

After your exam, the doctor will send the results to a VA claims processor.  The claims processor will then decide to approve or deny your claim based on the exam results along with other medical and military records. It can take  3-4 months for a decision to be made.

If your claim is not approved, you can file an appeal.  You have the right to good representation in your VA compensation case and more often than they should, the VA makes a mistake in its initial determination.  A good VA claims advocate attorney or service officer will look at your claim & the VA decision and be able to figure out what went wrong and help you fix it.  It’s ok to ask for help.

Get Help With Your VA Claim Today

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VA Claim Remands & More Explained: BVA Decisions

VA Claim Remands & More Explained: BVA Decisions

When you submit a claim to the Board of Veteran’s Appeals (BVA), three different BVA decisions can be made; grant, deny, or remand.

We are going to look at each of these BVA decisions and discuss what they mean.

Your Appeal is Granted

You receive a letter in the mail stating that your appeal was granted.  This is the best case scenario for you.  You submitted all of your medical evidence along with all of the forms that are required.  You wait for what seems like forever and then you receive a letter saying your appeal was granted.  Your appeal is over.  Congratulations!

Your Appeal Gets Remanded

You receive a letter in the mail stating that your appeal, in whole or in part, is remanded.  This is not necessarily a bad thing.  The BVA can remand your case, or specific claims within your case, for a few different reasons.

For example:

  • There has been a change in the law
  • Your disability worsened during your appeal
  • You introduced new evidence in your hearing
  • The regional office did not process your claim correctly
  • The regional office did not gather enough evidence or did not gather the correct evidence

These are not all of the reasons your BVA decision may be remanded, but there should be an explanation in the letter you receive.  It will also state what the Regional Office (RO) needs to complete or what evidence they may need to gather.

After The Remand

When your appeal is remanded,  the BVA will send your claims file back to the RO (regional office) where your claim was first adjudicated.  Along with your file, the BVA will also send a list of what you, your attorney, and the RO need to do before the RO makes a new decision.

After this, if more evidence was requested, this new evidence is gathered. You will have 30 days to submit the new evidence.  The VA is required to help you develop your claim such as scheduling you for another exam or gathering records on your behalf.

One the RO receives the new evidence or the 30 days are up, then the VA adjudicator will make a new decision on your appeal.  They will either grant or deny or appeal.

If they grant your appeal, then you are done!  You have won your appeal and can be done with the process.

If they deny your appeal, they will send you a Supplemental Statement of the Case (SSOC).   The SSOC will state why you were denied along with a summary of the evidence relevant to your case and a summary of the laws and regulations used to make the decision.  You can file a VA Form 9 in response to this SSOC and request a hearing.

Your Appeal Gets Denied

If your appeal gets denied, you may continue with the appeal, you can accept the decision, or you can file again from the beginning (and lose your date of claim).

If you choose to continue with the appeal, you will need to make an appeal to the United States Court of Appeals for Veterans Claims (CAVC).  However, there are other motions you can file directly with the BVA to have your decision reconsidered.

BVA decisions are a complex thing.  You always hope you are granted, but you do not have to be completely disappointed if you are remanded or denied.  There are additional steps you can take.

We Help Veterans in VA Claims in Spokane, Eastern Washington, and Northern Idaho

If you are in the appeal process and need help, please contact us today!

Contact Us!
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How to Fill Out a VA DBQ (Disability Benefits Questionnaire)

How to Fill Out a VA DBQ (Disability Benefits Questionnaire)

If you are a disabled veteran and are submitting a claim, you will want to know about the VA DBQ (Disability Benefits Questionnaire)

Here is a little bit of advice and assistance to help you perfect your claim.

If you need additional help, please reach out to us at the contact form in this article. 

What a VA DBQ is

A VA DBQ is a Veteran’s Disability Benefits Questionnaire.  They are not required in your initial claim or appeal but can be very helpful..

A DBQ documents your medical conditions.  It’s an opportunity to provide the VA with information on your claims that meets their needs for adjudication and is convenient for you and your health care provider to complete.  As a bonus, using a DBQ is supposed to help reduce the time it takes the VA to make a claims decision.

You can fill out a DBQ with your private doctor or health care provider.

Where to Find a VA DBQ

You can find 70 different VA DBQs on the US Department of Veteran’s Affairs website.  You will want to find the VA DBQ that matches your condition.  You can either search by DBQ List by Form Name or DBQ List by Symptoms.

Not all conditions have a DBQ available.  For example, you will not be able to use a DBQ for the following:

  • Initial Examination for Post-Traumatic Stress Disorder
  • Hearing Loss and Tinnitus
  • Residuals of Traumatic Brain Injury
  • Cold Injury Residuals
  • Prisoner of War Examination Protocol
  • Gulf War Medical Examination
  • General Medical Examination for Compensation Purposes
  • General Medical Examination for Pension Purposes

Who Needs to Fill Out a VA DBQ

You can either have a VA clinician fill out your VA DBQ if you are using a VA doctor – or, if you are being seen by a private provider, then you will have them fill out the DQB and either fax it to your regional office or send it in the mail to the VA.

Either provider must have an active medical license and must sign and attest to a medical condition on your completed DBQ. Your provider can print out the appropriate DBQ and fill it out, or they can fill out the PDF on the computer and then print it out.

Mental health DBQs cannot be filled out by a general provider.

According to the US Department of Veteran’s Affairs website:

To conduct an initial examination for mental disorders, the examiner must meet one of the following criteria:

  • a board-certified or board-eligible psychiatrist;
  • a licensed doctorate-level psychologist;
  • a doctorate-level mental health provider under the close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist;
  • a psychiatry resident under the close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist; or
  • a clinical or counseling psychologist completing a one-year internship or residency (for purposes of a doctorate-level degree) under the close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist.

To conduct a review examination for mental disorders, the examiner must meet one of the following criteria:

  • any criteria from above; or
  • be a licensed clinical social worker (LCSW), a nurse practitioner, a clinical nurse specialist, or a physician assistant, under the close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist

VA DBQ Process

The DBQ process has four steps:

  1. Access the appropriate form online.
  2. Have your healthcare provider (VA or private) complete and sign the form.
  3. Save a copy for your records.
  4. Submit the DBQ to the VA either by fax or mail.

For more information on DBQs, you can see the VA’s DBQ frequently asked questions, call 1-800-827-1000, or Ask a question on the US Department of Veteran’s Affairs website.

We Help Veterans in VA and Social Security Disability Claims in Spokane, WA

You can contact us for any veteran’s disability questions you have.

Contact
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What Does VA “Development Letter Sent” Mean?

What Does VA “Development Letter Sent” Mean?

What Does VA “Development Letter Sent” Mean?

 

Did you recently notice a status on your eBenefits saying “VA development letter sent” but you are unsure what that means?

You may be especially confused if you have not received a physical letter.

Here’s what you need to know.

 

What “VA Development Letter Sent” Means on eBenefits

Development letters are typically sent in the early stages of your claim.  They acknowledge that you have submitted a claim and may ask you for additional evidence if you have any to add.  This letter is legally required to be sent to anyone who submits a claim. If your eBenefits status says “VA development letter sent,” but you have not received a physical letter yet, do not worry too much, it still may be on the way.  It updates in the system sometimes before you get the actual letter in the mail.  It should arrive shortly.

If you do not receive your letter, you might want to submit a letter in your claim asking for a copy of your development letter to be sent to you  ASAP.

 

Items That May be Included with the Letter

Along with the letter, there may be forms.  Sometimes the forms included in your letter are forms you have already filled out and submitted when you put in your initial claim.  If you are not sure if you should or should not fill anything out, reach out to your service office, or to us, and we can help you figure these issues out.

The letter may also ask you for things that are not applicable to your specific case.  You do not have to send in everything the letter asks for.  You only have to submit anything you have not already sent in.

In a separate letter or phone call, you will likely get a notification for a compensation and pension exam (comp & pen or C & P exam).  So, this is not THAT letter.

 

Sending in Additional Evidence

You may have additional evidence that you want to submit, but you need to decide carefully if it will greatly affect your case.  If you submit more medical evidence, it can cause decisions on your case to be delayed pending review of the new information.  Moreover, if you have already submitted a Fully Developed Claims (FDC)  there might be other considerations to assess.

Regardless, more evidence always runs the risk of your claim could be delayed; however, it is always best to delay an initial claim adjudication vs. appealing a wrong decision based on too little evidence.

 

eBenefits Statuses

Keep in mind that when looking at your claim status on eBenefits it can go back and forth between the different states.  Your claim status might read, “review of evidence” today, then when you look in a few days, it might have changed back to, “gathering of evidence,” or “review of evidence.”

This normal.  However, it certainly can be stressful.  If you have a question about the status of your claim, feel free to reach out to our team at your convenience.

 

Contact LCL With Questions About Your VA Claim Status

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Lilac City Law Founding Attorney Randi L Johnson Awarded for Business Leadership

Randi L Johnson Award

 

Lilac City Law founding attorney, Randi L Johnson was recently named one of 12 awardees for the Women in Business Leadership Award by the Spokane Coeur d’Alene Living Magazine.

The WIBL award singled Randi’s leadership in establishing a successful business and retaining close ties to the community and her family.  

The awards for the 8th Annual Women in Business Leadership Awards will be held on Thu, March 22, 2018, from 7:30 AM – 9:00 AM, additional details of the event as well as RSVP are available, here.

 

Women in Business Leadership Awards, 2018

Randi L Johnson Award

 

 

 

Connect With Lilac City Law for Estate Planning, Social Security Disability, or VA Disability

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How to Understand VA Schedular Ratings Vs TDIU

How to Understand VA Schedular Ratings Vs TDIU

Understanding the difference between VA schedular ratings and TDIU can be confusing.

In this article, we explain each of them and how you can determine which best fits you.

VA Schedular Ratings Explained

When dealing with VA disability claims there are two distinct ways of viewing ratings or awards.   By far the most common system is the schedular system.  This is the percentage based rating schedule.  The rating schedule is broken up into 10% increments from 0%-100% service connection.  Other special ratings, such as TDIU, are based upon the ratings schedule but have criteria that are separate and follow other policy directives.

The VA Ratings Schedule breaks down disabilities into categories based on which part of the body is impacted.  Within those categories is a list of diagnoses and each of the diagnoses has a diagnostic code.  Each code specifies the symptoms required for different ratings of disabilities.  Typically, more severe disabilities receive a higher rating, and then, obviously, less severe disability should receive a lower rating.

An example, Under the Digestive System Category in the Ratings Schedule there are four groups

  1. Ulcers
  2. Postgastrectomy syndromes
  3. Weight loss
  4. Coexisting abdominal conditions

There are three diagnoses under ulcers, one being “ulcer, duodenal.”  This diagnosis has a diagnostic code of 7305, and under this code, there are four different ratings.

  1. Severe, 60%
  2. Moderately severe, 40%
  3. Moderate, 20%
  4. Mild, 10%

Each of these schedular ratings lists symptoms you must have.  For a severe rating for an ulcer, you must have periodic vomiting and only partial relief from ulcer therapy.

There are literally thousands of different rating combinations.  But each follows this pattern.  Category, group, diagnosis, rating.  You can get an idea of where you are on the schedule and where you should be.  In fact, if you are bookish, you can get a great idea of how to approach your initial claim or appeal, based on doctors records and your current conditions as they relate to the ratings laid out for your disability.

How Does the VA Assign my Rating

The VA looks at what body system category is affected.  They will then locate your diagnosis and find the diagnostic code that correlates with your symptoms.  They will carefully look at your medical information to make sure the evidence matches the rating they are assigning.

To find out how much the VA currently pays for each rating you can see current VA compensations rate tables.

 

Total Disability based on Individual Unemployment (TDIU)

If you can not do a substantial amount of work and can prove that you are unable to do a substantially gainful occupation, you may be eligible for Total Disability for Individual Unemployment (TDIU) even if you are not rated at 100% disabled under the schedular ratings (above).  Being able to do a substantially gainful occupation means being able to have an occupation that has an annual income above the poverty rate.  The benefit of pursuing TDIU is that you could be compensated at 100% even though by the schedule you are not at 100%.

This seems counter-intuitive at first, however, the purpose of a 100% rating is to reflect total unemployability (or total disability which is assumed to be unemployable) due to an injury.  The problem is that by schedule, and through the multiple disabilities calculator linked above, it is quite difficult to come up with a combination of ratings that are individually less than 100% and have them come together to form a collective 100%.  Without going too deep into the math.  Assuming you have 50% for PTSD, 50% for Bi-Lateral Hearing Loss, & 50% for Back Injuries – your overall rating would be, 90% (not 150%).  So, even though you got a lot of challenges, even with (3) serious ratings decisions, you still are not rated at 100%!  VA Math…  But, that’s the gap that TDIU fills.

The basic criteria for TDIU: An inability to work needs to be linked to a service-connected disability rated at 60% or higher.  If you have more than one disability, then at least one of the disabilities needs to be rated at 40%, and the combined rating needs to be 70% or more.

How to Tell Which Fits You Best

If you have a service-connected disability, you want to apply for VA disability benefits as soon as possible.  Once you receive your rating, if you believe you are eligible for TDIU, then you need to apply for TDIU. To apply you use the VA Application for Increased Compensation Based on Unemployment.

Both the schedular ratings and TDIU will get you the same end result; being paid for your disability. They use a different process to decide a rating but can give you an income where you may not have one otherwise.

Often clients will reach out to us seeking Social Security while receiving VA Disability.  In that conversation, it is discovered that they should have, or already have, qualified for TDIU and it either was not pursued, was turned down, or was never considered by the VA.  This is wrong and we can help.

Contact Us About TDIU Claims!

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