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Successfully filing a VA claim

Post-9/11 Vet Newsletter header
Woman with paperwork, at her laptop.

By Donna Stratford, APR, Strategic Communications, Veterans Benefits Administration

Many Veterans filing a disability claim with VA simply fill in the 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, list the disabilities they are filing a claim for, cross their fingers and hope for the best. Unless you are just leaving the military, with well-documented and easily accessible service treatment records, this isn’t the best approach.

Having recently completed training as a rater, I’d like to offer some suggestions to help you be successful with your claim the first time it’s submitted.

Intent to file. It may take some time for you to gather the information to support your fully developed claim, such as private treatment records and written statements. You can hold your effective date by filing a VA Form 21-0966, Intent To File A Claim For Compensation and/or Pension, or Survivors Pension and/or DIC. The date this form is received by VA is used as your potential effective date for payment purposes. You have a year after it’s received by VA to file your completed claim application.

To receive VA disability compensation, you must meet three criteria: 1) an event in service that caused or aggravated a disability or illness; 2) a current diagnosed medical disability or illness; and 3) a medical opinion connecting the two.

Without all three items, a claim can’t be granted. It’s like a three legged stool – without any one of these legs, the stool will fall over. If you provide evidence of the first two items, the VA exam will provide the doctor’s opinion for the third. Be aware that just because a doctor’s opinion is requested on service connection, doesn’t mean that the opinion will be favorable to you.

There are some things you need to know about the people rating your claims. First, most are Veterans, or family members of Veterans. They should always give the benefit of the doubt to the Veteran. This is by regulation, by training, and frankly, that’s what they want to do. But, you have to give them something to work with. The rater’s motto is, “Approve if you can, deny if you must.”

Write a Statement in Support of Claim. When filing your claim, include a VA Form 21-4138, Statement in Support of Claim. Do a separate paragraph for each disability you are claiming, and explain the event in service (be specific) and your current disability or symptoms related to your injury or illness. Provide any evidence available on the event, such as personnel records, award narrative, and medical records. If you don’t think this event is in your service personnel or medical records, see if you can find someone you served with to fill out a form to provide their witness statement for the event. While a witness statement alone usually is not enough to grant a claim, it can be combined with other evidence to strengthen a claim for service connection.

Your statement is considered evidence, just like your military or treatment records, and the rater will use it to make the decision. It also tells the rating team where to look, and the timeframe for information to validate your claim.

Include medical records. VA can access treatment records from other VA and military medical facilities. Just make sure you include where you’ve been treated on your application (name of treatment facility) so the records can be found and added to your electronic record. It may take some time to retrieve service personnel and treatment records from the military archives, and records from private physicians. If you can include copies of your service records showing treatment or an event in service, and private physician records, including lab results, showing your current diagnosis, it may eliminate weeks or even months of processing time. Providing all of this information with your claim will help the rating team process your claim more quickly.

Compensation and Pension (C&P) Exam. Even if you submit all of your medical records, you may be scheduled for a C&P exam. This is not a typical doctor’s exam, and in some cases, the doctor may just review your records – including any statements in your file – and ask you a few questions. While this may seem unusual for an exam, the doctor is actually filling in a Disability Benefits Questionnaire (DBQ), which the rater will use to determine if your claim can be granted, and at what percentage. Some information for the form will come from your medical records, and additional information is gathered from you.

Part of the DBQ is a statement from the doctor that your disability is either more or less likely than not connected to your service. That’s the third leg of the stool. Be honest and specific with your answers. For example, if the doctor asks about an injury, instead of saying, “I hurt my back in the service,” be specific and say, “I was getting something off of a shelf in the warehouse and fell off a ladder. There is an accident report. My back has given me problems ever since.” This allows the doctor to connect an incident in service to the current disability.

To find out how to check on the status of your claim, go to Check Your VA Claim Or Appeal Status | Veterans Affairs.

By providing a more complete picture of your situation to the rating team when you file your application, you not only make it easier for the raters to find your information and process your claim, you increase your chances of having your claim granted. Although it will take a little more effort on your part, it can pay off with faster VA processing and will increase your chances of a successful claim the first time.

Remember, the rating team is on your side, but you can help them by including everything they need to approve your claim.