There is favorable medical evidence in my file, so why is the VA not approving my claim?
This is a question that I am asked almost on a weekly basis.
Unfortunately, when it comes to dealing with the VA, sometimes it is hard to answer this question with complete certainty. I will attempt to shed some light on this topic and highlight some of the common problems I see in my practice when reviewing veterans’ claims.
The VA Claims File
The first, and arguably the most important step when dealing with the disability process, is to obtain a copy of the complete Claims File. The Claims file is also known as the C-File.
The C-File should contain all of the records, medical and non-medical, that the VA has collected during the course of the claim. Once the file is received, a thorough review is conducted to assess all of the evidence, both positive and negative.
The Compensation And Pension Exam
When a veteran files an initial claim, oftentimes the VA will order compensation and pension examinations as a part of its duty to assist (i.e. duty to fully develop the claims). The C&P examiner will then write opinions about the medical merits of the veteran’s claims. Once the VA receives the opinions and finishes developing the claims, then it will issue a Rating Decision.
If the veteran is unsatisfied with the decision and decides to appeal, if there are new developments, or if it has been a long time since the initial exams, then the VA may order another round of examinations. After the additional development, the VA will then issue a new decision.
Unfortunately, the C&P exams ordered by the VA are often lacking at best, and oftentimes, downright negative. However, far too often, veterans tell me that they thought the exams went well, until they are blindsided by what the report actually says or doesn’t say.
Another common situation is where veterans believe that their treating physicians are supportive of their claims; however, the complete opposite is actually the case. Meaning, the records paint a different picture from what the veteran believes to be true.
Issues With VA Healthcare Records
For example, I recently worked on a case where the veteran filed a claim for fibromyalgia. Her only medical treatment was at the VA. The VA doctor wrote in the records that he believed the veteran was exaggerating her symptoms, and even more damaging, the doctor did not diagnose her with fibromyalgia. The veteran had no idea what was documented in her records. Needless to say, this was not good for our case.
Putting The Pieces Together
The take away lesson is that the veteran, nor counsel, knows what kind of case they have until the complete C-file is received and thoroughly reviewed. Once the file is reviewed, all parties can have a better grasp of the evidence. The records that were once thought to be ‘favorable,’ can suddenly turn the case into a different ballgame once the evidence is reviewed for what it really is, whether good or bad.
