What Is a 1151 Claim and How Can It Help You Get VA Benefits?

Section 1151 is a lifeline that can offer support to veterans with injuries or conditions that occurred due to the negligence or fault of a VA healthcare provider. We’ll explain what Section 1151 is, how it differs from standard VA disability benefits, and how you can make a VA claim under this provision.

What Is Section 1151?

Section 1151 is part of Title 38 of the United States Code, the law that governs veterans’ benefits. This specific section is designed to protect veterans who have been harmed due to the negligence or shortcomings of the VA’s medical staff or facilities. The provision allows you to claim benefits for injuries or medical conditions that happened because of: 

• Mistakes made during medical treatment at a VA facility
• Lack of proper care or improper actions during your stay at a VA facility
• Surgical errors or other medical mishaps

It also covers injuries incurred or aggravated while pursuing a course of vocational rehabilitation under 38 U.S.C. Chapter 31 or participating in compensated work therapy under 38 U.S.C. 1718. 

In essence, Section 1151 is there to support veterans who have experienced harm due to the VA’s fault. It’s a way for the government to take responsibility for any mistakes that happen under their watch. 

If the Veteran’s claim is approved under Section 1151, it will entitle the veteran or survivor to receive VA Disability Benefits or Dependency and Indemnity Compensation, as applicable. 

Section 1151 Claims vs. Standard VA Benefits

The world of VA benefits can be confusing, with various types and categories of benefits to navigate. However, understanding the differences between standard VA disability benefits and Section 1151 claims can be a game-changer.

• Origin of Condition: Standard benefits are for service-related conditions, while Section 1151 claims are for conditions caused by VA medical care
• Purpose: Standard benefits aim to compensate for service-related harm, whereas Section 1151 aims to compensate for harm due to medical errors or negligence
• Claim Process: The procedures to claim these two types of benefits are different and require different sets of documents and evidence

Standard VA Disability Benefits

Standard VA disability benefits are provided to veterans who have sustained injuries or suffer from conditions that are related to their military service. Here’s what they usually cover:

• Physical Injuries: Such as loss of limb, hearing loss, or other bodily harm
• Mental Health Conditions: Like post-traumatic stress disorder (PTSD) or depression
• Illnesses: Acquired during or after your service, including diseases caused by Agent Orange

Section 1151 Claims

Section 1151 is a bit different. These benefits are not for injuries or conditions directly caused by your military service, but rather for those that occur due to the negligence or mistakes made by VA healthcare providers. Under Section 1151, you can claim benefits for:

• Medical Errors: Including surgical mistakes or wrong medication dosage
• Inadequate Care: Such as failure to diagnose or treat a medical condition properly
• Mistreatment: Any improper action that led to your harm while in a VA facility

How to File a Section 1151 Claim

Before diving into the paperwork, you must first meet specific conditions to qualify for a Section 1151 claim. You must be able to demonstrate that:

1. You have a new or worsened medical condition
2. This condition was caused or aggravated by VA medical care or treatment
3. The care or treatment did not meet the generally accepted standards in the medical community 

The Filing Process

1. Consult Medical Records: Thoroughly review your VA medical records to find evidence that supports your claim. 
2. Seek Professional Opinion: If possible, consult an independent medical professional for an opinion linking your condition to the VA’s negligence or fault. 
3. Fill Out the Appropriate Forms: The primary form for a Section 1151 claim is VA Form 21-0966 (Intent to File a Claim). You may also need additional forms based on your specific circumstances. 
4. Compile Evidence: Along with the forms, prepare all supporting documentation, such as medical reports, eyewitness accounts, or expert opinions. 
5. Submit Your Claim: Once everything is prepared, you can submit your claim either online, by mail, or in person at a VA facility. 
6. Follow Up: Keep track of your claim status and be prepared to attend any required medical examinations or interviews. 

Documents Required for a Section 1151 Claim

• Completed VA Form 21-0966 (Intent to File a Claim) 
• Medical records and reports supporting your claim 
• Statements from eyewitnesses, if applicable 
• Any additional evidence that strengthens your claim  

FAQs About Section 1151

What conditions are eligible for a Section 1151 claim?

Any condition that was caused or worsened due to the negligence, errors, or shortcomings of VA medical staff or facilities can qualify for a Section 1151 claim.

Do I need a lawyer to file a Section 1151 claim?

While you can file a claim on your own, the process is intricate and often requires legal expertise. Consulting with an attorney who specializes in VA disability and Section 1151 claims can increase your chances of a successful outcome.

How long does it take for a Section 1151 claim to be processed?

The duration can vary widely depending on the complexity of your case and the evidence provided. Generally speaking, it could take several months to a year for a decision.

Can I appeal if my Section 1151 claim is denied?

Yes, you can appeal a denied claim. The appeal process is another complex undertaking and it’s highly advisable to seek legal counsel for it.

How are Section 1151 benefits calculated?

Benefits are usually determined based on the severity of your condition, just like standard VA disability benefits. However, under Section 1151, you may also be eligible for additional compensation for suffering and inconvenience.

Can I file for both standard VA disability benefits and a Section 1151 claim?

Yes, you can file for both. They are not mutually exclusive and, in fact, a Section 1151 claim can provide benefits in addition to your standard VA disability benefits.

How to Prove a Section 1151 Claim 

Navigating the legal landscape of Section 1151 claims can sometimes feel like walking through a maze. It’s crucial to know the potential challenges you might face and how to avoid common pitfalls.

Common Problems with 1151 Claims

• Incomplete Documentation: Failing to submit all required forms and supporting documents can stall or even derail your claim
• Lack of Medical Evidence: Insufficient or unclear medical records may weaken your case substantially
• Missed Deadlines: Failing to file your claim within the prescribed time frame can result in forfeiture of your benefits

Legal Complexities

Section 1151 claims are fraught with legal nuances that can make or break your case. Here are some of the legal challenges you may encounter:

1. Burden of Proof – Proving that the VA’s negligence directly caused your condition can be challenging. Suffering from a foreseeable complication of a VA procedure may not be enough to qualify for 1151 benefits unless VA’s actions were negligent or careless.
2. Technicalities – Legal language and documentation requirements can be complex, potentially leading to mistakes or omissions.

To navigate these challenges successfully, it may be wise to seek professional assistance, like hiring an experienced VA disability attorney who can provide targeted advice and help you build a strong case. Get a free case evaluation to see if Hill & Ponton is able to assist. 

Medical Opinions That Can Prove 1151 Claims 

Section 1151 claims, similar to a medical mal–practice claim against the VA, have been known to be very difficult to win.  To offset the VA’s very high standard of proof, the Veteran or survivor should consider obtaining a competent medical opinion that the VA was at fault for the disability or death of the Veteran. 

Under the current provisions of 38 U.S.C.A. § 1151 compensation shall be awarded for a qualifying additional disability or a qualifying death of a veteran in the same manner as if such additional disability or death were service-connected. However, if a veteran is found eligible for compensation under Section 1151, the disability is considered service-connected for payment purposes ONLY. 

For purposes of this section, a disability or death is a qualifying additional disability or qualifying death if the disability or death was not the result of the veteran’s willful misconduct and the disability or death was caused by hospital care, medical or surgical treatment, or examination furnished the veteran under any law administered by the Secretary, either by a Department employee or in a Department facility, and the proximate cause of the disability or death was: 

(A) carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the Department in furnishing the hospital care, medical or surgical treatment, or examination; or (B) an event not reasonably foreseeable. 

From the plain language of the statute, it is clear that to establish entitlement to Section 1151 benefits, these factors must be shown: 

1. disability/additional disability; 
2. that VA hospitalization, treatment, surgery, examination, or training was the cause of such disability; and 
3. that there was an element of fault on the part of VA in providing the treatment, hospitalization, surgery, etc., or that the disability resulted from an event not reasonably foreseeable.

The regulation also provides that it must be shown that the VA failed to exercise the degree of care that would be expected of a reasonable health care provider; or VA furnished the hospital care or medical or surgical treatment without the Veteran’s informed consent. 

In order for a Veteran to succeed in these claims, the record must contain a competent medical opinion establishing that the physician was fully informed of the pertinent medical history of the case.  

It is good practice to provide the medical expert with the Veteran’s entire VA Claims File (C-file), and all relevant medical records.  However, a review of the C-file is not always required, since a physician can become aware of the relevant medical history through a factually accurate medical account reported by a Veteran or by having treated a Veteran for a long period of time. 

In addition, the medical expert has to be able to provide a fully articulated opinion.  A medical opinion that is ambiguous or unclear, or expressed in hypothetical language does not provide the degree of certainty required for medical nexus evidence. 

And most importantly, the medical opinion must be supported by a reasoned analysis. The medical opinion cannot only contain data and conclusions, but it must also provide support for its conclusion and a reasoned analysis for it to bear any weight in court. 

Specifically to Section 1151 claims, the medical professional is required to provide medical proof and support their opinion that “it is as likely as not” that the Veteran’s alleged mal–practice was caused by or is the result of carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the Department in furnishing the hospital care, medical or surgical treatment, or examination. 

The expert’s knowledge and proficiency in the medical field may also provide a basis as to whether it was reasonably foreseeable that the outcome could have been prevented. 

Case Studies: Real-world Examples

Sometimes the best way to understand the ins and outs of Section 1151 claims is to look at actual cases. These real-world examples can offer insights into what works and what doesn’t, and can provide you with a clearer perspective on the process.

Case Study 1: Surgical Error

1. Background: A veteran underwent surgery at a VA facility and experienced severe complications due to a surgical error. 
2. Outcome: Filed a Section 1151 claim, backed by medical evidence and expert opinions, leading to a successful grant of benefits. 
3. Lesson: The importance of collecting robust medical evidence and expert testimonies can’t be overstated.

Case Study 2: Misdiagnosis

1. Background: A veteran was misdiagnosed for a serious condition, which led to ineffective treatment and worsened health. 
2. Outcome: Initially denied benefits due to lack of direct evidence. Hired a VA attorney and successfully appealed the decision. 
3. Lesson: Legal expertise can be crucial, especially in complicated cases where initial claims may be denied. 

Case Study 3: Delay in Treatment

1. Background: A veteran had to wait an extended period to receive treatment, exacerbating their condition. 
2. Outcome: Faced challenges in proving that the delay was due to VA negligence but ultimately succeeded by presenting internal VA correspondence as evidence. 
3. Lesson: Sometimes unconventional forms of evidence, like internal communications, can tip the scales in your favor.  

These case studies show that every Section 1151 claim is unique, and various factors can influence the outcome. However, strong evidence, timely filing, and legal expertise often play critical roles in the success of a claim.