Key Takeaways
In this article you’ll learn how to strengthen your VA Disability claim with:
- Lay Statements and Illness Narratives: How lay statements help your examiner understand the broad nature of your disability.
- Diagnostics: How to use diagnostics to confirm your disability and why they are critical for a successful claim.
- Lost Work Time Documentation: Find out how documenting lost work time can strengthen your claim and credibility with the examiner.
- Lost Work Functionality Documentation: Learn how to show the impact of your disability on your work functionality, even if you haven’t lost work time.
- Example of Common Case We See: Accurate Range of Motion (ROM) Measurements for Orthopedic Claims: Get your examiner to be accurate with your range of motion for orthopedic conditions.
As a Nurse Practitioner specializing in VA C&P Disability Exams, I’ve worked with countless veterans who are seeking to establish service-connection for disability claims.
If there is one Achilles’ heel that I’ve seen over and over again in these claims, it is the lack of effective supporting documentation.
One thing I always tell veterans is that the VA Disability System is incredibly bureaucratic – properly-filled paperwork is king, and failure to obtain it can doom your claim from the start.
But as with anything related to obtaining VA disability benefits, knowledge is power. Here, I’ll be sharing important insights and tactics for getting the right documentation to help you:
1. Establish service connection.
2. Obtain a rating that accurately reflects the severity of your disability.
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A Detailed History of Your Illness
Most veterans I see are claiming disabilities that have impacted their lives for many years before the day of examination itself.
Because it’s been so long, veterans can have difficulty remembering the specific details we, as examiners, are interested in… especially when they feel the pressure of being interviewed during a disability exam!
Because of this, you’ll want to go into the exam having already furnished paperwork regarding the narrative of your illness.
Lay statements (i.e, formal written statements provided to the VA regarding the nature of your disability in your own words) are the easiest way to do this.
That said, in my experience, they’re usually missing key pieces of information that would be very helpful for the examiner.
If all your lay statement describes is how your disability affects you in the present day, I won’t have much to work off of in understanding your history.
Of course, that information is helpful and should always be included, but it doesn’t give me the details regarding when the problem began, what happened that caused it (if you know), where the injury occurred, and treatment you’ve received for the disability (surgeries, specialty visits, therapies, etc).
Another problem I tend to see with lay statements is discordant or conflicting information.
For example, one veteran I examined claimed ankle swelling and pain secondary to the medications she was taking for a mental health condition, but her medical records indicated that she suffered from ankle issues long before she started taking those therapeutics.
In this case, I don’t actually think she intended to be misleading, but she had received so much medical treatment for several major conditions that it all got “lost in the sauce,” so to speak.
This is why comparing your lay statement to your available medical records (which you can request from the VA) can help you stay consistent and accurate while helping to establish the narrative of your condition for your examiner.
Leverage Diagnostics to Confirm Your Disability
The very first thing the VA wants to know from me is whether or not you are actually diagnosed with your claimed disability.
This is important to remember, as I often encounter claims that are doomed from the start when this is not properly understood and there is no documentation of diagnostics to confirm the presence of their disability.
The most common example I see? Arthritis.
Often, based on their symptoms, a veteran will think they have arthritis in a joint that is bothering them.
They may be having pain, but it’s critical to understand that you can’t actually diagnose arthritis (which is degeneration of a joint) if you don’t see it on an x-ray or some other type of image.
Another one I frequently see is a claim for chronic sinusitis. The VA requires that chronic sinusitis be substantiated by diagnostic imaging.
So, if you can’t see certain indicators on an XRay or CT of the Sinuses, you don’t have a diagnosis of chronic sinusitis.
Now, I may award an alternative diagnosis of recurrent sinusitis or rhinitis if imaging is negative, but other examiners may not, and instead simply fail to diagnose you with the claimed disability as it is specifically worded on your claim.
If you’re already service connected for an issue, diagnostics can also help to show the progression of that disability, which may help increase your rating.
Imaging of your spine, for example, can show new nerve involvement, worsening degeneration, or the introduction of all new problems.
Similarly, serial A1c lab readings (which averages your blood sugar readings over a 3-month span) can show the progression of your diabetes over time.
Documenting Lost Work Time
Remember that the VA cares a lot about the impacts of your disability on income earning potential.
Despite this, I can count on one hand the number of times I’ve seen veterans furnish records showing how much work time they’ve lost due to their disability – in my eyes, that’s astounding considering how helpful it can be!
Claiming you’ve lost >5 weeks of work time due to just one disability can be met with some skepticism and make the examiner question your credibility, but not if you have it in writing!
Plus, the VA requires hard documentation for anything over 4 weeks, so going in prepared with this information is critical.
Documenting Lost Work Functionality
“But I haven’t lost work time!”
This is a legitimate response to the above scenario – some veterans can’t afford to lose any work time, regardless of the severity of their disability.
But what you can show is how your disability is affecting you while you’re on the clock.
For example, if you’re excessively tired during the day due to a diagnosis with Obstructive Sleep Apnea, have a co-worker write a buddy statement (which is similar to a lay statement) on your tendency to fall asleep at inopportune times.
It’s even better if you can provide a letter from your manager or superior, who may describe how a chronic service-connected back pain limits your ability to lift heavy objects or sit for extended periods.
The key here is to be specific – name particular tasks you have a hard time doing because of your disability. One way to approach this is:
- Request a meeting with your supervisor or colleagues.
- Ask them to be clear on how your disability may be affecting your work performance. Let them know they can be honest and specific in light of the purpose of the information.
- Take notes on what they say and get it written up into a formal letter (if they’re willing, they can do this on their own).
- Submit the letter via official VA Disability channels to enter into your record.
For Orthopedic Claims: The Importance of Accurate Range of Motion
This section may be particularly helpful if you’re submitting a claim for a joint issue you’re having.
When the VA receives paperwork from your disability examiner for an orthopedic problem (e.g., knee pain), they expect accurate measurements of your range of motion for the affected joint.
Why? Range of motion measurements are one of the main pieces of information used by the VA to assign a rating to your disability.
Since your rating heavily depends on this, you’ll want to make sure your examiner knows what it actually is.
If you’re seeing a provider who’s treating you for that joint, get them to provide documentation regarding your measurements, and, if possible, mention that they used a goniometer when taking them (i.e, the official tool for measuring degrees of range of motion).
Make sure they’re specific within 5 degrees – can your knee flex 90 degrees, or 95?
If you’re not currently being treated by a doctor for your joint issue, a second-best solution is take the measurements yourself!
While there is some knowledge to be acquired regarding taking these measurements, it’s nothing you can’t quickly learn with some Google image searches.
Typically, the measurements you’ll want to report are flexion, extension, rotation, abduction, and adduction.
These look a bit different for each joint, so searching online for relevant images can help you understand how to measure it for whatever joint you’re claiming.
Here’s a quick example of what this may look like on paper:
Right Hip Active Range of Motion Measurements
Flexion: 95 degrees
Extension: 20 degrees
Abduction: 30 degrees
Adduction: 15 degrees
Internal rotation: 20 degrees
External rotation: 40 degrees
As a third best option, simply have a friend take photos of your range of motion at its furthest reaches (but without too much pain), and then submit those photos via normal VA disability documentation channels.
As an examiner, if I see official documentation in your c-file regarding range of motion, it helps me identify potential discrepancies in my own ROM measurements.
It can also be really useful if your range of motion gets much worse on days when you may be having a flare-up (which may not happen on the day of an examination).
In conclusion, effective documentation is the center-point of a successful VA disability claim and will go a long way in helping your examiner genuinely understand your condition.
Detailed lay/buddy statements, comprehensive diagnostics, documentation of lost work time, employer statements, and accurate ROM measurements can all play a vital role in strengthening your case.
By following these strategies, you can not only ensure that your service-connected disabilities are acknowledged, but also maximize the benefits you receive for those conditions.
Read More Content from VA Medical Examiner Nathan Costiuc, MSN, APRN, FNP-BC
