Hill & Ponton, P.A.

Top six reasons VA denied my claim

1. VA did not have proof of your injury in service

You must show that your disability is related to an in-service incident.  If VA said that there was no proof of what happened in service then you need to find something to back up what you say happened.  The most common evidence to prove your incident in service is service records.  These can be either medical records or records of your duty stations or performance evaluations.  If VA said it could not find these records and you believe that they exist then it is worth writing to the National Personal Record Center to obtain them.

Even if the records are missing, proof of an in service incident can be found through other means.  Find others who served with you and have them write buddy statements describing the incident.  These statements count as evidence.  Also, you can look for unit records through the National Archives or records of your base, ship or unit on the internet.

2. VA says you do not have a disability

To obtain service connected disability benefits your disability must have a diagnosis.  Pain is never a diagnosis.  Exposure to deadly substances like Agent Orange in Vietnam or TCE in Camp LeJuene is not enough if the exposure does not result in a current diagnosis.  So if a Vietnam veteran, exposed to Agent Orange, develops Diabetes then that is a diagnosis.

Two common areas where this is a problem are back problems and mental illnesses.  Often veterans will treat for back pain but the doctor will not give a diagnosis.  With mental illness you might be treating with a doctor for mental health problems but VA will deny benefits because VA’s doctor will state that you do not meet all that is needed for the diagnosis.  This problem happens a lot with PTSD cases.  It is important if you are treating with a doctor that you ask for them to give you a diagnosis.  If it is a mental health case like PTSD, then you need to ask the doctor to lay out all the elements of the diagnosis in the medical record.

3. VA says that your illness is not related to service

To get service connected benefits, you have to show that there is a link, or nexus, between what happened in service and the current diagnosis.  If VA says that they are not connected then it probably did so based on an exam from its own doctors, a C&P exam.  If the C&P doctor says that there is no connection then you should go get an opinion from your doctor or an independent medical exam from outside doctor.  You should give them the service records and medical records that they need to not only say that your disability is related to service but to explain why it is.

 4. VA says you did not show up to your C&P exam

It has recently come to light that VA was setting C&P exams, the exams VA uses to determine of a veteran’s service connected compensation benefits, and not telling the veteran.  Then VA would deny the benefits and say that the veteran did not show up to the C&P exam and that is why it was denied.  VA gets an automatic denial if the veteran does not attend the C&P exam.  Unfortunately, VA has been denying on this reason when it never told the veteran about the exam.

In this case, you should write VA and state that you were never informed.  If you were informed and did not attend then you should also write and state why you could not attend.  If you do not hear back from VA after a couple of months then you should file an NOD and appeal the case.

5. VA doesn’t believe your doctor

If you got your doctor to write a favorable opinion for your claim and VA rejected it then you need to go back and look at the opinion to see if it is thorough enough.  VA routinely rejects opinions from treating doctors—both VA and private doctors.  There are certain areas that VA always looks to in dismissing your doctor’s opinion:

  1. Your doctor did not review your C file. The doctor does not have to review the whole file, just the part relevant to your claim.
  2. Your doctor must review everything in the C file and outside of it that relates to your claim and state he did so in the report. An opinion that states the doctor discussed the claim with the veteran and nothing else will be rejected.
  3. Your doctor must use VA’s language—that the disability is ‘it is likely as not’ to service
  4. Rational: the doctor must state why he believes that they are connected

6. How do I know that VA got the evidence to prove my claim?

VA has a duty under the law to get the evidence needed to prove your claim.  This duty includes getting medical records, service records, Social Security records and medical exams.  But how do you know that VA did this?  You need to request from VA your C file.  This is the folder that the VA benefits section keeps on you.  It will have all information about every claim you have filed since getting out of service.  Most importantly, it will show you the evidence VA used in its decision on your case.  You want to check this to make sure that all the favorable evidence you sent, or asked VA to get, is in the file.  You don’t know what VA is using against you until you review your file