VA Disability Benefits:  What Happens To My Claim If I Am Wrong About My Diagnosis?

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It is extremely common for a veteran to receive competing diagnoses for a psychiatric condition if he or she sees different mental health providers at the VA, or privately, over a period of years.  This situation also arises sometimes with claims for physical disabilities. Some conditions are very hard to diagnose, and patients may go through multiple diagnoses over a period of years before their doctor realizes that they have a condition such as lupus, fibromyalgia, or chronic fatigue syndrome.  So when you file a claim, how do you know for which diagnosis to file a claim?  And what happens if you choose one diagnosis but the VA determines that another is actually the correct diagnosis?  What happens to your claim?

If you know that your condition has received multiple diagnoses, of course, you could just file separate claims for each of the diagnoses you have been given, just to be safe.  But what happens if you don’t know or if the C&P examiner determines that your treating doctor did not diagnose you correctly?  What if you haven’t been diagnosed at all and file a claim for a general “back problem” or “knee problem” that is later diagnosed by the C&P examiner as arthritis or degenerative disc disease?   The Court of Appeals for Veterans Claims has been very clear in its determination that multiple diagnoses do not necessarily require multiple claims where those diagnoses are based on the same reported symptoms.

The Court noted in the case of Clemons v. Shinseki that most veterans applying for disability compensation are not medical experts.  As a layperson, a veteran’s diagnosis of his or her condition would not be accepted as evidence that the condition exists.  Why then, would the VA be allowed to hold the veteran to that diagnosis in terms of limiting his or her claim?

Instead, a veteran is considered to be competent to provide testimony as to what symptoms he or she observes and experiences, but not to assign a diagnosis to those symptoms.  The VA, then, in considering a veteran’s claim, may not limit the claim to the diagnosis listed by the veteran in his or her claim form but must consider the symptoms described by the veteran and the medical evidence provided which relates to those symptoms.  As stated by the Clemons court, “the fact that the [veteran] may be wrong about the nature of his condition does not relieve the [VA] of [its] duty to properly adjudicate the claim.”

It should be clarified that there is, in fact, a requirement in almost every case that the veteran have some diagnosed disability in order to receive disability compensation.  [See our post on Gulf War-related illnesses to find an exception to that rule].   So a veteran can be wrong about the proper diagnosis and still receive compensation, but if the VA finds that the veteran cannot be diagnosed with ANY condition, no compensation will be paid.

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