When Not to Pursue a Disability Claim

I come from a family of Veterans, my grandfather served in WWII, my father was a Marine in Korea and Vietnam, my brother was in Grenada with the Army, my step-father was Navy, and my ex-husband served in the Air Force with the Army VII Corps during the first Gulf War. To say that helping Veterans is a job I love is a little bit of an understatement. But sometimes we have to deliver bad news and tell someone that they shouldn’t go forward with a claim.  I always want to find the ways to help veterans get their benefits, so doing this goes against my grain. But I would be remiss if I also allowed a veteran to continue to fight for something they had no chance of winning and causing them frustration, stress, and time wasted that could be spent enjoying their family and the gifts of life. So when does that time come, when we have to say, as representatives, we can’t go any further?

When There Just Aren’t Any Records

Sometimes we have claims that are about an event that occurred and we have no documentation that proves the event happened. In some cases, this is not a cause to give up as there are other ways to secure documentation such as through buddy statements and “markers.”  Markers are events that can show changes in behaviors or patterns that can indicate an event happened even if there is no documentation of the event. So in these cases, we push forward. However, there are some events or medical conditions you must have a record of to file a successful claim with the VA.

Exposure records:

Regardless of any conditions a veteran may have, the claim will not be approved if there is no documentation verifying presences in an AO exposed area. If you try to claim for presumption to any exposure of contaminants, you must have proof of the ability to have been exposed. You don’t have to prove you were actually exposed, just that you could have been by your presence.  For example, if you are claiming Agent Orange exposure, there must be some proof that you were in service during the Vietnam era, you were either on ground or in inland waterways, and you served in a plane that carried herbicides, or were at a base that stored herbicides. Another example is Camp LeJeune. If you were present on Camp LeJeune between 1953 and Dec. 31, 1987 you are eligible to file a claim for presumptive illnesses, but you have to again have records or proof that you were there. You could have drunk bottled water the entire time, but as long as you were on the base during those periods you are eligible.

Medical Conditions:

Too often we see claims for medical conditions that veterans do not have or have not been diagnosed with. This will always result in a denial. If you are going to claim a medical condition, you must have been diagnosed with the condition and/or being treated for the condition. Too often we see someone who read that the VA has Diabetes on the list of presumptive illnesses for Agent Orange exposure so, since they were in Vietnam on the ground in 1967, they file a claim for Diabetes due to AO Exposure. Unfortunately, they don’t actually have diabetes. Having documentation of symptoms of an illness is often not enough by itself unless the symptoms are severe enough that a C&P Examiner can diagnose the condition and there is a history of it being treated. The only time this would not be applicable is in the case of Gulf War Syndrome where you can file for particular symptoms of which there is no actual diagnosis or etiology. Other than that particular instance, most every other condition, illness, or injury must have some supporting documentation that shows it was treated and/or diagnosed by a medical professional.

Mental Health Conditions:

Mental health conditions require different types of documentation, especially when we are discussing personal trauma or military sexual trauma. Evidence of changes in behavior such as statements from people who know the veteran well, statements from employers who saw changes in performance, and such items are called “markers.” These markers, while not direct evidence that an event occurred, are indicative of a traumatic event occurring that changes the behavior of the victim. This can include such things as service records that show a veteran who was normally doing well all of the sudden getting disciplinary actions, someone who starts using substances all of the sudden, becoming reckless, all of the sudden engaging in high risk activities they didn’t engage in before, or any other noted changes in behavior. However, this is still documentation of a change, a possible trauma that is shown in the record. Again, there is still a need for proof, even if it is just proof that something happened, not specifically what that something was.

Already Rated Correctly

I know the VA makes mistake, I wouldn’t have a job if they didn’t. But, sometimes they do get it right too. If a veteran seeks out a claim from the VA and they are awarded a rating and that rating is correct, and the effective date is correct, don’t appeal it. If you aren’t sure, let an expert review it for you. Most reputable representatives will tell you if the rating and effective dates are correct or not. You can also look up the VA’s rating system and check for yourself. Here is an example: Say you work around jets and you get tinnitus. The day you are discharged you file a claim for tinnitus. It is awarded as of your day of discharge at the rate of 10%, which happens to be the maximum rating for tinnitus by law. Many times a veteran will get the 10% rating and then appeal it to get a higher rating.  The rating system does not always seem fair. We see people who are rated high for something then others who are rated low or not at all for a condition that may be more debilitating. Only working with your representative who is familiar with the rating process and schedules can advise you properly, but if they tell you that you are being compensated fairly, then maybe you are.  You can also check at the VAs VASRD website which has the rating schedules for each rateable condition listed. Type in the name of the condition or the 4 digit number on your rating sheet in the box on the page and you can look up the requirements for each conditions rating schedule.

Lying or Committing Fraud

It happens. We hate to admit it, but it does. The C&P Examiners will sometimes note on exams that the veteran was uncooperative or was a poor historian. This, to someone reading the exam reports, means that they think the veteran was lying. Financial problems, anxiety, fear of losing health care benefits, and other situations will often lead someone to overstate their pain or lie about their condition in an effort to keep their benefits. This usually ends up working against them.  This will not only cost the veteran money they have to pay back (past benefits and possibly health care costs) but also jail time. And it also costs other veterans in increased wait times and lower cost of living increases (2017’s COLA increase is only 0.3%) Be honest, and be sure that you have a representative assist you in your claims to make sure everything is reviewed before you send it into the VA.

Not Being Educated about the VA

Do not file a claim if you do not know how to do it. Okay, maybe that is a bit redundant because I don’t think even the VA is quite sure how to file the perfect claim. But whatever you do, get yourself educated before you file anything. There are a few things you need to know before you file a claim and making sure you do your research, have your paperwork in order, and knowing what you are and should be filing for will decrease your wait time and improve your chances of having a successful claim. There is a guide in our blog here.

Of course, everyone has the right to file a claim regardless of what anyone else tells them, be it the VA, an attorney, or a service representative. Advice is just that, advice, and no one can force someone not to file a claim. The main thing to remember when you are dealing with the VA is to be upfront and honest. The VA also has a duty to assist but the burden of proof still lies with the veteran in the end. Know the rules, research, educate yourself, and ask for help.