Top Five Things To Know When Preparing Your Compensation Claim

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TOP FIVE THINGS TO KNOW WHEN PREPARING YOUR COMPENSATION CLAIM

 Dealing with the Department of Veterans Affairs and managing a compensation claim has been described as a never-ending cycle often looking like a hamster on a wheel. Once you get on it is difficult to get off. As you transition back to civilian life you want to get off the hamster wheel and get back to your life as soon as possible.

Service-Connected Disability Compensation is an important benefit recognized to be an important interlocking tool in helping Veteran transition to civilian life more effectively.  Some Veterans will manage the compensation process on their own, but the majority will seek the service of a Veterans Service Officer (VSO) sometimes known as a Veterans Service Representative (VSR). These qualified technical experts are important in helping the Veteran create a map a strategy in the claim process, answer letters, and keep the claim moving so that you can get off the process wheel. When working on your claim it is important to create a plan of action and know what to look for in a certified-trained VSO. Here are five things to know while you prepare to file your compensation.

  1. Most claims are denied for lack of evidence to support the requirements.

Evidence beats conversation. Don’t expect that the VA will prove your case for you. Take direct action on understanding what the evidence requires. Can circumstantial evidence prove your case with the VA? What is Lay witness statements and how powerful can these be? How should I word my medical opinion letter?

There are five ways to prove service connection. A Veteran should become familiarized with all five eligible avenues for service connection. Depending on the path you will take to prove your service connection, you will need to know what the rules and requirements of that path are. The five methods are (a) direct (b) secondary (c) aggravation (d) presumptive or (e)  disability during VA medical treatment.

  • Resources for this topic: 38 C.F.R 3.303-3.310
  • Presumptive Basis : 38 C.F.R 3.309; §3.311-3.318

Here are a list of illnesses that cannot be service connected.

  • Transitory illnesses or superficial injuries, which resolve or heal with no ascertainable chronic or permanent residuals (38 C.F.R. § 3.303(b))
  • Congenital or developmental defects such as a personality disorder or a simple refractive error of the eye (38 C.F.R. §§ 3.303(c), 4.9)
  • Injuries which are either the immediate or the remote result of the veteran’s own willful misconduct (38 C.F.R. § 3.301(a))
  • Any disability or death solely on the basis that it is the result of the veteran’s use of tobacco products during service (38 C.F.R. § 3.300)
  1. Preparing medical documentation:

All claims require medical evidence. Some evidence proves the condition started on active duty or manifested while one was on active duty while other evidence support the fact that the condition is still chronic. A Veteran will need to prepare their medical documentation. Take your time in creating a history of your medical condition.

  • Private treatment records while on leave can be kept at home to be used after discharge.
  • Emails, letters, pictures also serve as proof If you did not report certain symptoms.
  • Keep copies of all your in service treatment records including personnel records to include duty assignments, location transfers, evaluation reports.
  • When discharged NEVER GIVE YOUR ONLY COPY TO ANYONE. The VA does not require original.
  • After discharge, register with VA health care and seek medical care immediately.

While certain diseases identified as “chronic” in 38 C.F.R §3.309 do not require a nexus statement, the VA assumes that if it existed in service or during a presumptive period following service and it currently exists a nexus exist between the two.  If there is no clear in-service diagnosis of the currently diagnosed chronic disease, then a showing of continued symptom must be presented to the VA. This means you must show that symptoms manifested on active duty, over the course of time, continued to manifest and present themselves in treatment. Remember, nothing beats documentation. Therefore obtaining medical treatment records as part of your evidence is crucial in proving continuity.

A symptom may appear in your treatment records in communication with your treating specialist. For example, a note entered “patient complains of continued pain existing for more than six months” or “a low back pinching pain that extends to the lower leg”. Medical record contains the verbal complaints of patients in their words such as “my brain feels like it is on fire” or “I feel crawlies in my legs” to describe a headache or a numbness tingling feeling in the legs. These symptoms can be used to satisfy the requirement of a nexus. Symptoms may result in a diagnosis. A doctor may writer their impression of the condition manifested by the symptoms expressed by the patient. The symptoms with a complete assessment can result in a diagnosis of a condition. Note that you do not need a diagnosis to use the symptoms as evidence of manifestation while on active duty or after service.

Symptom is subjective evidence (clues) of a potential diagnosis. However, the VA is inundated with appeals that resulted in denials because the symptom was not enough in rendering the decision. Therefore, I caution against filing too soon without stronger evidence. A Veteran should discuss preparing his/her case with a certified-trained VSO.

  1. Correlation: the causation myth in VA compensation claims.

Many Veterans make the mistake in filing a claim based on presumption. Meaning that an illness is presume linked to service if a Veteran was in a certain region during a specific time leading to manifestation of a medical condition. As in-service connection under presumptive path (38 C.F.R §3.307;3.309;3.317) certain medical condition are presumed to have begun in service or the result of certain incidents or circumstances in service when certain factors are present. For example, an Iraq war time Veteran who served in Saudi Arabia after September 19, 2001 and who presents with a minimum of 10% symptoms while on active duty may apply for a condition on this list of presumptive chronic symptoms.  I caution a Veteran to assume correlation. The VA consistently denied claims when faulty VA examinations rendered the condition less likely linked to areas of contamination.  Do not assume that being in a specific location correlates to compensable conditions. Again, you must know your facts and evidence. Know what the VA wants in a case and provide the evidence.

  1. Interview your Veteran Service Officer

There are many reasons why you would want to engage services with a qualified professional in any work your contract with. We often pre qualify baby sitters, contractors and even doctors. You want to do the same thing with the person telling you they can help you with your claim. You do not want someone who simply knows how to fill out a form and knows were to send it. Here is a list of things to know.

  • Are you certified with a Veteran organization. Most local Count of Los Angeles VSO should be trained and accredited via California Department of Veterans Affairs. Ask to see their accreditation letter. This way you know you are working with a person who is up to date on the training.
  • Look to see if they are using the Veteran book of rules laws and regulations know as 38 USCS; 38 Code of Federal Regulations. This is one of the most important tools your VSO should use on a daily basis to effectively advocate for Veterans.
  • Observe if your VSO is taking note son your case. Is there a platform for keeping all your details. This will help retrieve personal medical and legal facts with ease instead of relying that this person will remember your details. Remember that a VSO can see between 5-15 people per day!! The likelihood that you will have to help remind and recall details of your claim on your next visit is high if the VSO does not have a system/platform to hold important data.
  • Always keep copies of what you sign. Review written statements sent on your behalf.

5. There is always possibility of developmental and factual errors in all VA Claims.

You did your research and educated yourself on VA regulations. You are prepared to submit claim with evidence to support in service evidence of illness and or medical injury. You attached medical records to prove condition is still chronic after discharge from service. You receive a decision that does not make sense.  Most errors in decision are either not on part of the VA, not the claimant, YOU! A development error is when the VA process is missing certain steps. Maybe the decision was made without a VA examination. A fact error example is when the decision letter stated “your service treatment records are silent for treatment or complaints of symptoms” when you provided documentation of symptom or condition mentioned in your service treatment records. This means that a detail was overlooked. Make sure you seek help from a qualified representative to help you dispute such VA errors.

 

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