By Leonard J. Selfon, JD, CAE
It is important to understand that applying for and establishing entitlement to VA benefits is often a complex and challenging task. A successful claim requires knowledge of the specific benefits that the VA offers to veterans with disabilities; an understanding of applicable laws, regulations, and VA policies; knowing what kind of evidence is necessary to support the claim; and how to obtain and submit such evidence. Even if the VA grants the claim, the veteran will need to know whether the VA has granted all the benefits that he or she is entitled to.
The first step in obtaining VA disability compensation is establishing that a current disability is service-connected. This means that the disability had its onset during active military service, or that a disability that existed prior to a veteran’s entry into service was aggravated during service beyond its natural progression. Once service connection has been established, the VA will review the most recent medical evidence to evaluate the current level of the severity of the symptoms associated with the disability. The VA will then issue a rating (sometimes called a disability ‘evaluation’), expressed in a percentage of the amount of disability caused by the disease or disorder. This percentage rating determines the amount of monthly compensation paid.
Eligibility for VA disability compensation generally requires the satisfaction of three fundamental requirements. First, there must be a medical diagnosis of a current disease or disorder. Second, there must be medical or sometimes non-medical (called ‘lay’) evidence that such disease or disorder either began or was aggravated during such service. Third, there must be medical evidence of a linkage (called a nexus) between military service and the current disease or disorder. The standard that the VA uses to determine if the medical nexus requirement has been satisfied is whether the medical evidence of record demonstrates that it is “as likely as not” that the current disability is related to the veteran’s military service.
These requirements can be satisfied by recent medical records that reflect a diagnosis of a current disease or disorder. A doctor’s letter that discusses the veteran’s diagnosis and treatment will also satisfy the current diagnosis requirement. In order to properly rate the level of disability caused by the disease or disorder in question, the medical records should further reflect current symptoms and the degree of disability caused by the condition. Next, there must be a notation in the veteran’s service medical records that reflects complaints, treatment, diagnostic test results (such as x-rays), or diagnoses that relate to the claimed disability. Finally, there must be a doctor’s statement, or opinion, to the effect that it is at least as likely as not that the current disability is related to something that happened during the veteran’s military service (e.g., injury, onset, or aggravation of disease; exposure to hazardous material). There is an exception to this requirement for certain chronic diseases, diseases that have long manifestation periods, and diseases that result from exposure to toxic agents, radiation, and other environmental hazards.
The VA also provides disability benefits for veterans who do not have any service-connected disorders. VA nonservice-connected (NSC) pension benefits are available where the veteran had at least 90 days of active military service, at least one day of such service was during a period of war, the veteran’s military discharge was under conditions other than dishonorable and there is medical evidence that the veteran is currently totally disabled as the result of a disability that was not caused by willful misconduct. NSC pension is income-based, meaning that the veteran’s household (rather than individual) income must/can exceed an annual maximum dollar amount set by the VA each year. In effect, NSC pension is designed to bring the veteran’s total annual household income to the level of the maximum annual amount. There is a dollar-for-dollar offset between the annual amount of the pension and the veteran’s income, including retirement pension and Social Security benefits. Certain types of expenses, however, can be deducted from the veteran’s countable income, such as unreimbursed medical expenses. Even if a veteran is preparing or has filed a claim for VA disability compensation, he or she can submit a claim for NSC pension, provided that the pension eligibility requirements are satisfied.
When submitting a claim to the VA, it is best to provide all of the medical evidence that you can at the beginning of the claims process. If you have copies of your military service records or records of post-service medical treatment for the disability you are claiming as service-connected, you should submit them along with your application for compensation. You may also sign a VA consent form and request the VA to obtain records from your doctor. If possible, ask your doctor to write a letter describing the severity of your disability and its effect on your daily activities. If the VA grants the claim, it will award service connection for the claimed disability and establish a rating (based on medical evidence of the current degree of disability) that will determine the dollar amount of monthly compensation payments. The VA pays the same dollar amount at each percentage level, regardless of the nature of the veteran’s disability.
Congress sets the amount of VA disability compensation payments each year. The current VA disability compensation payment rates, as well as complete information concerning BA benefits and health care can be viewed on the VA’s Web site www.va.gov.
Leonard J. Selfon, JD, CAE, is National Service director of VetsFirst.