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Monday, April 27, 2015

How To Submit a Perfect VA Disability Claim

So it’s time to submit your VA Disability Claim, and you want to make it the best it can possibly be in order to decrease the processing time and ensure the most accurate ratings for your conditions. Good for you! You are already so much closer to success than the majority of Disabled Veterans out there.

We cover the basics of submitting a claim on our VA Disability Claim page, but there are two areas that, with a bit extra attention, can turn a good claim into an outstanding claim.

#1: Listing Your Conditions

How you list your conditions is very important. I’ve heard many theories on the best way to list your conditions, and I’ve come up with what I believe to be the best approach.

- List every condition you have. When you are putting together your claim, it is not your place to assume to know what the VA’s Rating Authorities will and won’t rate. Yes, you should definitely be knowledgeable about it and have a pretty good idea, but ultimately, it is the Rating Authority’s decision what will be rated, not yours. You may hear about things like the Pyramiding Principle that won’t allow conditions that affect the same body function to both be rated. This is a true principle, but don’t then say, “Well, if they won’t rate both, then I’ll only list one.”

NO. It’s very nice of you and everything to want to make the Rating Authority’s job easier, but this part of the claim is NOT the place to do it. By not listing the second condition, you have ensured that that condition will not be rated at all. There is no way. They will only rate conditions that you tell them to consider and rate. If you don’t list it, they won’t do it. There may be a special circumstance (the VASRD has many) that you don’t know about that makes an exception to the Pyramiding Principle in your particular case, and both of your conditions can, in fact, be rated. Since you chose to not list the one, however, you’ve taken this option off the table.

The Rating Authorities will look at every condition that you list and will break them down and combine them as needed to give you the best rating possible for all of your conditions. It’s their job. List EVERYTHING you have, and you’ll keep from limiting yourself at this stage.

- Only list diagnosed conditions. While you definitely need to list every condition you have, let’s not go overboard. List only conditions that have been officially diagnosed. There are two layers to this guidance.

First, you don’t want to list every single symptom that you have. A symptom is NOT a condition. If you list every single symptom you have, you will definitely annoy your Rating Authority, no question. Not a good idea. List only diagnosed conditions. So if you have GERD, don’t also list heartburn. Heartburn is a symptom of GERD and would thus be covered by a rating for GERD. It is NOT a condition in and of itself, but a product of the GERD. Just list GERD. Similarly, if you have arthritis in your elbow, don’t also list elbow pain. The number one symptom of arthritis is pain, so it’s already a given. Arthritis is the official diagnosis, so just list that.

Now all this being said, if you don’t know if a symptom is covered by a particular diagnosis, it is better to go ahead and list it separately than leave it off. Use your best judgement here.

Second, do NOT list a condition that has not been officially diagnosed. For example, if you personally think that you have PTSD, but nowhere in any official medical record has PTSD been diagnosed by a psychologist, then listing PTSD is a sure fire way to get your claim denied. If you disagree with a diagnosis that a physician has made, then you need to take that up with your physician and have him change the diagnosis. Never apply for a condition that has not been diagnosed or cannot be found in your medical record. Your claim for that condition will be denied.

Instead, list whatever HAS been diagnosed. In the case of PTSD, if your psychologist only listed Anxiety Disorder as a mental health diagnosis in your medical records, then by all means list Anxiety Disorder on your claim. The Rating Authority will see that it was clearly diagnosed and will rate it accordingly. In this particular case, as well, although PTSD may sound more severe, both PTSD and Anxiety Disorder are rated on the exact same criteria, so regardless of the name, this vet will receive the same rating. The name doesn’t make a difference in this case except that a claim for undiagnosed PTSD will be denied while a claim for Anxiety Disorder will not. List whatever conditions you have been diagnosed with, and your claim will be processed correctly.

- Don’t be vague. I’ve heard some people say to just list a generic idea like “stomach condition.” What?! What is a stomach condition? Can you be any more vague? What kind of condition? No doctor will ever diagnose someone with a “stomach condition.” Again, list your diagnoses. You aren’t covering more territory by being vague, instead you are making the Rating Authority’s job harder by having to figure out what the heck you mean by “stomach condition.” List what you have.

If you have something that has been recorded in your medical record, like stomach pain, but no official diagnosis was ever made, then just list it as found in your medical record. Don’t be vague and call it a “stomach condition.” List it as it appears in your records: “stomach pain.”

Believe it or not, “pain” is a legit thing when it comes to Military Disability. In some cases, like pain with motion in the joints, it can even be rated without an official diagnosis. Regardless, you have nothing to lose by listing it, so if you don’t have a diagnosis, but do have pain recorded, list it on your claim.


#2: Your Supporting Materials

The other day, I was contacted by a service member who was preparing to submit his VA Disability Claim, and he was wondering if there was a preferred way of organizing his medical records, like by condition or chronologically. Now the majority of veterans have probably never thought a thought like this. As long as they have my records, who cares? But I say kudos to this service member! I predict that this man’s VA Disability Process is going to go very smoothly. Why? Because not only is he trying to be prepared and submit a good claim, he is going above and beyond and ultimately showing RESPECT.

The Rating Authorities who review the claims and make the rating decisions are very powerful people with the ability to make a big difference in your future. While they are required to follow the laws in place, there are many instances where they do have to make judgement calls. While personal feelings are never supposed to have any sway in their decisions, I don’t think any of you would argue that a person wanting to get you the best they can because they like you could in any way be bad, right?

So how do you make friends with someone you can’t see or talk to? Showing them respect by submitting a superb claim that is organized to make their job as easy and quick as possible is a great start. Coming across a claim like this when I worked for the PDBR would definitely have put me in the right mood…

So, after listing your diagnosed conditions clearly and succinctly, organizing your supporting material in an easily accessible fashion will entitle your claim to a smiley sticker.

There is no ultimately right or wrong way to organize your materials, but here are my recommendations based on my experiences sorting through thousands of medical records for the PDBR. This is what I would have liked to see and what I would do if I were submitting my own claim.

1. Only include medical records that are for the conditions that you are listing on your claim. The VA asks you to submit your entire military medical record to make sure that you don’t miss submitting essential information that will then cause the process to stop while they scramble to get the right info. In reality, however, an entire medical record can consists of THOUSANDS of pages, many of which probably have nothing to do with your claim.

For example, if you are claiming a stomach ulcer, don’t include all your dental records. Your Rating Authority does NOT want to have to go through each of your dental records to find the pages that actually matter for your stomach ulcer. Do include everything you have on your stomach, but leave out anything that has no relation at all.

If you are in doubt about whether or not a record is relevant, then definitely include it. It isn’t worth leaving out something that could end up being really important. Just get rid of the things are clearly unrelated, and you will have a much happier Rating Authority.

2. Organize your medical records chronologically by condition. Sort through all your documents and put them in piles for each of the conditions that you are claiming. Then organize each pile in chronological order. If submitting a paper claim, paper clip all the records for each condition together and label the pile for the condition. Then put the piles in the order you listed the conditions on the claim. If submitting an electronic claim, try organizing the files in a similar fashion. Make sure to name each file so that it is clear without having to open it what the file contains. This will make it super easy for the Rating Authority to find all the evidence needed for each condition, and they will be very happy.



That’s it. With clearly listed diagnosed conditions and easily accessible medical records, the Rating Authority’s job will be much easier and proceed much more quickly, thus making your VA Disability Claim the best it can be.

24 comments:

  1. Sir,
    First, thank you for the work you do and the guidance and support you provide Veterans through your website and blog. I have one question for you regarding diagnostic exams such as X-rays, MRI's, CT scans, ultrasounds, etc. My question is: How important is it to have the actual images put on CD for evidence to support my VA Claim along with all of the conditions being claimed? For example, I have the paper report, which has the results of the X-rays and MRI's, but will that weigh enough to the raters who are looking for evidence to substantiate my condition? I have an X-ray paper report which states I have severe degenerative disk disease between C5-C6 of my back that I picked up from radiology, but I don't know if it will be enough to substantiate my condition? Is it worth getting this X-ray image put on a CD to send to the VA with my claim, or will the paper copy with the X-ray results be enough?

    Thank You sir

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    1. Hi Eric -

      This is a really good question. Honestly, when I did ratings for the PDBR, I never once looked at a disc of images. I never even received one. I can't really imagine a rater ever actually taking a look at the images to see if the report is correct. Pretty much everything they do will be based on the report. If you feel that the report doesn't properly define your condition, then you might want to include the disc and refer them to it, but if the report properly diagnoses your condition, then I can't imagine they would bother to look at the images. They (most likely) aren't trained radiologists, so they will probably just trust the radiologist's report.

      That being said, it is always a good idea to keep a copy of your images for yourself. Future docs who treat your condition would rather have the actual images than the report.

      So, ultimately, I recommend definitely getting a disc for yourself, but I don't really think it's necessary to include them in your disability claim.

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  2. Hi Sir,
    I'm currently in the process of asking for an increase in my disability rating for plantar fasciitis. I'm trying to complete a fully developed claim via ebenefits, but the application had DBQs that needed to be filled out. I took them to my podiatrist (who's located at the VA) today to fill out and he sent me downstairs to schedule a C&P exam instead. I called the VA call center to explain what happened today and she assured me that I can still submit my claim without the DBQs and it will still be considered an FDC...even if I'm scheduled for a C&P exam later on. Is she correct? Thank you in advance for your help.

    Sincerely,
    LaKeitha

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    1. Hi LaKeitha -

      Yes, as long as your C&P Exam is scheduled and in the VA's system before you submit your claim, you should be fine. It must be scheduled for the claim to be a FDC, so that's why I normally say that the C&P Exam should come first. Since yours is scheduled, you should be good to go. The results of the exam should automatically go straight into your claim file.

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  3. -I was pretty disappointed today when I went to file my VA Claim 6 months prior to leaving the military after 27 years. I met with the VSO in my area, and I e-mailed my claim 24 hours in advance, so he could review it prior to our appointment, and he told me that he would not submit my claim the way it was typed up by me because I should not have listed diagnosed conditions and that the VA would tell me what is wrong with me when I am called for my VA medical appointments. For example, I had plantar faciitis, Pes Cavus feet, heel spurs, Haglund’s deformity. He took that off of my claim and put “feet-B/L”
    -I have severe degenerative disks in my lumbar and thoracic region of my back, and a bulging disk, which are verified by x-rays in my medical record. He took all 3 of these conditions off of my claim and put “back” in the block on the VA claim form.
    -I have osteoarthritis in my knees and I have chondromalacia patella. He took these terms off of my VA claim form and put “knees-B/L”.
    -I have 3 urinary conditions listed separately: hesitancy, smaller stream, and urinary frequency. He listed all as “urinary condition”.
    -I have BPH diagnosed. He put “prostate” on my claim form.
    -I have a deformed 4th digit from an accident on my left hand, which also resulted in a range in motion loss and a tendon repair surgery on my 2nd digit, left hand, 1 ¾ inch scar that goes across my 2nd digit and L-hand. He changed all of the above, which I had listed separately on my VA claim and put “Left Hand” on my claim form. He said the VA will tell me what is wrong with me when they start calling me to their medical facility and that I was being too specific and that if he filed my claim like I had it, it would take years to adjudicate. He also said that the examples above are how “he was trained” to submit claims.
    I could go on with a lot more examples, but I think you get the point. My question is: what recourse do I have now that the claim has been filed?
    Do I just wait until my determination comes back and file a different claim again, or do I just explain to the VA what my actual conditions are once I get there for my 4-5 VA medical appointments that my VSO thinks I will have prior to my retirement date?
    I think it’s pretty sad when the person submitting the claim knows more than the paid person there to help you submit your claim.

    Any advice you can give would be appreciated.

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    1. Sorry to hear about this, but I'm glad you brought up these issues. There are so many factors involved that it's impossible to discuss every aspect in a single blog, so this is opening up some great topics for discussion.

      Yes, it seems like your VSO is one of those that supports the idea of listing "vague" conditions.

      The reason I don't support listing vague conditions is because I've seen cases where a veteran lists "right foot" and he is given a single rating for a right foot condition. In reality, however, his right foot has two separate ratable conditions. He should have been given two ratings, but the Rating Authority justified just one. Should the Rating Authority have given him both? Yes. Did the Rating Authority make a mistake? Yes. Most likely he could get this corrected with an appeal, but that's more headache, more paperwork, and more time. Had he listed his two ratable conditions separately on the claim, the Rating Authority would not have been able to make this mistake so easily and so justifiably. It most likely would have been done right the first time.

      That being said, is it the end of the world to list a vague condition? No. It just leaves greater room for error. It's much more likely for the VA to miss conditions or ratable symptoms when they are not clearly listed on the claim.

      Now your VSO does have a good point in that the VA will put a lot of consideration on the results of the VA medical exams. If you have a solid diagnosis, however, it would be very odd to suddenly have your VA physician make a completely different diagnosis. It is possible, yes, but not likely unless your condition has not yet be firmly diagnosed or there is a lot of uncertainty over the diagnosis. In certain circumstances when there is a lot of uncertainty, then it might be best to list your condition more vaguely. This would allow for more flexibility if the VA physician diagnoses something differently. Again, however, this would be rare and does open up other avenues for error.

      Now, would it be a problem if the VA physician diagnoses something different than what you have on your claim? Yes, actually, it would be. The problem, however, isn't really that the diagnosis is different than what is on the claim, but that it is different than what is recorded in your military medical records. For the VA to rate a condition, it must be service-connected, mostly meaning that it must be in your service medical records (there are other ways to be service-connected, but this is the most pertinent for this discussion). If your VA physician diagnoses something different than what is in your military records, the VA will most likely decide that it is not service-connected and thus does not qualify for VA Disability. The real issue here is not what is on the claim. The real issue is that you need to do all you can to make sure that the VA physician agrees with your military diagnoses in order for them to be eligible for VA Disability. This is where it is vital to go to your VA exams prepared and knowledgable about your conditions, service-connection, and how your conditions are rated. If the VA physician makes a different diagnosis, then you will be screwed no matter what you put on the claim. It won't matter.

      This is why I support the idea of listing diagnosed conditions. Your military diagnoses are the most important (they equal service-connection), and so are the ones that should be on the claim and then subsequently diagnosed by the VA physician. You aren't protecting yourself by being vague and waiting for the VA physician's diagnosis. If he doesn't agree with your military diagnosis, the Rating Authorities will have trouble determining your case no matter what is on the claim.

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    2. They have a word limit, so I had to break my reply up into two posts.

      As for your VSO's statement that it will take years to adjudicate such a specific claim: not true. If you have a diagnosed condition listed on your claim, they look at your military records and clearly see it, they look at your VA exam and clearly see it, then their job will actually be faster. They won't have to sift through everything trying to figure out what they heck your "stomach condition" is. You said "hiatal hernia" - they see "hiatal hernia" - done. It sure made my life easier in the PDBR.

      So this discussion is great and all, but what do you do now? Don't stress too much over the fact that your VSO vague-ified your claim since it has already been submitted. Hopefully your Rating Authority will be a good one that will be able to carefully separate out each of your ratable conditions and everything will be fine. What is absolutely vital now is that you prepare properly for your VA exams. Make sure that you go in with the knowledge necessary to get the VA physician to agree with the diagnoses of all your conditions. You already had each diagnosed condition listed on the claim, so approach your VA exams with the goal of obtaining the same diagnoses. As long as the VA physicians agree with your military diagnoses, you're claim should hopefully process fine.

      That's all you can do at this stage. If after your claim is adjudicated, you find that they didn't properly rate everything, then you can either submit a new claim for the conditions they missed or appeal if they made any errors.

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  4. Sir,

    I appreciate all of your time and the information you provided above. I just received a letter in the mail from my VSO stating that he would "no longer represent me" because I sent additional conditions to be a part of my claim. He also stated that "he has notified the DVA that they will no longer be representing me with my claim". I did a VA-Form 21-4138 and listed conditions he left off of my claim. I asked him not to submit my claim because I was not satisfied with the way he filled it out, but he told me that it had already been submitted. I have 2 questions for you: 1) Since my VSO will no longer represent me, and they have notified the DVA, does this put me at a disadvantage? (2) Also, the Veteran Service Organization's decision not to represent me, will this cause my claim to sit idle, disappear, or go into a holding pattern? Finally, do you recommend trying to find a different VSO?
    Thank You

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    1. Ultimately, having a VSO is not essential. Vets submit claims all the time on their own without any problems. Having your VSO ditch you like this should not hinder your claim at all. Now that the VA is aware that he no longer represents you, they simply cannot share any of your claim information with him. The VSO had to inform them legally so that your information is kept private. There should not be any kind of delay to your claim at all.

      As for whether or not to get another one, that is entirely up to you. VSO's are there for guidance - they serve no other purpose. Many VSO's were threatened when they first found out about our site, assuming that we were trying to replace them by making public the information and guidance that they are supposed to be giving their veterans. Our goal is definitely not to replace them, but assist them by giving them another tool to use to help their vets. I believe that VSOs do great work many times and can be a great guidance tool. They are not, however, essential to your disability. The VA doesn't care whether or not you work with a VSO. They are just available if you want their help. Ultimately, it's up to you.

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  5. As always, thank you sir for the awesome insight and advice.

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  6. I am submitting a FDC for back, neck, and shoulder pain and PTSD. Other than shoulder surgery, I have not been treated for the PTSD. Should I see a doctor for this prior to submitting the claim, or just wait to see if the VA requires an exam? I am in the Philippines and seeing a doctor is not easy.

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    1. You don't technically have to see a doc before you submit a claim for PTSD, however, if it is not officially diagnosed by a psychologist, your claim will be denied. It would be better to go ahead and see a psychologist for this first and have it diagnosed before applying.

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  7. How do you document "prostrating" condition due to migraines? I currently average over 15-16 migraine headache days per month. My neurologist suggested I perform my own IM injections as a convenience to avoid frequent and long wait times in the ER. I see in your website that to be considered 50% disabled for migraines that you have to be prostrating 2-3 time per week. I keep a headache journal that my neurologist validates each month. Would that suffice?

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    1. The headache journal should be enough as long as it is included in your official medical records or reports from the neurologist. Basically, the headaches just have to be well-documented in your medical records in order for them to be used for rating purposes.

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    2. Hi sir,
      I have a quesrion. I am a vet with asthma. I have been denied twice for migraines as secondary to the asthma due to medication. I have daily prostrating migraines sometimes lasting a few days to weeks. Can you give me some advice on how to appeal decision? Thank you

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    3. Hi Natasha -

      Unfortunately, there is very little definitive evidence that asthma medications cause migraines. While some scientists have been doing studies that show loose connections between asthma and migraines, the majority of these indicate that treatment of asthma will decrease migraines, not increase or cause them. Because of this, there simply isn't the medical evidence needed to prove that your migraines are in fact caused by your asthma. Without this evidence, your claim is unlikely to succeed.

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  8. Hello. Where is a list of diagnosed conditions in my VA medical records? I see a problem list but what is actually diagnosed? I have private MRI results which show results. Is that a diagnosis it itself?

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    1. Yes, MRI results are usually considered diagnoses as long as they are conclusive. There isn't really a list of all diagnosed conditions; just medical records with diagnoses. So every time you went to your doctor, in his report, there should be a section that says Diagnosis. Anything in this category on any medical record is considered an official diagnosis.

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  9. I plan to upload my BDD FDC claim to Ebenefits. How would you upload your full claim. In one large file, or by individual claim? Is there a place in Ebenefits to select BDD/FDC and is there a maximum number of individual claims I can make in Ebenefits for a BDD/FDC? Do I also, upload all of my family information such as birthday certificates and marriage license in the same place? Do I upload a scanned​ copy of the 21-526ez, or is everything digitally filled out in Ebenefits? Thanks for your time.

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    1. There isn't a maximum number of claims, but you don't want to submit multiple claims at the same time if you can at all avoid it. It will confuse the system and slow the process down.

      The best thing to do is to submit a single claim that includes all of your conditions. Submit for everything, just do it on a single claim. They'll guide you to fill it all in digitally.

      As for family info, when you apply for Dependents, they'll ask for the proof they need and you can upload it directly.

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  10. Thanks. I do plan on adding all of my conditions to my initial claim. I've been unable to find highly detailed step-by-step instructions that cover the digital claim process in eBenefits. There are some videos on ebenefits, but they don't show a section where the individual claimed conditions are entered. How would I find the information I am looking for? I also, didn't see a section where BDD claim is entered. I appreciate your assistance very much.

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    1. I don't think there is thorough instructions on that, but you can start and save an unfinished claim at any time. The best option is just to start your claim to figure out how it works. As you go through it, they'll prompt you to input all of your conditions.

      The claim either becomes an FDC or BDD based on the information you put on your claim, like the fact that you are applying before discharge. It is all through the same system.

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  11. Thanks. Should I claim secondary conditions for Crohn's Disease when I file my BDD claim, even though Crohn's isn't officially service connect yet? Also, I did find some detailed instructions, but it appears that all of my dependent information is uploaded separately from my claim. Is that an accurate assumption and should I upload my claims evidence one claim at a time?

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