Intro

Ready to MAXIMIZE your military disability? You've come to the right place!

Through our blog, we jump deep into Military Disability topics, concerns, upcoming changes, etc. For a complete overview of the veteran's disability systems, ratings, and benefits, check out our website, www.MilitaryDisabilityMadeEasy.com. It has an immense amount of information, and should be able to address the majority of your questions very well.

Comment, ask questions, let us know what YOU need. We are here for you!

Tuesday, July 6, 2021

What Evidence is Most Important? -- The Hierarchy of Evidence for Supporting Your Ratings


While it is the VA’s job to decide the ratings for your conditions, it is YOUR job to provide the evidence necessary to support the correct ratings. 

Evidence is essential to your military disability. 

 

No evidence = no benefits. No question.

 

But not all evidence is created equal. The VA will give more “probative value” to some evidence over others. The basic idea is that if the evidence comes from a more official source or from someone with more authority to speak on the topic, then that evidence is more likely to be true and accurate. Thus, evidence from a neurosurgeon will have more probative value than from a chiropractor, an official exposure document will have more probative value than a Buddy Letter, etc. 

 

So when it comes to supporting your ratings, what evidence is the best evidence? 

 

Here’s a list of evidence ranked from the most important to the least important for supporting your ratings.

 

As you go down this list, if your ratings are firmly established with the evidence you have from #1 through #4 (the essentials), you don’t really need to proceed further. If it isn’t, though, or it could be stronger, then add something from the next number, then the next, etc., until your evidence for your ratings is as solid as you can make it.

 

Before compiling your evidence, make sure you find your condition on our site so you know what evidence is necessary to properly rate your condition.

 

1. Official diagnostic medical records


For each and every condition on your claim, there needs to be a clear diagnosis. No diagnosis means that there isn’t a condition to rate. If you claim ischemic heart disease, but only heart murmurs are officially diagnosed, your claim will be denied. So the first thing your evidence must do is show proof that the condition exists and has been diagnosed officially.

 

2. Current medical evidence from specialists


The VA rates all conditions on their severity at the time you submit the claim, so there must be sufficient current legitimate medical evidence that supports your rating. 

 

Evidence from specialists will always have the highest probative value, so it’s important before submitting your claim to ensure that you have current evidence from a specialist for your condition (cardiologist for heart disease, psychologist for mental disorders, etc.). 

 

If this means making a new appointment to have your conditions re-examined, do it. The specialist can be a civilian physician or a VA physician. It doesn’t matter. However, the VA’s C&P Exam does NOT count as evidence under this section (see number 3 below), so do not think that a C&P exam is all you need here. It’s not.

 

The VA has DBQs that you can have your specialist fill out to help support your claim. DBQs are helpful but not essential. As long as you know what evidence (measurements, tests, etc.) is needed to rate your condition, you can have your specialist simply record that information in your medical records. A DBQ is not needed as long as the correct information needed to rate your conditions is recorded. 

 

A Quick Note: Not all conditions need to be treated by a specialist, so if your general practitioner (GP) has been the one to manage your condition, then your GP is considered the one with the most knowledge of your condition, and so qualifies as the best one to give evidence here.

 

3. C&P Exam(s)


After you submit your claim, the VA will schedule you to see one of their VA physicians for a C&P Exam. You may only have a single C&P Exam by a general practitioner, or you could have multiple with various specialists. The VA will decide based on the amount of evidence you have and the complexity of your conditions.

 

At the C&P Exam, the VA physician will review your conditions and perform tests. It is essential that you make sure all the correct tests are performed and necessary evidence recorded to rate your conditions during this exam. Do not assume the VA physician knows what information is needed to rate your conditions. The majority of the time, they don’t. 

 

Also do not suppose that the information gathered during the C&P exam will be enough so you don’t have to get this information from specialists in #2 above. WRONG. The evidence from #2 is vital, and here’s why:

 

The VA will put a lot of probative value on the C&P exam since its entire purpose is to evaluate conditions for VA Disability. However, in order to ensure that you get the correct rating, it is more important for you to focus on outside evidence from specialists for two reasons. 

 

First, if the evidence gathered during the C&P exam agrees with the evidence from your specialists, your case will be solid. Second, if the C&P exam evidence doesn’t agree, you’ll have submitted strong evidence to throw doubt on the C&P exam. If there is enough of this strong evidence, the VA could still decide in your favor, despite the C&P exam.

 

So even though the VA does give significant weight to the C&P exam and it is important for you to make sure the correct info is recorded then, your outside medical evidence is even more important. 

 

4. All other recent medical evidence. 


Since the VA rates conditions on their current severity, all of the medical evidence you have regarding your condition from the past 12 months is very important. 

 

Many ratings look closely at the 12 months prior to submitting your claim, so don’t just submit the most current records from your specialist. Submit everything from lab tests, radiology, physical therapy, etc. Everything from the past 12 months that has anything to do with your condition can be valuable to your rating. 

 

For example, migraine headaches are rated on how often they occur and their severity. On average, one prostrating migraine each month rates 30%, so in order to properly assign a 30% rating, the VA will need to see evidence of migraines occurring at least once each month on average for the past 12 months. 

 

A note as we move on: We are now getting into things that don’t apply to every condition, so if your evidence is already solid by this point, you may not need to add anything further from this list. Regardless, additional supporting evidence never hurt a claim...

 

5. Medical evidence connecting the current condition to the original diagnosis.

 

As we discussed in our previous blog, The Hierarchy of Evidence for Proving Service-Connection, if your condition was diagnosed a while back, then it is vital to be able to show proof that your current condition is the same as the original condition for service-connection purposes. However, this evidence can also be valuable for rating purposes as it shows the development of the condition over time. 

 

Since the VA only rates conditions on their current severity, this evidence won’t affect the ratings for the majority of conditions. But some ratings, especially for conditions like mental disorders, look at the entire condition and how it affects all aspects of your life over time, so this history can add helpful evidence in these cases.


6. Commander/Employer letters

Some ratings, like the ratings for mental disorders, look at how the condition affects your ability to do your job. For these ratings, it can be very helpful to get a letter from your boss that addresses how your condition affects your work performance.

 

7. Buddy/Family letters


Like Commander/Employer letters, letters from friends and family that testify to how your condition affects your daily life can strengthen your claim for conditions, like mental disorders, that look at your daily functioning when determining a rating.

 

8. Personal Statements


You are always welcome to write a personal statement, but this is always lowest in the hierarchy of evidence simply because if there is no other evidence to support the things stated in your personal statement, it will be ignored. There must be outside evidence to corroborate your statement in order for it to have any value.

 

Because of this, personal statements are not needed in the majority of claims. They really are only helpful in providing one more point of support, and so come in handy for conditions, like mental disorders, that are rated based on things that cannot be tested and officially proven. The idea is that if you, your boss, and your wife all testify of a symptom that affects your daily life, then it is more likely to be true than if it is only mentioned in one place.

 


As you compile your evidence, remember to focus on gathering evidence with the highest probative value, and your claim will be solid.

Tuesday, June 8, 2021

What Evidence is Most Important? -- The Hierarchy of Evidence for Proving Service-Connection


In order for the VA (and DoD) to rate a condition, it MUST be Service-Connected. And it is ultimately your responsibility to submit the evidence necessary to prove service-connection.

 

Evidence is essential to your military disability. 

 

No evidence = No benefits. No question.

 

But not all evidence is created equal. The VA will give more “probative value” to some evidence over others. The basic idea is that if the evidence comes from a more official source or from someone with more authority to speak on the topic, then that evidence is more likely to be true and accurate. Thus, evidence from a neurosurgeon will have more probative value than from a chiropractor, an official exposure document will have more probative value than a Buddy Letter, etc. 

 

So when it comes to proving service-connection, what evidence is the best evidence? 

 

Here’s a list of evidence ranked from the most important to the least important for each type of service-connection. Click on the type of service-connection to be taken to the discussion of it on our site so you can know which applies to your conditions.

 

As you go down this list, if your service-connection is firmly established with evidence you have from #1 and #2, you don’t really need to proceed further. If it isn’t, though, or it could be stronger, then add something from the next number, then the next, etc., until your evidence for service-connection is as solid as you can make it.

 

Conditions Diagnosed While in the Military

 

1. Service-Treatment Records (STRs). STRs are your medical records from your time on active duty, so these alone can establish service-connection as long as there is clear record of the diagnosis and subsequent treatments (up to the current condition). 

 

2. Military Personnel Records. As long as the diagnosis and treatments are clear in your STRs, then you only need the following personnel records: 

1.     DD214 is essential in every case to establish your service dates. 

2.     Deployment records are necessary if your condition occurred while deployed. 

3.     Official Exposure records are necessary if your condition was caused by an officially recorded exposure.

4.     Line of Duty determinations are necessary for Reservists. Reservists must be able to prove that the condition occurred in the Line of Duty in order to be service-connected. If an official LOD is made, then that’s all you need to prove LOD. If you don’t have an official LOD, that’s okay as long as your medical records clearly record how the condition developed in relation to your service. Incident reports or Buddy Letters from those witnessing the event can also be helpful here. 

 

3. Veteran Medical Records. If you are claiming your conditions once you are a veteran, then you need to show that your current condition is the same as the one diagnosed during service. Medical records from your date of separation up to the present (from civilian and/or VA physicians) are essential to show that the condition is not two separate conditions. So if you hurt your back in service, but it healed and there’s no evidence of any other issues for the next 20 years, then you hurt your back again, those are going to be considered two separate conditions and not related.

 

Conditions Aggravated by Military Service

 

1. Service-Treatment Records (STRs). STRs are your medical records from your time on active duty, so these alone can establish service-connection as long as there is clear record of how your condition was aggravated by your military service. Your entry examination should thoroughly record the severity of the condition upon entry (if nothing is recorded, it is assumed asymptomatic) and then your STRs over time need to show the abnormal development of the condition caused by service in relation to the standard development of the condition in most cases.

 

2. Military Personnel Records. As long as the diagnosis and treatments are clear in your STRs, then you only need the following personnel records: 

1.     DD214 is essential in every case to establish your service dates. 

2.     Deployment records are necessary if your condition was aggravated by or during your deployment. 

3.     Official Exposure records are necessary if your condition was aggravated by an officially recorded exposure.

4.     Line of Duty determinations are necessary for Reservists. Reservists must be able to prove that the condition was aggravated in the Line of Duty. If an official LOD is made, then that’s all you need to prove LOD. If you don’t have an official LOD, that’s okay as long as your medical records clearly record how the condition was aggravated because of your service. Incident reports or Buddy Letters from those witnessing the event can also be helpful here. 

 

Conditions Caused by Service-Connected Conditions (“Secondary”)

 

1. Service-Treatment Records (STRs)/Military Personnel Records. These are listed first because they are essential in establishing service-connection for the original condition. Once the original condition is firmly service-connected, then you can move on to #2 to connect the secondary condition to it. 

 

2. Veteran Medical Records. All secondary conditions diagnosed after service need clear medical records that show the development of the condition with as much connection to the original condition as possible. If these records don’t connect it firmly to the original condition, then #3 is a MUST.

 

3. NEXUS Letter. A NEXUS Letter from the physician that knows your condition the best is VITAL for most secondary conditions. This firmly connects the secondary condition to the original condition.

 

4. Other Medical Evidence. With the NEXUS and the rest of your evidence, your case should be fairly solid. But if it’s not as firm as you like, it could help to submit additional evidence that supports the relationship between your secondary and original conditions. This could be things like legitimate published research studies, medical articles, etc. 

 

Conditions Caused by Exposure

 

If your exposure condition was diagnosed in service, use the first section above to prove it. This section is for exposure conditions diagnosed after service.

 

1. Military Personnel Records. It is not easy to prove exposure unless there are official exposure records or the condition is on the Presumptive List. Here are the prioritized personnel records that can help establish the exposure: 

1.     Official Exposure records (including Incident Reports) with exact locations, dates, severities, lengths, etc., are very important if you have them. 

2.     DD214 is essential to establish your service dates. 

3.     Deployment records are necessary if the exposure happened during your deployment. 

4.     Duty Assignments can add valuable evidence if you were exposed because of the duty you were performing.

 

2. Service-Treatment Records (STRs). Since your condition wasn’t diagnosed until after service, there won’t be much evidence of it in here. However, these can provide clues that could support the exposure itself. Maybe you were examined after the incident that caused the exposure? Maybe symptoms appeared soon after the exposure? If you have anything like this in your STRs, it could be additional evidence of the exposure even if they were not attributed to it at the time. The symptoms, of course, would have to be known common symptoms of that type of exposure. 

 

3. Veteran Medical Records. It is essential to show the development and diagnosis of the condition. Any records that include information about the condition’s relation to the exposure are even better.

 

4. Commander or Buddy Letters. If with the evidence above you have not yet created a strong enough case that the exposure did indeed occur, then Commander and/or Buddy Letters could save the day. A letter from your Commander or any of the people you served with at the time of the exposure can provide valuable testimony to the exposure. Each letter should include as much detail as possible, including dates, locations, type, length, and severity of exposure, etc. 

 

5. NEXUS Letter. A NEXUS Letter from the physician that knows your condition the best can provide essential testimony that they believe the condition “more likely than not” was caused by the exposure.

 

6. Personal Statement. If there are no official records of the exposure, then you will need to write a personal statement detailing everything you can about the exposure itself, including dates, locations, type, length, severity of exposure, etc. This information will be strongest when matching the other evidence noted above. 

 

Conditions on the VA Presumptive List

 

1. Military Personnel Records. For conditions on the VA Presumptive List, it is essential to prove the service requirements of the appropriate category. 

1.     DD214 is essential to establish your service dates and length. 

2.     Deployment records and Duty Assignments are necessary to prove that you served in a certain place at a certain time. Make sure these records also show how long you were in that location.

3.     Prisoner of War records are needed if you are applying for a condition on the POW list.

4.     Any other personnel records that support the requirements on the appropriate Presumptive List.

 

2. Veteran Medical Records. It is essential to show the development and diagnosis of the condition. Most of the Presumptive List categories require the condition to have developed to a certain severity by a certain time, so this proof must be found in the veteran medical records in order for the conditions to qualify.

 

3. Commander Letters/Buddy Letters/Personal Statements/Service Treatment Records. These are really only useful for the Mustard Gas or Lewisite Presumptive List since there are few official records of exposure that were kept at this time. Because of this, as much evidence surrounding the exposure as possible, the stronger your claim will be. A personal testimony also providing as many details as possible will be essential. Testimonies from your commander or others present that corroborate the personal statement are valuable evidence of exposure. Service treatment records detailing anything from the exposure event or the immediate effects of the exposure can also help. The more you can provide, the better.


That's all the evidence needed for each type of Service-Connection. Remember that the evidence with the highest probative value will hold the most weight and influence, but it's always better to be safe than sorry, so including as much other evidence as possible as well definitely won't hurt.

Wednesday, March 3, 2021

Understanding the Slight to Severe Scale for Rating Muscles

The majority of muscle conditions are rated on either limited motion or the Slight to Severe Scale, whichever gives the higher rating.  

The Slight to Severe Scale offers four different levels (Slight, Moderate, Moderately Severe, and Severe) that are associated with different ratings for each muscle group, depending on the functional impact of the damage to that muscle group.


For example, Group III for the muscles that control raising the arm out to the side is rated 40% for the dominant hand’s Severe level, while Group IV for the muscles that control the rotation of the arm is rated 30% for the dominant hand’s Severe level. Basically, the inability to raise the arm out to the side is considered a more serious disability than being unable to rotate the arm and so is given higher ratings for the Slight to Severe Scale levels.

 

But how does the Slight to Severe Scale work? Let’s start by talking about the Cardinal Signs and Symptoms.

 The Cardinal Signs and Symptoms


One of the criterion looked at when determining the Slight to Severe Scale level is the Cardinal Signs and Symptoms. 


The Cardinal Signs and Symptoms include:


  • Loss of power. This is the inability to actively use the muscle in a proactive task, like pushing or lifting in the shortest amount of time possible.
  • Weakness. This is different than the loss of power in that weakness isn’t just active, but passive. There is an overall lack of strength in the muscles. 
  • Easily fatigued. The muscle has no endurance, but gets tired much faster than it should. 
  • Pain with fatigue.  The muscle hurts when it gets tired. 
  • Lack of coordination. This means that the muscle isn’t able to perform movements with as much precision of time, effort, and direction as it should. 
  • Decreased movement control. This is similar to lack of coordination, but is more about the communication between the brain and the muscle. The nervous system is telling the muscle to move (either directly or as a reflex), but the muscle is unable to follow the instructions like it should.


The Criteria


Each level on the Slight to Severe Scale has a variety of criteria that cover things like the type of wound, the Cardinal Signs and Symptoms, scarring, limitation of function, the ability to work, etc. 


Since muscles can be damaged in many different ways and result in many different symptoms and limitations, it’s important to remember that the criteria used for each level are meant to give an overall idea of the functional disability for that level.


A condition does not have to match each of the criterion perfectly, but generally reflect the same overall disability. 


For example, each level has a criterion that defines the type of external wound that would qualify for that level, but many muscle conditions are not caused by external forces and so won’t have an external wound at all. In those cases, this criterion simply does not apply. 


When assigning a level, the VA will focus only on the criteria that applies to the type of injury and the symptoms present. 


The Slight to Severe Scale Levels


We aren’t going to go criterion by criterion through each level, since you can find the entire Slight to Severe Scale on our site, but let’s discuss how to choose the right level. 


There are four levels:


  • Slight. This disability will have little to no functional limitations.
  • Moderate. This disability will have symptoms and some limitations. 
  • Moderately Severe. This disability will have significant limitations and the constant presence of serious symptoms. 
  • Severe. This disability will have constant severe limitations and symptoms. Basically, these muscles no longer function in any helpful or meaningful way. 


In order to choose the right level, the symptoms and circumstances of the muscle damage needs to be compared to the criteria for each level. 


Remember, ignore the criteria that does not apply. Instead, focus on the described severity of the criteria that does apply.  


Start at the Severe level. If any of the applicable criteria does not match the level described here, then move down to Moderately Severe, etc., until you find the level that best covers the overall severity of the condition. 


Once the Slight to Severe Scale level is identified, the rating associated with that level for the muscle group is assigned. 


Special Circumstances 


There are a couple rules that cover two special circumstances.  


The first states that any muscle damage that is the result of an open comminuted fracture (in the initial injury, the bone is crushed or splintered and there is an open wound above it) will be rated at the Severe level. 


The only time this rule doesn’t apply is when the open comminuted fracture is in a purely boney spot, like the wrist, where there isn’t much muscle. No muscle damage, no muscle rating. But as long as a muscle is clearly involved, then the damage to it will always be considered Severe. 


The second states that a through-and-through muscle injury (in the initial injury, a bullet or projectile went in one side and straight out the other) will be rated no less than Moderate, but can be rated more if the symptoms qualify.  



Want more? 



Become an All-Access Member and get free access to instructional videos that delve deep into topics like rating muscle disabilities, the VA Presumptive List, the Top 10 Things to Do to Maximize your Disability, and more!