Many veterans face the disappointment of a denied disability claim, often due to specific reasons that, while avoidable, require careful attention. Understanding these common denial reasons—and knowing how to address them—can be invaluable in crafting a stronger case. This article explores the most frequent causes of VA disability claim denials and offers practical advice on how veterans can prevent and resolve these issues to secure the benefits they deserve.
1. Lack of a Clear Service Connection
One of the most common reasons for VA claim denials is the lack of evidence connecting a veteran’s disability to their military service. A service connection requires demonstrating that the disability was caused or aggravated by active duty service, which can be challenging to prove without thorough documentation.
•Solution: Gather and organize your service records, medical documentation, and any other relevant records that show the connection. A Nexus letter from a medical professional who can link the condition to service is also valuable. If the condition surfaced after discharge but is related to service, ensure the Nexus clearly explains the connection.
2. Insufficient Medical Evidence
The VA often denies claims when the medical evidence provided does not adequately support the veteran’s disability or its severity. This can happen if there’s a lack of medical records, incomplete documentation, or if the medical records do not fully reflect the severity of the condition.
•Solution: Compile a comprehensive medical history that covers all aspects of the disability, including treatment dates, symptoms, and impact on daily life. Obtain updated medical exams and statements from healthcare providers that clearly indicate the condition’s severity and service connection.
3. Inaccurate or Missing Disability Information on Forms
Incorrect or incomplete information on the application forms can lead to an immediate denial. Details such as wrong Social Security numbers, incorrect disability ratings, or incomplete answers can cause delays or outright rejections.
•Solution: Carefully review all application forms and ensure every section is complete and accurate. Double-check essential details and consider having a Veterans Service Officer (VSO) or representative review the forms before submission.
4. Pre-existing Conditions Not Properly Noted
If a veteran had a pre-existing condition that was aggravated by service, failing to note the aggravation can result in a denial. The VA requires clear evidence that the service worsened the condition, beyond its natural progression.
•Solution: Provide medical evidence showing how the pre-existing condition worsened during service. A statement from a medical professional who can confirm that service contributed to the condition’s progression can make a significant difference.
5. Failure to Attend a C&P Exam
A Compensation and Pension (C&P) exam is often required for disability evaluations. Missing or failing to attend this exam without prior notice to the VA can lead to an automatic denial.
•Solution: If the VA schedules a C&P exam, make sure to attend or reschedule if you are unable to make it. Document communication with the VA regarding the exam to avoid potential misunderstandings. If a rescheduling is necessary, contact the VA as soon as possible to arrange a new appointment.
6. Denial Based on Temporary Disabilities
Veterans sometimes file claims for temporary conditions or symptoms that did not persist after service, which can result in a denial. The VA requires that the disability be ongoing and significantly impact the veteran’s life.
•Solution: Ensure that the disability is a chronic, ongoing condition rather than a temporary ailment. If symptoms have persisted, provide a medical history that documents these issues over time, including any relapses, flare-ups, or ongoing treatments.
7. Failure to Submit New Evidence for a Supplemental Claim
In the case of a Supplemental Claim, new and relevant evidence must be submitted to prompt a review. Filing a Supplemental Claim without this additional evidence typically leads to denial.
•Solution: Submit relevant new medical records, statements from medical providers, or other supporting documents that directly relate to the disability in question. Clearly mark this evidence as “new and relevant” when filing the Supplemental Claim.
How to Address a Denial and Strengthen Future Claims
If you’ve received a denial, understanding the specific reason for denial can help in filing a stronger appeal. Here are steps to take:
1. File a Higher Level Review or Supplemental Claim
If the denial was due to an error in evidence interpretation or incomplete documentation, a Higher Level Review can correct this oversight. Alternatively, a Supplemental Claim with new evidence may be more suitable for providing additional proof.
2. Seek a VSO or Legal Representation
Consider partnering with a Veterans Service Organization (VSO) or a VA-accredited representative. They can review your documentation, help identify missing evidence, and provide guidance on filing a more robust claim.
3. Compile a Comprehensive Evidence Package
Include a Nexus letter, statements from medical providers, and updated medical records to provide a clear picture of your disability and its connection to service. The more organized and complete your evidence package, the better your chances of approval.
Conclusion
Understanding the common reasons for VA claim denials can help veterans avoid preventable mistakes and strengthen their case. By preparing thorough documentation, ensuring medical records are complete, and working with trusted advocates, veterans can successfully navigate the VA claims process. Veterans Valor is committed to helping veterans understand these common pitfalls, build stronger cases, and secure the benefits they deserve.
