Veterans may sometimes receive VA decision letters that are incomplete, unclear, or based on errors. Identifying these mistakes is crucial when preparing a Higher-Level Review (HLR) or appeal. This guide will walk you through common errors in VA decisions and how to spot them effectively.
1. Review Your VA Decision Letter Thoroughly
The VA decision letter contains the reasons for approving or denying your claim and the evidence they considered. Pay attention to: the rationale (did the VA clearly explain their decision?), the evidence cited (did they review all the evidence you submitted?), and errors in interpretation (were any facts about your service or disability misrepresented?). Highlight sections that seem incomplete, incorrect, or unsupported by evidence.
2. Check for Missing Evidence
The VA has a Duty to Assist veterans in developing their claims, which includes obtaining all relevant evidence. If they overlooked medical records, service records, or Nexus letters, this could be grounds for an appeal. For example, the VA denied your PTSD claim but failed to retrieve your mental health records from a VA clinic. Compile a list of missing evidence and explain its relevance when filing an appeal or HLR.
3. Analyze the VA’s Interpretation of Medical Evidence
Sometimes the VA improperly interprets medical evidence, such as downplaying the severity of a condition or dismissing a diagnosis. Did the VA correctly recognize your diagnosis? Did they acknowledge symptoms or limitations documented by your doctor? If errors are found, gather additional medical evidence or request a Nexus letter from a qualified provider to address the oversight.
4. Assess the VA’s Use of the Wrong Effective Date
The effective date determines when your benefits begin, and an incorrect date can result in lower retroactive payments. Common issues include failing to recognize an Intent to File or using the date of a later application instead of the initial claim submission. Compare the effective date on your decision letter with your claim submission date. Provide proof if the date is incorrect.
5. Ensure All Diagnosed Conditions Were Addressed
The VA may ignore certain disabilities you claimed or fail to rate secondary conditions (e.g., conditions aggravated by a service-connected disability). For example, a knee injury is rated, but chronic pain caused by the injury is ignored. List all conditions claimed and cross-check them against the decision letter to ensure nothing is missing.
6. Verify Proper Application of VA Disability Rating Criteria
Each condition is rated based on the VA’s Schedule for Rating Disabilities. Misapplication of these criteria can result in a lower-than-deserved rating. Signs of misrating include your symptoms aligning with a higher rating level but being assigned a lower percentage or the VA failing to recognize how your condition limits your daily life. Refer to the VA rating criteria for your condition and compare it with the decision letter.
7. Look for Legal Errors
The VA must follow specific laws and regulations when deciding claims. Legal errors, such as misinterpreting statutes or failing to follow the Benefit of the Doubt Doctrine, can be appealed. For example, denying a claim despite equal supporting and opposing evidence. If you suspect a legal error, consulting a VSO or legal expert can help clarify your case.
8. Use Resources to Assist Your Review
Understanding the VA decision process can be challenging. Use resources like Veterans Service Organizations (VSOs), which offer free claim reviews, VA.gov to access your decision letters and review submission timelines, and VA Rating Tables to compare your assigned rating with official criteria.
Conclusion
Errors in VA decisions are more common than many veterans realize. By carefully reviewing your decision letter, identifying missing evidence, and addressing misinterpretations, you can build a stronger appeal or request a Higher-Level Review. At Veterans Valor, we’re here to help you navigate this complex process and ensure you receive the benefits you deserve.
