Many veterans are frustrated by inconsistent VA disability ratings, long wait times, and confusing denial letters. Understanding how VA raters evaluate disability claims can help veterans better prepare their applications and avoid unnecessary delays or denials. Knowing what the VA looks for can also increase the chances of receiving the highest possible disability rating.
Who Are VA Raters?
VA raters, also known as VA claims adjudicators, are employees of the Veterans Benefits Administration (VBA) responsible for reviewing disability claims, applying VA regulations, and assigning disability ratings. They determine whether a veteran’s medical condition qualifies for compensation and at what percentage.
The Steps in the VA Rating Process
- Reviewing Service Records – VA raters check military service records, medical records, and incident reports to verify the veteran’s service history and any injuries or illnesses sustained.
- Examining Medical Evidence – The VA looks at doctor’s reports, test results, and treatment history to confirm that a condition is service-connected.
- Considering C&P Exam Results – Compensation & Pension (C&P) exams play a critical role in VA decisions. If the VA examiner states that a condition is “less likely than not” related to service, the claim may be denied.
- Applying the VA Rating Schedule – The VA rates disabilities using the VASRD (VA Schedule for Rating Disabilities), which assigns percentages based on the severity of the condition and how much it limits daily activities.
- Checking for Secondary Conditions – If a veteran has additional conditions caused by a service-connected disability (such as depression from chronic pain), the VA rater may approve secondary claims.
- Combining Multiple Ratings – If a veteran has multiple disabilities, the VA does NOT simply add percentages together but instead uses a complex formula to calculate the overall rating.
Common Reasons VA Raters Deny Claims or Assign Lower Ratings
- Lack of Medical Evidence – If the VA finds insufficient proof of a condition or connection to service, they may deny the claim.
- Inconsistent C&P Exam Results – If the C&P examiner downplays symptoms or states the condition is unrelated to service, the VA will likely side with the examiner.
- Failure to Show a Nexus (Connection to Service) – Veterans need a medical nexus letter linking their disability to military service.
- Old or Incomplete Medical Records – VA raters prioritize recent medical records when making decisions. Veterans should ensure their files are up to date.
How to Improve Your VA Disability Claim
- Gather Strong Medical Evidence – Veterans should submit detailed doctor reports, test results, and treatment history supporting their claim.
- Get a Private Medical Opinion – A nexus letter from a private doctor can challenge an unfair VA decision.
- Prepare for the C&P Exam – Veterans should clearly explain their symptoms and how their condition affects their daily life.
- File for Secondary Conditions – If a condition has led to other health issues, adding secondary claims can increase your rating.
- Appeal Denied or Low-Rated Claims – Veterans should request a Higher-Level Review (HLR) or Board Appeal if they receive an unfair decision.
Final Thoughts
VA raters follow strict guidelines, but veterans can increase their chances of approval by submitting strong medical evidence and preparing properly for the process. Understanding how claims are evaluated helps veterans anticipate potential denials and take action to secure the highest possible VA disability rating.
