VA Disability Claims, VA Nexus Letters, VA Claims Appeals

Disabled Veterans Resource Center

There are a number of resources available to veterans and individuals seeking assistance with VA claims and appeals. The Disabled Veterans Resource Center refers veterans to various organizations if they need these services:

VA Disability Compensation

In acknowledgement of the economic loss veterans experience due to injuries, diseases, and disabilities that are acquired or aggravated during military service, the Department of Veterans’ Affairs offers monthly disability payments to qualifying veterans and their family members upon a veteran’s discharge from service or death.

VA disability compensation programs include:

Disability Compensation

Monthly tax-free payment plus full medical care for qualifying health conditions to help offset economic hardships that come with injury, disease, or disability.

Dependency and Indemnity Compensation (DIC)

Monthly tax-free payment to surviving family members of deceased service members whose death occurred during service or due to service-connected disabilities.

Special Monthly Compensation (SMC)

Monthly tax-free payment to veterans and family members to cover costs of caregiving, aid, and attendance needs of the disabled veteran.

Special Circumstances Claims

Additional benefits for service-connected disabled veterans covering needs like dental care, hospitalization costs, temporary 100% ratings for pre-stabilization or convalescence, automobile costs, clothing costs, healthcare costs for birth defects, and individual unemployability.

VA Disability Ratings System

VA determines how much a veteran will receive per month by assigning a disability rating. The more severe the health condition or combination of health conditions, the higher the rating, and the higher the payment.

VA assigns disability ratings using the evidence provided in the veteran’s claim – including medical records, military records, medical nexus letters, and witness statements from other veterans, family, or friends.

VA expresses disability ratings in percentages, ranging from 10% disability to 100% disability. For veterans with no dependents (spouse, parents, children), compensation rates based on disability rating are as follows:

Disability Rating Compensation (veteran alone, no dependents)
10% 144.14
20% 284.93
30% 441.35
40% 635.77
50% 905.04
60% 1,146.39
70% 1,444.71
80% 1,679.35
90% 1,887.18
100% 3,146.42

The above listed baseline compensation rates increase with the number of dependents once you achieve a 30% rating or more, including spouse, parents and children. The exact amount of disability compensation a veteran receives each month will also depend on the veterans total combined rating. With multiple dependents and a high disability rating, veterans can receive as much as $3,731.90 per month.

VA assigns a percentage rating to each individual health condition. A veteran who receives service connection for multiple physical or mental health conditions will receive a combined rating for those conditions.

A combined rating is not the sum of the individual ratings but is still greater than the veteran’s highest individual rating. Generally, here is an example of how VA calculates a combined rating:

Veteran's Individual Disability Ratings

  • 60%
    PTSD
  • 30%
    Chronic Pain
  • 75%
    Combined Disability Rating

To arrive at the combined disability rating in the above example, VA takes the highest rating (60) and adds half of the next highest rating (half of 30, or 15). The combined rating is 60 + 15, or 75%. The amount is then rounded in the usual fashion. So, 75% would round to 80% and 73% would round to 70%.

For each additional disability, the calculation is repeated, but each added disability receives slightly lower weight in the calculation.

Veterans can maximize their disability compensation by service connecting all possible mental and physical health conditions.

Service Connection For Increased Ratings

To receive VA disability benefits, the veteran must prove that their disability is connected to service. The more disabilities that can be connected to service, the higher the combined disability rating.

To receive service-connection for each health condition, the veteran must provide evidence of three elements:

  • 1
    Qualifying service,
    an in-service event
  • 2
    Current diagnosis
    of disability
  • 3
    Connection between service and
    current disability (medical nexus)

Certain health conditions and benefit types require certain types of qualifying service. For example, a veteran seeking to service connect cancer to Camp Lejeune toxic water exposure must have evidence showing they were stationed at or lived at Marine Corps Base Camp Lejeune or Marine Corps Air Station New River in North Carolina for at least 30 days between August 1, 1953 and December 31, 1987.

This veteran must also have evidence showing a current cancer diagnosis. In addition, if the cancer is not among those listed on the Camp Lejeune VA presumptive list, the veteran would need to obtain an expert medical opinion providing evidence that their particular cancer is caused by exposure to the toxins found in the water at Camp Lejeune – also known as a VA Nexus Letter.

When the veteran can show that there is at least a 50% chance that their time in service caused their mental or physical health condition, the VA will grant service-connection for that condition. There is no limit to the number of health conditions a veteran can seek service connection for.

Veterans can also seek secondary service connection for health conditions that are aggravated or caused by a service-connected condition. For example, clinical and medical evidence has shown that chronic knee pain can cause severe depression over time. Therefore, a veteran with service connection for knee pain caused by an injury that occurred during service could seek secondary service connection for depression that developed years after military discharge.

VA combines all types of service connection to calculate the combined disability rating. With each service connected or secondary service-connected condition, the disability rating rises.

VA Nexus Letters

One of the most common calls we receive is from veterans seeking guidance on how to obtain a medical nexus letter to support their VA claim. When a veteran develops a health problem years after service, a health problem that is not listed on the VA presumptive list, or is seeking secondary service-connection, a strong medical nexus letter becomes critical to establishing service connection.

VA doctors and C&P exams are not good sources for VA nexus letters due to bias and conflict of interest. Veterans often want their private doctor to write a nexus letter, but private doctors may not meet VA requirements for nexus letter doctor training and licensure. In most cases, private doctors do not understand the language, scientific and clinical evidence, and standard of proof that the VA expects in a nexus letter.

The Disabled Veterans Resource Center maintains a list of qualified nexus letter doctors and offers referrals of qualified doctors who are experienced in writing medical nexus letters for VA disability claims.

Veterans do not have to have an exam performed by a medical nexus doctor in most cases involving service connection. Instead, nexus letter doctors use the veteran’s medical records, military records, clinical knowledge, and scientific literature to form a thorough, detailed medical nexus opinion. If there is an increased rating claim, then sometimes the nexus doctor would need to see a veteran in person. However, with shifts in our culture due to the Covid-19 pandemic, more and more doctors are offering tele-medicine.

Once a veteran locates a qualified doctor to write the medical nexus letter for their VA claim, the doctor will need access to the complete claims file, including service and post-service medical records, and any other key evidence.

The high cost of obtaining an expert VA nexus letter is often the limiting factor. Medical experts experienced in preparing VA nexus letters can charge between $1,500 and 10,000 – often too expensive for the average veteran to afford with marginal income due to a service-related disability.

Even with the aid of a hired medical expert, the nexus letter is just one form of evidence in the VA claim. While the nexus letter is often the most important form of evidence, other information plays a role in the VA’s decision to grant or deny benefits. Therefore, a veteran could pay thousands for a quality medical nexus letter and still be denied VA disability benefits.

One option to help get around the cost of a nexus letter is to obtain legal assistance in preparing the VA claim. Lawyers who help veterans prepare and submit VA appeals for disability benefits will often pay the costs of the medical nexus letter up front, requiring no fees from the veteran until they win their claim and collect their VA disability compensation.

Should the VA deny the veteran’s claim, the veteran owes nothing. This means legal advocates are not willing to take on VA claims that are unlikely to win. But since these legal advocates prepare the full claim, not just the nexus letter, veterans who are accepted by these advocates have improved odds of winning disability compensation.

VA Claims Process

In general, the initial VA disability claims process

In general, the initial VA disability claims process proceeds as follows:

  • 1
    Veteran determines whether they are eligible for VA disability compensation.
  • 2
    Veteran gathers evidence and supporting documents (medical records, military records, witness statements) to help demonstrate that their health conditions are associated with military service.
  • 3
    Veteran fills out the Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ), plus all additional required VA claim forms completely.
  • 4
    Veteran submits the completed VA claim with supporting documents. Veterans can file their VA claim in several ways:
    1. Online: Veterans can file a VA disability claim online at the VA website.
    2. By mail: Submit the Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ) to the Department of Veterans Affairs, Claims Intake Center
    3. In person: Delivering the Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ) to the local VA Regional Office.
    4. Through a legal advocate: Many veterans opt to have a legal advocate assist with their VA claim preparation and submission.
  • 5
    Once VA receives the claim, a VA representative will review the application and determine whether further information or evidence is needed.
  • 6
    When VA determines that a claim needs more information or evidence, the VA may request this evidence themselves, may ask the veteran to supply the additional evidence. At any point in the claims process, prior to a decision, veterans may supply additional evidence or witness statements supporting their claim.
  • 7
    The VA issues decision on service connection and rating for the health condition in question.
  • 8
    Veteran receives a rating decision from the VA, containing an explanation of the decision to grant or deny service connection, and any associated disability ratings.
  • 9
    Veteran reviews the VA's decision. If the veteran disagrees with the VA's decision, the veteran may appeal or file a new claim.

VA Appeals Process

If a veteran disagrees with the VA’s disability rating or denial of service connection, the veteran can appeal the decision. Veteran appeals for disability compensation claims are common. Most veterans must go through multiple appeals to receive disability benefits.

Appeals typically involve the submission of new or updated evidence showing the need for a higher disability rating or proof that a condition is related to service. Veterans can also file a new claim for a higher rating if a health condition has worsened since the original rating date.

Veterans who disagree with a VA decision received after February 19, 2019 can select one of three decision review options:

  • Higher-Level
    Review
  • Supplemental
    Claim
  • Board
    Appeal

Higher-Level Review

Veterans who feel that the VA made a mistake in their decision can request that the claim be reevaluated by a higher-level “senior claims adjudicator.” The senior reviewer will examine the same claim and make a new decision.

For this option, no new evidence can be submitted. If the senior reviewer finds that the previous reviewer made a clear and unmistakable error, the VA will issue a new decision. If the veteran doesn’t agree with the decision of this senior reviewer, they may request a Supplement Claim or Board Appeal.

Supplemental Claim

Veterans who have new and relevant evidence that could change the VA’s decision can submit this new evidence in a supplemental claim. For this option, VA has a duty to help the veteran gather evidence to support their claim, including military and medical records. A new reviewer will evaluate the claim with the added evidence and make a new decision. If the veteran doesn’t agree with the new decision, they can request a Higher-Level Review, another Supplemental Claim, or a Board Appeal.

Board Appeal

Veterans who disagree with VA’s claim decision, a higher-level decision, or a supplemental claim decision can appeal directly to the Board of Veterans Appeals where a Veterans Law Judge will review the decision.

In a Board Appeal, veterans with no new evidence can request a direct review without a hearing, can submit additional evidence without a hearing, or can participate in a hearing with the Judge. If the veteran doesn’t agree with the Board Appeal decision, they can submit a Supplemental Claim or appeal to the U.S. Court of Appeals.

Veterans can change their appeal option any time before a VA decision. So, if your claim is under Higher-Level Review and you discover new and relevant evidence, you can switch to a Supplemental Claim.

The option you select will be based on several factors, including whether you have new evidence to submit and how many appeals you have gone through before. What does the VA consider “new” evidence? For appeals, VA will accept what they call “new and relevant” evidence. “New” evidence is evidence that has never been submitted to the VA. “Relevant” evidence is evidence that relates to the veteran’s claim. Any evidence a veteran submits in an appeal must be both new and relevant.

For example, if the VA denied a Gulf War veteran’s service connection to sleep apnea, the veteran could submit a supplemental claim with a new medical nexus letter explaining how scientific and clinical data shows that toxins from burn pits cause sleep apnea. The nexus letter is new, and relevant to the case.

When a review finds evidence that supports the veteran’s claim, that favorable finding is binding for all future VA appeals. An appeal cannot hurt your claim unless the review finds clear and unmistakable evidence of error.

Veterans can appeal a claim indefinitely. As long as the claim is continuously in review, the effective date will remain as the date of the initial claim. If the veteran receives a decision and does not submit an appeal for more than one year (or more than 120 days for appealing a Board Decision to the U.S. Court of Appeals), it is no longer considered continuous and the claim decision may become final. In this case, the veteran would file a new claim rather than appealing.

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