Tuesday, October 18, 2016

Types of VA Disability Claims

Before filing a claim it is important to know which category you fall into.  It is also important to note that if you file a claim and it is not decided as it should be based on the evidence, that instead of filing an appeal, which could take up to 3 years to decide, you can have your case reopened.  Below is a list of the types of claims and important links:

Types of Claims
There are numerous types of claims that apply to disability compensation. They can be based on disabilities that existed when entering military service, but were made worse, disabilities that occurred during service, or disabilities that arose after you left military service. Additionally, there are claims that are filed for special circumstances.

Pre-Discharge Claims
Service Members that are within 180 days of separation or retirement from active duty or full time National Guard duty may file claims for disability compensation. Learn more about pre-discharge claims

Claims Based on Pre-Service Disabilities
Individuals may enter military service with a known disability. Should this disability become worse due to military service, VA may be able to pay compensation. This is known as aggravation; however, compensation can only be paid for the level of aggravation. For example, at entry into military service, an individual has a disabling condition that could be considered 10% disabling. In order for this condition to be considered aggravated, it would have to have worsened due to military service to at least 20%.

Claims Based on In-Service Disabilities
These claims are based on disabilities that are a result of an injury or disease that occurred in active service, and in the line of duty. Injuries or diseases as a result of the Veteran's own willful misconduct or abuse of alcohol or drugs are excluded.

Claims Based on Post-Service Disabilities
Claims for post-service disabilities would include claims for disabilities that are a result of disabilities considered to be service-related, even though the disability arose after service. There are various classifications of presumptive disabilities which can be based on location or circumstances of service or just by military service itself. Learn more about post service claims

Claims Based on Special Circumstances
Claims regarding compensation are not always based on an in-service event. In other words, after a disability has been determined to be service connected, there may be other types of claims a Veteran or surviving spouse may wish to file. This might include a claim for a temporary 100% rating due to surgery for a service-connected disability, or additional compensation based on being in need of regular aid and attendance. Learn more about special claims

How VA Identifies Claims
Original Claim

An original claim is the first claim you file for compensation from VA. This can be filed by a Servicemember, Veteran or survivors of deceased Veterans.

Reopened Claim

A reopened claim is a claim filed for a benefit that could not be granted and the decision has become final, meaning that it is over one year old and has not been appealed. VA cannot reopen these claims unless new and material evidence is received. New evidence is evidence that the VA has never before considered in connection with the specific benefit claimed. Material evidence is evidence that is relevant to and has a direct bearing on the issue at hand.

Example 1

A Veteran was treated several times during service for pain in the right elbow. He filed a claim for service connection in 1989, but his claim could not be granted because no orthopedic abnormalities were found on VA examination. Two years later, his private physician x-rayed the elbow and noted arthritic changes in the joint. The Veteran submitted the new evidence to VA. Because it suggested a residual of his in-service elbow problems did exist, VA reopened his claim.

Example 2

 A Veteran was discharged from service in 1977. He filed an original claim for service connection for pes planus (flat foot) 20 years later. VA was unable to grant his claim because pes planus was never noted in the Veteran's service treatment records. In 2001, he attempted to reopen his claim by submitting a statement from his private physician confirming the diagnosis of pes planus. VA was unable to reopen the claim because, while the evidence was "new," it was not "material," in that it failed to demonstrate the Veteran was diagnosed with pes planus during service.

New Claim

A new claim is a claim for a benefit that may or may not have been filed before. Generally, the decision made on the claim is based entirely on new evidence. These may include claims for:


  • An increased disability evaluation
  • Special monthly compensation
  • Individual unemployability- Be aware that if you claim unemployability you will no longer be able to work.

A new claim differs from a reopened claim in that a decision on the claim is totally independent of any evidence submitted in connection with an earlier claim.

Secondary Claim

These are claims for disabilities that developed as a result of or were worsened by another service-connected condition. In other words, it is recognized that a service-connected disability may cause a second disability. This second disability may not otherwise be considered service-connected.

Example 1

A Veteran has a service-connected knee injury that causes him to walk with a limp. He subsequently develops arthritis in his hip. Although the arthritic condition was not incurred during or aggravated by service, service-connection may still be established if the arthritis is a result of his knee condition.

Example 2

A Veteran was in the Army for twenty years. During her military service, she was diagnosed with hypertension. After her discharge, service-connection was established for hypertension. She was subsequently diagnosed with a heart condition. Service-connection for her heart condition may be established as secondary to the hypertension.


Tomorrow we will have an overview of Vocational Rehabilitation benefits.
TTYL

4 comments:

  1. This is very helpful. I am transitioning out of the service in December and haven't had any guidance on this.

    ReplyDelete
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    1. Thank you for your comment. Tomorrow I'll talk about the TAP program which is what you need.

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  2. You have to be a Doctor to read the records

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    Replies
    1. i looked at key words on the medical visits that I wanted to apply for. Then I looked them up so I'd know what to research.

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