Denial of VA Disability Claims – What you need to know
Learn the common reasons for denial of VA disability claims. See how high the VA error rate is with wrongly denying valid claims, and understand your right to appeal all or part of the decision.
When VA disability claims are initially denied, the first thing veterans should know is that the VA has a very high error rate. After you receive your decision packet with details of your decision or award, you can appeal all or part of the decision. The appeal process can take a long time, but knowing that there is a high error rate and that a lot of denials are later overturned can help guide your decision whether to appeal.
Error Rate in Claim Processing is Very High
The Department of Veterans Affairs (DVA) admits that it makes a lot of errors when evaluating VA disability claims. However, it doesn’t officially agree with the magnitude of the problem. The DVA has stated that it has an error rate of 14%. The Center for Investigative Reporting analyzed a group of claims and found an error rate of closer to 38%.
In response to much media and Congressional attention to the problem with errors, the DVA claims it has reduced its error rate to 12% in FY 2016. In a recent sampling at the Los Angeles Regional Office, in a batch of 90 disability claims reviewed, 24 claims were found to be incorrectly processed. Incorrect dates to begin payments were assigned in two out of 30 claims reviewed.
Common reasons for initial denial
Just because your claim was denied does not mean you are not eligible for disability benefits. As noted above, the VA commonly makes errors in its determinations, by not applying the facts of your case correctly. Mistaken denials can also result from the DVA misplacing documents from your file. An independent review of documents at a VA regional office found hundreds of evidentiary documents from claimants files had mistakenly been put in the shredding pile.
For these reasons, it’s important to request a complete copy of your claim file after you receive your decision.
Once you’ve reviewed your file for any procedural errors, it may be possible to address certain problems with the substance of your claim. Some issues may be resolved by contacting the VA — such as, if your claim was denied for failure to attend a VA medical exam, you can ask the VA to re-open your claim and schedule the exam. If the VA agrees you have a disability, but says it doesn’t have evidence of your service record, you can ask the VA to reconsider if you have evidence of your service.
Denials also commonly result from these areas that may require more work and evidence to challenge:
- Not enough medical evidence to support your disability;
- Agreeing that you have a disability, but not finding enough evidence to show that it is connected to your military service;
- They may agree you have a disability, but find that is was pre-existing to your military service and not aggravated by your service.
Many of these types of denials have a strong chance on appeal if you can secure documentation to refute them. It’s best to plan ahead and cover all your bases in your initial application. Track down all of your own military records and medical records; don’t rely on the VA to do that for you. In addition, seek your own medical opinion showing the connection between your disability and your military service. Seek advice to spot any weaknesses in your claim before you file it.
A case of missing evidence
A story from the San Francisco ABC affiliate highlighted a case of a Navy veteran whose claim was initially denied. The veteran served in 1983 on a destroyer that saw battle off the coast of Lebanon. In 2008, he filed a disability claim for post-traumatic stress disorder and depression.
The VA denied his claim, because it said it couldn’t find actual evidence that he was in combat. A VA employee later came forward and said she’d done a Google search and actually found that the destroyer was engaged in combat, but the VA still issued the denial. The Navy vet has filed another claim and is waiting to hear a decision.
Since this veteran’s initial claim in 2008, the DVA has relaxed its evidence requirements for showing PTSD. However, this case shows a powerful example of how a claim can be denied for the wrong reasons.
The Center for Investigative Reporting has concluded that many veterans are unfairly denied their benefits. If you’ve received a denial letter, review our article Appealing Veterans Disability claims denials.