Navigating the labyrinth of veteran disability ratings can often feel like an impossible challenge. For veterans seeking to increase their disability rating, the journey involves a complex amalgamation of legal codes, bureaucratic VA processes, medical terminology, and an ever-evolving understanding of one’s health and how their military service affected it.

This article aims to shed some light on the steps involved in this complex and intricate process.

Before you get started:

As you’ll see below, this can be a complex and at times, overwhelming process. There are hundreds of regulations to learn and multiple processes to plan out before you can even think about submitting your appeal. On top of that, if you’re one of the 84% of people who are initially rejected (for what are often just administrative errors), the appeals process can take years to complete – leaving you without the support you deserve. To avoid putting yourself through the additional stress and wasting more years of your life fighting an enemy who was supposed to be on your side, I highly recommend hiring a professional representative to handle your appeals process.

A professional representative will immediately identify the path to a successful appeal, tell you exactly what legwork you need to do, and file everything for you so you don’t experience frustrations, delays, and administrative letdowns.

Give us a call to see if we can help you at (850) 306-6846 or visit the rest of our website.

You already fought for our country. Let us fight the VA for you now.

Examining Your Current Disability Rating

Understanding your current disability rating is the foundational step in this journey. The Department of Veterans Affairs (VA) assigns disability ratings in 10% increments, based on the severity of the service-connected condition and its impact on the veteran’s ability to work.

However, deciphering the specifics of your rating, and why it was assigned, can be a perplexing process fraught with legal jargon and medical terminology.

1. Obtain Your Rating Decision Letter

The first step in understanding your current disability rating is to review your Rating Decision letter from the VA. This document provides the foundation for your assigned rating, detailing the evidence considered, the laws and regulations applied, and the rationale for the decision. If you do not have a copy, you can request one through your VA regional office or via your eBenefits account.

An eBenefits account is a central online platform that serves as a crucial resource for veterans, service members, and their families to manage their benefits and services provided by the VA and the Department of Defense (DoD). This account offers a wide array of functionalities designed to facilitate access to the various benefits veterans are entitled to, including disability compensation.

As of 2023, a lot of the functionality was moved to the VA’s website but it will still be necessary for about 50% of disability-related functionality.

Regarding veteran disability specifically, an eBenefits account allows veterans to:

Check the Status of Claims and Appeals: Veterans can view the current status of their disability compensation claims and appeals, providing a transparent and up-to-date overview of where they stand in the process.
Access Official Documents: The platform enables veterans to access and download official documents related to their service and benefits, such as the Certificate of Eligibility for loans or the Statement of Benefits.
Submit and Manage Disability Claims: Veterans can submit new disability compensation claims and upload necessary documentation directly through eBenefits. They can also add or remove dependents, apply for increases in their disability rating, and manage other aspects of their claim.
View Disability Rating: The account provides veterans with detailed information about their current disability rating, including the breakdown of ratings for individual conditions and the total combined rating.
Secure Messaging: eBenefits offers a secure messaging feature that allows veterans to communicate directly with VA representatives regarding their claims and receive assistance with their questions.
Update Personal Information: Veterans can update their personal information, such as address, banking details for direct deposit of benefits, and contact information, ensuring they receive timely and accurate benefit payments and correspondence.

To create an eBenefits account, veterans typically need to go through a verification process to confirm their identity and eligibility for benefits. This process ensures that sensitive personal and health information is securely managed and accessed only by authorized users.

In essence, an eBenefits account is a vital tool for veterans seeking to manage their disability claims and navigate the complexities of the VA system. It empowers veterans with direct access to their benefits information and streamlines the process of managing their claims, making it easier to obtain the support and compensation they have earned through their service.

2. Analyze the Legal and Medical Criteria

To delve deeper into understanding your veteran disability rating, it’s essential to familiarize yourself with the VA’s Schedule for Rating Disabilities, a comprehensive guide outlined in Title 38, Code of Federal Regulations, Part 4. You can view this yourself here. This schedule is the cornerstone for determining disability ratings and is meticulously designed to quantify the impact of various conditions on a veteran’s overall health and ability to function in a work environment. Here’s how you can navigate this process:

Step 1: Identify Your Diagnostic Code(s)

Every service-connected condition recognized by the VA is assigned a specific diagnostic code. These codes are crucial for understanding how the VA categorizes and evaluates the severity of different health issues. Your disability rating decision letter from the VA should list the diagnostic codes for each of your service-connected conditions. If you’re unsure about your codes, you can consult your eBenefits account or request assistance from a VA representative.

Step 2: Review the Schedule for Rating Disabilities

Once you have your diagnostic codes, you can refer to the Schedule for Rating Disabilities to find the specific criteria associated with each code. This document is structured to provide clear guidelines on how disabilities are rated based on their severity and the veteran’s symptoms. The criteria for each condition are detailed, including physical manifestations, psychological symptoms, and the impact on the individual’s daily life and employment capabilities.

There is also a combined ratings table that will help determine the total rating based on the severity of conditions separately. For example, If a veteran is rated at 60 percent disability, they will be considered 40 percent efficient. Going from that 40 percent efficiency, the effect of a further 30 percent disability leaves only 70 percent of the efficiency remaining after considering the first disability which results in 28 percent efficiency altogether. So the veteran is 72 percent disabled as shown in that table.

Step 3: Compare Your Medical Situation with VA Criteria

With the relevant sections of the schedule in hand, compare the VA’s criteria for rating your condition(s) against your own medical situation and symptoms. This comparison is crucial for understanding the rationale behind your current disability rating. The schedule describes how symptoms translate into specific percentages, indicating the degree to which the condition affects your health and employability.

Here is an example of a schedule excerpt rating acute, subacute, or chronic musculoskeletal systems:

Acute, Subacute, or Chronic Diseases

	Rating
5000 Osteomyelitis, acute, subacute, or chronic:
Of the pelvis, vertebrae, or extending into major joints, or with multiple localization or with long history of intractability and debility, anemia, amyloid liver changes, or other continuous constitutional symptoms	100
Frequent episodes, with constitutional symptoms	60
With definite involucrum or sequestrum, with or without discharging sinus	30
With discharging sinus or other evidence of active infection within the past 5 years	20
Inactive, following repeated episodes, without evidence of active infection in past 5 years	10
Note (1): A rating of 10 percent, as an exception to the amputation rule, is to be assigned in any case of active osteomyelitis where the amputation rating for the affected part is no percent. This 10 percent rating and the other partial ratings of 30 percent or less are to be combined with ratings for ankylosis, limited motion, nonunion or malunion, shortening, etc., subject, of course, to the amputation rule. The 60 percent rating, as it is based on constitutional symptoms, is not subject to the amputation rule. A rating for osteomyelitis will not be applied following cure by removal or radical resection of the affected bone.
Note (2): The 20 percent rating on the basis of activity within the past 5 years is not assignable following the initial infection of active osteomyelitis with no subsequent reactivation. The prerequisite for this historical rating is an established recurrent osteomyelitis. To qualify for the 10 percent rating, 2 or more episodes following the initial infection are required. This 20 percent rating or the 10 percent rating, when applicable, will be assigned once only to cover disability at all sites of previously active infection with a future ending date in the case of the 20 percent rating.

Understanding the Nuance

Severity of Symptoms: The VA assigns ratings based on how severe your symptoms are utilizing their doctor’s medical opinions in the absence of other evidence. For example, a condition causing mild intermittent pain may receive a lower rating than the same condition causing chronic, debilitating pain.

Functional Limitations: How much your condition limits your ability to work and perform daily activities is a significant factor. Conditions that severely impair your functionality are likely to be rated higher. Congress has defined functional impairment as “The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. Whether the upper or lower extremities, the back or abdominal wall, the eyes or ears, or the cardiovascular, digestive, or other system, or psyche are affected, evaluations are based upon lack of usefulness, of these parts or systems, especially in self-support. This imposes upon the medical examiner the responsibility of furnishing, in addition to the etiological, anatomical, pathological, laboratory and prognostic data required for ordinary medical classification, full description of the effects of disability upon the person’s ordinary activity. In this connection, it will be remembered that a person may be too disabled to engage in employment although he or she is up and about and fairly comfortable at home or upon limited activity.”

Combination of Conditions: If you have multiple service-connected conditions, the VA uses a complex formula to calculate a combined disability rating, rather than simply adding the percentages together. This combined rating reflects the overall impact of your disabilities on your health and work capacity.

For example, where a third disability rated at 10% disabling is then added to a veteran already rated at 50% disabling and 30% disabling on a prior combined rating, the VA would take the combined value of 65 and look for that number in the left column of the combined ratings table below. The VA then looks for 10 in the top row—and finds the number where the left column and top row meet. In this example, that number would be 69. This number is then rounded up to 70% for the combined disability rating for all three conditions.

Next Steps

Gather Comprehensive Medical Evidence: To argue for an increased rating, ensure your medical records thoroughly document the severity of your symptoms and their impact on your life. This includes doctor’s notes, treatment records, and any relevant tests. Without sufficient medical evidence, the VA will rely on their own opinions and those that are already in your file.

The quality of medical evaluations at the VA is interesting, to say the least. Most people would agree that you will get a far better evaluation using a third-party source. The VA has to take the information provided by a third-party evaluator as seriously as they would an internal evaluator due to the regulations below.

Consideration of Evidence (38 U.S.C. § 5107): Under this statute, claimants are responsible for providing evidence that supports their claim, and the VA is responsible for evaluating all evidence, whether it supports or contradicts the claim. This includes third-party medical evaluations, which can be critical in establishing entitlement to benefits.

Private Medical Evidence (38 CFR 3.159): This regulation, part of the Code of Federal Regulations which implements the statutes in Title 38, addresses the use of private medical evidence in claims processing. It specifies that private medical evidence can be submitted by the claimant and must be considered by the VA in the context of the claim. This regulation directly facilitates the use of third-party evaluations by ensuring they are part of the evidence record.

Besides the fact that the VA has to use third-party medical evidence and evaluations, there are multiple reasons why we do not recommend utilizing the evaluators at the VA:

Resource Constraints: The VA system has faced challenges with resource constraints, including funding, staffing, and facilities. These constraints can lead to overburdened staff, longer wait times for appointments, and, potentially, rushed or inadequate evaluations.
Bureaucracy and Administrative Issues: The VA, like many large government organizations, can struggle with bureaucratic inefficiencies. Red tape and administrative hurdles may impact the timeliness and quality of care and evaluations veterans receive.
Staffing Issues: There have been reports of difficulties in hiring and retaining skilled medical professionals within the VA system. This could be due to a variety of reasons, including competitive salary issues, workplace environment, and the high stress of managing a population with significant health issues. These staffing challenges can lead to cases where less experienced or overwhelmed staff are conducting evaluations.
Training and Expertise: Concerns have been raised about the level of training and expertise of some VA healthcare providers, especially regarding specific conditions that are prevalent among veterans, such as PTSD, traumatic brain injuries, and issues related to exposure to hazardous materials. Inadequate expertise can result in evaluations that fail to fully capture the veteran’s medical needs.
Allegations of Incentives for Poor Evaluations: There have been accusations that the VA system, either directly or indirectly, incentivizes providers to give evaluations that minimize veterans’ disabilities and health issues. The rationale behind these allegations often revolves around cost-saving measures. However, evidence of systemic incentives for poor evaluations is a matter of serious debate and investigation. It’s important to differentiate between systemic policy and individual misconduct or negligence.
Variability in Quality: The VA healthcare system is vast, with facilities spread across the United States. There can be significant variability in the quality of care and evaluations from one facility to another, leading to disparities in veterans’ experiences.
Perception and Trust Issues: The VA has faced several high-profile scandals regarding care quality and wait times in the past. These incidents can affect veterans’ trust in the system and might contribute to a perception that evaluations are systematically poor, even in areas where the VA has made improvements.
Mental Health Stigma: Stigma surrounding mental health issues can lead to underreporting of symptoms by veterans or a lack of adequate focus on mental health evaluations by healthcare providers.

Luckily, there are companies like us that not only process appeals but also maintain a network of reliable professionals to perform evaluations.

If you need to be evaluated to help with your VA disability claim appeal, contact (833) 580-5681.

Seek Professional Guidance: Given the complexity of the VA’s rating criteria and the legal intricacies involved, consulting with a VA-accredited attorney or claims agent can provide invaluable assistance. They can help interpret the rating schedule in the context of your medical situation and advocate on your behalf.

In essence, understanding your veteran disability rating through the lens of the VA’s Schedule for Rating Disabilities requires diligent research and a detailed comparison of your condition(s) against the VA’s standardized criteria. You need to develop a sufficient enough understanding to convince the VA rater of each condition’s severity and limitations, and then how the combination of those effects corresponds to their published tables. This process is fundamental to uncovering the specifics behind your rating and forms the basis for any appeal or claim for an increased rating.

3. Review Your Service Medical Records

Your service medical records play a crucial role in establishing the service connection and severity of your condition. Reviewing these documents can help you identify the medical evidence that was used to determine your rating. Look for diagnoses, treatment records, sick-call visits, and any other documentation or notes that relate to your service-connected conditions.

4. Seek Clarification from Medical Professionals

Medical terminology and the VA’s interpretation of your health condition can be difficult to understand. Consulting with medical professionals who can explain your diagnosis and the severity of your condition in layman’s terms can be invaluable. They can help you understand the medical basis for your rating and may even uncover additional evidence that could support a higher rating.

5. Understand the Legal Jargon

Familiarize yourself with the legal language used in your Rating Decision letter and the VA’s regulations. This may involve researching specific terms and legal principles related to disability law. Websites, veterans’ law blogs, and legal guides specifically designed for veterans can be helpful resources. This will be touched on more later in the article as well as it is the most complicated and the most important part of the process.

6. Consult with a VA Accredited Claims Agent, Veterans Service Officer (VSO), or Attorney

Navigating the complexities of your disability rating can be overwhelming. VA Accredited Claims Agents, Veterans Service Officers, and specialized attorneys can offer guidance and interpretation of your rating decision. They can help you understand the specifics of your case, identify any areas where the VA may have erred, and advise on the potential for increasing your rating. These professionals can assist you in the difficult process of understanding your rating decision and appealing inaccuracies or appealing incorrect applications of the law to your situation.

7. Engage with Veteran Communities

Sometimes, hearing from others who have been through similar experiences can provide insights into your own situation. Online forums and local veteran support groups offer a platform to discuss your rating and learn how others have navigated the appeal process or successfully increased their ratings.

By taking these steps, you can start to demystify your VA disability rating, understanding not just the “what” but the “why” behind your assigned percentage. This understanding is crucial for any veteran seeking to challenge or increase their disability rating, as it provides the groundwork for any appeals or new claims.

Why You’ve Struggled To Increase Your Rating

If you’ve struggled to increase your rating so far, just know, that it isn’t your fault. You’ve most likely been failed by the system that is supposed to support you.

The biggest reason why most veterans do not have the rating they deserve is because they started with an initial under-assessment. There are many reasons why a veteran might have suffered an under-assessment but it can be hard to pinpoint why that is if you are not a professional.

Reasons why your rating might not be as high as it should be need to be addressed in an appeal. A professional appeal service will be able to figure out the most effective and efficient way to address the following:

Errors and overlooked evidence
Insufficient medical evidence
Conservative assessments
Complexity of unique health conditions and how they apply to service
Overcoming system limitations

The system limitations mentioned here don’t only apply to initial claims but permeate into the appeals process at even more dramatic levels.

System Limitations

Besides the many limitations of medical evaluations which were touched on above in the “Gather Comprehensive Medical Evidence” section of “Next Steps”, there are many limitations to the veteran disability system.

Characterizing VA claim processors as universally “bad” at their jobs would do a disservice to people who are working hard at the VA. It would overlook the complexity of the issues involved in processing veterans’ disability claims. Many VA employees are dedicated professionals who work hard to assist veterans. However, there are systemic challenges and constraints that can impact the efficiency and accuracy of the claims processing system. Understanding these factors can provide a more nuanced view of the challenges faced by both claim processors and veterans:

High Volume of Claims: The VA handles a very high volume of claims, which has been increasing over the years due to various conflicts and the aging veteran population. This volume can lead to backlogs and delays, putting pressure on claim processors to work through claims quickly, sometimes at the expense of thoroughness.
Complexity of Cases: Many disability claims involve complex medical conditions with extensive documentation. The need to thoroughly review medical records, service documents, and other evidence for each claim — while also applying a detailed and sometimes subjective rating system — can lead to errors or oversights.
Training and Experience Variability: There can be significant variability in the training and experience of VA claims processors. While many are well-trained and knowledgeable, others may be newer to the role or less familiar with specific types of claims, leading to inconsistency in claim evaluations.
Resource and Staffing Constraints: The VA has faced staffing shortages and resource constraints, impacting its ability to process claims efficiently and accurately. Although efforts have been made to address these issues, including hiring additional staff and implementing new technologies, challenges remain.
Regulatory and Policy Changes: The rules and policies governing VA benefits can change, requiring claims processors to continuously update their knowledge and understanding. Adapting to these changes can be challenging and may affect the processing of claims.
Mental and Emotional Toll: The nature of the work, which involves reading about and evaluating the impacts of serious injuries and conditions on veterans’ lives, can take a mental and emotional toll on claims processors, potentially affecting their work performance.
Technology and System Issues: Although the VA has made strides in modernizing its claims processing systems, technological issues and system limitations can still hinder efficiency and accuracy.

All of these issues are stacked against an individual veteran seeking out the disability rating they deserve. Luckily, professional services like us know how to overcome these system deficiencies to ensure veterans get their full disability rating in the most efficient timeframe.

How The VA Calculates Your Rating – Title 38

Once you fully understand your current situation it is time to take the most important step. Learning how the VA views disability rating decisions. This is of the utmost importance before identifying your path to increasing your rating.

Understanding your veteran disability rating involves not only medical evaluations and evidence but also navigating through a complex legal framework. This legal framework is largely outlined in Title 38 of the United States Code (USC) and Title 38 of the Code of Federal Regulations (CFR).

These documents are pivotal in governing veterans’ benefits, including disability compensations. To effectively advocate for an increased disability rating, or simply to understand the rationale behind your current rating, a thorough comprehension of relevant sections of Title 38 USC and Title 38 CFR is essential. Here’s how you can approach this:

Title 38 USC: The Legal Foundation

Title 38 USC is the foundation for the laws promulgated by Congress that authorizes the creation and governance of veterans’ benefits. It lays out the laws passed by Congress related to veterans’ affairs, including eligibility for disability compensation, the definition of service-connected disabilities, adjudication of benefit programs, and the structure of benefits.

Understanding Eligibility and Definitions: Begin by familiarizing yourself with the chapters, parts, subparts, and individual sections that each define what constitutes a service-connected disability, eligibility criteria for veterans, and the types of benefits available. This can help you understand the legal basis for your disability rating.

Researching Specific Terms: When reviewing your Rating Decision letter, you may come across legal terms or references to specific sections of Title 38 USC. Research these references to grasp how the law applies to your situation. Legal dictionaries and veterans’ law guides can clarify these terms and their implications.

Title 38 CFR: The Regulatory Details

Title 38 CFR provides the detailed regulations that the VA follows to implement the laws outlined in Title 38 USC. It includes the VA’s Schedule for Rating Disabilities, procedures for filing claims, and guidelines for how the VA evaluates different conditions.

Diving into the Schedule for Rating Disabilities: This is where you’ll find the diagnostic codes and the criteria for assigning ratings to specific disabilities. Cross-reference the diagnostic codes mentioned in your Rating Decision letter with those in the CFR to understand how the VA determined your rating. For example, to understand how the VA is required to determine functional loss, it is helpful to know that the CFR defines this is in Title 38, Chapter I, Part 4, Subpart B, Section 4.40 as: “Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like.”

Understanding the Evaluation Process: The CFR also details the process for evaluating disabilities, including how evidence is weighed and how decisions are made. Familiarizing yourself with these regulations can provide insights into how the VA assessed your claim and determined your rating.

A good place to start is the CFR’s General Policy in Rating. Below are the topics within this Subpart A and you can find further detail here.

§ 4.1 Essentials of evaluative rating.

§ 4.2 Interpretation of examination reports.

§ 4.3 Resolution of reasonable doubt.

§ 4.6 Evaluation of evidence.

§ 4.7 Higher of two evaluations.

§ 4.9 Congenital or developmental defects.

§ 4.10 Functional impairment.

§ 4.13 Effect of change of diagnosis.

§ 4.14 Avoidance of pyramiding.

§ 4.15 Total disability ratings.

§ 4.16 Total disability ratings for compensation based on unemployability of the individual.

§ 4.17 Total disability ratings for pension based on unemployability and age of the individual.

§ 4.17a Misconduct etiology.

§ 4.18 Unemployability.

§ 4.19 Age in service-connected claims.

§ 4.20 Analogous ratings.

§ 4.21 Application of rating schedule.

§ 4.22 Rating of disabilities aggravated by active service.

§ 4.23 Attitude of rating officers.

§ 4.24 Correspondence.

§ 4.25 Combined ratings table.

§ 4.26 Bilateral factor.

§ 4.27 Use of diagnostic code numbers.

§ 4.28 Prestabilization rating from date of discharge from service.

§ 4.29 Ratings for service-connected disabilities requiring hospital treatment or observation.§ 4.30 Convalescent ratings.

§ 4.31 Zero percent evaluations.

Leveraging Legal Resources

Veterans’ Law Blogs and Websites: Many legal professionals specialize in veterans’ law and share their expertise through blogs and websites. These can be invaluable resources for understanding the complexities of Title 38 USC and CFR.

Legal Guides for Veterans: There are guides and handbooks designed specifically to help veterans navigate the legal aspects of their claims. These resources often break down legal jargon into more understandable language.

VA Resources and Legal Assistance: The VA itself offers resources and assistance to help veterans understand their benefits and the legal framework governing them. Additionally, VA-accredited attorneys and claims agents are trained in veterans’ law and can provide personalized guidance.

Board of Veterans’ Appeals

The Board of Veteran’s Appeals was delegated authority under executive order to assist with veteran appeals and help interpret the applicable laws in the CFR. You can search their decisions as a resource to see if there is further guidance on your particular situation here. An example of a search for “tinnitus” shows a decision in Docket No. 18-46 203 (dtd February 28, 2023) that gives some context for the award given certain facts related to that veteran’s service in the Persian Gulf War.

“5. Entitlement to service connection for tinnitus.

The Veteran contends that his tinnitus started during his last tour of duty in the service when he was exposed to jet and rotary aircrafts, often without hearing protection. See Board hearing transcript, pages 19-20.

The Veteran has a current diagnosis of tinnitus as evidenced by his testimony at his Board hearing. The Veteran testified that his ears were currently ringing and that this ringing was constant. See Board hearing transcript, pages 18-19. The first element of service connection has been met. Tinnitus is also an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d at 1331.

While the Veteran’s STRs do not document any pertinent reports and while the Veteran’s DD-214 Form and personnel records are not of file, a December 2022 Memorandum from the Agency of Original Jurisdiction (AOJ) does confirm that the Veteran served in the Southwest Asia theater of operations during the Persian Gulf War. Also, the May 2016 VA hearing loss and tinnitus examiner confirmed that the Veteran was in the Marines and in the infantry during his active military service. At this examination, the Veteran reported noise exposure from artillery, rifles, pistols, automatic weapons, aircraft engines, heavy equipment, and explosives. Further, the Veteran testified that his tinnitus started during his last tour of duty in the service when he was exposed to jet and rotary aircrafts, often without hearing protection. See Board hearing transcript, pages 19-20. Based on the aforementioned, the Board finds that the Veteran was exposed to excessive noise exposure during his active military service. The second element of service connection has been met.

While no post-service treatment records exist during the applicable presumptive period, the Board finds that the Veteran continued to experience the same symptoms following his military discharge. The Veteran is competent to report that he experienced symptoms of ringing in his ears during that period but did not seek treatment. because “life can’t end because you’ve got a pain. I mean, I still have to live. His testimony is credible and entitled to probative weight, as it is internally consistent and consistent with other evidence of record.

In light of the foregoing, because of the credible evidence of tinnitus symptoms during and since service, and resolving all reasonable doubt in the Veteran’s favor, the Board finds that service connection for tinnitus is warranted. The claim is granted.”

Building Your Knowledge

As you delve into Title 38 USC and CFR, take notes on sections directly relevant to your condition and rating. Creating a personal reference document, cross-referencing those against each portion of the CFR with your relevant conditions, can make it easier to discuss your case with a legal advisor or when preparing an appeal. Your accredited VA claims agent can also assist with this process as well. Understanding the legal language and principles related to your disability rating is not only empowering but essential for advocating effectively for your rights as a veteran.

Identify Your Path to Increasing Your Disability Rating

Increasing the Rating of One Issue

When seeking to increase the rating of a specific condition in your veteran disability claim, the burden of proof rests on demonstrating that the condition has indeed worsened since the last evaluation or that the initial evaluation did not accurately reflect the severity of your condition. This endeavor is a meticulous process that involves several key steps to compile a convincing case for reevaluation by the VA. Here’s a detailed approach to tackling this challenge:

Gathering Substantial Medical Evidence

The cornerstone of your claim is the medical evidence you provide to support the assertion that your condition has deteriorated. This involves:

Comprehensive Review of Medical Records: Collect all relevant medical records since your last VA evaluation. This includes hospital visits, doctor’s notes, diagnostic tests, and treatment records. Look for documented changes in your condition that indicate worsening symptoms or impacts on your daily life.

Securing New Medical Evaluations: If your existing medical records do not sufficiently document the progression of your condition, consider undergoing new medical evaluations. Independent medical examinations by specialists who can attest to the worsening of your condition can be particularly persuasive.

Comparative Analysis: Prepare a side-by-side comparison of your health status at the time of the last VA evaluation and your current status. Highlight specific changes in symptoms, frequency of medical consultations, escalation in treatments, or any new limitations arising from your condition.

Documenting the Impact on Your Life

Personal Statements: Write a detailed personal statement describing how the worsening condition affects your daily life, work, and overall well-being. Be specific about the changes you’ve experienced and how they relate to the deterioration of your health. Working with your professional advocate can greatly help in understanding how best to phrase these items for your claim’s success.

Buddy Statements: Statements from family, friends, or colleagues who have witnessed the impact of your condition on your life can add a personal dimension to your claim. These narratives can corroborate your account of the worsening condition and its effects. If drafted properly, these can also be used to help substantiate that a condition was related to your service if the buddy statement comes from someone who was there at the time and witnessed an event.

Navigating Through Recent Medical Records

Organize Your Documentation: Ensure your medical records are organized chronologically and clearly labeled. This will help the VA efficiently review your case and understand the progression of your condition.

Highlight Key Findings: Use summaries or cover letters to draw attention to the most compelling evidence in your medical records. Point out any diagnoses, test results, or treatment changes that clearly indicate a worsening condition.

Securing New Evaluations

Choosing the Right Specialists: When possible, seek evaluations from healthcare providers who specialize in your condition. Their expertise can lend credibility to your claim and provide detailed insights into the severity and progression of your health issues. Ensure your healthcare provider can communicate their findings in the detail required by the VA or work with a provider recommended by your VA-accredited claims agent. In a select example related to joint motion, check to ensure they are describing ankylosis measurements in a manner consistent with how the VA measures this in CFR Title 38, Chapter I, Part 4, Section 4.71.

Objective Medical Evidence: Encourage your healthcare providers to include objective measures of your condition’s progression, such as diagnostic test results or clinical findings, in their evaluations. This type of evidence can be more persuasive than subjective reports of symptoms alone. Ensure that your healthcare providers are able to provide findings or opinions that are able to correspond with the CFR requirement related to each condition or work with a professional advocate who can help bridge that gap.

Legal Considerations

Consult with a VA-Accredited Representative: Consider seeking advice from a VA-accredited attorney or claims agent. They can provide valuable guidance on strengthening your case, navigating the VA’s procedures, and ensuring your evidence is presented effectively.

Understanding VA Regulations: Familiarize yourself with the VA’s criteria for evaluating the severity of conditions and how ratings are determined. This is a repeated step from above that can help you gain the knowledge that will help you target your evidence to address the specific criteria the VA uses to assess your condition.

In summary, proving that your condition has worsened since your last VA evaluation or was initially evaluated incorrectly is a detailed process that requires thorough preparation and strategic presentation of evidence. By meticulously documenting the progression of your condition and its impact on your life, and potentially seeking professional guidance, you can build a strong case for an increased disability rating.

Adding Other Issues

Adding new medical issues to your veteran disability claim is a strategic move that can potentially increase your overall disability rating, but it comes with its own set of challenges. It’s starting the process all over again with an initial claim.

Establishing a service connection for each new condition is essential, as the VA requires clear evidence that a disability is linked to your military service to grant disability benefits. Here’s a deeper dive into the process of adding new conditions to your disability claim:

Understanding Service Connection

The concept of service connection is foundational in successful VA disability claims. For a new condition to be added and considered for compensation, you must demonstrate that the condition is directly related to your military service, was aggravated by your service, or is secondary to an already service-connected condition. This requires a thorough understanding of what constitutes a service connection and how to prove it in a manner consistent with the laws governing VA procedures.

Steps to Establish Service Connection

Identify Potential Service-Connected Conditions: Review your medical history for conditions that have developed or worsened due to your military service. Conditions can be physical injuries, mental health disorders, or illnesses that appeared during or after your service.

Gather Evidence: The success of adding a new condition to your claim hinges on the evidence you provide.

Service Records: Highlighting any incidents, injuries, or exposures during your service that could be linked to your new condition.

Medical Records: Presenting current medical records that diagnose the condition and, if possible, suggest a link to your service.

Nexus Letters: Obtaining a Nexus letter from a healthcare provider is particularly valuable. This is a statement that explicitly connects your condition to your service, based on your medical and service history. These healthcare providers can be from the VA or your own healthcare provider.

Understand Presumptive Conditions: The VA recognizes certain conditions as presumptively connected to service under specific circumstances, such as exposure to Agent Orange or service in particular geographic locations. If your condition is on the VA’s list of presumptive conditions and you meet the service requirements, proving a service connection may be more straightforward. These laws are often updated and VA-accredited attorneys or claims agents can greatly assist in understanding any changes in these laws. Most recently is the Sergeant First Class (SFC) Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act. The PACT Act provides presumptive service-connection for toxic exposures by veterans of the Vietnam, Gulf War, and post-9/11 eras. This act created over 20+ presumptive conditions not previously recognized by the VA and presumptive-exposure locations.

Preparing and Submitting Your Claim Appeal

Submitting an appeal for a VA disability claim involves several steps and choices, depending on when you filed your original claim and the nature of your appeal. The process changed significantly with the implementation of the Appeals Modernization Act (AMA) in February 2019.

If your claim was decided after February 19, 2019, you’re under the AMA process. Here’s a general guide on how to appeal your VA disability claim:

1. Understand Your Decision Notice

After receiving a decision on your VA disability claim, review the notice. If you disagree with the decision, the notice will detail the reasons for the decision and provide information on how to appeal.

2. Choose Your Appeal Path

Under the AMA, you have three options for appealing your decision:

Supplemental Claim: You submit new and relevant evidence not previously considered by the VA.
Higher-Level Review: A more senior VA reviewer will take a new look at your case without considering new evidence.
Board Appeal: You appeal directly to the Board of Veterans’ Appeals. Within this option, you have three choices:
- Direct review: The Board reviews the case as is, without any new evidence.
- Submit new evidence: You submit new evidence for the Board to review.
- Hearing: You request a hearing with a Veterans Law Judge, with the option to submit new evidence.

3. Submit Your Appeal

Below are your options depending on the path you have chosen. All of these forms will need to be submitted to your VA.gov account as highlighted at the beginning of this article.

Supplemental Claim: Fill out VA Form 20-0995, “Decision Review Request: Supplemental Claim.” Attach any new and relevant evidence.
Higher-Level Review: Fill out VA Form 20-0996, “Decision Review Request: Higher-Level Review.”
Board Appeal: Fill out VA Form 10182, “Decision Review Request: Board Appeal (Notice of Disagreement).”

4. Submit Evidence (If Applicable)

If you’re submitting a Supplemental Claim or a Board Appeal with new evidence, ensure that all new and relevant evidence is submitted according to the VA’s guidelines.

5. Follow-Up

After submitting your appeal, you can track its status online through the VA’s website or contact a VA regional office for updates.

6. Seek Assistance

Navigating the VA appeals process can be complex. Consider seeking help from a VA-accredited representative, a Veterans Service Organization (VSO), or a VA-certified attorney who can provide guidance and representation.

Important Notes:

Pay close attention to deadlines. For example, a Supplemental Claim must be filed within one year of the decision.

The details provided here are a general guide. Specific cases may require additional steps.

The VA’s official website provides the most current forms and detailed instructions on how to submit your appeal. It’s crucial to use the latest forms and follow the VA’s guidelines closely to ensure your appeal is processed efficiently.

The Importance of Continuous Documentation

Even after submitting your claim, continue to document your conditions and how they affect your life. New medical evaluations, treatments, or changes in your condition can be crucial for appeals or future claims.

Be Prepared for VA Examinations

The VA may request additional examinations or information to verify the service connection and assess the severity of your new conditions. Attending all scheduled examinations and responding promptly to VA requests is critical to the success of your claim.

Adding new medical issues to your veteran disability claim is a nuanced process that requires a strategic approach to evidence and documentation. By thoroughly establishing the service connection for each new condition and effectively presenting your case, you can enhance your claim and ensure that all service-related health issues are recognized and appropriately compensated.

An Alternative To Doing It Yourself – Hire a Claims Agent or Attorney

The process of increasing a veteran disability rating is fraught with legal, medical, and bureaucratic complexities that can be overwhelming for many veterans. This path involves understanding and applying specific legal standards, interpreting medical evidence, and navigating the procedural nuances of the VA. Given these challenges, seeking the assistance of a professional, such as a claims agent or attorney, becomes not just a convenience but a strategic decision to enhance the probability of a successful outcome. Here’s an expanded look at why enlisting professional help is often the best approach:

Expertise in Veterans’ Law

Legal Acumen: Claims agents and attorneys specializing in veterans’ benefits have a deep understanding of veterans’ law, including the critical nuances and updates of Title 38 of the United States Code (USC) and Title 38 of the Code of Federal Regulations (CFR). In addition to this set of laws are the decisions issued from time to time by the Board of Veterans Appeals which interpret these laws. Understanding how these decisions, the facts of your condition, and drafting them into crafting a compelling argument for your claim or appeal is indispensable.

Strategic Advice: Professionals can provide strategic advice on how to structure your claim, which medical evidence will be most persuasive, and how to articulate the connection between your service and your disability. They can foresee potential pitfalls in your claim and guide you in avoiding them.

Navigating Medical Evaluations and Evidence

Medical Documentation: A significant part of increasing your disability rating involves presenting comprehensive medical evidence. Claims agents and attorneys can help identify what additional medical documentation is needed, advise on obtaining nexus letters from medical professionals, and interpret complex medical reports in the context of VA regulations.

Objective Assessments: Professionals can assist in obtaining independent medical examinations (IMEs) that provide objective assessments of your conditions, often offering the critical evidence needed to substantiate your claim for an increased rating.

Dealing with VA Bureaucracy

Navigating Procedures: The VA’s procedures for submitting claims, appealing decisions, and managing paperwork are intricate and often change. A claims agent or attorney stays abreast of these procedural requirements, recent trends, and ensures that your claim complies with current VA guidelines, avoiding unnecessary delays or rejections.

Communication with the VA: Professionals can handle communication with the VA on your behalf, ensuring that inquiries are promptly and accurately addressed. This can be particularly valuable during the appeals process, where legal arguments and evidence must be presented clearly and persuasively.

Alleviating the Burden

Emotional and Mental Relief: The process of increasing a disability rating can be stressful and emotionally taxing. Having a professional manage the complexities of your claim can provide peace of mind, allowing you to focus on your health and well-being rather than the stress of navigating the claims process.

Time-Saving: By managing the intricacies of your claim, professionals can save you a significant amount of time, allowing you to avoid the extensive research and learning curve associated with veterans’ benefits law and VA procedures.

Enhancing Success Rates

Increased Probability of Success: Perhaps the most compelling reason to hire a professional is the increased likelihood of a successful outcome. With their expertise, claims agents and attorneys can significantly enhance the strength of your claim or appeal, increasing your chances of receiving the benefits you deserve.

In summary, while it is technically possible for veterans to navigate the claims process independently, the complexities and demands of such an endeavor make it an arduous and often inefficient path. The support and expertise of a claims agent or attorney not only simplify the process but also elevate your claim’s potential for success. Veterans seeking to increase their disability rating are encouraged to consider the value of professional assistance as a worthwhile investment in securing their rights and benefits.

How to Increase Your Veteran Disability Rating: Navigating the Maze