What Happens When (Not Just How) You File Your VA Disability Claim
Last week’s post explained why you want to file your disability claim, not just how to file it. Now we’ll get into why you should prepare as much of your claim as possible up front as a “fully developed” package. It’s time (once again) to visit the Veteran Service Officer.
Why you want a fully-developed claim
The VA is required by law to research and develop your claim before their raters can evaluate the severity of your disability. If you do all the work for the VA up front and submit a fully-developed claim then they’ll skip most of the development process and render a faster decision.
The big advantage of the fully-developed claim is that you retain much more control over the process. That’s because you (and the VSO) are doing almost all of the work. When you file the claim, you’ll affirm to the VA that you’ve submitted all of the evidence and that you don’t have any more records for them to locate or evaluate.
Another benefit of a fully-developed claim is that its results will be determined more quickly. (The VA saves time in the process because, once again, you’ve done most of their work.) If the VA realizes that more information is needed then they’ll pull the claim from the fully-developed pipeline and do the additional work. But if they agree with you that they have all the data then they’ll move straight to the next step.
Filing the claim
It’s tempting to just sign up for a VA eBenefits account and start uploading your medical records. Don’t do that yet! The last post showed you how to work with a VSO (and your team) to gather and organize your records, and now you can use the VSO to help submit the fully-developed claim. They’ve reviewed hundreds of medical records and filed those claims for other veterans, so they’ll avoid your potential mistakes.
The VSO will not only review your medical record for problems that you’ve reported at sick call. They also have the database of presumptive conditions which are already linked to known exposures. Vietnam veterans are asked about Agent Orange exposure and Gulf War veterans may be checked for symptoms from burning oil wells. Navy engineering duty might imply exposure to asbestos steam-pipe lagging, and submariners are questioned about radiation exposure.
I had a long talk with the Oahu Disabled American Veterans VSO about exposure to the airborne radioactive isotopes from the 1986 Chernobyl reactor accident (all the way out in the North Atlantic) and the effects of breathing volcanic ash during the 1991 Mount Pinatubo volcanic eruption. “Luckily” no presumptive conditions are linked to those disasters (yet). If any medical or physical effects had been related to those events then I would have had to start digging for a pile of submarine deck logs and air-sampling records (classified?) as well as old “I was there” fitness reports and buddy statements. Personally it’s also a big relief to know that neither of those incidents is likely to have a long-term impact on me, and maybe now I’ll sleep better at night.
After the VSO checks for presumptive conditions, they’ll look for links to other service-connected disabilities. In addition to showing that an issue arose from your service, there needs to be a persistent impact on your life after the military. The VA wants to know how you’re affected by a situation and see that you’re still seeking treatment for a problem. If you’ve avoided the military medical system (or seen a civilian doctor on your own) then the VSO can help you determine whether you can document your claim and can even help you track down records.
Once you’ve reviewed your medical records with the VSO then you’re ready to submit your claim. You’ll include your DD-214 to prove your dates of service and the character of your discharge. Some VA benefits are linked to your family status so you’ll include your marriage certificate (even if you’re married to another military veteran) and birth certificates for any minor children who you’re still financially supporting. That family information is used by the VA to determine your compensation rate for your disability.
After all your record-gathering and research, filing the claim is surprisingly anticlimactic. The VSO will bundle up the pile of medical records and other documents that you’re submitting, print out a few forms for your signature, and click a “Submit” button on the VA’s website. They’ll forward your documents to the nearest VA regional office for scanning and adding to the VA database.
Even after your claim is submitted by the VSO, you’ll still stay in touch with them. As part of submitting your claim you’ll give them a limited power of attorney to represent you with the VA. The VSO will guide your fully-developed claim through the VA bureaucracy, and they can also answer your questions about the next steps in the process.
One final tip: when you submit your claim to the VA, they’re going to schedule some medical exams. It’ll take at least 2-4 weeks for them to set up the appointments, but you want to be available for those appointments. If you know that you’ll be out of the area for a long period of time (a deployment or extended travel) then you might wait on filing your claim until you’re back home for at least 2-3 months.
Your eBenefits account
Now that your claim has been filed, you can track it with your eBenefits account. Sign up, log in, and in a few days you’ll be able to review the data on the dashboard. You’ll also need to add your bank account information so that the VA can distribute your compensation (if any) by direct deposit. The VA will update your dashboard with the status of your claim and any messages they need to send to you.
Your Compensation and Pension medical exams
After a wait of a few weeks to a few months, you’ll be notified of your appointment(s) for your C&P exam(s).
These can be a problem. The VA hires contractors to schedule the appointments for you, and the doctors who administer the exams are very busy. I’ve seen plenty of complaints about last-minute notifications, time conflicts, or even letters arriving after the appointment date. When you’re living in an area with a high concentration of veterans, or if your claim requires an assessment by a medical specialist, then you may have to drive quite a distance. You’ve probably filed your disability claim as part of your impending separation (as recommended in the first post of this series) so you already have a lot on your calendar. These appointments will just complicate your schedule, but they’re a necessary burden.
I asked one of the C&P doctors about the appointment scheduling. She had to go through a certification process to do these exams for the VA, so there are already a limited number of doctors for your claim. The VA asks the doctors to put their available time slots on the contractor’s scheduling website, and then the contractor fills in the schedule. If the doctor’s schedule changes then they can’t just call you– they have to go through the contractor. If the doctor needs more time (or if they’re called away on an emergency) then you’re going to be waiting until the doctor’s available. If the appointment conflicts with your schedule, then the contractor will put you at the bottom of their list for the next C&P appointment. Your claim is stuck in the processing pipeline until the appointment is completed, and plenty of other veterans are competing with you for limited resources.
You can see the potential problems if you’re about to separate from the service and move to a new address. Make sure that your eBenefits account, your VSO, and your VA clinic all have your latest mailing address and phone number. If you know that you’re making a big move on a certain date, and there’s not enough time to finish your C&P exams before the move, then it’s worth waiting on filing your claim until after you’ve made the move and settled in to the new address.
If the contractor messes up the appointment (or the mail isn’t delivered in time) then tell your VSO and the VA (through eBenefits) as quickly as you can. That starts the documentation trail if your claim is mishandled or if you later appeal a finding. You’ll have to work out a new appointment with the contractor, and that may be an unpleasant experience, but the contractor also knows that their performance is monitored by the VA. Be polite, be persistent, and let the contractor know that you’ll keep the local VA office informed as well.
Pro tip: when the contractor notifies you of your C&P appointment, rearrange your life to make it happen. If you’re on active duty, be willing to take leave if necessary. If you’re out of the military already, take the day off work and figure out childcare or other logistics. Nobody cares about how busy (or how important) you are. You have very little negotiating power here, and the next rescheduled appointment could be weeks away.
C&P exam study guide
The C&P doctor is simply an objective third-party authority who tries to clarify and validate the details of your claim. They don’t diagnose or treat any symptoms, and they don’t make the final decisions. They don’t determine the final rating (the VA does that) but they give the VA the data needed for that analysis.
The C&P doctor is also a human being. Some of them do C&P exams because they’re rock-star professionals who feel a deep commitment to helping veterans. (Maybe they’re military vets too, or maybe one of their loved ones is a vet.) A few doctors do C&P exams because it helps them fill their appointment book and pay their medical school student loans. Any of those doctors could be having a bad day when you walk into the exam room. Your attitude will definitely set the mood for how your claim is assessed, and if the doctor forms a bad first impression then your entire claim could be derailed.
No pressure, right? 99% of these appointments go well, and you might even learn helpful advice from the doctor. Unfortunately this situation calls for varsity-level adulting, and you need this appointment to succeed a lot more than the doctor needs you. Regardless of how well the two of you hit it off, you’re going to have to be the polite and reasonable grownup. This is a fantastic time to have your family member, friend, or wounded-warrior advocate in the room with you to help defuse any rising tension. (Just the presence of another person may help encourage professional behavior from everyone.) Let the doctor know right away why they’re with you, and tactfully obtain their permission before you try to record any video or audio.
Your C&P doctor has also done many more exams than you, and they’ve developed finely-tuned attention for the way you describe your condition. (They may even have a preconceived opinion on your diagnosis.) They’re not going to heal you and they don’t work for you– they’re simply trying to gather technical medical info for the VA. They’ll have specific questions and they’ll be alert for specific vocabulary. Hopefully the two of you can have a conversation rather than an interrogation, but it’s up to you to avoid an adversarial relationship. This exam is not the time for long detailed war stories or for trying to take charge of the situation. Don’t exaggerate or dissemble. Try to offer short, factual responses that the doctor can transcribe into their examination report, and try to make it easy for the doctor to do their job. (The next section will give a few more tips on making the doctor’s life easier.) Ideally the doctor will relax, open up a little, and engage you in a conversation that exchanges more information.
Ask polite questions if you don’t understand what the doctor is doing. If you’re impressed or surprised by the techniques or equipment that they’re using, then say so! Your feedback could prime the doctor’s conversational pump and help both of you understand each other. The more you know about what the doctor is trying to find, the faster and easier you can make the exam for them.
Pro tip: don’t be tough. You’re at the C&P exam because you have a condition that affects your ability to earn a living, and it might even cause chronic pain. Show exactly where it hurts, don’t minimize (or exaggerate) the symptoms, and don’t try to set new personal records for strength or flexibility. Have concrete examples of how it affects your daily life. One of my C&P doctors wanted to know how long I could stand, how far I could walk, and exactly how many stairs I could climb before my knees hurt. Another doctor surprised me by asking whether my tinnitus wakes me up. (No– but yikes!) The questions may seem odd or even intrusive, but the doctors are trying to translate your description into standardized, precise medical terminology that will quickly be processed by the VA raters. They know a lot more than you ever will about what the VA needs to know, and it’s up to you to make it easy for them to supply that info.
Another pro tip: assume that the doctor couldn’t read your medical records. The VA now scans your fully-developed claim onto their website and gives the doctor online access. However if your records are illegible or the scan is poor or the doctor’s network has a glitch, then they might have to reschedule your appointment. You can save the day by bringing a copy of your medical record for their personal use. If you have the time, you could even organize it and tab it by specific dates and symptoms. During the exam, ask the doctor about anything that you feel should be brought up in the claim. Figure out whether they’ve already seen it in your online records or else point it out to them.
If you’ve generated (or found) more medical records since your claim was filed, then upload them to your eBenefits account and absolutely bring a paper copy for the doctor. The VA will eventually assess the documents you upload, but it might not happen in time for your C&P doctor to see them.
One of my C&P doctors (at the VA clinic) was so concerned by my description of my knee symptoms that he sent me to the X-ray lab. I literally walked up to the counter, checked in, and was sent back to the imaging table within seconds. Sure enough, the X-rays immediately confirmed the arthritis (!) symptoms that I’d described. Along with older imagery on file at the VA clinic, and the diagnosis in my medical record, they’re exactly the evidence that the VA rater uses to determine the disability rating.
This video “privides” another overview of the VA’s C&P exam process. (Hopefully they’ll catch that typo.) Again, your exam could happen at a VA clinic or at a private doctor’s office.
Queue the DBQ for your cues
Here’s another way to make the doctor’s life easier: the Disability Benefits Questionnaire.
This extremely valuable advice comes from long-time reader Ben and was confirmed by the VSO. The VA is expanding the Disability Benefits Questionnaires as part of the fully-developed claim, and they’re available for the most common symptoms.
In technical terms, the DBQ is the doctor’s guide to the International Classification of Diseases medical codes for describing the precise details of the disabilities you’re claiming. In layman’s terms, it’s a checklist of all the symptoms that can be linked to an ICD code for the VA raters to determine the degree of disability. You want to use this form to learn the doctor’s questions about your symptoms and how you’ll describe your answers. You’ll also learn a lot of interesting (scary, gross) medical vocabulary.
Before you go to your C&P exam, spend an hour reading through the form and looking up the meanings of the codes. You’ll find the vocabulary that the doctor will use as they write up their diagnosis for the VA. If you have the time, try to fill out the entire DBQ and bring it along with you. If you and the doctor are getting along, then as the exam is finishing up you could politely mention that you tried to fill out the DBQ. Ask the doctor if they’d like to refer to it as they’re writing up their results.
Keep in mind that you’re using the C&P exam and the DBQ as one more way of communicating with the system. You’re not trying to memorize the vocabulary or exaggerate your symptoms. You certainly want to avoid giving the impression that you’re a medical commando. Instead you’re making sure that the doctor has everything they need to write up their analysis for the VA, and so that you two don’t have to repeat it if anything is missing.
When you’ve filled out a DBQ (to help you and the doctor have a productive conversation) then you might be tempted to upload it to your eBenefits account. More evidence must be a good thing, right? I decided not to do this because I’m not trained on the best way to fill out a DBQ. I don’t understand all of the “right” techniques and I’d hate to make a rookie mistake. Instead I offered the DBQs to the doctors and let them decide how to include my ideas in their reports.
3000 words later I’m finally at a good stopping point, so I’ll finish this post off next week with the third part. If you haven’t already read the first post on filing the VA claim, then here’s that link again.
And in conclusion, here’s the last part of the series: What The VA Really Does With Your Disability Claim.