What The VA Really Does With Your Disability Claim

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This is the final part of a three-post series on why you want to file a VA disability claim (even if you think you’re not disabled) and what goes on behind the scenes.

The first post explained why you want to file your disability claim, not just how to file it.  The second post explained why you should prepare as much of your claim as possible up front as a “fully developed” package and described various techniques to handle the Compensation & Pension exams. Now we’ll wrap it up with the VA’s actions and your final decisions.

 

After the C&P exam

Image of the Veterans Administration logo with a link to your eBenefits account | The-Military-Guide.com

Click here for your eBenefits account.

When you leave the doctor’s office, you still have homework to finish.

The most important task is taking notes on anything you heard or thought of during the exam that you need to research later. Your hot washup (and the actions you take afterward) might help you avoid weeks of confusion which could slow down your claim or even cause a denial. When you’re back home, review any recordings or other thoughts and add your notes to your personal record of your VA claim. If a problem crops up later, this reference will help you keep track of the chronology and maybe even identify mistakes.

Pro tip: the C&P doctor is not treating you, but they may suggest other treatments or physical therapy. Follow up on those suggestions– they may help improve your health! If you seek additional treatment or physical therapy, upload those records to your eBenefits account so the VA can see that you’re still seeking treatment for the disabilities that you’re claiming.

Save all of your papers from the C&P exams, including the notification letter for your appointment. If the VA has questions (or if your claim is denied) then you (or your lawyer) may need to follow up with the doctor. The VA will also send you a feedback survey which asks for the name of your doctor. If the doc did a great job (or if you felt there were issues) then that survey is the best place to let the VA know.

The VA can’t use your feedback survey to evaluate your claim, but answering the survey questions will help you review your records again. If the C&P doctor isn’t doing a good job for the VA, then your frank feedback could avoid problems for many other vets. Besides, if you skip out on the surveys then the eBenefits website might decide that your account is incomplete.

 

What happens next?

Once the C&P exam is returned to the VA, their raters translate the doctor’s ICD codes and analysis into specific disability percentages. That process is completely out of your control, and most of it is also difficult to reverse engineer from a search engine. (We’ll get back to that in a few paragraphs.)  After the raters determine the numerical value of each disability, they’ll calculate an overall disability rating.

Disability math is equally confusing, and it’s an entire other post. Thankfully I won’t have to create it because my blogger mentor Ryan Guina has already written an excellent summary of the math of a VA disability rating. You can also listen to his podcast about determining how the individual disability ratings are combined into a final score.

Once your rating has been determined, the VA figures out your compensation.

Here’s another rookie mistake:  for many years, I naïvely assumed that the disability rating for retirees was multiplied by your pension to figure out how much you’d be giving up for tax-free compensation. This gross conceptual error kept me blissfully ignorant of why I needed to file a claim right away. After all, if I was “only” 10% disabled and that saved me taxes in the 15% bracket, then I was just saving 10% x 15% = 1.5% of my pension, right?

Um, no. Not only is this <buzzer> wrong wrong wrong, the first post of this series listed several other very compelling reasons to file your claim. Learn from my mistakes.

The VA rater enters a set of compensation tables with your rating, as well as your marital & family status. (Remember giving them a copy of your marriage license and your kids’ birth certificates?) The veterans compensation benefits rate tables show exactly how many dollars you’ll receive, or how much of your pension you may be giving up. If you’ve entered your financial account numbers into your eBenefits account then the VA is ready to send you money (and eventually tax forms).

 

Show me the money?

If you’re a military veteran yet not a military retiree, then that VA money is headed your way. Remember that you’re also potentially eligible for a host of other veteran’s benefits from vocational rehabilitation to medical care to education to reduced fees on VA loans.

But by now a few of you retirees are thinking “Wait, what? Giving up pension?!?” Well, yeah. It’s the VA disability compensation offset.

Your military pension is paid by the DoD but your disability compensation is paid by the VA. Even though you’re disabled, the law says that if you’re less than 50% disabled then all you get is a tax break. You give up a dollar of your (taxable) DoD pension for every dollar of (tax-free) VA disability compensation that you receive. This reduces your taxable income (and your tax bill) without actually creating a new stream of income.

However if you’re 50% or more disabled, then you’ll keep both your pension and your VA compensation. Read Ryan’s post on Concurrent Retirement Disability Pay for the details.

If you’re at least 10% disabled and it’s connected to combat (or training for combat, or hazardous duty, or an “instrumentality of war” that injured you instead of the enemy) then you’re eligible for the Combat Related Special Compensation program. That might completely eliminate the VA disability compensation offset, or it might only reduce it a little. The requirements are complex and confusing, but read about the details in Ryan’s CRSC post.

If you believe that you’re eligible for either CRDP or CRSC, then contact your VSO to work it out with the VA and DFAS. (How’s that for acronym jargon bingo?) You’ll have to apply with both the VA and the Defense Finance and Accounting Service because they’re separate programs with different verification requirements. You may also be eligible for backdated compensation. Those details are far beyond the scope of these posts and they have highly individual answers, so read Ryan’s posts at TheMilitaryWallet.com and contact one of us if you have questions.

 

Just a few more things.

When your claim is finished, the VA archives all of their work in their claims file (also known as a “C-file”). Once your claim is finished, even if you agree with everything, remember to file a request for a copy of the file. You want to have your own record of your claim in case your situation changes over the years, and you’ll absolutely need your C-file if you’re appealing the results of your claim. Talk to your VSO, or read more about obtaining your C-file at Nolo’s legal website.

It’s possible (yet unlikely) that years from now the VA will re-evaluate your claim. They might have made a mistake, or the medical evidence has changed, or you may have claimed an additional disability which re-opened the question of one of your original disabilities. Save these documents for the rest of your life. It’s also remotely possible that your survivors will need the data to protect their survivor benefits.

Let’s make one thing clear: if you disagree with the VA’s decision on your disability claim, then get a copy of your C-file and review it with your VSO. The VSO can explain the VA’s claim letter and maybe even find the paper trail in your C-file. If that explanation isn’t satisfactory then you should decide whether it’s worth your time (and money) to hire a lawyer. Again, every claim letter is a highly individual assessment, and I can’t help you figure out why the VA made the decision they did. Consult a lawyer and decide whether the possible compensation is worth the very real cost of time & effort (and legal fees).

 

My personal details of my VA disability claim

(Some of the readers have asked. If you don’t care then you can skip this section.)

I submitted my “fully developed” claim in February 2016, nearly 14 years after retiring. (The first post in this series explains how I made that mistake.) I’ve finished the C&P exams and I’m waiting for the VA to ask more questions– or to determine the disability rating I just got word from the VSO on 2o April that the VA has everything they need.  They’ve turned the claim over to the raters for processing and determining the disability rating.

My injuries are relatively minor yet all too common among vets:

  • Tinnitus. (Both ears.) For my fellow submariners, it’s 12-18 KHz tonals but no broadband (yet).
  • Hearing loss. People seem to sneak up on me from behind. I have trouble picking higher-pitched voices out of background noise, much to the disgust of my spouse and daughter.
  • I’ve torn the ACLs in both knees and scraped up the cartilage in all four meniscuses (“meniscii”?). I’ve stressed the surrounding tendons. My left tibia is rotated a few degrees outboard. There’s less joint space between my tibias & femurs and extra bone growth around my medial meniscuses. The damage shows up on an X-ray as early degenerative osteoarthritis. It’s constant minor pain (2-3 out of 10).
  • I have a submarine history of ear infections, respiratory viruses, bronchitis, and pneumonia. That continued through shore duty but it finally eased up in retirement. Chronic fatigue? Stress? Atmosphere control chemicals? I still take a daily antihistamine for congestion.
  • If you were inport Subic Bay during the eruption of Mount Pinatubo in June 1991, please contact me to discuss the hazards of inhaling volcanic ash for 24 hours.

As I said, minor. My tinnitus and hearing loss is a hazard of submarine engine rooms (even despite excellent hearing protection) yet millions of civilians cope with those conditions every day. My knee pain is reduced with exercise (surfing, walking, squats, lunges) and ibuprofen. I’ve given up skydiving, skiing, basketball, and (regrettably) taekwondo. I can run if I must, but no triathlons or even 5Ks for me. My lung capacity is down to 70% but (frighteningly) that’s considered “normal for a man of my age”.

Everything probably adds up to a disability rating of 30%. Again, for more details on those numbers (including the dreaded “bilateral” factor), read about the calculations and the math of the VA disability rating at Ryan Guina’s excellent post on The Military Wallet.

 

Call to action:

Every blog post should inspire you to go forth and do something. Here’s what you can tackle after reading this post.

If you’re on active duty: Make sure everything is documented in your medical and service records! If you’re concerned that the military medical community may ground you (or even disqualify you) then at least take care of your health with a civilian doctor (and get a copy of those records). Even if an injury or illness is your own dumb fault, it’s still likely service-connected and could someday be eligible for disability compensation.

If you’re leaving active duty: When you have your separation physical, discuss all of your lingering medical issues and seek treatment for them. (You have to show that a disability impacts your life, and you have to seek treatment for it.) Get a full copy of your medical record and get started on your VA disability claim.  Don’t wait– I can affirm that the process does not get easier after 14 years.

If you’ve already separated: Contact your local VA Regional Office or a veteran’s organization to find a VSO. Once they’ve answered your questions then you can decide on filing a claim. Remember, if you don’t file a claim now, then someday your family members (or your survivors) may have to do it for you in order to obtain your benefits. Save everyone the trouble and file your claim now.

If you’ve already filed a claim: When you receive your claim letter, apply for a copy of your C-file! It’s the only way to check for accuracy, and you’ll absolutely need it if you’re appealing the claim. Even if you agree with the VA’s decision, get that C-file. Someday you (or your family, or your survivors) may have to upgrade your claim and they’ll need the information.

If you disagree with your VA disability claim results and you want to appeal: Get a copy of your C-file, discuss it with your VSO, and (if you’re still not satisfied) find a lawyer.

 

 

Related articles:
Lessons I Learned Filing For Disability Benefits
How NOT To Do It: Applying For VA Disability Years After Military Separation



WHAT I DO: I help you reach financial independence. For free. I retired in 2002 after 20 years in the Navy's submarine force. I wrote "The Military Guide to Financial Independence and Retirement" to share the stories of over 50 other financially independent servicemembers, veterans, and families. All of my writing revenue is donated to military-friendly charities.

10 Comments
  1. Reply
    Donald Deabler October 11, 2017 at 2:15 PM

    The 3-part series was VERY informative, thank you. Since I’ve already submitted a FDC, mostly what you did for me was affirm that I have a great VSO working for me. My claim involves in-service experiences from 40 years ago, but I never connected them to my problems until last year, when a former shipmate found me accidentally and inquired about my life. When I told him things had never been very good, he said, and I quote, “I remember what happened to you, and I remember feeling bad I didn’t intervene. If you want to make a claim, you have a witness.” I wound up getting two detailed eyewitness accounts, which my VSO says is a rare thing. My question is, based on your experiences, how much do “buddy statements” affect the overall process, timeline and final rating?

    • Reply
      Doug Nordman October 14, 2017 at 1:18 PM

      I’m glad it helped, Donald!

      The fully-developed claim is processed much more quickly by the VA, because you’ve already done most of the work for them. They don’t have to hunt down other medical or service records (although that is eventually accomplished) and they don’t have to chase down other sources like civilian medical records (or buddy statements). You’ve already given them everything they need to make their decision, or at least that’s what you’ve promised them. From that perspective, the buddy statement greatly speeds up the process.

      The real benefit of a buddy statement is that it’s how the VA verifies your disability claim is service connected. Unless you have other documentation in your service or medical records, it’s probably impossible to get the claim approved without the buddy statement.

      The buddy statement gets your claim into the system (because your claim is now service connected). After that, the timeline and the final rating depends on the C&P exams and the VA’s raters. You’re already using a VSO, so you’ve already optimized your claim. Make sure you have your eBenefits account set up, along with the correct family & financial data, and then check it every few weeks. You should continue to seek treatment for your symptoms. That not only can improve your health, but it also demonstrates to the VA that your disability is “continuing” instead of “cured”.

      Please let us know how it works out.

      • Reply
        Donald Deabler October 22, 2017 at 10:09 AM

        OK, now I have another relevant question. Although we had submitted a 781a and attached supporting statements, I received a request for same. I simply resubmitted the originals electronically, and within a week of that have already attended my PTSD C & P Exam. The question is “does the examiner read the 781a and attachments, and factor them into the final report?”

      • Reply
        Donald Deabler October 14, 2017 at 9:32 PM

        Considering I’m currently a HUD/VASH client, and “Chronic PTSD” has been on my (extensive) Problem List for a decade, I’m betting they can figure out the condition is a continuing one. As I said, I never connected the dots before to realize I have a valid claim. I do have my eBenefits and HealtheVet accounts active and up to date, and I recommend the same for any Veteran I meet, and have helped many set them up. I and a friend have set up an internet “Rolodex” of sorts in an effort to give back to the Veteran Community, but after 6 months we haven’t attracted any participants.

  2. Reply
    John P. April 23, 2016 at 6:28 PM

    Thank for post. I never thought of claiming benefits until last week when I received my navy reserve retirement package. As a reservist there is no exit physical or TAP program. Wondering where I stand. Any advice would be welcome

    • Reply
      Doug Nordman April 24, 2016 at 4:29 PM

      Thanks, John!

      Your best option is to talk with a VSO. Find one in your area from the VA’s website, or contact your local American Legion, Disabled American Veterans, or MOAA chapter. They’ll start with your big-picture questions and move into a review of your medical records. Their advice about what works (and what doesn’t) will save you a lot of what another reader calls “discovery learning”…

  3. Reply
    Ryan April 21, 2016 at 10:59 PM

    Excellent tutorial, Doug. The disability claim process can be a complicated, especially as more time goes by. I second your recommendation that everyone apply when they out-process the military, if possible. If that isn’t possible, then the sooner the better. It will never be easier if you wait longer!

    Good luck with your claim!

    • Reply
      Doug Nordman April 24, 2016 at 4:31 PM

      Thanks, Ryan!

      I just got the word that the VA has all the info they need, and the claim is with their rater for adding up the math. The decision should be made before August.

      • Reply
        Paul Eichholz August 8, 2017 at 11:52 AM

        I will be interested in the final results Doug. I too am an ex-submariner and have filed a claim for almost the exact same issues as you. I am scheduled for C&P exams starting this week. I too waited way too long, almost 17 years to file, I was an idiot!

        • Doug Nordman August 9, 2017 at 3:32 PM

          Thanks, Paul, and at least we’re trainable!

          I hate to give away the surprising conclusion of this saga, but here’s the post:
          http://the-military-guide.com/happens-va-disability-claim-approved/

          The short version is a 10% disability rating for tinnitus (because it’s what everyone gets for that condition) and a 10% disability rating for each knee (plus the bilateral factor).

          My hearing is still good enough that it’s rated at 0% disability, and my chronic rhinitis (respiratory problem) is also rated at 0%. The significance of 0% is that they’re considered service-related, so if they get worse then we won’t have to revisit that question– just whether they reach the 10% threshold.

          Although the volcanic ash from the Mt. Pinatubo eruption undoubtedly affected my lungs in the short term, the VA has not observed any long-term issues among us survivors– yet. The “good” news is that my presence at the eruption is documented in the claim file, so if there ever is a medical issue then the VA already knows it’s service-connected.

          The disability ratings math is subtractive (not additive), and there’s a lot of rounding of the numbers, but the result is (barely) 30%. For a married veteran without other dependents, that’s $455.75 per month. Since I’m receiving a military pension, I’m giving up $455.75 of (taxable) pension for the tax-free VA compensation. That amount is indexed to inflation so it goes up a little every year, the same as a military pension.

          Getting to a 40% disability rating would be a big step, and it’s not as simple as “just” another 10%. I’ve read what it’d take to have a 40% disability rating, and I’m trying to stay out of that club.

          After I received my rating (and the VA compensation) I filed a FOIA request for my claims file (the “C-file”). That took a year, and it came in the mail on a CD. I can tell that the VA pulled my medical & dental records from the St. Louis archives, as well as all the documents that I filed with my fully-developed claim. It’s nice to have everything in one place, and I’ve backed up that CD.

          Make sure you work through those Disability Benefits Questionnaires so that you understand what the C&P doctors are seeking:
          http://www.benefits.va.gov/COMPENSATION/dbq_ListBySymptom.asp
          I even offered the doctors a copy of my completed DBQs, and I can tell (from the C-file) that they used them.

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