How to successfully file a VA compensation claim

What you should know--and include--with your VA claim


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There are two ways to file a VA compensation claim: print the 526EZ and mail/fax it, or submit it electronically through VA and DoD’s eBenefits web portal. Most Veterans opt for the former, cross their fingers, and hope for the best. But unless you are just leaving the military, with well-documented and easily accessible service treatment records, this isn’t the best approach.

As a public affairs officer for the Veterans Benefits Administration (VBA), I wanted to learn more about the VA compensation claim process. So, I went to school. I recently completed training as a rater so that I could share with you the information and tips and tricks and suggestions I learned while working with those who rate claims for VBA.

Intent to file

The Intent to File is required, but here’s why it’s a good thing: It immediately establishes your effective date for pay purposes. Best of all, it only takes a few minutes to complete online in eBenefits. (You can submit your Intent to File online in eBenefits here)

We know that it may take you some time to gather all the evidence you need to support your fully developed claim (FDC), such as your service treatment records, private treatment records and DBQs, and written witness/buddy/commander/spouse/lay statements. The Intent to File for a VA compensation claim lets VA know that you are planning to file a claim, and it locks in your “backpay” date. You then have one year to complete your claim application.

What info does VA need from me?

To receive VA disability compensation, you must meet three criteria: an event in service that caused or aggravated a disability or illness; a current diagnosis of a medical disability or illness; and a medical opinion connecting the two (the latter as a result/because of the former).

  • Event in service is something that happened in service that caused or aggravated your current disability. For example, you fractured an ankle in service and now have arthritis in that ankle. Or, you served in Vietnam, were exposed to Agent Orange, and now have a disease that is considered presumptive for Agent Orange exposure;
  • A current VA or private doctor’s diagnosis showing that you have a medical condition related to the service event; and
  • A doctor’s opinion that the event in service and current diagnosis are connected. This is called the nexus. Unless the connection is obvious through your medical records, this opinion, or nexus, will usually come from your VA-scheduled Compensation & Pension (C&P) exam. For presumptive illnesses, VA presumes the connection between the documented event in service and the current diagnosed illness. In this case the nexus is established by law.

Without all three of these items, a VA compensation claim can’t be granted. It’s like a three legged stool – without any one of these legs, the stool will fall over. If you provide evidence of the first two items but not the third, VA will schedule you for a C&P exam to determine a doctor’s opinion for the third. Be aware that just because a doctor’s opinion is requested on service connection that that doesn’t mean a doctor will agree that your current condition is related to your service.

Write a statement in support of your claim

When filing your VA compensation claim, include a VA Form 21-4138. This is called the Statement in Support of Claim. It’s important to write a separate paragraph for each disability you are claiming. It’s equally important to explain how the event in service (be specific) affects your current disability or symptoms related to your injury or illness. Provide every piece of evidence from the event that you can think of, such as personnel records, award narratives, pictures, medical records, unit profiles, prescriptions, etc. If you don’t think this event is in your service personnel or medical records, find someone you served with to fill out a form to provide their witness statement to the event. While a witness statement alone usually is not enough to grant a claim, it can be combined with other evidence to strengthen a claim for service connection.

Your statement is considered evidence, just like your military or treatment records, and the rater will use it to make the decision. It also tells the rating team where to look in your records, and the timeframe for information to validate your claim.

Include medical records

VA can access treatment records from other VA and military medical facilities, but don’t assume that “VA has everything it needs.” Remember above: VA and military records are just one leg of the three-legged stool.

If you have your service medical records, include them as evidence. It also helps VA if you include where it was that you’ve been treated for your medical conditions on your application (name of treatment facility). You should also highlight the pages and passages that refer to your medical conditions, such as lab results and diagnoses, which may eliminate weeks or even months of processing time. Providing all of this information with your claim will help the rating team process your claim more quickly.

If you don’t have your service records, VA will request them from your military branch archives, but this can take several weeks or more. If you don’t have them and would prefer to request them yourself, contact the National Personnel Records Center (NPRC) here.

Compensation and Pension: Your C&P exam

Even if you submit all of your medical records, you may still be asked to go to a C&P exam. This is not a typical doctor’s exam. You won’t be diagnosed or treated, and in some cases, the doctor may just review your records—including any statements in your file—and ask you a few questions. While this may seem unusual for an exam, the doctor is actually filling in a Disability Benefits Questionnaire (DBQ), which the rater will use to determine if your claim can be granted, and at what percentage.

So, in the exam, be honest and specific with your answers. For example, if the doctor asks about an injury, instead of saying “I hurt my back in the service,” you should say “I was getting something off of a shelf in the warehouse and fell off a ladder. There is an accident report. My back has given me problems ever since.” This allows the doctor to connect an incident in service to the current disability, and the DBQ the doctor submits will contain an opinion that your disability is either more- or less-likely than not connected to your service. That’s the third leg of the stool.

What if I need help?

If all of this sounds like Greek to you, then you should either follow our helpful tutorials on YouTube that walk you through the VA compensation claim application process, or enlist the help (FREE) of a Veterans Service Organization (VSO) to assist you.

Then what?

Once you or your VSO has submitted your VA compensation claim, you can check on its current status in eBenefits (hover over “Manage,” then click on “View or update your Compensation and Pension (C&P) claim”). On the status page, you can view more detailed information by clicking on the claim date.

It’s important to note that, once you have submitted your fully-developed claim online, or by mail/fax, you are telling VA that you have no further evidence or information to submit. Submitting un-requested evidence or information after it has been submitted will cause a delay in processing.

Did you know?

By providing a more complete picture of your situation to the rating team when you file your VA compensation claim application, you not only make it easier for the raters to find your information and process your claim, but you also increase your chances of having your claim granted. Although it will take a little more effort on your part, it can pay off with faster VA processing, and will increase your chances of a successful claim the first time.

Remember, the rating team—most of whom are Veterans just like you—is on your side, but you can help them by including everything they need to approve your claim.

Author

Donna Stratford

Donna is a public affairs specialist in Veterans Benefits Administration Corporate Communications. She spent most of her career in government public affairs and communications. She recently completed Rating Veterans Service Representative training. Donna is an Air Force Veteran and retired from the Air Force Reserve.

Comments

  1. william cauthern    

    I just received my claims decision and it seems the VA has ignored my intent to file. The VA set the date for 111th May 2016, which is the date my SRO filed my claim. But I filed an intent to file on 17th Jun 2016. I believe that I now need to appeal in order to get back pay. I thought that the intent to file would lock in an effective date. Is this common and is there a quicker way to have them look a my effective date without appeal? Seem silly to clog the system with a easy fix.

    1. Gulf Vet    

      May 11th comes before 17th of June 2016. Next you may want to look at the laws to. If you gave the VBA medical evidence showing how you had the illness in your VA records for up to one year before you even filed the VBA can go back that year too. That is a part of the new regulation added in March 2015.
      Talk to your VSO.

    2. K. Robett Lewus    

      The filing date for the intent to File is the date of the claim unless that later date is the date of diagnosis. Dont need to appeal . Hopefully you have a copy of the submitted Intent to File with a date stamp or fax record. If it was submitted it is there and got missed. Make an appointment wuth a veterans service officer to assist.

    3. Michael E White    

      Hi My Name Michael I Wanted Know What Avg % For A Three Time Hernia Operation The Last Operation Withen Three Years

  2. Ronald E. Rytter    

    Only took 7 months to get a partial copy of my medical records.
    When I initially filed some years ago I used the State Veterans Office, they filled out the paperwork with one word statements, no explanations or medical reports. Was told the VA had all records and they would be able to research them and make sure you would be rated correctly. Learned that wasn’t true, you had better do your own research and make copies of your records and submit with claim.I’m sure anyone who reads this comment will laugh and think what a dummy should know the VA doesn’t do that, well folks I retired after 20 years 7 months and 2 days in 1981, when someone in an authoritative position told you something you could take it to the bank, so when I was told all was good I believed them, in today’s world you had better do your own research and file every Dr.’s note you can find.
    When you reach my age the old memory isn’t so good and most of your buddies are dead or you are unable to find them and of course their memory “ain’t what it used to be”.
    Am glad to see that there are site’s and places to get help, maybe just maybe the VA will catch up and it won’t take years that some of us don’t have to get claims settled. I have asked for the extreme age thing, have been told I’m in the Agent orange group so claims are expedited, still waiting.

  3. Glenn Starkey    

    It would be nice to be able to get my medical records. But I have not been able to accomplish that.

    1. Gulf Vet    

      You can get your VA medical records by going to the “Release of Information” ask for all dates.
      If you have been treated at more then one VAMC or CBOC let them know as they need to get those records too.

      You can get your military treatment records that are in your C-file with the help of your VSO by asking for everything in your C-file.

  4. Gulf Vet    

    Work with a good VSO or agent Claims for some things are easy while others take a lot of work and help for those that know that part of the law the bet. One type are claim for Gulf War Illness. 38 CFR 3.317.

    You can get some help from the National Gulf War Center.
    http://www.ngwrc.org

  5. Daniel F Hensley    

    The reference to finding out the status of a claim in ebenifits needs help. Ebenifits status really does not say much. A little more detain information would be very helpful and make us feel a lot better about the process. Also it sure would be helpful if letters from past claims and current mail was available for us to download. I never received all the letters they claim I had and some that I did I cannot now find.

  6. Bill Brown    

    Hi Donna,
    When you discuss the “3 legged stool”, is there a way you could work in the caveat on “presumptions” that apply in some VA recognized conditions and diseases- specifically with Agent Orange and other herbicides. Perhaps a lead in sentence ‘While some conditions and diseases approved by the VA are covered by a presumption, most require a Nexus….”
    Reason I suggest this is- that time after time I find vets who are exposure victims, who have not filed claims- because they believe it is incumbent upon them to locate a physician to establish their nexus. It is highly unlikely they will locate someone who can establish that nexus today, for events ranging back 45-50 years. Especially when it’s not necessary. Critical time is being lost! Possible to clarify?

  7. Donna Stratford    

    That’s a great suggestion Bill. I will post an update. Using the stool analogy, I would suggest that for presumptions, one leg of the stool is already there. I may do a separate blog on presumptions.

  8. Nate Franklin    

    How do you file for a claim where you have service connected diagnosis but was never rated but later developed the condition? Is there a waiting process and what is the process?

  9. Janice Brown    

    I need information on how to apply for benefits from my husband who is currently receiving benefits.

  10. Mr. Lee    

    I filed claim for a low back condition. I submitted three nexus letters from three different doctors, including my primary VA doctor. The letters were all opinions stating the bilateral service connected knee condition were related to my low back condition.

    I, Also submitted a MRI report detailing how severe the back condition had gotten.

    I know the VA will not consider or disregard my very valuable evidence. The will always accept…What
    ever the C&P doctors say. This is so unfair and unjust. The Veteran waste another 2 years fighting
    through a long appeal process.

    What is the remedy for this game that happens 90%
    of the time.

  11. Robert L. Malloy    

    Recently submitted a Compensation Claim after being discovered I have prostate cancer. Presently being treated with radiation. Was exposed to Agent Orange after serving tw0 tours on the ground in the Republic of Vietnam. It’s has been several weeks since my claim submission. Is there a specific number i can contact to follow up on my submission?

  12. Gregory Stanley    

    i retired September 2012 and file for va disability and i am still waiting!i have sent my medical records of over 100 pages
    and they still have not compensated me yeti have been deemed by social security disabled since 2012.

  13. John W. Schuft    

    I was crippled by a VA operation that went bad and applied for compensation in 2014,The request was denied on superficial and irrelevant grounds so I appealed and am still waiting.My state senator advised me to file a tort suit,but I am now 75 and really expected the VA to do the right thing,I have great respect for the VA and am amazed they do as well as they do considering the huge number of vets who rely on them ,but I feel they should reimburse me for my pain and extra expense!!

  14. Jerry & Susan Fortney    

    I applied for benefits two years ago and requested a copy of my medical records via the information process. When I received them from the va none of my Viet Nam records was on the cd. I filed my claim and statement and have not heard a word from them. Any advice what to do next.

  15. edward p domingo    

    I just want to inquire how long would it take for the processing of a death pension benefits of a veteran’s surviving spouse? I have submitted the application using the 21-534EZ form on Augutst 9,2016 without the Social Security Number of the veteran but with VA a file number. The only available files which i submitted are the marriage contract, death certificate of the veteran, Medicald identification card, copy of honorable discharge from the service and passports of the veteran and the surviving spouse. Could it be possible to generate other datas from the VA system inorder to complete the needed documents for the processing of the the claim. A million thanks.

  16. Beverly Edwards    

    What happens to your claim and appeal when the V A states they cannot find 4+ years of medical records with trreatmeants and diagnosis from WRAMC from 1994 -1998 on which all your TBI and other injuries are based and it’ going on over 8+ years the appeal has been going on? Does the Veteran not get the benefit of support when there is numerous supporting documention from 3-5 + MD specialists to support the claim but they never answer the question if they have found my records from that time frame some I can have a copy.

  17. Eric    

    The VA compensation claim process has been confusing and challenging for many veterans. Thanks for putting the effort into this post and offering your perspective. I know there will still be struggles, but I hope your three legged stool analogy helps others through the process.

  18. Stanley T. Williams    

    This post is specifically addressed to Mrs Donna Stratford.

    Mrs, Stratford, How do you file a successful VA benefits claim when you have been filing since 1986, and when you finally corner the run around, St. Louis Records said that your records were sent to Montgomery Alabama and sent proof that they were sent there. But Montgomery claim center is still to this day denying that they have them and meanwhile my family and I are on the verge of back to homelessness in February. I’m being offered job training and all that good stuff but how can you successfully complete any task when you and your family don’t have the basics or stability, because of the run around and constant changes (to continue the run around) that the Department of Veterans Affairs has taken you and your family throughout the years. Please let me know what we can do. Stanley T. Williams 205-317-2568. Or respond asap to this post

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