This episode's goal is to demystify some of the more confusing aspects of applying for VA disability benefits. I realize there are other benefits that the VA offers that are not covered in this episode. There are far too many resources to mention in any detail in just one episode. I'd be happy to do another episode sometime in the future if there are other benefits that would be useful to discuss.
Links & Resources
- How to apply
- When to use 3rd party for assistance
- Use VSO for assistance - mileage may vary but are typically free and can represent you
- Non-recognized organizations can assist, but not represent you
- VA math
- Fully developed claim
- Checklist for fully developed claim https://www.benefits.va.gov/FDC/checklist.asp
- What conditions are eligible
Today I want to do another solo episode. It’s been a while since I’ve done one of those. Don’t worry though, I have a bunch of great guests lined up over the coming weeks, so we’ll get back to hearing their stories next week. Actually, I only have a few more episodes to round out the second year of this podcast, which will be in the beginning of June so I’m pretty excited about that.
Anyway, today I want to talk about disability benefits from the VA for service connected conditions. I’m a member of several veteran related Facebook groups and I keep seeing some of the same questions over and over again from veterans about their disability ratings, how to apply, why the math of a rating change doesn’t seem to make sense, and a number of other things. So I figured I’d use this episode to unravel some of the mysteries behind VA disability claims as best as I can, because let’s be honest it’s all a bit of a mystery even if you’ve gone through the process before.
OK, so first I want to talk about who these claims are for. If you served - it doesn’t matter if you were active duty, reserves, national guard, or if you were in basic training at the time of a service connected injury or illness. If you served and got sick or injured while serving, had a pre-existing condition that got worse by your service, or a disability related to your service that didn’t appear until after you ended your service, you very likely could have a valid VA disability claim. You also generally have to have had an honorable discharge unless you can get your discharge reviewed and upgraded. There’s a whole process for that, which I’m not familiar with, but it is possible.
Now, a lot of people will say that they won’t apply for a rating because they say “I don’t want to take it away from someone who really needs it” or “I didn’t get blown up by an IED so I don’t deserve it.” That’s a bunch of crap. Anyone who has any condition that developed during their service should apply. You’re not taking it away from anyone if you apply. The only person you are taking it away from is yourself if you don’t apply.
The whole idea behind the disability benefits is that, well first off you’re not going to get rich off of it. At most, even if you’re rated at 100%, you’re looking at a little over $3,000/month depending on how many kids you have and if you’re married. The idea behind the disability payment is that it will compensate you for the condition you sustained while serving. This can offset lost wages or other expenses while getting treatment for your condition. If you can’t work due to your condition, it can offer you a basic level of income, which helps ease the burden of the condition you developed during your service. Again, you’re not going to get rich off of VA disability. If you’re not 100% rated it should be able to offset some lost wages while you get treatment for your condition.
For example, if you get rated for PTSD, you’ll likely find yourself taking time to go to appointments with a psychologist. This could take time away from work and result in lost wages. The VA rating helps by making up some or all of those lost wages. But it isn’t a system where you submit for specific lost wages. If you’re rated at a certain percentage, the VA compensates you based on that percentage, so it may or may not cover all lost wages. And if you’re worried that you’re going to take benefits away from someone else or you just don’t deserve it, these ratings aren’t always permanent. In the PTSD example, you may get re-evaluated a few years after your initial rating and your rating could get lowered or eliminated altogether depending on your progress. In other cases the rating may be permanent, such as if you have an irreversible condition.
So, what conditions are eligible for compensation? Way more than I’ll list off in this episode. There are over 800 disabilities that are eligible and you can find them on the eBenefits site. Things like chronic or long lasting back pain, breathing problems, severe hearing loss, tinnitus, scar tissue from a service related injury, range of motion injuries like if you can’t lift your arm above your head, for example, ulcers, cancers, a TBI, PTSD, depression, and anxiety are probably some of the more common issues service members might face. Now, just because you have one of these conditions doesn’t mean you’ll instantly be approved to receive compensation. You’ll have to prove that it was connected to something that happened to you in your service.
This leads me to my next point, which is if you are still serving, get everything documented. I know you may not want to go to sick call - it makes you look weak or like you’re shaming. E4’s have no excuse here, but everyone else get your butt out there and get your conditions documented. When you’re applying for a rating, one of the things that you’ll need to do is prove that the condition developed or got worse during your service. It’s pretty hard without a time machine to do that unless you get it documented while you’re still in service. Even things that you don’t think are a big deal at the time. A weird cough that you developed while deployed - that could be evidence of lung cancer from breathing in toxic fumes coming off of the burn pit on your base. Or, the ringing in your ears after a day at the range because your ear-pro didn’t fit properly. Speaking from personal experience here, I’ve had the same ringing in my ears for over a decade now. In my case it’ll be there for the rest of my life unless medical science comes up with some miracle cure. Regardless, no matter what the condition is, go talk to your doc and get it documented.
In my case, I ended up applying long after I got out of the military. I was actually told by someone when I was still in that tinnitus isn’t covered by the VA, so I just never bothered. I also wasn’t diagnosed with PTSD until well after getting out of the military, so I only recently applied for those even though I have been out since 2011. While the tinnitus was documented to some extent, it wasn’t documented all that well since only my hearing loss was really documented. I did have a couple things working in my favor though. Since I had an MOS where it was likely that I would come in contact with loud noises, the VA assumed that it was as likely as not that my tinnitus developed during my service. Similarly, for PTSD, I had zero documentation while I was serving because I avoided mental health like it was the plague. However, since I deployed and was awarded a combat badge or ribbon, they assumed that the PTSD was again at least as likely as not that it developed during my service, versus from some other unrelated tragic event.
So I didn’t have the most ideal package as far as documentation goes, but the reason I shared my situation is because it’s still possible to receive a rating even if you never had anything documented. It’s harder, but it is possible.
So, OK document everything. If you’re out now and never had anything documented, you’re not totally screwed, but you’re probably going to do a bit more work to get documentation. The VA does accept what they call “buddy statements”, which are written by people who are close to you that can attest to the impact your condition has on you. If you have any battle buddies that served with you who were with you when you got injured, you can ask them to write a buddy statement describing the incident, and even better how it has impacted you in your day to day life.
Before you apply, you will want to make sure you have all the evidence you can gather on your condition. This includes things like private medical records from your doctor, x-rays, MRIs, test results, lab results, and things like that. These records can come from a civilian doctor, a non-VA hospital, or some other treatment center. If you don’t have any of this, it’s OK. A civilian doctor report isn’t required, but it can help if your military medical record is incomplete. You can make an appointment with your doctor to get an exam, and ask them to provide you with any reports or results to include with your claim. We already talked about the medical records from when you served in the military. When I was in, I would make copies of any new paper that was added to my medical file. Then I kept it in a file at home so no matter what schmuck was handling the official medical file, I’d always have a copy of it. If you were injured on a deployment there was likely a mission report or an incident report, get your hands on that if you can. If you received treatment from the VA, you can login to your eBenefits account and download everything they have on you. Get all of it. Put together those buddy statements I talked about earlier. The VA says that you can submit letters from family members, friends, clergy members, law enforcement, or those you served with that can tell them more about your condition and how and when it happened.
Now that you have all of that information, you will want to file what’s called a Fully Developed Disability Claim. That basically means that you’re submitting everything the VA should need to determine whether or not to provide you with a disability rating. At this point, you’re not requesting any additional exams or for the VA to dig any further to determine your eligibility. I recommend this because if you’re relying on someone else to dig into records for you, it’s possible that they won’t find what they’re looking for and determine that the claim shouldn’t be approved. Personally, I’d rather know for sure what information they were working off of. And there isn’t any risk to doing it this way. If the VA determines if they need other records to make a decision, they’ll make the claim a standard claim and continue processing it as any other claim.
Once when you start a fully developed claim, you do have up to one year to complete it. This should give you plenty of time to get appointments, buddy statements, and gather documentation if you need it. When you submit your claim, if it’s approved, you will be paid back to the day that you started it. So, for example, if you start your claim today and don’t file for another year, then the VA takes two months to approve your claim, so 14 months total from the time you started your claim. For simple numbers, let’s say you were approved to get $1,000 per month. When your claim is approved you will get a lump sum of $14,000 since it was 14 months since you started your claim, plus $1,000 per month for every month after that. So the earlier you start your claim, the better it is for you as long as you think you can complete it within a year.
After you submit your claim, the VA may reach out to schedule what they call a compensation and pension, or C&P exam. This exam helps them rate your disability. Basically, they’re looking to see how severe your disability is, which affects the amount of compensation you’ll receive. Not everyone will have to have a C&P exam, but it’s possible that they will reach out for you to have this exam. Also, the C&P exam may be done by the VA or by a non-VA provider that they contract with. Your own doctor can do the exam too if they provide the necessary forms.
Now, assuming you went through the whole process to file your claim, went to the C&P exam, and the VA determines that you should receive a rating, you’ll get a letter in the mail describing their decision and how much your rating is. Assuming you agree with their decision, you’ll want to set up direct deposit so the money hits your bank account right away. The other alternative is to get a check each month, which could come a little later, and has a possibility of getting lost in the mail.
If you only are rated for one condition, the rating is pretty straightforward. If you’re rated at 10, 30, 50, 70% or whatever, that’s it there’s nothing more to it to figure out your rating. However, if you have multiple ratings for several conditions, that’s where things start to get a little fuzzy. The VA is notorious for using some funky math to calculate a total rating for vets with multiple ratings. For example, someone with two conditions that are both rated at 50% doesn’t have a 100% rating. They’d actually have a 75% rating, which gets rounded up to 80%. It actually makes some sense but you have to forget pretty much everything about math that you’ve ever learned.
The VA assumes that if you don’t have a rating, then you’re 100% healthy. You can’t be more than 100% healthy just like you can’t be more than 100% unhealthy. There’s only one of you, which can only be 100%.
So in that example of someone with two 50% ratings the first rating is applied to a 100% healthy person. So 50% of 100 is 50. That first rating gives that individual a 50% rating, which means that the person is no longer 100% healthy. They are now only 50% healthy. Pretty straightforward, so far, right? It gets a little wonky when you apply new ratings to that person. Any new rating will be applied against the remaining healthy portion of that person, which in this case is 50%.
The new 50% rating is where things get funky. This second rating is applied to a 50% healthy person, since the VA already determined that they’re no longer 100% healthy. So we have to take 50% of the remaining 50% healthy person, which gives us 25. That 25 is how unhealthy this new condition made the remaining healthy portion of this person. So, this person’s combined rating will be 75% because 50 plus 25 gives you 75. But wait, one more step. The VA rounds all ratings to the nearest 10%, so in this case, the veteran’s rating is 80%.
It gets harder and harder to increase your rating the higher you are rated. If that same person was rated 50% for a third condition, their total rating would only increase to 90%. Doing the math, the person is only 25% healthy now, so 50% times the remaining 25 gives 12.5. Add that to the 75 unhealthy portion, and it gives a combined rating of 87.5%. This gets rounded up to 90%.
VA math is weird isn’t it? But hopefully that clears up how it works. The VA has a ratings table, which is clear as mud. There are a few good online ratings calculators, which I’ll link to in the show notes so you can see how that works.
OK, now anyone listening to this should apply for a migraine rating after trying to figure out that math. Just kidding, don’t do that.
After getting your rating, if you happen to notice that the condition has worsened over time, you can apply for an increased claim. These ratings aren’t static, meaning that once a decision is made it can be changed. Since you’re rated for the disability, it was already determined to be service connected. Now you’ve noticed it has since gotten worse. You can apply to have your rating increased in this case.
In my case, it was determined that my hearing loss was service connected, but it wasn’t bad enough for me to be compensated for it so I am rated at 0% for it now. If that gets worse over time, I can apply for an increase and since it was already determined to be service connected, it is more likely for me to get that increase.
You may also have a secondary service connected claim. This could be for something like arthritis that was caused by a service connected knee injury. Or maybe migraines that you developed after being rated for a TBI. This type of claim is similar to any other claim in that you’ll need to provide documentation, such as medical records, and things like that. You will also want to get a doctor to sign off that this secondary condition exists because of the original service connected condition you were rated for. Again, as a, let’s say, 35 year old you probably wouldn’t expect that you would develop arthritis at such a young age. So if you had a service connected knee injury, it’s pretty likely that the knee injury caused the arthritis to develop. That would be a pretty good case for a secondary service connected claim.
If on the other hand, your initial claim was denied, you can file what’s called a supplemental claim, which provides the VA with new evidence to support your claim. Maybe you had a test that was done after you filed the original claim, or after it was denied, which has more conclusive evidence than what you originally submitted, it may make sense to file a supplemental claim after it is denied. Again, ratings and decisions can be changed so it isn’t the end of the world if you’re denied initially.
If you received a rating and you disagree with the rating, you can appeal the VA’s decision too. So all hope is not lost there. However, at this point you may want to work with someone who knows the process who can make sure you have all your T’s crossed and I’s dotted, and paperwork in line. Personally, I never worked with anyone else. I reached out to a few Veterans Service Organizations (VSO’s) and I never really got much help from them so I figured I’d just wing it and see how it went, which worked out fine for me. In all honesty, I never really pressed the VSO’s for help either. If I was a little more persistent, I may have gotten some better help from them. I just thought I could figure it out on my own. But I can totally see how that might not be the case for everyone.
Before I get too far with VSO’s and others who can help you out, I should mention why you may disagree with a rating. They’re not looking for something like “my buddy and I were deployed to the same location and went out on every mission together. We saw the same stuff. He got 50% for PTSD and I only got 10%, so I disagree with my rating because I think I deserve the same as him.” That doesn’t cut it. The VA uses guidelines for each condition, and a specific rating is assigned to each condition based on the severity of that condition. So your friend who is rated 50% for PTSD may have more severe symptoms than you do, so he got rated higher. I won’t go through all of the possible conditions and ratings because there are hundreds or thousands of combinations of conditions. I will put a link to a resource in the show notes that has a number of tables based on the conditions that you can read through. Find your conditions and see what the criteria for the various ratings are. Just as a quick example, mental disorders can be rated at either 0, 10, 30, 50, 70, or 100%. Using that example where your friend is rated 50% and you’re rated 10%, the guideline for 50% says:
Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.
On the other hand, 10% says:
Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.
So, if you’re able to perform your job on a day to day basis except for during periods of significant stress, and your buddy is having panic attacks several times per week, then you’re probably rated correctly.
I want to circle back to VSO’s for a minute. The VA recommends that you work with a VSO or an accredited Veterans representative to assist you with your claim. There are people and organizations who can legally represent you in your claim with the VA. They’ve been through specialized training to help veterans navigate the VA’s processes. Hopefully, this means they can break things down for you if you have trouble understanding what you need to do. So, these people can help you understand and even apply for VA benefits. They can help you gather supporting documents such as your doctor’s reports or medical test results. They can file a claim or appeal on your behalf, and even help with things like transportation to your appointments.
If you aren’t sure whether or not you can handle putting the documentation for your claim together on your own, reach out to one of these organizations. Generally, they won’t charge you any fees for your initial application unless there are unusual expenses. Be sure to talk to them about any fees that might come up though so you’re aware of how they work. However, after the VA has made a decision about your original claim, they can charge for their services if there are any other claims. So you might dispute a claim, or need some other help from them. If you want them to represent you, be sure you are clear about what fees they charge. Some may not charge anything, but you want to be clear on all of that stuff beforehand.
There are also other non-recognized organizations who offer their services to veterans to help get a higher rating. Almost all of these charge a fee to the veteran. I saw one who advertised that they charge 50% of the monthly increase that they get you for the first six months. So if you’re getting $1,000 per month, then ask them for help, and they get you bumped up to $2,000 per month, they’ll charge you $500 per month for the next six months. I know, more math, right?
If you’re rated at 10% and you think you should be rated much higher like 70 or 80%, I definitely wouldn’t suggest working with one of these companies. 10% is only around $140 per month. 70% is around $1,400 per month. That’s over a $1,200 difference, which would cost you around $600 per month for six months. You’d be better off trying to get the increase on your own at that point. Now, if you’re already rated at 70% and you think you should be rated at 80%, that’s only about a $200 difference, so you’d be charged around $100 per month for six months. Not quite so bad. All of these companies charge different rates. I’m just using one company’s fees that I saw as an example. Do your homework to figure out what they all charge.
I know it might seem like these companies are exploiting veterans, and I get that, but this is their job. Some are even owned by vets who struggled their way through the process themselves, and figured out how to help other vets through the process. If they offered their services for free they wouldn’t be able to keep a roof over their head or put food on the table, so I get the fees. I don’t think I would use their service personally, but I don’t think they are all bad either. I’m sure there are some bad ones out there, so again, do your homework if you want to work with any of them.
I guess my point is that there are a lot of VSOs out there who do the work for free, so if you need help, see how well they’ll work for you first before trying one of these non-recognized organizations.
OK, I think the last thing I want to talk about is how long it takes for your claim to be processed. I think the best answer is “results may vary”. My first claim was filed in August of 2019, and it didn’t get approved until February of 2020, so about six months. My second claim was filed in late October 2020 and it was approved in mid-November 2020. I really don’t know why one took six months and the other took a couple weeks. Maybe it was because of the type of claim, or maybe one had more complete documentation than the other. Honestly, I wish I knew.
Anyway, that’s all I have for this week. Key takeaways are to file your intent to file as soon as possible. Get all your records in order, and if you’re still in get everything documented. I hope this helps. Thanks for listening.