VA Benefits Appeal. To win a VA disability claim, a veteran must prove all elements. Generally, VA will approve a VA benefits claim when a veteran proves the following:
In-service event, disease or injury,
Current disability, and
Medical nexus between the in-service event and the current disability.
After you submit your claim, VA is obligated to issue a decision. Based on the evidence, VA may decide to approve your claim completely. Alternatively, VA may either deny the claim outright, or grant your benefits at a low disability rating. Regardless, veterans have the right to appeal any VA benefits decision to a higher authority.
What is the point of an appeal?
VA decision-makers are not perfect. They often make mistakes. For a disabled veteran who is barely making ends meet, VA’s mistakes can be costly. This is why Congress created the appeals system. It gives veterans a fighting chance to correct VA’s mistakes without losing years of benefits.
VA benefits appeals are great because they preserve the earliest effective dates. Take the example of J. Stone, who filed a claim for PTSD in 2011. VA denied his claim in 2013 because they could not confirm the traumatic in-service event. His friends told him to just file another claim. Instead, he consulted the experts at Disability Help Group (DHG).
A DHG representative helped him file an appeal along with evidence of the in-service event. In 2015, VA decided the appeal in Mr. Stone’s favor. As a result, he received a 70% rating effective 2011, the date he filed his claim. He received
Appeals in the Legacy System
The Legacy system refers to the VA appeals structure for decisions issued prior to February 19, 2019. When VA first denies a claim in Legacy, the veteran may appeal with a Notice of Disagreement (NOD). The deadline to file a legacy NOD is 1 year from the date of the decision.
When you file a timely NOD, you are asking a senior VA officer to overrule the previous decision. If the VA agrees with you, then it will issue a new decision awarding benefits. If not, VA will issue a Statement of the Case (SOC) to explain why the previous decision should stand.
Fortunately, an SOC is not the end of the road. Using a VA Form 9, you can appeal an SOC to the Board of Veterans’ Appeals (the Board). Unlike the lower decision, you have only 60 days to appeal an SOC. A VA Form 9 is a request for a Veterans Law Judge to take a fresh look at your case. If the judge finds in your favor, he/she will award benefits effective the date you first filed. If the judge finds against you, then you can appeal to the U.S. Court of Appeals for Veterans’ Claims.
The Appeals Modernization Act changed everything
Any decisions issued on or after February 19, 2019 fall within the Appeals Modernization Act (AMA). If VA denies your claim, or approves it with a very low rating, you can appeal it by filing one of these forms:
VA Form 20-0995 Supplemental Claim, 20-0996 Request for Higher Level Review, or 10182 Notice of Disagreement to the Board of Veterans’ Appeals
Each lane has its pros and cons. Visit this link for more details [Link to the AMA article].
What’s the downside of an appeal?
First, a VA benefits appeal can take a very long time. Take a look at the search results when you Google “VA appeals backlog.” Prior to the AMA, VA took an average of 2.5 years to process appeals.
Second, you may have to appeal several times to get the job done. If your first appeal is not successful, then you should appeal to a higher tribunal (like the Board of Veterans’ Appeals). When you believe in your claim, you should never give up. Don’t let VA win.
Hire an expert to give yourself the best chance to win
Every VA benefits appeal is different. The best indicator of success is having an experienced representative. This is a very complex system. Most veterans are not equipped to force VA to change a decision. Some cases already have the evidence needed to win, but are lacking a good legal argument. Other cases lack both evidence and argument. An experienced representative can plug the holes in your case.
At DHG, our experts review each case with a fine-toothed comb. This is how we figure out the best path forward. We don’t just file a VA benefits appeal and then wait around for VA to act. Instead, we actively develop winning evidence and arguments to deliver for our clients.
Do you need help with your VA benefits appeal? Contact the experts at DHG for a free consultation.
Disability Help Group, Call Now for a Free Case Review, 800-700-0652
Make sure you start your claim the right way and apply for all the benefits you deserve. Contact us now for a free consultation.
Because memory deficits are common VA TBI residuals, a veteran should always have an advocate. Disability Help Group specializes in TBI cases and is here to answer your questions now.
The Appeals Modernization Act has reduced the average time to receive a VA disability decision. Older claims typically took 3-7 years to receive a decision. In order to address this issue, Congress passed the VA Appeals Modernization Act in 2017. On February 19, 2019, VA officially implemented this new law. As a result, VA’s new goal is to complete claims and appeals in an average of 125 days. This reflects VA’s renewed focus to deliver timely decisions to veterans and their survivors.
The VA Disability Claims Process Applying the Appeals Modernization Act
Filing an Original VA Disability Claim
The Appeals Modernization Act applies if you have already applied for VA Disability Benefits. Therefore, if you are filing an Original Claim it will not apply at the time of filing. If you never filed a VA claim before, then you’ll need to file an Original claim. Per VA rules, you can only file an original claim using a VA Form 21-526EZ. The form asks for your Social Security number, dates of active duty service, branch of service, and other biographical information. Most importantly, you must briefly explain why your claimed disability is related to your active duty service.
Filing a VA Disability Supplemental Claim
When VA denies a claim, it must explain why. VA has always had this duty. However, the Appeals Modernization Act has enhanced this duty in the veteran’s favor. As of February 19, 2019, VA must explain to the veteran which elements he successfully proved. With that knowledge, a veteran should focus on getting evidence for the unproven element(s). This New and Relevant evidence could change VA’s mind. A veteran who obtains such evidence should submit it to VA with a Supplemental Claim.
Take the example of Joe Smith
Joe served in the Coast Guard for 3 years. In 1991, he filed an Original claim for PTSD. In a 1993 decision, VA denied the claim because there was no current diagnosis of PTSD. Joe was so discouraged by this decision that he did not file an appeal. During a 2019 visit to the local VA hospital, doctors diagnosed Joe with PTSD. Unsure of what to do, Joe contacted DHG for a free consultation. The experts at DHG agreed to represent him in a Supplemental Claim. DHG filed a completed VA Form 20-0995 on Joe’s behalf, along with a copy of the current diagnosis. Four months later, VA granted his PTSD claim at a 70% rating.
Appeals Modernization Act: Filing a Higher Level Review
This path improves on the Decision Review Officer (DRO) lane from the legacy system. The main difference is that if the claimant requests a telephonic hearing in Higher Level Review, VA must grant it. In the DRO lane, VA could reject a request for a telephonic hearing for any reason. Thanks to the Appeals Modernization Act, VA cannot delay your right to a hearing.
Sometimes, VA denies a claim even though it has evidence to satisfy all 3 elements. Either VA overlooked evidence, or it misunderstood the law it applied to the case. In either scenario, it’s not that the veteran failed to prove his case. VA just made a mistake. If VA’s decision is infected by that kind of mistake, then your best bet is to file a Request for Higher Level Review. This path involves an experienced VA adjudicator checking a Rating Decision for errors. This adjudicator may issue a revised Rating Decision that corrects these errors. And it does not require new evidence.
Appeals Modernization Act, but with slightly different facts
In this example, assume Joe filed an Original claim for PTSD in 1991. He filed the claim with a copy of a 1991 PTSD diagnosis and his service treatment records, which showed an in-service diagnosis related to a combat incident. In a 1993 decision, VA conceded all other elements were met except the diagnosis. Joe became discouraged and gave up. Years later, he asked a DHG rep to review his case. The DHG rep noticed that VA overlooked the 1991 PTSD diagnosis. DHG immediately filed a Request for Higher Level Review on VA Form 20-0996. DHG also attached a two-page argument that explained the legal errors. Five months later, VA issued a revised Rating Decision that granted his PTSD claim effective 1991. This is the benefit of the Appeals Modernization Act.
Filing a Notice of Disagreement to the Board of Veterans’ Appeals (BVA), using Appeals Modernization Act
What do you do if VA denied your Original Claim, Supplemental Claim, and Request for Higher Level Review? Your next option is go over their heads to the Board of Veterans Appeals. VA Form 10182 gives you 3 lanes:
Direct,
Evidence, and
Hearing
The Direct lane is for cases where all evidence and legal argument is already in VA’s records. The Evidence lane gives you 90 days to provide additional evidence. The Hearing lane gives you the right to make your case directly to a Veterans Law Judge. In the Hearing lane, you also have 90 days after the hearing to submit additional evidence.
Disability Help Group, Call Now for a Free Case Review, 800-700-0652
Allow us to help you win the most money you can receive in the faster manner possible. You may be entitled to significant compensation that you were not even aware of. Contact us now for a free consultation, 800-700-0652.
You should hire a VA disability lawyer, especially from https://www.lipconlawfirm.com/truck-accidents/. With a budget over $217 billion, the U.S. Department of Veterans Affairs (VA) is one of the largest federal agencies. VA’s disability benefit program was intended to be veteran-friendly. However, for most veterans, applying for VA benefits is a long and frustrating process. A veteran who represents himself is at a huge disadvantage. There are hundreds of rules and regulations about the veteran’s rights and VA’s duties. The process becomes even tougher when VA sends mixed messages, requests information it already has, or issues a decision that completely ignores the evidence.
Do You Have the Expertise?
Most veterans have not studied VA disability law. Even fewer veterans follow the Federal court cases that change the law every year. But without that knowledge, many VA claims are doomed to fail. A VA Disability Attorney’s knowledge and experience can make all the difference. Specifically, an attorney, especially the professionals from https://www.denvercocriminaldefenselawyer.com/, can determine exactly how to turn a loss into a win.
Who Needs a VA Disability Lawyer?
Beeman Heifner Benge – Personal Injury Lawyers says that in this fight, a veteran needs someone who is aiming for the same target. That’s why many of our clients left previous arrangements. Before hiring DHG, many of our veteran clients did not have a VA disability attorney. Some represented themselves. They learned very quickly that VA didn’t share the same urgency and had a different result in mind. Others were represented by a Veteran Service Organization (VSO) such as DAV or American Legion. Because they work out of VA facilities, there is a perceived conflict of interest. Does a VSO work for VA or the veteran?
What is a VA Disability Lawyer’s Role?
Your VA disability claim is too important to risk. When you hire a VA Disability Attorney, you’re hiring your own specialist to get the job done. Most of them work for a contingency fee. They don’t get paid unless they win past-due benefits for the veteran. And because the contingency fee is usually a fixed 20%, the attorney has every incentive to win the largest possible award. Plus, the attorney-client relationship ensures he/she is on your side. Both you and the attorney would be aiming at the same target.
An experienced VA Disability Attorney knows VA’s written and unwritten rules has the knowledge to prepare a game plan to best achieve your objective. Working together with your attorney, you have a better chance to hit your target.
When Should I Hire a VA Disability Lawyer?
Immediately! The earlier you can prove your case the faster you can receive your VA disability benefits. In addition, the VA Disability Lawyer will be able to analyze your disability onset date and make sure you receive the maximum back benefits, according to an experience elder abuse law firm Chicago. Generally, a veteran must prove the following to win a VA disability claim:
Current diagnosis,
In-service event, disease or injury, and
Medical nexus between the first 2 elements.
If you don’t have a medical diagnosis, then you need to see your doctor. Only licensed medical professionals can diagnose medical conditions. Attorneys cannot do so. However, if VA denies your claim for any of these reasons, you should probably hire a VA Disability Lawyer:
Negative medical nexus (“less likely than not”),
No documented proof of in-service event, disease or injury, , or
VA ignored evidence proving all 3 elements.
Which VA Disability Lawyer Should I Hire?
VA Accreditation
Only attorneys who have been accredited by VA can represent veterans in disability cases, as a result, VA holds Disability Lawyers to a high ethical standard. Accreditation reflects VA’s standard for responsible, qualified representation of this nation’s veterans. A searchable database of VA accredited attorneys, claims agents and VSOs is available here.
Experience
Experience makes a world of difference. Since 1993, the National Organization of Veterans’ Advocates (NOVA) has been the leading organization for training and support of VA Accredited representatives. At Disability Help Group, our representatives are long-standing NOVA members. You know what you are looking for, the https://www.sweetesq.com/car-accidents/ has all details you need and you can choose your lawyer easily.
Speak to The Lawyer
There are many firms out there that you never get to speak with the attorney. At Disability Help Group our representative will talk to you and be your main contact during your entire case. When you hire an attorney you should ask:
When will I get to speak with my lawyer?
Who will be my main point of contact?
How many cases has my lawyer won?
Disability Help Group, Call Now for a Free Case Review, 800-700-0652
Has VA ever denied your case? You may be entitled to significant compensation. Contact us now for a free consultation.
If you do not understand how VA rates or weighs TBI residuals this article will help.
Are Your VA TBI Residuals Related to Service?
Before VA will assign a rating for TBI, it must first determine whether it is related to service. The question is whether VA should award service connection for TBI. Generally, VA will deny service connection for TBI unless the following elements are met:
Proof of a current diagnosis,
Proof of an in-service event, disease or injury,
and
Proof of a medical nexus between the first 2
elements.
Do you have a current TBI diagnosis
If you file a claim for TBI without a confirmed diagnosis, then you should expect VA to deny the claim. It is not enough for the veteran to say they have VA TBI residuals. Before VA will rate TBI, it must confirm that it has been medically diagnosed. For VA purposes, only one of the following specialties can diagnose TBI:
Neurologist,
Neurosurgeon,
Physiatrists, or
Psychiatrist.
Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. If you had sudden head trauma during service, you may have VA TBI residuals in the following areas:
Cognitive (such as decreased memory, concentration, or attention),
Emotional/behavioral (such as anxiety, crying spells, short temper), or
Physical (such as seizures or balance problems)
If you have any of these symptoms, then you should probably get checked for a TBI. To prove the current diagnosis element, one of the approved specialties must provide the diagnosis.
In-service event, disease or injury
According to the Department of Defense, more than 313,816 service members have sustained a TBI in training or combat. Common causes of this kind of head trauma include blast-related concussion events resulting from training or combat. In fact, TBI is known as a signature injury of the Iraq and Afghanistan wars due to the frequency of IED attacks. However, a simple fall down a 10-foot ladder could also damage the brain.
If you cannot prove that your VA TBI residuals are related to service, then VA may assume that it happened after discharge. For this reason, it is critical that service members document any and all head injuries. Your case is much easier to win if head trauma is clearly documented in your service medical records. In the absence of official records, statements from witnesses would be helpful.
Medical nexus is required to prove VA TBI residuals
Proving the first 2 elements of the claim is not enough. To win a TBI claim, you still need medical evidence linking your current diagnosis to the in-service event. In most cases, a statement from your doctor can provide a medical nexus.
Fortunately, a medical nexus does not have to express 100% certainty. Instead, here is the question: is it at least a 50/50 chance that the TBI was caused by in-service head trauma? If your doctor’s answer is “Yes” and he provides a reasonable explanation, then you have your medical nexus.
Rating VA TBI Residuals
After VA concedes service connection for TBI, it turns to the rating percentage. The rating percentage determines how much money VA must pay to the veteran. The ratings for TBI residuals are covered in the VA Schedule of Ratings.
VA divides the rating criteria for VA TBI residuals into 10 categories. Veterans are then rated based on the level of severity and impairment in each of these areas:
Memory, attention, concentration and executive
functions: Executive functions include goal setting, planning, self-monitoring,
and flexibility in changing actions when they are not productive.
Judgment: Is the veteran able to make reasonable
decisions?
Social interaction: How often does the veteran
act appropriately in social situations?
Orientation: Is the veteran aware of who, where,
and when he is?
Motor functions: Is the veteran able to perform
previously learned motor activities (such as riding a bike)?
Visual spatial orientation: Does the veteran get
lost even in familiar surroundings? Is
he able to point at or name own body parts?
Subjective symptoms: Symptoms that cannot be
measured with objective tests, such as panic attacks and thoughts of suicide.
Neurobehavioral effects: Examples include lack
of motivation, verbal aggression, physical aggression, and lack of empathy.
Ability to communicate: Can the veteran
communicate either by spoken or written language? Can he communicate basic needs?
Consciousness: Is the veteran in a coma or a
vegetative state?
VA rates TBI residuals on a scale of 0, 1, 2, 3, or total. Each increment corresponds to a disability rating:
0 = 0% (normal functioning)
1 = 10% (mild)
2 = 40% (moderate)
3 = 70% (severe)
Total = 100%
If any residuals of TBI are rated “total”, then VA will award a 100% rating. If no residual is rated “total”, then VA must rate based on the highest rated residual. For example, let’s say a veteran has TBI residuals in 3 out of the 10 categories. He has a 1 for Judgment, a 3 for Ability to Communicate, and a 2 for Orientation. In this example, VA will award 70% because 3 is the highest residual rating.
Because memory deficits are common VA TBI residuals, a veteran should always have an advocate. Disability Help Group specializes in TBI cases and is here to answer your questions now.
VA rates TBI residuals on a scale of 0, 1, 2, 3, or total. Each increment corresponds to a disability rating. 0 = 0% (normal functioning); 1 = 10% (mild); 2 = 40% (moderate); 3 = 70% (severe); or Total = 100%.
How does VA review TBI residuals?
VA divides the rating criteria for VA TBI residuals into 10 categories. Veterans are then rated based on the level of severity and impairment. For example, Neurobehavioral effects include lack of motivation, verbal aggression, physical aggression, and lack of empathy.
What medical nexus proves TBI?
To win a TBI claim, you still need medical evidence linking your current diagnosis to the in-service event. In most cases, a statement from your doctor can provide a medical nexus.
Understanding the basics will help you learn how VA Rates TBI. Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. According to the Department of Defense, more than 313,816 service members have sustained a TBI in training or combat. Common causes of this kind of head trauma include blast-related concussion events resulting from training or combat. In fact, TBI is known as a signature injury of the Iraq and Afghanistan wars due to the frequency of IED attacks. However, a simple fall down a 10-foot ladder could also damage the brain. Any veteran who suffered TBI during service should obtain a VA rating to fairly compensate for this significant injury.
Only Specific Doctors can Diagnose TBI
Because TBI involves damage to the brain, it may affect nearly every other body system. Any symptoms secondary to the initial brain trauma are called residuals. Before VA will rate TBI, it must confirm that it has been medically diagnosed. For VA purposes, only one of the following specialties can diagnose TBI:
Neurologist,
Neurosurgeon,
Physiatrists, or
Psychiatrist.
Ultimately, TBI is a medical question best answered by a doctor. However, a veteran and his family should be on alert if any common TBI residuals present themselves.
Common Residuals – VA Rates TBI
There are 3 main areas of dysfunction that may result from TBI:
Cognitive (such as decreased memory, concentration, attention, and executive functions of the brain)
Emotional/behavioral (such as anxiety, crying spells, panic attacks, short temper), and
Physical (such as motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems).
If you have any of these symptoms after a sudden hit to the head during service, then you should get checked for TBI immediately.
VA Rates TBI
After VA concedes service connection for TBI, it turns to the current TBI residuals. VA divides the rating criteria for TBI residuals into 10 categories. Veterans are then rated based on the level of severity and impairment in each of these areas:
Rating based on level of severity
Memory, attention, concentration and executive functions: Executive functions include goal setting, planning, self-monitoring, and flexibility in changing actions when they are not productive.
Judgment: Is the veteran able to make reasonable decisions?
Social interaction: How often does the veteran act appropriately in social situations?
Orientation: Is the veteran aware of who, where, and when he is?
Motor functions: Is the veteran able to perform previously learned motor activities (such as riding a bike)?
Visual spatial orientation: Does the veteran get lost even in familiar surroundings? Is he able to point at or name own body parts?
Subjective symptoms: Symptoms that cannot be measured with objective tests, such as panic attacks and thoughts of suicide.
Neurobehavioral effects: Examples include lack of motivation, verbal aggression, physical aggression, and lack of empathy.
Ability to communicate: Can the veteran communicate either by spoken or written language? Can he communicate basic needs?
Consciousness: Is the veteran in a coma or a vegetative state?
TBI disability rating
0 = 0% (normal functioning)
1 = 10% (mild)
2 = 40% (moderate)
3 = 70% (severe)
Total = 100%
If any residuals of TBI are rated “total”, then VA will award a 100% rating. If no residual is rated “total”, then VA must rate based on the highest rated residual. For example, let’s say a veteran has TBI residuals in 3 out of the 10 categories. He has a 1 for Judgment, a 3 for Ability to Communicate, and a 2 for Orientation. In this example, VA will award 70% because 3 is the highest residual rating.
Special Monthly Compensation -VA Rates TBI
If you are trying to get the most VA compensation for TBI, then do not stop at the standard rating criteria. Depending on the circumstances, a veteran may be entitled to Special Monthly Compensation for TBI. This would be in addition to any ratings VA assigns under § 4.124a.
How We Won This Case
We represented a 30 year-old combat veteran of the Army. He came to us with a 10% rating for residuals of TBI. After developing the case, we urged VA to rate his TBI residuals at no less than 70%. In addition, we discovered that his mother had been his primary caregiver since his return from military service. Among other duties, the veteran’s mother assisted with medication management, personal hygiene, reminding him of and taking him to appointments, and paying his bill. The local VA hospital had already appointed the mother as his VA caregiver. We argued that the record clearly showed the veteran has a permanent need for regular aid and attendance due to his TBI. In response, VA increased the TBI rating to 70% and granted Special Monthly Compensation at the (r)(2) rate. As a result, the veteran’s monthly payment changed from $264.02 to $8,343.91.
Every C&P exam involves the doctor asking questions of the veteran. The doctor relies on the veteran to explain his symptoms, some of which may not present or observable on the day of the exam. Because memory deficits are common TBI residuals, a veteran should attend C&P exams with a spouse, family member, or friend who knows them well. They can fill in the blanks if the veteran is unable to either remember or communicate certain residuals during the exam.
