claim denied 3 Common Reasons the VA Denies Claims

Common Reasons the VA Denies Claims

In this post, we will briefly explain some of the most common reasons the VA denies claims. Many of these are easy to avoid with awareness and having someone on your team to help you with the process!

1. A lack of current disability. Most veterans know they must have a current condition to establish service connection. While it is easier to proceed with a formal diagnosis, the law does not require a formal diagnosis to be eligible for service-connected compensation. The two things to remember with a condition are: A. It must be related to service, and B. It must affect your functionality and or work/life earning. With that being said, psychiatric disabilities are some that a diagnosis is extremely beneficial to have moving forward.

2. No proof of in-service illness, event or injury. If there isn’t proof of an in-service illness, event or injury, veterans can get the testimony and accounts from other service members, friends and family, (often called lay statements),  who have knowledge of the in-service connection OR the impact on functionality and work/life earning potential. Any medical documentation is extremely beneficial. It’s also good to remember that exposure itself is not a VA disability. Any conditions that occur BECAUSE of exposure are. 

3. Not establishing a medical nexus between your disability and service. Most medical nexuses come from a C&P exam. Always request a copy of the findings from your C&P exams. If the exam failed to establish a nexus, you can seek a separate, private medical opinion. Lay statements and treatment records can also be submitted.

4. Lack of evidence. If you feel a C&P exam didn’t accurately describe your disability or the severity of it on functionality or work/life earning, bring it up to the VA. The VA has a “duty to assist”, meaning they are required to gather information that can help support the veteran’s claim. If they are unable to obtain records after making a reasonable effort, they must notify the veteran that they are responsible for providing the VA with any records.

CP exam Common Reasons the VA Denies Claims

5. A missed C&P exam appointment. The VA can deny your claim if you do not attend your scheduled C&P exam appointments. 

6. The wrong form was used. There are separate forms for almost everything with the VA claims/appeals process, and it’s crucial that the correct form(s) are used. A very important form is Form 21-8940, which is the Application for Increased Compensation Based on Individual Unemployment, and is needed for total disability based on individual unemployability (TDIU). If a veteran does not submit this form, it’s not unusual for the VA to deny the claim.

7. Missed form deadlines. Deadlines are important when filing or appealing with the VA. A veteran only has one year in which to file a Notice of Disagreement with the VA’s rating. A subsequent unfavorable decision gives the veteran 60 days in which to file a VA Form 9, to appeal to the Board. Read more details on form and appeal deadlines here.

If your think, or question, if your rating is lower than it should be, or just want to see if you are eligible for a higher rating, we are here to help! Fill out this form for a free consult with us – this helps us determine how we can assist! 

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