Table of Contents
TL;DR
VA Claims 101: What the VA Evaluates
The VA disability system evaluates over 900 medical conditions, from chronic pain and sleep disorders to PTSD and hearing loss. Veterans who understand how the VA evaluates claims are better positioned to provide the documentation the VA needs for accurate assessment.
Successful claims aren't necessarily from veterans with the most severe conditions; they often come from those who understand what evidence the VA requires. Understanding medical evidence standards is fundamental to the VA's evaluation process.
The Three Elements the VA Evaluates
Veterans may receive denials for conditions they believe are service-connected. The VA follows a specific legal framework requiring three elements working together.
First, the VA evaluates whether there is a current medical diagnosis. This requires documentation of a diagnosed condition from a healthcare provider, stated in clear medical terms.
Second, the VA reviews whether something occurred during service that could have caused the condition—an injury, exposure, or documented incident that appears in service records.
Third, the VA examines whether medical evidence establishes a connection between the current condition and the service event. This is known as medical nexus evidence. Without this connection documented by a medical professional, even clear relationships may not meet the VA's evidentiary standards.
When any of these three elements is absent or inadequately documented, claims may be denied.
Different Claim Types Follow Different Standards
The VA evaluates different claim types according to different criteria.
Initial claims represent a veteran's first request for service connection for a particular condition. These require documentation of all three elements described above.
Increase claims address conditions already rated as service-connected but which have worsened over time. The VA evaluates medical evidence showing deterioration since the most recent rating decision.
Secondary claims address situations where a service-connected condition causes or aggravates another condition. For example, a service-connected knee injury that leads to chronic back problems. The VA evaluates whether medical evidence establishes that the already service-connected condition caused or worsened the secondary condition. The secondary condition doesn't require independent proof of service connection—only evidence that the primary service-connected condition caused it.
Example: A veteran with a 30% rating for a right knee injury from a parachute landing develops chronic lower back pain from years of compensating for the knee injury. A secondary claim for the back condition would focus on medical evidence showing the knee injury caused the back problems. Medical documentation establishing this causal relationship resulted in an additional 20% rating.
How VA Combined Ratings Work
The VA uses a combined rating formula that differs from simple addition. If a veteran has 50% for PTSD and 30% for a back condition, the combined rating is not 80%.
The VA applies a "whole person" theory—it considers the highest rating (50%), then applies the second rating (30%) to the remaining capacity (the other 50%). This means 30% of 50% equals 15%, resulting in 50% + 15% = 65%, which rounds to 70%.
VA ratings range from 0% to 100% in 10% increments, with each level corresponding to a specific monthly compensation amount.
Understanding Medical Evidence Standards
Medical evidence forms the foundation of VA disability evaluations. When medical documentation doesn't meet VA standards, even clearly service-connected conditions may be denied.
Veterans with legitimate service-connected conditions may receive unfavorable decisions when medical evidence doesn't address the specific criteria VA raters evaluate. The format and content of medical documentation matters as much as the diagnosis itself.
DBQs: Standardized Medical Documentation
Disability Benefits Questionnaires (DBQs) are standardized forms that capture medical information in the format the VA uses for evaluation. These forms address the specific diagnostic criteria VA raters apply when determining disability percentages.
Each condition has a corresponding DBQ with targeted questions about symptoms, severity, and functional impact. When a qualified healthcare provider completes a DBQ, the documentation aligns with VA evaluation standards, supporting accurate rating determinations.
Many healthcare providers are unfamiliar with DBQs or VA-specific documentation requirements. Veterans may receive general medical reports that don't address the functional impact criteria the VA evaluates. This disconnect between a veteran's actual limitations and what medical records reflect can affect VA decisions.
DBQ Documentation Considerations:
☐ The appropriate DBQ form exists for each specific condition
☐ Healthcare providers qualified to complete VA disability evaluations
☐ Comprehensive medical records available for provider review
☐ Detailed symptom documentation showing frequency and severity
☐ Sufficient appointment time allocated for thorough evaluation
☐ Completed DBQ reviewed for completeness before submission
Independent Medical Evaluations and VA C&P Examinations
The VA may schedule a Compensation & Pension (C&P) examination when existing medical evidence is insufficient for the VA to make a rating determination. These examinations are provided at no cost to the veteran.
Independent medical evaluations provide veterans with additional documentation options. Veterans can select healthcare providers who specialize in their specific conditions and who understand VA evaluation criteria.
When comprehensive independent medical evaluations provide thorough documentation of a condition's full scope and functional limitations, the VA may have sufficient evidence to make a determination without requiring additional examinations.
The Claims Process Timeline
Many veterans submit claims before gathering complete documentation, often due to financial pressures. However, incomplete claims may face longer processing times or require additional evidence requests.
Effective claims preparation begins well before submission. This includes obtaining military service medical records, post-service treatment records, and identifying documentation gaps. Missing records can be requested, though this process requires time.
Recent discussions have emerged regarding VA disability benefits, with critics describing them as "overly generous." Experts note that VA disability compensation addresses service-connected injuries and illnesses, with veterans required to demonstrate both their condition and its connection to military service, as reported by Task & Purpose.
Documentation Gathering
Military medical records establish in-service events, while post-service records document how conditions have progressed over time. Continuity of care—consistent treatment from service to present—strengthens claims.
The VA may not possess all relevant medical records. Military medical documentation can be incomplete, particularly for veterans who served in combat environments where documentation was limited. Post-service records from private physicians, hospitals, and specialists all contribute to the evidentiary record.
Records gathering should begin early, as some facilities charge fees, others have lengthy processing times, and some records may be in archives requiring weeks to retrieve. Understanding common reasons for VA claim denials can inform documentation preparation.
Medical Records That May Be Relevant:
Military Service Medical Records • Service Treatment Records (STRs) • Personnel records documenting duty stations • Unit medical records where available
Post-Service Medical Records • Primary care provider records • Specialist consultation reports • Hospital records and discharge summaries • Diagnostic test results (imaging, laboratory studies)
Addressing Documentation Gaps • Identifying missing documentation • Requesting records from all healthcare providers • Obtaining lay statements for undocumented events
Lay Statements: Witness Testimony
Lay statements are sworn testimony from individuals who witnessed an injury or can describe how a condition affects daily functioning. These statements carry evidentiary weight and can be significant when medical records are missing or incomplete.
Effective lay statements are specific and detailed. Rather than general statements like "John injured his back in Iraq," stronger statements provide specific information: "On March 15, 2005, I witnessed Sergeant John Smith fall approximately 8 feet from a Humvee during convoy operations outside Fallujah. He immediately grabbed his lower back and exhibited difficulty walking for the remainder of our deployment."
Family members can provide statements documenting how conditions affect daily activities, employment, and relationships. These statements help the VA understand real-world functional impact beyond what medical records alone convey.
Example: A veteran had no documentation of a knee injury from a training accident in service records. Her squad leader provided a lay statement: "During our Iraq deployment in March 2010, I witnessed Specialist Sarah Johnson fall into an unmarked drainage ditch while carrying full combat gear. She immediately grabbed her right knee and could not bear weight on it. I assisted her to the aid station, where the medic was overwhelmed and provided only ibuprofen. Specialist Johnson exhibited a pronounced limp for the remainder of deployment." Combined with post-service medical records documenting ongoing knee problems, this statement helped establish service connection despite the absence of contemporary military medical documentation.
Strategic Timing Considerations
Timing decisions can affect effective dates for benefits and potential retroactive payments. Understanding mechanisms like Intent to File, pre-discharge claims, and Fully Developed Claims can impact financial outcomes.
Intent to File: Preserving Effective Dates
An Intent to File establishes an early effective date while allowing time to gather evidence. Veterans have one year from the Intent to File date to submit a complete claim. If approved, benefits are backdated to the Intent to File date.
Example: A veteran files an Intent to File in January but doesn't submit the complete claim until June. If approved, benefits are backdated to January rather than June.
Intent to File can be submitted online at no cost. There is minimal downside for veterans planning to file but needing additional time for preparation.
Pre-Discharge Claims: Transition Planning
The Benefits Delivery at Discharge (BDD) program allows service members to file claims up to 180 days before separation. When processing proceeds smoothly, decisions may be issued within 90 days of military separation.
This timing can significantly affect financial planning. Rather than waiting months or years for initial disability payments, benefits may begin immediately upon separation. For veterans with dependents or those facing employment challenges, this can provide financial stability during the transition period.
The limitation is that veterans must be available for VA medical examinations, which can be challenging while on active duty or during permanent change of station moves.
Fully Developed Claims: Expedited Processing
Fully Developed Claims (FDC) allow veterans to submit all evidence at the time of filing rather than waiting for the VA to request additional documentation. This approach trades preparation time for potentially faster processing.
With an FDC, veterans indicate that all relevant evidence is included in the initial submission. This can reduce processing time because the VA doesn't need to issue development letters requesting additional information.
The consideration is thoroughness. If evidence is incomplete, adding materials later may require converting to a standard claim track.
When Cases Become Complex
Some claims follow straightforward patterns: an injury occurred during service, documentation exists in service records, diagnostic imaging confirms the condition, and the service connection is apparent. Other claims involve complex medical conditions, multiple interconnected disabilities, or situations where service connection is less obvious.
Complex cases often benefit from specialized medical evidence development. Professional documentation services maintain networks of healthcare providers who specialize in VA disability evaluations and understand condition-specific requirements.
Medical Nexus Opinions
When the connection between military service and a current condition is not readily apparent from service records, medical evidence establishing this connection may be necessary. Independent medical opinions can provide expert analysis of whether a condition is related to military service.
The strength of medical opinions varies. The most persuasive opinions come from specialists in the relevant medical field who have thoroughly reviewed both military and post-service medical records. These opinions explain not just whether a connection exists, but why it meets the VA's evidentiary standard of "at least as likely as not" (50% probability or greater) that the condition is service-connected.
Medical nexus opinions can affect outcomes for previously denied claims. The key factor is identifying healthcare providers who understand both the medical aspects of the condition and the VA's legal and evidentiary standards.
VA Appeals Pathways
The Appeals Modernization Act provides veterans with three pathways to challenge VA decisions: Supplemental Claims, Higher-Level Review, and Board of Veterans' Appeals. Each pathway applies to different circumstances and has distinct evidentiary standards.
When Professional Documentation Services May Be Valuable
Some claims can be pursued independently. Others involve complexities where professional documentation services may provide value through specialized expertise and medical evidence coordination.
When Documentation Complexity Increases
Straightforward claims may not require professional assistance. However, cases involving complex medical conditions, multiple interconnected disabilities, or unclear service connections present documentation challenges.
Complex cases often benefit from professional documentation services, particularly regarding medical evidence development. These services provide access to healthcare providers who specialize in VA disability evaluations and understand condition-specific requirements.
The value extends beyond medical expertise. Professional documentation services understand VA regulations and rating criteria, helping veterans avoid documentation errors that might require months or years to address. Understanding the role of medical evidence in VA disability evaluations demonstrates why professional services may be valuable for complex cases.
Indicators That Professional Documentation Services May Be Valuable:
☐ Multiple interconnected medical conditions
☐ Missing or incomplete service medical records
☐ Conflicting medical opinions or diagnoses
☐ Previous denials without clear explanations
☐ Secondary conditions requiring nexus establishment
☐ Mental health conditions with subjective symptom criteria
☐ Rare or unusual medical conditions
☐ Need for specialized medical expertise
How REE Medical Coordinates Independent Medical Documentation
Many veterans face challenges obtaining comprehensive medical documentation that accurately reflects the full scope of their conditions. REE Medical coordinates connections between veterans and independent healthcare providers who specialize in VA disability evaluations, facilitating thorough documentation.
REE Medical provides transparent cost information and flat-rate pricing with no hidden fees or commission-based charges. Veterans understand costs upfront and what services they receive.
REE Medical coordinates access to independent, licensed healthcare professionals who provide thorough, accurate DBQs. REE Medical does not prepare, present, or prosecute VA disability claims; the Department of Veterans Affairs makes all rating determinations.
Many REE Medical team members are veterans themselves, providing firsthand understanding of the challenges involved in navigating the VA system. The team provides specialized knowledge for developing strong medical evidence while helping veterans avoid common documentation errors.
Veterans seeking comprehensive medical evidence for VA disability evaluations can learn how REE Medical coordinates connections with qualified healthcare providers who understand VA requirements and provide thorough documentation of service-connected conditions.
Bottom Line
Navigating the VA disability system involves understanding complex requirements, but knowledge of the fundamentals—service connection elements, strategic timing, and proper medical evidence standards—provides veterans with a foundation for pursuing benefits.
VA disability compensation reflects military service and the conditions that resulted from it. With thorough preparation, comprehensive medical evidence, and understanding of VA evaluation criteria, veterans can navigate the disability system effectively.
DISCLAIMER
REE Medical, LLC is not a Veterans Service Organization (VSO) or a law firm and is not affiliated with the U.S. Veterans Administration ("VA"). Results are not guaranteed, and REE Medical, LLC makes no promises. REE Medical's staff does not provide medical advice or legal advice, and REE Medical is not a law firm. Any information discussed, such as, but not limited to, the likely chance of an increase or service connection, estimated benefit amounts, and potential new ratings, is solely based on past client generalizations and not specific to any one patient. The doctor has the right to reject and/or refuse to complete a Veteran's Disability Benefit Questionnaire if they feel the Veteran is not being truthful. The Veteran's Administration is the only agency that can make a determination regarding whether or not a Veteran will receive an increase in their service-connected disabilities or make a decision on whether or not a disability will be considered service-connected. This business is not sponsored by, or affiliated with, the United States Department of Veterans Affairs, any State Department of Military and Veterans Affairs, or any other federally chartered veterans service organization.
Informational Disclosure
Content in this article is provided for general educational purposes and does not constitute legal, medical, or financial advice. REE Medical, LLC is not affiliated with, endorsed by, or connected to the U.S. Department of Veterans Affairs (VA) or any other government agency. The information shared is not intended to assist in, prepare, present, or prosecute any claim before the VA or any other entity. Information referenced from VA.gov and other external sources is publicly available and intended to help readers better understand VA processes and terminology. Clicking external links may direct you to websites not operated or controlled by REE Medical.
