Proven Tips #4: Beat Denials & Lowball Ratings

February 19, 2011 | Benjamin Krause

Here’s a recap of where we’re at with this process. I’ve written about the disability claim process up through the VA appointment with an evaluator and supplying evidence to the VA about your claim. Now, we will go through what to do when you get your adjudicated claim back with an approval or denial. You will generally have one of three outcomes: 1) full grant of your claim; 2) a partial grant: for example, they gave you TBI but at 10 percent instead of 40 percent; 3) full denial – do not pass go, do not collect $200. With the paperwork the VA sends you, you may never know what your true rating should be.

Be in the know. Request a copy of your file from the VA first. This is the only way to know everything the VA examiners found and how the VA then adjudicated your claim based on that information. Click here for a copy of the Freedom of Information Act (FOIA) letter you can send for a copy of your file.

In my own case, I had filed a claim for Traumatic Brain Injury (TBI). I had a head injury while in service and received a Psychoeducational Evaluation in college. The evaluator believed my head injury caused some degree of memory loss. When the VA performed their own evaluation, the Neurologist gave me a hard time because I like to drink beer, wine and whiskey in typical Portland-style quantities. A psych evaluator reaffirmed the memory loss during another test. An MRI found brain scarring. Good to go, right?

Wrong. I received a letter back from the VA confirming my condition, kind of. The TBI was rated at 10 percent because the memory loss was related to the fact that I enjoy my drink, according to the neurologist, with no mention of the brain scarring. Note: the neurologist did not have a copy of my C-File for the exam, so his opinion could carry less weight during an appeal than a rebuttal opinion that did review my file. The brain scarring was claimed to be likely from Multiple Sclerosis and not a head injury. I do not have MS. “What the F?!” I thought. That’s the difference between a 10 percent and 40 percent rating, or $523 per month (Vet + Child). So, that little bob and weave allowed the VA to keep $6,200 of my money every year, if I gave up.

Beat the machine. I requested a copy of my file to read through the full analysis. Coincidentally, I also had an appointment with the Speech Pathology person at the VA. He reviewed my MRI and the evaluation from the neurologist. “That’s BS…” he told me. There is no way drinking can cause the memory loss that I have unless I was drunk and still drinking at the evaluation. I wasn’t. In addition, the MRI brain scarring claimed as Multiple Sclerosis was completely off base. One little VA trick was that the radiologist probably did not have a copy of my claim (C-file) but was just given the MRI and some notes to review.

I then received new evaluations from the VA on the Health care side that rebutted the claims from the Benefits side. I did not drink for one month before the evaluation of another psychologist, to rule out the “booze effect.” The MRI was reviewed and rebutted by another radiologist. The radiologist stated Multiple Sclerosis was not the cause of the scarring, leaving only the head injury. Both evaluators reviewed my C-File during the process. My note to readers: the Health side of the VA can be very helpful in fighting against the dark side of the VA, especially when they have your C-File handy to review the mistakes of the Benefits side. It’s very “Star Wars.”

Abracadabra. Once all the information was assembled, I walked over to my friendly Veterans Service Officer (VSO) at the VFW and filed a Notice of Disagreement. I personally elected for DRO review. The VSO told me it was the best appeal he had ever seen from a veteran. The claim went from 10 to 40 percent. And out of the top hat popped $6,200 per year plus a lump sum for retroactive pay. I didn’t give up and I didn’t die in the process. Hooray for me, and hooray for my daughter.

To look at how I document my claims, check out my Sinusitis claim. You’ve now walked through the process of filing for your disability claim and appeal with me, soup to nuts. Click here to read the whole process and good luck!

Comments

  1. Ben, great article…it just shows not to give up on appeal, especially when you know the denial letter makes no sense.. thanks for not quoting Jim Strickland, that guy is so annoying and his website is cheezy.

  2. I filed a claim for pow an anxity an depresion was denied because it wasn’t document. Sentor amy klosb of minnesota find the evidence.finily ask a cp phys.an she denied me.I appelled. I have suffered ever senses I got out of the military.the physc doc.said I was a angry alcholic at that time I had 15 yrs. Sobrity.what should I do also I was hijacked to cuba in 1969 an the cuban military beat me when they let me go to the bathroon there was 114 service personal on board.the gov.said this never happened but I have all the records. What to do

  3. Women service members. How are they faring when it comes to filing claims? I contracted std, was kidnapped, and suffered miscarriage while in service. Have no police report (informed superior officers of incident which was "taken care of" in house, basically slap on the wrist to assailant (a co-worker); no record of medical treatment, with exception of brief note on std. Am now infertile, traumatized (post dramatically), and having no success in proving service connection. Any suggestions/advice?

    • yes, please go to http://www.vetwow.com The founder, Susan Avila-Smith, is a veteran herself and she has ample advice (in simple easy to understand language). I was denied twice, and with the help of Susan, i was able to get thru the appeal process and win my claim. She is wonderful and there are many vetwow sisters that can offer insight and assistance. Just in case any of our male veterans are wondering, vetwow also advocates for male veterans as well. Vetwow does offer assistance in Military Sexual Trauma, as well as other claims. Please check out this website.

  4. wizardz says:

    I have had over $1800 taken back from my disability pension as they said I didn't get the proof in to them in time. Also they denied my appeal & my request for an account audit. I proved I had passed on the dependent care monies to my dtr. How do I get the extra money they took from me back? I can;t even afford to get a vehicle cause of them. I live in a small town 20 miles away from a bigger sity & am stuck here 99% of the time just barely exsisting.try living off $100 a mth for groceries after all the housing cost are paid just to keep a roof over my head.
    CAN SOMEONE HELP ME OPR AT LEAST GIVE ME SOME DIRECTION HERE PLEASE?

  5. poor will says:

    my va claim was denied base on no record of evidence after almost six yrs of requesting both military and medical record thru congress ,and finnaly after trying reverse search for vessel log ,muster roll . incident report i contact someone at the nprc who search and found my record, 35 boxes from where there suppose to be my question is how do i persent this new evidence on my old claim do i open new claim or wait the next 100 yrs for a B.A.V.traval appeal hearing to persent this new record of evidence ?

    • Contact your VSO and ask their advice. If you don't have one, get one. Receipt of previously unavailable STRs will automatically reopen a claim as new and material evidence. However, I don't think anything can be rated while it is under appeal. Again, contact your VSO.

  6. Charlotte says:

    I once spoke to Mr Stricklland on the phone once and found him to be very rude and cold. He told me not to waste his time. i lost respect for him and his website right then.

  7. sue berry says:

    Yes u run into so many obsticles that u just want to say the H with it but then I look @ my husband & it makes me sooo mad that they the gov. Did this to him & now he’s lived thru vietnam he’s got to live hopefully thru the cancers & tumors and who knows what else that agent orange causes. But I’ve always been a firm believer in what goes round come around. Although I would not wish this on anyone its really hard not to think like that. This is GODS call.

  8. DOES ANYONE UNDERSTAND HOW SCARS ARE RATED,I HAVE A KELIOD SCAR ON THE BACK OF MY SKULL THAT IS 5"X6",THATS PAINFULL,DISCOLOR AND INFLAM

    • Scars are rated by size, they have to be pretty big to get a rating, and by whether they are painful or unstable or restrict motion.

  9. Can U recieve 100% va disability if u are unemployed during surgery?

  10. I served in the U.S. Army from May 1977 through September 1985. I'm O.K., but now I am 53 years old, and my health is fading. Are their any benefits for me in the government. I'm not looking for much. I gave the Army my youth, now I'm getting old.

    • xenonlit says:

      Go to Benefitscheckup.org

      You don't give your name or personal info, but you put in your income and other information.

      Very quickly, the Federal, State, VA and local programs that you may be eligible for will come up.

      Then the work starts! You will at least have some leads to check out for programs that you might get some help from!

  11. xenonlit says:

    I got denied and have requested my VA file, but it seems that it will take two months! It will take 90 days before I can even inquire about my national records center requests.

    Today, I had the most disappointing encounters with people who are being paid to serve vets, but who are more about serving themselves.

    Now I'm mad.

    It is an undependable and messy world of cozy relationships between the vets groups and the counties and the VA. I am very disgusted after talking to a state VA coordinator who talked more about the comfort level and needs of the bureaucrats and clubs than she did about the needs of us vets.

    There has to be a way to break this up and to send a message that we need service, not self service.

    Right now, I am just looking for a decent rep. I used to be able to find one good one for every two rotten ones, but not lately.

    • Two months? I submitted a Freedom Of Information request for a copy of my C-File, rating decision letters, etc., and to no surprise I have been waiting on my file for nearly a whole year! The VA keeps telling me that my C-File is under review for pending claims. I had a C&P exam with favorable results (per my Progress Notes) to support my claim for increased compensation for generalized anxiety disorder, PTSD and Bi-Polar I Disorder 5 months ago, but still no C-File! The VA is not your friend – believe me!

  12. MICHAEL says:

    i sympathize with all of you I've been plugging along for 40 yearsDon't forget about the pension part of your claim. they give you whatever is highest. yOUR PENSION OR SERVICE CONNECTED DISABILTY PAYMENT. I THOUGHT THEY WERE TELLING THE IRAQI VETS EVERYTHGING AND VIETNAM VETS THEY TRIED HIDE EVERYTHING. BUT I GUESS THAT IT IS BUSINESS AS USUAL FOR THE V.A.

  13. BEWARE of this board. I was put on TDRL with 40% from the military and and initial 40% from the VA. I had 17 years of service. Went before the initial PDR board and the military discharged me from active duty and downgraded my rating to 20% and gave me a lump sum severence, I then got an attorney at the cost of 4,500 to appeal to the next board. That was a huge waste of money. The whole time my VA rating was going up. I have appealed to every board all the way up the line to get just a 30% rating from the military, who originally rated me at 40%, so I can officially be considered "retired". I sent my paperwork to this final miltiary board. The board rated me at 30% finally!, Then the secretary of the army's representative over road the boards' decision! Yes, just one person, who is not a physician, over road the entire boards decision.

  14. Now I have no recourse. I was astounded that after this FINAL board had made a decision, on person could over ride them. So, a word of caution to everyone, do not be deceaved. These 2 " special boards" are not the final authority. It's just the same bs packaged in a different way. . I've had 2 hip replacements, am contantly taking steriod shots in my back, hips and hands and have had significant negetive effects from the medications I've been on for many years. It is shameful what the military does with the soldiers. I must say I have been treated very fairly by the VA and have only great things to say about them. Just keep putting in your claim every time you get new evidence of your disability. Have every physician you see, annotate your disability/disabilities and resubmit the paperwork every time you have more proof. I also had great VA reps at the VA hosp. and in my town. USE these folks. They know how to write the letters to the VA so they take a good look at your claim. If any one knows of a competent attorney please let me know

    • Consider yourself very lucky! I have gone between the two VA hospitals here in Middle Tennessee, and my VA doctors refuse to write anything about my disabilities that will help support my VA claims. They go as far as to say that I deny things about my conditions, which I don't – it's a lie!

  15. I submitted a claim for a local recurrence of bone cancer that was initially found while in service. I was devastated to receive a 10% rating based on two non-compensable items and a diagnostic code referencing a KNEE INJURY. I have never had a knee injury. I submitted specific medical evidence for my cancer and the VA didn’t even read it!!! Now I’m forced to go through a five year appellate process to get my benefits that are retroactive to 2008?!?!
    Why back to 2008? Because my medical liaison in the service let my claim expire the first time around when she went on maternity leave and left my file in her desk drawer.

  16. I’m at my wits end here! According to the disability rating schedule, I was supposed to receive a 100% rating and then be re-evaluated after a year from my treatment. I feel like the VA did this on purpose in hopes I wouldn’t fight it so they didn’t have to pay out my retroactive compensation.
    I am so offended and I am so disgusted by this process. I feel we have no voice as Veterans within this organization. Our hands are tied with a few forced options that take years to claim what we are entitled to because of some unqualified or purposeful VA employee.
    The best part of this whole thing is that when I went to the doctor at Walter Reed at the onset of this disease, he didn’t biopsy the mass that he found before surgery- he biopsied it afterwards, and they performed the wrong surgery which enables this cancer to keep growing back. He didn’t even tell me until 3 months later that the pathology reports showed a malignancy.
    We deserve a much better system than this. It is absolutely abhorrent. Animals get better medical treatment than this.

  17. H. D. Houfek says:

    Thank you for this site and all of your comments. I have been going in circles with the VA with " Long Term Medical Effects of Being a USN diver = EOD and Deep Sea for 17 years, as well as being a submariner. I retired in 79' as a CWO3. 1st exam 2 years ago was with a PA, who did not know anything about diving or orthopedics. Recieved 20% for totally damaged rotary cuffs (2).
    The VA had me have another exam, but this time I had a USN aviation/diving/aero-space doctor who knew his stuff, but felt he is always losing his cases that he confirms are real disabilities. Reason being ? The folks who evaluate our cases are LAWYERS, not doctors. The doc told me he was going to change his evaluations and beat the lawyers at their own BS game. God Bless all. H. D. Houfek, Sr. CWO3 USN ( Ret ) Gulf Breeze, Fl.

  18. H. D. Houfek says:

    March 9, 2013 I go to the VA facility in Pensacola, Fl. where my counselor is
    with the American Legion and submits my claims info to the VA facility in
    St Petersburg, Fl. which is across the bay from Tampa. Whenever I get letters
    from the VA in St Pete there is no address, no telephone number, or email to
    contact them directly. A couple months ago I was going to drive down to St.
    Pete and find out WTF was going on. Not just for me, but wanted to see how
    they were conducting business on behalf of all veterans. No address could be
    found anywhere. Guess I could go to the post office, see who picks up their mail and follow them to there location. Oh well. Have a good day all.

  19. The VA will screw most of the time, making things that are not true. Remember our dealing with Government people, and they don't care; and they don't want you to have anything. Also, remember these idiots get real live money Bonus, "real money" for screwing you out of what you are entitled to be receiving.

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