The Three Pillars of a Successful VA Disability Claim

August 5, 2022

There are certain conditions that the VA does not consider eligible for service connection, such as congenital or hereditary diseases and conditions, these may have developed due to the veteran’s own willful misconduct. To alleviate the process of filing a claim there are 3 main pillars of a successful VA disability that has to be taken into consideration, namely;

  • The In-service event
  • Current disability or condition
  • Medical Nexus

Element 1: In-Service Event, Injury, or Illness

The event, injury, or illness does not have to have been incurred in a combat situation; any illness, injury, or event that arose during active-duty military service can be eligible for a disability rating if it causes a disability after you leave active duty.

The major exception to this is if the injury occurred due to misconduct. According to VA, willful misconduct is “an act involving conscious wrongdoing or known prohibited action.” For example, if an active-duty service member was involved in a car accident in which s/he was driving under the influence of alcohol and became injured as a result of the willful misconduct, residuals of that injury would not be eligible for compensation.

The best forms of evidence to prove service connections are service treatment (medical) records and service records. Any illness or injury you had while on active duty should have been noted in service treatment records. The VA is responsible for requesting those records from the Department of Defense. When combined with buddy statements from individuals who served with the veteran and witnessed the incident giving rise to the disability, lay statements from the veteran can be especially powerful. These statements can support the timeline and manner of the event.

Element 2:  Current, Diagnosed Disability

A diagnosis must be current in order to qualify for VA disability compensation. Disabilities incurred in-service that have since healed and no longer impair earning capacity are not eligible for VA compensation. For example, a veteran who sprains their ankle while on active duty may be eligible for disability payments after service if that ankle has not fully healed, or if there are lingering symptoms of the injury. If it was a minor sprain that completely healed, however, and there are no longer symptoms, there is no disability and therefore no disability compensation.

Veterans should submit evidence of a current disability with their claim, whether that is in the form of medical records from a doctor you have seen after your time in service, or a lay statement where you describe your current symptoms.

Element 3: Medical Nexus

A medical nexus is a link between your current disability and the event, injury, or illness during service. The best way to establish a nexus is through medical evidence. A statement from your treating doctor affirming that they believe your condition was “at least as likely as not” caused by military service can prove to be a powerful piece of evidence.

As part of the VA’s duty to assist veterans in obtaining evidence to support their claims, the department should schedule a medical examination to assess the severity and origin of the veteran’s condition. The findings of this Compensation and Pension (C&P) Examination may help to establish a medical nexus. If the results of this examination are not favorable, veterans may bring the report to another medical professional for a second opinion.

Not all medical evidence is weighed the same by the VA when the time comes for adjudication. There are some ways to ensure medical opinions hold as much probative value as possible, such as:

  • A practitioner working in a relevant clinical field or specialty has written the opinion.
  • Based on the veteran’s service and medical histories, as well as prior and subsequent personal medical histories, the opinion should be specific to the veteran.
  • According to the conclusion, the veteran’s illness was “at least as likely as not” brought on or exacerbated by military service.
  • The opinion offers an argument in favor of the assertion. In other words, by explaining how they arrived at their conclusion, the medical expert “displays their job.”

If you meet all three elements above, but you are still being denied service connection, or you are unsatisfied with your rating, contacting a seasoned Veterans Advocacy lawyer at the Law Office of Andrew P. Gross.