VA Claim Denials
Receiving a denial for VA disability benefits from the U.S. Department of Veterans Affairs doesn’t have to spell defeat. If your VA denied claim has been denied or you receive a lower rating than you believe you deserve, you can appeal the denial.
If you have more information to support your case, you can submit a supplemental claim and include it. If you don’t have additional evidence, you can still request a higher-level review or board appeal.
However, to succeed at the next level, you must understand why your claim was denied, how the appeal process works, and how to avoid further errors.
Understanding VA Denials
To receive approval for VA benefits, you must file a complete application with sufficient evidence proving your eligibility. If you receive a denial, it means the VA has determined one of two things:
- Your application was incomplete or filed incorrectly.
- You are ineligible based on the information you submitted.
Denials are discouraging. However, they can be contested, and many are overturned on appeal. The key is to learn from an initial denial and avoid the mistakes that cost you approval at the initial stage. If you understand the basis for the denial, you’ll know better what to do next.
Common Reasons for VA Disability Claim Denials
Most VA claims denials fall into one of two categories: administrative errors and insufficient evidence.
Administrative errors include leaving a section blank or missing a deadline. Evidence-related denials result when the information you submitted doesn’t prove a qualifying disability or doesn’t demonstrate a service connection.
Lack of Medical Evidence or Nexus Letter
Lack of medical evidence means the records you submitted fail to verify your disability and its service connection. Either you haven’t submitted enough material to demonstrate that you qualify, or what you have submitted is insufficient to prove eligibility.
One form of evidence that can help your case is a nexus letter. A nexus letter is a written report from a medical provider describing the nature and severity of your condition and establishing its connection to your military service.
Unfortunately, the VA still denies claims with a nexus letter. That may happen because of the following:
- The letter failed to establish the cause and nature of your condition and its impact on your ability to work.
- The provider lacked sufficient expertise in a related specialty.
- The provider did not submit enough supporting documentation.
If you did not submit a nexus letter or the VA rejected one, submitting a new one on appeal may help your case.
Failure To Meet Service Connection Criteria
A veteran is only eligible for VA disability benefits if their service has either caused or exacerbated their condition. Your application must demonstrate that connection.
The VA deems certain conditions presumptive, meaning that if you meet certain service criteria, the VA automatically assumes your condition is service-related. If you don’t have a presumptive condition, the evidence you submit must show a connection between your disability and your time in the military. Such evidence may include documentation that an injury or illness occurred during your service, such as a military hospital report.
Procedural Issues and Filing Errors
To receive approval, you must submit a completed application within a year of filing your Intent to File. The Intent to File helps establish your effective date for benefits, possibly qualifying you for back pay. It also starts the clock for filing your complete application.
If your application is late, incomplete, or includes incorrect information, the VA has grounds to deny your claim. You may also receive a denial if you fail to submit required additional forms, such as statements related to in-service psychological trauma.
Understanding the VA Denial Notice
A denial notice from the VA should include the following:
- A general explanation of service connections
- Your claimed disability
- Denied benefit type
- Required criteria
- Reason for denial
The last section, covering the denial itself, should explain the missing elements that led to your denial.
Consider this your guide to filing an appeal. When you know what is missing or why the VA denied your claim, you can more effectively plan your next steps.
How To Respond to a VA Denial
If you have received a denial letter from the VA, don’t give up. There are multiple appeal options to suit your specific circumstances.
Under this system, the VA disability appeal success rate is 28 percent, or slightly over one in four. The stronger your evidence, the better your chances of success.
Supplemental Claims
If you have relevant evidence that doesn’t appear in your original application, you may file a supplemental claim. You can submit any documents that you believe may strengthen your claim. Be sure to include anything that corrects the errors mentioned in your denial.
Higher-Level Reviews
As the name indicates, a higher-level review means a more senior VA representative assesses your claim and makes a new determination. These may be successful if an error occurred or the new reviewer interprets your claim differently.
You may not submit new evidence, but you can request an informal conference call with a reviewer. This option allows you to highlight errors or discuss information already included in your application.
You can request a higher-level review for a new or supplemental claim.
Board Appeals
A board appeal is a request for a case review by a Veterans Law Judge at the Board of Veterans’ Appeals in Washington, D.C. You may request it after receiving the result of an initial claim, supplemental claim, or higher-level review.
You can request one of three types of appeals:
- Direct review: A Veterans Law Judge will review your appeal based on current evidence.
- Evidence submission: You may submit new evidence, provided you send it within 90 days of your request for appeal.
- Hearing: You will meet with a Veterans Law Judge, either in person in Washington, D.C., or by videoconference, with or without new evidence.
Direct reviews are the simplest and fastest option. Hearings have the longest estimated wait time, but they are the only option for a two-way conversation, and give you the best shot at fully presenting your case.
Tips for Avoiding VA Denials in Future Claims
VA reviewers follow strict guidelines when making a determination. Whether you’re filing a claim or making an appeal, here’s how to improve your chances of meeting those requirements:
- File as soon as possible: Have your paperwork ready when you submit your Intent to Appeal.
- Document everything: Send all the medical records you have related to your condition.
- Obtain a nexus letter: A specialist familiar with your situation is the best source.
One way to avoid common pitfalls is to work with an experienced attorney. A lawyer can review your letter, reference a list of VA denial codes, and help you determine how to proceed.
Frequently Asked Questions About VA Denials
How Long After a VA Denial Can I Appeal?
You must submit a higher-level review or board appeal within one year of your most recent decision. There is no specific deadline for a supplemental claim, but you must have new information to submit.
Can I File a New Claim After Being Denied?
If your claim was denied, you can file a new claim. The VA does not explicitly prohibit filing the same claim again, but you must address the reasons for denial if you want a different result.
Does a Denial Affect My Chances of Approval Later?
No, a denial does not mean you’re unlikely to get approval with an appeal or future claim. The VA reviews the documentation you submit and determines whether it meets the requirements for approval.
Let Veterans Guide Help You Overcome Your VA Denial
The VA may deny a claim because of administrative errors or insufficient evidence of a qualifying disability. If a denial is evidence-related, it usually means that the documentation doesn’t establish the severity, effect, or service connection of your disability. Review your letter to determine what type of appeal is best.
The appeals process can be complicated, and personalized guidance goes a long way in navigating it effectively. Veterans Guide is here to help with interactive tools, including a VA disability calculator, and customized support in applying for benefits.
Whether you had a VA claim denied or want to avoid a denial, contact us today. We’ll help you figure out your next steps.
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