Common Reasons Why VA Disability Claims Get Denied
VA disability claim denials are frustrating. You risked everything for our country, only to have the door to your rightful benefits slammed in your face. The disability application process is complex, and this complex system is responsible for many eligible veterans being denied. However, if the Department of Veterans Affairs has denied your claim, it isn’t necessarily final. You have options to appeal the decision and receive approval for benefits.
Veterans Guide is here to help. In this guide, we walk you through the most common denial reasons and provide practical advice on getting approved for the benefits you’ve earned. Please note that nothing in this article should be considered legal advice. Contact us to get connected with legal advocates who can answer questions about a specific claim.
Common Reasons VA Disability Claims Are Denied
The most common VA disability claim denial reasons are paperwork technicalities and insufficient evidence. The VA has strict qualifying criteria for service-connected disabling conditions. Understanding why the VA denies disability claims can help you build a stronger claim.
1. Failure to Establish Service Connection
Even if you successfully prove you have a disabling condition, the VA will only approve your claim if you also prove your condition is related to your military service. The VA considers an injury or illness service-connected if it meets one of the following criteria:
- Your military service caused it.
- Your condition was aggravated or exacerbated by your military service.
- It is a condition the VA has deemed presumptively connected to military service.
If you have a presumptive condition, the VA will presume your condition is service-connected. Otherwise, you must prove it is related to your service, known as a nexus. “Lack of nexus” is one of the most common reasons the VA gives for denials.
To prove nexus, or service-connection, obtain a written statement from a qualified doctor that your condition resulted from your service. Ask the doctor to make the statement direct and conclusive, and to include the medical details that support their conclusion.
2. Insufficient or Incomplete Medical Evidence
The VA makes decisions based on what is in your medical record. Even if your symptoms clearly limit your daily activities, it will not be enough to get your claim approved. Your medical records must document both your symptoms and your limitations and should include all of the following:
- A formal diagnosis from a qualified health care provider
- Objective findings, such as test and imaging results
- Documentation of ongoing treatment
- Detailed examination notes that document your symptoms and limitations
Outdated medical records, vague notes, or missing test results can lead to denials for “insufficient evidence” or “inadequate information.” To avoid a denial, review your medical file or allow a knowledgeable disability lawyer to review it. Obtain up-to-date test results, and ask your health care providers for clear, definitive notes. Be sure to obtain medical records from all of your providers.
3. Problems with the C&P Examination
The Compensation and Pension exam, or C&P, is often a critical step in the VA disability application process. The VA uses such an exam to determine the severity of a condition and whether it is related to service.
The C&P exam can hurt your claim if the examiner lacks access to your complete medical record, fails to ask the right questions, or reaches conclusions that conflict with your medical file.
To prepare for your exam, upload medical records for non-VA providers ahead of time using the VA’s online claim status tool. If you need help with the technology, a Veteran Services Officer or a VA-accredited attorney can assist you in uploading the documentation. You can also bring medical records with you, but this is not recommended.
If you’re concerned your C&P exam might work against you, ask your doctor to order additional tests to strengthen your claim.
4. Incomplete or Incorrect Paperwork & Missing Deadlines
The paperwork for the VA claims process is complicated. Anyone can make a mistake. Many deserving veterans have their claims denied because of little errors like the following:
- Forgetting to sign the documents
- Using the wrong form
- Forgetting to check boxes
- Omitting answers
- Not completing requests for appeals
- Missing deadlines
Technicalities are common reasons for denials. Before submitting your application, double-check each question and ensure that you have completed all fields. Consider consulting a Veteran Services Officer or a VA-accredited attorney for assistance.
5. Condition Not Severe Enough or Improper Rating
Sometimes, the VA acknowledges a service-connected condition but gives it a 0% rating. In this case, your denial reason may say “symptoms aren’t severe enough.”
To avoid such a denial, make sure your doctor lists all of your functional limitations in your medical file. The VA needs clear documentation of not only your symptoms, but also how they affect your daily activities. For example, suppose you have back pain. The VA may not consider it disabling unless your medical records document a connected limitation, such as an inability to sit, stand, or walk without assistance.
If you have multiple disabling conditions, get documentation to support each one. Even if one condition isn’t disabling enough, you could receive a high combined rating for multiple conditions. Use our combined rating chart to estimate your rating.
6. Pre-Existing Conditions Not Aggravated by Service
If you had a medical condition before you started serving in the military, you can only receive VA disability compensation for it if your military service worsened or aggravated it. The VA has denied many claims after finding a pre-existing condition was not aggravated by service.
Aggravation is difficult to prove. You will need medical records from before, during, and after your military service to establish a clear timeline of the worsening of your symptoms. You will need clear doctor’s notes verifying how military service aggravated the condition.
7. Inconsistencies, Credibility Issues, and Suspected Fraud
When reviewing your application, the VA will assess your statements, your medical records, and your military service records for consistency. If your claims are inconsistent with your medical records or each other, the VA may suspect you are exaggerating. You may see a denial reason like “suspicion of fraud.”
Being accused of fraud can be a distressing experience. It does not mean you were untruthful. It can happen when your medical record is incomplete, you misunderstand a question, or your symptoms vary from day to day.
Here are a few ways you can avoid this accusation:
- Be mindful of consistency, always considering how the VA could interpret each answer.
- Avoid exaggerations, but describe your symptoms and limitations candidly.
- Ask your doctor to include all limitations and symptoms in your medical record.
- Allow a VSO or a veterans disability lawyer to represent you.
- Obtain corroborating evidence, such as buddy statements and objective medical tests.
8. VA Didn’t Fulfill Its Duty to Assist
The VA has a legal obligation to make reasonable efforts to gather medical and service records to support your claim. “Reasonable effort” means the following:
- Continuing to request federal records until the VA receives them or determines they do not exist
- Making at least one follow-up request for private medical records and notifying you if unable to obtain them
- Scheduling a C&P exam if medical records are insufficient
If your claim is denied because the VA neglected its duty to assist, you can raise this during an appeal. If found during a Higher-Level Review, the VA will start a new claim. If found during a Board Appeal, the VA will close the appeal and send the claim to a regional office to gather evidence.
Rather than rely on the VA, be proactive. Gather as much information as you can, submit it to the VA, and monitor your claim’s progress.
What To Do If Your Claim Was Denied
A denial doesn’t have to be final. The VA offers the following options to appeal:
- Higher Level Review: A reexamination by a higher-level reviewer
- Supplemental Claim: Submission of new and relevant information
- Board Appeal: Your choice between a direct review, evidence submission, or a hearing
Before you submit an appeal, read your denial letter carefully to understand the reasons for the decision. This will help you determine the best form of appeal and what evidence you will need. You may need additional medical records, a more robust medical nexus opinion, or a correction of an application error.
Consider contacting a VSO or a VA-accredited attorney to help you understand the reason for the denial, gather evidence, and handle your appeal. Veterans Guide is here to help.
Maximize your VA Disability Claim
The most common reasons why the VA denies disability claims are a lack of medical evidence, a lack of service connection, paperwork errors, problems with the C&P examination, pre-existing conditions, and the VA’s neglect of its duty to assist. Knowing the common reasons for denial can help you prepare a strong claim and avoid mistakes.
If your claim is denied, it’s not the end of the road. Our experienced VA disability lawyers at Veterans Guide can help you understand the reason for denial and appeal the decision. Contact us today to learn how to file your appeal and get the benefits you deserve.
Client Reviews
ANN WILLIAMS SHELLY DONNETT'E Want to Increase Your VA Rating?
