5 Reasons Your VA Claim Was Denied | VetLaw

The VA denies veterans disability claims that fail to meet eligibility requirements or lack proof of qualifications.

Summary

• The VA denies disability claims for various reasons, which can prevent injured or ill veterans from securing the benefits they are entitled to receive.
• An experienced veterans disability benefits denial lawyer can offer valuable legal assistance with filing an appeal.
• Common reasons for denial include lack of medical diagnosis or service connection, the condition doesn’t qualify as a disability, lack of in-service evidence, and missed deadlines.
• VetLaw offers expertise in navigating VA appeals and can help veterans obtain the disability benefits they deserve.

While the VA will deny claims for minor reasons, like using the wrong billing code, claims denied due to fundamental issues should be appealed with the support of an experienced veterans disability benefits denial lawyer.

VetLaw can be a valuable ally and help you build a VA claim that can withstand scrutiny. There may be multiple reasons your VA claim was denied. Our skilled team of veterans disability appeals lawyers at VetLaw can help.

We’ll sort out the issues that are holding you back from accessing VA disability benefits with a strong appeal. We encourage you to schedule a free consultation by calling us at (855) 670-0614 or filling out our contact form today.

1. Your VA Disability Claim Cannot be Proven With a Formal Medical Diagnosis

The VA accepts claims for both physical and mental health conditions, but it is not enough to simply say that you have a health issue. You’ll need documentation of your illness or injury from a licensed medical provider who has verified that you meet the diagnostic criteria for the condition.

Without that information, the VA could deny you benefits due to a lack of diagnosis.

Unfortunately, the nature of some service-connected disabilities means that they are challenging to diagnose. This is especially true for veterans who do not fulfill the standard criteria for the condition or those who do not fit the typical demographic for that particular disability.

Medical issues that are rare, have significant symptom overlap with other conditions, are functional rather than structural, or have ambiguous symptoms are more likely to go undiagnosed or misdiagnosed.

If the VA wants more information about the extent or origin of your disability, they will schedule a C&P exam for you with an approved provider or specialist. It’s still important for you to attend your C&P exam, even if you submitted other medical records. Otherwise, the VA may question the severity of your disability and deny your claim.

2. You Didn’t Establish a Medical Nexus Between Your Service and Your Disability

It is not uncommon for the VA to deny a veterans disability claim due to a lack of service connection. That means a veteran needs to demonstrate their military service caused their disability or made a pre-existing condition considerably worse. A medical nexus is the evidence that supports this cause-and-effect relationship.

If a VA provider believes that a veterans disability was “at least as likely as not” caused by an incident or conditions during their military service, then they are supposed to award a service connection. Veterans with pre-existing conditions may be more likely to struggle with this standard.

The reason for this is if you want to claim that your military service has a connection to your pre-existing condition, you need to show that your symptoms are worse than they would have been if you hadn’t served. That essentially means proving something that never happened, which is a challenge under any circumstances.

Without adequate medical proof of a service connection, the VA may agree a harmful event occurred during your military service and that you have an illness or injury, but dispute that the two facts are related. A strong medical nexus letter from a healthcare provider who has personally evaluated you is often the most effective way to show service connection.

3. Your Condition Requires an Extra-Schedular Rating

A service-related illness or injury must reach a certain level of severity to warrant VA disability benefits. The threshold for benefits is a 10% level of impairment. If you have a mental or physical condition that’s generally not considered serious enough to inflict symptoms that correspond with a 10% disability rating, the VA will likely deny the claim.

Alternatively, you may be seeking additional VA benefits for a service-related condition that is usually relatively minor. The VA may not offer the level of disability benefits you requested given the typical severity of your condition.

The VA may also deny your veterans disability claim seeking a rating increase if your symptoms do not align with the description for that higher level of disability, even if you have other symptoms related to the condition that are impacting you just as severely.

However, if you have a particularly severe, aggressive, or rare form of a condition, the “standard” presentation of your condition may not reflect your experience. In cases like this, the VA can perform an extra-schedular rating of your disability to determine benefits.

These situations are rare, so many claims that receive extra-schedular ratings are denied first.

4. Your VA Claim Lacked Sufficient In-Service Evidence

Usually, when the VA denies a veterans disability benefits claim for a lack of in-service evidence, it is because there is not enough proof that either: 

• the event or circumstances you believe caused your disability to happen
• or, the event or circumstances you think caused your disability occurred while you were serving on active duty

The in-service event or condition could be anything from a broken piece of machinery to a helicopter crash to a sexual assault to an open-air burn pit. The VA accepts a range of evidence as proof, such as military service records, photos, and buddy letters. However, some veterans disability claims still fall short.

Establishing the in-service connection is often tougher for Army Reserve veterans and National Guard veterans. They are typically on active duty on a part-time basis. Therefore, they have to document that their disability was caused or aggravated during those specific windows of time. 

Veterans who served on Special Forces teams, such as the Army Green Berets or the Navy SEALs, may also face difficulty providing documentation of in-service events that occurred on covert or classified assignments.

A veterans disability claims attorney can help you navigate these complex situations to overcome a VA denial. 

5. You Waited Too Long to File a VA Disability Benefits Claim

The VA does not impose a deadline on when a veteran can seek disability benefits for a service-related condition. However, it does stipulate that you must currently be suffering from an illness or injury to be eligible for VA disability benefits. Otherwise, you can be denied.

For example, say you suffered a broken arm while serving as an active-duty Sailor immediately prior to your discharge from the service. After several weeks in a cast, your arm heals with no long-term deficits.

If you waited until that point to file a VA disability benefits claim, you would no longer have grounds to seek benefits even though you had a medical diagnosis and your disability was clearly service-connected.  

In other cases, a VA claim is denied when the veteran waits too long simply because the evidence they could have used to support their claim has been lost, compromised, or destroyed. For instance, an eyewitness who saw you get injured on active duty may pass away before providing a statement. Consequently, this weakens your proof of a service connection.

Trust VetLaw to Successfully Appeal the Reasons Your VA Claim Was Denied

To avoid receiving another denial from the VA, hire a veterans disability benefits denial attorney. Our team can help ensure the information you provide is complete, accurate, and thorough.

VetLaw is a reputable name amongst veterans dealing with the VA claims system because we consistently deliver results. We are not deterred by denials from the VA because we understand that a rejection does not necessarily mean you do not have a viable claim.

To address an unfair VA denial, we’ll take a comprehensive approach to your case and unapologetically advocate for you. Our team is ready to offer you our services so you can file a VA appeal and obtain disability benefits.

Give us a call at (855) 670-0614 or fill out our contact form today. We will help you schedule a free consultation with our team of VA-accredited attorneys.

Frequently Asked Questions

What is the VA’s Benefit of the Doubt doctrine?

Often, deciding to grant VA disability benefits or deny a claim is a judgment call. The VA’s Benefit of the Doubt policy regulates that judgment.

When a VA evaluator is reviewing a claim where the evidence could go either way, they are obligated by the Benefit of the Doubt doctrine to decide in favor of granting benefits to the veteran.

So, if your VA claim was denied, then the VA determined that there was not enough evidence to support your eligibility for disability compensation. In effect, this helps that could have just as easily been approved if a different evaluator had been responsible for the case to avoid a VA denial.

Does the VA explain the reasons your VA claim was denied?

When the VA denies a disability benefits claim, it also issues a claim denial code. These codes correspond with the general reasons your VA claim was denied. However, you may be unfamiliar with the terminology the VA uses, let alone understand how to fix the error.

A veterans disability benefits denial lawyer can clarify the VA’s basis for denial and explain the appeals process.

Which branch of the military is most likely to be denied disability benefits by the VA?

A study conducted by the GAO identified that Army Reserve veterans and National Guard veterans face higher rates of rejection for VA disability benefits. VA approval rates for initial disability claims were consistently lower for these two groups by a significant margin. 

In 2021 alone, there was an approximately 13% gap between the approval rate for VA claims from active duty veterans and VA claims from veterans who served in the Army Reserve or National Guard.

Can I appeal if the VA wrongfully denied my disability benefits claim based on a Clear and Unmistakable Error?

Yes, although this is a rare type of appeal. The VA has a high bar for Clear and Unmistakable Error (CUE) claims. First, you need to establish the VA made an obvious error in judgment.

The decision must have resulted from one of two things. Either the VA didn’t account for existing facts or they failed to properly implement a standard when assessing your claim. 

Additionally, you need to show that the Clear and Unmistakable Error undeniably negatively affected your VA disability claim. For example, if the CUE was the blatant reason your VA claim was denied or your disability benefits were decreased, your case may meet the criteria.