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Benefits Denial Due to Lack of Diagnosis

Legally reviewed by Brendan Garcia , Partner and Lead Attorney

Benefits from the VA disability compensation program can form a major portion of a veteran’s income after discharge from the military. In order to collect these benefits, you must be able to establish a current medical condition that resulted from an injury sustained during active duty.

However, it is not uncommon for a former servicemember to be denied benefits after filing an application, in many cases due to lack of a formal diagnosis. VetLaw’s team of compassionate attorneys can evaluate why your application for VA disability compensation benefits was rejected and help you prove your condition to the VA. They can also explain the VA’s definition of disability and help you file an appeal to keep your case moving forward. Call today if you have received a benefits denial due to lack of diagnosis.

Disabling Conditions

Any active-duty position in the U.S. military, whether in front-line combat or not, exposes military personnel to a variety of physical, environmental, and occupational hazards. The VA recognizes this fact and has established a compensation program to provide benefits to veterans who suffer from service-related injuries.

Disabling conditions that result from active-duty service can stem from combat, training, administrative and logistics roles, or even while at home. All military positions pose some risk to servicemembers, and you are covered for injuries 24 hours a day, 7 days a week while serving on active duty. Additionally, mental health problems may qualify a veteran for benefits. For example, conditions such as depression, anxiety, and PTSD can form the basis for a valid claim.

In other cases, a person may have entered the military with a preexisting condition such as asthma or partial hearing loss. Even though the genesis of these conditions may not be connected to military mobilization, a veteran who can show that their preexisting condition worsened while on active-duty service may also qualify for VA compensation benefits.

The Necessity of Medical Records

While proving that active duty service caused a condition is a key part of any claim, it is just as important to demonstrate how that condition affects your daily life. Despite the effect that conditions such as joint damage, hearing loss, or mental health concerns may have on your daily activities, the VA may try to deny your claim and state that they do not qualify as disabilities.

After they receive an application for benefits, the VA reviews the disabilities claimed and supporting medical evidence either provided by the veteran or contained within VA medical records.

Medical records that show a diagnosis but do not document the functional impact of that disability on a veteran’s daily activities may result in an award of entitlement to service connection but with a zero percent disability rating, otherwise known as a non-compensable rating. Although non-compensable ratings may form the basis for other VA benefits, including health care or the VA Home Loan program, they do not result in monetary benefits. The VA takes the documentation in medical records very seriously when determining a veteran’s rating. A VA-accredited attorney can help you understand the VA’s rating schedule and how to properly document the extent of your current disabilities and the functional impact on your daily activities.

What conditions automatically qualify you for VA disability?

Certain conditions automatically qualify veterans for VA disability benefits due to the severity and undeniable service connection of these conditions. These conditions, often referred to as “presumptive conditions,” include a variety of ailments and injuries recognized by the VA as being directly linked to specific military experiences or exposures. Examples include diseases linked to Agent Orange exposure, certain chronic illnesses that manifest within a specified period after service, and conditions like amyotrophic lateral sclerosis (ALS) that have a known high incidence among veterans. In addition, severe disabilities such as the loss of limbs, blindness, or traumatic brain injury (TBI) typically qualify for automatic benefits due to their significant impact on daily life. Veterans diagnosed with these conditions do not need to prove a direct service connection, as the VA assumes the condition is related to military service. It is essential for veterans and their families to be aware of these conditions to ensure they receive the benefits they are entitled to without unnecessary delays.

How an Attorney Can Help with a Benefits Denial Due to Lack of Diagnosis

Many veterans rely on VA medical care, which provides preventative care and ongoing treatment for medical needs, including the diagnosis and treatment of service-connected injuries and disabling conditions. These medical records may be the only evidence that a VA claims evaluator can rely on to make a disability rating assessment, so it is essential to be honest and forthcoming about the scope of your condition. Incomplete medical records could result in receiving insufficient compensation or even a benefits denial due to a lack of diagnosis.

VetLaw’s team of attorneys can help if your medical records are incomplete or the lack of a formal diagnosis resulted in you being denied benefits. They can work to analyze your denial letter, reexamine your medical records, and pursue an appeal to get you the benefits that you deserve. Call our team today to learn more.