Friday, May 17, 2024

Does The Va Investigate Disability Claims

Don't Miss

Your Disability Rating Does Not Qualify You For Benefits

How Long Do Veterans Disability Claims Take?

Even if the VA accepts that you have a current diagnosis and its service-connected, the VA may have assigned you a disability rating that does not accurately reflect your medical condition. If a veteran receives a rating of less than 10%, they will not qualify for compensation, leading the VA to deny any financial compensation for their VA disability claim. Learn more about appealing a VA disability rating.

Providing more evidence of your disability and including other relevant informationsuch as notes from your doctor, buddy statements, medical bills, and extensive medical recordscan lead the VA to increase your rating. You want to make it as easy as possible for the VA to understand the limitations of your condition. Getting a legal team on your side can make the process even smoother.

Was Your Va Disability Claim Denied Here Is What To Do

If the VA denied your disability claim, you are certainly not alone.

Largely for financial reasons, Claims Examiners deny about a third of the applications they review. There is only so much money to go around, and every dime paid out takes money away from the bureaucratic machine. Fundamentally, you have two choices in this situation: accept the result or work to change it.

Usually, that second alternative is the best one, especially since most of the aforementioned claims denials are clearly erroneous.

Essentially, claims examiners hope the psychological blow of a denial is enough to deter future action. These bureaucrats do not count on assistance from a good veterans disability attorney.

Document Document Document It Will Greatly Improve Your Va Claim

Your claims acceptance depends on how well you have documented your injuries and chronic conditions. That includes how many times youve been treated for this condition.

Having a paper trail for your condition is important because it can act as evidence that youre injury or condition has gotten worse over time. Fo

The takeaway here is dont hesitate to get your medical issues checked out. Documentation helps the VA see that a disability is continuously affecting you, making them more apt to accept your claim regardless of when you file.

Recommended Reading: How To Calculate Disability Retirement Pay

Montgomery Gi Bill Selected Reserves

The Montgomery GI Bill Selected Reserves offers National Guard and Reserve members educational benefits up to $11,000 to help with costs of various education and training programs. Benefits under MGIB-SR benefits end for eligible members on the day they leave the Selected Reserve.

VA lists the eligibility criteria as follows, and all criteria must be met:

  • Applicant must have a six year obligation to serve in the Selected Reserves
  • Have completed Initial Active Duty for Training
  • Serve in a drilling unit and remain in good standing
  • Have a high school diploma or its equivalent

Mistake #: Not Having A Plan

 Does The Va Investigate Ptsd Claims

When you were in the Army, did you ever go out on an ambush without a plan?

How about you Navy submariners out there you guys had all sorts of plans to deal with rough situations.torpedoes getting stuck in tubes, electrical fires while submerged, etc.

VA Claims are like this, too.

If you dont have a plan going in, you are going to get side tracked or distractedor angry at the VA when they screw things up.

But how does a Veteran put together a plan?

For years until I hired a software developer to automate our clients case development process I used a paper form called a VA Claim Map.

On that map, I had spots to identify and organize all the vital elements of the VA Claims I filed for my clients.

It keep me focused on what I needed to prove, and it helped me make sure that I didnt miss anything important.

The more I used it, the faster my clients claims got granted.

Right after my firm started using it, we got news that we won a TDIU Claim for one of our clients in under 3 months. Why? We used the VA Claims Map to organize and structure our evidence and arguments.

I would love to tell you about the VA Claims Map visit this post to find out more about it and where you can get your copy.

Recommended Reading: Disability Pay In California

Fairport Man Pleads Guilty To False Claim Of Ptsd To Get Va Disability Payments

CONTACT: Barbara BurnsPHONE: 843-5817FAX #: 551-3051

ROCHESTER, N.Y. U.S. Attorney James P. Kennedy, Jr. announced that Michael Pecka, 33 of Fairport, NY, pleaded guilty before U.S. District Court Judge Charles J. Siragusa to making a false official statement. The charge carries a maximum penalty of five years in prison, a fine of up to $250,000, or both.

Assistant U.S. Attorney Craig R. Gestring, who is handling the case, stated that Pecka filed a claim for VA Disability Benefits in 2011 claiming that he had Post Traumatic Stress Disorder from witnessing the suicide of two fellow soldiers while deployed to Kuwait in 2004-2005 with the Army Reserve. In support of his claim for PTSD, the defendant described in detail the two suicides that he claimed to have witnessed to include his distance from the soldiers, the manner in which they each committed suicide, his observation of the bodies, and his role in the investigations. As a result of this claim, Pecka received a high disability rating and was awarded tax free disability benefits of $3,167 per month. The defendant filed the initial claim while he was an inmate in federal prison for an unrelated bank fraud conviction.

As a result of his false statements to the VA, Pecka received over $92,000 in tax free VA Disability benefits to which he was not legally entitled.

Pecka also has a pending violation of his supervised release conditions from the prior federal bank fraud conviction.

# # # #

Widows And Widowers Of Deceased Veterans

Widows and widowers of deceased veterans may also be entitled to payments based on a disability of their spouse. The VA law provides for a monthly payment, known as DIC benefits, where a service connected condition contributed to the death of the veteran or where the veteran was totally disabled because of a service connected condition for a certain period of time before the death.

Recommended Reading: Adhd And Intellectual Disability

The Job Of The Rating Activity

After all development actions are complete, the cross-functional team VSR refers the claim to the team RSVR for a rating. The RSVR reviews all the evidence associated with the claim, makes decisions on issues raised by the claimant, and identifies any inferred issues that should be addressed. The rater documents the rating decision in a standard format, using an automated rating preparation system called Rating Board Automation 2000. The system automatically calculates the disability rating. After completing the rating decision, the team completes the claim for follow-up and issue. This process implements the rating decision by preparing either a monetary award or a denial. It also prepares notification letters for the claimant and representative.

When performing a rating evaluation, RVSRs consider all evidence associated with the claim. This includes service medical records, VA medical examination records, clinical summaries from VA medical centers where treatment has been provided to the veteran, and evidence provided from private sources, such as the veteran’s treating physician.

Your Condition Is Not Considered Service

Blue Water Navy Veterans Receiving Incorrect VA Back Pay, Effective Dates

To receive disability benefits, you have to prove that your disability is service-connected. This means that your disability is a direct result of your military service, or was clearly made worse by your service.

The VA may determine that your medical condition is independent of your time in the military, or that it may have been pre-existing, meaning they believe that it was present before your military service began and was made no worse during your time in the military.

For your disability to qualify as service-connected, you must undergo a C& P exam by a qualified VA doctor. The doctor will look at your medical records, examine your symptoms, and determine the origin of your disability. As long as they can determine that your condition was at least as likely as not to have begun or become worse as part of your military service, your disability should qualify as service-connected.

Read Also: Ivds Va Rating

How To Prepare For A Request For The Va To Review Your Medical Conditions

If you feel confident that, after reviewing the VA literature on compensation and maximum limits for your conditions, that you have a case for increased compensation, youll need to be careful and methodical about moving forward.

This includes several steps that can help you make the strongest case possible for a review and increase in VA disability percentages.

What Happens If You Receive Notice Of A Proposed Rating Reduction

If you are a disabled veteran and VA proposes a decrease in your disability benefits, they are required to notify you if the proposed decrease will lower the amount of compensation you are entitled to each month. Its worth noting that the proposal is simply that: a proposal. It isnt a final decision. You will have a limited time to respond to the proposed reduction if you believe it is unfounded.

Specifically, you will have a 60-day window to present evidence showing why you believe your benefits should not be reduced. You will also have 30 days, or the first half of that 60-day window, to request a hearing in your case. At the hearing, you can present evidence in person, including medical records and other documentation, to show why you believe the proposal is unwarranted.

It is imperative that you show up for your re-examination. If you arent able to attend the examination due to unforeseen circumstances, you must call and reschedule the examination . Missing the appointment will likely result in an automatic reduction or termination of your disability benefits.

When the VA makes their final decision regarding a proposed decrease in your benefits, they must consider all evidence that you submitted during the 60-day window after they sent the proposal, as well as the full medical history that the VA already has on file in your case.

Read Also: How Much Does Disability Pay In California

Establishing Service Connection In Your Va Disability Benefits Claim

You dont need a presumptive condition to file a claim years after your military service ended. You just have to prove your disability is connected to your military service. That isnt always easy, but you will definitely have more success when you provide a Nexus letter.

This letter, usually from a medical professional, connects a veterans current medical condition to another service-connected condition, or to circumstances directly related to military service.

A link to an already service-connected disability opens the door for filing for other symptoms youre dealing with because of the original injury.

For example, some over-the-counter pain remedies and prescribed medications can cause gastroesophageal reflux disease over time. You may have heard this acid reflux called GERD. If you have GERD because of medications you are taking for your service-connected injuries, you can file a new claim for the GERD.

How Social Security Investigates Fraud

 Does The Va Investigate Ptsd Claims

The agency has created more Cooperative Disability Investigation units, which are designed to find and prosecute healthy people who are collecting disability benefits. Unfortunately, it takes very little to start an investigation. You can be the victim of a neighbor with a grudge, a hostile ex or a jealous relative who thinks you somehow have it easy.

All it takes is a anonymous report to start an investigation against you.

How, then, can you avoid being accused of fraud when your disability isnt the kind that shows up on an MRI or some other physical test? We know a few approaches that can help you with your Social Security fraud investigation if it ever comes to that.

You May Like: Changing Va Direct Deposit

Granting Va Disability Claims By Remote Questionnaire Led To Fraud Report Shows

A North Carolina veteran completed a public-use disability benefits remote questionnaire for a Department of Veterans Affairs claim for a mental health condition arising from three service-connected conditions.

Ultimately, the VA awarded about $6,500 in disability to the veteran, despite the fact that an examination by a licensed clinical psychologist ruling there was no direct relationship between the veteran’s symptoms and conditions. That’s according to a new VA inspector general report released Tuesday, finding that use of questionnaires administered remotely increased bad rulings and led to fraud.

In this case, the veteran went through a private provider in Puerto Rico via teleconference to fill out the questionnaire. The VA prohibits staff from using questionnaires completed remotely by non-VA doctors when determining benefits.

The report suggested that the Veterans Benefits Administration “determine whether public-use disability benefits questionnaires continue to be an effective means of gathering evidence to support claims for benefit entitlement and, if not, take steps to discontinue their use.”

Related:Military Health Record Milestone Delayed as VA Requests $1 Billion Funding Increase

But IG staff found VBA claims processors have used the telehealth questionnaires to make decisions in more than half of the claims it reviewed, adding up to about $613,000 in payments from April 2017 through September 2018.

Timeline For Veterans Filing For Va Disability Benefits Claims

What if you are just now learning about your rights to file a claim, even 20 years after your military service? The good news is that theres no law that says you have to file a VA claim within a certain amount of time. The bad news is that you may have missed out on years of VA disability compensation, so begin thinking about filing your VA claim soon!

If you served during a wartime that the VA recognizes, you may want to consider filing a presumptive disability claim. For example, a common presumptive claim is a condition that is associated with Agent Orange exposure during the Vietnam War.

Another presumptive exposure is contaminated drinking water at Camp Lejeune or atomic exposure from diffusion plants in Paducah, Kentucky, Portsmouth, Ohio, or Oak Ridge, Tennessee, before Feb. 1, 1992.

The VA presumes that exposure to certain substances is the likely cause of certain diseases. If you have one of these identified diseases and served during a place and time where you could have been exposed, you can submit a presumptive claim. The VA should accept it without much additional burden of proof on your part.

Recommended Reading: How Much Is The Average Disability Check

What Happens If Fraud Is Discovered

If the VA investigators discover that someone has fraudulently claimed a disability or exaggerated the severity of a disability, they can issue an arrest warrant. If the person is convicted, they could face fines and imprisonment. Besides, they may be required to repay all benefits received under the fraudulent claim.

If you believe that you are under investigation by the VA for a fraudulent claim, contact a lawyer who is specialized in this domain. You can arrange for a no-obligation consultation by filling out the easy online form or by calling us today. We will work with you through the entire process and help you maintain your rights under the law.

Know And Understand Your Current Va Rating

Common TDIU VA Claim Errors: Individual Unemployability

As mentioned above you will need to fully understand the VA disability rating for your existing condition and the VA justification for assigning that rating.

For example, tinnitus ratings are a maximum 10%. Do you know why this is? Or understand what VA policies dictate the cap on such ratings?

These are important things to understand going forward as these details can help you decide if you have a case the VA will take seriously or if you should leave well enough alone based on the risk of actually having the rating lowered based on current VA policies.

Don’t Miss: How To Appeal A Va Disability Claim

How To Submit Lay Evidence For Va Claims

Right now, the VA does not require lay evidence to be submitted using any one specific form. However, specific forms do exist. For example, the general form for submitting lay evidence VA Form 21-4138: Statement in Support of Claim and VA Form: 21-0781 Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder specifically for PTSD claims. Technically, Veterans can submit lay evidence on any sheet of paper. Statements must be signed and dated.

Who Is The Va Psychologist Who Fakes Ptsd

Not long ago I wrote an article about two combat vets and their attempts to paint veterans as pitiful victims of PTSD. A VA psychologist read the article and contacted me. He cant speak publicly because he still works at a large VA center, but I verified his identity and work. Ill call him John.

You May Like: Va Disability Rating For Bulging Disc

How To File A Request For An Increased Va Disability Rating

You will be required to fill out VA Form 21-526EZ. This form may be a bit confusing at first as it is used for a variety of things including applying for:

  • Disability Service Connection
  • Benefits Based on a Veterans Seriously Disabled Child
  • Increased Disability Compensation
  • Specially Adapted Housing/Special Home Adaptation
  • Automobile Allowance
  • Adaptive Equipment Compensation under 38 U.S.C. 1151
  • Secondary Service Compensation
  • Temporary Total Disability Rating

What Is A Line Of Duty Determination And How Can That Affect A Va Disability Claim

Veterans Benefits for Widows: What Are the Qualifications ...

A Line of Duty determination is an administrative procedure used by the military for determining a members duty status at the time of injury, illness, disability, or death. The L-O-D decision has a direct bearing on whether or not a service member is eligible for VA benefits.

Heres how it works. Under military regulations the L-O-D process is required when an active duty service member has an illness, injury, or disease that results in the inability to perform military duties for more than 24 hours, is likely to cause permanent disability, or results in the death of a service member. The outcome of a Line of Duty investigation will be one of four decisions.

The best possible outcome is In the Line of Duty. This is the presumed decision unless the facts show that the service members illness, injury, or death occurred while the individual was absent without authority or caused by that persons misconduct. If the determination is In the Line of Duty, then the service member is eligible for VA benefits.

If you are denied benefits because of an unfavorable L-O-D determination, you do have a one-time right to appeal the decision, but you must file your appeal within 30 days.

If you have been denied VA disability benefits due to an unfavorable L-O-D determination or for any other reasons, contact us at Cuddigan Law for a fresh look at your situation and there is never a cost or obligation for an initial evaluation.

Recommended Reading: Dyscalculia Symptoms Checklist

More articles

Popular Articles