When it’s time to retire or separate from military service, getting your medical records and having your medical issues rated by the Department of Veterans Affairs is an important part of the process.
When you get rated by the VA for possible compensation for service-connected or service-aggravated medical conditions, it’s easy to assume that this is a one-time only process. But if you feel your conditions are improving or getting worse, you may be able to petition the VA for a review of your condition for a revised rating.
There are no guarantees when it comes to pursuing a revised VA disability rating, and there is also potential that the Department of Veterans Affairs may lower the rating based on the evidence. But there are plenty of cases where the review-and an increase in disability rating-is justified and necessary.
Should Veterans Apply For Increased Ratings From The Department Of Veterans Affairs?
This is a question best answered on a case-by-case basis. There are no guarantees that the VA will raise your disability rating, and your entire file may be subject to review not just the condition you want to have reviewed.
So the answer is not simple, but there are ways you can get closer to a decision. One of those is to examine the VA Schedule For Rating Disabilities, also known as 38 CFR Book C.
Reviewing this document can go a long way toward helping you understand what the VA is looking for, how the agency rates your specific condition, and what the compensation percentages are.
As mentioned above, the VA is willing to re-examine your medical claim, but if you don’t understand how the VA does this, under what conditions additional compensation may be justified, and what the maximum compensation might be for your condition, you take a big risk in getting re-evaluated.
VA Maximum Compensation Rules
There are some medical conditions that are assigned a specific percentage of disability. In many cases that percentage cannot be increased. If you are rated at a certain percentage for a given condition, you may not be eligible for more compensation even if the problem gets worse.
If you are already at the maximum amount of VA compensation for that medical issue, a review of the condition will not give you the opportunity for additional payment.
The Tinnitus Example
An excellent example of this can be found in 38 CFR Book C under the heading Impairment of Auditory Acuity. One of the most common types of VA medical claims involves hearing damage. Military people are commonly exposed to loud noises, continuously running engine noise, power tools, etc.
As a veteran you may experience hearing damage with resulting loss of hearing, degraded hearing, or persistent hearing problems such as tinnitus.
Tinnitus is a continuous or prolonged ringing in the ears. The ringing (or other auditory disturbance related to the condition) may be intermittent or it may be continuous. The ringing can get louder over time depending on the extent of the damage or future exposure to loud noises.
The VA medical claims process includes a disability rating percentage for tinnitus. But the maximum compensation amount for this condition is 10% and will never increase beyond that unless the VA revises its’ schedule of compensation and disability ratings for the condition.
That means that if you submit a request to have your tinnitus reviewed and are already collecting the maximum amount, you won’t be awarded more even if it’s demonstrable that your tinnitus has gotten worse since leaving the military. The maximum percentage rate is your “ceiling” for compensation for that condition.
Not All VA Disability Ratings Are Awarded At The Maximum
All that said above, you may not be awarded the maximum amount of compensation for a specific medical issue, or you may have been awarded the maximum amount for an issue “as-is” without added complications.
In those cases, when the condition gets worse or begins showing signs of complications, you may be fully justified in getting your case reviewed by the VA to see if more compensation and treatment are needed.
If you don’t know the maximum VA disability rating for your condition in its current state or whether certain complications may increase your eligibility for more care and disability pay, you should definitely review the VA Schedule For Rating Disabilities at the VA official site to see what your options are.
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, you’ll 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.
Know And Understand Your Current VA Rating
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.
It’s not enough to proceed with your original medical records from the first time you submitted the claim. VA doctors want to know that the condition has changed and under what circumstances that change has occurred.
The going advice is that you should never assume the Department of Veterans Affairs will do this work for you. It’s your claim, and you will need to be proactive about gathering the documentation to support your claim.
If you do not have any medical records to support the claim that your condition is worse than originally diagnosed, or that your condition has gotten worse since the original claim, you will need to generate those records by getting evaluated and diagnosed all over again.
Getting Evaluated By An Expert
You may need to get re-evaluated by an independent medical authority not associated with the Department of Veterans Affairs before you submit your request for a claim review. What you need is an expert in disability medicine who can help make more sense out of medical issues that are unclear or that may be misinterpreted or misdiagnosed during the VA’s review process.
For example, what is the difference between the symptoms of PTSD and Traumatic Brain Injury or TBI? Are there any differences in these symptoms? Are medical or emotional problems related to either of these considered “co-morbid” with other medical conditions? Does TBI occur simultaneously with PTSD?
You may not know the answer to these questions, but an independent medical expert with expertise in disability medicine can help you understand what is diagnosable, what is treatable, and when your condition may be complicated by other factors. And if there has been a general worsening of the condition overall, you may be able to get help tracking and identifying such complications.
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 Veteran’s Seriously Disabled Child
- Increased Disability Compensation
- Individual Unemployability
- Special Monthly 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
Who VA Form 21-526EZ Is For
VA instructions on this form advise those submitting a claim for increased disability compensation or for those who “disagree with an evaluation decided more than one year ago” to complete and submit VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. But not all can use this form.
Those who disagree with a VA evaluation “decided within the past year and have new and relevant evidence” OR for those who need to file a supplemental claim, (described by the VA as a claim after an initial claim for the same or similar benefit on the same or similar basis was previously decided) will need to file VA Form 20-0995, Decision Review Request: Supplemental Claim.
You Can Apply Online
It is strongly encouraged for veterans to apply for VA disability compensation via the eBenefits portal.
This online application process allows you to upload all supporting documentation and file a claim without having to do the initial paperwork in person. The VA also allows you to get help from an accredited Veterans Service Officer (VSO). You can start looking for a VSO at your state’s Office of Veterans Affairs. A state-by-state guide to these offices is at the VA official site.
It is a very good idea to get the help of a VSO when submitting such claims; these officers have experience working with the VA system and may be able to help you save valuable time, better utilize your resources for gathering medical evidence, and may even be able to advise you on the practicality of your revised claim based on past experience in similar cases.
Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter for Air Force Television News
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