Basic disability filing - start with well-grounded claims

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Posted on: Monday, April 30, 2012

Jim,

I have a basic question about the initial VA claim procedure:

Should I file each injury separate (e.g., one for right knee, one for right hip, one for left heal, one for left Achilles' tear, one for right Achilles tear, etc.) or should these be placed on one claim for everything? And, should I submit all my files with the claim or wait until they request them (e.g., accident report, profiles, physical therapies, history of medications for pain / anti-inflammatory etc.?)

I cannot find anything that tells someone how to file from multiple injuries stemming from a single accident. One the other hand, I would think that if only one section within the VA may have the claim folder at the same time and if something holds up one injury, that the entire set of injuries on a single claim would come to a halt thereby stalling all the claims in lieu of waiting for the halted claim to complete before going on to the next section within the VA claims office.

Reply:

In broad terms, you should file all well grounded claims in an initial application. Keep that "well grounded" term in mind...it's important. This is only when submitting an initial filing for disability compensation or a later filing when there are no active claims in process.

The origin of the claimed conditions isn't particularly important. Whether the vet is claiming injuries of a single event or a combination of injuries/illnesses over time doesn't matter as much as the more basic requirement of a diagnosis for each condition and the evidence showing how each claimed condition is disabling.

If you have the evidence, by all means submit it with the VA Form 21-526. If you are confident that you can get the evidence but that it may take a couple of months, file the 526 to set the effective date and submit evidence as you obtain it. I prefer that it be submitted all at once.

This is often referred to as perfecting a claim. To be properly perfected the claim should provide evidence of the event causing the condition, the current diagnosis by a medical professional and a description of the disabling effects of the condition.

I do recommend that the veteran only file well grounded claims when filing a cluster. In my mind the term well grounded means that the veteran will have adequate supporting evidence to support each claim as a stand-alone piece of the overall claim. For example, if the vet files 3 claims; a knee injury, a shoulder injury and a hip injury each must be looked at individually. If there is good supporting evidence for the knee and the shoulder but the hip claim is not very clear, I recommend that the hip claim be left for a future time.

(The term "well grounded" was used by VA in the past as a way of rejecting claims and not completely processing/adjudicating them. If VA said a claim was not well grounded, it implied that there wasn't adequate evidence to support an affirmative decision so they just didn't pursue it. Today VA is required to process all claims and to lend the veteran benefit of the doubt as well as to assist the veteran to develop and perfect the claim. That isn't always done as thoroughly as it should be though. Veterans are advised to help themselves and not rely on VA to do the research required.)

Other advocates would disagree with me. They would argue that the hip claim should be filed so that the effective date of the claim be as early as possible. In theory this will have an effect on the amount of the payout when the final rating is established. I agree that such a scenario is correct but that because of the Combined Ratings Table (CRT) the effect may be negligible. Following our example, if the vet gets an award of 30% knee, 20% shoulder and 20% hip...the CRT may offer the same monetary award as if only the shoulder and knee were awarded.

The hip claim could add a lot of time to the overall process. While VA should make the decision quickly on all 3, you may find yourself going for extra C & P exams for the hip or experiencing delays while VA searches for evidence.

I like to make initial claims as well greased as possible. The first claims should be supported by overwhelming evidence presented in such a way that the rater won't have a choice but to make the proper award. Once that's done and the vet is established in the system, receiving a monetary and a health care benefit, then he/she has time to pursue the other claims that may exist.

I can't help but add that once a claim is filed, the vet shouldn't make any changes. I advise no additional evidence be submitted, no additional claims be made and so on during the process. If there is additional evidence discovered during the process, save it for the appeal. It is more likely than not that there will be an appeal on every claim. While the claim is processing, the vet should spend time preparing the appeal. This will save time in the future.

During that initial filing the vet should include all available evidence. The VA will probably send out a series of computer generated letters asking for evidence as the process is ongoing...those may be ignored. You may want to tell them that you have no more evidence and that you wish to have a decision ASAP. That may get the denial to you faster so that you can go into the appeal and get the award you earned.

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