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When the VA makes a decision on a claim, they send the veteran a Rating Decision letter. This decision lists out the reasons and bases for how and why the VA arrived at the decision they made. Unfortunately, more often than not, these rating decisions contain copy/pasted templates that don’t adequately address or inform the veteran as to how or why the VA made the rating decision it made.
Many times, veterans receive their rating decision and are utterly confused as to why their ratings are so much lower than they anticipated. So, what is there to do about it? The Arizona military law attorneys at Stone Rose Law explain.
The most important part of assessing any claims decision is first to obtain a copy of your VA claims file (or “C-file”). Your C-File contains every piece of information the VA used when deciding your claim – including the Compensation and Pension examination (C&P exam) reports. The C&P exams are undeniably necessary when trying to determine whether you have been misrated but unfortunately they are not released to the veteran as a matter of course.
To obtain your C-File, you generally must file a VA form 3288 requesting specifically your entire C-File. This process can take many, many, many months (assuming the request hasn’t been lost or misplaced by the VA). After obtaining your C-file, you then have all the evidence the VA used to decide your claim.
When the VA issues a rating decision, it also prepares a “code sheet” which lists each disability, the “diagnostic code” for that disability, and the percentage awarded for that disability. This is not released to veterans as a matter of course but is absolutely necessary to ensure an accurate rating decision.
VA regulations require raters to evaluate all of the evidence of record to get a full understanding of the veteran’s disabilities. Unfortunately, raters are under tremendous pressure to quickly (though not necessarily accurately) process claims. This means that raters typically will rely solely on the C&P exams and overlook additional evidence of the disability picture. To compound matters, C&P examiners are supposed to review the entire claims file and address the evidence in the file in their examination and written report.
They rarely, if ever, do this. Thus, many veterans find themselves misrated or underrated due to rushed VA raters or lazy C&P examiners.
When you obtain your C-file, it is important to compare your C&P examination reports to the rating decision and code sheet.
Now that you’ve got your C-file in hand, you should begin by first mapping out every claim you’ve made, how it was decided, and under what diagnostic code (“DC”). The diagnostic code assigned to the disability determines how it is rated under the VA Schedule of Rating Disabilities. Many times, a disability can fall under multiple diagnostic codes – in which case the VA has a duty to apply the DC which maximizes benefits.
As you can likely guess, many times the VA doesn’t properly apply the correct DC. A common example:
A veteran presents with painful motion of the knee and recurrent instability. If rated under one Diagnostic Code, the veteran would be entitled to 10%. If rated under another diagnostic code, the veteran would be rated at 30%.
After mapping out your claims and the attendant diagnostic codes, you should review the applicable diagnostic codes in the VA Schedule of Rating disabilities to ensure that you were rated under the proper DC.
Next, you should compare the results of your C&P exam to the VA schedule of rating disabilities to verify that the rater appropriately reviewed the examination and assigned an appropriate disability rating. Many times VA raters fail to carefully review the examination report and miss criteria that would entitle you to a higher rating!
Truthfully, it is! And this isn’t the half of it. After reviewing the C&P exams as they are, you should next examine whether the examinations were adequate – i.e., did they provide a reasoned medical opinion supported by evidence? Did they address the evidence in the record? Are there any conflicting opinions or contradictory findings?
Next, did the VA or the examiner overlook any evidence of record? By that, we mean did they miss anything in your service treatment records that is important for the claim or an appropriate rating? Did they obtain all of the relevant service treatment records or are they missing any? What about records from private medical providers?
Let’s be honest – that is a lot of work. Compounding the effort in obtaining and reviewing the documents is the fact that you need to then research the appropriate statutes, VA regulations, and medical literature!
Being frank, it’s a lot of work to expect an individual person to do – especially when they are working full time or going to school. On top of that, VA regulations and statutes are confusing, contradictory, and complicated (almost by design)!
However, our accredited VA disability benefits attorneys at Stone Rose Law are experts in VA disability law, including the regulations, diagnostic codes, and medical principles necessary to evaluate ratings decisions! Whether you need assistance evaluating your situation or appealing a VA disability claim, we can help.
The best part? We are happy to review your claims file thoroughly and completely for free. More than that, because all of our attorneys are fully accredited by the Department of Veterans Affairs, we are able to obtain your complete claims file electronically much, much quicker than if you request it yourself! Contact the dedicated Nationwide Veterans Disability Benefits attorneys at Stone Rose Law today for your FREE claims file review.