U.S. veterans may be eligible for disability benefits, and the amount that may be granted is based on how the U.S. Department of Veterans Affairs (VA) rates the applicant’s service-related disability or health condition. In case the veteran has more than one service-associated disability, the monthly compensation amount will be based on his/her combined disability rating. A medical records review will be performed to establish disabling physical conditions such as an injury or a chronic illness or mental health conditions such as PTSD that developed before, during or after service. Therefore, medical records and their analysis are vital to complete a VA disability claim.
VA Disability Claims That Need Medical Record Analysis
- Tinnitus: It is the No.1 easiest VA disability to claim for all veterans, according to the 2018 – 2019 disability claims data. It involves the sensation of hearing sounds such as buzzing, ringing, roaring, clicking, humming or hissing even if there is no external sound present. This health condition can have only one VA rating, either 10% or nothing. In other words, there is no lower VA rating or higher VA rating and so it is called a “low-value” claim. There were 157,152 compensation recipients and 93.6% of veterans were rated at 10%.
Read more about VA disability benefits for Tinnitus in our earlier blog:
Those who work in noisy conditions such as musicians, military personnel, and the elderly are most at risk of developing Tinnitus. Veterans planning to file their VA Tinnitus claim as a secondary disability need to know that conditions such as Meniere’s disease, depression and anxiety, TBI, PTSD, head and neck conditions, hearing loss, high blood pressure, and TMD or temporomandibular joint disorder can make Tinnitus worse.
- Hearing loss: Among the applicants, 93.6% of veterans were rated between 0% and 10%. To detect and diagnose hearing loss, the audiogram test is used and the medical records should reflect this fact. The VA department would look for a certain level of hearing loss as the first step, and considers two factors to rate hearing loss after the examination.
- Decibel loss at 5 different frequency ranges from low to high: To be found eligible, an average loss of 26 or more decibels in 3 of the 5 frequency ranges constitutes hearing loss.
- Speech discrimination or how well the veteran can hear normal conversation: A series of monosyllabic words is presented and it is determined how well the veteran can hear them. A score of lower than 94% in speech recognition corresponds to a number related to hearing loss. The veteran may not be ensured compensation even if the audiogram shows that one ear is 100% deaf. The likelihood of getting benefits decreases if the hearing loss in the other ear is not significant.
The second step is evaluating service-connected hearing loss. The veteran’s chances of getting disability benefits may increase or decrease based on his/her MOS (Military Occupational Specialties). An example is the job of flight mechanics. These service men have “noise exposure conceded” which means that it is understood that they were exposed to high noise levels during their service period. On the other hand, aircraft pilots whose cockpits are sound-insulated may not automatically be given this concession.
- PTSD or Post-traumatic stress disorder: 90.7% of veterans were rated at 30% or higher for mental health; 41.1% of veterans were rated at 70% or higher, according to the 2018 – 2019 VA data. Mental health conditions such as PTSD, generalized anxiety disorder, major depressive disorder, and somatic symptom disorder are considered “high-value” claims. Such claims have a high likelihood or getting rated at 30% and above. PTSD is a mental health condition that stems from experiencing or witnessing a terrifying event. Medical records should document symptoms such as nightmares, insomnia, depression, flashbacks, anxiety, anger issues, suicidal thoughts, relationship issues and work problems. There are 37 ratable VA mental health conditions under the law under which the veteran can file a claim for disability benefits due to PTSD or any other mental health condition.
- Scars: These are 4th in the list of the most compensated claims for all veterans across all demographics. While 76.2% of veterans are rated at 0% for skin conditions and 18.6% are rated at 10%. So, scars are a low-value claim.
- Limitation of flexion of the knee: The 2018 – 2019 data showed that 92.2% of veterans were rated between 0% and 20%. This is also considered a low-value claim. Conditions that come under this include issues with joints and muscles. They must involve limitation of range of motion (flexion) and/or painful motion. Medical documentation should prove the existence of symptoms such as painful motion, loss of power, decreased movement control, fatigue, arthritis, lack of coordination, arthritis and weakness and so on. Musculoskeletal disabilities can be considered as secondary VA disability claims and these include issues with muscles.
- Cervical/lumbosacral strain: 2% of all veterans were rated between 0% and 20%, which makes this type of VA claim a low-value one. This condition signifies an injured, stretched, or torn tendon or muscle in one’s neck and is medically connected to trauma and overuse. It is represented by diagnostic code 5237 and has ratings between 0% and 100%.
- Paralysis of the sciatic nerve or sciatica: 2% of the veterans were rated between 0% and 20%, and so this also is a low-value claim.
- Limitation of motion of the ankle: Another low-value claim with 92.2% of veterans receiving ratings between 0% and 20%, VA ratings for the ankle are typically at 0% and 10%, with some rising up to 20%. A medical record review would focus on finding documentation related to arthritis, limitation of range of motion or flexion, weakness, fatigue, painful motion, lack of coordination and decreased movement control. This is a musculoskeletal disability that can also be filed as a secondary VA disability claim and can be caused or worsened by conditions such as medication side effects, post-traumatic stress disorder, depression and anxiety, and temporomandibular joint disorder among others.
- Migraine: This is a high-value claim because patients are very likely to get rated at 30% or higher. Migraine, being a serious neurological condition, is rated between 0% and 50%.
- Migraine with very frequent prolonged/prostrating attacks productive of severe economic inadaptability is rated at 50%.
- Migraine with characteristic prostrating attacks occurring on an average once a month over the last several months is rated at 30%.
- Migraine with characteristic prostrating attacks occurring on an average once in 2 months over the last several months is rated at 10%.
- Migraine with less frequent attacks is rated at 0%.
The term “prostrating” is very important in this regard because it signifies the severity or intensity of the migraine. The word shows that the migraine is so severe that the patient has to lie down. A medical peer review physician evaluating the condition would look for symptoms such as nausea, throbbing pain, dizziness, and sensitivity to sound and light recorded in the patient’s medical chart.
- Degenerative arthritis of the spine: The most common type in this category is osteoarthritis, also called degenerative joint disease. The patient’s medical records should show evidence of worn out/degenerative bone, swelling, and significant pain. Other symptoms include weakness, pain, and tingling in the arms and legs. Typically, this condition receives a rating between 0% and 50%.
Medical Evidence Required to Support the VA Disability Claim
Attorneys representing veterans typically use the service provided by a medical record review company to evaluate the medical records and find evidence that can connect the veteran to the particular condition and get rated at the appropriate level to support the plaintiff’s VA disability claim or appeal. The documents required include the following.
- Hospital records and VA medical records related to the claimant’s illness/injury. Also, records that show that the claimant’s rated disability has worsened.
- Supporting statements from family and friends, law enforcement personnel, clergy members, or those whom the veteran may have served. These people can explain the plaintiff’s claimed condition and how/when it happened or got worse.
- Private hospital reports/medical records that have a connection with the plaintiff’s claimed illness/injury or that show the disability has become worse.
Medical records and medical record review are perhaps the most important aspects in a VA claim for disability. Solid and timely medical evidence will help establish the genuineness of the disability and convince the authorities.
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Disclaimer: The above content is sourced from reliable internet resources and other credible sources. It is not the opinion or inference of MOS (Managed Outsource Solutions) or any of its stakeholders. The content is meant for informative purposes only. For a professional view, please consult an experienced disability attorney.