Disability Claims Processing for Veterans – Some Facts

by | Published on Sep 21, 2016 | Social Security Disability

Honorably discharged veterans are eligible for disability benefits, i.e. compensation and medical care for any disabling medical condition/injury incurred or aggravated while they were in service. A disability claim must be supported by relevant medical records. The VA (Veterans Affairs) will ask the applicant to undergo a Compensation and Pension (C&P) medical examination to obtain evidence of the disabling condition. This exam is typically conducted by healthcare professionals contracted by the VA. If the veteran doesn’t agree with the results of this C&P examination, and finds that he/she needs a “nexus letter” that will provide a degree of expert medical opinion to associate an active duty event to the present disabling condition, they are often told to seek an IME (Independent Medical Examination). This constitutes obtaining the opinion of an unbiased, neutral, expert physician. The veteran may not have to undergo a complete physical examination but his/her medical records will be reviewed by the independent medical examiner, who may utilize a medical review service to speed up the process and ensure accuracy of the review. A comprehensive medical records review will help offer an opinion of causality or the cause and effect relationship between an event while in service and a disabling condition/illness/injury today.

The Department of Veterans Affairs helps veterans get their claims processed faster through the FDC (Fully Developed Claims) process. The veteran has to fill the FDC claim on the appropriate form and submit all required evidence for the VA to come to a decision on the claim. The veteran can submit a signed statement that all the supportive evidence has been submitted at the time of filing, and include it as part of his/her filing. The VA will review the claim quickly. If the veteran’s disability treatment is completely provided by the VA’s healthcare system, the VA has to be notified of the same. If an outside provider provided the treatment, the VA has to be informed about this and a form has to be completed, authorizing VA to develop the claim by requesting medical records from this outside provider. In this case, though, the claim will not be considered “fully developed” and will be processed as such. There is a provision for veterans to submit a DBQ (Disability Benefits Questionnaire) along with their claim.

The DBQ can be conveniently downloaded from the VA website. This form is important because it helps speed up the processing of the claims. It gives veterans more control over the disability claims process by giving them the option of visiting a primary care physician in their community at their expense, as an alternative to completing an evaluation at a Department of Veterans Affairs facility. DBQs were developed to help simplify the collection of the required medical evidence necessary for claims processing. These forms use check boxes and standardized language to enable accurate and quick decision regarding disability rating. The DBQ can be completed by the veterans’ private treatment providers or clinicians of the Veterans Health Administration (VHA). The provider must have an active medical license and must sign and attest to a medical condition on the completed DBQ. It is best to complete a DBQ before submitting the claim because it can significantly speed up claims processing.

Veterans going to an independent medical examiner must ensure that he/she is a recognized expert who knows the VA system. Such a physician can easily find relevant medical information in the medical chart that may have been overlooked earlier. An accurate diagnosis will ensure a fair and rational analysis of the case and the physician can provide an unbiased assessment of the applicant’s disability. When the case is handled in a careful and timely manner, it will help avoid years of appeals and related hassles.

The U.S. Department of Veterans Affairs provides the online service MyHealtheVet (www.myhealth.va.gov,) that allows eligible veterans to access their health records round the clock. Veterans are also given free training designed to teach them how to access their electronic records. Other facilities the website offers include:

  • Can re-order medication
  • Check appointment times
  • Download medical records

Often, there are delays and denials in getting a claim approved and veterans who are represented by experienced disability lawyers stand a better chance of filing their claims accurately and getting them approved.

Discover our medical record review solutions and partner with us for your next case.

Related Posts