How A VA Disability Claim Actually Works

Intent to file — the step that pays you

This one is money. Most people never hear about it.

Your effective date is the date VA starts counting your money from. An intent to file locks that date in while you go get your evidence together.

• File VA Form 21-0966, Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC — va.gov/find-forms/about-form-21-0966
• Or just start the application online. VA sets your effective date automatically when you begin filling out the form, before you ever submit it
• You then have one year from that date to file the complete claim

File the claim — five ways in

The form is VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits.

If somebody tells you it is online or nothing, that is wrong. VA takes it five ways:

• Online at va.gov/disability/how-to-file-claim
• By mail
• In person at a VA regional office
• By fax
• With the help of a trained professional

Who can represent you, and what they may charge

VSO stands for Veterans Service Organization — not officer. The person who sits with you is an accredited VSO representative.

VA recognizes three kinds of representative: an accredited attorney, an accredited claims agent, or an accredited VSO representative.

• A VSO representative accredited by a recognized organization cannot charge you a fee at all. Not a dollar, not a percentage
• An accredited attorney or claims agent may charge, but only after VA issues notice of an initial decision on your claim
• A person who is not accredited may not represent you at all

Evidence — what VA owes you, and what is still on you

VA has a duty to assist. That is a right you have, not a favor.

• VA obtains your service records, your VA medical records, and other Federal records
• Once you authorize the release — VA Form 21-4142 and 21-4142a — VA will make at least an initial request and one follow-up for your private medical, employer, and state or local records
• You may submit medical records, buddy statements (a written account from somebody who saw what happened to you or saw how you are now) and any other evidence yourself, at any time

Proving the event — the special PTSD rules

For PTSD, the rule that sets out how you prove what happened is 38 CFR § 3.304(f).

VA needs three things: a diagnosis of PTSD, a link between your symptoms and an in-service stressor, and proof the stressor happened. That third one has easier paths for combat, fear of hostile or terrorist activity, and personal assault including military sexual trauma. The full walk-through is at vsgsolutions.org/no-sick-call-record.

The claim exam — only if VA asks

Also called a C&P exam, short for compensation and pension.

• VA asks you to have a claim exam only if it needs more information to decide your claim
• If VA does schedule one, go. Missing it delays your claim and VA may decide it on the evidence already in hand

What VA is actually looking for

• A current disability — a diagnosis or condition you have now
• An in-service event — an injury, illness, exposure or event during service
• A nexus — a link between the two
• Severity — how the condition affects your daily life and your ability to work

Service and discharge — the gate nobody explains

Guard and Reserve time counts. Read that again.

• Active duty, active duty for training, and inactive duty training all count toward the service requirement
• An other than honorable, bad conduct or dishonorable discharge may make you ineligible

The eight stages you will actually see

The status tool on VA.gov does not show six boxes. It shows eight stages.

VA reviews all the evidence and may ask you for more. At the end you get a decision letter with your rating and your payment information. Then the monthly payments start, and other benefits may open up to you on the strength of that rating.

va.gov/disability/after-you-file-claim

How ratings are really set

There is no single mild / moderate / severe ladder. Anybody who prints one is guessing.

Each condition is rated only at the levels its own diagnostic code provides in the VA Schedule for Rating Disabilities, 38 CFR Part 4 — VA's rating rulebook. Those levels measure one thing: the average impairment in earning capacity the condition causes.

• Some codes step 0, 10, 30, 50, 70, 100. That is the General Rating Formula for Mental Disorders at 38 CFR 4.130 — the one that ends at total occupational and social impairment. That phrase is the 100% test for mental health conditions only, not for everything
• Other codes step 10, 20, 30, 40, or other steps entirely
• So a 20% or a 40% is a normal, real, paid outcome under a code that offers it — and under a code that does not offer it, not getting one is not an error
• VA publishes a payment rate for every 10% level from 10% to 100%

A 0% rating is not a denial

No monthly payment. Still a service-connected rating, and worth having.

• Care related to that service-connected condition carries no copay
• It is on the record if the condition gets worse and you file for an increase
• It can combine with other ratings later
• It may help you qualify for a VA health care priority group — a compensable 0% rating reaches Priority Group 6, and a noncompensable 0% reaches Group 5 if your income is below VA's limits: va.gov/health-care/eligibility/priority-groups

What the rating pays, and pay for your Family

• The payment is monthly and tax-free
• At 30% and above, VA pays a higher rate if you have a dependent spouse, child, or dependent parent
• At 10% and 20% it does not — dependents do not raise those rates
• Add a spouse or child on VA Form 21-686c. Add a dependent parent on VA Form 21P-509

Special monthly compensation (SMC)

A higher rate on top of, or in place of, the regular rating, for loss of use, loss of a body part or sense, or a need for another person's help.

Effective dates — when your money starts

The general idea: whichever is later, the day VA receives your claim or the day your entitlement began.

A denial or a low rating is a stage, not the end

VA gives you three review lanes: Supplemental Claim, Higher-Level Review and Board Appeal.

Which lane fits, the forms and deadlines, and how to keep your original effective date while you fight are at vsgsolutions.org/appeal-a-va-decision and vsgsolutions.org/claim-denial-reasons. VA's page: va.gov/decision-reviews.

Real phone numbers and official pages

• VA benefits hotline: 800-827-1000, Monday to Friday, 8:00 a.m. to 9:00 p.m. ET
• VA health benefits hotline: 877-222-8387, Monday to Friday, 8:00 a.m. to 8:00 p.m. ET
• MyVA411 main information line: 800-698-2411 (TTY 711)
• Veterans Crisis Line: 988, then press 1, any hour
• Local: Junction City, Kansas — Veteran's Strategic Solutions LLC, 785-579-9071. I can point you to an accredited representative; I am not one and I do not file your claim for you

• How to file a disability claim
• Disability compensation for PTSD
• Effective dates
• Special monthly compensation
• Decision reviews and appeals
• Find an accredited representative