You served your country selflessly, but during your service you were injured or developed a condition that is still affecting your life today. After applying for veterans’ disability benefits through the U.S. Department of Veterans’ Affairs, you have finally received a decision about your application. Upon opening the decision, you will see two important pieces of information: Notification Letter and Rating Decision.
The Notification Letter is usually stapled on top of the Rating Decision. The date on this notice is important because any additional information or an appeal of the decision (Notice of Disagreement) must be submitted within one year of the date on the letter. The letter will give a brief explanation of the VA’s decision on your claim and, if benefits are awarded, the effective (beginning) date of payments.
The Rating Decision includes several sections: Introduction, Decision, Evidence, and Reasons for the Decision.
Introduction: The introduction identifies the veteran and his/her qualifying service.
Decision: This section lists all of your conditions and/or impairments, as identified by you or the VA Reviewer. This list can include expressly claimed issues, reasonably raised issues, and subordinate issues.
An expressly claimed issue is a condition or impairment that you listed on your application for disability benefits.
A reasonably raised issue is a condition or impairment that may not have been listed on your application, but is directly related to a condition or impairment that is listed. For example, if you listed diabetes as a service-connected impairment in your application for benefits and your medical records show that you also have vision problems related to the diabetes, the VA Rating Representative can take your vision problems into consideration, even though you did not specifically list vision problems as an impairment.
A subordinate issue stems from a related condition or impairment. For example, a VA Rating Representative may consider additional aid or compensation for a spouse that is caring for a 100% disabled veteran.
The Decision section also indicates whether each condition/impairment was granted or denied service connection, the disability rating, and the effective date of each condition/impairment.
Service-connection – Your injury or disease occurred or was aggravated during active duty or active duty for training, or inactive duty training.
Disability rating – The VA created the Schedule for Rating Disabilities to help streamline compensation; it is intended to reflect the loss in earnings that a veteran may experience because of their impairments. Ratings range from 0% to 100%.
Effective date of impairment – The date that compensation for your conditions/impairments will begin. Generally, this will be the date of the claim (or date you filed your intent to file application), but there are instances where a later effective date is appropriate.
Evidence: This section will include a list of all the evidence that was considered in making the decision to award or deny benefits. This section will also identify any evidence that was requested by the VA, but not received. It is important to compare this section to your own medical records and information. Often, the VA will not receive all of the medical evidence requested, which could lead to a decision that is inaccurate or fails to consider the severity of all of your impairments.
Reasons for the Decision: This is the most important section! Here, the VA Reviewer must include an outline of how the evidence was considered and the regulations used to arrive at the final decisions regarding service-connection, disability, ratings, and effective date.
It is important to review the above documents thoroughly. Your Veterans Service Officer (VSO) can help you understand your decision. Using their experience and knowledge of the regulations, they can review the decision to make sure that the VA followed the proper procedures; reviewed all relevant evidence; and made decisions based on that evidence.
If there is information missing, a clear error, or if you disagree with the decision based on service connection, rating of your impairment, or any other issue, your VSO may recommend that you submit additional information or appeal the decision by filing a Notice of Disagreement. You only have one year from the date on the Notification Letter to take action (without starting the process again from the beginning), so it is important that you review the ENTIRE decision as soon as you receive it!
Finding answers to your disability claims questions doesn’t have to be difficult. Take our free quiz today to determine what resources are available for your specific needs.
Once you have begun an application for veterans disability benefits, you may be required to complete a medical exam called the Compensation & Pension Exam. This examination is sometimes referred to as the C&P Exam or the VA Claims Exam. The exam is given by a doctor who works for the Veterans Administration (VA) or a private doctor that is contracted by the VA to complete the exam. The physician will examine your condition and document your disability on a Disability Benefits Questionnaire (DBQ). The DBQ will be used by the VA when deciding your disability claim.
Keep in mind that the C&P exam is only one part of your veterans disability application. The doctor who examines you will not make the decision regarding your disability claim. The DBQ form that the doctor completes is only one of the materials used by the VA to determine your disability rating.
What is a DBQ?
The DBQ was created to “help streamline the collection of necessary medical evidence for the purpose of processing Veterans’ claims.” At your scheduled C&P Exam, a VA clinician will complete the DBQ to document the severity of the condition or illness that led to your application for veterans’ disability benefits.
There are over 70 different DBQs depending on the diagnosed condition, which range from psychological conditions to the loss of the sense of smell. Each DBQ can be used to provide more information about your experience with that particular medical condition or symptom.
How a C&P Exam is ScheduledAfter you apply to the VA for disability benefits, make sure that the VA Medical Center that you attend has your current address. They will automatically schedule your appointment and send you a C&P Exam notice by mail or contact you via phone to schedule a date/time for the exam. A letter will provide you with the details of the appointment, including the date and time.
Before your exam date, you should:
Review the date and time of the exam; if you need to reschedule, do so right away.
Gather together your medical records.
Call and confirm your appointment.
Preparing for the ExamWhat to bring to the C&P Exam:
Exam notice: Have your appointment letter with you.
Medical records: Bring all previous doctor reports and tests to the appointment.
Prescriptions: If you are taking any medications, bring the information for each prescription with you.
A spouse or friend: You may be nervous, especially if this is your first C&P Exam. Consider bringing someone who can give you support and help you remember details about your condition.
The length of your exam will depend on the type of disability you have claimed. The doctor will ask questions and prepare a DBQ. You may be given a physical exam, but that does not always happen. It depends on the disability being examined.
Provide your doctor with as much information as possible. Be honest and straightforward, and do not exaggerate your symptoms. Go over each of your conditions, and provide the physician with details regarding your medication, treatments, pain and suffering, and anything else that is related to your disability claim. Depending on the type and number of conditions you’re claiming, either a single doctor or multiple doctors will examine you. If more than one doctor must examine you, than multiple exams will be scheduled. For example, a back specialist may examine you for chronic back pain, while a psychiatrist would examine you separately for posttraumatic stress disorder (PTSD).
Mental health exams
If your disability includes an evaluation for a mental health condition, then your psych exam will consist primarily of the doctor asking you questions. You will need to explain your symptoms and possibly complete a psychological test.
DBQs Completed by Private Physicians
While a VA clinician is often more familiar with the DBQ and understands its value when making a disability determination, having a private physician complete it can be helpful. Many veterans will choose to have a private specialist or a long-time treating physician complete the form because of their extensive knowledge of the disabling condition or the veteran’s treatment history.
Keep in mind that the VA will not reimburse you for any expenses related to the completion of a DBQ by your private physician. However, veterans will not be charged for any appointments scheduled by the VA with a VA clinician or contracted physician.
Which DBQ Form Should I Use?
Many clinicians will select the appropriate DBQ forms for use in your exam. However, especially if your private physician will be completing the exam, it is important to come prepared with the correct form(s).
The DBQ forms are listed by symptom and body part or system. Some conditions have their own specific DBQ form and other conditions fall under a broad system or condition. If you have a condition that is not listed, it is perfectly fine to choose a DBQ form that is more generically related or falls into a broader category. For example, under the Psychological category, the VA lists three forms: Eating Disorders; Mental Disorders (other than PTSD), and Review Post Traumatic Stress Disorder. If you suffer from anxiety, your best option would be the Mental Disorders form because anxiety falls under that broad category.
If you have multiple conditions that fall under a broad category, you may use one form to document the severity of all of the related conditions. If your claim for disability benefits involves more than one condition and they are not related, you should use a separate form for each condition.
A C&P Exam is one of the most important components used by the VA to determine your disability claim. Make sure that you attend all your C&P appointments and get the appropriate DBQ forms completed at each one. If you fail to report to one of your exams, the VA may prolong its decision or determine your rating “as-is” based only on the other materials submitted with your claim.
Remember, the C&P exam is a doctor’s evaluation of your condition for VA disability purposes, not for treatment. You will not receive any treatment or prescriptions. Rather, the doctor will be evaluating your disabilities. If you have any questions about your C&P exam(s) or DBQs, discuss them with your Veterans Service Officer (VSO) to make sure you are prepared for your appointment.
Finding answers to your disability claims questions doesn’t have to be difficult. Take our free quiz to determine what resources are available for your specific needs.
You courageously served your country and completed your military service, but you were left with an injury or illness that is limiting your ability to live life to the fullest. If you are a veteran of the U.S. Armed Forces and have a current injury or condition that is connected to that service, you may be eligible for disability compensation.
If your service or medical records are incomplete or do not demonstrate the connection between your impairment and your service, you can choose to submit additional materials to support your veterans disability claim. While your Veterans Service Officer (VSO) can help you determine what information you should submit, one of the most common supporting materials is a “nexus” letter.
What Is a “Nexus” Letter?
In order to qualify for veterans’ disability benefits, you must be able to show that your current condition or injury began during your military service or was aggravated by what you experienced during that service. In other words, you need to show that there is a “nexus” or connection between what happened in the military and your current medical condition. A nexus letter is written by a doctor, specialist, or expert and provides insight into your injury to confirm its connection to an event or injury that occurred during your military service.
Why Do I Need a Nexus Letter?
Many injuries or conditions are difficult to connect directly to your military service. Common examples include back and knee injuries, cancer, mental impairments, etc. Since service members are often reluctant to get something treated while they are in the service, or they simply underestimate the severity of an injury when it first occurs, this can pose a challenge for proving a connection at a later date.
Perhaps you hurt your knee performing work during your service and instead of seeking treatment, you bought a knee wrap from the grocery store and took some aspirin. Now your knee is in terrible shape and is limiting your ability to stand, walk, and sit. However, it is likely that the Veterans Benefits Administration (VBA) will not be able to verify the connection between your knee injury and the problems that you are experiencing now because you did not get treatment at the time of your injury. This is where a letter from your doctor, specialist, or psychologist or psychiatrist (depending on the nature of your impairment) can be especially helpful and supportive of your claim.
Another example involves exposure to Agent Orange. The VBA has recognized exposure to Agent Orange as a presumptive cause of several types of cancer and/or disease. While many veterans suffer from the effects of exposure to Agent Orange, they often have difficulty drawing the connection to their military service because their condition is not on the presumptive list of conditions. A nexus letter from an oncologist or other expert can provide additional support to the claim and may establish service connection, resulting in approval for disability benefits.
What Should a Nexus Letter Include?
As stated earlier, a nexus letter should be written by an expert. Most of the time, this will be your treating physician, a specialist (like an oncologist), or a psychologist or psychiatrist; someone who has expertise in your condition or type of injury.
The expert should review all of your related medical records, including service medical records, before drafting a nexus letter. The expert should indicate in the letter which records were reviewed so that the reader understands the history and depth of the expert’s observations and opinions. Additionally, it is always more persuasive if you have been examined recently by the expert that is drafting the letter.
The letter should be clear, concise, and should detail your injury or condition and how it relates to an injury or event that occurred during your military service. Fortunately, the expert does not need to state that he or she is 100% positive that the triggering accident or event caused your current injury or impairment. The expert only needs to express whether “it is more likely than not” that your illness or injury was incurred or aggravated during your active service.
Nexus letters can be a powerful resource and provide valuable support to your claim for disability benefits. It is helpful to first discuss with your VSO the potential experts that could write your nexus letter(s) before deciding who to ask. Your VSO may be able to suggest a doctor or specialist who is familiar with the veterans’ disability claims process and who may have written successful nexus letters for other veterans.
The VA disability benefits claims process can be lengthy, overwhelming, and frustrating, but finding answers to your disability claims questions doesn’t have to be difficult. Take our free quiz today to determine what resources are available for your specific needs.
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