3/3 RVN Ass’n Vol 1 Issue 1 09/01/2004 Page 4
VA Disability Rating Criteria:
A former 30 year employee of the Veterans
Administration wrote the following after his retirement. He is also a disabled vet. It addresses the lack of knowledge many applicants have about what is involved in processing their disability claims.
His statements are not to be interpreted in any way as being officially sanctioned by the Department of Veterans Affairs. The information is meant for general understanding only. There are always exceptions and the law is subject to change. We hope this helps alleviate some of the anger and frustration many experience due to the seemingly endless delay in processing their claim.
When a veteran submits a claim to the VA, he/she should understand there are several prerequisites for a successful disability claim. Among them are:
1. The evidence of record must show the claimed condition was incurred in (first occurred or diagnosed) during military service. That means the medical evidence provided by the veteran and/or the service department (usually the Fed. Records Center in St. Louis) must show the claimed disability. If the disability pre-existed service, such as a knee condition, the evidence must show that the condition became worse during military service. That is one reason it is important to insist on a discharge physical examination. It is your last chance to make certain disabilities are in your record. REMEMBER, if the claimed disability is not shown in your service medical records it DIDN'T happen. Exceptions to this rule are conditions, which may not manifest until after military service is complete. For example PTSD. In such cases, the veteran's service record is requested to determine if his/her service was under such conditions, that the present diagnosis can clearly be associated with military service.
The fact that your drill sergeant was mean to you would not qualify.
2. Assuming service medical records show the claimed disability exists, then it must be determined how disabling the condition is at the present time. Usually the claimant is scheduled for an examination at the nearest VA Medical Center. The examining physician completes a report showing his/her diagnoses and clinical findings. Keeping with the knee example. The doctor will check for range of motion, looseness of the joint, pain, etc. For sake of our discussion, we will assume the knee was initially injured during military service.
3. The report is sent to the Regional Office for review. The rating specialist reviews all the medical evidence, with special consideration to the examining physician's report. The rating specialist then consults a rating schedule. The diagnosis tells him/her under which disability to rate the knee. For
example, chronic knee strain, torn ACL, traumatic arthritis, etc. The clinical findings will be compared to descriptions given to various percentages. The percentage, which closest agrees with the
physician's findings, will be given as the evaluation of the disability.
4. If the veteran has more than one disability, each of which is considered at least 10% disabling, they will be applied to a combined rating schedule to yield a combined evaluation. The individual disabilities are not added to give a final percentage. For example: Assume our hypothetical veteran has 3 disabilities: knee, heart, and psychological. Each disability is considered 50% disabling. The veteran is not considered 150% disabled. What happens is EACH % is applied to the remaining healthy person.
With no disabilities the veteran is considered 100% healthy.
When the knee condition is considered, the veteran is now 50% disabled and 50% healthy. The 50% evaluation of his heart is applied to the remaining healthy 50% and he/she is considered 75% disabled and 25% healthy. Since evaluations are only in even 10%, the evaluation is rounded off
to 80% disabled and 20% healthy
The final 50% psychological condition is applied to the remaining 25% healthy person. Remember the actual combined evaluation was 75%. It was just rounded to 80%.
He/she is now 88% disabled. The evaluation is rounded to 90% disabled and 10% healthy.
5. The veteran would automatically be considered for individual unemployability. The rating specialist would determine that if based on the veteran's education, skills, etc. are his/her disabilities so severe as to render him/her individually unemployable. If the answer is yes, he/she is paid at the 100% rate although his/her disabilities only warrant a 90% evaluation.
Although the monetary benefit is the same, there is an important distinction between a combined scheduler 100% and 100% due to individual unemployability. If the 100% is by the schedule, the veteran may, if able, hold a regular job.
If the 100% is due to being unemployable, he/she may not engage in anything other than marginal employment. The VA checks annually through the individual states for vets, who are considered unemployable and are holding a regular job.
It can become very ugly financially for the veteran, if he/she is caught. It could result in anything from a reduced evaluation, to full repayment, to jail time.
Contrary to popular belief, the mind set in the VA is to resolve all doubt in favor of the veteran. Consider, if the claimed benefit can be granted, there is a happy veteran and one less file someone must review.
For assistance, see your service representative, the VA locally, or visit the VA site:
