All You Need to Understand about Appealing Your VA Disability Rating
Anytime the VA grants service-connected disability benefits, the VA also assigns a corresponding disability rating.
Sometimes, however, that disability rating is lower than a veteran deserves based on the veteran’s medical history. Other times, the disability later worsens, causing more functional impairment and requiring more medical care, rendering the rating inconsistent with the severity of symptoms.
Even despite evidence of worsening symptoms, the VA, for a variety of reasons, may deny a claim or appeal for an increased rating.
When the VA assigns you a lower disability rating than you think you deserve or denies a claim for an increased rating, you are entitled to file a VA disability appeal.
What is a VA disability rating?
Decisions on VA disability claims have numerous parts.
When the VA makes a decision on a claim, it addresses three issues:
- Whether the condition is related to service,
- The proper effective date of the claim, and
- The disability rating.
The VA disability ratings are based upon a list of symptoms specific to each type of disability on a scale of 0% to 100%.
The disability rating reflects the severity of the condition, particularly insofar as it affects a veteran’s ability to work, and is based on how the veteran’s symptoms fit into the rating schedule. The rating schedule includes most conditions that veterans face and a list of possible symptoms for those conditions and corresponding ratings. The VA then compares the rating schedule with a veteran’s medical history and evidence to identify the proper rating based on symptomatology.
For example, the rating schedule for diabetes mellitus looks like this:
| Requiring more than one daily injection of insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated | 100 |
| Requiring one or more daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated | 60 |
| Requiring one or more daily injection of insulin, restricted diet, and regulation of activities | 40 |
| Requiring one or more daily injection of insulin and restricted diet, or; oral hypoglycemic agent and restricted diet | 20 |
| Manageable by restricted diet only | 10 |
Thus, if a veteran’s service-connected diabetes mellitus is manageable by restricted diet only, then the veteran’s rating would be 10%. If a veteran has multiple service-connected conditions, the veteran will likely have multiple corresponding ratings. For instance, a veteran can have a 30% disability rating for hearing and a 10% disability rating for tinnitus. These disability ratings should be based on the medical and lay evidence during the entire appeal period.
The VA disability rating determines the monthly VA disability compensation. Higher ratings correspond with higher monthly payments. However, other factors such as marital status or the number of dependents will also be used to determine the monthly payment amount.
What can qualify you for a higher disability rating?
If you believe that your assigned disability rating does not adequately compensate for your impairment, you should go through the VA appeal process with the help of a VA disability advocate or attorney. If your local VA office rated your disability too low or your condition has worsened and requires more health care, consider appealing the currently assigned rating or filing a supplemental claim for an increased rating.
Suppose your condition has advanced, and now you cannot work due to a service-related disability. In that case, you may qualify for a higher rating and/or a total disability rating based on individual unemployability (TDIU).
There are specific guidelines for every disability rating, varying for each medical condition. Therefore, before you embark on a VA disability appeal, you must review your medical records carefully. Also, consult a VA disability appeal attorney for guidance.
The process of appealing a disability rating
For claims rejected on or after February 19, 2019, veterans must adhere to the Appeals Modernization Act (AMA) rules. Under the AMA, there are three ways to pursue an increased rating:
- File a supplemental claim for an increased rating: This can be used to file a claim for an increased rating at any time, and just requires “new and relevant” evidence. If a veteran receives a decision and wants to appeal it, this lane should be used within one year to preserve the original effective date. Veterans should use VA Form 20-0995 for this lane.
- Appeal to the Board of Veterans Appeals: Once a veteran receives a decision, the veteran can appeal to the Board and select whether they want a hearing, to submit more evidence, neither, or both. To select this option, the veteran should use VA Form 10182.
- Higher-level review: It is important to note that this is also an appeal option, but a veteran cannot submit new evidence with a Higher Level Review, so if any new evidence establishes an increase in the disability, this may not be the best option.
To be successful with your appeal, you must identify and prove errors in the VA’s decision and highlight evidence that establishes entitlement to a higher rating. If you do not submit an appeal within the set timeframe, you must submit new and relevant evidence and may lose out on benefits to which you are entitled.
Unfortunately, a VA disability appeal takes time. On average, a case may take anywhere from several months to several years, especially when going through several rounds of appeals to obtain the appropriaterating. Knowing what the VA’s rating schedule requires and providing the right evidence of your symptoms can help make the appeal process smoother and the rating more accurate.
Vets National can help you with appealing your VA Disability Rating
If you need help appealing a VA disability rating, contact Vets National for qualified legal assistance. Our experienced attorneys have committed their legal careers to walk with veterans as they fight for their rights and pursue the benefits they deserve. Contact us today for a free consultation.
