What are Extra-Schedular Benefits?
The VA has a duty to maximize the benefits it awards to a veteran. This means the VA must consider the entire record, many different arguments and theories, and all the relevant regulations, to provide the veteran the maximum amount of benefits allowed.
When evaluating the severity of a condition, the VA will use the Schedular Rating Criteria, which lists many medical conditions, the symptoms for those conditions, and the proper ratings for each condition depending on the severity of the symptoms. These “Schedular Ratings” are typically set based on the impairment of earning capacity due to the medical condition.
But what happens if a veteran’s service-connected condition includes symptoms that are not on the Schedular Rating Criteria? Then the veteran may be entitled to extra-schedular benefits.
A claim for extra-schedular benefits will be granted if the regular schedular standards are impractical because the disability is “so exceptional or unusual” as evidenced by factors like “interference with employment or frequent periods of hospitalization.”
An example of this can be seen with tinnitus (ringing in the ears), which has a maximum schedular rating of 10%. If the tinnitus is of a certain severity as to cause monthly hospitalizations, or the tinnitus intereferes with the veteran’s employment, the veteran may be entitled to an extra-schedular rating in order for the veteran’s compensation to be consistent with the severity of his condition and to match the impairment of earning capacity due to the tinnitus.
What is Extra-Schedular TDIU?
Additionally, veterans may be entitled to extra-schedular TDIU, or a Total (100%) Disability rating based on Individual Unemployability.
As background, a veteran can receive TDIU when the veteran’s service-connected conditions prevent the veteran from maintaining substantially gainful employment, and certain rating percentages are met—if there is one disability, it must be ratable at 60 percent or more, and if there are two or more disabilities, there must be at least one disability ratable at 40 percent or more, and a combined rating of 70 percent or more. This is schedular TDIU.
However, extra-schedular TDIU is available when those percentages are not met, but the veteran’s employability is still hindered.
When a veteran is unemployable because of a service-connected condition, but he does not meet the percentage rating standards noted above, the VA Rating Boards must submit the case to the Director of the Compensation Service. The VA Rating Board must also include in the
referral a statement about the veteran’s service-connected disabilities, employment history, educational and vocational attainment, and any other relevant factors.
Only the VA Director of Compensation Service may approve extra-schedular evaluations in compensation claims.
How to Apply for Extra-Schedular Benefits
The VA is required to maximize your benefits, and extra-schedular benefits are a tool that the VA can use to compensate you properly. Therefore, when the record shows that extra-schedular benefits might be warranted, the VA should address that evidence.
However, you can’t always rely on the VA to find these benefits for you!
If you think your service-connected conditions are “so exceptional or unusual” due to factors like “marked interference with employment or frequent periods of hospitalization,” then you should expressly raise the issue of extra-schedular benefits to the VA adjudicator. This means you should argue to the VA that these benefits apply. You can do so by filing a Supplemental Claim or submitting an argument in writing along with a claim or appeal for an increased rating.
If the issue of extra-schedular benefits is substantiated by the evidence in the record, the VA Regional Office will refer the claim to the VA Director of Compensation Service for extra-schedular consideration.
Appealing a Denied Extra-Schedular Claim?
Extra-schedular claims are a great way to maximize your VA benefits, but these benefits can often be overlooked or misunderstood. Vets National Advocates is available to discuss your appeal options. Call 877-777-4021. Or, fill out our Denied Claims Rapid Response Form.
