Eligibility for VA Disability Benefits
The basic two qualifications without which you cannot file a disability claim are:
- You have a current illness or injury that affects your mind or body.
- You served on active duty, active duty for training, or inactive duty training.
Also, if you have less than an honorable discharge, you likely will not qualify.
Once those two requirements are met, you must meet one of three other criteria:
- You got sick or injured while serving in the military and can link this condition to your illness or injury (called an in-service disability claim), or
- You had an illness or injury before you joined the military and serving made it worse (called a pre-service disability claim), or
- You have a disability related to your active-duty service that didn’t appear until after you ended your service (called a post-service disability claim).
Typical conditions that may warrant a disability claim include, among others:
- Chronic back pain
- Severe loss of hearing
- Traumatic brain injury (TBI)
- Post-traumatic stress disorder (PTSD)
- Cancers caused by contact with toxic chemicals
To file your claim, you need VA Form 21-526EZ which you can fill out online, send by mail, or present in person at the nearest VA regional office. Along with the form, the VA requests that you submit:
- VA medical and hospital records relating to your illness or injury
- Private medical and hospital records relating to your illness or injury
- Supporting statements from family, friends, clergy, and others, including fellow service members who can shed light on the origins of your disability
Appealing a Decision
After you submit your form and supporting documents, there’s a good chance the VA may disapprove it. Some of the reasons other than error include lack of medical evidence, incomplete information, lack of evidence of the disability being service-related, a pre-existing condition as the cause, or simply a lack of belief you’re disabled.
As mentioned in the opening, if you are denied, you have three options to make a case for a decision review:
Supplemental claim: This means adding more evidence to your original claim. You can do this at any time, but the VA suggests doing it no later than a year after receiving your decision letter. You can supply the evidence yourself or ask the VA to request more medical records from a VA medical center or other treatment facilities. To file a supplemental claim, you must use VA Form 20-0995.
Higher-level review: You can request a higher-level review either after the initial decision or after your supplemental claim has been denied. You have one year to do so. You must use VA Form 20-0996. You cannot request a higher-level review if you’ve already had one or if you’ve appealed to the review board (next option).
Board appeal: You can file an appeal with the Board of Veterans’ Appeals in Washington, D.C. after the initial review, a supplemental claim review, or a higher-level review, but you cannot request a board review twice. A judge experienced in veterans’ law will review your appeal. You have three options: a direct review, a review for which you submit additional evidence, or a hearing (either in-person, virtually, or through videoconferencing at a VA location near you).
VA Five-Year Rule
When you do get your claim approved, the VA will assign to you what is called a rating. Unless your disability is determined to be permanent, the VA reserves the right to have you re-examined within five years of your initial disability rating. The VA may order what is known as a routine future examination (RFE) if it feels your disability may improve over time. The request for the RFE could come at any time in the first five years.
As a result of your re-examination, your benefits may remain the same, be lowered, or even terminated. There is also a 10-year and 20-year rule. At 10 years, they can still lower your rating, but at 20 years they cannot change it.