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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

veterans, 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.

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