Why VA Disability Claims Get Denied

Many veterans are surprised when their initial VA disability claim is denied. Even when a condition is real and connected to military service, the Department of Veterans Affairs may determine that the evidence submitted does not meet the legal requirements for service connection.

Understanding why claims are denied can help veterans prepare stronger applications and avoid common problems during the claims process.

While every case is different, several issues appear frequently in VA disability decisions.

Missing or Incomplete Medical Evidence

A claim needs evidence of a current disability. A diagnosis is important in many cases, and some conditions have specific diagnostic requirements, but a diagnosed underlying pathology is not universally required.

In some cases, veterans file claims before a formal diagnosis has been documented in their medical records.

In Saunders v. Wilkie, the Federal Circuit recognized that pain without a diagnosed underlying condition can qualify if it causes functional impairment of earning capacity. Evidence of the applicable service connection is still required.

Medical documentation from VA providers or private physicians can play an important role in establishing the existence and severity of a condition.

Lack of a Service Connection

In addition to a current diagnosis, the VA must determine that the condition is connected to military service. This connection is often referred to as a “nexus.”

If the VA cannot identify a clear relationship between the veteran’s condition and an in-service event, injury, exposure, or illness, the claim may be denied.

Service connection may be established in several ways, including:

• direct connection to an event or injury during service

• conditions that developed during active duty

• secondary conditions caused or aggravated by an existing service-connected disability

Establishing this connection often requires medical evidence and supporting documentation.

Incomplete Service Records

In some cases, the VA may not have access to the full set of service treatment records or personnel records that document events during a veteran’s service.

If key records are missing, the VA may conclude that there is insufficient evidence to establish a service-related injury or exposure.

Veterans may be able to strengthen a claim by locating additional records, providing personal statements, or submitting supporting statements from fellow service members.

Unfavorable Compensation and Pension (C&P) Examinations

Many claims involve a Compensation and Pension examination performed by a VA examiner. The examiner’s report may influence how the VA evaluates the claim.

If the examination concludes that the condition is not connected to service, or if the examiner determines that the symptoms do not meet the rating criteria, the VA may rely on that opinion when issuing its decision.

Veterans sometimes disagree with the conclusions reached in these examinations, particularly if the exam was brief or did not fully consider the veteran’s medical history.

Insufficient Evidence of Severity

Even when the VA grants service connection for a condition, the assigned disability rating may be lower than expected.

Disability ratings are based on specific criteria established in federal regulations. If the medical evidence does not clearly document the severity of symptoms required by those criteria, the VA may assign a lower rating.

Providing thorough medical documentation can help ensure that the full extent of a condition is properly evaluated.

Understanding the Next Steps

A denial does not necessarily mean the claim lacks merit. In many cases, the issue involves missing documentation, unclear medical evidence, or the need for additional supporting records.

Veterans who receive a denial may have several options depending on the circumstances. These can include submitting additional evidence through a supplemental claim, requesting higher-level review of the decision, or appealing to the Board of Veterans’ Appeals.

Understanding the reason for the denial is often the first step in determining the most appropriate next action.

Learning More About the VA Claims Process

Veterans seeking a clearer explanation of how the VA evaluates disability claims can review the firm’s guide to VA Disability Claims and Appeals, which explains the structure of the VA claims process and the options available after a decision is issued.

D.C. Burnette is a U.S. Air Force veteran, Missouri-licensed attorney, VA-accredited attorney, and member of the bar of the U.S. Court of Appeals for Veterans Claims. The Law Office of D.C. Burnette, PLLC focuses on VA disability claims and appeals, CAVC cases, and selected military matters.