How To Appeal A Veteran’s Disability Denial The Right Way

Even if you’ve crossed your T’ s and dotted your I’s, a denial of your claim is still a strong possibility Many veterans have seen their claims denied on the first try. But that doesn’t mean the VA gets the last word. You have the right to appeal the VA’s decision, but you do have to follow procedure to make sure it’s done correctly. An attorney with experience in VA denial appeals can also help increase your chances of a successful outcome.

How To Appeal A Veteran’s Disability Denial The Right Way

Time Limits

There may be any number of reasons why your claim was denied, that’s why it’s important not to take the initial denial as a final decision. This list of common VA errors may give you several reasons and methods for your appeal.

You’ll have one year from the date of your VA decision letter to file your appeal. If you miss the deadline, you’ll have to start over with a new claim, but you’ll have a new date of application. The time spent working on the first one won’t count towards the second one.

Notice Of Disagreement

The first step is to file an NOD (Notice of Disagreement) with the VA within one year. It’s just a simple statement informing the VA in writing that you disagree with their rating decision. While there isn’t a specific form for it, VA Form 21-4138 is typically used, or just type a letter stating that you disagree with the VA’s decision. You can get the Statement in Support of Claim form online at the VA’s website.

When writing your NOD, don’t begin by listing all the reasons you disagree with the VA; save that for the hearing. You’ll be able to discuss why you disagree with the VA at that point, and you must be specific when you do.

At the top of the letter or Form 21-4138, write “Notice of Disagreement.” Include the date of the letter and the denial decision. State that you plan to appeal and that you disagree with all of the reasons of the denial decision. If you do decide to list some of your reasons, state that it’s not a complete list, and your disagreement is not limited to these reasons.

Sign your letter and make sure to keep a copy for your files (and with your denial letter.) Mail it certified, return-receipt requested to the VA office that sent you the denial letter (unless your file has been moved to a different office. Keep the documents from the post office in your file to show that you met the deadline.

Once that’s completed, start collecting and assembling more evidence to bolster your claim.

Don’t Re-Use the Same Evidence

The evidence you used in your original claim wasn’t enough to get an approval, so you’ll need to find and pull together additional evidence, both from military and VA doctors and from civilian doctors you’ve seen and consulted with. Information from private doctors is allowed, so make sure you’re covered. Get new and additional evidence to support your claim, including:

·         Medical experts—if you have a specific medical condition, your specialist will have strong information to bolster your claim. For instance, if you’ve had a heart attack, your cardiologist would be your best “medical expert.”

·         Vocational experts—if you’re unable to work due to your disability, a vocational expert can write a report supporting your disability claim, explaining why you’re unable to work. This is especially helpful for Total Disability Individual Unemployability (TDIU) claims, which can also be appealed if denied.

·         Psychologists—if your disability is mental in nature, or if your physical condition has caused a secondary service-connected mental condition (i.e., depression due to being in chronic pain), a psychologist or psychotherapist has specific information on how your disability affects you.

·         “Buddy Statements”—if your medical records have been lost (and it happens), a “Buddy Statement” is one given by friends, family, and/or fellow service members who can testify to your service-connected disability. For instance, a colleague who witnessed your disability when it happened is a strong statement verifying your claim. A friend or family member who is involved in your disability care can also verify your day-to-day difficulties and how the disability affects you now. A Buddy Statement can be used for physical or mental disabilities, or both. They are particularly useful when no records of your injuries were kept at the time they occurred.

·         Secondary service-connected disabilities—you may have just one form of disability, but two or three conditions that are less prominent than the first one. With medical evidence to support your claim, make sure any secondary conditions that came out of the primary condition one are listed and included with your claim.

Two Types Of Appeals

You can chose to have our appeal heard by a decision review officer (DRO) or by the Board of Veterans Appeals (BVA.)

If you chose a DRO, you can either request a review of your file and claim, or request a personal DRO hearing. Both offer a somewhat shorter waiting period.

If the DRO denies your claim, you can still appeal to the BVA, but it will take longer. The DRO is an additional chance for a reversal of your claim decision.

Information From the VA

The Veterans Administration website also lists a number of resources, that can help you with your appeal. Use this information when assembling your evidence and starting your claim.

Let Us Represent You

Denied by the VA? Don’t rely on someone who hasn’t had VA claims and appeals experience. We have. Call The Herren Law Firm today at 713-682-8194 (or use our online form) to schedule your free consultation. We’ve helped over 4,000 Houstonians navigate the VA’s complicated application and appeals process to get the benefits they deserve. There’s up-front fee and no obligation, and you won’t owe us a fee until we win your case.

Is Your Veterans Disability Rating Inaccurate? Here’s How To Get Your Benefits

The Veterans Administration uses a rating system to determine how “disabled” someone from injuries received during military service. This is the Veterans disability rating that can be inaccurate at times if not properly performed. Your rating determines your monthly disability payments, so it’s important that you’re accurately rated for your condition.

Is Your Veterans Disability Rating Inaccurate? Here's How To Get Your Benefits

Injuries and/or illnesses must be acquired (or aggravated) during your military service to qualify. Many service-related injuries and illnesses may increase over time, increasing your current disability.

How The VA Determines Disability

The VA uses the Schedule of Ratings Disabilities for baseline criteria to determine the percentage that a veteran is disabled. Originally created in 1945, the Schedule is being updated, taking into account the advances in medicine and treatments that are available now.

Before you begin, find out for sure what your current disability rating is now. You may have a letter from them, but you can also research it at the VA’s eBenefit website.

Re-examinations may be required to verify the continuance of your disability. Your ratings may be changed based on these new medical exams.

Type Of Requests

If it has been less than a year since you’ve been awarded benefits, you should file an appeal of your original decision.

If your benefits were awarded more than a year ago, the process for increasing or correcting your disability rating is simpler. Use the VA’s online form 21-526 EZ to start the process. You also can apply in person from a VA regional office, state or county veterans affairs office. Help is also available from accredited veterans assistance organizations. Fill out Form 21-526b, Veteran’s Supplemental Claim For Compensation, if you’re not going online.

Medical Evidence

Before you begin, acquire a copy of your VA claim file. You need to see what’s in it before you proceed. If your claim has been denied, you may find the reason for it, as well as what’s missing in order to re-evaluate your claim.

Make sure that your all of your medical evidence backs up your claim; the VA won’t just take your word for it. Much of it may be in your claim file.

If you’ve been treated by the VA, you’ll need to include the name of the facility where you’ve been treated for your disability. (This includes both VA and military medical facilities.) If your treatment is from private doctors, hospitals and clinics, you will need Form 21-4142 along with your medical records.

Consider Potential Outcomes

Understand that if you request the VA re-evaluate you for a re-rating, they will re-examine your entire case. They may find errors in the original evaluation, and your rating could also be downgraded, leading to a reduction in your disability payments.

That’s not to say that you shouldn’t consider requesting a re-evaluation. You must file based on an increase in your disability not a need for increased benefit payments. Be aware of the possibility of a reduction, and do whatever you can to win an increase. If your claim is denied, you can file an appeal.

The VA does make mistakes. But just because you’ve been told “no” doesn’t mean it’s all over. You have rights, and The Herren Law Firm stands ready to help.

Overwhelmed?

Dealing with the VA can be an exhaustive process. You don’t have to do this alone. The Herren Law Firm have helped over 4.000 Houstonians get the veteran’s benefits they deserve.  Contact us today at (713) 682-8194 or (800) 529-7707 for a free consultation for help with a VA claim. Our contingency fee arrangement means you won’t owe us anything unless we win your case.

What is ERISA and How Might it Affect My Long Term Disability Claim?

ERISA is short for Employee Retirement Income Security Act, established in 1974. It’s is a federal law under the US Department of Labor that “sets the minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in the plans.”  Unfortunately, it doesn’t always work that way.

What is ERISA and How Might it Affect My Long Term Disability Claim?

ERISA governs long-term disability policies and only applies to most private employers that offer benefits. It was created to ensure that plan administrators didn’t misuse pension and other employee funds. Public (governmental) or church employees (including church-owned hospitals) and private policies are excluded. ERISA only establishes minimum standards for employers who do offer benefits for their employees. It doesn’t require them to offer benefits.

ERISA And Long Term Disability Policies

A lot depends on what your company and the policy calls “disability.” Research your policy and find out exactly how yours defines it since it could determine if you can get LTD and for how long.

Some policies say “any occupation,” which means you’re unable to work at any job. “Own occupation” indicates that you can’t work in your current occupation, but you could work in a different one. (For instance, an injured construction worker who becomes a project manager.)  Some policies go from “any occupation” to “own occupation” after 24 months, meaning you could work another job, even if you can’t work in the one you had before.

Claim denials are common for even the most legitimate disability cases.

ERISA means that if your LTD plan is employer-funded if you should need to file suit, you will:

  • Have a hearing with judge, but no jury
  • Not be awarded attorney’s fees
  • Not be able to recover any damages
  • Likely to be ruled against in a court proceeding

Plan administrators are given considerable leeway in the administration of a plan.

How ERISA Can Keep You From LTD

It was intended to “protect” your rights, but ERISA ends up protecting the rights of the insurance companies. ERISA preempts most state law “bad faith” lawsuits, denying you the right to sue your insurance company should your claim be denied. Unlike a personal injury suit, where you can sue for damages, attorney’s fees and other compensation, ERISA prevents you from doing that. The most you can receive from a lawsuit would be the monies you were originally due when the insurance companies denied your claim to begin with. In the administrative hearing, the judges can only determine if the insurance company committed an “abuse of discretion.”

ERISA has complex rules and regulations that must be followed exactly, and deadlines that must be met without exception. Miss one deadline, or make one mistake in your claim, and the claim will be quickly denied without any opportunity to appeal or reopen your case.

Your employer may have additional requirements, with deadlines, for you to follow before you can access LTD. Ask for any and all related documentation so you can review it yourself. Deadlines and other requirements should be detailed in these documents, so read them carefully and take note of all deadlines you need to be aware of.

Your Doctor

When submitting your LTD claim, you’ll need to prove your disability. Before you file, you’ll need to have copies of all medical records, test results, X-Rays, your doctor’s communications with the insurer, and any other medical evidence related to your case. If you find errors in any of your records, write your doctor a letter and request that they be corrected.

If your doctor declines to help you in your disability case, find another one. A doctor who does support you in your claim can’t guarantee a successful outcome. But a doctor who doesn’t support you can easily sink your claim.

Submit All Evidence In Your Original Claim

Should your case proceed to federal court, you will NOT have the opportunity to submit additional evidence. The judge is limited to whatever is in your claim file. Neither you nor your doctor will be allowed to testify. Make sure that all relevant evidence—medical reports, testing, expert opinions, evaluations, etc.—is included in your claim. Include more favorable evidence than you think you need while the claim is open to ensure it’s complete.

Deadlines Count

Insurers have specific deadlines for filing claims as well as appeals. ERISA appeals are complex and detailed.

The Herren Law Firm can help you with your application, appeals and help you get the long-term disability benefits you need. Contact us today at 713-682-8194 to schedule your free consultation. There’s no obligation and no up-front fees.  We only collect if we win your case.

A First Look At 2018 Veterans Disability Rates

If you’re receiving VA disability payments, you’re getting a raise. Check out the new veterans disability rates below.

Veterans who rely on disability benefit payments saw only a small increase of .03 percent in 2017, and there were no increases in 2016. But in 2018, veterans will see full 2% increase (called cost-of-living adjustment, or COLA) in their monthly disbursements.

A First Look At 2018 Veterans Disability Rates

House Bill 1329, titled the Veterans’ Compensation Cost-of-Living Adjustment Act of 2017 authorized this increase. The president signed it into law on November 2nd, 2017.

This is the largest increase in VA disability benefit payments since 2012.  The new, increased rate became effective on December 1, 2017, and will appear in payments issued beginning on December 31, 2017.

If you are a retiring veteran this year, you’ll also see a temporary COLA increase from the increase in active duty military pay given in January.

COLA Calculations

Cost of living adjustments are computed by examining the Consumer Price Index (CPI-W) from the US Bureau of Labor Statistics. Using the CPI-W from the third quarter of both the current year and the previous year (July, August and September), the COLA is based on the increase percentage from the 2016 third quarter to the third quarter in 2017.

This year’s weather disasters in the southern US may have contributed to the assigned increase as well, due to higher gas and other consumer prices  as well as other inflation-related items.

How Much?

If you’re at 10% disability and have no dependents, you’ll receive an additional $136.24 per month, or $1,634.88 for the year.

If you’re at 20% disability without dependents you’ll see an increase of $269.30 per month, or $3,231.60 for the year.

These ratings have no other adjustments for spouses, parents or children. However, things get a bit more complicated with higher ratings.

If your rating is between 30% and 60%, and you’re alone, you’ll receive $417.15 for 30% to $1083.52 for 60%. The rates increase with a spouse, a parent, spouse and parent (one or two), and an additional stipend for a spouse who needs “aid and assistance” (listed as a/a) as well as veterans with children.

For veterans rated 70% to 100% disabled with no dependents, the increased amounts start at $1365.48 for 70% disabled to $2937.96 for 100% disabled. With a spouse, dependent parents and/or children, there are also upward adjustments for each.

Your ratings consist of a single number for any and all conditions that rate you as “disabled.” You can review the complete breakdown of increase amounts here.

As A Reminder

VA disability payments are not listed as “gross income” on tax returns, since it is non-taxable.

Need Help?

If you’re applying to the VA for disability benefits, but can’t seem to get anywhere, call The Herren Law Firm. We’ve helped over 4,000 Houstonians navigate the VA’s complicated application and appeals process to get the benefits they deserve. Call us today at 713-682-8194 to schedule your free consultation. There’s no obligation, and we’ll take your case on a contingency fee basis, with no up-front charges.

Do I Qualify for VA Disability Backpay?

When applying for VA disability benefits in Houston, there is one thing you can certainly expect: waiting, and possibly waiting for quite some time for the Houston VA offices to make their decision. The VA is aware of this, and to make up for the time between the VA’s decision and your date of eligibility, the VA has instituted VA disability back pay.

Do I Qualify for VA Disability Backpay? | Houston VA Attorney Herren Law

If you have a service-connected disability and you’re applying to the Veterans Affairs for disability benefits, then it’s important to understand backpay and how it affects your claim. More importantly, you need to get a Houston attorney specializing in VA disability benefits. At Herren Law, we work on a contingency basis, meaning that you won’t owe a penny until you get your benefits. And after years of helping Veterans just like you, attorney William Herren understands what you’re going through and will work with you as well as the VA to get you the benefits you deserve.

Call our Houston law office today at (800) 529-7707 for a free consultation. In the meantime, you can learn more about VA disability benefits below.

Eligibility for VA Disability Backpay

If you are awarded disability benefits from the VA due to your service-connected injury, then you are eligible for retroactive benefits. If awarded benefits, however, the problem that many Veterans face is the amount of back pay they are entitled to. By understanding the relevant federal laws and the Houston VA disability process, you can make sure that the VA is providing a fair and full amount. To do this, the first aspect of VA disability benefits that you need to know is the “effective date.”

The Effective Date of Your VA Disability Benefits Claim

The “effective date” of your claim is the moment the Department of Veterans Affairs (VA) has received your application for disability benefits. When you finally receive disability benefits, which can sometimes be months, or even years, after the VA receives your application, you will receive disability benefits dating back to that effective date (starting the first of the month after the effective date). For instance, if the VA receives your application on March 3rd, 2015, and you’re awarded benefits in February 2017, then your benefits will be considered from May 1st, 2015 and onward.

This is true for most new claims as well as claims to increase the rating of a pre-existing, service-connected disability. However, there is some conflict regarding what actually constitutes a claim, including what specific documentation you need to include in your claim. Generally, the VA states that a valid claim is VA Form 21-526, citing 38 USC §5101(a). However, there are many types of communications which may qualify as “a claim,” outside of the VA Form 21-526. Also, if the VA receives an informal claim, it must send out VA Form 21-526. The veteran needs to return the Form 21-526 within a year, and if so, the date the VA received the informal claim will be the effective date.

There are also exceptions to these rules, and so, regardless of your situation, it can help to speak with your attorney.

Effective Dates for Direct Service Connections

When you were injured in the military or a pre-existing injury was made worse, then you have a direct service connection. If this is your case, your effective date can be:

  • The date the VA receives your claim, or
  • The date you first got your illness or injury

If the VA receives your claim within one year of the day that you left your military service, then the effective date can be as early as the separation date. For instance, you finished your service on August 4th, 2014, and you had a disability. You apply for benefits within a year on June 10th, 2016. The VA awards 40% disability and, because the VA received the claim within a year of service, the VA sets an effective date at September 1st, 2014.

Effective Dates for Presumptive Service Connections

When you are awarded disability benefits for a presumptive service connection, and the VA receives your claim within one year of your separation from the military, then your effective date may be the date that your first got your illness or injury. Otherwise, if you file a claim after one year of your separation from the military, then your effective date is typically the date the VA receives your claim.

Call Herren Law Today for a Free Consultation

It is important to note that there are many nuances to this law, whereas the effective date can also depend on liberalizing law changes, reopened claims, and with claims based on a Veteran’s death in service. As such, to navigate these complex issues and speak to an expert who will fight for fair and maximum disability back pay, then call Houston VA disability attorney Herren Law at (800) 529-7707 for a free consultation. Evening appointments are available.