It’s Veterans Day, and you’ve no doubt read articles reminding us all that many veterans need their physicians to be their medical advocates
If a veteran comes to your practice with a medical problem, he or she may need your help navigating the famously disorganized VA disability claims process to see if compensation is available.
You and your staff can use these tips (created with input from vets who have mastered it all) to give your veteran patients the best possible chance of getting the compensation they deserve.
At a minimum, veterans need to meet three requirements in order to receive benefits:
- The vet has a documented in-service event, meaning that he/she was on active duty—with at least one day within a period of war. Veterans can have a service-connected condition regardless of whether they actually served in a particular war. This event in service could include a single incident (like explosion, gun shot, exposure to chemicals, or seeing a friend die in combat, which triggers PTSD). The physician must rely on the vet’s account of the service event, unless the event is in records available for the physician to review.
- The vet needs a current diagnosis of a physical/mental condition from an Independent Medical Exam (IME). This is where you may come in as the veteran’s ECP. As a physician, you are qualified to conduct an IME and make a diagnosis.
- Based on the IME, the physician needs to determine the “nexus,” or connection between the in-service event and the current diagnosis. The nexus needs to be stated in a formal letter from you. In the letter, state the vet’s symptoms, when the symptoms began, and the extent to which the symptoms affect his/her ability to drive and earn a living. If the vet is homeless or about to become homeless, state that as well.
The Paperwork
In your nexus letter, the VA requires precise language to demonstrate the connection between the vet’s time in service and his/her current medical condition. Use this language when stating the nexus in your letter:
- If there is a 50% chance that the vet’s condition was caused/aggravated by his/her time in service, then write, “This condition was as likely as not caused/aggravated by the vet’s in-service event (state the event).”
- For a 75% chance, write, “This condition was more likely than not caused/aggravated by the vet’s in-service event (state the event).”
- For a 100% chance, write, “This condition is due to the vet’s in-service event (state the event).”
- If you’re not certain of the percentage, but the evidence appears plausible, use the 50% chance phrasing.
During the Independent Medical Exam (IME, the exam you conduct for the vet), you also need to complete a Disabilities Benefits Questionnaire (DBQ). Published by the VA, DBQ’s are medical examination forms specific to the disability of the veteran. The VA uses the DBQ when reviewing your IME and nexus letter to assign the appropriate amount of disability compensation to the vet. The DBQ’s are categorized by type of condition/disease. Find all DBQ forms here. Find the DBQ for Eye Conditions here.
Attach your nexus letter and diagnosis to the DBQ. Note: The DBQ does not always ask for a nexus, diagnosis, or how the condition has affected the vet’s ability to work, but make sure to give that information to the VA, as it is crucial to vets getting compensation.
To ensure that the VA reviews all of your paperwork and not just the DBQ, do the following:
- On the last page of the DBQ, there’s a space for remarks or comments. Write, “See my attached nexus opinion” so the VA has to find it.
- Number every page of the paperwork packet (DBQ, nexus letter, IME paperwork) so that nothing gets lost.
- At the top of the DBQ, write, “This is a VA Exam” so that the VA does not discard it.
The final steps:
- Make a copy of the DBQ, nexus letter, and IME and give the copy to the vet. You will keep the originals. Please keep the vet’s paperwork for 10-20 years.
- Vets are responsible for submitting their paperwork to one of these Mailing Addresses for Disabilities Claims. The vet should send the paperwork via certified mail and request a return receipt. The VA often loses documents and then blames the vet for not sending them, so vets need to track their paperwork.
Some vets should seek legal representation if their claims have been denied several times. Refer them to the Veterans Benefits Manual, the most reliable source of legal information for vets to win their claim. You can also refer vets to this list of lawyers who represent veteran claimants, vetted by the National Organization for Veterans Advocates.
Learn More: VA Medical Centers and Navigating Through It, online forum, Hadit.com “Veterans, VA Claims, and Medical Opinions,” Podcast, Jerrel Cook, Dr. Craig Bash, John Dorle, Hadit.com “How Does the VA Rate and Pay Veterans Disabilities?” Nolo.com
