How Can I Seek Review of the VA’s Decision Denying My Claim for Service-Connected Compensation?

When you file a claim for VA disability compensation, the Department of Veterans Affairs (VA) will review your application and any supporting evidence before sending you a Rating Decision. Ideally, this Rating Decision will confirm that you are eligible for Service-Connected Compensation benefits and explain how much you can expect to receive each month and when payments will begin. Of course the Rating Decision may deny your claim, finding the condition or conditions are not service-connected or the VA may underrate your claim(s), awarding you a lower percentage than what you may actually be entitle to.

Fortunately, a Rating Decision that denies your claim or underrated your claim is not the last word when it comes to VA disability benefits. If you disagree with any aspect of the VA’s rating decision, you can ask for a review. There are actually three separate decision review options, which are briefly explained below.

Option 1: Supplemental Claims

A supplemental claim allows you to submit new and relevant evidence that was not previously considered by the VA when it issued its decision letter. For example, if you have a new medical report or witness statement that helps prove you suffered a service-related injury, that can be submitted as a supplemental claim. Alternatively, you can file a supplemental claim if there has been any change in the law that would lead the VA to reach a different decision in your case.

Option 2: Higher-Level Reviews

Within one year of a VA decision denying your claim (or supplemental claim) for disability benefits, you can seek what is known as a “higher-level review.” Basically, this involves having another VA official take a second look at your decision. You are able to request that the reviewer schedule an informal conference with you and your attorney and determine if the decision to deny your claim was based on legal error. If there was an error, the reviewer can issue a new decision letter in your favor. Unlike a supplemental claim, however, you are not allowed to submit new evidence during a higher-level review. Nor can you ask for a higher-level review on an issue that’s already been reviewed.

Option 3: Board Appeal

If you are dissatisfied with the outcome of your initial disability claim, supplemental claim, or higher-level review, you can ask for a board appeal within 1 year of the decision you wish to challenge. With a board appeal, a Veterans Law Judge reviews your case. There are three types of board reviews: Direct Review, Evidence Submission, and Hearing. You can choose any of these options but note that you cannot request 2 board appeals in a row for the same claim.

Contact a VA Disability Lawyer

It can take many months, even years, to fully resolve a VA disability claim. An experienced VA disability attorney can guide you through the process of filing a claim and pursuing any avenues of appeal that may be necessary to secure benefits for you and your family. Contact Gustad Law Group, PLLC, today to schedule a consultation. We serve clients nationwide.

Magistrate Judge Awards Disability Benefits to Woman with Fibromyalgia

A federal magistrate judge here in Washington State recently chose the latter option in a case, Jennifer P. v. Bisignano, involving a woman (the plaintiff) twice denied SSDI benefits following an ALJ hearing. The plaintiff here suffers from “fibromyalgia, osteoarthritis of the right knee, and hip osteoporosis,” according to court records. According to medical evidence submitted by the plaintiff’s treating physician, the plaintiff’s conditions cause her “widespread pain, especially in the hip and knee,” which limit her to “severely limited and sedentary work.” Even then, she would be “off task and unproductive over 30% of the time during a 40-hour workweek.”

Despite presenting over a decade of treatment notes and supporting evidence, the ALJ that conducted the plaintiff’s second hearing only afforded “partial weight” to the treating physician’s conclusions. On appeal, however, a federal magistrate judge said that the doctor’s findings properly documented that “Plaintiff suffers fibromyalgia flares of severe pain at least one day per month.” More to the point, the ALJ’s decision to reject this medical opinion was “not supported by substantial evidence.”

The ALJ also rejected the medical opinion of a second physician who examined the plaintiff and determined she was “unable to walk or stand” without the use of a cane,” and even then she would be restricted to standing or walking less than 2 hours in an 8-hour workday. The magistrate judge said the ALJ did not offer a “specific and legitimate reason” for rejecting this opinion.

Considering these and several other improperly rejected medical opinions, the magistrate judge concluded the appropriate remedy was to reverse the ALJ’s Notice of Decision- Unfavorable and remand the case back to Social Security for an award of Social Security Disability Insurance (SSDI) benefits. disability benefits. The Federal District Court will often order Social Security to conduct a new hearing (remand) before the ALJ, which in fact previously happened in this case. But as the federal magistrate judge explained, when the court decides “to credit improperly discounted evidence as true,” a new hearing is unnecessary, as the ALJ “would be required to find Plaintiff disabled” based on a correct reading of the evidence.

Credit as True: When Social Security Improperly Rejects Medical Evidence of Disability

Social Security Disability (SSDI) cases are often decided on the strength of medical evidence. At a contested hearing, a Social Security administrative law judge (ALJ) must decide if such evidence, notably the testimony of medical professionals who examined or treated the applicant, support a finding that the applicant is incapable of gainful employment. If the ALJ improperly discredits or discounts such medical evidence, a reviewing court can order a new hearing, or in extraordinary cases directly order an award of benefits.

Contact a Social Security Disability (SSDI) Attorney

Social Security officials are often quick to reject medical evidence, even when it clearly reflects the Claimant’s inability to work. This is why it is important to work with an experienced Social Security Disability (SSDI) attorney who will aggressively advocate for your case in the face of government resistance. Contact Gustad Law Group, PLLC, today to schedule a consultation. We serve clients throughout the United States.

Source:

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