ARTICLE —
6

Aiding in the VA Claims Process

Posted on
May 19, 2021

The VA claims process can be lengthy and bring up stresses and emotions related to service, injury or illness. Veterans may be anxious about a required compensation and pension physical or mental health exam and frustrated with delays and bureaucratic hurdles in the process. In cases related to trauma, the process may bring up difficult memories. Being aware of the process can help you to provide support and understanding through the process.

UNDERSTAND HOW IMPORTANT YOU ARE IN THE PROCESS

As a provider, you may play an important role in the VA claims process. Veterans will often need information from their provider to support their claim for VA service-connected disability compensation. You are legally allowed to make necessary disclosures of information consistent with applicable laws, including the Health Insurance Portability and Accountability Act (HIPAA), and the Substance Abuse Act.

It is also important for you to know what conditions to flag for possible service-connection. You can then tell the veteran that applying for VA benefits is a possible avenue. For instance, if a veteran has PTSD as a result of military sexual trauma or race-based military trauma.

When evaluating conditions, information from treating sources is essential to accurately assess the onset and severity of claimants' impairments and their effect on functional capacity. This applies to new claims, determinations of continuing eligibility for current beneficiaries, and appeals.

WHAT INFORMATION MAY BE DISCLOSED?

Psychotherapy notes, as defined by HIPAA, are protected and do not need to be submitted. VA will not re-disclose medical records it receives to other entities or individuals without prior written consent, except in the very limited manner permitted or required by federal law and regulations. (45 CFR § 164.501. Privacy Act of 1974, Freedom of Information Act, and federal regulations per 20 CFR 401.)

For more information: VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA), to be completed by the veteran, legally authorizes you and other professionals to release medical records.

Recommended Readings:

GUIDELINES FOR A PTSD MENTAL HEALTH EVALUATION
We offer an outline for a comprehensive evaluation by a mental health professional.

WRITING A PTSD STRESSOR STATEMENT
We guide the veteran step-by-step through the process of preparing an effective stressor statement for their PTSD claim.

PTSD STATEMENTS FROM FRIENDS AND FAMILY MEMBERS
Family members and friends have an idea of how the veteran’s life has been affected by military service. Here’s how to tell the VA what they have observed.

DISABILITY BENEFITS QUESTIONNAIRES

Disability benefits questionnaires (DBQs) are forms for non-VA healthcare providers to complete in order to provide evidence in the veteran’s disability compensation and pension claims. DBQs are important for veterans who receive primary care outside of the VA as it is a substitute for an evaluation from a VA provider.

DBQs document the medical condition or symptoms for VA to evaluate the veteran's claim for disability or pension benefits. Onset of the condition, clinical course, and the current state of the condition will provide the rating specialist with enough information of the veteran’s condition.

Because the rating specialist has a non-medical background, it is important that you are as clear as possible and provide as much information as the form allows.

A list of DBQs for service conditions can be found at: https://www.benefits.va.gov/compensation/dbq_publicdbqs.asp.

UNDERSTANDING PRESUMPTIVE CONDITIONS

There are many conditions which are presumed to be service-connected based on location, time, and circumstances of services. In these cases, the veteran patient does not need to prove specific causation. They need only show they meet eligibility criteria and have a specific diagnosis in order to qualify for valuable benefits and care. No proof beyond exposure to risks and diagnosis of condition is needed to establish connection.

Included in this category are certain conditions related to the following service:

• Gulf War veterans with chronic disabilities;

• veterans who served on active duty or resided at Camp Lejeune for thirty days or more between August 1, 1953 and December 31, 1987;

• all veterans who develop amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease;

• veterans exposed to Agent Orange and other herbicides in the republic of Vietnam between January 9, 1962, and May 7, 1975;

• veterans who participated in radiation risk activities as defined in VA regulations while on active duty, active duty for training, or inactive duty training;

• veterans with certain chronic and tropical diseases; and

• prisoners of war.

Combat veterans have a lower burden of proof when seeking benefits for PTSD. Combat-related PTSD may be demonstrated through a diagnosis which is consistent with the time and conditions of service. There is no need to prove a specific traumatic event as causal.

Up next...
Chapter

Read more from this chapter

Community discussion

E-NEWSLETTER

Be the first to know

Subscribe to our e-newsletter and stay current with veteran issues and news.
REad the latest issue