VA Disability Compensation: What the Claim Has to Show

Service connection is decided on the evidence in the file, under the rating schedule and the benefit-of-the-doubt rule. Patrick Nolan is a Missouri attorney accredited by the U.S. Department of Veterans Affairs, and he helps veterans identify what the record needs and how to document it.

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VA disability compensation is a monthly payment for disabilities connected to military service. It is an earned benefit provided by federal law, and compensation payments are generally not subject to federal income tax. A 0 percent evaluation means the disability is service connected but noncompensable, so it carries no monthly payment, although it can still matter for other purposes.

VA decides claims on the evidence in the file. Where the evidence for and against a material issue is in approximate balance, the benefit of the doubt goes to the claimant. What is in the file, and how directly it answers the legal questions, is where representation does its work.

The Basic Elements of Direct Service Connection

Direct service connection generally requires three things:

1. A current disability. A current disability must exist. A formal diagnosis is often the clearest proof, but it is not invariably required; pain that causes functional impairment of earning capacity can qualify, and a claimant may claim symptoms without knowing the correct diagnostic label.
2. An in-service event, injury, or disease. Service treatment records are one route, but not the only one. VA considers all pertinent medical and lay evidence, and competent, credible lay evidence may establish an in-service event, injury, symptoms, or exposure.
3. A nexus. A link between the current disability and service. This is not categorically a question of medical opinion; lay evidence, continuity of symptomatology, or an applicable presumption may suffice in some cases, while complex questions of medical causation ordinarily require medical evidence. A private nexus opinion may come from a physician, psychologist, nurse practitioner, physician assistant, audiologist, or other qualified clinician.

Nexus evidence is a frequent point of dispute. The work is to see that the record contains evidence that actually addresses the legal question, including a private medical opinion where appropriate.

Other Roads to Service Connection

• Presumptive service connection. Federal law and VA regulations may presume service connection when the veteran has both qualifying service or exposure and a listed condition meeting the applicable requirements. The PACT Act identifies specific diseases tied to specified locations and periods of service. Gulf War claims are decided under 38 C.F.R. § 3.317, which sets its own criteria for undiagnosed illness and medically unexplained chronic multisymptom illness. Camp Lejeune presumptions apply to listed diseases with qualifying presence. Radiation claims run either through the listed diseases in § 3.309(d) for defined radiation-exposed veterans or through dose development under § 3.311, which is not a blanket presumption. A veteran denied years ago may want current law reviewed against the service and the diagnosis.
• Secondary service connection. A disability caused or aggravated by a service-connected disability may itself be service connected. Causation or aggravation still has to be established, and the resulting evaluation may be 0 percent. A service-connected knee disability may, in some cases, lead to a hip disability; tinnitus may, in some cases, contribute to a depressive disorder.
• In-service aggravation of a preexisting condition. If a condition was noted at entrance, the question is whether service increased it beyond its natural progression. If it was not noted at entrance, the presumption of soundness applies, and VA must produce clear and unmistakable evidence both that the condition preexisted service and that it was not aggravated by service.
• Secondary aggravation. Under 38 C.F.R. § 3.310(b), compensation may be paid for the incremental increase in a nonservice-connected disability over its established baseline when a service-connected disability aggravates it.

Character of discharge matters. Some discharges create a statutory or regulatory bar to VA benefits, and others call for a VA character-of-discharge determination under 38 C.F.R. § 3.12, which is a separate question from a discharge upgrade through the service department. The regulations include insanity and compelling-circumstances provisions, and 2024 amendments expanded access for some claimants with other-than-honorable or special court-martial discharges. Limited health care eligibility may exist even where benefits are barred. If discharge status is complicating eligibility, it is worth reviewing before you give up.

Thinking about filing, or refiling?

Consultations for VA disability matters are free. For ordinary VA compensation matters, we do not charge an attorney fee for services performed before VA issues notice of its initial decision with respect to the claim. After that notice, our written agreement uses the direct-pay contingent structure permitted by law: a fee of 20 percent of past-due benefits awarded, paid by VA from those past-due benefits. The client remains responsible for reasonable out-of-pocket case expenses, such as obtaining medical records and private medical opinions, whether or not benefits are awarded. Any potential case expenses and any permissible post-decision fee arrangement will be disclosed in writing before representation begins.

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Evaluations, VA Math, and Effective Dates

Service connection is one question. The evaluation and the effective date are the others.

• Evaluations. The rating schedule (38 C.F.R. Part 4) is designed to compensate the average impairment in earning capacity resulting from service-connected disabilities in civil occupations. Evaluations run in steps from 0 to 100 percent, and the diagnostic code that applies controls the criteria used.
• Examinations. An examiner may estimate additional functional loss during flare-ups from a competent description of them, so the goal is a complete and accurate description of the whole pattern: frequency, duration, severity, and the functional loss involved.
• VA math. Multiple evaluations are combined using the combined ratings table rather than added. A 50 percent and a 30 percent combine to 65 percent, which rounds to 70 percent, and special rules such as the bilateral factor can apply. The combined percentage alone should not decide whether a meritorious condition is claimed or appealed, because 0 percent awards, TDIU thresholds, special monthly compensation, secondary conditions, and health-care eligibility can each turn on an individual evaluation.
• TDIU. Total disability based on individual unemployability may be assigned when a veteran is unable to secure or follow a substantially gainful occupation because of service-connected disabilities. The schedular thresholds are generally one disability rated at least 60 percent, or a combined evaluation of 70 percent with one disability rated at least 40 percent, with grouping rules that can treat certain disabilities as a single disability. Marginal employment is not substantially gainful employment. Cases below the thresholds may be referred for extraschedular consideration under 38 C.F.R. § 4.16(b).
• Effective dates. The effective date of an award is generally the later of the date VA receives the claim and the date entitlement arose, subject to exceptions, including claims received within one year of separation, continuous pursuit of a claim, increased-rating rules, liberalizing laws, and newly received service-department records. An intent to file establishes a potential effective date if a complete claim is received within one year and the claim is granted; only one intent to file may be active at a time. Effective-date errors can materially reduce past-due benefits. Once a decision becomes final there is no freestanding claim for an earlier effective date; revision requires clear and unmistakable error or another recognized exception.

How We Work a Claim

1. Free case review. We read the records, the decision notices, and the diagnoses, and give you an honest read on service connection, evaluation, and effective date.
2. Evidence plan. Service records, private treatment records, lay statements from you and from the people who know you, and, where appropriate, a private medical opinion addressed to the applicable legal standard. Obtaining records and opinions can involve client expenses, which are identified in advance.
3. File and respond. We prepare the claim and respond to VA development requests. Preparing for a VA examination is a matter of describing your symptoms and their functional effects completely and accurately, not of performance. After a decision, the evidence rules depend on the review option chosen: a Higher-Level Review is decided on the record as it stood, while Supplemental Claims and the Board dockets have their own windows.

If VA has already decided your claim, see VA appeals for the decision-review options and the deadlines that apply. A Higher-Level Review or a Board appeal generally must be filed within one year of the decision notice; a Supplemental Claim may generally be filed later, though filing within the year matters for continuous pursuit and the effective date. And if your disability picture is changing what your family needs from a Missouri estate plan, see estate planning for veterans, which is a separate Missouri service under a separate written engagement.

FAQs

What do I have to prove for service connection?

Generally three things: a current disability, an in-service event, injury, or disease, and a nexus linking them. A formal diagnosis is often the clearest proof of the first element but is not invariably required. The in-service element may be shown by service records or by other competent and credible evidence, including lay evidence. The nexus is not categorically a matter of medical opinion, although complex questions of medical causation ordinarily require medical evidence. Nexus evidence is a frequent point of dispute, which is why a well-supported private medical opinion often matters.

What is a presumptive condition?

Federal law and VA regulations may presume service connection when the veteran has both qualifying service or exposure and a listed condition meeting the applicable requirements. Examples include the diseases identified under the PACT Act for specified locations and periods, herbicide-exposure presumptions, Gulf War claims under the separate criteria of 38 C.F.R. § 3.317, listed Camp Lejeune diseases with qualifying presence, and radiation claims under § 3.309(d) or through dose development under § 3.311. You still have to show the qualifying service or exposure and the current condition, and each presumption has its own requirements.

Why is my combined evaluation lower than my ratings added together?

VA does not add evaluations; it combines them using the combined ratings table. A 50 percent and a 30 percent combine to 65 percent, which rounds to 70 percent, and special rules such as the bilateral factor can apply. The combined figure alone should not decide what to claim or appeal, because 0 percent awards, TDIU thresholds, special monthly compensation, secondary conditions, and health-care eligibility can each turn on an individual evaluation.

Can I be paid at the 100 percent rate without a 100 percent evaluation?

Sometimes. Total disability based on individual unemployability may be assigned when service-connected disabilities leave a veteran unable to secure or follow a substantially gainful occupation. The schedular thresholds are generally one disability rated at least 60 percent, or a combined 70 percent with one disability rated at least 40 percent, with grouping rules for certain disabilities. Marginal employment is not substantially gainful employment, and cases below the thresholds may be referred for extraschedular consideration under 38 C.F.R. § 4.16(b).

How far back will my benefits go?

Generally to the effective date, which is usually the later of the date VA received the claim and the date entitlement arose, subject to exceptions such as claims received within one year of separation, continuous pursuit, increased-rating rules, liberalizing laws, and newly received service-department records. An intent to file can establish a potential effective date if a complete claim follows within one year and the claim is granted. Effective-date errors can materially reduce past-due benefits, and once a decision is final, an earlier date generally requires clear and unmistakable error or another recognized exception.

Do you charge for helping me file my first claim?

No. Federal law generally prohibits VA-accredited attorneys and claims agents from charging a fee for services performed before VA issues notice of its initial decision on the claim or claims involved; limited exceptions exist in the regulation, such as certain Chapter 37 loan matters and qualifying payments by a disinterested third party. After that notice, a fee may be charged under a written agreement filed with VA. The law permits fixed, hourly, percentage, or combination fees in non-direct-pay agreements; our agreement uses the direct-pay contingent structure permitted by law, a fee of 20 percent of past-due benefits awarded, paid by VA from those past-due benefits. The client remains responsible for reasonable out-of-pocket case expenses, such as obtaining medical records and private medical opinions, whether or not benefits are awarded.