You probably have a trusted relationship with your family doctor. If you have been seeing your family doctor for a long time, he or she knows all about your health. This is exactly the kind of relationship that can help you develop the evidence needed for your VA disability claim.
However, while your family doctor can help you with your VA claim, you should seek out a doctor who is experienced with the VA’s criteria. The VA looks for specific information when rating disabilities and approving service connections. Without this information or the facts to support it, a letter from even the most knowledgeable doctor might be dismissed by the VA.
Therefore, to place your VA disability claim in the best possible position for success, it will be your responsibility to make sure your doctor provides exactly the information needed by the VA or find a doctor who can.
In this article about getting a VA nexus letter from your family doctor:
- How Can My Family Doctor Help Me with My VA Claim?
- Having Your Family Doctor Prove Service Connection
- How to Find a Family Doctor to Help with a VA Claim
- What Happens After You Submit Your Family Doctor’s Records and Letters?
- What to Do If Your VA Disability Claim is Denied
How Can My Family Doctor Help Me with My VA Claim?
For a VA disability claim to be approved, the claim must contain:
- An explanation that the veteran is eligible for benefits: You will need to show through service records that you had the requisite time in service and were not dishonorably discharged.
- A current diagnosis for a disability that the VA compensates: Although the VA compensates most disabilities, it does not compensate veterans for disabilities that the veteran has recovered from or disabilities that resulted from willful misconduct like the commission of a crime or intentional drug or alcohol abuse.
- A service connection for the disability: Every VA disability claim must include facts that connect the disability to the veteran’s military service. This is usually both a factual recitation of what happened during service and a medical opinion stating that those facts caused the veteran’s disability.
Your personal physician, whether it be a private physician or a VA physician, can help with two of the three elements for a successful VA disability claim.
Having Your Family Doctor Explain Your Diagnosis
The VA uses rating schedules to rate disabilities. These rating schedules can be a bit complicated for a layperson to understand but should be clear to your family doctor.
However, what your family doctor must understand about the rating schedules is that your VA disability rating will be based on symptom groups that will differ in the symptoms presented, their severity, and their frequency. If your family doctor forgets to include all these elements in the doctor’s letter for disability, the VA might misrate your disability.
For example, a hiatal hernia is rated at 10%, 30%, or 60%. To receive a 60% VA disability rating, the medical records must show “pain, vomiting, material weight loss and hematemesis or melena with moderate anemia” or another combination of symptoms that produce “severe impairment of health.” For a 30% VA disability rating, the medical records must show symptoms that produce “considerable impairment of health” including “persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation” and pain in the arm, shoulder, or below the sternum. The VA assigns a 10% disability rating “with two or more of the symptoms for the 30 percent evaluation of less severity.”
As you can see, there are some “magic words” that the VA uses to judge the severity of a veteran’s hiatal hernia. If your family doctor says your symptoms “severely impair” your health, you have a better chance of obtaining a 60% rating, whereas if your family doctor says your symptoms “considerably impair” your health, you might not receive anything higher than 30%. What this means in concrete terms is that one word might cost you more than $700 a month in VA disability benefits.
Having Your Family Doctor Prove Service Connection
A service connection is one of the more difficult obstacles in many VA disability claims. A doctor must establish the service connection between a disability and your time in the military by a medical opinion (also called a nexus letter).
In fact, this is such an important part of a VA disability claim that you will find many online search results for doctors who write nexus letters for veterans. Woods and Woods has a network of medical professionals we trust to get the evidence our clients need. We work with doctors who review medical records and write reports and work with psychologists and vocational experts who are trained in VA law.
However, you can have your family doctor write a nexus letter. There are also a few websites that can provide a sample nexus letter.
A few key points you should make sure your family doctor is aware of:
- Explanation: The nexus letter must contain the doctor’s reasoning for the connection between the disability and your service. If the nexus letter merely contains a conclusory statement that your service caused the disability, it could be given little weight by the VA. Instead, ask your doctor to explain how an event during your service led to your disability.
- Medical studies: If the nexus letter contains any assertions that would not be apparent to any doctor, ask your doctor to support the assertion with articles from medical journals. For example, in a toxic exposure claim, a doctor might cite a medical journal article linking toxic chemicals given off by burn pits to thyroid disorders. You can also search our site for links to more information on these conditions.
How to Find a Family Doctor to Help with a VA Claim
Many veterans have only seen VA doctors since their discharge from the military. However, some VA doctors are reluctant to help veterans with their VA disability claims. You might seek an outside doctor so you can provide the VA with an objective view of the veteran’s disability. As a result, you might seek out a family doctor specifically to examine you for your VA disability claim.
Can Veterans Go to Any Doctor Now for Treatment?
Yes, veterans can always go to any doctor for treatment. However, the VA will only pay for those doctor visits if you meet certain criteria including current enrollment in VA healthcare and if:
- You must wait more than 20 days for a general appointment or 28 days for a specialist appointment.
- Your average drive time is more than 30 minutes for primary care, mental health care, or non-institutional extended services or more than 60 minutes for specialty care.
- You live in Alaska, Hawaii, New Hampshire, Guam, American Samoa, Commonwealth of the Northern Mariana Islands, or the U.S. Virgin Islands.
- You require services not provided at a VA medical facility.
- You have been referred to a non-VA provider by the VA because it is in your best medical interest.
- The medical treatment you require from your nearest VA medical facility has been identified by the VA as not meeting the VA’s quality standards.
If you do not meet at least one of these criteria, you will need supplemental insurance, like Medicare or private insurance, if you want to visit the doctor of your choice without paying out of pocket.
Can 100% Disabled Veterans Use Private Doctors?
Yes. If they meet the criteria for private doctors, the VA will pay for community care instead of requiring treatment at a VA medical center.
Note that these criteria do not limit the use of private doctors based on your disability. For example, a veteran with a mild disability, like tinnitus, is just as entitled to use private doctors as a veteran with a 100% disability.
Can My Family Doctor Submit VA Disability Application on My Behalf?
Usually not. There are two typical routes to submitting private medical records to the VA to support a VA disability benefits claim:
- You collect the records from your doctor and submit them to the VA.
- You authorize the VA to collect the records from your doctor.
What Happens After You Submit Your Family Doctor’s Records and Letters?
The VA will review your case based on the service records, medical records, and nexus letters you submit. Using this information, the VA will assign a disability rating. This disability rating will be based on your symptoms, as well as their frequency and severity.
Doctrines That Favor Veterans in Examining VA Disability Claims
Two doctrines favor veterans in assigning VA disability ratings and determining service connections:
- Benefit of the Doubt doctrine: By statute, the VA must resolve any situation in which the evidence is equal on both sides in favor of the veteran. For example, if a VA examiner’s report states that your symptoms considerably impair your health and an equally credible and supported letter from your family doctor says your symptoms substantially impair your health, the VA must resolve the doubt in your favor and find substantial impairment. This also means that if the VA finds that your symptoms qualify for disability benefits under two different ratings, it must grant the higher rating.
- Overall symptomatology: In assessing your VA disability claim, the VA must look at the overall picture of your symptoms and find the rating that most closely approximates your disability. This means that if a symptom or two are missing but the overall picture of your disability matches a higher rating, the VA can still assign the higher rating.
Compensation and Pension (C&P) Examinations
One reason it may be critically important to obtain a letter from your family doctor or another qualified outside doctor is that the VA will likely order you to attend a C&P examination before reviewing your VA disability claim. A C&P examination is an examination by a VA doctor to provide medical evidence for your claim file. The VA doctor who performs the C&P examination is usually not the VA doctor you have seen for treatment to minimize the risk of bias or conflict of interest.
It would be incorrect to assume that the C&P examination is intended to prevent you from receiving VA disability benefits. However, it would also be incorrect to assume that the C&P examination exists to boost your claim. To err on the safe side, you should prepare as if the C&P examination will be skeptical of your disability claim and that, under the “benefit of the doubt” doctrine, you will need a letter to balance out, or outweigh, the C&P examination report.
Here, one of our VA disability lawyers gives tips and suggestions on what to do during your C&P Exam.
What to Do If Your VA Disability Claim is Denied
If your VA disability claim is denied, you are allowed to submit additional evidence to support your claim before you appeal or request a review. If your original claim lacked a letter or had one that needs to better prove that your disability is service connected, you can take this opportunity to add a letter from your family doctor to balance out the evidence used to deny the claim.
This is where it can be critical to seek out the help of a VA attorney. Many VA attorneys have existing relationships with doctors who can examine your records and provide the letters you need for an original claim or supplement a claim after denial.
If your family doctor is unfamiliar with the VA or if you need a review of your doctor’s letters before submitting them to the VA, contact us today. We have on-staff doctors who can discuss veterans’ medical cases for free, regardless of where you are located or whether you were deployed.