The VA Disability Claim: Evidence, Exams, and Ratings

A VA disability claim is decided on three linked showings: a current diagnosed condition, an event, injury, illness, or exposure during service, and a medical link — a nexus — between the two. If all three are present, the condition is service connected and VA assigns a percentage rating under a published diagnostic code. Most claims that fail do not fail because the veteran was not hurt. They fail because one of the three links was never put on paper. Everything else in the process — the examination, the evidence requests, the rating decision — is machinery built around those three questions.

The three elements, and which one is usually missing

VA disability compensation is a federal program. It is run by the U.S. Department of Veterans Affairs under federal statute and regulation, and the same rules apply in every state. That distinguishes it from most subjects on this site: your city and your state do not set VA eligibility. State and county veterans service offices do help you file, and some states run their own separate benefits, but the claim itself is federal from start to finish.

The three elements work like this.

The nexus is the element that goes missing most often. A veteran files with a stack of current treatment records and a clear memory of the injury, but nothing in the file says the one caused the other. Some conditions are presumed connected by statute or regulation for particular service — certain exposures, certain periods, certain locations — and where a presumption applies you do not need to prove the nexus separately. Which presumptions exist and who they cover changes as Congress legislates, so check the current list on VA's disability pages rather than relying on what was true a few years ago.

Worth knowing: a condition can also be service connected as secondary to an already-connected condition — a knee injury that changes your gait and wears out the other hip, or depression that follows chronic pain. Secondary claims still need a nexus opinion, just a different one.

Filing, and why the date you start matters

Two mechanisms affect the date from which benefits run, which is separate from whether you win.

The effective date determines retroactive payment. Because payment amounts change and depend on rating, dependents, and other factors, do not rely on any figure you read anywhere except VA's own current tables. Nothing on this page states a payment amount, and you should be suspicious of any source that promises one.

Building the evidence file

You do not have to prove your case beyond doubt. VA is required to give the benefit of the doubt when positive and negative evidence are in approximate balance, and it has a duty to assist you in gathering records. That duty is real but it is not a substitute for your own file — VA will request federal records, but it generally will not chase private providers for you unless you give it the authorization and the addresses.

• Service treatment records and your personnel file — request copies through the National Archives if you do not hold them.
• Current treatment records from every provider, VA and private, that has seen the condition.
• A nexus opinion from a clinician who has reviewed the service records, not just a note saying the condition exists.
• Lay statements from people who saw the event or the change in you afterward — spouses, squad members, supervisors.
• Anything that fixes dates: awards, deployment orders, incident reports, sick call slips, contemporaneous letters home.

Lay evidence carries real weight for things a non-expert can observe. You can testify that your knee has hurt continuously since a specific fall; you cannot testify that the fall caused degenerative changes visible on imaging. Split your statement along that line and it will be harder to discount.

The compensation and pension examination

If the file needs a medical opinion or a current measurement of severity, VA schedules a compensation and pension examination. It may be performed by a VA clinician or a contracted examiner. It is not a treatment appointment. The examiner is filling in a structured questionnaire tied to the rating criteria and, where asked, giving an opinion on whether the condition is at least as likely as not related to service.

Careful: an examiner's negative opinion is evidence, not a verdict. It can be rebutted with a better-reasoned opinion from a clinician who reviewed more of the record — and a poorly explained opinion is one of the strongest grounds for a later review.

How the rating is assigned

Each service-connected condition is matched to a diagnostic code in the federal rating schedule. Each code carries criteria describing levels of impairment, and each level carries a percentage. The rater compares your evidence to the criteria and assigns the level your record supports. This is why generic evidence underperforms: a note saying "chronic low back pain, stable" tells the rater almost nothing the criteria ask about, while a note recording measured range of motion, documented flare-ups, and prescribed bed rest speaks directly to them.

Where a veteran holds multiple ratings, they are not simply added. VA combines them using a table that accounts for the whole person, so two conditions rated the same do not produce double the figure. Separate rules address unemployability where service-connected conditions prevent substantially gainful work. All of these live on VA's site with the current criteria; the structure is stable, the numbers are not, and we do not restate them here.

A rating does more than set compensation. It can open doors elsewhere — certain education entitlements discussed in using the GI Bill and transferring benefits to dependents, hiring advantages covered in veterans preference in public employment, and, if the veteran dies of a service-connected condition, entitlements for the family described in survivor benefits and the death gratuity.

If the decision is wrong, you are not stuck with it. There are three distinct review routes, described on VA's decision reviews pages, and choosing between them is a real decision — we walk through it in appealing a VA decision through the three review lanes. If a bad discharge characterization is blocking eligibility in the first place, that is a separate proceeding covered in discharge upgrades and correcting military records.

Common questions

Do I need a lawyer to file the first claim?

No, and fee rules generally restrict paid representation on an initial claim in any event. Accredited veterans service organization representatives and county or state veterans service officers assist free of charge and file claims every day. Paid attorney representation typically becomes available once there is a decision to challenge. Whoever helps you, confirm they are accredited to practice before VA before signing anything.

My records were destroyed. Is the claim dead?

No. Where service records are unavailable through no fault of yours, VA has a heightened duty to assist and to consider alternative evidence. Unit histories, morning reports, pay records, personnel files, letters written at the time, and statements from people who served alongside you can substitute. Say plainly in your submission that the primary records are missing and identify what you are offering instead.

Can I claim a condition that got worse in service but started before it?

Yes. This is aggravation. If you entered service with a noted condition and service made it permanently worse beyond its natural progression, that increase can be compensated. The evidence question shifts: you are proving the change, so entrance examination findings and early service treatment records become central, alongside a medical opinion that addresses natural progression directly rather than in passing.

Does receiving military retired pay stop a disability claim?

It does not stop the claim. It can affect how payments interact, because rules govern concurrent receipt and offsets between retired pay and VA compensation. Those rules are technical and depend on retirement type, rating level, and combat-relatedness. File the claim on its merits and ask VA and your retired pay office how the offsets apply to your specific situation.

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