This article, a 25,000 foot overview of how to go from zero claim case knowledge to a successful outcome, is an outline of how to successfully develop your case. To be clear, this article is not a set of claim assembly, writing, and development instructions. While such a detailed guide may exist, the problem with the detailed approach is that while claims are broadly similar, they are importantly different. In other words, what may work as a valid set of instructions in one case, will be incompatible with the details of another case. Consequently, this article will help you determine a path and roughly speaking, where to go to seek helpful information to assemble your case. If you want a decent VA webpage that is a one-over-the-world for VA disability compensation, go here.

Before we begin, a helpful caveat: this article does not require that you have pre-existing VA claims filing knowledge or even military service. We understand that many readers are entering the VA claim system for the first time, while others may be seeking help in filing a claim after a loved one’s death. Either way, we can show you how to go from where you are to where you need to be.

Success. What does it look like? There is not a pot of gold at the end of a Veteran’s Benefit Administration (VBA) rainbow. In developing your case there are two success metrics that matter: 1) service connection, and 2) an appropriate disability award rating. Don’t know what service connection is? That’s okay, see the committee’s other related posts on the RRVA Medical tab.

Beginning. If you are an old hand at VBA claims filing and you have plenty of experience, then you should probably not read further. If you are brand new to the VBA claims filing path and you need to know where to start, this article is expressly written for you. Let’s dig in.

Seeing A Path. There is NO cookie cutter approach for success, but there are helpful blueprints. I will write that again but use different words: there is no simple 1-2-3 success recipe. Moreover, anyone who asserts that to you does not know what he/she is talking about. Honestly, there is a cottage industry out there of people and organizations that put forward their guide or approach to getting the claim decision you want from the VBA. While we agree with some of those people and some of their work, it is important to know that there is an ability and outcome spectrum for many folks that hang out a shingle to help Veterans and their families.

That spectrum explains why so many claims representatives (designated people inside Veterans Services Organizations such as VFW, American Legion, etc.) that work to assist readers like you produce a wide range of results. For simplicity, the outcome that ought to matter to you is that service connection is awarded along with an appropriate percent disability rating. However, the cases many claims representatives develop vary widely. Importantly, this article is not about how to select a VSO claims representative for your claim. Instead, this article is about helping YOU do the work of fully developing YOUR claim.

We often hear folks expressing interest in our narrative up to this point. However, when the idea of work arises, many folks become intimidated or ask, “Can’t someone do this work for me?” That’s a relevant question. Our take is simple: who knows the particulars of your case and who walked your path to today? There is no one better suited to tell your story than you. The work is in learning how to tell your story to a VBA disability and compensation claims examiner using terms, concepts, and notions peculiar to the VBA world. In other words, you are learning to speak their language to get what you need. Make no mistake, your task is to tell your story and do it effectively.

Since we avoid the term “blueprint” because it implies a sure-fire approach, we qualify this article as a framework. That distinction is important because it suggests that you have to bring details and fill in a narrative with relevant information. While the terms “blueprint” and “framework” are different, there is an important outcome common to either word: if you omit any portion of what follows you are likely sabotaging your case. Who would do that? Lastly, many would-be claims developers are looking for the speed line that does not exist. Importantly, there is no short cut nor is there a substitute for good work. Let’s begin.

Framework Floor Joist (1): What Is The Problem?

First up, you will have to think. It is especially helpful to reason out your case, using thinking skills, not emotions. You have to stop believing you are right and the VBA is wrong. If you cannot do this, your resentments will come through in your writing and that will have the effect of turning off the very person you are trying to win over: the VBA claim representative sitting in a cubicle trying to do his/her job as best he/she knows. After all, they have bosses too.

Next, ask yourself a straight forward question—now…before you sink a lot of personal effort and perhaps more than a few bucks into this odyssey: what do I want from the VBA? For example, if you have chronic pain that you perceive (I use that word frequently and with good reason) and you have not filed a disability claim seeking service connection for this ongoing (another key qualifier) pain as an identifiable medical issue with an associated VBA diagnostic code, then you might answer the above question with, “I want service connection for this _________ injury and I am seeking a ___ percent disability award rating.” If that is an example of your thinking, good work. You will achieve good things with a statement like that.

However, that is not your problem statement. Here is what I mean. The difference between the outcome you want, your knowledge, and the medical (and related non-medical) data you have on hand is your actual problem. Some of you picked up on a distinction: the preceding statement contains at least two, perhaps multiple problem statements. Who addresses those problems? You do. Before you can solve those problems, you must first see them as problems. There is another way to see this in VBA Land (where you are): what you do not know cannot help you. That’s important. I just wrote that there is no speed line and there is not. However, unintentional ignorance—a tactful way of saying you don’t know everything you will need to know, will sabotage your case. Some of you are thinking, that you cannot know what you cannot know. Well, in VBA Land, that does not hold up. Why? Because there is a path, as the title of this article suggests. So unintentional ignorance is an example of what good people do when they encounter something in VBA literature or they fail to investigate a good online information lead, or they opt to not ask a question. In other words, turn over every rock. You have no idea whether something you need will be written on the under-side.

Next, there is another sort of problem statement at work here. It is the statement of problem that relates to what you are attempting to do within the case. This point is important, so follow us through…say hypothetically, the VBA previously awarded service connection for injury “X” and awarded a 0% disability rating. After further consideration, your opinion is that 0% is inappropriate (another key word). Your statement of problem is: “As a problem I must develop a convincing response because I disagree with the VBA’s percent disability rating.” Now, your path—what you must do within your appeal to that VBA rating decision, is to demonstrate how 0% is not captured by the relevant diagnostic codes that the VBA claims examiner had to use to make his/her decision in your case. The diagnostic codes that make up the current VA Schedule for Rating Disabilities (VASRD) are located here. As an example, here is how YOU can go about locating important answers you will need in developing your claim a 10 minute internet search.

Everything the VBA uses to rate Veteran claims and adjudicate each claim request is, for the most part, publicly accessible law. For example, the VASRD is a trove of helpful information that is not difficult to read or comprehend, it’s merely challenging to know where to look. Let’s use another example, this one will be a condition that fits under painful joint motion. For clarity, this pertains to an injury that occurred in service—in line of duty. The first place you ought to look is here. The value of this passage from 38 CFR § 4.59 is that it helps you—a layman, step into the language used here in VBA Land.

In other words, if you insist on using only YOUR words and terms in your claims without using any of the words and terms known to a VAB claims examiner, you are most likely making it unduly hard on yourself, if not flat out risking denial. We ask again: who would do that? While § 4.59 is interesting, it still does not tell you how a VBA claims examiner (working in cubicle with a stack of Veteran claims) actually rates what you built in your claim. For that, go here. That is a 127-page (as of this writing in FEB 2022) document published by the Government Printing Office (on behalf of the VA) that lists every diagnostic code (DC) that is possibly ratable by the VBA. These DCs descend from the individual 38 CFR paragraphs, e.g., § 4.59. Here, the hands of the VBA claims examiner are cuffed: they can use only the DCs specified in the VASRD. Interestingly, the VA has the current VASRD always posted on their website. We applaud them for arranging it in way that frankly, is so much better than it used to be. So, our example was painful joint motion. To see what the VA posts on their departmental website for painful joint motion, click here then scroll down ~ 1/3 of the way to 4.59.

The web data in those links helped inform you as to what you ought to know and provides you the hints as to what you ought to prove in your claim in order for it to stand a chance of approval. I stop short of writing that awareness of all the previous data will guarantee a claim success because so much is determined by your writing and case assembly technique. We have scratched the surface but deep enough to get you started. There is much more. Onward.

Framework Floor Joist (2): Request Your C-File From The VBA

Your whuh? Again, you’re in VBA Land where they speak a language that resembles English, but is filled with arcane acronyms. Don’t get frustrated. You’d learn more French to go on a 14-day vacation to France; you can do this. Your “C-File” is your case file. Okay, what’s that? It’s a formal records request for everything the VA know(s) about you, this includes both the VBA and the Veteran’s Health Administration (VHA).

“Is the C-File really that important? I mean, if I have to wait eight months for my C-File to arrive in my mailbox, is it really worth the wait or should I blow it off and file the claim anyhow?” Hmmm. Have you ever tried to win an argument without knowing what the other person knew? Have you ever attempted to do that in a courtroom or other official proceeding? As a simple strategy of convenience to you, how did that approach work out? More importantly, as a strategy it will often yield failure. You need something with a higher odds of success. Otherwise, why are you wasting your time? Again, who would do that?

You can locate the latest version of the VA’s Form 3288, Request For and Consent To Release Information From Individual’s Records, here.

NOTE: if you were already in the VA enterprise—that is, being seen by VHA providers at a VA clinic, hospital, etc., your C-File with have all of those care provider’s notes and associated data. On the other hand, if you are beginning your first claim and are not nor have you even been seen in the VA enterprise, then your C-File ought to be all of your respective military service medical records sent to the VA by DOD. At bottom, one of the reasons why you request the C-File is to determine for yourself if the VA even has all of your military service medical records.

HINT: you want to get started on seeking your C-File ASAP! I mean, do not put it off for one more day! For Widows/Widowers an important detail: if your late significant other’s claim was to some degree completed but NOT filed, then from date of his/her death, according to federal law, as the surviving spouse you have only 365 days filed with the VBA. If your deceased spouse filed a claim but got a service connection/associated disability rating you disagree with, you have 365 days from the date of the decision letter (top, first page—that date) to file a notice of disagreement (NOD), or what is more commonly called, an appeal. Back to C-Files…

Sending the VA Fm 3288 is done in writing via snail mail, yeah, the super slow US mail. TIP: when you mail the VA Fm 3288 (ensure you keep a photocopy) do it via certified US mail. You will get a return card when your request was received at the VA Intake Center. You can locate that mailing address and relevant information, here. Wait 14-21 days, send another VA Fm 3288 and rinse-lather-repeat the entire process. That means send the second request also via certified mail. Now you have two return receipts. The VA may subsequently claim they did not get your C-File queries; however, you have written evidence (certified return cards) that says otherwise.

Final word here before pressing on to the next framework component: you can certainly build your (the) case as you understand it. But, you should not (we are not saying “do not”) file the claim with the VBA unless you’ve reviewed everything in the C-File which typically comes to you as a CD-ROM disk. Also, you are now looking through medical records in the C-File…some record remarks were originally handwritten while others were keyboard written. In all cases the record remarks were made by doctors infamously known for horrible handwriting (ugh!) and nurses whose writing was not much better. When you get the C-File, do not pretend you understand everything in it. Unless you are a trained medical professional with extensive recent experience, get some help.

We have a rule around here: if you think you need help, you need help. Locate someone with the relevant medical training and experience to help you make heads/tails of what is in the C-File. This part is hugely important. You cannot assemble a good case unless you know what’s in the C-File, what it says, and importantly, want it does not say. What that medical reviewer shares with you is more likely than not another example of what you gain by turning over the C-File rock to see what is written on the under-side. Something you would never see if you failed to take a look in the first place. When you have these answers you can then sit back and ruminate on the C-File and ponder its meaning for your case. A lot more ground to cover. Onward.

Framework Floor Joist (3): Learn The Law

This likely reads as instantly intimidating. But, actually, there are a lot resources out there—free, that will help you learn the VBA claims filing systems, legacy and AMA. We have already made a lot of law-related detail available in the previous links. In very important ways, we live in an age of explained and animated VBA claims filing knowledge like never before. Go to YouTube and wade in. There is some helpful stuff out there. But do not expect a set of claim assembly instructions. They don’t (should not) do it for the same reasons we do not do it: it is actually a disservice.

However, some advice: don’t go to va.gov to first learn about claims filing. If you do this, you will be buried under an avalanche of information, three empty toner cartridges, seven dead small pine pulp trees, and days of bloodshot eyes. You will end up with a monstrous pile of paper on your kitchen table and not a clue how to make sense of it all, let alone how to put it all into your claim case.

Instead, get to know the law first at any number of Veterans blogs of VBA claims filing, related laws, and tips for developing your claim case. When you’ve established a foundation of knowledge, then data mine the va.gov website for specific forms, facts, information, etc. Whichever route you choose on your path, the claim form you are most likely interested in is the VA Form 21-526EZ and only the latest version of that form (it has and can change). If you are seeking claims appeals forms, seek out the form that fits your need.

Next, if you are working on a claim that was based on an appeal decision first rendered before 19 February 2019, read this at va.gov. It is written in an easy to understand format with a good visual depiction. If you are starting a new claim or appending an existing one after 19 February 2019, you must do so in the what is called the “AMA Claim System,” or VBA Land parlance, the ”new” claim system. A good read for this new system is actually a GAO Report with a range of reading attachments you can find here. Here, there are numerous new claim system vids available at YouTube. Go take a look and take notes.

HINT: if your research is sufficient, you will learn enough about the new claim system (AMA) to credibly get this done. This process of learning dovetails very well with your decision to organically craft your own claim and/or appeal. We reiterate why you ought to do your own claim: no one knows your story the way you do. No one. Okay, the floor is built. We now begin to put up walls to support the rest of the structure that is your completed case.

Framework Wall Stud (4): The Logic of Your Claim As A Case

Folks, don’t put your hammer down because you are tired. We’ve come to a very important part of this whole effort: the 4 (called “walls” here) points that your claim should (some experts would say “must”) rest upon. I will briefly list them here, but do see the other posts here on the RRVA Medical tab for a more detailed discussion of their composition and assembly. Without delay:

Wall #1: Determine if you satisfy the basic eligibility criteria to file a VBA claim. I know this sounds like a no-brainer, but you must, for example, not be dishonorably discharged from service in order to file a VBA claim. There are other components to this particular wall stud and I will put them forward so you can research and learn: 1) presumption of soundness and 2) presumption of aggravation. Here, if know what to look for and you run both of these terms to ground, you begin to see how they fit into your effort to build a solid case.

Wall #2: Here, you need to determine what you must medically prove using C-File data or information from another source. Other sources include other medical provider supplied information. All of the medical data you will need to use to prove up on your claim turns on a straight forward question: is there enough valid medical diagnoses from qualified, relevant provider(s)?

Next, you must be able to demonstrate that the injury, disorder, or condition occurred in military service. For further help, see the post on the RRVA Medical Tab titled, “What Is Direct Service Connection?” The last piece to discuss here before moving on is service connection. Since this ought to be the first goal of any new VBA claim, this is super important. For further explanation here, see the article on the RRVA Medical tab titled, “Service Connection Explained.”

Wall #3: What is the best-case disability award rating I can expect for this specific issue, condition, or disorder? Here, things can quickly get into the weeds. First, a rating of 0% is an award. And, it’s a place to start later, if you want to revisit—by filing a supplemental claim or appealing the claim decision you have, a decision for a higher percentage. But here’s the key point: VBA claims representatives (the folks that actually study your claim case and render a decision), should be using the diagnostic codes in 38 CFR, Veterans Administration. A useful tip is to web search diagnostic codes that pertain to a given injury, condition, or disorder, then study what you get for returned information. Space does not permit a full explanation of the diagnostic codes, but they are the yard stick that will be help up to your claim to determine the disability award percentage.

Wall #4:Can you persuade the VBA claim representative to see your claim the way you do, facts, conclusions, and all? If I had to point to one of the most common flaws in claims development, it is poor writing, followed by poor or incomplete reasoning. Recall that I stated at this article’s beginning that you should “think.” This is where your ability to think clearly and completely will pay off. If you are a poor writer and you know it, or are just unsure if your writing is up to snuff, hand a summary of your claim and its reasoning, written in a word processor program to a friend and ask a simple question: “do you understand what I’ve written and does it effectively, concisely persuade you?”

So, anyone who lives in a house or shed understands that 4 walls are something we can now build rafters on—rafters that hold up a roof. This is when we get to a recognizable, useful structure.

Putting Up The Rafters (5): Evidence—Proving Your Claim

You have a ready resource in an article at the RRVA Medical tab, titled, “What Is Direct Service Connection?” This is solid overview of evidence that you need to prove up on your claim. Remember, you do not have a fully developed case because you say so. You have the elements of a fully developed case when you have proven it using the VBA’s own metrics for what constitutes evidence worthy of acceptance.

Go read the online article and then hold it up to the light and the elements of your case as you understand them. What is proven? What remains unproven? What is weakly proven but could use some strengthening? Remember, on the claim form (for first time claimants), you have limited space but can continue on a blank sheet. Adhere to the KISS principle and the other hidden gem of effective persuasive writing, sometimes…less is more. Continuing…

Building The Walls (6): Draw Your Lines and Make Your Stand

Everybody knows that even barns need walls. The walls are an important metaphor because by design they will enclose your entire claim. A claim under the same roof is whole, everything is present; the case and its facts are tied together. This is the result of the exercise you went through earlier when you put your writing into the hands of an objective person and asked that person if your work makes sense? Does it succeed?

Installing Wiring, Plumbing (7): It Works or When To Get Help

For folks fully invested in their claim, this is one of the toughest precepts to get him/her to acknowledge and embrace: when has my expertise been exhausted and when do I have to ask for outside help? Look, this really is not a hard question. However, folks are often afraid to have their ideas, opinions, reasoning, and facts examined by a trained professional. So, I ask this: do you want a professional (doctor, specialist, nurse, PA, etc.) to examine and provide critical feedback before you file or do want the VBA claims representative to later provide this feedback? I know which one I will seek out. I want my claim to win on the first pass because I don’t want to fight on an appeal—if I can avoid it.

Practically, this means finding the relevant medical professionals and asking his/her to hear your case and look at the data. What does this person think? That written, if your medical authority agrees on the merits of your claim and its various facts and their arrangements, then you will need that person’s opinion in writing. If you walk out of a medical authority’s office without a written statement in hand or an agreement that one will follow, then you may have missed an opportunity to form and/or strengthen your claim.

Here is where we are frequently asked: when is it time to get a lawyer? Okay, a couple of thoughts. First, I’m not a lawyer and nowhere in this entire article should you construe any of it as binding legal advice. Instead, see this article for what is: one Vet talking to another Vet or a Vet’s significant other. This is fully legal and ethically balanced as all Vets are authorized to seek out information deemed appropriate to the completion of and in the service of their claim. Second, once you learn about what could follow an adverse decision; read that to mean a VBA denial, then I think the decision to seek legal assistance becomes less murky and somewhat more clear.

Just know that in between a lawyer (state board certified and accredited to represent Veterans in the VBA claims appeal system) and a claims representative who may be a retired Marine Corps Gunnery Sergeant down at the local VFW hall, there is something called a Veterans Agent. These are more highly trained—and accredited (by the VA Office of General Counsel) to also assemble claims cases and represent Veterans in the VBA claims appeal system) like an attorney can. If you feel you need to go this route, va.gov lists every VA OGC accredited Agent in all 50 states and territories. Find someone near you and call that Agent to get his/her sense of your claim case.

The Lights Go On, Water Flows (8): Protect The Others

The barn becomes a house when the windows are installed, the doors are hung, the water runs, and the lights work. Similarly, your case now takes on that same integrated form. You worked hard to pull together the relevant facts, learn the law, integrate evidence, build a case, and scrub your writing.

In VBA literature, there is an important term known as the Fully Developed Case (FDC). To know more about FDC, click here. A fully developed case is a claim that is eligible for submission and accelerated review for service connection and a disability percentage award. But a fully developed case has another implied meaning: it is ready for prime time. That is, your claim is not only as good as you can make it, but it is sufficiently crafted as to stand the best possibility of producing an award of service connection and a disability rating. Folks, if you go to school on this entire article then click here, you will know ~ 75% of what you need to know to get started. The remaining 25% is found in this article and the others on the RRVA Medical tab for Veteran’s Claim Filing. Suddenly, you can do this!

However, there is something else to consider. While I know of no Veteran who sees a modest monthly disability payment from the VA as sweepstakes winnings, if we do not survive our cancer or other terminal illness, the monthly disability payment awarded to us continues to our spouse after our death. To learn more about VA death benefits, go here. The takeaway is this: even if you don’t see great value in a monthly disability payment, your family may have a different view of that payment’s value and importance after your death. Just do it.

In closing, this stuff reads as time consuming, tedious, and outright arcane. You’re right. It’s all those things and more. But that is not the point. What is the point? How do you eat an elephant? One bite at a time. And, when you construct a claim and succeed at obtaining service connection and a disability rating award, you make a way for others like you to follow. Tell others about this page and our work here.

Pass it on.