What documents do I need to file for US compensation and claim through the Veterans Affairs for a back surgery?

2023-12-19T12:44:27-05:00

Looking for advice was medically retired in May of 2020, did not submit all of my medical documentation to the VA so I am working on a compensation claim. I'm attempting to do this myself i've had two surgeries on my back, I have the line of duty of where I was injured at Fort Drum, I have been ongoing Pain management treatment for the last three years I'm currently at 90% are there any tips pointers or documents that anybody can foresee any needing ? Are there any other documents I may need ?

Response by PO1 H Gene Lawrence made Dec 19 at 2023 6:43 PM

2023-12-19T18:43:33-05:00

May I suggest that you enlist the aid of a VSO?

Response by COL Randall C. made Dec 19 at 2023 6:52 PM

2023-12-19T18:52:22-05:00

First, regardless of the below questions, you shouldn't "do this yourself". Contact a VSO and have them assist you. There is no reason you should do a claim process by yourself.

The answer is both simple and complex at the same time. As with all VA C&P claims, you have to show three things in order to establish a service connection:
1) That you have a disability that you're claiming.
2) That some event or occurrence was the direct, proximate or contributing cause of the disability or caused an existing disability to become worse.
3) That the cause occured during your service in the military.

That's the first part. Once a service connection is established, then an evaluation is done about how disabling a disability is. For this the adjudicator looks at the evidence to determine the impact according to the rating schedule* - how much limitation do you have? how does the pain affect you? how often is the pain? are there physiological limitations? etc.

So, what documents do you need? The easy answer is "anything that will show limitations, personal impact, etc". While normally these are medical files, the range of what could be used is actually pretty broad* - as long as it is relevant, credible, and either supports or refutes something, it is generally considered.

A few questions:
● Are your medical files from outside of the military's medical system?
● Was your back evaluated as part of the IDES process when you were medically retired?

Is there some reason the VA wouldn't have had access to them if they were from the military side? The VA will normally have full access to all of your medical files from the military unless there is some reason they wouldn't (e.g., you have the original records from before they were digital).

If your back was part of the evaluation when you were being boarded and the VA considered everything you have as part of the C&P evaluation and denied a service connection, then you'll be filing a Supplemental Claim (you're outside the appeal window). If it was given a rating but has gotten worse (or you don't feel it was rated correctly), then you'll be filing an Increased Claim.

In either case, a VSO can help you with the right paperwork and getting the evidence together.
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* VA Schedule for Rating Disabilities - https://www.ecfr.gov/current/title-38/chapter-I/part-4
* VA Guidelines for reviewing and weighing evidence - https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/ [login to see] 01018/content/ [login to see] 14383/M21-1-Part-V-Subpart-ii-Chapter-1-Section-A-Principles-of-Reviewing-and-Weighing-Evidence

38 CFR Part 4 -- Schedule for Rating Disabilities

Response by MSgt Private RallyPoint Member made Dec 20 at 2023 12:54 PM

2023-12-20T12:54:53-05:00

Talk to a VSO (Veterans Service Officer) at your local Vet Center.

Response by CPL Larry Snyder made Jan 17 at 2024 7:43 PM

2024-01-17T19:43:48-05:00

I do also recommend using a VSO if you feel you need to or are not sure what to do.
Personally, I tried using 2 different ones and they were no help. All they did was submit the claim, and add my documentation. All of which I could do myself. When I asked questions, they did not know any of the answers so I ended up doing all it all myself. I read about the injuries, the claims, and got as much documentation I could get from my civilian doctors. I requested all my medical records from the archives, and attached those to establish the service connections.
When I got a percentage that I did not agree with, the VSO was no help in trying to dispute it. I ended up not disputing any and reopening each of my claims.
Ultimately, it ended up getting me 100%.

Response by SSG Dalia Cox made Jan 18 at 2024 8:42 AM

2024-01-18T08:42:49-05:00

Was the surgery done by a va doctor? If so, then the summary notes, should be in you VA records. You can access them thru the myhealthyvet website, if you signed up for it.
2. Look into 38CFR schedule of ratings, chapter 4. It will tell you regulations on what surgical procedures qualify for rating percentages.
The VA should already have the summary notes of you surgery. If you decide to get a VSO to help you, make sure that they are accredited with your state. Not all VSO's are accredited.

Response by CPO Chief Chief made Jan 18 at 2024 4:25 PM

2024-01-18T16:25:32-05:00

In most cases i would agree with all leaders in this forum stating use your VSO!... However, in your case at 90%, i have to urge you to look at your submitted claims already and if your stating all the injuries and treatments (back related already) have been addressed then you can continue your treatment. Your options for surgery is between you and your neurosurgeon. Request CitC (Care in the Community). It may have took me 3 years of failed plans from pain meds, physical therapy, multiple imaging and finally worsened condition over the year but Rods and Screws are my new hardware. 90% your in for anything, dont let them tell you otherwise, just keep them sick call visits. Now you want 100%....... see your VSO!!!! (KnifeHand) Carry on