Navigating the VA claims process and understanding the rating system’s nuances is something that we at Vet Comp & Pen Medical Consulting have made part of our mission. It can be challenging to go at it alone without having extensive medical and VA experience under your belt. It can often be confusing and frustrating for Veterans, and we would like to explain one of the ways we can add value when you come to us for help.
The VA assigns you a rating that corresponds to the level of service-connected disability that you are experiencing. Many Veterans receive a rating that is lower than what they medically, legally and ethically qualify for. This article will explain the considerable financial gap between a 90% and 100% rating and how it is possible to get yourself there if you are already at 90%.
The difference between an overall rating at 90% and an overall rating at 100% is at least $1,200 more dollars if you do not factor in other variables. It’s a tremendous amount of money a Veteran could be receiving every month. Annually, it adds up to an additional $14,400, which is tax-free, by the way. And while it may seem like 90% is very close to 100%, because of the way VA calculates ratings, this is tricky terrain. Sometimes 90% is not 10% away from 100% overall rating. We will explain the nuances involved here.
For example, let’s take a hypothetical case of a Veteran who is rated for PTSD at 70%. This Veteran also has sleep apnea at 50%. It would seem that these two ratings would put the Veteran at well over 100%. However, the way the VA calculates it, the extra 50% is 50% of the leftover. What is leftover from 70% to 100%? 30%. So, half of 30% is 15%, so you add 70% plus 15%, you get 85 points, that’s the point total. The hypothetical Veteran is paid at 90% because the 85 is rounded up to 90. It would seem like this Veteran is very close to 100%. However, at 85 points, 30 more points are needed to reach 100%. 30% more can seem like a huge hurdle. However, it is entirely possible that there are secondaries and additional service-connected conditions that this Veteran can medically, legally and ethically qualify for.
Here are some other hypotheticals to add on. Let’s say this Veteran has Tinnitus. Tinnitus is rated at 10%. Let’s say this Veteran also has severe pes planus. Pes planus (flat feet) was a condition he had when he entered the military and though it was asymptomatic, it became severe, requiring the Veteran to wear inserts. This Veteran is rated at 50% for pes planus.
Using the online benefits calculator, and adding all the conditions together from above, this Veteran calculates out to 94 points. The Veteran is very close to 100%. 94 points rounds down to 90%, so this Veteran only needs 10% more to get to 100%. This is a case that we actually worked on. When this Veteran came to us for consulting, we reviewed their case, and we kept reviewing their calculations – something was not adding up. This Veteran should have already been at 100%.
We called the Veteran and said, “You know what, you’re at 100%.” Confused, the Veteran replied, “What are you talking about?” We told the Veteran that the VA did not add the bilateral factor for their bilateral pes planus. We confirmed the Veteran did indeed have it on both sides (both feet). We recommended that the Veteran file for the bilateral factor and have their ratings looked at by a rater to make sure that they were being paid the correct amount. The Veteran did that, and sure enough, that rater sent a decision letter acknowledging the bilateral factor for pes planus. When the Veteran received that letter, they went to 95 points, which is paid at 100%. Now, this Veteran is also going to file a motion for review, because the VA made a clear error when they applied the law to their ratings, only allowing benefits for one foot. This Veteran is now eligible to potentially receive back pay dating back five years.
Many Veterans are leaving money on the table and missing out on valuable monthly compensation that they could be getting for their disabilities. There is undeniably a lot of bureaucracy involved in the calculation of VA ratings. But when you trust Vet Comp & Pen to review your medical history, we can see if there is medical evidence that can support an increase for you or establish a secondary condition. You have nothing to lose because we will review your case for free. If we can’t help you increase your ratings, you don’t pay us anything.
Call us today and we will help you with medical evidence to support claims for any benefits that you medically, legally and ethically qualify for.