Comprehensive Veteran Guide – Enhancements in VA Disability Claims and Ratings

Welcome to the first in a five-part series on VeteransBenefitsHub.com, where we dive deep into what I call the Five-Step Process for maximizing your earned veteran disability compensation. This series is hands-down the most comprehensive guide you’ll find to ensure you’re getting the benefits you’re owed. In this post, we focus on Increases—the first step to ensuring your disabilities are properly rated.

The Five-Step Process Overview

The Five-Step Process is a roadmap for veterans to maximize their disability benefits:

1. Increases (this post)
2. Secondaries
3. Denials
4. New Claims
5. Presumptive Conditions & TERA

Each step will have its own dedicated post series, linked above, but today we’re starting with Increases—how to ensure your current service-connected disabilities are rated accurately.

Step 1: Increases – Ensuring Proper Ratings

Increases involve reviewing your service-connected disabilities to confirm they’re rated correctly based on current symptoms and medical evidence. Here’s a step-by-step guide, illustrated with a hypothetical veteran, “John Doe,” whose information is anonymized to protect privacy.

Step-by-Step Process for Increases

Let’s walk through how to check if a veteran’s disabilities are properly rated, using John Doe’s case. John served in multiple deployments and is rated for several conditions, totaling 87% (rounded to 90%). We’ll focus on a few key conditions to demonstrate the process.

1. Gather Information

Start by collecting generic details about your service history (e.g., deployments, service periods) to identify potential PACT Act or Atomic Veteran presumptive conditions. Review your current service-connected disabilities and their ratings, and check for dependents to ensure you’ve claimed dependency benefits.

2. Research Rating Criteria

Use the 38 CFR eCFR (Code of Federal Regulations) to find the rating criteria for each condition. The VA’s Disability Ratings page can also provide an overview. Here’s how to do it:

• Find the Condition: Search for your condition in 38 CFR. For example, “bilateral pes planus” (flat feet) is under diagnostic code 5276. If you don’t know the diagnostic code, use Ctrl+F to search for common terms like “flat feet.”
• Check the Diagnostic Code: Diagnostic codes (e.g., 5276 for flat feet) ensure you’re looking at the correct rating criteria. You can retrieve your codes via the VA API (requires VA.gov login).
• Compare Symptoms: Match your current symptoms to the rating criteria. For example, John Doe is rated at 30% for bilateral pes planus, which aligns with “severe” symptoms per 38 CFR. If his symptoms match the 50% criteria (e.g., “pronounced” symptoms), an increase may be warranted.

3. Examples from John Doe’s Case

Here’s how we applied this process to John’s conditions:

• Bilateral Pes Planus (Flat Feet, 30%): John’s symptoms match the 30% criteria (severe) per 38 CFR §4.71a, DC 5276. If he reports “pronounced” symptoms (e.g., marked pronation), he should visit his VA or private primary care to document evidence for a 50% rating increase.
• Insomnia (30%): Rated under the General Rating Formula for Mental Disorders. John’s symptoms (irritability, fatigue, unemployment) suggest a possible increase to 50%. He should document symptoms with a healthcare provider. Note: As of January 2024, secondary insomnia is rated with its primary condition (e.g., back pain).
• Tinnitus (10%): Tinnitus is maxed out at 10% per 38 CFR §4.87, DC 6260. No increase is possible, but check for related conditions like hearing loss or dizziness (DC 6204).
• Migraines (0%): John’s migraines are rated at 0% per 38 CFR §4.124a, DC 8100. If he has prostrating migraines, he should document frequency and medication (e.g., 15 pills every three months) with a primary care provider for an increase. A personal statement and hard medical evidence are key, as migraine logs are self-reported and less impactful.
• Rhinitis (0%): Rated under 38 CFR §4.97, DC 6522 (allergic rhinitis). If John has 50% nasal obstruction or uses nasal spray, he could pursue a 10% increase with medical evidence. Polyps (30%) are less common.
• Pseudofolliculitis Barbae (PFB, 60%): Rated under 38 CFR §4.118, DC 7806 (general skin rating formula). At 60%, John is at the maximum rating, so no increase is recommended.

4. Recommendations

Based on John’s case, recommendations include:

• Pes Planus & Migraines: Visit primary care (VA or private) to document symptoms for potential increases.
• Insomnia: Document symptoms for a possible increase or explore new claims (e.g., anxiety) if symptoms evolve.
• Tinnitus & PFB: No increase possible (maxed out).
• Rhinitis: Document nasal obstruction or medication use for a 10% increase.

Always submit evidence-based claims. Use an Intent to File to gather evidence before submitting.

Key Resources for Veterans

Two critical tools to master the increases process:

1. 38 CFR eCFR: Your go-to for rating criteria. Search conditions or diagnostic codes at ecfr.gov.
2. Veterans Benefits Knowledge Base: An A-Z master condition list with common names and ratings, available at VeteransBenefitsHub.com.

Why Increases Matter

Service connection is the hardest part of a VA claim. Once established, it’s protected after 10 years and rarely revoked (except in cases of fraud). For increases, focus on documented symptoms. Don’t rely on Compensation and Pension (C&P) examiners, as their reports can be incomplete. If you have documented medical evidence, you can challenge a poor C&P exam through a Higher-Level Review (HLR). Waiting to gather evidence via an Intent to File is better than submitting an unsubstantiated claim, which risks denial.

Next Steps

This is just the beginning! The next post in this series will cover Secondaries, where we’ll explore how to claim conditions caused by your service-connected disabilities. Stay tuned for the full five-part series on VeteransBenefitsHub.com. I challenge you to follow all five posts to master the process of maximizing your benefits.

Thank you for reading, and stay tuned veterans always ask how to get properly rated—this series is your answer.

Have questions? Drop them in the comments below, and let’s keep the conversation going!

Disclaimer: Some portions of this article reflect the author’s opinions based on experience and are not official legal or medical advice. Always consult with a qualified professional for personalized guidance.