Understanding Higher-Level Reviews vs. Supplemental Claims for VA Disability
There’s a recurring phrase that our contributor believes applies here: this claim “needs more cowbell.” For those unfamiliar, it’s a reference suggesting that something is lacking or could use more impact or support. This article explores that idea through the lens of VA claims, particularly focusing on the distinction between a higher-level review and a supplemental claim.
Start with the Decision Letter
If a VA disability claim is denied, there is no automatic path to pursue. One cannot automatically go for a higher-level review, file a supplemental claim, or escalate to the Board of Veterans’ Appeals. It is critical to first examine the decision letter to understand the reasoning behind the denial.
Case Study: Mental Health Secondary to Tinnitus
In this scenario, the claim centers on a mental health condition that is secondary to an already service-connected disability—tinnitus. Logically, this makes sense, as tinnitus can significantly impact mental well-being, such as causing anxiety or depression due to constant noise disturbances. These are recognized mental health outcomes that could warrant a secondary service connection.
A supplemental claim requires new and relevant evidence. If the VA concedes a diagnosis, but service connection is still denied, then the missing element is often the nexus—a documented medical opinion linking the current condition to military service.
The Importance of the Nexus
The decision in this case stated: “We did not find a link between your medical condition and your military service.” That statement is rooted in 38 CFR § 3.303. Here, “the nexus” refers to the link. When the VA provides a Compensation & Pension (C&P) exam and their examiner opines that there is “no link,” that becomes the basis for denial—especially if no independent medical opinion is provided to counter it.
It becomes a matter of one medical opinion against none, which often results in a denial. To improve the chance of success, an independent medical nexus statement is highly recommended. A strong statement might read: “It is at least as likely as not that the veteran’s depression and anxiety are caused by service-connected tinnitus.” Even a 50% probability, or “at least as likely as not,” meets the legal threshold since the tie goes to the veteran.
Exam Documentation and Missteps
In the C&P exam documentation, the veteran reportedly made “frequent references to difficulties experienced at work.” While mental health claims are evaluated based on occupational and social impairment, referencing a current work environment too much might skew the examiner’s opinion. The result in this case was a denial, citing that the mental disorder was “more likely related to the current work environment” and not military service.
Favorable Findings and What They Mean
The decision did include favorable findings: service connection for tinnitus was acknowledged. However, the mental health claim was not substantiated due to the lack of a nexus. The claim was ultimately denied.
When to Use a Higher-Level Review vs. a Supplemental Claim
If a claimant has strong new evidence—like a well-supported nexus letter—they might choose a higher-level review. This would be appropriate if the VA reviewer overlooked existing evidence or improperly weighed it. However, if there was no independent medical opinion at the time of the original claim, the better path is likely a supplemental claim with that new nexus evidence included.
Conclusion
In this scenario, a supplemental claim with new medical evidence—such as a properly written nexus letter from a private provider—could significantly improve the outcome. Claims like these are high-value, especially when mental health ratings are stacked on top of existing ratings like 10% for tinnitus. It’s critical to submit strong medical documentation and tailor the evidence specifically to the service-connected condition.
Pro tip: Mental health claims should reference current experiences, ideally within the past several months to a year. Going back too far can weaken the argument for a current diagnosis.
Disclaimer: This article includes portions that reflect the opinions of our contributor based on personal insights and experiences with the VA claims process. Information is intended for educational purposes only and should not be considered legal or medical advice.
