Dispelling the Myths: How the VA Manages Medical Evidence in Disability Claims

When it comes to navigating the VA disability benefits system, the reality is clear: if you’re seeking compensation, it’s not just about filing claims—it’s about understanding the “money rules” that determine what you receive. In this system, winning a claim doesn’t necessarily mean you’ll receive meaningful compensation. For example, you can “win” a claim and receive a 0% rating. While technically a win on paper, it doesn’t equate to a financial benefit, which is often a key goal for many veterans.

Know the VA Math and Rating Criteria

Before filing any claim, especially under the PACT Act, it’s crucial to understand how the VA’s rating system works. You should research the disability you plan to claim and review its rating criteria in advance. This helps you anticipate the likelihood of receiving a rating that will significantly affect your compensation.

Case Study: Allergic Rhinitis

Allergic rhinitis is a good example. It maxes out at a 30% disability rating, compared to other conditions—such as mental health issues—that can be rated up to 100%. If allergic rhinitis is your main claim, you’re already limited in how much it can contribute to your overall rating.

Under the VA criteria:

• 30% rating is given only when nasal polyps are present.
• 10% rating is given without polyps.
• If neither applies, you may receive a 0% rating, which holds no financial value.

So if your goal is to increase your compensation, you need to consider whether filing a claim for allergic rhinitis, or similar low-rated conditions, will realistically help. Many veterans find themselves stacking low-rated disabilities that do little to move their overall rating—or financial compensation—higher.

Consider Strategic Alternatives: TDIU

Instead of filing claims that cap at low percentages, one potentially more impactful route is TDIU—Total Disability based on Individual Unemployability. TDIU can grant you compensation at the 100% level, even if your combined rating is below 100%, as long as your service-connected disabilities prevent you from working.

TDIU is awarded based on your ability to maintain substantially gainful employment, not just whether you’re currently working. However, it’s important to show that your inability to work is due to service-connected disabilities—not due to economic conditions or unrelated factors.

Two Routes to TDIU

1. Schedular TDIU:
   • One disability rated at 60% or more, or
   • Two or more disabilities with a combined rating of 70%, and at least one rated at 40%.

   This is commonly referred to as the 60/70/40 rule and is more straightforward.

2. Extraschedular TDIU:

   Applies when you don’t meet the schedular requirements, but your service-connected disabilities still prevent you from working. These claims are more complex and typically require a vocational expert to provide supporting evidence.

Revisiting Allergic Rhinitis in TDIU Context

Let’s say you filed a claim for allergic rhinitis and received a 0% rating. If you believe this condition (or others) contributes significantly to your inability to work, extraschedular TDIU may still be a viable option. You must already have a service-connected rating to apply for TDIU, but even low-rated conditions can be used to make your case—if documented and supported correctly.

If you’re close to meeting the schedular thresholds for TDIU, it may be smarter to first focus on increasing ratings for higher-impact disabilities and then apply for TDIU once you’re eligible under the schedular route. This can be a more reliable and streamlined path to 100% compensation.

Final Thoughts

Navigating the VA system isn’t just about filing claims—it’s about knowing which claims to file, understanding the money rules, and planning a strategy based on where your case realistically fits. Filing for conditions with low rating ceilings may give you an award, but not necessarily one that affects your wallet. In contrast, TDIU—especially when carefully approached—can unlock 100% benefits for veterans who qualify.

Disclaimer:
Some portions of this article are based on opinion, interpretation, and strategic insight drawn from personal experience and observation. While factual information regarding VA rules and criteria is included, readers should consult official VA documentation or a certified VA claims agent for formal guidance on their specific situation.