VA Denials Based on Pre-Existing Conditions: Can You Appeal?

VA Denials Based on Pre-Existing Conditions: Can You Appeal?

Veteran benefits are only granted if the condition is service-connected and limits their functionality or employability. Veterans cannot be awarded benefits if the condition was caused by an unrelated event, or if the disability existed prior to their service. However, disability appeals are commonly rejected when a condition is wrongly categorized as a preexisting condition. Heart problems, sleep apnea and orthopedic complications are just a few examples of common conditions that are incorrectly considered to be preexisting. 

If you believe that your disability was unfairly classified as a preexisting condition, therefore denying your benefits, contact an attorney at the soonest opportunity. Knowing what to expect from the VA appeals process is essential to seek the benefits you are entitled to. For advice specific to your case, call the Comerford Law Office.

Presumption of Soundness as Grounds for a VA Benefits Appeal 

A presumption of soundness must be used when applying for VA disability benefits. Essentially, this law assumes that a veteran was healthy when they entered service unless there is evidence that clearly demonstrates the contrary. If a health condition is not included in your entrance exam, the VA is not legally able to claim it as a preexisting condition. Exceptions include any health issues that you had from the time you entered the military, which would have been noticed and documented by the physician who completed your exam. 

While the presumption of soundness can assist a veteran in their appeal, it doesn’t guarantee that you will be granted disability benefits. You will still need to prove your disability is service-connected and impacts your ability to function. For example, a veteran who seeks benefits for sleep apnea is unlikely to be approved since most veterans do not undergo the necessary sleep study for diagnosis while they are completing their duty. Therefore, it is unlikely that the condition will be categorized as a primary disability. However, when a veteran is diagnosed with a traumatic brain injury or PTSD, sleep apnea may be considered a secondary service connection. 

The VA only refutes the presumption of soundness in limited situations. Typically, the VA would request proof that the initial exam failed to diagnose a developmental or congenital defect. 

Can I Receive Benefits If a Preexisting Condition Was Aggravated By Service?

Even if your entrance exam contains a note about your condition, you aren’t automatically ineligible for disability benefits. If you show evidence that your condition was worsened as a result of your military service, you may be able to receive benefits. When pursuing benefits for aggravation of a preexisting condition, keep these two provisions in mind: 

• The aggravation isn’t due to your disease’s natural progression. 
• You are not entitled to benefits if it is a temporary flare-up.

Both physical impairments and mental health issues are eligible for benefits if they are worsened by service. This is the key step: you must demonstrate that you had your health condition under control at the time your service began. A veteran may provide evidence that he or she was taking medication and held a full-time job prior to service. 

Begin the Appeals Process With a VA Attorney

If you are wondering whether you may appeal your denied veterans benefits, call a Chicago veterans lawyer at the Comerford Law Office to begin. We are available for a consultation.