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Welcome to The Veterans Disability Nexus, where we provide unique insights and expertise on medical evidence related to VA-rated disabilities. Leah Bucholz, a US Army Veteran, Physician Assistant, & former Compensation & Pension Examiner shares her knowledge related to Independent Medical Opinions often referred to as “Nexus Letters” in support of your pursuit of VA Disability every Tuesday & Wednesday at 7AM Central.
Take control of your medical evidence related to your benefits and visit https://podcast.prestigeveteranmctx.info/veteran/ for more information and to connect directly with us!
Hey, guys. It's Leah
Speaker 1:V from Prestige Veteran Medical Consulting. I am a US Army veteran physician assistant and former compensation and pension examiner. Today, I have Rebecca Deming from ProVet Legal on to discuss some really important stuff, regarding aggravation and VA disability. But before we jump into that, for those of you who don't know her, she's been on several times. Please check out some of our past videos.
Speaker 1:But, Rebecca, can you tell the viewers a little about yourself and your firm?
Speaker 2:Sure. I'm the founding attorney of ProVet Legal. We're a law firm with four attorneys, and support staff, and we represent veterans and their families in VA disability claims.
Speaker 1:Okay. Awesome. So today, we're gonna talk about, like I mentioned, something that trips up a lot of veterans when filing disability claims, and that's aggravation. So not just what it means, but how it's applied in, some different ways. And we're gonna also break down how, VA rates aggravated conditions and why the timing of symptoms can matter.
Speaker 2:So, Rebecca, can you tell us about what exactly aggravation means in the in the VA disability world?
Speaker 1:Right. So kinda just to start off with, to get VA disability benefits, you have to show that you have a disability that is a current disability that's connected to service or that started in service. So, generally, VA is looking at stuff that was not preexisting service or pre predating service because then it's not it didn't start in service. Aggravation is kind of the one loophole. It's where something that you had prior to service got worse because of your service, and it got and when they say worse, it it's beyond the, the normal progression of the disability.
Speaker 1:Mhmm. So and that's because of your service, then VA will pay you the difference between whatever it would would have been rated before service and and how much it got aggravated during service.
Speaker 2:Got it. So, with these preexisting conditions, if someone had a condition before they joined the military and it got worse during service, How how does that work? Can you give us some real world examples of what you've seen?
Speaker 1:Sure. So in order for, in order for VA to say this preexisted service, they have to show that it was marked on your entrance exam or that it otherwise clearly preexisted service. So, you know, if they think that you might have had some symptoms before, they're looking at it, they think it might have predated. That's not enough. They have to show that it was something that the, entrance examiner noted on your entrance exam.
Speaker 1:Mhmm. One of the most common ones that we see and we see a few different ones, but one of most common ones we see is flat feet. A lot of people will enter service, and they have a diagnosis of flat feet, but it's asymptomatic. They don't have any symptoms of you know, they don't have any pain in their feet. Essentially, it's just if you look at your foot, the arch isn't as as pronounced as it normally should be.
Speaker 1:So they get a waiver to enter service with flat feet, and then they have to run around in crappy boots with poor arch support. And their arches collapse further, they get really painful feet and plantar fasciitis and painful flat feet. And so the way that VA rates the flat feet, they have their code, and they're talking about pronation and and, pain and, swelling and that kind of stuff. So if it was asymptomatic before, it would have been a zero percent rating. And then if it got worse in service because of the wearing bad boots, they might get a ten percent, 30% rating, or higher, based on it being aggravated by service.
Speaker 2:Okay. So what about someone who had a condition but didn't get treated during service and late and it got worse later?
Speaker 1:So if it got worse after service, that's typically not aggravated by service. Occasionally, we'll see something if you didn't get treatment for it, but it actually did get worse during service and you just kind of treat it over the counter, then you'd have to show that those symptoms started during during service or got worse during service, but that you'd have to develop that evidence with lay statements, buddy statements, anything else that you can do to, document that those symptoms started in service even if you didn't get treatment. But it definitely adds a challenge if you didn't get treatment in service.
Speaker 2:So what about veterans, and medical opinions? Do they need medical opinions in order to show aggravation?
Speaker 1:So if you ask VA, nobody ever needs a private medical opinion, because you can always just get a C and P exam. Mhmm. But with aggravation, it really is a a pretty complex issue. Was it clearly marked on your entrance exam that it preexisted? And then what was the level of disability?
Speaker 1:And so you're kind of guessing backwards because you can't go back and take measurements or develop a migraine log to show how frequent your migraines were prior to service. So those kind of things. It it's hard to kind of develop a baseline, but the case is supposed to develop that baseline. So getting a private medical expert, like your company, Leah, or if you work with your doctors, it can really be helpful in these cases because it's such a kind of complex, nuanced, thing that you're trying to show that it was aggravated by service, by the types of activities you were doing in service, by some injury that you had in service. And not just that it was aggravated, but, like, what degree of aggravation occurred during service so that VA can assign an appropriate rating for you.
Speaker 2:Sure. And and as you mentioned, it it's not always, like, a requirement or anything. The the VA, C and P examiners are quite capable of providing a positive opinion. That doesn't necessarily mean they will. And even if they provide a negative opinion, maybe, you know, the adjudicators look at the totality of evidence to determine whether something is service connected or not.
Speaker 2:But these are just elements that can be helpful at times. Right?
Speaker 1:Yeah. Definitely.
Speaker 2:So if a if a service member or veteran has no treatment in service but says their condition got worse, what other types of evidence can be helpful to help establish this?
Speaker 1:I mean, I don't know if you can go on profile if you don't have medical treatment. But if you've got put on profile for something because you can't run or you can't do certain things, that would be helpful. Buddy letters, it could be a letter from a spouse saying, you know, I the veteran would come home from from training and ice his feet or, you know, went into service and, you know, he had some headaches before, but they were manageable and then came back from Iraq and was having migraines every day, but, you know, didn't wanna let his unit down. And so he just took exaggerated and muscled through it, but they were getting more and more severe after the TBI that happened or the deployment and exposures or or whatever. So statements from people who know you are really helpful.
Speaker 1:Statements from people who served with you and and, you know, said, hey. You know, when we used to run, I you know, we'd always, stay back because of the blisters on our heels and, you know, I'd make sure that the veteran crossed the line or, you know, whatever those kind of statements, to show that it's not just you saying, yeah. I think it got worse during this period of time.
Speaker 2:What about their private medical records? Can those be helpful?
Speaker 1:So private medical records from it depends on the period of of time that I mean, private medical records can always be helpful. But private medical records from after service could be helpful, but you're trying to show what was aggravated during service. And so sometimes those are helpful. Again, you might wanna get a specialist to say, you know, if it's an arthritis thing or something, like, what is the normal progression of this condition and saying it's unlikely that it would get to be this bad without the the stressors and the the trauma from from service that, made it worse. So, you know, you've got a 38 year old with a with arthritis of a 75 year old or something.
Speaker 1:Well, that's probably because of the stuff that happened in service and not because of their accountant job post service. So those kind of records are are really helpful. Now if you have reserve time when you said private records, it made me think of, you know, you've got reservists. And it the aggravation for reservists can be very difficult without a line of duty letter. Sure.
Speaker 1:Because we're trying to show that, you know, you you did your one weekend a month, two weeks a year, you know, or a little bit more, and we're trying to show that something that kind of progressed over time was attributable to just those few days or those few weeks, it it gets very challenging. So versus if you're active duty, anything that happens during the active duty period is attributable to service, even if it happens on your family ski trip while, you know, while you're off duty, it's still during an active duty period and would be attributable to to service. But that's not the same for reservists. We're really looking at what happened during drill time, during your activation periods.
Speaker 2:Sure. So, and and that's in most cases. Right? So you just made me and I and I know you know this, but, just making me think about line of duty knows. So unless the person's on active duty and they've done something that's like, you know, drinking and driving.
Speaker 2:And and even sometimes that can it's case by case. But unless there's something, that by regulation, it can't be in the line of duty and granted service connection or or whatever. Most of the time, it's always gonna be in the considered service connected. Right?
Speaker 1:Yeah. Now we will with private rec where private records for reservist time can come into play a little bit more helpfully is if, you know, you let's say you do your your one weekend, and then you come back in the week after your your drill weekend, you go see your orthopedic surgeon because you busted your knee, but you didn't have time during that one weekend to go see the the medic or the corpsman on duty. So if you can show that you went to your private doctor immediately after a drill weekend and and those are hard too because, you've gotta keep your own drill records. VA doesn't always have access to the exact dates that you were drilling. Those can be hard to to kind of reconcile.
Speaker 1:But if you're able to kind of show both that you were drilling and then immediately after went to see a private doctor even without a line of duty letter, we're sometimes able to show that those were aggravated by by service.
Speaker 2:So what is what is the biggest mistake that you see veterans make when they're filing aggravation claims?
Speaker 1:Oh, I would say the biggest mistake I see is on the VA side where they they presume that something is a preexisting condition when it wasn't noted on the intake exam. And so people will get that decision and just kind of assume that VA is right. So I'd say that's the biggest error that I see. And then the other one is and, again, I think it's really errors on VA side, but it's helpful to understand where VA can mess up so that you can kind of help get your records in line. VA is required to establish a baseline in order to, if it is a preexisting condition, they need to establish that baseline.
Speaker 1:And so getting those records to show that if you did have a preexisting condition, that the symptoms were minimal before you went into service or, you know, asymptomatic diagnosed condition with but it was asymptomatic, and then, showing the progression in service.
Speaker 2:So do you have any, like, last advice or or final advice for veterans that are pursuing these types of claims?
Speaker 1:I would say just be if if you really think that something got worse during service and be honest with yourself. I mean, if it didn't get worse during service, don't Mhmm. Don't waste your time and VA's time. But if you really think it got worse during service, I wouldn't take no for an answer from VA. I would keep fighting.
Speaker 1:I'd go find a an accredited VA attorney or accredited claims agent to help you fight those cases because these kinds of cases are ones that we see VA get get wrong a lot. Mhmm. And so I think the the biggest piece of advice is not to give up if you if you really think you have a valid claim. Find someone to help you get the benefits you deserve.
Speaker 2:Well, thank you as always, Rebecca. You're, such such a great asset to veterans out there that are that are needing help, and the information that you provide is great. I know that you're about to start your, YouTube channel, which I'm super looking forward to seeing all the contents on. So veterans out there that are watching, I'm gonna drop a link to, Rebecca's website on the description of this video so you can reach out to her and, hopefully, check out some of her YouTube content once she starts putting it out there in in 2026. So
Speaker 1:thank you. Forward to having you on as a guest too, Leah. It's gonna be awesome.
Speaker 2:Yeah. It's gonna be great. So thank you for, coming on the show today. And all you veterans out there, please like and subscribe to the channel. And if you have some comments or questions, just go ahead and drop them, and we try to answer those, daily just about.
Speaker 2:So, again, Rebecca, thank you so much for being here.
Speaker 1:Awesome. Thank you, Leah.
Speaker 2:Alright. See you guys later.