Elements of a Claim

Before the VA must assist in developing evidence, the claimant must present a reasonably possible claim. Generally, claimants will receive VA development assistance unless they are legally ineligible for the benefit (for example, the claimant doesn’t have qualifying service) or the claim is inherently incredible. When the claim is submitted, the advocate should present reasons why benefits should be granted and cite appropriate statutes, regulations, and the VA’s Adjudication Procedures Manual M21-1. If the VA decides that the claim is not reasonably possible or decides to deny the benefit, the VA must provide its reasons for that decision. In particular, the VA must explain how it reached any medical conclusions.

Disability compensation claims have three elements:

1. The veteran must currently suffer a disability or have suffered from a disability since the claim was filed;

2. There must have been some incident (for example, injury, disease, exposure, or event) in service that could have caused the current disability; and

3. There must be a connection between the current condition and the in-service incident.

The veteran almost always needs more than just his or her own testimony to support claims involving medical causation or diagnosis. It is extremely helpful if a medical expert states that the incident in service at least as likely as not caused the disability. For example, if a veteran suffers from a knee condition 30 years after discharge, then a statement from the veteran’s doctor that it is likely (or at least as likely as not) that the current knee disability was caused by a specific incident in service would support the grant of benefits.