In regards to VA disability benefits, "gaps in care" refer to the periods of time that veterans went without receiving medical treatment for a medical condition that they desire to be service connected. Oftentimes, this makes it more difficult to get a rating for VA disability benefits due to the fact that the VA requires documentation and evidence of consistent medical care to support their claims.
How can gaps in care affect your VA disability benefits claim, and what should you do if you have gaps in your medical care history? Here's what you need to know:
When does a gap in care matter, and are there any exceptions?
Gaps in care are significant at all stages of the VA disability benefits claim filing process. Here's how they can impact various stages throughout the claim process and also the long-term usage of benefits:
The initial claims process: During the initial claims process, if you have gaps in care, it will be hard for the VA rater to award a percentage (if at all) because you must clearly demonstrate the continuity of the condition since time in service.
Increasing your rating: Gaps in care are also relevant if you already have VA disability benefits but are trying to increase your rating. Consistent medical records showing that your symptoms have worsened over time is the most compelling way to increase a rating. Luckily, even if you do have gaps in care, there are still a few ways to prove your condition without treatment notes (we'll cover that in the next section).
Reevaluations: If your VA disability benefits are being reevaluated, you'll want to make sure any gaps in care are covered to avoid an unjust lowering of your rating.
Appeals: If you're not happy with the results of your VA disability benefits claim or you received a denial, you'll want to fill in any gaps in care before you file for a higher level review or supplemental claim.
Note on exceptions: Chronicity is an exception, meaning a gap in care doesn't matter when chronicity is present in service at the time of diagnosis. If the condition that is diagnosed is accepted by the medical community to be a chronic condition with no chance of returning to the normal state, then the gap in care does not matter. Arthritis is one example of this. If your service diagnosis was arthritis and not strain, sprain, or joint pain – then the assumption of chronicity is assumed because arthritis is not a temporary or curable condition.
How can you prove continuous symptoms without treatment notes?
If you have a gap in care and your treatment records, don't panic – there are other ways you can prove your condition during the gap to the VA. Competent evidence is credible, relevant, and reliable information that can fill the gaps and prove that your condition still existed despite the lack of medical record.
The following are examples of competent evidence you can use to prove continuous symptoms:
Proof of receiving special accommodations
Proof that you received specific roles at work due to condition
Written letters from supervisors or others involved
Receipts for other health-related items
A documented service event
Helping veterans one document at a time
An effective VA disability benefits claim starts with the right documentation. With Nexus Letters, DBQs, chart reviews, and more – we're here to get you what you need for a high rating. Sign up for a chart review or view other services here. Instead of navigating the process alone, work with one of our professional medical experts to get exactly what you need.
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