If you’re a veteran and suffered a service-connected injury or condition after returning home from military duty, you may be eligible for the extra-schedular rating offered by the U.S. Department of Veterans Affairs (VA). This rating gives you an additional percentage of compensation for your disability, but only if your symptoms are unique and exceed what's expected for that rating code.
For example, if you suffered an elbow injury, you might receive a 20 percent rating because the range of motion in your arm is limited. However, you might be considered for the extra-schedular rating if you’re unable to work at a computer for more than 30 minutes before there's intense pain and swelling in the elbow.
Getting an approved claim for an extra-schedular rating requires a significant amount of evidence, so it’s helpful to hire a VA disability lawyer to assist you through the appeal process for this financial support.
Evidence for the Extra-Schedular Rating
Some veterans have special and exceptional conditions that make them eligible for the extra-schedular rating. Their symptoms may not match the criteria for a specific disorder or listing, but their illness, disorder, or injury exceeds the rating code. They may have experienced a life-changing event and now suffer with consequences that make it difficult to sustain gainful employment, or live a life that allows for a normal, daily routine. Veterans in these circumstances are considered for the extra-curricular rating.
However, it’s important to understand the evidence you need to make a successful claim for the extra-schedular rating. Here are three tips for helping to ensure your claim is approved:
- Know what’s in your C-file. A veteran’s claims file—also known as a C-file—is considered the most significant element to a successful claim. Consequently, it’s important that you have a copy of the information that’s in the file because, in general, it contains all the information the VA is using to make a determination about your claim. The information may include service records, service medical records, C&P exam request letters and opinions, post-service treatment records, VA correspondence, and VA legal documents like your notice of disagreement (NOD).
The C-file also contains code sheets. Each time the VA issues a ratings decision, a code sheet is usually attached to the last page of the decision. This code sheet tells you and any legal advocate you have which claims were service-connected, the effective dates of the injury or condition, the impairment ratings, the method of service connection, and the diagnostic codes used to make a determination. It’s a critical piece of documentation that many veterans don’t know exists.
It’s important that you also know what’s not in your C-file. If the VA can’t find parts of your paperwork, the agency may conclude that there’s an absence of evidence against the claim. And because people at every level of the claims process read and review your C-file, it’s important that critical documentation be there.
- Provide superior proof and credible evidence. The evidence you provide with your claim for an extra-schedular rating must clearly show why you need and deserve this financial benefit. It’s not good enough to simply fill out the forms, state that you have a service-connected condition, and expect the VA rater to immediately see or understand your situation. To show your eligibility, your evidence should:
- Be given by a specialist or someone who has expertise and skill. The person should have personal knowledge of your condition and, if possible, training in that area to offer substantiated proof that your symptoms are documented accurately.
- Be factual. Your claim should show that you're an eligible veteran; suffered a service-connected injury or condition; and have received a medical statement of the diagnosis with an expert medical opinion about how your condition is related to your military service.
- Provide both lay evidence and medical evidence. These are generally the two classification types for evidence in a VA claim. Here is a brief look at each:
- Lay evidence. Typically, lay evidence is proof that doesn’t need trained, skilled, or knowledgeable expertise. This can include your “buddy statement” that confirms and substantiates the events that led to the injury or condition; your own testimony about the incident and the symptoms you suffer with your disability; your spouse’s testimony about how the condition has affected you; and even your performance evaluations following the incident can be used.
- Medical evidence. This typically comes from a physician, psychologist, medical examiner, or a professional in the medical field. If you have a private medical expert offer an opinion about your condition and its connection with your military service, it’s important that he include critical words and phrases in that opinion to ensure it’s considered competent by the VA, including:
- “I reviewed the claimant’s entire C-file.” VA raters may believe that the medical professional can’t possibly give an expert opinion if he hasn't looked at all the medical information.
- “As least as likely as not.” This phrase is important to show that you’ve met the burden of proof and have enough evidence to support your claim. However, medical professionals aren’t used to this phrase, and may not feel compelled to cite their findings this way, even though it’s the best way to state that they have a reasonable degree of medical certainty about your condition.
- Words that explain why the medical professional reached the conclusion he did and why the diagnosis may differ from the VA C&P exam results.
Let Us Help You
If you need help applying for the extra-schedular rating, or want to know if you meet the extra-schedular criteria, contact the VA disability attorneys at Cuddigan Law. We can help answer your questions. To discuss your situation, start an online chat on our website today or call us today for a free evaluation (402) 933-5405.