The Importance of Medical Documentation to TDIU Claims

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TDIU Claims

Some veterans who do not have a 100% disability rating are eligible to receive the same Veterans Administration disability benefits as veterans who are totally disabled. Those veterans must establish that they have a serious disability that makes them unemployable. The benefits are known as Total Disability Individual Unemployability (TDIU).

Two kinds of evidence are required to make a successful claim for TDIU benefits. Unemployability is typically proved by vocational experts. Before it is time to engage an expert, however, it is important for the veteran (and the veteran’s lawyer) to be sure that medical documentation supports the claim.

A claim for TDIU benefits must be established by medical evidence. That evidence must generally prove two things. First, it must establish that the veteran has a service-related disability, or a combination of disabilities, that make the veteran eligible for TDIU benefits. Second, the evidence should include functional capacity evaluations that help a vocational expert determine whether the veteran is employable.

Disability Ratings

The VA assigns disability ratings for service-related physical or mental impairments. If an impairment was not caused or exacerbated by military service, the VA will ignore it when it determines disability ratings.

Ratings are assigned by adjudicators at a VA regional office, not by doctors. Adjudicators base the ratings on medical evidence submitted by the veteran. The evidence does not need to come from VA healthcare records. Records from any physician who has examined or treated the veteran can be considered when the VA determines a disability rating.

Ratings are assigned in increments of 10% that correlate with the severity of the disability (or combination of disabilities). The lowest rating is zero and the highest is 100%. Since disabilities may change over time, a worsening service-related disability may require periodic evaluations and the assignment of updated ratings.

Adjudicators base disability ratings on a rating schedule known as the Veterans Affairs Schedule for Rating Disabilities (VASRD). The schedule is intended to give adjudicators objective criteria for assigning ratings. The VASRD includes hundreds of diagnostic codes that describe medical conditions. Each code can be modified by specific symptoms that might make the condition more disabling.

To qualify for TDIU benefits, the veteran must have a service-connected disability rated at 60% or more, or a combination of two or more service-connected disabilities with a combined rating of 70% or more, provided that at least one disability is rated at 40% or more. When a veteran does not have a disability rated at 60%, it is often possible that a combination of impairments will result in a 70% rating. For example, the VA’s Combined Ratings Table states that a 50% disability combines with a 30% disability to create a 65% disability. That disability rating must be rounded to the nearest 10%, resulting in a final disability rating of 70%.

Medical Evidence of a Service-Related Disability

Evidence that a disability was caused or exacerbated by military service is usually based on documents that were created while the veteran was still serving. The veteran’s DD214 and other separation documents prove that the veteran served in the military. Service treatment records and documents in the veteran’s personnel file usually establish the injuries that were sustained on active duty. 

Medical records created after separation from service are equally important. Proof that a veteran was injured in the service is not necessarily sufficient to establish that the injury is related to a current disability. Medical records showing a “continuity of symptomology” are helpful to connect the service injury to the veteran’s current condition. If records establish that the veteran consistently experienced the same symptoms from the time of the injury to the time that a disability claim is made, it is usually apparent that the symptoms of a current disability are related to the service injury.

In some cases, no medical records establish a continuity of symptomology. For a variety of reasons, veterans might not seek treatment for ongoing symptoms until the symptoms become intolerable. And in some cases, a veteran might have a service-related condition that was not treated during the veteran’s service or that only developed after separation. Post-traumatic stress disorder (PTSD) is an example of a condition that is often left untreated until a veteran has endured its symptoms for years.

When existing medical records alone do not prove that a disability is service-connected, the veteran will need to obtain a diagnosis and treatment from a physician or psychologist who can generate new records that will support the claim. The VA might respond by requiring the veteran to submit to a compensation and pension (C&P) examination by its own healthcare provider. The results of a C&P exam are often unfavorable. The veteran may want to consult a lawyer to understand how they can prepare for the exam and maximize their opportunity for a fair outcome.

A few conditions are presumed to be service connected, particularly when they originate within one year of separation. For example, when the time and location of the veteran’s service makes exposure to Agent Orange possible, the existence of certain symptoms might be presumptive evidence that a disability is service related. In some cases, symptoms of Gulf War Syndrome might lead to a presumption that a disability is service related. A lawyer can often help veterans understand whether presumptions will help them prove their claim. In any event, medical records remain an important part of the claim process.

Medical Records and Functional Evaluations

Functional evaluations are a particularly important part of the documentation that supports a TDIU claim. Doctors prepare functional evaluations by measuring limitations in a patient’s ability to perform physical or mental functions. For example, a functional evaluation might determine that a patient can stand for 10 minutes, can sit for 30 minutes, and cannot climb or kneel at all.

Vocational experts use functional evaluations, as well as all other medical records, to assess employability. Vocational experts match the requirements of jobs that the veteran has the skills to perform to the veteran’s functional ability to perform them. If the expert finds that there are no jobs in the veteran’s geographic area that the veteran has the skills and functional ability to perform, the veteran may be entitled to TDIU benefits.