Wait- Chronic Pain is a Disability Now?
Chronic pain is a relatively new VA disability. Today I will discuss how you file a VA claim for chronic pain. Chronic pain can eventually lead to a 100% disability rating. This was not possible a few years ago, but 2018 was an important year for veterans. That is the year that the VA acknowledged that pain alone was a disability. Thankfully, the current laws surrounding pain as a disability improved the previous laws.
Saunders v. Wilkie No. 17-1466 (Fed. Cir. 2018) is the pivotal case that creates the option for a chronic pain rating. Saunders served on active duty during the late 80’s and early 90’s. Her active-duty service records noted she reported patellofemoral pain syndrome (chronic knee pain). However, she did not have any of the typically ratable symptoms (loss of flexion, lack of mobility, weakness, etc.).
Thankfully, Saunders persisted, and the VA awarded the rating. That rating resulted from the Appeals Court of the Federal Circuit that oversees disability claims. Saunders was the first to successfully file a VA claim for chronic pain, but her win at Appeals Court was a major victory for all veterans.
A Claim For Chronic Pain – Is It Really That Valuable?
VA raters are now bound by this precedent, but the initial rating is NOT why you should file a claim for chronic pain. Chronic pain is still (by itself) a weaker claim. The rater will end up rating based on the body part that is affected by the pain. For example, the rater may rate ankle pain based on diagnostic code 5271 (limitation of motion of an ankle). See the issue? The rater needs to find a rating to “fit” pain into.
You can expect some push back and potentially some issues connecting your current pain to your military service. However, the result is worth it. That disability will open the door for secondary claims.
A primary disability requires three things:
1) A current disability diagnosis
2) Proof that the disability occurred on active duty
3) “Nexus” (Proof that the current disability is continuation of the active-duty injury)
Secondary Disabilities Related to Chronic Pain
Secondary claims are much easier to prove. You only need to prove that a service-connected disability caused or aggravated the secondary condition. Secondary claims that connect to chronic pain are very valuable.
A veteran injures their back on active duty. They now have chronic pain that prevents them from sleeping properly. However, they have normal range of motion, no spinal damage, and no noted abnormalities of the back. They do not fit a typical disability claim.
The VA uses the chronic pain disability to award a rating. Subsequently, the veteran files a secondary claim for insomnia. The VA rates insomnia claims using the mental health claim scale. The exact rating depends on the effect insomnia has on the veteran’s daily functions.
Potentially, insomnia is rated as low as 0%. On the other hand, the VA also rates it as high as 100%. (The veteran could also use a 70% insomnia claim as the basis for an unemployability claim. The result would be a 70% rating that is paid like a 100% claim). See the value?
Filing a claim for chronic pain opens the door to more than just insomnia. Chronic pain can have other serious health side effects. The VA will normally prescribe prescription medications to treat chronic pain. Many medications have side effects, and those side effects are now a secondary claim.
Mental Health: The Serious Side Effect
In addition, chronic pain will often lead to anxiety or depression. Unfortunately, that is a consistent side effect of living in pain. The inability to perform daily tasks pain free takes a mental toll on veterans.
As with insomnia, the VA rates anxiety and depression using the mental health 0%-100% scale. You can have both anxiety and depression, but the VA will treat that as one mental health claim. You will never receive more than one mental health rating. However, mental health claims can be substantially more valuable than a chronic pain claim.
What Next? How Do I File A VA Claim For Chronic Pain?
The ability to file a claim for chronic pain is very new. It may not a “high value” claim on its own, but it certainly can be helpful. Your first step will be to look for proof in your active duty records of you reporting pain. The next step will be to demonstrate that you still suffer with pain. I would recommend you see your VA doctor (or pain management) to establish a care plan. The last step will be the most difficult.
You need to prove “nexus.” You need to prove your active duty injury caused the current pain. Need help? Do what I did! Enroll in COMBAT CRAIG’S BOOT CAMP! He will teach you how to take charge and file your claim the RIGHT way.