VETERANS: Final decision from VA isn’t always final

When a veteran gets a decision letter from the VA that denies service connection for a claimed disability, the decision is not final until one year from the date of the notification letter. During this year, the veteran can submit additional evidence and reopen the claim for reconsideration, or send VA Form 21-0958 Notice of Disagreement, which starts a lengthy appeals process.

If a year has passed and the decision becomes final, a veteran can still reopen a claim for the denied condition. However, before the VA will reopen such a claim, the veteran must first provide “new and material evidence.” “New” means evidence the VA has never seen and “material” means that the evidence must relate specifically to the reason for the denial. If a veteran does not provide new and material evidence, the VA will not order any compensation and pension (C&P) exams and will again deny the claim. If a veteran opens a claim for a disability that has been denied and that decision is final, the VA will send a letter explaining that the condition was previously denied, what date it was denied and that it was considered final one year later. It will also include an explanation that new and material evidence must be sent in order for them to reopen the claim.

For example, one of my clients was denied service connection for a left knee disability more than 20 years ago. The decision said that while he was treated for sprains and strains, there was no medical evidence of a “chronic” condition and that his knee problem was “acute and transitory” and had “resolved.” However, the veteran obtained a copy of his service medical records and discovered a radiology report of the left knee that that showed bone spurs and abnormalities. He reopened the claim with this previously missed evidence, along with current medical evidence of his chronic knee disability (which had become arthritis), and he was granted service connection.

New and material evidence can also be a medical opinion from the veteran’s own physician. For example, if a veteran was denied service connection for hypertension despite high readings during service because there was never a formal diagnosis of the condition noted in service medical records, the veteran’s doctor can write an opinion letter and/or complete a VA Disability Benefit Questionnaire for the specific conditions, noting that the veteran had hypertension on active duty based on his review of the treatment records and medical history.

Another example would be a veteran who was on jump status during his military career. His military occupational speciality and personnel records would show his number of jumps made, which can be many. He may not have gone to sick call much because he didn’t want to be taken off of jump or flight status, and therefore, service medical records would not back up his claim for a chronic, diagnosed knee or hip disability he now suffers from, so he would be denied service connection. However, if the veteran’s doctor writes an opinion as to why he believes the veteran’s current disability is related to service based on the numerous jumps, with the known wear and tear caused by such activity, he would have new and material evidence with which to open his claim.

It’s always best to consult with an experienced veterans service officer who can advise you on what is needed to reopen a denied condition after the decision is final, and if it is possible to do so.

Sandy Britt is a Montgomery County veterans service officer.