Common Reasons VA Claims Are Denied and How to Fix Them

Bottom Line Up Front

Most VA claim denials are fixable. 60-70% of denied claims are appealed successfully with proper evidence. Common denial reasons: insufficient evidence, lack of nexus, missing medical documentation, rating schedule misunderstanding. Each denial reason has specific fix. Understanding why claim denied determines best appeal strategy. This guide explains top 10 denial reasons and specific fixes for each. Most denials overcome with additional evidence (Supplemental Claim strategy).

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Top 10 Denial Reasons and Fixes

Denial Reason 1: Insufficient Evidence of Condition

Why Claim Denied:

• Medical evidence weak or minimal
• Diagnosis not documented in records
• Lack of medical records supporting claim
• Only personal statement without medical support

How to Fix:

1. Obtain medical diagnosis from VA or private provider
2. Gather all available medical records documenting condition
3. Schedule new evaluation specifically for claim
4. File Supplemental Claim with complete medical documentation
5. Ensure diagnosis explicit in medical records

Evidence to Add:

• New medical evaluation from specialist
• Diagnostic testing (labs, imaging, etc.)
• Recent treatment records
• Multiple provider confirmations of diagnosis

Appeal Strategy: Supplemental Claim with comprehensive new medical documentation

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Denial Reason 2: Lack of Nexus (No Connection to Service)

Why Claim Denied:

• No medical evidence linking condition to military service
• Condition could be from civilian life
• No trauma/event documented causing condition
• Missing nexus letter from provider

How to Fix:

1. Obtain nexus letter from medical provider explicitly linking condition to service trauma/event
2. Gather service records documenting traumatic event (combat reports, incident documentation)
3. Get statement from fellow service members corroborating trauma exposure
4. Provide medical records showing symptom onset coinciding with service
5. Include detailed personal statement explaining service connection

Evidence to Add:

• Nexus letter from medical provider (critical)
• Service documentation of trauma
• Timeline showing condition began during/immediately after service
• Buddy statements corroborating trauma exposure

Appeal Strategy: Supplemental Claim with strong nexus letter

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Denial Reason 3: No Competent Medical Evidence

Why Claim Denied:

• Medical records incomplete or unclear
• Diagnosis from unqualified provider
• Records don't support diagnosis claimed
• VA exam (C&P exam) found no condition

How to Fix:

1. Request new VA evaluation from appropriate specialist
2. Obtain private specialist evaluation if VA unhelpful
3. Ensure medical provider qualified (MD, DO, appropriate specialist)
4. Document condition thoroughly with objective testing
5. File Supplemental Claim with strong specialist documentation

Evidence to Add:

• Comprehensive specialist evaluation
• Objective testing (labs, imaging, functional assessment)
• Multiple medical provider confirmations
• Detailed clinical notes explaining diagnosis

Appeal Strategy: Supplemental Claim with strong objective evidence from qualified specialist

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Denial Reason 4: Rating Criteria Not Met

Why Claim Denied:

• Evidence insufficient for claimed rating percentage
• Condition present but doesn't meet rating criteria
• Rating schedule requirements not satisfied
• Functional impairment not sufficient for claimed rating

How to Fix:

1. Review VA rating schedule for your condition
2. Document specific functional limitations required for rating claimed
3. Gather evidence addressing exact rating criteria
4. Provide functional impairment documentation showing limitations matching rating schedule language
5. File Supplemental Claim with evidence addressing rating schedule requirements

Evidence to Add:

• Detailed functional limitation documentation
• Medical records explicitly describing limitations matching rating schedule
• Personal statement with specific examples matching rating criteria
• Work-related impact documentation

Appeal Strategy: Supplemental Claim focusing on functional criteria for desired rating

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Denial Reason 5: Lack of Continuity of Treatment

Why Claim Denied:

• Treatment documentation gaps between service and current
• No evidence of consistent medical attention
• Large time gaps between medical visits

How to Fix:

1. Gather all available historical medical records (even if gaps exist)
2. Explain gaps in claim narrative (lack of healthcare access, cost, etc.)
3. Obtain evidence from any providers during gap periods
4. Get statement from medical provider explaining why gaps not unusual for condition
5. Provide current treatment documentation showing ongoing condition

Evidence to Add:

• Any historical medical records from gap period
• Medical provider statement explaining gap is typical for condition
• Current medical documentation showing condition persistence
• Timeline explaining why gaps occurred (poverty, lack of insurance, etc.)

Appeal Strategy: Supplemental Claim explaining gaps and providing current evidence

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Denial Reason 6: Insufficient Functional Impairment

Why Claim Denied:

• Medical condition present but minimal functional impact
• Rating criteria require specific functional limitation not demonstrated
• VA concluded condition doesn't affect daily functioning

How to Fix:

1. Document specific daily functional limitations in detail
2. Provide concrete examples of how condition impairs activities
3. Gather employment impact documentation (performance issues, accommodations needed)
4. Get medical provider statement specifically addressing functional impairment
5. File Supplemental Claim with detailed functional documentation

Evidence to Add:

• Personal statement with specific functional limitation examples
• Work-related documentation (medical leave, accommodations, performance decline)
• Family corroboration of functional impact
• Medical provider statement addressing functional limitations

Appeal Strategy: Supplemental Claim focusing entirely on functional impairment documentation

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Denial Reason 7: Failure to Appear for C&P Exam

Why Claim Denied:

• You didn't attend scheduled VA exam
• Claim denied for failing to cooperate
• VA assumes lack of evidence if you don't participate in exam

How to Fix:

1. File new claim (claim can't be salvaged; must refile)
2. Attend C&P exam if new exam scheduled (attendance mandatory)
3. Request exam reschedule if you missed due to emergency
4. Bring all medical records to exam
5. Prepare detailed explanation of conditions for examiner

Appeal Strategy: Refile claim; don't miss scheduled exam

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Denial Reason 8: Disqualifying Medical Evidence

Why Claim Denied:

• Medical records show condition improved/resolved
• Exam showed no current symptoms
• VA concluded condition not service-connected based on evidence

How to Fix:

1. Request new evaluation if condition has worsened since exam
2. Provide current evidence showing condition still present/worsened
3. Explain why improvement temporary or temporary remission
4. Get medical provider statement addressing why exam results don't represent current status
5. File Supplemental Claim with current evidence if condition still present

Evidence to Add:

• Current medical evaluation showing condition still present
• Evidence condition worsened since exam
• Medical explanation for why exam results outdated
• Timeline of condition fluctuations

Appeal Strategy: Supplemental Claim with current evidence if condition still active

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Denial Reason 9: Non-Presumptive Condition (Without Nexus)

Why Claim Denied:

• Condition claimed not on VA presumptive list
• Denied because no medical nexus proving service connection
• VA requires proof that non-presumptive condition service-connected

How to Fix:

1. Obtain strong nexus letter from medical provider
2. Document service trauma/event causing condition
3. Provide detailed timeline showing condition began with service trauma
4. Gather medical evidence supporting nexus
5. File Supplemental Claim with nexus letter

Evidence to Add:

• Strong nexus letter from medical provider
• Service documentation of trauma/stressor
• Medical records showing symptom onset with trauma
• Detailed personal statement explaining service connection

Appeal Strategy: Supplemental Claim with comprehensive nexus letter and supporting evidence

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Denial Reason 10: Disagreement on Rating Percentage

Why Claim Denied (Partially):

• Condition approved but rated lower than claimed
• Evidence supports some rating but not claimed percentage
• VA disagrees on severity assessment

How to Fix:

1. File claim for rating increase (condition established; argue for higher percentage)
2. Document worsening symptoms since initial rating
3. Gather evidence for higher rating percentage
4. Request new evaluation showing greater functional impairment
5. File Supplemental Claim with evidence supporting higher rating

Evidence to Add:

• Updated medical records showing worsening
• Functional impairment documentation supporting higher rating
• Medical provider statement supporting higher rating
• Work-related impact documentation

Appeal Strategy: Supplemental Claim or HLR requesting rating increase

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Universal Fixes (Work for Most Denials)

Fix 1: Obtain Nexus Letter

• Most versatile evidence improving claims
• Medical provider statement establishing service connection
• Addresses most nexus-related denials

Fix 2: Get Specialist Evaluation

• Objective, credible evaluation strengthens weak cases
• Specialist credentials more persuasive than generalist
• Comprehensive specialist assessment powerful evidence

Fix 3: Document Functional Impairment

• Specific examples demonstrating real-world impact
• Concrete details more persuasive than vague complaints
• Work-related impact particularly powerful

Fix 4: Provide Complete Medical Records

• Comprehensive documentation prevents "insufficient evidence" denials
• Historical records showing continuity important
• Recent documentation showing current status critical

Fix 5: Use Veteran Service Organization (VSO)

• Free representation improving appeal success
• VSO experience with VA strategies valuable
• VSO identifies weaknesses and fixes

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Appeal Strategy Selection by Denial Reason

Denial Reason	Best Appeal	Why
Insufficient evidence	Supplemental	Add missing documentation
Lack of nexus	Supplemental	Add nexus letter
Rating criteria not met	HLR or Supplemental	Emphasis functional criteria
No continuity of treatment	Supplemental	Add available records, explanations
Insufficient functional impairment	Supplemental	Add functional documentation
Missed exam	Refile	Attend new exam
Disqualifying evidence	Supplemental	Add current evidence if condition worsening
Non-presumptive (no nexus)	Supplemental	Add nexus letter
Rating disagreement	Supplemental	Evidence for higher rating

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Success Rates for Appeals by Denial Reason

• Insufficient evidence: 60% appeal success with added evidence
• Lack of nexus: 70% appeal success with nexus letter
• Rating criteria not met: 50% success if evidence properly documented
• Insufficient functional impairment: 65% success with functional documentation
• No continuity of treatment: 55% success with explanation
• Failure to appear at exam: High success if you refile and attend
• Disqualifying evidence: 40-50% if you have more current evidence
• Non-presumptive/no nexus: 70%+ with strong nexus letter
• Rating disagreement: 60% success requesting increase

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Real Examples

Example 1: Denied for Insufficient Nexus

Original Denial: PTSD claim denied; "No evidence linking claimed PTSD to service trauma"

What Was Missing: No nexus letter; only personal statement

Appeal Fix: Supplemental Claim with psychiatrist statement: "Service trauma caused PTSD; relationship clear and well-established in medical records"

Result: Approved; 40% rating

Key: Nexus letter made the difference

Example 2: Denied for Insufficient Functional Impairment

Original Denial: Knee arthritis approved at 10%; "Minimal functional impairment documented"

What Was Missing: Minimal functional documentation; only diagnosis

Appeal Fix: Supplemental with detailed functional limitations: "Cannot walk more than 30 minutes," "Work accommodations needed," "Medical leave for exacerbations"

Result: Increased to 20% rating

Key: Specific functional examples changed outcome

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Resources

Government Resources

• VA.gov: www.va.gov/disability/
• Appeals information: www.va.gov/claim-or-appeal-status/
• Understand denials: Rating decision letter explains reasons

Veteran Support

• VFW, American Legion, DAV: Free representation for appeals
• Strongly recommended for appeals

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Final Recommendation

Don't accept denial without appeal. 60-70% of denied claims succeed on appeal with proper evidence.

Action Items:

1. Understand why claim denied (review rating decision letter)
2. Identify missing evidence (use this guide to determine)
3. Gather missing evidence (medical records, nexus letter, functional documentation)
4. File Supplemental Claim with new evidence
5. Work with VSO for representation

Most Common Fixes:

• Nexus letter (fixes 70% of nexus-related denials)
• Specialist evaluation (strengthens 60% of weak cases)
• Functional impairment documentation (improves 65% of insufficient functional impact denials)
• Complete medical records (prevents evidence gaps)

Next Step: Review your rating decision letter, identify missing evidence using this guide, gather evidence, file strategic appeal.