Myth-Busting Series :You Need Treatment in Service to Win a Claim

0:04Leah Bucholz Hey, guys. Welcome back to our myth busting series. Today, we are busting another really common VA disability claim myth, and this one causes a lot of veterans to assume they don't have a claim before they even file. The myth is if I wasn't treated for the condition while I was in the military, I can't get service connected. Or maybe you've heard some version of this.

0:27 Right? My service treatment records are silent, so I'm just screwed. K? I never went to sick call. I didn't get diagnosed until years after I get I got out. I didn't complain about it while I was in. Therefore, the assumption becomes VA can't service connected. That's just simply not true. It's just not that's not gonna be true in all cases. So before we get into this, I want to, make an important distinction because I don't want anybody misunderstanding what I'm saying.

0:57 I'm not saying that a lack of treatment records doesn't matter. Right? It's it absolutely that can absolutely matter. I'm also not saying that every condition diagnosed after military service is related to military service. Obviously, that's not true either. What I am saying is that there is a huge difference between I don't have documentation of treatment and service, and I don't have evidence of an in service event, injury, disease, exposure, symptoms, or circumstances that could potentially be related to my current condition. Those are not the same thing. Right? What does VA actually need? Let's start with the basic framework.

1:41 For a typical direct service connection claim, think about three major pieces. Okay? One, a current disability. Number two, an in service event, injury, or disease. And number three, a link. That's what we commonly call the Nexus between the current disability and what happened during service. Notice what I didn't say. I did not say, you have to have gone to sick call. I did not say, you must have received medication. I did not say, you must have had an MRI or an x-ray while you were in service.

2:18 I did not say, you must have received a formal diagnosis while you were on active duty in order to be service connected. And I definitely did not say, you must have a service treatment record documenting the exact condition that you're claiming today. The question is much broader than that. So what happened during service? What disability exists now?

2:39 And is there a medically supportable relationship between the two? That is the framework. Right? And VA itself recognizes that some disabilities related to active duty service don't even appear until after military service has ended. So let's talk about why this myth causes so much confusion. So why is it that so many veterans don't have treatment records? I served in the military, and anybody who served probably understands exactly where I'm gonna go with this. Right? There are a million reasons people don't seek treatment. Maybe you're in the field.

3:13 Maybe you're deployed. Maybe you're in the middle of a training cycle. Maybe you don't wanna get pulled from your job. Maybe you're worried about your flight status. Maybe you're worried about your career. Maybe your unit culture discourage you to go to sick call. Maybe you were 22 years old, and you thought everything would eventually get better. Maybe you had knee pain, back pain, headaches, numbness, sleep problems, or whatever else, and you treated it with Motrin, and you just kept it moving. And sometimes people simply just don't recognize that what they are experiencing is actually the beginning of a medical condition. So think about headaches.

3:54 Right? A service member might say, yeah. I got headaches all the time. Did they necessarily call them migraines? No. Did they necessarily see neurology? No. Not necessarily. Did they necessarily have a formal migraine diagnosis? No. K? Maybe they took ibuprofen. They drink some water, found somewhere dark for a little while, and went back to work. So ten years later, they're formally diagnosed with migraine headaches. The fact that somebody didn't have the word migraine written in their service treatment records does not automatically answer the medical question at hand of whether those symptoms began, like when they began, or what caused the current condition.

4:38 That is the important distinction. No treatment record does not mean no evidence. This is probably the most important point in this entire video. Your service treatment records are evidence. They are not necessarily the only evidence. VA specifically recognizes both medical evidence and lay evidence in disability claims. That can include statements from the veteran, and depending on the circumstance, on the particular circumstances, statements from people who actually observed what happened, observed the symptoms, things like that. So imagine a veteran says, I hurt my back during an airborne operation in 2003. There's no treatment record. Okay.

5:19 Fine. That means we have a missing piece of contemporaneous medical documentation. It does not necessarily mean that the jump never happened or, that the injury didn't happen. Let's start looking at the rest of the record. Was the veteran actually airborne? Was the veteran what was their MOS? What unit were they assigned to? Are those are there personnel records? Are there jump logs? Are there statements from people who served with that veteran?

5:49 Did the spouse notice any any problems when they came home? Did they start seeking treatments after separation? What do those early post service treatment records say? Do they describe a long standing history? What is the current diagnosis? K? Is the mechanism of injury medically consistent with the current pathology? And very importantly, are there other possible explanations for that condition? Because a good medical analysis doesn't just collect evidence supporting the veteran. It should also consider evidence that weighs against the claimed relationship.

6:28 So let's use a bat condition as an example. Okay? Let's say somebody leaves the army in 2005. Twenty years later, they have degenerative lumbar spine disease. They say my back started hurting in the army because I was airborne infantry. I carried heavy equipment. I did repeated rut marches. I jumped out of aircraft, and I had several hard landings. But there's no service treatment record showing chronic back treatment. Does that automatically mean the current lumbar condition is, service is or is not service connected?

7:02 No. But does the absence of treatment automatically mean it's not service connected? Also, So now we have to analyze the evidence. K? So what exactly happened during service? When did the symptoms reportedly begin? Were the symptoms continuous, or were they intermittent? When was treatment first documented? What happened during the years between military service and diagnosis? What does the imaging show?

7:35 Were there significant post service injuries? Was a person in a car accident? What kind of work did the veteran do after the military? Are there other risk factors? Does the medical literature support the proposed mechanism? Does the veteran's current pathology make sense in the context of the reported history? That's what a medical Nexus analysis is supposed to address. And sometimes the answer is yes. Sometimes the answer is no. Sometimes there simply isn't enough evidence to support the relationship.

8:07 But I searched service treatment records and didn't find a doctor's visit. It's not by itself the entire medical analysis. So lay evidence definitely matters, but understand what it can and cannot do. Right? This is another area where I see a lot of confusion. Veterans sometimes hear that lay evidence matters and interpret that as if I write a statement saying my current condition came from service, VA has to just accept it. No. That's not what this means. There is a difference between being competent to report something you personally experienced and being qualified to give a complex medical causation opinion. You are generally capable of reporting observable things like, you know, for example, my knee started hurting after this event.

8:54 My back hurt after carrying this equipment. I started having headaches while I was deployed. I had ringing in my ears after repeated weapons firing. My wife noticed I stopped sleeping normally after I returned. My roommate saw me fall. K? My squad leader knew I was having problems with my shoulder or whatever. Those are observations. But saying things like my current multilevel degenerative disc disease was caused by this particular biomechanical process twenty five years ago might require some medical expertise. That's where medical evidence and, when appropriate, a medical opinion can become important.

9:35 So use lay evidence for what lay evidence is to actually good at, or consider it, describing events, symptoms, timelines, observations, and circumstances. Don't try to turn a personal statement into a medical textbook. So let's talk about huge gaps in treatment. So here's another common problem. A veteran might say things like, my knees started hurting in 1998, but I didn't see anybody, until about 2015.

10:03 Is that fatal to this claim? Not automatically. Is it relevant? Yeah. For sure. It's gonna be relevant. So a fifteen or twenty year treatment gap is something that may need to be addressed. Okay? This is where veterans sometimes get frustrated because they say, well, I just dealt with it. Okay? Then explain that. Explain how and what you did. What happened during those years? Were symptoms present? How severe were they?

10:33 Did they, did you self treat? Did you use braces, over the counter medications, ice? Right? Heat. So did you modify your activities at all? Did your spouse or coworkers observe the problem as well? Did you avoid going to the doctors? Why? Right? Did you have insurance? Were there occupational, physicals that you might have had? Did you mention it anywhere else? Again, none of these things automatically prove service connection, but they help establish a timeline and a pattern. K? So and timelines matter enormously in medical causation.

11:16 So a later diagnosis can still be very important. Here's another misconception. Right? I wasn't diagnosed until after I got out, so it can't be service connected. Again, that's too simplistic. There are conditions that are diagnosed after military service even though the relevant disease, process, symptoms, exposure, injury, or other circumstances occur during service. These specifically recognize as post service disability claims. There are also presumptive conditions where the legal framework can be different because certain relationships are presumed when the veteran meets the applicable, requirements. And secondary service connection is another obvious example of why the idea that everything has to be treated during service just doesn't make sense. So let's say somebody is already service connected for a knee condition.

12:04 Years later, another condition develops that is claimed as secondary to that service connected disability. The new condition obviously may not have existed during military service at all. The question in a secondary claim is generally whether the new condition is linked to an already service connected disability. So whenever someone tells you every disability has to be documented in your service treatment records, that statement just doesn't fit the basic structure of many VA claims. The other side of this myth that we should talk about is, you know, flipping this around because there's another mistake veterans make.

12:39 Sometimes veterans hear, you don't need treatment and service, and they interpret that as service treatment records don't matter. No. Please don't make that mistake. Right? So contemporaneous medical records can be incredibly valuable evidence. If you're currently serving and you're injured or you're having symptoms, please take medical care. Your health comes first. And from an evidence standpoint, records are created, records created close in time to an event can provide important information about what happened, when symptoms began, how severe they were, and what the clinicians observed. So if your treatment right if you have treatment records, use them. If you don't have them, then the question becomes, what other reliable evidence exists?

13:28 That's a much better way to approach the claim, medically speaking. So what should you look for if your service records are silent? If I were reviewing a case where the veteran didn't receive treatment and service, I would wanna reconstruct the timeline as objectively as possible. I would look at things like personnel records. Do they establish the veteran's duties, locations, deployments, occupational specialty, or other circumstances relevant to the claim condition?

13:55 Lay statements. Is there someone who actually observed the event or symptoms? Post service medical records like we talked about. Right? So how soon after separation do symptoms or treatment appear? Historical statements in the medical records can be very important. So before a VA claim can ever, before a VA claim ever existed, did the veteran, tell clinicians that the condition had been been present for years? That can be important in context. Imaging and diagnostic testing. What does the objective medical evidence actually show?

14:28 Other injuries and risk factors were there car accidents, like I mentioned earlier? Were there work injuries, sports injuries, age related changes, genetics, weight, occupational exposures, other medical conditions, medication effects. A medical opinion should not ignore those things. Right? And then, you know, medical literature.

14:57 So this is gonna be really important. Does the scientific evidence support the proposed relationship? Not just some article that contains the same two words as the veteran's condition. Actual literature that applies to the veteran's circumstances and the proposed mechanism. That is how you build a meaningful medical analysis.

15:15 So another example, hearing loss. Right? Let's say a veteran worked around an aircraft or worked around lots of aircrafts. Right? They didn't complain about hearing loss while they were serving. Years later, they have a documented hearing loss. Again, don't reduce the entire case to were you treated for hearing loss in service. We need to know, you know, important things like what was the noise exposure? What hearing protection was used? What did the audiogram show?

15:47 Were there threshold changes? What happened after service? What exposures were, you know, post service? Did the veteran work around significant occupational noise? What recreational noise exposure existed? What is the current audiogram pattern? What does the medical evidence say about causation in that particular case? That's an actual analysis. Okay, guys? Another example, mental health conditions.

16:15 Right? So mental health is another obvious area where veterans may not seek treatment during service. There may be many reasons. Some people didn't recognize symptoms. Some didn't want to, you know, have a mental health diagnosis documented while they were serving. Some worried about their career. Some simply tried to push through it. So the absence of mental health treatment during service doesn't necessarily mean the veteran experienced no mental health symptoms or traumatic events during service. But, again, we still need to review the evidence, and we need evidence. Right?

16:46 So what happened? When did symptoms begin? How did behavior change? Did family members notice changes? Did performance change? Were there disciplinary problems or other potential markers? When did the veteran eventually seek treatment? What diagnosis were actually made eventually? And does the clinical evidence support the claimed relationship? That's very different from simply stating, did you see behavioral health while you were in?

17:11 Don't confuse a weaker claim with an impossible claim or weak medical evidence with impossible medical evidence. This may be the best way to summarize today's entire video. Missing evidence can make a claim harder without making the claim impossible. If I have two otherwise identical cases and one veteran has extensive contemporaneous records documenting the injuries, symptoms, treatment, follow ups, and persistence of the condition, while the other veteran has none of that, of course, those aren't evidently, you know, identical cases. Documentation matters.

17:46 But that is a very different thing from saying no treatment in service equals automatic denial. It just doesn't. The actual question is, what does the total evidence show or support? What I would not, you know, recommend, medically speaking, is that if your service treatment records are silent, don't panic and start throwing random documents into your files. Right?

18:08 Please don't exaggerate your history because you think that's what somebody needs to hear. Consistency matters. If you don't remember something, just say you don't remember it. Right? You know, just make it up. If symptoms were intermittent, then be honest. Be truthful about that. If there was another injury after service, don't hide it. If your medical records contain conflicting information, that needs to be addressed. A credible medical opinion should be able to acknowledge unfavorable facts or or negative fact patterns.

18:37 In fact, sometimes explaining the negative evidence is one of the most important parts of an opinion. The goal shouldn't be to create the most favorable story. The goal should be to accurately reconstruct the medical history and determine whether the claim relationship is medically supportable. So here's the takeaway, guys. Let's officially bust today's myth.

19:00 You need treatment and service to win a VA disability claim. No. Right? Treatment during service can be extremely helpful evidence, but it is not a universal requirement for service connection. For a typical direct claim, think current disability, in service event, injury, or disease, and a nexus between the two.

19:23 Okay, guys? If the service treatment records don't document the condition, then you may need to look more carefully at the other available evidence. Your personnel records, your lay statements, buddy statements, your post service medical history, like we said, diagnostic testing, the chronology of your symptoms, the circumstances of your military service, potential alternative causes, and when the question requires medical expertise, a competent medical analysis explaining whether the evidence supports a relationship. And remember, no treatment record does not automatically mean no in service event. No in service diagnosis does not automatically mean no service connection.

20:06 And a diagnosis that occurs years after discharge does not automatically mean it cannot be related to military service. Every claim turns on its own, every claim is different. So don't self deny your your own history because somebody told you that if you didn't go to sick call, that you have no chance. Look at the evidence. Look at the timeline.

20:25 Understand what type of service connection you're actually going for and determine what evidence is available to support that. That's the difference between repeating a VA claim myth and actually understanding how it works. If this claim helped to clear up some confusion, make sure you subscribe because we're continuing this Myth- Myth- Myth-Busting Series and breaking down some of the most common things Veterans hear about VA disability claims that aren't quite as simple as they sound. And as always, this content is educational in nature. Every Veteran's medical history and claim is different, and nothing in this video guarantees a particular decision.

20:57 Please check with your DSOs and accredited legal professionals for legal advice. And as always, thank you for watching. Alright. See you.