Evidence Needed for a VA Rating Increase

Building Your Evidence Package

The strength of your rating increase claim depends entirely on the quality and relevance of your evidence. Unlike your initial service connection claim, an increase claim focuses on demonstrating that your current symptoms are more severe than what your rating reflects. The VA needs clear, recent evidence showing increased severity and functional limitations.

Many veterans make the mistake of submitting stacks of medical records without a clear narrative. The key is submitting evidence that directly addresses the rating criteria in 38 CFR (Code of Federal Regulations) for your specific condition. Understanding what types of evidence carry weight and how to present them effectively can mean the difference between a successful increase and another denial.

Real Talk: Evidence is everything. I cannot stress this enough. You could have the worst PTSD case I've ever seen, but if you don't have the documentation to prove it, the VA will deny you. They're not going to take your word for it.

I've seen Purple Heart recipients get denied because their paperwork wasn't complete. I've seen veterans with no visible injuries get 100% because they built an airtight evidence package. The difference isn't who deserves it more. It's who documented it better.

Types of Medical Evidence

1. Treatment Records

Ongoing treatment records are the foundation of your increase claim. They show a documented pattern of worsening symptoms, increased medical intervention, and functional decline over time.

What makes treatment records valuable:

• Consistency: Regular visits (monthly, quarterly) showing continuous treatment create a timeline of worsening

• Symptom documentation: Notes describing specific symptoms, their frequency, and intensity

• Functional impact: Records mentioning how symptoms affect work, relationships, daily activities

• Treatment escalation: Evidence of increased medication dosages, new treatments tried, or referrals to specialists

• Failed treatments: Documentation of treatments that didn't work, showing severity

Where to obtain treatment records:

• VA medical centers (download from My HealtheVet or request official records)

• Private physicians and specialists

• Hospital emergency room visits

• Mental health treatment providers

• Physical therapy and rehabilitation centers

Pro Tip: Request your VA treatment records for the past 2-3 years, not your entire file. Recent evidence carries more weight. Focus on records that document worsening symptoms since your last rating decision.

2. Private Medical Opinions (IME)

An Independent Medical Examination (IME) from a private physician can be one of the most powerful pieces of evidence. Unlike a VA C&P exam, which is often brief and limited, a private IME allows for a comprehensive evaluation by a specialist who can spend adequate time assessing your condition.

What a strong medical opinion should include:

• Physician's credentials: Board certification in relevant specialty, years of experience

• Review of records: Statement that the doctor reviewed your complete VA file and treatment history

• Detailed examination findings: Objective findings from physical exam or mental status examination

• Functional assessment: Specific limitations in activities of daily living, work capacity, social functioning

• Rating criteria analysis: Direct comparison to the 38 CFR rating criteria for your condition

• Opinion on rating: Clear statement that your symptoms meet or exceed a specific rating percentage

• Rationale: Medical reasoning explaining why the higher rating is appropriate

Cost considerations:

Private IMEs typically cost $1,500 to $3,500 depending on the condition's complexity and the physician's specialty. While expensive, a high-quality medical opinion can result in thousands of dollars in increased monthly benefits and retroactive pay. Some options to manage costs:

• Some VA accredited attorneys will advance the cost and deduct it from your back pay if successful

• Use your regular treating specialist's opinion (usually covered by insurance) rather than hiring a separate IME provider

• Calculate the potential monthly increase to determine if the investment is worthwhile

3. Nexus Letters for Secondary Conditions

If you're claiming an increase based on secondary conditions (new conditions caused by your service-connected disability), you'll need a nexus letter establishing the medical connection.

What a nexus letter must contain:

• Clear causal statement: "It is at least as likely as not that [secondary condition] is caused or aggravated by the veteran's service-connected [primary condition]"

• Medical rationale: Scientific or clinical reasoning supporting the connection

• Review of records: Reference to specific medical evidence showing both conditions

• Timeline: Documentation of when the secondary condition developed relative to the primary condition

Common Secondary Conditions: Sleep apnea secondary to PTSD, knee problems secondary to back injury, depression secondary to chronic pain, erectile dysfunction secondary to diabetes or PTSD, hypertension secondary to sleep apnea or PTSD.

4. Diagnostic Test Results

Objective test results provide measurable evidence of worsening:

• Range of motion measurements: For musculoskeletal conditions, showing decreased flexibility

• Imaging studies: X-rays, MRIs, CT scans showing progression (new arthritis, disc degeneration, nerve compression)

• Pulmonary function tests: For respiratory conditions, showing decreased lung capacity

• Sleep studies: For sleep apnea, documenting severity and oxygen desaturation events

• Psychological testing: Standardized assessments (PHQ-9, PCL-5) showing symptom severity

• Neurological testing: EMG/nerve conduction studies for radiculopathy or neuropathy

5. Medication and Treatment History

Documentation of your medication regimen and treatment intensity demonstrates severity:

• Medication lists: Current prescriptions with dosages (higher doses suggest more severe symptoms)

• Medication changes: Records showing increased dosages or addition of new medications

• Specialty referrals: Being referred to specialists indicates complex or severe condition

• Hospitalizations: Emergency room visits or inpatient admissions

• Surgical interventions: Operations, injections, or procedures to manage symptoms

• Assistive devices: Prescriptions for canes, walkers, wheelchairs, CPAP machines, hearing aids

Lay Evidence: Buddy Statements and Personal Statements

The VA is legally required to consider lay evidence—testimony from you and people who know you about how your condition affects your daily life. For conditions that are difficult to measure objectively (especially mental health), lay evidence can be decisive.

Your Personal Statement

You are competent to testify about your own symptoms and how they affect you. An effective personal statement should:

• Be specific: Describe concrete examples rather than general statements ("I can't sit for more than 15 minutes before pain forces me to stand" vs "My back hurts a lot")

• Address rating criteria: Review the 38 CFR criteria for your condition and address each element

• Document frequency: How often symptoms occur (daily, weekly, during flare-ups)

• Explain functional impact: What activities you can no longer do or must do differently

• Compare to past: How your symptoms have worsened since your last rating

• Describe bad days: For conditions with flare-ups, describe your worst days

Buddy Statements (Lay Witness Statements)

Statements from people who observe your daily struggles provide independent corroboration. The best buddy statements come from:

• Spouse or partner who sees you daily

• Adult children who can compare your current state to the past

• Roommates or close friends

• Coworkers (especially regarding work limitations)

• Fellow veterans who knew you before and after your condition worsened

What buddy statements should include:

• Relationship and context: How they know you and how often they see you

• Observations of symptoms: What they've witnessed (anxiety attacks, sleepless nights, difficulty walking)

• Functional limitations: Activities you can't do or need help with

• Changes over time: How they've seen your condition worsen

• Impact on relationships: Social withdrawal, irritability, inability to participate in family activities

• Specific incidents: Memorable examples that illustrate severity

Example - Strong Buddy Statement Excerpt:

"I am John's wife of 15 years. Over the past two years, I've watched his PTSD symptoms become much worse. He now has nightmares 4-5 nights per week, compared to maybe once a week three years ago. These nightmares cause him to wake up screaming and sweating, and he cannot fall back asleep. The next day he's exhausted and irritable. He's stopped going to our daughter's soccer games because crowds trigger his anxiety. Last month, he had a panic attack at the grocery store and we had to leave our cart. He now refuses to go to stores at all. He's withdrawn from friends and barely speaks to our neighbors anymore. This is not the man I married—his PTSD is controlling our entire family's life."

VA Form 21-4138 for Statements

Both personal statements and buddy statements should be submitted on VA Form 21-4138 (Statement in Support of Claim), or at minimum on signed and dated letterhead. This ensures they're properly associated with your claim.

Documenting Functional Limitations

The VA doesn't just rate diagnoses—they rate how your condition affects your ability to function. This is why functional evidence is often more important than diagnostic evidence.

For Physical Conditions

Document limitations in:

• Mobility: Walking distance, stair climbing, standing tolerance

• Lifting/carrying: Weight limitations, need for frequent breaks

• Self-care: Difficulty bathing, dressing, grooming

• Household tasks: Can't do laundry, yard work, cleaning

• Sleep disruption: Pain preventing sleep or causing frequent waking

• Need for assistance: Requiring help from family members

• Use of assistive devices: Canes, walkers, braces

For Mental Health Conditions

Document impact on:

• Social functioning: Isolation, inability to maintain relationships, conflict with others

• Work: Difficulty concentrating, absenteeism, conflicts with coworkers, inability to handle stress

• Self-care and hygiene: Neglecting personal hygiene during depressive episodes

• Daily routine: Inability to maintain schedule, sleeping all day

• Panic attacks: Frequency, duration, triggers, and impact

• Suicidal ideation: Frequency of thoughts, any attempts or hospitalizations

• Memory and concentration: Forgetting appointments, inability to follow complex instructions

The "Flare-Up" Problem

Many conditions have periods of increased severity (flare-ups). VA rating regulations state that ratings should be based on your condition during flare-ups, not during periods of remission. Document:

• How often flare-ups occur

• How long they typically last

• What you're unable to do during flare-ups

• What triggers flare-ups

• Medical treatment required during flare-ups

Evidence That Can Hurt Your Claim

Not all evidence helps. Be aware of evidence that can work against you:

Warning: Never, ever say "I'm fine" or "I'm doing okay" during medical appointments or C&P exams. The VA will quote those exact words in your denial letter. I've seen it happen dozens of times.

That C&P examiner isn't your buddy. They work for the VA, not for you. Be honest, but describe your worst days, not your best. "I'm doing okay" will get you a 10% rating when you deserve 70%.

Medical Records Showing Improvement

• Notes stating "doing well" or "symptoms improved"

• Discharge summaries from treatment programs showing successful completion

• Medication reductions or discontinuations

• Cancelled appointments or gaps in treatment (can be interpreted as condition not being severe)

Inconsistent Statements

• Telling your doctor you're feeling better, then claiming severe symptoms to the VA

• Employment records showing full-time work while claiming inability to work

• Social media posts showing activities inconsistent with claimed limitations

What to Do If Records Show Improvement

If some of your records show temporary improvement, address it directly:

• Explain the context (e.g., "I told my doctor I was doing better because I was having a good week, but that's not representative of my typical functioning")

• Provide more recent records showing worsening

• Submit a statement explaining that symptoms fluctuate and the good periods are brief

• Emphasize overall trend rather than isolated good reports

Using 38 CFR Rating Criteria as Your Guide

The most strategic approach to gathering evidence is to start with the rating criteria for your specific condition, found in 38 CFR Part 4. Each condition has specific criteria for each rating percentage.

How to use the rating criteria:

1. Look up your condition: Find the diagnostic code for your condition in 38 CFR Part 4

2. Review the rating levels: Read the criteria for the rating you currently have and the next higher rating(s)

3. Identify the gaps: Determine what evidence you need to demonstrate you meet the higher rating criteria

4. Gather targeted evidence: Obtain specific evidence addressing each criterion at the higher rating level

5. Address each criterion: In your claim, explicitly state how your evidence meets each element of the higher rating

Example: If you have PTSD rated at 30%, review the 50% criteria. You'll see it requires "occupational and social impairment with reduced reliability and productivity." Your evidence should specifically document problems at work (discipline, attendance issues, inability to complete tasks) and social problems (isolation, relationship conflicts). A statement from your employer and buddy statement from your spouse addressing these exact issues would be highly effective.

Organizing and Submitting Your Evidence

Create a Clear Summary

Don't just dump records on the VA. Submit a cover letter or statement that:

• Lists each piece of evidence you're submitting

• Explains the significance of each piece

• Walks through how your evidence meets the higher rating criteria

• Highlights the most important evidence

Submit Through the Right Channel

• VA.gov (recommended): Fastest and provides confirmation of receipt

• QuickSubmit: For uploading documents to an existing claim

• Mail: Send certified mail with return receipt to your regional office

• Fax: To your regional office (get confirmation page)

• In person: At regional office or VA medical center

Keep Copies of Everything

The VA loses documents. Always keep copies of everything you submit, along with proof of submission (confirmation numbers, certified mail receipts, fax confirmation pages).

The Evidence Checklist

Before submitting your increase claim, ensure you have:

• Recent treatment records (within past 12 months) from VA and/or private doctors

• Medical opinion addressing the rating criteria for your condition

• Diagnostic test results showing objective worsening (if applicable)

• Your personal statement describing functional limitations

• At least one buddy statement from someone who observes your daily functioning

• Documentation of medication changes or treatment escalation

• Evidence of how your condition affects work (if applicable)

• Nexus letter for any secondary conditions (if claiming)

• Cover letter summarizing your evidence and addressing rating criteria

• Copies of all evidence for your records

Final Thoughts

The quality of your evidence determines the outcome of your claim. While it may seem overwhelming to gather comprehensive evidence, remember that each piece strengthens your case. A well-documented claim with strong medical evidence and lay statements addressing the specific rating criteria has a much higher chance of success than a claim with minimal documentation.

If gathering evidence feels daunting, consider working with a VSO or accredited attorney who can help identify what evidence you need and how to obtain it. The investment in building a strong evidence package—whether through your own effort or professional help—often pays off in the form of a higher rating and thousands of dollars in increased benefits.