Why MST Claims Get Denied, and How to Ask VA to Look Again

The 2018 report reviewed a sample of denied claims and found these kinds of errors:

• VA did not order a medical exam and opinion when the evidence was enough to get one. This includes cases where staff missed behavior markers.
• VA did not gather evidence it should have, such as private treatment records.
• Required outreach did not happen, such as a phone call or the required letter language.
• VA decided the claim on a medical opinion that was unclear or contradictory, instead of sending it back.

The 2021 report found the same kinds of problems: missed markers, records not obtained, and exams not requested. It also found that about 80% of sampled claims were handled by staff who were not designated MST processors.

• VA says there is no evidence the event happened. Check whether VA looked for markers, not just a report.
• The exam did not address the markers, or the examiner never gave an opinion on them.
• VA never sent notice about other kinds of evidence, or never gave you time to respond.
• VA treated the lack of a report as proof nothing happened. A federal appeals court said in 2013 that VA may not do this.
• There is no current diagnosis, or no medical opinion linking the condition to service.

• Patton v. West (1999): the Court of Appeals for Veterans Claims said VA must give special consideration to PTSD claims based on personal assault.
• Menegassi v. Shinseki (2011): a medical opinion based on an exam after service can help show that an in-service assault occurred. VA still decides how much weight it gets.
• AZ v. Shinseki (2013): the lack of a service record of an unreported assault is not evidence it did not happen. Failure to report is not evidence either.

A senior reviewer looks at the same evidence. You cannot add new evidence. This lane can fit when the file already holds markers VA ignored, when VA skipped the required notice, or when VA relied on an exam that did not address the markers.

Use VA Form 20-0996 or file online. You can ask for one optional informal conference. Request it within one year of the date on your decision letter.

This lane is for new and relevant evidence VA has not seen. Examples include a statement from a family member or roommate who saw changes in you, records that show a transfer request or a drop in performance, civilian treatment records, or a private medical opinion.

Use VA Form 20-0995 or file online. The form has an optional question about MST notices. You can file at any time, but filing within one year of the decision letter helps keep your original effective date.

VA Form 10182 sends your case to the Board of Veterans' Appeals. You choose a docket: direct review, evidence submission, or a hearing. For most benefits, you have one year from the date on your decision letter. Board appeals usually take longer than the other two lanes.

Reviewing an old denial can bring up hard memories. Free, confidential support is available now, whether or not you file a claim. VA provides free care for mental and physical health conditions related to MST. You do not need a disability rating, and you do not need to have reported the MST. Former service members with an Other Than Honorable discharge, or fewer than two years of service, may still qualify. If you are in crisis, contact the Veterans Crisis Line: dial 988 then press 1, or text 838255.

A ClaimScope review reads the denial and the whole file for markers VA may have missed, and shows which review lane fits the reason VA gave. This is general information, not legal advice, and it does not guarantee any VA decision.