Navigating the complex landscape of Veteran Affairs benefits can be daunting for most veterans. In addition to the complex eligibility requirements and documentation, understanding the available benefits can be a task. Other than the standard benefits for which most disabled veterans, or those who passed away, are eligible, there is also another available avenue for compensation to a specific select veteran. 38 USC § 1151 is a crucial provision for veterans whose disabilities or worsening of their disability/condition stem from VA healthcare or certain VA-provided activities. Understanding this statute, who it could apply to, and what must be eligible to claim under this specific benefit.
What is 38 USC § 1151?
The statute 38 USC § 1151 is often referred to as “Section 1151” and lays out what could be provided as compensation to veterans who suffer additional disabilities or death as a direct result of:
- Hospitalization, medical or surgical treatment furnished under any laws administered by the Secretary (VA). This includes negligence, malpractice, or even unavoidable complications during VA-provided care.
- Participation in a vocational rehabilitation program under chapter 31 of this title.
- Participation in a compensated work therapy program.
- Participation in a program of independent living services and assistance under chapter 31 of this title.
- Participation in a program under chapter 17 of this title (relating to hospital, nursing home, domiciliary, and medical care).
- Participation in a program under chapter 35 of this title (relating to educational assistance to eligible persons).
In essence, 38 USC § 1151 recognizes that when the VA itself contributes to a veteran’s disability or death, it incurs a unique responsibility to provide compensation.
How do 38 USC § 1151 Differ from Standard Service-Connected Claims?
The crucial distinction is that the standard service-connected claims focus on disabilities resulting from events during military service, whereas § 1151 addresses disabilities that are caused or exacerbated by medical care provided specifically by the VA.
Here are some key differences:
- Causation: Standard claims require demonstrating a link between military service and the disability. While § 1151 requires a link between VA care/programs and the disability.
- Negligence is not always needed: while malpractice is covered, even unavoidable complications from VA care can result in 1151 coverage.
- Derivative Nature: Section 1151 claims are often considered “derivative” from veterans’ entitlement to VA healthcare or participation in VA programs.
What is Needed to Claim Benefits Under 38 USC § 1151 Successfully?
The success of a § 1151 claim depends heavily on the complete documentation presented in the application. Veterans are highly recommended to meticulously gather and organize all relevant medical records, expert opinions, and supporting evidence to establish their eligibility under this statute.
Below is a general step-by-step guide to applying for a claim benefit under § 1151:
- Gather Medical Records:
- Obtain all relevant medical records from the VA facility where the treatment occurred.
- Include records of any subsequent treatment related to the new or worsened disability.
- Seek independent medical opinions from qualified professionals.
- Establish Causation:
- 1151 claim is centered on demonstrating a direct causal link between the disability and the care received by the veteran directly from the VA care/program.
- Medical evidence is crucial in establishing this link.
- An expert witness testimony may be necessary, especially in complex cases.
- Document the Disability:
- Provide detailed documentation of the new or worsened disability.
- It would be beneficial to include information on the severity of the disability, its significant impact on the veterans’ daily lives, and related complications.
- File a Claim:
- File a formal claim with the VA, explicitly citing 38 USC § 1151.
- Use VA Form 21-526EZ, “Application for Disability Compensation and Related Benefits.”
- Clearly state the basis of the claim and provide all supporting documentation.
38 USC § 1151 provides a valuable avenue for eligible disabled veterans for compensation. Even though the process can be complex and challenging, eligible veterans under this rule must pursue their claim to obtain their rightful benefits. However, given the complex nature of filing for VA benefits, it may be valuable for a veteran to seek sound legal counsel from a qualified veterans’ law attorney to ensure a successful claim.
If you or a loved one needs counsel on 38 USC § 1151, you can count on us to assist you in filing your claim. At McKown and Myers, it’s our job to help Hoosiers like you get the compensation they need to get medical treatment and support their families. We’re here to answer your questions about your application – call 765-668-7531 or complete our contact form here. There’s no obligation – we’re here to help.