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    • Well the way the VA is if they fail to read evidence submitted the first time around... then re-submit it on your NOD... B/C if they don't read it or consider it the first round  and its not in your reason & bases of the decision   then them idiots won't even know you submitted it the first time,around .... ok  now if they do go back and possibly read it  in your NOD they stick there foot in their mouth......I Would think? b/c the evidence was there in the first round to basically substantiate your first round! I think it sucks for  a veteran to have to go get a Private IMO the second time around just to please them when the first round of evidence is clear cut. besides most veterans don't have private Insurance and can't afford a Private Dr About the only advice I can give is for the veteran to organize his/her  first initial  claim and lay it out nice and neat prepare it as to where they have to read it..., point out the evidence by # or letter  see page 1 second paragraph, or letter ( a) on page 3  ect,,ect,,  hi-lite the evidence that is most strong in your claim & point it out to them, submit it in a organized fashion using clear color plastic sheets in between he subject matter, making it easy for them to read. Always put your name and address and claim number on the top left of every page you submit. First page would be an index of what you have sent them with the subjects, like> records of medical, STR's  D'r's names, dates ,& locations any crucial part of your evidence in order, then in each category place a clear COLOR plastic sheet in between each separate topic of evidence, when it comes to the very strongest of your evidence  I use the Red clear plastic sheet, this makes them wake up and take note as to how your prepared for your claim  and it tells them you know what your doing, but just remember this  its the strong concrete evidence that will win your claims. you simply want them to read all of your evidence And of course in the last section   Thank them in Advance for their most valuable time in helping you with your claim  cordial  yours  Jack Q Veteran  # 123-45-6789 jmo .......................Buck
    • It is often much more than a nexus 'letter',- it is proof of the link between your service and the disability you have now. That is why vets need a copy of their SMRs, to prove any treatment for inservice injury , inservice illness with residuals, or any MH issues. I assume that is why you received no C & P exam because  even if VA states they received a veteran's SMRs, that sure does not mean they carefully perused them for anything to support the claim.I mentioned here before a vet I helped whose vet rep, and even his lawyers at the CAVC never fully went over his SMRs. I sure did and it was very time consuming  and they were handwritten entries from the 1960s...very hard to read. The veteran himself never took the time to do all that and could have succeeded on his claim much sooner then the many years it took to award it. I did have a clue from his initial BVA denial.  A medical word no one had looked up,that BVA mentioned in the first paragraph of his denial. When I looked up the medical word, I felt he might succeed.After doing much more research I knew he had a winner. The word helped establish the inservice nexus. I was also able to prepare a strong NOD as to why his CAVC lawyers failed to meet the 5 conditions for fee payment. I never heard the outcome on that and I know he would have been contacting me if the VA paid them (for doing nothing at all to advance his claim.) I don't do that one -to-one stuff anyone.And  even good vet reps don't really have the time to do it.They have hundreds of claims,  we usually have only one or two. You need a copy of your SMRs. We will know more when the decision comes.  
    • HELLO ALL! CLAIM IS MOVING FAST! PREPARATION FOR NOTIFICATION THIS AM.  WHEN WILL I BE ABLE TO SEE PERCENTAGE ON EBENFITS?
    • AND, it all depends on if you choose to file your Claim for an Increase or New SC as an FDC (Fully Developed Claim) or as a traditional Reg Axx Claim. FDC Decisions, I've had a couple, Award/Denial Decisions in less than 8 months. Reg Axx claims Decisions are still taking 18 to 24 months, depending on complexity. Semper Fi
    • As to your A & B question, no & No. A good friend, 100% Scheduler, always told me he would never sign up for Medicare because he got everything from the VA. That was his position, until 02/15. I got a call from his wife, he was vacationing in Fla and had a life threatening Emergency Room Admittance, at a Private Hospital. He's 68 at the time and doesn't have Medicare, the Hospital Admission staff want him to sign up for Medicare right then, they want their $$$. I told his wife not to sign anything, advise the Admitting Staff he was a VET covered by the VA and that they needed to contact his VMC for authorization for treatment and transportation to the nearest VMC capable of treating him, after his Emergency had Stabilized. She did as I instructed and about a week later he was transported by ambulance, 250 Mls to the Nearest VMC. From there, he was eventually transported to a VA Med facility back in Ft Myers. All along, no Medicare A & B Coverage, right. It turns out, he's got New Medical Problems, Life or Death type, and doesn't want to rely on the VA. We talked about his options regarding Part B and the 20% co-pays. He signed up for Medicare, paid the late signing penalty and chose, I think ARRP's United Health for the Part B. Cost him in the area of $150 per month, no co-pays or deductibles. Go's to local top rated Dr's & Hospital for treatment of his New condition. 999, might be time to set down with an Elder Law Attorney, Ins is good but certain Trust's can also help to protect your Assets. A comprehensive Family Trust, +or- $2K cost, would help ease your mind. Trusts & Wills are best to get set up, while both of you have the cognitive ability to do so. What did your Financial guy have to say about the timing of your Capital Gain, long/short term? Sometimes, timing is everything. Semper Fi





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Presumption Of Sound Condition: Aggravation Of A Disability By Active Service

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[Federal Register: May 4, 2005 (Volume 70, Number 85)]

[Rules and Regulations]

[Page 23027-23029]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr04my05-3]

DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 3

RIN 2900-AL90

Presumption of Sound Condition: Aggravation of a Disability by Active Service

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

SUMMARY: This document amends the Department of Veterans Affairs (VA) adjudication regulations regarding the presumption of soundness of a veteran by adding a requirement that, in order to rebut the presumption of soundness of a veteran on entrance into active service, VA must prove not only that the condition existed prior to entrance into active service, but also that it was not aggravated by the veteran's active service. This amendment reflects a change in VA's interpretation of the statute governing the presumption of sound condition, and is based on a recent opinion of VA's General Counsel as well as a recent decision of the United States Court of Appeals for the Federal Circuit. The intended effect of this amendment is to require that VA, not the claimant, prove that the disability preexisted entrance into military service and that the disability was not aggravated by such service before the presumption of soundness on entrance onto active duty is overcome.

DATES: Effective Date: May 4, 2005.

Applicability Date: This rule applies to claims that were pending on or filed after the effective date of this rule, May 4, 2005. It does not apply to claims that were finally decided prior to the effective date of this rule or to collateral challenges to final decisions rendered prior to the effective date of this rule.

FOR FURTHER INFORMATION CONTACT: David Barrans, Attorney, Office of General Counsel (022), Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, telephone (202) 273-6315.

SUPPLEMENTARY INFORMATION: VA is amending its adjudication regulations at 38 CFR 3.304(b) to reflect a change in the interpretation of the statute governing the presumption of sound condition.

Section 1111 of title 38, United States Code, provides that veterans are presumed to have been in sound condition when they were examined, accepted, and enrolled for service, except as to conditions that were noted at the time, or ``where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service.'' Section 1153 of title 38, United States Code, states that ``[a] preexisting disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease.''

VA's regulation implementing the presumption of sound condition, 38 CFR 3.304(b), historically has stated that the presumption may be rebutted by clear and unmistakable evidence that a condition existed prior to service. Although this appears to ignore the last seven words of 38 U.S.C. 1111 (``and was not aggravated by such service''), VA historically has interpreted those seven words to relate to the presumption of aggravation under 38 U.S.C. 1153.

Accordingly, VA's regulation implementing the presumption of aggravation under 38 U.S.C. 1153 also implements the last seven words of section 1111, as VA previously construed those words. That regulation, 38 CFR 3.306(b), states that, when a preexisting disability increased in severity during service, the presumption of aggravation may be rebutted only by clear and unmistakable evidence that the increase was due to the natural progress of the disease. The regulation further states that aggravation will not be conceded when a preexisting disability underwent no increase in severity during service.

Under VA's current regulations, if a condition was not noted at entry but is shown by clear and unmistakable evidence to have existed prior to entry, the burden then shift[ed] to the claimant to show that the condition increased in severity during service. Only if the claimant satisfies this burden will VA incur the burden of refuting aggravation by clear and unmistakable evidence.

VA is revising its interpretation of section 1111 to provide that, if a condition is not noted at entry into service, the presumption of sound condition can be rebutted only if clear and unmistakable evidence shows both that the condition existed prior to service and that the condition was not aggravated by service.

Under this interpretation, the burden does not shift to the claimant to establish that a preexisting condition increased in severity during service. Rather, VA alone bears the burden of proving both that the condition existed prior to service and that it was not aggravated by service. If the evidence fails to support either of those findings, the presumption of sound condition is not rebutted.

Our revised interpretation of section 1111 is based on the extensive analysis of the history of that statute stated in a precedent opinion of VA's General Counsel, VAOPGCPREC 3-2003, and the Federal Circuit's opinion in Wagner v. Principi, No. 02-7347 (Fed. Cir. June 1, 2004).

As the General Counsel and the Federal Circuit noted, the

language of section 1111 literally provides that, if a condition was not noted at entry into service, VA bears the burden of showing both that the condition existed prior to service and that it was not aggravated by service. If VA fails to establish either of those facts, the claimant would be entitled to a presumption that he or she entered service in sound condition.

VA ha[d] previously refrained from adopting a strictly literal interpretation of section 1111, because such a literal reading compels results that have been described as ``illogical'' by the General Counsel, ``self-contradictory'' by the Federal Circuit, and possibly ``absurd'' by the United States Court of Appeals for Veterans Claims. See VAOPGCPREC 3-2003, Wagner, slip op. at 8; Cotant v. Principi, 17 Vet. App. 116, 129 (2003).

Among other things, a literal construction of the statute would require VA to presume that a veteran entered service in sound condition even in cases where clear and unmistakable evidence shows the contrary, merely because VA cannot prove the absence of aggravation in service. It is unclear why the question of whether a preexisting disability was aggravated in service should have any bearing on the logically preliminary question of whether there was a preexisting disability at all.

Despite these concerns, VA's General Counsel and the Federal Circuit have concluded that the legislative history of section 1111 strongly suggests that Congress intended what the language of the statute literally requires. The General Counsel also concluded that, although the statute's requirements seemed counterintuitive, they were not so bizarre that Congress could not have intended them.

The rebuttal standard in what is now section 1111 originated in the Act of July 13, 1943, ch. 233, Sec. 9(b), 57 Stat. 554, 556 (Pub. L. 78-144), as an amendment to Veterans' Regulation No. 1(a), part I, para. I(b) (Exec. Ord. No. 6,156) (June 6, 1933).

Prior to the amendment, paragraph I(b) stated that the presumption of soundness could be rebutted ``where evidence or medical judgment is such as to warrant a finding that the injury or disease existed prior to acceptance and enrollment.''

In 1943, a bill was introduced in the House to make the presumption of soundness irrebuttable (see H.R. 2703, 78th Cong., 1st Sess. (1943)). That bill apparently was introduced in response to the concern that ``a great many men have been turned out of the service after they had served for a long period of time, some of them probably 2 or 3 years, on the theory that they were disabled before they were ever taken into the service'' (89 Cong. Rec. 7463 (daily ed. July 7, 1943) (statement of Cong. Rankin)).

The Administrator of Veterans Affairs recommended that the bill be revised to permit rebuttal of the presumption ``where clear and unmistakable evidence demonstrates that the injury or disease existed prior to acceptance and enrollment'' (S. Rep. No. 403, 78th Cong., 1st Sess. 6 (1943)).

The Senate thereafter approved an amendment to the bill adopting the Administrator's suggested language, but adding to it the phrase ``and was not aggravated by such active military or naval service.'' That language was approved by the House and was included in the legislation enacted as Public Law 78-144. The provisions of Veterans' Regulation No. 1(a), part I, para. I(b), as amended, were subsequently codified without material change at 38 U.S.C. 311, later renumbered as section 1111.

A Senate Committee Report concerning the 1943 statute stated that ``[t]he language added by the committee, `and was not aggravated by such active military or naval service' is to make clear the intention to preserve the right in aggravation cases as was done in Public [Law] No. [73] 141.'' S. Rep. No. 403, at 2. Public Law 73-141, referenced as the model for the Senate amendment, provided for restoration of service-connected disability awards that had been severed under depression-era statutes, and provided that:

The provisions of this section shall not apply * * * to persons as to whom clear and unmistakable evidence discloses that the disease, injury, or disability had inception before or after the period of active military or naval service, unless such disease, injury, or disability is shown to have been aggravated during service * * * and as to all such cases enumerated in this proviso, all reasonable doubts shall be resolved in favor of the veteran, the burden of proof being on the Government.

Act of March 27, 1943, ch. 100, Sec. 27, 48 Stat. 508, 524. This statute appears to have placed the burden on the government to show by clear and unmistakable evidence both that the disability existed prior to service and that it was not aggravated by service. It is thus consistent with the view that the presumption of soundness enacted in 1943 was intended to place the burden of proof on VA with respect to both issues. That purpose is also reflected in other statements made during the debate on the 1943 legislation. See 89 Cong. Rec. 7463 (daily ed. July 7, 1943) (statement of Rep. Rankin) (``It places the burden of proof on the Veterans' Administration to show by unmistakable

evidence that the injury or disease existed prior to acceptance and enrollment and was not aggravated by such active military or naval service.'')

Based on the foregoing authorities, VA is revising its regulations at 38 CFR 3.304(b) to provide that, in order to rebut the presumption of sound condition, VA must establish by clear and convincing evidence both that the disability existed prior to service and that it was not aggravated by service. To accomplish this, VA is amending Sec. 3.304(b) by adding, at the end of the first sentence, ``and was not aggravated by such service.''

The effect of this new interpretation is to establish different standards to govern for disabilities that were noted at entry into service and those that were not. If a disability was not noted at entry into service, VA will apply the presumption of sound condition under 38 U.S.C. 1111. If VA fails to establish either that the disability existed prior to service or that it was not aggravated by service, the presumption of sound condition will govern and the disability will be considered to have been incurred in service if all other requirements for service connection are established. In such cases, the presumption of aggravation in 38 U.S.C. 1153 will not apply because VA will presume that the veteran entered service in sound condition. On the other hand, if a condition was noted at entry into service, VA will consider the claim with respect to the presumption of aggravation in section 1153.

This final rule is an interpretative rule explaining how VA construes 38 U.S.C. 1111, and it merely reflects the holding in the Federal Circuit's decision in Wagner. Accordingly, there is a basis for dispensing with prior notice and comment and delayed effective date provisions of 5 U.S.C. 552 and 553.

Unfunded Mandates

The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 1532, that agencies prepare an assessment of anticipated costs and benefits before developing any rule that may result in an expenditure by State, local, and tribal governments, in the aggregate, or by the private sector, of $100 million or more (adjusted annually for inflation) in any given year. This rule would have no such effect on State, local, or tribal governments, or the private sector.

Regulatory Flexibility Act

The Secretary hereby certifies that this regulatory amendment will not have a significant economic impact on a substantial number of small entities as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-612. Only VA beneficiaries could be directly affected. Therefore, pursuant to 5 U.S.C. 605(b), this amendment is exempt from the initial and final regulatory flexibility analysis requirements of sections 603 and 604.

Paperwork Reduction Act

This document contains no provisions constituting a collection of information under the Paperwork Reduction Act (44 U.S.C. 3501-3521).

The Catalog of Federal Domestic Assistance program numbers are 64.102, 64.109 and 64.110.

List of Subjects in 38 CFR Part 3

Administrative practice and procedure, Claims, Health care,

Individuals with disabilities, Pensions, Veterans.

Approved: April 4, 2005.

Gordon H. Mansfield,

Deputy Secretary of Veterans Affairs.

For the reasons set forth in the preamble, 38 CFR part 3 is amended as follows:

PART 3--ADJUDICATION

Subpart A--Pension, Compensation, and Dependency and Indemnity Compensation

1. The authority citation for part 3, subpart A continues to read as follows:

Authority: 38 U.S.C. 501(a), unless otherwise noted.

Sec. 3.304 [Amended]

2. In Sec. 3.304, paragraph (b) introductory text, remove ``thereto.'' and add, in its place, ``thereto and was not aggravated by such service.''

[FR Doc. 05-8899 Filed 5-3-05; 8:45 am]

BILLING CODE 8320-01-P

sound condition.pdf

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