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VA Disability Claims: 5 Game-Changing Precedential Decisions You Need to Know
Tbird posted a record in VA Claims and Benefits Information,
These decisions have made a big impact on how VA disability claims are handled, giving veterans more chances to get benefits and clearing up important issues.
Service Connection
Frost v. Shulkin (2017)
This case established that for secondary service connection claims, the primary service-connected disability does not need to be service-connected or diagnosed at the time the secondary condition is incurred 1. This allows veterans to potentially receive secondary service connection for conditions that developed before their primary condition was officially service-connected.
Saunders v. Wilkie (2018)
The Federal Circuit ruled that pain alone, without an accompanying diagnosed condition, can constitute a disability for VA compensation purposes if it results in functional impairment 1. This overturned previous precedent that required an underlying pathology for pain to be considered a disability.
Effective Dates
Martinez v. McDonough (2023)
This case dealt with the denial of an earlier effective date for a total disability rating based on individual unemployability (TDIU) 2. It addressed issues around the validity of appeal withdrawals and the consideration of cognitive impairment in such decisions.
Rating Issues
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Tbird, -
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Are all military medical records on file at the VA?
RichardZ posted a topic in How to's on filing a Claim,
I met with a VSO today at my VA Hospital who was very knowledgeable and very helpful. We decided I should submit a few new claims which we did. He told me that he didn't need copies of my military records that showed my sick call notations related to any of the claims. He said that the VA now has entire military medical record on file and would find the record(s) in their own file. It seemed odd to me as my service dates back to 1981 and spans 34 years through my retirement in 2015. It sure seemed to make more sense for me to give him copies of my military medical record pages that document the injuries as I'd already had them with me. He didn't want my copies. Anyone have any information on this. Much thanks in advance.-
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RichardZ, -
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Caluza Triangle defines what is necessary for service connection
Tbird posted a record in VA Claims and Benefits Information,
Caluza Triangle – Caluza vs Brown defined what is necessary for service connection. See COVA– CALUZA V. BROWN–TOTAL RECALL
This has to be MEDICALLY Documented in your records:
Current Diagnosis. (No diagnosis, no Service Connection.)
In-Service Event or Aggravation.
Nexus (link- cause and effect- connection) or Doctor’s Statement close to: “The Veteran’s (current diagnosis) is at least as likely due to x Event in military service”-
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Tbird, -
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Post in ICD Codes and SCT CODES?WHAT THEY MEAN?
Timothy cawthorn posted an answer to a question,
Do the sct codes help or hurt my disability ratingPicked By
yellowrose, -
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Post in Chevron Deference overruled by Supreme Court
broncovet posted a post in a topic,
VA has gotten away with (mis) interpreting their ambigious, , vague regulations, then enforcing them willy nilly never in Veterans favor.
They justify all this to congress by calling themselves a "pro claimant Veteran friendly organization" who grants the benefit of the doubt to Veterans.
This is not true,
Proof:
About 80-90 percent of Veterans are initially denied by VA, pushing us into a massive backlog of appeals, or worse, sending impoverished Veterans "to the homeless streets" because when they cant work, they can not keep their home. I was one of those Veterans who they denied for a bogus reason: "Its been too long since military service". This is bogus because its not one of the criteria for service connection, but simply made up by VA. And, I was a homeless Vet, albeit a short time, mostly due to the kindness of strangers and friends.
Hadit would not be necessary if, indeed, VA gave Veterans the benefit of the doubt, and processed our claims efficiently and paid us promptly. The VA is broken.
A huge percentage (nearly 100 percent) of Veterans who do get 100 percent, do so only after lengthy appeals. I have answered questions for thousands of Veterans, and can only name ONE person who got their benefits correct on the first Regional Office decision. All of the rest of us pretty much had lengthy frustrating appeals, mostly having to appeal multiple multiple times like I did.
I wish I know how VA gets away with lying to congress about how "VA is a claimant friendly system, where the Veteran is given the benefit of the doubt". Then how come so many Veterans are homeless, and how come 22 Veterans take their life each day? Va likes to blame the Veterans, not their system.Picked By
Lemuel, -
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Question
hedgey
Okay. So my DH got his big white envelope. Here's the background of his disability: He was in an jeep accident back in the military, severely burned, especially his arms, shoulder, and head (both his ears were burned off and most of the back of his scalp - they did reconstructive surgery and did a decent job, but the scars are still very noticible. His shoulder joint was partially burned away, and he very narrowly missed having both hands amputated. He spent a year in the Burn Center at BAMC. He recovered (miraculously) and stayed in to eventually just get out a few years later with a regular honorable discharge in 1985.
His friend said go to the VA, and to the VA he went. He got rated at 50%: 10% + 10% for 2nd degree burn scars, and 30% for left shoulder condition. He was young and happy to have 50%, so he didn't question anything about it. He didn't even know he had access to VA healthcare, he just went on his way.
25 years later, he filed for an increase, only because a buddy asked him how long it had been since he'd been evaluated. "25 years!! Get ye to the VSO!!". That's what he did, but in addition to the scars he filed for loss of motion in both his hands.
So here we are with the decision today.
They ADDED 30% for 3rd degree burn scars on his head.
They ADDED 30% for 3rd degree burn scars back, neck and chest.
They Increased from 10% for 2nd degree burn scars to 30% 3rd degree burn scars on his left arm.
They Increased from 10% for 2nd degree burn scars to 20% 3rd degree burn scars on his right arm.
They said that his Left Shoulder Condition had not worsened, that it was DJD and is not changed, and remains at 30%.
They denied both of his claims for his hands (even though they admit in the narrative that both hands suffered 3rd degree burns). They state that there was no evidence in the record of any injury to the hands. (uhhhh....)
In addition, we saw that they did not receive or consider an IMO from a board certified doctor
and they did not receive or consider evidence that his hands had been un-usable for a period of time.
So here are my questions:
First of all, can he file something about the VA missing that his burns were 3rd degree back in 1985? He had no instructions that he could appeal. There's surely no way that his burn scars changed from 2nd degree to 3rd degree over the 25 years.... If they're 3rd degree now, they were that back then. Plus, how the heck did they miss the scars on his head??? If they had just appeared magically, they wouldn't be SC now, would they?
Second, how does he disagree with the examiner's findings on his shoulder? When the examiner (NP) told him to reach up with his left arm, he said it hurt. He said do it anyway. DH had tears rolling down his cheeks. It's even stated in the decision that he was in pain throughout the examination, but that he had little loss of ROM due to pain. They also state that he was guarded in his movements.
The same thing happened with his hands - the examiner made him squeeze a grippy thing and told him to squeeze as hard as he could, regardless of the pain. DH squeezed until there were tears in his eyes. Ergo, no loss of grip, no range of motion.
I feel like we're looking a gift horse in the mouth, but at the same time, it feels like he's been cheated.
Any thoughts or advice? Thanks! And if you think I'm being greedy, say that too, okay?
Edited by hedgeyLet us be kind, one to another, for we are each of us together in our pain.
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