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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
ruby
For those of you that are going to apply for SSD perhaps this might help you.
I called and got an appointment to take in my paperwork. This was the wrong thing to do, why, when I go there they are required to put it all in the computer anyway. The hard copies (paper) that I did was wasted time and effort.
I looked at the app on line and knew it would not show how my condition disables me, after a lot of research on the internet I chose to go in person for this reason.
I filled the app out and I also did my own additional paperwork.
I reviewed what I had researched on the internet and prepared all the paperwork they could ask for at the begininng so I could by pass the waiting period for approval or denial.
When I went to the appt and the intake person submitted everything on line, I was upset that my matrices were not going to be submitted. This person was nice and said they could fax 15 additional pages to DDS board. I took the most important papers, the ones from my DOC saying I was P&T disabled along with a letter I had him sign for the VA saying the same thing and the matrices I made.
I told him that I had already gotten a copy of my medical records and I had letters from family friends and employers along with a copy of my X-rays (computer disk) it was imperative that DDS recieved this material.
This person was really nice, and said that they are required by law to send the signed consent to release records by mail and that he would put my disk in that file--Who knows if he will? He also said I could send DDS anything I wanted to and gave me his personal office number and DDS's number. Told me to call him in a couple of days to get the name of my claims rep at DDS.
my appointment took 4 hours.
Here is what I would recommend call and get an appointment in person. In the mean time do the app on line. So when you get to the appt all they need to do is review it to make sure its correct.
While I don't know what will happen to my case, I do beleive the information I have researched on SSD that writing your own matrices on how your disabilities effect me will help--only you know your body and your symptoms.
I wrote how I functioned prior to being disabled this included work, home and weekends and how my disablities now effect my work, home and weekend activities. I did this in great detail.
I sit at the computer for 15-20 minutes at a time and then due to the pain in my wrist,back and , swelling my hands I must rest for 15-20 minutes.
I said my co workers having been helping me at work to get my job done in detail giving examples. I had them sign statements to that effect.
If I get approved I will post my matrices for other to see how to do them, that was the hardest part. I paid someone to give me examples. I also ask for legal advice. I will share what he said the normal process is at SSD, what I did was everything they could ask during this 5 month waiting period and gave it all to them(prepared it all) so all they had to do is make a decision.
This was recommended by another source. I might have already pasted this here I don't remember.
January 1, 2000 - Claimant files application by calling or writing
January 10, 2000 - Social Security acknowledges receipt of
application and schedules a phone or office interview.
January 25, 2000 - Social Security intake clerk takes down
information contained in formal Application for Benefits
Form SSA-16-F6).
I called got the appointment first it took 10 days --I eliminated the first 30 days by doing it my way.
February 1 - March 30, 2000 - DAS claims processor sends form
requests for medical records to all doctors and hospitals listed
on Form SSA-16-F6. The claims processor may also send you a
Disability Report (Form SSA-3368-BK) and a Work History Report
(Form SSA-3369-BK).
April 1 - 15, 2000 - DAS claims processor collects, organizes and
reviews medical records, Disability Report and Work History Report.
Adjudicator will also send your file to staff physician and/or
staff psychologist for review.
I have copies of my records and I did the Work History Report. Again saving time for the claims processor. Which just saved me 4 months of waiting time.
In my case, I feel my medical records do not support my claim, all the doc writes is P&T and not specifically why I am P&T and this is what SSD wants, however, my X-rays clearly demonstrate that I am disabled by anyone that knows how to read X-rays. This is the reason the docs don't write anything specific regarding my ability to do anything.
It will take me months for me to get the docs to write it the way SSD wants it written, my next appointment isn't until March. If I am denied in the next 30-60 days I will have an appointment and all the information I need for the doc to document in my records and an RFC (residual functional capacity form) so I can submit that for a request for reconsideration.
[if evidence supports a favorable decision, claimant is notified
and claim is sent for payment processing.]
April 25, 2000 - Claims processor issues a form based denial notice.
You have 60 days to appeal.
June 1, 2000 - you file your appeal (Request for Reconsideration
form SSA-561-U2 and Reconsideration Disability Report form
SSA-3441-F6).
June 10, 2000 - DAS acknowledges claim
June 15, 2000 - DAS claims processor reviews Reconsideration
Disability Report and sends out form requests for updated medical
information and records from any new physicians. If mental health
or physical consultative exams are called for, the claims processor
will schedule appointment and send you an appointment notice
letter.
June 20, 2000 - DAS claims processor sends you Daily Living
Questionnaire and will request statement from a person who
knows you.
August 1, 2000 - Claims processor organizes file, reviews it and takes
it to an in-house physician/psychologist for review.
[if evidence supports a favorable decision, claimant is notified
and claim is sent for payment processing.]
August 15, 2000 - Claims processor issues a form based reconsideration
denial notice. You have 60 days to appeal.
September 15, 2000 - you file Request for Hearing (form HA-501-U5)
and Claimant's Statement when Request for Hearing is Filed and
the Issue is Disability (form HA-4486).
September 30, 2000 - Social Security office issues confirmation of
receipt of hearing request.
November 1, 2000 - your claims file is physically moved from the
DAS to the Office of Hearings and Appeals (OHA).
June 15, 2000 - OHA personnel unpack file and begin to organize it.
August 1, 2001 - OHA finishes working up file and sends notice
to you (and your attorney) that file is ready to be reviewed.
September 1, 2001 - Case is assigned to a Judge and a hearing notice
is issued for hearing on October 15, 2002.
October 15, 2002 - case is called by Administrative Law Judge
March 1, 2002 - Judge issues decision.
Hope this helps other.
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