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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
free_spirit_etc
A Statement of Case I received refers to a Medical Opinion. I sent an IRIS to ask for a copy of the opinion.
They told me to send a written request and tell them what opinion I am referring to, since my husband's record is so "large."
My questions are:
1. I REVIEWED his case file last July and didn't see any such medical opinion. Is it possible they have the date wrong? And they didn't request the opinion until October 2007 - instead of 2006?
If so - should I mention that? (i.e. I don't want to spend forever waiting for this opinion only to receive a letter telling me their is NO opinion dated Oct. 19, 2006) Or since I AM asking for the opinion they referred to in the SOC - will they most likely send it, even if the DATE is wrong?
2. I asked for his ENTIRE C-file LAST JUNE.
My husband requested his file in August 2006. But they didn't provide it by the time he died in Feb. 2007.
I had to RE-REQUEST it after he died. I sent a written request on June 14 of 2007 asking to:
a. recieve an copy of his entire C-file
b. be allowed to VIEW his C-file
c. expedite a limited request for a copy of his discharge physcial while I was waiting for the entire folder.
This was on ONE request.
They let me view the C-file July 2007. But have not provided me with a copy.
They usually say it takes 6 months or more to get a copy. They never did find a copy of the discharge physcial (though one of the VA doctors referred to it in his opinion.
However, I have NOT recieved the letters my husband used to get telling me they are working on it. So I am beginning to wonder if they figured since they let me SEE the file, they don't have to follow up with giving me COPIES of the file I requested.
I am considering adding to THIS request that this request does not REPLACE the request for the ENTIRE C-file I submitted last June. But I am concerned that if I even MENTION getting the whole C-file NOW - they might stick this request in the "we will get to it in 6 months pile" - and I would like to get this SOONER than that.
So is it okay to send in this LIMITED request NOW - and then follow up after I get this medical report with a reminder that the June 14, 2007 request for the ENTIRE C-file has not been fulfilled?
This is a copy of what I am sending:
Privacy Act Request for Access Letter
January 20, 2008
Re: Privacy Act Request for Access / FOIA request
Re: xxxx
CSS xxxx
To Whom It May Concern:
This is a request under the Privacy Act of 1974.
Please consider that this request is also made under the Freedom of Information Act.
This is a limited request for records under the Act.
The Statement of Case I received from the VA dated November 8, 2007 states that part of the evidence considered was a Medical Opinion dated October 19, 2006.
The Reasons for Decision section states:
“To assist in gathering evidence to support the claim, we requested a VA medical opinion. In response to that request, a VA physician reviewed the records and noted that the symptoms noted during the veteran’s treatment in the service suggest manifestations of viral respiratory tract illness, and that none of the episodes can be reasonably linked to an early manifestation of lung cancer. “
In order to assist in the development of my claim I would like to receive:
1. A copy of the Medical Opinion dated October 19, 2006
2. A copy of the request for a medical opinion the VA sent to the VA physician.
3. Copies of any other documents related to the VA’s request for a medical opinion and the VA physician’s response to that request.
Thank you,
xxxxx
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