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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
allan
<H2 class=date-header>Saturday, February 07, 2009</H2><H3 class=post-title><A href="http://vnvets.blogspot.com/2009/02/time-to-start-restructuring-dva.html">Time to Start Restructuring the DVA </H3>
Congress's hands are not clean over the Blue Water Navy issue. They have consistantly passed budgets over the years while the DVA takes appropriations away from Veterans to build new facilities. We refer mainly to costly 'Rural VA Health Centers'.
Consider:
The DVA had to have money appropriated in its budget to acquire the land for these centers.
<LI>Then they had to have money appropriated to construct them.
<LI>Then they had to have money to staff them.
<LI>Now they have to have money to keep them running.
This is a very costly program.
Consider the alternatives, however. Not having them forces the Veterans to travel very long distances to receive diagnosis and treatment for any conditions thay have or develop. They have to travel to VA Hospitals...
OR,
...Congress could authorize the issuance of a Veterans Health Care Card, with coverage levels based on DVA Categories of eligibility, and with a payment schedule identical to the one Social Security uses for Medicare. There would be no deductibles or copays for full coverage. The Veterans would use the card at any and all medical facilities they choose, and the medical provider would be barred by law from billing the Veteran for any difference in fees and costs. Prescription coverage would be the same as they have with the DVA, based on categories of eligibility.
The DVA could then sell those costly Rural Health Centers, applying any moneys realized to the next year's infrastructure maintenance budget to repair and modernize any DVA Hospitals to begin to switch their primary role to that of long term care. Staff reductions will further reduce the budget.
What could be the advantage of this system?
Politically, the Democrats will embrace it because it is a step closer to universal health care. The Republicans will embrace it because it shrinks government [hundreds of administrative clerks are far cheaper to pay for than thousands of administrators, doctors, nurses, pharmacists and therapists].
Medical professionals will embrace it because it does not force many of them to take any experience and training they garnered while serving in the Armed Forces and work within the DVA healthcare system. They can work where they want, and their expertise will be spread throughout the nation and be available to all, not just Veterans.
Veterans should embrace this plan since it allows them to go to their family doctor for treatment, and their local hospital for emergency and long term services.
This would reduce instances where Veterans go to DVA Hospitals in an emergency only to find they have no Emergency Room, or to be turned away because of a snafu, or by an undertrained staffer who just doesn't care, forcing the Veteran to seek emergency care at a local facility that is NOT DVA, and then be forced to pay the bill.
Chances are, the Veterans contemplating suicide will receive better judgement on examination in Emergency Rooms of civililan facilities and not be turned away. They would likely receive better care after admission as well.
Mostly, though, this would eliminate many of the "cracks" that Veterans fall though in their health care system. Quality of care varies greatly from DVA Medical Facility to Facility, making treatment a hit or miss reality for the Veteran. Many of the staff at DVA facilities are simply overburdened, and have become callous to their patients.
Positive Results
Let's get the DVA out of the business of being the ones who treat all of our Veterans and into long term care only, and whatever period of time a wounded warrior needs to transition from the active Military to Veteran status and be ready to go out into the civilian world.
Finally, by freeing up money in the DVA Budget by stopping the acquisition, construction, staffing and running of DVA Rural Health Centers, and divesting itself of them using the above concept, perhaps the DVA could spend more money, time and effort in paying the benefits to Veterans that they fight so hard to deny. It is time to zero in on the DVA and force massive changes in its thinking, and operations. This is one step, and it starts with Congress.
VNVets
http://vnvets.blogspot.com/2009/02/time-to...turing-dva.html
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