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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
Continue Reading on HadIt.com-
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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>Monday, February 09, 2009</H2><H3 class=post-title><A href="http://vnvets.blogspot.com/2009/02/restructuring-dva-part-two.html">Restructuring the DVA: Part Two </H3>
News reports indicate Congress is being asked to fund an increase of 55,000 new employees for the DVA. Some will go to staff new Rural Health Centers and others will go into the Claims Process system.
We think that without a viable training program, this is merely throwing good money after bad. It grows government where it is not necessary, adding to the bureaucracy.
Instead, we believe a wholesale change in the training and personnel administration of employees of the DVA is what is called for.
Here is what we propose:
NVLSP Involvement
We would like to see the National Veterans Legal Services Program [NVLSP], an organization that already trains people in the DVA Claims system, in conjunction with input from the DVA and the various Veterans Service Organizations, develop a classroom training program for employees of the DVA and Veterans Service Officers from the Veterans Service Organizations [American Legion, VFW, AMVETS, DAV, Veterans of Modern Warfare, FRA, V V A, and so on.] This warrants a grant from Congress to fund the NVLSP's effort and a warrant from the same authorizing legislation that allows the NVLSP to be the final arbiter in any issues raised by either the DVA or the VSOs.
The NVLSP would also be responsible for training the training staff comprised of DVA Instructors, and Veterans Service Officers from the various Veterans Service Organizations. Trainers would be licensed and would participate in training classes as instructors in various regional locations across the Country. Expenses for the VSOs would be funded by their Veterans Service Organizations, but wages for training classes will be paid from the DVA Budget. The classes where trainers are trained will lead to Trainer's Licenses. The training of VSOs and DVA Claim Processors will result in Professional Licensure, required to serve in either capacity. Refresher training shall be required every five years in order to renew the license.
The Program
The training program puts the Veterans Service Officers into the same classrooms at the same time as the Claims Processing Personnel from the DVA are trained. That way, every claim processor, and every VSO is on the same page when handling claims. Further, some portion of each training class will be required by all administrative staff. The Secretary and the Undersecretaries and Assistant Secretaries should also be required to complete the same training course as the VSOs and the Claims processors in order that all shall know what is required of the Veterans to complete a valid claim for benefits. The medical staff personnel employed in any medical or administrative capacity shall be required to attend the classes so they may also see what the Veteran must go through before they even get to the Doctors and Nurses, and medical administrative staff. Finally, legal staff should also participate in the training program to see first hand the fruits of their labors. Finally, attorneys and paralegals that work with Veterans Claims and as Veterans Advocates may take the training also, and should be licensed as well. Their expenses incidental to the training should be at their own expense, including the cost of the training, as they earn money from what they do.
The Details
The course will be covered over a two week period, with classes lasting 6 hours each day, with a half our break at mid-morning and again at mid-afternoon, and an hour for lunch. The last hour of every day is spent in review exams, review and Q&A sessions. The classroom work ends at the end of a full day of review and preparation for the final exam on the second Tuesday. The final exam is on Friday. The Practical Exam, where test claims are filed by the instructors, to be processed by the students on Wednesday and Thursday.
Successful completion of the course is required for licensure. Failure will result in the individual waiting until a review course is available, a 7 day, shortened version with the last five days the same as the full course. A second failure will result in termination from the VSO program for VSOs, or from Claims Processing positions for DVA Claims processors. The DVA may provide alternate employment for those refused licensure, but at no time may that employee ever become a part of the claims process system at any level.
The Kelley Principle
The indomitable Charles Kelley of the website 2nd Battalion, 94th Artillery, is a strong and dedicated advocate for change in the DVA. He emphasizes, among other things, a standardization of ratings, and a common sense/logical approach to claims. If, he posits, a claimant has a head injury and the claim processor approves the claim for 50%, then identical cases of head injuries should automatically be approved for 50%, and after that, if any varations are warranted, a deeper examination of the claim may be in order. I like to call this system of establishing case precedents, the "Kelley Principle".
This, in its simplicity is a major key to reducing any backlog in claims processing. We have embraced his concept from the start, and see it applied here as part of the training.
We believe the claims process should go through a number of steps.
All of the above subject to review by supervisory staff at each level. Each step is handled by an increasingly senior claim's processor.
Advancement of these licensed personnel shall be based not just on seniority, but an acceptable level of claim reversals on appeal, or by supervisory personnel, and a satisfactory claim completion rate.
It is highly recommended that all claim personnel be Veterans of the United States Military.
Positive Results 2
We think the adoption of this policy, should Congress embrace it, is a common sense no-brainer. It effectively addresses the regional variations in claim ratings and denials, and provides a clear structure to the claims process. It additionally places everyone in the claim process system except the Veteran into a standardized system that would provide the same results for identical claims at any Regional Office in the Country. It would simplify the claims process, and eliminate the backlog. It would be an efficient method of serving the Veterans of this Nation.
VNVets
http://vnvets.blogspot.com/2009/02/restruc...a-part-two.html
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