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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
Ricky
Had to stop beating my head trying to word my appeal and thought I would drop a few lines to congress. I keep hearing "change the system to make it better." So I thought I would offer my two cents worth about change.
(Was addressed to various member of congress and the committee)
For well over 50 years now the American Public has heard the phrases most often used by the Veterans Affairs “Take better care” “speed claims processing while decreasing errors”. However, here we are now in the year 2006 and not only has the VA failed to produce, they have gotten worse.
Yes it is time that we change the system. However, the focus needs to shift from the veterans that use the system to the system itself.
The VA has a hard job. But lets face it there has been no action to correct the problems that make the system adversarial and burdensome and costly. Inefficiency, apathetic attitudes and most of all lack of over sight waste billions of tax payer’s dollars every year. Wasted dollars which could be used to improve the system by adding additional health care improvements, disability pay and manpower.
Congress mandated through legislation the minimum requirements to take care of America’s heroes. In doing so they tasked the VA to develop regulations to implement those laws. Although this system seems to have been developed using a logical thought process, Congress, in a “slap in the face” tactic allowed the VA to police itself during the development and implementation of those regulations. By doing so they created one of the most wasteful and inefficient government organizations that exist in our world today. VA is the only government organization that I know of that has this authority.
This authority without outside oversight has given the VA the power to be “above the law”. This “above the law” power enjoyed by the VA has bred nothing but incompetence, apathy and some times actions that down right violate U.S. Law by VA employees. These symptoms are seen throughout the VA from contact teams to raters all the way up to the management level. From improper application of the laws to intentional failure to apply the applicable laws in an effort to meet productivity requirements is a daily occurrence throughout the VA. These types of actions only serve to send an all ready over burdened system into a non-recoverable status. These actions result in untimely and unnecessary appeals and remands. As a result of this you find deserving veterans waiting 3, 5 sometimes 10 years for a proper adjudication of their claim at a cost to the American taxpayer that runs into billions of dollars.
Why is this done? Simple, it is the lack of oversight and accountability. This is proven by reading GAO report after GAO report in which these actions have been brought to the attention of the VA and Congress without any improvement in the system. The results of report after report has been briefed to the committee by GAO in which the VA has stated “ we accept the comments of the GAO, and will taken action to resolve the issues” as they go “wink, wink” and continue down the same path. Not only do they continue down the same path but year after year the problems get worse. Follow up reports disclose that in the wake of increasing problems the VA employees continue to fail to properly apply the required regulations, appear to be untrained and the back log caused by these problems has increased by several hundred thousands of claims awaiting adjudication in excess of 1 year.
When will it stop? Not until Congress changes the system that will require VA employees at all levels to be held accountable for their actions. I work for a department of the Federal Government that deals with laws and the regulations that implement those laws. If I fail to follow those regulations it is considered to be a violation of U.S. Law. Not only would I lose my job but I would be prosecuted promptly. Why is it that we can not expect the same of VA employees? Especially those tasked with the most important part of the VA mission – the senior raters and service center managers. These employees are paid salaries starting at around 69.000.00 yearly and go up from there. They are the ones tasked to insure the junior personnel are trained and follow the U.S. Code in performing their duties while being fair to the claimant. However, they are the ones that most often fail to properly do their job. They are the ones who have been around in the “system” for many years and fully understand the protections afforded to them in this “above the law” organization. They are the ones who will rubber stamp an inaccurate rating decision from one of the junior employees so the numbers will be in their favor during promotion and salary increase time. They are the ones when questioned by a claimant about the application of a specific law in a claim who simply thumb their noses at the claimant. Why worry about one claim when there are thousands of other simply waiting on the “rubber stamp” approach that will result in a large annual bonus for the service manager which will in turn assuredly result in that step increase at the end of the performance rating period. Who cares how much extra manpower will be required by their apathetic actions? They will not have to pay the cost the tax payer will; so what if the claim is sent into a vicious cycle of appeals and remands? Once again it is not their money; it does not cost them anything. So what if the Board of Appeals remands the claim two, three, ten times? They do not care. They simply use the ole rubber stamp each time. Yeah, Yeah the board did say something about they needed to apply the proper law and re-adjudicate the claim. Who cares the board won’t do anything for not following their orders. Oh, the court! It can not enforce any ruling on them. Just think a Federal level court without any enforcement authority – it must be heaven.
I hope that my point has been made. The VA system does need revamping. It needs to be brought into the year 2006 and taken out of 1010 A.D when the ruler simply killed those who did not like the way he was running things. It needs to be forced into an era in which oversight and accountability is mandated. Mandated in a way that will result in the loss of income for those found to be inefficient and prosecution is guaranteed for those who intentionally violate the laws of the U.S. Code.
That, my dear Congress person, is where your efforts to revamp the VA system should be focused.
Ricky E. Hicks
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