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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
Hoppy
The recent posts between Berta, I and hollywoodnc concerning doctors reports has motivated me to put up some pro’s and con’s I ran into. And when I say pro’s and con’s what I mean is that there are some doctors who are real pro’s at being a con’s. The best part is the second to last paragraph.
When my claim started through the system in the mid 90’s there was no requirement that a VA doctor had to write reports or make notes in the medical file as to their opinion about service connection issues. In 2000 there was a new directive requiring primary care doctors to make an assessment of whether or not they thought medical diagnosis noted in the SMR were related to current diagnoses.
Great, now we get to talk to primary care doctors who do not want to get involved in the first place. And they are being forced by the VA to get involved. These primary care doctors have no training as to how they should form their opinions. I had one primary doctor who tried to lump me in with the general population and give statistical guesses as to the chances of my condition actually being caused by something never mentioned in my SMR. You can’t lump somebody into a general population when they are already known to have the disease you are trying to say they do not have. The fact that I had the disease was undisputable by stacks of doctor’s reports. If I had done something like this in a research or experimental design class when I went to college I would have got a big “F”. Can Primary doctors rebut diagnoses made thirty years ago based on theory and speculation. Can they make up new diagnoses without running tests or treating you for only one or two appointments when the military doctors had seen you numerous times over periods of many years. Can they make verbal statement disqualifying your claim and refusing to assist without even writing up the basis of their opinions. Guess what they think they can. A primary doctor did it to me. I think any doctor who does this should be put in jail. They are circumventing the system and jamming their maverick BS decision down your throat.
Now for current C&P exams. The RO appears to have the option of determining if your C&P exam will be performed by a physician’s assistant or the head of the department. The hospitals claim that C&P exams are performed by staff physicians only. I have had numerous C&P exams over the years. I had one performed by a physician’s assistant on my knee who did not know how to properly perform a drawer test. This test had been done on my knee at least 25 times by other doctors including two surgeons who operated on my knee. I could perform the test if I were able to lay on a table sit on my foot and pull on my knee at the same time. I had seen this physician’s assistant working the walk in clinic for years. I had never seen him in ortho. I was so pissed I walked straight over to ortho and told them that the RO schedule me a C&P exam and some guy who works in the walk in clinic did the exams. I demanded that the clinic schedule an appointment with one of there surgeons. They did it, the doctor put the results in his notes and I sent it off to the RO. When the DRO scheduled a C&P on my angioedema claim it was performed by the head of the clinic. The result was a good exam.
To answer some of the question I addressed above I can tell you what I learned from a Workers comp claim I had in the State of California. My union scheduled me with an MD/JD. This is a guy who went to both medical school and law school. He was certified to run a hospital. My employer was listening to reports from a physician who was under diagnosing my condition. What really ticked my MD/JD guy off was that they performed no post surgical MRI’s to see why I was having ongoing problems after the surgery. He gave me a quick primer course on what he had to do and what I had to do for the court to give weight to his opinion.
I had to come to appointments until he said I was done. He had to treat me for at least as long of time as the surgeon who my employer was listening to did. The courts took the opinion of a treating physician over an examining physician. He did not want the court to perceive him as an examining physician. He had to run the post surgical MRI’s. He had to have reports, records from my surgeries. He could only base his opinion on his treatment and the reports.
In the case of Jim S, where the C&P examiner saw him for about a half hour and blew off the diagnosis made by military doctors and invented a new one without even giving a clue as to how and when the new diagnosis occurred and the RO bought it without any questions, somebody should have went to jail. This is glaring evidence that the VA system stinks and you have to be on your toes with these guys. This sh__ is worse than communism. I had to throw that in. It is one of my favorite sayings when I am confronted with BS.
The reason the VA system stinks can be illuminated by comparisons to workers comp. The advantage about the workers comp system is that the doctors and lawyers actually talk to each other about how they can best serve the claimant. They specialize in serving claimants only. When you are required to get opinions from primary doctors or C&P doctors for any reason, you lose this advantage and can get a doctor who has an extreme bias, or minimal abilities to think through legal aspects of medicine, and or feels an obligation to save the tax payers money. I am of the opinion that it takes a special breed of doctor to write good reports. Attorneys can runs circles around doctors when it comes to the process of making a decision that will be given weight by the courts. I personally told the DRO to schedule an exam with a VA doctor because he wanted to schedule an exam with a contractor. I was afraid that the contractor would think that he had to write reports favorable to the VA in order to get ongoing business from the VA. Thus, causing even more delays. I figured I would take my chances with a staff VA physician because they get paid for showing up to work. Disallowing veteran’s access to medical examiners that are known to the veteran to be working for the benefit of the veteran only, is the single biggest disadvantage to the VA system. Bad reports can be overcome. It just takes years of delays and you need to get somebody like Berta to work over the doctors.
I will give my opinion on the board. I was a printer and plumber by trade. My disabilities made it impossible for me to finish my college education and sustain myself over the years. I could have never guessed how important several years of college would have benefited me in my old age. I had to learn how to take on doctors and lawyers to survive. Several years of education in the UC system is the only thing that made it possible. For reasons noted in my other posts I spend my time at home or in places where the air is clean and the prevailing wind is onshore. Going to the VA is like playing Russian Roulette for me.
Hoppy
100% for Angioedema with secondary conditions.
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