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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
broncovet
Link:
http://www.pva.org/site/DocServer/SOAR_Vol...pdf?docID=12444
Appeals Checklist & TipsIt is important for anyone appealing to the Court of Appeals for Veterans Claims (Veterans Court), to be sure to present all issues and arguments in the
opening brief. An appellant cannot wait to present them to the Court in a replybrief because the Court will not consider
them. Courts, including the Veterans Court, “have consistently concluded that the failure of an appellant to include
an issue or argument in the opening brief will be deemed a waiver of the issue or argument.” Carbino v. West,
168 F.3d 32 (Fed. Cir. 1999). See also Fugere v. Derwinski, 1 Vet. App. 103, 105 (1990) (“Advancing different arguments
at successive stages of the appellate process does not serve the interests of the parties or the Court. Such a practice hinders the decisionmaking process and raises the undesirable specter of piecemeal litigation”), aff’d, 972 F.2d 331 (Fed. Cir. 1992).
Claims Checklist
. The supervisor of VALO, Linda E. Blauhut, PVA associate general counsel and her colleague, Jennifer Zajac, PVA assistant
general counsel, have been able to identify some of the most frequent reasons the Court has given for
remanding appeals to the VA for additional development and adjudication of veterans’ claims. By identifying the
reasons why the Court remands cases to the VA, Blauhut and Zajac were able to create a claims checklist for
use by PVA service officers as they file and develop claims by PVA members and other claimants for VA benefits.
Use of the checklist may help PVA representatives to ensure that the claims of members and other claimants
are fully developed.
Has adequate VCAA notice been provided? The Veterans Court has remanded many appeals to VA because
VA did not provide notice to the claimant of information and evidence that is necessary to substantiate his or
her claim.
Has VA provided incorrect notice? The Veterans Court has remanded many cases because VA gave the veteran incorrect information.
Have all of the veteran’s servicerecords been obtained? A surprising number of veterans’ appeals are remanded by the Veterans Court because the agency did not obtain all of the service medical and personnel records. PVA representatives should review each veteran’s claims file to ensure that all service records are present in the claims file. If not, the representative should notify the VA and request VA to obtain the missing records.
Have all of the veteran’s private medical records been obtained? Many cases are remanded because the records before the Court indicated that the veteran had been receiving private medical care but the records of that care had not been obtained. PVA
representatives should request that the veteran obtain a copy of these records and provide them to the representative for review before they are submitted to VA. When the records are obtained the representative should review them to decide whether they are relevant to resolution of the veteran’s claim.
Have all of the veteran’s VA treatment records been obtained? Many court-ordered remands are issued because all of a veteran’s VA treatment records were not obtained or reviewed by VA adjudicators. PVA representatives should ensure that all VA treatment
records have been obtained. If the records are missing, the VA should be asked to obtain them for incorporation into the veteran’s claims folder.
Is the VA examination or VA medical opinion adequate? Many cases are remanded by the Court because of inadequate VA examinations or opinions. PVA representatives should closely examine VA examination reports and medical opinions to ensure that they are adequate and respond to the medical issues involved in each claim. If found inadequate, the representative should
inform the VA and request that the agency obtain a more accurate examination report or medical opinion. If it appears to the veteran’s PVA representative that VA’s examination report or medical opinion does not support the veteran’s claim, the representative should notify the veteran of this conclusion and should advise the veteran to obtain and submit a medical opinion
that supports the claim to benefits. Many claims for VA benefits require detailed and well-reasoned medical opinions or examination reports. When reviewing the quality of medical opinions or examination reports, try to ensure that they are complete and
unambiguous. If they are incomplete, confusing, or ambiguous, request that VA obtain a more complete medical opinion or examination report. See 38 C.F.R. § 4.2 (2004) (requiring that, if examination report “does not contain sufficient detail, it is incumbent upon the [RO] rating board to return the report as inadequate for evaluation purposes”); see also Bowling v. Principi,
15 Vet.App. 1, 12 (2001) (emphasizing the BVA’s duty, under 38 C.F.R. § 19.9 (2000), to return inadequate examination report); Hicks v. Brown, 8 Vet.App. 417, 422 (1995) (1995) (concluding that inadequate medical examination frustrates judicial review).
Did VA inform the veteran of the need to obtain and submit an expert medical opinion? The Veterans Court frequently finds it necessary to remand an appeal because VA did not inform the veteran that he or she should file an expert medical opinion to support a claim. PVA representatives should review a veteran’s records to determine whether to advise the veteran to obtain
and submit an expert medical opinion that supports the veteran’s claim.
Did VA provide the veteran with an adequate personal hearing? Did the VA official conducting the veteran’s personal hearing inform the veteran of all of the issues involved in the case?
Did the VA hearing official also suggest to the veteran that the veteran should obtain and submit necessary information and evidence to help support his or her claim to VA benefits?
During the hearing the veteran’s PVA representative should ask the VA hearing official to state, on the record, what he or she believes the issues to be in the case. The veteran’s PVA representative should also ask the VA hearing official to state, on the record,
whether the veteran needs to obtain and file additional evidence to support his or her claim.
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