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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
BasehorVet
Hi all,
I was discharged by the USAF in 1985 under AFR 35-4, with the narrative reason for separation being "Discharge by reason of physical disability with entitlement to severance pay". The findings by the USAF PEB was the member is unfit because of physical disability and the disability is permanent. I was given a 10% rating by the board for Facet Syndrome, lumbar spine with low back pain with a VA diagnostic code number of 5299-5295.
I applied for my VA benefits right after returning home after my separation, went through a quick medical evaluation at the local VA hospital and was denied my claim because the diagnosed back condition was of a constitutional or development nature. Being young and dumb I did not appeal the decision.
On a recent VA response I received they described the application based upon spondylolysis, L1 left. I was discharged for Facet Syndrome but had conflicting medical evaluations in the USAF where depending on which doctor I saw, they diagnosed it as spondylolysis, spondylotheisis or Facet Syndrome.
25 years later I have reopened my claim using new and material evidence, I also tried in 1990 and I thought also in 1999 but they do not show that request in their records nor do I have any documents from then. In this latest round I have been using the services of the American Legion at the local VA hospital and I just had a medical evaluation of my spine (no results yet) and I have been scheduled for a MRI in 2 weeks. First time that I actually had the chance to have an evaluation in 25 years and things have really went downhill over the last 25 years, bowels and bladder not working right, cannot work due to the episodes that put me into bed for a few days at a time and I waddle like a duck when my hips start burning after walking short distances.
I have copies of all my old military records, made before the discharge. I noticed that the separation code is wrong on my DD214, it is listed as JFL and should have been JFL1.
JFL = Physical Disability - Severance pay or juvenile offender
JFL1 = Physical Disability with severance pay USAF
The VA did not notify me of my qualification for medical care through the VA because of the status of injured in the line of duty until I went to the VA hospital in 1999 because of a sever pain episode. I thought I would have to pay and I had no private insurance at that time, greatly surprised to hear that my care was covered with only a prescription co-pay. I also learned that if the correct code would have been on my 214 that I would have qualified for 6 months worth of exchange privileges.
On my DD214 there was also another error where the wrong SS# was entered on it and I applied for a DD215 to correct the SS# error but was not aware of the separation code error (there was no Internet back then).
Could the separation code error be the reason why I have all these problems over the years? Would this be a Clear Unmistakable Error (CUE)?
Any help or ideas are appreciated.
Victor
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