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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
pacmanx1
NEW VA RULE: PHYSICIANS NO LONGER NEED TO CO-SIGN C&P EXAMS
NEW VA RULE: PHYSICIANS NO LONGER NEED TO CO-SIGN C&P EXAMS A physician's co-signature is no longer required for a C&P examination performed by a mid-level practitioner. This should expedite the claims process.
by Larry Scott, VA Watchdog dot Org
I am not sure if this is good or bad.
It certainly could speed up the claims process.
However, I already hear complaints from many veterans that they don't want mid-level practitioners, such as a NP or PA, doing their C&P exam ... they want a doctor.
Now, in many cases, doctors are being taken completely out of the loop.
VBA's Fast Letter 10-32 is posted below.
-------------------------
DEPARTMENT OF VETERANS AFFAIRS
Veterans Benefits Administration
Washington, D.C. 20420
September 1, 2010
Director (00/21)
All VA Regional Offices and Centers
In Reply Refer to: 211
Fast Letter 10-32
SUBJ: Removal of Certain Co-Signature Requirements and Ordering Specialist Examinations
Purpose
A joint workgroup of the Veterans Benefits Administration (VBA) and the Veterans Health Administration (VHA) identified several initiatives to expedite compensation and pension (C&P) examinations. This fast letter implements one of these initiatives by liberalizing signature requirements for VHA clinicians performing C&P examinations.
Examination Report Signature Requirements
Effective immediately, regional office and center staff may accept examination reports signed by a nurse practitioner or physician's assistant that are not co-signed by a physician. This change in signature requirements does not apply to examinations conducted by specialists, such as mental health, dental, audiology and optometry.
The M21-1 Manual Rewrite (MR) requires that a physician signs all original examination reports (see M21-1MR Part III, Subpart iv, Chapter 3, Section D, Topic 18, Block a, or
M21-1MR III.iv.3.D.18.a). Law does not mandate this policy, and it can unduly delay processing C&P examinations. In VHA, an individual physician accepts legal responsibility for the unsigned work of a mid-level practitioner, such as a nurse practitioner or physician's assistant. As a result, a physician's co-signature is no longer required for a C&P examination performed by a mid-level practitioner.We will update the MR to reflect this change.
Specialist Versus Specialty Examinations
Please note that a specialist is only required in limited situations such as dental, vision, hearing, and psychiatric examinations, as indicated by
M21-1MR III.iv.3.A.8. For all other types of examinations, a generalist clinician may perform the examination. For example, an office may order a cardiac examination, but it should not generally request that a cardiologist (a specialist) conduct it.Questions
E-mail questions concerning this letter to VAVBAWAS/CO/21Q&A.
/S/
Thomas J. Murphy
Director
Compensation and Pension Service
My intentions are to help, my advice maybe wrong, be your own advocate and know what is in your C-File and the 38 CFR that governs your disabilities and conditions.
Do your own homework. No one knows the veteran’s symptoms like the veteran. Never Give Up.
I do not give my consent for anyone to view my personal VA records.
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