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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
georgiapapa
Hello,
I am a retired CSRS employee and have the same health insurance as active federal employees. I also served in the USMC from 1966 to 1970 including 1967 and 1968 on the ground in Vietnam. I have recently been diagnosed with Multiple Myeloma (Smoldering). Multiple Myeloma is an incurable blood cancer. I now go to my local oncologist for monthly blood tests and I also go for extensive diagnostic tests at the Myeloma Institute for Research & Therapy in Little Rock, Arkansas every three months.
After seeking advice from others, including some in these forums, I was preparing to file a claim with the VA for my Multiple Myeloma since this is one of the diseases presumed to have been caused by exposure to Agent Orange herbicide. After talking with different people at the Myeloma Institute, I am reluctant to file for VA benefits at this time. Some told me my federal health insurance will not pay any benefits for injuries or illnesses sustained during active military duty. I know this is usually true of private insurance plans but I am not sure if this is true of federal health insurance. Others told me if I was approved for VA benefits, I would have the option of using either the VA system or my private health care providers without incurring any problems with my current federal health insurance. Some told me my federal health insurance may require me to file for VA benefits so they would not have to pay any benefits for medical services related to my Multiple Myeloma. I do not know what to believe at this time. I do not want to contact my current health insurance company because they may decide to suspend any benefits for my Multiple Myeloma until they determine if they should pay for the benefits or the VA should pay. This could take months for them to make a decision.
I know the VA has some great doctors and treatment facilities but if possible I would prefer to keep using my current doctors and myeloma treatment center with the option of using the VA for my medications. I am looking for responses from anyone who could address my concerns, especially civilian federal retirees or active federal employees who are in a similar situation or know of someone else who could answer my questions. I would like to apply for VA Disability Compensation to help pay for my out of pocket expenses (medical, medications, travel & hotel expenses to Arkansas), etc. I also feel I need to file a VA claim at some point in time so my wife will be able to file a claim for DIC & CHAMPVA benefits after my death.
Any thoughts or suggestions would be appreciated.
Georgia Papa
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