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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
Chuck75
I ran into an interesting and frustrating situation that I and not a few other veterans seem to be in!
The VA has placed documents on it's web site(s) that indicate that an A.O. presumptive veteran is not charged Co-Pay for treatment (includes drugs)
of various problems that are related to A.O. exposure.
The first document is titled:
"VA Health Care Eligibility & Enrollment"
"Outpatient Prescription Copay"
And states:
"Exceptions to Copay Rules for Medication"
"VA does not charge a copay for medications used for treatment of --"
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"A veteran's conditions related to a veteran's exposure to:"
"Herbicides during the Vietnam-era"
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And so forth
The document also contains a statement relating to reduction of co-pay and to contact
the "Enrollment Coordinator at your local VAMC" or for further information call the VA at 1-877-222-8387
(Who profess to no knowledge and/or expound the co-pay until "adjudicated" VA stand)
Now, moving on to the next VA document ---
Fact Sheet 164-8
2010 Copay Requirements at a Glance
Dated July 2010
This document lists the one through eight "Priority Groups" that the VA places Veterans into, and lists Co-Pay requirements in a table corresponding to each group.
Three groups of the eight are involved.
"Group 2 & 3 (Service connection 10-30%) No medication co-pay for SC condition or ex POW"
(This applies to all conditions that have been "adjudicated" as being service connected. )
The real heart of the matter.
"Group 6 Combat Veteran SHAD, SC 0% - - - Agent Orange Exposure ---- Copay rules apply if unrelated to group 6 placement". Since "adjudicated" conditions fall under group 2 & 3, this can only apply to un"adjucated" or 0% conditions.
Evidently, the VA interprets a veteran's change to Group 2 or 3 from another Group, due to one or more "adjucated" condition(s) as removing the veteran from Group 6 entirely, thus making any un"adjudicated" conditions covered by Group 6 subject to co-pay.
THE VA IS CHARGING COPAY for Group 6 conditions, AND REFUSING TO STOP UNTIL A.O. PRESUMPTIVE CONDITIONS ARE "ADJUCATED", at which time a veteran changes from Group 6 to Group 2 or 3.
Web Reference
www.va.gov/healtheligibility/Library/pubs/CopayGlance
A second web reference
http://www4.va.gov/h...iptionCopay.asp
Further, The VA Finance, VAMC Business Office, VARO, the 1000 number, etc. take the same stance about "adjudication"
In other words, The VA is saying one thing in WRITING, and doing something different in actual fact! (What else is new!)
The VA is also ignoring the difference between an A.O. related presumptive condition and a directly connected (by adjudication or law) condition.
The key difference is that a presumptive condition is, by law and regulation, to be treated as a service connected condition, unless the VA can, under strict limitations, prove otherwise. (Adjudication)
Since the amounts per drug are "only" eight dollars, those in "high places" don't seem to be concerned, or even willing to look at the matter. (For that matter, they are almost unreachable by the average veteran.)
But, when you consider multiple thousands of veterans waiting to have A. O. & SHAD claims "adjucated", and take multiple prescription drugs for their conditions, The money involved is considerable.
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