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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
I am a Vietnam vet (67-68) who served with USMC 1966-1970. I was diagnosed with Multiple Myeloma (Smoldering) this year and am currently receiving care at the Myeloma Institute of Research & Therapy at the University of Arkansas in Little Rock. I live in Geoergia and drive to Little Rock every 3 months for follow up tests and staging updates. My disease is Agent Orange presumptive disease and I know I am eligible for VA benefits for the disease. However, I can not apply for benefits until I know positively sure that upon receipt of VA benefits my current FEHB insurance will not stop providing me with benefits for my treatment in Little Rock.
I know some folks wonder why I don't go ahead and apply for VA benefits and use the VA for treatment of my disease. Multiple Myeloma is a rare incurable cancer and very few cancer centers specialize in the treatment of this disease. The Myeloma Institute in Little Rock is reputed by some to be the best place in the world for treatment of my disease. Nothing personal against the VA doctors but I believe I would live longer if I continue to go to Little Rock.
I already posted a message on this forum and other forums regarding my situation but I have received so many different opinions from so many different people that I do not know what to do. It is hard for me to believe this situation has not arisen before. I know there is someone out there who can help. Someone with reliable documentation to back up their opinion. I have communicted with OPM and was told this was between my FEHB plan and the VA. I communicated with my FEHB plan and my question was sent to their claims office which provided a response which did not address my question.
I need input from veterans who currently have FEHB plan coverage and also have health care coverage through the VA due to their service connected disability and get their treatment for their service connected disability (disease or injury) at both their FEHB private providers and the VA.
NOTE: I am not talking about receiving treatment at the VA for service connected problems and treatment at FEHB providers for non-service connected problems. I am also not talking about receiving treatment at the VA for non-service connected problems and billing your FEHB plans. I am talking about receiving treatment for service connected disabilities(disease or injury) at both VA and FEHB private providers where the FEHB has no problems with paying benefits for a service connected disability.
Some folks on this forum have told me they received benefits from their FEHB plan for treatment of their service connected disabilities but it was not clear if there FEHB plan was aware they were receiving VA health care benefits for their SCN. I do not want to just take a chance and hope the FEHB doesn't find out about my VA benefits because it not only could cost me a great deal financially but it could jeopardize my longevity if my FEHB stops paying benefits for my Multiple Myeloma treatment in Little Rock.
Is there a SCN veteran out there who has used both FEHB and VA benefits for treatment of their SCN at both the VA and FEHB private providers and whom has something in writing from their FEHB plan or the OPM stating the FEHB plan can pay benefits for a scn disability at a FEHB private provider?
Also, if you have something in writing stating the FEHB plan will not pay the benefits, I also need to know. In this situation, my plan B would be to wait until I only have a few months left and then apply for VA benefits so my wife can receive DIC and CHAMPVA benefits after my death. I would have to carefully time this event.
There should be a directive or something addressing this question. However, so far I have not found it. Even Google could not answer this question.
Sorry for the length of this post and for being repetitive but I did not know how to make it any shorter without leaving something out and I wanted to be as clear as possible about what I am seeking.
Thanks...Georgia Papa
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