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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
tck5810
I need some help/guidance on service connection for depression. While I was active duty a variety of events led me to have a near total breakdown beginning in November 1999. It got so back that my wife was very close to forceably having me admitted to Heidelberg Hospital in Germany. After several sessions with a Chaplain friend of ours, I finally relented and visited a Psychiatrist beginning in about February 2000. He started me on Atavan and Paxi, and I visited him about once a week for nearly 3 months. This is now where it gets complicated...At the end of April 2000, my father had a near fatal heart attach back homein Colorado (on My Daughter's 2nd birthday). I immediately flew back to be with my mom and family, because we weren't sure if he'd survive. As it turns out, he lingered for about 3 weeks, before finally passing away. I extended my emergency leave to help attend to his estate, and for lack of better explanation, I put my on troubles aside to help out my mom. I ran out of my drugs, and quite them cold turkey. Then I got back to Germany, just in time to PCS back to CONUS. I had access to my medical records (the paper ones at least), and I pulled out anything having to do with depression, because I knew I was coming up on my periodic TS reinvestigation, and I absolutely needed that clearance for the job I was going to.
This isn't to say I was better though. I struggled with it for nearly a year longer, finally come out of that bout of depression in about spring 2001. Because I didn't want to lose the clearance, I decided against seeing any Psych or Psychologist, although my wife coudl tell you that I was a basket case at home, after holding together as much as I could at work. I also traveled a lot, so it gave me diversions in thought. Fast forward to my retirement physical in 2003, and I put on there that I had a short bout of depression, but I stated it was because of my father's death and was more grief related than anything else. I did this, because the retirement job I was hired for also need a TS/SCI clearance. So everything hinged around my trying to hide my depression to stayed employed in my field.
In May 2005, I noticed that I was starting to experience a lot of anger issues, especially at home. I started seeing a counselor in the summer of 2005, but then it was easy to couch the sessions around dealing with our Autistic son. So I used many convenient excuses to hide the fact that I experienced several extended bouts of depression. And in 2005, I had no filed yet for any VA benefits. Then in January 2007, I had a C4-6 anterior fusion, which worked for a few months until I began having an unrelenting bout of severe pain. That led me to 7 monhs of cervical steroid epidurals. As they no lone worked, I agreed to a double laminectomy in June 2008, where the surgeon emplaced rods and screws. I woke up from that surgery with severe pain and hyperthesia to my left arm and hand. It didn't help that I could not get referred for physical or occupational therapy.
Along with several other problems, I finally filed a comprehensive claim with the VA through my VFW VSO. I received an inital 70% evaluation, which was later knocked down to 60% because a QTC examiner (without ever doing an exam of my neck) said that I had full range of motion. That caused me to be dropped fom 20% post-surgery for my neck to 10% permanent. In the same claim, I was basically turned down for everything else. I submitted a NOD, and even went to an independent medical examiner who I thought said all the right things, and in most cases he did. He even commented on a Thyroid problem that at least started in 2000 when I was on active duty, except that nobody ever contacted me from the MTF to tell me that my thyroid was very low....more on that later. I have recently received my DRO review letter. It seems that I've been S/C'ed for nearly everything I had initially requested, although I don't yet know what level I'm at with any of those ratings yet. The letter, with very little discussion of the reduction on my neck, just stated that I was going to be placed back at 20%, and that I would also receive at 10% incease to 20% for DDD for the lumbar region. So I think for the moment I'm generally happy with where my claim is going. However, I was denied yet again for depression, even though I've been seeing a Psychologist pretty steady for 4 years, and I recently started seeing a MTF Psychiatrist (I'm no longer worried about clearances).
In my NOD, I wrote a very lengthy explanation of my depression, and how I'd been seen at the Heidelberg Army Hospital, and that I had used my father's passing as a way not to call attention to the depression at the time. I also had my wife write a letter to state from her point of view how I have been. Now though, not only was I dealing with that initial depression, but because of the damage done to my spinal cord in my June 2008 surgery, the pain that was initially in my left arm and hand has spread to nearly all of my body. It has intensified in my Left arm and had to the point that I cannot stand even my kids touching me. I turn on it at night, and I wake up, or I never fall asleep because it hurts too much. I'm on many differnent drugs to help me sleep and several anti-depressents and anti-anxiety drugs. But apparently the VA didn't S/C my depression, because they have no records showing that I was ever treated for it; this after I told them what treatment facility I was seen at. Betweent he pain and the depression, my work is now effected signifcantly. i have a very high pressure position which demands much of me, especially in making decisions, but I out too much, and even when I'm there I feel like all I'm concentrating on is pain, since it never lets up now. Even if I didn't have depression during my A/D career, I sure have it now, after living with unrelenting pain for nearly 2 1/2 years! Still the DRO refused to S/C it! I need some advice on how to get them to understand what I'm going through.
I mentioned that I had a problem with my thryroid (low) way back in 2000, that I was never told about. Well, when my initial claim came back denied for nearly eveything, for the first time I went through every single page of my SMR. By then though, I already had found out I had hypothyroidism, thanks to the insight of my new family doc. AFter my June 2008 surgery I had to completely quite physical activity, and my weight ballooned up 75 pounds. When I went in to see him about he, ran some blood tests and immediatley put me on thyroid replacement medicine. Fast forward to about this time last year when my big brown envelope showed up. When I saw that I had not been given a fair deal, I started lookikng though every page of my record. Low and behold, I found out that I had been administered a thyroid blood test in August 2000, and had never been notified of the results, which were nearly identical to the test I had been given in August 2009. So I filed a new claim for hypothyroidism. My weight has come down some, but it's still way above where it should be,and this with a very strict diet. I take synthoid everyday now,and will for the rest of my life. I can only wonder why nobody at the military hospital notified me back when I was still active, so that I could have started the medication 8 years earlier, but that's where it is now. I was also denied S/C for insomnia, rather because of the depression, chronic pain, or hypothryroidism (which hasn't been adjudicatedyet), since it is not a disease but a symptom.
So I'm stuck in not knowing how else to make the VA understand the depression is longstanding,and it has gotten worse because of the chronic pain Ilive with daily, eventhough I tried to explain that to them. I'm sure my next step will be to appreal to the VBA. But I want to make sure my ducks are in a row, and my explanations can be substantiated. I'm sorry for such a long message, but Ihope there are some seasoned folks out there who can advise me on what to do next.
Thanks,
TCK5810
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