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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
Introduction
Disability examinations of Gulf War veterans have unique requirements because this group of veterans is eligible for compensation not only for disability due to diagnosed illnesses, but also for disability due to undiagnosed illnesses. An undiagnosed illness is established when findings are present that cannot be attributed to a known, clearly defined diagnosis, after all likely diagnostic possibilities for such abnormalities have been ruled out. Examiners should follow the guidelines in the "Handout of Instructions for Compensation and Pension Examinations" but will also need to request more laboratory tests and specialists' examinations than average in these cases.
Guidelines
1. Thoroughly review the claims file.
2. Address all conditions and symptoms specified on the examination request and also address all additional conditions and symptoms that you can elicit from the veteran during the examination, even if not specified on the request form.
3. Conduct a comprehensive general medical examination, following the AMIE General Medical Examination worksheet. For all conditions and symptoms which the General Medical Examination worksheet does not address in detail, follow the appropriate additional AMIE worksheets, and request specialists' examinations as indicated. Provide details about the onset, frequency, duration, and severity of all complaints and state what precipitates and what relieves them.
4. List all diagnosed conditions and state which symptoms, abnormal physical findings, and abnormal laboratory test results are associated with each. If all symptoms, abnormal physical findings, and abnormal laboratory test results are associated with a diagnosed condition, additional specialist examinations for diagnostic purposes are not needed. Diagnosed conditions will be handled as standard claims for service connection. Symptom-based "diagnoses" such as (but not limited to) myalgia, arthralgia, headache, and diarrhea, are not considered as diagnosed conditions for compensation purposes.
5. However, if there are symptoms, abnormal physical findings, or abnormal laboratory test results that have not been determined to be part of a known clinical diagnosis, further specialist examinations will be required to address these findings.
6. Provide the specialist with all examination reports and test results. Specify the symptoms, abnormal physical findings, and abnormal laboratory test results that have not been attributed to a known clinical diagnosis. Request that the specialist determine which of these, if any, can be attributed in this veteran to a known clinical diagnosis and which, if any, cannot be attributed in this veteran to a known clinical diagnosis.
7. After the specialists' examinations have been completed, and all laboratory test results received, make a final report providing a list of diagnosed conditions. Separately list all symptoms, abnormal physical findings, and abnormal laboratory test results that cannot be attributed to a known clinical diagnosis. Reconcile all differences among the examiners, by consultation or work group as necessary, before the examination is returned to the regional office.
http://www.vba.va.go...ms/disexm25.pdf
As I have posted many times before, I believe that it would be easier if a veteran file claims for specific conditions/disabilities that were diagnosed either in the military or shortly after discharge by a medical physician instead of filing claims for undiagnosed disorders. They both can be service connected but having in-service medical treatment and treatment after service should be a great help. This does not mean that VA will not deny your claims because VA has denied mine and my claims are still at BVA waiting for a decision.
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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