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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 was in a jeep accident in Vietnam in 1968 which resulted in the transverse fracture through the anatomical neck of the humerous of my left shoulder. I underwent surgery in a field hospital in Vietnam which left a large ugly ragged deep tissue scar on my left shoulder. Shortly after my discharge from the Marine Corps in 1970, I filed a claim for disability with the VA. The VA service connected my shoulder injury at 0% and I appealed their decision and provided the VA with a photograph of the scar on my shoulder. After I appealed, the VA awarded me 10% disability for residuals of fracture of left shoulder. I appealed the 10% award and underwent an exam by the VA in 1971. During the 1971 VA exam, the examining doctor stated the following in his report:
"On examination, there was a 10 and 3/4 inch slighly ragged nonlineal scar running down the anterior left shoulder and into the anterior axilla. The scar was old and well healed and not symptomatic. The veteran could go through all motions with the left shoulder, but it seemed to be somewhat stiff. He complained of pain and tenderness just posterior to the acromioclavicular joint on the left shoulder. X-ray films showed possible minimal cortical irregularity involving the metaphysial region of the left humerus, more apparent in external rotation, compatible with old, healed, remote fracture. The final diagnosis was old fracture, left upper humerus, moderate."
My scar runs from under my arm pit and goes completely over the top of my shoulder. Looking at my shoulder from the front it appears that my arm had been ripped off at the shoulder and sewed back on. The scar's width varies in width from about 3/4 inch to over an inch. Because of my scar's ugly appearance I do not go out in public without a shirt on. Even when I go swimming I always wear a t-shirt to cover the scar. I would estimate my scar covers between eight to ten square inches.
In the Statement of the Case I received from the VA in 1971, it made the following reference concerning their denial of a rating for my scar: "For a compensable rating to he assigned for scars of the shoulder, there must be poor nourishment with repeated ulceration, tenderness and pain on objective demonstration, or limitation of function of the part affected. (Codes 7803, 7804, 7805)." NOTE: Based on this statement by the VA I felt further appeal for a rating for the scar would be futile.
In the Decision paragraph of my final letter from the VA it states the following: "Entitlement to an increased rating for left shoulder disability or to an earlier effective date of the compensable rating for left shoulder disability is not established. Accordingly, thte appeal is denied."
In doing some recent research about the scars rating criteria used by the VA, I discovered the VA has changed their scars rating criteria one or more times since my claim in 1970. The most recent rating criteria I could find (Diagnostic code 7801) Burn scar(s) or scar(s) due to other causes, not of the head, face or neck, that are deep and nonlinear and cover at least 6 square inches but less than 12 square inches is entitled to a 10% rating for the scar. Based on this recent criteria, it appears that I would be rated at 10% if rated by the VA under the current criteria. NOTE: Nothing in the VA decision letter from 1971 referenced Diagnostic Code 7801. It appears the VA indicated in their decision letter that my shoulder scar did not meet any VA criteria for them to even consider a compensable rating for my shoulder.
QUESTION: Does anyone know if Diagnostic Code 7801 contained the same criteria in 1970 as it does today?
QUESTION: If Diagnostic Code 7801 did contain the same criteria in 1970, would I have a basis for a CUE since it appears Diagnostic Code 7801 was not considered in my decision?
QUESTION: If the VA used the correct Diagnostic codes and rated my scar appropriately in 1971, would I be successful in asking the VA for a review and reconsideration to now allow a compensable rating for my scar under the current Diagnostic Code 7801 criteria?
QUESTION: Should the VA have service connected my shoulder scar and at least awarded a 0% rating so the rating could be increased if the criteria changed in the future?
I really feel like I was low balled by the VA when they made the decision about my shoulder but that is water over the dam. I have had other problems with my left shoulder over the years (bursitis, arthritis, torn rotator cuff, etc.) and if I am entitled to any additional compensation for my shoulder I defintely want to file a claim for the additional compensation. Any input or suggestions hadit members can provide would be appreciated.
Georgia Papa
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