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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.- 4 replies
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RichardZ, -
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
Capt.
Hello All,
I thought it would be somewhat helpful especially to our Veterans new or old to remind all that use the VA and its prescription program that you may be entitled for reimbursements for the copays.
I became service connected and started receiving Copay notices for prescriptions that were ,,,,,in my opinion directly RELATED to the treatment of those Service Connected diseases/injuries.
My first step was to write a letter of appeal to the finance office where charges occurred which were several years worth. I listed all of the prescriptions that even possibly could be associated with the claim that were service connected and those diseases granted not long ago .
Within 2 weeks I received a phone call from the Finance dept and a very nice pleasant representative that informed me they had carefully examined my appeal and TOTALLY agreed with my concerns and said that they were changing the billing formality that affected me. Isn't is nice to have some really nice folks to deal with at the VA. Its not all bad.
While talking with her , I also asked about the reimbursetment of medications BACK TO THE EARLIEST EFFECTIVE DATE OF THE SERVICE CONNECTED DISABILITIES. She informed me ,,,YES,,,, she had already filed a request of audit of the account because of my request. Now that is splendid news and it does mean reimbursement of those funds back to the EED. I thanked her for her help and kindness and had to have another smile for yet another small victory by being persistant and patient. Life is still good and not all a major battle with the VA.
Now the audit also will include any copays for the Doctor Visits for those Service Connected Disabilities recently awarded.
I hope I can remember this correctly and someone correct me if I am wrong but I believe it is 30%or more that will start this type of process repayment. If a Vet gets to 50% THEN ALL of the Meds and Doctors Visits are taken care of.
I also hope this helps another Veteran to pursue their benefits and the correct benefits that a Veteran is entitled to. Sometimes the old saying .....You don't get it unless you ask for it applied here.
NEVER GIVE UP. God Bless, C.C.
Edited by Capt.ContaminateLink to comment
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