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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
OSC
November 2010 I put in a claim for PAD of my right leg, left and right carotid arterial surgeries and a couple of other things. During the waiting process I was diagnosed with DMII and I also found out about the AO presumptive court decisions for Viet Nam Navy Vets and since I had proof of “Boots on the Ground” I added a claim for the heart attack I had in 2003.
Last September I had a scheduled Roto-rooter on my right leg performed by the VA. This was the third or fourth one done so it should have been no big deal. The procedure went fine and because I was having the surgery out of state, I was to spend the night in the hospital and then fly home the next day.
The next day and a few hours before I was due to be released to fly home, my blood pressure dropped and I felt tremendous pain in my abdomen area. What they discovered was that an artery (one of the ones they had been working on the previous day) had burst and I was bleeding internally. They rushed me to emergency surgery to patch me up and I ended up spending another week in the hospital in recovery.
The doctors during that emergency surgery had to “Filet” me and I ended up with a 22cm scar as measured by the doctor who conducted a C&P exam on me 4 months later. I still have some pain in that area plus of course that new lovely scar.
Fast forward to March 2012 when I received my completed compensation package from the November 2010 claim. I received approval for SC of the 2003 IHD heart attack and DMII, but all of my PAD surgeries and procedures were denied including this one done in September.
My intentions are to seek a civilian doctor and pay for a second opinion and while I am being examined I will have them fill out the appropriate DBQs.
I am in the process of preparing my NOD for appeal, but was wondering if this would be an 1151 claim instead. In reading the past posts about 1151 claims, I’ve been unable to make the determination if this is either a standard appeal or an 1151 claim or both.
If during the appeal process, I am again denied Service Connection for PAD etc, will the raters consider an 1151 claim and then rate it as such, or can I and should I file both?
Because I receive my entire medical from the VA, I am very hesitant in filing a full Tort claim. I really don’t think that I want to have surgery performed by someone I just sued. So with that in mind, would I be able to file strictly for compensation without a tort claim if I go the 1151 route?
Thanks for listening and any help would be greatly appreciated.
OSC
60 Nephropathy w/Hypertension
60 PN Upper Left
40 PN Lower Left
40 PN Lower Right
30 IHD
20 DMII
20 PAD Lower Left
20 PAD Lower Right
10 PN Upper Right
10 Scar L/R Carotid
10 Scar Abdomen
0 Hypertension
0 Surg Rt Ring Finger
100% P&T plus SMC (K-1)
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