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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
USNDW
After calling the Claims Management Office, and them getting the DRO who has my file for over 2 years working my NOD appeal, I finally get a C&P exam for inflammatory arthritis (SeroNegative). I think they doubled in the Housebound or Aid & Attendance exam at the same time.
My wife, who is my VA Caregiver, takes me down to the VA Hospital for my exam. We get there and my wife is freaked out about the number of Veterans there trying to get care. We were just on time, not early, and as soon as we sat down they called my name. We walked into the exam room and here we go.....
The doctor introduced himself to me, shook my hand and as my wife was walking in the room he asked "who are you and why are you here"? She said that she was my wife and was there because she was my caregiver. The doc asked what a caregiver was. I started to explain and he looked at me, cut me off, and asked my why I thought I had Rheumatoid arthritis? I started to explain that I don't think I have RA, but a Rheumayologist diagnosed me with Sero Neg RA, as I was still talking he told me to ge changed into a gown, so I did and he asked the exact same question. I can barely do one thing at a time so in the middle of taking my clothes off I stopped and said, "Once again, I don't think I have RA, I have doctros who" and he cut me off again and said continue getting undressed. So my wife started to explain the diagnosis and treatments and he asked her to be quiet saying that this was my exam, not hers, he was examining me and if he wanted her input he would ask her for it.
I have problems getting things over my feet, like socks, and a knee sleeve I wear under my brace. My wife stepped up to help me take off the sleeve and the doc pretty much yelled "stop touching him" she responded that I needed help getting this sleeve off and he again went on his little spiel that this was my exam and he had to determine whether I could get my self dressed. She looked at him and told him there were things I needed help with when getting dressed and undressed and that was one of the reasons she was my caregiver.
I was done undressing at this point and he asked to hop on the table. I don't do a whole lot of hopping anymore, so my wife helped me get on the table and the doc didn't like that either. I had to ask him to pull out the leg rest because I cannot leave my right leg hanging over the edge. He asked why not and I explained I had complex regional pain syndrome, Nerve damage, and that it would be very painful to hang it over. My wife explained that I had chronic pain. The doc looked at her like she was crazy. He started his exam which was pretty lame, no measuring instruments, no recording. He asked if I had swelling and I sad yes in my hands, and he said where in your hands, I said My whole hand, he said point to it so I pointed my right index finger at my knuckles on my left hand and showed him, then he said "use your finger like a pointer and show me" I had to yell "I AM"!!
So we were done with that part and he said get dressed. My wife stood up to help me with my knee sleeve and he again went ballistic on her. She turned around and told him that I needed help with certain items, the doc responded that he would be the judge of that not her and that he needed to examine me to see if I can do these things. Once again she said he cannot get this over his foot and we already know this I take care of him everyday. The doc asked her if she felt insulted and she said yes. He recommended she go to the waiting room. I was standing basically in disbelief. This examiner was treating both of us like idiots and wasn't listening to a freakin word we were telling him. She sat down in the chair and he asked her to go to the waiting room, I told her go ahead, knowing that this freakin crazy ass doc could make comments in a report that might hurt our benefits.
When she stepped out he asked if she was mad at him so I told him she was because you are not listening to us. He looked at me and said you did it though. I asked what did I do, and he said got dressed by yourself. I explained that no I hadn't my wife had placed the sleeve over my foot, and he said it again, "see, you did it all alone" so I raised my voice and said "did you hear me? I just told you that she helped me and you are not listening to what I am telling you". Apparently that finally got his attention and he began asking real medical questions. I told him to refer to my chart and records from my file. He said he didn't have a file, all he had was access to my VAMC records which are scant because I use private care.
I explained that the RO should have sent him my file to review and that in the file there were records to support the diagnosis of SeroNeg RA, and treatment records, along with all the testing, lab work, X-rays, MRI's and a Nuclear Bone scan that showed turnover in every joint. This really got his attention. He asked if I had any of those records and I began handing him the records I brought that verified all this and records from several other doctors who agreed with the diagnosis and treatment. He made copies and then started asking about my medical history and medications.
It wasn't until that point that he actuall acted like a doctor. He said he had not received any file on me but he would look for one. I went to the Nurse to get vital, BP 160/105, getting ready to stroke out. My wife is in the hallway crying with a couple of Veterans comforting her and telling her to go the patient advocate's office, which she did. While I went to X-ray and labs she went to speak with them.
I guess she got someones attention because the next morning the C&P Department Head physician called me and asked me what happened. I tried to retell the story as well as I could and she was shocked. She apologized more than once and then explained that this examiner was not even a C&P examiner, he worked in Rheumatology and she really didn't even know who he was, but she kept apologizing. Finally after much discussion we came to the conclusion that he did not know he was supposed to have my C file and the only thing he saw was the very few records the VAMC has which has nothing about arthritis and my other medical conditions. She informed me she would track down his report, find my C file, get the X-ray and lab reports, review my medical records to determine the question as whether I have SeroNeg RA and if I do need aid and attendance. I explained that my wife was approved to be mu caregiver and those qualifications are more strict than Aid and Attendance. She agreed and said she would let me know if she needed anything else.
So, the point is, if the doc hadn't been a jackass, and if he had just been polite and performed a routine exam, there is no way he would ever have saw my medical records, and there certainly is no way that the C&P Chief would have became involved in the case. I am not going to tell him thank you for being an A-hole to my wife, actually I filed a complaint with the Senators office and they were on top of that.
Beware of exams where the examiners don't have your records. Never assume they do, because they might not.
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boomer2
Sorry to hear you got a JERK for a Doc. Your wife did the right thing by going to the Patient Advocate and you filing a complaint with your Congressman. We need to do more of this and do it on a regul
AFMedic09
I am just so sorry for your experience. My heart broke reading your post. Certainly it has turned out for the better, but to have to go through that - I can't even imagine. For your blood pressure to
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