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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
4MR05C
Hi all,
I'm new to this website as a member; but I've been here many times to read up on stuff in regards to my claim. I have a question that I'm hoping some of the more experienced members here can help me with, because I'm concerned that my last exam, which was yesterday (yes, a Saturday) was not done correctly, or by a competent doctor.
A little background first.... I have filed my first claim (since separating from the Army in 1984) in May of 2012. There has yet to be any decision on my case.
I have been to 5 previous C&P, none of which have been on a Saturday. This was at the local QTC offices here in Atlanta. This exam was for my claim for a secondary condition of my ankles (they are painful and occasionally, I limp from not being able to put a lot of weight on them.) The primary condition is that I had a shattered sesamoid bone totally removed from my right foot (its like a ball bearing at the big toe joint) which was not replaced with anything. Over the years, I have developed a way of walking that takes the pressure off that joint by walking on the OUTSIDE of my foot and shifting my weight to the other foot whenever possible, which I contend has caused my ankle problems on both sides.
Now, on to yesterday's exam: First problem: I brought in a pair of flip flops that I have been using this summer to walk in, she refused to exam them, saying that "those are going to do that." Well, no, cause it shows a clear wear pattern on the outside of my shoe.
Second problem, she wanted to see the shoes I had just taken off, well, these shoes are relatively new as I bought them last winter/spring and have not worn them much, she looked at them (entirely disregarding me saying "I haven't worn those much" and said "There's no wear pattern here." Well, duh, I haven't worn them much!
Third problem: When she asked if I had been to doctors about this, I forgot that I had been to see the podiatrist at the VA, for my foot issues (I don't think he made any notations on my ankles, he was more interested in coming up with a custom prosthetic for the bottom of my foot.) that when she asked me if I had gone to the doctor to see about my ankle, I said "No." to which she repeatedly said to me "So they hurt but not enough to go to the doctor?" (in an incredulous tone). My ankles have an ache damn near constantly, but not sharp stabbing pains all the time AND I have a VERY high pain threshold... (I had stitches put in my hand last year and the doctor hadn't numbed my my hand properly, so for at least a couple stitches, I felt the needle go in...and out and in and out - I didn't punch the doctor or anything.. I just gritted my teeth and let him finish. He even said that he was impressed that I could tolerate such pain). so, back to the lady doctor, she rudely cut me off when i tried to tell her that I have a high pain threshold and started scribbling on her notes (my medical records were NOWHERE in sight, btw) while I was trying to talk to her.
Fourth problem: She used her hands to rotate my bare feet around and around, and kept saying "give them to me" to which I explained that she was hurting me so I was resisting her), she just kept insisting that I ""give them" to her and didn't stop trying to twist my feet around.
Fifth problem, Now, I don't know what "repetitve use test" really is, but she never asked me to do any lifting of my heels or standing on my tip toes, she just asked me to walk about 6 feet from the chair I was sitting in to the wall of the exam room and back (three trips total chair to wall, turn, back to chair, and then back to the wall). That as the extent of the repetitive use exam.
Sixth problem, she eyeballed my feet/ankles when she asked me to push them down, wasn't there supposed to be a measurement taken?
Seventh problem: She looked at my feet from the back... while I still had my shoes ON. (isn't there supposed to be an exam from the back with shoes off?
Eighth problem: She did take out the goniometer and measure when she asked me to pull my feet up, and when I did, she asked (again in an incredulous tone) "Can't you get them to go higher?" To which I said "No." Also when she was doing the measuring, (the one and only time that she actually measured anything) she measured my left foot from the outside ankle bone and the right foot from the INSIDE (with out adjusting the alignment goniometer).
Ninth problem: She asked me how my ankles affected my work to which I relied that I was a student and ddn't stand on my feet all day but I had to walk arcross campus and that I had stairs to climb, but I also said, most of the day, I sit (which is the truth). Then she asked "Well, how did it affect your previous job" to which I said "Well, I was a paralegal" and she jumped in with a "So, you sat then too." And I saw her mark a BIG "O:" with a line through it (I'm assuming this was for how my ankles affected my ability to work).
Tenth problem: She's a gynecologist!!!! How is a gynecologist supposed to rate an orthopedic problem (and no, she has never been qualified as an expert witness or anything like that for ortho, I checked on-line.)
I did have x-rays taken and the x-ray tech asked me if I had had a recent injury to my ankles because they looked swollen to her, and I said, "No, that's just the way they are, all the time."
So, now that you've read this small book... what can I do to make sure my claim is done correctly and that I am examined fairly? (Which I do not feel happened here.)
Do I even have grounds for a complaint? Should I complain now or wait until I get a decision of some sort? Any help would be greatly appreciated. Thanks!
Btw, I found this online as a guide on how to test ROm in ankles: https://www.med.unc.edu/surclerk/medselect/resources/suggested-readings-for-subspecialty-clinics/rheumatology/Foot%20exam%20reivew_11-4-09.pdf
Edited by 4MR05CLink to comment
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