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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
Continue Reading on HadIt.com-
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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
David301
Hi good afternoon, Need some help here. Wow a hard time to post this SOC. Here is the issues: I filled July 08, 2010 unfortunately through DAV which I had to invoke 2 years ago. I received 0% rating Sept. 2012, filed NOD within 2 weeks, VA came back 0% April 2013 filled new & material evidence civilian dermatologist records May 2013 with other issues for disability. I have 70% with psoriasis 30% & 10% scaring & disfigurement. This should go back to date of file 7/08/10 or date of retirement 1/01/10 like other rating % I have... I had QTC DR exam 2/16/12 the cfile exam <5% for both total body are/Exposed area. No mention of dermatitis which I filed on 7/08/10 When I had the exam I believe VA/QTC did not have all my USN medical records especially 2000-2009. I had to send my USN dermatologists records 3 times to VARO & 1 time was through US Congressman. Which I think would have proved more than 20%. 2nd QTC/C&P exam different DR 1/06/14 completely different measuring tape tries to count plaques gives up too many scalp & face.. VA award letter Feb 10, 2014 30% & 10 scaring & disfigurement nothing changed was worse on 1st C&P exam...Both exams did take pictures of area's.... Broken service had 10% for right knee meniscus tear prior which VA stopped upon reentry to USN. I did not ask for increase & DRO review which is what leads now to VBA appeal May 21, 2014 now to get Form 9 done go to WDC... I also in same situation with another decision but have time.... I read lots of advice, help & success here... Thanks final posted... Need to add NOD filed again 2/13/14 on EED should be date of retirement or date of file. I will take either, I know if file within 1 year from separation goes to date of separation or retirement...
Thanks,
David
DECISION:
Entitlement to an effective date for the 30 percent increased evaluation for psoriasis is denied'
TheeffectivedateofMayS,20l3remainsunchanged.
REASONS AND BASES:
You filed a claim for psoriasi s on 07 -21 -20 1 0 '
VAratingdecisiondated0s-23-2l:2grantedserviceconnectionforpsoriasisandassignedan
evaluation of 0 percent effective 01-01t010, the date following separation from service'
Youlrledatimelynoticeofdisagreementwiththisdecision.WeissuedyouaStatementofthe
case (Soc) on o+_t+_2013 that continued the evaluation of psoriasis at 0 percent from 01-10-
2010. You did not complete and return the vA Form 9 to substantiate your appeal'
you submitted a claim for an increased evaluation on 05-08-2013' VA rating decision dated 02-
'3-z'l4increased
the evaluation of psoriasis to 30 percent disabling effective 05-08-2013' the
date you filed Your claim'
you filed a timely notice of disagreement on 02-21-2014 and elected to participate in the
Decision Review officer program. rtris decision is based on a "de novo" review of the evidence
described.
In your statement submitted with your notice of disagreement you reported that you believed your
effective date for psoriasis at 30 percent should be from 01-01-2010' You had psoriasis that
coveredupto40percentofyourbodyfromthetimethatyouwereintheserviceuntilpresent.
you were granted a 0 percent evaluation and you filed a notice of disagreement in 09-2012' You
were not satisfied with that decision and were told to leopen your claim' Your understanding was
thatiftheclaimwasgranted,youreffectivedatewouldbe0l-01-20l0becausetheclaimwas
never closed out'
VETERANS
Treatment records from Dr. Nguyen, ppM dated 02-rr-200g showed dermatological examination
that revealed no lesions, sores or discoloration. The texture, tone, and turgor were norrnal' There
was adequate digital hair growth'
Records from Dr. Nguyen dated 03-31 -2009 showed your dermatological examination was
unremarkable.
The vA examination on 0i-26 -z'rzshowed a diagnosis of psoriasis- Treatment was with topical
costicosteroids of ress than 6 weeks d"r;,i;;. itr" lnyri"ut elxamination revealed the total body
area was less than 5;";;;"rra,n" whole body area was less than 5 percent'
Treatment note tiom Dr. camar'ro dated 09-30-2013 stated that your psoriasis was stable' The
documentea rn"Ol"utio"' *ttt topical prescriptions for dry skin'
Records from Dermatology Specialists dated 10-0g-2012 showed Sebopsoriasis; psoriasiform
plaques with micec."", .l""ftand aboJ io : p"'"t"t gS'A'ibodv surface area) distributed on the
scalp, face, elbowr, ;; chest and on",rpoio" Lack;.soles with mild hyperkeratosis' Treatment
on 02-25-2013 showed psoriasiform ptu'qt'"' with micaceous scale distributed on the scalp' face'
elbows, and groin. A few small areas ;;;; "" the back. Treatment was with topical creams'
Records from Hemet Dermatorogy aut"a t 2-27-2013 showed treatment for psoriasis on the
elbows, scalp, post ear, penis, una .y"uio*1.-rn" diagnosis was PS 5 to 10%' Treatment was
with toPical medication'
Treatment note from Dr. vadmal and Dr. Taheri dated 06-2013 showed psoriasis on the elbows'
chest, back, and penis' Treatment was with topical cream'
TheVAexaminationon0l-06-zL|4revealedadiagnosisofpsoriasis.Theconditioncaused
scarring described as visible lesions "; ,-""t" iu".,"urra chin. Treatment was with oral or topical
medications in the past 12 months. T;;;i;il was with topical corticosteroids' The examiner
reported the total bfdy area was 5 p"t"*' U* less than ZO p"t"""t' The total exposed area was 20
percent but less than 40 Percent'
Entitlement to an earlier effective date prior to 05-0g-20r3 for the 30 percent evaluation is not
warranted. The provisions of 3g cFR i.+oo (0) provide, ,'u,,'" effective date shall be the date
of receipt or.rui- o, ih" du,. entitlement uror", whicnever i, tut"'' If the increase occurred within
one year prior to ,ft"'i"" of claim, ,h";;;;;";e shali be the date the increase was factually
ascertainable. If the increase o".,,.r.1 ut", irr" dat. of ciuim, the increase shall be the date of
claim.
The ava'able medical evidence fa'ed to show your disab'ity met the 30 percent evaluation
criteria prior to the2014VA examiriiti"t. si"l" th":Y;;tt was showrafter the date you filed
your claim, tr-r" .ii""iive date of 05-08-2013 was assigned' Although your claim had been
Vt I TKANb
continuouslr-prtrsecure; since 1.',ur raring in l01l. n'e sent )'ou a Statement of the Case (SOC)
and based on De \or.. Revie*lthe evaluation of 0 percent was continued because the available
medical evidence ar rhar rime t-ailed to shorv your disability met the 30 percent evaluation criteria.
The earliest date that it rras t-actuall-v ascertainable that your disability met the 30 percent
er,aluation criteria w.as the date of the VA examination on 01-06-2014 therefore the effective date
of 05-08-2013 was assigned as the date you filed your claim'
The 30 percent evaluation is assigned based on 20 to 40 percent ofthe exposed areas affected.
Additional symptom(s) include:
. At least 5 percent, but less than 20 pefcent, of the entire body affected
. No more than topical therapy required during the past 12-month period
A higher evaluation of 60 percent is not warranted unless there is:
. More than 40 percent of the entire body affected; or,
. More than 40 percent of the exposed areas of the body affected; or,
. Constant or near-constant systemic therapy such as corticosteroids or other
immunosuppressive drugs required during the past 12-month period
Note: Systemic Therapy must consist of corticosteroids or other immunosuppressive drugs
Corticosteroids are anti-inflammatory drugs that are synthetic derivatives of the natural steroid,
cortisol, which is produced by the adrenal glands. They are called "systemic" steroids if taken by
mouth or given by injection u, oppor.d to topical corticosteroids, which are applied directly to the
skin. Corticosteroids that are applied topically are not considered systemic for VA pulposes
Edited by David301Link to comment
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