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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
propp3
I am rated 20% for my back condition...over 20 years now. Originally, my rating was 10% for muscular low back pain but having 2 back injuries in-service, an L3 fx, spondololothesis at L5/S1 documented, I appealed. The VA then increased my rating to 20% after the BVA appeal, and labeled it IVDS/intervertebral disc syndrome, at L5/S1 with degenerative changes. That was 1995. They never found the old L3 fx, but there was also evidence of a T12 compression fx on film, as early as my first C&P exam, Jan 1992...less than 60 days after I'd been discharged after 8 1/2 years active duty.
Later, the old L3 fx showed on film, as well as an L2 crush fx,(1997 & 1999). Then, a T11 compression fx(as well as the older T12) showed up on and MRI(2001). In 2014 I had films and another MRI at my own insistence(the VAMC said there was no need) which pretty much shows all of the above, plus new compression fx's L3, L1, T6, and facet hypertrophy and the start of foraminal stenosis at L4/L5, and L5/S1. I've also had sciatica in my left leg for near 20 years.
I asked that my rating be increased, filing in July, and got a new C&P exam in oct 2014. In Jan, 2015 I rec'd a letter denying an increase. The statement of the case now labels my condition as degenerative disc disease, L5-S1, lumbar spine, with radiculopathy left lower extremity, as 20% disabling...continued(but no increased rating). I've never been rated for the radiculopathy, the sciatica, etc...that was the point of asking for the increase...the sciatica, the new findings over the years showing all the new compression fx's, etc.
I composed a reply/argument and some additional evidence asking for BOTH, a reconsideration of their decision AND a BVA appeal. I asked(using the duty to assist) for the VA to obtain all my previous films(even those taken in-service) and send to the local VAMC, and for a comprehensive comparison study to fully document the changes over the past 20+ years: body loss height, demineralization, etc.
Am I going about this wrong???
Should I be seeking a new claim, set of claims, etc?
I mean, should I be trying to open a new claim for sciatica...DJD of the lumbar spine....DJD of the thoracic spine(because of all those new compression fx's) ? I know the VA treats the thoro-lumbar spine as 1 segment for measuring using the general formula for rating ROM.
BUT, I've always been rated by the VA for the changes/disability at L5-S1...the lumbo-sacral spine(and the lumbo-sacral articulate).
The 38CFR calls the LS spine a 'minor joint' for ratings purposes. But in other parts(The Joints) it also calls both the Lumbar and Thoracic spine/s 'minor joints, treated as major joint'...presumably for rating under arthritis, degenerative or traumatic.
I've got clear cut x-ray/imaging showing: L5/S1 changes(for which I'm rated)...AND...degenerative/arthritic changes and compression fx's in both the lumbar, and thoracic spine.
Advice? Would the VA call any new claim an attempt to pyramid? How would I show DISTINCT manifestations of each, as a separate disability...especially since the general formula treats the entire thoro-lumbar spine as one segment in measuring range of motion?
I asked my rep at the DAV but he doesn't seem to understand what I'm asking...
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pwrslm
There is a whole group of conditions for the spine that only get 1 rating. Both the neck, and the rest of the spine (thoracic, lumbar and sacrum), are rated as 2 separate joints. Here are the spine
Punisher
That's definitely something I'll have to keep in mind. I'm actually hoping that my claim for Chronic Sleep Impairment, which is in that block of "Mental Disorders" as well. In fact I have most of wh
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