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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
Berta
We all know that CUEs cannot be filed against denials that do not extend the provisions of BOD (Relative Equipoise ) because they almost always involve argument over medical opinions. The decision will say why they didnt apply BOD.:
"4.3 Resolution of reasonable doubt.
It is the defined and consistently applied policy of the Department of Veterans Affairs to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. See § 3.102 of this chapter.
[40 FR 42535, Sept. 15, 1975]" 38 CFR 4.3
However a violation of the above regulation can be filed as CUE this way.....
If the VA defies the proper application of the above regulation, as cited in M21-1MR, that is a CUE:
"a. Notifying the Claimant That the Benefit-of-the-Doubt Rule Was Considered
Whenever a claim is awarded on the basis of the benefit-of-the-doubt rule, or is supported by significant favorable evidence but nevertheless denied, in the notification letter
·54 include a discussion of the benefit-of-the-doubt rule, and
·55 describe and weigh the positive and negative evidence.
Note: If the claim is denied, it is sufficient to include a statement similar to the following: “The benefit-of-the-doubt rule does not apply because the preponderance of evidence is unfavorable.”
Reference: For more information on applying the benefit-of-the-doubt rule, see
·56 M21-1MR, Part III, Subpart iv, 2.B.6.c, and
·57 M21-1MR, Part III, Subpart iv, 2.B.7.h.
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CCYQFjAB&url=http%3A%2F%2Fwww.benefits.va.gov%2Fwarms%2Fdocs%2Fadmin21%2Fm21_1%2Fmr%2Fpart4%2Fsubptii%2Fch02%2Fch02_seca.doc&ei=ahP8VKbLOpPIsQSdpIGoAg&usg=AFQjCNGV8G-GMQt-jG9b03N563I6912Lvg&bvm=bv.87611401,d.cWc"
In my Absurd 1151 denial post, the VA ,in the decision never made any statement whatsoever that complies with anything above in M21-1MR.
I had preponderance of evidence, from VACO Cardio doctor that was part of my FTCA settlement award.
It fully stated that the VA had caused my husband's HBP to contribute to his death , due to an inappropriate prescribed medication (sudafed) in addition to an inappropriate dose of lisinopril.
The VA could have easily awarded me the 1151 claim under BOD regs above.
I have nothing in the decision to indicate that any VA medical professional even prepared the opinion they referred to.
My point is that, if you have preponderant probative evidence or even equal evidence for your claims, and VA denies , they MUST make a statement as found within M21-1MR above.
This is one of 3 CUEs so far I am asking them to CUE themselves on.
They violated (a), 54,55,56, and 57 of the above M21-1MR citation.
I have never seen any decision like this before whereby the claimant's evidence is cited, and is highly probative, ( I won a FTCA settlement due in part to this VACO report, yet they did not even refer to and cite Benefit of Doubt.
and why they did not apply it in the denial I got Saturday.
I have found 3 CUEs so far in their decision.
They cited a medical opinion, but never said who did this opinion and what their qualifications were.
It isnt even written like hundreds of VA opinions I have read over the years and is not a post humous C & P exam ( I got many of them in the past) and the VA put the doctor's name in those C & P exams in the SOCs.
I will ask the director Monday when I attach my CUE Yourself VA claim in email to her, (and to Ms Hickey)that I need a copy of the opinion and the name and qualifications of whoever prepared it.
Because I am sure the General Counsel will want to know that Buffalo has a medical entity (?)who
attempted to overrule a VACO opinion, ordered by the GC lawyer I dealt with years ago,
with a ridiculous medical rationale.
Not one single sentence in it is correct, based on the established medical and legal record VA has.
I LOLLed at one statement.
They said the veteran only had a sudafed prescription filled once by VA ( VA filled it every month by mail, (as VACO and OGC knew) and had "pre existing HBP ".
The coroner was even aware of it.
Yeah it 'pre -existed 'his death by 6 years because the VA caused the HBP...... As my evidence from VACO revealed.
I hope no one here ever had a violation of the M21-1mr application of BOD regs as I did.
I have never seen any RO do that before, here or in any BVA decision., in over 20 years as a veteran's advocate.
And I have never seen any RO opinion outweigh a VACO opinion.in this manner.
They have to award me under Relative Equipoise (BOD)
Edited by BertaGRADUATE ! Nov 2nd 2007 American Military University !
When thousands of Americans faced annihilation in the 1800s Chief
Osceola's response to his people, the Seminoles, was
simply "They(the US Army)have guns, but so do we."
Sameo to us -They (VA) have 38 CFR ,38 USC, and M21-1- but so do we.
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Berta
We all know that CUEs cannot be filed against denials that do not extend the provisions of BOD (Relative Equipoise ) because they almost always involve argument over medical opinions. The decision wil
Philip Rogers
Good post, Berta!!! pr
CBaker84
I like this post. I wish we could compile all these little gems lol. The VA did not apply the proper burden in my case. I had two IMO's (anaise / bush), dbq, medical screening all done, 15 lay
15 answers to this question
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