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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
Please disregard my past information here on the issue of Independent contractors who work at VA and provide medical care to veterans.
The issue started last year when I became involved with a very usual situation, whereby a disabled veterans was seeking help,via many news outlets, and seeking anyone with past FTCA experience.
He has a bill in Congress on this ( HR 7105)-I rewrote the Bill for him only to find out that a major vet org has done the same thing.
It was suggested ,by the vet org, that his bill be incorporated into a bill I have before Congressman Roe-
But the info I found yesterday shocked me. And changed everything I posted here.I am beyond disgusted with what I learned, and will never get involved in anything like that again...it regarded the Tally case.
If you feel you have a basis for a FTCA and/or 1151 issue, you will need a strong IMO- but you will also need to find out if the doctor(s) or any medical professional you feel misdiagnosed or in any way mistreated you, to the point you have additional disability, is a federal contractor.
It might not matter if they are….but it would matter if the General Counsel told you or your lawyer they are, without any proof of that.And if they also told you these independent contractors do NOT fall under FTCA or 1151.
U.S. Code Title 38. VETERANS’ BENEFITS Part II. GENERAL BENEFITS Chapter 11. COMPENSATION FOR SERVICE-CONNECTED DISABILITY OR DEATH Subchapter VI. GENERAL COMPENSATION PROVISIONS Section 1151. Benefits for persons disabled by treatment or vocational rehabilitation”
(1)the disability or death was caused by hospital care, medical or surgical treatment, or examination furnished the veteran under any law administered by theSecretary, either by a Department employee or in a Department facility as defined in section 1701(3)(A) of this title, and the proximate cause of the disability or death was—" etc
The key statement there is "or in a Department FAcitiy"
Also:
§ 46.8 Independent contractors.
Independent contractors acting on behalf of the Department of Veterans Affairs are subject to the National Practitioner Data Bank reporting provisions of this part. In the following circumstances, VA will provide the contractor with notice that a report of a clinical privilegesaction will be filed with the National Practitioner Data Bank with a copy with the State Licensing Board in the State(s) in which the contractor is licensed and in which the facility is located: where VA terminates a contract for possible incompetence or improper professional conduct, thereby automatically revoking the contractor's clinical privileges, or where the contractor terminates the contract, thereby surrendering clinical privileges, either while under investigation relating to possible incompetence or improper professional conduct or in return for not conducting such an investigation or proceeding.
(Authority: 38 U.S.C. 5705)
https://www.federalregister.gov/documents/2002/04/23/02-9875/policy-regarding-participation-in-national-practitioner-data-bank#sectno-reference-46.8
(I have found nothing that alters or rescinds that above regulation. NPDB is the entity that the VA is supposed to contact when any type of malpractice settlement is paid by the US Treasury Dept. The info also should go to the specific state licensing board and from there it is posted on every state's Disciplined practitioners web site, for the public to know if their medical practitioner has a valid license and was ever reported to the NPDB.)
I am beyond disgust to learn that I don't not believe Mr. Tally or even his lawyer checked out the fact that the negligent doctor was or was not an independent contractor.
Also I am disgusted to realise that his lawyer seemed to fail to even research the regulations that cover independent contractors and FTCA.It is even more alarming to me that it took so long for the OGC to find out ( maybe ,maybe not true) that the doctor was an independent contractor, and that caused his Statute of Limits ran out. This was a case of bonafide established medical malpractice.
So if the VA pulls this on you or your lawyer, saying the VA is not liable for any malpractice you have suffered due to the fact that th medical entity who committed it, was Not
a VA employee, they have evidence above to fight that , and should determine as soon as they take your case, if that would be a potential defense for the VA.
I was told critical information from Mr Tally, in a phone call, on his case, and asked not to tell anyone....but the end result, of all the ways I tried to help him, brought me more questions that, often like we see here, questions that never get answered.What bothers me the most is the unanswered questions his lawyer never responded to me with.
News articles quoted his lawyer as saying:
"That's the real tragedy here, the way that current law is set up - for somebody like Brian - there is no accountability," Sturtevant said.
https://abc7news.com/health/va-misdiagnoses-and-delays-nearly-kill-socal-veteran/4451312/
But where is the accountability for his lawyer?????
I am beginning to think that FTCA/1151ers would do better to fight their cases without a lawyer-like I did....if they are willing and able to go the whole 9 yards.
What they need , more than a lawyer, is proof positive from an IMO/IME doctor that they have been malpracticed on, and that the malpractice caused them additional disability or death-meaning their surviving spouse has to file 1151/ FTCA.)
The audio at this site also reveals what the lawyer said.
I am exhausted with this whole thing- and shocked at what appears to be a 'cover up' of the facts.Same as how I found a cover up during my husband''s VA medical care, by doctors at the Syracuse VA....trying to over up the malpractice that occured at the Bath NY VA.
GRADUATE ! 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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