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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
Dan1865
Hi All,
I filed a claim for benefits on Feb 4, 2020 and am still waiting for a decision! Here is what I claimed and will explain.
1. VA 1151- I was diagnosed with appendicitis at the VA hospital. Then said it was an emergency and surgery needed to happen ASAP. Thirty-four hours later they performed the surgery. The student surgeon was allowed to perform the surgery by himself with no attending surgeon present. The student messed up and almost killed me. He ended up leaving almost 5cm of a 6cm organ in my body. Over a 3 month period I kept on getting sick. Out of the blue, I became very ill with high fever, vomiting, and horrible abdominal pains. Went back to ER and they discovered I had appendicitis again. This is when they found out the organ was leaking and in tack. The surgeons tried to say it was a mistake on the CT exam.
I went into the OR for a second surgery. They had to abort the surgery due to the lack of instruments. 10 days later I had a 3rd surgery. In the end, I now deal with major problems with my colon and stomach due to the constant infections. I have a rare form of chronic colitis. I have submitted everything imaginable to the VA. I have a nexus letters from 2 doctors who are specialists in surgery and GI. I have a Medical Opinion from a highly regarded Surgeon/Radiologist. The IMO clearly defines the many 1151 violations. The attending surgeon was also investigated by the OIG. He was terminated for allowing students to perform surgery without him present. OIG discovered that during surgeries he would not even be in the hospital, but would sign off on the surgery a day or 2 later like he was there.
2. Non Combat PTSD.
Everything is clearly documented. I have multiple buddy statements and records from this time period. They have a boatload of information; including, records from a civilian hospital suicide attempt.
3. Unemployability: I am on SSDI for the GI Issues, Mental Health, Ischemic Heart Disease. and Paraneoplastic Syndrome associated with tumors in my lungs.
I had all exams before May 20, 2020. I figured they would have given me a decision by December. My doctor told me to write my senator; which I did. They told the senators office they were waiting on employment records. I get a call in Jan telling my claim was about finished and he needed a different address for a previous employer. I explained the employer went bankrupt and there is no address. He said my decision would be completed in 30 days. The very next day I get a call from my VSO stating they scheduled me for more exams. Believe it or not, they scheduled me the same PTSD exam I had in May of 2020. It ended up being with the same doctor as the first. He said in 22 years he has never had to do the same exam on someone during the initial Claim. So, for 3 hours we went over the first exam report. He made changes and submitted it the VA. Then in middle of March I get a call from the same guy at the VA. He told me my claim was done and I should have a decision within a week. My wife and I was super excited. The lady at the senators office received a statement stating a decision was forthcoming very soon. The very next day, my VSO calls me and said they scheduled you for PTSD "rework" exam. The same doctor yet again; 3rd time now I have seen this guy. We were able to do this exam over the computer and it was only 8 mins. Then on March 23,2021 they scheduled a new exam. This exam is a record review only. I received a VES overnight stating my record review was completed on 4/8 and it gave me the Physician Assistants name. So, again I sit here and wait.
Sorry for the long post and thanks for reading. What else can I possibly due to receive a decision? My health is declining and want to make sure a decision is reached to find out what I need to do next. My ultimate goal is to hold this VA system accountable for what they did to my body. They really jacked up my stomach and colon by doing what they did on a routine surgery. My goal is to make sure that the kids are taken care of in the event something happens to me.
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Berta
sorry for typos- I am still angry and grief stricken- my husband should be alive and here at hadit, like he was on Prodigy Veteran BBS, before they malpracticed on him , and eventually killed him.
GBArmy
Dan1865 Hi; welcome to Hadit. I think your claim wins the trophy for the VA's delay tactic of the month! It is more than terrible. In any case you must wait for your decision letter in order to appeal
Berta
Anyone here with 1151 or FTCA issues can write to the bill's sponsors. This is part of my letter asking for the bill to be changed- which it was. (Sent March 2019) Please Note that some of the bi
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