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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
grayling12
This is going to be long winded!
I just noticed in my VA treatment notes that my CBOC put a disruptive behavior red flag in my records. I'm pretty sure this stems from me sending 3 emails in the last month, to my PCP mentioning that I think she is making ethical violations and possibly falsifying my treatment records. I have gone to this CBOC for 12 years and have never had a problem till a month ago.
A little back ground. I had been noticing issues with my treatment notes both PCP and Mental Health for a while now. I wanted an appointment to see my PCP to discuss issues with my IBS and also to ask her to stop cutting and pasting my yearly physical notes from one year to the next. I called to make the appointment and the check in lady, who is not a medical professional, required me to go into detail about why I wanted this appointment, I had to tell her about my deep dark private medical issues, just to get passed on to the triage nurse. The triage nurse spent 20 minutes asking me about 40 unrelated questions, he then tells me, now I have to talk to my PCP nurse before I can get an appointment, but it's late Thursday and I'll have to wait till Friday.
Friday comes and I call my PCP nurse around 3pm, she then spent a full 30 minutes telling me that I don't need an appointment and all I need to do is guzzle some Pepto Bismol, and I'll be just fine. She made every effort to stonewall me and prevent medical care. I finally told her, If she was going to refuse me medical treatment then just post that in my treatment notes, she got snotty and said "I'm NOT refusing you treatment", I said " THEN MAKE THE APPOINTMENT". She told me, you have to call the front desk Monday to make the appointment. The front desk was the one that got this merry go round started in the first place. Monday comes along and I get a call from my PCP who's scolding me for not accepting her nurses road blocks, she lied to me and said she was sitting there and heard the whole conversation, so I asked her about some of the things we talked about and she didn't know what to say. I guess if a PA is going to blatantly lie to you, then you should never expect any kind of integrity from her. She agreed to the appointment and I still had to call the front desk lady that I spoke to originally. This makes 5 people over 5 days to make one simple appointment, it's a good thing I wasn't dying.
Her nurse Ratchet kept demanding to know exact details before she would approve the appointment. After the appointment was made I sent an email asking them not to put some of the things I mentioned to nurse Ratchet in my treatment notes. Surprise! They entered my email into my notes with the info I didn't want included. I took this as a slap in the face and decided to follow up the previous email with a new one explaining why the other one was sent in the first place. In this email I spelled out that I felt that my PA was unethical and possibly falsifying my records, I also requested that this email get included into my chart next to the previous one.
40 minutes later, I get a call on my way to work, telling me that my appointment was double booked and I needed to reschedule, I said I was driving and couldn't do it then. Later on I'm like wait a minute, I just sent them an email calling out my PCP now they want me to change my appointment, I'm like, this is straight retaliation. I sent another email stating that this was retaliation and I was going to fight it straight to Washington DC if I had to. I then followed that one up with an email where I said if they overbooked my slot that was scheduled for 19 days already, then they needed to reschedule the other person instead of me, and pursue disciplinary actions against the employee that made the mistake. This makes a total of 4 emails over 1 month, 1 email don't count as it was only an explanation of my phone call with her nurse. I realized a few days later that the appointment that was changed was for my therapist and not my PA, oops! I sent an email explaining that that there was confusion on my part regarding the appointments and I apologized.
A week after this I went to my mental health appointments with my therapist and my shrink. When I was checking in I asked the check in lady if I had to play the merry go round game every time I made an appointment. She was confused, so I explained what happened, her supervisor heard us talking and said "can I help you", I said "sure you can", I asked her if it was common practice now to run us through the wringer when we try to schedule an appointment. Things were peaceful at this point, She had the gall to say " we have veterans with real problems that may need to be seen ahead of you"! Their theme from the beginning from everyone was that I was trying to cut in front of someone else. I had explained to all of them that I was not having an emergency, I wasn't trying to cut in front of anyone, and I had no problem waiting till next month to get in, I said repeatedly " just plug me into a vacancy". After she put me and my medical problems down and disrespected me to my face, I raised my voice about one octave above baseline, I was louder, but not yelling and screaming. She kept escalating by telling me that there were veterans with worse problems than me, wait, what, how does she know anything about my medical issues? I don't think front desk check in supervisors are trained nurses or Dr.'s, I'm pretty sure they are simply office help.
Now I see this disruptive behavior red flag in my records, one issue out of 12 years and these nut jobs lost there minds. Basically they are saying that the four emails calling out my PCP disrupted their entire operation. This flag is basically because they consider me an annoyance because I am not accepting substandard care, disrespect by their employees and I'm calling them out on possible ethics issues. I am in fact lumped into the same category as lunatics who may be assaulting patients and threatening to kill people, nuisance patients and lunatics get lumped in together, they apparently don't distinguish between the two.
I tried calling this CBOC to see what was up with this flag, I wanted some details, not only were they no help, they kindly hung up on me. I called the Saginaw VA hospital who oversees them, with no luck, apparently they are all trained in how to initiate these flags, but no one has any info regarding them. I tried leaving a message with the patient advocate but they haven't returned my call.
I did some online research, and found some info and policies regarding these flags. Every veteran in this country should be aware of how simple it is to be flagged as a trouble maker by the VA and any of it's employees. Per VA policy, if you so much as complain to a VA employee about how long it took you to get in to see your provider, they can have you flagged for disruptive behavior, If you complain that you are receiving substandard care, flagged, you don't have to raise your voice, you don't need to be upset, just the fact that you are speaking up and advocating for yourself is enough to be flagged. If they think you are bad mouthing them online, Facebook etc., Flagged. Per their policy, in order to be accused of being violent, you don't have to say anything violent or mean, you don't have to do anything aggressive, all they have to say is that they are scared by your mere presence, Flagged as a violent lunatic! I'm sure you think I'm making this up, it can't possibly be that pathetic, sure is, per their policy. These aren't the only things that will get you flagged, If you are in excruciating pain and your PCP decides that you are a dirty little pill popper, Flagged, every VA doctor from now on is only going to see you as a dirty pill popper whether you are or not doesn't matter to them.
Apparently, since they enacted a universal policy department wide, the numbers of psycho, lunatic, violent, nuisance veterans has steadily been climbing. Is the problem that all of these veterans are just trouble makers by nature, or are they just vets that are tired of substandard care by the VA and simply advocating for themselves, and the VA is trying to silence them by labeling them as dangerous nuisances and pushing them out of the VA healthcare system. It seems the VHA wants you to accept substandard care quietly, and if you do speak up, they will put a big target on your back and try to push your face back into the mud where it belongs. This is a warning to all vets using VA healthcare, if you ever try to advocate for yourself, lookout! Review your records often.
Here's some resources, read the OIG report, it is really precious in what they consider to be disruptive behavior, basically anything you say or do to stand up for yourself will get you flagged. If you think you are immune from this, remember the numbers of flagged veterans are climbing fast, so sit down and shut up, and you will be just fine.
There is more info available on the web, I'm trying to get copies of the current policies as well.
VHA DIRECTIVE 1160.08(1)
https://www.va.gov/oig/pubs/vaoig-11-02585-129.pdf
Since I am apparently a trouble maker, I am going to fight this as long as I can.
Questions:
1. I'm not getting anywhere dealing with my local CBOC or their parent hospital. They keep just hanging up or giving me extensions that go no where. Do patient advocates have email addresses? Do they actually do anything or are they just there to give you a warm fuzzy feeling then forget about you as soon as you walk out the door?
2. My CBOC doesn't have a patient advocate , are we able to talk to the facility supervisor? Is there someone else at the local CBOC that handles these issues?
3. Is there someone at the main hospital besides a patient advocate that can deal with patient issues?
4. I plan on going to my congressman eventually since I'm pretty sure nothing is going to happen through the VA side of things. Will they expect me to exhaust all efforts through the VA first?
5. Are there online resources with VA phone numbers and/ or email addresses anyone is aware of?
I realize I am going to be fighting a corrupt bureaucracy and simply can't win over their corruption, but I'm not going down without a fight.
Thanks for any info!
P.S. I do understand that there are a lot of veterans out there that can't afford better healthcare and just accept what they have, so they simply don't question their VA healthcare. I do also believe that there are a lot of us that are simply tired of receiving substandard care. I'm also not trying to rock the boat with any VA employees on this site, I simply don't want to be crapped on anymore, someone has to take a stand against VA tyranny.
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