Justia Public Benefits Opinion Summaries

Bell served on active duty from 1952-1954 in the Army, and from 1955-1957 in the Air Force. During service, Bell sustained a lower back injury. Years later Bell filed a VA claim for entitlement to service connection for a lumbar spine disability and received a 20% disability rating, effective March 2017. In a December 2019 internal memorandum, the agency requested an administrative review by the Director of Compensation Service on the issue of entitlement to an extra-schedular rating for Bell’s lumbar spine disability under 38 C.F.R. 3.321(b)(1); the agency recommended denying entitlement to an extra-schedular rating. The Director issued an advisory opinion denying entitlement, finding that the “lumbar spine disability picture does not demonstrate an unusual or exceptional disability pattern that would render application of the regular rating criteria impractical.” The regional office denied entitlement to an extra-schedular disability evaluation.The Board of Veterans’ Appeals the Veterans Court, and the Federal Circuit affirmed the decision. Bell “d[id] not present any argument, under any applicable authority,” why the denial should be reversed. The regulation authorizing the Director of Compensation Service to approve an extra-schedular rating does not prohibit the Director from considering recommendations from agency officials before making this decision. View "Bell v. McDonough" on Justia Law

Bufkin served in the Air Force from 2005-2006. In 2013, he sought service connection for an acquired psychiatric disorder. VA medical records reflected his visits with a VA psychiatrist, who wrote that he met the criteria for PTSD but did not identify the specific stressor or whether the stressor related to Bufkin’s military service. The VA scheduled an examination with a VA psychiatrist, who opined that his “symptoms do not meet the diagnostic criteria for PTSD.” Bufkin filed a notice of disagreement, arguing that the favorable opinion and the unfavorable opinion were in equipoise, and therefore, VA was legally obligated to grant service connection. Bufkin underwent another VA examination with another examiner, who concluded that his symptoms did not meet the diagnostic criteria for PTSD. The VA continued its denial of service connection. While his appeal was pending, another VA psychiatrist opined that in addition to a severe anxiety disorder, Bufkin “suffers from chronic PTSD.”The Board of Appeals denied service connection, finding that the preponderance of evidence supported a finding that Bufkin does not have PTSD. The Veterans Court and Federal Circuit affirmed. There was no error in the Board’s application of the benefit of the doubt rule, 38 U.S.C. 5107(b): “[w]hen there is an approximate balance of positive and negative evidence” the Secretary “shall give the benefit of the doubt to the claimant.” The Board considered conflicting medical statements but found that the rule did not apply. View "Bufkin v. McDonough" on Justia Law

Cavaciuti served in the Army, 1965-1967. In 2020, the Board of Veterans’ Appeals granted him entitlement to a total disability rating due to individual unemployability (TDIU) and directed the VA to assign him an effective date. The VA nonetheless denied Cavaciuti’s claim, finding that he was capable of gainful employment. Cavaciuti sought a writ of mandamus. After negotiations, the VA informed the Veterans Court that it had granted Cavaciuti entitlement to TDIU with a 2008 effective date. Cavaciuti argued that the case was not moot because the RO had not invalidated its erroneous rating decision and that the VA misused confidential settlement information to render the case moot.The court dismissed Cavaciuti’s petition as moot because the VA had provided him with the relief that he sought. Cavaciuti sought attorney fees and expenses under the Equal Access to Justice Act. The Veterans Court denied the application, finding that Cavaciuti did not satisfy the criterion for prevailing party status because the dismissal order did not award benefits, change the parties’ legal relationship, or otherwise address the merits of Cavaciuti’s writ petition. The Federal Circuit affirmed. There was no judicial change in the parties' legal relationship. The VA implemented the Board’s decision, as Cavaciuti requested, following a settlement rather than based on any court order. The fact that the government’s representations would prevent future changes does not render the dismissal a judicial imprimatur sufficient to make Cavaciuti the prevailing party. View "Cavaciuti v. McDonough" on Justia Law

Perciavalle, serving in the Army from 1962-1964, injured his knee, which required surgery. The VA awarded Perciavalle a 10 percent disability for medial menisectomy under Diagnostic Code (DC) 5259 for “[c]artilage, semilunar, removal of, symptomatic.” In 1971, Perciavalle underwent another orthopedic examination. The VA did not increase Perciavalle’s disability rating. Perciavalle did not appeal. In 2015, Perciavalle requested a reopening of the 1971 rating decision for clear and unmistakable error (CUE), claiming that he was entitled to two separate disability ratings, one for slight instability of the knee under DC 52571 and another based on the 1971 examination for limitation of motion of flexion and discomfort secondary to arthritis under DC 5003-5260. Perciavalle argued that the 1971 x-ray “clearly show[ed] degenerative changes” as compared to the 1966 examination. The regulations allowed for the combination of two or more disability ratings, but stated that the evaluation of the same disability under various diagnoses is to be avoided.The Veterans Court affirmed the Board of Veterans’ Appeal’s denial of Perciavalle’s claim. The Federal Circuit vacated in part. The Board incorrectly interpreted Perciavalle’s CUE claim. Perciavalle’s CUE claim set forth the relevant facts and regulations. Under a sympathetic reading of that claim, the VA was required to “determine all potential claims raised by the evidence, applying all relevant laws and regulations.” View "Perciavalle v. McDonough" on Justia Law

Grounds served in the Army from 1969-1972. He was charged with being AWOL during three periods in 1972 (less than 180 days). To avoid a court-martial. Grounds requested to be discharged “for the good of the service,” citing marital and financial problems and stating, if he were to remain in the Army, he would continue going AWOL. Grounds was discharged “[f]or the good of the [s]ervice” and “[u]nder conditions other than [h]onorable.”In 2013, Grounds applied for veterans' benefits. The VA found his multiple periods of AWOL constituted “willful and persistent misconduct,” rendering him ineligible for benefits under 38 C.F.R. 3.12(d)(4). The Board of Veterans Appeals agreed, concluding his discharge was considered “dishonorable” for VA benefits purposes. The Federal Circuit affirmed the Veterans Court's rejection of an argument that 38 U.S.C. 5303(a) controls and cannot be superseded by 38 C.F.R. 3.12(d)(4). Section 5303(a) provides that a veteran is not eligible for benefits if he was discharged by reason of court-martial on the basis of being AWOL for a continuous period of at least 180 days. Under Federal Circuit precedent, section 5303(a) is not the exclusive test for benefits eligibility; 38 C.F.R. 3.12(d)(4) is consistent with and authorized by statute. While Grounds’ misconduct did not constitute a statutory bar to VA benefits under section 5303. the Board did not clearly err in finding that his multiple periods of AWOL constituted a regulatory bar to benefits. View "Grounds v. McDonough" on Justia Law

The VA’s Schedule for Rating Disabilities includes diagnostic codes (DCs), each with a corresponding disability rating, 38 U.S.C. 1155. A particular veteran’s disability may not clearly fall under a delineated DC. VA regulations provide: When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected but the anatomical localization and symptomatology are closely analogous. The VA considers the functions affected by ailments, the anatomical localization of the ailments, and the symptomatology of the ailments.Webb served in the Army, from 1968-1970, receiving an honorable discharge. Webb later developed service-connected prostate cancer, the treatment for which caused him to develop erectile dysfunction (ED). In 2015, Webb was assigned a non-compensable (zero percent) rating for his ED. The Schedule did not then include a diagnostic code for ED. The VA rated Webb’s disability by analogy to DC 7522, which provides a 20 percent disability rating for “[p]enis, deformity, with loss of erectile power.” The Board explained that DC 7522 required Webb to show “deformity of the penis with loss of erectile power.” Without such a deformity, he was not entitled to a compensable disability rating. The Veterans Court affirmed. The Federal Circuit vacated. The listed disease or injury to which a veteran’s unlisted condition is being rated by analogy must be only “closely related,” not identical. View "Webb v. McDonough" on Justia Law

Hampton served in the Navy from 1985-1989. In 1997, she filed a claim for VA disability compensation for migraines. In 1998, the regional office (RO) increased Hampton’s rating to 30 percent, effective from 1997. In 1999, Hampton applied for a total disability rating based on individual unemployability (TDIU) effective from 1997 due to “migraine[s], bladder, [and] reflux.” The RO denied TDIU. Hampton never filed a notice of disagreement but filed a new claim for increased compensation based on migraines. This claim was denied in 1999; Hampton filed a notice of disagreement. In 2000, the Board affirmed the RO. In 2003, Hampton filed a new claim for increased compensation and a second TDIU application. The Board ultimately granted Hampton TDIU, effective from 2003. Hampton argued that her 1999 TDIU claim was still pending because she submitted additional evidence within the one-year appeal window but never received a determination. The Board denied entitlement to an earlier effective date, finding that the 1999 TDIU claim was not still pending when Hampton filed her 2003 claims.The Veterans Court and Federal Circuit affirmed; 38 CFR 3.156(b) does not require the VA to explicitly state whether submitted evidence is new and material to a claim, where that claim is implicitly denied after consideration of the evidence. The Board’s 2020 decision, by finding the 2000 decision an implicit denial of TDIU, was not making a new and material evidence determination in the first instance. The RO did so in 1999. View "Hampton v. McDonough" on Justia Law

Frazier served in the Navy from 1988-1993. In 2008, Frazier fractured the fourth and fifth fingers of his right hand after being startled by a nightmare--according to Frazier, a frequent occurrence due to PTSD, a disability for which Frazier had been awarded service connection. The VA's examining physician noted that Frazier experienced pain in his right hand and that the injury was secondary to his PTSD but that the pain “does not result in/cause functional loss.” The Board of Veterans Appeals granted Frazier service connection for the injury; the regional office assigned a noncompensable rating for that injury,The Federal Circuit affirmed, rejecting Frazier’s argument that he was entitled to a compensable rating of 10 percent under 38 C.F.R. 4.59. That regulation provides: The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Frazier cited Diagnostic Codes 5219 and 5223, which provide 20 percent and 10 percent ratings, respectively, for unfavorable and favorable ankylosis of the ring and little fingers. The Board properly focused on Diagnostic Code 5230, which provides for a zero percent rating for limitations of motion in the little or ring fingers. Section 4.59 does not “create a freestanding painful motion disability that is always entitled to a 10% disability rating” and Frazier did not have ankylosis. View "Frazier v. McDonough" on Justia Law

Bean served in the U.S. Army from 1966-1969. In 1997, he sought disability compensation. Bean was diagnosed with major depression and generalized anxiety disorder, but not PTSD. The VA denied him entitlement to service connection for PTSD. In 2006, Bean sought service connection for major depression, generalized anxiety disorder, and PTSD. In response, the VA notified Bean that it was “working on [his] application for service-connected compensation” for major depression and generalized anxiety disorder and his “claim to reopen for” his PTSD-related claim. In 2007, he was diagnosed with PTSD and major depressive disorder. The VA found service connection for PTSD, deemed the PTSD 30% disabling, and assigned an August 2006 effective date. Bean filed a Notice of Disagreement, concerning the disability rating and effective date.In 2012, the Board of Veterans Affairs addressed Bean’s rating. Bean sought reconsideration. In 2019, the Board dismissed Bean’s appeal of the 2013 denial of his claim without addressing the merits.The Federal Circuit reversed the Veterans Court’s dismissal of the appeal for lack of jurisdiction. When a claim is adequately presented to, but is not addressed by the Board, the Board’s disposition of the appeal constitutes the Board's decision on that claim that may be appealed to the Veterans Court. The Veterans Court's jurisdiction is not limited to the Board's affirmative determinations and covers the disposition of an appeal that is challenged as improperly failing to address contentions clearly before the Board. View "Bean v. McDonough" on Justia Law

Crawford served in the U.S. Army and Florida National Guard for two decades. He was discharged in 2011 due to his service-connected PTSD. Crawford’s PTSD began after his second tour of duty in Iraq. The Florida State Surgeons Medical Discharge Review Board (SSMDRB) found Crawford did not meet medical retention standards and that his PTSD was incurred in the line of duty. It recommended a fitness determination by a Physical Evaluation Board (PEB), a prerequisite for medical retirement, 10 U.S.C. 1201. Crawford was not referred to a PEB but was discharged as if his PTSD was not service-related, without medical retirement.Crawford sought correction of his records and retroactive benefits before the Army Board for the Correction of Military Records (ABCMR). Notwithstanding the SSMDRB’s findings and the fact that Crawford was discharged for failure to meet medical retention standards, a doctor opined Crawford met retention standards at the time of his discharge. Crawford filed suit. On the government's motion, the court remanded for a fitness determination and development of the record. On remand, the ABCMR found Crawford was entitled to medical retirement based solely on the evidence available at the time of his separation and granted him complete relief, including the correction of his records and retroactive medical retirement benefits.The Federal Circuit reversed the denial of Crawford’s subsequent motion for attorneys’ fees and expenses under the Equal Access to Justice Act. Crawford was a prevailing party. View "Crawford v. United States" on Justia Law