Justia Public Benefits Opinion Summaries

A veteran who suffered a traumatic brain injury from an improvised explosive device while deployed sought financial assistance under the Traumatic Servicemembers’ Group Life Insurance (TSGLI) program after experiencing a stroke within two years of the injury. The Army denied his claim, determining the stroke was a physical illness or disease, not a qualifying traumatic injury as defined by the relevant statute and regulations. The veteran then petitioned the Department of Veterans Affairs (VA) to amend its rules to include coverage for illnesses or diseases caused by explosive ordnance, arguing these conditions are analogous to those already covered under existing exceptions for injuries resulting from chemical, biological, or radiological weapons.The VA initially denied the rulemaking petition but agreed to further review as part of a program-wide assessment. After several years, extensive consultation with medical experts, and consideration of the petition and supporting materials, the VA issued a final denial. It concluded that expanding coverage to delayed illnesses or diseases linked to explosive ordnance would be inconsistent with TSGLI’s purpose, which focuses on immediate injuries, would deviate from the insurance model underlying the program, and could threaten its financial stability. The VA also found insufficient evidence of a direct causal relationship between explosive ordnance, traumatic brain injury, and downstream illnesses like stroke.The United States Court of Appeals for the Federal Circuit reviewed the VA’s denial under the highly deferential “arbitrary and capricious” standard of the Administrative Procedure Act. The court held that the VA provided a reasoned explanation addressing the petitioner’s arguments and the record, and did not act arbitrarily or capriciously. The petition for review was therefore denied. View "MCKINNEY v. SECRETARY OF VETERANS AFFAIRS " on Justia Law

James Young, a veteran who served in the military during the mid-1980s, initially filed a claim for service-connected disability benefits in 1988, alleging head injuries from an in-service car accident. The Department of Veterans Affairs (VA) regional office denied his claim in 1991, and after several years of proceedings, the Board of Veterans’ Appeals denied the claim in 1999, citing Young’s failure to appear for scheduled medical examinations. Young did not appeal the Board’s 1999 denial. Years later, in 2017, following a new claim and medical examinations, the VA granted service connection for his head injuries effective August 17, 2012.Seeking an earlier effective date linked to his original 1988 claim, Young filed a motion in 2022 with the Board to vacate its 1999 denial, alleging due process violations because the Board had failed to ensure the regional office complied with orders to search for certain records. The Board denied the motion, characterizing the alleged error as a “duty to assist error” rather than a due process error. Young appealed this denial to the United States Court of Appeals for Veterans Claims, which dismissed the appeal. The Veterans Court found that while the appeal was timely regarding the denial of the motion to vacate, such a denial was not an appealable decision under its jurisdictional statute.Upon review, the United States Court of Appeals for the Federal Circuit affirmed the Veterans Court’s dismissal. The Federal Circuit held that the Board’s denial of a motion to vacate under 38 C.F.R. § 20.1000(a), when based solely on alleged material error known at the time of the original decision, does not constitute an appealable “decision” under 38 U.S.C. § 7252. The court determined that allowing appeals from such procedural denials would undermine the statutory time bar and permit indefinite judicial review of Board decisions. View "YOUNG v. COLLINS " on Justia Law

The claimant served in the U.S. Navy and, upon his voluntary separation in 1992, received a lump sum Special Separation Benefit (SSB) under 10 U.S.C. § 1174a. Many years later, in 2017, he was awarded VA disability compensation with entitlement to a total disability rating, effective from late 2016. The Department of Veterans Affairs (VA) notified him that it would withhold a portion of his monthly disability benefits to recoup the SSB payment, which the claimant contested, arguing that SSB payments are not subject to recoupment and that the relevant statutory authority did not apply to his situation.The Board of Veterans’ Appeals found that the VA acted properly in withholding his disability compensation to recoup the SSB payment. The claimant then appealed to the United States Court of Appeals for Veterans Claims, which affirmed the Board’s decision. He sought reconsideration, asserting that the court had relied upon the wrong statutory provision. The Veterans Court granted reconsideration, but in its new decision, it again held that the relevant statute required recoupment of his SSB payment from his VA disability compensation, and affirmed the Board’s decision.The United States Court of Appeals for the Federal Circuit reviewed the statutory interpretation de novo. The court held that 10 U.S.C. § 1174(h)(2) applies to SSB payments received under 10 U.S.C. § 1174a, requiring such payments to be deducted from VA disability compensation. The court rejected the claimant’s alternative statutory interpretation, finding it inconsistent with the statutory text and structure. The court also dismissed for lack of jurisdiction arguments that were not addressed by the Veterans Court. The judgment was affirmed in part and dismissed in part. View "COLAGE v. COLLINS " on Justia Law

Edward Amezquita, a U.S. Navy veteran, appealed a decision denying service connection for his left shoulder disability. Prior to his service entrance examination in June 2003, Amezquita had undergone Bankart repair surgery on his left shoulder due to a motor vehicle accident. The service entrance examination noted the surgery but stated he was asymptomatic with no physical limitations. Amezquita served from July 2003 to March 2005. Shortly before his separation, he reported a shoulder injury, which was diagnosed as a sprain. In June 2005, he filed a claim for service connection for his left shoulder disability, which was denied by the VA in September 2005, citing no evidence of aggravation due to service.The Board of Veterans’ Appeals denied Amezquita’s claim in August 2021, finding that the presumption of soundness did not apply because his preexisting condition was noted upon service entry. The Board analyzed the claim under the aggravation standard and found no evidence of in-service aggravation. Amezquita appealed to the U.S. Court of Appeals for Veterans Claims, arguing that his asymptomatic condition should not be considered a noted defect. The Veterans Court affirmed the Board’s decision, relying on precedent that an asymptomatic condition can be noted as a preexisting defect.The United States Court of Appeals for the Federal Circuit reviewed the case. The court affirmed the Veterans Court’s interpretation that an asymptomatic condition can be noted as a preexisting defect under 38 U.S.C. § 1111. The court dismissed Amezquita’s arguments regarding the factual determination that his condition was resolved upon service entry, as it lacked jurisdiction to review factual findings. The decision was affirmed in part and dismissed in part. View "AMEZQUITA v. COLLINS " on Justia Law

Petitioners, veterans Joshua Bufkin and Norman Thornton, applied for service-connected PTSD disability benefits from the Department of Veterans Affairs (VA). Bufkin's claim was denied due to insufficient evidence linking his PTSD to his military service. Thornton, who already received benefits, sought an increased disability rating, which the VA denied. Both cases were reviewed de novo by the Board of Veterans’ Appeals, which upheld the VA's decisions. Bufkin and Thornton then appealed to the U.S. Court of Appeals for Veterans Claims, arguing that the evidence was in "approximate balance" and they were entitled to the benefit of the doubt.The Veterans Court affirmed the Board's decisions, finding no clear error in the approximate-balance determinations. Petitioners appealed to the Federal Circuit, challenging the Veterans Court's interpretation of 38 U.S.C. §7261(b)(1). They argued that the Veterans Court should review the entire record de novo to determine if the evidence was in approximate balance. The Federal Circuit rejected this argument and affirmed the Veterans Court's decisions.The Supreme Court of the United States reviewed the case and held that the VA's determination of whether evidence is in "approximate balance" is predominantly a factual determination, subject to clear-error review. The Court clarified that the Veterans Court must review the VA's application of the benefit-of-the-doubt rule using the same standards as other determinations: de novo for legal issues and clear error for factual issues. The judgment of the Federal Circuit was affirmed. View "Bufkin v. Collins" on Justia Law

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