VETERANS (VA) BENEFITS LAW
Lyles v. Shulkin, 29 Vet.App. 107 (Nov. 29, 2017)
HELD: “[E]valuation of a knee disability under DCs 5257 or 5261 or both does not, as a matter of law, preclude separate evaluation of a meniscal disability of the same knee under DC 5258 or 5259, and vice versa.” Entitlement to a separate rating depends on whether the symptoms have already been compensated under another DC. For musculoskeletal conditions based on limited motion, a symptom has not been compensated if it “did not result in an elevation of the evaluation under 38 C.F.R. §§ 4.40 and 4.45 pursuant to the principles set forth in DeLuca v. Brown, 8 Vet.App. 202 (1995).”
SUMMARY: Thomas Lyles sought an increased rating for residuals of his service-connected left knee disability, which was rated 30% under DC 5257 for instability. After ten years of appeals, he was finally granted an additional 30% rating under DC 5261, based on limited extension. He appealed to the Court, which remanded for the Board to address whether he was entitled to an additional separate rating under DC 5258 (dislocated semilunar cartilage) or 5259 (removed and symptomatic semilunar cartilage).
The Board obtained a new VA joints examination in which the examiner noted objective evidence of pain, tenderness, and crepitus, but concluded that he could not offer an opinion as to whether pain, weakness, fatigability, etc., resulted in additional functional loss because there was “no objective evidence” to support such loss. The Board denied an additional rating, finding that his additional symptoms were “already ‘encompassed’ by his current evaluations under DCs 5257 and 5261.” The Board determined that Mr. Lyles was not entitled to a higher rating under DeLucabecause there was “no clinical evidence” of further impairment and the VA examiners “‘could not say without resort to mere speculation what such impairment would be.’” The Board concluded that an additional rating would violate the rule against pyramiding, and denied the claim.
On appeal to the Court, Mr. Lyles argued that the plain language DCs 5257 and 5261 shows that they only cover instability and limited extension, and do not include not all the manifestations of his left knee disability – popping, locking, grinding, pain, and swelling. He acknowledged that VA mayconsider these symptoms under DC 5261, pursuant to DeLuca, but that those manifestations had not been compensated in his case. The Secretary argued that his left knee symptoms had already been considered under DC 5261 and could not be rated again under DC 5258 or 5259.
The issue before the Court was whether “evaluation of a knee disability under DC 5257 or 5261 preclude, as a matter of law, separate evaluation of a meniscal disability of the same knee under DC 5258 or 5259.” The Court held that it does not.
DC 5257 covers “recurrent subluxation or lateral instability” and DC 5261 covers limitation of leg extension. See 38 C.F.R. § 4.71a. DC 5258 provides a 20% rating for “cartilage, semilunar, dislocated, with frequent episodes of ‘locking,’ pain, and effusion into the joint.” DC 5259 provides a 10% rating for “cartilage, semilunar, removal of, symptomatic.” Id.
The Court found that the plain language of 38 C.F.R. § 4.71a “does not expressly prohibit separate evaluation under DC 5257 or 5261 and a meniscal DC,” Lyles, 29 Vet.App, at 114(citing Esteban v. Brown, 6 Vet.App. 259, 261 (1994) (examining separate ratings under scar DCs) and Yonek v. Shinseki, 722 F.3d 1355, 1358 (Fed. Cir. 2013) (regarding separate ratings under musculoskeletal DCs)). The Court noted that VA’s rating schedule “is replete with rules that prohibit separate evaluations of other disabilities,” such as 38 C.F.R. § 4.96 (prohibiting separate ratings of specific respiratory conditions), § 4.113 (regarding rating digestive conditions), § 4.115 (prohibiting separate ratings for heart conditions and nephritis). Id. The Secretary’s demonstrated ability to “craft regulations that expressly forbid” separate ratings strongly suggests that the absence of such language in § 4.71a “must be read as a deliberate decision to permit separate evaluation.” Id. at 115.
The Court briefly explored the regulatory history of § 4.71a, and held that the language of the regulation, its history, and the surrounding regulations “unambiguously reflect that evaluation of a knee disability under DC 5257 or 5261 does not preclude, as a matter of law, separate evaluation of a meniscal disability of that same knee under DC 5258 or 5259,” and vice versa.
As to whether Mr. Lyles’ symptoms have already been compensated, the Court found that DC 5257 “compensates veterans only for knee impairment resulting in recurrent subluxation and lateral instability,” and thus reversed the Board’s determination that this DC also compensated him for pain and swelling.
Because DC 5261 is based on limitation of motion, the Court discussed the relevant regulations pertaining to rating musculoskeletal conditions based on limitation of motion – 38 C.F.R. §§ 4.40, 4.45, and 4.59. These regulations provide for higher ratings where there is evidence of (1) functional loss due to pain and other factors, (2) reduction of normal movement, or (3) an “actually painful, unstable, or malaligned” joint. *13 (citing Mitchell v. Shinseki, 25 Vet.App. 32, 36-37 (2011); DeLuca, 8 Vet.App. 205-07; Southall-Norman v. McDonald, 28 Vet.App. 346, 352 (2016); and Petitti v. McDonald, 27 Vet.App. 415, 425 (2015)). Lyles, 29 Vet.App. at 117-18.
The Court stated that the purpose of the rating schedule “is to ensure that a claimant is properly compensated, but not overcompensated, for the actual level of impairment.” Id. at 118. Mr. Lyles conceded, and the Court agreed, that each of his additional symptoms couldbe compensated under DC 5261 – by assigning a higher rating pursuant to DeLucaand §§ 4.40, 4.45, and 4.59. The Court found, however, that the Board’s discussion of §§ 4.40 and 4.45 demonstrates that these symptoms have not been compensated in Mr. Lyles’ case. The Court based this determination on the Board’s “failure to address whether swelling, popping, locking, or grinding caused additional functional limitation” that would result in a higher rating under DC 5261 and DeLuca, and the Board’s improper reliance on medical opinions in which the examiners refused to offer the requested opinions regarding additional functional limitation during flare-ups. Lyles, 29 Vet.App. at 419-20 (citing Sharp v. Shulkin, 29 Vet.App. 26, 36 (2017)).
The Court remanded for the Board to determine whether a separate evaluation is warranted under DC 5258 or 5259.
Advocacy Note: Lylesdemonstrates how VA’s own regulations – 38 C.F.R. §§ 4.40, 4.45, 4.59 – require adjudicators to assess additional functional loss based on limited motion or painful motion. The Court has repeatedly admonished VA for not complying with its own regulations when rating musculoskeletal conditions, and the cases cited in Lyles reflect this history.
Gray v. Secy of Veterans Affairs, 875 F.3d 1102 (Fed. Cir. Nov. 16, 2017)
HELD: The Federal Circuit lacks jurisdiction to review VA’s policy manual revisions that exclude Navy personnel who served outside the “inland waterways” – including ports, harbors, and open-water bays – because the M21-1 policy manual is merely “guidance to VA adjudicators” and “lacks the force and effect of law.”
SUMMARY: Robert Gray is a Blue Water Navy veteran who challenged VA’s exclusion of Da Nang Harbor from its definition of “inland waterways” for purposes of presumptive service connection for conditions related to herbicide (Agent Orange) exposure. The Veterans Court concluded that VA’s definition was “both inconsistent with the regulatory purpose and irrational,” and remanded for VA to “reevaluate its definition of ‘inland waterway’ to be consistent with [38 C.F.R.] § 3.307(a)(6)(iii),” the regulation governing the presumption of herbicide exposure.
Instead of amending the regulation – which would have required notice-and-comment rulemaking – VA amended its M21-1 policy manual with language that continued “to exclude all Navy personnel who served … in [Vietnam’s] ports, harbors, and open waters  from presumptive service connection for diseases or illnesses connected with exposure to Agent Orange.”
Mr. Gray challenged the amendment to VA’s policy under 38 U.S.C. § 502, which governs judicial review of rules and regulations. This statute limits the Federal Circuit’s jurisdiction to agency actions that are subject to two provisions of the Administrative Procedure Act – 5 U.S.C. § 552(a)(1) and § 553. The question in this appeal is whether the revision to the M21-1 falls under § 552(a)(1). The Federal Circuit held that it did not.
This provision covers agency actions that are published in the Federal Register and are “substantive rules of general applicability as authorized by law, and statements of general policy or interpretations of general applicability formulated and adopted by the agency.” In other words – notice-and-comment rulemaking. The Federal Circuit stated that there are three factors to consider in assessing “whether an agency action constitutes substantive rulemaking … (1) the [a]gency’s own characteristics of the action; (2) whether the action was published in the Federal Register or the Code of Federal Regulations; and (3) whether the action has binding effects on private parties or on the agency.” (quoting Disabled Am. Veterans v. Sec’y of Veterans Affairs, 859 F.3d 1072, 1077 (Fed. Cir. 2017).
The Court found that the M21-1 is meant to guide VA adjudicators, but “is not intended to establish substantive rules.” The Court noted that the Board is not bound by the M21-1 – and thus “where the action is not binding on private parties or the agency itself, we have no jurisdiction to review it.”
The Court found that Mr. Gray – and his fellow Blue Water Navy Veterans – still had other options to pursue. First, if they are “adversely affected by a M21-1” provision, they can challenge that provision on direct appeal. Second, they can petition VA for rulemaking. (Mr. Gray pointed out that both options were currently pending.) The Court recognized that it would likely take years for “individual adjudications or petitions for rulemaking” to run their course. Unfortunately, the sad reality of this situation does not change the Federal Circuit’s jurisdiction.
In a partial dissent, Judge Dyk argued that DAV was wrongly decided and that it unnecessarily narrows the Court’s jurisdiction. In Judge Dyk’s view, the “relevant question for jurisdictional purposes … is whether the Manual revisions here are properly characterized as ‘statements of general policy or interpretations of general applicability.” If so, the Federal Circuit would have jurisdiction to review the challenge. The problem with DAV (and, now, the majority opinion in this case), is that it essentially enables VA to evade judicial review by simply not publishing the revision in the Federal Register.
Nov. 10, 2017 - University of Missouri School of Law, Columbia, MO
Modern Warfare: Challenges Arising from the Gulf War and the War on Terror
ABK will present on "Environmental Challenges: Burn Pits."
LINK TO PROGRAM: http://law.missouri.edu/faculty/symposia/veterans-clinic-symposium/
James v. Shulkin, 29 Vet.App. 127 (per curiam order) (Oct. 30, 2017)
HELD: Notice of Appeal that is timely placed in a personal mailbox, but not picked up by the mail carrier prior to the expiration of the 120-day deadline, is not an “extraordinary circumstance” beyond one’s control that warrants equitable tolling.
SUMMARY: Mr. James sought to appeal a January 28, 2016 Board decision. On the last day to file his Notice of Appeal, he placed the NOA in his personal mailbox, raised the flag to alert his mail carrier to pick up the mail, and left town for the weekend. When he returned, the flag had been lowered, but the NOA had not been picked up. He mailed the NOA four days after the 120-day deadline.
The Court rejected his NOA as untimely and found that the circumstances of his case did not warrant equitable tolling. Mr. James argued that the “errantly lowered flag on his residential mailbox constitutes an extraordinary circumstance beyond his control” and that the diligence required here should be the same type of diligence required in cases where the veteran files his NOA on time, but in the wrong place.
The Court disagreed that this situation was the same as the “timely misfiled” cases because he did not timely misfile his NOA – he placed the NOA in his personal mailbox on time and then left town. He filed the NOA 4 days late. The Court found that “a fallen mailbox flag is not an extraordinary circumstance beyond the appellant’s control that warrants equitable tolling, but rather an ordinary hazard of last-minute mailing that could have been avoided but for the appellant’s ‘garden-variety neglect.’”
Judge Greenberg dissented, asserting that by placing his NOA in the mailbox on the 120th day, the appellant “did everything required of him to ensure timely mailing under 38 U.S.C. § 7266.” Judge Greenberg stated that it is “irrelevant that there were other methods of mailing available, as his actions would have likely been sufficient to ensure timely mailing but for circumstances beyond his control” – and noted that the majority was imposing requirements on veterans beyond what is required by statute or at common law. Judge Greenberg stated that the majority was relying on “decades-old caselaw” to find Mr. James’s mailing amounted to “garden variety negligence” – and reminded the majority that Henderson v. Shinseki“and the repeated admonishments from the Federal Circuit for denying equitable tolling have changed the fundamental approach to the timely filing requirements.” (citing 562 U.S. 428, 441-42 (2011)). The Judge urged the Court to “start applying its equitable powers more broadly.”
[NOTE: This case was appealed to the Federal Circuit on Dec. 6, 2017.]
Mead v. Shulkin, 29 Vet.App. 159 (per curiam order) (Oct. 27, 2017)
HELD: To warrant equitable tolling of the 30-day deadline to file an EAJA application, a claimant must demonstrate that physical or mental illness, individually or in combination, rendered “one incapable of handling one’s own affairs or rational thought and decisionmaking,” and thus “directly or indirectly” prevented the timely filing of the EAJA application.
SUMMARY: The attorney in this case filed an application for fees under the Equal Access to Justice Act (EAJA) 52 days late. The Court ordered her to explain why the application should not be dismissed as untimely. She admitted that she mistakenly believed she had 60 days to file her EAJA application. However, she explained to the Court that during the appeal, she had been seen for suspected cancer, underwent testing and outpatient surgery, and was under the care of a psychiatrist. She submitted her opposed EAJA application 52 days late – and the Court ordered her to provide additional information regarding the medical procedures and mental health diagnosis. She declined, stating that it would be a privacy violation and would set “an unfortunate precedent that calls into question the integrity of advocates practicing before this Court.”
The Court explained that the 30-day deadline to file an EAJA application is subject to equitable tolling “if it is established that some ‘extraordinary circumstance’ prevented a timely filing, and that despite the circumstance the applicant pursued her rights diligently.” The Court found that the attorney had not demonstrated that “her physical or mental health singly or in combination directly or indirectlyprevented her from timely filing her EAJA application within the 30-day period.” (emphasis in original). The Court noted that she had outpatient surgery 2 days into the 30-day filing period and was on anti-depressants during the appeal, but found that she did not “allege that these problems rendered her incapable of rational thought or decisionmaking, and she declined to provide opinions from her medical care providers as to her abilities during the 30-day EAJA filing period.” The Court further noted that she had mistakenly thought she had 60 days to file the application – which it characterized as “the type of garden variety neglect not contemplated by equitable tolling.”
Regarding the attorney’s privacy concerns, the Court stated that she could ask the Court to lock the record. The Court added that it “had not required anything more of counsel than it requires of a veteran seeking equitable tolling of a deadline” – and dismissed the application as untimely.
Judge Greenberg dissented on two grounds. First, he would have found that the attorney’s “potentially life-threatening illness” amounted to an extraordinary circumstance and that she was diligent in her representation during this time. Second, he challenged the Court’s Internal Operating Procedures that allowed for review of a single-judge decision by two judges as a violation of 38 U.S.C. § 7245(c)(1). This statute states: “A majority of the judges of the Court shall constitute a quorum for the transaction of the business of the Court.”
In this case, Judge Greenberg had granted equitable tolling in a single-judge order – but two other judges disagreed and called the decision to panel. At that time, there were six active judges on the Court. Judge Greenberg argued that “sending a matter for precedential panel disposition constituted ‘business of the Court’ that should have required a 4 vote majority” – and that “[s]ubjecting an individual Judge’s equitable tolling discretion to panel review is inconsistent with the IOP itself” and with the basic tenets of equity jurisprudence. He concluded that “[a] process that allows for a single Judge’s veteran-friendly decision to be overturned merely because two other Judges disagreed goes against the intent of Congress in creating our Court, which was to ‘place a thumb on the scale in the veteran’s favor in the course of administrative and judicial review of VA decisions.’” (quoting Henderson v. Shinseki, 562 U.S. 428, 440 (2011)).
Sucic v. Shulkin, 29 Vet.App. 121 (per curiam order) (Oct. 26, 2017)
HELD: A child of a deceased veteran is eligible for substitution only if he/she meets VA’s definition of “child” at the time of the veteran’s death – not just during the pendency of the veteran’s claim.
SUMMARY: The veteran was granted service connection for PTSD in 2007, effective 2003. He appealed for an earlier the effective date all the way up to the Federal Circuit. In February 2016, the Federal Circuit reversed the Veterans Court’s decision and remanded the matter for the Court to consider a 1992 effective date. In May 2016, the CAVC remanded the issue to the Board.
In August 2016, the veteran’s attorney notified the Court that the veteran had died in April 2016 and requested substitution of his three adult children. The attorney acknowledged that the “children” were now adults – but argued that the Court should allow them to be substituted because this appeal involves the effective date of PTSD for the period from 1992 to 2003, and the veteran’s children were minors for all or part of this time period.
The Court disagreed – and held that in order to be substituted “an individual must satisfy the requirements of the statutory framework for these benefits when the veteran dies as opposed to at some point during the pendency of the veteran’s claim.” VA defines an eligible “child” as one who is unmarried and under 18 or “became permanently incapable of self-support” prior to age 18 or who is under age 23 and a full-time student. 38 U.S.C. § 101(4)(A). The Court held: “A child of a deceased veteran is therefore eligible for substitution only if he or she satisfies the definition of 38 U.S.C. § 101(4)(A) ‘upon the death’ of the veteran.” Because none of the adult children met VA’s definition of eligible “child” at the time of the veteran’s death, the Court denied the motion to substitute.
Oct. 13, 2017 - St. Petersburg, FL
nova 2017 Fall Conference
ABK presentation - Analyzing a BVA Decision: Identifying Issues and Making Decisions on How to Proceed
LINK TO PROGRAM: https://vetadvocates.org/2017-fall-conference/
Urban v. Shulkin, 29 Vet.App. 82 (Sept. 18, 2017)
HELD: When assigning a single disability rating for co-existing respiratory conditions, 38 C.F.R. § 4.96(a) allows VA to (1) determine which disability is predominant and then (2) evaluate the overall severity of the multiple conditions under the diagnostic criteria for the predominant disability. The fact that the non-predominant disability may cause symptoms that are not listed in the diagnostic criteria for the predominant disability does not automatically warrant a higher rating.
SUMMARY: Mr. Urban is service connected for obstructive sleep apnea (OSA) and asthma, evaluated as 60% disabling under the Diagnostic Code (DC) for asthma since that DC results in a higher rating than the DC for OSA. He appealed for a higher rating, arguing that although he was entitled to a 60% rating under the DC for asthma, he should be rated 100% because his OSA required the use of a CPAP machine and caused him to be tired during the day – two factors that are not part of the 60% rating.
The Board denied the higher rating based on 38 C.F.R. § 4.96(a), which precludes separate evaluations for certain listed respiratory conditions, including asthma and OSA.
On appeal to the Veterans Court, Mr. Urban argued that the specific criteria for the higher evaluation listed in the predominant disability’s DC need not be met – and that symptoms in the non-predominant disability can warrant a higher rating. The Secretary argued that a higher rating is warranted only when the criteria listed in the DC for the predominant disability are met. Mr. Urban also argued that the Board erred when it denied referral for extraschedular consideration under 38 C.F.R. § 3.321 “because the availability of a higher scheduler evaluation does not prevent extraschedular referral.” The Secretary conceded that the Board may have erred in suggesting that referral was not warranted because of the availability of a higher rating, but argued that the error was harmless because the Board’s overall extraschedular assessment was adequate.
The Court agreed with the Secretary. Under § 4.96(a), certain listed respiratory conditions cannot be combined, and are instead rated under the DC “which reflects the predominant disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation.” The Court noted that the language at issue in this appeal is the meaning of “where the severity of the overall disability warrants such elevation.” The Secretary argued that after determining which disability is predominant, VA then must apply the DC for that disability, “considering all of the signs and symptoms attributable to either one or both of those disabilities.” Mr. Urban agreed that the phrase requires VA to look at the symptoms of both disabilities and evaluated them under DC 6602, but argued that “his symptoms need not match the criteria for a higher evaluation listed in DC 6602 to obtain a higher evaluation under § 4.96(a) and that OSA symptoms not listed in DC 6602 may nevertheless form the basis of a higher evaluation under that DC.”
The Court found that the language in § 4.96(a) was ambiguous and thus deferred to the Secretary’s “reasonable” interpretation of the phrase “with elevation to the next higher evaluation” to refer to the “next higher evaluation level of the predominant disability DC.” To attain the higher rating, “the criteria listed in that evaluation level are key to assessing the severity of the overall disability from both respiratory conditions.” The Court found that this interpretation allows VA “to assess the overall symptoms of the coexisting respiratory conditions against the criteria listed in the predominant disability’s DC.” The Court found the interpretation to be consistent with the plain language of the regulation, as well as with its purpose within VA’s regulatory scheme (“to avoid duplicate compensation payments for the same symptoms,” i.e., “pyramiding”).
Goodman v. Shulkin, 870 F.3d 1383 (Fed. Cir. Sept. 18, 2017)
HELD: VA adjudicators may rely on a medical examiner’s opinion as to whether a condition is a medically unexplained multi-symptom illness (MUCMI). However, these decisions are not precedential and do not prevent other veterans from establishing entitlement to service connection for the same condition as a MUCMI under 38 C.F.R. § 3.317.
SUMMARY: Prezell Goodman served in the U.S. Army from 1972 to 1992, including service in Southwest Asia during the Persian Gulf War. His service medical records were negative for rheumatoid arthritis and he did not report joint pain at separation. In 2007, he was treated for hand stiffness and knee pain, which he said began in service. Shortly after this treatment, he filed a claim for service connection for rheumatoid arthritis. The RO and the Board denied the claim.
He appealed to the Veterans Court, and the parties entered into a Joint Motion to Remand the appeal for the Board to consider whether Mr. Goodman was entitled to presumptive service connection for rheumatoid arthritis as a MUCMI under 38 C.F.R. § 3.317. The parties agreed that the question of whether Mr. Goodman’s rheumatoid arthritis was a MUCMI is a medical determination.
The Board obtained a medical opinion by a VA hospital’s Director of Rheumatology, who concluded that it was less likely that Mr. Goodman’s rheumatoid arthritis was a MUCMI under § 3.317 because “it has at least partially explained and widely accepted concepts in regards to etiology and pathogenesis that are well documented and established in the literature.” The examiner added that it was less likely that his rheumatoid arthritis was related to any in-service exposure event because he had no symptoms in service and it was diagnosed 15 years after his discharge. The Board relied on this opinion to deny the claim.
Mr. Goodman appealed again to the Veterans Court, asserting that the Board erred in relying on the medical opinion because it did not “pinpoint a specific etiology or pathophysiology” for his arthritis. The Court found that the Board did not err in its interpretation of § 3.317 and found that the regulation allows “medical experts to identify which diseases . . . have at least a partially explained etiology and pathophysiology.”
On appeal to the Federal Circuit, Mr. Goodman argued that the Veterans Court misinterpreted § 3.317 by “improperly delegate[ing] the authority for determining a qualifying disease to an individual physician.” He asserted that “a medical expert in an individual case cannot establish a general or precedential rule precluding rheumatoid arthritis from qualifying as a MUCMI.”
The Federal Circuit rejected this argument. The Court first noted that 38 U.S.C. § 1117 provides Persian Gulf War veterans with presumptive service connection for a “qualifying chronic disability” that “cannot be attributed to any known clinical diagnosis.” The statute defines “qualifying chronic disability” as one that results from “[a]n undiagnosed illness” or “[a MUCMI] . . . that is defined by a cluster of signs or symptoms.” 38 U.S.C. § 1117(a)(2). The implementing regulation, § 3.317, contains a similar definition of “qualifying chronic disability”: “[T]he term [MUCMI] means a diagnosed illness without conclusive pathophysiology or etiology, that Is characterized by overlapping symptoms and signs . . . . Chronic multisymptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained.” 38 C.F.R. § 3.317(a)(2)(ii).
The Court found that the regulation did not expressly “prohibit medical professionals from professing whether certain medical diseases may constitute a MUCMI.” However, because neither the statute nor the regulation “state who has the power to diagnose illnesses that may qualify as a MUCMI,” the Court considered the relevant statutory and regulatory history. In October 2010, VA published guidelines on the regulation to allow medical professionals to provide opinions that adjudicators could use in making MUCMI determinations on a case-by-case basis. The Court noted that this gave VA adjudicators the same authority in MUCMI determinations that they have in other disability claim determinations. See 38 C.F.R. § 4.2 (“It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history…”). The Court thus held that “VA adjudicators may rely on a medical examiner’s evaluation of whether a veteran’s condition qualifies as a MUCMI pursuant to § 3.317(a)(2)(ii).”
With respect to Mr. Goodman’s argument that a medical examiner in a particular case cannot establish precedent regarding whether a condition is a MUCMI, the Court noted that Board decisions are not precedential (38 C.F.R. § 20.1303), and the medical opinion in this case only applies to Mr. Goodman’s rheumatoid arthritis. The Court held that “in individual MUCMI determinations, the VA adjudicator may consider evidence of medical expert opinions and all other facts of record to make the final determination of whether a claimant has proven, based on the claimant’s unique symptoms, the existence of a MUCMI.” The Court further held that there is nothing in the regulation that “precludes a previously-denied, or future, rheumatoid arthritis claimant from seeking the presumptive service connection afforded pursuant to § 3.317.”
Jensen v. Shulkin, 29 Vet.App. 66 (Sept. 12, 2017)
HELD: In order to be eligible to receive a specially adapted housing (SAH) grant, a claimant “must (1) have a permanent and total disability (2) due toa disorder that (3) involves bothlower extremities and (4) causes a loss of use so severe that it precludeslocomotion without the regular and constant use of assistive devices.” Under 38 U.S.C. § 2101(a)(2)(B), “a loss of use exists if a veteran has suffered a deprivation in his ability to use his lower extremity so severe that he is precluded from perambulating without one of the required assistive devices.” However, “locomotion is precluded even if a veteran is capable on occasion of moving about unaided.”
SUMMARY: Robert Jensen was service connected for residuals of a right-foot fracture shortly after his separation from service in 1984. In 2002, he was service connected for degenerative disc disease of his lumbar spine. In 2006, he was granted an unemployability rating. He had been using a cane since 2004. In 2008, a nurse practitioner wrote that “he is severely limited in his ability to walk due to his condition.” His doctors recommended aqua therapy, which helped. Unfortunately, “the travel and expense necessary to attend therapy sessions had become onerous,” so he filed a claim for SAH, requesting a one-time grant of $50,000 “to defray the cost of installing a heated therapy pool in his home.”
Under 38 U.S.C. § 2101(a)(1), VA may assist a veteran in acquiring housing or equipment that is made necessary by the veteran’s disability. A veteran is eligible for this benefit if he/she is “entitled to compensation . . . for a permanent and total service-connected disability” that results in the “loss, or loss of use, of both lower extremities such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair.” 38 U.S.C. § 2101(a)(2)(B)(i).
The RO denied Mr. Jensen’s claim and he appealed to the Board. He stated that he needed a cane or crutches to ambulate and that “without the assistance of prosthetic devices and daily aqua-therapy,” he would “no longer have the use of both lower extremities.” After several VA examinations and a Board remand, the RO granted service connection for several related conditions, but continued to deny the SAH grant. The Board affirmed the denial.
On appeal, the Court considered whether Mr. Jensen’s disabilities resulted in the “loss of use” of both lower extremities that would establish entitlement to SAH. Neither the statute nor the relevant regulation – 38 C.F.R. § 3.809(b)(1) – define “loss of use,” but the Secretary urged the Court to adopt the definition of this phrase from the regulation dealing with special monthly compensation, 38 C.F.R. § 3.350(a)(2)(i).
The Court discussed the relevant statutory and regulatory history and determined that the definition of “loss, or loss of use” in 38 C.F.R. § 3.350 did not apply to section 2101(a)(2)(B)(i) for several reasons. First, § 3.350(a)(2)(i) defines “loss of use of a foot,” whereas section 2101(a)(2)(B)(i) deals with the loss of use of both lower extremities. Second, other sections of § 3.350 expressly discuss the “loss of use of both lower extremities.” The Court found that the Secretary’s proposed interpretation essentially separated the phrase “loss of use” from “lower extremities” – and that this “interpretation alters the statute rather than clarifies it.”
The Court also found it persuasive that “Congress and VA have had nearly 60 years to give some hint of a cross-reference between [§ 3.350 and section 2101(a)(2)(B)(i)] that would have given claimants and adjudicators a clear idea of their intentions, and they never have.”
Having rejected the Secretary’s proposed interpretation, the Court turned to the dictionary to define “loss of use” and “such as.” The Court held that “a loss of use exists if a veteran has suffered a deprivation in his ability to use his lower extremity so severe that he is precluded from perambulating without one of the required assistive devices.” The Court further held that “locomotion is precluded even if a veteran is capable on occasion of moving about unaided.” Applying this definition to the facts of this case, the Court concluded that Mr. Jensen met the requirements for SAH and reversed the Board’s denial.
Finally, the Court addressed the Secretary’s argument that “every time an individual is prescribed an assistive device in conjunction with a lower extremity disability, he or she would then automatically be eligible to receive” SAH. The Court rejected this argument by stating that an eligible claimant “must (1) have a permanent and total disability (2) due toa disorder that (3) involves bothlower extremities and (4) causes a loss of use so severe that it precludeslocomotion without the regular and constant use of assistive devices.”
Kisor v. Shulkin, 869 F.3d 1360 (Fed. Cir. Sept. 7, 2017)
HELD: When newly received service records do not “remedy the defects” of a prior claim, those records are not “‘relevant’ for purposes of § 3.156(c)” and thus will not warrant an earlier effective date.
SUMMARY: Mr. Kisor was a Vietnam combat veteran. In 1982, he filed a claim for service connection for PTSD. His Vet Center therapist submitted a letter with a diagnosis of PTSD. However, a 1983 VA (C&P) psychiatrist diagnosed a personality disorder. The RO denied the claim due to the lack of a PTSD diagnosis. Mr. Kisor did not appeal this decision and it became final.
In 2006, he filed a request to reopen his previously denied claim. He subsequently submitted a psychiatric evaluation showing a diagnosis of PTSD. He also submitted service records showing his combat history. The RO obtained an opinion from a VA examiner who confirmed the diagnosis of PTSD. The RO then made a Formal Finding of Information Required to Document the Claimed Stressor and verified his combat service. The RO granted service connection for PTSD, rated 50%, effective June 5, 2006, the date it received his request to reopen. The grant was based on the PTSD diagnosis and the Formal Finding of Information.
Mr. Kisor appealed for a higher rating and an earlier effective date. The RO granted a higher rating, but denied an earlier effective date.
Mr. Kisor appealed to the Board, arguing that there was clear and unmistakable error (CUE) in the 1983 RO decision. The Board rejected his arguments, but identified an alternative argument for an earlier effective date – via 38 C.F.R. § 3.156(c), which requires the VA to reconsider a veteran’s claim when relevant service department records are newly associated with the veteran’s claims file, whether or not they are ‘new and material’ under § 3.156(a).” (quoting Blubaugh v. McDonald, 773 F.3d 1310, 1313 (Fed. Cir. 2014)). The Board considered whether the new evidence warranted reconsideration of his claim such that he would be entitled to a 1982 effective date. The Board determined that the new records were not “relevant” for purposes of § 3.156(c) because the 1983 decision denied service connection due to a lack of a PTSD diagnosis – and there was no dispute as to his combat status or in-service stressor.
Mr. Kisor appealed to the CAVC, arguing that the Board failed to apply § 3.156(c). The Court rejected this argument, noting that the newly submitted service records did not contain a diagnosis of PTSD – and that the lack of such diagnosis was the basis for the 1983 denial. The Court found no error in the Board’s application of § 3.156(c).
Mr. Kisor appealed to the Federal Circuit, arguing that the Veterans Court misinterpreted § 3.156(c)(1). He argued for a broad interpretation of the word “relevant” based on the Federal Rules of Evidence, which would find a service record “relevant” if it has “any tendency to make the existence of any fact that is of consequence to the determination of the action more probable or less probable than it would be without the evidence.”
The Secretary argued for a narrower interpretation of “relevant” that “depends upon the particular claim and the other evidence of record.” The Secretary stated that Mr. Kisor’s newly submitted service records only relate to the existence of an in-service stressor – not to a diagnosis of PTSD – and that the “issue of an in-service stressor was never disputed in the 1983 claim.” The Secretary stated that neither the Board nor the Veterans Court “required that the evidence relate to the basis for the prior denial in all cases.” However, in Mr. Kisor’s case, the evidence relating to the in-service stressor “could not be relevant without a medical diagnosis for PTSD at the time of the previous claim.”
The Federal Circuit first determined that the term “relevant” in 38 C.F.R. § 3.156(c)(1) was ambiguous, and found that the Board’s interpretation was not “plainly erroneous or inconsistent with VA’s regulatory framework.” The Court found that the newly submitted service records were “superfluous” and determined that since they “did not remedy the defect of his 1982 claim and contained facts that were never in question,” there was no error in the Board’s conclusion that they were not “relevant” for purposes of § 3.156(c)(1).
In response to Mr. Kisor’s argument that the Veterans Court construed § 3.156(c)(1) too narrowly, the Federal Circuit held that their interpretation did not require “that relevant records must relate to the basis of a prior denial,” but rather that “on the facts and record of this case, Mr. Kisor’s later-submitted materials were not relevant to [the] determination of his claim.” The Court thus affirmed the CAVC’s decision.
Sharp v. Shulkin, 29 Vet.App. 26 (Sept. 6, 2017)
HELD: Whether VA is obligated to obtain an examination during a flare-up period depends on the nature of the disability and the frequency and duration of the flare. The Board cannot rely on an examiner’s broad statement that an opinion as to the extent of functional loss during a flare-up is not possible “without resort to speculation” because there is “no conceptual or empirical basis for making such a determination” without first determining that this statement “is predicated on a lack of knowledge among the ‘medical community at large’ and not the insufficient knowledge of the specific examiner.” Lay statements can provide “an adequate basis on which to formulate an opinion regarding additional functional loss during flares.”
SUMMARY: Mr. Sharp was service connected for arthritis of both shoulders, rated 10% each, and both hands and forearms, rated 0%. He appealed for higher ratings. The Board remanded for an examination that included range-of-motion (ROM) testing, and asked the examiner to explain the extent to which the veteran has “functional loss due to pain” or any other symptoms “during flare-ups and/or with repeated use.”
In September 2015, a VA examiner noted “the veteran’s reports of experiencing periodic flares,” but indicated that he was not experiencing a flare-up during the examination. The examiner stated that the veteran reported “additional functional loss during flare periods in terms of increased pain and lack of endurance,” but concluded that “it was not possible without mere speculation” to estimate the loss of ROM or functional loss during flares “because there is no conceptual or empirical basis for making such a determination without directly observing function under these circumstances.”
The RO granted 10% ratings for Mr. Sharp’s forearm and hand conditions, but denied higher ratings.
The Board affirmed the RO’s decision, finding that “VA substantially complied” with its remand, and that the examiner provided an adequate explanation for not providing an opinion regarding functional loss during a flare-up.
On appeal to the Court, Mr. Sharp argued that the Board clearly erred in accepting the VA medical opinion as adequate because the examiner failed to estimate the additional functional loss during a flare, as required by law and by the Board’s remand. The Secretary argued that this Court’s case law allowed the examiner to “decline to offer an opinion on the grounds that doing so would require resort to speculation.”
The Court summarized the current law surrounding the requirements for evaluating musculoskeletal disabilities, and stated that, according to the VA Clinician’s Guide, “examiners are instructed to inquire whether there are periods of flare,” and, if so, “state their severity, frequency, and duration; name the precipitating and alleviating factors; and estimate, ‘per [the] veteran,’ to what extent, if any, they affect functional impairment.” The obligation to obtain an examination during a flare-up period depends on the nature of the disability in the particular case. For example, if a veteran reports flare-ups that last weeks, it may be possible to schedule an examination during a flare, whereas it is impractical to require an examination during a flare that generally only lasts a few hours or a day. “Thus, the frequency, duration, and severity of flares are necessary considerations when determining whether VA must attempt to schedule an examination during a flare.” (citing Ardison v. Brown, 6 Vet.App. 405, 408 (1994) and Voerth v. West, 13 Vet.App. 117, 122 (1999)).
The Court further explained its holding in Jones v. Shinseki, 23 Vet.App. 382 (2010), as allowing “the Board to accept a VA examiner’s statement that he or she cannot offer an opinion without resorting to speculation, but only after determining that this is not based on the absence of procurable information or on a particular examiner’s shortcomings or general aversion to offering an opinion on issues not directly observed.”
In this case, the Court found that there was no evidence of record regarding the frequency or duration of Mr. Sharp’s flare-ups other than the notes in the examiner’s report. Because of this, the Court determined that the Board did not err in finding the examination inadequate solely because it was not conducted during a flare.
However, the Court determined that even though VA is not required to obtain an examination during a flare-up, VA examiners are required to “estimate the functional loss that would occur during flares.” (citing DeLuca v. Brown, 8 Vet.App. 202, 204 (1995); Mitchell v. Shinseki, 25 Vet.App. 32. 44 (2011); and Petitti v. McDonald, 27 Vet.App. 415, 429-30 (2015) (holding that “credible lay evidence of functional loss due to pain, including during flare periods, observed outside of the VA examination context could constitute objective evidence in support of an evaluation”)). The Court determined that the examination in this case was inadequate because the examiner “did not elicit relevant information as to the veteran’s flares or ask him to describe the additional functional loss, if any, he suffered during flares and then estimate the veteran’s functional lost due to flares based on all the evidence of record—including the veteran’s lay information—or explain why she could not do so.”
The Court held that its “case law and VA guidelines anticipate that examiners will offer flare opinions based on estimates derived from information procured from relevant sources, including the lay statements of veterans.” The Court rejected the examiner’s broad statement regarding “no conceptual or empirical basis” for assessing functional loss during a flare because it is “contradicted by the VA Clinician’s Guide, which specifically advises examiners to try to procure information necessary to render an opinion regarding flares from veterans.”
The Court further reiterated its holding in Jones, stating that “before the Board can accept an examiner’s statement that an opinion cannot be provided without resort to speculation, it must be clear that this is predicated on a lack of knowledge among the ‘medical community at large’ and not the insufficient knowledge of the specific examiner.”
Finally, the Court rejected the notion that lay statements “can never provide an adequate basis on which to formulate an opinion regarding additional functional loss during flares” as “inconsistent with this Court’s case law and VA’s own practice as set forth in VA’s Clinician’s Guide.”
Patricio v. Shulkin, 29 Vet.App. 38 (Aug. 31, 2017)
HELD: A surviving spouse can challenge VA’s denial of status as a surviving spouse for DIC purposes – even where there is a prior determination that the marriage was not valid for purposes of adding the spouse to the veteran’s benefit during the veteran’s lifetime. The surviving spouse does not have to challenge that earlier decision on the basis of CUE in order to appeal the DIC denial. In fact, the surviving spouse would lack standing to bring such a challenge since the spouse was not the “claimant” in the earlier decision. (The veteran was.)
SUMMARY: This case involves the validity of a marriage for DIC purposes. The veteran, Antonio Patricio, was married to his first wife, Susan, in the Philippines in 1968. They had a daughter in 1970, and her birth certificate lists the veteran’s nationality as American. In 1973, a California court entered final judgment on a divorce decree.
In 1980, the veteran married the appellant in this case, Corazon, in Seoul, Korea. They had a son in 1982, and his birth certificate indicates that the veteran was naturalized as a U.S. citizen in 1973.
In 1986, the veteran filed a Status of Dependents form, seeking additional benefits for his children from both marriages. The RO sought a legal opinion from VA’s district counsel regarding whether the 1973 California divorce legally terminated the veteran’s marriage and, thus, whether Ms. Patricio could be recognized as his wife for the purpose of being added to his award as a dependent. The opinion held that because the veteran lived in the Philippines during and following service, Philippine law governed – and that law does not recognize foreign divorces by its citizens. The RO denied the claim for additional dependents’ benefits and the veteran filed a Notice of Disagreement, but did not perfect his appeal to the Board.
The record also contains a 1989 birth certificate that lists the veteran and a third woman as the child’s parents, with both of their nationalities listed as American. The birth certificate indicates they were married in 1976 in California.
In 1989, the veteran and Ms. Patricio moved to Florida. The veteran died in Texas in 2009. Prior to his death, he had been granted service connection for various disabilities, and was paid as a single veteran with no dependents.
In August 2009, the first wife (Susan) filed a claim for dependency and indemnity compensation (DIC). Two months later, the appellant filed a claim for DIC. In 2011, the RO granted DIC to Susan, and denied the appellant’s claim. Ms. Patricio appealed.
In September 2015, the Board denied Ms. Patricio recognition as the veteran’s surviving spouse because Philippine law would not recognize the 1973 divorce from his first wife, Susan. The Board also determined that Ms. Patricio’s marriage could not be “deemed valid” because DIC benefits had already been granted to Susan.
On appeal to the CAVC, Ms. Patricio argued for reversal under the Constitution’s Full Faith and Credit Clause, asserting that the Court and VA must recognize the validity of the 1973 California divorce decree. The Secretary urged the Court to dismiss the appeal for lack of jurisdiction because Ms. Patricio had not properly filed a motion to revise the 1986 decision on the basis of clear and unmistakable error (CUE). Alternatively, the Secretary argued that the Court should remand the case for the Board to determine the veteran’s citizenship in 1973, when he and Susan divorced.
The Court rejected the Secretary’s argument to dismiss because Ms. Patricio had appealed the RO’s decision that determined that the veteran’s first wife, Susan, was his surviving spouse for VA benefits purposes. This was the subject of the Board decision – and the Court clearly has jurisdiction over final Board decisions. The Court noted that Ms. Patricio was not challenging the 1986 decision that denied the veteran additional compensation based on dependents. In fact, the Court noted that she could not file a CUE motion with that decision – since a CUE challenge can only be initiated by the Secretary or the claimant – and she was not the claimant in that decision. See Rusick v. Gibson, 760 F.3d 1342, 1345-46 (Fed. Cir. 2014) (stating that a veteran’s survivor lacks standing to raise a CUE challenge to a decision pertaining to the veteran’s benefits).
The Court further noted that VA decides survivors’ claims “without regard to any prior disposition of those issues during the veteran’s lifetime,” citing 38 C.F.R. § 20.1106, so the 1986 dependency decision is irrelevant to Ms. Patricio’s DIC claim.
The Court determined that remand was the appropriate remedy, since there were factual issues that the Board did not address – specifically, the veteran’s citizenship at the time of the 1973 California divorce. If he was a naturalized citizen at that time, then U.S. law would govern the issue of surviving spouse status and the California divorce would be valid. If he was a citizen of the Philippines, however, that country’s law would govern – and the 1973 divorce would not be recognized. Because the Board did not make any findings with respect to the veteran’s nationality at the time of the 1973 divorce, the Court determined that remand was necessary for the Board to address this issue.
The Court declined to address Ms. Patricio’s Full Faith and Credit argument, but noted that even if it did address this argument, it might not necessarily result in an award of benefits – since the record contains evidence of a marriage to a third woman that occurred prior to the appellant’s marriage to the veteran. So, even if the divorce from Susan was valid for surviving spouse purposes, it is unclear if and/or how the marriage to the third was terminated. Because the Court cannot make factual findings in the first instance, it remanded the appeal for the Board to address these questions.
Gazelle v. Shulkin, 868 F.3d 1006 (Fed. Cir., Aug. 22, 2017)
HELD: The Federal Circuit affirmed the CAVC’s decision in Gazelle v. McDonald, 27 Vet.App. 461 (2016), and held that 38 U.S.C. § 1114(s)(1) “is clear and unambiguous in its direction to calculate special monthly compensation using the combined ratings table.
SUMMARY: Mr. Gazelle was service connected for PTSD, rated 100%, and or multiple disabilities that combined to a 50% disability rating under VA’s combined ratings table, 38 C.F.R. § 4.25. If his disability ratings for these conditions were added, as opposed to combined, the disability rating for his physical conditions would equal 60%.
Under 38 U.S.C. § 1114(s)(1), a veteran is entitled to a higher rate of compensation – special monthly compensation (SMC) – if s/he has “a service-connected disability rated as total” and “additional service-connected disability or disabilities independently ratable at [sixty] percent or more.” Because Mr. Gazelle’s additional disabilities did not combine to a 60% rating, the Board denied SMC.
The Veterans Court affirmed the Board’s denial, holding that “consistent with the plain meaning of subsection 1114(s), the Board appropriately applied the combined ratings table to determine eligibility for SMC benefits.”
Mr. Gazelle appealed to the Federal Circuit, challenging the CAVC’s interpretation of 38 U.S.C. § 1114(s). The Federal Circuit examined the language of the statute, the legislative history, and the placement of this provision in the statutory scheme, and affirmed the CAVC’s decision, holding that “§ 1114(s)(1) unambiguously requires the veteran’s additional disabilities be rated at least at sixty percent based upon the combined ratings table and not the addition of individual disability ratings.” (emphasis in original).
Garcia v. Shulkin, 29 Vet.App. 47 (Aug. 9, 2017)
HELD: A claimant must raise all possible errors on a claim in a final Board decision when filing the initial motion for revision on the basis of clear and unmistakable error (CUE) – and this rule applies even when the Court remands that initial CUE challenge. Where the Board has determined that there was no CUE in a prior claim, the Court lacks jurisdiction to remand for the Board to consider any new CUE allegations.
SUMMARY: Veteran Teofilo Garcia was denied service connection for a psychiatric condition in 2003. He appealed to the Board and, after a remand for additional development including a new medical opinion, the Board denied his claim in 2006. He appealed that decision to the Court, through his current counsel, but withdrew the appeal in 2007.
In July 2008, Mr. Garcia, through the same attorney, filed a motion to revise the Board’s 2006 decision on the basis of CUE, arguing that revision was required because (1) the Board did not afford sufficient weight to the favorable medical evidence of record; (2) he was entitled to “a greater duty to assist” since his service records had been destroyed; and (3) the Board should have given him the benefit of the doubt.
The Board denied the motion in April 2010. In July 2010, Mr. Garcia requested reconsideration of that decision, asserting that the Board failed to consider Mr. Garcia’s wife’s hearing testimony. In August 2010, the Board denied the motion to reconsider, finding that its 2006 decision specifically considered Mrs. Garcia’s testimony.
Mr. Garcia appealed to the Court of Appeals for Veterans Claims. In December 2011, the Court affirmed the Board’s determination that there was no CUE in the 2006 decision based on the three arguments he had raised. However, the Court also determined that the Board was required to address Mr. Garcia’s fourth allegation of CUE regarding his wife’s hearing testimony, and remanded for the Board to provide an adequate explanation for its determination that it had properly considered the hearing testimony in its 2006 decision.
The Court also noted Mr. Garcia’s arguments regarding what appeared to be “inappropriate influence” exerted on the VA examiner by the rating specialist, but found that Mr. Garcia had not asserted that this was a due process violation.
Shortly after the Court’s decision, Mr. Garcia died, and his wife was substituted in his appeal. In October 2012, the Board addressed the issues in the Court’s remand and continued to deny the appeal. Mrs. Garcia filed a motion to vacate and reconsider, raising the constitutional due process argument to the Board for the first time. The Board denied the motion and Mrs. Garcia appealed to the Court.
In October 2014, the Court again remanded the issue of CUE regarding the Board’s consideration of Mrs. Garcia’s hearing testimony. The Court also dismissed the constitutional due process allegation because it had not been presented to the Board in the initial CUE motion and the Court thus lacked jurisdiction to consider it.
In May 2015, the Board again determined that there was no CUE in the 2006 decision. Mrs. Garcia again appealed to the Court.
In the present decision, the Court reiterated that “an appellant has only one opportunity to raise allegations of CUE for each claim decided in a Board decision, and any subsequent attempt to raise a CUE challenge to the same claim contained in a Board decision must be dismissed with prejudice,” citing Hillyard v. Shinseki, 24 Vet.App. 343 (2011). The issue in the present appeal was “whether a new CUE challenge may be raised where the Court remands the initial CUE challenge.” The Court held that Hillyard applied to this situation, stating that the “rule established in Hillyard rightly requires that all possible errors in a final Board decision be raised at the time a motion for revision of that Board decision based on CUE is filed.”
The Court concluded that in 2011 and 2014 it had “improperly entertained the fourth allegation of CUE regarding Mrs. Garcia’s testimony,” and that it should have dismissed the appeal of the Board’s decision on that fourth allegation. Because it had no jurisdiction to address this issue, the Court dismissed this portion of the appeal.
Similarly, the Court recognized that it lacked jurisdiction over the due process allegation, since it was not raised in Mr. Garcia’s initial CUE motion. The Court rejected the argument that “due process violations are special and may be raised at any time, regardless of the finality of the underlying decision,” citing Cook v. Principi, 318 F.3d 1334, 1339 (Fed. Cir. 2002) (en banc), for the proposition that there are only two exceptions to finality. The Court acknowledged a footnote in Cook that appeared to be on point with the present issue, and adopted its reasoning in holding that “even an allegation of a due process violation may not vitiate the finality of a decision.” The Court thus dismissed the due process allegation.
Manzanares v. Shulkin, 863 F.3d 1374 (Fed. Cir. July 19, 2017)
HELD: A claim for an increased rating for a service-connected condition does not automatically include a claim for service connection for a secondary condition related to that original condition. The effective date for the grant of service connection for the secondary condition is the date VA receives the claim for that condition.
SUMMARY: Veteran Martha Manzanares was service connected for stress fractures of both ankles, rated 0%. In February 2006, she submitted a request for an increased rating and was granted 10% for each ankle, effective the date of her request. In April 2007, she filed a timely Notice of Disagreement, as well as a claim for service connection for a back condition, secondary to her ankles.
The RO granted service connection for the back, effective April 2007, the date of her claim. She appealed to the Board, arguing that the effective date should be February 2006, pursuant to 38 C.F.R. § 3.156(b), which states that “[n]ew and material evidence received prior to the expiration of the appeal period . . . will be considered as having been filed in connection with the claim that was pending at the beginning of the appeal period.” The Board denied the earlier effective date, stating that the effective date for service connection is the later of the date VA received the claim or the date entitlement arose. Because she filed her claim for secondary service connection for her back in April 2007, that is the correct effective date for the grant of benefits.
The CAVC affirmed the Board’s decision, finding no error in the Board’s determination that the secondary service-connection claim for her back condition was not part of the increased-rating claim for the ankles and was not filed until April 2007. The Federal Circuit agreed.
Ms. Manzanares argued that she was entitled to a February 2006 effective date based on two regulations – 38 C.F.R. § 3.156(b) (regarding new and material evidence, quoted above) and § 3.310(a), which states that “[w]hen service connection is . . . established for a secondary condition, the secondary condition shall be considered a part of the original condition.”
The Federal Circuit found that these arguments were an attempt to avoid its prior holding in Ellington v. Peake, 541 F.3d 11364, 1369 (Fed. Cir. 2008), which determined “that § 3.310(a) does not mean that primary and secondary conditions receive the same effective date.” In that case, the Court stated that it would be illogical to require the same effective date for primary and secondary conditions – since “secondary conditions may not arise until years after the original condition.” Ellington, 541 F.3d at 1369. Ellington essentially held that “secondary service connection is not part of a primary claim for service connection” – and the Court found that this holding applied to the present case, emphasizing that § 3.310(a) “speaks in terms of conditions, not claims.” (emphasis in original).
The Court added that there was nothing in the regulatory history of 38 C.F.R. § 3.310(a) that “suggests that secondary service connection is part of a claim for primary service connection or one for increased rating for a primary condition.” The Court thus held that “§ 3.310(a) does not make a claim for secondary service connection part of the primary service connection claim.”
Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. July 14, 2017)
HELD: When rating skin conditions, “the use of topical corticosteroids does not automatically mean systemic therapy because DC 7806 distinguishes between systemic and topical therapy.” 862 F.3d at 1335 (emphasis in original).
SUMMARY: Under 38 C.F.R. § 4.118, Diagnostic Code (DC) 7806, a skin condition is rated based on the percentage of the body or exposed area affected by the condition or the frequency and type of therapeutic treatment (topical or systemic).
Veteran Paul Johnson was rated 10% for his service-connected skin condition and appealed for a higher rating. He treated this condition with “constant or near-constant corticosteroids and other topical medications.” The Board denied a higher rating because the condition did not affect a higher percentage of his body and, while it did require “constant or near-constant” use of topical corticosteroids, this was not considered “systemic therapy.”
The Court of Appeals for Veterans Claims (CAVC) reversed the Board’s decision, holding that the plain language of the diagnostic code requires that the phrase “systemic therapy . . . includes the use of corticosteroids without any limitation to such use being oral or parenteral as opposed to topical.”
The Federal Circuit reversed, finding that the CAVC “gave an overly broad reading of the term ‘systemic therapy’ in DC 7806 that encompasses any and all forms of topical corticosteroid treatment.” The Court held that “[t]he structure and content of DC 7806 make clear that it contemplates two types of therapy, ‘systemic therapy’ and ‘topical therapy’” and that it distinguishes between the two. Systemic therapy “means ‘treatment pertaining to or affecting the body as a whole,’ whereas topical therapy means ‘treatment pertaining to a particular surface area.’”
The Court noted that topical treatment could potentially be administered on a large enough scale that it would effectively meet the definition of “systemic.” However, that was not the case with Mr. Johnson – and the Court stated that the “mere possibility that the use of a topical corticosteroid could amount to systemic therapy in some cases does not mean all applications of topical corticosteroids mean systemic therapy.” The Court added that the alternative method of rating under DC 7806 (based on the amount of skin affected) further supports the distinction between topical and systemic.
Mathis v. Shulkin, 582 U.S. ___ (2017)
HELD: The Supreme Court declined to review the Federal Circuit’s decision that refused to disavow the presumption of competence afforded to VA examiners. The reason the Federal Circuit refused to disavow the presumption in this particular case was because the veteran did not challenge the VA examiner’s credentials or qualifications at the agency level.
Justices Sotomayor and Gorsuch wrote separate statements questioning the presumption. Justice Sotomayor stated that in order for a veteran to challenge an examiner’s qualifications, the veteran must know the examiner’s credentials. This can be difficult/impossible to get from VA – which creates a “Catch-22” for the veteran. She added: “A decision by the VA to deny benefits in reliance on an examiner’s opinion, while denying the veteran access to that examiner’s credentials, ensures that the presumption will work to the veteran’s disadvantage.” She left the door open to a future review, stating: “Full review would require a petition arising from a case in which the VA denied a veteran benefit after declining to provide the medical examiner’s credentials.”
Justice Gorsuch questioned the origin of the presumption – noting that it does not come from statute. He described how the presumption works in practice: “VA usually refuses to supply information that might allow a veteran to challenge the presumption without an order from the Board of Veterans’ Appeals” and the Board will not issue an order unless the veteran provides “a specific reason for thinking the examiner incompetent.” He further questioned how “an administrative agency may manufacture for itself or win from the courts a regime that has no basis in the relevant statutes and does nothing to assist, and much to impair, the interests of those the law says the agency is supposed to serve.” He recognized that several Federal Circuit judges have questioned the propriety of the presumption and stated that “this may well mean the presumption’s days are numbered.” However, he did not hold out hope – and concluded that the issue was worthy of the Supreme Court’s attention.
Disabled American Veterans v. Sec’y of Veterans Affairs, 859 F.3d 1072 (Fed. Cir. 2017)
HELD: The Federal Circuit can only review M21-1 provisions that are subject to 5 U.S.C. §§ 552(a)(1) and 553 of the Administrative Procedure Act (APA). VA altered the definition of what constitutes a “medically unexplained multisymptom illness” (MUCMI) in its procedure manual (M21-1), but the Court determined that it could not review this M21-1 change because it did not fall under either § 552(a)(1) or § 553.
SUMMARY: Section 552(a)(1) of the Administrative Procedure Act (APA) “refers to agency actions that must be published in the Federal Register.” Section 553 “refers to agency rulemaking that must comply with notice-and-comment procedures under the [APA].” VA regulation 38 C.F.R. § 3.317 defines “a medially unexplained multisymptom illness” (MUCMI) as “a diagnosed illness without conclusive pathophysiology or etiology.”
VA consolidates it policies and procedures into a manual called the M21-1. Any VA employee can request revisions to the M21-1. On the request of an employee, the Secretary revised the definition of MUCMI in the M21-1 from an illness with “no conclusive physiology or etiology” to one with “both an inconclusive pathology, and an inconclusive etiology.” The Secretary also added that sleep apnea cannot be presumptively service connected under 38 C.F.R. § 3.317 “since it is a diagnosable condition.”
Disabled American Veterans (DAV) petitioned the Federal Circuit to review these M21-1 changes, arguing that the changes were similar to cases where the Court had previously reviewed VA policy changes. The Federal Circuit distinguished its prior cases, noting that they fell under 5 U.S.C. § 552(a)(1) because they involved agency actions that had to be published in the Federal Register. See Splane v. West, 216 F.3d 1058 (Fed. Cir. 2000) (reviewing a precedential General Counsel opinion); LeFevre v. Secretary of Veterans Affairs, 66 F.3d 1191 (Fed. Cir. 1995) (reviewing VA’s decision to not add certain conditions to the list of presumptive conditions related to Agent Orange exposure); Military Order of the Purple Heart v. Sec’y of Veterans Affairs, 580 F.3d 1293 (Fed. Cir. 2009) (reviewing a VA Fast Letter).
DAV argued that the Federal Circuit should review the M21-1 revisions because “the revisions announce substantive rules subject to § 553 which should be voided for failure to provide the required notice and comment.” The Court rejected this argument, finding that (1) “VA does not intend for the M21-1 Manual to carry the force of law” and (2) the M21-1 is not binding on VA or the courts.
The Federal Circuit noted that an individual veteran who is adversely affected by an M21-1 provision can challenge that provision by contesting “the validity of that provision as applied to the facts of his case” in the course of a direct appeal. However, the Court dismissed this petition, holding that it lacked jurisdiction to review manual provisions that “are interpretations adopted by the agency, not published in the Federal Register, not binding on the Board itself, and contained within an administrative staff manual.”