Long: Secondary service connection and extraschedular evaluations do not require a showing of direct causation

Long v. McDonough, 38 F4th 1063 (2022)

HELD: Neither 38 C.F.R. § 3.310(a) nor § 3.321(b)(1) require a showing of direct causation between the secondary symptoms and the primary service-connected disabilities.

Summary: Veteran was service connected for hearing loss. He testified that his hearing aids cause ear pain. The CAVC held that the Board did not need to consider ear pain in its extraschedular analysis because the pain was caused by the hearing aids, not the hearing loss. The Federal Circuit disagreed and found that the CAVC did not properly analyze the veteran’s ear pain under the extraschedular analysis.

The Court reiterated the Thun factors to state that “extra-schedular consideration is available to a veteran when (1) the schedular rating criteria are inadequate to describe the severity and symptoms of his disability; (2) the disability is exceptional or unusual, such as because of marked interference with employment or frequent periods of hospitalization; and (3) the award of an extra-schedular disability rating is in the interest of justice.” The Court held that the CAVC “erred in holding that direct causation between a secondary condition and an original condition is required for extra-schedular consideration of the secondary condition.”

Event: NOVA 2018 Spring Conference

March 15-17, 2018 - San Diego, CA

NOVA 2018 Fall Conference

ABK presentation - Establishing Secondary Service Connection

LINK TO PROGRAM: https://vetadvocates.org/2018-spring-conference/ 

Harvey: Attorney serving as expert witness

Harvey v. Shulkin, docket no. 16-1515 (Feb. 7, 2018)

HELD: Whether an attorney’s submission should be treated as a medical opinion depends on several factors, including (1) the text of the submission, (2) the identification of the author as attorney or medical professional, (3) the indicators of legal advocacy/argument in the submission, and (4) the presence of a medical opinion with supporting rationale. 

SUMMARY: Mr. Harvey appealed the denial of service connection for sleep apnea. At the agency level, he was represented by David Anaise, a licensed medical doctor, attorney, and accredited VA representative. In his “appeal brief” to the RO, he stated that the veteran’s sleep apnea was more likely related to his service-connected PTSD on a secondary basis, and cited supporting medical literature. The Board denied service connection, relying on a negative C&P opinion and stating that “[t]here are no contrary opinions of record.” 

On appeal to the Court, Mr. Harvey argued that the denial was in error because the Board failed to address the favorable medical opinion “submitted by his attorney-physician representative.” The Court noted that VA law does not establish requirements for determining “whether a specific submission constitutes a medical opinion” and declined to “prescribe absolute requirements” for such determinations. The Court held that these determinations are “to be undertaken individually,” and that the Board may “be obligated to assess whether that submission is a medical opinion and consider it in adjudicating a claim.” 

The Court outlined several factors that should be considered in making this assessment, including whether the author of the submission identified himself/herself as a medical professional, whether the content of the submission indicated that it was legal argument, and whether the content of the submission indicated that it was a medical opinion. Because Mr. Anaise did not identify himself as acting in the capacity of a medical professional, and because the submission contained indications of legal argument and no indication that it was a medical opinion (i.e., there was no language, such as “in my medical opinion”), the Court determined that the Board did not err by failing to treat this submission as a medical opinion. 

The Court also ordered oral argument for the parties to address the ethical issue of an attorney representative serving as an expert witness in a case. Because the Court held that Mr. Anaise’s “brief” was not a medical opinion, it found there was no violation of Rule 3.7 of the Model Rules of Professional Conduct.

Finally, the Court addressed the appellant’s argument that “the Board improperly relied on its own medical judgment to determine that the article reflected a correlative rather than a causal relationship between PTSD and sleep apnea.” The Court discussed the medical treatise evidence that had been submitted and stated that it is within the Board’s purview to interpret such treatise’s meaning and assess its probative value. The Court found that the Board correctly applied the legal standard required for assessing service connection on a secondary basis. The Court explained that that “correlation” between a service-connected condition and a secondary condition is not sufficient to establish secondary service connection; “a causation or aggravation relationship is required.” 

FULL DECISION

Frost: Secondary service connection

Frost v. Shulkin, 29 Vet.App. 131 (Nov .30, 2017)

HELD: “[F]or a veteran to receive secondary service connection on a causation basis under § 3.310(a), the primary disability need not be service connected, or even diagnosed, at the time the secondary condition is incurred.” 

SUMMARY: In 1980, during his active duty service, veteran John Frost was involved in a train accident, injuring his shoulder and leg. In 1982, following his separation from service, he got into a fight with a store proprietor and was shot in his neck. In 1985, he was awarded non-service-connected pension for left extremity paralysis due to the 1982 gunshot wound (GSW). 

In 2001, he filed a claim for service connection for PTSD related to the 1980 train accident. He reported that after the train accident, he received two Article 15 punishments for fighting, occasionally became violent, and that his wife filed for divorce shortly after his separation from service. A VA examiner diagnosed PTSD and noted recurring memories of the 1980 train accident. The Regional Office granted service connection for PTSD. 

A few years later, he filed a claim for the residuals of the 1982 GSW as secondary to his now service-connected PTSD. The RO denied the claim and he appealed, asserting that his PTSD caused him to become involved in the fight that resulted in the GSW. The Board denied the claim, finding that he was first shown to have PTSD in 2002, twenty years after the 1982 incident. 

On appeal to the CAVC, the Court examined the regulation governing service connection on a secondary basis, 38 C.F.R. § 3.310, and held: “Nothing in the text of the regulation specifies or indicates that the primary condition must be service connected, or even diagnosed, at the time the secondary condition is incurred.” Because there is no reference in § 3.310 to a temporal requirement, the Court rejected VA’s argument that Mr. Frost’s claim was barred as a matter of law. 

The Court recognized the “basic logic” that there must be a primary service-connected condition in order to establish secondary service connection, but clarified that “at the time that any decisionestablishing entitlement to secondary service connection is rendered, there must be a primary service-connected condition.” The Court concluded that “for a veteran to receive secondary service connection on a causation basis under § 3.310(a), the primary disability need not be service connected, or even diagnosed, at the time the secondary condition is incurred.” The Court remanded the claim to the Board to determine whether a VA examination is necessary to determine whether the GSW residuals are proximately due to or the result of his service-connected PTSD. 

FULL DECISION

Manzanares: INCREASED-RATING CLAIM DOES NOT AUTOMATICALLY INCLUDE SECONDARY CONDITION(S) FOR EFFECTIVE DATE PURPOSES

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.” 

FULL DECISION