Justia U.S. Federal Circuit Court of Appeals Opinion Summaries

The 2010 Caregivers and Veterans Omnibus Health Services Act required the VA to establish two programs to help individuals who provide eligible veterans with personal care services. One program provided assistance to family caregivers, 38 U.S.C. 1720G(a); the other provided assistance to general caregivers, section 1720G(b). The VA promulgated implementing regulations, 38 C.F.R. 71 (2015). In 2018, Congress amended the Act.; the VA MISSION Act expanded the class of veterans who qualify as eligible under the family caregivers program. The program now applies to all veterans regardless of their service dates, and there are new avenues for a veteran to qualify as eligible for benefits. The VA overhauled its regulations that attempted to clarify, streamline, and regularize implementation of the Act.Objectors challenged six definitions in 38 C.F.R. 71.15 and a residency requirement imposed in 38 C.F.R. 71.10(b). The Federal Circuit addressed standing; rejected challenges to the definitions of “three or more activities of daily living,” “serious injury,” “inability to perform one or more activities of daily living,” and “monthly stipend rate”; and to the imposition of a geographic residence requirement. View "Veteran Warriors, Inc. v. Secretary of Veterans Affairs." on Justia Law

Wolfe, who was enrolled in VA health care, obtained emergency treatment at a non-VA health care facility, incurring expenses of $22,348.25. Her employer-sponsored healthcare contract covered most of the expenses. She was responsible for a copayment of $202.93 and coinsurance of $2,354.41. The VA denied reimbursement of those expenses; 38 U.S.C. 1725(c)(4(D) bars reimbursement for “any copayment or similar payment.” Wolfe filed a Notice of Disagreement; rather than await the outcome of her appeal, Wolfe also filed a mandamus petition. The Veterans Court certified her requested class and granted her petition, invalidating a VA regulation prohibiting the reimbursement of deductibles and coinsurance for being within the category of “similar payments,” and requiring the VA to re-adjudicate claims denied under the invalidated regulation.The Federal Circuit reversed. Deductibles are excluded from reimbursement under the correct interpretation of the statute and other adequate remedies (appeal) were available with respect to coinsurance, so mandamus was inappropriate. Coinsurance is the type of partial coverage that Congress did not wish to exclude from reimbursement. View "Wolfe v. McDonough" on Justia Law

Martinez-Bodon served on active duty in the Army, 1967-1969. In 2016, he sought benefits for diabetes and for anxiety secondary to his diabetes. At his VA psychiatric examination, he reported: “I can’t sleep well, my right eye trembles too much and that bothers me and I get very anxious about it.” He denied having other symptoms. The VA examiner found that these symptoms did not meet the “criteria for a mental condition as per DSM–5” and concluded that she could not establish a relationship between Martinez-Bodon’s diabetes and anxiety.The VA granted him a service connection for diabetes but denied him a service connection for a mental condition. The Board of Veterans’ Appeals affirmed. The Court of Veterans Claims rejected an argument that even without a formal diagnosis, his symptoms constitute a disability for service-connection purposes under Federal Circuit precedent defining “disability.” The Federal Circuit affirmed that 38 C.F.R. 4.125(a) and 4.130, “require a DSM–5 diagnosis as a precondition to compensate mental conditions.” View "Martinez-Bodon v. McDonough" on Justia Law

Gurley served in the Army, 1972-1974 (a period of war) and the National Guard, 1975-1982. As of 1997, VA was paying him service-connected disability compensation benefits at the 100 percent disability level based on individual unemployability. In 2011, Gurley was convicted of a felony and was incarcerated for nearly six months. When a veteran is incarcerated for a felony conviction, the veteran “shall not be paid” the full amount of awarded compensation benefits “for the period beginning on the sixty-first day of such incarceration and ending on the day such incarceration ends,” 38 U.S.C. 5313(a)(1). Gurley’s payment should have been reduced to the 10% disability level. Gurley, however, received his full benefits because VA did not learn of his incarceration until six days after his release.The VA notified Gurley that he had been overpaid by $10,461 and that it would reduce its payment of Gurley’s current benefits “until the amount . . . overpaid is recouped.” Gurley unsuccessfully requested a waiver under 38 U.S.C. 5302 and disputed the debt. The Board of Veterans’ Appeals, Veterans Court, and Federal Circuit affirmed. The retroactive benefit reduction and recoupment of the overpayment through the withholding of continuing benefit payments were proper. View "Gurley v. McDonough" on Justia Law

Breland served in the Army in Vietnam, 1965-1968, and was exposed to Agent Orange. In 2006, Breland was diagnosed with carcinoma of the tongue; he completed his treatments in January 2007. The VA Regional Office denied Breland’s claim for service connection. A January 2008 biopsy revealed the recurrence of Breland’s tongue cancer. He underwent surgery. Breland filed a Notice of Disagreement. In 2010, a VA examiner note Breland’s complaint of continuing dry mouth, found no recurrence of Breland’s cancer, and concluded that the condition was “less likely related” to herbicide exposure. Breland’s claim was again denied.In 2015, Breland submitted a medical opinion tying his tongue cancer to Agent Orange exposure and retroactively granted service connection, with a 100% rating for December 2006-August 2007, and a non-compensable rating, based on Breland’s inactive disease. Following a September 2017 VA examination, the Regional Office granted service connection for certain residual conditions and determined that a 100% rating for Breland’s tongue cancer was warranted retroactively for an additional eight-month period. The Board of Veterans’ Appeals and Federal Circuit upheld those determinations. Diagnostic Code 7343 does not require the VA to continue a 100% disability rating until it performs a “mandatory VA examination” six months following treatment when the disability rating is assigned retroactively after the six-month period has passed. Breland has been and is fairly compensated based on the actual state of his health. View "Breland v. McDonough" on Justia Law

B.W., a two-year-old in good health, experienced immune thrombocytopenic purpura after receiving his measles, mumps, and rubella vaccine. Later blood tests showed his condition had resolved. More than six months after he was first diagnosed, B.W. presented with bruising, a possible symptom of immune thrombocytopenic purpura, but blood tests showed the condition had not recurred. In a suit under the National Childhood Vaccine Injury Act of 1986, the Claims Court ruled in favor of B.W., holding that those blood tests, occurring more than six months after his initial diagnosis, were “residual effects” of B.W.’s vaccine injury that satisfied the severity requirement of 42 U.S.C. 300aa-11(c)(1)(D).The Federal Circuit reversed. A residual effect must be a change within the patient that is caused by the vaccine injury. B.W.’s later bruising was not caused by his vaccine injury, and his tests did not reveal, constitute, or cause any somatic change. Tests revealed B.W. had no lingering symptoms or recurrence of thrombocytopenic purpura. There was no argument that the testing itself was detrimental to B.W.’s health such that it might qualify under section 300aa-11(c)(1)(D)(i) as a “residual effect” or a “complication” of thrombocytopenic purpura. View "Wright v. Secretary of Health and Human Services" on Justia Law

Philbrook served in the Army, 2000-2004, then was awarded disability compensation for PTSD. In 2011, Philbrook stipulated to a judgment of “guilty except for insanity” in connection with a felony. He was ordered into the custody of the Oregon State Hospital “under the jurisdiction of the Psychiatric Security Review Board . . . for care, custody, and treatment for a maximum period not to exceed 20 years.” Philbrook then applied for total disability based on individual unemployability (TDIU).A VA regional office concluded that Philbrook’s PTSD did not entitle him to TDIU because it did not preclude gainful employment. The Board of Veterans’ Appeals denied TDIU “as a matter of law”; 38 U.S.C. 5313(c), precludes the assignment of a TDIU rating for any period “during which the veteran is incarcerated in a Federal, State, local, or other penal institution or correctional facility for conviction of a felony.” The Veterans Court affirmed.The Federal Circuit reversed. Philbrook was not confined in a “penal institution or correctional facility”; he was committed to a mental institution, “a hospital for people with mental or emotional problems.” The term “correctional facility” cannot encompass a hospital that treats civil patients, and a hospital cannot be a correctional facility for some patients and not others. View "Philbrook v. McDonough" on Justia Law

Larson served on active duty for training in the Navy Reserves in 1988 and on active duty in the Navy, 1989-1993. He gained a substantial amount of weight before, during, and after his active service. In 2009, Larson filed a claim for service connection for multiple conditions, including obesity and dysmetabolic syndrome (DMS). The VA denied the claims in 2010. The Board affirmed that denial in 2016, holding that neither DMS nor obesity was a disability because neither condition is ratable under the VA Schedule of Rating Disabilities. The Veterans Court affirmed the denial of service connection for DMS and obesity, holding that it lacked jurisdiction to review a Board determination of what constitutes a disability under 38 U.S.C. 1110 because such inquiry amounted to a review of the rating schedule, prohibited by 38 U.S.C. 7252(b).The Federal Circuit reversed, noting that it has previously held that the Veterans Court has jurisdiction to review a Board determination that a claimed condition did not constitute a disability for purposes of section 1110. Larson seeks only to establish a service connection for his conditions and is not asking the Veterans Court to invalidate or revise any portion of the rating schedule. View "Larson v. McDonough" on Justia Law

In 1982, while serving in the Air Force in Germany, Jones was struck in the eye by the door of an armored personnel carrier. He developed intense headaches; it became increasingly difficult for Jones to perform his duties. A 1988 Clinical Resume reflects that Jones had developed “intermittent right cranial nerve 4th palsy associated with chronic right retro-orbital stabbing pain, usually occurring during the late afternoon or night.” Jones described "a nearly constant headache which was relieved only with repetitive doses of intramuscular Demoral.” A Physical Evaluation Board recommended that Jones be discharged with severance pay based on a 10% disability rating for “Post-traumatic pain syndrome manifest[ing] as headaches.”Jones was honorably discharged with severance pay. In 1989, his discharge was amended to reflect that his injury was combat-related. Effective in 2017, the VA awarded Jones a 100% disability rating. Jones petitioned the Air Force Board for Correction of Military Records for changes to his record that would entitle him to a disability retirement dating back to 1988, when he was discharged, 10 U.S.C. 1201. The Board denied Jones’s petition. The Federal Circuit affirmed the Claims Court: the claim for disability retirement pay and benefits was a claim under a money-mandating statute, as required by the Tucker Act, 28 U.S.C. 1491(a)(1), but jurisdiction was lacking because the claim was barred by the six-year statute of limitations, 28 U.S.C. 2501. View "Jones v. United States" on Justia Law

Buffington served on active duty in the Air Force, 1992-2000. After leaving active duty service, Buffington sought disability benefits. The VA found that Buffington suffered from service-connected tinnitus, rated his disability at 10 percent, and awarded him disability compensation. In 2003, Buffington was recalled to active duty in the Air National Guard. He informed the VA of his return to active service, and the VA discontinued his disability compensation, 38 U.S.C. 5112(b)(3), 5304(c). In 2004, Buffington completed his active service in July 2005. Buffington did not seek to recommence his disability benefits until January 2009. The VA determined Buffington was entitled to compensation effective on February 1, 2008—one year before he sought recommencement; 38 C.F.R. 3.654(b)(2) sets the effective date for recommencement of compensation, at the earliest, one year before filing. Buffington challenged the effective-date determination.The VA Regional Office rejected his challenge, providing further reasoning for the February 2008 effective date. The Board of Veterans Appeals affirmed. The Veterans Court held that section 3.654(b)(2) was a valid exercise of the Secretary of Veterans Affairs rulemaking authority and was not inconsistent with 38 U.S.C. 5304(c). The Federal Circuit affirmed. Section 3.654(b)(2) reasonably fills a statutory gap. View "Buffington v. McDonough" on Justia Law