GERALDO P. ORTIZ, Claimant-Appellant v. DENIS MCDONOUGH, SECRETARY OF VETERANS AFFAIRS, Respondent-Appellee
20-1911
United States Court of Appeals for the Federal Circuit
July 28, 2021
Appeal from the United States Court of Appeals for Veterans Claims in No. 19-70, Judge Michael P. Allen.
KENNETH M. CARPENTER, Law Offices of Carpenter Chartered, Topeka, KS, argued for claimant-appellant.
ASHLEY AKERS, Commercial Litigation Branch, Civil Division, United States Department of Justice, Washington, DC, argued for respondent-appellee. Also represented by JEFFREY B. CLARK, ELIZABETH MARIE HOSFORD, ROBERT EDWARD KIRSCHMAN, JR.
Before NEWMAN, TARANTO, and CHEN, Circuit Judges.
The Department of Veterans Affairs (VA) awarded veteran Geraldo Ortiz benefits for a service-connected disability based on posttraumatic stress disorder (PTSD), acting pursuant to a regulatory change that lightened his previous evidentiary burden. The dispute before us concerns the starting date for the benefits awarded, i.e., the effective date of the award. We conclude that the regulatory change that enabled Mr. Ortiz to obtain the benefits was a “liberalizing” one, entitling Mr. Ortiz to the earlier effective date, and hencе the larger award, that he seeks.
Mr. Ortiz had first claimed service-connected disability benefits based on PTSD, under
Mr. Ortiz contended that the effective date should have been one year earlier (May 22, 2011). For that contention, he relied on
We reverse. We conclude that the addition of
I
A
The precedents that the parties principally debate are Spencer v. Brown, 17 F.3d 368 (Fed. Cir. 1994), and Routen v. West, 142 F.3d 1434 (Fed. Cir. 1998). In those decisions, this court did not directly interpret and apply the effective-date “liberalizing” regulation at issue here,
Statutes and regulations governing veterans benefits expressly state general rules of finality for VA decisions. That is so for a decision by a VA regional office (or agency of original jurisdiction) unlеss timely appealed to the Board. See
As the above-quoted statutes make clear, however, exceptions are authorized. One exception, not invoked in the present case, is for “clear and unmistakable error” in the original decision.
This court concluded in Spencer that, in Routen‘s words, there is also a “third” path around an otherwise-final claim rejection—namely, a new original claim—if certain statutory or agency-adopted changes have been made since the earlier rejection. Routen, 142 F.3d at 1438, 1442. The court in Spencer quoted with approval the Veterans Court‘s reasoning:
When a provision of law or regulation creates a new basis of entitlement to bеnefits, as through liberalization of the requirements for entitlement to a benefit, an applicant‘s claim of entitlement under such law or regulation is a claim separate and distinct from a claim previously and finally denied prior to the liberalizing law or regulation. The applicant‘s later claim, asserting rights which did not exist at the time of the prior claim, is necessarily a different claim.
Spencer, 17 F.3d at 372 (quoting Spencer v. Brown, 4 Vet. App. 283, 288–89 (1993) (Spencer CAVC); alteration and internal quotation marks omitted). This court agreed with the Veterans Court that the finality protection of
In ruling that the statute allows a new original claim based on certain changes of law, notwithstanding the otherwise-prescribed finality of an earlier claim‘s rejection, this court and the Veterans Court in Spencer, as well as this court in Routen, relied on what they found to be a necessary implication of a statutory effective-date provision,
B
Unlike Spencer and Routen, the present case involves an effective-date question requiring direct application of the regulation adopted to implement the statute.
Section 5110(g), one of the subsections of the statutory provision titled “Effective dates of awards,” dates back to 1962. Addressing a change-of-law situation, it provides that, “[s]ubject to the provisions of section 5101” (concerning “claims and forms“),
where compensation . . . is awarded or increased pursuant to any Act or administrative issue, the effective date of such award or increase shall be fixed in accordance with the facts found but shall not be earlier than the effective date of the Act or administrative issue. In no event shall such award or increase be retroactive for more than one year from the date of аpplication therefor or the date of administrative determination of entitlement, whichever is earlier.
A regulation, also dating back to 1962, implements that statutory subsection. Under
(a) Effective date of award. Where . . . compensation . . . is awarded or increased pursuant to a liberalizing law, or a liberalizing VA issue approved by the Secretary or by the Secretary‘s direction, the effective date of such award or increase shall be fixed in accordance with the facts found, but shall not be earlier than the effective dаte of the act or administrative issue. Where . . . compensation . . . is awarded or increased pursuant to a liberalizing law or VA issue which became effective on or after the date of its enactment or issuance, in order for a claimant to be eligible for a retroactive payment under the provisions of this paragraph the evidence must show that the claimant met all eligibility criteria for the liberalized benefit on the effective date of the liberalizing law or VA issue and that such eligibility existed continuously from that date to the date of claim or administrative determination of entitlement. The provisions of this paragraph are applicable to original and reopened claims as well as claims for increase.
(1) If a claim is reviewed on the initiative of VA within 1 year from the effective date of the law or VA issue, or at the request of a claimant received within 1 year from that date, benefits may be authorized from the effective date of the law or VA issue.
(2) If a claim is reviewed on the initiative of VA more than 1 year after the effective date of the law or VA issue, benefits may be authorized for a period of 1 year prior to the date of administrative determination of entitlement.
(3) If a claim is reviewed at the request of the claimant more than 1 year after the effective date of the law or VA issue, benefits may be authorized for a period of 1 year prior to the date of receipt of such request.
C
Mr. Ortiz served during the Vietnam era, a “period of war,”
the applicability of
To secure benefits under
Exercising his rulemaking authority under
Over time, VA promulgated exceptions to the general requirements. After Mr. Ortiz‘s original claim was finally decided, but a couple of years before Mr. Ortiz moved to reopen his claim, the Secretary further implemented
If a stressor claimed by a veteran is related to the veteran‘s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of posttraumatic stress disorder and that the veteran‘s symptoms are related to the claimed stressor, in thе absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran‘s service, the veteran‘s lay testimony alone may establish the occurrence of the claimed in-service stressor. . . .
As we have explained,
claimed stressor‘; (2) the VA psychiatrist or psychologist‘s findings are not contradicted by
The change made a decisive difference for Mr. Ortiz. VA denied his 1997 claim, despite a VA medical examiner‘s opinion stating a PTSD diagnosis tied to Vietnam combat, because Mr. Ortiz failed to present corroborating evidence of the in-service stressor. J.A. 17 (stating that “the claimed in-service stressor(s) cannot be confirmed“). That decision became final in 1999, but when VA received Mr. Ortiz‘s motion to reopen the claim on May 22, 2012, VA quickly reopened the claim and granted it, with a 100 percent disability rating. J.A. 30–36 (September 26, 2012 decision). There is no dispute before us about whether “new and material evidence” was present, justifying the reopening, or about Mr. Ortiz‘s entitlement to service-connected disability benefits based on PTSD. And VA itself stated that it granted the claim “because [it] conceded that [Mr. Ortiz] experienced fear due to hostile military or terrorist activity while serving in Vietnam and because the VA examiner related [his] diagnosis of PTSD to that fear,” which was now enough because new
D
The only dispute before us is whether
Mr. Ortiz timely appealed. We have jurisdiction under
II
We conclude that the addition of
A
We generally must “interpret the words consistent with their ordinary meaning at the time” of adoption. Wisconsin Cent. Ltd. v. United States, 138 S. Ct. 2067, 2070 (2018) (cleaned up). The Secretary agrees that, in general, “to liberalize’ means to make policies or lаws less strict.” Secretary Response Br. at 17 (citing Black‘s Law Dictionary (11th ed. 2019)). This general meaning was common at the time of
The 2010 change was a “liberalizing” one under the term‘s ordinary meaning. Bеfore the 2010 addition of
The Secretary agrees: “We do not dispute that section 3.304(f)(3) made the evidentiary burden for establishing service connection for PTSD based upon fear of hostile terrorist or military activity less strict.” Secretary Response Br. at 17 n.7 (citing above passages). For good reason: Before the changе, Mr. Ortiz‘s claim was rejected, whereas after the change, it was granted undisputedly because of the elimination of a concrete component of what he was previously required to show in his affirmative case for entitlement to an award.
In fact, the 2010 change is a prototypical example of a “liberalizing” change resulting in an “award.” Cf. McBoyle v. United States, 283 U.S. 25, 27 (1931) (Holmes, J.) (relying on the idea of a “picture” “evoke[d] in the common mind“). The term “liberalizing” when used with “law” and “VA issue” in the context of a “claim” most naturally
This meaning fits the context of
B
The Secretary nevertheless argues that we should not apply the ordinary meaning of “liberalizing” here, resting that argument entirely on Spencer and Routen. For two independent reasons, however, we reject the argument. First, neither Spencer nor Routen actually decided the issue of what changes suffice to trigger application of the regulation (or, for that matter, of the statute) to give a veteran the earlier effective date. They decided a different issue: what the implications of the statute (and regulation) are for the availability of a new original claim that, outside the statutory reconsideration paths, avoids the otherwise-applicable statutory bar based on a previous final rejection of a veteran‘s earlier claim. Second, the change in the present case materially differs from the particular changes that the court in Spencer and Routen held insufficient to allow a new original claim. We conclude not only that the two precedents provide no persuasive basis for rejecting the ordinary-meaning application of “liberalizing” to cover
1
Unlike this case, neither Spencer nor Routen involved an effective-date issue, so in neither case did this court directly apply
We agreed. As to the denial of reopening for want of new and material evidence, we concluded that we lacked jurisdiction to address it, for reasons not pertinent to the issue now before us in this case. See id. at 373-74. The veteran‘s right to proceed therefore depеnded on whether he had available a new original claim. We adopted the Veterans Court‘s conclusion, as quoted above, that
Routen involved a materially identical posture. In that case, the veteran‘s claim had been denied in a final decision before the relevant regulatory change. 142 F.3d at 1436-37. After the regulatory change (concerning the government‘s rebuttal burden on in-service aggravation of a preexisting injury), the veteran sought to reopen his claim based on new and material evidence and to have his claim considered de novo as a new original claim. Id. The regional office declined to reopen the veteran‘s claim for new and material evidence and did not consider the claim a new original claim. Id. The Board and the Veterans Court again agreed with the regional office. Id.
So did we. As to the denial of reopening, we determined that a “presumption” is not itself new and material evidence. Id. at 1439-41. As to the new-original-claim issue, we concluded that the relevant regulatory amendment was insufficient to support allowing the claim as a new original one. Id. at 1441–42. We recognized that the issue was one of seeking to harmonize the express statutory finality principle of
Spencer and Routen therefore involved only the question of how far express statutory provisions—the statutory finality bar, subject to only limited express statutory routes for reconsideration—had to be deemed implicitly modified by
“When a prior decision does not ‘squarely address[] [an] issue,’ a court remains ‘free to address the issue on the merits’ in a subsequent case.” Arthrex, Inc. v. Smith & Nephew, Inc., 880 F.3d 1345, 1349 (Fed. Cir. 2018) (alterations by Arthrex; quoting Brecht v. Abrahamson, 507 U.S. 619, 631 (1993)). Spencer and Routen do not control the resolution of the issue here. And the Secretary has given no sound reason that the questions in those cases and the question in this case must have the same answer. Relying only on Spencer and Routen, which we conclude do not control, the Secretary has furnished no reason that interpretation of the regulation at issue,
which, as noted, the Secretary agrees
2
We conclude that Spencer and Routen are not controlling here for another reason: The 2010 addition of
a
Just before the 2010 addition, a showing of service connection for a PTSD claimant in Mr. Ortiz‘s position required: “medical evidence diagnosing the condition in accordance with [38 C.F.R.] § 4.125(a) of this chapter; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred.”
Notes
This change is fairly described as a “new basis of entitlement.” Spencer, 17 F.3d at 372, 373. It is also fairly described as more than “procedural.” Id.; see also Carmell v. Texas, 529 U.S. 513, 544–45 (2000) (concluding that an elimination of a corroboration requirement went to the “sufficiency of the evidence . . . for meeting the burden of proof” and thus was not a “mode[] of procedure“). In fact, the court in Routen suggested that something materially similar, if not identical, would meet its own standard. See 142 F.3d at 1441–42 (“Thus, if the old law required рroof of facts A, B, and C, and the new law requires proof of facts A, B, and D, a veteran who lost the A, B, C case under the old law because he could not establish C would seem free to claim under the new law, assuming he can establish A, B, and D.“).
The Secretary suggests that there is a difference between a fact as an element and evidence of such a fact. See Secretary Response Br. at 13–14. But Spencer and Routen do not elaborate such a distinction. Moreover, it remains true that the 2010 addition of
elimination of the corroboration requirement, so that the veteran‘s lay testimony suffices, id., anything other than liberalizing.
[PTSD],” “a link, established by medical evidence,” and “supporting evidence.” And VA‘s general counsel, in at least one precedential opinion, has treated relaxation of evidentiary requirements for a claimant as substantive for purposes of the “liberalizing” standard. See Vet. Aff. Op. Gen. Couns. Prec. 26-97 (“Because this change liberalized the evidentiary basis on which entitlement to a benefit could be established, it may be considered a substantive change providing a new basis for establishing entitlement to benefits and, consequently, a liberalizing VA issue for purposes of 38 C.F.R. § 3.114(a).” (emphases added)); cf. Vet. Aff. Op. Gen. Couns. Prec. 9-92 (opining that “[w]here an increased rating is occasioned only by revision of criteria for rating psychoneurotic disorders which became effective February 3, 1988, the increased rating is to be considered based on a liberalizing VA issue per 38 U.S.C. § 5110(g) and 38 C.F.R. § 3.114,” even though the elements to grant the claim remained unchanged).
In relevant respects, the 2010 change is akin to a creation of a presumption that, when certain preconditions are met, a crucial element of a service-connection case is presumed proved. That matters because, notwithstanding Spencer and Routen, the Secretary agrees that such a presumption is a liberalizing change. Secretary Response Br. at 14 n.5; see also Effective Dates of Benefits for Disability or Death Caused By Herbicide Exposure; Disposition of Unpaid Benefits After Death of Beneficiary, 68 Fed. Reg. 50,966, 50,966 (Aug. 25, 2003) (noting that the “regulations establishing presumptions that certain diseases are associated with herbicide exposure in service” were “liberalizing“); Oral Arg. at 15:56–16:48, 19:50–21:28. And we have treated such a presumption as a liberalizing change. See Hunter v. Shinseki, 538 F. App‘x 904, 905 (Fed. Cir. 2013) (concluding that a statute and certain implementing regulations that “modified the presumption of herbicide exposure for veterans who served in Vietnam . . . [were] liberalizing provision[s]“); Williams v. Principi, 310 F.3d 1374, 1377-78, 1380–81 (Fed. Cir. 2002) (accepting that a creation of a presumption is liberalizing).
Section 3.304(f)(3) is materially similar to a presumption. A presumption itself is an “[e]videntiary rule,” which effectively “supplies the required evidence” when specified “preconditions are satisfied.” Snyder v. McDonough, 1 F.4th 996, 1004 (Fed. Cir. 2021); see also Routen, 142 F.3d at 1440 (“When the predicate evidence is established that triggers the presumption, the further evidentiary gap is filled by the presumption.“). Section 3.304(f)(3) does the same. Presumptions are generally rebuttable on proof that meets a specified standard of convincingness. Routen, 142 F.3d at 1440. Section 3.304(f)(3) states that the government can overcome the exception to the corroboration requirement when there is “clear and convincing еvidence to the contrary.”
For those reasons, the 2010 addition of
b
Spencer and Routen, on their facts, also did not involve changes like thosе made by the 2010 addition of
In Spencer, we rejected the contention that a set of general changes made by the VJRA created a new basis of entitlement, concluding that the “reforms implemented by the VJRA were directed to improving the adjudicative process.” 17 F.3d at 372. The opinion‘s focus was on the new availability of judicial review, but the court mentioned, as well, the provision that “[w]hen there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant,”
Routen likewise did not involve a concrete relaxation of a component of a veteran‘s affirmative case. Rather, it involved a heightening of the government‘s rebuttal burden in a particular situation. A regulation provided that, when a veteran claims disability based on aggravation during service of a preexisting injury, see
It was that regulatory change Routen held not to qualify. That change did not alter the veteran‘s affirmative case at all. It altered only the government‘s rebuttal case—and did so only at the general level of specifying how persuasive the government‘s evidence must be, not by altering particular components of proof. Those features critically differ from the elimination of a proof element of a veteran‘s affirmative case that was effected by the 2010 addition of
C
To the extent relevant, VA‘s statements in adopting the 2010 thе Final Rule underscore the conclusion that
The Veterans Court in Foreman concluded that the 2010 addition of
Finally, VA in the Final Rule asserted that the 2010 addition of
III
For the foregoing reasons, we reverse the decision of the Veterans Court.
The parties shall bear their own costs.
REVERSED
