Vazquez-Flores v. ShinsekiVazquez-Flores v. Shinseki
Thе Secretary of Veterans Affairs appeals two related judgments from the Court of Appeals for Veterans Claims (“Veterans Court”). Because the parties make substantially identical arguments, we address the appeals together. Veterans Angel Vazquez-Flores and Michael R. Schultz each applied for an increased rating for them service-connected disabilities. Their regional offices (“ROs”) denied the claims, and the Board of Veterans’ Appeals (“Board”) affirmed in both cases. On appeal to the Veterans Court, the veterans argued that the Department of Veterans Affairs (“VA”) provided inadequate notice for an increased rating claim. The Veterans Court agreed, remanding the claims back to the Board.
See Vazquez-Flores v. Peake,
BACKGROUND
I. Vazquez-Flores
Veteran Angel Vazquez-Flores served on active duty in the U.S. Army from July 1963 to July 1965 and again from January 1966 to January 1969. After his release from service, he received service connection for nephrolithiasis. Since April 1976, Vazquez-Flores’s condition has been rated at 30% — the maximum disability rating possible under diagnostic code (“DC”) 7508, the diagnostic code for nephrolithiasis.
See
Although 30% is the maximum disability rating under DC 7508, that diagnostic code cross-references other diagnostic codes that permit even higher disability ratings. Specifically, in most circumstances DC 7508 requires nephrolithiasis to be rated as “hydronephrosis” under DC 7509.
See
In 1994, Vazquez-Flores requested an increased rating. Following the request, the case shuttled back and forth between the Board and the RO a number of times. The RO issued a number of supplemental statements of the case (“SSOCs”), which summarized any newly submitted evidence and provided the reasons and bases for the RO’s decision to deny an increased rating; some of the SSOCs referenced the diagnostic codes for nephrolithiasis, hydrоne-phrosis, and renal dysfunction (but not hypertension).
After the RO again denied an increased rating for Vazquez-Flores’s nephrolithia-sis, he requested Board review. The Board denied an increased disability rating after evaluating the medical evidence in light of the diagnostic codes for nephroli-thiasis, hydronephi’osis, renal dysfunction, and hypertension. The Board also found that the VA had satisfied its duty to notify and to assist.
See In re Vazquez-Flores,
No. 96-37 108A,
The Veterans Court held, in relevant part, that under
After comparing these requirements to the notice Vazquez-Flores received, the Veterans Court concluded that the VA did not satisfy its duty to notify. The Veterans Court examined two writings relied upon by the Board: an April 2001 notice letter (“the 2001 letter”), and a December 2003 letter from the VA’s Appeal Management Center (“the AMC letter”). The Veterans Court found that the 2001 letter did not tell Vazquez-Flores how to substantiate his claim for an increased disability rating — instead, the letter focused on how to substantiate a claim for service connection. Id. at 48. According to the Veterans Court, the AMC letter was likewise deficient because it merely asked Vazquez-Flores to provide evidence that his nephrolithiasis had “gotten worse.” Specifically, the court concluded that the AMC letter failed
to explain that thе evidence must demonstrate the effect of that worsening on his occupational and daily life or to provide, at least in general terms, the criteria beyond the effect of the worsening of the disability upon the occupational and daily life that is necessary to be awarded *1274 the higher disability rating for his condition. Moreover, the totality of information provided in these documents was also confusing in that it provided differing versions of what was required to show entitlement to a higher disability rating.
Id.
(citations omitted). The Veterans Court concluded that the Board’s finding that the VA provided adеquate notice was clearly erroneous in light of “the lack of adequate information in the notice and the otherwise confusing nature of the notice.”
Id.
The Veterans Court then remanded the case based on its conclusion that any notice error was presumptively prejudicial under our then-in-effect decision in
Sanders v. Nicholson,
The government filed a motion to stay the precedential effect of the decision, but the Veterans Court denied the request.
Vazquez-Flores v. Peake,
II. Schultz
Veteran Michael Schultz served in the military during the 1980s and 1990s.
3
He currently has a 20% disability rating for a right shoulder disability (rated by analogy to DC 5202,
see
In April of 2001, the RO sent Schultz a notice letter, which explained that to receive an increased rating Schultz would have to show that his conditions had “become worse or more disabling.” The letter also informed him that he might receive а new VA examination and that he could “submit [his] own statements or statements from other people describing [his] physical or mental disability symptoms.” Schultz received additional medical examinations and submitted a letter showing how his disabilities “affected his daily life and employment, and describing the pain caused by his disabilities.”
Schultz,
After Schultz’s case was submitted back to the Board, the Board determined that Schultz was not entitled to an increased rating for his service-connected injuries.
In re Schultz,
No. 98-14 324,
The Veterans Court relied on
Vazquez-Flores
in finding that the April 2001 notice was inadequate. The court reached that conclusion because the notice did not “inform the appellant that he should submit evidence describing the effects of his worsened condition on his employability and daily life.”
Id.
at *5. In addition, the
*1275
Board had indicated that Schultz’s knee disabilities could be evaluated based on diagnostic codes relating to “limitation of motion, dislocated or removed cartilage, nonunion and/or malunion of the tibia and fíbula, or the presence of genu recurva-tum.”
Id.
Since each of these methods for evaluating Schultz’s knees depended upon different evidence — “not simply a showing that the overall condition has worsened,” as stated in the April 2001 letter — the court found that the notice did not comply with the requirements of
DISCUSSION
Under
The Veterans Court remanded both
Vazquez-Flores
and
Schultz
to the Board. In
Williams,
we noted that we typically do not review remand orders because they are not final judgments.
On appeal, the government prеsents two questions: whether the Veterans Court erred in holding that
I. Diagnostic Codes
As the Veterans Court stated, its Vazquez-Flores holding requires
a review of the previously assigned DC and disability rating, and a commonsense assessment whether the criteria for a higher rating under the assigned or a cross-referenced DC includes criteria “that would not be satisfied by the claimant demonstrating a noticeable *1276 worsening or increase in severity of the disability and the effect of that worsening ... on the claimant’s employment and daily life (such as a specific measurement or test result).” See Vazquez-Flores,22 Vet.App. at 43-44 . If it does, then general notice of that criteria must be provided to the claimant.
Order Denying Stay,
The veterans attempt to distinguish those cases by arguing that they are limited to their particular facts — under the veterans’ interpretation,
Wilson
stands for the proposition that
In
Paralyzed Veterans,
we addressed a general challenge to the regulations promulgated by the VA following the enactment of the VCAA. In particular, we analyzed
When VA receives a complete or substantially complete application for benefits, it will notify the claimant of any information and medical or lay evidence that is necessary to substantiate the claim. VA will inform the claimant which information and evidence, if any, that the claimant is to provide to VA and which information and evidence, if any, that VA will attempt to obtain on behalf of the claimant. VA will also request that the claimant provide any evidence in the claimant’s possession that pertains to the claim.
In
Wilson,
we addressed a veteran-specific challenge to
Both
Wilson
and
Paralyzed Veterans
speak to the question at hand. In
Wilson,
the “particular type of claim” was a claim for service connection, and the discussion surrounding the “particular type of claim” language made it clear that that phrase was intended to distinguish between types of claims, i.e., between claims seeking service connection and those seeking increased ratings. The “particular type of claim” contemplated in
Wilson
was not, as the veterans would have it, a “veteran-specific” claim, or one that would depend upon the particulars of a given veteran’s case. In other words,
Wilson
and
Paralyzed Veterans
put to rest the notion that the VA is required to provide veteran-specific notice, although
Wilson
requires the notice to be claim-specific. As a result, generic notice provided in response to a request for service connection must differ from that provided in response to a request for an increased rating.
See Wilson,
The Veterans Court appeared to embrace
Wilson
and
Paralyzed Veterans
— in fact, the court cited both cases in its
Vazquez-Flores
opinion, and discussed the excerpts of
Wilson
highlighted above.
The veterans next direct our attention to a Senate Report accompanying the Veterans’ Benefit Improvement Act of 2008 (“VBIA”) in support of them argument to the contrary. While the veterans acknowledge that the VBIA was enacted well after the notices at issue, they nonetheless argue that Congress’s reasoning ought to inform the outcome in this case. As noted, the Act added a subsection to
(i) shall specify different contents for notice based on whether the claim concerned is an original claim, a claim for reopening a prior decision on a claim, or a claim for an increase in benefits;
(ii) shall provide that the contents for such notice be appropriate to the type of benefits or services sought under the claim;
(iii) shall specify for each type of claim for benefits the general information and evidence required to substantiate the basic elements of such type of claim; and
(iv) shall specify the time period limitations required pursuant to subsection (b).
II. Daily Life
In addition to requiring the VA to provide notice of alternative diagnostic code criteria, the Veterans Court would require the VA to inform the veteran that he or she may submit evidence of the effect his disability has on his “daily life”:
[T]he Secretary [must] notify the claimant that, to substantiate a claim, the claimant must provide, or ask the Secretary to obtain, medical or lay evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on the claimant’s employment and daily life. ... Additionally, the claimant must be notified that, should an increase in disability be found, a disability rating will be determined by applying relevant DCs, which typically provide for a range in severity of a particular disability from 0% to as much as 100% (depending on the disability involved), based on the nature of the symptoms of the condition for which disability compensation is being sought, their severity and duration, and their impact upon employment and daily life.
Vazquez-Flores,
The government challenges this requirement on two grounds. First, the government argues that this interpretation is inconsistent with the statute, which obliges the Secretary to “adopt and apply a schedule of ratings of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations.”
The veterans counter by pointing out that the VA’s regulations explicitly reference “daily life” —
We are convinced that the government is correct.
This conclusion is reinforced by the VA’s interpretation of the term “disability.” The VA is authorized to award benefits when a veteran receives a disability in the line of duty.
See
As the veterans point out, the phrase “daily life” is used in Part 4 of 38 C.F.R.
See
In sum, the question is not whether the VA would be prudent to urge an applicant for an increased rating to provide evidenсe relating to “the effect that worsening has on the claimant’s ... daily life.” The question is whether the VA’s failure to do so constitutes a breach of its duty to provide adequate notice to such claimants. For the reasons discussed herein, it does not.
CONCLUSION
As in
Wilson,
the arguments made by the veterans in this case “overlook[] the many statutory and regulatory provisions that do apply to VA’s actions after an initial RO decision.”
We remand to the Veterans Court for a determination of whether the notices provided to Vazquez-Flores and Schultz satisfied the VA’s duty to notify in light of the foregoing analysis.
See Mayfield v. Nicholson,
COSTS
Each party shall bear its own costs.
VACATED AND REMANDED
Notes
. Under
. Congress amended
. The Board’s opinion states that Schultz was on active duty from December 1980 to December 1984 and again from June 1985 to November 1993; the Veterans Court opinion states that he had active military service from July 1985 to November 1993.