Patrick D. MacPhee Claimant-Appellant v. R. James Nicholson, Secretary of Veterans Affairs
Docket: 05-7089
Court: Court of Appeals for the Federal Circuit; August 15, 2006; Federal Appellate Court
Patrick D. MacPhee appeals a decision from the United States Court of Appeals for Veterans Claims, which upheld the Board of Veterans' Appeals ruling that MacPhee's 1988 medical records did not represent an informal claim for increased disability benefits. MacPhee, who served from June 1969 to January 1972, initially received service connection for post-traumatic stress disorder (PTSD) with a 30% disability rating in 1982, later reduced to 10% in 1986. His 1988 hospitalization records indicated severe PTSD symptoms and alcohol dependence, leading him to claim an increase in benefits.
However, the Regional Office (RO) and subsequently the Board denied his claim for alcohol dependence as secondary to PTSD, stating that his 1988 records could not serve as an informal claim under 38 C.F.R. 3.157(b)(1) since alcohol dependence had not been previously adjudicated. The Veterans Court affirmed this decision, explaining that MacPhee had not filed a prior claim for alcohol dependence, thus disqualifying the 1988 records as an informal claim. Additionally, the Veterans Court denied MacPhee’s requests for a second copy of his claims file and for the entire claims file to be included in the appeal record. The appeals court maintains jurisdiction under 38 U.S.C. 7292(c).
Unlawful regulations or interpretations by the Court of Appeals for Veterans Claims will be set aside if they are arbitrary, capricious, abuse discretion, contrary to constitutional rights, exceed statutory jurisdiction, or violate legal procedures. The case focuses on the interpretation of regulations regarding informal claims, specifically 38 C.F.R. 3.155(a) and 38 C.F.R. 3.157(b)(1). Section 3.155(a) pertains to original informal claims requiring the identification of the sought benefit and intent to apply, with a formal claim needed within a year after VA notification. In contrast, Section 3.157(b)(1) allows a medical report to serve as an informal claim for increasing or reopening prior compensation determinations when related to established service-connected disabilities.
MacPhee contends that the Veterans Court incorrectly interpreted Section 3.157(b)(1) by not remanding for adjudication based on his 1988 medical records related to alcohol dependence secondary to PTSD. He argues that the court mistakenly utilized Section 3.155 instead of Section 3.157(b)(1), asserting that his medical records should qualify as an informal claim. The Veterans Court, however, determined that the medical reports did not constitute an original informal claim under Section 3.155(a) as they failed to show intent to apply for secondary service connection. This conclusion was supported by a precedent case, Brannon v. West, which similarly ruled that mere medical evidence does not establish intent for secondary service connection. Furthermore, the Veterans Court found that MacPhee's records could not be considered an informal claim under Section 3.157(b)(1) because he had not previously filed for secondary service connection for alcohol dependence. MacPhee's interpretation that medical records could serve as an informal claim without a prior claim contradicts the regulation's language.
An informal claim under 38 C.F.R. § 3.157(b)(1) pertains to requests for increasing or reopening a disability determination, specifically for conditions that have previously been recognized as service-connected. The regulation stipulates that a medical examination report can serve as an informal claim only if there has been a prior formal claim related to that condition. MacPhee had not filed a service connection claim for alcohol dependence, nor had any prior claims been decided regarding it or its potential connection to PTSD. Consequently, the Veterans Court correctly determined that MacPhee's 1988 medical records could not be considered an informal claim for increased compensation due to alcohol dependence. Additionally, while MacPhee argued that 38 C.F.R. § 3.310 could establish proximate causation linking his alcohol dependence to PTSD, no prior claim or determination existed to support this connection, thus precluding it from being part of the original PTSD claim. Furthermore, the claim that the VA has a duty to broadly interpret veterans' claims does not apply here, as the medical reports do not meet the criteria for informal claims under § 3.157(b)(1). The Veterans Court’s interpretation of its Rules of Practice and Procedure was also upheld as correct. Ultimately, the judgment of the Veterans Court is affirmed.
The Department of Veterans Affairs may grant an adjudication in favor of MacPhee regarding an informal claim, potentially providing additional disability benefits retroactively from August 1988 to April 1992. According to 38 C.F.R. § 3.155(a), any communication indicating an intent to apply for benefits may qualify as an informal claim, provided it identifies the benefit sought. Upon receiving such an informal claim, the Department will send a formal application to the claimant, which, if returned within one year, will be considered filed as of the date of the informal claim. Furthermore, 38 C.F.R. § 3.310(a) establishes that disabilities resulting from a service-connected disease or injury are service-connected, and if a secondary condition is established as related to the original condition, it will be treated as part of that original condition.
