The Clemons Case: Defining The Scope Of A Claim

30 Jun 2017

As veteran representatives, we see claims come to us in many different stages of development. Sometimes, we start at ground zero, and prepare and file the original claim(s) for our clients. At other times, veterans come to us after the claim(s) have undergone some development, say, the VA has obtained the veteran's treatment records or has procured VA medical examinations.

In either case, representatives should always be aware that the scope of a claim may change during its development. This is the lesson of Clemons v. Shinseki, 23 Vet.App. 1 (2009). Clemons says that the scope of a claim is determined by all the information and evidence received by the VA, not just by the way a claimant pleads his claim.

Clemons v. Shinseki

In Clemons, the veteran filed a claim, alleging entitlement to service-connected PTSD. However, during the development of the claim, medical evidence was obtained supporting a diagnosis of anxiety disorder and schizoid personality disorder. The Board denied the claim, reasoning that there was insufficient evidence of a diagnosis of PTSD.

Vacating the Board's denial, the Veterans Court explained that the veteran's mistaken belief that he suffered from PTSD was not a basis for denying his claim in the face of medical evidence diagnosing him with an anxiety disorder and a schizoid personality disorder. Rather, the Board should have evaluated all the evidence -- both lay and medical - to determine the proper scope of the claim:

"For purposes of the claim and its adjudication, it matters little that the appellant believes his symptoms should be diagnosed as PTSD if the medical evidence establishes that his symptoms are actually something different. And, the fact that the appellant may be wrong about the nature of his condition does not relieve the Secretary of his duty to properly adjudicate the claim". 23 Vet.App. at 6.

Applying Clemons v. Shinseki:

The rule of Clemons is not limited to psychiatric claims; it applies to all physical and mental conditions. The point of Clemons is that veterans are not experts in medical science; they are capable of describing the symptoms of their conditions, but are not competent to diagnose the conditions themselves.

For example, a veteran who pleads entitlement to service-connected sarcoidosis, a pulmonary disease, is not necessary limited to that condition. If, during the development of the claim, evidence establishes that he/she has tuberculosis, the VA must consider this condition as part of the same claim.

In practical terms, the scope of the claim is determined by the body part (e.g., head, neck, back) or by the body system (e.g., cardiovascular, digestive, respiratory systems) alleged in the VA claim form 21-1438, and by the medical evidence received in connection with the claim.

VLG's Bulletin is an educational resource for VSOs. These Bulletins will discuss how court decisions, statutes & regulations can be applied to the advantage of your clients' claims.