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Jones v. Wilkie

United States Court of Appeals, Federal Circuit

March 13, 2019

JACQUELINE H. JONES, Claimant-Appellant
v.
ROBERT WILKIE, SECRETARY OF VETERANS AFFAIRS, Respondent-Appellee

          Appeal from the United States Court of Appeals for Veterans Claims in No. 15-3919, Chief Judge Robert N. Davis, Judge Mary J. Schoelen, Judge Margaret C. Bartley.

          Meghan Gentile, Veterans Legal Advocacy Group, Arlington, VA, argued for claimant-appellant. Also represented by Harold Hamilton Hoffman-Logsdon, III.

          Albert S. Iarossi, Commercial Litigation Branch, Civil Division, United States Department of Justice, Washington, DC, argued for respondent-appellee. Also represented by Robert Edward Kirschman, Jr., Loren Misha Preheim, Joseph H. Hunt; Brian D. Griffin, Samantha Ann Syverson, Office of General Counsel, United States Department of Veterans Affairs, Washington, DC.

          Before Moore, Reyna, and Chen, Circuit Judges.

          Chen, Circuit Judge.

         Jacqueline Jones, who substituted as appellant for her deceased husband Josephus Jones, appeals the decision of the U.S. Court of Appeals for Veterans Claims (Veterans Court), which affirmed the Board of Veterans' Appeals (Board) decision denying an earlier effective date for service-connected compensation for post-traumatic stress disorder (PTSD). Ms. Jones argues that the Veterans Court erred in using a heightened legal threshold to determine whether the Veterans Administration (VA) was required to assist Mr. Jones in obtaining his VA treatment records, which he asserted might contain an earlier, informal claim that could entitle him to an earlier effective date for benefits. Because the Veterans Court erred in analyzing the VA's duty to assist, we vacate the Veterans Court's decision and remand for consideration of Mr. Jones's complete VA treatment file.

         Background

         In general, the effective date of a VA benefits award is the date the VA receives an application for the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. However, under the VA regulations that applied to Mr. Jones's claims, if an applicant submitted an "informal claim, "[1] the VA was required to send the applicant a formal application form, and, assuming the applicant returned the form within one year, the VA would deem the formal application submitted as of the date of receipt of the informal claim. 38 C.F.R. § 3.155 (2000).

         Mr. Jones served in the Marine Corps from 1968 to 1970. A VA psychiatrist treated him and diagnosed him with PTSD in 2000. J.A. 1; J.A. 17. Mr. Jones formally applied for disability benefits for PTSD in April 2011. J.A. 27. In February 2012, the VA Regional Office (RO) awarded Mr. Jones a 100% disability rating for PTSD, effective April 13, 2011, the date the RO received his formal application. J.A. 2; J.A. 37.

         Later in 2012, Mr. Jones filed a notice of disagreement arguing that he should receive an earlier effective date that reflects VA medical treatment for PTSD beginning in 2000. Mr. Jones asserted that he "did not file until 11 years later because the doctors did not explain to [him] what PTSD really was back in 2000." J.A. 61. On July 17, 2015, the Board denied Mr. Jones's claim for an earlier effective date. The Board acknowledged the existence of "VA medical records showing treatment for mental health symptoms" in 2000, but the Board found that the records before it "[did] not indicate an intent to file a claim for benefits and are not considered an 'informal claim' under any applicable regulations at the time." J.A. 17.

         Mr. Jones appealed to the Veterans Court, which affirmed the Board's decision. The Veterans Court did not review Mr. Jones's complete treatment files. The Veterans Court noted: "The Secretary tacitly admits that the complete VA medical records from 2000 and 2001 are not in the record . . . ." J.A. 1. In light of Mr. Jones's statement that he did not request benefits until 2011, however, the Veterans Court found that "the likelihood of such an informal claim [from 2000 or 2001] appearing in the unobtained VA medical records is extremely low." J.A. 3. Further, the Veterans Court found, even if the records contained a communication that met the definition of an "informal claim," Mr. Jones had not shown that such an informal claim was received by the "benefits section of the VA," as opposed to a doctor at the "Veterans Health Administration." J.A. 4.

         Mr. Jones passed away in October 2016, and his wife substituted into the case and appealed on his behalf.

         Discussion

         We have jurisdiction to review a Veterans Court decision "with respect to the validity of a decision of the Court on a rule of law or of any statute or regulation . . . or any interpretation thereof (other than a determination as to a factual matter) that was relied on by the Court in making the decision." 38 U.S.C. § 7292(a). "We review de novo legal ...


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