Forensic Psychiatry Commentary: The Saunders v. Wilkie decision, which is unlikely to be overturned by the veteran friendly Supreme Court, will add a new component to the adjudication of VA service-connected disability. The new step in the process will be to consider the veteran’s complaint of pain, whether it developed during or was caused by or aggravated by military service. Pain without a specific diagnosis or identifiable pathology will be considered a condition that may be capable of causing disability, and it then must be determined in what ways the complaint of pain affects overall function and the ability to work. Dr. Brown July 2018
Melba Saunders v. Robert Wilkie, Acting Secretary of VA
United States Court of Appeals for the Federal Circuit, April 3, 2018
When pain is a condition without a diagnosis what should the VA do? There were 3 issues on appeal from the United States Court of Appeals for Veterans Claims in the matter of Ms. Saunders claim for benefits. The 1st concerned whether the Court of Appeals for the Federal Circuit had jurisdiction to hear the appeal, and it did. The 2nd was whether pain can constitute a disability without a medical diagnosis under, 38 U.S.C., 1110, and 3rd, if so, what would be the remedy.
Ms. Saunders served on active duty in the Army from November 1987 until October 1994. She did not experience knee problems before entering military service. During the period of active duty service she sought treatment for knee pain and was diagnosed with patellofemoral pain syndrome (“PFPS”). Beginning in 1994, Ms. Saunders applied for VA disability on the basis of knee, hip, and bilateral foot pain. The VA denied her claim because “pain” could not suffice as a diagnosis for Saunders’s knee condition. An examining physician went as far as to state that there was no pathology or diagnosis.
In rendering its decision, the court reviewed Sanchez-Benitez I &II, which had been previously decided by the Veterans Court and interpreted to mean that pain alone without pathology or a diagnosis to account for it could not be considered a “disability.” In its decision, the US Court of Appeals for the Federal Circuit examined common dictionary definitions of disability, reviewed 38 USC, 1110, and determined that pain without a diagnosis could qualify as a disability because it adversely affects function and the ability to work and earn. The decision of the lower court was reversed and remanded for further proceeding consistent with this opinion.