Can a veteran claim "additional disability" benefits for an injury that was not directly caused by government hospital care?
The Federal Circuit Court of Appeals ruled this week that he can.
Army vet John Viegas was injured in a diving accident after he left the service. That accident resulted in “incomplete” quadriplegia. In May 2004, Viegas suffered additional injuries while participating in a prescribed aquatic therapy session at a Department of Veterans Affairs (VA) medical center in Palo Alto, California. While he was in the restroom at the VA, the grab bar he was using to lift himself into his wheelchair came loose from the wall and he fell to the ground. As a result of the fall, Viegas sustained injuries to both his upper and lower extremities.
Viegas’ medical condition deteriorated after his fall. Prior to his fall, Viegas could sometimes walk with a walker, but since the accident he can only stand with assistance.
In July 2004, Viegas filed a claim for section disability benefits under 38 U.S.C. § 1151. He asserted that — as a result of the fall in the VA restroom — he had “incurred severe injury to his shoulder and neck resulting in loss of use of his lower extremities and impairment of his upper extremities.” The VA and Veterans Court denied the claim because Viegas’ injuries weren’t “directly caused by the provision of medical care,” but the Federal Circuit Court of Appeals saw things differently.
Section 1151 delineates three prerequisites for obtaining disability compensation:
- A putative claimant must incur a “qualifying additional disability” that was not the result of his own “willful misconduct.”
- That disability must have been “caused by hospital care, medical or surgical treatment, or examination furnished the veteran” by the VA or in a VA facility.
- The “proximate cause” of the veteran’s disability must be “carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the [VA],” or “an event not reasonably foreseeable.”
So Section 1151 contains two causation elements: A veteran’s disability must be “caused by” the hospital care or medical treatment he received from the VA, and “proximately caused” by the VA’s “fault” or an unforeseen “event.”
Everyone agreed that Viegas’ injury met the second causation element since it was proximately caused by the VA’s failure to properly install and maintain the grab bar. The sole issue presented on appeal was whether his injury was “caused by” the medical treatment or hospital care he received from the VA.
The Federal Circuit, noting that §1151 never states that an injury must be “directly” cause by VA treatment and the statute should be construed liberally, reversed the Veterans Court decision, and remanded Viegas’ claim for further proceedings.
- Viegas v. Shinseki (FindLaw’s CaseLaw)
- Reality Trumps Eligibility in Disability Benefits Appeal (FindLaw’s Federal Circuit Blog)
- Vets Aren’t Guaranteed Effective Counsel for Benefits Appeals (FindLaw’s Federal Circuit Blog)