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The VA 1151 Claim: Righting a Wrong

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  • The VA 1151 Claim: Righting a Wrong

    “How do I sue the VA for what they did to me?”

    I used to get this question at least once a month from some disabled veteran who passionately believes that VA medical care has caused him undue suffering in one way or another. Rather than point him to the “legal aid” section of the Yellow Pages, I often assume what he wants is information on filing a claim under Title 38 U.S. Code section 1151.


    The 1151 statute states, in pertinent part: “Compensation under this chapter…for a qualifying additional disability or a qualifying death of a veteran in the same manner as if such additional disability or death were service-connected…if the disability or death was…caused by hospital care, medical or surgical treatment, or examination…and the proximate cause of the disability or death was…carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the Department in furnishing the hospital care, medical or surgical treatment, or examination; or…an event not reasonably foreseeable.”

    Simply put, this means that a veteran who is injured or dies due to negligent VA medical care will be compensated as if the injury or death was service connected---a simple explanation for an extremely complicated endeavor. Prevailing on an 1151 claim is infamously difficult. Why? Because a medical “wrong” that has been committed is not necessarily “wrongful” in the eyes of the law. A physician who provides a veteran informed consent of the necessary consequences of a surgery has not breached his duty of due care simply because the veteran ended up on the unfavorable end of the risk spectrum. Sometimes, a veteran has no choice but to have a high-risk surgery, and doctors are only required to exercise reasonable care; not perform miracles. When the worst happens, foreseeable or not, it seems only fair that someone should have to pay. Unfortunately, it will not be the VA if all reasonable steps were taken to give that veteran the best possible chance of recovery despite the unfortunate outcome.

    So when should a veteran pursue 1151 compensation? If you feel that your situation warrants at least consideration of a claim, first ask yourself some basic questions:

    -Were you given informed consent about the procedure (prior written acknowledgment of the risks of treatment)?

    -Was the alleged wrong a necessary consequence of properly- administered medical care (e.g. paralysis after a laminectomy)

    -Is the wrong commonplace in the type of care administered (e.g. a dural tear during spine surgery)?

    If your answer was ‘no’ to any or all of these, you then must contemplate whether the wrong substantially contributed to the outcome. Was the wrong uneventful considering adequate care was ultimately provided? And are there any identifiable residuals that were directly caused by the wrong?


    Speaking of cause, the VA will often cite “natural progression” to deny an 1151 claim when the evidence fails to support a definitive theory on how the disability at issue occurred. Your best bet is to obtain a factually based medical opinion from an expert in the field involved that explicitly rules out Mother Nature or some other coincidental event as the direct cause of disability. Causation need not be proven with clear and convincing certainty although this would be ideal; only that your theory on causation is more likely than not true. To determine whether your claim is well grounded or supported by the evidence of record, you should obtain this opinion prior to filing a claim since your entire case will rest on it. And the chances that a VA doctor will give you such an opinion in writing are as good as hitting the lottery, so be prepared to seek out a reputable private physician who will need to examine your medical records and provide an objectively derived basis for his or her conclusion. A small price to pay if your claim is eventually granted.

    In closing, any legitimate 1151 claim is winnable despite the aforementioned challenges. But it all starts with an objective analysis of the evidence by an expert who must reconcile the tough questions in your case. For when you have your day in court, so to speak, the evidence alone is your most persuasive advocate. ♦

  • #2
    Concerning 1151

    About a year ago I started to pursue a claim for widows pension under the 1151 rule. I also wanted to protect my statue of limitations so I filled out the form 95, however when I first went to the VA medical Center in question they refused to accept it, and wouldn't even acknowledge that I was present that day. I believe my evidence to be overwhelming for malpractice, but found out the government never accepts responsibility. My husband died of liver cancer, but could have been saved if only the PA had given him any kind of care. I work in the medical field, and I would advise anyone seeking care at the VA, and for the life of me now that I know they have no accountability, would get care there, I would suggest finding someone who can read medical records to read yours or your loved ones. I found 7 pages of single spaced medical errors.
    But, I am furious that this VA medical center refused to accept form 95, and under the VA law they have to, and it has to be accepted at the place where the injury happened. I had to go through all kinds of trouble to finally get someone to accept it, and that person didn't work for the said medical center because that one was a satilite, but from the VA hospital, because they still refused to accept it. I feel like my civil rights have been violated, since every American has the right to submit a form 95, whether it is deemed to have merit, that is to be determined but it must be accepted. Anyone have an ideas, It was extremely close to the statue of limitations, since it goes by the death of the veteran, and not the day that I discovered definitely that it was malpractice, since I had to do research. Anyone who can help me I appreciate it

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    • #3
      First, let me say that I am so sorry for your loss.

      Can you mail them a copy return receipt requested? They will have accepted not knowing what it is. Get a good VSO to help you.

      Also go to http://vets.yuku.com/directory and put your request in the general claims section. This website is staffed by former raters, VSO's, psychologists and every other former VA sort. You will get a good and correct answer on that site, I guarantee you as they know every rule and procedure intimately. They will show you how to kick some azz.

      Maybe they don't want to take the paper because it is not being submitted by an attorney. These things usually are. Good luck and let me know what you find out, please.
      Anything worth doing, is worth doing to excess

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      • #4
        how long after incident do you have to file ?

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        • #5
          I would strongly encourage you to discuss your individual needs and situation in this area with your Veterans' organization national service officer (the PVA is best, in my opinion). If you don't have one, get one by contacting your closest PVA Service Office, which you can find here: http://www.pva.org/site/c.ajIRK9NJLc...ce_Offices.htm

          (KLD)
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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