Chronic Multisymptom Illness

Regulation

• 38 C.F.R. § 3.303

  Direct service connection — a current disability linked to service. (Continuity of symptomatology under § 3.303(b) is limited by case law to the § 3.309(a) chronic diseases — Walker.)

Case law

• Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004)

  The three-element test: current disability, in-service event, and a nexus between them.

• Holton v. Shinseki, 557 F.3d 1363 (Fed. Cir. 2009)

  Federal Circuit restatement of the same three direct-service-connection elements.

• Caluza v. Brown, 7 Vet. App. 498 (1995)

  The evidentiary framework a rater weighs each element against.

• Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)

  Continuity of symptomatology (§ 3.303(b)) is available ONLY for a chronic disease listed in § 3.309(a); any other condition must use the medical-nexus pathway.

• Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009)

  A categorical 'a medical opinion is always required for nexus' is legal error — competent lay evidence can suffice.

• Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994)

  A veteran is competent to report symptoms they personally observe (Layno), and lay evidence can even establish a simple diagnosis in the right case (Jandreau).

• McLendon v. Nicholson, 20 Vet. App. 79 (2006)

  A LOW threshold — evidence that merely indicates a nexus MAY exist obligates VA to provide a C&P exam.

• 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990)

  When the evidence is in relative equipoise, the tie goes to the veteran — the preponderance must be AGAINST the claim to deny it.