In the interests of simplifying and streamlining assessment of claims covered under presumptive conditions, the approach to onset considerations in applying presumption is detailed below.
It is not uncommon for onset of conditions to be backdated by treating doctors. Often this backdating is reasonable, based on a clinical understanding of the nature of the disease progression and reported symptomology. However, case law also is clear that it is necessary that all relevant signs, symptoms and features of a condition are present in order for a condition to have onset by a certain point. As such early symptomology may not necessarily reflect a disease is fully present at that point or may reflect a different condition. For instance, back pain may result from a strain rather than spondylosis - disc degeneration and constant or frequent symptomology would need to be present to say that spondylosis had onset.
In general terms if the diagnosing doctor has a long-term treating relationship of the veteran then their view can be weighted more highly. But the further in time the onset of a condition is back-dated, the more difficult it becomes to accurately assess. In order to simplify assessment of onset as far as possible, the policy position for onset considerations in relation to presumptive conditions is if a condition is diagnosed within the required specified onset timeframe then no further investigations are required. Further should a treating doctor provide an onset date within the 5 years prior to the date of their assessment/diagnosis this may be taken as a reasonable onset timeframe and no further investigation is required. If doctor backdates onset beyond 5 years, further investigations of the available medical evidence should be undertaken to verify the onset timeframe– see above for further information.