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Page Number: 5.0

2 

GEORGE v. MCDONOUGH 

Opinion of the Court 

of the VA then determines whether the veteran satisfies all 
legal prerequisites, including the requirement that military
service caused or aggravated the disability.  §511(a); see 38 
CFR §3.100(a) (2021).  To that end, the statute governing 
wartime service imposes a “[p]resumption of sound condi-
tion”: If a veteran’s disability was not noted at the time of 
entry into service, then the veteran is presumptively enti-
tled to benefits unless the VA shows by a heightened bur-
den of proof that the disability “existed before . . . and was 
not aggravated by such service.”  38 U. S. C. §1111.  After 
applying  this  and  other  statutory  and  regulatory  require-
ments, the regional office issues an initial decision granting
or denying benefits.  §§511(a), 5104(a).

A veteran dissatisfied with this decision may challenge it 
through several layers of direct review.  As a general rule, 
the veteran may appeal within one year to the VA’s Board 
of Veterans’ Appeals (Board).  §§7105(b)(1), 7104(a).  If the 
Board also denies relief, the veteran may seek further re-
view outside the agency.  Such review was once limited to 
constitutional and certain statutory claims, but since 1988 
Congress has generally allowed veterans 120 days to appeal 
any  Board  decision  to  the  Court  of  Appeals  for  Veterans
Claims (Veterans Court).  See Henderson v. Shinseki, 562 
U. S. 428, 432, and n. 1 (2011); §§7252(a), 7261(a), 7266(a).
A veteran dissatisfied with that court’s decision may seek 
review  of  any  legal  issue  in  the  Federal  Circuit  and  ulti-
mately in this Court.  §7292; 28 U. S. C. §1254(1).

After this direct appeal process, the benefits decision gen-
erally  becomes  “final  and  conclusive  and  may  not  be  re-
viewed  by  any  other  official  or  by  any  court.”    38  U. S. C. 
§511(a); see §7104(a).  Still, the veteran enjoys a few limited 
options for seeking collateral review in exceptional circum-
stances.  E.g., §5108(a) (supplemental claim based on new 
and relevant evidence); §503(a) (discretionary relief based
on  administrative  error);  §5110(g)  (increase  of  benefits
based on subsequent liberalizing legal change).