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CHD and the Law: The Heart of a Soldier

Jul 15

Posted by: ACHA
7/15/2014 2:41 PM  RssIcon

By Michael Pernick

This blog series features stories involving congenital heart disease and the law. The blog posts may discuss contemporary or historical court decisions, laws or regulations, or other legal issues that relate to CHD. These posts are purely for entertainment and educational purposes and are not legal advice. Any opinions expressed in this series of posts are solely those of the author and do not represent the Adult Congenital Heart Association.

Sheldon Monroe is a Korean War veteran. He entered the service in September 1951, thinking he was entirely healthy. He had been a member of his college basketball and football teams. He was shocked when, shortly after basic training, a physical examination revealed a severe heart murmur. He was soon diagnosed with a ventricular septal defect. He served for two years and was honorably discharged in 1953.

Thirty-six years later, Monroe wasn’t doing as well. He was having serious heart trouble and he decided to apply to the Regional Office of the Veterans Administration for disability benefits. The Regional Office rejected his application, simply saying that his defect pre-existed his service. Monroe wasn’t happy, so he appealed to the United States Court of Veterans Appeals.

The Court struggled with his appeal because the law was particularly murky. One statute said that veterans could receive compensation for “diseases and injuries,” while another statute said that veterans could not receive benefits for “congenital defects.” These two statutes were in conflict—on the one hand, he should be entitled to benefits if his military service made his condition worse; on the other hand, the law said that congenital heart patients were not entitled to compensation. The law was further complicated by a directive from the General Counsel for the Department of Veterans Affairs, which said that “diseases,” including congenital heart disease, should be covered but “defects,” like congenital heart defects, should not be covered.

After wrestling with this complicated statutory scheme, the court decided to take a step back and do the right thing. The court explained that in these types of cases, veterans are entitled to a “rebuttable presumption.” Even if a veteran couldn’t prove that the military service made his heart condition worse, so long as the veteran was born with a heart condition and it worsened while he was in the service, the court would find that there is a rebuttable presumption that the military service was the cause of the aggravation. This means the veteran would earn disability benefits unless there was clear and unmistakable evidence that the service was not the cause of the aggravation. In other words, the court made it easier for veterans with congenital heart defects to earn benefits—all they need to show is that their condition got worse while serving in the military, not that their military service was the cause of the aggravation.

Monroe was able to convince the court that his condition worsened during his service. Of course, military service cannot give someone a congenital heart defect, but if someone was born with a heart condition, the strain and stress of serving in the military can certainly make it worse. That is what happened to Monroe. As a result, the court held that he earned his rebuttable presumption and the Regional Office was wrong to reject his application.

Monroe won his appeal. But the impact of his appeal was even bigger than his own case. The court’s decision in his case—called “Monroe v. Brown”—would go on to become a frequently cited case within the Board of Veterans Appeals. Hundreds of decisions made by the Veterans Administration have referenced Monroe’s case as the leading statement of the law explaining how to determine whether a veteran is entitled to benefits. Moreover, this decision is important for adults with congenital heart disease serving in the military, because if their service aggravates their condition, they could be entitled to benefits through the Veterans Administration.

This blog post references Monroe v. Brown, 4 Vet. App. 513 (1993).

Michael Pernick was born with tetralogy of Fallot and grew up on Long Island, New York. He is currently a third-year student at New York University School of Law. He attended college at Wesleyan University and worked for several years on political campaigns and issue advocacy campaigns in New York, Connecticut, and Boston.


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