Breland v. McDonough — Diagnostic Code 7343’s mandatory VA examination requirement does not apply to retroactive ratings

Willis Breland, a Vietnam veteran exposed to Agent Orange, was diagnosed with tongue cancer in 2006 and treated through early 2007. VA initially denied service connection, but later granted service connection retroactively after receiving a favorable medical opinion. In doing so, VA assigned staged 100% ratings for the periods of active malignancy and treatment, plus six months after treatment, and then rated the disability on residuals when the record showed no recurrence or metastasis.

Breland challenged the reduction to noncompensable or residual ratings, arguing that the note to 38 C.F.R. § 4.114, Diagnostic Code 7343 required a mandatory VA examination six months after discontinuance of treatment before VA could assign anything less than 100%. The Board and Veterans Court rejected that theory, and the Federal Circuit affirmed. The court held that the note’s text, read with 38 C.F.R. § 3.105(e), is prospective: it governs continuation and reduction of an existing total rating, not a rating assigned retroactively after the relevant period has passed. Because VA could not perform the contemplated six-month examination in hindsight, and because the veteran’s records showed no active cancer during the disputed periods, VA properly rated the condition on residuals.

The decision is important because it prevents veterans from using retroactive service-connection awards to convert long-past inactive disease periods into continuing total ratings. It also clarifies that the diagnostic-code note is tied to real-time rating reductions and notice procedures, not to later retrospective adjudication based on records already in the file.

The note to 38 C.F.R. § 4.114, Diagnostic Code 7343 applies to existing total ratings and prospective reductions after treatment, not to retroactive awards where the rating decision is made years later based on the historical record.

A retroactive grant of service connection for cancer does not automatically preserve a 100% rating until a later VA examination; if the record shows no recurrence or metastasis after treatment, VA may rate the disability on residuals for those past periods.

Breland is a key rating-interpretation case for malignant neoplasm diagnostic codes. It confirms that the mandatory six-month examination language is not a windfall provision for retroactive awards, and it gives VA and advocates a clear rule for when residual ratings may replace total ratings after treatment ends.

Assuming a retroactive grant of service connection requires continuation of a 100% cancer rating until VA later conducts a mandatory examination.

A veteran’s cancer claim is granted service connection in 2025, but treatment ended in 2018 and the records show no recurrence after 2018. Under Breland, VA may assign a 100% rating for the active-treatment period and then rate residuals for the earlier inactive periods without awarding an additional retrospective total rating until a 2025 examination.

Use this case to defend residual ratings or reduced evaluations in retroactive cancer awards, and to argue that Diagnostic Code 7343 does not require a fictional six-month follow-up exam when the historical record already shows the disease was inactive.

Breland v. McDonough