Thursday, May 20, 2010

An open letter to Eric Shinseki 7th United States Secretary of Veterans Affairs.

Honorable Eric Shinseki
Washington D.C. Regional Office
1722 I Street N.W. CSS
Washington DC 20421

Dear General Shinseki,

I have been involved with a VA disability claims since I retired from the Air Force in 1990. I would like to make some observations on how the clams process can be streamlined from a veteran's perspective.
  1. The C-file is bogging the entire system down. After prevailing in a BVA appeal, my claim was split between the AMC and Bay Pines VARO. While the AMC spent a year working on my claims, the Bay Pines VARO was unable to work on their part of the claim until my C-file was returned from Washington. Since the C-file has not been turned into electronic records, the single paper C-file can add years to the claim process.

  2. The VA needs an integrated database. When My Disabled American Veteran (DAV) representative looks at my claims status, he has to go into 5 different electronic systems. If I call different organizations in Washington or at Bay Pines about my claims, I get different very different answers from the VA representative on my claims' status. 

  3. Both VA and veteran representatives frequently move and this creates an institutional knowledge gap. I am on my fifth DAV service officer and my third Bay Pines VARO claims officer in the past year. Transfers need to be slowed down to improve service and to maintain institutional knowledge. 

  4. The Board of Veteran Appeals (BVA) should be given the authority to raise a disability rating to the next higher level. Using 7903 as an example:

7903 Hypothyroidism

Cold intolerance, muscular weakness, cardiovascular involvement, mental disturbance (dementia, slowing of thought, depression), bradycardia (less than 60 beats per minute), and sleepiness--100%

Muscular weakness, mental disturbance, and weight gain--60%

Fatigability, constipation, and mental sluggishness--30%

Fatigability, or; continuous medication required for control--10%

For example if a veteran has been rated 10 per cent disabled for 7903, Hypothyroidism and the BVA believes the rating is too low, The BVA should have the authority to raise it to the next level that is 30 per cent in the 7903 example. 

The BVA could offer the veteran the next higher rating or the option to remand the appeal for a rating higher than the 30 per cent level . Many veterans would accept the next higher rating. This would avoid another year or more of paperwork that a remand at this time requires. This could reduced the remand load on both he AMC and the VAROs.

The AMC and VAROS are ignoring Appeals Court guidance on disability ratings. Symptoms listed in the rating criteria are simply examples of the type and degree of the symptoms, or their effects, that would justify a particular rating; analysis should not be limited solely to whether the claimant has the symptoms of all of the examples of a particular rating level. 
  1. These examples are not rating criteria and the VA Appeals Court has repeatedly stated the Veteran does not have to meet all of the examples to be rated at a particular rating level. In fact, the higher levels are inclusive of the lower levels (Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002) and DIANNE C. TATUM, APPELLANT).

This suggests the AMC and VAROS are starting at the bottom of the 38 CFR, Part C rating examples and then moving from the bottom of the scale upwards and ignoring the higher level indicators of a condition as well as the medical evidence that the veteran is providing (see UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS NO . 07-2728.This is an institutional problem that is allowing the VA to low ball veteran's claims.

If the VA wants to be a true advocate for the veteran, the claims officers should start at the 100 per cent level to see if the higher level indicators exist. If not, the rater should move to the next lower level. 

In the hypothyroidism example, the rating officer would move from the 100 per cent level to the 60 per cent level. The rating process would be more equitable if this process were used and the number of appeals would be reduced in the VA.

It is my express hope that these observations will be useful to the VA. It is clear during the Bush administration that the VA system is broken and I know that you and President Obama are working hard to improve the Veterans Administration.


The Major, USAF (ret)

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