Tuesday, September 27, 2011

Veterans Administration disability claim timelines

The Vietnam Veterans of America (VVA) and the Veterans of Modern Warfare (VMW) sued the Department of Veteran Affairs in 2008 for it slow performance to make timely determinations on requests for disability benefits to veterans. The VVA and VMW lost the suit.

However, the complaint contained some very interesting information.

Some of the facts contained in the complaint:

  1. the VA claims it takes 182 days to process the initial claim. However, it take 4-1/2 years to appeal an incorrect decision which is the case in 60 to 70 per cent of the claims. Yet 38 USC paragraph 5109B requires that the Va resolve appeals in a timely manner. 
  2. there are approximately 25 million veterans in the US.  Between 5 to 8 million are enrolled in the VA health care system and 3.4 million receive benefits.
  3. most claims have merit: Approximately 88 per cent of VA claims result in a disability determination. 
  4. although the VA claims to take 182 days to process the initial claim, it often takes more than a year to reach the initial determination. Note: the VA Regional offices have been caught fudging these dates by the VA Office Inspector Generals (VAOIG). 
  5. Veterans who use a traditional appeal to the Board of Veteran Appeals have an  additional 4.4 year wait.
  6. if the BVA finds problems with the VARO decision and remands the decision back to the VARO, it will take the VARO 648 days to process the remanded appeal and fix its errors. 
  7. to make matter worse, approximately 75 per cent of the cases that are remanded are appealed a second time to the BVA.  More than one quarter of these cases are remanded back to the VARO for another 500 day delay. 
Rightardia has looked at congressional testimony and thinks most of the VA problems are related to the following issues. 

1. the VAROs need to streamline their disability process to make it more functional. The Social Security Administration (SSA) disability process is more streamlined. Time and motion experts need to take a detailed look on how the VA processes disability claims to fix the process. 
2. Use the Compensation and Pension  (C&P) clinicians to help vets who lack health insurance which was why these doctors, nurses and assistants were authorized by congress in the first place. If a vet has adequately documented his condition with letters from private practice physicians and other documentation, there is no need to have a physical by a C&P clinicians. 

Is this a revolutionary idea: hardly! The SSA does not require that you see its contract physicians if the applicant has provided sufficient documentation. 
3. Speed up appeals.  One solution would be to have permanent BVA judges at the regional offices in each state rather than the traveling judges that are based in DC. More BVA administrative law judges are needed. 

Rightardia has said before that justice for many disabled vets starts with the BVA. 

Rightardia got a kind note from the VVA on its civil law suit: 

Bernie Edelman wrote:

The lawsuit was not won by VMW and VVA.  However, the issue remains very much alive. 

The VA recognizes they have a problem, that the veterans they serve have a problem.  Under Secretary Shinseki, the VA has embarked on a number of pilot programs in an attempt to learn what can be put in place that will cut the waiting time for proper ratings to be decided upon.

Part of any “solution”, we believe, must be a change in the corporate culture of the VA (actually, the Veterans Benefits Administration), from its current adversarial nature to one that advocates for veterans.  This, however, is a slow process.

Rightrdia agrees. The VA is supposed to be helping the vet, but it isn't. Although the VA has many wonderful men and women, these people are not there to help you. At least, not yet!

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