Quality Assurance Of Claims

[lipro]

The big problem I see from reading everyone's stories and my own is that there is no QA at the Rating Officer level or anywhere in the claims process. The GAO does not inspect any of the R O work and all I can find is a program called STAR unit which is based out of Nashville, TN and has a total of 15 people assigned to monitor the 57 regional offices. The annual requirement is to sample 120 claims from each office which equal only 6,840 case files being checked for the entire nation. How many of you think your case is one of those files being looked at? To me this is the key pit fall in the claims process and if we veterans do not get this changed to an acceptable Quality Assurance program then we will never achieve quality results from the Rating Officers. My own story is one of total disbelief; I had surgery at Bethesda Naval in 2006 to remove a nodule that turned out to be carcinoma. I was on active duty at the time and filed my claim under the new BDD program, when I got my decision letter from the VA my cancer claim was denied mainly due to the fact that the path report stated carcinoma and no where in the report was there any mention of cancer. For everyone who does not know carcinoma is cancer and there is not a path report in the world that says cancer on it, they list the exact type of cancer. If a QA program had been in place this would have never occurred, it would have been caught and I hope training would have been conducted with the RO to correct his knowledge of cancer terms. We really need to come up with a better process and get it done or we will never have quality from the VA.

[Berta]

In 2005 the Inspector General (VA) did a report that I posted here as to the error rate at VAROs as well as the fact that survey revealed many raters etc-simply dont have time- or take the time- to adequately read and resolve our claims.

Then Knight Ridder News did a series of articles in the Washington Post as to the ludicrous remand system that is the main cause of the BVA backlog.

In 2006 James Terry-Charman of the BVA -in his annually report to Congress or the Pres -forget who- again stated in that report the many reasons for the unconscionable backlog.

Vets need to pressure COngressmen/women and Senators to get the VA off the pot on all this-

Congressman Filner- in my opinion- and I have dealt with quite a few congressional people is the ONLY person in the gov who is actively trying to resolve these claims issues.

As a matter of fact I have to finsih a letter to him today regarding matters we discussed recently-

I am member of numerous vet orgs who have been in personal one to one contact with him on many vets issues-

but these things take alot of time and work to get resolved-

Is your COngressman and are your State Senators actively supporting vets issues? Their voting record is public-and if not- why not-

Your claim- the VA must know that carcinoma means cancer-did you NOD this immediately?

I would have enclosed with the NOD a copy of a page from any dictionary or internet printout that defines what carcinoma is.

Did you have a nexus to your service?

It seems to me there had to have been more reasons and bases to their denial.