To All S/c Veterans And Those Working On It...

[Meddac]

This is NOT intended to start a big squabble match nor to solicit defaming comments. Several of you know that I am here and who I work for. I only intend to help in the most sincere way. Some of you that I have contact with away from here can attest to that fact.

To all veterans: One of the quickest ways to get reduced is to lie about your conditions. You could get worse.

I had the chance encounter in the past 3 weeks to come across an increase claim for a veteran. After my usual work on the claim I did an administrative decision. That decision required my signature and 2 others. All three signatures came back to me today. As of 1:30 PM this afternoon when I left work, the claim, admin decision, and this veterans future are in dire straits. I proposed to sever all current benefits. Yes, the veteran is S/C for some things....or was S/C, and it was granted by an RO that I do not feel is up to the task of serving veterans. I would put them in your "Dirty Dozen", but I am not giving names. I had to hand carry the file to my rater to do the rating proposal. The rater was nearly done when I left for the day. My day was pretty much dead at that point. I don't feel good about what I had to do, but it was blatant and I caught it immediately.

My rater has had to do a CUE. It was CLEAR, it was UNMISTAKABLE, and it was an ERROR. I do not feel for this veteran at all, but I am also not proud of my task. I wish it had been someone elses digit, and not mine. It will cost the vet money, cause a large overpayment, and on Monday it will cost them their free medical care.

The story is very long, and I won't post it on here. It's on my chest, and I eventually have to vent it out....somehow. I just wanted you guys/gals to know that benefits can be reduced (which you already know), and that they can be taken away completely. We have a saying in our office that never really meant anything until today: "The wheels of the government move very, very slowly...but they move."

The veterean was S/C for about 3 years, and I feel like sh!t.

Sorry "c2"

Edited April 3, 2009 by Meddac

[Wings]

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And the BIG bit of advice from a VA Adjudicator: DON'T LIE!!

WOW, No kidding?! I didn't know that (sarcasm) ...

I suggest, you keep the particular's of this claim to yourself Meddac, we can go and read all about it at the BVA search engine. How would it benefit us here, to know that one veteran was less than honest?!

I suggest, If you are having emotional problems with your job, that you go and see a shrink like the rest of us. You'll probably end up with PTSD from working for the VA, but you won't get to file a claim for that. No Sir. That would be fraud.

The bottleneck in VA Claims isn't caused by Fraudulent Claimants. The backlog jam at the VA is due to many factors; fraudulent claims being among the least of our problems.

Otherwise, your military service is highly esteemed and respected. The good folks at Hadit are obviously hungry for an inside look at the Department, please, continue to help them navigate the complexities. We appreciate you. ~Wings

[john999]

Time

I see that you are attacking me for being inconsistent. I don't think you understand my point in saying "big deal" about there being people who fake their way to benefits. What I mean is that this has been going on for decades. I don't know what ax you have to grind? I say that for every vet who uses fraud to get benefits there are 10 vets who are victims of VA fraud to deny benefits. I don't think I have ever foamed at the mouth about vets using fraud to get benefits as you seem to imply. I know it goes on, but I just don't think it is that big of a deal in the VA system. Fraud against vets is a big deal both in the active duty military and the VA. Many thousands of military were kicked out of the service after Vietnam due to "pre-existing personality disorders" to avoid paying compensation to soldiers with PTSD. That is still going on inside the military today. Now that is fraud on a grand scale. Thousands died from agent orange when the VA fought tooth and nail to deny benefits. There is the real fraud. I had no problem with what Maddoc was saying. I just think we should put in context of the whole VA system where many thousands have to fights for years for deserved benefits. If you have some personal problem with me send me an email and explain yourself.

[Philip Rogers]

Whoaaa! I took so much from Meddac's post! My interpretation(sp) was the following: 1) Asking for more (an increase) opens your claim for more scruntinity(sp). 2) in doing so you could lose what you have. 3) He feel's bad that the claimant "may" lose their benefits. 4) He wishes someone else got the "digit" (I still like finger, it fits). 5) Had this claimant not requested an increase they may have continued to have a content life.

Let us not chase another VA employee away who can give us incite(sp) as to the VA's way of thinking. I'm hoping LL is enjoying his retirement and is happy w/his decision not to be here anymore! And now, the rest of the story . . . which should be pending, today. I think I've been here about 15 yrs. jmo Forgot to mention "I like me!"

pr

Edited April 5, 2009 by Philip Rogers

[rentalguy1]

I seriously wish the folks that are hammering Meddac would stop and think this over. Everyone here bitches about the VA not following the laws and regs. Here we have a case where they have done just that, and you folks are getting your thongs in a wad. Those laws and regs work both ways; for the vet and for the VA (aka the American Taxpayer). Yes, the VA screws up on our claims. Yes, the VA does have some unscrupulous raters that twist our words and the regs against us. But damnit, this person is following the regs and should be commended, not admonished! A vet that lies about his conditions hurts all of us. This is the exact reason that there are so many laws and regs to begin with. This is also a large part of the reason that there are claims backlogs; vets hearing of handouts 30 years after getting out of the military and then sidling up to the trough for their piece of the pie. Some are legit, of course, but how many thousands are bogus? Some of you really make me ashamed to be a vet when you display a "holier than thou" attitude. We are no better than the population at large. We simply answered the call, without question, when our country needed us. Doing the right thing does not make you special or elevate your status in any way.

Meddac, please post whatever details you can so that those among us that wish to learn may do so. I, personally, will take on any bit of wisdom that I can, whether I like it or not, so that I may help another veteran somewhere down the line.

[Meddac]

//

Edited April 6, 2009 by Meddac

[windy city]

I feel certain that no one will have blocked this post even after demanding that it not happen or that the entire thread be locked. Too many want to see what happened.

Posted by Purple:

"I know you didn't want to start an argument but........wow. All of the things you mentioned for taking away this vets benefits are administrative issues...nothing medical. And some are not even any of the VA's business! (like police reports?) So are we all being followed?? Continually watched?? Can benefits be taken away for "administrative" issues?"

No…nothing medical. There were medical things in the file, but they do not play into this decision. Police reports will come in your personnel file if there is an incident that involved the authorities. Yes, benefits can be taken away for administrative issues. That's what has happened here…and Administrative Decision.

Posted by Carlie:

Did the claim for an increase concern an existing service connected disability

or was it for a different disability to be added to what was current?

I could not help it but to read this post and feel that all this fighting among vets., and this is the story that everybodys was dying to read. I thought that it was going to be something really big. In this case I blame the veteran for lying but I also blame the VA for not catching this thug. I was always under the impression that the VA looks into your medical records when you file a claim and they did not catch this.

The claim was for an increase in S/C disability AND to add one new issue.

Can you tell us a little more about administrative decisions - to my knowledge we have never

had much mention or discussion regarding administrative decisions.

Admin Decisions cover several different issues to include:

Statutory Bar to Benefits and Character of Discharge

Former Prisoner of War (POW) Status

Willful Misconduct and Line of Duty

Insanity

Homicide

Presumption of Death

Finding of Fact and Date of Death

Reversal of Prior Determinations and Administrative Errors

As far as I have ever seen, they are internal.

I do realize sometimes VA does grant when the evidence of record truly supports a denial.

I am not much of a believer in statistics, but are you aware if there are stats on this,

besides some yearly reports and audits ?

I have no information on statistics. It's not as often as one would think.

May I ask what the Clear and Unmistakable Error was. If you do not feel comfortable answering, I understand and will not pressure you nor be offended.

The biggest glaring error was that the previous RO did not evaluate the evidence….at all, I think. A Rater then rated the case without much thought to what he/she was doing.

Can this overpayment somehow be back billed or the end product code of the RO that originally granted it the claim - be changed or charged. Is it possible that an employee at the RO that granted the claim - is in ca-hoots with the claimant?

No, to all of these except possibly the last one. There is no evidence of that, however.

Geez, are you sure the claimant was even a veteran, it reads like must be a ton of fraud.

The claimant is a veteran. There is no doubt.

Posted by Wings:

It's one thing to have concrete evidence to disprove the veterans claim, it's another animal altogether for a lack of evidence to justify a severence of compensation or service-connection.

If Meddac proposed severence of compensation, it would follow that the veteran is given the opportunity to argue his case. Our system of justice provides the Constitutional Protection of Innocent until proven Guilty. The Fifth Amendment of the U.S. Constitution reads, in part, "No person shall be ... deprived of life, liberty, or property without due process of law ..."

There is concrete evidence for what I did.

We often hear that the United States Constitution guarantees that an accused is "..innocent until proven guilty.." in a court of law. Ok, Now do a word by word search through the complete text of the US Constitution and find the words "guilty" or "innocent". Are they in the Constitution? Not that I have ever seen. "..innocent until proven guilty.." seems to be more of a judicial maxim.

The veteran will receive appellate rights, 60 days due process, and all of the other rights that other veterans get.

What's a digit? – Sharon graciously answered this one.

Rater??? – A Rater I am not. It is far more seldom than anyone thinks (if ever) that a Rater does an Administrative Decision.

Hope I answered most of them. The negative comments can lay right where they are. It's an amazing thing how people jump to conclusions, rattle the cage, and make assumptions.

It's a veteran, the first thing I saw was a claim for increase, and a new issue. The file was sent to us from another RO because it was going to require an exam.

I have a duty to the veteran in gathering evidence for their claim so I begin my work following the last rating...The personnel file.

I see that the veteran has an issue with being young and newly "of age" for buying alcohol. It seems to cause more than one altercation during service with fellow service members. (Some might say here that the veteran could have been "self medicating". Very unlikely, but okay…)

The veteran is ordered to attend alcohol rehab.

One night before rehab begins, the veteran goes out on a binge, and upon return they have a near fatal accident involving the veteran, a fellow service member, and a very large parked truck (empty).

It was a very serious accident causing considerable injury to the veteran and the other service member (nearly killing the other service member).

At the hospital (civilian), the veterans BAC was .192… Well over the limit. Twice over and then some.

Two hospitals later the veteran is back on station.

The veteran was put though physical rehab, ordered once again to alcohol rehab, and non-judicial proceedings began.

There were no less than 6 recommendations for everything from "Dishonorable Discharge" to "Under Honorable".

The veteran, seeing that Courts Martial was eminent, resigned their commission in lieu of "Administrative Separation for Cause".

The resignation was accepted, the veteran was discharged, and given an "Under Honorable".

The veteran made a claim with the VA not hiding what had caused the disabilities, but not even getting close to telling the true facts surrounding the events.

The RO inexplicably granted benefits. The personnel file contains everything. From entry to commission to accident reports, punishments, police reports, hospital reports, and final proceedings. It doesn't hide anything from your eyes.

The claim goes south at this point because the veteran has again changed the story in claiming the new condition tying in directly to the "accident".

Bells ring in my head. How can this happen? It was all right here all along. Now I am the "Fall Guy" for what is about to take place. Seems that there are some on here that might have seen fit to turn a blind eye.

Below are CFRs that I used in the decision. Say what you want about me… I am still here to help anyone that I can.

DECISION:

The injuries sustained by the veteran on [DATE], were the result of willful misconduct.

REASONS AND BASIS:

CFR 3.1(n) states "Willful Misconduct" means an act involving conscious wrongdoing or known prohibited action (malum in se or malum prohibitum). A service department finding that injury, disease, or death was not due to misconduct will be binding on the Department of Veterans Affairs unless it is patently inconsistent with the facts and the requirements of laws administered by the Department of Veterans Affairs.

(1) it involves deliberate or intentional wrongdoing with knowledge of or wanton and reckless disregard of its probable consequences;

(2) mere technical violation of police regulations or ordinances will not per se constitute willful misconduct;

(3) willful misconduct will not be determinative unless it is the proximate cause of injury, disease, or death.

38 CFR 3.301(a) Line of duty. Direct service connection may be granted only when a disability or cause of death was incurred or aggravated in line of duty, and not the result of the veteran's own willful misconduct or, for claims filed after October 31, 1990, the result of his or her abuse of alcohol or drugs. (Authority: 38 U.S.C. 105)

38 CFR 3.301© 2) The simple drinking of alcoholic beverage is not of itself willful misconduct. The deliberate drinking of a known poisonous substance or under conditions which would raise a presumption to that effect will be considered willful misconduct. If, in the drinking of a beverage to enjoy its intoxicating effects, intoxication results proximately and immediately in disability or death, the disability or death will be considered the result of the person's willful misconduct. Organic diseases and disabilities which are a secondary result of the chronic use of alcohol as a beverage, whether out of compulsion or otherwise, will not be considered of willful misconduct origin. (See §§21.1043, 21.5041, and 21.7051 of this title regarding the disabling effects of chronic alcoholism for the purpose of extending delimiting periods under education or rehabilitation programs.) (Authority: 38 U.S.C. 501(a))

38 CFR 3.301(d) Line of duty; abuse of alcohol or drugs. An injury or disease incurred during active military, naval, or air service shall not be deemed to have been incurred in line of duty if such injury or disease was a result of the abuse of alcohol or drugs by the person on whose service benefits are claimed. For the purpose of this paragraph, alcohol abuse means the use of alcoholic beverages over time, or such excessive use at any one time, sufficient to cause disability to or death of the user; drug abuse means the use of illegal drugs (including prescription drugs that are illegally or illicitly obtained), the intentional use of prescription or non-prescription drugs for a purpose other than the medically intended use, or the use of substances other than alcohol to enjoy their intoxicating effects. (Authority: 38 U.S.C. 105(a))

end

I guess I could reasonably ask any of you if you are veterans since some of you think that I'm not. I am A PROUD VETERAN. I served our country in Missouri (Ft. Leonard Wood), Texas (Fort Sam Houston), Alabama (Fort Rucker), Korea (Camp Casey and Stanley), Kuwait (Gulf War I), and Texas again (Fort Hood). I gave and paid my price.

I am also PROUD TO SERVE THOSE WHO SERVE with the Department of Veteran Affairs. I am not a Rater (I actually can do more to help as an adjudicator). I am also a "HE" and not a "SHE" (although there is nothing wrong with the fairer of the two).

Thanks for heeding my intro to the initial post "This is NOT intended to start a big squabble match nor to solicit defaming comments." That's very classy of many of you, indeed.

Meddac