Streamlining Claims Process

[BMCS00]

It's easy enough to complain about how long it takes to get what seems to be a simple claim through the process in a timely fashion. We all know complaining does little good unless the right person hears it.

Some of you have worked as a VSR or for the VA in some other capacity in your past, most of us sit around and wait for our claims to be finished to our satisfaction.

How about post here some ways to improve the process. I think it takes too long between Comp & Pen exam to rating decision, but I don't know or understand the process in between. I think a timeline should be established for a new claim, from the day it arrives at the VBA to the day a rating decision is made. How long should it take for each step of the process? How many steps to the process are there? Are we really just searching for the holy grail in the world of disability claims processing?

I would like to foster some discussion here, and see what we can come up with ... what do you say?

Jim

Life is good! B)

[Berta]

One big reason for the backlog is that so many VCAA letters over the last decade have been faulty.

A VCAA letter that is so deficient that it is detriment to a claim causes the BVA to remand the whole claim unless the veteran's evidence can thoroughly overcome the faulty VCAA letter.

The VA must thoroughly read the claim in order to even prepare the VCAA letter and they often send out a generic one but things have gotten a little better there.

I spoke to COngressman Filner about this problem 2 years ago and asked him to support an amendment I wrote to the VCAA. With his attention however on HR 2254-I let the VCAA problem fall by the wayside-

it should be up to a service rep to question a faulty VCAA letter right away as they get copies of the same letter their vets get.

Then again common sense can tell us what evidence we need whether the VCAA letter is wrong or not.

The best thing I feel a vet or widow can do is begin to gather and submit to the VA any evidence at all ASAP to help their claim.

The VCAA letter they get has the clues to success but when the letter says they need medical evidence to support the claim and if that evidence is lacking in their VA med recs, they need to consider that they might well have to obtain an IMO.

As long as a C & P docs are paid by the VA directly or indirectly- we have a conflict of interest there that has been the SOP for decades.

The fact that many vets and widows succeed on their claims even after they have gotten denials based on lousy C & P exams- succeeding due either to IMOs or due to competent lay medical evidence that is unrebuttable by the VA and/or raises to level of Relative Equipoise-

shows that the C & P process is faulty and lends to the backlog.

Evidence gathering should begin ASAP and be sent to the VA soon after filing the claim if possible.

A C file could end up with considerable evidence in it that no one ever considers so it is best to focus on sending the strongest evidence right away.

Depending on JSRRC to verify a stressor is in my opinion not always a good idea- it pays to seek buddy statements and unit histories and anything in your 201 fles that can help verify a stressor.

Ir write to JSRRC yourself. I advised a vet here last year to dfo that when the VA said that JSRRC could not verify his stressor. I wonder if the VA even asked them too-

He wrote to JSRRC and posted here that he got verification of his stressor himself.

I am calling JSRRC today to see if I can get them on the SVR radio show- or at least gets some pointers from them.

I am not sure if they will verify stressors in every case, without being asked by the VA, and want to know how they handle these requests.

I guess my point here is- we need to do all we can to get our evidence to them without waiting for a C & P result that might be very negative or a DIC denial because we had no evidence of the service nexus.

The VA however has to begin some sort of accountability as their claims process has been reckless at best and ,after Shreddergate, I think it has bordered on criminal behavior.

"I would like to foster some discussion here, and see what we can come up with ... what do you say?"

The hearing schedules for the H VAC and their Sub Committee- particularily the claims committee has been altered due to the snow storm last week in DC.

Anyone can request that their testimony be accepted into the record for these committees that develop ways to change VA procedures.

There is a format for this type of submission-if it isn't at the H VAC site I will post it- if anyone os interested.

They need to hear from those of us who have had negative experiences in the claims process that deliberately added years to our claims and whose evidence was chronically ignored by ROs-yet fully read by the BVA.That fact alone- that the BVA process is often the first time medical evidence gets read by the VA-shows that ROs are NOT doing their job and our rights are being crapped on until we get to the BVA (which will take years)

(

Edited February 22, 2010 by Berta

[Vync]

Regarding streamlining the process, let's hope this is not all just smoke and mirrors.

[john999]

Grass roots action by vets is the only thing that is going to make a radical change in the dysfunctional VA claims process.

[blanco63]

I know a way to get some claims processed faster. When th VA offers some new programs like the ECAI, use them, don't curse the program and the VA and keep putting down the VA. I used this program. I signed up for the program on june 3, 2009 with the Phila VARO and had my C and P om 6/30 and on oct 3,2009, I received their decision increasing me from 30 to 50%. Wow, exactly 4 months. I think that is fast. Also, did you ever see that spot on IRIS that says compliment, use that too. My friend and I started our claims around the same time, june 2007, and he still has not been service connected. He likes calling and sending the VA IRIS's every month complaining. That really helps. He says don't use the ECAI,the VA is taking away your rights. I told him that I did not. I went from nothing to SC to 10 to 30 to 50% in a little over 2 years by using just reconsiderations. He always asks, how do you do it? I sent a compliment to the VARO by IRIS and within a few days I got a phone call thanking me. He said that out of 500 IRIS's they get one compliment. We laughed, that's a good one. Well, everyone has their own system. Mine works for me.

[BMCS00]

... One big reason for the backlog is that so many VCAA letters over the last decade have been faulty.

A VCAA letter that is so deficient that it is detriment to a claim causes the BVA to remand the whole claim unless the veteran's evidence can thoroughly overcome the faulty VCAA letter.

... The VA must thoroughly read the claim in order to even prepare the VCAA letter and they often send out a generic one but things have gotten a little better there.

... They need to hear from those of us who have had negative experiences in the claims process that deliberately added years to our claims and whose evidence was chronically ignored by ROs-yet fully read by the BVA.That fact alone- that the BVA process is often the first time medical evidence gets read by the VA-shows that ROs are NOT doing their job and our rights are being crapped on until we get to the BVA (which will take years)

(

Hi Berta, thank-you for your response. I think you made some valid points.

VCAA Letter - I'm not being sarcastic, but how do you see that a VCAA letter is faulty or deficient? Is it that they don't list or address all the items on a vets claim? Time frames? I'm not a VSR, I'm a layman, so please bear with me. I'm just trying to get some ideas flowing.

Ignored evidence - I'm trying to think of a way for a VSR to confirm they read all]/b] the medical evidence to a veterans satisfaction. I'm not sure we can. On the other hand, the veteran can use a highlighter and sticky notes on any medical evidence that gets sent in, to point out key information. I think a veteran being proactive in the process is important, and doing the best they can to present the information needed for a favorable decision.

I was thinking that each RO should have a process in place for the team whose initial work was overturned by the BVA, to review each remand case, glean some lessons learned and share them with the others involved in the RO process, so they can strive to not make the same mistake twice. Does that make sense? Just a thought.

Thanks again Berta,

--Jim

Life is good!

[Berta]

"how do you see that a VCAA letter is faulty or deficient"

I recall when the VCAA act was signed in 2000.

Claims could no longer be denied as not "well grounded" and our Duty to Assist regs were supposed to become highly enhanced by the VCAA.

My VCAA letter of 2003 was deficient and a good excample of what I mean. Every attempt I made to get my POA to challenge it failed so I complained to the General COunsel.

It was obvious what it should have stated so I was able to overcome it's deficiencies with medical evidence.

The VCAA letter I received gave me no statements whatsoever as to what evidence the VA needed.This part of a VCAA letter is supposed to be written in italics or bold type and underlined.For widows like me it is supposed to contain reference to the Hupp decision and for veterans, it must comply with the Pelegrino case.

Not only did they fail to make any highlighted statement as to what evidence they wanted from me, the enclosure list in the letter was blank.

I then got a letter saying I had failed to respond to the VCAA letter ( they had NOT enclosed the VCAA response form.

This is the main reason my claim took 7 years.

Although I sent probative medical evidence throughout the 7 years, the VA still held ( and my POAs allowed them to get away with this) that I had not responded to the VCAA letter with the VCAA response form (which the VCAA letter clearly indicates they never sent to me to respond with).

I told Congressman Filner the ROs have turned the VCAA into one big scam that allows them to continually deny claims they dont feel like working on.And if you have lousy vet reps, they dont care at all -as they get paid whether a vet or widow succeeds or not.

When claim gets to the BVA (and if they violated the VCAA it surely will be in the appeals process for years) the very first thing the BVA does is determine if VCAA errors were made that were detrimental to the vet- or widow- and if so-the claim gets remanded back to the same VARO whoch didnt prepare the proper VCAA letter in the first place.

Vets and widows have to make sure their VCAA letter contains a specific highlighted (bold type) or underlined statement as to what evidence the VA needs.

The enclosure reference should contain mention of the VCAA response form.and include the Response form.Ot has to be filled out , signed, copied and submitted back to the VA

If the letter indicates they have enclosed a pamphlet explining the VCAA - I doubt if anyone ever gets the pamphlet.

I understand they had thousands and thousands of these pamphlets printed by GPO and never included them with the VCAA letters,(if they had done that more vets might have been able to stave off long remand periods as the pamphlet was supposed to explain exactly what a VCAA letter is or should be )

The CAVC held in Moore V Shenseki that when Moore claimed his VCAA rights were violated-(VA failed to obtain his inservice psychiatric records)it was somehow "irrelevant" to the outcome of his claim.Moore had filed his claim within the first year after his service and had won some staged ratings but that was not his point.

A Federal Circuit court rejected the VA's position that this was harmless error.

VA had violated their statutory duty to assist by not obtaining Moore's inservice medical records.

your second statement-

"Ignored evidence - I'm trying to think of a way for a VSR to confirm they read all]/b] the medical evidence to a veterans satisfaction. I'm not sure we can"

I succeeded in my claims over 15 years by making sure-if the VA ignored my evidence -which they did continually-that I still kept this evidence in the forefront- stating in the very first sentence of all of my SOC responses and on my I-9 form that they had continually ignored it.If you read my Sub Committee testimony last year ( HVAC on line) you will see that I had 53 tracking USPS slips to prove I not only sent this evidence but it had been continually ignored by the VA for years.I dont know if it was shredded or lost or misplaced.

The SOC will have an evidence list.

If anything snt listed -this means if they had it, they ignored it.

If they DO list evidence, they are supposed to refer to that evidence in the SOC narrative. If they dont, this is a key avenue of rebuttal as you can raise the evidence again.

The BVA is often the only entity within VA that will actually read and consider ALL evidence they have.

I made sure that I sent to the BVA copies of all of my crucial evidence because the RO had ignored it- andf I could not determine if it was still in my C file or not.

The BVA read it all and awarded.

The RO has sent me three award letters based on the BVA award- all wrong- but they did rectify one situation and sent me that retro amount last week-almost TEN months after the BVA award.I guess they hoped I would die before that came.

If the VA employed individuals at the ROs of the legal caliber that the BVA does (these are all lawyers at the BVA level) I feel this would completely alter the claims process for the better-

the entire Modus operanda of any lawyer is centered on Evidence-and the BVA lawyers are quite willing and able to read and assess it all properly-whereas the ROs are set up to ignore probative evidence as long as we (and many vet reps out there) allow that to continue to occur by not rebutting and challenging their faulty decisions until they DO read our evidence.

sorry for the long post- this subject angers me-

I was eligible for the REPS benefit due to my recent award.

I sent the REPS people my award, some SSA documentation, and the REPS application.REPS saw no problem whatsoever with paying me this benefit.(Sept 2009)

The VA held them up from making a decision until a few weeks ago- all VA had to do was verify my award but that took them many months to do-

REPS told me 2 weeks ago my check will be here first week in March- it was fully approved,should have taken 3 months or much less to do but the only problem was it took VA many more months to verify the award they made in April.

These situations- ignoring evidence, deficient VCAA letters, and stalling over simple verifiable information are -in my opinion- deliberate tactics or even worse- this is the end work product of illiterates.

Edited February 23, 2010 by Berta