23 Percent Of Va Claims Processed Incorrectly

[jbasser]

I just bumped into this article. On behalf of our friends over at Military.com.

Link: http://militaryadvantage.military.com/2011/05/va-audit-23-percent-of-disability-claims-incorrectly-processed/#idc-cover

Basser

[Chuck75]

Veldrina identified a major contributor to the problems.The 3.5 case a day bit.

The VA system is a disaster that has been ongoing for too many decades.

The VA engages in denial tactics that are totally reprehensible. I'm certain that the 3.5 rate is a major contributor.

Denials are easier and quicker to process than awards. (Gotta make rate!)

Evidently, equal credit is given for denials. This is really wrong for several reasons.

It encourages RO's to deny in order to make rate.

Full and proper development of a case involving other than a "hangnail" easily involves several days of work.

Finally, the VA often takes on the attitude of "devil's advocate", and blatantly does not follow the intent of the law.

Depending on whose numbers you look at, between ~23% and about 84% of the decisions are incorrect.

Not mentioned is how this breaks down into improper denials and awards. Which do you think is greater?

From recent VA OIG activities, it's obvious that improper denials are not a major OIG concern.

Given a choice, I'd not care to work for the VA, unless it's in a management position that normally gets bonuses. <G>

Then, if that were the case, I'm not sure that I could live with myself!

[jbasser]

Cool Breeze, Those Monday Morning Reports do the majority of the 8000 members here about as much good as a bald man getting a haircut. They look good sitting in the barber shop but there is nothing to cut.

I wish you could find another avenue to grasp on to so you can vent.

J

[HM1retiredUSN]

I was comparing the Monday reports for Phoenix, and am trying to figure out how many claims they are doing on the average per week. THe numbers are extremely low, only around 114. You are stating 3.5 cases a day, they must only have a few raters in the Phoenix VARO doing claims. Is your standard for your site only?

It is not that her site is different. When most of a Regional Office is working on Nehmer cases, you are going to have "low" numbers. It has nothing to do with how slow that office is. It comes down to exactly how many Raters are actually Rating cases, and how many are dedicated to Nehmer cases only.

[Veldrina]

Actually, denials aren't any easier than grants. Things that DO make us take a long time on claims are multiple claims, where a vet claims one thing, the process gets going and a month down the line says HEY i wanna claim this too. Since we no longer have sequential end products (which was a godsend before some idiot took it away) and we now have this deferral mess, you are just asking for your claim to be in limbo. Either claim it all at once or wait till we're done with what u gave us.

Also, try NOT to handwrite letters...many of them are illegible & many raters will give up & not even bother trying to decipher it. And medical records...you might think it;s a good idea to send the records of the 38 doctors you've seen over the years, and sending duplicates (unasked for) is good. Keep in mind we have to review all that & they give us no detail time. So guess who's claim goes to the back of the line?

Also, know which evaluations are at maximums....ie dont claim an increase for tinnitus if you are at 10%...there is no increase for that & u are jst adding another claim that will be C&C'd, and if you already claimed 3 things, the tinnitus makes 4 & again, a case with 3 issues is tastier than a case with 4.

[allan]

So Veterans with say multiple sclerosis or tbi who have multiple medical issues to claim, just go to the bottom of the pile? No wonder the evidence gets zero weight. Might get it processed faster if just MS were claimed and take the 30%. Than spend the next 20 years fighting for the remaining issues simply because a rater couldn't take the 60 seconds to look up what the symptoms of MS or TBI are and associate it with the evidence submitted.

I think I've learned something today.

[Chuck75]

I'm afraid that I'd have to quibble about this one.

That's based upon reasons for denials I've seen that do not stand up to commonly available medical references, and the various provisions in the laws and regulations.

Many of the cases that were appealed were eventually granted.

I'd also have to say that things have changed in the VA in very recent times.

One case I'm aware of involved a denial of a claim for physical and functional loss of a "reproductive" organ.

(bilateral, one of two was surgically removed in a military hospital, with treating military doctors written "duty related" statements in the records.)

The reason cited for denial was that the veteran was "not sterile". I see no reason for this RO behavior, other than- -

Some sort of quota for approvals and denials (Which would be illegal on the face.)

A simpler SOC for the denial, compared to a detailed SOC for an approval. (The approval signoff process whatever the details are)

The RO simply decided to deny for whatever reasons.

I'd also ask where and when in the process does the RO get the "credit" for completing the case.

When the RO decides to deny, how long before the case credit is assigned, vs. a case that is granted.

After the RO completes, which (denial or approval) goes out the door sooner?

Which likely involves more detailed "rewrite" to make those approving the decision happy?

"Actually, denials aren't any easier than grants."

As to hand written - - I agree such things are hard to read.

A big concern is that Adobie reader is commonly used to fill out many of the VA forms.

It seems that recent restrictions intended to preserve the blank forms can also prevent proper filling out, printing, and digital storage of the filled out forms from Adobie reader.

My most recent example of this was VA form 26-1880 Mar 2011. I could print the blank form, store it digitally, etc. But not fill out a "fillable" form or print the filled out form.

I also see this with some state tax forms, in that I cannot save a filled out form digitally. (Print, Scan and save as a jpg or tiff, yes)

Actually, denials aren't any easier than grants. Things that DO make us take a long time on claims are multiple claims, where a vet claims one thing, the process gets going and a month down the line says HEY i wanna claim this too. Since we no longer have sequential end products (which was a godsend before some idiot took it away) and we now have this deferral mess, you are just asking for your claim to be in limbo. Either claim it all at once or wait till we're done with what u gave us.

Also, try NOT to handwrite letters...many of them are illegible & many raters will give up & not even bother trying to decipher it. And medical records...you might think it;s a good idea to send the records of the 38 doctors you've seen over the years, and sending duplicates (unasked for) is good. Keep in mind we have to review all that & they give us no detail time. So guess who's claim goes to the back of the line?

Also, know which evaluations are at maximums....ie dont claim an increase for tinnitus if you are at 10%...there is no increase for that & u are jst adding another claim that will be C&C'd, and if you already claimed 3 things, the tinnitus makes 4 & again, a case with 3 issues is tastier than a case with 4.

Edited May 26, 2011 by Chuck75