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VA to Expedite Claims Decisions for Veterans Who Have Waited a Year or More

April 19, 2013

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WASHINGTON – The Department of Veterans Affairs announced today it is implementing an initiative to expedite compensation claims decisions for Veterans who have waited one year or longer. Effective today, VA claims raters will make provisional decisions on the oldest claims in inventory, which will allow Veterans to begin collecting compensation benefits more quickly, if eligible. Veterans will be able to submit additional evidence for consideration a full year after the provisional rating, before VA issues a final decision.

“Too many Veterans wait too long for a decision, and this has never been acceptable,” said VA Secretary Eric Shinseki. “That is why we are implementing an aggressive plan to eliminate the backlog in 2015. This initiative is the right thing to do now for Veterans who have waited the longest.”

Provisional decisions will be based on all evidence provided to date by the Veteran or obtained on their behalf by VA. If a VA medical examination is needed to decide the claim, it will be ordered and expedited.

“Issuing provisional decisions not only provides Veterans with applicable benefits much more quickly, but also gives them an additional one-year safety net to submit further evidence should it become available. Our door will remain open and if a Veteran has additional evidence, their case will be fast tracked,” said Allison Hickey, Undersecretary for Benefits.

If any increase is determined to be warranted based on the additional evidence received, benefits will be retroactive to the date the claim was initially filed. The initiative protects the Veteran’s right to appeal the decision. If no further evidence is received within that year, VBA will inform the Veteran that their rating is final and provide information on the standard appeals process, which can be found at http://www.bva.va.gov/

Throughout this initiative, VA will continue to prioritize claims for homeless Veterans and those claiming financial hardship, the terminally ill, former Prisoners of War, Medal of Honor recipients, and Veterans filing Fully Developed Claims. More information about filing Fully Developed Claims is available at: http://www.benefits.va.gov/transformation/fastclaims/

Claims for Wounded Warriors separating from the military for medical reasons will continue to be handled separately and on a priority basis with the Department of Defense through the Integrated Disability Evaluation System (IDES). Wounded Warriors separating through IDES currently receive VA compensation benefits in an average of 61 days following their separation from service.

As a result of this initiative, metrics used to track benefits claims will experience significant fluctuations. The focus on processing the oldest claims will cause the overall measure of the average length of time to complete a claim - currently 286 days - to skew, rising significantly in the near term because of the number of old claims that will be completed. Over time, as the backlog of oldest claims is cleared and more of the incoming claims are processed electronically through VA’s new paperless processing system, VA’s average time to complete claims will significantly improve. In addition, the average days pending metric - or the average age of a claim in the inventory - will decrease, since the oldest claims will no longer be part of the inventory.

While compensation claims are pending, eligible Veterans are able to receive healthcare and other benefits from VA. Veterans who have served in recent conflicts are eligible for 5 years of free healthcare from VA. Currently, over 55% of returning Iraq and Afghanistan Veterans are using VA health care, a rate of utilization greater than previous generations of Veterans.

Veterans can learn more about disability benefits on the joint Department of Defense—VA web portal eBenefits at: https://www.ebenefits.va.gov/ebenefits-portal/ebenefits.portal.

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[JT24usn]

Not defending, just saying. Dependency claims are considered non rating claims. Meaning no real timelines while comp claims do have a timliness issue. Meaning priority wise low on totem pole. I have a dep claim for July 8 2012 To add my newborn son. Best I keep telling myself is the retro. Jmho.

[AFButch]

Not defending, just saying. Dependency claims are considered non rating claims. Meaning no real timelines while comp claims do have a timliness issue. Meaning priority wise low on totem pole. I have a dep claim for July 8 2012 To add my newborn son. Best I keep telling myself is the retro. Jmho.

I guess they do not even follow audit exceptions as I have pasted below:

February 7, 2008, Department of Veterans Affairs, Office of Inspector General

Introduction

The Office of Inspector General (OIG) conducted this audit to assess the Veterans Benefits Administration's (VBA) processing of non-rating claims. Non-rating claims involve both compensation and pension (C&P) benefits, and in general can be processed by a Veterans Service Representative (VSR) without a rating decision. Examples of non-rating claims are dependency changes, claims for veteran burial benefits, and initial death pension claims for widows. Delayed processing of non-rating claims can result in overdue retroactive payments and overpayments, both of which can have a negative financial impact on veterans and their dependents (beneficiaries). The objective of the audit was to determine if Veterans Service Center (VSC) staff at VA Regional Offices (VAROs) were promptly processing non-rating claims.

Example 3

. A veteran submitted a claim to add his wife as a dependent to his compensation benefits. VSC staff did not put the claim under control until 25 days after receipt. The claim contained all the documentation needed to process, and could have been processed within a few days of receipt. However, VSC staff did not take action to add a dependent to the veteran's award until 319 days after the VARO received the claim. As a result, the veteran did not receive his additional benefits timely. The veteran received a delayed retroactive payment of $4,685. VSC management cited limited staffing resources and the higher priority VBA management has placed on rating claims as reasons for the delays.

Of the 533 non-rating claims found to have avoidable delays, we determined that 206 (39 percent) could have been processed as at-once claims. However, for these 206 claims that required neither development action nor a predetermination notice, it took an average of 283 days to complete processing. Processing time for these 206 claims ranged from 94 to 601 days.

Conclusion

VBA needed to improve the timeliness of non-rating claims processing at VAROs. Avoidable processing delays can result in overdue payments and overpayments, both of which can have a negative financial impact on beneficiaries. Delayed payments may cause beneficiaries financial hardship by depriving them of entitled benefits when they need them. The resulting collection efforts associated with overpayments may also cause beneficiaries hardship. We estimated that about 57,100 claims, from a universe of 72,743 claims, would have avoidable processing delays. Of these 57,100 claims, about 21,400 beneficiaries would receive approximately $45.4 million in delayed retroactive payments; and about 4,300 beneficiaries would be overpaid by approximately $12 million because of claims processing delays. The funds paid to beneficiaries in the overpayment cases could have been put to better use. Improving non-rating claims processing timeliness is critical to beneficiaries who rely on VSC staff to take prompt action on their claims.

VBA needed to increase accountability and strengthen controls over the processing of non-rating claims to meet their goal of providing beneficiaries with high-quality benefits delivery. Without increased priority on non-rating claims, beneficiaries will likely continue to experience delays in receiving entitled benefits and VBA's backlog of pending non-rating claims will potentially continue to grow.

Recommendations

Recommendation 1. We recommended that the Under Secretary for Benefits take action to address the lengthy ADP and backlog of non-rating claims.

Recommendation 2. We recommended that the Under Secretary for Benefits track and analyze non-rating claims processing timeliness for the remainder of FY 2008 and, if determined necessary, establish new timeliness goals

[meghp0405]

AF Butch,

a fully developed claim is a claim that is submitted to the VA with all documentation needed to support your claim.

I have been submitting dependency claims on a VA FM 21-526ez along with VA FM 21-686c. The payments on these claims have been taking about 6 months that I have seen.

Unfortunately, for you and hundreds of others, the dependency claims were not submitted with a VA FM 21-526ez, and that is one of the reasons why it's taking so long for these type claims.

I posted an additional response earlier to this subject where I went into detail about the processing of dependency claims.

Good luck!

[rpowell01]

I am coming up on a year. Lets see if it gets expedited...BTW I have also had a dependency claim coming up on a year....I call this BS on the VA and I will still be sitting here in 6 months waiting for my claim to be processed. I haven't had a C&P exam yet....I don't know if this is because I have enough evidence (Dr. Bash IMO) or they are just that slow on getting the C&P Exam done.

BTW this is at the St Pete RO that has an estimate 46,000 active claims. They are second in the US right behind Texas with 48,000..Figures released this month or last month...

Edited April 25, 2013 by rpowell01

[carlie]

Again,

any claim after the first one - is a claim for increase

and ditto on the post that claims for additional comp for our dependent/s

is low on the totem pole,as far as working claims go.

JMHO

[AFButch]

Not sure where they are going with that statement but in their press release they are supposed to: Throughout this initiative, VA will continue to prioritize claims for homeless Veterans and those claiming financial hardship, the terminally ill, former Prisoners of War, Medal of Honor recipients, and Veterans filing Fully Developed Claims. Makes you wonder why the RO's basically do what they want and no one is accountable when they skirt directives. Must be nice to run amuck and get away with it daily.

I tried and failed to say that my dependent claim is fully developed but received the following: Fully Developed Claims are those for Service Connection disability compensation or Non Service Connected Disability Pension. Dependency Claims are NOT considered as fully developed claims. They are considered Dependency Claims and as such are worked in a separate category than disability compensation claims.