Provisional Claim Closed

[Alishape]

I am writing because I finally got my big brown envelope and I have some new info regarding the process. My claim was closed and I was given a provisional rating under the new initiative to close older claims. Several of my contentions were denied, but the letter said I could submit new evidence for a year before the rating decision became permanent. I had some info, but wasn't sure where to send it because according to ebenefits the claim was closed, leaving me with no electronic submission option. Plus the claim said to send the info to the address at the top of the letter. That's cool and everything except for two things. First, ebenefits also states that my claim is on the way to the scanning center and second, my claim was fast tracked at a different RO than my original RO. The address at the top of the letter was not the same as the one on the envelope. Of course being a good ex-sailor I followed the directions on the letter.

I felt a little shakey about the whole thing so I called Peggy. Peggy said that he was going to put in a request to have my claim reopened. That means no lengthy appeals process, and access to electronic document submission if it gets reopened. He also suggested I fill out a VA form 21-4138 statement in support of claim to send in with the documents. I'll keep you all posted on how it goes, but so far I'm feeling pretty optimistic. I wanted to share because I know I had been looking for some info about this new initiative and others will be too. More later...

[john999]

I would not trust "Peggy" to put in request to re-open a claim. You should do that via paperwork you send to your VARO yourself via Certified mail/return receipt. I trust claims that are in writing. The FDC thing has not worked for me at all. When you send evidence, NOD's, appeals etc. you must have evidence of submission in your hand. The VA cannot find their own ass with both hands.

John

[Motoman172]

Update:

Still no change... I have since passed the so called 1 yr mark from my provisional. The "Administrative Review" is still showing but below where it shows completed claims the Provisional rating doesn't show the Appeal link anymore. VA has not scheduled the 2 C&P exams needed in the provisional, so I don't see how they can deny me appeal when the final rating comes down...

Anyhow I had another issue come up.

I required back surgery on my SC back and was out of work for a month.

I called Peggy and she stated that I could not apply for the Temporary 100% until I was discharged. So I did that, that was June 24th... I am scheduled to go back to work tomorrow but my claim has not been looked at yet. I once again called Peggy and for a financial hardship rush i would have to be in foreclosure on my home.... Seriously??

Anyone else have any luck with the Provisional denials?
Been interesting watching the VA squirm in congress...

Its all totally unacceptable...

Delay Delay Deny Deny Until they all Die!

[carlie]

Update:

Still no change... I have since passed the so called 1 yr mark from my provisional. The "Administrative Review" is still showing but below where it shows completed claims the Provisional rating doesn't show the Appeal link anymore. VA has not scheduled the 2 C&P exams needed in the provisional, so I don't see how they can deny me appeal when the final rating comes down...

Anyhow I had another issue come up.

I required back surgery on my SC back and was out of work for a month.

I called Peggy and she stated that I could not apply for the Temporary 100% until I was discharged. So I did that, that was June 24th... I am scheduled to go back to work tomorrow but my claim has not been looked at yet. I once again called Peggy and for a financial hardship rush i would have to be in foreclosure on my home.... Seriously??

Anyone else have any luck with the Provisional denials?

Been interesting watching the VA squirm in congress...

Its all totally unacceptable...

Delay Delay Deny Deny Until they all Die!

You might want to start this as a NEW TOPIC thread.

[Alishape]

New update, and possibly good news for us provisionals. Here is an article I found and the recommendations of an OIG investigation follow it (If you google reveiw of vba's special initiative to process rating claims you can see the whole thing):

Over 7,800 of the unresolved benefit claims disappeared from the backlog after the VA issued what it called a “provisional rating,” a preliminary decision based on incomplete or outdated medical information in a claims file. It is a classification that requires additional work by VA staff to become a final disability or pension rating and cannot be appealed by veterans, the IG found.

The department practice overstated the reduction in pending claims and progress toward eliminating the overall claims backlog, Linda Halliday, the assistant VA inspector general for audits and evaluations, testified to the House committee.

“They were working hard — they had to try something to clear the backlog — but we feel it misrepresented the workload,” she said.

Furthermore, the VA then “lost control” of the provisional ratings cases, which were pushed further to the back burner, where they were ignored. Some veterans might never have received final rating decisions if not for the IG investigation, according to Halliday.

Recommendations

1. We recommended the Under Secretary for Benefits implement a plan to

identify all provisionally-rated claims and ensure the proper controls are

entered in the electronic system to track, manage, and complete them.

2. We recommended the Under Secretary for Benefits implement actions to

include provisionally-rated claims in the rating inventory and correct the

aging of provisional claims in pending workload statistics.

3. We recommended the Under Secretary for Benefits implement a plan to

expedite final decisions on all issues in provisionally-rated claims.

The Under Secretary for Benefits concurred with our recommendations and

directed a complete review of all provisional rating decisions on

June 2, 2014. Further, VBA established procedures to closely monitor

and track provisional claims under end product (EP) 934. Finally, VBA has

provided direction to VAROs on the review and finalization of provisional

rating decisions. VBA anticipates completion of these recommendations by

September 1, 2014.