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Cold Hard Facts


Ricky

Question

Just sitting around without anything to do so I decided to do a little research. Looking at the Monday Morning Report is what go me started.

The Stats for my VARO are as follows:

Percentage of rated cases sent to appeals: 57% This does not mean that they granted 43% of the cases received. You have to also take into account those that are denied and the vet simply forgets it, those that the VARO award at a lower level in which the SO convinces the vet that they go a good deal and those in which the vet died while claim was pending at the RO level.

Based upon the high percentage of appeals I decided to take a look at the BVA rulings on these cases. Surely there would be some good reading there. To my amazement when I did a search on just recent decisons for my VARO I found that out of 300 cases, 70 percent had been remanded. Some of them were on their second and third go around.

The majority of the cases had been remanded for:

-RO failure to associate listed evidence with the file

-RO failure to comply with previous remands

-RO failure to provide requested and required meetings (DRO meetings and BVA level meetings)

-RO failure to obtain VA medical records even after being informed of their existence by the Vet.

- RO improper development of the claim

Ya know we all make mistakes sometimes. Maybe failing to put a piece of key evidence into the packet before shipping it off to the Board 10, 15 or even 20 times a year one could understand. But hundreds upon hundreds of times a year is nothing short of intentional. The same goes for the other mistakes - continued failure to comply, failure to all due process hearings over and over again is simple criminal acts all the while thumbing your nose at the law.

I thought they were just lazy, but even a lazy person would have better stats than this. This little bit of research opened my eyes and depressed me. How can such criminal acts be tolerated by the government? I am going to send my little research efforts to the newspapers and news stations that provide coverage of the area in which the RO is located. Maybe it will shame them into an attempt to clean up their act. Nah, hell I am just dreaming.

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Guest rickb54

Ricky,

This is infomative. I would be interested in how many total claims the VA screws up, and what the reasons for the mishandled claims are. All too often someone tells a veteran not to put a claim in, because it might not be valid and will add to the backlog. I submit the VA is the major cause of the backlog, the few unjustified claims do not compare with the incompentance of some of the va raters.

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Ricky -the stats from the Inspector General are awful too--

in a 2005 survey the IG found that

“Sixty-five percent of VA raters

and Decision Review Officers (DRO) surveyed by the IG, in conjunction with its May 2005

report, admitted that they did not have enough time to provide timely and quality decisions. In

fact, 57 percent indicated that they had difficulty meeting production standards if they took time

to adequately develop claims and thoroughly review the evidence before making a decision”

I have a log of my AO claim and in January there was significant movement of it- appeals coach,rater, VSM, DRO, appeals team, three separate authorizations, etc etc-all month long-then nothing seemed to happen until they sent it to the BVA in July.

I got a remand very fast-but still I do not believe a single person who handled the claim in the many movements of it in January even read the appeal and of course by then they had still not addressed any of the evidence. Even my POA statement at the appeal level was a generic statement that also did not reflect any

actual attention to the claim or the appeal or to the 2 IMOs with the appeal.I managed to tell them they ignored my evidence on the first page of the appeal- how could they miss it?

They didnt even read it.

Many remands (my POA has plenty there for this violation) involve that fact that the veteran did not get a proper VCAA Notice.

As I understand it, the POA gets a copy of the VCAA notice-

When they see it is deficient -instead of doing something about it-I think most of these vet reps just let it slide by as this lack of proper VCAA notice will get the claim to the BVA and then tie it up for 2 years-only to be remanded again- while the vet rep can sit back and say Whew-got rid of another one-

I actually had to inform my POA's main office of what a real VCAA Notice was- and show them how mine was deficient.I also sent them (they were ticked at this)a partial list of links to the 40 claims I found so far in 2006 at the BVA that they were POA on that had already been remanded due to the same VCAA violation.There are plenty more.

The fact that vet reps and NSOs are often poorly trained or lack the ability to help a veteran develop a claim at the initial levels or simply just dont care as long as their pay check comes couples with a system that -as the above survey shows- is unable to do proper and consistent claims work-and this all ties 2 hands behind a veteran's back-from the git go-

What seems to surprise me these days more than anything-is when the VA actually makes a good decision based on actually reading the evidence.

They have spent much more time on my claim by NOT reading the evidence than if they had done that in the first place.

Edited by Berta (see edit history)
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The only way we'll get any major reaction is for vets across this country to expose every aspect of the system to the media. Another area to be concentrated on is what the VA, Tri-Care or Medicare is getting charged for. Medical supply places at a minimum double teh price on everything they buy. Depending on the item they as much as quadruple it. Recently I re-injured my back and needed a back-brace and cane from service connected injuries. The VA primary care doctor told me I would have to have an appointment with prosthetics. The appointment came in the mail and was for over a month away. So, having Tri-Care I went to see my private doctor for teh scripts via th eVA letter stating I was to report for evaluation for the types I'd need. The back-brace I received from the medical supply place costs them less than $200, I used to buy them when I worked there. They charged Tri-Care over $1000.00, of which they paid $644, the company gracioulsy wrote off $200 and sent me a bill for $160.00!!!!!

If we all worked together to report this greed we could insure our policies not to increase for years.

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Guest rickb54

A little food for thought.

Here is a good example of what is happining to the claims processing system:

The biggest reasons there is such a large backlog is that too many VA employees fail to do there job correctly the first time around and cause so many appeals that are remaned or reversed on DE Novo, at BVA or by the Court of Veteran Appeal. We always hear VA employees or SO say veterans bog down the system with too many invalid claims. Some people even say this on this board. The VA will not admit they are 95% of the problem. Just look at how many times some of my claims have been handled before they were finally awarded.

In Oct 1988 Asthma claim won on CUE after two previous denials with EED of June 1986.

In Oct 2003 request for increased rating Asthma won on De Novo with EED of Nov 2000.

in Jan 2003, Adapted housing grant awarded on DE Novo with EED of Feb 2001.

In Feb 2005, additional and seperate award for knee injury granted on de novo review, with EED Nov 2000

In Feb 2005, hearing claim, and tinnitis awarded on third claim going back to June 1986.

In Jul 2005, COPD secondary to asthma claim awarded after a 20 years of denials.

IN Mar 2006 auto adapted equipment (air conditioner) awarded by BVA with EED of Feb 2004.

In all the above claims were reviewed 19 times before they were finally awarded. And in some cases they were reviewed by more than one regional office. Just think of all the other claims that could have been processed if the va had handled my claims right the first time, and think of all the money the va would have saved if they had done their job right the first time. Ironically I still have one issue at the Court of Appeals and two issues waiting De Novo appeal.

The next time someone tells you not to submit a claim because it might bog down the system remind them if the VA did their job properly the system would not be back logged.

The VA must be the only employer that rewards people for criminal incompentence.

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  • HadIt.com Elder

No doubt the VA is going out of its way to slow down the granting of claims to vets. If they worked as hard to help vets obtain compensation there would be a lot of happy vets. Even when you have direct evidence of service connection you can be sure you will have to submit to a C&P exam and a nice long wait. You will then most likely be low balled. My primary care doctor says I have severe PN and the C&P doctor agrees and the VA awards me 10%, so here come the appeals.

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rdawg - I used the Monday Morning Report to get factual remand - ie claims pending for a specific period of time divided by number of claims pending appeal = appeals rate. So if the constant number of appeals pending rating = lets say 13,000 and the constant number of appeals pending = 7000 then the appeal rate would be 53 percent (7000/13000). Now that does not mean they have an error rate of 53 percent only that 53 percent of their decisions have been appealed. Now to be fair to the RO I am sure that X percent of those appeals were good sound denials.

My other comments were made on my own research of BVA cases submitted by my RO. I did a search on my RO at the BVA site. When the cases came up I had to sit in front of my computer and read case after case. This ain't to hard when case after case read remanded, remanded, remanded remanded..........

This was easy for me becasue there were very few, if any, partial awards with a remand. More than the majority of the cases were complete remands because of the reasons stated in my original post. Most of the time I was able to read through six to seven pages of BVA decisions before finding one claim that was actually decided by the BVA.

My little research project is in no was backed by firm numbers from the RO nor is it intended to be a complete picture of my supporting RO. It was simply a small project done for my own use which I felt to be alarming. I know that there are hundreds if not thousands of dedicated VA workers in the system and I do not blame them for anything. It is the politicians and management within the system that is corrupt which causes the employees to appear to be the same. Do you think that some GS11 rater or GS13 DRO would, by themselves, decide to not follow a regulation which was designed to implement a U.S. Federal Law. I do not think so for if they did they would definitely end up in jail. However, if the system they have to work within is above and beyond the law and scrunity of law makers then it is no foul no harm and they must do as told to do in order to keep their jobs - business as usual.

The system has always been this way and will probably still be this way 50 years from now. As I stated in another post the majority of Americans always stand up and go rah-rah troops but when they find out that those same troops are now back at home and injured we are viewed as beggars simply setting around with our hands out sucking the life out of the country when we ask that our service connected injuries be compensated and cared for. They quickly forget those that spent lonely and blood filled nights spent on the battlefield watching our brothers and sisters die and the pain suffered by some of us as we were being removed from the battlefield less two legs, one eye or other serious injury. They only remember being able to sit in their cozy little homes, reading bedtime stories to little Jack and Jill and thinking about later that night when they were going to be in bed with Barbie nice and cozy.

Enough ranting - I think we all can see the picture that I am talking about - it ain't ever going to change guys. It is ok for us to go into battle to support the ideas of this country but when we ask for a little support back the majority of Americans will look at you and say "hell, you are the one who went into the service, it ain't my fault". Therefore, no support for change equals no change.

Ricky

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Well sure,

We all know the non adversarial definition of the claims process is bullshit BUT........

Isnt the real villain here the congress and its unwillingness to fully fix and fund a system that doesnt reward its fat cat corporate friends and wealthy donors?

1. The system is so complicated that it invites mistakes by us Vets

2. The government doesnt pay the raters a whole lot of money but the decisons they have to make are extremely complicated. With all due respect working for the VA or any federal government agency does not typically attract the graduates of the top business schools.

3. On top of the systems complicated systems , the huge numbers of claims place unbelieveable production demands on raters with emphasis on quantity not necessarily quality of work.

ASK yourself why the VA isnt funded to hire and train more people to handle a growing workload?

4. The system was originally set up with claims to be rated by a team of three including one medical doctor, this recognizing the complex nature of the decisons.

ASK yourself why this procedure was soon thrown out? Could it have been because congress decided it cost too much to pay a medical doctor as part of the team?

IMHO the real reason the system of claims assessment stinks is the failure of our representatives to truly desire to fix and fund a better way

Finally, can anyone tell me why that great American hero and patron of us Vets and likely next Presidential nominee of his party, the Honerable senior senator and ex admiral John McCain has a pro Vets voting record from the DAV of 25% in 2004 and 20% in 2005??????? HUH!!!!

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I agree in paert with your statement, But I also agree with Terry. The system is over complex and it adds confusion mixed with major mistakes.

I disagree about the money they make for I am a former Employee and I know for a fact that the People who answer the phones are GS 5or 6 and they make upper 20s to low 30s. The Raters are GS 8/9/ andy make upper 30s to mid 50s depending on length of service. A DRO is at least a GS 12 and a SCM is probally a 14 or 15 making big bucks.

If the RO has a chinese fire drill ongoing, Like Terry says, Get it to the BVA. I was lucky to win at the RO level and I would not have won without inteference from Rep Ben Chandler and the Knowledge from Hadit.com.

The Government knows what is wrong but it is not high enopugh on the priority scale because the end result is additional money and benefits to Veterans and they need to use it to finance other projects.

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I humbly disagree with Terry. Not that veterans making sure their claims are properly presented wouldn't help, because it would.

But, I don't find it realistic to require Veterans with disabilities to learn a complicated process and medical knowledge to achieve well presented claims at the beginning. The information to do so is not readily available. If it was, Hadit would not have a purpose.

I agree for the most part this is a congressional problem. A lack of funding, and a lack of caring by those in control, the ones sending soldiers into harms way, is by far the bigger issue. They have the opportunity to change things and no one else. They have chosen not to help us so far. Simple as that.

Time

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I sure feel that a vet has got to be proactive and agree with Terry- get your med recs, your SMRs, you c file copy , an IMO if needed, and good support for your nexus-read their SOcs very carefully and use VA case law against them whenever you can.

The NEXUS is everything-someone said that here and they are correct! I got a call recently from a vet who-long ago- I gave links to for his unit and to some historic records to try to support a nexus that the VA could not verify-also I told him that S & S (Stars and Stripes)charges for archives but he said the incident was definitely reported in S & S so what would a few bucks matter to get a copy of that article-excellent evidence-he needed solid witness statements for a stressor or this article could sure have helped.His claim was denied.

He did nothing at all in all this time waiting for a decision and was mad that his vet rep didnt find anything to help him.

But he uses a PC hours every day -his vet rep does not have the internet at work-and he had every opportunity to contact his unit for a buddy statement or S & S on line, or whatever other way to prove his stressor.

His position is that the VA diagnosed him with PTSD. The truth is So what?

He has to prove it is related to his service.

(what he told me and his shrink was pretty serious stuff.The VA wants proof of what he said.If it really happened there is a way it can be proven.But he didnt even try-maybe it happened but he wasnt there anyhow.)

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Yes, but this assumes the vet is able. Are the ones that aren't just SOL?

I disagree. Vet's need to be able to hire someone that allready knows how to build a case. It took me YEARS to learn how. Having severe limitations in an educational envirnment didn't get my claim approved very fast.

The Vet being his own best advocate is the way the system is now. It doesn't make it right. To hold the opinion that this is the best way leaves Vets like me in the dark. It has to stop.

Time

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You are right Time-

I give this advise knowing full well that many vets cannot possibly do this all themselves-

The fact that there are paid service officers and Vet reps who should do more for vets-

but don't -just adds to the problem-

It really makes me sick to read BVA remands -with well known vet orgs on the brief- that could have been supported much better by the vet rep or SO.

My own husband got so ill- there was just no way he could have handled his claims alone.

He had the DAV and they did send support for his evidence to the RO but they were continually so negative-by phone- that it was very upsetting to him.

When he died with two claims in progress- first I got "the claims died with the veterans"from the DAV and then when I said I would re-open in my own behalf-then for 3-4 years-they sent brief supporting statements to the RO for my evidence but by phone my NSO always told me -no way would these claims succeed.

Of course those claims did succeed.

The lack of support from some vet reps and SOs for valid claims is so hurtful-

this too makes it all the more difficult for many veterans to want to continue the fight.

What is the answer?

A vet who cannot do it themselves needs to have a family member or friend try to help them-

a good NSO or vet rep should give a vet like this some sort of priority as to giving them positive help-

then again the good ones are overwhelmed as it is because they do take the extra steps.

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