Vike 17- What Exactly Is The Process?

[Guest jangrin]

Vike 17,

It is fairly apparent that you have had or currently have exposure and experience in the VA claims process. It would be really nice if you would take a few minutes and explain the claim process (ideally the process) the typical claim takes through the VA maze and the steps it takes to be processed and granted. Start to Finiah.

I understand that their are many problems and things don't go smoothly, but having an idea of what happens and typically how long it should take and how many different people are assigned to each file and who makes the detrmination.

You know what I mean, the flow chart of a typical claim. It would be most helpful. And please who are those people who answer the 800# and the IRIS inquiries. Why so many different answers to questions that contradict each other? Help us out here maybe with some addtional knowledge we can be more productuive and help unclog the VA claims systems by doing our part more completely or something.

Thank you

Jangrin

[john999]

Jangrin

That would be like writing a book for Vike. Perhaps Vike should write a book on the claims process. The Veterans Survival Guide is good, but another book with the latest rules and regs and documentation would be good. There is the offical process the way things are supposed to happen and then their is reality.

[dougbo1943]

Vike 17

As Jangrin says you have a great knowledge of the VA claims process. I read all of your posts. I have learned a lot from you. I would love to see you to explain the process the way the VA makes it work to deny claims, but I have to agree with John999 that it would take a book to do it. I am looking forward to reading more of your posts.

Gunny

[Guest jangrin]

Vike 17,

I understand everyones concern that it would take a book or a series of books to decode the VA claims process. I don't agree with that. I think the process is simple but I think we are missing some important vision in the claims process to have resulted in so many claims being denied.

It may stem from the SOs not really helping the veterans properly from the beginning. I don't know but I sure would like to hear your insight on things.

I repeat could you please share some knowledge about the flow of the claims in the VA system and job descriptions of the people processing the claims and maybe some of your rationale on why there is a bogg/clogg of the VA claims. I for one would be interested in your opinion.

Thank you,

Jangrin

Edited January 1, 2007 by jangrin

[Vike17]

There are essentially six "teams" at a Regional office that make the "process." When a veteran files a claim for benefits with VA, it is received at what is called a 'Triage Team.' This is where the incomming mail ect is routed to the different sections or "team" to be worked. Picture this as a Triage unit at Hospital. There they decide who goes wher according to the condition involved. This is the way it works at VA too. For example, a veteran submits a NOD on a rating decision and has requested a DRO review. The Triage Team would then send this NOD to the Appeal Team (a bit more on this section later) to be worked. The main function of the Traige Team is screen all incomming mail. Within the Triage Team there are other sub components; the Mail Control Point, Mail Processing Point, and to a certain extent supervision of the file s activilty. The mail control point is staffed with VSR (Veteran Service Representatives) who are actully trained in claims processing. this is also where they receive and answer the IRIS inquiries. The mail Processing point is where chapter 29/30 claims are processed/awarded, and to a certain extent dependency issues are resolved.

The next step is the "Pre-Determination Team." This is where a claim for benefits is sent to be developed, meaning verification of service from the Service Department if a certified copy of the DD 214 is not submitted by the veteran, SMR's are obtained from St. Loius, any CURR verification are done for PTSD stressors, any private treatment records are obtained under the "Duty to Assist," inferred issued are Identified ect... Once all the developmental work has been done on a claim, it is then designated as "Reday to Rate" and sent to the Rating team.

The Rating Team is where most veteran want to have their claim. This is where the claim for benefits is decided. The RVSR (Rating Veteran Service Representative) is the person who rates a veteran's claim. They review the entire C-file to insure it is ready to be rated, and schedule any C&P exams that may be needed. If a C&P exam is needed they go ahead and do the paperwork to schedule this. Once the RVSR has all the needed paperwork to rate the claim, they make their decision. If the RVSR determines that there is something missing from the claim to make a decision, they send the claim back to the Pre-Determination Team for further development. Once the have reached their determination, they produce a rating decision with their decision and forward the C-file to the Post- Determination Team. The Rating Team aslo produces SOC's when the veteran has elected to have their appeal handled by the traditionl route (Having it sent to the BVA).

The Post-Determination Team is where the rating decision is promulgated. In other words, it is where the decision gets entered into the system and the rating decision is prepared and sent out to the veteran. If the veteran has a POA, they give a heads up to them as to whatthe decision was. If a claim has been granted and the retro involves over $25,000.00, it is sent to the VSCM (Veterans Service Center Manager) or their assistant for a thrid signature. The Post Determination Team also does the following action; accrued benefits claims not requiring a rating, apportionment decisions, competency issues not requiring a rating, original pension claims not requiring a rating, dependency issues, burials, death pension, and specially adapted housing and initial CHAMPVA eligibility determinations when a pertinent rating is already of record.

The Appeals Team handles appeals in which the veteran has elected the DRO review. They also handle any remands that have been sent back from the BVA and the Court. The Appeal Team is a self containing unit within the Regional office. They make determinations on appeal, make rating decisons that are on appeal, do any developmental work on any issue that may be on appeal, and issue any SOC's and SSOC's in conjunction with their review.

The Public Contact Team’s primary functions are to conduct personal interviews with, and answer telephone calls from, veterans and beneficiaries seeking information regarding benefits and claims. In some regional offices, depending on their workload, also handles IRIS inquiries and fiduciary issues.

As one can see the VA claims process can be complex. In essence a veterans claim is continously going from team to another until it has been decided. Now couple this with 1000's of claims going on at once with multiple issues and it is no wonder it can be a frustrating process.

Vike 17

[Guest jangrin]

Vike 17,

Thank you for responding-it does help but also I have tons of questions-however, I will try not to bogg you down all at once with my ignorance of the system.

I would like to ask you, In your experience what imput or role do the SO's with their POA have in the process. I know they are supposed to help prepare the claim and I know they are suppose to represent the veteran in the appeal hearings, but what about the daily operations and the actual claim rating. Are they involved in that process or are they there to look on the computer and see of the claim is actually moving through the system. I wonder if we are expecting them to know things that they themselves are not privy to?

Thank you again,

Jangrin

[Pete53]

Vike:

Thanks for a a good explanation of how it is supposed to work. On paper its sounds good but the fact remains that it takes the VA entirely to long to finish their work. Veterans deserve much better treatment than they are getting from the VA. From my view point it is not much better than when I filed my first claim in 1991.There is still a huge backlog of claims and unfortunately most Veterans like me tried as hard as they could to stay out of the system.

It appears to me that the Military should make more of an effort to educate the ones who are separating from the Service. In 1970 when I did I was afraid of anything that would slow getting out down.

Anyway your willingness to help us see how things work is much appreciated