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

[Guest jangrin]

Jangrin,

While it is true a veteran can request a hearing in front of the decision makers at VA at anytime during their claim process, the VA, however, "will not normally schedule a hearing for the sole purpose of receiving argument from a representative" The purpose of a hearing is "to permit the claimant to introduce into the record, in person, any available evidence which he or she considers material and any arguments or contentions with respect to the facts and applicable law which he or she may consider pertinent" Now, you may say this somewhat contradictory because the regulation states that the purpose of the hearing is "...any arguments or contentions with respect to the facts and applicable law," but then states that a hearing won't be scheduled for the dole purpose of "receiving argument." What this means is the VA won't schedule a hearing if the veteran is just going to argue, for example, why he/she thinks a certain IMO should be afforded a certain amount of weight in the rating decion. The VA should schedule a hearing if the veteran has evidence or arguments that have a certain "applicability to the law." The words "with respect to the facts and applicable law" are the key here.

I suspect the reason why VA doesn't schedule many hearings while the claim is in its initial process, is because the veteran just wants make an argument as to why they think they should be awarded service-connection and not actually submit any pertinent evidence that have any bearing with the law. Most of the hearings would probably be really subjective in nature and not really accomplish much except for getting the blood pressure up of the veteran and giving the RVSR a headache!

The regulation for hearings is §3.103©;

"© The right to a hearing.

(1) Upon request, a claimant is entitled to a hearing at any time on any issue involved in a claim within the purview of part 3 of this chapter, subject to the limitations described in §20.1304 of this chapter with respect to hearings in claims which have been certified to the Board of Veterans Appeals for appellate review. VA will provide the place of hearing in the VA office having original jurisdiction over the claim or at the VA office nearest the claimant’s home having adjudicative functions or, subject to available resources and solely at the option of VA, at any other VA facility or federal building at which suitable hearing facilities are available. VA will provide one or more employees who have original determinative authority of such issues to conduct the hearing and be responsible for establishment and preservation of the hearing record. Hearings in connection with proposed adverse actions and appeals shall be held before one or more VA employees having original determinative authority who did not participate in the proposed action or the decision being appealed. All expenses incurred by the claimant in connection with the hearing are the responsibility of the claimant.

(2) The purpose of a hearing is to permit the claimant to introduce into the record, in person, any available evidence which he or she considers material and any arguments or contentions with respect to the facts and applicable law which he or she may consider pertinent. All testimony will be under oath or affirmation. The claimant is entitled to produce witnesses, but the claimant and witnesses are expected to be present. The Veterans Benefits Administration will not normally schedule a hearing for the sole purpose of receiving argument from a representative. It is the responsibility of the VA employee or employees conducting the hearings to explain fully the issues and suggest the submission of evidence which the claimant may have overlooked and which would be of advantage to the claimant’s position. To assure clarity and completeness of the hearing record, questions which are directed to the claimant and to witnesses are to be framed to explore fully the basis for claimed entitlement rather than with an intent to refute evidence or to discredit testimony. In cases in which the nature, origin, or degree of disability is in issue, the claimant may request visual examination by a physician designated by VA and the physician’s observations will be read into the record. (Authority: 38 U.S.C. 501(a))"

Does this make sense?

Vike 17

Vike 17,

Thank you for your response to my many quaries. I do understand the right of the veteran to request a hearing. I do understand the difference in a hearing to clarify an issue or to submit evidence to support ones position as opposed to arguing the rating.

I do think that Berta might be one who could really benefit from this entitlement as she could request the hearing (to submit the IMOs that have not been officially recieved and documented as part of her evidence.

Do you think that this would be something for her to do to get official recognition of her evidence?

I suspect I may be too optomistic but what I really wanted to know is why the claims adjusters and raters did not work with the veteran when there is a question about records or the aduster is confused? Wouldn't a simple phone call or letter to the veteran to clarify or help the adjusters in sorting out the claim, dates, time, etc. It seems that the raters would rather deny a claim than ever actually ask a vet or have personal contact with the vet about the claim.

It seems that the adjusters have a duty to assist as long as they don't have to actually have any contact with the veteran. Why is it that there seems to be such animosity? Also why do we get such false information from the IRIS and 800# people. It seems the answers are always in conflict with one another from hours to hour. and one day to another.

I realize you have had access to this system from the inside and I admire the fact that you come on Hadit to help the vets. Your information is reliable and accurate. But you opinion on the VA system and the inner workings could be as revealing as understanding the regulations. You obviously know how it is suppose to work, but what I was asking is "how does it really work" and why the seperation rather than a true joint effort to make the process more user friendly?

Thanks Vike 17 I appreciate the time.

Jangrin

[Brandy]

Vike 17,

I suspect I may be too optomistic but what I really wanted to know is why the claims adjusters and raters did not work with the veteran when there is a question about records or the aduster is confused? Wouldn't a simple phone call or letter to the veteran to clarify or help the adjusters in sorting out the claim, dates, time, etc. It seems that the raters would rather deny a claim than ever actually ask a vet or have personal contact with the vet about the claim.

Jangrin

Jangrin,

I submitted a claim for multiple secondary conditions to my husband's DMI. Since I have received two VCAA notices. The first one was about 20 pages long. The second notice was a little more precise of the evidence and particular conditions that they needed clarification or more information on. One of their questions even said to provide more information on a particular condition and then later in the letter actually said something like: "It seems or are you claiming this condition is secondary to your service connected other condition?" With this statement they actually told me that the second conditon they had already deemed was service connected because it was one of the new conditions we claimed! I guess my point is that they were asking specific questions about my claims that they were trying to understand.

I think sometimes it depends on which office you are dealing with. So far, whoever is handling our claim seems to be doing things by the "book", in supplying us with the notices with info on what they still need to decide our claim, etc.

Brandy

[RockyA1911]

Surprisingly enough, the VARO in St. Louis contacted my buddy by phone last week. The previous week he had gotten a letter awarding increase for PTSD but deferred Sleep Apnea secondary to PTSD and TDIU.

The guy said he was the rating officer and wanted to know more info or if he had any medical records for the Sleep Apnea. My buddy told him he had sleep studies both by VAMC and IM sleep study, that the VA gave him the CPAP and showed him how to use it etc. along with the C&P and had sent them all that last May. The RO said he did not have those records and asked that he mail them to him attention his name and also stated he was going to fill out some request form to OPM for the TDIU.

So this one did actually contact the veteran and was interested in getting his claim resolved completely.

[RockyA1911]

VIKE17,

I and others really appreciate your explaination on how the process works and the 6 teams. You stated that it is when the claim is at the rating board and the RVSR requests the C&P exams if necessary.

For myself and others the rating board and the RVSR is the last place it goes and I and others C&P exams are sometimes 6 months or older before our claims are even sent to the rating board.

I thought a ready to rate status meant that the claim was just that, ready to rate with all medical evidence and necessary documents verified PRIOR to sending to the rating board and RVSR so all they have to do is review the claim and make the decision.

So when you said it goes to the RVSR and he is the one that schedules the C&P I am completely confused now.

[Vike17]

Jangrin,

You asked "how does it really work." Well, believe it or not, the system really does work as I have posted i.e. the six teams and how a claim is processed. One thing to keep in mind is that alot of times what the claimant thinks is happening or should happen to their claim is far from from it. For example, just because a veteran thinks "Geez, I sent in all the records I had, it should be ready for a decision" doesn't mean that all the records 'available' to the decision maker aren't in front of them. Alot of times when a VSR or RVSR actually works on the claim and goes through the C-file, they'll see stuff in the records that may need to be further developed. For example, let's say you claim hearing loss and it is now 15 years after your discharge, and you submitted all the SMR's and private treatment records in your possession, but when the RVSR when through those records, he/she noticed that you were seen a year after your discharge at some clinic for your claimed hearing loss and those records aren't in the C-file. The RVSR may contact you just to request those records from the clinic to try and further substantiate your claim if the issue of service-connection hasn't been decided. Many times there isn't an actual need for the VSR or RVSR to contact the veteran. Having said that, there have been a number of claims I've done where the VA has contacted the veteran to clarify an issue or something of that nature without having that veteran actually request a hearing. As a matter of fact, that happened to me a few years ago with my Clothing Allowance application. The VAMC lost my application and after two emails to the VA about the status of it, the Regional Office called me and apologized for the mishap and said they would go ahead and award the clotting allowance based on my medical records in my C-file and that I didn't need to bother with the VAMC anymore.

Another thing to rememeber is when you call the 1-800 and get someone from the public contact team, or send an IRIS inquiry and a VSR reads it, they do not actually have your C-file in front of them to give a 100% accurate answer. They are just reading a computer screen with diary inputs as to what is happenning with a claim. As I have said before, every claim is unique in the sense of developement and anything needed to make a decision, so you cannot compare your claim and its movement with your buddies.

Rocky,

The reason why a RVSR has the authority to schedule a C&P exam is many times when they receive a "Ready to Rate" C-file, there may be enough medical info in the records to rate it without having to send the veteran to a C&P exam. Does this make sense. A VSR in the pre-Determination Team isn't as trained as much in this matter as a RVSR and such decisions are out of their jurisdiction.

I hope this has answered your question.

Vike 17

Edited January 7, 2007 by Vike17

[Guest jangrin]

Vike 17,

Thank you for your time I for one appreciate the information and your insite to the systems workings from your point of view

I would like to know at what level the VSO/POA is involved in this process. I know they can help file the claim form. iI some cases they actually help the veteran develope the necessary evidence to SC their claim, although I find that to be an execption rather than the rule.

How else are they involved? How many cases are they responsible for at one time?

Jangrin