Claims

[dapilgrim]

What is the deferred VA claim approval rate?

[broncovet]

Good question.  VA "carefully guards" its denial/award percent rates,  deliberatly not making those available to us.  Alex observed about a 85 percent denial rate on first time claims, and this is consistent with my knowledge AND my experience.  

However, its my opinion that the decision maker "defers" instead of denies, because he feels there is "evidence lacking", that may support the claim.  That is, hes not fully convinced the claim should be denied, but is waiting on additional evidence to award/deny.  

In other words, I would suggest the decision maker thought there was at least some evidnece to support the claim.  I would specualate that the claim had at least 2 out of 3 caluza elements present, and he was waiting on additional evidence to get number 3.  (All 3 caluza elements must be present for an award:  current diagnosis, in service event or aggravation and nexus.) . 

For the above reasons, I would give "greater" than 15 percent chance.  Significantly greater, IMHO, because a rater that did not care could simply deny if its missing at least one caluza element.  

My guesstimate: a Deferred decision would be greater than 50 percent chance of being awarded.  In fact, it would make sense that the percent may be as high as 85%.

Here is my reason.  The "missing caluza element" is "probably not" the in service event.  No in service event suggest a nexus is impossible and a denial is in order.  

The in servicee event can "not" be fixed with an IMO.  

However, either a lack of diagnosis or missing nexus could be fixed by a IMO/IME.  

For those reasons, I htink the chances of an eventaul award with a deferred decision is high.  

[63Charlie]

I filed an 1151 for a spine claim.

The decision was deferred as the RO decided the claim needed more development requiring a medical evaluation.

I never got a C&P exam or anything.

A RVSR at the RO decided that I didn't need that medical opinion after all, and subsequently denied the 1151 claim.

This rater decided that SHE was qualified to make a medical determination on her own without involving a medical professional.

I filed a NOD and am spinning in the Appeals Management Hamster Wheel approaching 4 years.

Therefore, my personal approval rate is 0-1.

 

 

Edited February 16, 2019 by 63Charlie

[jfrei]

During the workweek I would call the Appeals management center supervisor if her number hasn’t change (202) 530-9149. Explain your situation and she may try to get you to the person working your claim. She had helped me when mine was spinning on the wheel... sorry I don’t know her name she doesn’t pick up she does second respond to her VM.