VA Disability Benefit denials

[GBArmy]

I wanted to start a new thread because I didn't want to mess up richard 1954's post. Does anyone know for real why the VA Benefit people bend over backwards to deny veteran's claims. I was told a while back by a VSO who should know that they certainly had a quota to disposition claims.; so many a week or a month.I also heard that the managers, but not the lower tier workers, got some kind of bonus for "cost savings."  What are  those"cost savings?"Do they actually get financially rewarded for denying or making lower rated decisions some how? There has to be some actual truth to this kind of thought because of some of the ways these claims get denied. They ignore facts, don't read the evidence we high light for them, apply wrong diagnostic codes, combine separate disabilities, etc.,etc. Anyone got any knowledge of where we can find any facts if it is indeed financial?

[paulstrgn]

6 hours ago, vetquest said:

I just think that the raters have quotas to meet

I was speaking with a VA employee and he did say they do have a quota/production to meet. As a federal employee I do understand why they might (to make sure employees are staying gainfully employed) but I am worried all it does for some of these employees don't care of the quality as long as they meet their goal. Instead they should be held to a quality standard to ensure that the right decision and percentages are given to the vet. If they did in time the backlogs would reduce, especially the need for HLR and the BVA. JMO

[Blessed]

As a former VA VSR the guys/ladies in my barbershop know this subject sends my BP through the roof thinking we were all incompetent so I will be brief!! First guess who were the first to quit claims processing(15 ppl in one week left for soc sec)....VETS!! Yes calling/posting complaints is very different than  when a stack of "very" difficult files are placed on your desk! My major VA complaints were MEDICAL professionals should be deciding ratings!!! Next can't hire fulfilling quotas!! The cases are difficult to work! I shouldn't be teaching a coworker how to pick up a phone call hospitals etc to "correctly"  request records because so many requests come back done incorrectly slowing up cases!!! I found a mistake that got a vet a HUGE refund and he complained the check didn't release fast enough. I knew then I would be leaving VA as well.....I BURNED OUT!! My supervisor was MAD when I announced I was transferring!

[broncovet]

I appreciate "blessed" point of view.  We would do well to not criticize "until we have walked a mile in his shoes".  

Some time ago, there was a case on the "two signature" requirement for large retro's.  The court ruled that the EAP (Extrordinary Award Plan which required multiple signatures for large retro's) was CUE.  (Link, below).  

But, I thought about that a little deeper.  Of course there are 2 sides of this.  First, we do need someone out there "protecting taxpayers" against fraud awards, but we do need to balance that with the interests of Veterans.  

I have been on hadit more than 10 years, and have heard and answered thousands of vets questions.  During that time, I noticed the EXTREME rarity of Pro Se or Vets getting awarded large retros at the VARO level.  Its so rare, that I think they simply dont allow rating specialists at the VARO level to award 100,000 retro.  These happen almost exclusively (unless your name is Berta) by a judge at the BVA or above. 

For that reason, I think "someone" at Va is "tracking" awards especially large retro's.  There is no doubt in my mind that VA managers "call in" any rating specialist and ask why they are awarding so many claims, especially with larger retro's.  

One rating specialst denies this, and claims he trains raters "deny if you must, award if you can".  

This "motto" would appear to be in conflict with whoever it is at VA who tracks awards and especially large retro's, and probably holds those people accountable. 

These managers are operating "on a budget" and must meet budget goals.  A few 100k or more retro's can blow that budget quickly.  Now, this rating specialist claimed that "VA payments" to Veterans were in a different budget, not controlled by raters direct management.  Remember, tho, all of those budgets are under VASEC control, and there is no doubt "department head A" talks to "department head b", and they likely do each other favors.  

    So, whoever controls the budget for VA payments could/probably does exert pressure on other departments to keep those large retros "down".  

    I think you are dreaming if you think "money" is not a consideration for VA management.  Else, why would they even "track" those large retro's? 

    So, yes, I think raters consider carefully how many large awards and large retros they grant.  Management, no doubt, lets them know that "they are being watched".  

    If I was a rater, and awarded 100 retros over 100k  in a year, you can bet their managers take notice.  This is even a suggestion of fraud..maybe this rater is on the take???  

    So, its much safer to join the ranks of raters who award zero 100k retros in a year. 

Macklem showed EAP equals Cue.  

http://thomasandrewslaw.blogspot.com/2010/08/macklem-eap-equals-cue.html

 

[broncovet]

I beleive the "Macklem" case suports what I posted.  If, as that rater suggested, there is no management tracking of large retro's, why would the VA even know that "VA rater A"

even awarded large retro absent 2 signatures?

Its my opinion VA still changed nothing even with Macklem.  They still require 2 signatures for retros over 25k, but do it quietly and dont let the Vet know.  

[vetquest]

@Blessed, we are not attacking you.  We are attacking a system that encourages denials of claims.  When we see a claim denied for something like, "the veteran is receiving long term disability so is still considered employed", we have a reason to complain.  This is an actual excerpt from one of my denials.  Some of the raters are obviously looking out for veterans but some of them are biding their time to retirement.  As you say you transferred out, maybe the good raters opt out because of the pressure of making grants.  Much like the good doctors are run off by the VA, I know a lot of good doctors that used to work for the VA, they just could not hack it.  One of my best doctors at the VA did some serious testing on me and some other vets, he was just gone one day.

Please do not think we are attacking you personally.  We are just frustrated with a system.  

[paulstrgn]

@BlessedAs a federal employee who works in an agency that pushes production over quality (even through they say quality is everything). I am sure the VA has the same issues, but also like any agency you have the good and the bad employees. The vast majority of these employees are doing the best they can. The VA needs to invest more into training, higher medical professional who know how to fill out the paperwork correctly and ask the vet the right questions. Production will always take a hit when you have training, but if the training is good then your production will go up. There will be less errors/mistakes which in turn will mean less HLR or BVA filings. Any VA employee that is on this site should never take any of this personally, for we are not attacking you its the system in general that is broken. I learned to never take things personally at work for when I use to deal with the public just learned to understand their frustration. JMO