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?

[Fat]

I hope this isn't the case. Claims and appeals should be based on evidence.

[Richard1954]

I don't think VA employees bend over backwards to deny claims,  I just don't think they know how to do the job. It used to be that it was much easier to approve a claim than to deny it. This was because they had to jump thru hoops with facts to deny a claim , but with an approval they just quote the rating guidelines which is so much easier.  When I look at some of the denials I have received over the years, especially the more recent denials,  I just can't understand how anyone  with any common sense  could deny a claim that oh its face is valid. Moreover, I do think that the C/P examiners are the people that actually go out of their way to deny a claim. For example, I actually had a C/P examiner that I though I had communicated  well with ( this has happened more than once )  she was a NP, and it turns out that she really had no idea what she was doing.  Her reasoning for denial was just ludicrous. It was fortunate that  she actually worked for the VA and the examination was done in a VA Facility,  I was able to review the C/P results on line because they were in my VA medical records.  She apparently realized her rational was flawed, or someone told her she had a flawed rational because 21 days later she went back and wrote a completely different reason for denial. She actually cited part of a sentence form an opinion paper that had noting to do with my medical issue. She did not even identify the source document correctly .  I had no trouble finding this document on line and upon reading it I discovered that the sentence she had claimed did not actually exist in the document.  I had the appeal  written even before I received the denial.  I cited the document she claimed to use as reference, and indicated she had fabricated  the information she claimed to cite.  I provided the actually document to the VA,  so that a rater could see for their self how convoluted  the denial was.  Now this denial also did not take into consideration an IMO that I had also submitted with the original claim which indicated the complete opposite of what the VA examiner stated. Instead of the Rater giving  me the benefit of the doubt, the VA required that I have another C/P examination, I think they were seeking to get another adverse examination so that they could say they had considered giving me the benefit of the doubt  but the second examiner confirmed what the IMO indicated and I was awarded service connection. 

We have to be vigilant when we submit a claim. we have to make sure all the requirements meet the rating guidelines for the particular  medical condition before we submit a claim, and we have to make sure that the diagnoses is in the medical record, It is also important if you have a doubt about treatment records actually confirming a service connection, to get an IMO before we submit the claim. If we do everything we need to do and still get a denial, they we know the raters have no idea what they are doing, and they get overturned by a DRO or the BVA. The system has become so adversarial that even when the evidence exist to grant the claim, they raters look for reasons to deny. 

Part of the  problem is that raters are not medical personal  so they take as gospel what ever an examiner states even when the examiner makes no sense.  It is left up to us to make darn sure our claim is approved, buy calling out the examiners when they are wrong and presenting facts that support our claim. These facts come mostly from  medical records, but also IMO's and even documents we find on the internet that support our claims. If that still is not enough, then buddy statements or spouse statements come into play. 

I have received more denials than I can even count, and with the exception of one claim I have always prevailed even  a 0% rating its always better than a denial. 

 

[vetquest]

I told a woman she was eligible for a ALS DIC claim because her husband was prior military.  She filed her claim and was more information was requested because the VA claims they were separated at the time of his death.  She submitted a state notarized document that they were living together at the time of his death and she was his caregiver.  She called me yesterday because she was denied, for being separated at the time of his death.  These raters are not reading the evidence.

[Berta]

"WASHINGTON – Veterans with amyotrophic lateral sclerosis (ALS) may receive badly-needed support for themselves and their families after the Department of Veterans Affairs (VA) announced today that ALS will become a presumptively compensable illness for all veterans with 90 days or more of continuously active service in the military."

https://www.va.gov/opa/pressrel/pressrelease.cfm?id=1583

Thanks for trying to help her- I bet many vets and their survivors do not know ALS is presumptive, as above.

Can she join us here?

" These raters are not reading the evidence." That is why so many claims get denied.

If she could scan and attach the VA denial and post it here, we can figure out what to do----Did she send them the notarized statement before or after the denial came?

The VA does not treat widows well-they played every trick they could on me.....

and ignoring my evidence was a big part of that battle.

Their reason for denial however, is something I have never seen before.

I wonder where the VA came up with that reason.Maybe they just made it up.

It would be best if she could join and post her denial in the DIC forum.

 

Edited June 26, 2019 by Berta

[vetquest]

@Berta, I will see if this lady wants to join the board.  She is in her seventies and is not computer literate so she might not want to join.

[Berta]

That is unfortunate, and I think VA hopes there  are many veterans and survivors who cannot use a PC.

I dont see how most claimants can get anywhere these days, without PC internet  access.

I hope she can find a good  VSO.