VA IG on PTSD claim screw ups

[Berta]

PTSD vets need to read this- if they have a claim in process or have already been denied.

 

I think many denials might hold a valid CUE....... because of this report and 38 CFR 4.6.

 

In part:

 

 

"Claims processors did not request or verify the in-service stressor in an estimated 14,600 of the 18,300 claims. · Claims processors did not obtain a medical examination, medical opinion, or clarification of examination inconsistencies in the remaining estimated 3,800 claims."7

 

and "The OIG estimated that 6,300 of the 18,300 improperly processed claims resulted in errors

affecting benefits, totaling improper payments of $90.6 million to veterans.

10 The improper payments consisted of both overpayments and underpayments. If VBA continues to make PTSD

compensation claim processing errors at time of this review, future improper payments would total an estimated $271.9 million over the next three years unless VBA takes corrective action. 11 Claims Processors Did Not Fully Understand In-Service Stressors or the Stressor Verification Process During interviews with VBA staff, the review team had."   etc 

 

 

 

 

 Posttraumatic Stress Disorder Claims Processing Training and Guidance Need Improvement (va.gov)

Posttraumatic Stress Disorder Claims Processing Training and Guidance Need Improvement (govdelivery.com)

 

What a disgrace but not surprising.....

 

The VA has granted SC for PTSD to Wannabees, somehow over the years- who often are caught by the IG, or Dept of Justice, but at the same time, they (VA) are negligent in properly addressing valid PTSD claims.

 

This is a long report but I feel many here should read it----those 14,600 had no attempt by VA to verify their stressors and that is why it is often imperative for  veteran themselves to seek that proof.

 

A lot of these VARO claims people do not even have any idea of what military service is about,.and they caused one of my successful personal CUE claims.

They had denied my AO IHD death claim right off the bat saying the veteran ( my dead husband,) had no evidence of IHD in service.

SAY WHAT? I wrote a scathing CUE telling this idiot ( I sent it to the initials on the decision) 

that these combat veterans vets in the 1960s were still KIDS, sent to Vietnam,  and would have never gotten into service ,if their pre enlistment physical revealed heart disease,

and I rattled off 38 CFR.4.6 as told them this is the regulation they violated and that I expected a proper decision ASAP.

 

Three weeks later they awarded AO IHD death, due to the CUE , Section 1151 stroke (CUE pending on that), and also awarded a SMC CUE I had pending at Buffalo RO for almost 8 years. That's right- 8 years- 100% SC P & T PTSD and 80% (ultimately changed to 100% P & T for a Section 1151 stroke- an EASY claim to award)

 

What a system- snafued and fubared up the ying yangs----and, as I often say, literacy is probably not even a requirement  ,to became a paid VA claims adjudicator.

 

 

 

 

 

 

 

[bwilson]

6 hours ago, Berta said:

PTSD vets need to read this- if they have a claim in process or have already been denied.

 

I think many denials might hold a valid CUE....... because of this report and 38 CFR 4.6.

 

In part:

 

 

"Claims processors did not request or verify the in-service stressor in an estimated 14,600 of the 18,300 claims. · Claims processors did not obtain a medical examination, medical opinion, or clarification of examination inconsistencies in the remaining estimated 3,800 claims."7

 

and "The OIG estimated that 6,300 of the 18,300 improperly processed claims resulted in errors

affecting benefits, totaling improper payments of $90.6 million to veterans.

10 The improper payments consisted of both overpayments and underpayments. If VBA continues to make PTSD

compensation claim processing errors at time of this review, future improper payments would total an estimated $271.9 million over the next three years unless VBA takes corrective action. 11 Claims Processors Did Not Fully Understand In-Service Stressors or the Stressor Verification Process During interviews with VBA staff, the review team had."   etc 

 

 

 

 

 Posttraumatic Stress Disorder Claims Processing Training and Guidance Need Improvement (va.gov)

Posttraumatic Stress Disorder Claims Processing Training and Guidance Need Improvement (govdelivery.com)

 

What a disgrace but not surprising.....

 

The VA has granted SC for PTSD to Wannabees, somehow over the years- who often are caught by the IG, or Dept of Justice, but at the same time, they (VA) are negligent in properly addressing valid PTSD claims.

 

This is a long report but I feel many here should read it----those 14,600 had no attempt by VA to verify their stressors and that is why it is often imperative for  veteran themselves to seek that proof.

 

A lot of these VARO claims people do not even have any idea of what military service is about,.and they caused one of my successful personal CUE claims.

They had denied my AO IHD death claim right off the bat saying the veteran ( my dead husband,) had no evidence of IHD in service.

SAY WHAT? I wrote a scathing CUE telling this idiot ( I sent it to the initials on the decision) 

that these combat veterans vets in the 1960s were still KIDS, sent to Vietnam,  and would have never gotten into service ,if their pre enlistment physical revealed heart disease,

and I rattled off 38 CFR.4.6 as told them this is the regulation they violated and that I expected a proper decision ASAP.

 

Three weeks later they awarded AO IHD death, due to the CUE , Section 1151 stroke (CUE pending on that), and also awarded a SMC CUE I had pending at Buffalo RO for almost 8 years. That's right- 8 years- 100% SC P & T PTSD and 80% (ultimately changed to 100% P & T for a Section 1151 stroke- an EASY claim to award)

 

What a system- snafued and fubared up the ying yangs----and, as I often say, literacy is probably not even a requirement  ,to became a paid VA claims adjudicator.

 

 

 

 

 

 

 

 

[bwilson]

I put in for PTSD in 2019 with a QTC psychologist doing my private exam and the VBA put it in as somatic symptom disorder / chronic pain I did everything the 781 and buddy statements they just blew me off.

 

[Berta]

If you scan and attach the denial maybe we can help-cover your c file #, name, address prior to scanning it. Did you formally appeal the denial?

We need to see their rationale for the denial and the Evidence list they used.

[Berta]

Never mind, in another post it looks like you did quite well , with an award.

[broncovet]

If the VA can mess up PTSD, does this mean they "can not" mess up MDD, TDIU or any other rating?  Probably not.  

It just shows VA is a mess, M21 mr is a mess, training is a mess, and many Vets are over awarded or under awarded.  

[Berta]

Yeah- the report says:

"In addition, VBA’s procedures manual was not effectively organized to allow staff to locate this information and lacked specific guidance for some aspects of PTSD claim processing. The OIG recommended that the under secretary for benefits determine the actions needed to ensure staff understand the requirements for gathering evidence and verifying stressor requirements for PTSD claims and, once the actions are implemented, monitor the results to ensure effectiveness. VBA should also assess whether its adjudication procedures manual needs to be reorganized and amended to help staff process PTSD claims accurately."

That is why we all need to be able to read M21-1MR, as it applies to our claims.

I see many BVA remands due to M21-1MR errors.

Like this recent one:

https://www.va.gov/vetapp20/files2/20011482.txt

and this one is good:

The veteran called a CUE on them:

In part:

 

"Specifically, VA’s Compensation & Pension Service (C&P) has issued information concerning the use of herbicides in Thailand during the Vietnam War. See VA Adjudication Manual, M21-1MR, Part IV, Subpart ii, Chapter 2, Section C (M21-1MR). In a May 2010 bulletin, C&P indicated that there was significant use of herbicides on the fenced-in perimeters of military bases in Thailand intended to eliminate vegetation and ground cover for base security purposes. As such, C&P stated that special consideration of herbicide exposure on a facts-found or direct basis should be extended to those veterans whose duties placed them on or near the perimeters of Thailand military bases. Significantly, C&P stated, “[t]his allows for presumptive service connection of the diseases associated with herbicide exposure.”

 

"Accordingly, the Board finds had the correct version of 38 C.F.R. 3.304(f) been applied in the May 2003 decision, the outcome of the decision would have been manifestly different. As noted above, the Board determined that there was CUE in a May 2003 rating decision. As such, the Veteran’s claim of service connection is entitled to an earlier effective date than the application date of his later claim to reopen. In the instant case, because of a showing of CUE, the effective date of the Veteran’s service connection for major depressive disorder should be the original date of the receipt of the Veteran’s claim for PTSD, which is March 10, 2003. See 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. Accordingly, an effective date of March 10, 2003, is granted for the award of service connection for PTSD."

https://www.va.gov/vetapp19/files3/19123533.txt