Bogus Claims Clogging The System?

[Hoppy]

The question of VA backlog and bogus claims jamming the system has come up once again. The VA through its procedures actually invites bogus or more accurately described as "poorly thought out" claims. Correct me if I am wrong or if anything has changed recently. The last time I went into an RO there was a flier on the wall telling people that if they feel they have a claim to just fill out the claim form and the VA will do the rest. This flier explained the duty to assist as being the VA's motivation to process the claim.

The veteran then goes to a service rep. sitting at a desk and tells him he wants to file a claim. This rep has a mind of his own and interacts with the veteran. The rep can decide to file a claim or become argumentative because he feels the claim is a waste of time (this happens for a fact. It has happened to me both ways. I have encountered argumentative reps and reps who just rubber stamped my request and sent it along.) In the event the rep decides to start a claim either because the veterans story sounds plausible or because somebody told him to start all claims requested by the veteran and the rep decides to go along with the program and thus the claim is started.

VA procedures then required that the veteran provide the RO with the names and addresses of treating physicians and release authorizations for the records. Additionally, the RO acquires and reads the SMR. If the adjudicator thought that their might be a connection then a C&P can be scheduled. If he thought the claim was a waste of time then he can deny the claim as not being plausible or without any possibility of being able to be developed due to lack of medical support.

The VA must feel a little paternal to go to all the trouble to read the SMR's and or doctors reports just because they have a duty to assist. The VA should accept the claim form and set the claim date. However, they should add a step in the process. The VA could save a lot of time by requiring the veteran to obtain and have the rating schedule, SMR and the personnel file in his possession prior to the VA obtaining and reading them on their own. This would give the veteran and his representative (should he have one) a chance to look at the claim more objectively and then decide whether or not they want to continue. Then the veteran could file a statement that he has obtained the SMR, rating schedule and desires to continue with the claim.

In one of my claims the VA went to all the trouble to obtain and read my entire SMR for a condition that they thought I was not even treated for in the military. What a waste of time. Had they had me read the SMR and I found out that I filed a claim for something I was not even treated for in the military I would have dropped the claim. Had they told me to obtain and read my SMR I would have noticed that the military doctors called the same symptoms by a different name than the post service doctors and diagnostic term I used when I filed my claim. This little problem delayed my claim by three years and caused the RO to waste their time typing up a denial that was based on inaccurate information. The denial was eventually overturned.

Edited March 16, 2007 by Hoppy

[Ricky]

I believe that there are claims out there that should be filed and awarded. However, SO's keep telling the vet to not bother with it. yep it might be a 10 percenter but a 10 percenter is a 10 percenter. That will be the problems with attorneys. They will only be willing to take the claims that you have worked for years that have the possibility of getting a large retro on. They will not want to bother with claims of 10,20 or even 70 percent unless they think they can fish the system for a while and roll them into retro. Now I still believe we should have that choice. Back on subject here...... yep there are a lot of useless claims out there that clogg the system. However, I feel that the VA could help weed them out by being upfront in their decisions.

[Guest RickB54]

There are likely some bad claims in the system but overall it is the va's red tape that really bogs down the system. I think some changes could help speed up the process. But not all will agree.

1. All claims must have new medical records submitted with any claim.

2. All claims must have nexus letter submitted with claim if veteran is out of service more than a year. ( It only takes one or two doctor visits to acquire a letter. )

If just these two changes were implemented claims would go somewhat quicker, and many C/P exams would not be necessary.

granted not all veterans will have access to active duty medical records, but they should have all current post service medical records.

[mobie16r]

Back log!

STATEMENT OF THE HONORABLE R. JAMES NICHOLSON

SECRETARY OF VETERANS AFFAIRS

FOR PRESENTATION BEFORE THE HOUSE COMMITTEE ON VETERANS' AFFAIRS February 8, 2007

Compensation and Pensions Workload and Performance Management

VA's primary focus within the administration of non-medical benefits remains unchanged-delivering timely and accurate benefits to veterans and their families. Improving the delivery of compensation and pension benefits has become increasingly challenging during the last few years due to a steady and sizeable increase in workload. The volume of claims applications has grown substantially during the last few years and is now the highest it has been in the last 15 years.

The number of claims we received was more than 806,000 in 2006. We expect this high volume of claims filed to continue, as we are projecting the receipt of about 800,000 claims a year in both 2007 and 2008.

The number of active duty service members as well as reservists and National Guard members who have been called to active duty to support Operation Enduring Freedom and Operation Iraqi Freedom is one of the key drivers of new claims activity. This has contributed to an increase in the number of new claims, and we expect this pattern to persist. An additional reason that the number of compensation and pension claims is climbing is the Department's commitment to increase outreach. We have an obligation to extend our reach as far as possible and to spread the word to veterans about the benefits and services VA stands ready to provide.

Disability compensation claims from veterans who have previously filed a claim comprise about 55 percent of the disability claims received by the Department each year. Many veterans now receiving compensation suffer from chronic and progressive conditions, such as diabetes, mental illness, and cardiovascular disease. As these veterans age and their conditions worsen, we experience additional claims for increased benefits.

The growing complexity of the claims being filed also contributes to our workload challenges. For example, the number of original compensation cases with eight or more disabilities claimed nearly doubled during the last 4 years, reaching more than 51,000 claims in 2006. Almost one in every four original compensation claims received last year contained eight or more disability issues. In addition, we expect to continue to receive a growing number of complex disability claims resulting from PTSD, environmental and infectious risks, traumatic brain injuries, complex combat-related injuries, and complications resulting from diabetes.

Each claim now takes more time and more resources to adjudicate. Additionally, as VA receives and adjudicates more claims, this results in a larger number of appeals from veterans and survivors, which also increases workload in other parts of the Department, including the Board of Veterans' Appeals.

The Veterans Claims Assistance Act of 2000 has significantly increased both the length and complexity of claims development. VA's notification and development duties have grown, adding more steps to the claims process and lengthening the time it takes to develop and decide a claim. Also, we are now required to review the claims at more points in the adjudication process.

We will address our ever-growing workload challenges in several ways. First, we will continue to improve our productivity as measured by the number of claims processed per staff member, from 98 in 2006 to 101 in 2008. Second, we will continue to move work among regional offices in order to maximize our resources and enhance our performance. Third, we will further advance staff training and other efforts to improve the consistency and quality of claims processing across regional offices. And fourth, we will ensure our claims processing staff has easy access to the manuals and other reference material they need to process claims as efficiently and effectively as possible and further simplify and clarify benefit regulations.

Through a combination of management/productivity improvements and an increase in resources in 2008 to support 457 additional staff above the 2007 level, we will improve our performance in the area most critical to veterans-the timeliness of processing rating-related compensation and pension claims. We expect to improve the timeliness of processing these claims to 145 days in 2008. This level of performance is 15 days better than our projected timeliness for 2007 and a 32-day improvement from the average processing time we achieved last year. In addition, we anticipate that our pending inventory of disability claims will fall to about 330,000 by the end of 2008, a reduction of more than 40,000 (or 10.9 percent) from the level we project for the end of 2007, and nearly 49,000 (or 12.9 percent) lower than the inventory at the close of 2006. At the same time we are improving timeliness, we will also increase the accuracy of our decisions on claims from 88 percent in 2006 to 90 percent in 2008.

www.va.gov/OCA/testimony/...020800.asp

[Berta]

RickB VERY GOOD IDEA!

Nicholson says:

"Almost one in every four original compensation claims received last year contained eight or more disability issues"

Some of them are ridiculous- he is right -and they all take time to be assessed by the rater-

I saw a few at BVA with over 20 issues!

This is ridiculous-in my opinion-

a vet should focus on their main conditions and anything secondary-

and should focus on the likelihood of getting the evidence to SC the main stuff.

This is one of the main problems:

"management/productivity improvements"

Claims processes have become a production line with quantity not quality as the goal.

Twenty years ago the VA read claims thoroughly. Ten years ago that all started to change-the OIG survey (2005)of DROs and raters I posted

here before stated very clearly that they did not have the time to properly assess every claim.

Then the Secretary states:

"We expect to improve the timeliness of processing these claims to 145 days in 2008."

145 days? for what -- a denial and a illegal VCAA letter?

sure- they could do that in 145 days !

"In addition, we anticipate that our pending inventory of disability claims will fall to about 330,000 by the end of 2008, a reduction of more than 40,000 (or 10.9 percent) from the level we project for the end of 2007, and nearly 49,000 (or 12.9 percent) lower than the inventory at the close of 2006. At the same time we are improving timeliness, we will also increase the accuracy of our decisions on claims from 88 percent in 2006 to 90 percent in 2008."

Where the heck is he getting this info?

88 % accuracy in 2006---

Didnt he ever hear of the remands at the BVA?

The last time I griped to the Sec he sent my letter to the VARO and it held up my claim-and sat at the Congressional Inquiry desk for months it had Nothing to do with my claim.I had to ask them to withdraw it from the Congressional desk- because they couldnt answer it anyhow-

I wont' directly write to him again until my main claim is resolved-maybe some of you will think about these statements from Sec Nicholson and send the Sec a response.He seems quite out of touch as to the way it REALLY is.

Edited March 17, 2007 by Berta

[Guest jangrin]

Sec. Nicholson says,

"In addition, we anticipate that our pending inventory of disability claims will fall to about 330,000 by the end of 2008, a reduction of more than 40,000 (or 10.9 percent) from the level we project for the end of 2007, and nearly 49,000 (or 12.9 percent) lower than the inventory at the close of 2006. At the same time we are improving timeliness, we will also increase the accuracy of our decisions on claims from 88 percent in 2006 to 90 percent in 2008."

Willie Nelson and Meryl Haggart were in the area last night giving a performance. Sec. Nicholson must have been hanging around in the crowd, probably in amongst the groupies taking "really deep breaths", cuz he sure is thinking "funny".

[Pete53]

I have been in the VA System since the older GW Bush was President and the Sec was Derwinski. Of all who have run the VA I think that Sec Principi was the best. When I see that idiot Nicholson make up stuff and lie about the VA it makes me miss Principi even more.