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

[Tbird]

oh geez, more rabbit out the hat numbers.

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".

[Testvet]

That is , precisely, why I like the thought of having a "Learned-VA Lawyer". You'll know, up-front, what your chances of winning are. In my case, I have no doubt that a good Lawyer can help develop my case and win. I will use one, later. This process takes so L-O-N-G. Most don't want to do it because of that. For me, its a matter of principle... right and wrong. I am a Gladiator.... fighting for justice.... in the American Way !

Yes, I will get a Lawyer.... and get SERIOUS... but, not yet.

Captain America died or haven't you seen the news ?

[Hoppy]

The point that lawyers will not be interested in 10%'s is well taken. I had a slam dunk case against a city agency. Attorneys would ask what the medical bills where and the wage lose then throw me out of there office because their estimate of the settlement was less than $20,000.00. It took me a year to find an attorney willing to take the case. There would need to be some type of a system where both attorneys and SO's are an option.

RickB54,

Thompson testified to the senate back in 1999 or 2000 that adjudicators could determine the need for a C&P from the seat of there pants and be right 99% of the time. That is of course after the have wasted their time reading the SMR'S and other relevant info on the poorly thought out claims. Thompson had all kinds of statistics to discourage the congress from establishing a policy of "in-service diagnosis plus post service diagnosis warrants a C&P". The congress did not care about the extra effort required and wanted the 1% that was falling through the holes to have better options.

The problem is that the VA system is still junk compared to the way civil attorneys work. The VA needs to establish a department at the hospitals specifically set aside for developing nexus letters. The doctors need to be screened and subject to approval by service organizations or veterans attorneys. Under labor law plaintiff attorney's can choose the doctors they want to use to resolve disputes. Primary care doctors chosen at random by the veteran is not adequate. Civil attorneys choose the doctors they want to do the prep for litigation, not the injured party.

I was one of the 1% that reversed an adjudicators original decision not to schedule a C&P. It took me five years. I personally tried to get a nexus letter from primary doctors who had no interest in getting involved. One doctor told me that the question I asked was a legal question not a medical question. He told me he practiced medicine and refused to get involved. After the passing of the VA directive requiring primary doctors to write nexus letter another primary doctor made up some illegal and bogus excuse about my condition in the military was the result of bad drinking water. I immediately notified the RO that the primary doctors where not taking the directive seriously and making up bogus excuses to keep out of the loop. The RO did not respond to my complaint and refused to schedule a C&P for over five years. It took me years to find a doctor to write a nexus letter at a VA hospital. It was a slam dunk that was used by a DRO for service connection. I won my claim on the nexus letter. No C&P was performed. At the time I was living on food stamps and general relief welfare and could not afford an IMO. Everybody I knew thought I was wasting my time taking on the VA.

Edited March 17, 2007 by Hoppy

[john999]

Hoppy

I just got SC'ed for two conditions without a C&P exam. I had letters from my VA primary care doctor saying my conditions were service connected. I just asked for the letters and it sailed through for once. My medical records supported the primary care doctor's letter. The evidence was all in my medical records at the VA. I think years ago no VA doctor would write such a letter. Now we have a window of opportunity to get VA docs to write letters. The system is broken and we all know it. 800,000 claims being developed or in appeals.

[Hoppy]

John999

I guess it might depend on the type of claim that turns on the primary doctor. Maybe they like broken bones and bullet wounds. I had 26 years of treatment notes including numerous admissions to emergency rooms for life saving intervention for a systemic disease that is recognized as an occupational illness. All 26 years of treatment notes were from VA hospitals. I was not talking about chronic sniffles and these doctors knew it. The primary doctors I ran into could not care less. Where does the VA tell you if that you might need to talk to 3 or 4 different primary doctor before you might find one who wants to go along with the program. Think about it. I wound up 100% and it took 5 years to get a nexus letter.

The idea of telling veterans to get nexus letters from primary doctors was thrown in the trash when they passed the VCAA. That is where that idea belongs. Claims are in fact getting more complex with the recognition of systemic diseases. ( RickB's idea is a little to optimistic). Adjudicators are supposed to schedule C&P's when there is a post service diagnosis and an inservice diagnosis. The problem is that the veterans representitive is not involved in the process for determing which doctors perform the C&P exams. When I filed a claim for workers comp my attorney sent me to see an MD/JD who had special training and an expressed desire to advance the rights of injured workers. Random sellection of C&P doctors is the next VA problem that needs to go in the trash.

Edited March 18, 2007 by Hoppy

[FamblyRus]

I think they are full of BS. They already knew there was/is a problem in the DVA system. So what does this adminstration do? Send us into another area (Iraq) and then blame the Veterans for filing claims?

Don't let them make you all feel bad for something you didn't ask for, their incompentence and stupidity for not planning ahead and funding what they already had.

On my bad days I can think better then they can and that is scary!

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.

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