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

[sixthscents]

Magic numbers with no oversight. It's just crap.. excrement... (sigh). The VA KNOWS what needs done, but they just aren't going to do it... no matter what.

[Big]

Speaking of primary doctor letters, i have back and neck injuries (non service connected).

I have applied and been turned down twice for SSD.

MY VA primary doctor refuses to write a letter i can prsent to SS.

She advised me that SS would have to request such a letter from her which will never happen.

I surely don't understand this.

Big

[spike]

Would it help any if the files were electronically transfered over after your exit physical from DOD to a VA database for VARO to use. Then how about letting Veterans to access it with Accounts and Passwords. With status on claims information. I dont get why we need so many correspondence people at the VA Hospitals. In addition having an automatic imaging in que for the raters to review and approve. The papershuffle is one huge problem in VA claims.

As far as bogus claims, does VA have fraud investigators? I wish they would. I know a Reservist who injured his knee at 25 and he already plans on making a claim that he hurt it while being active. He claims he is a veteran even though he is still just started his reservist duties 3 years ago.

[Hoppy]

Spike,

Those are some pretty good ideas. Maybe a letter to a senator might help. However, consider that the military is about 20 years behind the rest of the health care providers. The military has endurred much criticism about their inabilitay to keep proper paper trails of treatment and injuries for people serving state side.

I would not worry to much about the bogus claim. The VA is pretty tough.

[Hoppy]

Big,

Do you have an attorney helping you with the SS?. What state do you live in? I know how to make a doctor write a letter for social security. I had one VA doctor refuse to write a letter. A year later I got a letter from another VA doctor.

I want to make sure you are still following this post before I type up a "Big" reply.

[Pete53]

I think that the title should read Bogus VA Clogging the System

Edited March 25, 2007 by Pete53