Jim Fausone
Veteran Advocate

Disabled vets are still waiting too long for medical benefits.

InSeattle,Washington, 25,000 disabled vets are still waiting to receive medical benefits. According to a new report, it could take a year or more for those benefits to be processed.

Claims by disabled vets to the Veterans Administration have at least tripled throughout theU.S. since 2010, and the influx ofIraq andAfghanistan returning home has helped to overburden the already-strained disability benefits system. Adding to the mix is a new, electronic medical and service record system.

“There are at least 2.1 million claims for vets currently pending before the Veterans Benefits Administration,” commented veterans disability attorney James Fausone. “These men and women deserve to better supported be by their government, and not have to wait an egregiously long time for basic benefits to which they are entitled.”

One such vet who is still trying to get his benefits is Seattle-based Aaron Bisol, who says his wait has lasted, at last count, more than 505 days. Bisol completed two tours inAfghanistanas part of the airborne infantry, and sustained a leg injury and damage to his hearing while serving. He filed his medical claims with the Veterans Administration in October 2011, and has yet to begin receiving his benefits. When he calls the VA 1-800 number, he says that he typically waits on hold for two hours before speaking with someone. 

A study recently released by the Center for Investigative Reporting found that the wait nationally for vets is 273 days, on average. The time can vary by state:Seattle vets wait an average of 323 days; andNew York City vets can wait as long as 600 days for their benefits. Even the assistant supervisor of Seattle Disabled American veterans, Greg Kotanchick, had to wait for four years for his claim to go through after hisPersian Gulf service. Kotanchick has stated that he , too, believes the new electronic records system is likely to blame for the long processing time.

The VA has stated that it anticipates the two-year backlog of claims will be cleared within 90 days once the system is fully operational and running at top speed.

 Sources
http://q13fox.com/2013/03/13/huge-va-disability-backlog-frustrates-local-veterans/#ixzz2OmCiV9qN
http://q13fox.com/2013/03/14/disabled-vet-says-hes-been-waiting-more-than-500-days-for-va-benefits/

Jim Fausone
Veteran Disability Attorney

VA has been under tremendous criticism for the backlog of claims that it has which is approaching 1,000,000 this year.  Congress has been holding hearings on how to clear up the backlog.  Heads may actually roll at VA over this embarrassment.

So VA has to resolve the new claims being filed and the old claims waiting around. VA has been thinking about how to handle recent filings so they don’t become part of the backlog.  VA plans on computerization to assist on the new claims.  We have heard stories of a software program that will scan applications and use artificial intelligence to make the rating. Call me skeptical that rating by buzz word is a better approach.

On the backlog, VA is proposing to have raters review the oldest claims first and issue a provisional rating based on the file.  VA would not have a complete file or send out questions or send the veteran to an exam.  The VA Fact Sheet on this provisional rating states that the veteran will have up to one year to submit additional evidence to change the provisional decision.  The provisional rating can also be appealed.   Ok, I am still skeptical that this will work.  It should help some people who have good records, but other files are not developed sufficiently for a fair rating.  Time will tell if this approach cuts the backlog.

http://news.msn.com/us/vas-plan-to-reduce-backlog-met-with-skepticism#tscptme

 Jim Fausone
Veteran Advocate

 The Secretary of Veterans Affairs, Eric Shinseki, explained this past week that he is committed to ending the backlog of claims by 2015. His plan to do that?  Replace paper records with electronic records.

Right now, VA considers about 600,000 claims, or 70 percent, to be “backlogged”. These are the number of claims that have been pending for more than 125 days.

The VA has put in a new computer system in place in about 20 regional offices around the country. The goal is to have the system in all of the regional offices by the end of 2013. Part of the computer system allows all of the veterans’ records to be in electronic form. This will enable workers from anywhere in the nation to view the files and will eliminate the time that it takes to ship the file between regional offices or the Board of Veterans Appeals.

Congressional committees have held two hearings on the VA disability claims backlog in the past two weeks. Millions of veterans are tired of hearing the same excuses from VA regarding the increased workload and the increased complexity of claims. We here at Legal Help for Veterans can attest to the backlog firsthand. An average time period for an appeal, between the time we file a notice of disagreement and the time the VA issues a Statement of the Case is about two years.

The fact that the country has been embroiled in a war for 10 years now has only added to the backlog. Unfortunately, these changes should have been made to VA’s antiquated system YEARS ago—way before the problem got this out of hand.

Jim Fausone
Veteran Advocate

We receive about 300 emails a month asking for help. We try to sort out those VA disability claims where we can really help. The first two rules are you have to have a current disability and then explain how it is service connected. If you just feel entitled or need money or the government owes you for serving, it is not a claim that should be filed or re-filed. If you do not have a legitimate claim, you are part of the 900,000 claims backlog and only clog the system.

Today I received an email stating, “I am at the point that I must procure legal representation for my claim. I am on my third appeal. Have been diagnosed with PTSD and have knee problems as well”. The veteran was last denied in 2010.

If you wait until your third appeal, or second, to get help, then you are your own worst enemy. Either you don’t have a legitimate claim (an attorney or VSO should tell you that) or you don’t speak VA’s language and you need professional help.

Stop banging your head against the wall. Please get help earlier in the process.

Jim Fausone
Veteran Disability Attorney

One of the saddest situations we help with involves military sexual trauma (MST).  The rape of men and women in the military is a black stain on the Defense Department.  The VA disability process only makes this stain more stubborn.

We have developed an approach that looks at markers that show the MST even when it has not been reported.  The fact is that 70-80% of MST is not reported.  We often approach the VA process to prove the mental aspect of the MST, such depression, PTSD, etc.  We point out the fall off of performance ratings, discipline issues, AWOL, drug use, alcoholism or dark letters home.

This unique problem is now getting Congressional attention. The Ruth Moore Act aims to reduce the standard of proof for victims of military sexual assault so that they can more easily obtain benefits, similar to how the Veterans Administration two and a half years ago relaxed the burden of proof for combat veterans with post-traumatic stress disorder.  The Ruth Moore Act, if it passes, would make it so that victims need only a diagnosis of a mental health condition and a link between the assault and that condition to receive benefits.  This is a step in the right direction. Let’s hope Veteran Service Organizations support this bill and Congress acts on this bill.

http://www.stripes.com/news/us/maine-woman-inspires-federal-bill-to-help-military-sexual-assault-victims-get-va-benefits-1.207371

Jim Fausone, Esq
Veteran Disability Attorney

So now, the Inspector General reports that VA overpays veterans.  Really?  Most veterans fight for years to get the compensation correct.  The IG looked at a narrow batch of cases where veterans temporarily receive a 100 percent disability rating while undergoing surgery or debilitating treatments and convalescing.    Claims examiners allegedly failed —in two out of three sampled cases — to seek a follow-up medical exam to determine if the veteran’s condition has improved and the temporary 100 percent disability rating should be reduced accordingly, inspectors said.  The IG claims this 66% error rate has allowed 12,800 vets to be over compensated during a 16 year period.  This is focusing on the flea on the tail of the dog.  There is a backlog of 900,000 claims.  So this report focuses on 1.4% of the VA backlog claims.  This is typical government thinking; focus on the small problems, make them seem really important and you can ignore the big problems, which are important.

http://www.federaltimes.com/article/20130125/DEPARTMENTS04/301250002/Auditors-Veterans-Affairs-overpaid-disabled-vets?odyssey=nav%7Chead

Vietnam Veterans of America has joined a proposed class action lawsuit in Connecticut against the armed forces. The lawsuit, filed by a veteran last year against the Army, Navy and Air Force, states that Vietnam War-era veterans who suffered PTSD were discharged under other-than-honorable conditions which meant they were ineligible for disability and other benefits. The military has not reviewed or upgraded the discharge statuses of thousands of those vets with service-related PTSD. As John Rowan, national president of

Vietnam Veterans of America, said, PTSD was not understood by mental health professionals when those vets were in service.

“Now that diagnoses have been updated,” says veterans’ lawyer James Fausone, “it seems perfectly reasonable that there are some vets who would like their discharge status changed to reflect that.”

The U.S. Attorney’s Office is currently reviewing the matter and plans to respond in court. The office is representing the military in this lawsuit, which was filed by Vietnam vet John Shepherd. Shepard says he was first diagnosed with PTSD in 2004, but repeatedly has had his discharge upgrade requests denied. Shepherd is being represented by Yale Law School students who are working at a Connecticut-based legal services clinic for vets. According to those students, the Army has approved less than 2 percent of Vietnam vet upgrade applications since 2003, in sharp contrast to the 46 percent of overall discharge upgrades. And, say the students, some of the vets who are being denied an upgrade have been formally diagnosed with PTSD by Veterans Affairs.

The students estimate that some 85,000 of the 250,000 other-than-honorably discharged Vietnam veterans had PTSD. Their PTSD was likely a factor in the discharges that were based on conduct including drug use, unauthorized absence without leave, and shirking.

Sen. Richard Blumenthal, D-Conn., is in support of the vets, and has reportedly been working in concert with the Yale Law Clinic and federal agencies to attempt to resolve the issue. He stated that though PTSD was not understood in the past, that should not preclude how cases are assessed now.

http://www.seattlepi.com/news/us/article/Vietnam-veterans-sue-military-in-Conn-over-PTSD-4087471.php

Jim Fausone
Veterans Disability Lawyer

The VA compensates veterans for primary and secondary disabilities connected with service.  Traumatic Brain Injury is a signature injury of Iraq and Afghanistan wars because of IED.  So it is good news that VA is considering the secondary effects of TBI.  Last week  VA began the process of adding five illnesses — unprovoked seizures, dementia, Parkinsonism, some hormone deficiencies and depression — as “secondary” illnesses connected to a proven TBI injury.   Researchers from the National Academy of Sciences’ Institute of Medicine have found relationships between brain trauma and these other illnesses.  VA does not anticipate significant changes because of the new rule change, because the secondary illnesses still require an existing TBI diagnosis. Those of us who work with VA would disagree because the recognition of these secondary conditions eliminates proving such to VA which can take years and every RO treats these matters differently.  A secondary condition recognition will force that a national standard be applied.

http://www.stripes.com/news/va-relaxes-rules-for-benefits-for-tbi-related-illnesses-1.199762

Jim Fausone
Veterans Disability Lawyer

We talk to hundreds of veterans a month about their VA disability claim status.  Many people want to know why it takes so long and when will their case be decided.  Well it is not getting any better based on a recent VA report.  The delays in processing went up 40% in 2012.  In fiscal 2012, the average days to complete a VA disability compensation or pension claim rose to 262 days, up from 188 days in fiscal 2011, according to a recently completely VA performance report. During that same period VA hired more staff and poured resources into training. The department has seen a massive increase in claims from veterans in recent years, both younger ones from Iraq and Afghanistan and older ones who have recently been able to file claims on new conditions. Claims the past four years have topped 1 million a year.  We do not expect that 2013 will be any better.  We advise patience and persistence with dealing with VA.

http://www.stripes.com/news/veterans/va-claims-processing-delays-hit-highest-level-in-20-years-1.198825

Jim Fausone

Veteran Disability Lawyer

In order to receive VA disability compensation, you have to prove a service connected disability.  The disability has to occur on active duty as compared to monthly training in which National Guard and Reserve have traditionally participated.  But since 9/11 the Guard and Reserve components have made up about 40% of the active duty assignments both here and abroad.

It is not clear that VA understands the way that DOD utilizes these components today. New data obtained by Veterans for Common Sense under the Freedom of Information Act shows the denial rate for claims filed by reserve component combat veterans is 4 times higher than for post-9/11 combat veterans who were active-duty members.

Guard and Reserve troops tend to be older and have less years of service than active troops. These facts may make proving claims more difficult.  This discrepancy has come to light and we hope the VA and National Guard leadership work to eliminate this disparity.

http://www.militarytimes.com/news/2012/10/military-reserves-va-disability-compensation-102312w/