Archive for the ‘Claims Processing’ Category

VA Inspector General’s Findings at Regional Offices

by Kristina Derro
Veterans Disability Lawyer

This month, the VA’s Office of Inspector General released its report on the systemic issues identified at 16 VA Regional Offices (VAROs) from April 2009 to September 2010. You can view the full report here: http://www.va.gov/oig/52/reports/2011/VAOIG-11-00510-167.pdf

Unfortunately, the report revealed the ineptitude that all the veterans experience and suffer from on a daily basis. The report identified that VARO staff incorrectly processed 23% of an estimated 45,000 claims. The biggest mistakes involved claims for posttraumatic stress disorder (PTSD) and traumatic brain injuries (TBIs).

Over 8% of claims for PTSD were not adequately processed because the VARO staff “lacked sufficient experience and training to process these claims accurately. Additionally, some VAROs were not conducting monthly quality assurance reviews”. The bulk of the errors were in failing to properly verify claimed stressors and assigning incorrect effective dates for the grant of benefits for PTSD.

75% of VAROs inspected did not follow VA policy when processing claims for residuals of a TBI. In December 2009, it was estimated that 28,000 veterans suffered from a TBI, with many more being added to that list daily with the increase of bombings and IED attacks that our military is exposed to in Afghanistan and Iraq. The Inspector General’s findings regarding the VAROs’ incompetence in processing these claims can have disastrous effects for our veterans. Over 19% of claims for TBIs were not processed correctly. The report found that 42% of the errors were due to the VARO staff utilizing inadequate medical examinations which did not contain sufficient information upon which to make a decision. Evidently, the VA medical examiners were not using the most current examination formats and therefore not providing the VARO staff with sufficient information. Unfortunately, due to the VAROs staff’s lack of experience and training, they did not recognize when an examination was inadequate and failed to send it back to the VA examiner for corrections.

Compounding this problem is the fact that when the VARO actually did grant service connection for a TBI, 42% of errors involved the VARO assigning incorrect evaluations for the residuals of TBIs. The VA policy requires a separate evaluation for any disability with a distinct diagnosis related to a TBI, such as headaches or tinnitus. Regrettably, VARO staff failed to give separate ratings for disabilities and instead lumped them together in one rating.

A statistic which will come as no big surprise to any veteran that has sent information to VA is the fact that the report found 75% of the VAROs failed to properly control and process mail according to VA policy. Shockingly, the majority of mistakes were attributed to the staff being “generally unaware of policy requirements, including date stamping, governing mail processing at VA facilities. Further, VARO workload management plans contained unclear procedures or first-line supervisors did not always follow guidance delineated in these plans”. The failure to properly date-stamp materials obviously has catastrophic effects on a veteran’s claim. For instance, the document may be considered to be untimely, even though it was timely submitted but the VARO staff failed to properly date stamp it. Additionally, if a claim came in on January 31st, then the start date for benefits when the claim is ultimately granted would be February 1st. However, if the item isn’t date stamped until February 1st, then the start date for benefits would be March 1st.  This would cause the veteran to lose out on a month of benefit payments.

An interesting read for sure, the report details the mistakes that the 16 VAROs made, along with the Inspector General’s suggestions for improvement. All we can do is wait and see if VA actually gets around to implementing the suggestions. Until then, veterans’ claims continue to be improperly handled on a daily basis…

To learn more or to contact a Veterans disability lawyer, Veterans disability attorney, Veterans lawyer, or Veterans attorney call 1.800.693.4800 or visit Legalhelpforveterans.com

Ninth Circuit Rips Apart VA Over Mental Health Care

by Kristina Derro
Veterans Disability Lawyer

The United States Court of Appeals for the Ninth Circuit unleashed its fury on the VA last week in a decision where the judges ruled that the “unchecked incompetence” by the VA had led to poor mental health care and slow processing of disability claims for veterans. Two nonprofit organizations, Veterans United for Truth and Veterans for Common Sense, filed a lawsuit seeking to force VA to make changes to the way it treats veterans with mental health disabilities and handles compensation claims.

The Ninth Circuit agreed with the plaintiffs’ case that the VA must put mental health initiatives into effect throughout the entire system and change the way it adjudicates disability compensation claims in its various regional offices. The Court cited to statistics that it often takes weeks for a suicidal veteran to get a first appointment at a VA and that it often takes VA an average of four years to fully provide the mental health benefits owed to veterans.

During the trial, emails between high-ranking VA officials were entered into evidence, revealing that VA was aware of the high suicide rates among veterans and that it harbored a desire to keep quiet the number of veterans under its care who attempt suicide. The Ninth Circuit opinion stated that “[n]o more veterans should be compelled to agonize or perish while the government fails to perform its obligation”. The Court found that there were no suicide prevention officers at any of the VA’s 800 community-based outpatient clinics, the screening for suicide by the VA was not rigorous, and that 70% of VA medical centers did not have systems to track potentially suicidal veterans.

The Ninth Circuit also wrote a scathing opinion regarding the way VA handled disability compensation claims. The opinion noted that the processing of an initial claim usually took longer than the 120-day goal set by the VA itself, and that regional offices take more than a year to certify appealed claims which the Court found was “a merely ministerial act”. The Court found that no official with VA “was able to provide the court with a sufficient justification for the delays”.

To learn more or to contact a Veterans disability lawyer, Veterans disability attorney, Veterans lawyer, or Veterans attorney call 1.800.693.4800 or visit Legalhelpforveterans.com

TBI & Helmets

by Jim Fausone
Veteran Disability Lawyer

We all know the IEDs and TBI are the signature problems of the Afghanistan and Iraq wars.   Battlefield doctors in Afghanistan diagnosed more than 300 troops per month with concussions or mild traumatic brain injuries last summer.  A recent study suggested an eighth of  an inch of padding would decrease injuries by 24%.  Could it be this simple? Yes.  DOD needs to implement this idea ASAP.  Let’s avoid the problems down the road with VA claims processing, by implementing this simple idea.  Read about this study below. 

http://www.usatoday.com/news/nation/2011-04-17-army-helmets-brain-injury.htm

To learn more or to contact a Veterans disability lawyer, Veterans disability attorney, Veterans lawyer, or Veterans attorney call 1.800.693.4800 or visit Legalhelpforveterans.com

Backlog Excuses Rise

by Jim Fausone
Veteran Disability Lawyer

When VA recognized additional presumptive disabilities, you could expect an increase in claims. So the VA added 3,000 claims processors last year, for a total of 14,000.

Nevertheless, the number of veterans’ initial disability claims taking more than four months to complete has doubled.  The number of claims that take more than 125 days to decide has gone from 200,000 a year ago to 450,000 today.  This does not count the half million or so claims on appeal after an initial decision. 

So, what are the excuses?  The VA says the delays are due in part to (1) a generation of Iraq and Afghanistan veterans with more complex claims, (2) the expanded compensation for Agent Orange-related illnesses and (3) the poor economy.  Nobody doubts the reasons, but action, not excuses, is what is needed by the VA brass.

http://www.usatoday.com/news/military/2011-04-07-1Abacklog07_ST_N.htm

To learn more or to contact a Veterans disability lawyer, Veterans disability attorney, Veterans lawyer, or Veterans attorney call 1.800.693.4800 or visit Legalhelpforveterans.com

New Legislation Will Help MST Victims

by Kristina Derro
Veteran Disability Lawyer

A 2008 survey performed by the military revealed that over 21% of service women are victims of Military Sexual Trauma (MST). Unfortunately, due to the private nature and the stigma attached to this type of assault, along with the embarrassment and fear of retaliation that the victims have, most incidents go unreported. In fact, the Department of Defense has acknowledged that 75% of MSTs are not reported.

Victims of MST suffer through the initial assault and the repercussions during his or her time in service. The victims then end up being re-victimized when they apply for compensation from VA for the assault they suffered. The majority of VA claims for compensation for MST are denied because of a lack of documentation proving that they occurred. At this time, military records documenting MST are destroyed between one and five years after filing. This provides no lasting record for the MST victims.

A new piece of legislation has been recently introduced into Congress by Senator Amy Klobuchar (D-Minn) and is authored by members of both political parties. This Bill will change the way records regarding MST are made and retained across all five branches of the military. The goal is to allow MST records to be kept for a longer period of time, allowing the documentation to be available if and when the veteran ultimately applies for service connection years down the road. The Bill also includes provisions for research on sexual assault and harassment into the military, in an attempt to discover ways to combat and prevent MST from happening in the first instance.

 Read more about this piece of legislation at:

http://www.vabenefitblog.com/new-bill-addresses-record-keeping-for-military-sexual-trauma/  

Do not be discouraged if you suffered from MST while in the military and failed to report it. Here at Legal Help for Veterans, PLLC (LHFV), we have been successful in getting benefits for those service men and women who either did not report the incident at the time it occurred, or had the records destroyed by the time they filed for VA benefits. In lieu of official military documents, we have used testimony from friends and family members who noticed pronounced changes in behavior in the veteran after the MST. Further, military performance reviews that have documented a significant and sudden decrease in performance have also been helpful in indicating that an MST occurred.

To learn more or to contact a Veterans disability lawyer, Veterans disability attorney, Veterans lawyer, or Veterans attorney call 1.800.693.4800 or visit Legalhelpforveterans.com

VA Blogging Good or Bad

by Jim Fausone
Veterans Disability Lawyer

Social media has made its way to the VA.  Blogging is now in the VA’s communication tool box. VA has hired former bloggers who were critical for VA to come to the other side and blog for VA.  The mission is to revolutionize how the VA interacts with veterans on the Internet, so that veterans can get information, and people with complaints can get answers.

In theory this is a good idea. We will have to see how it develops over time. A lot of VA ideas are great but become corrupted by the system.  Anyone using IRIS to get information on their claim only to get junk answers back or bad information knows how bad the system can be.  We use it dozens of times a week and are appalled at how bad the information response is to the simplest Internet inquiry, like “what is the status of my claim.”  Let’s hope the blogging tool does not just become a propaganda machine.  Read about how this came about below.  I have also provided the blog link.

 http://www.stripes.com/news/va-enlists-harsh-critics-as-it-belatedly-embraces-the-web-1.138798#

 http://www.blogs.va.gov/VAntage/

To learn more or to contact a Veterans disability lawyer, Veterans disability attorney, Veterans lawyer, or Veterans attorney call 1.800.693.4800 or visit Legalhelpforveterans.com

Rare US Supreme Court Case

by Jim Fausone
Veteran Disability Lawyer

It is rare for the US Supreme Court to take up a case involving veteran issues. 

In a recent decision known as Henderson, Justice Samuel Alito said, “The (Department of Veterans Affairs) is charged with the responsibility of assisting veterans in developing evidence that supports their claims, and in evaluating that evidence, the VA must give the veteran the benefit of any doubt. Rigid jurisdictional treatment of the 120-day period for filing a notice of appeal in the Veterans Court would clash sharply with this scheme.” 

Alito said Congress, in writing the veterans’ judicial-review law, had not prevented judges from looking at individual situations to see whether a deadline exception was warranted.  VA has been strict in using deadlines to kill off a veterans claim. 

Veteran disability lawyers have argued for years the Court must look at the circumstances and apply legal concepts like equitable tolling.  Now the US Supreme Court has indicated agreement. This should help veterans and tell VA to be more flexible in claim review. See the following article for more information.

http://www.armytimes.com/news/2011/03/ap-high-court-allows-flexibility-for-ill-veterans-030111/

To learn more or to contact a Veterans disability lawyer, Veterans disability attorney, Veterans lawyer, or Veterans attorney call 1.800.693.4800 or visit Legalhelpforveterans.com

Korea DMA Agent Orange

by Jim Fausone
Veterans Disability Lawyer

We hear from veterans who served in Thailand, Korea, Japan, Philippines, etc., that claim to be exposed to Agent Orange. Boots on the ground in Vietnam results in presumed AO exposure. The evidence about certain Thailand bases is pretty solid. VA also recognizes spraying of AO around the Korean DMZ.

Under the final regulation published Jan. 25, 2011 in the Federal Register, VA will presume herbicide exposure for any veteran who served between April 1, 1968, and Aug. 31, 1971, in a unit determined by VA and the Department of Defense to have operated in an area in or near the Korean DMZ in which herbicides were applied. However, many SE Asia veterans exposed to AO at logistic depots, navy vessels, air transport do not get treated the same.

To read about the new regulations dealing with the Korean DMZ, see the following article:

http://durangoherald.com/article/20110227/COLUMNISTS17/702279993/-1/s

To learn more or to contact a Veterans disability lawyer, Veterans disability attorney, Veterans lawyer, or Veterans attorney call 1.800.693.4800 or visit Legalhelpforveterans.com

Korea AO

by Jim Fausone
Veteran Disability Lawyer

Vets were exposed to Agent Orange in Vietnam, Thailand and Korea. Veterans exposed to herbicides while serving along the demilitarized zone (DMZ) in Korea will have an easier path to access quality health care and benefits under a Department of Veterans Affairs (VA) final regulation that will expand the dates when illnesses caused by herbicide exposure can be presumed to be related to Agent Orange.

Under the final regulation published 25 JAN in the Federal Register, VA will presume herbicide exposure for any Veteran who served between April 1, 1968, and Aug. 31, 1971, in a unit determined by VA and the Department of Defense (DoD) to have operated in an area in or near the Korean DMZ in which herbicides were applied. Previously, VA recognized that Agent Orange exposure could only be conceded to Veterans who served in certain units along the Korean DMZ between April 1968 and July 1969.

To learn more or to contact a Veterans disability lawyer, Veterans disability attorney, Veterans lawyer, or Veterans attorney call 1.800.693.4800 or visit Legalhelpforveterans.com

Camp Lejeune Water

by Jim Fausone
Veteran Attorney

Every week we receive emails from Marine veterans who are concerned that they have been exposed to contaminated drinking water at Marine Base Camp Lejeune, NC. The water was contaminated with trichloroethylene (TCE), tetrachloroethylene (PCE), benzene and vinyl chloride. Many young men passed thru Camp Lejeune from the 1950s to the mid-1980s when the wells were shut off. VA has been reluctant to recognize the medical nexus of exposure to contaminated drinking water and various disabilities.

The VA decided last fall to consolidate all its Lejeune-related claims at a regional office in Louisville, Ky. The two US Senators from North Carolina are pushing a legislative fix to this problem. Creating a presumption for that medical nexus will be important for many families. This legislation is worth supporting and keeping track of.

Read more: http://www.mcclatchydc.com/2011/02/03/108067/hagan-burr-push-anew-to-help-camp.html##ixzz1CzRcO8xR

To learn more or to contact a Veterans disability lawyer, Veterans disability attorney, Veterans lawyer, or Veterans attorney call 1.800.693.4800 or visit Legalhelpforveterans.com