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PostPosted: Wed Jan 23, 2013 5:17 pm 

Joined: Wed Dec 05, 2012 12:25 am
Posts: 20
This was posted at another site but is so informative I thought it would help those that venture here also.

"First, allow me to introduce myself with some background info. I am a veteran, a nurse, a woman, and decide VA disability claims." Author Unknown

I share many of the frustrations of veterans when I see claims that have not been properly or expeditiously decided. It is my mission to correct these where possible. I have called errors on prior decisions and awarded benefits back to the original claim date. I'm sure that I also have made errors and hope others have caught and corrected these.

Please keep in mind that this is my personal perspective. I have no authority to speak for my Regional Office or any other.

That said, I would like to
1) share some insight on how veterans can help themselves to get their claims through the system as quickly as possible.
2) share some of my frustrations with many system clogging claims that I get and must address.

First, here's some general info on claims processing steps in my office:

Please be aware that many VA Regional Offices, including mine, receive thousands of pieces of mail every day. Each of these must be stamped with the date received. This takes time.

Next, for claims, the veteran's C-file is retrieved from the files and is sent to the development section. Development then sends a letter acknowledging receipt of the claim and lists the claims. This letter should also include release of information form(s) 4142 so that private medical records (not VAMC) that the veteran says are relevant to the claim can be obtained. When the veteran returns the signed forms, the VA contacts the care provider by mail requesting the records. Sometimes we receive no response and must request the records again. This also delays the decision process.

When all records are received, or it is determined that records are unobtainable, the claim goes to the Rating Board.

1) Hints I hope are helpful:

- Be clear about what it is you are claiming. VA policy says that we must respond with a letter acknowledging and listing your claimed conditions or conditions for which you are claiming an increase. If we need to ask for clarification, it just slows the process. Example of unclear claim: "nerve condition" This could mean nerve damage or a mental condition. Please be specific.

- Put your claimed conditions where they can be found, at the beginning. The development people are buried in paper. A rambling explanation with claims hidden in lengthy text can get missed. I can't count the number of times that I've had to send a claim back to the development section for another letter to the veteran acknowledging the missed claim. Another delay.

- I understand that some veterans cannot afford to pay for copies of their private medical records. However, if at all possible, include copies of relevant medical records with your claim. It really does speed the process. We have to give the doctor or hospital 60 days to respond to our request before sending a second request. They have 30 days after that. If they don't respond, we do no more because it is ultimately the responsibility of the veteran to provide relevant private records.

- Relevant is the key. I go through every piece of paper sent in support of the claim. If for instance, you are claiming knee problems, your psychiatry records, gynecologists records, billing/insurance statements, etc are not needed and just slow my ability to decide the claim. More is not better, relevant is.

-Help us to help you. Do get copies of your service medical records and service personnel records when you are discharged or from the National Personnel Records Center (NPRC). If VA has them request copies. It's free folks. It just takes a bit of effort on your part. Yes, VA and other agencies do lose/misfile records. It stinks, but this is the reality of any monstrously huge agency such as VA and NPRC. Without these records, my hands are tied. I may personally believe you, but I must have in-service medical evidence for most claims.

- Don't send in additional claims before you get a decision on the initial or increase claim. Depending on the issues, this can cause the processing of your claim to be sent back to the beginning.

2) Frustrations:

- Think before you claim. Is this really a disability? Is this a condition that occurred in service? I must address each claimed condition no matter what it is. We have daily production requirements. Therefore, a claim that has numerous issues, especially obviously merit less ones (more on that later), tends not to get handled as quickly.

- Most veterans are sincere and want only what they deserve. Some are in desperate financial shape and are hoping we can help. My heart and my best efforts go out to them. Others may not realize a claimed condition is not a disability. Others.... Here are just a few examples of some claims for disability that I have received which cause a slow down in an already overloaded system: compensation for a venereal disease contracted and cured in 1971, abnormal PAP smears (weird cells but not malignant or showing other disease); tubal ligation, circumcision, vasectomy (the last 3 are voluntary: and unless there were medical complications are not disabling); exposure to local people; my wife's miscarriage; numbness of the legs due to spinal anesthesia administered in the 1960s (this from a veteran serving a life prison sentence. No spinal anything in service: but the prison treatment records show diabetes with leg neuropathy); claims for injuries, medical conditions, and diseases that occurred long after the veteran left service (that are not presumptive i.e.: Agent Orange, radiation related); claims for medical problems that occurred while a dependent spouse.

-Our office processes 600-700 claims per week. We come back to work on Monday, only to find that many or more new claims. Most of us are hard workers who care about the quality of our decisions. It is frustrating to be accused of delay tactics when the sheer volume of claims and the complexity of many claims makes it impossible to schedule a VA exam or render decisions as quickly as the veteran would like. I apologize to you, but I'm pedaling as fast as I can.

- Veterans working for the VA do NOT have their disability claims rated by the Regional Office in which they work. We employee veterans do not even have access to our VA files. They are stored at another VA office. And, I can personally attest that military veteran VA employees do not get preferential treatment for their claims. It is my experience and that of others in my office that we go through the exact same process as other veterans. The difference is that we know what is required to get a claim decided more quickly. I'm glad to share with you and hope it helps.

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