VA Hits Important Benchmark, but Problem Far from Solved

The Department of Veterans Affairs (VA) took a step forward toward alleviating the backlog of disability claims, but that problem is still far from solved.

For the first time since February 2011, the number of backlogged disability claims dropped below the 350,000 mark. That’s a decrease of more than 250,000 cases in the past year, a pace that officials believe they can maintain to bring the backlog to zero by 2015.

Still, 350,000 veterans remain in what has been a rather long waiting line for the past several years. The backlog number is based on the number of claims pending for more than 125 days.

VA Undersecretary of Benefits Allison Hickey said that new technology, the new paperless claims system, better training of claims workers, and improved communication systems have all contributed to the decrease. In addition, the Undersecretary acknowledged that mandatory overtime for claims processors over the last two years has been a critical tool for shrinking the backlog, but constant overtime is not a sustainable business model.

Although there is much work to be done, this is certainly welcome news. The backlog number is also at its lowest mark since before claims tied to new presumptive illnesses from Agent Orange exposure overwhelmed the benefits system.

The move to make those presumptive illnesses eligible for VA benefits in 2010 was popular among veteran advocacy groups, but it also led to a dramatic slowdown in the completion of disability claims as tens of thousands of new cases poured into the claims processing system.

The VA’s ability to deal with claims quickly and reliably came into question, and the Department received stricter scrutiny from Capitol Hill. Now, almost four years later, it seems as though the VA has achieved some progress toward shrinking the backlog for veterans.

To read more on this issue, read the Army Times recent report: http://www.armytimes.com/interactive/article/20140331/BENEFITS04/303310043

So Nothing Got Done This Year

Jim Fausone

Veterans Disability Lawyer

When you look at 2013 there was no shortage of issues of interest to veterans.  VA operations were often in the news from the backlog on disability claims, the quality of health care or the troubled electronic medical record system.  The Stars and Stripes report that no major veteran initiatives made it out of Congress this year.  The one noteworthy black spot on that do nothing record is a budget proposal to remove COLA from retiree pay for those under 62 years old.  So when the politicians are pandering to veterans, as they do every election year, keep this year of zero accomplishments in mind before promising your vote.

http://www.stripes.com/news/veterans/veterans-disappointed-in-lack-of-legislation-for-2013-1.257487

Former VA Secretary Calls for VA Disability Benefits Reform

According to former VA Secretary Anthony J. Principi, the VA backlog of disability claims is in large part due to the more recent policy decisions and laws have burdened the system. 
 

Principi argued that current eligibility requirements are far more liberal than, as President Lincoln once charged, "To care for him who shall have borne the battle and for his widow and his orphan." He said that the 50,000 veterans wounded in Iraq and Afghanistan who have filed for disability claims are not the reason the system is clogged, but that the system was already overwhelmed by veterans who were filing claims from long-ago service.  

"While every benefits system may face the occasional questionable filing, the focus of the VA disability benefits system needs to support the servicemen and servicewomen who need those benefits to which they are entitled," commented veterans disability attorney James Fausone.

Principi called for the restoration of the "integrity" of the Veterans Administration claims system in a keynote address this June at forum on the VA. The forum, co-hosted by Concerned Veterans for America The Weekly Standard magazine, featured Principi's keynote, where he stated that Congress, vet service organizations and the VA must address the expansion of disability pay eligibility. Principi has called for a "rebalancing" of priorities or the VA system will be at risk, he said. His remarks were in sharp contrast to other speakers, who urged the VA to work more efficiently and faster on the backlog of disability claims still pending.

More than one million claims are filed each year; an estimated 80 percent of these are filed from veterans who served prior to 2001, Principi said. A vet who served a single day in Vietnam can file for medical conditions typically seen in aging men, Principi said, such as prostate cancer, lung cancer, Parkinson's disease, and Type II diabetes.

It has been 40 years since the end of the Vietnam War, and 37 percent of VA claims have been filed by Vietnam vets, twice as many as those filed by recently discharged vet, according to Principi. And, says Principi, as much as 11 percent of claims, 100,000 or more, have been filed by veterans who never saw conflict. Vietnam-era vet claims increased, posited Principi, due to assumptions that "ailments of aging" such as some heart diseases and Type II diabetes, were added to the list the VA accepted as caused by exposure to Agent Orange.

The VA paid out $26.6 billion in 2005 in disability compensation. By the end of 2013, it will pay out more than $60 billion.

Source
http://www.military.com/benefits/2013/07/03/principi-eligibility-explosion-behind-va-backlog.html?comp=1198882887570&rank=6

Bipartisan Push to End Veteran Claim Backlog

The backlog of Veteran Affairs disability claims has risen by more than 2,000 percent during the past four years, while the agency's budget has been increased by only 40 percent.

Now Congress is pushing for President Obama to "take direct action" to end the backlog. A bipartisan letter helmed by Reps. Patrick Murphy, D-Fla. and Mike Coffman, R-Colo. and cosigned by 164 House Republicans and Democrats, is urging the white House to run interference in order to help the more than 600,000 vets currently waiting for their overdue disability claims. The average time they wait to have a first-time filing processed is between 317 and 327 days, the letter states. Many vets are waiting as long as two years for their claim to be processed, and there are vets who waited as many as 1,000 days.

This letter is not the first of its kind – a similar one was sent a month ago by 67 senators which also requested that President Obama take action by becoming involved in solving the disability claims backlog at the Department of Veterans Affairs. Some cities are running a lag time longer than others; the average wait for a disabled vet in New York is 642 days, while the average wait for a vet in Philadelphia is 510 days. While Congress has approved more funding and more employees for the Department of Veteran Affairs, the backlog situation has not improved. A spokesperson for Veterans Affairs has stated that the agency has processed more than 4 million claims in the past four years – a record number – while admitting that more needs to be done.

The VA's goal is to process the backlog of claims by the end of 2015 as the system completes a switch from paper-based processing to a new electronic system. A backlogged claim is any claim 125 days or older. The electronic system has been rolled out in 20 offices throughout the United States, and should be in all of the 56 offices by the end of 2013.

In response, White House press secretary Jay Carney said that the President is "deadly serious" about clearing the extensive backlog by 2015. But while the backlog issue predates Obama's administration, advocates are pushing for him to become more hands-on in order to get the system resolved. According to Iraq and Afghanistan Veterans of America (IAVA), more than 575,000 vets have been waiting for their claim to be processed for more than 125 days.

Source 

http://www.foxnews.com/politics/2013/06/01/democrats-and-republican-in-both-chamber-press-obama-to-end-backlog-veterans/

Overtime is the Solution

Jim Fausone

Veteran Disability Attorney

So it seems every week the VA offers a new plan to reduce the backlog.  Last week it was the requirement of mandatory overtime.  Everyone will be spending the summer working an extra 20 hours a month through September 30th.   At Legal Help for Veterans, PLLC, we often work long hours and Saturday mornings to keep up on the work.  My staff does it because they are dedicated and motivated to help veterans. 

The VA has taken the approach it must mandate overtime.   Under the plan, all 10,000-plus VA employees who process disability claims will be required to work at least 20 hours overtime each month.  We won’t speculate how this will impact morale.  I would hope that those employees do not take out missing the summer events on the veterans who have claims in the backlog.

http://www.stripes.com/news/va-workers-told-to-work-overtime-to-clear-claims-backlog-1.221099

40 Year Tale

Jim Fausone

Veterans Disability Lawyer 

The largest group of veterans with claims pending are from the Vietnam era. It has been 40 years since the war ended and the tale of that war, which shows in disability claims, is still lengthening.  We can expect that the Iraq/Afghanistan tale to also be 40 years in the making with claims increasing until 2054.

VA officials recently blogged:

"In fact, about 60% of the 845,000 pending disability claims are from Veterans for whom VA has already completed at least one claim. About 78% of those Veterans are already receiving monetary compensation at some level—and about half of those are rated with at least a 50% disability, receiving $1000 or more monthly. The other 40% of the total inventory are from Veterans filing for the first time. This 60/40 percent split is roughly the same proportion for claims that have been pending more than 125 days—i.e. the backlog. Also, many people—including reporters covering the story—attribute the growing number of claims to the wind-down of current conflicts.

In reality, only one in five claims in the inventory come from Iraq and Afghanistan Veterans. The largest portion is actually from Vietnam-era Veterans. "

So veteran advocates, like the VA, have no shortage of work.

http://www.blogs.va.gov/VAntage/9378/separate-system-ensures-wounded-troops-receive-disability-benefits-quickly/

Appeals Wait Longer

Jim Fausone

Veteran Disability Lawyer

We work with over a 1000 veterans and most of those veterans are waiting on appeals of VA decisions.  The initial decision backlog at VA is  getting a lot of national attention.  A hidden story has finally made the national news.  That story is how long it takes to have an appeal heard of a VA denial of service connection or low rating by the regional office in an initial decision. So after waiting a year for that initial decision, the veteran can expect a multi year wait on an appeal.    At the first level, the Board of Veterans' Appeals in Washington, it takes an average of 1,040 days, almost 3 years,  for the agency to render a ruling. That's 3½ times slower than the response for those awaiting word on their initial filings.  The Pittsburgh Tribune-Review recently published an article on its study  of  4 years of data.  It found:

"Sifting through more than 160,0000 appeals from 2009 through early 2013, the Trib discovered 2,936 cases in which veterans or their surviving spouses died before getting decisions on their disputed claims.

If that rate holds, more than 500 veterans will die this year while their appeals languish — about one vet every 18 hours."

Some may dismiss this as only 1.8% of the cases.  But if it was your mother, father, brother or sister waiting on a decision to improve their quality of life, you would not think this way.  This story proves what many suspected -  VA denies and delays until you die. Our veterans deserve better.

http://www.stripes.com/veterans-families-seeking-benefits-from-va-are-dying-for-a-decision-investigation-finds-1.220686

Disabled Vets Still Waiting for Benefits in Seattle, Notes Veterans Disability Attorney

Jim Fausone

Veteran Advocate

Disabled vets are still waiting too long for medical benefits.

In Seattle, 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 the U.S. since 2010, and the influx of Iraq and Afghanistan 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 in Afghanistan as 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; and New 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 his Persian 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/

Provisional Rating Approach

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

 

VA Claim Backlog

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.

Veterans Post Surgery Compensation

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

 

VA Malpractice Found $3.7 Million Awarded

Jim Fausone

Veterans Disability Lawyer

We hear from hundreds of veterans a month about VA disability claims or medical malpractice.  We understand the frustration of a veteran going it alone against the federal government.  When we have filed medical malpractice actions against the VA it seems like pushing water up hill. What gives you hope in these situations are stories like this one where a federal judge had the courage to find the VA's actions negligent and properly find for a veteran.

On January 16, 2013, Senior U.S. District Judge James M. Munley  awarded $3.7 million to an Iraq War veteran from who sued the U.S. Department of Veterans Affairs after his war-induced post-traumatic stress disorder worsened because the agency prescribed him the wrong medication and treated him over the telephone.    The ruling was in favor of Stanley Laskowski III, 34, and his wife, Marisol, after a civil nonjury trial before the judge at federal court in Scranton.  It took 3 years for the case to be heard for this Marine Sergeant. He was required to testify and relive the stressors that gave him PTSD in Iraq.

In Judge Munley's 69-page ruling, he agreed that clinicians with the local VA should never have prescribed Sgt. Laskowski new medications or changed his medications over the telephone to treat his PTSD.

Also when Sgt. Laskowski first sought help in April 2007, he was not treated by a physician for several months and instead dealt mainly with "physician extenders" - medical professionals like nurses and physician's assistants, the judge wrote.

In addition, clinicians did not immediately offer psychotherapy to help him overcome nightmares, paranoia, insomnia and flashbacks spawned by his gruesome wartime experiences, according to court testimony.

The lack of appropriate care worsened his condition, causing him to make the rash choice to break into a pharmacy in Olyphant and steal prescription medications, his attorneys argued.  So this case should give veterans and their attorneys hope that there are reasonable federal judges who will find the VA at fault.  This Pennsylvania veteran had to fight his demons since his discharge in 2007 without appropriate care. Let’s hope this award allows him to get the care he needs and encourages VA to help all those veterans who need its help.

http://thetimes-tribune.com/news/carbondale-veteran-awarded-3-7m-in-ptsd-case-1.1430479

Here we go again - Missing Records

Jim Fausone

Veteran Disability Lawyer

After handing thousands of veteran claims for disability over a dozen years some patterns emerge.  One of the more frustrating is the loss of military records that veterans need to prove disability claims to the VA. 

A joint investigation by ProPublica and The Seattle Times has found that the recordkeeping breakdown was especially acute in the early years of the Iraq War, when insurgents deployed improvised bombs with devastating effects on U.S. soldiers. The military has also lost or destroyed records from Afghanistan, according to officials in previously undisclosed documents.  The loss of field records — after-action write-ups, intelligence reports and other day-to-day accounts from the war zones.  This is a chronic problem that certainly dates back to the World War II, Vietnam and other war zones.

Recordkeeping was so poor in Afghanistan from 2004 to 2007 that "very few Operation ENDURING FREEDOM records were saved anywhere, either for historians' use, or for the services' documentary needs for unit heritage, or for the increasing challenge with documenting Post Traumatic Stress Disorder (PTSD)," according to an Army report from 2009.   Entire brigades deployed from 2003 to 2008 could not produce any field records, documents from the U.S. Army Center of Military History show.

So guys, save your records.  Keep notes of your buddy's name and the letters and emails you wrote home.  That may be the only proof you have years from now about your service experiences.

http://www.stripes.com/news/us/missing-war-records-complicate-benefit-claims-by-iraq-afghanistan-vets-1.196570