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HEY VETS, LET'S GET IT RIGHT THE FIRST TIME! --

Advice on filing a VA claim from Veterans'

Advocate Jim Strickland.

Veterans' Advocate Jim Strickland provides regular columns for VA Watchdog dot Org.

If you would like to contact Jim about his columns, you can email him here...

The archive of Jim's articles is here...

   Learn More about how to get a VA Loan today -- Click Here

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I was chatting with a friend and we were talking about the ways that different advocates or Veterans Service Officers (VSO's) submit applications to the Veterans Benefits Administration (VBA). My friend told me of a Service Officer she knows well. She tells me he's been in the business a long time and he has all the various hats, jackets, pins and other flair necessary to look important in our circles.

Our Veterans Service Organizations promote more flair than a Ruby Tuesday waitress to show how important we are.

This particular VSO works with one of the Big Important Veterans Service Organizations and according to my friend, he speaks disdainfully of all others.

My friend tells me that when she asked his procedure of filing, he informed her all that is necessary to submit to the VBA is the DD214, the application for benefits and a short statement about the condition under which the veteran is asking for a service connected disability benefit. He tells her “The VA handles the rest.” According to her conversation with him, “He sends this in, gloats that he has done a good job, everything is under control and the Veteran will be pleased with the outcome.”

It's unfortunate that this approach is widely used amongst all of the people who represent Veterans. In some of my previous writing I've compared this to a situation where you, as a homeowner, have a dispute with a neighbor over a property line. Let's say your neighbor constructed an above ground swimming pool close to a fence that borders your property and water and construction debris have caused damage to your side of the property. He built the pool in violation of city and county codes and without necessary permits.

Knowing your neighbor is adversarial, you retain an attorney to represent you. That attorney completes the necessary paperwork to get your dispute into a civil court for action. In the legal brief he submits to the court, he states “My client has a dispute with his neighbor.”

Prior to any action being moved to the court's docket, the clerk of court reviews everything to ensure completeness and accuracy. Your attorney didn't tell the court anything about what laws have allegedly been violated, what remedy you're asking for or any other details. In a prescheduling conference with the judge the clerk recommends that this one isn't ready for show time and the judge rejects your case.

You get a call from your lawyer who tells you that the court is playing hard ball and he wants to know if you're ready for the lengthy and expensive appeal.

Is this beginning to sound familiar somehow?

I've said that most applications for disability benefits awards are lost at the first step. Each day that goes by, I become more convinced that you will gain a swift and sure award of deserved benefits if you have 3 things in place.

1.  You deserve an award because you have a condition that is the result of your military service.

2.  You complete the application properly.

3.  You provide the necessary evidence to support your claim.

You will not receive an award if you don't deserve it. Every day I open my email and read a letter from a Vet who tells me he needs an award because of his financial condition. Many of these Vets have sad tales to tell. Jobs are lost, spouses or children have fallen ill, the kids have been accepted to Ivy League colleges and there's no money for tuition and so on. Most of these writers begin to tell me of a sprained ankle or an aching back of 35 years ago that is bothering them today.

I write back and tell them that the VBA doesn't care. Disability compensation isn't doled out because you need it, only because you've earned it.

If you don't complete that application properly, it's going to be denied or delayed. It doesn't make any difference if you've sent in forms or written a letter, if you didn't sign it where it needed to be signed, it isn't going to begin its journey in the system and the result will be a lengthy delay. If you tell the VBA, “My leg hurts.”, you've just added a year or two to the processing of your claim as VBA digs for information why your leg hurts. If you change addresses and you don't inform the VBA, mail sent to you may be returned and your file will eventually be thought of as abandoned. The VBA isn't your nanny and they won't do this for you.

If you don't have the evidence to support your claim and you expect that VBA will provide it for you, you've set up your future for a continuing dispute with VBA. Evidence is proof that what you allege happened did, in fact, happen.

I read a comment about an article I wrote in a Veterans help web site a few days ago. This Vet said “You know I like Jim I really do, however, his time would be better spent explaining how to get the VA to recognize the evidence submitted in support of a claim. Jeez, we all know that evidence is the key to a successful claim - what we do not know is how to win a claim that has a ton of evidence however, the VA idiots will not recognize it.”

Of course, I disagree with that commentary (except the part about how likable I am).

First and foremost, once you have the attitude that you're dealing with “the VA idiots”, you've already lost a lot of your credibility. In any walk of life, you get what you give. Most VBA workers are intelligent, hard working and do all they can to grant you a benefit in accordance with the law. If you show them respect, you'll get respect back. If you enter the arena with that chip on your shoulder, you'll lose.

I'd like a chance to examine that “ton of evidence” that the writer speaks of. Not a week goes by that someone doesn't send me evidence in the form of “Buddy Statements” from their mom or pastor or a reference to a chiropractor who treated them 25 years ago who is thought to be dead today. I also get reams of copies of the laws that they think may apply to their situation. None of that is evidence.

To understand why some claims are approved and others aren't, you need a basic understanding of the system itself.

The 57 Veterans Administration Regional Offices (VARO's) that handle disability benefits claims are akin to manufacturing factories. Raw material comes in one door through a receiving dock and a finished product goes out another door to be shipped to a customer. The quality of that end product is dependent on only two variables; the first being the quality of the raw materials and the second being the skills of the people involved in the manufacturing process.

We have no control over the skills of the people involved in the process. We can only hope and believe that the majority of the folks who handle our file are competent and caring. We also have to understand that beyond anything else, these people are restricted to doing what they do by law. They can't use emotions, they aren't allowed to use intuition and the VBA doesn't issue them a crystal ball or tea leaves. The law demands evidence, nothing short of that will do.

Our hope for an award that is fair and comes about quickly relies on the quality of the information, that raw material, that we feed into the process. There's no mystery or magic to any of this...you have to be clear and tell VBA what you deserve, why you deserve it and how you're going to prove it.

The VBA likes the term “develop” when referring to the process of building your file. The process that's in place is similar to an assembly line. Not unlike building a car, your file goes along to different stations in the process where different people have varying responsibilities as your claim develops.

As your file is developed or built, the first stop is where your application gets a time and date stamp that indicates what point your award will begin if you prevail. Then it's given a quick look for basics like signatures and addresses. From there it may move on to a Veterans Service Representative (VSR) who will seek out and organize medical data, history of your service and so on. Once your file is “fully developed” it's sent on to raters for adjudication. Those decisions may be double-checked by senior staff and then your file heads off for the final steps in the process to tell you the decision.

In a report issued by the General Accounting Office (GAO) in May of 2000 it's recognized that; “the process contains as many as 66 decision points and 39 queues. Of the 39 queues, 28 are points at which claims wait for attention from regional office staff, and 11 are points at which regional office staff wait for information from external sources not under their control. For example, (it's) reported in 1997 that it was not unusual for regional offices to take as long as 80 days to request and obtain information such as (1) military service dates; (2) service medical records; (3) verification of receipt and amounts of military severance pay, separation pay, and/or retired pay; (4) medical records from private physicians, hospitals, and VA medical centers; and (5) other evidence in the custody of military authorities or other government agencies.”

The 5/2000 report also tells us that; “Veterans seeking compensation benefits often claim multiple disabilities. For example, in a sample of about 69,000 veterans whose initial claims were rated during fiscal year 1998, VBA found that the veterans claimed a total of about 316,000 disabilities, or an average of about 4.6 disabilities per veteran; the largest number of disabilities claimed by an individual veteran was 56.”

This May of 2000 report has an especially detailed set of work flow charts that explain the process in detail. Have a look by clicking here,

http://www.gao.gov/archive/2000/h100146t.pdf

Moving on to April of 2002 the GAO says, “Despite Recent Improvements, Meeting Claims Processing Goals Will Be Challenging”. Reading on we learn that, “Since we testified before the Subcommittee on Oversight and Investigations of this Committee in May 2000, VBA’s rating-related claims inventory has risen by about 85 percent; the number of claims waiting more than 6 months has risen by more than 175 percent; and the timeliness of completing decisions has worsened.” In the same report we hear, “According to officials at some of the regional offices we visited, staff have recently been focusing on completing simpler and less time-consuming cases. Officials told us that focusing on completing simpler cases might result in increases in production and short-term improvements in timeliness.”

This report is here;

http://www.gao.gov/new.items/d02645t.pdf

In May of 2005 the GAO says, “Claims Processing Problems Persist and Major Performance Improvements May Be Difficult”. This report provides us with, “When a veteran submits a claim to any of VA’s 57 regional offices, a veterans service representative (VSR) is responsible for obtaining the relevant evidence to evaluate the claim. Such evidence includes veterans’ military service records, medical examinations and treatment records from VA medical facilities, and treatment records from private medical service providers. Once a claim is developed (i.e., has all the necessary evidence), a rating VSR, also called a rating specialist, evaluates the claim and determines whether the claimant is eligible for benefits. If the veteran is eligible for disability compensation, the rating specialist assigns a percentage rating based on degree of disability. Several factors may impede VA’s ability to make, and sustain, significant improvements in its claims processing performance. These include the potential impacts of laws, court decisions, and the filing behavior of veterans; VA’s ability to improve claims processing productivity; and program design and structure.”

This report is here;

http://www.gao.gov/new.items/d05749t.pdf

Jumping ahead up to March 2007 GAO continues in that same vein, “Long-Standing Claims Processing Problems Persist”. This GAO report really hasn't much of anything new to say, “In summary, VA continues to face challenges in improving service delivery to veterans, specifically in speeding up the process of adjudication and appeal, reducing the existing backlog of claims, and improving the accuracy and consistency of decisions.”

Click here to read this one.

http://www.gao.gov/new.items/d07512t.pdf

If we take the time to study the GAO reports, we see that a Veteran has only one opportunity to help himself with his claim. You must give the VBA what they require to find in your favor...you have to do their job for them, you have to make it easy for them and you have to provide all of the information necessary for that rater to find in your favor.

Rather than having your claim sit for an average of 80 days while VBA waits on your medical reports, you can drop by the ROI office at your clinic or hospital or civilian doctor's office and have those reports in 1 day.

If, like the VSO we discussed earlier, you believe that all you need do is submit a “DD214, the application for benefits and a short statement about the condition under which the veteran is asking for a Service Connection” and then, “The VA handles the rest.”, you're wrong.

Let's read those excerpts from those reports again...this time let's rephrase the messages into a single thought; “Several factors may impede VA’s ability to make...improvements in its claims processing performance. These include ...the filing behavior of veterans. Veterans seeking compensation benefits often claim multiple disabilities...the largest number of disabilities claimed by an individual veteran was 56. (Evidence required to develop a claim) includes veterans’ military service records, medical examinations and treatment records from VA medical facilities, and treatment records from private medical service providers. (It's) not unusual for regional offices to take as long as 80 days to request and obtain information such as medical records from private physicians, hospitals, and VA medical centers. (It's reported) at some of the regional offices we visited, staff have recently been focusing on completing simpler and less time-consuming cases.”

I look over initial claims submitted by others every day. I see constant abuses of the process. If the Veteran has lung cancer and he is a Vietnam Vet, why is it necessary to file for Hypertension, Erectile Dysfunction, Cataracts, Peripheral Neuropathy, Sleep Apnea, Depression and 10 other relatively unimportant conditions?

If a Service Officer will focus on development of the lung cancer condition, pointing out that it is not temporary, “no future exams” should be noted in the award and then providing all the treatment records in an orderly fashion, that application is likely to sail through the process with few delays. If you just write down whatever comes to mind, throw it all up against the wall in hopes something will stick, you're going to be disappointed.

Once the initial and most important facet of your claim has been developed and you've won that award, then you may go back and file all those other little issues you want credit for.

In the last month or two I've been asked to review appeals that include such things as lung cancer where the VSO submitting the application treated it as an almost secondary condition to hypertension, cataracts and erectile dysfunction. The lung cancer had first been rated at 0%, then at 100% but temporary and at 6 months it has been proposed that the 100% be reduced to 60% because of “improvements” in the Veteran's condition. All other conditions were denied. In the original filing that VSO missed the target and created confusion with too many extraneous conditions and the Veteran has suffered the consequences. The VSO, of course, blames “the VA idiots”.

I reviewed a case of back pain where the Veteran alleged a serious injury that occurred 35 years ago. He had no record of an injury other than a few visits to a chiropractor some time after he separated from the military. There was no treatment of his injury on active duty and he had no explanation why. Since seeing the chiropractor 30 years ago he hadn't been treated at all and even the chiropractor had no record of him. But, in 2005 his finances worsened so he decided to file for disability. His claim was denied but his VSO appealed it and he was on his way to a Board of Veterans Appeals (BVA) hearing, and he sought my advice a week prior to the hearing. I advised that he had no case...not exactly what he wanted to hear.

I looked over another vet's application for disability benefits that would service connect his diabetes. He told me about family illness and asked if I knew of a way to hurry the process along because of his financial need. That he had never been diagnosed with diabetes, wasn't taking insulin or any oral hypoglycemic medications didn't stop his VSO from claiming diabetes as a condition. And, he claimed diabetes as a secondary condition to others that were not service connected.

A month or so ago a Vet shared his anger with me and proudly told me of his pending claims...I seem to recall he had 19 claims in various stages of appeals. He'd never actually won anything in 20 years of trying and, of course, it was all the fault of “the VA idiots”.

Raters and other VBA functionaries, like traffic cops, have a quota they must fill. I'm told 5 closed or adjudicated files each day.

You have a choice when you file your claim. You can shotgun a bunch of stuff in the general direction of that VARO and hope you hit something or you can go for a surgical strike precisely targeted so that you can't miss. If you make a claim of disability with VBA, you should make the effort up front to have a case that is so well presented to that rater that he knows yours is one he should close right now, today, to make his quota.

If you've done your part, he'll do his...you'll both win.

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Larry Scott  --

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