14 December 2013

Claims errors, long appeals still haunt disabled veterans–years wasted in appeals which should have been accurately resolved in the beginning!

Mistakes and years-long appeals continue to haunt veterans seeking disability benefits even as the Department of Veterans Affairs achieves some success in reducing the backlog of initial claims, key senators warned a top agency official Wednesday.
Allison Hickey, under secretary for benefits at the veterans’ agency, insisted that claims processors have reached an unprecedented accuracy rate of 90 percent, as they dramatically reduced the backlog of disability claims.
But that runs contrary to recent findings by the agency's inspector general, which continues to find high rates of mistakes in claims it reviews, and by an independent examination of VA decisions done by the American Legion, which identified errors in more than half the cases.
“They are right for the way they look at it,” Hickey replied. “We are right for the way we measure it.”
Hickey did not explain the different methods for determining whether a claim is accurately rated. But she did say doing the cases correctly is an important part of the VA Secretary Eric Shinseki’s goal of ensuring all disability claims receive an initial rating within 125 days with 98 percent accuracy by 2015.
“We will not trade production for quality,” Hickey said, adding VA is still on track to meet that goal.
Of the six most recent reviews of claims-processing accuracy done by the VA inspector general, only one regional office had an error rate in the 10-percent range.
Three of the six offices made mistakes in more than 40 percent of the cases examined by the IG. The error rate in the Newark office was more than 45 percent.
A separate review of how the Los Angeles office processed claims under an initiative launched in April to eliminate all cases that were more than two years old found mistakes in more than 90 percent of the cases because of a flawed policy interpretation.
Hickey said that was an isolated incident and was corrected even before the IG got involved.
Recent studies by the American Legion show error rates as high as 83 percent for certain types of claims in certain offices.
Burr and committee chairman Sen. Bernie Sanders, I-Vt., honed in on the contradictions in the accuracy assertions of the VA, as well as the growing number of appeals that take years to resolve.
“Reducing the backlog at the expense of accuracy is not acceptable,” Sanders said, a sentiment echoed by several committee members from both parties.
As the Washington Examiner reported last month, errors in the initial rating of a disability claim can doom veterans to years of appeals.
A veteran who challenges an initial rating faces an average of more than three additional years to get a verdict from the Board of Veterans Appeals, according to agency reports.
In almost half of the cases, the board determines the regional office did not have enough information and sends the case back for more work. Of the cases it does decide, the board sides with the veteran more often than the agency.
Overall, almost three-fourths of the cases reviewed by the appeals board are either remanded to the regional office for more work, or decided in the veteran’s favor.
“It does astound me and it does kind of make us chuckle and roll our eyes when they sit there and say VA’s got a 90-percent accuracy rating,” Zack Hearn, deputy director for claims at the American Legion, told the Examiner.
The VA has long been under pressure to reduce the backlog of initial disability claims, filed by veterans seeking compensation for service-connected injuries or illnesses.
The backlog peaked in March, when more than 70 percent of the almost 900,000 cases in the system were more than 125 days old.
The agency responded in April by targeting the oldest claims and taking other steps including requiring claims processors to work at least 20 hours per month of overtime.
In its most recent report issued earlier this month, VA states about 57 percent of its 693,857 cases are backlogged.
At the same time, the number of appeals has ballooned from about 250,000 in March to 266,507 in December.
VA does not have a standard by which an appeal is considered backlogged, Hickey said.
Sanders said the time it takes to resolve an appeal is “clearly unacceptable” and asked Hickey to submit a plan within 45 days outlining steps to reduce wait times.

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