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Lawmakers want to know more about VA's quick progress on old claims

Jun. 21, 2013 - 01:43PM   |  
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While lawmakers are encouraged that the Veterans Affairs Department has processed 65,000 older disability claims in two months, they want details about the disposition and accuracy of the ratings decisions.

Rep. Jeff Miller, R-Fla., the House Veterans’ Affairs Committee chairman who has been critical of VA claims processing, said Thursday’s announcement that the department has processed 97 percent of its claims older than two years in 60 days is “welcome news.”

However, he added, “One can’t help but question how the department was able to process most of its 2-year-old claims in just 60 days. If two months was all VA needed to adjudicate these claims, why did the department let them sit for two years or longer?”

Sens. Dean Heller, R-Nev., and Robert Casey Jr., D-Pa., also want to know exactly how VA completed the cases.

In a June 20 letter to VA, the two senators ask if the claims being counted as done still have open issues, and express concern over the accuracy rate. They also asked if VA was able to determine why these claims had been pending for so long.

Their letter, addressed to Allison Hickey, VA’s undersecretary for benefits, asks for answers by July 1.

VA officials said in a statement that 70 percent of the claims processed by the initiative resulted in disability ratings being issued to the veteran, while 30 percent of claims were denied.

The 30 percent denial rate “is on par” with the typical rejection rate for claims, VA officials said.

“Claims are typically denied for a number of reasons, such as the claim does not show a diagnosis of the claimed condition; there is no in-service event, diagnosis or injury that may have caused the claimed condition; there is no medical opinion connecting a diagnosis to service; or in cases of increased ratings, the current medical evidence does not support an increase,” officials said.

While the program was designed to provide “provisional” ratings based on information on file with VA, permanent disability ratings were issued in the majority of cases. “The number of provisional decisions made was low,” VA officials said. “Most veterans received final decisions.”

They did not provide a specific breakdown, and said it was too early to know how many of the claims decisions might be appealed. In their letter, Heller and Casey asked for a breakdown of the permanent and provisional decisions.

The VA claims initiative is not over. While 97 percent of the 2-years-or-older claims were processed by June 19, VA has 192,000 claims at least one year old that are now getting attention in an effort that involves mandatory overtime for claims workers. VA officials intend to have this second batch of claims finished in four months.

Miller said quick processing of the oldest disability claims doesn’t mean VA has solved its problems. “What will happen to the backlog once VA employees are taken off of mandatory overtime and returned to regular duties?” he said. “When it comes to evaluating VA’s success in combating the backlog, the two most important numbers are zero and 2015. In other words, this problem won’t be solved unless the backlog is at zero by 2015, just as VA leaders have promised.”

Sen. Bernie Sanders, the Vermont Independent who is chairman of the Senate Veterans’ Affairs Committee, was more charitable in his assessment of VA’s progress.

“I’m very happy they are making progress at VA toward an ambitious goal of eliminating the claims backlog,” he said. “We stand ready to help them in any way we can.”

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