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Does Anyone Know Why Its Longer For More Complex Claims?


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15 replies to this topic

#1 USCG CWO4

 
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Posted 13 August 2012 - 12:26 PM

I recently retired and submitted my BDD claim. There were multiple items claimed and from what I have read it will take longer to get my claim processed. As a matter of fact they estimate late Dec 2012 to April of 2013 and I filed and had my C & P exam in February but my retirement date was 01 May. I understand that it will take longer for my claim because there are more items and its more difficult, but do they take the easier claims and put them on top of the pile? Don't they process claims in the order in which they are received? If so this would mean all claims would take about the same amount of time.

I am a patient man so I understand it will take time, just curious about the process.

#2 Sgt. Wilky

 
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Posted 13 August 2012 - 01:00 PM

Not to be a smartass, but the title to your post answers the question it asks...In my experience though, they're not "supposed" to put more difficult claims at the bottom of the pile, they work them in order in which they were received. Now, I know many members here may flame me, but remember, that's how it is "supposed" to work!!

Semper Fi!

P.S. I've been waiting on a very simple dependents claim now for the better part of a year, so I hope you are a vvvvveeeerrryyy patient man...!

#3 midnight340

 
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Posted 13 August 2012 - 05:05 PM

Complex = lots more to do!

I initially filed with help from the state commission on vets affairs, and the guy wrote it up with a whole lot of claims... depression, anxiety, back problems, sleep problems... on and on. This was not smart, it just confuses the raters (it shouldn't but it does...) I eventually filed for reconsideration after being denied outright. On the second round, I had some assistance from a social worker in the PTSD unit who focused on this.

When I was finally awarded, it was for PTSD solely. All else either fell under this category or was ignored. So, yes, simple and bare bones probably stands a better chance. If the rater is very responsible and attentive, and there are lots of contentions, then they have to follow through on a number of things, C&Ps for several issues, etc. If they are NOT as responsible as they should be it just looks like work!

I would say, don't ignore serious issues, but it is probably to your benefit to keep it as simple as possible.

#4 USCG CWO4

 
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Posted 14 August 2012 - 05:28 AM

This is what I thought was happening. It's an extract from the NY Times article from June.

http://www.nytimes.c...ner=rss&emc=rss


"The employees also complained about the performance review process used to measure their productivity, saying it reduced the quality of work and hurt morale. The process requires claims processors to complete a certain number of files per day. People who fall short can be denied promotions or fired. Those who meet or exceed quotas become eligible for bonuses.

The workers said those quotas encourage processors to take shortcuts that often lead to mistakes, or to focus on easier cases over complex ones. And when in doubt, processors tend to deny claims, the workers said, because denials are generally faster."

#5 broncovet

 
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Posted 14 August 2012 - 07:39 AM

Yes, I saw this. On one of the other well known websites, a moderator who alleges he was a DRO trainer gave an entirely different view point suggesting that Va employees erroneously award benefits because its faster than a denial.
While I knew this former DRO was feeding us with KRAP, I was pleased to get it refuted by employees who work there. It makes me wonder what else this DRO posted when he knew it was false.

A denial has to be faster. There are no calculations and retro to figure out, and multiple signatures are not required for a denial. They simply "cut and paste" the letter, and fill in a reasons and bases for denial. While awards also have a "reasons and bases", a Veteran is unlikely to ever dispute the "reasons" your benefits were awarded.

#6 Teac

 
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Posted 15 August 2012 - 03:46 PM

Yes, that the more you claim the longer it takes to get the claim settled. Claims are worked first in first out... but that does not mean that a claim that was submitted after your claim is decided after your claim.. it means you claim is started first and however long it takes to connect the dots is how long it takes to get a decision. It happends a lot that a newer claim is decided before older ones and this happends because some claims are submitted with everything necessary to decide it. while other claims are received with no information and the VA has to get medical records, and request c/p exams.

As to a denial being harder than an approval.... this is true!

Approvals are really easier because to get an approval all the facts are know and the facts justify the award

Denials however must be justified......they are not faster....

And I doubt that few awards are ever given if a denial is warranted, but ironically many denials that turn out to be incorrect.....

Just like that effeciency report we got in the Army (EER, SEER etc... ) the rater must justify his comments with facts, it is a lot eaiser to tell the truth and rate correctly that it is to make something up and rate down....

#7 jvretiredvet

 
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Posted 15 August 2012 - 04:38 PM

While you might choose to perceive the disability compensation process as but one single process, it is several separate (yet interconnected) processes. There's the evidence collecting process, the decision process, and the post/notification process. The collectors don't do the decisions, and the "decisioners" don't do the post/notification.

Since you started with the decision part .... yes, it is true. It is far easier to do a Rating Decision for a grant rather than for a denial. The verbiage for a grant can be as simple and as short as "Service connection for ________ has been granted because the evidence shows that this condition originated while you were in service and continues to the present time as a chronic condition. An evaluation of ___% is assigned because _____________. The effective date of this grant is ________ because that is the date we received your claim for compensation."

So, for a grant, an RVSR doesn't have to review a buncha evidence and then write that " ... the 843 pages of downloaded internet information you provided, though certainly fascinating reading, does not show a nexus or connection between your military service and your current condition."

As for There are no calculations and retro to figure out, and multiple signatures are not required for a denial , you are quibbling now. Calculations and retro amounts are done automatically, based upon the input percentage and the assigned effective date. True, a more senior VSR must authorize awards for a journeyman VSR, that's not that time consuming. Multiple signatures are not required for most grants either. Note: a run through DFAS does stall things a bit.

Rating decisions are extremely easy to do, and even more so in the mind of someone who has never done one.

Can the process be made better? Certainly. But, be careful for what you wish for. IMNSHO, if there ever is enough political will to change the VA to what veterans "want", we may find that the definition of what constitutes service connection might change as well.

Yes, I saw this. On one of the other well known websites, a moderator who alleges he was a DRO trainer gave an entirely different view point suggesting that Va employees erroneously award benefits because its faster than a denial.
While I knew this former DRO was feeding us with KRAP, I was pleased to get it refuted by employees who work there. It makes me wonder what else this DRO posted when he knew it was false.

A denial has to be faster. There are no calculations and retro to figure out, and multiple signatures are not required for a denial. They simply "cut and paste" the letter, and fill in a reasons and bases for denial. While awards also have a "reasons and bases", a Veteran is unlikely to ever dispute the "reasons" your benefits were awarded.



#8 broncovet

 
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Posted 15 August 2012 - 05:57 PM

The workers (VA employees) are the ones quoted as saying they denied claims because it was faster, (not me) rather than award them, which takes more time. To quote, they said it this way:


"The workers said those quotas encourage processors to take shortcuts that often lead to mistakes, or to focus on easier cases over complex ones. And when in doubt, processors tend to deny claims, the workers said, because denials are generally faster."

I think I can assume the VA employees who said this, knew about the VA claims process, much better than I do, as I have never worked for the VA. Further, I will go so far as to assume these workers are correct, as the statistics bear out what they say. Only about 15 percent of claims are awarded at the RO level, without an appeal. However, at the BVA, better than 50 percent of these denials are either remanded or awarded upon appeal. This suggests employees are denying claims, because it is faster and they can get more done, even if half of these denials are overtuned at the BVA level.

#9 john999

 
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Posted 15 August 2012 - 05:57 PM

This is also why you may get a partial grant with some issues deferred and some granted.

#10 jvretiredvet

 
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Posted 15 August 2012 - 06:30 PM

Yeah, whatever. One tends to believe or assign credence to whatever evidence that supports what they already want to believe.

The workers (VA employees) are the ones quoted as saying they denied claims because it was faster, (not me) rather than award them, which takes more time. To quote, they said it this way:


"The workers said those quotas encourage processors to take shortcuts that often lead to mistakes, or to focus on easier cases over complex ones. And when in doubt, processors tend to deny claims, the workers said, because denials are generally faster."

I think I can assume the VA employees who said this, knew about the VA claims process, much better than I do, as I have never worked for the VA. Further, I will go so far as to assume these workers are correct, as the statistics bear out what they say. Only about 15 percent of claims are awarded at the RO level, without an appeal. However, at the BVA, better than 50 percent of these denials are either remanded or awarded upon appeal. This suggests employees are denying claims, because it is faster and they can get more done, even if half of these denials are overtuned at the BVA level.



#11 jbasser

 
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Posted 15 August 2012 - 09:05 PM

Everyone is going to offer different opinions. Fortunately this is healthy discussion and it involves some very knowledgeable people.
There will always be a disassociation between an employee or someone who either works or has worked at the VA or a Veterans Service officer and the Veteran.
They are looking at this from their own point of view that was hammered into them from their training.
The Veteran looks at it in a different light. They only know what they have either been told or have learned through research.
Don't let this issue bother you too much as I will tell you from a Quality Assurance point of view exactly why complex claims take longer.

The greater the number of issues a Veteran has as well as the information provided to Prove service connection can be consistent on many factors. This information must be gathered. Then it has to be processed and organized in the claims folder before it even goes to the rater.
This takes time. The Rater also has a time limit he or she can work on an individual claim as the system pays on productivity. (Bonus)

The bottom line is the more issue you have the more adjudication is needed and that takes time.

Basser

Oh and one additional thing. Lets keep this professional. We need this discussion so we can kearn from one another.



#12 71M10

 
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Posted 16 August 2012 - 06:30 AM

My 2 cents,

Besides the obvious answer to the question, If I was on Blue Collar Comedy, I think I would say "here's your sign"!

As Basser was mentioning that juniour VSR gather the evidence, submit requests exct. before the file goes to the RVSR. VA switched to that model to improve efficiency, its latest incarnation is the CPI model, although the newest workflow process model has just been implemented in 16 VARO's and is a drastice departure from current methods.

Part of the problem how they do things right now is this, if you have multiple issues, you may need multiple C&P's. Since the VA can't walk and chew gum at the same time, they are unable to effectively schedule multiple C&P's. In my records it clearly shows they wanted 2 C&P's I received notices that I would be scheduled for 2 C&P's at two different VAMC's, one of them happened the other did not. Since my file was at one C&P office the second exam didn't happen, file went back - sat in common area(4-6 months) until picked up to rate, rater says where is my exam on X, send it out for the exam. C&P service argues that exam not needed, due to a previous exam, they settle on medical opinion/addendum, comes back sits for anohter 4-6 months, goes to rater, rater indicates both C&P's not sufficient/clear asking for additional medical opinion. When that is done, it will most likely sit 4-6 months until picked up again. Since the people typing up the exam/records requests are not the people making the decision, and they really arn't talking to each other (RVSR scribbles note on file for C&P exam or problem with C&P) The person actually setting up the request for the C&P is most likely doing it 30-60 days after the RVSR looked at the file. If the VSR doesn't understand the note from the RVSR and has to ask a question about it, The RVSR will not recall the specific case at all because they have looked at hundreds of other files. So the request may or may not be correct, but we won't know until 4-6 months after when a RVSR picks up the file to finish it.

Sprinkle in a little apathy, because the VA employee feels they are not appreciated by the population they serve, add a union to prevent any meaningful discipline for poor work performance. What you have left is a system that values quantity over quality, individual situations no longer really matter as long as you can make the numbers look good (gotta love statisticians).

That is part of the reason why complex claims take so long.

Best regards,

#13 deanbrt

 
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Posted 16 August 2012 - 07:47 PM

Multiple claims mean multiple money. So they kick the can down the road....

#14 Tbird

 
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Posted 17 August 2012 - 05:29 AM

Everyone is going to offer different opinions. Fortunately this is healthy discussion and it involves some very knowledgeable people.
There will always be a disassociation between an employee or someone who either works or has worked at the VA or a Veterans Service officer and the Veteran.
They are looking at this from their own point of view that was hammered into them from their training.
The Veteran looks at it in a different light. They only know what they have either been told or have learned through research.
Don't let this issue bother you too much as I will tell you from a Quality Assurance point of view exactly why complex claims take longer.

The greater the number of issues a Veteran has as well as the information provided to Prove service connection can be consistent on many factors. This information must be gathered. Then it has to be processed and organized in the claims folder before it even goes to the rater.
This takes time. The Rater also has a time limit he or she can work on an individual claim as the system pays on productivity. (Bonus)

The bottom line is the more issue you have the more adjudication is needed and that takes time.

Basser

Oh and one additional thing. Lets keep this professional. We need this discussion so we can kearn from one another.


I agree with Jbasser.

#15 broncovet

 
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Posted 17 August 2012 - 11:58 PM

Some VA employees, a few years ago, admitted they "cherry picked" claims. That is, they go through the pile and find a "single issue" claim and adjuticate it and let the others sit.

It helps their production numbers.

Now, if they have changed it so that 5 issues counts as 5 claims, it is probably way different.

#16 jvretiredvet

 
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Posted 18 August 2012 - 01:22 PM

Sounds like hearsay to me.

Some VA employees, a few years ago, admitted they "cherry picked" claims. That is, they go through the pile and find a "single issue" claim and adjuticate it and let the others sit.

It helps their production numbers.

Now, if they have changed it so that 5 issues counts as 5 claims, it is probably way different.