What Happens to My Claim After it Gets Submitted

Many Veterans wonder “What happens to my claim once it’s submitted?”  The standard government answer is “It depends on the current VA pending workload and the complexity of your claim.”  What does that really mean, and how can I make my claim stand out to go faster?

What You Need to Know on How VA Claims Processing Works

The Veterans Benefits Administration (VBA) is the arm of the VA in charge of all things benefits related for VA.  In each Regional Office, there is a Claims Team that works Original Claims that are submitted via Fax, Mail, or Electronically (via eBenefits or an approved VSO, CVSO, or Attorney).  Once a Claim is submitted, it is indexed and prepared by a Claims Assistant (CA) for placement into the work queue for the Veteran’s Service Representative (VSR), who does the majority of the work on the Claims.  The VSR does all of the work to prepare it for a decision, sends it to a Senior VSR for review, and is sent to a Rating VSR for approval.  Once that is approved, a Rating Award Letter is generated and sent to the Veteran and the digital record is updated.

The VSRs are on a point system for everything they do, and have a daily, weekly, and monthly quota.  Closing a file by recommending an award action is the highest point total for them.  While the VA has a mandated “Duty to Assist” the Veteran in the assembly and processing of their claim, that is the lowest point value in the quota system.  If a Claim requires too much work, it will be pushed aside for another claim that is easier to process in order for the VSR to make their point quotas.  Members of our team saw that first-hand when they worked for VBA in in recent years. It sucks for both sides (the VSR & Veteran), but knowing how to approach it can help you in the end.

What does VBA consider to be “Complex”

VBA classifies a Claim as “Complex” if a Claim has multiple claimed conditions and/or supporting documentation is incomplete.  Incomplete documentation can be anything from not providing proof of military service, not providing full medical documentation, to not defining what conditions you’re claiming.  These will result in your claim being pushed aside for easier to work on claims and your claim taking longer to be worked on, and subsequently, decided on.

How Can I Make My Claim Not Be Complex

The goal is to make the VSR’s job easy so they will snag your file quicker and do yours first before someone else’s that may be less complicated.  The goal is to make the VSR at VA that opens your file look at it and say “this looks like a claim I can look through and finish quickly.” Make it so that the dots of what you’re claiming and the evidence to support it are easily connected & supported – that’s how to make a claim more appealing to a VSR to work on first, and hopefully, produce a more successful outcome.  Here are some tips on how to organize your files in your claim:

• Organize the documents in a way where everything is separated by each claimed condition.
• In each file, start with when the first sign of the condition when it was documented during service
• Proceed chronologically with each reference to that condition until present day
• Label each file with the condition name as it is listed in the Schedule of Ratings, Citing the Condition Number and Name (for example: 5242 – Degenerative arthritis of the spine)
• Again, this is to make the VSR’s job easier.

No matter which way you choose to submit your claim, organizing it in a way to make it complete and more appealing to a VSR to complete will work well not only for you, but the VSR as well.  As far as the best way to submit your claim (self-represent, Veteran Service Organization, County Veteran Service Officer; paper by mail, fax, electronic), it all depends on what you feel most comfortable with.  We will cover that topic in another post.

The Secretary and Undersecretary Want to Hear From You – Does It Work?

A few months ago, the new Secretary of the VA, Robert McDonald, and the Undersecretary for Benefits (USB), Allison Hickey, decided that that wanted to hear directly from Veterans who have experience long delays in any VA Services.  To find out what was going on, they publically published their contact information so that Veterans could contact them.

Most of our team here were skeptical of this at first, thinking it was nothing more than lip service for the media to pick up.  As things have moved forward, we have been hearing of more cases of contacting them that have produced fast and successful results.  Recently, several members of the VBRG Team have used these lines of communication, and got immediate contact back from the USB, who also copied in the Director of the Regional Offices involved, and made fast work of the issues at hand, resolving most long-standing issues in under a week.  The USB has made it her mission to tackle any long backlogged claims (claims over 125 days since filing) and delayed appeals and get them moving forward and completed.  The USB has assembled an investigative team to tackle any and all inquiries.

The question is how do I contact them effectively?

• First off, Keep It Respectful – they are more likely to help a Veteran who is being calm, cool, and collected than one who is just yelling through the email.
• Provide as Many Details as Possible – Keep a Timeline of Contact on your case – exams, phone calls, letters, and/or major events.They want to help you, but they also want to take the information and help others by making improvements in processes.
• Let Them Know If you’re experiencing hardships because of delays in your case – Are At-Risk of losing your home, unable to pay utility bills, facing bankruptcy, debt collections, repossessions?If so, let them know.  Where normal hardship letters seem to fall on deaf ears in the past, going right to the top has produced results in many cases.

If they take the time to respond, respond back to let them know you have seen it, and again, keep it respectful.  Here is a sanitized response that one Veteran received from the USB 9 hours after emailing her:

[Veteran],

That made me tired just reading all the back and forth you have endured.  Let me ask [Regional Office Director] to get an expert on this asap and lets get this resolved with minimal back and forth moving forward.

[Regional Office Director] – please let me know the way forward.

Allison

If you feel that your case has been bogged down and want to see something happen, this is the way to go.  Below is a graphic of the contact information for the Secretary and USB:

We wish you all the best of luck, and we will keep the information coming.

 

The Yellow Ribbon Program – What is it?

There is a great benefit program that is a complimentary program to the Post-9/11 GI Bill that can open up opportunities to attend other colleges that may not be fully covered under the GI Bill – The Yellow Ribbon Program.

The Yellow Ribbon Program is a matching funds agreement between institutions of higher learning who choose to participate and the VA.  Each school sets the amount they want to contribute to covering the gap after the Post-9/11 GI Bill, and the VA then matches the contribution.  Schools can choose to put a limit on the dollar amount, the number of beneficiaries they will award it to a year, both.  In some cases, schools will contribute unlimited matching to cover all costs combined with the VA’s matching funds.  A school makes the choice of if they wish to be a Yellow Ribbon Program Participating School, and schools are added every year.

We would like to hear from you:

• Have you or any of your family members used the Yellow Ribbon Program?
• Was it beneficial to you?
• Were there any problems getting the Yellow Ribbon Benefit?

We want to hear from you!

 

The In-State Tuition for Veterans at All Public Universities

In all of the talk about the Veterans Access, Choice, and Accountability Act of 2014 passed recently, there is a key benefit that has not gotten a lot of press that will be of great benefit to Veterans attending any public university.

Buried deep within the Act (Page 4, Section 702 if you want to read it), any Veteran using the Post-9/11 GI Bill has to be afforded the in-state tuition starting the Fall Semester of 2015.

When a Veteran separates from the military and goes to attend school, typically they will either go to school where they got out of the military, or somewhere else where they may not have established residency for a long enough period of time to qualify for in-state tuition.  Members of Congress and the Veteran Community recognized that this was making a large financial burden on Veterans paying out-of-state tuition for the year or longer it takes to establish residency.  As things get set up by all the public colleges and universities, this will greatly improve access to education for Veterans and dependents utilizing the Post-9/11 GI Bill.

 

VA Health Care Specialty Care Referral Waiver

Here’s a not advertised fave for VA Health Care that does not get published anywhere.

If you need to be seen at a Specialty Care Clinic at a VA Medical Center and have a combined rating of 70% or higher, you do not need a referral from your Primary Care Manager. This can be very useful if you are active in your care decisions.

VA Clothing Allowance – A Little Known Benefit

There is a little know benefit from the VA that not a lot of people know about – The Annual Clothing Allowance.

The VA can provide a clothing allowance to Veterans “who have unique clothing needs as a result of a service-related disability or injury” to compensate for excessive wear and tear on clothing, shoes, and other related items.

Eligibility
You may receive a clothing allowance as a Veteran who uses either of the following:

• Prosthetic or orthopedic appliance, such as a wheelchair or crutches, because of a service-connected disability (Note: soft and flexible devices, such as an elastic stocking, are not included)
• Orthotic inserts for shoes, which wear down shoes faster then normal
• Medication prescribed by a physician for a service-connected skin condition that causes permanent stains or otherwise damages outer garments
• Additional clothing allowances may be provided if more than one prosthetic or orthopedic appliance, or medication described above, is used and/or affects more than one type of clothing garment.

The current rate is $753.00 per condition that impacts clothing.  You can claim multiple conditions for multiple clothing allowance awards.  To apply, download VA Form 10-8678 and fax it to your local VA Medical Center’s Prosthetics Clinic.  The annual deadline is August 1st.  Usually, the allowance is paid out in the middle of September.  You do need to re-apply annually.

For more information, go to http://www.benefits.va.gov/COMPENSATION/claims-special-clothing_allowance.asp.

Have you ever had any experience with the Clothing Allowance and have any experiences to share?  Please comment to let us know.

 

PTSD and How it’s Evaluated

One of the most prevalent conditions that is being recognized and identified is Post Traumatic Stress Disorder (PTSD).  After over a decade of supporting multiple conflicts and multiple deployment cycles, the mind and psyche never get the proper time a service member needs to properly process and recover from what they’ve experienced.  In most cases, PTSD will be a lifelong condition that will change a Veterans’ life, as well as the lives of those around them.

With all the emphasis on this, there are a lot of issues when it comes to the evaluation of PTSD when it comes to having the VA rate the severity of the condition.  Here is the exact description of the VA’s evaluation factors for Mental Disorders, per 38 C.F.R. § 4.130, DC 9411

• 100 Percent
• Total occupational and social impairment, due to such symptoms as: gross impairment in thought process or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name

• 70 Percent
• Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships

• 50 Percent
• Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining Effective work and social relationships

• 30 Percent
• Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events)

• 10 Percent
• Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication

• 0 Percent
• A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication

A lot of Veterans that we have known have gone through the evaluation exams for PTSD Ratings, both directly with the VA, or with one of the “Third-Party Contractors” – we put that in quotes because that phrasing implies that it could be impartial, but the VA is paying the bill to the contractor.

Here are some of the tips provided by other Veterans:

• The evaluator will ask you about your childhood and your family growing up, if you tell them that you have had a traumatic childhood they will try to link your PTSD to that instead of military exposure therefore denying you a rating.
• Make a list of the symptoms your experiencing and when they occur. Often in these interviews your symptoms will be at a minimum because the setting is reasonably safe and you are focused. Even things that seem unrelated can be symptoms. Such as problems maintaining attention or not expressing emotions.
• Be truthful, but not to the point that it will hurt their chance of a rating. IE: While the majority of my symptoms are controlled, let them know if you still struggle some symptoms daily.
• If the veteran is in school, show examples of how it’s a struggle.

If anyone has any other suggestions to pass along, please let us know so that we can share with others.

Presumptive Conditions for Agent Orange Exposure

We’ve talked about Presumptive Conditions and how they relate to Disability Compensation, mentioning that Agent Orange exposure was one of the first scenarios that had presumptive conditions applied to.

The process has 2 steps in the process to prepare a claim for Agent Orange Presumptive Condition(s):

• See if you have one of the Presumptive Conditions associated with Agent Orange Exposure
• AL Amyloidosis
• Chronic B-cell Leukemias
• Chloracne (or similar acneform disease)
• Diabetes Mellitus Type 2
• Hodgkin’s Disease
• Ischemic Heart Disease
• Multiple Myeloma
• Non-Hodgkin’s Lymphoma
• Parkinson’s Disease
• Peripheral Neuropathy, Early-Onset
• Porphyria Cutanea Tarda
• Prostate Cancer
• Respiratory Cancers (includes lung cancer)
• Soft Tissue Sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma)
• For more information including details on any of these conditions, go to http://www.publichealth.va.gov/exposures/agentorange/conditions/index.asp

• Be able to prove that you were in a region where Agent Orange was used or transported
• Look up the locations, ships, shipyards, and storage areas at http://www.publichealth.va.gov/exposures/agentorange/locations/index.asp

Also, there are conditions that can be claimed if a Veteran’s child shows any of the following conditions:

• Spina Bifida
• Birth Defects of in children of women Veterans
• Achondroplasia
• Cleft lip and cleft palate
• Congenital heart disease
• Congenital talipes equinovarus (clubfoot)
• Esophageal and intestinal atresia
• Hallerman-Streiff syndrome
• Hip dysplasia
• Hirschprung’s disease (congenital megacolon)
• Hydrocephalus due to aqueductal stenosis
• Hypospadias
• Imperforate anus
• Neural tube defects
• Poland syndrome
• Pyloric stenosis
• Syndactyly (fused digits)
• Tracheoesophageal fistula
• Undescended testicle
• Williams syndrome

For more on these conditions in children of Veterans, go to http://www.publichealth.va.gov/exposures/agentorange/birth-defects/index.asp

If you have a claim for an Agent Orange condition, get with a Veteran Service Organization and get their assistance.  This has been a major focus for the VA, as well as the VSOs.

Presumptive Condition for Traumatic Brain Injury Added

The VA has in the past made the decision to make certain medical conditions that are connected to a specific injury or exposure to a dangerous substance can be automatically presumed to be service-connected automatically.  The first big labeling of Presumptive Conditions was for exposure to Agent Orange during the Vietnam War.

The VA has now finalized a new round of Presumptive Conditions that are connected to Traumatic Brain Injury (TBI) that can be awarded as additional conditions for compensation ratings.  The Presumptive Conditions for TBI are:

• Parkinson’s disease
• Certain types of dementia including Alzheimer’s disease
• Depression
• Hormone deficiencies caused by changes of the hypothalamus
• Hormone deficiencies caused by changes of the pituitary glands

With many of the presumptive conditions, these may not present themselves right away.  In fact, in most cases with Agent Orange, can take years or decades to show any signs of these conditions.

If you have a TBI and have any of these presumptive conditions, you should contact either your VA Regional Office or your representation (lawyer or Veteran Service Organization).

Please spread the word on these major changes!

Individual Unemployability – What is it and How Does it Work?

One of the biggest questions about Veterans Benefits that always comes up in regards to Total Disability Individual Unemployability (TDIU) status when it comes to Disability Compensation.  Here’s what you need to know:

What is Individual Unemployability?

• Individual Unemployability (IU) is a part of VA’s disability compensation program that allows VA to pay certain Veterans compensation at the 100% rate, even though VA has not rated their service-connected disabilities at the 100% level.

What is the Eligibility Criteria for Individual Unemployability?

• A Veteran must be unable to maintain substantially gainful employment as a result of his/her service-connected disabilities. Additionally, a Veteran must have:
• One service-connected disability rated at 60 percent or more, OR
• Two or more service-connected disabilities, at least one disability rated at 40 percent or more with a combined rating of 70 percent or more.

Can I Work?

• Veterans who are in receipt of Individual Unemployability benefits may work as long as it is not considered substantially gainful employment. The employment must be considered marginal employment.

What is “substantially gainful employment?”

• Substantially gainful employment is defined as employment at which non-disabled individuals earn their livelihood with earnings comparable to the particular occupation in the community where the Veteran resides. 

What is the definition of “Marginal Employment?”

• Marginal employment is generally deemed to exist when a Veteran’s earned income does not exceed the amount established by the U.S. Census Bureau as the poverty level for the Veteran only. For more information on the U.S. Census Bureau’s poverty thresholds, see http://www.census.gov/hhes/www/poverty/data/threshld/index.html

Can I be Self-Employed or run my own business when it comes to TDIU?

• ‘Self-employment’ as a factor matters most for veteran’s with a psychological component to their claims and unemployability.  Self-employment is inherently ‘protected’ employment.  For example, if I have bad PTSD, I may be able to maintain employment as a computer consultant…I would make my own hours and have no interpersonal interaction with others…thus keeping me employed but by my own rules.  This veteran/person would be able to maintain employment but only under these circumstances.  They would fail miserably if they had to punch a time clock and have normal office place socialization and interactions.  VA will deny as saying…he’s employed.  But in reality, he’s only employed because he is his own boss and thus able to make his own rules.

Sources:

• http://benefits.va.gov/BENEFITS/factsheets/serviceconnected/IU.PDF
• Various Legal Proceedings on VA Appeals