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Claims appeals: Why they take forever

Claims appeals: Why they take forever

On June 18, the House Veterans’ Affairs Subcommittee on Disability Assistance and Memorial Affairs held a hearing to find answers as to why the Department of Veterans Affairs (VA) appeal process for veterans’ benefits takes so long to complete.

According to a fiscal year 2012 report from VA’s Board of Veterans’ Appeals (BVA), it takes about 900 days from the time an appeal is filed to when a final decision is reached. The claims appeals of more than 45,000 veterans are currently pending at BVA.

The American Legion, which has 2,500 accredited service officers nationwide and about a dozen full-time national appeals representatives in Washington, submitted a statement for the record. From Jan. 1, 2010 to June 1, 2013, the Legion’s appeals representatives have represented 29,542 veterans and their dependents who were trying to get benefits claims from BVA. The Legion effectively demonstrated that VA had erred, or failed to fully develop a claim, in 21,632 (nearly 75 percent) of those cases.

On June 3, VA reported an accuracy rate of 89.6 percent for claims adjudicated over the previous three months. Yet, the Legion’s statistics indicate that VA regional offices (VAROs) are providing quality decisions in less than one-fourth of the claims processed. Admittedly, claims handled by the BVA are only a portion of those submitted. However, they are a sampling of work that reflects the quality of claims decisions at 56 VAROs nationwide.

Unquestionably, the appeals process proves to be time-consuming and frustrating for our veterans. By the time BVA renders a decision, a claimant will often have spent several years in the appeals process.

About half the claims submitted to BVA are remanded to the Appeals Management Center (AMC), with clear instructions on how the claim should be further developed. Once that has been done, AMC makes its decision. If a veteran decides to appeal a denial, the claim automatically goes back to BVA for more review. This is where the Legion’s appeals representatives get involved again; they review more evidence, put together presentations for informal hearings and resubmit the appeal to BVA.

Unfortunately – despite clear instructions from BVA – the Legion’s representatives frequently argue successfully that AMC failed to comply with those instructions, resulting in another remand and delay of a decision for the veteran. The Legion stated that VA insiders "familiar with this process of repeated remands for the same claim refer to this endless cycle as the ‘perpetual remand wheel,’ where a claimant has to endure even more months, and often years, of claim development prior to receiving a final decision from BVA."

If veterans decide to appeal BVA’s final decision to the U.S. Court of Appeals for Veterans Claims, they may be in for another very long wait.

"VA has a daunting challenge forecasted for their future," The American Legion stated, referring to Secretary Eric Shinseki’s 2015 goal of processing all claims within 125 days at 98 percent accuracy. "It is clearly evident VA needs to vastly improve its adjudication accuracy to meet the Secretary’s objective."

The Legion concluded its statement with an answer to the hearing’s question: "Resolving the time frame that a claims waits in appeal status is largely connected with the manner VA originally adjudicates claims." If VA properly develops claims and renders decisions based existing laws and regulations, "then logic would dictate that fewer appeals would occur, thereby reducing the backlog of appeals.

"Additionally, if AMC staff would adhere to the remand instructions prepared by BVA, fewer cases of multiple-remanded claims for development would need to occur."

 

 

 

 

 

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JTsomewhereinfinfl

August 31, 2014 - 9:33am

Originally applied in 2000 when Dr's said I was never to return to work following a major surgery,never heard anything back from VA, begged my Dr to allow me to return to work as my family had lost everything due to me not being able to work, Applied again in 2010 and was given a 10% which has been taken to pay back my retirement from the US ARMY, took the Clinton's early out and I am awaiting my appeal as of 12/16/2013. What is the usual time frame for the Appeal Pending????

D

October 23, 2014 - 12:59am

Sorry to say JT, I have been waiting over 7 years. Plenty of evidence to make a decision, yet it sits.

Jimmy Wallace

May 11, 2014 - 3:34am

My claim was remanded to AMC on April 30 2014. FCas was remanded to AMC on April 30 2014 1 For Gather Medical Records from April 7 2012 to present. 2. then schedule veteran for a psychiatric examination. 3. make determination for the following PTSD/ANXITY,DEPRESSION/BIPOLAR DISORDER. IS THIS AS OPEN AND SHUT AS IT SEEMS OR am I IN FOR A LONG WAIT.

mary ann gilmore

October 31, 2013 - 4:01am

clain status

Anonymous

October 31, 2013 - 4:00am

what is 27/eBenefits

mary ann gilmore

October 31, 2013 - 4:05am

claim status

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