Claims Backlog

Claims Backlog

Post-Pandemic Claims Backlog Worse Than Expected

 

With rising immunity to Covid, many parts of life are getting back to normal. But that is not the case at the Veterans Administration. Officials expect cases to be seriously backed up until late 2022. The post-pandemic claims backlog is worse than expected.

 

Before the coronavirus pandemic began, a little over 70,000 cases had been pending for more than a month. That number peaked at 210,000 in the spring of 2021, and it has not gone down much. Processing times have improved, but there is no end to the backlog in sight. “Our workload is dynamic,” remarked VA Undersecretary Kenneth Smith. “We’re hoping to keep our backlog to under 200,000 through the end of the fiscal year. And we’re hoping we can reduce it to around 100,000 by the end of fiscal 2022.”

 

The modern-day backlog peaked at 610,000 cases in 2013, prompting some significant changes to the VA appeals process.

 

Evaluation

 

The 2017 VA appeals changed the VA disability appeals process in many ways. Late-stage cases changed the most. Additionally, some laws have changed recently, such as an extension of Agent Orange exposure benefits to more Vietnam Veterans. But in many ways, today’s VA disability process is much the same as it has been for decades.

 

Once Veterans file their claims, the VA usually schedules a Compensation and Pension medical examination. The C&P doctor might look at the Veteran’s service and medical records. But mostly, the C&P examination is purely a physical examination.

 

There are some potential problems here. For example, the VA has largely privatized this part of the process. So, your C&P doctor might have little experience in a certain area. If you have knee problems, you probably will not see an orthopedist. The professionals you do see are generalists and might not be able to fully assess your injury.

 

A Disability Benefits Questionnaire sometimes supplements the C&P examination. Most DBQs are relatively free-form documents which enable Veterans to share information. You can (and should) describe all your symptoms and how they affect your life.

 

This is the stage that really contributed to the claims backlog. With the pandemic, VA had to stop C&P examinations for many Veterans, leaving them waiting for the evidence they needed.

 

Examination

 

After the medical evaluation, a Claims Examiner usually reviews the Veteran’s service record to determine if his/her disability has a service-related connection. Then, the Claims Examiner usually shoehorns the Veteran’s symptoms into a particular disability classification.

 

Most Claims Examiners deny most disability claims, at least in part. It’s common for them to give a 30% rating when you have some symptoms at a 60% level, for instance. Significantly, this denial must usually include a detailed explanation. The Claims Examiner cannot simply deny your claim. The Claims Examiner must tell you why they denied it and also give you a roadmap to obtaining benefits.

 

These benefits usually include monthly cash payments as well as free medical care at any VA medical facility in the country.

 

Appeal

 

Before 2017, Veterans basically only had one option at this level. Now, they usually have three. In some cases, the VA must provide an ombudsman or other advocate to assist the Veteran. But in most cases, a lawyer fills this role.

 

A few disability matters involve CUE (Clear and Unmistakable Error). Claims Examiners sometimes apply the wrong formula, do not properly take the DBQ into account, or commit other obvious mistakes. But not just any mistake is “clear and unmistakable.” This is for an old decision that decided against you, and you never appealed, and now you want to say it was wrong given the facts they knew at the time. You can still argue this, but it has to be so wrong that no reasonable person could disagree. Usually it is easier to file a new claim. VA recently sped up the procedure for arguing CUE. Now it is more like filing paperwork than a long appeal process. With luck, this may help cut into the backlog.

 

VA Disability Appeals Compelling

 

More often, VA disability appeals involve compelling new evidence, often from an independent medical examination (IME). As mentioned, Claims Examiners must tell Veterans what additional evidence they need to obtain benefits. That means when Veterans pick their own IME physician, they know the right questions to ask.

 

Buddy statements or other lay testimony could be significant as well. Buddy statements fill in the gaps in a service record and lay testimony from friends and family often creates a more accurate picture of the nature of the disability. This usually can’t say what the disease or condition is, but it can definitely describe visible symptoms and when they started.

 

Live hearings are usually available as well. Sometimes, the necessary evidence is there. Obtaining benefits is largely a matter of an effective presentation. Other times, the new evidence is compelling but not overwhelming. So, a VA disability lawyer must advocate for victims.

 

Contact Dedicated Attorneys

 

Disabled Veterans usually have multiple legal options. For a free consultation with an experienced Veterans disability lawyer, contact the Cameron Firm, P.C. at 800-861-7262 or fill out the contact box to your right. We are here to represent Veterans nationwide.

 

This article is for educational and marketing purposes only. It does not create an attorney-client relationship.