| | |  Vallarta Living | Veteran Affairs 
Connect the Dots and Do the Math!
 David Lord - PVNN
January 04, 2010
 |  | VA claims personnel receive bonuses for the number of claims they process, increasing their pay by speeding the claim out the door. |  | | |
Veterans Benefits Administration reported on Monday that there are 481,751 pending claims, some of which will take more than a year to be processed. I believe 25% of all claims are taking over a year to process, not the 3% they report. At that rate, claims converted into years means a total of 390,000 claims/year. That is a heap of time on my calendar.
Three other government investigations released in September 2009 paint a picture of an agency that simply can't get it right.
An audit released Sept. 23 by the inspector general of Veterans Affairs found that 3 percent of all claims took more than a year for the VBA to process. Some say it is much higher, including me.
• A separate audit released Sept. 28, this one investigating VBA's control of veterans' claims folders, said that 437,000 claims - more than 10 percent of the 4.2 million on file - had been lost or misplaced. That is equal to 90% of today's backlogs, hope they don't lose them too!
• In a third report, released Sept. 30, the inspector general said employees at VA regional offices had shredded claims forms containing information needed to obtain benefits. Although the inspector general was unable to determine how many claims had been wrongly destroyed,(because they have not asked veterans), the investigation found claims placed in shred bins, waiting to be destroyed, at 41 VBA locations nationwide.
In response, a "VA spokesman," said they hired an additional 4,200 people over the past three years to help reduce claims-processing times. That is not addressing the problem but then they never do!
Seems to me a much greater problem exist and they won't address it, but I will take an educated guess after forty years of involvement with the VA System.
I received an exam after waiting over sixteen months from date of claim. The VA out sourced the exam to a private medical facility, they specialized in scar exams, (the VA needed an outside professional examiner for scars, why is that?) My problem, as regular readers know is the gunshot wound I received over forty one years ago in combat. The wound has had many breakdowns of the skin graft and difficulties stemming from it. New changes in the law allow for it to be rated separately as a condition for benefits.
When the VA sent me their rating decision saying that the "condition was unchanged" red flag. How could that be, since this was a first claim, and the scar had never even been evaluated until now. I realized after reading the decision, that the VA had re-examined me for the old gunshot wound, from 41 years ago, not the secondary condition relating to the wound that I had made claim for.
Not only did they misread the new claim (made clearly in the application, including diagnostic code) they re-rated an old wound. They failed to notice that a rating CANNOT BE CHANGED BY LAW when the original wound or condition rated is over twenty years old. The VA didn't even understand the reason for the exam, the fact that it was a painful scar with breakdown.
The independent Doctor's report was about scar and skin graft deterioration. The VA not only issued a wrong finding, they denied on the wrong issue. Additional mistakes made within the VA finding were material to claim, i.e. math, they stated that the area of gunshot scare measured 17 x 7 cm. giving the sq. area as 70 cm. DUH!!! 7 x 17 = 139 sq.cm. not the 70 sq. cm. Poor arithmetic? I think not! The determining factor for rating the percentage of disability is the surface area affected. The difference of 50%, 70 cm. vs. 139 cm is the difference between a 20%, or a 30% rating. They could not do the simple math, let alone understand the medical condition, so I will spend more years to appeal, they will delay, deny, hope I die.
Why are incorrect claims decisions made thousands of times per week, to thousands of disabled veterans. Why are independent medical facilities being used? It must cost three times as much, the duplication of doctor, the duplication of service, and the duplication of medical facility. Why?
Because claims personnel receive bonus for the number of claims processed, increasing their pay by speeding the claim out the door. Nothing to gain by doing a correct claim, it takes time. The adjudication/legal side of the VA has begun to ramrod claims past the back log of VA Hospitals across America.
This gets VA administration employees more income by finishing claims faster, side stepping the VA Hospital backlog, and having decisions made by civilian Doctors that often have minimal motivation to find in favor of the veterans or against the employing agency.
The veterans demand for faster processing is accomplished, and better yet for the administrators the processed claims are up, with higher bonuses as the reward. So clever of them, make the numbers look better, make more money, and the veteran gets another claim denied faster.
 David Lord is a V.A. accredited Veterans Service Officer living full time as a resident of Mexico. David is retired from U.S.M.C. for a gunshot wound, his unit received the Presidential Unit Citation at Khe Sanh Combat Base. He was a rifleman with the 1/26th, 5th Marine Division in 1968 during the 77 day Siege at Khe Sahn, then awarded The Purple Heart for a gunshot wound in Quang Tri Province. For more information, email him at david.lord(at)yahoo.com.
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