How much does the VA spend in the denial process of service-connected claims, as opposed to actually paying the claim from the outset?

PO3 Aaron Hassay — Fri, 12 Aug 2016 20:44:11 -0400

Is the VA actually spending close to equal or more money, then actually approving a claim with dignity and respect, using presumption to the Veteran Benefit, of an already MD PHD diagnosed as service caused illness, especially when a bit of fact checking confirms the illness is indeed proximate to the duty of the service member? Yes there will be some fraudulent claims, but treating nearly everyone as a fraudulent claim and denying them into an appeal process that takes years reinjures an already injured Vet trying to trust and seek support sometimes deep into the life destruction of such illness not treated. It just the oddest system going, funding exponentially, a VA claims denail system, compared just paying ,supporting, w/dignity n presumption

Response by Sgt Aaron Kennedy, MS made Aug 12 at 2016 9:17 PM

Sgt Aaron Kennedy, MS — Fri, 12 Aug 2016 21:17:14 -0400

Why should someone who was injured stateside not be covered? Or considered frivolous? I knew a guy who almost lost his eyes in MCT (Stateside Training Command). I knew another who rolled a HMMWV during workup Stateside?

Hell, my own condition didn't appear until AFTER I returned from the Gulf, while I was at a stateside "administrative command."

However, the reason claims are (generally) denied is lack of supporting evidence. There is no clear link to service, which is the LEGAL requirement for compensation to be assessed.

You do bring up the Pragmatic aspect of Cost spent denying vs Cost spent on benefits, and that should be assessed. A few years ago there was a study that showed the rate of fraud on VA claims was roughly comparable to the general fraud statistics (1 in 20), however the approval rate tends to be more drawn out and 2/3 of appeals are overruled (the VA gets it wrong most of the time).

Response by SGT Rick Ash made Aug 12 at 2016 9:40 PM

SGT Rick Ash — Fri, 12 Aug 2016 21:40:19 -0400

However much it is, they have spent a lot on my denials. 2 claims denied but on both of those they got my branch of service wrong (Even though I send a copy of my DD214 with every email.) Appeal denied with no answer given. And now, my NOD (Notice of Disagreement) was denied. I just didn't believe that was possible, given all of the evidence I provided. The last 12 years of my life have been pure hell. I got pancreatic cancer from the Hawk Missile System HIPIR radar, tons of ionizing radiation and RF. 6 years total, as a student, then after Germany as an instructor then S. Korea and Ft. Bliss where I ETS'd.
And now, General Counsel for the VA in Kentucky (KDVA) has prohibited me from contacting my local rep or my Regional Admin at the VARO. Can a VA lawyer legally prohibit me from contacting them? Now I have to complete a Form 9 and get that to the BVA within 60 days.I was 38 when I had a heart attack, and only 49 when diagnosed with the pancreatic cancer. Average age is late sixties. 6 surgeries so far....

Response by Sgt Private RallyPoint Member made Aug 12 at 2016 9:53 PM

Sgt Private RallyPoint Member — Fri, 12 Aug 2016 21:53:23 -0400

PO3 Aaron Hassay Have you submitted a fully developed claim with all supporting evidence?

http://taskandpurpose.com/8-steps-will-help-improve-va-disability-claim/

8 Ways To Improve Your VA Disability Claim

A lawyer who specializes in VA disability claims shares some insight on the process of filing your claim.

Response by SFC George Smith made Aug 13 at 2016 1:35 AM

SFC George Smith — Sat, 13 Aug 2016 01:35:23 -0400

Below is a Post that is Related to this Thread...
But the Fact is, the VA evaluations are Made By Civilians and they have No Since of Urgency and they very loosely interpret the Guidelines...
They are Paid and Get Monitory Bonuses for "Keeping Costs Down... your Evaluation and Monitory Compensation Hangs in the Balance and their Hands...
Most of the Time they (The VA Claims Assessors ) totally ignore The Facts about Injures and if that are Non Combat related, or even if They are even Service Connected... AS in "Line of Duty Yes or No" and Simply Blow off the injury and its related ratings...
I had to go to Senator Robert C. Bird to have the VA Evaluation done in Pittsburgh re-evaluated in Clarksburg and the 30% rating from Pittsburgh came back 70% from WV VA.
I receive 60% monitory Compensation because I did not loose sight or a limb or digit or motor functions in a Limb or Digit...
I recently found out Sleep apnea may Increase Ratings and monitory values 15-25%
I have an appointment to access the Issue next week...

REPOsT.... Fron "VA Rer-Vamp..."
You are Damn Right... YES !!!.
"You asked for it..."
The Difference between VA Hospitals are Like Night and Day.
The Service between Hospitals is also like Night and Day...
In the last 17 years I have dealt with 4 different hospitals and 2 out-laying Clinics.
Pittsburgh PA, Clarksburg WV, Durham NC and Raleigh Clinic, and Salisbury NC and Kernersville Clinic.
The Salisbury NC Hospital, and its Clinic in Kernersville, NC are nothing short of Fantastic!!!.
Personally I think the VA should Be a subordinate Organization of The DOD. The DAV Cards should be used as a Medical Insurance Cards around the country and the world, and accepted at all Medical Offices and Hospitals. (Pleas Note the period)
In this manor, The Vets could get Health Care in the Immediate areas closest to their Homes and First Rate care from local medical facilities with out the Damn Long waits they endure in many areas around the country or in Foreign Countries...
... By elimination of the many inefficient Hospitals and their operating costs and the costs of the Non medical Staff and the Costs of the Morons in DC running the VA, the cost of Funding The Veterans Hospitals and Facilities could converted to Maximum Payments and Support to the Veterans ... the Competent Medical staff could be assorted into the local areas Medical facilities and reduce the shortages they already Have ...
By going thru DOD and making VA a subordinate Organization would eliminate the Massive Ineffective Staff in The VA The amount of Funding would be Reduced to the Staff at the New DOD Department of Veterans Affairs...
The DOD Could almost instantly Confirm if the patient was truly a Veteran and not some well versed Bull Shit artist Impostor...
Think of all the Useless Civilian Admin Clowns that suck up massive amounts of the Funds Allocated for the VA that would be eliminated and along with Government Slugs and Non Funded Retirements they claim every Year also being eliminate...
By eliminating the Extensive out dated Facilities how much more $$$ could be saved and Used on the Treatment of The Veterans...

I am Thinking of saving Money and Spending where It is really needed ... ON The VETs... not the Government Slugs and Rooster Vacuums Who are really not That efficient...

(You Opened the Damn Big Box of worms ... never ask unless, you really want to Know... In My world This is a ..."STAND IN THE DOOR" Question...)

This is a sore Subject with Me I know several Vets who Died from the Poor and slow response from the damn VA...

Its Bed time and now I need a Drink...
take care out there Y'all
DOL...

Response by Cpl Glynis Sakowicz made Aug 13 at 2016 12:09 PM

Cpl Glynis Sakowicz — Sat, 13 Aug 2016 12:09:14 -0400

I've wondered that myself. You see, I had a spinal injury 'on the job.' I was put on light duty, then in and out of hospitals, physical therapy, and so on for three long years. My rank was frozen, and I was eventually 'retired' because of my injury with a 'generous 30 percent' I was told.
I didn't much mind, because I knew I could do SOME job, and for years I grit my teeth, lived on over the counter pain killers, and handled it... until it got too bad to ignore. I sought help, since working became almost impossible in jobs that would hire me, and I went thru the entire chain. The paperwork, the wait, the doctor evaluating me, and waiting again. I received my notice just lately that the VA sees no reason to up my percentage, since my KNEES are just find. I read it several times, and yes, it said clearly that my knees were fine... but I applied to get my disability increased for my BACK. I notified them that there must be a mistake, and I was told the decision had been made, and I would have to start the entire process over again if I wanted my spine to be evaluated.
I think most of us give up eventually because they make it so impossibly hard for us to get a disability rating. I've since gotten a lawyer and I'm paying painfully to get them to argue the point... and I have no idea how long this will take. Hope springs eternal though...

Response by SGT Private RallyPoint Member made Oct 28 at 2018 11:50 PM

SGT Private RallyPoint Member — Sun, 28 Oct 2018 23:50:18 -0400

I put in an initial claim after being out for a very long time. I was scheduled for medical appointments within a week. Three months after the appointments, I got my first notice that I received a 0% rating for my hearing loss and 10% for the related tinnitus. Two weeks later I had the final results that roughly half my claims were accepted, and half were denied with a total VA rating of 50%.

The funniest denial was the statement that there was no record of my injured shoulder. They mentioned in the final award letter that they found a record of my broken toe that I should consider filing for as it may be compensable. I dislocated the shoulder in the same accident as the broken toe. They were on the same medical intake form. Weird. Second funniest denial was my left foot. While in BASIC, I developed plantar fasciitis, and was given huge leather arch supports to stuff in my boots along with my size 12.5 EEEE feet. Ah the joys of that adventure, needless to say, they went in my boots exactly twice, before I hid them away until after training, when I could actually take more than 30 seconds to put on boots. Apparently only the right foot was written up in the notes, or my reviewer has a vision problem that they should file for that only allows them to selectively see half a page at time. So, my right foot scored a 30% rating, which would have been 50%, if my left foot was included. My messed up back was the last rating through the system on the first try, and was rated at 20%, of course using the measurement of how far I can bend and twist at the waist, which is no where near my painful cervical and thoracic spine. But hey, that's the way the "Military Diagnostic Checklist" shuffle goes. If it ain't on the list, it doesn't exist. And everyone proficient in VA Math following Zeno's Paradox for Percentage, as well as Benefit, understands how 10+20+30 =50. And 50% of $3000 is $850.

So, I got a respectable rating, and megre benefit, straight out of the box, in just under 4 months, filling out the single page paperwork myself, and listing a quick handful of things that I figured should be a no-brainer considering my medical record. Not to bad.

Then I filed again. I have not appealed any of the issues from my first filing yet, mainly because I did not want to get tied up in what looks to be a potentially ages long process. So what did I do? I just filed a new claim from my secondary list of complaints. I banged in my new filing online, again on my own, with a couple more complaints that I hadn't used yet, and another 2 issues that developed as a result of my now Rated back problems, and, guess what... 4 months after the second round through the medical appointments, especially REEXAMINING MY BACK TO SEE IF IT IMPROVED OR DECLINED, my secondary list, half denied, half approved, with my 2 secondary to the back being combined into one big 70% Rating, produced that elusive target of Zeno, a 100% Total and Permanent VA Disability rating from multiple issues.

Now I will probably go back and file the rest of my medical record, as well as "upset the apple cart" by appealing my list of denials as CUEs.