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The VA decision-making process

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Posted on: Tuesday, April 03, 2012

Jim,

I really appreciate what you do with this sight. I am very thankful for your answers. My question is how can VA make a decision on a denial claim within a month. But it takes two years to make a deciion on your claim. Thanks

Reply:

There are 2 people in the decision chain of command who are instrumental to your claim. There are many others who work around them but these 2 control the process. These are VA employees. Who is or isn't an employee of the federal Department of Veterans Affairs can be confusing. Any time you think about how the process works, be sure you know exactly who you're talking about.

The Veterans Service Representative (VSR) is responsible for gathering all the data required to make a claim decision. This process of organizing the information is often referred to as perfecting the claim folder or file. The VSR has a glance at the claim and begins to retrieve medical records, schedule C & P appointments and so on. Once the folder is perfected, it gets in a long line and waits to be reviewed by the Ratings Veterans Service Representative (RVSR).

The RVSR is the person who makes a decision on awarding a benefit or denying it. The RVSR works on a quota. He or she must completely close (x) number of files each day to meet the assigned quota. The way the quota is determined is complex. Some claims may count for extra points if they are complex and so on.

If the RVSR makes the quota each month there is a performance bonus that is added to their paycheck.

Of course, this is a terrible idea on the surface of it all. To set a quota is generally regarded as a bad idea in most industries...tying it to a performance bonus makes it worse.

The real problem comes when we realize that the work product of the RVSR isn't checked for quality. Only a few of the RVSR's decisions are ever looked at by a supervisor or a higher up manager. Even then, only awards that give substantial money to the veteran are checked. The VA is interested in trying to find ways to not pay you money.

This means that the claims that are denied go without any scrutiny at all. You're probably beginning to see the problem by now. If the RVSR has some tough cases to look through and needs to make that quota so he/she can get the bonus, the easy way to do that is to deny a few folders quickly and get on with business. The RVSR can scan a few folders and find anything at all that looks easy to deny...and then deny it. It doesn't matter if it's a good decision or a bad decision, the only person who will care is the veteran.

By the time the veteran gets a denial letter and then decides what to do about it can take months. Many vets get a denial letter and instantly give up without any appeal.

To receive a denial letter a month after filing, as you mention, is unusual. Most denial letters take about the same time that a well done award letter does. However, I can see where a quick and easy denial could happen if the demand for meeting a quota was a high priority.

The process is badly broken. Everyone but the RVSR agrees the quota system is the wrong way to do business. Typical of VA, everyone talks about it...nothing substantial is done.

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Comments

Submitted by tyuiop644 on Thu, 2012-04-12 15:57

Thanks Jim, for providing such a wonderful site of information for veterans to go and get valuable insite of how the VA System works on Veterans compensations. What is the backlog of claims at the Detroit Regional office and average wait time for rating decision after the C&P Exam?

Submitted by admin on Sat, 2012-04-14 13:20
Thanks for your kind words. We do our best at Stateside Legal and at VAWatchdog to provide veterans with intel that they can use and that is meaningful to the events taking place today. The backlog at the Detroit Regional Office is much the same as it is at all others. The current (04/07/2012) inventory at Detroit is18,780 claims pending and 12,122 claims pending over 125 days. That equals 64.5% of all claims that are past due by at least 125 days. The range across all VA Regional Offices is in that ballpark. Simply stating the numbers doesn't tell us much though. The questions left unanswered are how many workers are there to address the claims inventory and so on. The bigger question is how many claims that are finally adjudicated will be appealed because of errors? VAWatchdog has opined often that the error rate in the final decisions is about 70% at all VA Regional Offices. That means it's very likely that when you receive your decision letter, it will be so flawed that you will have to appeal to get a fair and correct rating. Most appeals are won so the error rate is obvious although VA doesn't measure that statistic. "How long will it take?" is a question that we get every day. There is really no way to predict that. Once you have completed the C & P exam, your folder and claim return to a very long line that will wait until a Ratings Veterans Service Representative (RVSR) can get to your case. The RVSR is the adjudicator who will make the decision on your claim. It may be a matter of months, it may be a year or more. There is no way to track the progress of your case as it inches slowly towards completion. The on-line services offered that purport to give you information about your claim aren't at all accurate. The answer that veterans most often receive is that, "Your case is in the decision phase." Well, of course it is. The decision phase begins the moment your claim is received and ends when you have your letter. You can learn a lot more about the 1,000,000 or so claims waiting to be processed by clicking here http://www.vawatchdog.org/The_Backlog.html and you may want to read up about how to track your claim by clicking here http://www.vawatchdog.org/Track_Your_Claim.html