I have been working with veterans all over this country of ours in their fight with the Department of Veterans Affairs (VA). The one thing that stands out is this: The VA has many regional offices throughout the country, and few rate veterans’ disability claims in the same way.
It does not matter if it is a claim for Post Traumatic Stress Disorder (PTSD) or Gulf War Illnesses (GWI), or something else. There seems to be little uniformity or standardization in the methods used to decide these claims from one region to another. This is not right!
When all factors are identical in two different claims, a veteran in one state will be approved for a 50 percent disability and the veteran in a different state is told that the disability is not related to his or her service. Where are the standards?
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Did these Rating Specialists (RS) not all get the same training? They all have to follow the same law – CFR 38. The VA has published a book that all of the RS’s are supposed to use in adjudicating claims. It is called the M21-1R. Yet despite these clear-cut instructions, we see vast disparities from one VA region to another.
The problem, as I see it, is that RS’s are poorly trained and overworked. Their daunting workload quite obviously has prevented many of them from remaining current on new protocols and training letters. They have to get through so many claims in a day and are not given the time for reading training letters or new instructions from headquarters.
Perhaps it’s time for the VA to conduct a “Training Stand-Down,” much like the military conducts periodic Maintenance and Safety Stand-Downs in order to address ongoing organizational and safety deficiencies.
The VA can add all the new RS’s it wants, but if these people are not properly trained in claims adjudication policies they will continue to make the same mistakes that have created a huge backlog of appeals before the Board of Veterans Appeals in Washington, DC.
The VA needs to do a better job of training the workers it has now. Then, as new RS’s are hired, they can get help from those who know the right methods to use in deciding a claim.
The cases I get most upset about are the Gulf War Veterans (GWV) claims. I have been focusing on these types of claims for many years.
These should be some of the easiest to work on given the clear-cut language contained in the laws concerning “presumptive” conditions for Persian Gulf War Veterans. Yet I see so many that are denied.
A lot of the denials include the same language – the RS denying the claim because there is no proof that the medical problem started in the service. Had the RS read the law, he or she would have noticed that GWV’s have until December 31, 2011, for the signs or symptoms to develop. In other words, the symptoms do not have to have started while the veteran was on active duty.
It is clear that far too many RS’s do not understand what “presumptive” is all about when it comes to adjudicating claims by GWV’s. Perhaps we need to give them a checklist.
In all claims there are two parts. The first is the hardest, and that is proving that the veteran’s illness is due to his or her service. The second part is determining to what degree the veteran is disabled, expressed by a percentage, 0 percent to 100 percent.
Here is my proposed RS checklist for GWI:
- Was the veteran present in the theater of operations during the timeframe established for the Persian Gulf War? Yes or No.
- Does the veteran have an undiagnosed illness or one that is a medically unexplained chronic multi-symptom illness defined by a cluster of signs and symptoms or any diagnosed illness as outlined in VA regulations to a degree that warrants a presumption of service connection? Yes or No.
- If the RS marks Yes to both of these questions, then the veteran’s disability is to be considered service-connected (SC) under Section 1117 – Undiagnosed Illnesses due to service in Southwest Asia. All that remains is a determination as to the percentage of disability.
The last part of my complaint about getting GWV’s their service-connected disability claims is the VA’s outdated computer check-in system. A GWV may have four to six problems but is able to have only one listed for his or her check-in. When the RS looks over the veteran’s file he/she does not see all of the problems that the veteran has because the VA’s computer system cannot handle it. This will affect the claim in terms of the percentage of disability awarded.
The veteran must ensure that the examining physician at the VA adds all complaints to the comment area. If the physician refuses to do so, the veteran should go to the VA’s ER for the other problems. Also, have someone keep track of when you are ill and how bad it gets.
For some of us, mostly men, admitting we are sick can be problematic. The common thing for us veterans is to “tough it out” and downplay how bad it really is. Veterans need to tell their doctor the truth about how bad it hurts and how they have a hard time working. Be truthful at all times.
The last thing I would like to talk about is Veterans Service Officers (VSO’s). There are some good ones and some bad ones. A veteran should not pay too much attention to who the VSO works for (DAV, American Legion, VFW, etc.) because it does not matter. The important thing is how well the individual VSO is versed in the laws concerning PGW veterans.
Veterans need to talk to the other veterans in their area. Having a good VSO involved with the claim will make a lot of difference in the outcome.
Finally if the veteran has a scar, and the VSO wants to file it under section 1117, the veteran should get a new VSO. Scars should never be filed as an undiagnosed illness. There is a nexus for the scar to your service. When your VSO files it as an undiagnosed illness he is causing a delay in getting the veteran’s claim approved.