Paralyzed Veterans of America Submits Statement on Why Veterans are Waiting Years on Claims Appeals

Stacks of filesOn June 18, 2013, Subcommittee Chairman Jon Runyan (R-NJ) and the House VA  Subcommittee on Disability Assistance and Memorial Affairs received testimony on the situation faced by thousands of veterans awaiting decisions on their appeals for veterans’ benefits.  This issue has been challenging the Department of Veterans Affairs (VA) for years.  Paralyzed Veterans of America (Paralyzed Veterans) expressed concerns that while it is good to conduct the hearing to try and find answers, that answers without action is meaningless.

With much of the discussion focusing on the VA disability claims backlog (defined by VA as initial claims that have been pending more than 125 days) and the litany of initiatives launched by the Veterans Benefits Administration (VBA) to address it, very little attention has been placed on the appeals process.  However, the downstream effects of the backlog, which sits at over 613,000 claims, fall to the jurisdiction of the Board of Veterans Appeals where nearly 43,000 appeals now await adjudication. 

For veterans who have endured the wait associated with backlogged claims, many face a new waiting game that will last 251 days on average once those claims become appeals.  The current remand rate now sits at 46 percent, which means nearly half of appeals are returned to VBA due to error or incompleteness.  This also means those appeals will spend an average of 251 days in the process plus the time it takes to fulfill a remand order.  This can take months or even years in some cases.

Paralyzed Veterans identified a number of reasons for the appeals backlog including the number of appeals that have to be sent back, or remanded, to VBA for additional development, inadequate medical exams, inadequate reasons and bases, and inadequate notice of examination.  In addition, when an appeal is remanded, it returns to the jurisdiction of VBA through the Appeals Management Center (AMC), a separate entity where assigned VBA staff are tasked to remedy flaws in claims development identified by the Board.  It is at the AMC where many remanded appeals idle on a procedural “hamster wheel” due to a failure to comply with the remand order, an automatic basis for continued remand.  In some cases, AMC will simply reiterate the rationale of a medical opinion without applying legal analysis or render a decision without complying with the Board’s remand directives thus unnecessarily extending the process.

Paralyzed Veterans also pointed out that the Board and appellants are also culpable to an extent.  Both the Board and VBA share a predilection for wrongly favoring VA exams over most others and will require one before rendering a decision, even when private medical evidence or treatment notes from an appellant’s treating VA physician is sufficient.  This is an issue Paralyzed Veterans has testified about on multiple occasions.

Paralyzed Veterans offered the following recommendations for improvement:

  • In order to reduce remands, the Board should order VA medical exams only when necessary and give appropriate weight to private medical evidence and treatments records from treating VA physicians.
  • Grant the Board settlement authority, similar to that allowed by the Veterans’ Court, to eliminate the need for time consuming additional development in cases where the appellant, an accredited representative, and the Board can agree to a resolution based on existing evidence of record.
  • Review examination scheduling procedures to reduce the number of remands related to inadequate notice.
  • Review AMC procedures and quality review as part of the VBA’s 21st Century transformation effort, to include the implementation of new technologies where applicable.

Without improvements in the appeals process, Paralyzed Veterans does not believe VA will be able to meet the Secretary’s deadline of 2015 to end the claims backlog that has damaged VA’s credibility and negatively impacted the lives of many disabled veterans.

Learn more about the work of Paralyzed Veterans of America on Capitol Hill

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    Paralyzed Veterans of America Submits Statement on Why Veterans are Waiting Years on Claims Appeals