Veterans Claims Help

I admire the vA for many things. They control the vertical and the horizontal of our claims. They are the only game in town and can pretty much do as they please. As long as they pay lip service to Congress and don’t hang out in Orlando too frequently or too long, they are left to their own devices. Or were.

In this modern day and age, the whole world is a large window. No one is exempt from scrutiny and vA hasn’t absorbed this concept yet. As with their paper system, they are inexorably trapped in a different time and way of doing things. If technology had not moved forward with such leaps and bounds, they’d still be happily living in their ignorance and bliss. It didn’t, they can’t and its now 2012.

In order to appear as thoroughly modern as Millie, they have recently embarked on blogs to get their convoluted message out. This was sent to me more than a month ago and I am just now excavating things like it out of my bookmarks pile. What concerns me the most is not the crude attempt to buy off a reporter or two and get a slanted story but the 189 comments from Veterans that followed. The diatribes all had one common theme- one we are uncomfortably all too aware of.

The blog attempts to evoke pity for the poor RVSRs and DROs who are trapped in this miasma of claims review. It probably is true. They do work hard to accomplish this. What is left unsaid is the 800 lb. gorilla in the room. I speak of the M-21 manual and all its computer iterations attached to claims processing. The M-21, while not a compendium of 38 CFR, nevertheless encompasses the “when you can” and “when you can’t” award SC for whatever the Veteran files for. This is the stumbling block and hill on which the vA attempts to make its stand like Custer. And much like Custer’s loyal troops, they’re falling like flies.

Let’s set aside all the talk of Orlando boondoggles and bonus payments and concern ourselves solely with the most obvious problem-the backlog. What provokes it and what is the repair order? Why does it continue to metastasize like a cancer in spite of radiation treatment and chemotherapy ( more raters and the beginnings of a paperless system)?

The answer is fairly obvious. vA refuses to look at the underlying bedrock principle of how they do this. The M-21 is grounded in principles of claims adjudication that do not permit objective inductive thinking. Its purely deductive process is designed to yield a product predicated on what is present in a paper file. Absent even one item, the whole claim fails. vA is absolved of any wrongdoing in this because they feel its the Veteran’s responsibility to make his case. What is overlooked is that a Vet is precluded from having any meaningful legal help to accomplish it. When the error is discovered at the denial stage, the Vet is shell-shocked that vA made no attempt to inform him of what was missing or what might be helpful in winning it. Too often what is received is a denial artfully worded that does not say something like “However, if you can find this, this, and this plus get copies of the treatmenta from you doctor, you stand a good chance of us changing our minds.”

The ex parte law process, while being touted as non adversarial to Vets is anything but. Many’s the time I have seen the CAVC take the BVA to task and say “Why isn’t there more  interaction and dialogue between adjudicators and the claimant? Why this impenetrable wall of silence?” Look in the mirror, gentlemen. I refer to the vA, not you Vets.

When I began my latest assault on the RO in 2007, you could still call 1-800-Dial A Prayer   and talk to a live operator at your local RO. He, in turn could walk over to the rater’s cave and talk with them. He/she could also call you back in a few minutes and resolve more than you and I can do in twenty letters and six months nowadays. Communication is essential in any endeavour as most know. This is what has been cast on the ash heap yet no one acknowledges it. Some brainchild inserted a suggestion to nationalize the Dial a Smile into a large network and it looked good on paper. The disconnect begins when the operator is in Salt Lake and you are in Columbia, S.C. Time lost in conveying the message to the proper RVSRs is time lost. Period. The longer it festers, the more gangrene develops. Being able to talk to someone who is actually familiar with your claim is elementary.

We now have Form 119s that simply hamburger what you asked the operator and his/her subjective interpretation of what it is you wanted to convey. I don’t know how many times I read about my calls in my C-file and found the “technician” had no grasp of what I wanted and worse- no conception of how their own system worked with respect to my inquiry. Thus you find out that the claim you want to ask a question about is not in the computer the tech is looking at. It might be in the other one the raters use, but they do not have access to that one. Its called ultimate deniability.

vA is only now beginning to retreat from the Hillary Clinton concept that “It takes a village to decide a claim.” That would be the system whereby the claim arrives and is divvied up into its component parts. Bob gets the dependency and Ralph gets the AO presumptives. Meanwhile Bob looks at the HCV. A whole new subset of claims developers jumps in to determine if you had red clay on your jungle boots (Vietnam), another crew tries to determine if you were legally divorced from Connie before you married Cupcake and whose kids are whose.

Eventually all the leads are chased down by all these Dick Tracys and the evidence piles up in a file for a Rater to sort through and make a decision. The actual adjudication is determined by the M-21. Does he have proof of Vietnam in the 214? No? Denied. No effort to ask him if he has proof in the form of orders showing duty or visitation to Vietnam. Nothing. End of claim. As for the HCV, does he have an episode of HCV in his contemporary SMRs from the 60s? No, denied. Never mind that HCV wasn’t discovered until 1989. The M-21 is not concerned with that. Similarly, a disease associated with hepatitis and AO (PCT) could have been caused by either one. Sorry, Charlie. That went over to the AO Sherlock who is not a doctor. Denied. Even though your claim asked that it be considered under both diseases as a secondary, it will never be done. The M-21 has spoken. No one calls you back and says “Dude. Why are you filing AO crap if you weren’t there?” This is the disconnect that is impenetrable.

So here we are in the fabulous twenty first century with acres of intelligence available at the push of a button, and no one at the RO is allowed to look at this  inductively and research it in such a way that a reasoned, informed decision ensues. This “Our way or the highway” is the single ingredient that vA stubs their toe on repeatedly. A groupthink attack on a subject will inevitably bring out sane logic. By allowing only a compartmentalized approach with each person developing one, or at best, two facets of a claim produces an airplane with no landing gear. It’ll fly in the most basic sense if it could get off the ground but it lacks wheels. No one addresses this. The Adobe Acrobat program generates a poorly worded denial with all the commas in the right spots. The logic is impeccable if-if it were developed to a logical conclusion. By disconnecting the  parts and pieces and trying to reassemble them into a coherent whole at the end, the ability of one person to supervise this from start to finish and prevent derailment is lost. Any semblance of cohesion in the claim is absent yet the vA will insist it is the product of impeccable workmanship.

Fortunately, vA is belatedly coming to the conclusion that this method, begun in 2004, is not producing timely, accurate results. Accuracy is not bothering them overmuch. It’s the timeliness that is the bone of contention. Mark my words. vA will eventually roll out their 2015 125-day model to the accolades of all. What will be lacking is the wheels to get airborne (accuracy). Speeding up the process of building a car on a production line in Detroit is all well and fine. When the car won’t start for lack of a motor as it rolls out, the repair order shouldn’t be to send it over to join all its neighbors in the rework parking lot (appeals).

I find nothing wrong with the team concept. If it works, we all benefit. Perhaps a more nuanced team concept where one person is ultimately in charge would be a superior model to do this with. It worked haphazardly until 2004. The claim wouldn’t have to just pass the M-21 test- it would have to pass the “smell test”. If the head honcho looks at the final product and still is  left with feeling that it is clearly and unmistakable erroneous no matter how shiny and correct it “looks”, then it should not become final. This will require a sea change in thinking at the vA.

Developing a claim properly is not rocket science. Developing it accurately based on sound medical principles and logic algorithms is. We all are aware by now of the fact that Monsanto scientists in 1957 were aware that 2,4,5 T caused Chloracne in all those who handled it. Other disease processes surfaced later but Cloracne was grossly evident from the get go. Why did we have to wait until 1991 for the vA to acknowledge this and start awarding SC for it and all the other AO diseases? Similarly, why didn’t the vA (and DoD), when HCV was identified in 1989 and jetgun use was suspect, quietly retire the guns in 1998 and keep mum? The same head-in-the-sand mentality exists today. It inhabits the vA and their entire thinking process. If you can’t prove it, it didn’t happen. Thus we will never see a medical study to determine if jetguns can transmit HCV. Our government squanders hundreds of thousands of dollars in research grant for things as extraneous as whether butterflies sneeze (University of Wisconsin, $500,00.00 and 1993) yet the CDC and its progeny at NIH aren’t interested in what is causing a HCV pandemic among Vietnam-era Vets? Hellooooooooooooooooooooooooooo?

Lay testimony has gradually become more of a viable component in our claims defense over the years. On paper. Lip service is paid to this as is the benefit of the doubt. M-21 doesn’t encompass 3.102. That is a flip of the coin that is always the opposite of what you called in the air. Heads I win and tails you lose is what the M-21 teaches. However, it does not appear that way to a Ratings Team. No single person is held accountable for the finished product. Few who were instrumental in developing the claim are aware of its ultimate demise or they might feel anger at having all the hard work that pointed towards a win reveal the opposite.

True reform will be hard to come by. If the only model for your claims technique is a Wheel of Fortune with 85% covered by Bankrupt or Lose A Turn, trying out a new technique or getting the powers to be to revamp their methods is going to be a long and arduous path. It’s time to begin anew with a new template. One that encompasses a give and take at the RO level and allows for discussion during, rather than after, a fait accompli may be in order. One that is truly objective and does not attempt to skew the facts in favor of the vA position would be refreshing.  Remember, this process is long on the “absence of evidence is negative evidence” theorem.  Nowhere is this seen in modern day civil adjudications yet the M-21 embraces it lock, stock and barrel.  vA asks that you do so in blind faith as well.

In closing, I would admonish Vets not to hurl abuse and pile unkind words on the rank and file at ROs. They have been handed a thankless task and then forced to do it with a manual that does not have the words “grant the claim” in it. I’m sure they must go home at night and scratch their heads wondering who does win at this. The abuse should be aimed at the whizbangs who continually rewrite the M-21 and teach the denial process to raters. Those are your enemy. Reform the technique and you eliminate the backlog. More simply put- get the decision right the first time and you won’t be forced to redo it again and again until the truth surfaces. Timeliness is essential. Accuracy should be axiomatic.

P.S. Let’s give Alex Horton, Lauren Bailey, Kate Holt and the rest of the VA bloggers a thrill and visit their site about 20 times a day to show hits. This will increase spending on their budget and make them feel like they’re being read. Or…. leave nasty comments about how vA treats us?